P

H
ARTNER
S
S
EALTHCARE YSTEM
TM
For Office Use Only

Date Employee Business Expense Report (Appendix A-1) Vendor No

Voucher Id
Employee Information Date
Name Address
SSN 1099 Eligible
Department Yes No

Explanation Of Business Purpose Section

Instance Date(s) Location Description / Explanation
1
2
3

Summary of Expense Section Daily Expense Amounts

Alcoholic
Instance # Dates Description Air Ground Trans Lodging Meals Beverages Other TOTAL
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ -
$ - $ - $ - $ - $ - $ -
Expense Analysis Section Total Expense $ -
Less Advances Paid to Employee Less advances paid to vendor(s) Non-PHS Reimbursement $ -
Total Owed Employee/(PHS) $ -
Prepared By Expense Distribution
Katherine Faherty Account Department Prjct\Grnt Resource
Bus Unit (4 Digits)
(6 digits)
Phys ID Amount
Phone (6 Digits) (6 Digits) Activity ID Type
617-525-3022
Approvers Email

Payee Attestation Section Total Check Request or (amount owed PHS) 0.00
I certify that this report has been completed in conformity with the attached instructions and accurately describes the actual and necessary business expenses incurred in
compliance with PHS policies unless specifically noted. I have not received reimburse

If airfare expense has been charged to a federally funded grant, I further certify that best efforts were made to obtain the lowest reasonable commercial airfare for such
travel.

Employee's signature Date Email

I attest that no alcoholic beverages have been charged to a federally funded grant.
Approval Section
Approvers must be individuals senior to payee. Please see PHS policy and procedure for Employee Business Expense for more
information regarding approvers and circumstances requiring Special Approval
General Approval Special Approval A/P Audit
Signature
Print Name
Title
Date
 Reimbursement for CALGB Travel

Instructions for Filling Out the CALGB/Brigham & Women's/Partners

Business Expense Report Form
April 2010

These instructions are intended for use by CALGB travelers authorized to be reimbursed
by the CALGB Chair's Office for costs incurred while traveling on CALGB business

NOTE: The Travel Voucher is not prepared or submitted on-line.

Open the Partners Healthcare Business Expense Report Excel template.

* Click "enable macros"
*Enter the date

EMPLOYEE INFORMATION; Enter traveler's name, address, SSN (first expense report only,
last 4 digits is acceptable. Enter CALGB in the space for department.

Explanation of Business Purpose Section: Enter departure and return dates, location, and
description (i.e., Fall CALGB Committee Meeting).

Instance # Dates Description Explanation

#1 9/20-21/10 Chicago, IL CALGB Fall Committee Meeting

SUMMARY OF EXPENSE SECTION: Each item has a row for entering expenses, fill in the
boxes with the appropriate dollar amounts and add text under "Description", for example:

Instance # Date Description Air Ground Trans Lodging Meals Alcohol Other
1 9/20/2010 Flight/Hotel/tax $320 $40 $179 N/A
1 9/21/2010 Taxi/Parking $40 $48

EXPENSE ANALYSIS SECTION: do not complete

Parking
PAYEE ATTESTATION:
* Enter date and email address for correspondence related to payment status
* Check the attestation that alcohol is not included in the expenses to be submitted

PRINT AND SIGN FORMS, MAIL COMPLETED FORM, ALL ORIGINAL RECEIPTS AND
BOARDING PASS/ITINERARY TO:

Katherine Faherty
CALGB Office of the Group Chair
75 Francis Street
Thorn 417B
Boston, MA 02115