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Backup Documents 11/13/2012 Item #16D 81 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 160 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original documents are to be forwarded to the Board Office only after the Board has taken action on the item.) ROUTING SLIP Complete routing lines #I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the excention of the Chairman's signature. draw a line through routing lines #I through #4, complete the checklist, and forward to Sue Filson (line #5). Route to Addressee(s) (List in routing order) Office Initials Date 1.Jennifer White CAO ,� �j Applicable) 2. Fred Coyle BCC Agenda Item Number 16D8 3. signed by the Chairman, with the exception of most letters, must be reviewed and signed 4. Core Contract Number of Original 4 5. resolutions, etc. signed by the County Attorney's Office and signature pages from Documents Attached V 6. Board of Minutes and Records Cle k o Cou 6 r-OviW M. PRIMAR N A T !W6AMhTIO3Vj (The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive summary. Primary contact information is needed in the event one of the addressees above, including Executive Manager, need to contact staff for additional or missing information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the item.) Name of Primary Staff Hailey Alonso Phone Number 252 -8468 Contact appropriate. (Initial) Applicable) Agenda Date Item was 1 1/13/12 Agenda Item Number 16D8 Approved by the BCC signed by the Chairman, with the exception of most letters, must be reviewed and signed Type of Document Core Contract Number of Original 4 Attached resolutions, etc. signed by the County Attorney's Office and signature pages from Documents Attached V INSTRUCTIONS & CHECKLIST \Al -Z, Z ill Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is Yes N/A (Not appropriate. (Initial) Applicable) 1. Original document has been signed/initialed for legal sufficiency. (All documents to be HMA signed by the Chairman, with the exception of most letters, must be reviewed and signed by the Office of the County Attorney. This includes signature pages from ordinances, resolutions, etc. signed by the County Attorney's Office and signature pages from contracts, agreements, etc. that have been fully executed by all parties except the BCC Chairman and Clerk to the Board and possibly State Officials.) 2. All handwritten strike - through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 3. The Chairman's signature line date has been entered as the date of BCC approval of the HMA document or the final negotiated contract date whichever is applicable. 4. "Sign here" tabs are placed on the appropriate pages indicating where the Chairman's HMA signature and initials are required. 5. In most cases (some contracts are an exception), the original document and this routing slip should be provided to the Executive Manager in the BCC office within 24 hours of BCC approval. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 6. The document was approved by the BCC on enter date) and all changes made HMA during the meeting have been incorporated ' the attached document. The County Attorney' Office has reviewed the chan , if a licable. \Al -Z, Z ill Co per County 160 81 Public Services Division INTEROFFICE MEMORANDUM TO: Board Minutes and Records FROM: Hailey Alonso, Operations Analyst; Public Service Division Administration DATE: November 15, 2012 RE: November 13, 2012, Agenda Item 16 D. 8 Please send the four contracts that are signed or stamped by the Board Chairman to John H. Armstrong, MD and request that all four be executed by John H. Armstrong, MD, Surgeon General /Secretary of Health, and returned to your office for County records. Once all four contracts have been returned to your office, please keep one and return the other three to my office. John H. Armstrong, MD's contact information is: John H. Armstrong, MD Surgeon General /Secretary of Health Department of Health Division of Administration 4052 Bald Cypress Way Floor: 03 Room: 305G BIN: B -02 Tallahassee, FL 32399 -1730 Thank you for your assistance. U? Public Seances Administration • 3339 Tamiami Trail East, Suite 214 • Naples, Florida 34112 -5361 •239- 252 -8468 • FAX 239 - 252 -3958 CLERK OF THE '-IRCI Dwight E. Brock COLLIER COUNTY LOUR Clerk of Courts 3301 TAMIAMI IL P.O. BOX 413044 November 27, 2012 llier :T COURT OUSE ST NAPLES, FLORIDA 14101 -3 Surgeon General /Secretary of Health Department of Health Attn: John H. Armstrong, MD Division of Administration 4052 Bald Cypress Way 3rd Floor, Room 305G, Bin B -02 Tallahassee, Florida 32399 -1730 Clerk of Courts Accountant Auditor Custodian of County Funds Re: Contract between Collier County Board of Commissioners and State of Florida Department of Health — For the operation of the Collier County Health Department Contract Year 2012 -2013 Dear Mr. Armstrong: Transmitted herewith, you will find four (4) originals for your signature, of the above referenced contracts, adopted by the Board of County Commissioners of Collier County, Florida, Tuesday, November 13th, 2012 during Regular Session. Please return the four (4) fully executed contracts, our office has provided a return envelope. Thank you. Very truly yours, DWIGHT E. BROCK, CLERK Martha Vergara, Deputy Clerk Enclosure Phone (239) 252 -2646 Fax (239) 252 -2755 Website: www.collierclerk.com Email: collierclerkracollierclerk.com z a r � Eby oo� aW� A O �.r W � CD (D O C.. W � �rDr. � � ►� r W v cr . IF J ���`.........'...yy�' ilre"I lue CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2012 -2013 This agreement ( "Agreement ") is made and entered into between the State of Florida, Department of Health ( "State ") and the Collier County Board of County Commissioners ( "County "), through their undersigned authorities, effective October 1, 2012. RECITALS A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Collier County Health Department ( "CHD ") is one of the County Health Departments created throughout Florida. It is necessary for the parties hereto to enter into this Agreement in order to assure coordination between the State and the County in the operation of the CHD. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this Agreement shall be effective from October 1, 2012, through September 30, 2013, or until a written agreement replacing this Agreement is entered into between the parties, whichever is later, unless this Agreement is otherwise terminated pursuant to the termination provisions set forth in paragraph 8, below. 3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Environmental health services shall be supported by available federal, state and local 16D 8 funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIV /AIDS, immunization, tuberculosis control and maintenance of vital statistics. c. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to: first contact acute care services; chronic disease detection and treatment; maternal and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources are set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II, Part II is an amount not to exceed $ 5,712,799 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, othercash orlocal contributions) as provided in Attachment II, Part II is an amount not to exceed $1,258,100 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this Agreement in the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. 2 c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either party may increase or decrease funding of this Agreement during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase /decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, Bureau of Budget Management. If the County initiates the increase /decrease, the County shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages to the Department of Health, Bureau of Budget Management. e. The name and address of the official payee to who payments shall be made is: County Health Department Trust Fund Collier County 3339 E. Tamiami Trail, Suite 145 Naples, FL 34112 5. CHD DIRECTOR /ADMINISTRATOR. Both parties agree the director /administrator of the CHD shall be a State employee or under contract with the State and will be under the day -to -day direction of the Deputy Secretary for Statewide Services. The director /administrator shall be selected by the State with the concurrence of the County. The director /administrator of the CHD shall insure that non - categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director /administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile" report located on the Office of Planning, Evaluation & Data Analysis Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of county purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State - contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of county purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director /administrator must sign a justification therefore, and all county - purchasing procedures must be followed in their entirety, and such compliance shall be documented. Such justification and compliance documentation shall 160 s 4 be maintained by the CHD in accordance with the terms of this Agreement. State procedures must be followed for all leases on facilities not enumerated in Attachment IV. c. The CHD shall maintain books, records and documents in accordance with those promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6.i., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: i. The revenue and expenditure requirements in the Florida Accounting System Information Resource (FLAIR). ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System /Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System /Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Collier County. e. That any surplus /deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited /debited to the state or county, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by state and county based on the ratio of planned expenditures in the core contract and funding from all sources is credited to the program accounts by state and county. The equity share of any surplus /deficit funds accruing to the state and county is determined each month and at contract year -end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of 4 16U 8 surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director /administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for Statewide Services has approved the transfer. The Deputy Secretary for Statewide Services shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this Agreement. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A -133 and may be in conjunction with audits performed by county government. If audit exceptions are found, then the director /administrator of the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties. i. The CHD shall not use or disclose any information concerning a recipient of services except as allowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this Agreement for a period of five (5) years after termination of this Agreement. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k. The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The i WOMIU010 CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his /her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this Agreement. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III. o. The CHD shall submit quarterly reports to the county that shall include at least the following: i. The DE3851-1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the county of service variances reflected in the DE3851-1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Bureau of Budget Management. � ' f p. The dates for the submission of quarterly reports to the county shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: i. March 1, 2013 for the report period October 1, 2012 through December 31, 2012; ii. June 1, 2013 for the report period October 1, 2012 through March 31, 2013; iii. September 1, 2013 for the report period October 1, 2012 through June 30, 2013; and iv. December 1, 2013 for the report period October 1, 2012 through September 30, 2013. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the county shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b. The county shall assure adequate fire and casualty insurance coverage for County - owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self- insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as county vehicles. The county shall assure insurance coverage for these vehicles is available through either a self- insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. TERMINATION. a. Termination at Will. This Agreement may be terminated by either party without cause upon no less than one - hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this Agreement become unavailable, either party may terminate this Agreement upon no less than twenty -four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This Agreement may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an 160 s obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Agreement. 9. MISCELLANEOUS. The parties further agree: a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2013, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Manaqers. The name and address of the contract managers for the parties under this Agreement are as follows: For the State: Joan M. Colfer, M.D. M.P.H. Name Director, Collier County Health Dept Title 3339 E. Tamiami Trail, Suite 145 Naples, Florida 34112 Address (239) 252 -8201 Telephone For the County: Steve Carnell Name Public Services Interim Administrator Title 3339 E. Tamiami Trail, Suite 214 Naples, Florida 34112 Address (239) 252 -8468 Telephone If different contract managers are designated after execution of this Agreement, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this Agreement. C. Captions. The captions and headings contained in this Agreement are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. .1 In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be executed by their undersigned officials as duly authorized effective the 1St day of October, 201`2. BOARD OF COUNTY COMMISSIONERS FOR COLLIER COUNTY SIGNED BY:- �,.s�_1J. NAME: Fed &I,, Co vie- STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: John H. Armstrong, MD TITLE: G A u ;2 a TITLE: Surgeon General /Secretary of Health DATE: /� DATE: ATTESTED T SIGNED BY: NAME: TITLE: � I b - . y CI ev DATE: 1\11�°�1V1 Attest si o chi s ra* tipnae �e.�.; SIGNED B" NAME: oan M. Colfer. M.D. M.P.H. TITLE: CHD Director /Administrator DATE: L AppMvod as to form & legal Su?ftjqfty Assis ant County Attorney i 160 8-1 ATTACHMENT COLLIER COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet (DHP 50 -20), Environmental Health Coding Pamphlet (DHP 50 -21) and FLAIR requirements because of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must comply with the special reporting requirements for that service. The services and the reporting requirements are listed below: E 4 5. 0 7 I Service Requirement Sexually Transmitted Disease Requirements as specified in F.A.C. 64D -3, F.S. 381 and Program F.S. 384. Dental Health Monthly reporting on DH Form 1008 *. Additional reporting requirements, under development, will be required. The additional reporting requirements will be communicated upon finalization. Special Supplemental Nutrition Service documentation and monthly financial reports as Program for Women, Infants specified in DHM 150 -24* and all federal, state and county and Children (including the WIC requirements detailed in program manuals and published Breastfeeding Peer Counseling procedures. Program) Healthy Start/ Requirements as specified in the 2007 Healthy Start Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. Family Planning Periodic financial and programmatic reports as specified by the program office. Immunization Periodic reports as specified by the department regarding the surveillance /investigation of reportable vaccine preventable diseases, vaccine usage accountability as documented in Florida SHOTS, the assessment of various immunization levels as documented in Florida SHOTS and forms reporting adverse events following immunization. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4* and DHP 50 -21* HIV /AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 64D -3.030 and 6413- 3.031. Case reporting should be on Adult HIV /AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV /AIDS Confidential Case Report CDC Form DH2140. 10 ATTACHMENT I (Continued) Socio- demographic data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1628 or Post -Test Counseling DH Form 1628C. These reports are to be sent to the Headquarters HIV /AIDS office within 5 days of the initial post -test counseling appointment or within 90 days of the missed post -test counseling appointment. 9. School Health Services Requirements as specified in the Florida School Health Administrative Guidelines (May 2012). 10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C. 64D -3 and F.S. 392. 11. General Communicable Disease Control Carry out surveillance for reportable communicable and other acute diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in the CHD Guide to Surveillance and Investigations. *or the subsequent replacement if adopted during the contract period. N W V Z g m D Z LL H N H � Z W ~ Z W CL W D Q ~ = W W -i G V = qJ Q_ � r O Z V O W V J W 0 O O () W N D W Z Z g a a N c� U 2 v -o U cco O m N CO .a N t � w U) U- N N F- '� p c� � = c -0 U co ? -*- m m O m E 2a co L j w cn w i CA co r r` N O O CO v N N U) c0 v O O M 00 N M } O � cn U O N N O O O U .- O m N N E w E a H N w 1- N c� U 2 v -o U cco O m N CO .a N t � w U) U- N N F- '� p c� � = c -0 U co ? -*- m m O m E 2a co L j w cn w i CA co r r` N O O CO v N N U) c0 v O O M r, _a r` 00 co O co M Cl) C � � O l N U C M O 0) O L- C � 0 N CL `o Co � 0 > N vo n D N C .= D v0 oo °O r N C m t N t N O E a C m V) U O CL s 3 N N O N m c 0) a N O N 'c w N C a c m at5i �O Q C 0 m O c N 0 C O U y C U N c m 0 0 n- 39 CL m U CL U) 16D g N r m N } O CV) cn U O N C N O M M U U m m N E w E a c c co }'. a w o 0 0 0 o UN a CN j N U- � p N H m p 30 2 t; 0 ID 0 U co cn0 c �- N M r, _a r` 00 co O co M Cl) C � � O l N U C M O 0) O L- C � 0 N CL `o Co � 0 > N vo n D N C .= D v0 oo °O r N C m t N t N O E a C m V) U O CL s 3 N N O N m c 0) a N O N 'c w N C a c m at5i �O Q C 0 m O c N 0 C O U y C U N c m 0 0 n- 39 CL m U CL U) 16D g N r Version: 1 Page 1 of 7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1, 2012 to September 30, 2013 :x State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 1. GENERAL REVENUE - STATE 015040 AIDS PREVENTION 19,261 0 19,261 0 19,261 015040 AIDS SURVEILLANCE 50,310 0 50,310 0 50,310 015040 ALG /CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0 015040 ALG /CONTR TO CHDS -AIDS PATIENT CARE 140,000 0 140,000 0 140,000 015040 ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK 0 0 0 0 0 015040 ALG /CONTR TO CHDS - SOVEREIGN IMMUNITY 0 0 0 0 0 015040 MINORITY OUTREACH - PENALVER CLINIC - MIAMI -DADE 0 0 0 0 0 015040 PREPAREDNESS GRANT MATCH 82,824 0 82,824 0 82,824 015040 SCHOOL HEALTH GENERAL REVENUE 80,855 0 80,855 0 80,855 015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0 015040 STD GENERAL REVENUE 0 0 0 0 0 015040 TREASURE COAST MIDWIFERY - MARTIN 0 0 0 0 0 015040 HEALTHY START MED- WAIVER - CLIENT SERVICES 0 0 0 0 0 015040 JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI -DADS 0 0 0 0 0 015040 LA LIGA- LEAGUE AGAINST CANCER - MIAMI -DADS 0 0 0 0 0 015040 MANATEE COUNTY RURAL HEALTH SERVICES 0 0 0 0 0 015040 METRO ORLANDO URBAN LEAGUE - ORANGE 0 0 0 0 0 015040 MIGRANT LABOR CAMP SANITATION 74,533 0 74,533 0 74,533 015040 DENTAL SPECIAL INITIATIVES 6,542 0 6,542 0 6,542 015040 DUVAL TEEN PREGANCY PREVENTION - DUVAL 0 0 0 0 0 015040 FAMILY PLANNING GENERAL REVENUE 36,794 0 36,794 0 36,794 015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0 015040 FL HEPATITIS & LIVER FAILURE PREVENTION /CONTROL 89,286 0 89,286 0 89,286 015040 HEALTHY START MED WAIVER - SOBRA 0 0 0 0 0 015040 ALG/IPO HEALTHY STARTAPO 0 0 0 0 0 015040 ALG/PRIMARY CARE 313,432 0 313,432 0 313,432 015040 BREAST & CERVICAL - ADMINISTRATION /CASE MANAGEMENT 0 0 0 0 0 015040 COMMUNITY SMILES - MIAMI -DADE 0 0 0 0 0 015040 COMMUNITY TB PROGRAM 78,326 0 78,326 0 78,326 015040 COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA 0 0 0 0 0 015050 NON - CATEGORICAL GENERAL REVENUE 1,638,824 0 1,638,824 0 1,638,824 GENERAL REVENUE TOTAL 2,610,987 0 2,610,987 0 2,610,987 2. NON GENERAL REVENUE - STATE 015010 ALG /CONTR. TO CHDS - BIOMEDICAL WASTE 14,050 0 14,050 0 14,050 015010 ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG 0 0 0 0 0 015010 CHD PROGRAM SUPPORT 0 0 0 0 0 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0 015010 PREPAREDNESS GRANT MATCH 0 0 0 0 0 015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0 015010 SCHOOL HEALTH TOBACCO TF 137,218 0 1 37,218 0 137,218 015010 TOBACCO ADMINISTRATION & MANAGEMENT 0 0 0 0 0 015010 TOBACCO COMMUNITY INTERVENTION 224,230 0 224,230 0 224,230 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0 015060 NON - CATEGORICAL TOBACCO REBASING 3,097 0 3,097 0 3,097 Version: 1 Page 1 of 7 Version: 1 Page 2 of 7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1, 2012 to September 30, 2013 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total NON GENERAL REVENUE TOTAL 378,595 0 378,595 0 378,595 3. FEDERAL FUNDS - State 007000 ABSTINENCE EDUCATION GRANT PROGRAM 0 0 0 0 0 007000 AIDS PREVENTION 255,477 0 255,477 0 255,477 007000 AIDS SURVEILLANCE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 21,208 0 21,208 0 21,208 007000 CHRONIC DISEASE PREVENTION & HEALTH PROMOTION 32,000 0 32,000 0 32,000 007000 COASTAL BEACH MONITORING PROGRAM 19,929 0 19,929 0 19,929 007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 141,770 0 141,770 0 141,770 007000 UNINTENDED/UNWANTED PREG -TEEN PREGNANCY PREV 28,000 0 28,000 0 28,000 007000 WIC ADMINISTRATION 1,462,607 0 1,462,607 0 1,462,607 007000 WIC BREASTFEEDING PEER COUNSELING 70,030 0 70,030 0 70,030 007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0 007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 17,624 0 17,624 0 17,624 007000 SYPHILIS ELIMINATION 0 0 0 0 0 007000 TEENAGE PREGNANCY PREVENTION REPLICATION 0 0 0 0 0 007000 TITLE X HIV /AIDS PROJECT 139,108 0 139,108 0 139,108 007000 TOBACCO FAITH BASED PROJECT 0 0 0 0 0 007000 RAPE PREVENTION & EDUCATION 0 0 0 0 0 007000 RYAN WHITE 0 0 0 0 0 007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0 007000 007000 RYAN WHITE -AIDS DRUG ASSIST PROG -ADMIN RYAN WHITE- CONSORTIA 77,945 0 0 0 77,945 0 0 0 77,945 0 007000 SAFE SLEEP EDUCATION 10,386 0 10,386 0 10,386 007000 MINORITY INVOLVEMENT IN HIV /AIDS PROGRAM 0 0 0 0 0 007000 PHP - CITIES READINESS INITIATIVE 0 0 0 0 0 007000 PRECONCEPTION HEALTH CARE 0 0 0 0 0 007000 PREGNANCY ASSOCIATED MORTALITY PREVENTION 0 0 0 0 0 007000 PUBLIC HEALTH INFRASTRUCTURE 0 0 0 0 0 007000 PUBLIC HEALTH PREPAREDNESS BASE 209,697 0 209,697 0 209,697 007000 007000 007000 IMMUNIZATION WIC LINKAGES MCH BGTF- GADSDEN SCHOOL CLINIC MCH BGTF - HEALTHY START COALITIONS 0 0 0 0 0 0 0 0 0 0 0 0 007000 MCH QUALITY IMPROVEMENT ACTIVITIES MCHBG 0 0 0 0 0 007000 MINORITY AIDS INITIATIVE 0 0 0 0 0 007000 007000 007000 007000 MINORITY AIDS INITIATIVE ICE COLLABORATIVE FGTF/FAMILY PLANNING -TITLE X HEALTHY HOMES AND LEAD POISONING GRANT HIV HOUSING FOR PEOPLE LIVING WITH AIDS 0 80,527 0 0 0 0 0 0 0 80,527 0 0 0 0 0 0 0 80,527 0 0 007000 HIV INCIDENCE SURVEILLANCE 0 0 0 0 0 007000 IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT 123,219 0 123,219 0 123,219 007000 IMMUNIZATION FIELD STAFF EXPENSE 0 0 0 0 0 007000 COLORECTAL CANCER SCREENING 2009 -10 0 0 0'', 0 0 007000 DENTAL SERVICES 0 0 0 0 0 007000 ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IMPL 0 0 0 0 0 007000 EXPANDED TESTING INITIATIVE (ETI) 0 0 0 0 0 007000 007000 FGTF /AIDS MORBIDITY FGTFBREAST & CERVICAL CANCER -ADMIN/CASE MAN 0 0 0 0 0 0 0 0 0 0 Version: 1 Page 2 of 7 ATTACHMENT H. COLLIER COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1, 2012 to September 30, 2013 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution 3. FEDERAL FUNDS - State 015009 MEDIPASS WAIVER -HLTHY STRT CLIENT SERVICES 015009 MEDIPASS WAIVER -SOBRA 007055 ARRA FEDERAL GRANT - SCHEDULE C 015075 SCHOOL HEALTH TITLE XXI 015075 SUMMER FOOD PROGRAM INSPECTIONS 015075 REFUGEE HEALTH FEDERAL FUNDS TOTAL 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 TANNING FACILITIES 001020 BODY PIERCING 001020 MIGRANT HOUSING PERMIT 001020 MOBILE HOME AND PARKS 001020 FOOD HYGIENE PERMIT 001020 BIOHAZARD WASTE PERMIT 001020 PRIVATE WATER CONSTR PERMIT 001020 PUBLIC WATER ANNUAL OPER PERMIT 001020 PUBLIC WATER CONSTR PERMIT 001020 NON -SDWA SYSTEM PERMIT 001020 SAFE DRINKING WATER 001020 SWIMMING POOLS 001092 OSDS PERMIT FEE 001092 I & M ZONED OPERATING PERMIT 001092 AEROBIC OPERATING PERMIT 001092 SEPTIC TANK SITE EVALUATION 001092 NON SDWA LAB SAMPLE 001092 OSDS VARIANCE FEE 001092 ENVIRONMENTAL HEALTH FEES 001092 OSDS REPAIR PERMIT 001170 LAB FEE CHEMICAL ANALYSIS 001170 WATER ANALYSIS- POTABLE 001170 NONPOTABLE WATER ANALYSIS 010304 MQA INSPECTION FEE 001206 CENTRAL OFFICE SURCHARGE FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 5. OTHER CASH CONTRIBUTIONS - STATE 010304 STATIONARY POLLUTANT STORAGE TANKS 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTIONS TOTAL 6.NIEDICAID - STATE /COUNTY 001056 MEDICAID PHARMACY 001076 MEDICAID TB 001078 MEDICAID ADMINISTRATION OF VACCINE 001079 MEDICAID CASE MANAGEMENT 001081 MEDICAID CHILD HEALTH CHECK UP Version: 1 LAM*- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,690 0 33,690 0 33,690 0 0 0 0 0 231,600 0 231,600 0 231,600 2,954,817 0 2,954,817 0 2,954,817 3,000 0 3,000 0 3,000 0 0 0 0 0 24,575 0 24,575 0 24,575 19,918 0 19,918 0 19,918 28,712 0 28,712 0 28,712 33,400 0 33,400 0 33,400 0 0 0 0 0 10,000 0 10,000 0 10,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 274,000 0 274,000 0 274,000 80,000 0 80,000 0 80,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,200 0 1,200 0 1,200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50,000 0 50,000 0 50,000 524,805 0 524,805 0 524,805 0 0 0 0 0 306,941 0 306,941 0 306,941 306,941 0 306,941 0 306,941 0 0 0 0 0 0 48,000 48,000 0 48,000 0 20,000 20,000 0 20,000 0 21,720 21,720 0 21,720 0 0 0 0 0 Page 3of7 4 6. MEDICAID - STATE /COUNTY 160 MEDICAID DENTAL 8 ATTACHMENT II. 001087 MEDICAID STD 001089 COLLIER COUNTY HEALTH DEPARTMENT 001147 MEDICAID HMO CAPITATION 001191 Part H. Sources of Contributions to County Health Department 001192 MEDICAID COMPREHENSIVE CHILD 001193 October 1, 2012 to September 30, 2013 001194 MEDICAID LABORATORY 001208 State CHD County Total CHD 001059 MEDICAID LOW INCOME POOL 001051 Trust Fund CHD Trust Fund Other MEDICAID - BEHAVIORAL HEALTH 001071 (cash) Trust Fund (cash) Contribution MEDICAID - DERMATOLOGY Total 6. MEDICAID - STATE /COUNTY 001082 MEDICAID DENTAL 001083 MEDICAID FAMILY PLANNING 001087 MEDICAID STD 001089 MEDICAID AIDS 001147 MEDICAID HMO CAPITATION 001191 MEDICAID MATERNITY 001192 MEDICAID COMPREHENSIVE CHILD 001193 MEDICAID COMPREHENSIVE ADULT 001194 MEDICAID LABORATORY 001208 MEDIPASS $3.00 ADM. FEE 001059 MEDICAID LOW INCOME POOL 001051 EMERGENCY MEDICAID 001058 MEDICAID - BEHAVIORAL HEALTH 001071 MEDICAID - ORTHOPEDIC 001072 MEDICAID - DERMATOLOGY 001075 MEDICAID - SCHOOL HEALTH CERTIFIED MATCH 001069 MEDICAID - REFUGEE HEALTH 001055 MEDICAID - HOSPITAL 001148 MEDICAID HMO NON - CAPITATION 001074 MEDICAID - NEWBORN SCREENING MEDICAID TOTAL 7. ALLOCABLE REVENUE -STATE 018000 REFUNDS 037000 PRIOR YEAR WARRANT 038000 12 MONTH OLD WARRANT ALLOCABLE REVENUE TOTAL 8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE 0 PHARMACY SERVICES 0 LABORATORY SERVICES 0 TB SERVICES 0 IMMUNIZATION SERVICES 0 STD SERVICES 0 CONSTRUCTION/RENO VATION 0 WIC FOOD 0 ADAP 0 DENTAL SERVICES 0 OTHER (SPECIFY) 0 OTHER (SPECIFY) OTHER STATE CONTRIBUTIONS TOTAL 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 008010 CONTRIBUTION FROM CITY GOVERNMENT 008020 CONTRIBUTION FROM HEALTH CARE TAX NOT THRU BCC 008040 BCC GRANT /CONTRACT 008030 CONTRIBUTION FROM HEALTH CARE TAX Version: 1 0 805,724 805,724 0 805,724 0 0 0 0 0 0 8,500 8,500 0 8,500 0 32,276 32,276 0 32,276 0 0 0 0 0 0 0 0 0 0 0 500 500 0 500 0 8.500 8,500 0 8,500 0 0 0 0 0 0 434 434 0 434 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,000 22,000 0 22,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 967,654 967,654 0 967,654 2,585 0 2,585 0 2,585 0 0 0 0 0 0 0 0 0 0 2,585 0 2,585 0 2,585 0 0 0 146,868 146,868 0 0 0 101,737 101,737 0 0 0 0 0 0 0 0 916,303 916,303 0 0 0 0 0 0 0 0 0 0 0 0 0 6,521,482 6,521,482 0 0 0, 1,258,313 1,258,313 0 0 0: 0 0 0 & 0 0 0 0 0 0 0 0 0 0' 8,944,703 8,944,703 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0' 0 0 Page 4 of 7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Department October 1, 2012 to September 30, 2013 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 9. DIRECT LOCAL CONTRIBUTIONS - BCC/T:A_X DISTRICT 008034 BCC CONTRIBUTION FROM GENERAL FUND 0 1,258,100 1,258,100 0 1,258,100 DIRECT COUNTY CONTRIBUTION TOTAL 0 1,258,100 1,258,100 0 1,258,100 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001060 VITAL STATISTIC -FEES & SERVICES 0 200 200 0 200 001077 RABIES VACCINE 0 0 0 0 0 001077 CHILD CAR SEAT PROG 0 0 0 0 0 001077 PERSONAL HEALTH FEES 0 193,377 193,377 0 193,377 001077 AIDS CO -PAYS 0 0 0 0 0 001094 ADULT ENTER. PERMIT FEES 0 0 0 0 0 001094 LOCAL ORDINANCE FEES 0 557,900 557,900 0 557,900 001114 NEW BIRTH CERTIFICATES 0 60,000 60,000 0 60,000 001115 VITAL STATISTICS - DEATH CERTIFICATE 0 240,800 240,800 0 240,800 001117 VITAL STATS -ADM. FEE 50 CENTS 0 4,000 4,000 0 4,000 001073 CO -PAY FOR THE AIDS CARE PROGRAM 0 0 0 0 0 001025 CLIENT REVENUE FROM GRC 0 0 0 0 0 001040 CELL PHONE ADMINISTRATIVE FEE 0 p 0 0 0 FEES AUTHORIZED BY COUNTY TOTAL 0 1,056,277 1,056,277 0 1,056,277 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 RETURNED CHECK ITEM 0 0 0 0 0 001029 THIRD PARTY REIMBURSEMENT 0 732,245 732,245 0 732,245 001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 p 0 0 0 001054 MEDICARE PART D 0 0 0 0 0 001077 RYAN WHITE TITLE II 0 0 0 0 0 001090 MEDICARE PART B 0 30,018 30,018 0 30,018 001190 HEALTH MAINTENANCE ORGANIZATION 0 0 0 0 0 005040 INTEREST EARNED 0 0 0 0 0 005041 INTEREST EARNED -STATE INVESTMENT ACCOUNT 0 0 0 0 0 007010 U.S. GRANTS DIRECT 0 0 0 0 0 008050 SCHOOL BOARD CONTRIBUTION 0 0 0 0 0 008060 SPECIAL PROJECT CONTRIBUTION 0 0 0 0 0 010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES 0 300 300 0 300 010301 EXP WITNESS FEE CONSULTNT CHARGES 0 0 0 0 0 010405 SALE OF PHARMACEUTICALS 0 0 0 0 0 010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0 011001 HEALTHY START COALITION CONTRIBUTIONS 0 412,562 412,562 0 412,562 011007 CASH DONATIONS PRIVATE 0 250 250 0 250 012020 FINES AND FORFEITURES 0 1,692 1,6921 0 1,692 012021 RETURN CHECK CHARGE 0 0 0 0 0 028020 INSURANCE RECOVERIES -OTHER 0 0 01 0 0 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 652,247 652,247 0 652,247 011000 GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING 0 0 0 0 0 011000 GRANT - DIRECT 0 293,816 293,816 0 293,816 011000 GRANT DIRECT- COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0 0 0 0 0 011000 COUNTY COMMISSION - LIP FUND 0 226,260 226,260 0 226,260 011000 GRANT -DRECT 0 0 0' 0 0 Version: 1 Page 5 of 7 160 s ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1, 2012 to September 30, 2013 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total yR 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTN" 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT DIRECT -ARROW 0 0 0 0 0 011000 GRANT DIRECT - QUANTUM DENTAL 0 0 0 0 0 011000 GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT - DIRECT 0 0 0 0 0 010402 RECYCLED MATERIAL SALES 0 0 0 0 0 010303 FDLE FINGERPRINTING 0 2,000 2,000 0 2,000 007050 ARRA FEDERAL GRANT 0 0 0 0 0 001010 RECOVERY OF BAD CHECKS 0 0 0 0 0 008065 FCO CONTRIBUTION 0 0 0 0 0 011006 RESTRICTED CASH DONATION 0 0 0 0 0 028000 INSURANCE RECOVERIES 0 0 0 0 0 001033 CMS MANAGEMENT FEE - PMPMPC 0 0 0 0 0 010400 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0 010500 REFUGEE HEALTH 0 0 0 0 0 005045 INTEREST EARNED -THIRD PARTY PROVIDER 0 0 0 0 0 005043 INTEREST EARNED - CONTRACT /GRANT 0 0 0 0 0 010306 DOH/DOC INTERAGENCY AGREEMENT 0 0 0 0 0 011002 ARRA FEDERAL GRANT - SUB - RECIPIENT 0 0 0 0 0 011004 LOW INCOME POOL - SUBRECIPIENT 0 0 0 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 2,351,390 2,351,390 0 2,351,390 12. ALLOCABLE REVENUE - COUNTY 018000 REFUNDS 037000 PRIOR YEAR WARRANT 038000 12 MONTH OLD WARRANT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDINGS -COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 p 0 525,048 525,048 GROUNDS MAINTENANCE 0 0 0 195,149 195,149 IT ALLOCATION & GOLDEN GATE RENT 0 0 0 84,900 84,900 INSURANCE 0 0 0 0 0 UTILITIES 0 0 0, 209,800 209,800 OTHER (SPECIFY) 0 0 0 0 0 BUILDING MAINTENANCE 0 0 0 0 0 BUILDINGS TOTAL 0 0 0 1,014,897 1,014,897 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY EQUIPMENTNEHICLE PURCHASES 0 0 0 0 0 VEHICLE INSURANCE 0 0 0 16,300 16,300 VEHICLE MAINTENANCE 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 01 0 0 Version: 1 Page 6 of 7 16U g a: ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1, 2012 to September 30, 2013 z State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund ( Contribution Total 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 16,300 16,300 GRAND TOTAL CHD PROGRAM 6,778,730 5,633,421 12,412,1 1 9,975,900 22,388,051 Version: 1 Page 7 of 7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service October 1, 2012 to September 30, 2013 Quarterly Expenditure Plan FTE's Clients Services/ Ist 2nd 3rd 4th Grand (0.00) Units Visits (Whole dollars only) State County Total A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION(101) 12.61 8,678 22,230 169,861 167,185 183,381 167,185 344,228 343,384 687,612 STD (102) 5.14 738 1,254 63,200 68,775 80,239 68,775 22,408 258,581 280,989" HIV /AIDS PREVENTION (03A1) 5.44 1,500 15,000 76,479 79,024 80,529 79,024 212,295 102,761 315,056 HIV /AIDS SURVEILLANCE (03A2) 1.35 60 300 15,690 31,644 19,418 31,644 98,396 0 98,396 HIV /AIDS PATIENT CARE (03A3) 9.30 576 9,173 156,913 275,847 230,156 275,847 578,152 360,611 938,763 ADAP (03A4) 2.07 36 120 27,185 22,892 26,708 22,892 99,677 0 99,677 TB CONTROL SERVICES (104) 1 1.34 791 5,193 154,069 177,047 189,056 177,047 408,756 288,463 697,219 COMM. DISEASE SURV. (106) 6.38 0 6,278 110,026 112,410 131,146 112,410 0 465,992 465,992 HEPATITIS PREVENTION (109) 2.04 1,570 2,130 28,816 31,445 36,686 31,445 128,392 0 128,392 PUBLIC HEALTH PREP AND RESP (116) 5.55 0 0 136,257 103,043 120,218 103,043 415,831 46,730 462,561 VITAL STATISTICS (180) 3.34 10,957 37,551 36,927 45,977 47,808 45,977 0 176,689 176,689 COMMUNICABLE DISEASE SUBTOTAL 64.56 24,906 99,229 975,423 1,115,289 1,145,345 1,115,289 2,308,135 2,043,211 4,351,346 B. PRIMARY CARE: CHRONIC DISEASE SERVICES (2 10) 0.60 173 3,445 8,246 9,926 11,580 9,926 39,678 0 39,678 TOBACCO PREVENTION (212) 3.00 0 5,551 42,920 59,489 54,404 59,489 216,302 0 216,302 WIC (21W1) 35.00 11,544 98,927 474,711 498,663 319,774 298,663 1,591,811 0 1,591,811 WIC BREASTFEEDING PEER COUNSELING (21W2) 3.00 4,356 2,908 27,294 15,053 19,029 15,053 76,429 0 76,429 FAMILY PLANNING (223) 2.75 2,628 3,080 103,320 115,760 105,885 115,760 439,596 1,129 440,725 IMPROVED PREGNANCY OUTCOME (225) 5.82 1,140 7,586 143,875 176,490 180,903 176,490 247,020 430,738 677,758 HEALTHY START PRENATAL (227) 12.02 1,106 6,462 129,171 177,136 177,492 177,1316 181,948 478,987 660,935 COMPREHENSIVE CHILD HEALTH (229) 2.01 234 700 28,999 75,846 59,321 75,846 0 240,012 240,012 HEALTHY START INFANT (23 1) 4.20 787 4,578 54,833 47,864 55,842 47,864 206,403 0 206,403 SCHOOL HEALTH (234) 7.33 0 222,756 67,103 114,579 133,676 114,579 328,977 100,960 429,937 COMPREHENSIVE ADULT HEALTH (237) 6.07 1,615 3,893 171,310 215,482 193,061 215,482 364,698 430,637 795,335 COMMUNITY HEALTH DEVELOPMENT (238) 026 0 26 11,973 641 415 641 13,670 0 13,670 DENTAL HEALTH (240) 14.39 5,052 10,812 184,567 401,477 350,603 401,477 6,427 1,331,697 1,338,124 PRIMARY CARE SUBTOTAL 96.45 28,635 370,724 1,448,322 1,908,406 1,661,985 1,708,406 3,712,959 3,014,160 6,727,119 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COASTAL BEACH MONITORING (347) 0.13 501 501 4,876 6,196 7,230 6,196 24,498 0 24,498 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.22 488 1,404 2,696 5,169 6,032 5,169 6,355 12,711 19,066 PUBLIC WATER SYSTEM (358) 0.00 0 0 129 21 26 21 97 100 197 PRIVATE WATER SYSTEM (359) 0.00 0 0 116 45 51 45 0 257 257 INDIVIDUAL SEWAGE DISP. (361) 8.03 2,713 5,542 91,580 122,874 143,352 122,874 226,202 254,478 480,680 Group Total 8.38 3,702 7,447 99,397 134,305 156,691 134,305 257,152 267,546 524,698 Facility Programs FOOD HYGIENE (348) 0.61 60 290 13,234 19,930 11,585 19,930 64,679 0 64,679 BODY PIERCING FACILITIES SERVICES 0.02 3 3 0 228 265 228 356 365 721 GROUP CARE FACILITY (35 1) 0.93 320 503 12,350 12,354 14,414 12,354 0 51,472 51,472 MIGRANT LABOR CAMP (352) 3.23 256 1,882 37,495 51,491 60,072 51,491 137,836 62,713 200,549 HOUSING,PUBLIC BLDG SAFETY,SANITATION (353)0.00 0 0 53 38 45 38 86 88 174 Version: 3 Page 1 of 2 X01 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service October 1, 2012 to September 30, 2013 Quarterly Expenditure Plan FTE's Clients Services/ 1st 2nd 3rd 4th Grand (0.00) Units Visits (Whole dollars only) State County Total C. ENVIRONMENTAL HEALTH: Facility Programs MOBILE HOME AND PARKS SERVICES (354) 0.58 94 243 10,931 8,520 9,939 8,520 37,910 0 37,910 SWIMMING POOLS/BATHING (360) 3.37 1,484 18,477 65,550 60,206 70,241 60,206 104,379 151,824 256,203 BIOMEDICAL WASTE SERVICES (364) 0.55 359 376 25,211 11,719 13,672 11,719 62,321 0 62,321 TANNING FACILITY SERVICES (369) 0.02 5 12 1,181 248 291 248 1,968 0 1,968 Group Total 931 2,581 21,786 166,005 164,734 180,524 164,734 409,535 266,462 675,997 Groundwater Contamination STORAGE TANK COMPLIANCE (355) 0.00 0 0 0 0 0 0 0 0 0 SUPER ACT SERVICE (356) 0.04 52 74 927 584 681 584 1,370 1,406 2,776 Group Total 0.04 52 74 927 584 681 584 1,370 1,406 2,776 Community Hygiene TATTOO FACILITIES SERVICES 0.01 0 0 1,400 132 153 132 896 921 1,817 COMMUNITY ENVIR. HEALTH (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0.07 0 57 444 1,391 1,621 1,391 2,391 2,456 4,847 LEAD MONITORING SERVICES (350) 0.00 0 0 0 6 7 6 10 9 19 PUBLIC SEWAGE (362) 0.00 0 0 0 2 2 2 4 2 6 SOLID WASTE DISPOSAL (363) 0.00 0 0 -6 0 0 6 0 0 0 SANITARY NUISANCE (365) 0.02 0 0 27 303 353 303 486 500 986 RABIES SURVEILLANCE /CONTROL SERVICES (366)0.00 0 0 0 0 0 0 0 0 0 ARBOVIRUS SURVEILLANCE (367) 0.00 0 0 0 0 0 0 0 0 0 RODENT /ARTHROPOD CONTROL (368) 0.00 0 0 0 53 53 53 78 81 159 WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0 INDOOR AIR (371) 0.00 0 0 0 0 0 0 0 0 0 RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0 TOXIC SUBSTANCES (373) 0.00 0 0 0 0 0 0 0 0 0 Group Total 0.10 0 57 1,865 1,887 2,189 1,893 3,865 3,969 7,834 ENVIRONMENTAL HEALTH SUBTOTAL 17.83 6,335 29,364 268,194 301,510 340,085 301,516 671,922 539,383 1,211,305 D. NON- OPERATIONAL COSTS: NON-OPERATIONAL COSTS (599) 0.00 0 0 18,788 16,143 22,168 15,282 35,714 36,667 72,381 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 13,336 5,500 3,000 28,164 50,000 0 50,000 NON - OPERATIONAL COSTS SUBTOTAL 0.00 0 0 32,124 21,643 25,168 43,446 85,714 36,667 122,381 TOTAL CONTRACT 178.84 59,876 499,317 2,724,063 3,346,848 3,172,583 3,168,657 6,778,730 5,633,421 12,412,151 Version: 3 Page 2 of 2 We"I re ATTACHMENT III COLLIER COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97 -35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. 22 ATTACHMENT IV COLLIER COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Collier County Health Department & Public Services Building H Immokalee Satellite Golden Gate WIC Office •1 Location Owned By 3339 E. Tamiami Trail Collier County Suite 145, Naples 419 North First Street Collier County Immokalee 4945 Golden Gate Parkway Benderson Unit 102, Naples Development 23 16u ATTACHMENT V COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT. CONTRACT YEAR 2010 -2011 2011 -2012 2012 -2013 2013 -2014 2014 -2015 PROJECT TOTAL STATE $ 0 $ 0 COUNTY $ $ 0 $ 0 SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of funds) : COMPLETION DATE: DESIGN FEES: CONSTRUCTION COSTS: FURNITURE/EQUIPMENT TOTAL PROJECT COST: COST PER SQ FOOT: $ TOTAL $ 0 $ 0 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. 24 16D 8' CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2012 -2013 This agreement ( "Agreement") is made and entered into between the State of Florida, Department of Health ( "State ") and the Collier County Board of County Commissioners ( "County "), through their undersigned authorities, effective October 1, 2012. RECITALS A. Pursuant to Chapter 154, F.S., the intent of the legislature is to "promote, protect, maintain, and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services." B. County Health Departments were created throughout Florida to satisfy this legislative intent through "promotion of the public's health, the control and eradication of preventable diseases, and the provision of primary health care for special populations." C. Collier County Health Department ( "CHD ") is one of the County Health Departments created throughout Florida. It is necessary for the parties hereto to enter into this Agreement in order to assure coordination between the State and the County in the operation of the CHD. NOW THEREFORE, in consideration of the mutual promises set forth herein, the sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference. 2. TERM. The parties mutually agree that this Agreement shall be effective from October 1, 2012, through September 30, 2013, or until a written agreement replacing this Agreement is entered into between the parties, whichever is later, unless this Agreement is otherwise terminated pursuant to the termination provisions set forth in paragraph 8, below. 3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below: a. "Environmental health services" are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Environmental health services shall be supported by available federal, state and local 160 a funds and shall include those services mandated on a state or federal level. Examples of environmental health services include, but are not limited to, food hygiene, safe drinking water supply, sewage and solid waste disposal, swimming pools, group care facilities, migrant labor camps, toxic material control, radiological health, and occupational health. b. "Communicable disease control services" are those services which protect the health of the general public through the detection, control, and eradication of diseases which are transmitted primarily by human beings. Communicable disease services shall be supported by available federal, state, and local funds and shall include those services mandated on a state or federal level. Such services include, but are not limited to, epidemiology, sexually transmissible disease detection and control, HIV /AIDS, immunization, tuberculosis control and maintenance of vital statistics. c. "Primary care services" are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control. These services are provided to benefit individuals, improve the collective health of the public, and prevent and control the spread of disease. Primary health care services are provided at home, in group settings, or in clinics. These services shall be supported by available federal, state, and local funds and shall include services mandated on a state or federal level. Examples of primary health care services include, but are not limited to: first contact acute care services; chronic disease detection and treatment; maternal and child health services; family planning; nutrition; school health; supplemental food assistance for women, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the CHD will be handled as follows: a. The funding to be provided by the parties and any other sources are set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment 11. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment 11, Part II is an amount not to exceed $ 5,712,799 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The State's obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility (direct contribution excluding any fees, other cash or local contributions) as provided in Attachment 11, Part II is an amount not to exceed $1,258,100 (amount listed under the "Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this Agreement in the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. 16D u c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either party may increase or decrease funding of this Agreement during the term hereof by notifying the other party in writing of the amount and purpose for the change in funding. If the State initiates the increase /decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, Bureau of Budget Management. If the County initiates the increase /decrease, the County shall notify the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages to the Department of Health, Bureau of Budget Management. e. The name and address of the official payee to who payments shall be made is: County Health Department Trust Fund Collier County 3339 E. Tamiami Trail, Suite 145 Naples, FL 34112 5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director /administrator of the CHD shall be a State employee or under contract with the State and will be under the day -to -day direction of the Deputy Secretary for Statewide Services. The director /administrator shall be selected by the State with the concurrence of the County. The director /administrator of the CHD shall insure that non - categorical sources of funding are used to fulfill public health priorities in the community and the Long Range Program Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director /administrator to the parties no later than October 1 of each year (This is the standard quality assurance "County Health Profile" report located on the Office of Planning, Evaluation & Data Analysis Intranet site). 6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that the following standards should apply in the operation of the CHD: a. The CHD and its personnel shall follow all State policies and procedures, except to the extent permitted for the use of county purchasing procedures as set forth in subparagraph b., below. All CHD employees shall be State or State - contract personnel subject to State personnel rules and procedures. Employees will report time in the Health Management System compatible format by program component as specified by the State. b. The CHD shall comply with all applicable provisions of federal and state laws and regulations relating to its operation with the exception that the use of county purchasing procedures shall be allowed when it will result in a better price or service and no statewide Department of Health purchasing contract has been implemented for those goods or services. In such cases, the CHD director /administrator must sign a justification therefore, and all county- purchasing procedures must be followed in their entirety, and such compliance shall be documented. Such justification and compliance documentation shall 16D 8 be maintained by the CHD in accordance with the terms of this Agreement. State procedures must be followed for all leases on facilities not enumerated in Attachment IV. c. The CHD shall maintain books, records and documents in accordance with those promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental Accounting Standards Board (GASB), and the requirements of federal or state law. These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public, except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6.i., below. Books, records and documents must be adequate to allow the CHD to comply with the following reporting requirements: The revenue and expenditure requirements in the Florida Accounting System Information Resource (FLAIR). ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System /Health Management Component Pamphlet; iii. Financial procedures specified in the Department of Health's Accounting Procedures Manuals, Accounting memoranda, and Comptroller's memoranda; iv. The CHD is responsible for assuring that all contracts with service providers include provisions that all subcontracted services be reported to the CHD in a manner consistent with the client registration and service reporting requirements of the minimum data set as specified in the Client Information System /Health Management Component Pamphlet. d. All funds for the CHD shall be deposited in the County Health Department Trust Fund maintained by the state treasurer. These funds shall be accounted for separately from funds deposited for other CHDs and shall be used only for public health purposes in Collier County. e. That any surplus /deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited /debited to the state or county, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by state and county based on the ratio of planned expenditures in the core contract and funding from all sources is credited to the program accounts by state and county. The equity share of any surplus /deficit funds accruing to the state and county is determined each month and at contract year -end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of • �1 On, surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital projects explained in Attachment V. f. There shall be no transfer of funds between the three levels of services without a contract amendment unless the CHD director /administrator determines that an emergency exists wherein a time delay would endanger the public's health and the Deputy Secretary for Statewide Services has approved the transfer. The Deputy Secretary for Statewide Services shall forward written evidence of this approval to the CHD within 30 days after an emergency transfer. g. The CHD may execute subcontracts for services necessary to enable the CHD to carry out the programs specified in this Agreement. Any such subcontract shall include all aforementioned audit and record keeping requirements. h. At the request of either party, an audit may be conducted by an independent CPA on the financial records of the CHD and the results made available to the parties within 180 days after the close of the CHD fiscal year. This audit will follow requirements contained in OMB Circular A -133 and may be in conjunction with audits performed by county government. If audit exceptions are found, then the director /administrator of the CHD will prepare a corrective action plan and a copy of that plan and monthly status reports will be furnished to the contract managers for the parties. i. The CHD shall not use or disclose any information concerning a recipient of services except as allowed by federal or state law or policy. j. The CHD shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to this Agreement for a period of five (5) years after termination of this Agreement. If an audit has been initiated and audit findings have not been resolved at the end of five (5) years, the records shall be retained until resolution of the audit findings. k. The CHD shall maintain confidentiality of all data, files, and records that are confidential under the law or are otherwise exempted from disclosure as a public record under Florida law. The CHD shall implement procedures to ensure the protection and confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65 and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality. All confidentiality procedures implemented by the CHD shall be consistent with the Department of Health Information Security Policies, Protocols, and Procedures. The CHD shall further adhere to any amendments to the State's security requirements and shall comply with any applicable professional standards of practice with respect to client confidentiality. I. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The i � • CHD will advise applicants of the right to appeal a denial or exclusion from services, of failure to take account of a client's choice of service, and of his /her right to a fair hearing to the final governing authority of the agency. Specific references to existing laws, rules or program manuals are included in Attachment I of this Agreement. n. The CHD shall comply with the provisions contained in the Civil Rights Certificate, hereby incorporated into this contract as Attachment III. o. The CHD shall submit quarterly reports to the county that shall include at least the following: L The DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report; ii. A written explanation to the county of service variances reflected in the DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included, a variance explanation is not required. A copy of the written explanation shall be sent to the Department of Health, Bureau of Budget Management. 160 8 p. The dates for the submission of quarterly reports to the county shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD's control: March 1, 2013 for the report period October 1, 2012 through December 31, 2012; ii. June 1, 2013 for the report period October 1, 2012 through March 31, 2013; iii. September 1, 2013 for the report period October 1, 2012 through June 30, 2013; and iv. December 1, 2013 for the report period October 1, 2012 through September 30, 2013. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in Attachment IV to this contract and the county shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b. The county shall assure adequate fire and casualty insurance coverage for County - owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self- insurance program or insurance purchased by the County. c. All vehicles will be transferred to the ownership of the County and registered as county vehicles. The county shall assure insurance coverage for these vehicles is available through either a self- insurance program or insurance purchased by the County. All vehicles will be used solely for CHD operations. Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund. 8. TERMINATION. a. Termination at Will. This Agreement may be terminated by either party without cause upon no less than one - hundred eighty (180) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. b. Termination Because of Lack of Funds. In the event funds to finance this Agreement become unavailable, either party may terminate this Agreement upon no less than twenty -four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. c. Termination for Breach. This Agreement may be terminated by one party, upon no less than thirty (30) days notice, because of the other party's failure to perform an 16D 8 obligation hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in person to the other party's contract manager with proof of delivery. Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Agreement. 9. MISCELLANEOUS. The parties further agree: a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance or payment hereunder, extends beyond the fiscal year beginning July 1, 2013, it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes. b. Contract Managers. The name and address of the contract managers for the parties under this Agreement are as follows: For the State: Joan M. Colfer, M.D.,M.P.H. Name Director, Collier County Health Dept Title 3339 E. Tamiami Trail, Suite 145 Naples, Florida 34112 Address (239) 252 -8201 Telephone For the County: Steve Carnell Name Public Services Interim Administrator Title 3339 E. Tamiami Trail, Suite 217 Naples, Florida 34112 Address (239) 252 -8468 Telephone If different contract managers are designated after execution of this Agreement, the name, address and telephone number of the new representative shall be furnished in writing to the other parties and attached to originals of this Agreement. C. Captions. The captions and headings contained in this Agreement are for the convenience of the parties only and do not in any way modify, amplify, or give additional notice of the provisions hereof. 16D 8 1 In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be executed by their undersigned officials as duly authorized effective the 1 st day of October, 2012. BOARD OF COUNTY COMMISSIONERS FOR COLLIER COUNTY SIGNED BY: " NAME: TCrees/ G' Co STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: �1� R NAME: John H. Armstrong, MD TITLE: TITLE: Surgeon General /Secretary of Health DATE: DATE: 1 Z J Z I 1 2 ATTESTE O: a SIGNED BY:,A"'� NAME -1 t TITLE• DATE: W1tF �U A"'Ast as to ClUffs 'r $19041 01- SIGNE NAME: irktrCs TITLE: CHD Director /Administrator DATE: 02 Appmved as to form & legal SufftlMOy �Assis ant County Attorney w I= ATTACHMENT COLLIER COUNTY HEALTH DEPARTMENT PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with specific program and reporting requirements in addition to the Personal Health Coding Pamphlet (DHP 50 -20), Environmental Health Coding Pamphlet (DHP 50 -21) and FLAIR requirements because of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it must comply with the special reporting requirements for that service. The services and the reporting requirements are listed below: Service Requirement Sexually Transmitted Disease Requirements as specified in F.A.C. 64D -3, F.S. 381 and Program F.S. 384. 2. Dental Health Monthly reporting on DH Form 1008 *. Additional reporting requirements, under development, will be required. The additional reporting requirements will be communicated upon finalization. 3. Special Supplemental Nutrition Service documentation and monthly financial reports as Program for Women, Infants specified in DHM 150 -24* and all federal, state and county and Children (including the WIC requirements detailed in program manuals and published Breastfeeding Peer Counseling procedures. Program) 4 5. A 7 91 Healthy Start/ Requirements as specified in the 2007 Healthy Start Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. Family Planning Periodic financial and programmatic reports as specified by the program office. Immunization Periodic reports as specified by the department regarding the surveillance /investigation of reportable vaccine preventable diseases, vaccine usage accountability as documented in Florida SHOTS, the assessment of various immunization levels as documented in Florida SHOTS and forms reporting adverse events following immunization. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4* and DHP 50 -21* HIV /AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 64D -3.030 and 64D- 3.031. Case reporting should be on Adult HIV /AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV /AIDS Confidential Case Report CDC Form DH2140. 10 ATTACHMENT I (Continued) 9. School Health Services 10. Tuberculosis 11. General Communicable Disease Control 160 s Socio- demographic data on persons tested for HIV in CHD clinics should be reported on Lab Request DH Form 1628 or Post -Test Counseling DH Form 1628C. These reports are to be sent to the Headquarters HIV /AIDS office within 5 days of the initial post -test counseling appointment or within 90 days of the missed post -test counseling appointment. Requirements as specified in the Florida School Health Administrative Guidelines (May 2012). Tuberculosis Program Requirements as specified in F.A.C. 6413-3 and F.S. 392. Carry out surveillance for reportable communicable and other acute diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in the CHD Guide to Surveillance and Investigations. "or the subsequent replacement if adopted during the contract period. 11 H Z w F- Q CL w o Z w J 2 = Q Q z O V w J J O 0 1- Q a I,r- MV c0 I N O O r O I� O LO 0 N H N I T- N U 2 U cco � 0 m m ° m E N t w (D U- a� H U ccp 0 m °m 42� of w (n LL cl r N N LO t0 0 0 M ti U) c0 co O I M C � L O LL N C O O M rn�c o E 4i U Q LO m a0 0 N �o O N m� c ° m m0 It N C m L N L N E a c ° vi U N O L Q d N N 0 UN .O N N m C N E o. m LO w m c C m UN N O CL c O m O c a� L L O C O U N C U m c N m 4) 'o a_ CL m U m �700 N e- L m N } O U M T O N C N U M U M c m L L � L L .0 m umi E N E N N C U N �m U d mm w o 0 0 0 o (� N a_ N_ O li .F N ''5 d N ++ _ _ L L p U m 0 00 (AO lr N M ti U) c0 co O I M C � L O LL N C O O M rn�c o E 4i U Q LO m a0 0 N �o O N m� c ° m m0 It N C m L N L N E a c ° vi U N O L Q d N N 0 UN .O N N m C N E o. m LO w m c C m UN N O CL c O m O c a� L L O C O U N C U m c N m 4) 'o a_ CL m U m �700 N e- 015040 AIDS PREVENTION 19,261 0 19,261 0 19,261 015040 AIDS SURVEILLANCE 50,310 0 50,310 0 50,310 015040 ALG /CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0 015040 ALG /CONTR TO CHDS -AIDS PATIENT CARE 140,000 0 140,000 0 140,000 015040 ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK 0 0 0 0 0 015040 ALG /CONTR TO CHDS - SOVEREIGN IMMUNITY 0 0 0 0 0 015040 MINORITY OUTREACH - PENALVER CLINIC - MIAMI -DADE 0 0 0 0 0 015040 PREPAREDNESS GRANT MATCH 82,824 0 82,824 0 82,824 015040 SCHOOL HEALTH GENERAL REVENUE 80,855 0 80,855 0 80,855 015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0 015040 STD GENERAL REVENUE 0 0 0 0 0 015040 TREASURE COAST MIDWIFERY - MARTIN 0 0 0 0 0 015040 HEALTHY START MED- WAIVER - CLIENT SERVICES 0 0 0 0 0 015040 JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI -DADE 0 0 0 0 0 015040 LA LIGA- LEAGUE AGAINST CANCER - MIAMI -DADE 0 0 0 0 0 015040 MANATEE COUNTY RURAL HEALTH SERVICES 0 0 0 0 0 015040 METRO ORLANDO URBAN LEAGUE - ORANGE 0 0 0 0 0 015040 MIGRANT LABOR CAMP SANITATION 74,533 0 74,533 0 74,533 015040 DENTAL SPECIAL INITIATIVES 6,542 0 6,542 0 6,542 015040 DUVAL TEEN PREGANCY PREVENTION - DUVAL 0 0 0 0 0 015040 FAMILY PLANNING GENERAL REVENUE 36,794 0 36,794 0 36,794 015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0 015040 FL HEPATITIS & LIVER FAILURE PREVENTION /CONTROL 89,286 0 89,286 0 89,286 015040 HEALTHY START MED WAIVER - SOBRA 0 0 0 0 0 015040 ALG/IPO HEALTHY START/IPO 0 0 0 0 0 015040 ALG/PRIMARY CARE 313,432 0 313,432 0 313,432 015040 BREAST & CERVICAL - ADMINISTRATION /CASE MANAGEMENT 0 0 0 0 0 015040 COMMUNITY SMILES - MIAMI -DADE 0 0 0 0 0 015040 COMMUNITY TB PROGRAM 78,326 0 78,326 0 78,326 015040 COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA 0 0 0 0 0 015050 NON - CATEGORICAL GENERAL REVENUE 1,638,824 0 1,638,824 0 1,638,824 GENERAL REVENUE TOTAL 2,610,987 0 2,610,987 0 2,610,987 2. NON GENERAL REVENUE - STATE 015010 ALG /CONTR. TO CHDS - BIOMEDICAL WASTE 14,050 0 14,050 0 14,050 015010 ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG 0 0 0 0 0 015010 CHD PROGRAM SUPPORT 0 0 0 0 0 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0 015010 PREPAREDNESS GRANT MATCH 0 0 0 0 0 015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0 015010 SCHOOL HEALTH TOBACCO IF 137,218 0 137,218 0 137,218 015010 TOBACCO ADMINISTRATION & MANAGEMENT 0 0 0 0 0 015010 TOBACCO COMMUNITY INTERVENTION 224,230 0 224,230 0 224,230 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 0 0 0 0 015060 NON - CATEGORICAL TOBACCO REBASING 3,097 0 3,097 0 3,097 Version: 1 Page 1 of 7 3. FEDERAL FUNDS - State 378,595 0 378,595 0 378,595 007000 ABSTINENCE EDUCATION GRANT PROGRAM 0 0 0 0 0 007000 AIDS PREVENTION 255,477 0 255,477 0 255,477 007000 AIDS SURVEILLANCE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 21,208 0 21,208 0 21,208 007000 CHRONIC DISEASE PREVENTION & HEALTH PROMOTION 32,000 0 32,000 0 32,000 007000 COASTAL BEACH MONITORING PROGRAM 19,929 0 19,929 0 19,929 007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 141,770 0 141,770 0 141,770 007000 UNINTENDED/UNWANTED PREG -TEEN PREGNANCY PREV 28,000 0 28,000 0 28,000 007000 WIC ADMINISTRATION 1,462,607 0 1,462,607 0 1,462,607 007000 WIC BREASTFEEDING PEER COUNSELING 70,030 0 70,030 0 70,030 007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0 007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 17,624 0 17,624 0 17,624 007000 SYPHILIS ELIMINATION 0 0 0 0 0 007000 TEENAGE PREGNANCY PREVENTION REPLICATION 0 p 0 0 0 007000 TITLE X HIV /AIDS PROJECT 139,108 0 139,108 0 139,108 007000 TOBACCO FAITH BASED PROJECT 0 0 0 0 0 007000 RAPE PREVENTION & EDUCATION 0 0 0 0 0 007000 RYAN WHITE 0 p 0 0 0 007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0 007000 RYAN WHITE -AIDS DRUG ASSIST PROG -ADMIN 77,945 0 77,945 0 77,945 007000 RYAN WHITE - CONSORTIA 0 p 0 0 0 007000 SAFE SLEEP EDUCATION 10,386 0 10,386 0 10,386 007000 MINORITY INVOLVEMENT IN HIV /AIDS PROGRAM 0 0 0 0 0 007000 PHP - CITIES READINESS INITIATIVE 0 p 0 0 0 007000 PRECONCEPTION HEALTH CARE 0 0 0 0 0 007000 PREGNANCY ASSOCIATED MORTALITY PREVENTION 0 0 0 0 0 007000 PUBLIC HEALTH INFRASTRUCTURE 0 0 0 0 0 007000 PUBLIC HEALTH PREPAREDNESS BASE 209,697 0 209,697 0 209,697 007000 IMMUNIZATION WIC LINKAGES 0 0 0 0 0 007000 MCH BGTF - GADSDEN SCHOOL CLINIC 0 0 0 0 0 007000 MCH BGTF - HEALTHY START COALITIONS 0 0 0 0 0 007000 MCH QUALITY IMPROVEMENT ACTIVITIES MCHBG 0 0 0 0 0 007000 MINORITY AIDS INITIATIVE 0 0 0 0 0 007000 MINORITY AIDS INITIATIVE TCE COLLABORATIVE 0 0 p p 0 007000 FGTF/FAMILY PLANNING -TITLE X 80,527 0 80,527 0 80,527 007000 HEALTHY HOMES AND LEAD POISONING GRANT 0 0 0 0 0 007000 HIV HOUSING FOR PEOPLE LIVING WITH AIDS 0 0 0 0 0 007000 HIV INCIDENCE SURVEILLANCE 0 0 0 0 0 007000 IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT 123,219 0 123,219 0 123,219 007000 IMMUNIZATION FIELD STAFF EXPENSE 0 0 p 0 0 007000 COLORECTAL CANCER SCREENING 2009 -10 0 0 0 0 0 007000 DENTAL SERVICES 0 0 0 0 0 007000 ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IMPL 0 0 0 p 0 007000 EXPANDED TESTING INITIATIVE (ETI) 0 0 0 p 0 007000 FGTF /AIDS MORBIDITY 0 p 0 0 0 007000 FGTFBREAST & CERVICAL CANCER -ADMIN/CASE MAN 0 0 0 0 0 Version: 1 Page 2 of 7 0 0 0 0 0 0 0 irk��-� M 0 0 0 0 0 0 0 33,690 0 .....or' 3. FEDERAL FUNDS - State 015009 MEDIPASS WAIVER -HLTHY STRT CLIENT SERVICES 015009 MEDIPASS WAIVER -SOBRA 007055 ARRA FEDERAL GRANT - SCHEDULE C 015075 SCHOOL HEALTH TITLE )OU 015075 SUMMER FOOD PROGRAM INSPECTIONS 015075 REFUGEE HEALTH FEDERAL FUNDS TOTAL 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 TANNING FACILITIES 001020 BODY PIERCING 001020 MIGRANT HOUSING PERMIT 001020 MOBILE HOME AND PARKS 001020 FOOD HYGIENE PERMIT 001020 BIOHAZARD WASTE PERMIT 001020 PRIVATE WATER CONSTR PERMIT 001020 PUBLIC WATER ANNUAL OPER PERMIT 001020 PUBLIC WATER CONSTR. PERMIT 001020 NON -SDWA SYSTEM PERMIT 001020 SAFE DRINKING WATER 001020 SWIMMING POOLS 001092 OSDS PERMIT FEE 001092 I & M ZONED OPERATING PERMIT 001092 AEROBIC OPERATING PERMIT 001092 SEPTIC TANK SITE EVALUATION 001092 NON SDWA LAB SAMPLE 001092 OSDS VARIANCE FEE 001092 ENVIRONMENTAL HEALTH FEES 001092 OSDS REPAIR PERMIT 001170 LAB FEE CHEMICAL ANALYSIS 001170 WATER ANALYSIS- POTABLE 001170 NONPOTABLE WATER ANALYSIS 010304 MQA INSPECTION FEE 001206 CENTRAL OFFICE SURCHARGE FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 5. OTHER CASH CONTRIBUTIONS - STATE 010304 STATIONARY POLLUTANT STORAGE TANKS 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTIONS TOTAL 6. MEDICAID - STATE /COUNTY 001056 MEDICAID PHARMACY 001076 MEDICAID TB 001078 MEDICAID ADMINISTRATION OF VACCINE 001079 MEDICAID CASE MANAGEMENT 001081 MEDICAID CHILD HEALTH CHECK UP Version: 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33,690 0 33,690 0 33,690 0 0 0 0 0 231,600 0 231,600 0 231,600 2,954,817 0 2,954,817 0 2,954,817 3,000 0 3,000 0 3,000 0 0 0 0 0 24,575 0 24,575 0 24,575 19,918 0 19,918 0 19,918 28,712 0 28,712 0 28,712 33,400 0 33,400 0 33,400 0 0 0 0 0 10,000 0 10,000 0 10,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 274,000 0 274,000 0 274,000 80,000 0 80,000 0 80,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1,200 0 1,200 0 1,200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50,000 0 50,000 0 50,000 524,805 0 524,805 0 524,805 0 0 0 0 0 306,941 0 306,941 0 306,941 306,941 0 306,941 0 306,941 0 0 0 0 0 0 48,000 48,000 0 48,000 0 20,000 20,000 0 20,000 0 21,720 21,720 0 21,720 0 0 0 0 0 Page 3 of 7 CEfL�.tE�, �rRJI� IY�J7 rant « SOi11�4 O toutn`bwioas OctobwIlt!"2 4 �y A 6. MEDICAID - STATE /COUNTY 001082 MEDICAID DENTAL 001083 MEDICAID FAMILY PLANNING 001087 MEDICAID STD 001089 MEDICAID AIDS 001147 MEDICAID HMO CAPITATION 001191 MEDICAID MATERNITY 001192 MEDICAID COMPREHENSIVE CHILD 001193 MEDICAID COMPREHENSIVE ADULT 001194 MEDICAID LABORATORY 001208 MEDIPASS $3.00 ADM. FEE 001059 MEDICAID LOW INCOME POOL 001051 EMERGENCY MEDICAID 001058 MEDICAID - BEHAVIORAL HEALTH 001071 MEDICAID - ORTHOPEDIC 001072 MEDICAID - DERMATOLOGY 001075 MEDICAID - SCHOOL HEALTH CERTIFIED MATCH 001069 MEDICAID - REFUGEE HEALTH 001055 MEDICAID - HOSPITAL 001148 MEDICAID HMO NON - CAPITATION 001074 MEDICAID -NEWBORN SCREENING MEDICAID TOTAL 7. ALLOCABLE REVENUE -STATE 018000 REFUNDS 037000 PRIOR YEAR WARRANT 038000 12 MONTH OLD WARRANT ALLOCABLE REVENUE TOTAL 8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE PHARMACY SERVICES LABORATORY SERVICES TB SERVICES IMMUNIZATION SERVICES STD SERVICES CONSTRUCTION/RENOVATION WIC FOOD ADAP DENTAL SERVICES OTHER (SPECIFY) OTHER (SPECIFY) OTHER STATE CONTRIBUTIONS TOTAL 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 008010 CONTRIBUTION FROM CITY GOVERNMENT 008020 CONTRIBUTION FROM HEALTH CARE TAX NOT THRU BCC 008040 BCC GRANT /CONTRACT 008030 CONTRIBUTION FROM HEALTH CARE TAX Version: 1 0 805,724 805,724 0 805,724 0 0 0 0 0 0 8,500 8,500 0 8,500 0 32,276 32,276 0 32,276 0 0 0 0 0 0 0 0 0 0 0 500 500 0 500 0 8,500 8,500 0 8,500 0 0 0 0 0 0 434 434 0 434 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22,000 22,000 0 22,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 967,654 967,654 0 967,654 2,585 0 2,585 0 2,585 0 0 0 0 0 0 0 0 0 0 2,585 0 2,585 0 2,585 0 0 0 146,868 146,868 0 0 0 101,737 101,737 0 0 0 0 0 0 0 0 916,303 916,303 0 0 0 0 0 0 0 0 0 0 0 0 0 6,521,482 6,521,482 0 0 0 1,258,313 1,258,313 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8,944,703 8,944,703 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Page 4 of 7 1,258,100 t 0 1,258,100 1,258,100 1,258,100 0 1,258,100 200 200 0 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 0 008034 BCC CONTRIBUTION FROM GENERAL FUND 0 DIRECT COUNTY CONTRIBUTION TOTAL 0 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001060 VITAL STATISTIC -FEES & SERVICES 0 001077 RABIES VACCINE 0 001077 CHILD CAR SEAT PROG 0 001077 PERSONAL HEALTH FEES 0 001077 AIDS CO -PAYS 0 001094 ADULT ENTER. PERMIT FEES 0 001094 LOCAL ORDINANCE FEES 0 001114 NEW BIRTH CERTIFICATES 0 001115 VITAL STATISTICS - DEATH CERTIFICATE 0 001117 VITAL STATS -ADM. FEE 50 CENTS 0 001073 CO-PAY FOR THE AIDS CARE PROGRAM 0 001025 CLIENT REVENUE FROM GRC 0 001040 CELL PHONE ADMINISTRATIVE FEE 0 FEES AUTHORIZED BY COUNTY TOTAL 0 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 0 001009 RETURNED CHECK ITEM 0 001029 THIRD PARTY REIMBURSEMENT 0 001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 001054 MEDICARE PART D 0 001077 RYAN WHITE TITLE II 0 001090 MEDICARE PART B 0 001190 HEALTH MAINTENANCE ORGANIZATION 0 005040 INTEREST EARNED 0 005041 INTEREST EARNED -STATE INVESTMENT ACCOUNT 0 007010 U.S. GRANTS DIRECT 0 008050 SCHOOL BOARD CONTRIBUTION 0 008060 SPECIAL PROJECT CONTRIBUTION 0 010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES 0 010301 EXP WITNESS FEE CONSULTNT CHARGES 0 010405 SALE OF PHARMACEUTICALS 0 010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 011001 HEALTHY START COALITION CONTRIBUTIONS 0 011007 CASH DONATIONS PRIVATE 0 012020 FINES AND FORFEITURES 0 012021 RETURN CHECK CHARGE 0 028020 INSURANCE RECOVERIES -OTHER 0 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 011000 GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING 0 011000 GRANT - DIRECT 0 011000 GRANT DIRECT - COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0 011000 COUNTY COMMISSION - LIP FUND 0 011000 GRANT- DIRECT 0 1,258,100 1,258,100 0 1,258,100 1,258,100 1,258,100 0 1,258,100 200 200 0 200 0 0 0 0 0 0 0 0 193,377 193,377 0 193,377 0 0 0 0 0 0 0 0 557,900 557,900 0 557,900 60,000 60,000 0 60,000 240,800 240,800 0 240,800 4,000 4,000 0 4,000 0 0 0 0 0 0 0 0 0 0 0 0 1,056,277 1,056,277 0 1,056,277 0 0 0 0 732,245 732,245 0 732,245 0 0 0 0 0 0 0 0 0 0 0 0 30,018 30,018 0 30,018 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300 300 0 300 0 0 0 0 0 0 0 0 0 0 0 0 412,562 412,562 0 412,562 250 250 0 250 1,692 1,692 0 1,692 0 0 0 0 0 0 0 0 652,247 652,247 0 652,247 0 0 0 0 293,816 293,816 0 293,816 0 0 0 0 226,260 226,260 0 226,260 0 0 0 0 Version: 1 Page 5 of 7 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 011000 GRANT - DIRECT 0 011000 GRANT - DIRECT 0 011000 GRANT DIRECT -ARROW 0 011000 GRANT DIRECT - QUANTUM DENTAL 0 011000 GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE 0 011000 GRANT - DIRECT 0 011000 GRANT - DIRECT 0 011000 GRANT - DIRECT 0 011000 GRANT - DIRECT 0 010402 RECYCLED MATERIAL SALES 0 010303 FDLE FINGERPRINTING 0 007050 ARRA FEDERAL GRANT 0 001010 RECOVERY OF BAD CHECKS 0 008065 FCO CONTRIBUTION 0 011006 RESTRICTED CASH DONATION 0 028000 INSURANCE RECOVERIES 0 001033 CMS MANAGEMENT FEE - PMPMPC 0 010400 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 010500 REFUGEE HEALTH 0 005045 INTEREST EARNED -TBIRD PARTY PROVIDER 0 005043 INTEREST EARNED - CONTRACT /GRANT 0 010306 DOH/DOC INTERAGENCY AGREEMENT 0 011002 ARRA FEDERAL GRANT - SUB - RECIPIENT 0 011004 LOW INCOME POOL - SUBRECIPIENT 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 12. ALLOCABLE REVENUE -COUNTY 0 018000 REFUNDS 0 037000 PRIOR YEAR WARRANT 0 038000 12 MONTH OLD WARRANT 0 COUNTY ALLOCABLE REVENUE TOTAL 0 13. BUILDINGS -COUNTY 0 0 ANNUAL RENTAL EQUIVALENT VALUE 0 0 GROUNDS MAINTENANCE 0 2,351,390 IT ALLOCATION & GOLDEN GATE RENT 0 2,351,390 INSURANCE 0 0 UTILITIES 0 0 OTHER (SPECIFY) 0 0 BUILDING MAINTENANCE 0 BUILDINGS TOTAL 0 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY 0 EQUIPMENTIVEHICLE PURCHASES 0 525,048 VEHICLE INSURANCE 0 0 VEHICLE MAINTENANCE 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 Version: 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,000 2,000 0 2,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,351,390 2,351,390 0 2,351,390 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 525,048 525,048 0 0 195,149 195,149 0 0 84,900 84,900 0 0 0 0 0 0 209,800 209,800 0 0 0 0 0 0 0 0 0 0 1,014,897 1,014,897 0 0 0 0 0 0 16,300 16,300 0 0 0 0 0 0 0 0 Page 6 of 7 Version: 1 Page 7 of 7 Port Ili. A ' Plswred:S A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (10 1) 12.61 STD (102) 5.14 HIV /AIDS PREVENTION (03A1) 5.44 HIV /AIDS SURVEILLANCE (03A2) 1.35 HIV /AIDS PATIENT CARE (03A3) 9.30 ADAP (03A4) 2.07 TB CONTROL SERVICES (104) 11.34 COMM. DISEASE SURV. (106) 6.38 HEPATITIS PREVENTION (109) 2.04 PUBLIC HEALTH PREP AND RESP (116) 5.55 VITAL STATISTICS (180) 3.34 COMMUNICABLE DISEASE SUBTOTAL 64.56 B. PRIMARY CARE: 315,056 CHRONIC DISEASE SERVICES (210) 0.60 TOBACCO PREVENTION (212) 3.00 WIC (21 W 1) 35.00 WIC BREASTFEEDING PEER COUNSELING (21W2) 3.00 FAMILY PLANNING (223) 2.75 IMPROVED PREGNANCY OUTCOME (225) 5.82 HEALTHY START PRENATAL (227) 12.02 COMPREHENSIVE CHILD HEALTH (229) 2.01 HEALTHY START INFANT (23 1) 4.20 SCHOOL HEALTH (234) 7.33 COMPREHENSIVE ADULT HEALTH (237) 6.07 COMMUNITY HEALTH DEVELOPMENT (238) 0.26 DENTAL HEALTH (240) 14.39 PRIMARY CARE SUBTOTAL 96.45 C. ENVIRONMENTAL HEALTH: 154,069 Water and Onsite Sewage Programs 189,056 COASTAL BEACH MONITORING (347) 0.13 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.22 PUBLIC WATER SYSTEM (358) 0.00 PRIVATE WATER SYSTEM (359) 0.00 INDIVIDUAL SEWAGE DISP. (36 1) 8.03 Group Total 8.38 Facility Programs 1,570 FOOD HYGIENE (348) 0.61 BODY PIERCING FACILITIES SERVICES 0.02 GROUP CARE FACILITY (35 1) 0.93 MIGRANT LABOR CAMP (352) 3.23 HOUSING,PUBLIC BLDG SAFETY,SANrrATION (353)0.00 0 8,678 22,230 169,861 167,185 183,381 167,185 344,228 343,384 687,612 738 1,254 63,200 68,775 80,239 68,775 22,408 258,581 280,989 1,500 15,000 76,479 79,024 80,529 79,024 212,295 102,761 315,056 60 300 15,690 31,644 19,418 31,644 98,396 0 98,396 576 9,173 156,913 275,847 230,156 275,847 578,152 360,611 938,763 36 120 27,185 22,892 26,708 22,892 99,677 0 99,677 791 5,193 154,069 177,047 189,056 177,047 408,756 288,463 697,219 0 6,278 110,026 112,410 131,146 112,410 0 465,992 465,992 1,570 2,130 28,816 31,445 36,686 31,445 128,392 0 128,392 0 0 136,257 103,043 120,218 103,043 415,831 46,730 462,561 10,957 37,551 36,927 45,977 47,808 45,977 0 176,689 176,689 24,906 99,229 975,423 1,115,289 1,145,345 1,115,289 2,308,135 2,043,211 4,351,346 173 3,445 8,246 9,926 11,580 9,926 39,678 0 39,678 0 5,551 42,920 59,489 54,404 59,489 216,302 0 216,302 11,544 98,927 474,711 498,663 319,774 298,663 1,591,811 0 1,591,811 4,356 2,908 27,294 15,053 19,029 15,053 76,429 0 76,429 2,628 3,080 103,320 115,760 105,885 115,760 439,596 1,129 440,725 1,140 7,586 143,875 176,490 180,903 176,490 247,020 430,738 677,758 1,106 6,462 129,171 177,136 177,492 177,136 181,948 478,987 660,935 234 700 28,999 75,846 59,321 75,846 0 240,012 240,012 787 4,578 54,833 47,864 55,842 47,864 206,403 0 206,403 0 222,756 67,103 114,579 133,676 114,579 328,977 100,960 429,937 1,615 3,893 171,310 215,482 193,061 215,482 364,698 430,637 795,335 0 26 11,973 641 415 641 13,670 0 13,670 5,052 10,812 184,567 401,477 350,603 401,477 6,427 1,331,697 1,338,124 28,635 370,724 1,448,322 1,908,406 1,661,985 1,708,406 3,712,959 3,014,160 6,727,119 501 501 4,876 6,196 7,230 6,196 24,498 0 24,498 488 1,404 2,696 5,169 6,032 5,169 6,355 12,711 19,066 0 0 129 21 26 21 97 100 197 0 0 116 45 51 45 0 257 257 2,713 5,542 91,580 122,874 143,352 122,874 226,202 254,478 480,680 3,702 7,447 99,397 134,305 156,691 134,305 257,152 267,546 524,698 60 290 13,234 19,930 11,585 19,930 64,679 0 64,679 3 3 0 228 265 228 356 365 721 320 503 12,350 12,354 14,414 12,354 0 51,472 51,472 256 1,882 37,495 51,491 60,072 51,491 137,836 62,713 200,549 0 0 53 38 45 38 86 88 174 Version: 3 Page 1 of 2 94 243 ? n rzx+ Ptrt illy � Statl��C € 3 (e t 8,520 C. ENVIRONMENTAL HEALTH: 0 Facility Programs 1,484 MOBILE HOME AND PARKS SERVICES (354) 0.M SWIMMING POOLS/BATHING (360) 3.3) BIOMEDICAL WASTE SERVICES (364) 0.55 TANNING FACILITY SERVICES (369) 0.02 Group Total 9.31 Groundwater Contamination 11,719 STORAGE TANK COMPLIANCE (355) 0.00 SUPER ACT SERVICE (356) 0.04 Group Total 0.04 Community Hygiene 1,181 TATTOO FACILITIES SERVICES 0.01 COMMUNITY ENVIR. HEALTH (345) 0.00 INJURY PREVENTION (346) 0.07 LEAD MONITORING SERVICES (350) 0.00 PUBLIC SEWAGE (362) 0.00 SOLID WASTE DISPOSAL (363) 0.00 SANITARY NUISANCE (365) 0.02 RABIES SURVEILLANCE/CONTROL SERVICES (366)0.00 ARBOVIRUS SURVEILLANCE (367) 0.00 RODENT/ARTHROPOD CONTROL (368) 0.00 WATER POLLUTION (370) 0.00 INDOOR AIR (37 1) 0.00 RADIOLOGICAL HEALTH (372) 0.00 TOXIC SUBSTANCES (373) 0.00 Group Total 0.10 ENVIRONMENTAL HEALTH SUBTOTAL 17.83 D. NON - OPERATIONAL COSTS: 2,776 NON - OPERATIONAL COSTS (599) 0.00 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 NON - OPERATIONAL COSTS SUBTOTAL 0.00 TOTAL CONTRACT 178.84 94 243 10,931 8,520 9,939 8,520 37,910 0 37,910 1,484 18,477 65,550 60,206 70,241 60,206 104,379 151,824 256,203 359 376 25,211 11,719 13,672 11,719 62,321 0 62,321 5 12 1,181 248 291 248 1,968 0 1,968 2,581 21,786 166,005 164,734 180,524 164,734 409,535 266,462 675,997 0 0 0 0 0 0 0 0 0 52 74 927 584 681 584 1,370 1,406 2,776 52 74 927 584 681 584 1,370 1,406 2,776 0 0 1,400 132 153 132 896 921 1,817 0 0 0 0 0 0 0 0 0 0 57 444 1,391 1,621 1,391 2,391 2,456 4,847 0 0 0 6 7 6 10 9 19 0 0 0 2 2 2 4 2 6 0 0 -6 0 0 6 0 0 0 0 0 27 303 353 303 486 500 986 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53 53 53 78 81 159 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57 1,865 1,887 2,189 1,893 3,865 3,969 7,834 6,335 29,364 268,194 301,510 340,085 301,516 671,922 539,383 1,211,305 0 0 18,788 16,143 22,168 15,282 35,714 36,667 72,381 0 0 13,336 5,500 3,000 28,164 50,000 0 50,000 0 0 32,124 21,643 25,168 43,446 85,714 36,667 122,381 59,876 499,317 2,724,063 3,346,848 3,172,583 3,168,657 6,778,730 5,633,421 12,412,151 Version: 3 Page 2 of 2 16D 8 ATTACHMENT III COLLIER COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. 3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97 -35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contracts, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other appropriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. 22 ATTACHMENT IV COLLIER COUNTY HEALTH DEPARTMENT 160 FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Collier County Health Department & Public Services Building H Immokalee Satellite Golden Gate WIC Office Location 3339 E. Tamiami Trail Suite 145, Naples 419 North First Street Immokalee Owned By Collier County Collier County 4945 Golden Gate Parkway Benderson Unit 102, Naples Development r-, 23 16D 8 ATTACHMENT V COLLIER COUNTY HEALTH DEPARTMENT SPECIAL PROJECTS SAVINGS PLAN IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT. CONTRACT YEAR 2010 -2011 2011 -2012 2012 -2013 2013 -2014 2014 -2015 PROJECT TOTAL STATE $ 0 $ $ 0 COUNTY S $ $ 0 $ $ 0 SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: PROJECT SUMMARY: Describe scope of work in reasonable detail. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of funds) : COMPLETION DATE: DESIGN FEES: $ CONSTRUCTION COSTS: $ FURNITURE/EQUIPMENT $ TOTAL PROJECT COST: $ - COST PER SQ FOOT: $ TOTAL $ 0 !t - $ 0 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. 24