Loading...
Backup Documents 10/26/2010 Item #10BHE.i.1� t Charlie Crist Governor November 2nd, 2010 The Honorable Fred W. Coyle, Chairman Board of County Commissioners Collier County Government Center 3301 East Tamiami Trail Naples, FL 34112 4 g Dr. Ana M. Viamonte Ros. State Surgeon General RE: FY 2010 -11 Contract between the Board of Collier County Commissioners and the Department of Health for Operation of the County Health Department Dear Chairman Coyle: Enclosed are four originals of the Core Contract between the Department of Health and Collier County as approved at the October 26th, 2010 meeting of the BCC. After signature, please contact me at (239) 252 -8206 or 5334 for courier pickup. If you have any further questions, please feel free to contact me at (239) 252 -8206. Sincerely, Alan L. Fords Director, Finance & Accounting Enclosures (4) //10 JU`. Collier County Health Department 3301 Tamiami Trail E, Bldg H, Naples, FL 34112 Phone: (239) 252 -8200 INTEROFFICE MEMORANDUM B Jieor County Health Department Coring— C— mitred. _ Hrlping...Dedicoted To the Wefineu of 0w Canmoniry DATE: November 29, 2010 TO: Ann Jennejohn, Sr. Deputy Clerk Minutes & Records Department FROM: Alan Portis, Business Manager Health Department SUBJECT: Contract between the Collier County Board of County Commissioners and the State of Florida for the Collier County Health Department Contract Year 2010 -2011 Enclosed please find a fully executed original contract, as referenced above, (Agenda Item #10B), which was approved by the Board of County Commissioners on Tuesday, October 26, 2010. If you should have any questions, please call me at 252 -8206. Thank you. Enclosures (1) 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 2010 -2011 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, 2010. 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 Qf 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, 2010, through September 30, 2011, 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 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 bf 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 II, Part II is an amount not to exceed $ 7,190,087 (State General Revenue, 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 I I is an amount not to exceed $1,324,400 (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 3301 Tamiami Trail E., Bldg. H 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 State Health Officer. 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 3 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 4 108 + 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 State Health Officer has approved the transfer. The Deputy State Health Officer 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, dated April 2005, as amended, the terms of which are incorporated herein by reference. 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 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. 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: L March 1, 2011 for the report period October 1, 2010 through December 31, 2010; ii. June 1, 2011 for the report period October 1, 2010 through March 31, 2011; iii. September 1, 2011 for the report period October 1, 2010 through June 30, 2011; and iv. December 1, 2011 for the report period October 1, 2010 through September 30, 2011. 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 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, 2011, 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 3301 Tamiami Trail E., Bldg. H Address Naples, Florida 34112 City (239) 252 -8201 Telephone For the County: Marla Olsvig Ramsey Name Public Services Administrator Title 3301 Tamiami Trail E., Bldg. H Address Naples, Florida 34112 City (239) 252 -8383 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. In WITNESS THEREOF, the parties hereto have caused this 29 page agreement to be executed by their undersigned officials as duly authorized effective the 1St day of October, 2010. BOARD OF COUNTY COMMISSIONERS FOR COLLIER COUNTY .*-�� W. SIGNED BY NAME: F-F-F-ri W • TITLE: btp.. v _ DATE: (>� 20tO ATTESTEE TO:. f SIGNED BYE. NAME: E - Id TITLE: 0,1,p-r�� DATE: lyx*bw Atte14 a to an Nrw 's .1104tw o ww f, A I;r leg►ali�tttey AWstan .onnty Attorney STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: Ana M. Viamonte Ros, M.D., M.P.H. TITLE: State Surgeon General DATE: // Ii � 40 WOR4, �.i .l •a! � � :viii_ !► TITLE:: C�HD Director /Administrator DATE: 1 10 ) e�01 Q 9 ATTACHMENT 100 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 1. Sexually Transmitted Disease Requirements as specified in FAC 64D -3, F.S. 381 and Program F.S. 384 and the CHID Guidebook. 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. 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. 5. Family Planning Periodic financial and programmatic reports as specified by the program office and in the CHID Guidebook, Internal Operating Policy FAMPLAN 14* 6. 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. 7. Chronic Disease Program Requirements as specified in the Healthy Communities, Healthy People Guidebook. 8. Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4* and DHP 50 -21* 9. HIV /AIDS Program Requirements as specified in F.S. 384.25 and 64D -3.016 and 3.017 F.A.C. and the CHID Guidebook. Case reporting should be on Adult HIV /AIDS Confidential Case Report CDC Form DH2139 and Pediatric HIV /AIDS Confidential Case Report CDC Form DH2140. Socio- 10 10. 11 12. ATTACHMENT I (Continued) 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. School Health Services Requirements as specified in the Florida School Health Administrative Guidelines (April 2007). Tuberculosis Tuberculosis Program Requirements as specified in FAC 64D -3, F.S. Specific Authority 381.0011(13), 381.003(2), 381.0031(6), 384.33, 392.53(2), 392.66 FS Law Implemented 381.0011(4), 381.003(1), 381.0031(1), (2), (6), 383.06, 384.23, 384.25, 385.202, 392.53 FS.381 and CHD Guidebook. 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. 11 a Q F- Z W F- a W 2 F- J Q w F- Z n O U w W J J O U F- Q CL N N O L � > C O 7 LL U o 7 N _co = C w 4-- m ° O r- cu 0 c rn LL 0 cu 0 N o cu N 0 U E = c ca W o m M M N d M M co O O M O N 0 c cD m m 0) c c u1 C U- co F- w T I LO co O CD 0 rn o_ 0 O N O M a� a0i E } n. CIO �m c o ° o U� � O O N 3 3 0 co � 00 O } � O C N O p UM o a� w � o E CD a CD a) i m 0 0 CL O T - •+ Or O C. N ca - U U 0 a� � cn O M co M ti I- ti N N ti C C O LL x N 0 O C M N ` CM N c o U o. o U) n o i> O N O O N Q' 1 a� U N C: 15 m0 ,It -9 N O 7 .n O C w c0 O C. O (0 C C cu O L O C U O CL LO C6 0 0 c t6 y N c 8 ai CD 2 a� a� C. O c vi co 0 O N 0 N 0 N c =3 0 C N Co L L y O 4 (A N O O C E O O O L c co a) ca Q Q _ ° v. cu LL L 0 C4 O cn LO N T- O 0-0 �. O C C ca CO � c ca a E .d v.41 N T- 0) � 0) L O L LO LO �p N LO O 0 r F- N N O L � > C O 7 LL U o 7 N _co = C w 4-- m ° O r- cu 0 c rn LL 0 cu 0 N o cu N 0 U E = c ca W o m M M N d M M co O O M O N 0 c cD m m 0) c c u1 C U- co F- w T I LO co O CD 0 rn o_ 0 O N O M a� a0i E } n. CIO �m c o ° o U� � O O N 3 3 0 co � 00 O } � O C N O p UM o a� w � o E CD a CD a) i m 0 0 CL O T - •+ Or O C. N ca - U U 0 a� � cn O M co M ti I- ti N N ti C C O LL x N 0 O C M N ` CM N c o U o. o U) n o i> O N O O N Q' 1 a� U N C: 15 m0 ,It -9 N O 7 .n O C w c0 O C. O (0 C C cu O L O C U O CL LO C6 0 0 c t6 y N c 8 ai CD 2 a� a� C. O c vi co 0 O N 0 N 0 N c =3 0 C N Co L L y O 4 (A N O O C E O O O L c co a) ca Q Q _ ° v. cu LL L 0 C4 O cn LO N T- O 0-0 �. O C C ca CO � c ca a E .d v.41 N T- ATTACHMENT H. 10B COLLIER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund bt4ei (cash) Trust Fund (cash) C44621"On .r : Total 1. GENERAL REVENUE - STATE 015040 ALG /CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0 015040 ALG /CONTR TO CHDS -AIDS PATIENT CARE 100,000 0 100,000 0 100,000 015040 ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK 0 0 0 0 0 015040 ALG /CONTR TO CHDS -AIDS PREV & SURV & FIELD STAFF 88,650 0 88,650 0 88,650 015040 ALG /CONTR TO CHDS- DENTAL PROGRAM 17,907 0 17,907 0 17,907 015040 ALG /CONTR TO CHDS - MIGRANT LABOR CAMP SANITATION 99,377 0 99,377 0 99,377 015040 MINORITY OUTREACH - PENALVER CLINIC - MIAMI -DADE 0 0 0 0 0 015040 PRIMARY CARE SPECIAL DENTAL PROJECTS 6,924 0 6,924 0 6,924 015040 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0 015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0 015040 STD GENERAL REVENUE 0 0 .0 0 0 015040 VARICELLA IMMUNIZATION REQUIREMENT 14,214 0 14,214 0 14,214 015040 HEALTHY START MED WAIVER - SOBRA 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 01 5040 LA LIGA CONTRA EL CANCER 0 0 0 0 0 015040 MANATEE COUNTY RURAL HEALTH SERVICES 0 0 0 0 0 015040 METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV 0 0 0 0 0 015040 COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA 0 0 0 0 0 015040 DENTAL SPECIAL INITIATIVES 3,295 0 3,295 0 3,295 015040 DUVAL TEEN PREGNANCY PREVENTION 0 0 0 0 0 015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0 015040 FL HEPATITIS & LIVER FAILURE PREVENTION /CONTROL 178,572 0 178,572 0 178,572 015040 HEALTHY BEACHES MONITORING 23,856 0 23,856 0 23,856 015040 ALG/IPO HEALTHY START /IPO 0 0 0 0 0 015040 ALG/PRIMARY CARE 307,852 0 307,852 0 307,852 015040 ALG /SCHOOL HEALTH/SUPPLEMENTAL 0 0 0 0 0 015040 CHILD HEALTH MEDICAL SERVICES 0 0 0 0 0 015040 COMMUNITY SMILES - MIAMI -DADE 0 0 0 0 0 015040 COMMUNITY TB PROGRAM 57,977 0 57,977 0 57,977 015040 ALG /CONTR. TO CHDS - IMMUNIZATION OUTREACH TEAMS 24,909 0 24,909 0 24,909 015040 ALG /CONTR. TO CHDS- INDOOR AIR ASSIST PROG 0 0 0 0 0 015040 ALG /CONTR. TO CHDS -MCH HEALTH - FIELD STAFF COST 0 0 0 0 0 015040 ALG /CONTR. TO CHDS - SOVEREIGN IMMUNITY 0 0 0 0 0 015040 ALG /CONTRIBUTION TO CHDS- PRIMARY CARE 24,717 0 24,717 0 24,717 015040 ALG/FAMILY PLANNING 44,654 0 44,654 0 44,654 015050 ALG /CONTR TO CHDS 2,350,530 0 2,350,530 0 2,350,530 GENERAL REVENUE TOTAL 3,343,434 0 3,343,434 0 3,343,434 2. NON GENERAL REVENUE - STATE 015010 ALG /CONTR TO CHDS - REBASING TOBACCO TF 32,134 0 32,134 0 32,134 015010 ALG /CONTR. TO CHDS - BIOMEDICAL WASTE/DEP ADM TF 12,704 0 12,704 0 12,704 015010 ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG/DEP ADM 0 0 0 0 0 015010 BASIC SCHOOL HEALTH - TOBACCO TF 137,218 0 137,218 0 137,218 015010 CHD PROGRAM SUPPORT 0 0 0 0 0 015010 ENVIRONMENTAL HEALTH PACE PROJECTS 0 p 0 0 0 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0 015010 FULL SERVICE SCHOOLS - TOBACCO TF 114,545 0 114,545 0 114,545 Version: 4 Page 1 of 7 ATTACHMENT II. 10 B "14 COLLIER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund fter °, (cash) Trust Fund (cash) C"Umi4a Total 2. NON GENERAL REVENUE - STATE 015010 IMMUNIZATION SPECIAL PROJECT 12,368 0 12,368 0 12,368 015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0 015010 TOBACCO ADMINISTRATIVE SUPPORT 46,000 0 46,000 0 46,000 015010 TOBACCO COMMUNITY INTERVENTION 140,000 0 140,000 0 140,000 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 0 0 0 0 0 NON GENERAL REVENUE TOTAL 494,969 0 494,969 0 494,969 3. FEDERAL FUNDS - State 007000 AFRICAN AMERICAN TESTING INITIATIVE (AATI) 0 0 0 0 0 007000 AIDS PREVENTION 217,508 0 217,508 0 217,508 007000 AIDS SURVEILLANCE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 29,000 0 29,000 0 29,000 007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0 007000 COASTAL BEACH MONITORING PROGRAM 20,910 0 20,910 0 20,910 007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 123,788 0 123,788 0 123,788 007000 WIC ADMINISTRATION 2,123,683 0 2,123,683 0 2,123,683 007000 WIC BREASTFEEDING PEER COUNSELING 74,437 0 74,437 0 74,437 007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0 007000 STD PROGRAM - PHYSICIAN TRAINING CENTER 0 0 0 0 0 007000 STD PROGRAM - PHYSICIANS TRAINING CENTER 0 0 0 0 0 007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 5,624 0 5,624 0 5,624 007000 SYPHILIS ELIMINATION 0 0 0 0 0 007000 TITLE X MALE PROJECT 75,565 0 75,565 0 75,565 007000 RYAN WHITE 0 0 0 0 0 007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0 007000 RYAN WHITE PART B SUPPLEMENTAL 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 0 0 0 0 007000 STATE INDOOR RADON GRANT 0 0 0, 0 0 007000 NATIONAL COMPREHENSIVE CANCER CONTROL PROGRAM 0 0 0 0 0 007000 ORAL HEALTH WORKFORCE ACTIVITIES 0 0 0 0 0 007000 ORAL HEALTH WORKFORCE ACTIVITIES 2010 -2011 0 0 0 0 0 007000 PUBLIC HEALTH EMERGENCY RESPONSE HIN1 170,000 0 170,000 0 170,000 007000 PUBLIC HEALTH PREPAREDNESS BASE 132,847 0 132,847 0 132,847 007000 RAPE PREVENTION & EDUCATION GRANT 0 0 0 0 0 007000 IMMUNIZATION FIELD STAFF EXPENSE 0 0 0 0 0 007000 IMMUNIZATION SUPPLEMENTAL 40,408 0 40,408 0 40,408 007000 IMMUNIZATION WIC- LINKAGES 0 0 0 0 0 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 IPO 0 0 0 0 0 007000 FGTF /FAMILY PLANNING -TITLE X 80,527 0 80,527 0 80,527 007000 FGTF/IMMUNIZATION ACTION PLAN 65,886 0 65,886 0 65,886 007000 HEALTH PROGRAM FOR REFUGEES 69,860 0 69,860 0 69,860 007000 HEALTHY PEOPLE HEALTHY COMMUNITIES 33,541 0 33,541 0 33,541 Version: 4 Page 2 of 7 ATTACHMENT II. 10 B :41 COLLIER COUNTY HEALTH DEPARTMENT Part H. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund Other r (cash) Trust Fund (cash) Contribiation . Total 3. FEDERAL FUNDS - State 007000 HIV HOUSING FOR PEOPLE LIVING WITH AIDS 007000 HIV INCIDENCE SURVEILLANCE 007000 COLORECTAL CANCER SCREENING 2009 -10 007000 DIABETES PREVENTION & CONTROL PROGRAM 007000 FAMILY PLANNING - TITLE X 007000 FGTF /AIDS MORBIDITY 007000 FGTF/BREAST & CERVICAL CANCER -ADMIN /CASE MAN 007000 FGTF/FAMILY PLANNING TITLE X SPECIAL INITIATIVES 015009 MEDIPASS WAIVER -HLTHY STRT CLIENT SERVICES 015009 MEDIPASS WAIVER -SOBRA 015075 REFUGEE SCREENING 007055 ARRA Federal Grant - Schedule C 015075 Inspections of Summer Feeding Program 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 Version: 4 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 0 252,200 0 252,200 0 252,200 10,155 0 10,155 0 10,155 0 0 0 0 0 3,603,884 0 3,603,884 0 3,603,884 3,500 0 3,500 0 3,500 270 0 270 0 270 69,775 0 69,775 0 69,775 17,000 0 17,000 0 17,000 30,000 0 30,000 0 30,000 32,000 0 32,000 0 32,E 0 0 0 0 0 8,500 0 8,500 0 8,500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 300,000 0 300,000 0 300,E 130,000 0 130,000 0 130,000 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 30,200 0 30,200 0 30,200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12,500 0 12,500 0 12,500 0 0 0 0 0 633,745 0 633,745 0 633,745 0 0 0 0 0 107,109 0 107,109 0 107,109 107,109 0 107,109 0 107,109 Paae3of7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT 10B t ■ Part H. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund Other' (cash) Trust Fund (cash) C"tribtlion Total 6. MEDICAID - STATE /COUNTY 001056 MEDICAID PHARMACY 216,837 346,963 563,800 0 563,800 001076 MEDICAID TB 23,076 36,924 60,000 0 60,000 001078 MEDICAID ADMINISTRATION OF VACCINE 18,700 18,700 37,400 0 37,400 001079 MEDICAID CASE MANAGEMENT 15,000 15,000 30,000 0 30,000 001081 MEDICAID CHILD HEALTH CHECK UP 0 0 0 0 0 001082 MEDICAID DENTAL 524,179 838,742 1,362,921 0 1,362,921 001083 MEDICAID FAMILY PLANNING 0 0 0 0 0 001087 MEDICAID STD 5,706 9,131 14,837 0 14,837 001089 MEDICAID AIDS 21,153 33,847 55,000 0 55,000 001147 Medicaid HMO Capitation 0 0 0 0 0 001191 MEDICAID MATERNITY 0 0 0 0 0 001192 MEDICAID COMPREHENSIVE CHILD 3,574 5,718 9,292 0 9,292 001193 MEDICAID COMPREHENSIVE ADULT 5,525 8,840 14,365 0 14,365 001194 MEDICAID LABORATORY 0 0 0 0 0 001208 MEDIPASS $3.00 ADM. FEE 100 100 200 0 200 001059 Medicaid Low Income Pool 0 0 0 0 0 001051 Emergency Medicaid 0 0 0 0 0 001058 Medicaid - Behavioral Health 0 0 0 0 0 001071 Medicaid - Orthopedic 0 0 0 0 0 001072 Medicaid - Dermatology 0 0 0 0 0 001075 Medicaid - School Health Certified Match 0 0 0 0 0 001069 Medicaid - Refugee Health 0 0 0 0 0 001055 Medicaid - Hospital 0 0 0 0 0 001148 Medicaid HMO Non - Capitation 0 0 0 0 0 001074 Medicaid - Newborn Screening 0 0 0 0 0 MEDICAID TOTAL 833,851 1,313,964 2,147,815 0 2,147,815 7. ALLOCABLE REVENUE - STATE 018000 REFUNDS 0 0 0 0 0 037000 PRIOR YEAR WARRANT 0 0 0 0 0 038000 12 MONTH OLD WARRANT 0 0 0 0 0 ALLOCABLE REVENUE TOTAL 0 0 0 0 0 8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE PHARMACY SERVICES 0 0 0 85,626 85,626 LABORATORY SERVICES 0 0 0 157,479 157,479 TB SERVICES 0 0 0 0 0 IMMUNIZATION SERVICES 0 0 0 1,186,952 1,186,952 STD SERVICES 0 0 0 0 0 CONSTRUCTION/RENOVATION 0 0 0 0 0 WIC FOOD 0 0 0 7,308,746 7,308,746 ADAP 0 0 0 2,429,923 2,429,923 DENTAL SERVICES 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 11,168,726 11,168,726 Version: 4 Page 4 of 7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT 10B jolt Part II. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund Other (cash) Trust Fund (cash) Contribution Total 9. DIRECT LOCAL CONTRIBUTIONS - COUNTY 008030 Contribution from Health Care Tax 0 0 0 0 0 008034 BCC Contribution from General Fund 0 1,324,400 1,324,400 0 1,324,400 DIRECT COUNTY CONTRIBUTION TOTAL 0 1,324,400 1,324,400 0 1,324,400 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001060 CHD SUPPORT POSITION 0 225 225 0 225 001077 RABIES VACCINE 0 0 0 0 0 001077 CHILD CAR SEAT PROG 0 0 0 0 0 001077 PERSONAL HEALTH FEES 0 147,977 147,977 0 147,977 001077 AIDS CO -PAYS 0 0 0 0 0 001094 ADULT ENTER. PERMIT FEES 0 0 0 0 0 001094 LOCAL ORDINANCE FEES 0 669,100 669,100 0 669,100 001114 NEW BIRTH CERTIFICATES 0 55,300 55,300 0 55,300 001115 Vital Statistics - Death Certificate 0 226,000 226,000 0 226,000 001117 VITAL STATS -ADM. FEE 50 CENTS 0 3,500 3,500 0 3,500 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 0 0 0 0 FEES AUTHORIZED BY COUNTY TOTAL 0 1,102,102 1,102,102 0 1,102,102 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 RETURNED CHECK ITEM 0 0 0 0 0 001029 THIRD PARTY REIMBURSEMENT 0 440,801 440,801 0 440,801 001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 0 0 0 0 001054 MEDICARE PART D 0 312,000 312,000 0 312,000 001077 RYAN WHITE TITLE 11 0 0 0 0 0 001090 MEDICARE PART B 0 192,860 192,860 0 192,860 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 008010 Contribution from City Government 0 0 0 0 0 008020 Contribution from Health Care Tax not thru BCC 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 0 0 0 0 010301 EXP WITNESS FEE CONSULTNT CHARGES 0 0 0 0 0 010405 SALE OF PHARMACEUTICALS 0 36,000 36,000 0 36,000 010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0 011001 HEALTHY START COALITION CONTRIBUTIONS 0 502,362 502,362 0 502,362 011007 CASH DONATIONS PRIVATE 0 4,767 4,767 0 4,767 012020 FINES AND FORFEITURES 0 0 0 0 0 012021 RETURN CHECK CHARGE 0 0 0 0 0 028020 INSURANCE RECOVERIES -OTHER 0 0 0 0 0 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 106,885 106,885 0 106,885 011000 GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING 0 0 0 0 0 011000 COUNTY COMMISSION - LIP FUND 0 159,450 159,450 0 159,450 Version: 4 Page 5 of 7 ATTACHMENT II. 10B "1 COLLIER COUNTY HEALTH DEPARTMENT Part II. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund Other ( —b) Trust Fund (cash) Contribution Total 11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 011000 GRANT DIRECT- COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0 0 0 0 0 011000 DIRECT -ARROW 0 0 0 0 0 011000 GRANT - DIRECT 0 424,021 424,021 0 424,021 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT DIRECT- QUANTUM DENTAL 0 0 0 0 0 01 1000 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 011000 GRANT - DIRECT 0 0 0 0 0 011000 GRANT DIRECT -ARROW 0 0 0 0 0 010402 Recycled Material Sales 0 0 0 0 0 010303 FDLE Fingerprinting 0 0 0 0 0 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 Eamed- ContractlGrant 0 0 0 0 0 010306 DOH/DOC Interagency Agreement 0 0 0 0 0 008040 BCC Grant/Contract 0 0 0 0 0 01 1002 ARRA Federal Grant - Sub - Recipient 0 0 0 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 2,179,146 2,179,146 0 2,179,146 12. ALLOCABLE REVENUE - COUNTY 018000 REFUNDS 0 0 0 0 0 037000 PRIOR YEAR WARRANT 0 0 0 0 0 038000 12 MONTH OLD WARRANT 0 0 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048 GROUNDS MAINTENANCE 0 0 0 195,149 195,149 OTHER (SPECIFY) 0 0 0 0 0 INSURANCE 0 0 0 0 0 UTILITIES - TELEPHONE, ELECTRIC, WATER & SEWER 0 0 0 247,800 247,800 OTHER (SPECIFY) 0 0 0 0 0 BUILDING MAINTENANCE 0 0 0 74,342 74,342 BUILDINGS TOTAL 0 0 0 1,042,339 1,042,339 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY EQUIPMENTNEHICLE PURCHASES 0 0 0 0 0 Version: 4 Page 6 of 7 ATTACHMENT II. COLLIER COUNTY HEALTH DEPARTMENT 10B Part II. Sources of Contributions to County Health Department October 1, 2010 to September 30, 2011 State CHD County Total CHD Trust Fund CHD Trust Fund Mer (cash) Trust Fund (cash) Contribution Total 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY VEHICLE INSURANCE 0 0 0 17,900 17,900 VEHICLE MAINTENANCE 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 17,900 17,900 GRAND TOTAL CHD PROGRAM 9,016,992 5,919,612 14,936,604 12,228,965 27,165,569 Version: 4 Page 7 of 7 ATTACHMENT H. COLLIER COUNTY HEALTH DEPARTMENT 10B ' Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of SerAce October 1, 2010 to September 30, 2011 Version: 1 Page 1 of 2 Quarterly Expenditure Plan FrE's Clients 1st 2nd 3rd 4th Grand (0.00) Units Services (Whole dollars only) State Ety Total A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (101) 20.18 19,799 45,146 344,686 295,445 344,686 295,445 801,216 479,046 1,280,262 STD (102) 10.29 1,297 12,649 150,291 128,821 150,291 128,821 443,855 114,369 558,224 A.I.D.S. (103) 21.34 2,409 19,640 563,178 482,724 563,178 482,724 875,125 1,216,679 2,091,804 TB CONTROL SERVICES (104) 14.33 1,651 10,418 234,949 201,385 234,949 201,385 612,319 260,349 872,668 COMM. DISEASE SURV. (106) 6.99 0 7,974 139,612 119,668 139,612 119,668 300,600 217,960 518,560 HEPATITIS PREVENTION (109) 3.92 2,565 6,001 66,235 56,773 66,235 56,773 246,016 0 246,016 PUBLIC HEALTH PREP AND RESP (116) 7.24 0 378 139,022 119,161 139,022 119,161 427,812 88,554 516,366 VITAL STATISTICS (180) 3.34 11,469 40,745 45,342 38,865 45,342 38,865 0 168,414 168,414 COMMUNICABLE DISEASE SUBTOTAL 87.63 39,190 142,951 1,683,315 1,442,842 1,683,315 1,442,842 3,706,943 2,545,371 6,252,314 B. PRIMARY CARE: CHRONIC DISEASE SERVICES (2 10) 0.93 44 1,223 15,551 13,330 15,551 13,330 18,048 39,714 57,762 TOBACCO PREVENTION (212) 3.77 0 3,091 58,230 49,911 58,230 49,911 216,282 0 216,282 W.I.C. (221) 41.26 18,738 138,369 617,393 529,194 617,393 529,194 2,280,870 12,304 2,293,174 FAMILY PLANNING (223) 2.19 5,313 10,902 76,875 65,893 76,875 65,893 285,536 0 285,536 IMPROVED PREGNANCY OUTCOME (225) 8.94 2,390 22,443 235,736 202,059 235,736 202,059 38,094 837,496 875,590 HEALTHY START PRENATAL (227) 15.53 1,550 42,272 219,879 188,467 219,879 188,467 306,060 510,632 816,692 COMPREHENSIVE CHILD HEALTH (229) 2.66 2,237 6,561 59,065 50,628 59,065 50,628 94,982 124,404 219,386 HEALTHY START INFANT (23 1) 3.95 776 16,983 63,022 54,019 63,022 54,019 121,650 112,432 234,082 SCHOOL HEALTH (234) 6.60 0 170,781 107,161 91,853 107,161 91,853 303,067 94,961 398,028 COMPREHENSIVE ADULT HEALTH (237) 5.71 1,850 9,224 147,420 126,360 147,420 126,360 281,390 266,170 547,560 DENTAL HEALTH (240) 15.78 4,009 26,604 317,680 272,297 317,680 272,297 408,030 771,924 1,179,954 PRIMARY CARE SUBTOTAL 107.32 36,907 448,453 1,918,012 1,644,011 1,918,012 1,644,011 4,354,009 2,770,037 7,124,046 C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COASTAL BEACH MONITORING (347) 0.29 1,037 1,037 7,655 6,562 7,655 6,562 28,434 0 28,434 LIMITED USE PUBLIC WATER SYSTEMS (357) 0.63 262 1,402 13,300 1 1,400 13,300 11,400 14,566 34,834 49,400 PUBLIC WATER SYSTEM (358) 0.00 0 0 0 0 0 0 0 0 0 PRIVATE WATER SYSTEM (359) 0.00 0 0 414 355 414 355 0 1,538 1,538 INDIVIDUAL SEWAGE DISP. (361) 5.65 1,607 7,533 105,627 90,537 105,627 90,537 178,856 213,472 392,328 Group Total 6.57 2,906 9,972 126,996 108,854 126,996 108,854 221,856 249,844 471,700 Facility Programs FOOD HYGIENE (348) 3.66 369 1,930 63,937 54,803 63,937 54,803 233,207 4,273 237,480 BODY ART (349) 0.00 1 2 50 43 50 43 186 0 186 GROUP CARE FACILITY (35 1) 1.37 437 809 22,599 19,371 22,599 19,371 0 83,940 83,940 MIGRANT LABOR CAMP (352) 2.34 116 711 42,705 36,604 42,705 36,604 90,831 67,787 158,618 HOUSING,PUBLIC BLDG SAFETY,SANITATION (350.))0 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARKS SERVICES (354) 0.52 107 261 8,199 7,028 8,199 7,028 30,454 0 30,454 SWIMMING POOLS/BATHING (360) 6.11 1,636 18,111 118,844 101,866 118,844 101,866 189,577 251,843 441,420 BIOMEDICAL WASTE SERVICES (364) 1.08 646 842 17,961 15,395 17,961 15,395 66,047 665 66,712 TANNING FACILITY SERVICES (369) 0.09 21 69 1,404 1,204 1,404 1,204 5,216 0 5,216 Group Total 15.17 3,333 22,735 275,699 236,314 275,699 236,314 615,518 408,508 1,024,026 Version: 1 Page 1 of 2 Version: 1 Page 2 of 2 ATTACHMENT II. 10B COLLIER COUNTY HEALTH DEPARTMENT Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service October 1, 2010 to September 30, 2011 Quarterly Expenditure Plan ITTE's Clients 1st 2nd 3rd 4th Grand (0.00) Units Services (Whole dollars only) State Gouty Tow C. ENVIRONMENTAL HEALTH: Groundwater Contamination STORAGE TANK COMPLIANCE (355) 0.00 0 0 0 0 0 0 0 0 0 SUPER ACT SERVICE (356) 0.23 158 258 3,823 3,277 3,823 3,277 14,200 0 14,200 Group Total 0.23 158 258 3,823 3,277 3,823 3,277 14,200 0 14,200 Community Hygiene OCCUPATIONAL HEALTH (344) 0.20 0 306 3,090 2,649 3,090 2,649 5,965 5,513 11,478 CONSUMER PRODUCT SAFETY (345) 0.00 0 0 0 0 0 0 0 0 0 INJURY PREVENTION (346) 0.53 0 0 9,871 8,460 9,871 8,460 19,053 17,609 36,662 LEAD MONITORING SERVICES (350) 0.00 0 0 61 52 61 52 118 108 226 PUBLIC SEWAGE (362) 0.00 0 0 3 3 3 3 6 6 12 SOLID WASTE DISPOSAL (363) 0.00 0 0 25 22 25 22 49 45 94 SANITARY NUISANCE (365) 0.01 1 3 182 156 182 156 352 324 676 RABIES SURVEILLANCE/CONTROL SERVICES (366)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 0 0 0 0 0 0 WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0 AIR POLLUTION (37 1) 0.02 0 19 315 270 315 270 608 562 1,170 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 0.76 1 328 13,547 11,612 13,547 11,612 26,151 24,167 50,318 ENVIRONMENTAL HEALTH SUBTOTAL 22.73 6,398 33,293 420,065 360,057 420,065 360,057 877,725 682,519 1,560,244 D. SPECIAL CONTRACTS: SPECIAL CONTRACTS (599) 0.00 0 0 0 0 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 0 0 0 0 0 0 0 SPECIAL CONTRACTS SUBTOTAL 0.00 0 0 0 0 0 0 0 0 0 TOTAL CONTRACT 217.68 82,495 624,697 4,021,392 3,446,910 4,021,392 3,446,910 8,938,677 5,997,927 14,936,604 Version: 1 Page 2 of 2 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. 22 108 I`+ 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 Location Owned By 3301 E. Tamiami Trail Collier County Building H, Naples 419 North First Street Collier County Immokalee 4945 Golden Gate Parkway Benderson Unit 102, Naples Development 23 10B 'I 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 2003 -2004 2008 -2009 2009 -2010 2010 -2011 2011 -2012 PROJECT TOTAL STATE $ 170,526 $ 170,526 COUNTY $ 113,684 $ 113,684 SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS: PROJECT TYPE: Renovation of CHID Offices TOTAL $ 284,210 $ 284,210 Balance Building H of the Collier County Government Complex NEW BUILDING ROOFING RENOVATION X PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 0 PROJECT SUMMARY: Describe scope of work in reasonable detail. The Collier County Health Department will be moving its Environmental Health Division from a satellite government complex to the main building (Building H) of the government complex located on Tamiami Trail during 2005 -2006 when the space becomes available. Medical Records will be recarpeted and the main lobby will get a information Kiosk to be staffed by administration. Other operating programs will also be reconfigured during the time frame 2005 -20010 including: School Health, Disaster Preparedness, Family Health, Epidemiology, Vital Stats, Pharmacy, and clinic areas of Communicable Disease. The Dental clinic will need to be expanded because of growth probably during the 2006 -20010 time frame. Also it is anticipated that Information Systems, Finance & Accounting, Human Resources, and the Director's Office will be renovated in 2007 -2010. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of funds) : COMPLETION DATE: 12/31/2010 $ 1,350,000 $ #DIV /0! 10/1/2005 DESIGN FEES: CONSTRUCTION COSTS: FURNITURE/EQUIPMENT TOTAL PROJECT COST: COST PER SQ FOOT: Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. 24 108 .1 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 2007 -2008 2008 -2009 2009 -2010 2010 -2011 2011 -2012 PROJECT TOTAL STATE $ 49,365 $ 49,365 COUNTY $ 32,906 $ 32,906 SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN PROJECT NAME: LOCATION/ ADDRESS PROJECT TYPE: WIC Renovation TOTAL $ 82,271 $ 82,271 Balance Building H of the Collier County Government Complex NEW BUILDING _ ROOFING RENOVATION X PLANNING STUDY _ NEW ADDITION OTHER SQUARE FOOTAGE: 2300 PROJECT SUMMARY: Describe scope of work in reasonable detail. The Collier CHD WIC operations are in critical need of additional space in Bldg. H due to rapid growth in recent years. However, this growth cannot be accomodated within Bldg. H without extensive modifications to the currently occupied spaces. A long -term plan has been developed to accomodate future growth as well as alleviating the current lack of space. Given the large scope and lengthy time -frame to completion, this project will be divided into three distinct phases. PHASE I will entail the relocation of all WIC operations in Bldg. H to another county-owned building or commercially -own facility and all associated moving costs (network setup, telephones, furniture, etc.) along with the demolition of current WIC spaces in Bldg. H. Phase II will commence in FY 08 and will involve the actual construction of WIC spaces in Bldg. H. Phase III will start in FY 09 and will involve relocating WIC operations back to Bldg. H. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of funds) : 10/1/2007 COMPLETION DATE: 6/30/2010 DESIGN FEES: $ 30,000 CONSTRUCTION COSTS: $ 300,000 FURNITURE/EQUIPMENT $ 170,000 TOTAL PROJECT COST: $ 500,000 COST PER SQ FOOT: $ 217.3913043 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. 25 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 2007 -2008 2008 -2009 2009 -2010 2010 -2011 2011 -2012 PROJECT TOTAL STATE $ 66,000 $ 66,000 COUNTY $ 44,000 $ 44,000 SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN TOTAL $ 110,000 $ 110,000 PROJECT NAME: Family and Personal Health Renovation LOCATION/ ADDRESS: Building H of the Collier Government Complex PROJECT TYPE: NEW BUILDING ROOFING RENOVATION X PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 2500 PROJECT SUMMARY: Describe scope of work in reasonable detail. This renovation will involve painting, replacing flooring, ceiling tiles, and some of the furniture. It will also re- design the space to provide a more funtional working area for both staff and clients. A small conference room will be removed to provide for a more open environment and facilitate improved air circulation /ventilation. Although not confirmed, some of the staff seated in this area have experienced respiratory issues probably due to dust and allergens found in the carpet, ceiling tiles, and furniture. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of fund: 10/1/2012 COMPLETION DATE: 2/1/2013 DESIGN FEES: $ 10,000 CONSTRUCTION COSTS: $ 65,000 FURNITURE/EQUIPMENT $ 35,000 TOTAL PROJECT COST: $ 110,000 COST PER SQ FOOT: $ 40 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. i 108 ' 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 STATE COUNTY TOTAL 2007 -2008 $ $ $ - 2008 -2009 $ 120,000 $ 80,000 $ 200,000 2009 -2010 $ $ $ - 2010 -2011 2011 -2012 PROJECT TOTAL $ 120,000 $ 80,000 SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN PROJECT NAME: Dental Clinic Renovation and Expansion LOCATION/ ADDRESS: Building H of the Collier Government Complex PROJECT TYPE: NEW BUILDING ROOFING RENOVATION X PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE: 1200 PROJECT SUMMARY: Describe scope of work in reasonable detail. $ 200,000 Dental cannot currently meet all the community needs. There are primarily appointments for pediatric patients and a limited number of adults. The Dental department itself is self- sustaining but cannot currently expand services due to limited space and equipment. This renovation and re- design of the space will enable the installation of two additional dental chairs and subsequently an additional dentist. An office and several walls will be removed to provide space for the additional chairs and equipment while dramatically improving ventilation /temperature which has been an ongoing facilities issue for the past several years. ESTIMATED PROJECT INFORMATION: START DATE (initial expenditure of funds) : 10/1/2011 COMPLETION DATE: 4/1/2012 DESIGN FEES: CONSTRUCTION COSTS: FURNITURE /EQUIPMENT TOTAL PROJECT COST: COST PER SQ FOOT: $ 25,000 $ 150,000 $ 25,000 $ 200,000 $ 145.8333333 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and mobile health vans. 27 ATTACHMENT VI 10B COLLIER COUNTY HEALTH DEPARTMENT PRIMARY CARE "Primary Care" as conceptualized for the county health departments and for the use of categorical Primary Care funds (revenue object code 015040) is defined as: "Health care services for the prevention or treatment of acute or chronic medical conditions or minor injuries of individuals which is provided in a clinic setting and may include family planning and maternity care." Indicate below the county health department programs that will be supported at least in part with categorical Primary Care funds this contract year: _X Comprehensive Child Health (229/29) _X Comprehensive Adult Health (237/37) Family Planning (223/23) _X Maternal Health /IPO (225/25) Laboratory (242/42) _X_ Pharmacy (241/93) Other Medical Treatment Program (please identify) Describe the target population to be served with categorical Primary Care funds. Maternal and Child Health Primary Care funding is utilized to support clinical services for Pregnant Women. Often these women are diagnosed diabetics and or hypertensive /preeclamptic and require intensive interaction to assure accurate blood sugar readings, accurate administration of insulin or routine and regular monitoring of edema and blood pressure. Funding is also utilized to support regular well child visits as well as educating about the importance of routine preventive services such as nutrition, exercise and nutrition. Comprehensive Adult Health and Pharmacy — The target populations to be served with these funds are the pregnant women; clients exposed to or who have contracted reportable communicable diseases and emerging infections; persons needing treatment for HIV /AIDS, Sexually Transmitted Diseases, and Tuberculosis; persons requiring prophylactic treatment for exposure to communicable diseases such as rabies; persons entering the country as refugees who require physical exams to ensure they do not have any communicable diseases and that they are fully vaccinated against vaccine - preventable diseases; persons at risk for certain communicable diseases such as Hepatitis; low income persons with diabetes and epilepsy requiring assistance with medications and adults requiring vaccination against vaccine - preventable diseases. 28 10B These funds provide the infrastructure to provide services to this population such as staff, medical records, fiscal support, medication acquisition, and necessary equipment and supplies when there are no other funding sources. Does the health department intend to contract with other providers for the delivery of primary health care services using categorical (015040) Primary Care funds? If so, please identify the provider(s), describe the services to be delivered, and list the anticipated contractual amount by provider. In addition, contract providers are required to provide data on patients served and the services provided so that the patients may be registered and the service data entered into HMS. 29