HomeMy WebLinkAboutBOCC.packet.spec.11062014 AGENDA ITEM SUMMARY
SPECIAL MEETING DATE: November 6, 2014
AGENDA ITEM TITLE: Public and Environmental Health Quarterly Update with
the Board of Health
STAFF RESPONSIBLE: Nan Sundeen, Liz Stark
ISSUE STATEMENT:
This is the fourth quarter update for 2014 between the Board of Health,the Pitkin County Public
Health Director, Community Health Services, Inc. (CHS),Pitkin County Local Medical Officer,
Pitkin County Environmental Public Health Advocate and Pitkin County Environmental Health
manager.
BACKGROUND:
The Board of County Commissioners (BOCC) serves as the Board of Health(BOH) for Pitkin
County. Quarterly,Liz Stark, Pitkin County Public Health Director,presents updates, issues,
policies and concerns for Board of/Health input and review. Today,Liz Stark,will focus on two
items. First, she will briefly present the 2015.CHS budget. Then she present information on
Ebola and local/state preparedness activities.
Update on Board of Health Intergovernmental Agreement with City of Aspen
Staff will present a draft Intergovernmental Agreement(IGA)to the Board of County
Commissioners and City Council on December 2❑d that will"merge"the Pitkin County and City
of Aspen Boards of Health. After the IGA is formally approved by the City of Aspen and the
Board of County Commissioners separately the Pitkin County Board of Health can be expanded
with one new member from City of Aspen and one from the Town of Snowmass Village(2
total). The Board of County Commissioners will solicit recommendations from the City of
Aspen and Town of Snowmass Village for representation on the expanded BOH. Once the Pitkin
BOH approves the two nominations, staff will draft a resolution establishing the Pitkin County
Board of Health with seven members.
Follow up on Joint CHS/BOH meeting
Below is an update on the next steps that were identified at the July 22nd joint CHS/BOH
meeting:
1. Clarify roles, responsibilities and structure-HHS staff is currently working on
articulating the scope of services and organizational roles and responsibilities for the
2015 contract with CHS. Once drafted we will review with CHS and the BOCC before
the contract is fully executed.
2. Jointly identifying strategic public health issues and goals-This meeting will be set up
early in 2015 after the Pitkin County Board of Health has expanded with new members.
3.. Creating a budget that reflects joint strategic goals—This opportunity will be
implemented with the 2016 budget when CHS will renew a three year partnership with
the Healthy Community Fund. .
LINK TO STRATEGIC PLAN:
Livable and Supportive Community- Self Sufficient Individuals and Families
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Prosperous Economy—Affordable and quality health care options
KEY DISCUSSION ITEMS
1. Review and discuss issues related to the 2015 CHS Budget.
2. Review and discuss questions related to the update on Ebola preparedness.
3. If time allows,review and discuss any questions related to the updates from Kurt Dahl
and Tom Dunlop
BUDGETARY IMPACT: None at this time.
RECOMMENDED BOH ACTION: None at this time
ATTACHMENTS:
A) Memo from Public Health Director, Liz Stark
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ATTACHMENT A
To: Pitkin County Board of Health
From: Liz Stark RN,Pitkin County Public Health Director; Director, Community Health
Services, Inc.; Kurt Dahl,Pitkin County Environmental Health Manager; Dr.
Kimberly Levin, Pitkin County Medical Officer; Tom Dunlop, Pitkin County
Environmental Public Health Advocate,
Date: October 29, 2014
Re: Quarterly Board of Health meeting on November 6, 2014
At this quarterly Board of Health meeting, I will be providing a brief CHS budget presentation
and updates on Ebola. Tom Dunlop,Pitkin County Environmental Health Advocate has also
provided an update. We would like to have time for discussion on Ebola so partners are
providing their updates as an FYI. .
Enclosed in your packet is the draft 2015 budget with a 2014 comparison (ATTACHMENT B).
Also attached is a PowerPoint budget presentation(ATTACHMENT C).
Below is general information about Ebola taken from the Center for Disease Control (CDC)
website and updates on current local and state preparedness activities.
What is Ebola?
Ebola,previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by
infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman
primates (monkeys, gorillas, and chimpanzees).
Ebola is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. Ebola
viruses are found in several African countries. Ebola was first discovered in 1976 near the Ebola
River in what is now the Democratic Republic of the Congo. Since then, outbreaks have
appeared sporadically in Africa.
The natural reservoir host of Ebola virus remains unknown. However, on the basis of evidence
and the nature of similar viruses, researchers believe that the virus is animal-borne and that bats
are the most likely reservoir.Four of the five virus strains occur in an animal host native to
Africa.
What are the symptoms of Ebola?
• Fever .
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach)pain
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• Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8
to 10 days. Recovery from Ebola depends on good supportive clinical care and the patient's
immune response. People who recover from Ebola infection develop antibodies that last for at
least 10 years.
How is Ebola transmitted?
Ebola is spread through
• direct contact(through broken skin or mucous membranes in, for example,the eyes,
nose, or mouth)with blood or body fluids (including but not limited to urine, saliva,
sweat, feces,vomit, breast milk, and semen) of a person who is sick with Ebola
• objects (like needles and syringes)that have been contaminated with the virus
• infected fruit bats or primates (apes and monkeys)
Ebola is not spread through the air or by water. A person is not contagious until symptoms
appear.
Who is at greatest risk of exposure?
Healthcare providers caring for Ebola patients and the family and friends in close contact with
Ebola patients are at the highest risk of getting sick because they may come in contact with the
blood or body fluids of sick patients.
What prevention measures are recommended?
If you travel to or are in an area affected by an Ebola outbreak, make sure to do the following:
• Practice careful hygiene. For example,wash your hands with soap and water or an
alcohol-based hand sanitizer and avoid contact with blood and body fluids.
• Do not handle items that may have come in contact with an infected person's blood or
body fluids (such as clothes, bedding, needles, and medical equipment).
• Avoid funeral or burial rituals that require handling the body of someone who has died
from Ebola.
• Avoid contact with bats and nonhuman primates or blood, fluids, and raw meat prepared
from these animals.
• Avoid hospitals in West Africa where Ebola patients are being treated. The U.S. embassy
or consulate is often able to provide advice on facilities.
• After you return, monitor your health for 21 days and seek medical care immediately if
you develop symptoms of Ebola.
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Healthcare workers who may be exposed to people with Ebola should follow these steps:,
• Wear appropriate PPE.
• Practice proper infection control and sterilization measures.
• Isolate patients with Ebola from other patients.
• Avoid direct contact with the bodies of people who,have died from Ebola.
• Notify health officials if you have had direct contact with the blood or body fluids, such
as but not limited to, feces, saliva,urine,vomit, and semen of a person who is sick with
Ebola. The virus can enter the body through broken skin or unprotected mucous
membranes in, for example,the eyes, nose, or mouth
How is someone diagnosed with Ebola?
Diagnosing Ebola in a person who has been infected for only a few days is difficult,because the
early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients
_ with more commonly occurring diseases, such as malaria and typhoid fever.
However, if a person has the early symptoms of Ebola and has had contact with the blood or
body fluids of a person sick with Ebola, contact with objects that have been contaminated with
the blood or body fluids of a person sick with Ebola, or contact with infected animals,they
should be isolated and public health professionals notified. Samples from the patient can then be
collected and tested to confirm infection.
There are no laboratories in Colorado that can perform the test for Ebola. In the U.S., specimens
are collected locally and sent to the CDC for testing.
What is the treatment for Ebola?
No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola.
Symptoms of Ebola are treated as they appear. The following basic interventions,when used
early, can significantly improve the chances of survival:
• Providing intravenous fluids (IV) and balancing electrolytes (body salts)
• Maintaining oxygen status and blood pressure
• Treating other infections if they occur
• Experimental vaccines and treatments for Ebola are under development, but they have
not yet been fully tested for safety or effectiveness.
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Preparedness activities for Ebola:
Pitkin County:
• Currently,there are no Ebola cases in Pitkin County or in the state of Colorado.
• We are at a heightened level of awareness in the US;there is not an outbreak.
• Community Health Services, Inc., (CHS) acting as the local public health agency for Pitkin
County, is responsible for controlling the spread of communicable diseases as defined by
federal and state authorities.As such,there is considerable reliance on partnerships with local
health care providers and hospitals.
• As the Emergency Support Function (ESF) 8 lead, CHS is the facilitator of ESF8, which is
the mechanism for coordinating medical response efforts during local public health
emergencies.
• The ESF 8 group has convened three times since August to discuss Ebola preparedness.
Primary partners include Aspen Valley Hospital(AVH),Emergency Medical Services
(EMS),Environmental Health, and Emergency Management. Due to the unique
circumstances of the Ebola situation,we have included partners from the local airport,
airlines, local public information officers and law enforcement.
• Public Health and Medical organizations are using the Center for Disease Control (CDC) as
the primary source of information and guidance.
• Pitkin County ESF 8 has been working closely with the infection control practitioner and
emergency manager at AVH and EMS to assure systems are in place to isolate, care for and
transport any suspected Ebola patient.
• ESF 8 has been working with airport personnel to post signage in the airport that informs
visitors to check with public health if they believe they have had an exposure to Ebola in one
of the West African countries of Sierra Leone, Liberia or Guinea.
• CHS distributes Health Alert Network broadcasts from the Colorado Department of Public
Health and Environment(CDPHE) and the CDC containing guidance.on infection control
'measures to all local health care providers.
• Dr. Kimberly Levin,Pitkin County Medical Officer, is acting as a liaison between public
health,the hospital and local health care providers.
• Per Colorado Rev. Stat. § 25-1-506 (2008), it is public health's duty to establish and enforce
quarantine or'isolation and exercise control over property and people within their jurisdiction
as is necessary to protect public health.
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• Quarantine means the separation of an individual reasonably believed to have been exposed
to a quarantinable communicable disease, but who is not yet ill (not presenting signs and
symptoms), from others who have not been so exposed,to prevent the possible spread of the
communicable disease.
• Isolation means separation of an individual or group who is reasonably believed to be
infected with a quarantinable communicable disease from those who are not infected to
prevent the spread of the disease. An individual could be reasonably believed to be infected if
he or she displays the signs and symptoms of the disease and there is some reason to believe
that an exposure had occurred.
• Public Health has the authority to issue a Public Health Monitoring Order to anyone
returning from West Africa with certain risk factors. This entails either active monitoring or
direct active monitoring of someone who has some risk of exposure to Ebola but has no
symptoms. Active monitoring consists of daily reporting of temperatures and symptoms
consistent with Ebola. For direct active monitoring, a public health authority directly
observes an individual at least once daily to review symptom status and monitor temperature.
The difference between quarantine and active monitoring is that the activities/movement of
the person are restricted when placed in quarantine.
• Public health will perform contact tracing for any confirmed Ebola case. This involves
interviewing the patient with the disease and identifying persons who had contact, and
interviewing the contacts to determine level of risk and interventions needed.
Colorado Department of Public Health and Environment:
• CDPHE is internally establishing and refining incident command structure (ICS)to
respond to exposures and cases that may occur in Colorado. Areas of engagement
include:
o Emergency Preparedness and Response
o Communications _.
o Communicable Disease Epidemiology
o Health Facilities
o Emergency Medical Services (EMS)
o Hazardous Materials Management
o Air and Water Quality Control
• Working with hospital and EMS partners to refine plans for identification, isolation, care,
and transport of suspect and confirmed Ebola patients
• Working with Hazardous Materials partners to refine plans to manage waste that may be
generated from management of potential cases
• Communicating regularly with partners such as hospitals, health care providers, first
responders, local public health agencies, and laboratories.
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o Weekly conference calls and written updates
o Health Alert Network(HAN) messages
o www.colorado.gov/ebola
• Conducting public outreach through www.colorado.gov/ebola and a radio campaign
which began on Monday, October 20th. Key messages are:
o Facts, not fear
o Ready to respond
• Communicating regularly with CDC, national public health organizations, and public
health agencies in other states.
• Reviewing and sharing the latest treatment and prevention guidance from national and
international agencies, as well as the primary scientific literature
• Working with partners (currently CDC, DIA, and Frontier Airlines)to identify
individuals with possible Ebola exposures. Directly monitoring exposed individuals for
signs and symptoms of Ebola and ensuring compliance with travel and other restrictions.
• Have developed and sent out News Releases.
• CO-HELP is now active with Ebola information for the Public. You can direct questions
from the public to CO HELP at 1-877-462-2911.
ENVIRONMENTAL HEALTH QUARTERLY UPDATE:
Submitted by Kurt Dahl—Pitkin County Environmental Health Manager
Consumer Protection Program:
Inspections—The department has completed about 15% of the inspections during the first quarter
of our CDEPHE contract(term is July 2014-June 2015).
Fees bill—The Environmental Health Directors, along with CCI and CALPHO are working on
bill for a fee change for restaurant licenses. Discussion between these groups and the Colorado
Restaurant Association(CRA)and continuing to progress but an agreement has not been made
on the amount of increase in the annual fee.
Contract with CDPHE—The State has asked EH and the Aspen Environmental Health
Department if we will combine our contracts for consumer protection into one contract. We plan
to include this as part of our efforts in establishing our expanded Board of Health with the City
of Aspen and it has been included in the proposed IGA.
Onsite Wastewater Treatment System (OWTS)Program:
New Construction permits-We have issued 60 new construction/repair permits to date. The same
time last year we issued 50 new construction/repair permits (120%). This is consistent with the
increase in building activity and permits the building department is seeing.
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Use Permits-We have issued 55 use permits to date. The same time last year we issued 49 use
permits (112%).
New Pitkin County OWTS Regulations-New OWTS Regulations were adopted in August 2014
and went into effect October 15, 2014. We are now in the process of putting together the new
renewable permit program which will go into effect July 2015 and have planned outreach to
contractors/realtors in early 2015.
Gray Water—The State Health Department has reinvested in their commitment to adopt Gray
Water Regulations and has released a second draft of the proposed regulations. EH has
commented on the drafts and will continue to monitor the progress. The tentative adoption date is
April 2015.
Disease Control:
Mosquito Control—EH is looking into contracting with a third party to perform mosquito
surveillance next summer. It has been 7 years since we last did mosquito trappingand with the
changing environment,we thought it best to do some more surveillance this year and see if there
are changes to our mosquito population types. -
Ebola—EH is supporting Community Health with their needs and is assisting in clarifying
requirements on transport of used personal protective equipment(ppe) and creating a list of local
contractors who are able to assist in clean up.
ENVIRONMENTAL PUBLIC HEALTH.ADVOCATE QUARTERLY UPDATE:
Submitted by Tom Dunlop
CDC Food Safety Modernization Act
Background:
As I presented to you at the October 2011 BOH meeting, I have accepted an appointment by the
Centers for Disease Control and Prevention (CDC)to represent the National Environmental
Health Association on a committee to help design the national response to the Act of.Congress
mentioned above. I am a member of the Food Safety Modernization Act(FSMA) Surveillance
Working Group of the Office of Infectious Diseases, CDC Board of Scientific Counselors. This
appointment extends from July 1, 2011 through June 30, 2017.
President Obama signed FSMA into law January 4, 2011. The intent of the law is to refocus
efforts of regulators from reacting to food borne illness to prevention of food borne illness. Go
to www.fda/fsma.gov for more information. This represents a significant step from being
reactive to being proactive in food safety.
During the first meetings of the FSMA work group the design and selection of specific academic
Centers of Excellence was completed. Five academic Centers were chosen(FL, CO, TN, MN,
OR)to address issues critical to protection of the food supply in the United States.Academic
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coordination, workforce development, communications,performance metrics and research are
the challenges assigned to the Centers.
Status update:
Our work group winter meeting will be held Dec 8-9 in Atlanta at CDC headquarters. I do not
have a final agenda as of this date, but the following is scheduled for discussion; improving
interagency coordination among CDC, Food and Drug Administration and US Dept of
Agriculture. It is my intent to continue to represent local environmental health departments as a
key player in the effort to improve coordination between the federal agencies and other partners.
A more specific discussion will include the process of investigating food borne illness. A focus
will be improving identification of attribution to the root cause of identified food borne illness,
multistate outbreak investigation, genome sequencing(an evolving technique to link
multijurisdictional food borne outbreaks), and an evaluation of current foodborne illness
outbreak surveillance tools. There will alsobe a discussion of performance of the 5 Food Safety
Centers of Excellence mentioned earlier. The lead Colorado academic representative, Elaine
Scallan, was recently appointed to a 3-year term on our work group.
I will provide you a more defined report at the next quarterly BOH meeting in February 2015.
My appointment as the Pitkin Co. Env. Public Health Advocate has helped me gain standing
with this work group. Although not a charge of the surveillance work group, I took the
opportunity in May to again stress to my federal colleagues how impacting the encompassing
FSMA standards are felt at the county level. It is necessary to remind my colleagues on the work
group about how important organizations such as the Pitkin Co. Environmental Health
Department are to this national debate.
CDC Environmental Public Health Tracking Network(EPHT)
Background:
I have reviewed this program with the BOH in past reports so will not go into a lot of detail. In
summary it is a national surveillance program designed to identify various illness and disease
associated with environmental exposures. Initial focus was pairing environmental exposures to
birth defects, asthma and various forms of cancer.
Colorado is a state funded by this federal program and is housed in the Colorado Dept. of Public
Health and Environment. I sit on the technical advisory committee for this program. This
program identifies linkages between certain illness and disease with environmental exposures
(air and water pollution, land use contaminants and other environmental stressors). I encourage
you to visit the web page www.coepht.org to view county specific data on heart attacks, asthma,
radon, etc.
Status update:
I serve on the National Association of County and City Health Officials EPHT work group. I was
appointed as chair of the work group for the next 12-24 months. Membership on this committee
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includes representatives from various local health departments across the United States (FL,NY,
WI, OH, MO, VA and MN).
I remain a member of the Colorado EPHT advisory group. I requested and was granted a meeting
in September with the Colorado Principle Investigator for the program. We met in Denver and
had a productive visit about the future of the program and how it will impact local health
departments. CDC recently completed an audit of the Colorado program and found it strong and
delivering good environmental public data. One suggestion CDC had was to make better use of
the advisory group, a goal for 2015. I urge Pitkin Co. Env Health Dept, City of Aspen Env
Health Dept and Community Health Service to visit the web page noted above from time to time
for important environmental public health trends being recorded for public sharing.
Colorado State University (CSU)
Background:
I continue volunteer duties with the CSU Department of Environmental and Radiological Health
Sciences on their advisory committee. To recap,this position may allow Pitkin Co. an
opportunity to entertain the option of placement of an Env Health intern from CSU to aid in
special projects. I am also actively engaged in curriculum design for the school.
Status update:
The director of the Department of Environmental and Radiological Health Sciences recently
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made a request to members of the advisory committee. He invited us to provide examples of
scientific and investigative written works each of us may have created in the past. The intent is to
offer examples to students on how to write research papers that are proper for an undergraduate
degree in environmental health. I offered four works I generated from various classes taken
towards my Masters of Public Health degree, including my final Capstone paper that was done
on Environmental Public Health Tracking.
Colorado School of Public Health (CSPH)
Background:
I received notice from CSPH that there is interest in me serving in discussions of creation of a
distance learning degree in the existing Masters of Public Health program. As a 2009 graduate of
the Univ of Massachusetts -Amherst MPH program, I have offered to share my UMass
experiences during the formative conversations at the CSPH. A larger outcome I hope to share is
how important a properly educated environmental public health workforce is to local health
departments.
Status update:
I recently met with the director of the Public Health Practice discipline of the MPH program. We
discussed the implementation of the distance learning program. He told me portions of the effort
to launch the off-campus program are underway and meeting with good reviews.
National Association of County and City Health Officials (NACCHO)
Background:
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I currently serve on a number of workgroups and committees for this national public health.
organization. The list includes: Environmental Health Essential Services Committee (of which I
am past Chair), Food Safety Workgroup, and the Environmental Public Health Tracking
Workgroup. I serve in an advisory capacity in policy development for topics such as mosquito
control,hydraulic fracturing, climate change, water quality, environmental justice and healthy
community design.
Status update:
The Food Safety Work Group has a meeting scheduled after this report is due. I will have a more
detailed summary for you at the February BOH meeting.Almost assuredly there will be
discussions surrounding the Food Safety Modernization Act.
My work on the Environmental Public Health Tracking Work Group is discussed above under
the CDC EPHT section.
Colorado Foundation for Public.Health and the Environment(CFPHE)
Background:
My volunteer service on this foundation is in its 20th year. I continue to find the challenges of
providing a non-profit organization perspective to the many opportunities to help provide
environmental and public health services to citizens of Colorado rewarding. To view what the
foundation provides please go to www.cfphe.org. Colorado public health and environmental
health organizations have the opportunity to use CFPHE to fund their projects at very low cost.
Status update:
Nothing new to report.
General
I have been sending important web information to Pitkin Co. Env. Health, City of Aspen.Env.
Health, Community Health Services and Pitkin Co. Medical Health Officer. For example;
NACCHO.and CDC recently offered two webinars on how the country is preparing for ever-
, challenging events surrounding Ebola. Ebola is an international environmental public health
crisis that becomes local the minute someone who is a carrier or potential carrier arrives.
The University of Wisconsin Population Health Institute in collaboration with Robert Wood
Johnson Foundation recently released the 2014 County Health Rankings. Each county in each
state is evaluated for specific health outcomes,health factors and policies and programs. Taken
from the report; "Health outcomes.represent how healthy a county is while health factors
represent what influences the health of the county."As I reported to you last year,Pitkin County
was ranked the healthiest county in Colorado. In 2014 Pitkin County is ranked 2nd in Health
Outcomes and 6th in Health Factors. We don't have time to discuss findings in this report at this
meeting, but perhaps at a future meeting. Everyone is encouraged to visit the website
www.countyhealthrankings.org/colorado for more details.An important takeaway to remember
is not all local factors are included in the rankings.
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This concludes this quarterly update. I am always prepared to receive advice from the Board of
Health, Community Health Services,Environmental Health and the Medical Health Officer
should there be an issue of interest.
Thank you.
Respectfully submitted,
Liz Stark RN BSN
Pitkin County Public Health Director
Director, Community Health Services, Inc.
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1:37 PM COMMUNITY HEALTH SERVICES, INC.
09/26/14 2 year Comparison Budget Overview
Accrual Basis January 2014 through December 2015
Jan-Dec 14 Jan-Dec 15
Ordinary Income/Expense •
Income
Client Fees
3000•Adult/Travel Vaccines 66,331.00 80,000.00
3001 •Adult 317 Immunization Fees 2,000.00 2,500.00
3105•Child VFC Immunization Fees 4,000.00 3,500.00
3109•Child Private Immunizations 20,000.00 7,000.00
3110•Family Planning Fees
3112• F P Contraceptives Income 15,000.00
3110•Family Planning Fees-Other 39,000.00 75,000.00
Total 3110•Family Planning Fees 54,000.00 75,000.00
3150•Flu Shots 33,000.00 45,000.00
3155•Prenatal Fees 13,000.00 15,000.00
3156•Prenatal Fees-Eagle 65,000.00 70,000.00
Total Client Fees 257,331.00 298,000.00
Local Contracts
3249•Eagle County Contracted Funds 34,838.00 41,760.00
3251 •Komen Foundation 43,000.00 35,000.00
3255•City of Aspen Funds 60,000.00 61,000.00
3256•Pitkin County Funds 320,000.00 320,000.00
3259•Snowmass Village Funds 15,000.00 16,000.00
Local Contracts-Other 0.00
Total Local Contracts 472,838.00 473,760.00
St.of Co Health Dept Contracts
3205•Emergency Preparedness 19,753.00 19,811.00
3209•State Immunizations 42,601.00 23,000.00
3210•Community Nursing LPH 61,049.00 65,539.00
3211 •State TB 1,500.00 5,250.00
3212•Women's Wellness Connection 25,783.00 23,256.00
3220•State Family Planning/STD 64,320.00 79,822.00
3245•WIC Nutrition 17,060.00 18,451.00
Total St.of Co Health Dept Contracts 232,066.00 235,129.00
3280•Donations
3260•Pitkin County In-Kind Rent • 57,029.00 57,029.00
3282•FP Donations 5,000.00 5,000.00
• 3284•Town of Basalt 1,000.00 1,000.00
3285•General Donations 3,000.00 3,500.00
Total 3280•Donations 66,029.00 66,529.00
3290•Other Income
3293• Dividend Income 8,500.00 6,500.00
Total 3290•Other Income 8,500.00 6,500.00
Total Income 1,036,764.00 1,079,918.00
Gross Profit 1,036,764.00 1,079,918.00
Expense
Contract Services
5645•Supervising Physcian 1,800.00 2,000.00
Total Contract Services 1,800.00 2,000.00
General&Administrative
5210•Advertising 3,000.00 4,000.00
5260•Computer County Network/Support 7,000.00 7,000.00
5275• Board's expense&Insurance 3,000.00 3,000.00
5330•Cont Education/Recertifications 1,000.00 1,000.00
5400• Dues and Subscriptions 2,000.00 2,000.00
5531 •Insurance Office/Prof Liability 9,000.00 11,000.00
5600•Office Expense&Copier Leasing 4,500.00 4,000.00
5610•Office Supplies 3,000.00 5,000.00
5615•Practice Management Expense 6,000.00 10,000.00
5660•Postage 500.00
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1:37 PM COMMUNITY HEALTH SERVICES, INC.
09/26/14 2 year Comparison Budget Overview
Accrual Basis January 2014 through December 2015
Jan-Dec 14 Jan-Dec 15
5670• Professional Fees,Accounting 4,000.00 4,000.00
5905•Telephone County Usage Charges 3,000.00 3,000.00
5907•Travel 4,036.00 3,000.00
Total General&Administrative 50,036.00 57,000.00
Payroll
Comp FICA 36,483.00 38,660.00
Comp MCARE 8,532.00 9,041.00
Wages&Salary
Gross 588,443.00
Wages&Salary-Other 623,556.00
Total Wages&Salary 588,443.00 623,556.00
5110 Health/Wellness 7,740.00 8,500.00
5510• lnsurance/Health/Disab 71,000.00 71,280.00
5515-Health Savings Account 16,000.00 • 16,000.00
5520•lnsurance/Workmans State Comp 3,000.00 3,700.00
5525•Employee Assistance Program 1,000.00 1,500.00
5800 •Retirment Plan Contribution/Co 29,601.00 32,472.00
Total Payroll 761,799.00 804,709.00
Program Expenses
5440•Family Planning Program Expense
5445•FP Birth Contraceptives 20,000.00
5440•Family Planning Program Expense-Other 25,000.00 50,000.00
Total 5440 •Family Planning Program Expense 45,000.00 50,000.00 -
5450•Women's Wellness Connection 11,200.00 5,500.00
5540•Komen Expenses/Direct 2,000.00 2,000.00
5550•Flu Vaccine&Expense 17,000.00 30,000.00
5595•Nursing Programs Expenses 10,000.00 10,000.00
5596•Adult Vaccine Expenses 25,000.00 25,000.00
5597•Child Vaccine Expense 11,500.00 3,000.00
5655•Prenatal Program 40,000.00 30,000.00
5656•Emergency Preparedness 4,400.00 3,500.00
5965• Pitkin County In-Kind Rent 57,029.00 57,209.00
Total Program Expenses 223,129.00 216,209.00
Total Expense 1,036,764.00 1,079,918.00 •
Net Ordinary Income 0.00 0.00
Net Income 0.00 0.00
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ATTACHMENT C
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para v ] SCommunity
-
Health �:.::
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Board of .Health
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., � 1I.ca a T. .et r'esentation
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November 6
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-''.'..''' ' ' '''•'''- '' •.• Staff prepare •draft budget in August to
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Community Fund
process and Healthy
Citizen Grant Review Committee:.
schedule.
4.. CHS-,-
with •
Finance Committee. ...
Pitkin CountyStaff
and m
Finance Director' to
et
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review and discuss •propo
sed 'budget
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• CHS Board- fo.rmally .approve budgetafter
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reviewed: and .approved by Board of
Health.
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rt • 4 inPro ramTrends 2014 com ared4„.., ,..
ry
to 2013 .3
.ty` 'k..• , Program .Numbers
" = '▪ - •:• Children's:Immunizations:
`3 ''''''`W'''V • 35% increase in number of children seen.
etz5 � % ,y. •
„ NA
, i . 57% decrease in child vaccine income.
fir' c
'i ' � E? r •:- Adult Immunizations:
.,r, , „. :l • 32% increase in number of adults seen.
AT' _ ,;Tfy rt� • 24% increase in adult. vaccine- -income
.Act A` '''"Nr• ct'N ▪ ,
,.`,,n0: . ••• Family Planning: ..
: 4„• , • a • 10% increase in number of clients served
• 25 % increase in Family Planning:fees.
,1s7 �C SG,y �,L ,,
4' 'x.1 : •: Women's Wellness Connection:
-y tr- z�• n • 31% decrease in number of women seen.
� � .��°ems,
�IY {4'a+� st
• '�,S c ▪i} •••• Public Health Planning.
• ` f� - Public Health Improvement Plan:Aging Well, Mental Health and Substance Abuse
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.,„_., .„,.....„:„.„.„„,: Overall: 20 I 5- Budget Trends
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compared to. 2014
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- ' Overall budget increase of 4. 16% compared
to 2014
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* Totalwages increased by 5.9% which incudes
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3% market adjustment and the addition of
one full-time employees' salary.
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® Total payroll increase of 5.6% due to
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adding additional employee to the health
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3,3'2g20;41:ig plan.
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g Projections„ :,_„!, ,,.;:-,.„...:,-.-„...,,,,,".-i:P-
for 2014 made. .
last year
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i Income from insurance billing for Family
Planning and Immunization services will
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f .fes
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Tr4 r ti ._ 0„!, , see decrease in local foundation. grants.
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” ` w .. Stage of Colorado contracts will remain
-'�• ` � St: abl •e' exceptionof onetime capacity
• building• •grants.
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� ` . 6 yr comparison
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t� e 35%
32%
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2012
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9i' i,* �e���� .+:• Respond to community needs•
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to ti''4� `"it tai �u °����1
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. Maintain existing programs
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ilitPublic- • Bud capacfor . Health
• ° 0 . Planning and Health •Promotion
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