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HomeMy WebLinkAbout2012-152 A TRUE COPY - CERTIFICATION ON LAST PAGE J R, 10I FH r LERi\ ORIGINALS TO 0K (ANN iDEMKo q - 1 WE CONTRACT BETWEEN INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE INDIAN RIVER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2012 =2013 This agreement ("Agreement") is made and entered into between the State of Florida , Department of Health (" State ") and the Indian River County Board of County Commissioners ( " County") , through their undersigned authorities , effective October 1 , 2012 , RECITALS A . Pursuant to Chapter 154 , F . S . , the intent of the legislature is to " promote , protect , maintain , and improve the health and safety of all citizens and visitors of this state through a system of coordinated county health department services . " B . County Health Departments were created throughout Florida to satisfy this legislative intent through " promotion of the public' s health , the control and eradication of preventable diseases , and the provision of primary health care for special populations . " C . Indian River County Health Department (" CHD ") is one of the County Health Departments created throughout Florida . It is necessary for the parties hereto to enter into this Agreement in order to assure coordination between the State and the County in the operation of the CHD . NOW THEREFORE , in consideration of the mutual promises set forth herein , the sufficiency of which are hereby acknowledged , the parties hereto agree as follows : 1 . RECITALS . The parties mutually agree that the forgoing recitals are true and correct and incorporated herein by reference . 2 . TERM . The parties mutually agree that this Agreement shall be effective from October 1 , 2012 , through September 30 , 2013 , or until a written agreement replacing this Agreement is entered into between the parties , whichever is later, unless this Agreement is otherwise terminated pursuant to the termination provisions set forth in paragraph 8 , below . 3 . SERVICES MAINTAINED BY THE CHD . The parties mutually agree that the CHD shall provide those services as set forth on Part III of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154 . 01 (2 ) , Florida Statutes , as defined below : a . " Environmental health services " are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease . I A TRUE COPY cFRT ! FICATION ON LAST PAGE 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 of the general public through the detection , control , and eradication of diseases which are transmitted primarily by human beings . Communicable disease services shall be supported by available federal , state , and local funds and shall include those services mandated on a state or federal level . Such services include , but are not limited to , epidemiology , sexually transmissible disease detection and control , HIV/AIDS , immunization , tuberculosis control and maintenance of vital statistics . C . " Primary care services " are acute care and preventive services that are made available to well and sick persons who are unable to obtain such services due to lack of income or other barriers beyond their control . These services are provided to benefit individuals , improve the collective health of the public , and prevent and control the spread of disease . Primary health care services are provided at home , in group settings , or in clinics . These services shall be supported by available federal , state , and local funds and shall include services mandated on a state or federal level . Examples of primary health care services include , but are not limited to : first contact acute care services ; chronic disease detection and treatment ; maternal and child health services ; family planning ; nutrition ; school health ; supplemental food assistance for women , infants , and children ; home health ; and dental services . 4 . FUNDING . The parties further agree that funding for the CHD will be handled as follows : a . The funding to be provided by the parties and any other sources are set forth in Part II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II . i. The State ' s appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II , Part II is an amount not to exceed $ 2 , 866 , 251 (State General Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C) , The State ' s obligation to pay under this contract is contingent upon an annual appropriation by the Legislature . ii. The County ' s appropriated responsibility (direct contribution excluding any fees, othercash orlocal contributions) as provided in Attachment II , Part II is an amount not to exceed $ 534 . 521 (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 2 A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period . 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 Indian River County Health Department Accounts Receivable Vero Beach , FL 32960- 3383 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 3 A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK compliance shall be documented . Such justification and compliance documentation shall be maintained by the CHD in accordance with the terms of this Agreement . State procedures must be followed for all leases on facilities not enumerated in Attachment IV. c . The CHD shall maintain books , records and documents in accordance with those promulgated by the Generally Accepted Accounting Principles ( GAAP) and Governmental Accounting Standards Board ( GASB ) , and the requirements of federal or state law . These records shall be maintained as required by the Department of Health Policies and Procedures for Records Management and shall be open for inspection at any time by the parties and the public , except for those records that are not otherwise subject to disclosure as provided by law which are subject to the confidentiality provisions of paragraph 6 . i . , below . Books , records and documents must be adequate to allow the CHD to comply with the following reporting requirements : i. The revenue and expenditure requirements in the Florida Accounting System Information Resource ( FLAIR ) , ii. The client registration and services reporting requirements of the minimum data set as specified in the most current version of the Client Information System/Health Management Component Pamphlet ; 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 Indian River 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 4 A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK which has been credited to each participating governmental entity . The planned use of 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 . 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 5 A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK 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 DE385L1 Contract Management Variance Report and the DE580L1 Analysis of Fund Equities Report ; ii. A written explanation to the county of service variances reflected in the DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount . However, if the amount of the service specific variance between actual and planned expenditures does not exceed three percent of the total planned expenditures for the level of service in which the type of service is included , a variance explanation is not required . A copy of the written explanation shall be sent to the Department of Health , Bureau of Budget Management . 6 A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK p . The dates for the submission of quarterly reports to the county shall be as follows unless the generation and distribution of reports is delayed due to circumstances beyond the CHD ' s control : i. March 1 , 2013 for the report period October 1 , 2012 through December 31 , 2012 ; ii. June 1 , 2013 for the report period October 1 , 2012 through March 31 , 2013 ; iii. September 1 , 2013 for the report period October 1 , 2012 through June 30 , 2013 ; and iv. December 1 , 2013 for the report period October 1 , 2012 through September 30 , 2013 . 7 . FACILITIES AND EQUIPMENT . The parties mutually agree that : a . CHD facilities shall be provided as specified in Attachment IV to this contract and the county shall own the facilities used by the CHD unless otherwise provided in Attachment IV. b . The county shall assure adequate fire and casualty insurance coverage for County- owned CHD offices and buildings and for all furnishings and equipment in CHD offices through either a self- insurance program or insurance purchased by the County . c . All vehicles will be transferred to the ownership of the County and registered as county vehicles . The county shall assure insurance coverage for these vehicles is available through either a self- insurance program or insurance purchased by the County . All vehicles will be used solely for CHD operations . Vehicles purchased through the County Health Department Trust Fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the County Health Department Trust Fund . 8 . TERMINATION . a . Termination at Will . This Agreement may be terminated by either party without cause upon no less than one- hundred eighty ( 180 ) calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties . Said notice shall be delivered by certified mail , return receipt requested , or in person to the other party ' s contract manager with proof of delivery . b . Termination Because of Lack of Funds . In the event funds to finance this Agreement become unavailable , either party may terminate this Agreement upon no less than twenty-four (24 ) hours notice . Said notice shall be delivered by certified mail , return receipt requested , or in person to the other party ' s contract manager with proof of delivery . c . Termination for Breach . This Agreement may be terminated by one party , upon no less than thirty ( 30 ) days notice , because of the other party ' s failure to perform an A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK obligation hereunder. Said notice shall be delivered by certified mail , return receipt requested , or in person to the other party' s contract manager with proof of delivery . Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Agreement . 9 . MISCELLANEOUS . The parties further agree : a . Availability of Funds . If this Agreement , any renewal hereof, or any term , performance or payment hereunder, extends beyond the fiscal year beginning July 1 , 2013 , it is agreed that the performance and payment under this Agreement are contingent upon an annual appropriation by the Legislature , in accordance with section 287 . 0582 , Florida Statutes . b . Contract Managers . The name and address of the contract managers for the parties under this Agreement are as follows : For the State : For the County : Mayur Rao Jason Brown Name Name Business Manager Budget Director Title Title 190027 1h Street 1801 27th Street Vero Beach , FI . , 32960- 3383 Vero Beach , FI . , 32960- 3383 Address Address 772 -794-7464 772 - 567-8000 Ext . 1214 Telephone 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. 8 A TRUE COPY CERTIFICATION ON LAST PAGE J . R . SMITH , CLERK In WITNESS THEREOF , the parties hereto have caused this 24 page agreement to be executed by their undersigned officials as duly authorized effective the 1St day of October , 2012 . BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA FOR INDIAN RIVER COUNTY DEPARTMENT OF HEALTH SIGNED BY : SIGNED BY . NAME : Gary C . Wheeler V•'• ° Yago °.NNN 'NM1 NAME : John H . Armstrong , MD N TITLE : Chairman iyv��•' a • TITLE : Surgeon General/Secretary of Health 1 V • j . s DATE : September 11 ,01 *0* 12DATE : • :o: ATTESTED TO : �. P� SIGNED BY . p • • SIGNED BY : NAME : C'N ET NAME : Miranda C . Hawker M . P . H . TITLE : �QFPU ri CL-GJZ <,, TITLE : CHD Director/Administrator DATE : — I DATE : g� 30e O APPROVED AS TO FORM UkND LE ^ek UFFI NCY sy WUNTY ATTORNEY 9 A TRUE COPY CERTIFICATION ON LAST PAGE ATTACHMENT I J . R . SMITH , CLERK INDIAN RIVER 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 CHD 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 . Environmental Health Requirements as specified in Environmental Health Programs Manual 150-4 * and DHP 50-21 * 8 , 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 - A TRUE COPY CERTIFICATION ON LAST PAGE ATTACHMENT I ( Continued ) J . R . SMITH , CLERK demographic data on persons tested for HIV in CHID 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 posttest counseling appointment or within 90 days of the missed posttest counseling appointment. 9 . School Health Services Requirements as specified in the Florida School Health Administrative Guidelines (April 2007) . 10 , 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, 3840 25, 385. 202, 392. 53 FS. 381 and CH Guidebook, 11 , General Communicable Disease Control Carry out surveillance for reportable communicable and other acute diseases , detect outbreaks , respond to individual cases of reportable diseases , investigate outbreaks , and carry out communication and quality assurance functions , as specified in the CHID Guide to Surveillance and Investigations . *or the subsequent replacement if adopted during the contract period . ATTACHMENT II INDIAN RIVER COUNTY HEALTH DEPARTMENT PART I . PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES Estimated State Estimated County Share of CHD Trust Share of CHD Trust Fund Balance Fund Balance Total 1 , CHD Trust Fund Ending Balance 09/30/ 12 724 , 288 6821642 114061930 2 . Drawdown for Contract Year (49 , 686 ) ( 87 , 228 ) ( 136 , 914 ) October 1 , 2012 to September 30 , 2013 3 . Medicaid Buyback ( 192 , 636 ) ( 192 , 636 ) October 1 , 2012 to September 30 , 2013 4 , Balance Reserved for Contingency Fund 481 , 966 595 , 414 1 , 077 , 380 October 1 , 2012 to September 30 , 2013 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects , and mobile health vans , CPU,) n ?o M --i � c T m C7 _ O C7 O r- z M o 7;z z r A cn -v D m :`jqFrF fiATTp�YGH NgTII � 41 111. 16 a� 17'SF a tj suy' " ' +• P s K ` '� S PART NT rrra� . 7 . n.;,y `� +, a 1 r " x Part IISoucc�s of Comb t >}s o ea th a me FF� - "F EL kr Uct 'ber ,+101 o e em e ; 30 ` �L013k a v. IxsFr IFr J, I.F IFIF IF 7 rr ` S a zHD my o a GHD• } . F ,., �, art, -. s _ _ . s . _ __. 1 . GENERAL REVENUE - STATE 015040 AIDS PREVENTION 0 0 0 0 0 015040 AIDS SURVEILLANCE 0 0 0 0 0 015040 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0 015040 ALG/CONTR TO CHDS-AIDS PATIENT CARE 100 000 0 1005000 0 10 000 015040 ALG/CONTR TO CHDS-AIDS PATIENT CARE NETWORK 0 0 0 0 0 015040 ALG/CONTR TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0 015040 MINORITY OUTREACH-PENALVER CLINIC - MIAMI-DADE 0 0 0 0 0 015040 PREPAREDNESS GRANT MATCH 295492 0 29492 0 291492 015040 SCHOOL HEALTH GENERAL REVENUE 66, 590 0 665590 0 663590 015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0 015040 STD GENERAI, REVENUE 0 0 0 0 0 015040 TREASURE COAST MIDWIFERY" - MARTIN 0 0 p 0 0 015040 HEALTHY START MED-WAIVER - CLIENT SERVICES 0 0 0 0 0 015040 JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI-DARE 0 0 0 0 0 015040 LA LICA-LEAGUE AGAINST CANCER - MIAMI-DADE 0 0 0 0 0 015040 MANATEE COUNTY RURAL HEALTH SERVICES 0 0 p p 0 015040 METRO ORLANDO URBAN LEAGUE - ORANGE, 0 0 0 0 0 015040 MIGRANT LABOR CAMP SANITATION 0 0 0 0 0 015040 DENTAL SPECIAL INITIATIVES 6, 540 0 6540 0 61540 015040 DUVAL TEEN PREGANCY PREVENTION - DUVAL 0 0 0 0 0 015040 FAMILY PLANNING GENERALRF,VENUE 273270 0 27,270 0 27,270 015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0 015040 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 0 0 0 0 0 015040 HEALTHY START MED WAIVER - SOBRA 0 0 0 0 0 015040 ALG/IPO HEALTHY START/IPO 0 0 p 0 0 015040 ALG/PRIMARY CARE 183 ,226 0 183 ,226 0 1831226 015040 BREAST & CERVICAL - ADMINISTRATION/CASE MANAGEMENT 0 0 0 0 0 015040 COMMUNITY SMILES IF MIAMI-DARE 0 0 0 0 0 015040 COMMUNITY TB PROGRAM 335238 0 33 ,238 0 33 ,238 015040 COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA 0 0 0 0 0 015050 NON-CATEGORICAL GENERAL REVENUE 1 , 160,347 0 1 , 160,347 0 1 , 1601347 GENERAL REVENUE TOTAL 15606, 703 0 1 , 606,703 0 1 ,606, 703 2. NON GENERAL REVENUE - STATE 015010 ALG/CONTR. TO CHDS-BIOMEDICAL WASTE 12, 140 0 12, 140 0 129140 015010 ALG/CONTR. TO CHDS-SAFE DRINKING WATER PRG 0 p 0 0 0 015010 INDIAN RIVER SUPER-ACT 65000 p 61000 0 600 015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0 015010 PREPAREDNESS GRANT MATCH 0 0 0 0 0 015010 PUBLIC SWIMMING POOLPROGRAM 0 0 0 0 0 015010 SCHOOL HEALTH TOBACCO TF 70,277 0 705277 0 70,277 015010 TOBACCO ADMINISTRATION & MANAGEMENT 0 p 0 0 0 015010 TOBACCO COMMUNITY INTERVENTION 0 p 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 p 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 p 0 0 0 015020 TRANSFER FROM ANOTHER STATE AGENCY 0 p 0 0 0 015060 NON-CATEGORICAL TOBACCO REBASING 4,266 p 41266 0 4,266 /ersion : 1 Page 1 of 7 r IP IlrP 7,F A T CAH q 1 kT x i '1 tl" III I T- III, ti y4 �'- Ft j yaW y A ,ti3 ± �" a AI a 1 IF r £ x dY.{ ! -� Ht �M� 5x� e �.r+ 'n, * f;- >n' ' IPP y.l. " 3-^" Il�DIAL�T1aR�0 Y ' ,TH DE' �iRTME1�iT w «' , ' 11 £z 4xIF Tt K , Al Part II murces of Contr><bu ons. . o o ea1�h De me " s If '' -nF � "ea2+ � F`T If IF IT ^, .1 IF 1, Oct f . 7 i .ar�-.t� ..:sh«•, 7G ober�. x �� Jy � aIF I Ir eCIID rComty� o Q q: ,� #r •s s x �, s - . -� s 7 IT IT, t� - St. IF TI � IV © , „ �Ilf�,� 'i 5 , cc .'k',,;w sR ... C89YUSrFU E9 14 _ 1 P NON GENERAL REVENUE TOTAL 925683 0 92, 683 0 921683 3. FEDERAL FUNDS ,, State 007000 ABSTINENCE EDUCATION GRANT PROGRAM 0 0 0 0 0 007000 AIDS PREVENTION 515788 0 511788 0 51 , 788 007000 AIDS SURVEILLANCE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 0 0 0 0 0 007000 CHRONIC DISEASE PREVENTION & HEALTH PROMOTION 0 0 0 0 0 007000 COASTAL BEACH MONITORING PROGRAM 11 ,957 0 111957 0 111957 007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 0 0 0 0 0 007000 UNINTENDED/UNWANTED PREG-TEEN PREGNANCY PREV 0 0 0 0 0 007000 WICADMNISTRATION 4925493 0 4925493 0 492,493 007000 WIC BREASTFEEDING PEER COUNSELING 49, 862 0 495862 0 49, 862 007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0 007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 0 0 0 0 0 007000 SYPHILIS ELIMN.4TION 0 0 0 0 0 007000 TEENAGE PREGNANCY PREVENTION REPLICATION 0 0 0 0 0 007000 TITLE X HIV/AIDS PROJECT 0 0 0 0 0 007000 TOBACCO FAITH BASED PROJECT 0 0 0 0 0 007000 RAPE PREVENTION & EDUCATION 0 0 0 0 0 007000 RYAN WHITE 0 0 0 0 0 007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0 007000 RYAN WHITE-AIDS DRUG ASSIST PROG-ADMIN 35 ,000 0 35 ,000 0 35 , 000 007000 RYAN WHITF,-CONSORTIA 0 0 0 0 0 007000 SAFE SLEEP EDUCATION 0 0 0 0 0 007000 MINORITY NVOLVEMENT N HIV/AIDS PROGRAM 0 0 0 0 0 007000 PHP - CITIES READINESS NITIXIVE 0 0 0 0 0 007000 PRECONCEPTION HEALTH CARE 0 0 0 0 0 007000 BIOTERRORISM HOSPITAL PREPAREDNESS 255000 0 251000 0 251000 007000 PUBLIC HEALTH INFRASTRUCTURE 703000 0 703000 0 705000 007000 PUBLIC HEALTH PREPAREDNESS BASE 185 , 886 0 1855886 0 185 , 886 007000 IMMUNIZATION WIC LINKAGES 0 0 0 0 0 007000 MCH BGTF-GADSDEN SCHOOL CLINIC 0 0 0 0 0 007000 MCH BGTF-HEALTHY START COALITIONS 0 0 0 0 0 007000 MCH QUALITY IMPROVEMENT ACTIVITIES MCHBG 0 0 0 0 0 007000 MNORITYAIDS INITIATIVE 0 0 0 0 0 007000 MNORITYAIDS INITIATIVE TCE COLLABORATIVE 0 0 0 0 0 007000 FGTF/FAMILY PLANNING-TITLE X 571F072 0 57,072 0 575072 007000 HEALTHY HOMES AND LEAD POISONING GRANT 0 0 0 0 0 007000 HIV HOUSING FOR PEOPLE LIVNGWITHAIDS 0 0 0 0 0 007000 HIV INCIDENCE SURVEILLANCE 0 0 0 0 0 007000 IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT 165534 0 161534 0 165534 007000 IMMUNIZATION FIELD STAFF EXPENSE 0 0 0 0 0 007000 COLORECTAL CANCER SCREENING 200940 0 0 0 0 0 007000 DENTAL SERVICES 27,205 0 275205 0 27,205 007000 ENHANCE COMPREHENSIVE PREVENTION PLANNNGAND IMPL 0 0 0 0 0 007000 EXPANDED TESTING INITIMIVE (ETD 0 0 0 0 0 007000 FGTF/AIDS MORBIDITY 0 0 0 0 0 007000 FGTFBREAST & CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0 Version : 1 Page 2 of 7 III t & ° .: }a` '` i _ r '° "` "u, r3 rF b ' irk` x' 3 '� � 'FIFFFII f 114lN+;. 4ATTA Jin § r ,s3, t -> �. r LX t ^6`. +h k xF .x .. krx IF 14' + " `'A"'` k xe 7! �'"*s l rir r4"T's-`` - ' FF I Fk .r ' F . s v`t'r�a� s, .�, I IF TNDRIVRd a HIMr DEP" TMENT jil IFF Fir Part II Sources oCont ba��ansy��e h e�artme� M Tf IF 7WUcoberal o e e b r 0 � Id � 3 as aIF Ir,r ' eq p T ady'#.� `�5}'`i } .. .1 `^+'2 f y kk III mmmmmmmm I IF, k �W *� Y 11 ,.rr F,er, _ _ _? _ _ +' " ? "_ ,:. '� � ,Yt. .� ". .. ��,�` `/- . . . aT!'U9t Fan c ' �� =. f0 ► t10 .... ._..� . rt..� 3. FEDERAL FUNDS - State 015009 MEDIPASS WAIVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0 015009 MEDIPASS WAIVER-SOBRA 0 0 0 0 0 007055 ARRA FEDERAL GRANT = SCHEDULE C 0 0 0 0 0 015075 SCHOOL HEALTH TITLE XXI 1505068 0 150, 068 0 150,068 015075 SUMMER FOOD PROGRAM INSPECTIONS 0 0 0 0 0 FEDERAL FUNDS TOTAL 1 , 172, 865 p 1 , 172, 865 p 15172, 865 4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 TANNING FACILITIES 2,239 0 2,239 0 21239 001020 BODY PIERCING 270 0 270 0 270 001020 TATTOO PERMIT 45446 0 43446 0 4,446 001020 MOBILE HOME AND PARKS 153318 0 15 ,318 0 15,318 001020 FOOD HYGIENE PERMIT 16,339 0 165339 0 161339 001020 BIOHAZARD WASTE PERMIT 165645 0 16,645 0 16,645 001020 PRIVATE WATER CONSTR PERMIT 0 p 0 0 0 001020 PUBLIC WATER ANNUAL OPER PERMIT 3 , 564 0 3 , 564 0 3 , 564 001020 PUBLIC; WPTER CONSTR PERMIT 0 0 0 0 0 001020 NON-SDWA SYSTEM PERMIT 0 0 0 0 0 001020 SAFE DRINKING WATER 0 0 0 0 0 001020 SWIMMING POOLS 543085 0 54,085 0 54,085 001092 OSDS PERMIT FEE 210,618 0 210618 0 210,618 001092 1 & M ZONED OPERATING PERMIT 0 0 0 0 0 001092 AEROBIC OPERATING PERMIT 0 0 0 0 0 001092 SEPTIC TANK SITE EVALUATION 0 0 0 0 0 001092 NON SDWA LAB SAMPLE 0 0 0 0 0 001092 OSDS VARIANCE FEE 0 p 0 0 0 001092 ENVIRONMENTAL, HEALTH FEES 2, 575 p 25575 0 21575 001092 OSDS REPAIR PERMIT 0 0 0 0 0 001170 LAB FEE CHEMICALANALYSIS 0 0 0 0 0 001170 WATER ANALYSIS-POTABLE 0 p 0 0 0 001170 NONPOTABLE WATER ANALYSIS 0 0 0 0 0 010304 MQA INSPECTION FEE 0 p 0 0 0 001206 CENTRAL OFFICE SURCHARGE 319973 0 31 ,973 0 31 ,973 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 35813072 0 358,072 0 3581l072 5. OTHER CASH CONTRIBUTIONS - STATE 010304 STATIONARY POLLUTANT STORAGE TANKS 0 p 0 0 0 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 49,686 0 495686 0 49,686 OTHER CASH CONTRIBUTIONS TOTAL 49,686 0 493686 0 495686 6. MEDICAID - STATE/COUNTY 001056 MEDICAID PHARMACY 0 p 0 0 0 001076 MEDICAID TB 0 p 0 0 0 001078 MEDICAID ADMINISTRATION OF VACCINE 0 411l361 415361 0 415361 001079 MEDICAID CASE MANAGEMENT 0 p 0 0 0 001081 MEDICAID CHILD HEALTH CHECK UP 0 385 ,998 385,998 0 3857998 001082 MEDICAID DENTAL 0 3905093 390,093 0 390,093 /ersion : 1 Page 3 of 7 VVI, A rVE �Aw All VAI "moi 2-�' a r �� r -' '�¢5a". ° .N Iry Ys 7 F . .�''� DINEt VIA VIA VAIg *ATTACHNEAl vr� �T IT ilk , ` f� x � f ars s�, x III IV. INDk1N RIPER CO TAI E�ARTMENT �^ 4vs t : tt"wl ', . t° wvw 3 C, xy^r s }`s xa ntx ,Part II Sources ofobuIons oCountIII yIealth Department `r IV � �a . , s ._ Y 't '� rt `, � - t Uctober 4 4 wt TN yt 2 4�+ ' , '�i-ux 's f x .� eu u ^tev . y � ��. , r s i , x`� «: .x4.,�+' -s,'x `� CiOLLI11 ' d , .. _,.� `s' �'txcad.,4.- � ;fi�` "�t ➢S LL (� AL , � r; r� treII VIA ' 'ryLLB WAS t rt jib VIA ,"` a zY lr * - �, F ; r III �s '" ,r`' z § fIf LI4 ,� i kty ? �"„ C83 Ly TCLL3L,BLLLLAIr � ` 3 17 1 t nAtfg ryJ .3 Afr :1 Llf: RA- 6. MEDICAID - STATE/COUNTY 001083 MEDICAID FAMILY PLANNING 0 179,549 1795549 0 1791V549 001087 MEDICAID STD 0 485579 483579 0 489579 001089 MEDICAIDAIDS 0 39,099 393099 0 39,099 001147 MEDICAID HMO CAPITATION 0 0 0 0 0 001191 MEDICAID MATERNITY 0 0 0 0 0 001192 MEDICAID COMPREHENSIVE CHILD 0 503 ,914 503 ,914 0 503 ,914 001193 MEDICAID COMPREHENSIVE ADULT 0 309, 891 3095891 0 309, 891 001194 MEDICAID LABORATORY 0 0 0 0 0 001208 MEDIPASS $3 . 00 ADM. FEE 0 7200 725000 0 72,000 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 0 11970,484 159707484 0 15970,484 7. ALLOCABLE REVENUE - STATE 018000 REFUNDS 0 0 0 0 0 037000 PRIOR YEAR WARRANT p 0 0 0 0 038000 12 MONTH OLD WARRANT p 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 76,889 765889 LABORATORY SERVICES 0 p 0 43 , 579 43 ,579 TB SERVICES 0 0 0 0 0 IMMUNIZATION SERVICES 0 p 0 5451l362 54515362 STD SERVICES 0 0 0 0 0 CONSTRUCTION/RENOVATION 0 p 0 0 0 WIC FOOD 0 0 0 2,057,867 2,057, 867 ADAP 0 0 0 0 0 DENTAL SERVICES 0 p 0 0 0 OTHER (SPECIFY) 0 0 0 0 0 OTHER (SPECIFY) 0 p 0 0 0 OTHER STATE CONTRIBUTIONS TOTAL 0 0 p 2, 723 ,697 2,723 ,697 9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT 008010 CONTRIBUTION FROM CITYGOVERNMENT 0 p 0 0 0 008020 CONTRIBUTION FROM HEALTH CARE TAX NOT THRU BCC 0 1 ,910, 845 15910, 845 0 1 ,9103845 008040 BCC GRANT/CONTRACT 0 801488 805488 0 80,488 008030 CONTRIBUTION FROM HEALTH CARE TAX 0 p 0 0 0 008034 BCC CONTRIBUTION FROM GENERALFUND 0 534, 521 534, 521 0 534, 521 /ersion : 1 Page 4 of 7 m VL p ANT II411 vf4 ma m ✓" * ww r } = '' a y`� xr 1m c> 1 11 ,�RIYI� 2 O S 7��^ P��.S ,. EPT '- $� Ear"tSaurc�esof Cont�r b ns" to oun x j � ' tVmydN l"th�e artment all ' a Rap 'a4- t � v rm C° 1 .. `fir"';` , . ar .S • Ime '�,os^� •t � �' r r e t ', � r �,�*s �� Y - '`t f� � � C. ��r'+k'aus� n ('r"OUII • ,.-� a n 1 CHAD us an r On U 0 . jx .. , . . _., � .... c� _wz_: . .2mi ., .ri::ra ,. , . .i/ DIRECT COUNTY CONTRIBUTION TOTAL 0 2,525, 854 2, 525, 854 0 2, 5253854 10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001060 VITAL STATISTICS - OTHER 0 2, 108 001077 2, 108 0 2, 108 RABIES VACCINE 0 0 p 0 0 001077 CHILD CAR SEAT PROG 0 0 001077PERSONAL HEALTH FEES 0 0 0 0 336, 856 336, 856 0 3363856 001077 AIDS CO-PAYS 0 0 0010940 0 0 ADULT ENTER. PERMIT FEES 0 0 0 0 0 001094 LOCAL ORDINANCE FEES 0 73, 596 001114 73 , 596 0 73 ,596 NEW BIRTH CERTIFICATES 0 37,676 375676 0 37, 676 001115 VITAL STATISTICS - DEATH CERTIFICATE 0 157,526 001117 VITAL STATS-ADM. FEE 50 CENTS 157,526 0 157, 526 0 2, 140 21140 0 25140 001073 CO-PAY FOR THE AIDS CARE PROGRAM 0 0 001025 CLIENT REVENUE FROM GRC 0 0 0 0 0 0 0 0 001040 CELL PHONE ADMINISTRATIVE FEE 0 0 0 0 0 FEES AUTHORIZED BY COUNTY TOTAL p 609,902 609,902 0 609,902 11 . OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 RETURNED CHECK TTEM p 0 001029 THIRD PARTY REIMBURSEMENT0 0 0 0 934469 93 ,469 0 93 ,469 001029 HEALTH MAINTENANCE ORGAN. (HMO) p 0 0 0 0 001054 MEDICARE, PART D 0 0 0 0 0 001077 RYAN WHITE TITLE I1 0 0 0 0 0 001090 MEDICARE PARTB 0 43 ,209 43 ,209 0 43 ,209 001190 HEALTH MAINTENANCE ORGANIZATION 0 0 0 0 0 005040 INTEREST EARNED 0 0 0 0 0 005041 INTEREST EARNED-STATE INVESTMENT ACCOUNT 0 1200 12, 000 0 12 ,000 007010 U. S . GRANTS DIRECT 0 0 0 0 0 008050 SCHOOL BOARD CONTRIBUTION 0 0 0 0 0 008060 SPECIAL PROJECT CONTRIBUTION 0 0 0 0 0 010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES 0 0 0 0 0 010301 EXP WITNESS FEE CONSULTNT CHARGES 0 0 0 0 0 010405 SALE OF PHARMACEUTICALS 0 0 0 0 0 010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0 011001 HEALTHY START COALITION CONTRIBUTIONS 0 303 ,253 3035253 0 303 ,253 011007 CASH DONATIONS PRIVATE 0 0 0 0 0 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 87,228 87,228 0 87,228 011000 GRANT DIRECT-NOVA UNIVERSITY CHD TRAINING 0 0 p 0 0 011000 GRANT-DIRECT 0 0 p 0 0 011000 GRANT DIRECT-COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0 0 0 0 0 011000 GRANTS AND DONATIONS 0 235370 235370 0 235370 011000 GRANT-DIRECT UNITED WAY DENTAL 0 45 , 500 45 , 500 0 45 ,500 011000 GRANT-DIRECT ST JOHN'S WATER 0 235862 23 , 862 0 23,862 011000 GRANT-DIRECT EH LEGAL SUPPORT 0 179130 175130 0 17, 130 011000 GRANT DIRECT-ARROW 0 0 0 0 0 ersion : 1 Page 5 of 7 -11 Lmfi OF 77 wr ATTACIiM14 ENT IIg _ � , 11 � ct yyy I 4L ,elf �TH�FfPART IK'd #k #}K. YS1''3'h E ,kP1 K * ,d �„. Y x iPartSources of ut><on Couu IIeathDep meu+ >�_ �. _�T _� � _ . . . � .__ . . _ _w�_ � __ ., . _.. �_.� '" "an : __ £ %" � _ �� �s�. �`? Trust"Fund ,3 �� :� �Ce9h ,� �� ��.�_ �° � • . . 11 . OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 011000 GRANT DIRECT-QUANTUM DENTAL 0 p p 0 p 011000 GRANT DIRECT-HEALTH CARE DISTRICT PAHOKEE 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 0 0 0 0 011000 GRANT-DIRECT 0 p 0 0 0 010402 RECYCLED MATERIAL SALES 0 0 0 0 0 010303 FDLE FINGERPRINTING 0 0 0 0 0 007050 ARRAFEDERALGRANT 0 p 0 0 0 001010 RECOVERY OF BAD CHECKS 0 p 0 0 0 008065 FCO CONTRIBUTION 0 0 0 0 0 011006 RESTRICTED CASH DONATION 0 p 0 0 0 028000 INSURANCE RECOVERIES 0 p 0 0 0 001033 CMS MANAGEMENT FEE - PMPMPC 0 41131 41131 0 41131 010400 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 p 0 0 0 010500 REFUGF,E HEALTH 0 p 0 0 0 005045 INTEREST EARNED-THIRD PARTY PROVIDER 0 0 0 0 0 005043 INTEREST EARNED-CONTRACT/GRANT 0 p 0 0 0 010306 DOH/DOC INTERAGENCY AGREEMENT 0 p 0 0 0 011002 ARRA FEDERAL GRANT - SUB-RECIPIENT 0 p 0 0 0 011004 LOW INCOME POOL - SUBRECIPIENT 0 p 0 0 0 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 653 , 152 653 , 152 0 6533152 12. ALLOCABLE REVENUE - COUNTY 018000 REFUNDS 0 p 0 0 0 037000 PRIOR YEAR WARRANT 0 p 0 0 0 038000 12 MONTH OLD WARRANT 0 p 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 0 0 p 0 0 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 329 ,005 3295005 GROUNDS MAINTENANCE 0 0 p p p OTHER (SPECIFY) 0 0 0 0 0 INSURANCE 0 0 0 0 0 UTILITIES 0 0 0 151 , 736 1519736 OTHER (SPECIFY) 0 0 0 0 0 BUILDING MAINTENANCE 0 0 0 12703 12703 BUILDINGS TOTAL 0 0 p 6089404 608,404 14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY EQUIPMENT/VEHICLE PURCHASES 0 0 p p 0 VEHICLE INSURANCE 0 0 0 0 0 VEHICLE MAINTENANCE 0 0 p p 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 p p 0 OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0 OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 p 0 0 Version : 1 Page 6 of 7 r 9 0 M N rn t M I Nr It R&� 4 ro� z N b fifz A� D M w ' SA oS vi It, � % § a o H . . C v' o d . oc v, 9 I Nor I. H , `'- ' c� Alk ' p . u r r At e s ze IN a a� } �r it s sI`I ILI41 to ^� It U] YF '�144 �k ; .` fN c ,1, Q kk OOL F l� l x41, LL A � l N _ Q .n 1. C� -IFIt IFir I I ITTF I It III. IF III, III- Fit, III FtI sS 1- y- g KT �,,. 9 `#�. +' 4153°, +3' "„ +?1 u. ', j + " '` e '1 vkra s �"9'f . :y , r w -"a.. S X� C* ,IIR``, t F N&t { .. IF IF % ra3 "hix �, / Ar � ,� Fii1..�T�h+� r�r7� fit Ij ;✓ :# t ^¢, � '. ry .TI IF { ,`' J:Cal.� . 'Y 3 PL M' . ., F ,+ rr n € -. " -. } > ' .. ,a .y-. `- = 's. w .T3i+ "., ,r„ iM Md�..� .> �` y � � & artIH lannedStaffing; Clients Services a g .e ditures a �Serv�ceAreaw �thm EacL Le a e, w d IF tys 0� 1. 3�'� 112 Ir I , b a ya nd�tn�e a a. + It. , IF IF 44s ZA t` : Ek, o e ao�ars o )"� ,' _ . _r . ,r . .d A. COMMUNICABLE DISEASE CONTROL : IMMUNIZATION ( 101 ) 6. 60 45890 7, 100 124,970 1075117 124,970 1071117 124, 501 3391673 4643174 STD ( 102) 6.91 19560 25360 95 ,293 81 , 680 955293 8100 182,203 171 , 743 3531946 HIV/AIDS PREVENTION (03A1 ) 0. 02 2 230 25458 2, 107 2458 25107 95130 0 9, 130 HIV/AIDS SURVEILLANCE (03A.2) 0. 80 8 9 14, 161 12, 138 14, 161 12, 138 31 ,968 20, 630 52, 598 HIV/AIDS PATIENT CARE (03A3 ) 4 . 37 980 15600 68,216 58 ,471 685216 585471 166, 198 87, 176 253 ,374 ADAP (03A4) 1 . 02 2 240 17, 849 15 ,299 171849 155299 54, 021 12,275 66,296 TB CONTROL SERVICES ( 104) 2. 28 755 25208 33 ,756 285934 33 , 756 28 ,934 87, 583 37,797 1251380 COMM. DISEASE SURV. ( 106) 1 .40 0 355 233776 20,379 23 ,776 203379 535672 349638 885310 HEPATITIS PREVENTION ( 109) 0. 00 0 0 0 0 0 0 0 0 0 PUBLIC HEALTH PREP AND RESP ( 116) 2 . 56 0 170 77,052 66,045 77, 052 661045 2683224 17,970 286, 194 VITAL STATISTICS ( 180) 1 . 13 7,080 18, 750 14, 038 12,033 14,038 12,033 0 52, 142 521142 COMMUNICABLE DISEASE SUBTOTAL 27 . 09 15 ,277 333022 471 , 569 404,203 4715569 4041?203 977, 500 7743044 1 ,751 , 544 B. PRIMARY CARE : CHRONIC DISEASE SERVICES (2 10) 1 . 11 4,436 111998 19, 898 171056 191898 171) 056 5907 141241 73 ,908 TOBACCO PREVENTION (2 12) 0 . 00 0 0 0 0 0 0 0 0 0 WIC (21W1 ) 11 . 30 45515 35 ,680 1691001 144, 858 1691,001 1445858 6013663 26,055 627, 718 WIC BREASTFEEDING PEER COUNSELING(21W2) 2. 26 0 21820 25 ,361 21 ,738 251361 21 , 738 85 ,656 81542 94, 198 FAMILY PLANNING (223) 11 . 34 2,478 4,405 169,720 1453474 169, 720 1455474 2345425 395 ,963 630,388 IMPROVED PREGNANCY OUTCOME (225) 0 . 00 0 0 0 0 0 0 0 0 0 HEALTHY START PRENATAL (227) 3 . 72 553 3 , 536 60,536 5108 60, 536 51 , 888 30,314 1945534 2245848 COMPREHENSIVE CHILD HEALTH (229) 18 . 06 3 ,200 8 ,200 30511088 261 ,504 3053088 261 , 504 123 , 118 1 ,0105066 1 , 1335184 HEALTHY START INFANT (23 1 ) 2 .30 220 100 38 , 121 325675 38, 121 325675 806 1335586 141 ,592 SCHOOL HEALTH (234) 5 . 64 0 199,978 923282 79,099 92,282 793099 332,005 10,757 3427762 COMPREHENSIVE ADULT HEALTH (237) 34 . 70 7,257 17,916 634,361 5431738 6349361 543 , 738 349,352 2,006, 846 253569198 COMMUNITY HEALTH DEVELOPMENT (238) 0 . 55 0 612 115143 91551 11 , 143 92551 41 ,388 0 417388 DENTAL HEALTH (240) 10 . 62 21602 55903 192,301 164, 829 192,301 1645829 583577 65503 714,260 PRIMARY CARE SUBTOTAL 101 . 60 25 ,261 282,728 1 ,717, 812 154723410 137175812 114721,410 11924, 171 49456,273 61,3805444 C. ENVIRONMENTAL HEALTH : Water and Onsite Sewage Programs COASTAL BEACH MONITORING (347) 0 .21 309 309 61954 51961 65954 5 ,961 17, 187 811643 2515830 LIMITED USE PUBLICWATER SYSTEMS (357) 0 . 32 70 520 5 , 558 43764 5 , 558 4,764 3 ,439 17,205 20,644 PUBLIC WATER SYSTEM (358) 0 . 08 0 224 17403 1 ,203 1 ,403 1 ,203 0 5 ,212 5 ,212 PRIVATE WATER SYSTEM (359) 1 . 17 370 1 ,700 215548 18,470 211548 185470 301 76,345 805036 INDIVIDUAL SEWAGE DISP. (361 ) 4. 05 874 3 , 630 7401 633944 741601 63 ,944 185 ,789 913301 277,090 Group Total 5 . 83 11623 6,383 1101) 064 94,342 110, 064 94,342 210, 106 198, 706 408, 812 Facility Programs FOOD HYGIENE (348) 0 . 66 82 370 115789 10, 105 11 , 789 10, 105 245008 19,780 43 ,788 BODY PIERCING FACILITIES SERVICES 0 . 06 2 12 1 ,450 1 ,243 1 ,450 11243 25420 2,966 5 ,386 GROUP CARE FACILITY (3 5 1 ) 0 . 19 65 132 35730 33197 31730 31197 3 ,241 103613 13 , 854 MIGRANT LABOR CAMP (3 52) 0. 01 3 16 184 158 184 158 270 414 684 HOUSING,PUBLIC BLDG SAFETY,SANITATION (353) 0 . 11 23 112 11751 13501 19751 1 , 501 0 6, 504 6, 504 Version : 2 Page 1 of 2 I IF iF ell 94 , , IF IF IF I I IFu aI m n 11 1 , z t W1`.f IF PFl 3Par�tIII Planned eta WI u � CL�encr a ces nE"fie u ogram Se s ' cVreartlt aclr e s r br o e , x 013 ..,.�. � .,jiz * ' sa - _ff } � . } Q� �, 711 ��+, 11 ., +� ,l `P * r' ak •et• . .��YJa ��` .,4 � r r llll� M VV Co ENVIRONMENTAL HEALTH . Facility Programs MOBILE HOME AND PARKS SERVICES (3 54) 0 . 14 40 100 2,399 25056 2,399 2,056 7,280 111630 81F910 SWIMMING POOLSBATHING (360) 1 . 04 329 869 181572 155918 18,572 15,918 465544 227436 68,980 BIOMEDICAL WASTE SERVICES (364) 0. 53 236 245 81 7,393 85625 7,393 21 ,999 103037 325036 TANNING FACILITY SERVICES (369) 0 . 04 10 22 656 563 656 563 13688 750 23438 Group Total 2 . 78 790 11878 49, 156 42, 134 495156 425134 107,450 7510130 1825580 Groundwater Contamination STORAGE TANK COMPLIANCE (3 55) 0 .21 8 19 4,285 35673 4,285 39673 1 ,347 145569 15 , 916 SUPER ACT SERVICE (356) 0. 19 170 240 31F510 31F009 35510 31009 7,267 5 , 771 13 ,038 Group Total 0, 40 178 259 7, 795 63682 71795 61 81614 20,340 285954 Community Hygiene TATTOO FACILITIES SERVICES 0. 01 0 20 196 168 196 168 683 45 728 COMMUNITY ENVIR. HEALTH (345) 1 . 53 0 300 23 ,376 205036 231F376 20,036 191F419 67,405 86, 824 INJURY PREVENTION (346) 0 . 00 0 29 40 34 40 34 52 96 148 LEAD MONITORING SERVICES (350) 0 . 00 2 4 25 21 25 21 41 51 92 PUBLIC SEWAGE (362) 0 .20 5 120 35539 35033 3 , 539 31033 0 13 , 144 13 , 144 SOLID WASTE DISPOSAL (363) 0. 04 0 14 910 780 910 780 0 3 ,380 39380 SANITARY NUISANCE (365) 0 . 05 13 32 722 619 722 619 0 21682 23682 RABIES SURVEILLANCF/CONTROL SERVICES (366) 0 . 34 45 125 6,453 55531 6,453 51531 0 231F968 231F968 ARBOVIRUS SURVEILLANCE (367) 0 . 01 0 0 180 154 180 154 0 668 668 RODENT/ARTHROPOD CONTROL (368) 0 . 01 0 20 237 203 237 203 0 880 880 WATER POLLUTION (370) 0 .25 0 480 5 ,002 4,288 51002 41288 0 181F580 18, 580 INDOOR AIR (3 7 1 ) 0 . 04 0 70 829 710 829 710 0 3 ,078 31078 RADIOLOGICAL HEALTH (3 72) 0 . 01 0 0 282 241 282 241 0 17046 13046 TOXIC SUBSTANCES (373 ) 0 .41 82 125 714638 61F547 7,638 6, 547 0 285370 28 ,370 Group Total 2 . 90 147 11339 491F429 1 491F429 4211365 203195 163 ,393 1831 ENVIRONMENTAL HEALTH SUBTOTAL 11 . 91 21738 95859 2163444 1855523 216,444 1851 346,365 457, 569 803 ,934 D. NONI, OPERATIONAL COSTS : NON=OPERATIONAL COSTS (599) 1 . 00 0 0 19,249 16, 504 191F249 161504 0 713506 715506 ENVIRONMENTAL HEALTH SURCHARGE (399) 0 . 00 0 0 8,608 75378 8 ,608 7,379 312973 0 3112973 vON-OPERATIONAL COSTS SUBTOTAL 1 . 00 0 0 27, 857 2311882 27, 857 23 , 883 31 ,973 711 1033479 TOTAL CONTRACT 141 . 60 43 ,276 325, 609 2,433 , 682 21F0861018 2,4335682 2, 086,019 3 ,280,009 55759,392 93039,401 /ersion : 2 Page 2 of 2 ATTACHMENT III A TRUE COPY INDIAN RIVER COUNTY HEALTH DEPARTMENT CERTIFICATION ON LAST PAGE CIVIL RIGHTS CERTIFICATE J . R . SMITH , CLERK 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 : 1 . 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 . A TRUE COPY CERTIFICATION ON LAST PAGE 1 . R SMITH . CLERK ATTACHMENT IV INDIAN RIVER COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned By Clinic , Dental , Vital Statistics , 1900 27th Street County of Environmental Health , WIC , Vero Beach , FL 32960- 3383 Indian River Administrative Headquarters 36 , 475 sq . ft . Gifford Health Center 46752 8th Court Indian River County 10 , 642 sq ft Vero Beach , FL 32967- 1330 Hospital District Co- Located Site : WIC 21 South Cypress Street City Of Fellsmere Fellsmere , FL 32948-6714 ATTACHMENT V INDIAN RIVER 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 2010-2011 $ $ $ _ 2011 -2012 $ $ $ _ 2012 -2013 $ $ $ _ 2013-2014 $ $ $ _ 2014-2015 $ $ $ _ PROJECT TOTAL $ - $ _ $ _ SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN PROJECT NAME : N 1 A LOCATION/ ADDRESS : PROJECT TYPE : NEW BUILDING ROOFING RENOVATION PLANNING STUDY NEW ADDITION OTHER SQUARE FOOTAGE : PROJECT SUMMARY: Describe scope of work in reasonable detail, ESTIMATED PROJECT INFORMATION : START DATE (initial expenditure of funds) : COMPLETION DATE : DESIGN FEES : $ CONSTRUCTION COSTS : $ FURNITURE/EQUIPMENT $ TOTAL PROJECT COST: $ - COST PER SQ FOOT: $ #DIV/0 ! Special Capital Projects are new construction or renovation projects and new furniture or equipment a ose prolec+�nbile health vans . RIDA INDIAN RIVER COUNTY THIS IS TO CERTIFY THAT THIS A TRUE AND CORRE COPY F THE ORIC? INA ON LE T S ; J ; OFFICE . - ; p : JEF MIT ER ' V 4 • * ; D . C . /J DATE L ••'0/1 RNEago cioQ7