Cabell-Huntington Health Department

Annual ReportJuly 1, 2014 – June 30, 2015

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Officers and DirectorsCabell-Huntington Board of Health

Thomas Gilpin, Atty, Chairman

J. Larry Crawford

Harriette Cyrus

Donna Rumbaugh

Omayma T. Touma, MD

Kevin Yingling, MD

Terms

Harriette CyrusDemocrat

Tom Gilpin - BOARD CHAIRRepublican

J. Larry CrawfordRepublican

Omayma T. Touma, MDDemocrat

Donna RumbaughDemocrat

Kevin Yingling, MDDemocrat

1-1-13 to 12-31-17

**County appointed is limited to two (2) full terms. City appointed has no term limit

1-22-07 to 12-31-11

1-1-08 to 12-31-12

1-1-14 to 12-31-18

1-1-12 to 12-31-12

1-1-14 to 12-31-18

1-1-12 to 12-31-16

1-1-12 to12-31-16

1-1-13 to 12-31-17

4

County

county

8

2

county

2

2

5

3

1

5County

7

7

61

26

1

58

City

County

County

City

City

CityCouncil District (Ward)Board Member Appointed Re-Appointed City/County Precinct Magisterial

District

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Cabell-Huntington Health Department

Physician Director

Harry K. Tweel, MD July 1 – October 31, 2014

Kevin McCann, MD (interim health officer) November 1, 2014 – April 30, 2015

Michael E. Kilkenny, MD, MS May 1, 2015 – June 30, 2015

Administrator

Tim D. Hazelett

Departmental Directors

Jack Mease, CPAAccountant

Kathleen V. Napier, RNDirector of Nursing

Stanley B. Mills, RS, MSEnvironmental Program Manager and Threat Preparedness

Elizabeth Ayers, MSDirector, Health and Wellness

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Organizational Chart

5

Physician Director’s ReportThe fiscal year began July 1, 2014 anticipating the retirement of Dr. Harry Tweel,

physician director for the previous 10 years. Accreditation efforts had started, the health department was beginning to measure its media presence and was doing an inventory of its employee culture. Organizational transition was underway. The “P-card” was coming into widespread use. The health department was in sound financial condition. Lacrosse encephalitis was discovered in Cabell County mosquitoes, the first indication of its presence in the county. Family planning services were increasing after hiring a Nurse Practitioner for the clinic. TB was on the decline. Hepatitis B and C were on the increase. Healthy food choices were being promoted and classes in chronic disease management were being organized in Huntington. The health department was doing its job, and doing it well.

As fall approached, auditors presented the health department with its first “clean” audit, affirming changes that had been made in financial management. Through the fall, accreditation efforts intensified, organizational culture was assessed and leadership adjusted to the findings. The health department was adding data-driven decision making to an already strong experience base. Organizational transition was accelerating. Chronic disease classes started, educating community members about living with and managing diabetes. A successful flu vaccination drive was held. Ebola response was developed and training held. While the search continued for a full time physician director, Dr. Kevin McCann became acting physician director, in addition to his duties as part time physician director in Wayne County. Tim Hazelett, administrator, ably assumed the burden of daily leadership while the Board of Health actively adjusted the physician director recruitment effort. Foreseeing future funding challenges, the board directed the exploration of alternative funding sources.

Winter saw further organizational development. The environmental services department delivered a program to the board and attending staff defining its scope of work and duties. Pay periods shifted from twice a month to biweekly. A syphilis outbreak was being characterized and managed. A new physician director was identified and the hiring process begun. The Huntington Mayor’s Office of Drug Control Policy was educating public groups about the epidemic of heroin use, associated crime, overdose and death. Grass roots organizers were also meeting with a huge outpouring of public support for interventions to address the many issues associated. The health department attended multiple meetings and was enlisted to intervene in the growing Hepatitis B and C problems by exploring a syringe exchange program, never before done in West Virginia. The strength of the organization was shown by its ability to not only continue its duties in providing essential services, but to undertake and develop a ground breaking intervention for an emerging public health crisis, and to do this in the absence of a full time physician director.

The legislative session dominated attention early in the spring of 2015 with threats to public health in the form of attempts to allow the sale of raw milk and to reverse clean air

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regulations by allowing smoking in more public spaces. Both of these efforts were defeated. Some Health Department staff were certified as chronic disease education specialists, able to provide certified classes in disease management and train others to do likewise. IV drug abuse related disease continued to increase as regional and national data were being published supporting local findings. Dr. Michael Kilkenny assumed the physician director’s position on May 1, 2015. His leadership presence was able to catalyze processes already in process so that the timeline to apply for accreditation in December 2016 was moved forward one year to 2015. Plans for a syringe exchange developed into a harm reduction program with partner agencies capable of providing education, testing, treatment, counselling, and referral services as well as clean syringes. All the while, the core work of the health department continued.

In all, the year has been a strong one for the Cabell-Huntington Health Department. The board of health challenges, questions, suggests, advises, supports and strengthens the health department as measured in the contents of the meeting minutes and lists of attendees and guests. The organizational transformation has been phenomenal, measured by volumes of documents and felt in the tone of meetings. From our presence in the offices of our partners to our measurable presence in the media, we are engaging our community. Stronger public health is the outcome of these efforts. Delivery of essential services is strengthened by these efforts. Innovative approaches to new challenges are developed by these efforts. Results are measured by these efforts. Moving forward, we will celebrate our successes and we will learn from our failures. We will adapt and innovate. Sometimes we will follow, and sometimes we will lead, but always for the better health of the citizens of Cabell County and Huntington, West Virginia.

Michael E. Kilkenny, MD, MS, Physician Director.

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Administrator’s Report

Department TitleNumber of Positions

Full Time (1.0 FTE) Part Time Total FTEs

Physician Director 1 1.00 1.00Administrator 1 1.00 1.00Accountant 1 1.00 1.00Secretary 1 1.00 1.00Maintenance Workers 2 2.00 2.00Director 1 1.00 1.00Nurse Practitioner 1 1.00 1.00RN 3 3.00 3.00RN 3 0.75 0.75LPN 1 1.00 1.00LPN (Part Time) 1 0.25 0.25Clerks (Full Time) 4 4.00 4.00Clerks (Part Time) 3 1.20 1.20Program Manager 1 1.00 1.00Sanitarion Supervisors 2 2.00 2.00GIS Programmer 1 1.00 1.00Sanitarians 9 9.00 9.00Clerks (Full Time) 2 2.00 2.00Director/PIO 1 1.00 1.00Accreditation Coordinator/Grant Specialist1 1.00 1.00Regional Tobacco Prevention Coordinator1 1.00 1.00

Other Epidemiology 1 1.00 1.00Total Positions 42 35 2.2 37.2Annual Payroll $1,541,373.00

Environmental

Health and Wellness

CHHD Clinic

Administration

Cabell-Huntington Health Department Personnnel Report 2015

2015 Turn Over by DepartmentDepartment Turn Over Number of Employees RateAdministration 3 6 50%Clinic 5 17 29%Environmental 1 15 7%Health and Wellness 1 3 33%Other 0 1 0%Total 10 42 24%

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2015 Turn Over by Department - Permanent EmployeesDepartment Turn Over Number of Employees RateAdministration 2 6 33%Clinic 2 17 12%Environmental 1 15 7%Health and Wellness 0 3 0%Other 0 1 0%Total 5 42 12%

2

2

1

2015 Permanent Employee Resignation Reason

RelocationRetirementNew Position

2015 Turn Over by Rate Temporary EmployeesDepartment Turn Over Number of Employees RateAdministration 1 6 17%Clinic 3 17 18%Environmental 0 15 0%Health and Wellness 1 3 33%Other 0 1 0%Total 5 42 12%

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Capital Expenditures

New generator installation South wall repair

o Brick and morter restorationo Lintel repair and restorationo Covering of elevator and basement windows with block

West Wall Repairo Brick and morter repair and restoration

North and East Wall repairo Brick and morter resoration on the east wallo Repair to wall covering on the front and east walls

Pressure wash entire building Window cleaning and minor repairs Developed an IT tunnel with Radiology Incorporated to transmit x rays electronically in a

secure manner Restriction and security access to fourth and fifth floors

1

1

2

1

2015 Temporary Employee Resignation Reason

PersonalNew JobPosition EndedRelocation

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o Restricted access to the clinic in rear of building with electronic access only Exploration of the energy reduction plan – implementation in stages in 2016 and

forward

Training and Education (agency wide, this is not department or specialty specific)

Active Shooter Training Driver’s Training HIPAA Privacy Training HIPAA Security Training Blood Borne Pathogen Training Harm Reduction Training – Office of Drug Control Policy Public Health Improvement Training – PHIT Quality Improvement and Performance Management

Programs

Signed and implemented the Service Level Agreement with the West Virginia Division of Personnel

Developed and executed the Cabell-Huntington Health Department Core Value Survey Implememented and completed the Dennison Culture Survey Institued a West Virginia Division of Personnel overtime policy for CHHD Developed and executed CHHD Departmental Plans

o These plans were integrated into the Strategic Work Plan approved by the Board Developed the Cabell-Huntington Health Department Leadership Team

o Established the CHHD Leadership Code of Conduct Established a Program Model

o This model provides the authority, autonomy and support for each department head to lead and guide their respective department

Adopted the Marcus Buckingham “First Break All the Rules” business model with a high emphasis on two of his 12 principles that focus on expectations and accountability

o Do I know what is expected of me at work?o Do I have the materials and equipment I need to do my work right

These two principles will set an organization in motion to achieve greater things

Established and launched the Regional Health Connect Harm Reduction Plan

o Researched and moved towards the implementation of a Harm Reduction Program

Continually strenghtened community partnerships Established a high expectaiton on increasing the value of the Cabell-Huntington Health

Departmento Community partnerships

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o Community Trainingso Community Outreach Clinicso Strengthen media relations

Set expectations on media events Tracked media impressions

Establishing a culture of performance management Empowered employees to look, challenge and question quality improvement Established the groundwork to Accreditation

o Moved all systems, work and outputs towards accreditation readiness Established new working relationships with Marshall Univeristy

o Career Serviceso MU School of Businesso MU School of Public Healtho MU School of Medicineo MU School of Pharmacy

Integrated a new Physician Director into the Cabell-Huntington Health Deparmento New visiono New managemento New Programso New way of doing businesso Strengthened the programmatic model

Continue to look at the systems, models and program to assess the impact on the community in terms of public health

Narrative

Significant changes have occurred at the Cabell-Huntington Health Department in 2015. Two areas stand out when speaking of these changes, accountability and empowerment. We have put a high level of emphasis on the programmatic model and allowed the department directors to own their respective division. The Board of Health reports have adapted to increase the outputs of the organization. The Cabell-Huntington Health Department developed the accreditation readiness strategy for applying for accreditation in late 2015. I am pleased with the changes this organization has implemented and the engagement from the staff. A change in leadership occurred in May, 2015. This commonly causes an organization to become conservative in approach and slow progress. The changes that occurred and the addition of Dr. Kilkenny has made this a stronger organziation. The integration of Dr. Michael Kilkenny in May of 2015 was seamless and efficient. The path of the organzitional model continued with no interruption of work.

We gained a lot of momentum in 2015. We have assessed our gaps, developed leaders and experts in the organization and had a significant impact on our community. The objective is simple. We must continue to increase our value through strategic planning, strengthening

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partnerships and imroving the public health of Cabell County. We must focus on our vision of “healthy people living and working in a healthy community”.

As the Board of Health, I certainly hope you have been able to see and feel the transformation this organization has made in 2015. The energy and passion for public health is evident on a daily basis. The staff has adapted and accepted the challenges during this year of change. The resiliency and effectiveness displayed shows our potential, abilities and our effectiveness. We feel continued growth will occur over the next few years. I want to commend the Cabell-Huntington Board of Health for your support, engagement and being outstanding members our team. I am looking forward to 2016!

Timothy D. Hazelett, Administrator

Health and Wellness

The establishment of Cabell-Huntington Health Department’s Health & Wellness Department began in 2014 to increase health promotion activities and to build a chronic disease section. In February 2015 an accreditation and grant coordinator was added to this department to help prepare the health department for accreditation and to research available grants to support programs and revenue.

TRAINING- Total Hours = 98

60

52

24

16

Division of PersonnelExcelHIPPAChronic DiseaseDrivers EducationSocial Media

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CHRONIC DISEASE PROGRAM- Over the past year several chronic disease classes and trainings were offered to the community and health department employees.

Community Leaders Trained – 36 Total

CDSMP DSMP DPP Master

1618

2

*CDMSP-Chronic Disease Self-Management Program *Diabetes Self-Management Program * Diabetes Prevention Program

Chronic Disease Classes Offered- 29 Participants (CDSMP & DPP)

Huntington Health & Rehab

Roxanna Booth Ceredo Manor CHHD-DPP0

2

4

6

8

10

12

14

COMMUNITY OUTREACH- Numbers represent total health fairs attended and how many individuals served along with community meetings attending. **Started tracking health fairs in January 2015. Clinic reported previously**

8 Health Fairs Served over 1,680 individuals Community Meetings Attended = 80

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MEDIA IMPRESSIONS- Numbers represent total media impressions from January 2015-June 2015 TOTAL= 5,962,177 83% EARNED Media!!!

January February March April May June

849,000

680,200

1,077,378940,489

1,211,662 1,203,448

EMPLOYEE WELLNESS Worked with PEIA to enhance CHHD employee wellness program. Employees were offered a 16 week onsite workout class with a certified fitness instructor. 5 employees participated.

Employees who were at risk for pre-diabetes were encouraged to take a 20 week diabetes prevention program (DPP) during work hours. About 29% of the employees who signed up for the program completed it.

COMMUNITY TRANSFORMATION GRANT (CTG)

The health & wellness department accepted reasonability for the Region 4 (9 counties) CTG statewide program. The grant had 3 strategic directions which focused on 1). Strengthen clean indoor air regulations 2). Implement healthy checkout aisles at grocery and convenience stores as well as support farmer’s markets. 3). Focus on chronic disease to implement classes and trainings across the region.

2014 Program Highlights -Supervised 2 prevention coordinators –Signed on 13 grocery stores, 2 farmer’s market and 7 convenience stores to implement healthy checkout aisles -Provided tobacco materials to enhance educational learning -Performed 4 air quality checks in Mason & Wayne Counties -Provided support to 40 local coalitions throughout the region -Created and maintained marketing strategy across the 9 county region -Provided and supported training opportunities in chronic disease programs -Supported chronic disease classes (DPP, CDSMP & DSMP)

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-Assisted Huntington YMCA Kids in Motion program with their data tracking –Provided state and county legislators with tobacco education

GRANTS

A new position of grant writer was established during the latter six months of the fiscal year.

The total number of grants submitted – 2 (AmeriCorps and Komen) Total funded-$509,098.00

Casey L. Napier, Accreditation Coordinator/Grant Specialist

Program Area Funding AmountEnvironmental (Regional Epidemiology) $80,000.00

Clinic (TB) $1,400.00

Environmental (Threat Prep) $120,919.00

Health and Wellness (Regional Tobacco Prevention)

$110,500.00

Clinic (Immunization) $52,089.00

Administration (WV Local Health Consultant) $74,000.00

Clinic (Hepatitis B) $29,000.00

Environmental (Medical Reserve Corps) $3,500.00

Health and Wellness (Volunteer WV) $41,190.00

TOTAL $ 509,098.00

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ACCREDITATION

Accreditation Readiness Process has: Helped us to recognize successes and opportunities for improvement Helped us to assess performance against national public health standards

Increased our collaboration with community partners and stakeholders Promoted continuous quality improvement of the services we provide in the community

2014-2015 Accreditation Readiness Achievements: Accreditation Coordinator hired Consultant hired to support the Accreditation preparedness process Established three Domain Workgroups to evaluate and collect documentation Sustain Planning Actions Coordinating Team (PACT) to drive overall agency accreditation

efforts Evaluate and reaffirm the agency’s core values, vision and mission Updating Strategic Action Plan each quarter Update Cabell County Community Health Assessment Launch and support Regional Health Connect, to enable monthly meetings and

engagement of community partners to prioritize addressing the most critical population health needs

Conduct Quality Improvement Projects

Elizabeth A. Ayers, MS, Director of Health and Wellness

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Regional Tobacco Prevention Coordinator Report

Educational Outreach and Cessation Education for 2014-2015

Cabell County -11 events reaching 804 people

Lincoln County- 2 events reaching 45 people

Logan County- 3 events reaching 172 people

Mason County- 4 events reaching 460 people

Mingo County- 3 events reaching 190 people

Wayne County- 3 events reaching 308 people

Community Meetings for 2014-2015 Total of 126 Meetings

Cabell County- 24 Lincoln County- 18 Logan County-24 Mason County-20 Mingo County-16 Wayne County-24

Cessation Classes

Agency County Attendees

SPOKES for Workforce WV Mason 9

Marshall University Cabell 47

Coalitions by County

Mini Grant

Pursuing Clean

Average members

BOH meetings

Public Forums( CI

Cessation specific events/ attendees

18

recipient Indoor Air attending attended( by designee

A/SHS)attendees

Cabell County Coalition for Tobacco Free Environment

yes no 14 yes n/a 4/9 attendees

Lincoln County Prevention Coalition

no no 19 yes n/a n/a

Lincoln County Youth Prevention

no 19 yes no n/a

Logan County P.I.E.C.E.S

yes 19 yes no n/a

Mason County Anti-Drug Coalition

no yes 23 yes One/35 3/47 attendees

Mason County Health and Wellness Coalition

no no 11 yes n/a n/a

Mingo County Health and Wellness Coalition

yes no 11 yes n/a 1/7 attendees

Wayne WATCH(Wayne Awareness Toward Cancer and Health Coalition

no yes 13 yes One/2 23/18 attendees

Teresa D. Mills, Regional Tobacco Prevention Coordinator

Clinic Report

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Non-flu Immunizations Influenza Immunizations0

1000

2000

3000

4000

5000

6000

7000

8000

Immunizations Given

2013-14 2014-15

For 2014-15, total immunizations decreased due to a decline in flu vaccines given. Non-flu immunizations increased by over 6%. The number of state supplied influenza vaccine doses was 92% less than the previous year.

In 2014-15 we saw a 12% increase in Family Planning patients. While the number of patients increased, the number of individual services provided were approximately 4% less. This appears to be due to more women receiving Long Acting Reversible Contraception (LARC). We distributed more condoms and had fewer positive pregnancy tests than the previous year.

Family Planning Patients0

500

1000

1500

2000

2500

2013-142014-15

20

Breast and Cervical Cancer Screening Program0

10

20

30

40

50

60

70

80

90

2013-142014-15

In 2014-15 we saw approximately 40% fewer patients in the Breast and Cervical Cancer Screening Program than the previous year. That is likely attributed to the Affordable Care Act since patients served by this program are uninsured.

STI Visits Chlamydia Screening Syphilis Screening Gonorrhea Screening0

200

400

600

800

1000

1200

1400

1600

1800

2000

2013-142014-15

In 2014-15 there was an increase of 3% in the number of clients seen for STI visits. Although there were slightly fewer screenings conducted for Chlamydia and Syphilis there was an 18% increase in the number of positive Chlamydia cases and a 13% increase in our Syphilis cases. There was an 11% decrease in positive Gonorrhea cases in 2014 compared with 2013.

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TB Contacts Investigated TB Testing Risk Assessment0

500

1000

1500

2000

2500

3000

3500

2013-142014-15

2014-15 saw a significant decrease in the number of TB case contacts investigated. Due to a shortage of Tubersol in 2013-14, risk assessments were conducted to determine those at high risk for tuberculosis. Due to the fewer number of TB contacts investigated we also saw a significant decrease in the number of people who needed to be treated for active or latent tuberculosis disease.

Clinic Services Provided◊ Child, Adolescent and Adult Immunizations◊ Breast and Cervical Cancer Screening Services

◊ Family Planning Services◊ Pregnancy Testing◊ Tuberculosis Screening◊ STI Screening and Treatment ◊ HIV Testing◊ Contact Investigations◊ Titers and Screens ◊ Adult Hepatitis Vaccine◊ Immigration Screening and Immunization

Community Outreach◊ Huntington Treatment Center ◊ Her Place◊ Recovery Point◊ University OB/GYN◊ Marshall Medical Outreach◊ Marshall University Student Health

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◊ Flu Clinics conducted at 49 locations throughout Cabell County◊ Participated in Health Fairs

Staff Education and Training◊ Immunization Summit◊ NDPP Lifestyle Class◊ Mental Health for Veterans Training◊ HIPAA Security Training◊ CPR Certification / Blood Borne Pathogen Training◊ Women’s Health Conference◊ HIV Conference◊ WV Free Options Counseling◊ HIV Training◊ WV Security Awareness Training◊ Neurological Trauma in Victims of Violence Training◊ WV AFP Conference◊ Mass Antibiotic Workshop◊ Spring Teaching◊ Infectious Disease Symposium◊ Sexual Assault Nurse Education Training◊ Active Shooter Training◊ Drivers Training◊ Hands Only CPR Training◊ CHHD Sponsored Computer Training

Kathleen V. Napier, RN, Director of Nursing

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Environmental Report

744

3083

3248

377

1826

292 220

FY 2015 Sanitarian Activities

Complaints Inspections Visits Notices IssuedFood Handlers Trained Samples Animal Bites

24

Dogs Healthy

Dogs Not Located - no shots

Cats Healthy

Cats Not Located - no shots

Bats - Not Located - taking shots

Raccoon Not Located - no shots

Fox tested - negative

0 20 40 60 80 100 120 140115

68

234

114

1166

16

11

FY2015 Animal Exposures

Campylobacte

r

Carbapenem-resis

tant Enterobacte

riace

ae

Group B Streptoco

ccus

Haemophilus i

nfluenza

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis

Giardia

Legionella

Listeria

Lyme's

Disease

Pertussi

s

Salmonella

Shigella

Streptoco

ccal p

neumonia0

10

20

30

40

50

60

70

14

2

12

3 2

65

19

30

1 1 1 1 36

1

19

FY 2015 Infectious Diseases

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ENVIRONMENTAL HEALTH / THREAT PREPAREDNESS FY 2015 REPORT

Bed Bugs – A great deal of staff time was spent trying to abate bed bug complaints. No one is spared from these insects. We also dealt with issues of over treating with pesticides where individuals were sickened by the sprays.

Subdivision issues – This year long project of getting gallons of sewage out of the creek finally has been corrected with the help of the Federal Bankruptcy Court.

Mosquito trapping – Staff trapped and identified over 13,000 adult mosquitos. We had mosquitoes that tested positive for West Nile Virus and for the first time, Lacrosse Virus.

Public Health Students – we had 5 students from the Public Health Program at Marshall University work with our staff on several different projects over the past year.

Food Standardizations – All sanitarians were standardized in Food service inspections for the first time. We are all performing inspections in a consistent manner.

Food borne illness trainings – All sanitarians were trained on the most current techniques for investigating food borne illnesses.

Risk based inspections – The sanitarians have begun inspection food service operations, using a new philosophy; keying in on those issues that create food borne illnesses.

Sewage Treatment Issues – A community is served by a failing community sewage system. The Public Service Commission and the Department of Environmental Protection have turned this issue to the CHHD for completion.

Four Pole Creek Watershed – staff have become active with the Four Pole Creek Watershed, trying to find the sources of pollution that are present in the watershed and correct them.

Solid Waste Survey – A survey of all the dumpsites in Cabell County was completed and mapped.

Radiological Trainings – All staff were trained on radiation awareness, radiation source detection and identification and

Ebola – This year we were tasked with being able to monitor individuals returning to the US after being in counties where the disease was rampant.

Home Aeration Unit Survey – Staff completed a survey of all the home aeration systems. We found a great percentage of the units that were not working and took actions to make sure the owners repaired them.

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Clean Indoor Regulation Legislation – There was a strong movement in the WV Legislature to overturn Clean Indoor Air regulations and allow smoking in various public venues. We were able to defeat these bills with a lot of very hard work!

Skin Rash from a Hot Tub – There were two families who had rashes after using a hot tub at a local recreational water facility. After a thorough investigation of the pool and interviews with the family, it was determined that the pH levels on the water in the hot tub was too basic and the family wore the wets suits for several hours after using the hot tub.

Special Processes at Retail – Sanitarians were trained on the complexities of processes, such as, drying, fermentation, vacuuming packing, etc.

Drug Rehabilitation Dwellings - After some legal challenges, we have now been able to inspect all these dwellings and are working with the owners on bringing them into compliance.

Pet Sheltering Drill – Our Cabell-Wayne MRC has taken on the role of managing pet shelters during an event where people and their pets would have to move into temporary housing.

Welcome Center Training – Several staff attended training on how to run a Reception Center for volunteers during an adverse event.

HSEEP Training – Several sanitarians attended and completed the Homeland Security Exercise and Evaluation Program training. We are now qualified to design our drills.

Boy Scout Camp – The failing sewage treatment plant was replaced with an alternative “green” septic tank- soil absorption system.

Stanley B. Mills, RS, MS

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Financial Report

Revenue

County Levy $ 1,365,662

State Aid 724,166

Federal Grants 277,714

State Grants 218,398

Clinical Service Revenue 159,380

Other Revenue 83,421

Capital Contributions 472,418

Total Revenue $ 3,301,159

41%

22%

8%

7%

5%

3% 14%Revenue 2015

County LevyState AidFederal GrantsState GrantsClinical Service RevenueOther RevenueCapital Contributions

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ExpensesSalaries $ 1,563,307 Fringe Benefits 579,465 OPEB 62,248 Administration/Environmental Health 107,337 Advertising 21,900 Building Maintenance & Expenses 206,303 Clinic Supplies 231,350 Contracted Services 81,619 Equip. Maintenance & Repairs 45,300 Grant Program Expenses 177,079 Transportation 47,629 Training 30,587 Utilities 57,693 Depreciation 89,342

Total Expenses $ 3,301,159

47%

18%2%

3%1%

6%

7%

2%1%

5%

1% 1% 2%3%Expenses 2015 Salaries

Fringe BenefitsOPEBAdministration/Environmental HealthAdvertisingBuilding Maintenance & ExpensesClinic SuppliesContracted ServicesEquip. Maintenance & RepairsProgram ExpensesTransportationTrainingUtilitiesDepreciation

Jack W. Mease, CPA