HomeMy WebLinkAboutAgenda - 06-26-1995 - VIII-L 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No. `L
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 26, 1995
SUBJECT: 1995-96 Contract Between the NC Department of Environment, Health
and Natural Resources and the Orange County Health Department.
DEPARTMENT: HEALTH PUBLIC HEARING: _ Yes X No
ATTACHMENT(S) : INFORMATION CONTACT:
HEALTH DIRECTOR'S OFFICE X2411
(1) Twelve Page Contract TELEPHONE NUMBER:
(2) Federal Assurance Agreements Hillsborough -732-8181
(3) Local Health Department Budget Pages Chapel Hill -968-4501
Mebane -227-2031
Durham -688-7331
PURPOSE:
To approve the annual consolidated contract.
BACKGROUND:
The attached contract stipulates the state contract support in the amount of Four
hundred ninety-one thousand fourteen dollars ($491,014) for the following
programs in FY 1995-96:
General CSHS Orthopedic
Communicable Disease MCH Block Grant Nutrition
Tuberculosis Maternal Health
AIDS (Federal) Child Health
Family Planning Adult Health
Child service Coordination Breast & Cervical Cancer
Immunization Action Plan Health Promotion
Environmental Health
Each year the state contracts with the health department to render specified,
mandated services. The attached contract outlines the terms in dollar amounts
for each program activity as well as local allocations and revenues which support
these mandated services. Minor changes in the contract terms are acceptable and
do not substantially alter the working relationship.
RECONOMATION(S): The Manager recommends that the Board approve the
contract, subject to the endorsement of the county
attorney and county purchasing director and authorize
the Chair to sign the contracts, assurances and budget
pages.
Page 2
CONSOLIDATED CONTRACT
BETWEEN
THE STATE OF NORTH CAROLINA
AS REPRESENTED BY
THE DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
(Hereinafter called the "State")
AND
ORANGE COUNTY HEALTH DEPARTMENT
(Local Health Department -- Hereinafter called the "Department")
FOR THE PURPOSE OF
MAINTAINING AND STIMULATING THE ADVANCEMENT OF
HEALTH IN NORTH CAROLINA
This Contract Shall Cover a Period From
July 01, 1995 to June 30, 1996
NOW, THEREFORE, the State and the Department agree that the provisions and clauses herein set forth shall
be incorporated in and constitute the terms and conditions applicable for the following activities involving
State funding. (State funding or funds means state, federal, and/or special funding or funds throughout this
contract.)
ACTIVITY ACTIVITY
General Comp Breast and Cervical Cancer Control
Transfer of Escrow Adult Health
Communicable Disease Health Promotion
Aids Immunization Action Plan
Environmental Health
Food and Lodging
Maternal Health
Family Planning
Child Service Coordination
CSHS Orthopedic
Child Health
MCH Block Grant Nutrition
DEHNR 2946(Revised 02/95)
Division of General Scrviccs (Rcview 0296)
Page 3
A. WORK TO BE PERFORMED
1. The Department shall perform activities in compliance with applicable program rules contained
in the North Carolina Administrative Code as well as all applicable Federal and State laws and
regulations.
2. The Department shall submit for approval the required Program Contract Addenda for State
funded budgets.
3. The Department shall submit completed reports as required by budgeted funding criteria and as
st)ecified in Listing, of Required Fiscal and Statistical Reports (Addenda 1).
4. The Department shall administer and enforce all rules which have been adopted by the
Commission for Health Services or approved by the State and adopted by the Local Board of
Health.
5. The Department shall provide to the State copies of rules adopted by the Local Board of Health
pursuant to G.S. 130A-39 and Public Health Ordinances adopted by the County Commissioners.
Copies of existing rules and ordinances shall be submitted to the State Health Director within
45 days. Thereafter, copies of rules adopted shall be submitted within 30 days of adoption.
6. The Department shall provide to the State a Community Diagnosis Prioritization of Problems
every biennium. The Department shall also provide a Community Diagnosis narrative, if
completed.
B. FUNDING STIPULATIONS
1. Funding for this contract is subject to the availability of State, Federal, and special funds for the
purpose set forth in this Contract.
2. During the period of this Contract, the Department shall not use State, Federal or Special Project
funds received under this Contract to reduce locally apyroariated funds as reflected in the Local
Health Department Budgets.
-- 3. The Department shall not use personal health program funds to support environmental health
personnel nor use environmental health program funds to support personal health programs.
4. Fees generated by the Food and Lodging fees collection program may only be used to support
Environmental Health activities.
5. Funds for Childhood Lead Poisoning Prevention may be used to support both environmental
health and child health activities.
6. The Department shall comply with Standards for Mandated Public Health Services, 15A NCAC
25, Section .0200; and Administrative Procedures Manual for Federal Block Grant Funds 1
NCAC 33, Sections .0100 - .1502.
7. The Department shall maintain employee time records for the contract period documenting the
portion of time that each employee attributes to each activity when State funds are budgeted for
the support of employee salaries and fringe benefits. The percentage of time each employee
spends in each activity shall be converted to dollars based upon the employees' salary and
Page 4 ,
benefits. These records will serve to document salary and benefit expenditures reported on
Forms DEHNR 2949 and DEHNR 2950, and compliance with Chapter 479, Section 99 of the
1985 Session Laws.
8. The Department participating in Medicaid Reimbursement shall:
a. Comply with the terms of the Interagency Agreement between the Division of Medical
Assistance, Department of Human Resources and the Department of Environment, Health,
and Natural Resources and the Provider Participation Agreement effective October 1, 1992
and any subsequent approved addenda or new Agreement approved and established during
the period of this contract.
b. Make every reasonable effort to collect its cost in providing services, for which Medicaid
reimbursement is sought, through public or private third party payors except where
prohibited by Federal regulations or State law. No one shall be refused services solely
because of an inability to pay.
9. The Department agrees to match the expenditure of Adolescent Pregnancy Prevention Project
grant funds with any in-kind source or newly generated funds, public or private available to the
project. Payment from the State shall be in accordance with G.S. 130A - 131.15 (d) (5) through
(8).
10. Funds budgeted for Adolescent Pregnancy Prevention Activities shall not be expended for dues
or out-of-state travel unless prior approval is received from the program.
11. Subject to the approval of the appropriate Division, a local health department may seek
reimbursement for services covered by a program operating under 15A NCAC 24A rules when
those services are not supported by other state or federal funds. All payment program rules and
procedures as specified in the Purchase of Medical Care Services manual must be followed.
12. Subject to the availability of funds and approval of the Office of Public Health Nursing, a local
health department may request reimbursement for:
a. Nursing service personnel participating in the Introduction to Principles and Practices of
Public Health and Public Health Nursing course (2 week course) and the Public Health
Nurse Supervisors Training Course (4 week course). Reimbursement is limited to no more
than $200.00 per week per participant upon successful completion of the course.
b. Community Health Assistants and Staff Nurse attending certain pre-approved Continuing
Education courses offered by the Office of Public Health Nursing. Reimbursement is
limited to $25.00 per participant per event.
13. The Department shall have an annual audit performed in accordance with The Single Audit Act
of 1984 as implemented by OMB Circular A-128. The audit report should be submitted to the
Office of the Controller within 6 months following the close of the contract. Audit findings and
resolution of said findings shall be handled by the Office of the Controller.
14. Equipment is a type of fixed asset consisting of specific items of property that: (1) are tangible
in nature; (2) have a life longer than one year; and (3) have a significant value.
• Page 5
a. For Budgeting and Reporting Purposes
1. Equipment purchases meeting the above definition and having an acquisition cost
of $500 or more must be budgeted and reported in Line Item 5000.
b. For Inventory Purposes
1. Equipment must be accounted for in accordance with Local Government Accounting
System Procedure No. 15.
2. Women, Infants and Children Program
All equipment with an acquisition cost of$500.00 or more must be inventoried with
the Division of Maternal and Child Health.
C. For Prior Approval Purposes
1. Equipment purchased or equipment leased where there is an option to purchase with
State/Federal funds must receive prior written approval from the appropriate
Division, Section, or Branch when the acquisition cost exceeds $500.00.
2. Women, Infants and Children Program
All medical equipment and computer equipment, regardless of cost and all other
equipment with an acquisition cost of$500.00 or more must receive prior approval
from the program office.
3. Equipment purchased with program income generated by the expenditure of Title
X Family Planning Funds with an acquisition cost of$500.00 or more must receive
prior written approval from the program.
C. FISCAL CONTROL
1. The Department shall comply with the Local Government Budget and Fiscal Control Act, North
Carolina General Statute Chapter 159, Article 3.
a. The Department shall maintain a purchasing and procurement system in accordance with
generally accepted accounting practices and procedures set forth by the Local Government
Commission.
b. The Department shall execute written agreements with all parties who invoice the
Department for payment for the provision of services to patients.
C. When subcontracting, the following conditions must be met:
1. The Department is not relieved of any of the duties and responsibilities provided in
this contract.
2. The subcontractor will agree to abide by the standards contained herein or to
provide such information as to allow the Department to comply with these
standards.
Page 6
3. The subcontractor will agree to allow state and federal authorized representatives
access to any records pertinent to its role as a subcontractor of the Department.
4. The Department will make available to the State upon request a copy of
subcontracts supported with State/Federal funds.
d. The Department shall receive prior approval from the State when subcontracting for
services in the Women, Infants and Children Program.
e. The Department shall retain all budgets, budget revisions, contracts, contract addenda, and
financial records in accordance with the current Records Disposition Schedule for County
and District Health Departments issued by the Division of Archives and History,
Department of Cultural Resources.
2. The Department shall prepare and maintain a budget for each activity covered by this contract
in a manner consistent with instructions provided with Forms DEHNR 3370 (Revised 2/93) and
DEHNR 2948 (Revised 2/93).
a. The Department shall prepare budget revisions for prior approval of the State when those
revisions are in the School Health Program (Line Item 6200).
b. The Department shall prepare budget revisions for prior approval of the State when State
funds will be increased or decreased.
C. The Department shall prepare an informational copy for the State of all other budget
revisions when proposed expenditures exceed the line amount budgeted.
d. The Department shall submit all revisions prior to the end of the term specified in this
Contract. Budget revisions received by the State after the end of the contract period will
be returned without action.
3. The Department shall observe the following conditions when budgeting and reporting earned
revenues:
a. All payments from persons, and public or private third party payors, shall be utilized for
the activity that generated the revenue and shall not reduce or replace locally appropriated
funds during the period of this contract.
b. All earned income must be budgeted in the program where earned, except that income
earned by a program which has no activity budget can be budgeted in a program approved
by the State.
C. All fees collected shall be used in the current year or succeeding fiscal years.
d. Use of program income generated by the expenditure of Federal categorical funds will be
governed by applicable Federal regulations, including but not limited to 45 CFR 74.
e. When budgeting:
i. Line item 9000 on the program budget must be used to budget the total of line
items 101, 102 and 103.
Page 7
ii. Line item 102 on the program budget must be used to budget TXIX earned
revenues.
iii. Line item 103 on the program budget must be used to budget other earned
revenues.
f. When reporting:
i. Line item 9000 on the Local Expenditure Report must be used to report the total of
line items 101, 102, 103.
ii. Line item 102 on the Local Expenditure Report must be used to report TXIX earned
revenues that were expended.
iii. Line item 103 on the Local Expenditure Report must be used to report other earned
revenues that were expended.
g. Line Item 6864 in Activity 4125, Transfer of Escrow Funds, shall be used to show
anticipated TXIX revenues only.
h. A local account shall be maintained for unbudgeted/unreported TXIX fees transferred to
the Department. Accounts shall be maintained in sufficient detail to identify the program
source generating the fees.
i. Title XIX revenues carried forward at the end of fiscal year 1996 may not exceed Title
XIX revenues earned during fiscal year 93-94 or $10,000.00 whichever is greater.
j. Program budgets that do not include an amount of TXIX funds sufficient to meet the
requirements of 3i. will not be approved by the State.
4. The Department shall submit a quarterly report of actual receipts and expenditures of the
Department according to instructions provided with Expenditure Reports, Form DEHNR 2949
(Revised 8/92) and Form DEHNR 2950 (Revised 2/93).
a. The Department shall submit quarterly expenditure reports to the State within 45 days
from the end of the reporting quarter.
b. The Department shall submit the final Expenditure Report to the State within 45 days after
the end of the contract period.
C. The Department shall submit amended or corrected expenditure reports within six (6)
months after the end of the contract period. Any such reports must be prepared for the
specific quarter to be amended or corrected. Reports received after December 31 will be
returned without action.
d. The Department shall refund to the State all State funds not supported by expenditures
within 45 days after notification of overpayment. When payment is not received by the
State within 45 days, future payments to the Department may be reduced by the amount
due or payments may be suspended until the refund is received by the State.
Page 8 '
e. The Department shall follow Women, Infants and Children Program and other Federal
program reporting requirements when they differ from those stated above.
f. The Department shall submit monthly WIC expenditure reports to the State no later than
the 8th of the following month.
g. Reimbursement of WIC approved expenditures for July, August, and September cannot
exceed one-fourth of the total budget for the contract period.
h. The Department shall submit monthly Maternal Outreach expenditure reports to the state
nu later than the 15th of the following month.
i. The Department shall submit expenditure reports for Mosquito Control activity in
accordance with 15A NCAC 1813, Sections .0104 and .0107.
j. The Department shall submit request for payment for services provided under 15A NCAC
24 A rules to the Claims Processing Unit, Purchase of Medical Care Services, DEHNR.
k. The Department shall submit request for reimbursement for nurse training to the Office
of Public Health Nursing. Form DEHNR 3300 - Public Health Nurse Training Activity
must be used as the invoice for payment.
5. The Department shall submit on an annual basis Staff Time Activity Report, DEHNR 3389. The
report shall accompany the final expenditure report and must be received by the State within 45
days after the end of the contract period.
D. PERSONNEL POLICIES
The Department shall adhere to and fully comply with State personnel policies as found in North
Carolina General Statute, Chapter 126, and 1 NCAC 8. Such policies include, but are not limited to,
the following:
1. Equal employment opportunity;
2. Affirmative action;
3. Policies for local government employment subject to the State Personnel Act;
4. "Local Classification and Salary Range";
5. "Compensation Policy for Local Competitive Services Employees"; and
6. "Recruitment and Selection Policy and Procedures";
7. Environmental Health Specialists employed by the Department shall be delegated authority by
the State to administer and enforce State environmental health rules and laws as directed by the
State pursuant to G.S. 130A-4(b). This delegation shall be done according to 15A NCAC 18A
.2300.
Page 9
a. Local health departments are responsible for sending their newly-employed environmental
health specialists (interns) to 40 days (8 weeks) of initial field training/orientation at the
training center within 180 days from date of employment.
b. Arrangements for initial field training/orientation for newly-employed environmental health
specialists will be handled by the Environmental Health Services Section, Division of
Environmental Health.
E. CONFIDENTIALITY
All information as to pe•3onal facts and circumstances obtained by Department personnel in connection
with the provision of services or other activity under this Contract shall be privileged communication,
shall be held confidential, and shall not be divulged without the responsible person's written consent
except as may be otherwise required by applicable law or regulation. Such information may be
disclosed in summary, statistical, or other form which does not directly or indirectly identify particular
individuals.
F. CIVIL RIGHTS
1. The Department shall assure that no person, on the grounds of race, color, age, religion, sex,
marital status, or national origin (unless otherwise medically indicated) or otherwise qualified
handicapped individual solely by reason of his/her handicap be excluded from participation in,
be denied the benefits of, or be subjected to discrimination under any program or activity
covered by this Contract.
2. The Department shall complete HHS Form 441, Assurance of Compliance with the Department
of Health and Welfare regulations, under Title VI of the Civil Rights Act of 1964; for the
Women, Infants and Children Program, FNS-64, Assurance of Compliance with the Department
of Agriculture Food and Nutrition Service, under Title VI of the civil Rights Act of 1964; and
HHS Form 641, Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973.
3. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate in
employment against a qualified individual with a disability and outlaws discrimination against
individuals with disabilities in State and local government services and public accommodations.
:.: The Department certifies that it and its principals and subcontractors will comply with
regulations in A.D.A. Title I (Employment), Title II (Public Services), and Title III (Public
Accommodations) in fulfilling the obligations under this agreement.
G. RESPONSIBILITIES OF THE STATE
1. The State shall provide to the Department upon request technical assistance in the preparation
of the Consolidated Contract/Activity Budgets and Contract Addenda.
2. The State shall specify those administrative forms/reports and their respective revision dates that
are required by particular activities pertaining to the Department's budget with the State in
Listing of Required Fiscal and Statistical Reports (Addendum 1) for the contract period. New
forms/reports not listed in Required Fiscal and Statistical Reports shall be implemented during
a contract period only with the approval of the State Health Director.
3. The State shall provide to the Department within thirty (30) days after receiving an activity
budget from the Department an approved signed copy of the budget.
Page 10
4. The State shall provide funds to the Department upon approval of the Contract Addenda, activity
budgets, and signing of this contract.
5. The State shall assist the Department to comply with all applicable laws, regulations, and
standards relating to the activities covered in this contract.
6. The State reserves the right to conduct reviews to determine compliance with the terms of this
contract.
7. The State shall be assured that the Department maintains expenditure of locally appropriated
funds for maternal health, child health, and family planning activities equal to or greater than that
reported on the Staff Time Activity Report for the period beginning July 1, 1984, and ending
June 30, 1985. This maintenance of effort shall be measured by salary equivalencies which are
to be maintained in accordance with Section B. 7. of this contract.
H. DISBURSEMENT OF FUNDS
The State shall disburse funds to the Department as follows:
1. For departments selecting monthly payments through the GMTS option - - -
Provided the Consolidated Contract is properly executed and all quarterly expenditure reports
are filed within the established time frames, payments equal to 1/12 of the total program
approved budget shall be made in the following months:
July August September October November January February April May
Based 'on expenditures reported for the first, second, and third quarters, payments shall be
adjusted either upward or downward, in payments made in the following months:
December March June
2. For Departments selecting monthly payments through the check option - - -
Provided the Consolidated Contract is properly executed and all quarterly expenditure reports
are filed within the established time frames, payments equal to 1/12 of the total program
approved budget shall be made in the following months:
July August September October December January March April June
Based on expenditures reported for the first, second, and third quarters, payments shall be
adjusted either upward or downward, in payments made in the following months:
November February May
3. For departments selecting quarterly reimbursement option, payments shall be made when the
quarterly expenditure report is received.
4. For departments receiving Rural Obstetrical Care Incentive funds, payment of such funds shall
be made in one lump sum the month following receipt and approval of the activity budget.
Page 11
5. For departments receiving Maternal Outreach project funds, payment will be based on actual
reported expenditures. Monthly payments will be made provided that expenditure reports are
received as required in C. 4. h.
6. Food and lodging fees will be disbursed to the department in one sum the month following
receipt and approval of the activity budget and any subsequent budget revisions.
7. Funds for Childhood Lead Poisoning Prevention will be disbursed once per quarter. The amount
will be determined by the number of confirmed cases identified in each county. Funds for
training will be disbursed upon request.
8. Funds for injury prevention projects will be disbursed in one lump sum during the first quarter
of the project budget approval.
9. Quarterly payment for reported expenditures in Line Item 1000 shall be limited to one-fourth of
the budgeted amount in that line item.
10. Increased or decreased payments necessitated by changes in the total budgeted amount will be
reflected in the monthly payments subsequent to approval of the budget revision.
11. Payments shall be suspended when expenditure reports are not received by the time specified
in C. 4. a and f. Payments will resume in the months subsequent to receipt of the expenditure
reports.
12. Payment is limited to the total amount of the budget by line item.
13. Final payments will be made based on the 4th quarter expenditure report. Final payments will
be equal to the difference between approved reported expenditures and the sum of previous
payments. Final payments should be made not later than September provided that an original
signed copy of an expenditure report for each quarter has been received by the Office of the
Controller. Final payment will be made only after the Staff Time Activity Report, DEHNR
3389, is received by the State.
14. Transfer of Title XIX Fees:
a. Title XIX fees received from Medicaid will be transferred to the Department as soon as
possible following receipt of payment to the State.
b. When fees received exceed the amount shown by program in Activity 4125 an internal
adjustment will be made to increase the amount shown.
I. AMENDMENT OF CONTRACT
Amendments, modifications, or waivers of this contract may be made at any time by mutual agreement
of all parties. Amendments shall be in writing and signed by appropriate authorities.
J. PROVISION OF TERMINATION
This contract may be terminated for reasons other than non-compliance upon sixty (60) days written
notice by either party. If termination should occur, the Department shall receive payment only for
allowable expenditures.
Page 12
The State may withhold payment to the Department until the State can determine whether the
Department is entitled to further payment or whether the State is entitled to a refund.
K. COMPLIANCE
1. The State shall assure compliance with all terms of this contract.
a. Upon determination of non-compliance, the State shall give the Department sixty (60) days
written notice to come into compliance. If the deficiency is corrected, the Department
shall submit a written report to the State which sets forth the corrective action taken.
b. If the above deficiencies should not be corrected to the satisfaction of the State after the
sixty (60) day period, disbursement of funds for the particular activity may be temporarily
suspended pending negotiation of a plan of corrective action.
C. If the deficiency is still not corrected within the next thirty (30) days following temporary
suspension of funding, program funds may be permanently suspended until the Department
can provide evidence that the deficiencies have been corrected.
d. In the event of the Department's non-compliance with clauses of this contract, the State
may cancel, terminate, or suspend this contract in whole or in part and the Department
may be declared ineligible for further State contracts or agreements. Such terminations
for non-compliance shall not occur until: (1) the provisions of Section K-1 (a-c) have
been followed, documented, and have failed to provide a resolution, (2) all other
reasonable administrative remedies have been exhausted.
2. If the Department or the State should be determined out of compliance with the provisions of
the contract, either party may file a formal appeal with the Office of Administrative Hearings.
IN WITNESS WHEREOF, the Department and the State have executed this agreement in
duplicate originals, one of which is retained by each of the parties.
LOCAL SIGNATURES DEPARTMENT OF ENVIRONMENT,HEALTH
AND NATURAL RESOURCES
Jonathan B. Howes, Secretary
Health Director Date
By
Finance Officer Date Department Head's Signature
or Authorized Agent
Chairman of County Date
Commissioners
(when required)
13
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSURANCE OF COMPLIANCE WITH SECTION 604 OF THE
REHABILITATION ACT OF 1973, AS AMENDED
The undersigned(hereinafter called the"recipient")HEREBY AGREES THAT it will comply
with Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C.7K.all require.
ments imposed by the applicable HHS regulation(45 C.F.R. Part 94),and all guidelines and
interpretations issued pursuant thereto.
Pursuant to 184.5(a)of the regulation 145 C.F.R. 84.5(a)),the recipient gives this Assurance
In consideration of and for the purpose of obtaining any and all Federal grants, loans,con.
tracts (except procurement contracts and contracts of insurance or guaranty), property, dis-
counts, or other Federal financial assistance extended by the Department of Health and Human
Services after the date of this Assurance, including payments or other assistance made after
such date on applications for Federal financial assistance that were approved before such
date.The recipient recognizes and agrees that such Federal financial assistance will be extended
in reliance on the representations and agreements made irr this Assurance and that the United
States will have the right to enforce this Assurance through lawful means. This Assurance
is binding on the recipient, its successors,transferees, and assignees, and the person or persons
whose signatures appear below are authorized to sign this Assurance on behalf of the recipient.
This Assurance obligates the recipient for the period during which Federal financial assistance
is extended to it by the Department of Health and Human Services or, where the assistance
is in the form of real or personal property, for the period provided for in 184.5(b) of the
regulation 145 C.F.R. 84.5(b)).
The recipient: (Check (a) or (b)J
a. ( rmploys fewer than fifteen persons;
b. ( ) employs fifteen or more persons and, pursuant to 184.7(x) of the regulation
(45 C.F.R. 84.7(a)J, has designated the following person(s) to coordinate its
efforts to comply with the HHS regulations:
Daniel B. Reimer
Name of Designee(s) (Type or Print)
Orange County Health Department P.O. Box R1R1
Name of Recipient4Type or Print) Street Address or P.O. Box
56-6000327 Hillsborough
(IRS) Employer Identification Number City
North Carolina, 27278-8181
State Zip
1 certify that the above information is complete and correct to the best of my knowltdge.
Date Signature and Title of Authorized Official
Moses Carey, Jr., Chair, Board of County Commissioners
If there has been a change in name or ownership within the last year, please PRINT the former
name below:
14
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES REGULATION UNDER
TIRE VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department (hereinafter called the "Applicant")
HUM of Appfiaat (type or pried
HEREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964(P.L.
88-352) and all requirements imposed by or pursuant to the Regulation of the Department
of Health and Human Services (45 C.F.R. Part 80) issued pursuant to that title, to the end
that, in accordance with Title VI of that Act and the Regulation, no person in the United
States shall, on the ground of race, color.or national origin, be excluded from participation
in. be denied the benefits of.or be otherwise subjected to discrimination under any program
or activity for which the Applicant receives Federal financial assistance from the Depart-
ment. and HEREBY GIVES ASSURANCE THAT it will immediately take any measures
necessary to efrectuate this agreement.
If any real property or structure thereon is provided or improved with the aid of Federal
financial assistance extended to the Applicant by the Department.this Assurance shall obligate
the Applicant, or in the case of any transfer of such property, any transferee, for the period
during which the real property or structure is used for a purpose for which the Federal financial
assistance is extended or for another purpose involving the provision of similar services or
benefits. If any personal property is so provided, this Assurance shall obligate the Applicant
for the period during which it retains ownership or possession of the property. In "'other
cases. this Assurance shall obligate the Applicant for the period during which the Federal
financial assistance is extended to it by the Department.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and
all Federal grants, loans, contracts, property, discounts or other Federal financial assistance
extended after the date hereof to the Applicant by the Department. including installment
payments after such date on account of applications for Federal financial assistance which
were approved before such date.The Applicant recognizes and agrees that such Federal finan.
cial assistance will be extended in reliance on the representations and agreements made in
this Assurance, and that the United States shall have the right to seek judicial enforcement
of this Assurance. This Assurance is binding on the Applicant. its successors. transferees,
and assignees. and the person or persons whose signatures appear below are authorized to
sign this Assurance on behalf of the Applicant.
Date Orange County Health Department
Applicaet (type or pnotl
By Signaturc and Title or Authorued Official
111 3 OnW, Jr., Cigar, Baud of Qmty
HHS-&+1 (Acv. 12/82)
15
open*TAT II.S. DEPARIMINT OF AGRICULTURE eee..eee*'ae crop��N•1M•
U." Food and nutrition Service
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF AGRICULTURE,
FOOD AND NUTRITION SERVICE, UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department
%NAme of Applicant)
(Hereinafter called the "Applicant.")
8LMY AGREES THAT it will comply with Title VI any improvements made with Federal finanelal
of the Civil lights Act of 1964 (P.L. 88-352) assistance extended to the Applicant by the
and all requirements imposed by the Regulations Department. This includes any Federal agreement,
of the Department of Agriculture (7 CFR Part 15), arrangement, or other contract which has as one
Department of Justice (28 CFR Parts 42 i 50), of its purposes the provision of assistance such
and FNS directives or regulations issued as food, food stamps, cash assistance for the
Pursuant to that Act and the Regulations, to the purchase of food, and cash assistance for purchase
effect that, no person in the United States shall, or rental of food service equipment or any other
on the ground of race, color, or national origin, financial assistance extended in reliance on the
be excluded from participation In, be denied the representations and agreements made in this
benefits of, or be otherwise subject to discrimi- assurance.
nation under any program or activity for which the
Applicant received Federal financial assistance BY ACCEPTING THIS ASSURANCE, the applicant agrees
from the Department; and SERER! GIVES ASSURANCE to compile data, maintain records and submit
THAT it will immediately take any measures reports as required, to permit effective enforce-
necessary to effectuate this agreement. ment of Title VI and pe r_it authorized USDA
personnel during normal working hours to review
THIS ASSURANCE Is given in consideration of and such records, books and accounts as needed to
for the purpose of obtaining any and all Federal ascertain compliance with Title VI. If there are
financial assistance, grants and loans of Federal any violations of this assurance, the Department
funds, reimbursable expenditures, grant or of Agriculture, Food and Nutrition Service, shall
donation of Federal property and interest in have the right to seek judicial enforcement of
property, the detail of Federal personnel, the this assurance.
sale and lease of, and 'the permission to use,
Federal property or interest to such property or This assurance is binding on the applicant, Its
the furnishing of services vitbout consideration successors, transferees, and assignees as long as
or at a nominal consideration, or at a consider- it receives assistance or retains possession of
ation which is reduced for the purpose of assist- any assistance from the Department. The person
ing the recipient, or in recognition of the or persons whose signatures appear below are
public interest to be served by such sale, lease, authorized to sign this assurance on the behalf of
or furnishing of services to the recipient„ or the applicant.
Dated Orange County Health Department
(Applicant)
Dy,
(Title of authorized official)
Moses Carey, Jr., Chair
Board of County Commissioners
P.O. Box 8181
Hillsborough NC 27278-8181
(Address of Applicant)
No further monies or other benefits may be paid out under Food and Nutrition Service Federal assistance
progrars unless this Assurance is completed and filed as required by existing regulations (7 CFR 15).
ape•.....
LOCAL HEALTH DEPARTMENT BUDGET 16
N.C.Department of Environment,
Health,and Natural Resources Revision Number——
Division of General Services
SFY Division of General Services ————P.O. Number
7 / 95 6 / 96 9 6 4 1 1 0 0 0 6 8
Effective Date Termination Date Contract Number
Contractor: ORANGE COUNTY HEALTH DEPARTMENT Activity: General
Project Director: Daniel B. Reimer Total Budget:$ 560,869
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 54,363
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health ? <<>< << '. 0 ? > >>>> ?<>>><> > < << < `: <> >'>?<>< <<` <
D
n'
Cll ictan l'wt t:E tk `':.' ' ...`i 7�3 >' Y < 5?
I
T
X.
Laboratory ................................................................................. .
Pharmacy Services
U
Transfer TXIX
R Subtotal State Expend. $ 54,363
E LOCAL EXPENDITURES: LOCAL EXP 9000 F S TOTAL EXPENDITURES—equal to Total Receipts $ 560,869
LOCAL FUNDS:
R Appropriation APPROP 101 368,506
E TXIX TXIX 102 68.000
Other Receipts OTHR REC 103 70,000
C
E Subtotal Local Funds $ 506,506
STATE/FEDERAL/SPECIAL FUNDS:
" I
P
T
S
Subtotal State/Federal./Special $ 54,363
TOTAL RECEIPTS—equal to Total Expenditures $ 560,869
Local Authorized Official Signature Date annch Hod Division/Section Signature Date
ininal
Finance Officer Signature Date Accoun nt Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
1
17
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number__
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of General Services P.O.Number
SFY 1996
7_/_95 6 / 96 96 4125 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Transfer of Escrow
Project Director: Daniel B.Reimer Total Budget: $ $436,901
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits
X Operating Expenses
P Purchase of Equipment T31E --55000'
E General Contracted or
7.
a-"y-
N Purchased Services
D School Health
I Clinician 11 " -°; �. 6$63::;:,
U Laboratory .3 86
R Pharmacy Services "`RXSER,
S Transfer TXIX 6864 436.901
Subtotal State Expenditures: $
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts $
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TXIX 102 436,901
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ 436.901
I STATE/FEDERAL/SPECIAL FUNDS:
P
T
S
Subtotal State/Federal/Special $
TOTAL RECEIPTS-Equal to Total Expenditures $
Local Authorized Official Signature Date mach ll..a DivisioniSeetion Signature Date
IruGal
Finance 011irer Signature Date Accmmtmtt Fiscal Management Signature Date
Iruual
DL•I INR 2948 t,Revised_93)
-;--.1 Srnwo Cnunm iiair : i
18
Page 1 or
N.C.Department of Environment,Health,and Natural Resources FY 1996 i
CONTRACT ADDENDUM
Division of General Services 4125 068
Office,Section or Branch Contract Number
Orange County Health Department Transfer of Escrow
Contractor Activity
4125 TB CONTROL 0 4178 NORPLANT 6,000
4126 STD CONTROL 5,647 4225 MAT CARE HOME VST 2,819
4127 ADULT TREATMENT 0 4226 POSTPARTUM MAT 1,428
4131 CARDIOLOGY 0 4227 POSTPARTUM NEWBRN 2,068
4132 NEUROLOGY 0 4228 POSTPARTUM EPSDT
4133 SPEECH&HEARING 0 4229 PSYCHOSOCIAL COUNS
4134 ORTHOPEDIC 4230 NUTRITION COUNSEL
4135 SPEECH THERAPY 4231 REFRESHER CHDBIRTH
4136 PHYSICAL THERAPY 4232 RHO D IMMUNE GLOB
4137 CHILD TREATMENT 8,500 4233 PREGNANCY TEST
4138 MATERNAL HEALTH 65,155 4234 ORAL GLUCOSE TOL
4139 INTRAPARTUM CARE 4235 MYELODYSPLASIC
4140 DENTAL HEALTH 68,000 4236 DEPO PROVERA 1,265
4141 NON STRESS 4237 CHRONIC DIS MONIT
4142 REFUGEE HEALTH 4238 COMPREHENSIVE ASSESMNT
4143 PAP SMEAR 4239 LIMITED ASSESSMENT
4144 MAT CARE INITIAL 13,253 4240 COLPOSCOPY W/O BIOPSY
4145 MAT CARE SUB 35,000 4241 COLPOSCOPY W BIOPSY
4146 CHILDBIRTH CLASS 4242 CYROSURGERY
4147 MAT HOME VISIT 4243 SCREEN MAMMOGRAPHY
4148 PARENTING CLASS 4244 HEMOGLOBIN A1C
4149 VAG DELIVERY ONLY 4245 BLOOD CHOLESTEROL
4150 TOTAL OBSTET VAG 4246 BLOOD GLUCOSE-SERUM
4151 NEUROMUSCULAR 4247 BLOOD GLUCOSE-FINGER
4152 ULTRASOUND 4248 STOOL OCCULT BLOOD
4153 OBSTETRIC CARE 4249 TB SKIN TEST-PPD
4154 CEASAREAN DELIV 4250 SERUM CREATININE
4155 HYSTERECTOMY 4251 TRIGLYCERIDES
4156 CHILD SERV COORD 101,706 4252 LIPOPROTEIN
4157 FAMILY PLANNING 25,853 4253 LIPID PANEL
4158 EPSDT 30,061 4254 RABIES IMMUNE GLOB
4159 IMMUN UPDATE 4255 RABIESFACCINFJUNIT
4160 DEC 4256 THERAP NUTR COUNSLING
4161 DEC SPEECH&HEARING 4299 HEALTHCHECK 70,146
4173 GONORR.EII A CULT IUD INSERTION
4174 AUDiorvm RY IUD REMOVAL
4175 BLOOD CHUM(6) TOTAL 436,901.00
4176 BLOOD CI IEIvt(12)
1
19
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 5151 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Family Planning
Project Director: Daniel B.Reimer Total Budget: S $574,659
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 122,262
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician CLN 6863
T _
U Laboratory
R Pharmacy Services
S Transfer TXIX
Subtotal State Expenditures: $ 122,262
LOCAL EXPENDITURES: LOCAL EXP 9000 452,397
TOTAL EXPENDITURES-Equal to Total Receipts $ 574,659
LOCAL FUNDS:
R Appropriation APPROP 101 407,039
E TXIX T= 102 33,118
C Other Receipts OTHR REC 103 12,240
E Subtotal Local Funds $ 452,397
I STATE/FEDERAUSPECIAL FUNDS:
P
T HMHC FUNDS: 1515-6100-5151-)CM 22,162
S NON HMHC FUNDS: 100,100
Subtotal State/Federal/Special $ 122,262
TOTAL RECEIPTS-Equal to Total Expenditures $ 574,659
Local Authorized Official Signature Date Bry kHad Division/Section Signature Date
Finance Officer Signature Date ACQ~tut Fiscal Management Signature Date
INWI
DEEINR 2913(Revised 2/93)
G.—I S.ry D-1" -1,94)
20
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number
N.C.Department of Environment,
Health.and Natural Resources —
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1996
7 / 95 6 —/-96 96 5318 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Child Services Coordination
Project Director. Daniel B.Reimer Total Budget: $ 153,582
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 51,876
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH HLTH 6200
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX �
Subtotal State Expenditures: $ 51,876
LOCAL EXPENDITURES: LOCAL EXP 9000 101,706
TOTAL EXPENDITURES-Equal to Total Receipts $ 153,582
LOCAL FUNDS:
R Appropriation APPROP 101 59,430
E TXIX T= 102 101,706
C Other Receipts - OTHR REC 103 0
E Subtotal Local Funds S 101,706
STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 51,876
S
Subtotal State/FederaUSpecial $ 51,876
TOTAL RECEIPTS-Equal to Total Expenditures $ 153,582
Local Authorized Official Signature Date BrwKhHnd Division/Section Signature Date
w�
Finance Otlieer Signature Date: acm.ftm Fiscal Management Signature Date
w�
IVI IINR_9.18(Rc%ised 2 9:)
21
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number
N.C.Department of Environment.
Health.and Natural Resources —
Division of General Services Division of Epidemiology P.O.Number
SFY 1996
7 / 95 6---/-96 96 4510 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Communicable Disease
Project Director. Daniel B.Reimer Total Budget: S $204,557
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 17,018
Y Operating Expenses OP ENT 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health " ru
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
E ,$
S Transfer TXIX 6864
Subtotal State Expenditures: $17,018
LOCAL EXPENDITURES: LOCAL EXP 9000 187,539
TOTAL EXPENDITURES-Equal to Total Receipts 204,557
LOCAL FUNDS:
R Appropriation APPROP 101 170,642
E TXIX TXIX 102 5,647
C Other Receipts OTHRREC 103 11,250
= E Subtotal Local Funds 187,539
I STATE/FEDERALISPECIAL FUNDS:
P
T DEHNR 17,018
S
I
Subtotal State/Federal/Special 17,018
TOTAL RECEIPTS-Equal to Total Expenditures 204,557
Local Authorized Official Signature Date anmhlind DivisiomSection Signature Date
tmar
— - Finance Ufticer Signature Date Fiscal Management Signature Date
DFI LNK:`I-IS kReNucd'-9'11
LOCAL HEALTH DEPARTMENT BUDGET 22
Revision Number__
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Epidemiology P.O.Number
SFY 1996
7 / 95 —6—/-96 96 4545 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Aids(Federal)
Project Director: Daniel B.Reimer Total Budgi 5 $31,000
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 $31,000
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
E
$ Transfer TXIX 6864
Subtotal State Expenditures: $31,000
LOCAL EXPENDITURES: LOCAL EXP 9000 50
TOTAL EXPENDITURES-Equal to Total Receipts 531,000
LOCAL FUNDS:
R Appropriation APPROP 101 50
E T= TX1X 102 So
C Other Receipts OTHR MC 103 50
E Subtotal Local Funds 50
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 531,000
S
Subtotal State/Federal/Special 531,000
TOTAL RECEIPTS-Equal to Total Expenditures $31,000
Local Authorized Official Signature Date Blond Had Division/Section Signature Date
WW
Finance Officer Signature Date Accom m Fiscal Management Signature Date
DEHNR 2948(Revised 393)
Gm"Saw"D�r�rwe R[vuw:111
LOCAL HEALTH DEPARTMENT BUDGET
23
N.C.Department of Environment,
Health,and Natural Resources Revision Number
Division of General Services
SFY Division of Environmental Health -----
P.O.Number
7 / 95 6 / 96 9 6 4 7 5 1 0 0 6 8
Effective Date Termination Date Contract Number
Contractor: ORANGE 000NIY HEALTH DEPAPMOU Activity: Environmental Health
Project Director: Daniel B. Reimer Total Budget:$ 564,526
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 6,000
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health
D
Clinician
::. . :...::::.::.:...:.. ... ...:..... nB(� .
I
T
..
Laboratory LAB .... 6862
Pharmacy Services t
Transfer TXIX
R Subtotal State Expend. $ 6,000
E LOCAL EXPENDITURES: LOCAL EXP 9000 558,526
S TOTAL EXPENDITURES—equal to Total Receipts $ 564,526
LOCAL FUNDS:
R Appropriation APPROP 101 306,276
E TXIX TXIX 102 0
Other Receipts OTHR REC 103 252,250
C
E Subtotal Local Funds $ 558,526
STATE/FEDERAL/SPECIAL FUNDS:
I
P DERW 6,000
T
S
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures $ 564,526
Local Authorized Official Signature Date Bnnch Hnd Division/Section Signature Date
Finance Officer Signature Date «a,ndn! Fiscal Management Signature Date
tniml
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET 24 ►
Revision Number__
N.C.Department of Environment,
I leallh,and Natural Resources
Division of General Services Division of Environmental Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 4752 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Food and Lodging
Project Director: Daniel B.Reimer Total Budget: S 750
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000
X Operating Expenses OP EXP 2000 750
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician M
T
U Laboratory LAB 6862
R Pharmacy Services
E w _
S Transfer TXIX
Subtotal State Expenditures: $ 750
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts $ 750
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TM 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ 0
I STATENEDERAL/SPECIAL FUNDS:
P
T DEHNR 750
S
Subtotal State/Federal/Special $ 750
TOTAL RECEIPTS-Equal to Total Expenditures $ 750
Local Authorized Official Signature Date Bnmh Heed Division/Section Signature Date
hitw
Finance OtTicer Signature Date A�twt Fiscal Management Signature Date
hutw
DEI LNR 2918(Revised 2.93)
Urnmd 3e "Dtw )Rms.„9A)
LOCAL HEALTH DEPARTMENT BUDGET 25
Revision Number
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 5101 068
Effective Date Tennination Date Contract Number
Contractor: Orange County Health Department Activity Maternal Health
Project Director: Daniel B.Reimer Total Budget: $ 407,652
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 74,483
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
E Transfer TXDt
S Subtotal State Expenditures: $ 74,483
LOCAL EXPENDITURES: LOCAL EXP 9000 333,169
TOTAL EXPENDITURES-Equal to Total Receipts $ 407,652
LOCAL FUNDS:
R Appropriation APPROP 101 213,446
E TX1X T= 102 119,723
C Other Receipts OTHR REC 103 0
E Subtotal Local-Funds $ 333,169
I STATE/FEDERAL/SPECIAL FUNDS:
P Maternal Health Subtotal S 38,525 Total DEHNR S
T Healthy Mothers/Healthy Children 35,958 1510-6100-5101 74,483
S General MCH Funds 0
74,483
Subtotal State/Federal/Special $ 74,483
TOTAL RECEIPTS-Equal to Total Expenditures $ 407,652
Local Authorized Official Signature Date amch H-d Division/Section Signature Date
Imhd
Finance Officer Signature Date A* wftl Fiscal Management Signature Date
Imad
DEfINR 2948(Revised 193)
G—W Sem—Ds—(Rm—L94)
26
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number
N.C.Department of Environment, ——
Health.and Natural Resources
Division of General Services Division of Maternal and Chid Health P.O.Number
SPY 1996
7 / 95 --6—/-96— 96 5323 0 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity CSHS Orthopedic
Project Director: Daniel B.Reimer Total Budget: $ 634
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 634
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services I RX SERV 6865
S Transfer TXIX
Subtotal State Expenditures: $ 634
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts $ 634
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TX DC 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ p
STATE/FEDERALSPECIAL FUNDS:
P
T DEHNR 634
S
Subtotal State/Federal/Special $ 634
TOTAL RECEIPTS-Equal to Total Expenditures $ 634
Local Authorized Official Signature Date Bt a hHnd Division/Section Signature Date
wtW
Finance Officer Signature Date Ace kM Fiscal Management Signature Date
Itutd
DEI M 2943(Revised 2.93)
G-"Se c"Dew I Rmov 19.0 r
1
LOCAL HEALTH DEPARTMENT BUDGET 27
Revision Number-02-_
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 5351 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Child Health
Project Director: Daniel B.Reimer Total Budget: S 494,313
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 39,980
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH HLTH 6200 10,033
1 Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: $ 50,013
LOCAL EXPENDITURES: LOCAL EXP 9000 444300
TOTAL EXPENDITURES-Equal to Total Receipts $ 494,313
LOCALFUNDS:
R Appropriation APPROP 101 334,633
E TXIX TXIX 102 107,042
C Other Receipts OTHR REC 103 2,625
E Subtotal Local Funds $ 444,300
1 STATE/FEDERAL/SPECIAL FUNDS:
P DEHNR: '1535-6100-5351-x=
T General Maternal and CH Funds 50,013
S
Subtotal State/Federal/Special $ 50,013
TOTAL RECEIPTS-Equal to Total Expenditures $ 494,313
Local Authorized Official Signature Date erwcnend Division/Section Signature Date
t,ae.i
Finance Officer Signature Date Ac whnt Fiscal Management Signature Date
INnd
DEHNR 2948(Revised 2 93)
G-"Sm."I]N e I Rm#w 194)
LOCAL HEALTH DEPARTMENT BUDGET 28
Revision Number__
N.C.Department of Environment,
Health.and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 5402 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity MCH Block Grant Nutrition
Project Director: Daniel B.Reimer Total Budget: $ 2,450
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 2,450
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services
" D School Health
I Clinician
T
U Laboratory
R Pharmacy Services
E
S Transfer TXIX
Subtotal State Expenditures: $ 2,450
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts $ 2,450
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX Txnc 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ 0
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 2,450
S
Subtotal State/Federal/Special $ 2,450
TOTAL RECEIPTS-Equal to Total Expenditures $ 2,450
Local Authorized Official Signature Date BMch Hnd Division/Section Signature Date
ww
Finance Officer Signature Date Ac�mnc Fiscal Management Signature Date
ww
DfilINR 2948 tRcvised 2.9±)
t LOCAL HEALTH DEPARTMENT BUDGET 29
N.C.Department of Environment, Revision Number_
Health,and Natural Resources
Division of General Services Division of Adult Health
SFY 19%
7 / 95 6 / 96 Activity: COMP.Breast& Cervical Cancer Control
Effective Date TerminationDate
Contractor. Orange qty Health Departmeztt ProjectDirector. Dwdel B. Reimer
TOTALBUDGET: S S
Screening Outreach
P.0.Number P.O.Number
9 6 5452 0 6 8 9 6 5453 0 6 8
ITEM DESCRIPTION CLASSIFICATION ITEM Contract Number Contract Number
STATE EXPENDITURES:
E Salaries&Fringe Benefits SA/FR 1000 13,664
X Operating Expenses OP EXP 2000 429
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100 11,857
D School Health SCH HLTH 6200
I Clinician CLN 6863
T Laboratory LAB 6862
U Pharmacy Services RX SERV 6865
R TransferTXIX 6864
E Subtotal State Expend. 25,950
S LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES—equal to Total Receipts
LOCAL FUNDS:
R Appropriation APPROP 101
TM TXIX 102
E OtherReceipts OTHR REC 103
C Subtotal Local Funds
E STATE/FEDERAL/SPECIAL
I Screening 1545 6100 5452 0135
P FUND OBJ RCC PROG
T Outreach 1545 6100 5458 0135
S FUND OBJ RCC PROG
Subtotal State/Federa.USpecial 25,950
TOTAL RECEIPTS—equal to Total Expenditures 25,950
i
Local Authorized OtficialSignature Date Branch Head Division/SectionSignature Date
initial
FinanceOtftcerSignature Date accountant Fiscal Manage:nentSignature Date
initial
LOCAL HEALTH DEPARTMENT BUDGET 30 1
Revision Number__
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Adult Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 5502 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Adult Health
Project Director: Daniel B.Reimer Total Budget: $ $108,562
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 5,502
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX .- .
Subtotal State Expenditures: $ 5,502'
LOCAL EXPENDITURES: LOCAL EXP 9000 103,060
TOTAL EXPENDITURES-Equal to Total Receipts $ 108,562
LOCAL FUNDS:
R Appropriation APPROP 101 103,060
E TXIX TXIX 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds $ 103,0601
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 5,502
S
Subtotal State/Federal/Special $ 5,502
TOTAL RECEIPTS-Equal to Total Expenditures $ 108,562
Local Authorized Official Signature Date BnmKh Hed Division/Section Signature Date
INhd
Finance Officer Signature Dale Amt-( Fiscal Management Signature Date
wad
DEHIIR 2948(Revised 2,93)
Gen"Servsn Dew n(Rvmu ;.94)
LOCAL HEALTH DEPARTMENT BUDGET 31
Revision Number__
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Adult Health P.O.Number
SFY 1996
7 / 95 6 / 96 96 5503 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Health Promotion
Project Director: Daniel B.Reimer Total Budget: S 0 63,849
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 22,116
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician "
Ivy
T
U Laboratory
R Pharmacy Services {
S Transfer TXIX '�
Subtotal State Expenditures: $ 22,116
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts $
LOCAL FUNDS:
R Appropriation APPROP 101 39,358
E TXIX T= 102 0
C Other Receipts OTHR REC 103 2,375
E Subtotal Local Funds $ 41,733
I STATENEDERAL/SPECIAL FUNDS:
P
T DEHNR 22,116
S
Subtotal State/Federal/Special $ 22,116
TOTAL RECEIPTS-Equal to Total Expenditures $ 63,849
Local Authorized Official Signature Date BtwnHnd Division/Section Signature Date
imtw
Finance Officer Signature Date Amountut Fiscal Management Signature Date
ITUw
DEIWR 2918(Revised 2.93)
GmwW 5e —Diw lR—L94)
32
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number__
N.C.Department of Environment,
I lealth,and Natural Resources
Division of General Services Division of Epidemiology P.O.Number
SFY 1996
7 / 95 6 / 96 96 5715 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Immunization Action Plan
Project Director: Daniel B.Reimer Total Budget: S $17,731
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 17,731
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH HLTH 6200
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: $ 17,731
LOCAL EXPENDITURES: LOCAL EXP 9000 0
TOTAL EXPENDITURES-Equal to Total Receipts $ 17,731
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TM 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ 0
I STATENEDERAL/SPECIAL FUNDS:
P
T
S
Subtotal State/Federal/Special $ 17,731
TOTAL RECEIPTS-Equal to Total Expenditures $ 17,731
Local Authorized Official Signature Date smack Hnd Division/Section Signature Date
Finance Officer Signature Date Acmmtmt Fiscal Management Signature Date
w�
DEI INR 29.13(Revised 2.93)
G—I St ..D,,—(Rv—L94