HomeMy WebLinkAboutAgenda - 04-19-1994 - VIII-F r•
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ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No. V=_F
ACTION AGENDA ITEM ABSTRACT
Meeting Date: April 19, 1994
SUBJECT: 1994-95 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 sixty-five thousand three hundred seventeen dollars ($465,317) which is a
4.6% increase over the previous year, for the following programs in FY 1994-95:
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
Health Promotion
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.
RECOMMENDATION(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.
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CONSOLIDATED CONTRACT
BETWEEN
THE STATE OF NORTH CAROLINA
AS REPRESENTED BY
THE DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
(Hereinafter called the "State")
AND
(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, 1994 to June 30, 1995
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
Communicable Disease
Tuberculosis
AIDS (Federal)
Family Planning
Child Service Coordination
CSHS Orthopedic
MCH Block Grant Nutrition
Maternal Health
Child Health
Adult Health
Breast & Cervical Cancer
Health Promotion
DEHNR 2946(Revised 02/94)
Division of General services (Review 02/95)
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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
specified in Listing of f 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 appropriated 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. Fees
generated by the Food and Lodging fees collection program may only be used to support
Environmental Health activities.
4. 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.
5. 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
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.
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6. 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.
7. 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 Chapter 689, Section 174 of the
1991 Session Laws.
8. 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.
9. 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.
10. 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.
11. The Department shall have an annual audit performed in accordance with The Single Audit Act
of 1984 as implemented by OMB Circular A-128. Audit findings and resolution of said findings
shall be handled by the Division of Fiscal Management, Budget & Analysis Section.
12. 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.
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.
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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.
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.
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State pursuant to G.S. 130A-4(b). This delegation shall be done according to 15A NCAC 18A
.2300.
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 personal 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 11 (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.
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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.
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 . 5. 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.
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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.
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 injury prevention projects will be disbursed in one lump sum during the first quarter
of the project budget approval.
8. Quarterly payment for reported expenditures in Line Item 1000 shall be limited to one-fourth of
the budgeted amount in that line item.
9. 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.
10. Payments shall be suspended when expenditure reports are not received by the time specified
in 4 a and f. Payments will resume in the months subsequent to receipt of the expenditure
reports.
11. Payment is limited to the total amount of the budget by line item.
12. 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 fiscal
management. Final payment will be made only after the Staff Time Activity Report, DEHNR
3389, is received by the State.
13. 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.
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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)
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSURANCE OF COMPLIANCE WITH SECTION SW 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. 794), all require-
ments imposed by the applicable HHS regulation(45 C.F.R. Pan 94),and all guidelines and
interpretations issued pursuant the cto.
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 Depanment or 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 irrthis Assurance and tha! 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 §84.5(b) of the
tegula:ion (45 C.F.R. 84.S(b)J.
The recipient: (Check (a) or (b)j
a. ( ) employs fewer than fifteen persons;
b. ( X ) employs fifteen or more persons and, pursuant to §84.7(a) of the regulation
[45 C.F.R. 84.7(a)], has designated the following person(s) to coordinate its
efforts to comply with the HHS regulations:
Danipl R_ Raimar
Name of Designee(s) (Type or Print)
Orange County Health Department P. 0. Box 8181
Name of Recipient-(Type or Print) Street Address or P.O. Box
56-6000327 Hillsborough
(IRS) Employer Identification Number City
North Carolina, 27278-8181
State Zip
I certify that the above information is complete and correct to the best of my knowltdgc.
Date Signature and Title of Authorized Official
Moses Carey, Jr., Chair, Board of County Official
If there has been a change in name or ownership within the last year, please PRINT the former
name below:
HHS-641 (Rev.421921
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ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES REGULATION UNDER
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department (hereinafter called tl:e "Applicant")
Name of Applicaw (type or print)
HEREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964 (P.L.
S8-352) 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 :he Depart-
ment; and HEREBY GIVES ASSURANCE THAT it will immediately take any measures
necessary to effectuate 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 all 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 behzlf of the Applicant.
Date Orange County Health Department
ADpluant hype or print)
By
Silnatute and Title of Authorized Official
Moses Carey, Jr., Chair, Board of County Camiissioners
HHS-4+1 (Rev. 12/12)
►oer•r11. U.S. DEPAR.X=% OF ALRICVLTME ►e.......0190 e..•.e.•.....
L3.75' Food and Nutrition Service 12
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF AGRICULTURE,
IOOD AND NUTRITION SERVICE, UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
nrnngp rnnnty Health Department
tName of Applicant) _
(Hereinafter called the "Applicant.")
HEREBT AGREES THAT it will comply with Title VI any improvements made with Federal financlal
of the Civil Rights Act of 1964 (P,L. 88-352) assistance extended to the Applicant by the
and all requfsements imposed by the Regulations Department. This includes any Federal agreement,
of jthe Deparrment 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 progra= or activity for which the
Applicant received Federal financial assistance BY ACCEPTING THIS ASSURANCE, the applicant agrees
fro= the Department; and REREB° GIVES ASSURANCE to compile data, maintain records and submit
THAT it will immediately take any measures reports as required, to per-it effective enforce-
necessary to effectuate this agreement. ment of Title VI and per--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 in such property or This assurance is binding on the applicant, its
the furnishing of services witbouc consideration successors, transferees, and assignees as long as
or at a no=final 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
ir,g 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)
By
(Title of authorized official)
Moses Carey, Jr., Chair, Board of County
Commissioners
P n unY 81R1
Hillsborough, NC 27278-8181
(Address of Applicant)
No further monies or other benefits may be paid out under Food and Nutrition Service Federal assistance
programs unless this Assurance is completed and filed as required by existing regulations (7 CFR 15).
e.o.,. •.1
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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.
ii. Line item 102 on the program budget must be used to budget TXIX earned
revenues. '
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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 1995 may not exceed Title
XIX revenues earned during fiscal year 92-93 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.
e. The Department shall follow Women, Infants and Children Program and other Federal
program reporting requirements when they differ from those stated above.
15
Page 7 of 11
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
no later than the 15th of the following month.
i. The Department shall submit expenditure reports for Mosquito Control activity in
accordance with 15A NCAC 18B, 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, DEHNR Division of Fiscal Management.
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.
6. For Adolescent Pregnancy Prevention Activity, the Department agrees to (1) have responsibility
for the immediate direction, supervision and evaluation of the activities supported through the
contract, which will be conducted in accordance with the amended plan/update submitted by the
Department; (2) submit any media material in writing to the Division of Maternal and Child
Health for approval prior to release to the public; (3) submit a mid-year report on progress in
meeting project objectives by February 1, 1995; (4) submit an evaluation report demonstrating
achievement of stated goals no later than August 16, 1995.
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 I NCAC 8. Such policies include, but are not limited to,
the following:
I. 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
16
LOCAL HEALTH DEPARTMENT BUDGET
�.
Department of Environment, '
iealth, and Natural Resources Revision Number--
,.-ision of General Services
Y Division of General Services ————P. O. Number
07 / 94 06 / 95 9 5 4 1 1 0 0 0 6 8
Effective Date Termination Date Contract Number
)ntractor: Orange Co. Health Dept. Activity: General
eject Director: Dan;P1 B, Reimer Total Budget: $ 569,498
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
3 STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 54,363
X. Operating Expenses OP EXP 2000
Purchase of Equipment EQUIP 5000
General Contracted or
Purchased Services GENERAL 6100
School He :<:>: CH<:: 'I : : : : .....
Clinician ..: 6.:
r ................................................................................................................. ...................
Laboratory
L
:
.............. ........................ ..... .. ........:.. :z:.
:>:;::.. _> .armac S ervices .......
Transfer TXIX
❑�,�r
Subtotal State Expend. $ 54,363
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES—equal to Total Receipts $ 569,498
LOCAL FUNDS:
Appropriation APPROP 101 408,216
TXIX TXIX 102 37,000
Other Receipts OTHR REC 103 69,919
J
Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
I
DEHNR 54,363
T
3
Subtotal State/Federal/Special $ 54,363
TOTAL RECEIPTS —equal to Total Expenditures $ 569,498
�ocal Authorized Official Signature Date &inch Hod Division/Section Signature Date
initw
Finance Officer Signature Date Accaununt Fiscal Management Signature Date
m aal
HNR 2948(Revised 2/93)
-ieral Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET 17
N.C. Department of Environment,
Health,and Natural Resources Revision Number
Division of General Services
SFY Division of General Services
P.O. Number
07/ 94 OA/ gs 9 5 4 1 2 5 0 6 8
Effective Date Termination Date Contract Number
Contractor: Orange Co. health Dept, Activity: Transfer of Escrow
Project Director: Daniel R. Rpimpr Tool Budget:$-- -1n11()/1q -
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
. ..... .
... . ... ......
........ ......
E STATE EXPENDITURES:
..........
...... ........ ..
.. .. ..... .... ........ ........... ..
...... .........
Salaries 6L Fringe Berbefits
X
Operating Expenses -01P EXF:::-w ........... ...
P Purchase of Equipment
7777 ......
...... . ...........
. .... ......
E- General Contracted or
... .................
Purchased Services
N
School Health SCH WTH
D
Clinician
Laboratory LAB
T Pharmacy Services RX SEFLV
U Transfer TXIX 6864
R Subtotal State Expend. LOCAL EXP 9000 $ 303,043
E LOCAL EXPENDITURES:
S TOTAL EXPENDITURES—equal to Total Receipts $ 303,043
LOCAL FLTNDS.
R Appropriation APPROP 101
E TXlX/SSBG Fees TX1X/SSBG 102
C — Other Receipts OTHR REC 103
E Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
P Transfer TXIX 303.043
T
S
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures $303,043
Local Authorized Official Signature Date 11
Division/Section Signature Date
Finance Officer Signature Date Fiscal Management Signature Date
WNW
DEHNR 2948(Rev 2/92)
C-wml S—im D"m(Review 2/94)
Page of 18 ,
N.C. Department of Environment, Health, and Natural Resources FY
Division of General Services `
CONTRACT ADDENDUM
Office, Section or Branch Contract Number
— Lzange-4,at—Hea Dept.
Contractor Activity
4125 TB CONTROL 0 4174 AUDIOMETRY
4126 STD CONTROL 4175 BLOOD CHEM (6)
3,�1a7 4176 BLOOD CHEM (12)
4127 ADULT TREATMENT 0 4178 NORPLANT 16.0674
4131 CARDIOLOGY
4225 MAT CARE HOME VST
4132 NEUROLOGY 4226 POSTPARTUM MAT
4133 SPEECH & HEARING 4227 POSTPARTUM NEWBRN
4134 ORTHOPEDIC 4228 POSTPARTUM EPSDT
4135 SPEECH THERAPY
4229 PSYCHOSOCIAL COUNS --
4136 PHYSICAL THERAPY
4137 CHILD TREATMENT 8,272 4230 NUTRITION COUNSEL -
4231 REFRESHER CHDBIRTH
4138 MATERNAL HEALTH 69,300 4232 RHO D IMMUNE GLOB
4139 INTRAPARTUM CARE
4140 DENTAL HEALTH 37,000 4233 PREGNANCY TEST
4234 ORAL GLUCOSE TOL
4141 NON STRESS 4235 MYELODYSPLASIA
4142 REFUGEE HEALTH 4236 DEPO PROVERA 527
4143 PAP SMEAR 4237 CHRONIC DIS MONIT
4144 MAT CARE INITIAL 13,252 4238 COMPREHENSIVE ASSESMNT
4145 MAT CARE SUB 30,812 4239 LIMITED ASSESSMENT
4146 CHILDBIRTH CLASS 4240 COLPOSCOPY W/O BIOPSY
4147 MAT HOME VISIT
4241 COLPOSCOPY W/BIOPSY
4148 PARENTING CLASS 4242 CYROSURGERY
4149 VAG DELIV ONLY 4244 HEMOGLOBIN A1C
4150 TOTAL OBSTET VAG 4245 BLOOD CHOLESTEROL
4151 NEUROMUSCULAR 4246 BLOOD GLUCOSE-SERUM
4152 ULTRASOUND 4247 BLOOD GLUCOSE-FINGER
4153 OBSTETRIC CARE 4248 STOOL OCCULT BLOOD
4154 CEASAREAN DELIV
4249 TB SKIN TEST-PPD
4155 HYSTERECTOMY 4250 SERUM CREATININE
4156 CHILD SERV COORD 95,040 4251 TRIGLYCERIDES
4157 FAMILY PLANNING 9,000
4252 LIPOPROTEIN
4158 EPSDT 19.884 4253 LIPID PANEL
4159 IMMUN UPDATE 0 4254 RABIES IMMUNE GLOB
4160 DEC 4255 RABIES VACCINE/UNIT
4161 DEC SPEECH & HEARING 4243 SCREEN MAMMOGRAPHY 235
4162 HEPATITIS CHILD
4163 HEPATITIS ADULT TOTAL 30 ,043
4173 GONORRHEA CULT
Reviewed by
DEHNR 3300 (revised 9/93) Initials Date
General Services Division (Review 1195)
19
LOCAL HEALTH DEPARTMENT BUDGET
Department of Environment,
,-Iealth, and Natural Resources Revision Number_—
�-lion of General Services
Y Division of Epidemiology ————P. O. Number
07 / 94 06 / 95 9 5 4 5 1 0 0 Q 6 g
Effective Date Termination Date Contract Number
�ntractor: Orange Co. Health Dept. Activity,: Communicable Disease
3ject Director: Daniel B. Reimer Total Budget:$ 178 699
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
? STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000
' Operating Expenses OP EXP 2000
? Purchase of Equipment EQUIP 5000
General Contracted or
Purchased Services GENERAL 6100
1
School Health ::.. �..B�.'�I.......... . ...� ...... ..:..... .... : ... .... ..::. ....
Clinician CLN 6863
Laboratory LAB 6862
Pharmacy Services RX SERV 6865
Transfer TXIX � ?<_>`<<>»�' `::
Z Subtotal State Expend. $ 4,133
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES—equal to Total Receipts $ 178,699
LOCAL FUNDS:
Z Appropriation APPROP 101 156,519
TXIX TXIX 102 3,047
Other Receipts OTHR REC 103 15,000
Subtotal Local Funds $ 174,566
STATE/FEDERAL/SPECIAL FUNDS:
I
•
T DEHNR 4,133
Subtotal State/Federal/Special $4,133
TOTAL RECEIPTS—equal to Total Expenditures $178,699
_.oval Authorized Official Signature Date B a C'h bead Division/Section Signature Date
wmd
:nance Officer Signature Date Acw—=t Fiscal Management Signature Date
U;n.1
i-NR 2948(Revised 2/93)
:oral Services Division(Review 2/94)
20
LOCAL HEALTH DEPARTMENT BUDGET
1 Department of Environment,
-icalth, and Natural Resources Revision Number
vision of General Services
Y Division of Epidemiology
P. O. Number
07 / 94 06/ 95 __L 4 5 5 1 0 0 6 8
Effective Date 'I ermination.Date Contract Number
)retractor: Orange Co. Health Dept, Activity: Tuberculosis
3ject Director: Daniel B. Reimer Total Budget:$ 13,218
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 13,218
Operating Expenses OP EXP 2000
Purchase of Equipment EQUIP 5000
General Contracted or
Purchased Services GENERAL 6100
School Health ...... .........
Clinician .........
.. . . ...... ..... ........
Laboratory
.................
X
Pharmacy Services 6-5:
Transfer TX1X
Subtotal State Expend. $ 13,218
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES—equal to Total Receipts $ 13,218
LOCAL FUNDS:
Appropriation APPROP 101
TXIX TXIX 102
Other Receipts OTHR REC 103
Subtotal Local Funds
STATE/FEDERAL/SPECIAL FUNDS:
DEHNR 13,218
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures $ 13,218
-ocal Authorized Official Signature Date B—d,Had Division/Section Signature Date
Finance Officer Signature Date Accoun=t Fiscal Management Signature Date
Inaial
HNR 2948(Revised 2/93)
leral Services Division(Review 2/94)
21
LOCAL HEALTH DEPARTMENT BUDGET
N.C. Department of Environment,
Health, and Natural Resources Revision Number--
Division of General Services
SFy Division of Epidemiolo¢y —————.
P.O. Number
07 / qA 06 / 95_. - 5 4 5 4 50 6 $_
Effective Date Termination Date Contract Number
Contractor: _Orange Co. Health Dept. Activity: Aids (federal)
Project Director: Daniel B. Reimer Total Budget.$ 28.000
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 28.000
Operating Expenses OP EXP 2000
P Purchase of Equipment u 3DQ0
E
G en 0
General Contracted r
N Purchased Services ;b1W
School Health ::5�'�i HL 4 ?
Clinician
T. Laboratory LAB 2 .:
Pharmacy Services R3t.;smY ..ZOO
U Transfer TXIX
R Subtotal State Expend. $ 28,000
E LOCAL EXPENDITURES: LOCAL EXP 9000
S TOTAL EXPENDITURES —equal to Total Receipts $ 28,000
LOCAL FUNDS:
R Appropriation APPROP 101
E TX1X/SSBG Fees TX1X/SSBG 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHNR 28,000
T
S
Subtotal State/Federal/S $ 28,000
TOTAL RECEIPTS—equal to Total Expenditures $
Local Authorized Official Signature Date brmb&Hmd Division/Section Signature Date
Finance Officer Signature Date mw Fiscal Management Signature Date
DFRWR 2948(Revired 2/92)
Gmeral Services Dt-W=(Review 2/'94)
22
LOCAL HEALTH DEPARTMENT BUDGET
1 Department of Environment,
-lealth, and Natural Resources Revision Number
.,ision of General Services
Division of Maternal and Child Health
Y P.O. Number
07 _24_ 06 /95 0
Effective Date Termination Date Contract Number
;retractor: Orange Co. Health Dept. Activity: Maternal -Outreach
eject Director: Daniel B. Reimer Total Budget:$ 370.087
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 74,483
Operating Expenses OP EXP 2000
Purchase of Equipment 5000
General Contracted or
Purchased Services GENERAL 6100
School Health SCH.,-BL-TH- :6200�
Clinician
.-6863:,:
Laboratory
Pharmacy Services RX SERV
Transfer TXIX
6864
Subtotal State Expend. $74,483
LOCAL EXPENDITURES: LOCAL EXF 9000 295'604
TOTAL EXPENDITURES—equal to Total Receipts $370,087
LOCAL FUNDS:
Appropriation APPROP 101 172,296
TXIX T)UX 102 123,308
Other Receipts OTHR REC 103 0
Subtotal Local Funds $295,604
STATE/FEDERAL/SPECIAL, FUNDS:
Prematurity Prevention DEHNR 14,306
Teen Pregnancy 1510-6100-5101 8,435
r Perinatal $74 483 15)784
35,958
Subtotal State/FederaUSpecial $74,483
TOTAL RECEIPTS—equal to Total Expenditures $370,087
:_,oval Authorized Official Signature Date Branch Had Division/Section Signature Date
WEW
Finance Officer Signature Date �==t Fiscal Management Signature Date
I INR 2948(Revised 2/93)
-ieral Services Division(Review 2/94)
23
LOCAL HEALTH DEPARTMENT BUDGET
�. Department of Environment,
-iealth, and Natural Resources Revision Number_ —
ision of General Services
Division of Maternal and Child Health -----
P. O. Number
07 / 94 06 / 95 9 5 5 1 5
_1_ 0 0 6 $
Effective Date Termination Date Contract Number
)ntractor: - Orange Co. Health pp- t-- Activit,: -Family Planning
eject Director: Daniel B. Reimer Total Budget: $ 557,055
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
? STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 116,562
Operating Expenses OP EXP 2000
Purchase of Equipment EQUIP 5000
General Contracted or
Purchased Services GENERAL 6100 5,700
School Health
Clinician CLN 6863
r Laboratory LAB` :.?:<.:::>:;::'
Pharmacy Services b865
J Transfer TXIX
Subtotal State Expend. $ 122,262
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES—equal to Total Receipts $ 557,055
LOCAL FUNDS:
Appropriation APPROP 101 397,212
E TXIX TXIX 102 26,201
Other Receipts OTHR REC 103 11,380
Subtotal Local Funds $ 434,793
STATE/FEDERAL/SPECIAL FUNDS:
I
P HMHC Funds] 22,162
T Non–HMHC Funds] DEHNR 1515-6100-5151 100,100
Subtotal State/Federal/Special $ 122,262
TOTAL RECEIPTS—equal to Total Expenditures $557,055
Local Authorized Official Signature Date Branch Hnd Division/Section Si atur Date
Iftimal
Finance Officer Signature Date n=o�t�t Fiscal Management Signature Date
wCW
'ENR 2948(Revised 2/93)
ncr,l Services Division(Review 2/94)
24
LOCAL HEALTH DEPARTMENT BUDGET
:.Department of Environment,
lealth,and Natural Resources Revision Number—
ision of General Services
Division of Maternal and Child Health ————P. O. Number
07 / 94 06/ 95 _2__5_ 5 3 2 3 0 Q 6 8
Effective Date Termination Date Contract Number
Orange Co. Health Dept. CSHS Orthopedic
atraaor: Activity:
ject Director: Daniel B. Reimer Total Budget:$ 634
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 634
Operating Expenses OP EX? - 2000
Purchase of Equipment EQUIP 5000
General Contracted or
T Purchased Services GENERAL 6100
School Health SCH`HLTH 6200
Clinician CLN 6863
Laboratory LAB 6862
Pharmacy Services RX SERV 6865
J Transfer TXIX
Subtotal State Expend. $ 634
LOCAL EXPENDITURES: LOCAL EXP 9000
1 TOTAL EXPENDITURES—equal to Total Receipt_ $ 634
LOCAL FUNDS:
Z Appropriation APPROP 101
TXIX TXIX 102
Other Receipts OTHR REC 103
Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
DEHNR 634
i
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures $
_oval Authorized Official Signature Date B=ch Hod Division/Section Signature Date
Finance Officer Signature Date w Fiscal Management Signature Date
i-DM 2948(Rcviscd 2/93)
,-1 G.,,,,—rW,4.;—lA..,a—7 10A
' 25
LOCAL HEALTH DEPARTMENT BUDGET
Department of Environment,
-iealth, and Natural Resources Revision Number ,—
ision of General Services
Division of Maternal and Child Health ————P.O.Number
07 / 94 06 / 95 9 5 5 3 1 8 0 0 6 8
Effective Date Termination Date r Contract Number—
ntractor: orange Co. Health Dept. Activity: Child Service Coordination
)ject Director: Daniel B. Reimer Total Budget:$ 213,279
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 51 )8 7 6
Operating Expenses OP EXP 2000
Purchase of Equipment EQUIP 5000
? General Contracted or --
Purchased Services GENERAL 6100
School Health SCH HLTH 6200
Clinician CLN 6863
Laboratory LAB 6862
Pharmacy Services RX SERV 6865
J Transfer TXIX
Z Subtotal State Expend. $ 51,876
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES—equal to Total Receipts $
LOCAL FUNDS:
Z Appropriation APPROP 101 66,363
TXIX TXIX 102 95,040
Other Receipts OTHR REC 103 0
Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
i
DEHNR 51,876
Subtotal State/Federal/Special $
TOTAL RECEIPTS—equal to Total Expenditures $
-ocal Authorized Official Signature Date Branch H=d Division/Section Signature Date
wtw
=finance Officer Signature Date Ac�=r Fiscal Management Signature Date
wtw
-NR 2948(Revised 2/93)
:cra]Scrviccs Division(Review 2/94)
26
LOCAL HEALTH DEPARTMENT BUDGET
N.C. Department of Environment,
Health, and Natural Resources Revision Number——
Division of General Services
SFy Division of Matemal and Child Health ————P. O. Number
07 / 94 06 / 95 9 5 5 4 0 2 0 0 6 8
Effective Date Termination Date Contract Number
Contractor: orange Co. Health Dept. Activity: MCH Block Grant Nutrition
Project Director: __ Daniel B. Reimer Total Budget: $ 2,450
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries 8c Fringe Benefits SA/FR 1000 2,450
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E
General Contracted or `
N Purchased Services GENF.Rf3L 6 I00
; .
School Health .'SCH HLTH 6200
D
Clinician W3 : ,:.;,:..... ::.
I
,1 Laboratory LAB::: .. 6862 ..
Pharmacy Services RX SERV 6865
Transfer TXIX
6864
R Subtotal State Expend. $ 2,450
E LOCAL EXPENDITURES: --FLOCAL EXP 9000
S
TOTAL EXPENDITURES —equal to Total Receipts $ 2,450
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TXIX 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHNR 2,450
T
S
Subtotal State/Federal/Special $ 2,450
TOTAL RECEIPTS —equal to Total Expenditures $ 2,450
Local Authorized Official Signature Date B�6 H=d Division/Section Signature Date
Finance Officer Signature Date Fiscal Management Signature Date
DEHNR 2948(Revised 2/93)
(n...:...,110d)
27
• LOCAL HEALTH DEPARTMENT BUDGET
Department of Environment,
::h, and Natural Resources Revision Number——
,n of General Services
Division of Adult Health -----
P. O.Number
071 94 06 / 95 5 5 0 2 0 0 6 8
riective Date Termination Date Contract Number
actor: Orange Co-Health Dept. Activity: Adult Health
Director: Daniel B. Redmer Total Budget: $ 105,161
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000
Operating Expenses OP EXP 2000
Purchase of Equipment EQUIP 5000
General Contracted or
Purchased Services GENERAL 6100 5,502
School Health ._:SCH,HLTH _. :6200
Clinician CLN 6863
Laboratory LAB 6862
Pharmacy Services RX SERV 6865
Transfer TXIX
Subtotal State EE2end. S
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES —equal to Total Receipts $
LOCAL FUNDS:
Appropriation APPROP 101 99.859
TXIX TXIX 102
Other Receipts OTHR REC 103
Subtotal Local Funds 5 99,859
STATE rFDERAL/SPECIAL FUNDS:
DEHNR 5,502
Subtotal State/Federal/Special S 5,502
TOTAL RECEIPTS —equal to Total Expenditures $ 105,361
:.al Authorized Official Signature Date Branch Had Division/Section Signature Date
Inim1
ante Officer Signature Date Accounant Fiscal Management Signature Date
mmal
?.2948(Revised 2/93)
Scrvica Divkian(R virw 2/94)
28
LOCAL HEALTH DEPARTMENT BUDGET ,
�. Department of Environment,
-iealth, and Natural Resources - Revision Number——
ision of General Services
1. Division of Adult Health —————
P. O. Number
07/ 94 06 / 95 —Q--a_Q 0 6 8
Effective Date Termination Date Contract Number
,ntractor: O3nize Co. Health Dept, Activity: Health Promotion
eject Director: Daniel B. Reimer Total Budget: $ 63,033
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000
Operating Expenses OP EXP 2000
Purchase of Equipment EQUIP 5000
General Contracted or
1 Purchased Services GENERAL 6100
School Health SCH HI:TH ' :::::<:::62a0.: .
Clinician C) .:,. ;,::' 3::::-
Laboratory LAB
r Pharmacy Services RX::::SERV. ;:: :.6865..::.:::
7
Transfer TXIX .::..6854..
Subtotal State Expend. S 22,116
L LOCAL EXPENDITURES: LOCAL EXP 9000 40,917
TOTAL EXPENDITURES — equal to Total Receipts S 63,033
LOCAL FUNDS:
R Appropriation APPROP 101 38,542
TXIX TXIX 102
Other Receipts OTHR REC 103 2,375
E Subtotal Local Funds S 40,917
STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHNR 22,116
T
S
Subtotal Sr-are/Federal/Special S 22,116
TOTAL RECEIPTS —equal to Total Expenditures S 63,033
Local Authorized Official Signature Date Branch Hod Division/Section Signature Date
ininal
Finance Officer Signature Date n�vmant Fiscal Management Signature Date
Wml
cHNR 2948(Revised 2/93)
-nr21 Services Division(Review 2/94)
LOCAL HEALTH DEPARTMENT BUDGET 29
'N.C.Department of Environment,
Health, and Natural Resources Revision Number
Division of General Services
S r y Division of Epidemiology ———--—
P.O.Number
071 94 06 / 95 4 5 2 4 0 fib_ 8 _
Effective Date Termination Date Contract Number
Contractor: Orange Co. Health Dept. Activity: Immunization Action Plan
Project Director: Daniel B. Reimer Total Budget: $ 11,861
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 11 .861
Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
-E General Contracted or
N Purchased Services GENERAL 6100
School Health
D
Clinician
M.
I
or
Lab ra
o t } �pp�
s3? isi? cy iii.:?izi ;?;;<>` > sisti ';�i'%ii% �i>'s`?
T
Pharmacy Services ..h rmac Se ry es
.. > . ... ....._ ...... ....... ............. .
Transfer ans er TXIX
R Subtotal State Expend. $ 11,861
E LOCAL EXPENDITURES: LOCAL EXP 9000
S TOTAL EXPENDITURES—equal to Total Receipts $ 11,861
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TXIX 102
Other Receipts OTHR REC 103
C
E Subtotal Local Funds $
STATE/FEDERAL/SPECIAL FUNDS:
I
P DEHNR 11,861
T
S
Subtotal State/Federal/Special $ 11,861
TOTAL RECEIPTS—equal to Total Expenditures $ 11,861
Local Authorized Official Signature Date B c d Division/Section Signature Date
ininal
Finance Officer Signature Date n«oWmnt Fiscal Management Signature Date
Lnidi
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
30
LOCAL HEALTH DEPARTMENT BUDGET
U.C.Department of Environment,
Health,and Natural Resources Revision Number
Division of General Services
SFY Division of Maternal and Child Health ————P. O. Number
o7 /94 or, / 45 3 _5_ 5 3 5 1 0 n
Effective Date Termination Date Contract Number
Contractor: C)rqngo Cn_ Naa 1 th nP!t_ Activity: Child Health
Project Director: n n n i P l R- R P i m a r Total Budget: $ 3 9 A,R 51
ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT
1 E STATE EXPENDITURES:
X Salaries & Fringe Benefits SA/FR 1000 39,980
Operating Expenses OP EX? 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
School Health SCH HLTH 6200 9,725
D Clinician CLN 6863
I
T Laboratory LAB 6862
Pharmacy Services RX SERV 6865
U Transfer TXIX ;:,< :< :;°::<; ::::' :< 6864
R Subtotal State Expend. $ 49,705
E LOCAL EXPENDITURES: LOCAL EXP 9000 347,146
S TOTAL EXPENDITURES—equal to Total Receipts $
LOCAL FUNDS:
R Appropriation APPROP 101 315,996
E TXIX TXIX 102 9R,1 5 6
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ 347,146
STATE/FEDERAL/SPECIAL FUNDS:
1 9,725
P School Health DEHNR $49,705 35,958
T HM/HCBG 4,022
General
S
Subtotal State/Federal/Special $ 49,705
TOTAL RECEIPTS—equal to Total Expenditures $ 396,851
Local Authorized Official Signature Date Branch H=d Division/Section Signature Date
mtual
Finance Officer Signature Date w=o—tmt Fiscal Management Signature Date
wtW
DEHNR 2948(Revised 2/93)
General Services Division(Review 2/94)
31
LOCAL HEALTH DEPARTMENT BUDGET
went of Environment,
anc ?va ural RtSOL`rCGS Revision Dumber --
. of General Services
Division of Adult Health -----
P. O. Number
07 / 94 06 / .95 9 5 5 4 525 0 6 8
ecbve Date Termination Date Contract Number
Qrnn$P Cn_ hPn1 th nopt Activity: COMP. Breast & Cervical Cancer Contl:ol
Director: Daniel R- ra;mar Total Budge-.: $25.913
ITEM DESCRIPTION I CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
Salaries & Fringe Benefits SA/FR 1000 13,454
Operating Expenses OP EXP 2000 F
Purchase- of Equipment EQUIP 5000
General Contracted or
Purchased Services GENTERAL 6100 11,260 "
i - Z
School Health SCH I3LT'I ;°'62�
CLnician CLN 6563
L�'�or ato:y LAB 6662
P;,a-nacy Services RX SERV • 6865
T ra..,sfer TXIa 6S�`
Subtota'. State Exaend. S24,714
OC!'- EXPENDI T URES: I LOCAL. EXP . 9000
T OTP.L EXPENDITURES — equal to Total Receipts 525,913
�OC.= FUNDS:
A-2cropriation P DPRnP 101
T} TXLX 102 9 s
Ot�e: Receipts OTHR RFC 103
Subtotal Local Funds $1,199
ST .i=! DAR=.L/SPECIAL FUNDS:
DEHNR 24,714
Subtotal State/Federal/S-oecial S 24,714
TOTAL RECEIPTS — equal to Total Expenditures S 25,913
ci r'.ut^crired Official Signature Date Bnnt? Hoa Division/Section Signature Date
W wj
".Ice 0–cer Signature Dace w«o�Unt Fiscal Management Signature Date
?.2943(Revised 2/93)
1 S^--viccs Div:,;—(P";.—,7/OE1