mid-michigan district health department · 2014. 3. 28. · 1. finance committee a. mid-michigan...

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org CLINTON Branch Office 1307 E. Townsend Rd. St. Johns, MI 48879-9036 (989) 224-2195 GRATIOT Branch Office 151 Commerce Drive Ithaca, MI 48847-1627 (989) 875-3681 MONTCALM Branch Office 615 N. State St., Ste. 1 Stanton, MI 48888-9702 (989) 831-5237 ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2 Stanton, MI 48888-9702 (989) 831-5237 MARK W. (MARCUS) CHEATHAM Health Officer ROBERT GRAHAM, DO, MPH, FAAFP Medical Director BOARD OF HEALTH Bruce Delong Jack A. Enderle Betty Kellenberger Tom Lindeman Laura McCollum Donald Zinn Your Public Health Team, Connecting with our Communities to Achieve Healthier Outcomes. BOARD OF HEALTH REGULAR MEETING At Mid-Michigan District Health Department Gratiot County Branch Office Ithaca, Michigan Friday, March 28, 2014 10:00 AM AGENDA We take action to assure the health and well being of our community and the environment by responding to public health needs and providing a broad spectrum of prevention and educational services. Pledge of Allegiance A. AGENDA NOTES, REVIEW, AND REVISIONS: 1. B. CONSENT ITEMS: 1. Meeting Minutes a. Michigan Association for Local Public Health (MALPH) Board of Directors Meeting held February 10, 2014 - Attached. 4 b. Mid-Michigan District Board of Health Regular Meeting held February 26, 2014 - Attached. 7 c. Mid-Michigan Health Plan (MMHP) Advisory Board held March 6, 2014 - Attached. 16 2. Communications a. Press Release dated March 20, 2014 from Governor Rick Snyder and the Department of Community Health regarding Healthy Michigan Open Enrollment to begin April 1, 2014 - Attached. 23 C. PUBLIC COMMENTS: D. BRANCH OFFICE EMPLOYEES: E. COMMITTEE REPORTS:

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Page 1: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

BOARD OF HEALTH

REGULAR MEETING

At

Mid-Michigan District Health Department

Gratiot County Branch Office

Ithaca, Michigan

Friday, March 28, 2014

10:00 AM

AGENDA

We take action to assure the health and well being of our community and the environment

by responding to public health needs and providing a broad spectrum

of prevention and educational services.

Pledge of Allegiance

A. AGENDA NOTES, REVIEW, AND REVISIONS:

1.

B. CONSENT ITEMS:

1. Meeting Minutes

a. Michigan Association for Local Public Health (MALPH) Board of Directors Meeting

held February 10, 2014 - Attached.

4

b. Mid-Michigan District Board of Health Regular Meeting held February 26, 2014 -

Attached.

7

c. Mid-Michigan Health Plan (MMHP) Advisory Board held March 6, 2014 - Attached. 16

2. Communications

a. Press Release dated March 20, 2014 from Governor Rick Snyder and the Department of

Community Health regarding Healthy Michigan Open Enrollment to begin April 1,

2014 - Attached.

23

C. PUBLIC COMMENTS:

D. BRANCH OFFICE EMPLOYEES:

E. COMMITTEE REPORTS:

Page 2: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

1. Finance Committee

a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and

Expenditure Report for February 2013 - Attached.

25

b. Mid-Michigan District Health Department's Expenses for February 22 - March 21, 2014

- Attached.

32

c. FY 12/13 Audit - Abraham & Gaffney (Note: One presentation will be given at the full

Board Meeting) - Provided Electronically and Handout.

47

d. Hospital-Based Dental Services - Attached. 90

2. Personnel Committee

a.

3. Program Committee

a.

4. Mid-Central Coordinating Committee

a. District Health Department #10 (DHD #10) Membership - Attached. 94

F. MEDICAL DIRECTOR'S REPORT: - Attached. 95

1. Influenza Activity

2. Pertussis

3. Update on PBB Study in Gratiot County

G. HEALTH OFFICER'S REPORT

1. Revised Continuity of Leadership Policy - Attached. 96

2. Health Officer Conference Report - Attached. 100

3. Impact of Women, Infants, and Children's (WIC) Program on Local Communities -

Attached.

101

H. OLD BUSINESS:

1. PBB Update, Bonnie Havlicek, Director of Community Health and Education

2. Clinton County Conservation District Update - Attached. 104

I. NEW BUSINESS:

1. Annual Self-Assessment of the On-Site Wastewater Treatment Management Program -

Attached.

106

2. County Health Rankings - Attached. 108

3. Emerging Issues

a. Increased Non-Community Water Supply Inspections - Attached. 111

b. Inspections for Low-Risk Food - Attached. 117

c. Caseload Changes in Community Health and Education Division Due to Medicaid

Expansion - Attached.

118

J. LEGISLATIVE ACTION: None.

K. INFORMATIONAL ITEMS: - Attached.

1. Mid-Michigan District Board of Health Action Items, February 2014 120

2. Salary and Staffing Report 121

3. Maternal Infant Health Program (MIHP) Impact on Birth Outcomes - Attached. 122

Page 3: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

L. RELATED NEWS ARTICLES AND LINKS:

1. MMDHD News Articles available online at www.mmdhd.org

2. Editions of MI FluFocus can be found online

at http://www.michigan.gov/mdch/0,1607,7-132-2940_2955_22779_40563-143382--

,00.html

M. AGENCY NEWSLETTERS: None.

Page 4: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 5: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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The Day at the Capitol will be April 30, 2014 and will coincide with DCH’s County

Health Rankings event. Stay tuned for more details. The Governor’s budget 9 , 5 8 - - , 0 7 3 . / 8 0 4 + 3 d , > , , 0 9 , 6 , 3 4 , 7 C 3 0 7 . , 4 . / - 8 0 ? 8 0 . + , f ] e ^ H > 5 8 - - / . . , , 8 0F I I 9 8 I 9 / 3 . / 8 0 4 c 8 9 . + , ^ , 0 3 . , / 4 p , > 9 H 3 9 ? ~ < Ô Õ 3 0 7 ~ = Ô Õ E e 8 H 4 , . , 4 . / - 8 0 ? / 4 4 , . c 8 9p , > 9 H 3 9 ? j : Ô Õ 3 0 7 ~ Ö Ô Õ E h , 2 / 6 6 > , 4 , , a / 0 1 × ~ - / 6 6 / 8 0 9 , 4 . 8 9 3 . / 8 0 8 c \ 4 4 , 0 . / 3 6 @ 8 5 3 6D H > 6 / 5 e , 3 6 . + ^ , 9 d / 5 , 4 7 8 6 6 3 9 4 . + 3 . 2 / 6 6 9 , . H 9 0 H 4 . 8 I 9 , [ ` / 5 + / 1 3 0 9 , 5 , 4 4 / 8 0 c H 0 7 / 0 1 E ` E^ 2 3 / 0 2 / 6 6 0 , , 7 4 . 8 9 / , 4 c 9 8 - . + , c / , 6 7 . 8 4 + 3 9 , 2 / . + 6 , 1 / 4 6 3 . 8 9 4 C 3 4 2 , 6 6 3 4 5 8 - I / 6 / 0 1 . + , 4 ,4 . 8 9 / , 4 3 4 + , 3 6 . + 7 , I 3 9 . - , 0 . 4 5 8 0 0 , 5 . 2 / . + 6 , 1 / 4 6 3 . 8 9 4 > 3 5 a / 0 . + , 7 / 4 . 9 / 5 . E h , 2 / 6 6 > ,3 6 / 1 0 / 0 1 8 H 9 - , 4 4 3 1 , 2 / . + . + , B 8 d , 9 0 8 9 8 0 / . , - 4 4 H 5 + 3 4 . + , e , 3 6 . + ? ` / 5 + / 1 3 0 D 6 3 0 C/ 0 c 3 0 . - 8 9 . 3 6 / . ? 9 , 7 H 5 . / 8 0 C 3 0 7 k u k 8 > , 4 / . ? I 6 3 0 E i 0 3 7 7 / . / 8 0 C 3 6 / 1 0 / 0 1 8 H . - , 4 4 3 1 , 2 / . +DCH’s strategic priorities. Still awaiting word from the U of M –

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Page 6: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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6

Page 7: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

BOARD OF HEALTH

REGULAR MEETING

at

Mid-Michigan District Health Department

Clinton County Branch Office

St. Johns, Michigan

Wednesday, February 26, 2014

10:00 a.m.

MINUTES

We take action to assure the health and well being of our community and the environment

by responding to public health needs and providing a broad spectrum

of prevention and educational services.

Members Present: Jack A. Enderle, Tom Lindeman, Betty Kellenberger, Laura McCollum, Chairperson

(participated via video conference), and Bruce Delong, Vice Chairperson

Members Absent: Donald Zinn

Staff Present: Mark W. (Marcus) Cheatham, Ph.D., Health Officer; Melissa Bowerman, Director of

Administrative Services; Cindy Partlo, Board Secretary; Robert Graham, DO, MPH,

FAAFP, Medical Director; and Bonnie Havlicek, Director of Community Health &

Education

Staff Absent: None

Guests: Ross Pope, Data Specialist (arrived at 10:25 a.m.); Sarah Doak, Supervisor of

Community Health and Education; Hazel Hall, Michigan Care Improvement Registry

(MCIR) Coordinator (both arrived at 10:32 a.m.)

L. McCollum, Chairperson called the regular meeting of the Mid-Michigan District Board of Health to order at

10:06 a.m., on Wednesday, February 26, 2014, at the Clinton County Branch Office of the Mid-Michigan

District Health Department, St. Johns, Michigan.

Pledge of Allegiance was led by L. McCollum.

7

Page 8: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

Page 2 of 9

A. AGENDA NOTES, REVIEW, AND REVISIONS:

Motion made by B. Kellenberger and supported by J. Enderle to approve the Agenda as

presented. Motion carried.

B. CONSENT ITEMS:

1. Meeting Minutes

a. Michigan Association for Local Public Health (MALPH) Board of Directors Meeting

held January 13, 2014

b. Mid-Michigan District Board of Health Regular Meeting held January 22, 2014

2. Communications

a. Letter dated January 21, 2014 to Mid-Michigan District Health Department from Dr.

Michele Marcus, Professor of Epidemiology, The Michigan PBB Registry, Emory

University regarding the agency's support of the PBB community meetings in

December 2013

Motion made by B. Kellenberger to accept and place on file Meeting Minutes B. 1. a. and b.

and Communications B. 2. a. Motion supported by T. Lindeman. Motion carried.

C. PUBLIC COMMENTS: None

D. BRANCH OFFICE EMPLOYEES: M. Cheatham stated that he was working to schedule the next

Administrative Orientation, so new employees might be attending the April Board of Health meeting.

E. COMMITTEE REPORTS:

1. Finance Committee – Tom Lindeman, Chair

a. Mid-Michigan District Health Department’s Monthly Balance Sheet, Revenue and

Expenditure Report for January 2014

Motion made by T. Lindeman to approve and place on file the Mid-Michigan

District Health Department’s Monthly Balance Sheet, Revenue and Expenditure

Report for January 2014. Motion supported by B. Kellenberger. Motion carried.

b. Mid-Michigan District Health Department's Expenses for January 11 through

February 21, 2014

Motion made by T. Lindeman to pay the Mid-Michigan District Health

Department’s Expenses for January 11 through February 21, 2014, totaling

$630,356.89. Motion supported by B. Delong. Motion carried.

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c. Women, Infants, and Children (WIC) Staffing Update

J. Enderle explained that the WIC Peer Counselor position based in the Clinton Branch

Office (CBO) was originally a .5 FTE position; however, was reduced to a .4 FTE at the

request of the employee holding that position. Upon resignation of the employee, the

agency externally posted the position as a .5 FTE. M. Cheatham noted that the change

was budget neutral due to a modification in benefits for a Public Health Nurse position.

Motion made by T. Lindeman and seconded by B. Delong to approve the WIC Peer

Counselor position based in CBO as a .5 FTE effective February 25, 2014. Motion

carried.

d. Condyloma Treatment Fee

T. Lindeman stated that the agency was now able to receive a higher reimbursement rate

for condyloma treatments for clients with commercial insurance.

Motion made by T. Lindeman and seconded by B. Delong to approve the fees for the

services provided for condyloma treatment effective March 1, 2014. Motion carried.

e. Community Health Worker

M. Cheatham explained that the Community Health Worker (CHW) position would be

discussed further under the Health Officer’s Report.

Motion made by T. Lindeman and seconded by B. Kellenberger to approve the

CHW Job Description at the Teamsters Local 214, T4 level as proposed, upon

approval by the Teamsters. Motion carried.

f. Insight Software

T. Lindeman stated that Finance Committee recommended the purchase of two Insight

software modules (Case Management and STD) at a cost of $15,000, with annual

maintenance costs of $2,100. M. Cheatham added that Equipment/Technology funds

would be used to purchase the modules.

Motion made by T. Lindeman and seconded by B. Kellenberger to authorize the

purchase of the Case Management and STD Modules for Insight as proposed at a

cost of $15,000 to be paid from the Equipment/Technology fund balance. Motion

carried.

g. FY 14/15 Budget Development Timeline

T. Lindeman stated that the Finance Committee recommended approval of the FY 14/15

Budget Development Timeline with the condition that M. Cheatham checks with Gratiot

County to be sure that the timeline works with their schedule. M. Cheatham asked L.

McCollum if the FY 14/15 Budget Development Timeline worked with Gratiot County’s

budget development schedule. L. McCollum stated that she had no concerns with the

timeline.

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Motion made by T. Lindeman and seconded by B. Kellenberger to approve the FY

14/15 Budget Development Timeline as proposed. Motion carried.

2. Personnel Committee – Betty Kellenberger, Chair – No topics.

3. Program Committee – Bruce Delong, Chair – No topics.

4. Mid-Central Coordinating Committee – Tom Lindeman, Vice Chair – No topics.

F. MEDICAL DIRECTOR’S REPORT: Robert Graham, DO, MPH, FAAFP

1. Influenza Update

Dr. Graham stated that the numbers of cases were lower than last year. Currently, influenza is

peaking. Interestingly, he said that the two A strains circulating – H3N2 and H1N1 have change

dominance from last year. Last year, the dominate strain was H3N2. This year the dominate

strain is H1N1. He noted that people between 18-35 years of age are having the most difficulty

with the virus. M. Cheatham reported that he read an interesting article regarding why that age

group was having difficulty with the virus; as only about 30% were vaccinated. With the efficacy

over 65% this year for the influenza vaccine, a lot of the deaths could have been avoided had that

age group been vaccinated.

2. Healthy Pregnancy

Dr. Graham also reported on preparations for preconception and postpartum health tips, noting

that the health department offers advice to women planning pregnancy, as well as after delivery

counseling and education to ensure healthy babies. He reviewed preconception preparation and

postpartum health tips that women can take to increase the chances of having a normal

pregnancy and delivery.

Dr. Graham offered the following as the Recommendation of the Board of Health (BOH) for the

month of March:

Women planning to become pregnant should quit smoking and alcohol consumption; eat

foods high in folic acid such as leafy green vegetables, fruits, dried beans, peas, nuts.

Women planning pregnancy should see a doctor prior to conception for a health review and

prenatal testing and bring mom’s immunizations up to date.

After delivery, parents should insist on a smoke-free environment1.

1Evidence-Based Prenatal Care: Part I. General Prenatal Care and Counseling Issues, April 5,

2005, American Family Physician

Motion made by T. Lindeman and seconded by J. Enderle to adopt the BOH Monthly

Healthy Living Recommendation for March as proposed. Motion carried.

Motion made by B. Kellenberger and seconded by T. Lindeman to accept and place the

Medical Director’s Report on file. Motion carried.

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G. HEALTH OFFICER'S REPORT: Mark W. (Marcus) Cheatham, Ph.D., Health Officer

1. Reschedule October 22nd

Board of Health Finance and Regular Meetings

M. Cheatham indicated that Michigan’s Premier Public Health Conference falls on the October

BOH regular meeting date. He requested that the meeting be rescheduled to accommodate

attendance at the conference by BOH members.

After discussion, motion made by J. Enderle and seconded by B. Kellenberger to

reschedule the October regular BOH meeting from October 22nd

to October 29th

in

Stanton. Motion carried.

2. Health Officer Upcoming Travel

M. Cheatham indicated that he will need to attend a Joint Public Health Informatics Task Force

(JPHIT) Summit in San Antonio, Texas, March 11-13, 2014. He explained that JPHIT is working

on a project for reporting diseases to public health. Currently, the proposal was to remove this

project from Meaningful Use, which could jeopardize the flow of surveillance data to health

departments. The JPHIT plans to propose solutions for not removing this reporting piece from

Electronic Medical Records (EMR)/Meaningful Use.

Additionally, the Summit would include four meetings in one to save on travel/attendance costs.

He stated that JPHIT would pay the costs of travel, lodging, and incidentals for him to attend as

Co-Chair. He requested Board approval to designate Bob Gouin as Acting Health Officer in his

absence.

M. Cheatham stated that he is considering running for NACCHO Board of Directors. If elected,

he would stop attending the JPHIT meetings. The NACCHO Board only meets face-to-face

twice a year, so Health Officer travel time would be reduced.

Motion made by B. Kellenberger and seconded by B. Delong to authorize M. Cheatham to

travel to the JPHIT Summit in San Antonio, Texas, March 11-13, 2014 and designate Bob

Gouin, Director of Environmental Health as Acting Health Officer. Motion carried.

3. National Public Health Week, April 7-13, 2014; Public Health: Start Here - www.nphw.org

M. Cheatham stated that the topic was for information only. B. Havlicek stated that the agency’s

Marketing Team discussed Public Health Week. She explained that there are themes for each day

of the week and discussed the agency’s plans for the week, as well as an employee featured in a

press release.

4. Performance Management

a. Performance Management System Update

M. Cheatham provided background regarding the agency’s Performance Management (PM)

System explaining the process of using data to make better decisions. He stated that the key

to productivity would be to automate the data collection and reporting processes.

Ross Pope provided an update regarding the agency’s PM System stating that the attachment

included in the meeting materials describes how the agency intends to move forward with the

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PM System. He stated that the PM System will be expanded as the agency becomes more

experienced working with the process. The plan would be to roll the PM System out to staff

at the fall District-Wide In-Service providing training to increase understanding of PM and

the agency’s goals.

b. Proposed Changes to Quarterly Service Report

M. Cheatham told the board that Ross Pope had made several proposed improvements to the

Quarterly Service Report. M. Cheatham provided background regarding the purpose of the

Quarterly Service Report and how it was started; inviting the Board to provide input into this

work. Ross Pope explained changes made to the Quarterly Service Report using the

Environmental Health Division as an example with the goal of making the report more useful

and user-friendly. He mentioned that the Community Health and Education Division (CHED)

data still needed to be fine-tuned regarding the types of data to track. He explained that

charting would now be available to assist in studying the data to make better-informed

decisions and to show trends. He mentioned that the data proposed to be removed from the

old format may be tracked in a different way with different goals in the PM System.

B. Havlicek explained her recommended changes to the CHED portion of the Quarterly

Service Report. M. Cheatham explained that in the old report, there were figures for the cost

of providing the service and the figures could be misleading therefore will be removed.

R. Pope asked the Board for their comments or feedback. He added that Fluoride Varnish

was being added to the Quarterly Service Report. J. Enderle stated that if the document was

more useful for the staff, he would support the changes. B. Kellenberger added that the new

reporting format was great.

Motion made by J. Enderle and seconded by B. Kellenberger to approve the changes to

the Quarterly Service Report as proposed. Motion carried.

5. Report Cards on Immunizations

M. Cheatham stated that the immunization reports show a very interesting story. He introduced

Sarah Doak, Supervisor of the Community Health and Education Division and Hazel Hall,

Michigan Care Improvement Registry (MCIR) Coordinator. He asked them to attend the Board

meeting to review the Quarterly Immunization Report Cards by county and to share with you

their interpretation of the data. He mentioned that these report cards show the percentage of the

population that are up to date on immunizations and are ranked by county. The reports are

another tool that the Board of Health can use to assess the agency’s performance.

Sarah Doak reviewed the reports noting that out of 84 counties as of December 31, 2013, Clinton

County was ranked 75, Gratiot County was 32, and Montcalm County was 54. She noted that

one reason for the poor ranking in Clinton County was because there are not very many Vaccines

for Children (VFC) providers. She stated that the children in Clinton County do not seek care in

Clinton County; however, they travel to Lansing Pediatrics. She referred the Board to the

summary of Clinton County Residents 19-36 months old showing residents seek care in Ingham

County.

Hazel Hall mentioned that Lansing Pediatrics enters vaccines administered into the MCIR

manually as they do not yet have EMR. They give between 800 and 1,200 vaccines per week and

do not have sufficient staffing to keep up with the data entry. She stated that she is working with

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their office to help them get caught up by obtaining copies of their vaccine records so MMDHD

staff can enter them. She added that for children under the age of 19, by law, vaccines must be

entered into the MCIR system within 72 hours. Once the Lansing Pediatrics records are caught

up, Clinton County’s rate should improve.

Hazel Hall explained that Clinton County Medical has gone live with a new process whereby

vaccines are entered into the MCIR at the same time they are entered into the EMR. She stated

that Clinton County Medical was considering becoming a VFC provider as they are expanding

and moving their office to property in front of Dunham’s.

M. Cheatham asked Sarah to explain waivers. She reported that Clinton County was 54 out of 84

for waivers received. She stated that students are assessed for immunizations at Kindergarten and

6th

grade, as well as any new student. Waivers are signed for philosophical or religious reasons;

although our agency only accepts the State of Michigan Waiver Form. She explained that school

funding is tied to immunization reporting and waivers are accepted in the reporting. She said that

schools are motivated to obtain signed waivers in order to receive their funding which can be

easier than asking a parent to take off work to take their children in for vaccinations. Sarah

described Ottawa County Health Department’s program where the waiver must be signed by a

nurse from the health department. An appointment must be made with the nurse that provides

education regarding the vaccines, and many times, the parent agrees to have their child

vaccinated. Sarah added that MMDHD just doesn’t have the staffing available to do a similar

program. J. Enderle asked if the schools could provide the education. M. Cheatham replied that

schools used to have school nurses, but now have volunteers or a health committee. J. Enderle

asked about the additional cost to run Ottawa County’s program. B. Havlicek stated that she

could explore what the costs would be to run a similar program. B. Havlicek stated that Sarah

has made good recommendations on changing nursing staff responsibilities to enable the Clinton

Branch Office to have two nurses that can administer vaccinations in addition to Sarah. B.

Havlicek summarized that it takes the involvement of the schools, health department, and

physicians to influence immunization rates in the community.

Hazel Hall mentioned that the Immunization Report Cards are available to the public on the

MCIR website at www.mcir.org.

H. OLD BUSINESS:

1. HUB Update, Marcus Cheatham, Health Officer

M. Cheatham provided an update on the progress of the community HUB projects. He outlined

Michigan’s State Innovation Model (SIM) and said the purpose was to organize preventive

services and health care and to improve health outcomes, quality of care, and control costs. One

component of the SIM is the pathways community HUB model. He explained the HUB model

and stated that the CHW for Clinton County approved by the Board would be connected to the

Ingham County HUB. He stated that Gratiot and Montcalm Counties were developing a HUB;

however, it made sense for Clinton County to work with the Ingham County HUB. The Ingham

County HUB has offered a grant to the agency of $50,000 for a CHW. He suspected the funding

would be available to the agency within one month.

He added that McLaren Health Plan has communicated that the Ingham County HUB was a good

model and recommended that model for the Gratiot/Montcalm HUB. He stated that the Ingham

Health Plan Corporation recently modified their business model to support the development of

HUBS and has offered to manage the Gratiot/Montcalm HUB for the agency. J. Enderle

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expressed concern for the safety of one staff person going out on home visits. M. Bowerman

explained that the Maternal Infant Health Program (MIHP) currently conducts home visits using

one staff person and that the agency could draw on those experiences for success with staff

safety. B. Havlicek provided information about how the staff has been trained in safety by

Trooper White of the Michigan State Police. She also added that cell phones are supplied for

staff conducting home visits. T. Lindeman asked if the agency could get started right away;

would there be a possibility that the funding would not be received? M. Bowerman replied that

the posting could be prepared, as well as other steps taken so that the agency is ready to recruit

once the funding is received.

2. Formal Hearing Update

M. Cheatham provided an update regarding the Formal Hearing that took place on February 13,

2014 stating that the Food Service License for Classic Pub & Grill in Clinton County was limited

to prepackaged foods based on the lack of active managerial control according to the Michigan

Food Law, Act 92, P.A. of 2000. He stated that J. Enderle and T. Lindeman represented the

Board of Health at the Formal Hearing and B. Kellenberger attended to observe.

I. NEW BUSINESS:

1. Epinephrine EpiPens® in Schools

M. Cheatham stated that he was contacted by the Superintendent of the Montcalm Area

Intermediate School District (MAISD) requesting the agency’s Medical Director to prescribe

EpiPens for the school to use and provide staff training in accordance with the requirements of a

new bill, House Bill 4353. M. Cheatham stated that the prescriptions needed to be written to the

School Boards, as opposed to an individual. He stated that only the Montcalm County school

districts have requested assistance with the new law. He summarized that no Board action was

needed because after researching the matter, the agency discovered that Spectrum Health offered

training in the use of EpiPens; therefore, the MAISD was referred to Spectrum Health for the

prescriptions.

2. Emerging Issues - None

J. LEGISLATIVE ACTION: None

L. INFORMATIONAL ITEMS:

1. Mid-Michigan District Board of Health Action Items, January 2014

2. Salary and Staffing Report

M. Cheatham mentioned that two vacancies were filled with two good candidates: the WIC Peer

Counselor position in Clinton County and the Oral Health Coordinator position in Montcalm

County. However, the Public Health Nurse position in Clinton County has been more difficult to

fill.

M. RELATED NEWS ARTICLES:

1. MMDHD News Articles available online at www.mmdhd.org

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2. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General,

2014 can be found at http://www.surgeongeneral.gov/library/reports/50-years-of-

progress/index.html

3. Editions of MI FluFocus can be found online at http://www.michigan.gov/mdch/0,1607,7-132-

2940_2955_22779_40563-143382--,00.html

N. AGENCY NEWSLETTERS: None

There being no further business to come before the Board, the meeting adjourned at 11:40 a.m.

Respectfully Submitted,

Cynthia M. Partlo

Board Secretary For

Laura McCollum, Chairperson

Mid-Michigan District Board of Health

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Mid-Michigan Health Plan Advisory Board

Mid-Michigan Health Plan

Serving Clinton, Gratiot, and Montcalm Counties

MEETING MINUTES

Carson Health

Thursday, March 6, 2014

9:00 a.m.

Members Present: Mark W. (Marcus) Cheatham, Ph.D.; Mike Hetzman; Colleen Hogle;

Richard Reid (attending on behalf of Duane Miller); and Craig Zeese

Absent: Bob Ferrentino, Barb Zumsteg, Mark Santamaria, Randy Flechsig, Dan

Petersen, Duane Miller, and Kent Schulze

Staff Present: Robin Reynolds, Executive Director, Ingham Health Plan Corporation

(IHPC); Andrea Tabor, Health Services Administrator; Melissa Bowerman,

Director of Administrative Services; Cindy Partlo, Administrative Assistant

for the Mid-Michigan District Health Department

Staff Absent: Peggy Fox, Nurse Navigator

WELCOME AND INTRODUCTIONS

I. AGENDA REVIEW AND REVISIONS

M. Cheatham called the meeting to order at 9:10 a.m. He welcomed Richard Reid,

representing Carson Health hospital replacing Duane Miller. Introductions were

made. He noted that attendance had been down in the past; however,

attendance was better for this meeting. M. Cheatham provided a brief overview of

the MMHP. He reviewed the Agenda and asked for revisions and/or additions. There

were none.

M. Cheatham asked that item IV. B., Clinton County Community Health Worker and

IV. C., IHPC Strategic Plan be switched so that the IHPC Strategic Plan is discussed

first, as item IV. B. would be more easily understood.

Motion by C. Hogle and seconded by C. Zeese to approve the Agenda as revised.

Motion carried.

II. APPROVAL OF MINUTES – August 15, 2013

Motion made by C. Zeese and seconded by A. Tabor to approve the Mid-Michigan

Health Plan Advisory Board Meeting Minutes from August 15, 2013 as presented.

Motion carried.

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III. MAINTAIN AND INCREASE FUNDING

A. Financial Highlights

R. Reynolds reviewed the Financial Highlights noting that Plan A revenue was

higher than expected as there were more members than budgeted. Expenses

for Plan A were over budget due to higher utilization than expected. Plan A

Pharmacy benefits were under budget and Administrative expenses had a

surplus of $8,278. For Plan B, revenues were as budgeted; expenses were lower

than budgeted, and pharmacy was higher than budgeted. Plan B ended the

month of January with a surplus of $11,648. The planned deficit was lower than

expected by $10,000 ($59,653 from a budgeted $69,650).

M. Cheatham summarized that the rates to physicians were increased slightly.

He reviewed the history of the MMHP fund balance from 2012 to present

showing that the fund balance was slowly decreasing. R. Reid asked what the

MMHP was doing differently as their fund balance projection was higher than

the other plans. After discussion, M. Hetzman stated that the health plan

expanded enrollment and raised rates to physicians. R. Reynolds mentioned

that she budgeted the MMHP out through September 2014 and showed the

plan ending the year with a $6,000 deficit. She noted that utilization was

higher for the MMHP than other health plans.

B. Disproportionate Share Hospital (DSH) Update

R. Reynolds stated that the State approved DSH payments for three quarters

of the year to be used for enrollment and outreach (through September

2014). The Governor had not budgeted DSH funding beyond September 2014

as many health plans were winding down, some closing March 31, 2014, and

with Medicaid expansion the environment was rapidly changing. Additionally,

the MMHP has been successful with hospital partners (Sparrow and Carson

Health) to draw down the DSH funds to leverage matching funds. She

reviewed some of the improvements in the DSH process such as CMS recently

approved a mechanism for instances when a hospital does go over and

money is to be taken back. DSH funds from other hospitals can be accessed

to make the hospital whole. She indicated that Carson Health’s capacity was

fine; however, Sparrow (Lansing) was close to capacity; therefore, she

reached out to Trinity Hospital in Livingston County who had DSH capacity

and was able to help Sparrow with DSH funds. She summarized that all of the

contracts have been signed for the year; and stated that she was thankful for

the hospital partners. She indicated that there was a small work group that

was planning to approach the State for DSH funding for FY 14/15.

C. Marketplace and Healthy Michigan Plan Update

M. Hetzman asked if there was a safety net for the health plans if Healthy

Michigan was not up and running by March 31, 2014. R. Reynolds replied that

the decision to close health plans is county-based. She reported that the

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MMHP would not disenroll members until April 30, 2014; however, that date

would be extended if Healthy Michigan is not up and running at that time.

A. Tabor stated that staff at the Mid-Michigan District Health Department

(MMDHD) has been trained on enrolling people in the Marketplace. She

reported success with the program with about 160 people enrolled by the

health department.

R. Reynolds summarized that the Federal government is working very hard on

improving the experience on the Marketplace.

IV. MAINTAIN AND IMPROVE SERVICE

A. Agreement with IHPC for Run Out of Claims

R. Reynolds provided background regarding IHPC stating that Health Plan

Management Services (HPMS), a division of the Ingham County Health

Department (ICHD), provided administrative support for 26 health plans;

however, with so many plans closing, they made a decision not to provide

those services any longer. IHPC still needed health plan support services, so

they transitioned to a new model contracting with 13 health plans to provide

background support for one year of claims lag and claims run out.

Consequently, services previously performed by HPMS; such as claim lag,

claim run out, and providing various reports due to the State would now be

done by the IHPC. Some of the HPMS staff has joined IHPC to provide

continuity of the services. M. Cheatham indicated that the proposed cost for

those services to be provided by IHPC for the MMHP was $41,250. R. Reynolds

added that the change would be voted on at the upcoming IHPC Board

Meeting.

B. IHPC Strategic Plan

M. Cheatham provided background regarding the IHPC Strategic Plan stating

that the plan was formulated after the State Innovation Model. He stated that

there are three HUBS operating in the State: 1) Ingham County; 2) Saginaw

County; 3) Muskegon County. He reported that the health plans feel that the

Ingham County HUB is very productive and successful. He provided

background about how a HUB operates. He stated the six recommendations

included in the IHPC Strategic Plan, adding that recommendations #2 (Care

Management and Coordination) and #4 (Continuation of Basic Health Care

Benefit) were relevant to the MMHP. He reviewed those recommendations. R.

Reynolds mentioned that Ingham received a grant from CMS to do the

Pathways Community HUB. She explained how IHPC was working with MPHI to

make the Pathways Community HUB sustainable. She explained how the HUB

works with community partners to prevent duplication of services and better

care coordination. She stated that the HUB collects and documents data.

M. Cheatham stated that the Mid-Michigan District falls into three separate

prosperity regions proposed by the Governor. Clinton County would align with

the Ingham County HUB and Gratiot and Montcalm residents would be served

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with a new HUB, however, there is currently no funding for that HUB. R.

Reynolds summarized that it was important to make this model sustainable.

She stated that coordinating medical care with social needs is the answer to

saving money. M. Hetzman stated that he is a huge supporter of the

Community Health Worker and case management; connecting residents with

social needs to medical care. M. Cheatham discussed the population to be

served with the Gratiot/Montcalm HUB and stated that because it wasn’t

grant funded; the HUB could select the population to be served. He stated

that the data showed that the population should be high utilizers of the

emergency rooms with mental health or substance abuse issues. R. Reynolds

stated that the Ingham County HUB is limited to serving the Medicaid and

Medicare population. She noted that others that that do not have Medicaid

or Medicare are struggling and she would be willing to explore a model

serving that population.

Regarding sustainability of the Pathways Community HUB, R. Reynolds

indicated that she was working with health plans, hospitals, commercial

insurers that would be willing to pay the HUB for saving them money; which

could also help the sustainability of other HUBS.

C. Clinton County Community Health Worker

M. Cheatham explained the role of a Community Health Worker (CHW) noting

that Ingham County Health Department was providing a $50,000 grant to the

health department to support a CHW through 2015. He stated that he hoped

to learn from the IHPC about how a HUB is formed, and then take that

knowledge to build the Gratiot/Montcalm HUB, partnering with the IHPC for

support. He also described the Job Description and the salary. R. Reynolds

described the kind of individual that would make a good CHW. M. Hetzman

added that Gratiot Co. Behavioral Health requires that case management

workers have a personal story of recovery so that they can relate and inspire

hope. He suggested that the Job Description include more of the peer

connection. M. Cheatham stated that M. Hetzman’s comments were very

helpful and would be considered.

M. Cheatham mentioned that the MMHP Advisory Board could decide to give

the MMDHD a grant from fund balance to fund a CHW for the Gratiot/

Montcalm HUB, once developed.

R. Reynolds mentioned that a consortium/community convener should be

established to advocate for unmet needs of the community identified by the

CHW. M. Cheatham indicated that a Tiger Team was formed comprised of

Gratiot and Montcalm County community members that could serve that

role. M. Hetzman and C. Zeese mentioned that the Gratiot Collaborative

Council could serve that role also. M. Cheatham added that the Montcalm

County Collaborative Council has been participating in discussions about the

Gratiot/Montcalm HUB.

Motion made by M. Hetzman and seconded by R. Reid to authorize M.

Cheatham, as Chair of the MMHP Advisory Board, to pursue negotiations with

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the IHPC and the Ingham County Pathways Community HUB to outline a

blueprint for how a HUB would operate in Gratiot and Montcalm Counties.

Motion carried.

D. Shall MMHP provide a benefit to remaining uninsured?

M. Cheatham explained that some health plans are deciding to start a re-

enrollment process of bringing those back into the plan that are exempt from

buying insurance on the Marketplace. He reviewed the report showing the

estimated number of uninsured non-elderly adults aged 18-64 by county

noting that the MMHP could have 3,900 eligible adults. He reviewed options

for the future of the MMHP noting that a Plan B benefit could continue with a

revised caseload or the health plan could close and use the fund balance to

transition to a different model. He expressed concern that the if the health

plan continued, could it be using funding that could possibly be used to

transition the health plan to something else. He asked the members for their

thoughts.

M. Hetzman stated that those goals fall under the service goals of the Gratiot

County Free Clinic adding that those residents would have the free clinic as

an option for their primary care. R. Reynolds noted that up to 300 members

could fall between 139%-150% FPL and be eligible to reenroll. M. Cheatham

mentioned that Clinton and Montcalm Counties do not have a free clinic;

therefore, the MMHP could continue to serve the low number of eligible

residents. Andrea asked R. Reynolds if other health plans are considering

continuing with reenrollment, if DSH does not continue, how would they

sustain the effort? R. Reynolds replied that they know their end date is

September, and as long as DSH funding was available, the health plans could

continue. M. Cheatham added that at the end of September, the health

department could work with members to help them get insurance on the

Marketplace. M. Hetzman stated that Alma College has been collecting data

on patients visiting the free clinic; and he has asked for data showing the

number of patients eligible to purchase insurance on the Marketplace. He

suggested that those that are exempt could be referred to the Gratiot Free

Clinic. M. Hetzman expressed concern about the sustainability of the Gratiot

Free Clinic through the transition of patients to the Healthy Michigan Plan. R.

Reynolds indicated that Livingston County has a free clinic that the IHPC has

been assisting. She indicated that they are going to transition to a Medicaid

provider so that they can continue to serve their patients. M. Hetzman

summarized that Gratiot Community Mental Health has resources for

uninsured for medical care that are not available in Clinton and Montcalm

Counties.

R. Reid asked if this was what the MMHP should become after April 1, 2014. M.

Cheatham clarified this would just get the MMHP through to the end of the

fiscal year or possibly through the end of the calendar year. R. Reid expressed

concern that by continuing with the health plan, too much of the fund

balance could potentially be used; then there wouldn’t be enough funds to

support the development of a Gratiot/Montcalm HUB. R. Reynolds reported

that the FY 13/14 Budget reflected the health plan continuing through

20

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Page 6

September 30, 2014. She reported that the health plan was projected to have

a $5,800 deficit on September 30, 2014. M. Cheatham added that would

barely affect the fund balance. Additionally, he stated that the MMHP could

reduce enrollment from 1,000 members to a safe 300 (100 in each county)

and continue to operate until September 30, 2014. In November, the

Marketplace would open and the health department could assist with helping

those members find insurance on the Marketplace. R. Reid suggested setting

a limit on using the fund balance so that the plan ends if it reaches the limit

(e.g., $200,000) before the end of the fiscal year. He recommended cautiously

continuing with the MMHP, serving a decreased enrollment through

September 30, 2014.

Motion made by R. Reid to continue operating the MMHP through

September 30, 2014, with a reduced enrollment of 300 members (100

members per county) and if the fund balance falls below $300,000, the MMHP

Advisory Board would reconvene to discuss options. Motion seconded by M.

Hetzman. Motion carried.

E. Nurse Navigator Project Update

M. Cheatham distributed and reviewed the Nurse Navigator Report noting

that for the first time with the navigator program, MMHP members remaining in

the plan for six months have shown a decline in smoking. He also noted good

success with the diabetes control program.

IV. IMPROVE COMMUNITY AWARENESS

A. Enrollment Activities and Plan

A. Tabor provided information regarding the outreach activities of the health

department to educate the public on the Affordable Care Act and the

Healthy Michigan Plan. She stated the agency has been enrolling residents in

the Marketplace and Healthy Michigan. She also stated that the health

department has been working with the MSU Extension on their Smart Choice

Program, and partnering with hospitals to schedule educational events

sponsored by Michigan Consumers for Healthcare.

IV. MAINTAIN AND IMPROVE PROVIDER RELATIONSHIPS

A. Updating Providers about Future of MMHP

1. Draft Letter to Providers

M. Cheatham stated that the IHPC has sent letters to health plan

members stating that they were either eligible for the Marketplace or

for the Healthy Michigan Plan. The letter created calls to the health

department where they were connected with a counselor to discuss

insurance on the Marketplace. He noted that there was a

misunderstanding among providers about their patients being

disenrolled. Therefore, he recommended the draft letter he distributed

21

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Page 7

for review by the Advisory Board be sent to providers requesting them

to continue seeing patients through the transition to the Healthy

Michigan Plan until April 30, 2014 and letting them know of the

disenrollment/reenrollment process. R. Reynolds reviewed the letter and

mentioned that 2. should be changed to remove the word

“undocumented”.

Motion made by M. Hetzman and seconded by R. Reid to approve the

letter to providers as modified. Motion carried.

V. OTHER BUSINESS – None.

Next Meeting: Thursday, May 15, 2014 at 9 a.m.

Carson Health, Carson City

Action Items

Task By Whom By When

Revise the CHW Job Description to include

more of a peer connection.

M. Cheatham 4/1/14

Work with IHPC to establish a Community

Convener Coalition to advocate for unmet

needs in Clinton County (Pathways

Community HUB) and Gratiot/Montcalm HUB

M. Cheatham

R. Reynolds

5/1/14

Reduce MMHP enrollment to 300 (100 in each

county) and set fund balance limit at

$300,000

M. Cheatham

R. Reynolds

5/1/14

Revise provider letter as proposed and send M. Cheatham

R. Reynolds

4/1/14

There being no further business to come before the Board, the meeting adjourned at 10:58

a.m.

Respectfully Submitted,

Cynthia M. Partlo

Administrative Assistant on behalf of

Mark W. (Marcus) Cheatham, Ph.D., Chairperson

Ingham Health Plan Corporation

22

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� � � � � �

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–A G H F � C D I ? J K L M N O J L P E M � C D E C Q O J R M S O N P T M J P G U V G T T W J C P K X M O Y P EZ � R V X [ P G L O K O J J G W J D M L P E O P P E M

state’s X M O Y P E K � C D E C Q O J \ Y O J C ] S N M S O N M L P G ^ M Q C J O D D M S P C J QO S S Y C D O P C G J ] G J = S N C Y _ B ` a _ b B W Y P C T O P M Y K S N G H C L C J Q E M O Y P E D O N M D G H M N O Q M P G J M O N Y K E O Y U O T C Y Y C G JT G N M � C D E C Q O J N M ] C L M J P ] F

“This is a significant step in our ongoing efforts to ensure the health aJ L c M Y Y ^ M C J Q G U O Y Y� C D E C Q O J L M N ]

,” Snyder said. “A healthier Michigan is an important part of our state’s continued D G T M ^ O D I F @ P c C Y Y E M Y S C T S N G H M E M O Y P E O J L d W O Y C P K G U Y C U M B ] O H M T G J M K U G N P O e S O K M N ] O J L f G ^S N G H C L M N ] O J L ^ G G ] P G W N M D G J G T K F @ O S S N M D C O P M P E M ] W S S G N P G U G W N Y M Q C ] Y O P C H M S O N P J M N ] C J P E C ]C J C P C O P C H M O J L P E M P N M T M J L G W ] c G N I G U G W N L M S O N P T M J P ] G U V G T T W J C P K X M O Y P E B X W T O J ? M N H C D M ]O J L g M D E J G Y G Q K B � O J O Q M T M J P O J L h W L Q M P P G E M Y S M J ] W N M O Y Y ] K ] P M T ] O N M Q G O J Lthere’s

O ] T G G P EM J N G Y Y T M J P S N G D M ] ] F @ M J D G W N O Q M M Y C Q C ^ Y M N M ] C L M J P ] P G T O N I P E M L O P M O J L Q G G J Y C J M B D O Y Y G N H C ] C P OY G D O Y R X ? G U U C D M G J G N O U P M N = S N C Y _.”g E M X M O Y P E K � C D E C Q O J \ Y O J c O ] ] C Q J M L C J P G Y O c ^ K P E M Q G H M N J G N G J ? M S P F _ i B ` a _ j F ? C J D M P E M J B� R V X ] P O U U E O ] c G N I M L D Y G ] M Y K c C P E P E M U M L M N O Y Q G H M N J T M J P O J L � C D E C Q O J S O N P J M N ] P G Q M P P E MJ M D M ] ] O N K C J U G N T O P C G J P M D E J G Y G Q K B U M L M N O Y O S S N G H O Y O J L S N G Q N O T G S M N O P C G J ] C J S Y O D M F � e P M J ] C H M@ g P M ] P C J Q O J L S N G Q N M ] ] E O ] ^ M M J T O L M P G O ] ] W N M P E M J M D M ] ] O N K ] K ] P M T N M d W C N M T M J P ] O N M N M O L K U G NM J N G Y Y T M J P F h M Q C J J C J Q = S N C Y _ B � C D E C Q O J N M ] C L M J P ] c C Y Y ^ M O ^ Y M P G O S S Y K U G N P E M X M O Y P E K� C D E C Q O J \ Y O J G J Y C J M B ^ K S E G J M B G N C J S M N ] G J O P P E M C N Y G D O Y � C D E C Q O J R M S O N P T M J P G U X W T O J? M N H C D M ] Z R X ? [ G U U C D M P G d W C D I Y K O J L M O ] C Y K L M P M N T C J M C U P E M K O N M M Y C Q C ^ Y M F@ J P E M U C N ] P K M O N B P E M X M O Y P E K � C D E C Q O J \ Y O J C ] O J P C D C S O P M L P G D G H M N j ` a B a a a � C D E C Q O J L M N ] BM H M J P W O Y Y K S N G H C L C J Q D O N M U G N b k a B a a a F g E M S Y O J M T S E O ] C l M ] S M N ] G J O Y N M ] S G J ] C ^ C Y C P K O J L^ M J M U C D C O N C M ] c C Y Y ^ M N M d W C N M L P G ] E O N M C J P E M D G ] P ] F g E M N M O Y ] G c C Y Y ^ M C J D M J P C H M ] U G N C J L C H C L W O Y ] P GP O I M N M ] S G J ] C ^ C Y C P K U G N P E M C N Y C U M ] P K Y M D E G C D M ] O J L P G T O C J P O C J G N C T S N G H M P E M C N E M O Y P E F= S S Y C D O J P ] U G N P E M X M O Y P E K � C D E C Q O J \ Y O J T W ] P ^ M ^ M P c M M J P E M O Q M ] G U _ m � i b B J G P D W N N M J P Y KM Y C Q C ^ Y M U G N � M L C D O C L B J G P M Y C Q C ^ Y M U G N G N M J N G Y Y M L C J � M L C D O N M B O J L M O N J C J Q W S P G _ j j S M N D M J P G U

23

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P E M U M L M N O Y S G H M N P K Y M H M Y Z O S S N G e C T O P M Y K n _ i B a a a U G N ] C J Q Y M S M N ] G J O J L n j j B a a a U G N O U O T C Y K G UU G W N [ FX M O Y P E D G H M N O Q M W J L M N P E M X M O Y P E K � C D E C Q O J \ Y O J C J D Y W L M ] ^ G P E U M L M N O Y Y K O J L ] P O P M T O J L O P M L� ] ] M J P C O Y X M O Y P E h M J M U C P ] ] W D E O ] O T ^ W Y O P G N K S O P C M J P ] M N H C D M ] B M T M N Q M J D K ] M N H C D M ] BE G ] S C P O Y C l O P C G J B T M J P O Y E M O Y P E O J L ] W ^ ] P O J D M W ] M L C ] G N L M N ] M N H C D M ] B C J D Y W L C J Q ^ M E O H C G N O Y E M O Y P EP N M O P T M J P B S N M ] D N C S P C G J L N W Q ] B N M E O ^ C Y C P O P C H M O J L E O ^ C Y C P O P C H M ] M N H C D M ] O J L L M H C D M ] B Y O ^ G N O P G N K] M N H C D M ] B S N M H M J P C H M O J L c M Y Y J M ] ] ] M N H C D M ] O J L D E N G J C D L C ] M O ] M T O J O Q M T M J P B S M L C O P N C D ] M N H C D M ]C J D Y W L C J Q G N O Y O J L H C ] C G J D O N M B O J L G P E M N T M L C D O Y Y K J M D M ] ] O N K ] M N H C D M ] O ] J M M L M L F@ J P E M S N G D M ] ] G U G S M N O P C G J O Y C l C J Q P E M X M O Y P E K � C D E C Q O J \ Y O J B � R V X N M D M C H M L O S S N G H O Y U N G T P E MV M J P M N ] U G N � M L C D O N M o � M L C D O C L ? M N H C D M ] Z V � ? [ G J R M D F j a B ` a _ j F g E C ] O S S N G H O Y O Y Y G c M L� R V X P G P N O J ] C P C G J N G W Q E Y K i a B a a a C J L C H C L W O Y ] U N G T P E M � M L C D O C L = L W Y P h M J M U C P ] p O C H M NZ = h p [ S N G Q N O T C J P G P E M J M c X M O Y P E K � C D E C Q O J \ Y O J B c C P E D G H M N O Q M ^ M Q C J J C J Q = S N C Y _ B ` a _ b F“Throughout the process of making the Healthy Michigan Plan a reality, our primary concern has ^ M M J M J ] W N C J Q G W N ] K ] P M T ] O N M U W Y Y K S N M S O N M L U G N � C D E C Q O J N M ] C L M J P ] O ] P E M K O S S Y K O J L G J D M P E M Kare enrolled,” said James K. Haveman, Director of the MDCH. “As the Healthy Michigan Plan C J D Y W L M ] O ] P N G J Q S M N ] G J O Y N M ] S G J ] C ^ C Y C P K U G D W ] B c M O N M M J D G W N O Q M L ^ K P E M S N G T C ] C J Q N M ] W Y P ]we’ve seen so far with the ABW population and loo

I U G N c O N L P G C T S N G H C J Q P E M E M O Y P E G U O Y Yresidents eligible for the Healthy Michigan Plan.”q G N T G N M C J U G N T O P C G J O ^ G W P P E M S N G Q N M ] ] G U P E M X M O Y P E K � C D E C Q O J \ Y O J G N T G N M L M P O C Y ] N M Q O N L C J QM J N G Y Y T M J P B H C ] C P c c c F T C D E C Q O J F Q G H r E M O Y P E K T C D E C Q O J S Y O J F ? P O K P W J M L U G N ] S M D C U C D M J N G Y Y T M J P] C P M O J L E G P Y C J M J W T ^ M N L M P O C Y ] F s s s

24

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Mid-Michigan District Health Department

Monthly Balance Sheet, Revenue and Expenditure Report

February 2014

Summary and Special Notes

As we have finished the first Quarter of Fiscal Year 2014, actual revenues and expenditures should be at

approximately 42% of the $5,770,539 total budget. The total revenues through February were $3,664,360.79 and

the total expenses were $3,371,243.85. The overall actual revenues and expenditures (adjusting for in-kind space

costs and Vaccines for Children) were at 43% and 37% of the budget, respectively, representing a deficit of

$293,116.94.

Special notes related to the February 2014 Revenue and Expenditure Report include:

Revenues

Environmental Health Fees (Lines 1-9) – Environmental Health fees are approximately $117,000 lower

than budgeted year-to-date. This is due to the seasonal nature of most of the programs. Food fees are

primarily collected in March and April, therefore, food fees will continue to be lower than budgeted for the

first six months of the year.

Women, Infants, and Children’s (WIC) Varnish Fees (Line 19) – The WIC Varnish program

implementation has been delayed; therefore, there is not any revenue generated year-to-date, representing a

deficit of $25,000.

Medicaid Full Cost Reimbursement (Line 28) – This line item represents two types of reimbursement.

One reimbursement represents a quarterly billing for 50% of the costs associated with Medicaid Outreach

activities performed by staff. The second reimbursement is the billing for a percentage of the full cost of

encounters performed in certain programs. The second type is an annual payment. Therefore, the

percentage for this line item is lower than budgeted. The overall deficit represented by this category is

approximately $90,000.

Expenses

Salaries/Fringe (Lines 1-10) – This is lower than budgeted mainly due to staff vacancies and lower than

budgeted health insurance rates representing a surplus in these categories of approximately $60,000.

Postage (Line 12) – The agency has switched to using Stamps.com for postage; preloading the accounts.

Additionally, the Michigan Care Improvement Registry (MCIR) program has been sending recall letters for

children/adolescents within the six-county MCIR region (recall means that the child/adolescent is missing a

recommended vaccine). This category is over budget year-to-date by approximately $12,000.

Computer Support (Line 34) – Many different components are factored into the computer support for

Insight. One module, Care Connect, has an annual maintenance of $8,300 per year. As this module has not

yet been implemented, we are unsure of when the maintenance would be due; therefore, the expense was

not budgeted. However, the Mid-Michigan District Health Department (MMDHD) was responsible for

paying both last year and this year’s maintenance for that module representing a deficit in this line of

approximately $16,000.

Equipment, Accreditation Fees and Computer Upgrades (Lines 36-38) – The Board of Health approved

the use of fund balance to pay for Insight Modules, prior year dental equipment, Public Health

Accreditation Board (PHAB) Accreditation Fees and Computer Upgrades which are designated in these

line items representing a deficit in the year of $83,000.

25

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Mid-Michigan District Health DepartmentFEBRUARY 42% FY 2014 AP: 5

Revenue Revenue and Expenditure Report

Account Budget Current Month Year-To-Date Balance % of Budget

1 Onsite Sewage 116,203.00 13,867.00 41,791.50 74,411.50 36%

2 Groundwater Quality 143,313.00 5,470.00 44,209.00 99,104.00 31%

3 Food Service 249,720.00 2,383.00 16,932.00 232,788.00 7%

4 Campgrounds 5,000.00 -422.00 -422.00 5,422.00 -8%

5 Swimming Pools 3,000.00 0.00 98.00 2,902.00 3%

6 Waste Haulers 7,925.00 0.00 287.00 7,638.00 4%

7 DHS Facility Inspections 21,750.00 2,432.00 10,291.00 11,459.00 47%

8 Body Art Fees 1,300.00 267.00 267.00 1,033.00 21%

9 EH Misc Fees 5,860.00 61.71 417.70 5,442.30 7%

10 Vision Fees 25,000.00 350.00 14,008.60 10,991.40 56%

11 Hearing Fees 21,000.00 616.20 12,172.20 8,827.80 58%

12 MIHP Fees 110,000.00 2,801.44 25,916.81 84,083.19 24%

13 Communicable Disease Fees 600.00 100.00 596.56 3.44 99%

14 Immunization Fees 95,000.00 5,868.07 66,473.14 28,526.86 70%

15 Family Planning/STD Fees 140,000.00 7,920.21 58,146.98 81,853.02 42%

16 Breast Cancer Fees 14,000.00 735.00 2,703.37 11,296.63 19%

17 Lead Fees 10,000.00 -208.72 4,673.97 5,326.03 47%

18 Varnish Fees 12,000.00 -1,036.23 4,337.92 7,662.08 36%

19 WIC Varnish Fees 60,000.00 0.00 0.00 60,000.00 0%

20 Ched Miscellaneous Fees 200.00 0.00 0.00 200.00 0%

21 Miscellaneous Other Fees 100.00 2.79 15.98 84.02 16%

22 VFC/317 Vaccine Revenue 400,000.00 17,120.15 85,936.25 314,063.75 21%

23 MDCH Grants 1,497,221.00 124,530.00 617,291.77 879,929.23 41%

24 Essential Local Public Health Services698,412.00 58,677.00 293,396.77 405,015.23 42%

25 MDCH Fee For Service Revenue 41,250.00 2,071.58 8,914.74 32,335.26 22%

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2/4 3/19/2014

26 DEQ Grants 76,255.00 5,691.00 26,978.50 49,276.50 35%

27 Other Grants/Community Support 310,660.00 35,266.52 155,129.01 155,530.99 50%

28 Medicaid Full Cost Reimbursement 330,347.00 0.00 46,857.64 283,489.36 14%

29 Interest 5,000.00 128.54 763.88 4,236.12 15%

30 Donations 7,000.00 78.20 782.40 6,217.60 11%

31 Cash Over/Short 0.00 0.00 0.10 -0.10 0%

32 Clinton Co - Appropriation 269,543.00 22,515.00 112,578.50 156,964.50 42%

33 Clinton Co - MMHP 121,472.00 10,069.00 50,345.00 71,127.00 41%

34 Gratiot Co - Appropriation 130,833.00 10,970.00 54,852.50 75,980.50 42%

35 Gratiot Co - MMHP 152,964.00 12,680.00 63,398.00 89,566.00 41%

36 Montcalm Co - Appropriation 250,203.00 19,088.25 95,441.25 154,761.75 38%

37 Montcalm Co - MMHP 175,458.00 14,544.00 72,719.00 102,739.00 41%

38 Prior Year Adjustments 0.00 -10.00 39.00 -39.00 0%

39 Space Occupancy 261,950.00 22,788.00 113,940.00 148,010.00 43%

40 Cigarette Tax - Clinton 0.00 0.00 2,117.64 -2,117.64 0%

41 Cigarette Tax - Gratiot 0.00 0.00 0.00 0.00 0%

42 Cigarette Tax - Montcalm 0.00 1,779.53 1,779.53 -1,779.53 0%

43 Deferred Revenues 0.00 0.00 0.00 0.00 0%

TOTAL REVENUE: 5,770,539.00 399,194.24 2,106,178.21 3,664,360.79 36%

W/O SPACE & VFC 5,108,589.00 359,286.09 1,906,301.96 3,202,287.04 37%

27

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Mid-Michigan District Health Department 42% FY 2014 AP: 5

Expenditure

Account Budget Current Month Year-To-Date Balance % of Budget

1 Board of Health Per Diem 5,000.00 263.00 1,370.00 3,630.00 27%

2 Salaries 3,166,213.00 234,065.49 1,284,679.25 1,881,533.75 41%

3 FICA 240,703.00 17,362.28 95,218.50 145,484.50 40%

4 Health Insurance 678,195.00 60,217.42 257,607.21 420,587.79 38%

5 Dental Insurance 48,324.00 3,673.74 18,162.94 30,161.06 38%

6 Retirement 263,665.00 19,541.58 106,379.55 157,285.45 40%

7 Work Comp 50,342.00 4,413.00 21,690.00 28,652.00 43%

8 Unemployment Comp 6,000.00 0.00 0.00 6,000.00 0%

9 Life Insurance 4,636.00 319.39 2,174.09 2,461.91 47%

10 Physicals 0.00 0.00 0.00 0.00 0%

11 Printed Materials 2,500.00 195.00 292.96 2,207.04 12%

12 Postage 10,500.00 -18.61 16,361.56 -5,861.56 156%

13 Office Supplies 39,750.00 3,521.06 18,430.13 21,319.87 46%

14 Computer/Printer Supplies 3,000.00 6,465.34 3,637.12 -637.12 121%

15 Medical Supplies 67,800.00 6,731.99 28,607.58 39,192.42 42%

16 CD Meds Biologics 30,500.00 101.64 23,671.75 6,828.25 78%

17 VFC Supplies 400,000.00 17,292.15 86,108.25 313,891.75 22%

18 Dental Supplies 600.00 0.00 0.00 600.00 0%

19 Contractual Services 95,500.00 14,141.71 38,647.32 56,852.68 40%

20 Legal Expenses 10,000.00 0.00 0.00 10,000.00 0%

21 Communications 65,120.00 4,488.07 26,952.69 38,167.31 41%

22 Travel 121,700.00 9,896.07 47,439.12 74,260.88 39%

23 Advertising & Recruitment 4,000.00 413.65 1,650.22 2,349.78 41%

24 Liability Insurance 34,000.00 2,742.00 13,710.00 20,290.00 40%

25 Equipment Maintenance/Lease 53,000.00 4,125.75 21,722.08 31,277.92 41%

26 Rent 26,100.00 2,031.50 10,984.50 15,115.50 42%

28

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4/4 3/19/2014

27 Space Occupancy 261,951.00 22,788.00 113,940.00 148,011.00 43%

28 Training 17,000.00 2,170.16 6,598.91 10,401.09 39%

29 Memberships/Certifications/Subscriptions14,540.00 860.00 10,243.45 4,296.55 70%

30 Tuition Reimbursement 3,000.00 0.00 294.75 2,705.25 10%

31 Laboratory 5,200.00 114.25 457.02 4,742.98 9%

32 Behavioral Risk Factor Survey 0.00 0.00 0.00 0.00 0%

33 Misc Other Expense 500.00 0.00 0.00 500.00 0%

34 Computer Support 39,200.00 16,510.00 57,193.30 -17,993.30 146%

35 Service Charges 2,000.00 295.78 1,894.17 105.83 95%

36 Equipment (FB) 0.00 15,000.00 32,780.00 -32,780.00 0%

37 Accreditation Fees (FB) 0.00 0.00 25,679.00 -25,679.00 0%

38 Computer Upgrades (FB) 0.00 0.00 24,429.34 -24,429.34 0%

39 Facility Development 0.00 0.00 288.39 -288.39 0%

TOTAL EXPENSES 5,770,539.00 469,721.41 2,399,295.15 3,371,243.85 42%

W/O SPACE & VFC 5,108,588.00 429,641.26 2,199,246.90 2,909,341.10 43%

Revenue Over Expenditures(Deficit) 0.00 -70,527.17 -293,116.94 293,116.94 0%

29

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MMDHD BALANCE SHEETAS OF 2/28/2014

CURRENT ASSETS

CASH TO TREASURER $ 1,204,761.45

CASH ON DEPOSIT/IMPREST CASH $ 2,730.00

ACCOUNTS RECEIVABLE $ 163,536.50

DUE FROM GOVERNMENTAL AGENCIES $ 659,241.75

INVENTORY - VFC IMMS $ 64,898.36

PREPAIDS $ 55,099.00

TOTAL ASSETS $ 2,150,267.06

LIABILITIES AND FUND BALANCE

ACCOUNTS PAYABLE $ (24,465.57)

PAYROLL DEDUCTIONS $ 223.11

PAYROLL PAYABLES $ 212,701.73

TRUST FUNDS $ 18,661.98

DEFERRED REVENUE PRIOR YEAR $ 73,430.48

DEFERRED REV - BRFS $ 14,040.20

DEFERRED REV DENTAL OUTREACH $ 72,243.38

DEFERRED REVENUE MCDC $ 249,000.00

DEFERRED REVENUE-VFC IMMS $ 65,070.36

FUND BALANCE END OF YEAR $ 169,890.41

FUND BALANCE $ 330,384.19

FUND BALANCE EQUIPMENT $ 135,697.74

FUND BALANCE FACILITY DEV $ 109,580.00

FUND BALANCE SELF INS BONDS $ 13,949.72

FUND BALANCE-FUTURE RETIREMENT $ 308,829.80

30

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FUND BALANCE-COMPENSATED LEAVES $ 395,390.47

FUND BALANCE-UNEMPLOYMENT $ 55,000.00

FUND BALANCE-TRAINING $ 35,000.00

FUND BALANCE-BRFS $ 11,522.00

FUND BALANCE-HEALTH INSURANCE $ 160,000.00

FUND BALANCE-POTENTIAL CLAIMS $ 12,234.00

FUND BALANCE-NATIONAL ACCREDITATION $ 25,000.00

BALANCE SHEET NET INCOME $ (293,116.94)

TOTAL LIABILITIES $ 2,150,267.06

TOTAL NET INCOME $ -

31

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EV 1761 177,534.00$

EV 1762 260,388.19$

TOTAL 437,922.19$

MONTHLY EXPENSES FOR

February 22, 2014 - March 21, 2014

32

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CK# EV 1761 3/7/2014

Payables

100555

thru Quantum Checks & Direct Deposits 53,287.05$

100586

Payroll

AFLAC Employee Deduction 421.95$

MERS Employee Electronic Transfer 3,363.94$

Chemical Bank Payroll-Ameriprise NBS 390.00$

Chemical Bank Payroll-Nationwide 2,335.00$

Chemical Bank Payroll-MERS 457 200.00$

Chemical Bank Payroll Tax Electronic Transfer

Federal 27,859.76$

State -$

MERS Employer Electronic Transfer Jan-14 -$

Chemical E-Banking fee Jan-14 -$

Chemical Bank Interest Jan-14 -$

Direct Deposit Payroll 89,676.30$

State of Michigan Unemployment 4Q FY13 -$

TOTAL 177,534.00$

Mid-Michigan District Health Department

615 North State Street, Suite 2

Stanton MI 48888

(989) 831-5237

33

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

36 03/07/14 END012 ENDERLE JACK A FEBRUARY 2014 02/28/14 10718 80.20$ -$ 80.20$

TRAVEL/PER DIEM

DIRECT DEPOSIT

CHECK TOTALS: 80.20$ -$ 80.20$

37 03/07/14 KEL038 KELLENBERGER BETTY FEBRUARY 2014 02/28/14 10716 132.96$ -$ 132.96$

TRAVEL/PER DIEM

DIRECT DEPOSIT

CHECK TOTALS: 132.96$ -$ 132.96$

38 03/07/14 LIN033 LINDEMAN TOM FEBRUARY 2014 02/28/14 10717 203.88$ -$ 203.88$

TRAVEL/PER DIEM

DIRECT DEPOSIT

CHECK TOTALS: 203.88$ -$ 203.88$

100555 03/07/14 ALL001 ALLEY T 35609 02/10/14 10729 96.00$ -$ 96.00$ 12 NEW EMPLOYEE TSHIRTS

COMPUTER CHECK

CHECK TOTALS: 96.00$ -$ 96.00$

100556 03/07/14 CAP095 CAPITAL AREA UNITED WAY 030714 03/07/14 10758 37.00$ -$ 37.00$

3/7/14 EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 37.00$ -$ 37.00$

100557 03/07/14 CDW016 CDW GOVERNMENT, INC. JZ98443 02/20/14 10706 013095-00 702.25$ -$ 702.25$

LAPTOP,INSTALL,RAM

COMPUTER CHECK

CHECK TOTALS: 702.25$ -$ 702.25$

100558 03/07/14 CHA166 CHARTER BUSINESS FEBRUARY 2014 02/18/14 10745 135.99$ -$ 135.99$

CLINTON INTERNET 2/28-3/27/14

COMPUTER CHECK

CHECK TOTALS: 135.99$ -$ 135.99$

100559 03/07/14 CRY023 CASAIR-CRYSTAL AUTO SYSTEM 134668 03/01/14 10736 1,500.00$ -$ 1,500.00$

BUSINESS INTERNET

COMPUTER CHECK

CHECK TOTALS: 1,500.00$ -$ 1,500.00$

100560 03/07/14 FRO027 FRONTIER 02/19/14 02/19/14 10744 65.49$ -$ 65.49$

989-875-3747 2/19-3/18/14

COMPUTER CHECK

02/20/14 02/20/14 10750 148.51$ -$ 148.51$

989-831-5522 1/20-2/19/14

2/13/14 02/13/14 10731 814.36$ -$ 814.36$

989-224-2195 2/13-3/12/14

2/19/14 02/19/14 10743 647.64$ -$ 647.64$

989-875-3681 2/19-3/18/14

2/20/14 02/20/14 10749 780.95$ -$ 780.95$

989-831-5237 1/20-2/19/14

CHECK TOTALS: 2,456.95$ -$ 2,456.95$

34

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100561 03/07/14 GLC013 GLC - SOPHE 3/20/14 CHERYL 03/20/14 10754 75.00$ -$ 75.00$

CHERYL THELEN SOPHE TRAINING

COMPUTER CHECK

3/20/14 SARA 03/20/14 10755 75.00$ -$ 75.00$

SARA THELEN SOPHE TRAINING

CHECK TOTALS: 150.00$ -$ 150.00$

100562 03/07/14 GRA005 GRATIOT ISABELLA RESD 2669 02/26/14 10738 60.00$ -$ 60.00$

1/29/14 STRATEGIC ROLLOUT

COMPUTER CHECK

CHECK TOTALS: 60.00$ -$ 60.00$

100563 03/07/14 GRA009 GRATIOT COUNTY HERALD 2014-2015 02/27/14 10739 70.00$ -$ 70.00$

2YR SUBSCRIPTION

COMPUTER CHECK

CHECK TOTALS: 70.00$ -$ 70.00$

100564 03/07/14 GRE079 GREAT LAKES CHAPTER - SOPHE SARA THELEN 201 02/01/14 10728 45.00$ -$ 45.00$

SOPHE MEMEBERSHIP

COMPUTER CHECK

CHECK TOTALS: 45.00$ -$ 45.00$

100565 03/07/14 HUC020 HUCH'S FINE JEWELRY 799 02/20/14 10737 70.00$ -$ 70.00$

CHRISTENSEN-CLOCK FOR RETIREMENT

COMPUTER CHECK

CHECK TOTALS: 70.00$ -$ 70.00$

100566 03/07/14 IMP002 IMPREST CASH-MONTCALM FEBRUARY 2014 02/13/14 10753 44.55$ -$ 44.55$

CLINTON POSTAGE/TROWEL

COMPUTER CHECK

CHECK TOTALS: 44.55$ -$ 44.55$

100567 03/07/14 MCC164 McCOLLUM LAURA FEBRUARY 2014 02/28/14 10719 51.92$ -$ 51.92$

TRAVEL/PER DIEM

COMPUTER CHECK

CHECK TOTALS: 51.92$ -$ 51.92$

100568 03/07/14 MEHA40 MEHA 00173 DEFORD 02/28/14 10724 215.00$ -$ 215.00$

2014 ANNUAL EDUCATION CONF

COMPUTER CHECK

00175 KALNINS 02/28/14 10723 215.00$ -$ 215.00$

2014 ANNUAL EDUCATION CONF

00177 REMUS 02/28/14 10722 180.00$ -$ 180.00$

2014 ANNUAL EDUCATION CONF

00178 JONGKIND 02/28/14 10721 230.00$ -$ 230.00$

2014 ANNUAL EDUCATION CONF

00179 FOWLER 02/28/14 10726 180.00$ -$ 180.00$

2014 ANNUAL EDUCATION CONF

35

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100568 03/07/14 MEHA40 MEHA 00180 GOUIN 02/28/14 10725 230.00$ -$ 230.00$

2014 ANNUAL EDUCATION CONF

CHECK TOTALS: 1,250.00$ -$ 1,250.00$

100569 03/07/14 MIC006 MICHIGAN DEPT OF AGRICULTURE 50250 02/20/14 10741 192.00$ -$ 192.00$

MONTCALM FOOD FEES

COMPUTER CHECK

CHECK TOTALS: 192.00$ -$ 192.00$

100570 03/07/14 MIC007 MICHIGAN PUBLIC HEALTH INST CURRIE 3/3/14 03/01/14 10727 50.00$ -$ 50.00$

CREDENTIALING & CONTRACTING

COMPUTER CHECK

CHECK TOTALS: 50.00$ -$ 50.00$

100571 03/07/14 MIS005 MiSDU/FRIEND OF COURT 030714 03/07/14 10757 359.08$ -$ 359.08$

3/7/14 EMPLOYEE DEDUCTION

COMPUTER CHECK

CHECK TOTALS: 359.08$ -$ 359.08$

100572 03/07/14 MOR105 THE MORNING SUN 2014 419-93142 03/01/14 10746 291.20$ -$ 291.20$

1YR SUBSCRIPTION

COMPUTER CHECK

CHECK TOTALS: 291.20$ -$ 291.20$

100573 03/07/14 NEH002 NEHA TRAINING 045000 07/26/12 10734 350.00$ -$ 350.00$

MONTCALM FOOD EXAMS

COMPUTER CHECK

089700 06/28/13 10733 325.00$ -$ 325.00$

9537300 MONTCALM FOOD EXAMS

173470 01/14/14 10735 150.00$ -$ 150.00$

9541718 GRATIOT FOOD EXAMS

CHECK TOTALS: 825.00$ -$ 825.00$

100574 03/07/14 NET026 NETSMART TECHNOLOGIES ACCT 161 02/01/14 10740 15,000.00$ -$ 15,000.00$

INSIGHT CASE MGMT/STD/TRAINING

COMPUTER CHECK

PAPH008372 01/31/14 10751 16,510.00$ -$ 16,510.00$

7/12-6/14 CONSUMER/ORDER CONNECT

CHECK TOTALS: 31,510.00$ -$ 31,510.00$

100575 03/07/14 OFF001 OFFICEMAX INCORPORATED 783277 02/12/14 10704 013084-00 67.68$ -$ 67.68$

COPY PAPER 2 CARTONS

COMPUTER CHECK

872268 02/17/14 10708 013088-00 61.96$ -$ 61.96$

LETTER TRAYS, MAG. FILES

872517 02/17/14 10707 013088-00 35.99$ -$ 35.99$

LAPTOP BACKBACK

CHECK TOTALS: 165.63$ -$ 165.63$

36

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100576 03/07/14 PER009 PERSPECTIVE ENTERPRISES 47047 02/20/14 10705 013093-00 381.50$ -$ 381.50$

INFANTOMETER WITH TOTE

COMPUTER CHECK

CHECK TOTALS: 381.50$ -$ 381.50$

100577 03/07/14 PLE041 PLEASANT GRAPHICS INC 21822 02/24/14 10700 013087-00 195.00$ -$ 195.00$

A/P CHECKS PGI#59790

COMPUTER CHECK

CHECK TOTALS: 195.00$ -$ 195.00$

100578 03/07/14 QUI003 QUILL CORPORATION 95065606 02/11/14 10710 013081-00 16.29$ -$ 16.29$

LETTER SIZE FOLDERS

COMPUTER CHECK

CHECK TOTALS: 16.29$ -$ 16.29$

100579 03/07/14 SAG102 SAGINAW CO DEPT OF HEALTH 8264 01/23/14 10732 250.00$ -$ 250.00$

FY13/14 LAB SERVICES

COMPUTER CHECK

CHECK TOTALS: 250.00$ -$ 250.00$

100580 03/07/14 SAN020 SANOFI PASTEUR INC 902658767 02/11/14 10709 013078-00 101.64$ -$ 101.64$

TUBERSOL

COMPUTER CHECK

CHECK TOTALS: 101.64$ -$ 101.64$

100581 03/07/14 SHR011 SHRED-IT 9403219563 02/12/14 10730 124.08$ -$ 124.08$

MBO/MO SHREDDING

COMPUTER CHECK

9403258633 02/21/14 10747 83.01$ -$ 83.01$

GRATIOT SHREDDING

9403258634 02/21/14 10748 321.12$ -$ 321.12$

GRATIOT CHED EXTRA SHREDDING

CHECK TOTALS: 528.21$ -$ 528.21$

100582 03/07/14 STA194 STAPLES ADVANTAGE 323642117 02/22/14 10702 013094-00 260.48$ -$ 260.48$

HP 98 HP 95 INK TONER

COMPUTER CHECK

3223642116 02/22/14 10701 013092-00 92.86$ -$ 92.86$

STAPLER,PENS,COPY PAPER

CHECK TOTALS: 353.34$ -$ 353.34$

100583 03/07/14 TIG047 TIGER MEDICAL 0012516-IN 02/12/14 10703 013034-00 2,558.33$ -$ 2,558.33$

2 BASIC EXAM TABLES

COMPUTER CHECK

CHECK TOTALS: 2,558.33$ -$ 2,558.33$

100584 03/07/14 UNI001 UNITED WAY OF MONTCALM CO 1002 09/10/13 10756 8,160.00$ -$ 8,160.00$

VOLUNTEER COMMUNITY NAVIGATOR

COMPUTER CHECK

030714 03/07/14 10760 108.00$ -$ 108.00$

3/7/14 EMPLOYEE DONATION

CHECK TOTALS: 8,268.00$ -$ 8,268.00$

37

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100585 03/07/14 UNI009 UNITED WAY OF GRATIOT CO 030714 03/07/14 10759 65.00$ -$ 65.00$

3/7/14 EMPLOYEE DONATION

COMPUTER CHECK

CHECK TOTALS: 65.00$ -$ 65.00$

100586 03/07/14 WAL017 WALMART COMMUNITY 1133 JANUARY 20 02/16/14 10742 90.13$ -$ 90.13$

MCIR/HEALTH FAIR SUPPLIES

COMPUTER CHECK

CHECK TOTALS: 90.13$ -$ 90.13$

BANK CODE TOTALS: 53,287.05$ -$ 53,287.05$

32 COMPUTER CHECKS

0 MANUAL PAYMENT CHECKS

0 VOID CHECKS - TRX

0 VOID CHECKS - STUBS

0 VOID CHECKS - ERROR

0 VOID CHECKS - FORM ALIGNMENT

3 DIRECT DEPOSITS

35 CHECKS TOTAL

COMPANY TOTALS: 53,287.05$ -$ 53,287.05$

38

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CK# EV 1762 3/21/2014

Payables

100153 VOID MIHP check from 9/20/13

100587

thru Quantum Checks & Direct Deposits 109,420.27$

100633

Payroll

AFLAC Employee Deduction 421.95$

MERS Employee Electronic Transfer 3,387.65$

Chemical Bank Payroll-Ameriprise NBS 405.00$

Chemical Bank Payroll-Nationwide 2,335.00$

Chemical Bank Payroll-MERS 457 200.00$

Chemical Bank Payroll Tax Electronic Transfer

Federal 28,339.40$

State 8,494.97$

MERS Employer Electronic Transfer Feb-14 19,541.58$

Chemical E-Banking fee Feb-14 69.26$

Chemical Bank Interest Feb-14 (5.44)$

Direct Deposit Payroll 87,778.55$

State of Michigan Unemployment 4Q FY13 -$

TOTAL 260,388.19$

Mid-Michigan District Health Department

615 North State Street, Suite 2

Stanton MI 48888

(989) 831-5237

39

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100153 03/13/14 COO174 6/6/13 09/17/13 10009 (4.80)$ -$ (4.80)$

VOID CHECK TRANSACTION BILLING VENDOR: COO174

CHECK TOTALS: (4.80)$ -$ (4.80)$

100587 03/21/14 ABR018 ABRAHAM & GAFFNEY, P.C. EL-21981 01/28/14 10774 11,400.00$ -$ 11,400.00$

FY13 AUDIT

COMPUTER CHECK

CHECK TOTALS: 11,400.00$ -$ 11,400.00$

100588 03/21/14 BLU008 BLUE CROSS BLUE SHIELD OF MI 0000 APRIL 2014 03/07/14 10818 25,789.55$ -$ 25,789.55$

007013890 HEALTH INS

COMPUTER CHECK

0001 APRIL 2014 03/07/14 10817 2,485.55$ -$ 2,485.55$

007013890 HEALTH INS

CHECK TOTALS: 28,275.10$ -$ 28,275.10$

100589 03/21/14 BLU034 BLUE CARE NETWORK APRIL 2014 03/07/14 10816 30,482.84$ -$ 30,482.84$

HEALTH INS FOR APRIL

COMPUTER CHECK

CHECK TOTALS: 30,482.84$ -$ 30,482.84$

100590 03/21/14 CAP095 CAPITAL AREA UNITED WAY 3/21/14 03/19/14 10838 37.00$ -$ 37.00$

EMPLOYEE DONATION FOR 3/21/14

COMPUTER CHECK

CHECK TOTALS: 37.00$ -$ 37.00$

100591 03/21/14 CEN021 CENTRAL MI DIST HEALTH DEPT FEBRUARY 2014 03/10/14 10783 4,309.11$ -$ 4,309.11$

MD FOR FEBRUARY

COMPUTER CHECK

CHECK TOTALS: 4,309.11$ -$ 4,309.11$

100592 03/21/14 CEN149 CENTURYLINK 1293459366 02/28/14 10767 245.59$ -$ 245.59$

LONG DISTANCE DISTRICT WIDE

COMPUTER CHECK

CHECK TOTALS: 245.59$ -$ 245.59$

100593 03/21/14 CHE172 CHERRY STREET HEALTH SERVICE MARCH 2014 03/04/14 10819 125.00$ -$ 125.00$

RENT FOR WIC CLINICS

COMPUTER CHECK

CHECK TOTALS: 125.00$ -$ 125.00$

100594 03/21/14 CIT014 CITIZENS BANK APRIL 2014 04/01/14 10782 6,672.73$ -$ 6,672.73$

LEASE PAYMENT FOR APRIL

COMPUTER CHECK

CHECK TOTALS: 6,672.73$ -$ 6,672.73$

100595 03/21/14 CLI092 CLINTON COUNTY ADMIN/ACCT APRIL 2014 04/01/14 10787 1,675.00$ -$ 1,675.00$

DENTAL OFFICE RENT

COMPUTER CHECK

CHECK TOTALS: 1,675.00$ -$ 1,675.00$

40

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ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100596 03/21/14 COH003 COHL, STOKER & TOSKEY 44233 02/07/14 10770 357.20$ -$ 357.20$

JANUARY 2014 LEGAL

COMPUTER CHECK

44289 03/06/14 10772 1,449.48$ -$ 1,449.48$

FEBRUARY 2014 LEGAL

CREDIT 43696 03/01/14 10771 (382.94)$ -$ (382.94)$

CREDIT INVOICE FOR DUPLICATE PAYMENT

CHECK TOTALS: 1,423.74$ -$ 1,423.74$

100597 03/21/14 COV178 COVENANT MEDICAL CENTER 3/4/14 GRATIOT 03/04/14 10814 43.00$ -$ 43.00$

20940 LABS

COMPUTER CHECK3/4/14 MONTCALM 03/04/14 10815 24.00$ -$ 24.00$

21654 LABS

CHECK TOTALS: 67.00$ -$ 67.00$

100598 03/21/14 DEL007 DELTA DENTAL OF MICHIGAN 501317 03/11/14 10769 4,773.65$ -$ 4,773.65$

APRIL 2014 DENTAL INS

COMPUTER CHECKCHECK TOTALS: 4,773.65$ -$ 4,773.65$

100599 03/21/14 DES011 DES MOINES STAMP MFG CO 1003721 01/17/13 10833 013057-00 64.00$ -$ 64.00$

SELF INKING STAMPER

COMPUTER CHECK

CHECK TOTALS: 64.00$ -$ 64.00$

100600 03/21/14 DOU055 DOUBLETREE BY HILTON HOTEL 86738796 CONF 05/01/14 10780 99.75$ -$ 99.75$

5/1/14 SIMON HOTEL

COMPUTER CHECK

CHECK TOTALS: 99.75$ -$ 99.75$

100601 03/21/14 DOW016 DOWNTOWN BAKERY 155705 02/27/14 10811 196.00$ -$ 196.00$

DONUTS FOR R4Q MEETINGS

COMPUTER CHECK

CHECK TOTALS: 196.00$ -$ 196.00$

100602 03/21/14 FRO027 FRONTIER 2/28/14 02/28/14 10791 63.13$ -$ 63.13$

989-224-4300 2/28-3/27/14

COMPUTER CHECK

CHECK TOTALS: 63.13$ -$ 63.13$

100603 03/21/14 GAN035 GANNETT MICHIGAN NEWS 2113022092 03/02/14 10773 688.40$ -$ 688.40$

CBO CHED PUBLIC HEALTH NURSE

COMPUTER CHECK

CHECK TOTALS: 688.40$ -$ 688.40$

100604 03/21/14 GIS055 GIS AUTHORITY FY13/14 03/03/14 10809 750.00$ -$ 750.00$

MEMBERSHIP

COMPUTER CHECK

CHECK TOTALS: 750.00$ -$ 750.00$

41

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RUN DATE: MAR 19, 2014 - 13:29 MidMichigan District Health Department PAGE 0003

ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECKNO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100605 03/21/14 GRA080 GRATIOT COUNTY UNITED WAY 2-1-1 03/17/14 10775 500.00$ -$ 500.00$

DONATION

COMPUTER CHECK

CHECK TOTALS: 500.00$ -$ 500.00$

100606 03/21/14 GSK052 GLAXO SMITH KLINE 31625187 03/12/14 10824 014013-00 665.06$ -$ 665.06$

BOOSTRIX

COMPUTER CHECK

C31625187 03/19/14 10842 (10.00)$ -$ (10.00)$ TO REDUCE INVOICE TOTAL

CHECK TOTALS: 655.06$ -$ 655.06$

100607 03/21/14 IMP002 IMPREST CASH-MONTCALM 10/30-2/5/14 02/28/14 10789 3.82$ -$ 3.82$ GBO CHED PETTY CASH REFUND

COMPUTER CHECK

CHECK TOTALS: 3.82$ -$ 3.82$

100608 03/21/14 LIN061 LINCOLN FINANCIAL GROUP APRIL 2014 04/01/14 10768 531.64$ -$ 531.64$

LIFE/LTDCOMPUTER CHECK

CHECK TOTALS: 531.64$ -$ 531.64$

100609 03/21/14 MAC165 MICHIGAN ASSOCIATION CO 2014 MEMBERSHIP 03/17/14 10821 200.00$ -$ 200.00$

MAC AFFILIATE

COMPUTER CHECK

CHECK TOTALS: 200.00$ -$ 200.00$

100610 03/21/14 MCK032 MCKESSON MEDICAL 40685072 02/27/14 10762 014001-00 959.30$ -$ 959.30$

GLOVES,COLLECTION KIT,INHALANT

COMPUTER CHECK

40919446 03/07/14 10825 014007-00 263.91$ -$ 263.91$ LIDOCAINE,NITRATE,CONTROLS

317.09 03/29/14 10763 013098-00 317.09$ -$ 317.09$

SPECULUMS, LANCETS,KLEENEX

CHECK TOTALS: 1,540.30$ -$ 1,540.30$

100611 03/21/14 MER016 MERCK & CO INC 700535518 01/08/14 10651 (1,622.14)$ -$ (1,622.14)$

ZOSTAVAX

COMPUTER CHECK

7005353442 01/08/14 10650 (922.63)$ -$ (922.63)$

HEP A, HEP B

7005371625 01/13/14 10653 013043-00 922.63$ -$ 922.63$ HEP A ADULT , HEP B ADULT

7005372166 01/13/14 10652 013043-00 1,622.14$ -$ 1,622.14$

ZOSTAVAX

7005578667 03/12/14 10828 014012-00 661.80$ -$ 661.80$

HEP B

7005581908 03/12/14 10827 014012-00 921.82$ -$ 921.82$

VARIVAX

42

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RUN DATE: MAR 19, 2014 - 13:29 MidMichigan District Health Department PAGE 0004

ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

CHECK TOTALS: 1,583.62$ -$ 1,583.62$

100612 03/21/14 MIC007 MICHIGAN PUBLIC HEALTH INST MONTGOMERY 3/11 03/01/14 10812 45.00$ -$ 45.00$

3/11 BREASTFEEDING BASICS

COMPUTER CHECKCHECK TOTALS: 45.00$ -$ 45.00$

100613 03/21/14 MIC159 MICHIGAN ACADEMY SIMON, LAURA 05/01/14 10781 205.00$ -$ 205.00$

5/1/14 TRAINING

COMPUTER CHECKCHECK TOTALS: 205.00$ -$ 205.00$

100614 03/21/14 MIS005 MiSDU/FRIEND OF COURT 3/21/14 03/19/14 10837 359.08$ -$ 359.08$

EMPLOYEE DEDUCTION FOR 3/21/14

COMPUTER CHECK

CHECK TOTALS: 359.08$ -$ 359.08$

100615 03/21/14 MNA004 MICHIGAN NURSES ASSOC 3/21/14 03/19/14 10836 541.10$ -$ 541.10$

MARCH 2014 DUES

COMPUTER CHECK

CHECK TOTALS: 541.10$ -$ 541.10$

100616 03/21/14 NOV039 NOVARTIS VACCINES 91780472 02/24/14 10786 82.12$ -$ 82.12$

MENVEO MONTCALM

COMPUTER CHECK

91780473 02/24/14 10784 246.36$ -$ 246.36$

MENVEO CLINTON

91780474 02/24/14 10785 164.24$ -$ 164.24$

MENVEO GRATIOT

CHECK TOTALS: 492.72$ -$ 492.72$

100617 03/21/14 OFF001 OFFICEMAX INCORPORATED 359174 03/10/14 10826 014010-00 306.09$ -$ 306.09$

PAPER,RAPID LETTER,PAPERCLIPS

COMPUTER CHECK

888232 02/19/14 10761 013091-00 299.99$ -$ 299.99$

LITERATURE ORGANIZER

CHECK TOTALS: 606.08$ -$ 606.08$

100618 03/21/14 PEO083 2/28/14 02/28/14 10793 38.88$ -$ 38.88$

TRAVEL THRU 2/28/14

COMPUTER CHECK

CHECK TOTALS: 38.88$ -$ 38.88$

100619 03/21/14 PER009 PERSPECTIVE ENTERPRISES 47068 03/04/14 10765 014000-00 898.00$ -$ 898.00$

INFANT SCALES,CARRYING CASES

COMPUTER CHECKCHECK TOTALS: 898.00$ -$ 898.00$

100620 03/21/14 QUI003 QUILL CORPORATION 1010179 03/03/14 10831 013080-00 31.98$ -$ 31.98$

NAME PLATES

COMPUTER CHECK

9953464 02/27/14 10764 014004-00 17.84$ -$ 17.84$

COLORED COPY PAPER

43

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RUN DATE: MAR 19, 2014 - 13:29 MidMichigan District Health Department PAGE 0005

ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

CHECK TOTALS: 49.82$ -$ 49.82$

100621 03/21/14 RAI058 RAINBOW INTERNATIONAL AP6 #1 03/17/14 10822 399.00$ -$ 399.00$

REFUND SEPTIC PERMITCOMPUTER CHECK

CHECK TOTALS: 399.00$ -$ 399.00$

100622 03/21/14 RIC007 RIC'S FOOD CENTER 2000701433 02/25/14 10790 24.83$ -$ 24.83$

COFFEE FOR R4Q MEETINGS

COMPUTER CHECK

CHECK TOTALS: 24.83$ -$ 24.83$

100623 03/21/14 SHE021 SHERIDAN VILLAGE MARKET 694420 03/12/14 10820 33.39$ -$ 33.39$

CHRISTENSEN RETIREMENT

COMPUTER CHECKCHECK TOTALS: 33.39$ -$ 33.39$

100624 03/21/14 SHR011 SHRED-IT 9403294978 02/28/14 10788 77.58$ -$ 77.58$ CLINTON CHED SHREDDING

COMPUTER CHECK

CHECK TOTALS: 77.58$ -$ 77.58$

100625 03/21/14 STA002 STATE OF MICHIGAN/DEQ 853229 02/20/14 10792 202.00$ -$ 202.00$ GRATIOT WATER LABS

COMPUTER CHECK

CHECK TOTALS: 202.00$ -$ 202.00$

100626 03/21/14 STA005 STATE OF MICHIGAN-MDCH BERES/STRATTON 05/01/14 10778 32.00$ -$ 32.00$ SORGENFREI/PETERS CSHCS 5/6/14

COMPUTER CHECK

FINN 05/01/14 10777 8.00$ -$ 8.00$

CSHCS 5/1/14 TRAINING

SIMON/FOX 06/01/14 10779 16.00$ -$ 16.00$

CSHCS 6/12/14 TRAINING

CHECK TOTALS: 56.00$ -$ 56.00$

100627 03/21/14 STA194 STAPLES ADVANTAGE 8028795818 02/15/14 10830 013089-00 24.40$ -$ 24.40$

CHAIR MAT

COMPUTER CHECK

9029068124 02/15/14 10829 013089-00 109.99$ -$ 109.99$

CHAIR

CHECK TOTALS: 134.39$ -$ 134.39$

100628 03/21/14 TEA001 TEAMSTERS LOCAL 214 MARCH 2014 03/19/14 10841 1,930.12$ -$ 1,930.12$ DUES FOR MARCH

COMPUTER CHECKCHECK TOTALS: 1,930.12$ -$ 1,930.12$

100629 03/21/14 TOW048 TOWN & COUNTRY RECREATION 1334 02/26/14 10810 150.00$ -$ 150.00$

R4Q ROOM RENTAL

COMPUTER CHECK

CHECK TOTALS: 150.00$ -$ 150.00$

44

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RUN DATE: MAR 19, 2014 - 13:29 MidMichigan District Health Department PAGE 0006

ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT

------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100630 03/21/14 UNI001 UNITED WAY OF MONTCALM CO 3/21/14 03/19/14 10840 108.00$ -$ 108.00$ EMPLOYEE DONATION FOR 3/21/14

COMPUTER CHECK

CHECK TOTALS: 108.00$ -$ 108.00$

100631 03/21/14 UNI009 UNITED WAY OF GRATIOT CO 3/21/14 03/19/14 10839 65.00$ -$ 65.00$

EMPLOYEE DONATION FOR 3/21/14

COMPUTER CHECK

CHECK TOTALS: 65.00$ -$ 65.00$

100632 03/21/14 VER004 VERIZON 9720520389 02/21/14 10776 563.27$ -$ 563.27$

CELL PHONES DISTRICT WIDE

COMPUTER CHECK9720704054 02/23/14 10813 219.09$ -$ 219.09$

2/24-3/23 MOBILE BROADBAND

CHECK TOTALS: 782.36$ -$ 782.36$

100633 03/21/14 FIR003 FIRST NATIONAL BANK OMAHA 8046 FEBRUARY 2 02/28/14 10795 18.19$ -$ 18.19$

EH LUNCH

COMPUTER CHECK

8796 FEBRUARY 2 03/05/14 10794 48.82$ -$ 48.82$

NEW EMPLOYEE LUNCH

9571 FEB 2014 02/28/14 10797 013069-00 240.95$ -$ 240.95$

STETHESCOPE

9571 FEB 2014-1 02/28/14 10798 013068-00 65.99$ -$ 65.99$

BUSINESS CARDS

9571 FEB 2014-1 02/28/14 10807 014002-00 27.47$ -$ 27.47$ BATTERIES

9571 FEB 2014-1 02/28/14 10808 014009-00 72.14$ -$ 72.14$

CISCO SPORT SWITCH/BELKIN 14'

9571 FEB 2014-1 02/28/14 10823 299.95$ -$ 299.95$ SUBSCRIPTION FOR CODING WEBSITE

9571 FEB 2014-2 02/28/14 10799 013073-00 2,967.15$ -$ 2,967.15$

MCIR STAMPED ENVELOPES

9571 FEB 2014-3 02/28/14 10800 013082-00 33.06$ -$ 33.06$

HANDHELD VACUUM

9571 FEB 2014-4 02/28/14 10801 013079-00 67.99$ -$ 67.99$ BUSINESS CARDS

9571 FEB 2014-5 02/28/14 10802 013077-00 310.11$ -$ 310.11$ 146 GB FOR SERVER

9571 FEB 2014-6 02/28/14 10803 013086-00 305.00$ -$ 305.00$ CBO EH STAMPED ENVELOPES

9571 FEB 2014-7 02/28/14 10804 014003-00 302.65$ -$ 302.65$

ADMIN STAMPED ENVELOPES

45

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RUN DATE: MAR 19, 2014 - 13:29 MidMichigan District Health Department PAGE 0007

ACCOUNTS PAYABLE CHECK REGISTER

CHECK CHECK\VOID REMIT-TO NAME INVOICE INVOICE VOUCH# P.O.-NO AMOUNT DISCOUNT CHECK

NO DATE VENDOR-# NO DATE PAID TAKEN AMOUNT------------------------------------------------- -------------------------------------------- -------------- ------------- ------------

100633 03/21/14 FIR003 FIRST NATIONAL BANK OMAHA 9571 FEB 2014-8 02/28/14 10805 013085-00 607.65$ -$ 607.65$ MBO EH STAMPED ENVELOPES

9571 FEB 2014-9 02/28/14 10806 013099-00 102.58$ -$ 102.58$ ADMIN DUAL MONITOR

9571 FEBRUARY 2 02/28/14 10796 394.54$ -$ 394.54$

POSTAGE/FARQUHARSON HOTEL

CHECK TOTALS: 5,864.24$ -$ 5,864.24$

BANK CODE TOTALS: 109,420.27$ -$ 109,420.27$

47 COMPUTER CHECKS0 MANUAL PAYMENT CHECKS

1 VOID CHECKS - TRX

0 VOID CHECKS - STUBS0 VOID CHECKS - ERROR

0 VOID CHECKS - FORM ALIGNMENT

0 DIRECT DEPOSITS48 CHECKS TOTAL

COMPANY TOTALS: 109,420.27$ -$ 109,420.27$

46

Page 47: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

ABRAHAM & GAFFNEY, P.C. Certified Public Accountants

East Lansing Auburn Hills St. Johns

Principals ---———--—— Dale J. Abraham, CPA Michael T. Gaffney, CPA Steven R. Kirinovic, CPA Aaron M. Stevens, CPA Eric J. Glashouwer, CPA Alan D. Panter, CPA William I. Tucker IV, CPA

3511 Coolidge Road Suite 100

East Lansing, MI 48823 (517) 351-6836

FAX: (517) 351-6837

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Page 48: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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ABRAHAM & GAFFNEY, P.C. Certified Public Accountants

East Lansing Auburn Hills St. Johns � � �

Principals ---———--—— Dale J. Abraham, CPA Michael T. Gaffney, CPA Steven R. Kirinovic, CPA Aaron M. Stevens, CPA Eric J. Glashouwer, CPA Alan D. Panter, CPA William I. Tucker IV, CPA

3511 Coolidge Road Suite 100

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Page 53: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 54: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Þ Û Û Ç Ð ¿ Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ Ü Ù Ç Ð Ð Ä Ú Á Ù À Ö Á Ù Ã à à Ç Ö ¿ Á Ô â ß Ä Æ ¿ Á Ö × Ç á Á Ö Æ Ó Á Æ ¿ À ÛÖ Á á Á Æ Ã Á Ù Â × Ç á Á Ö Æ Ó Á Æ ¿ À Û × Ö À Æ ¿ Ù Â Ô Ç Æ À ¿ Ä Ç Æ Ù Â Ð Á Á Ù À Æ Ô Ú Õ À Ö × Á Ù Ð Ç Ö Ù Á Ö á Ä Ú Á Ù Â Ä Æ ¿ Á Ö Á Ù ¿ Â Û Ç Ú À Û Â À Æ ÔÚ Ç Æ ¿ Ö Ä â à ¿ Ä Ç Æ Ù ½ Ø Õ Á × Ç á Á Ö Æ Ó Á Æ ¿ À Û À Ú ¿ Ä á Ä ¿ Ä Á Ù Ç Ð ¿ Õ Á Ý Á à À Ö ¿ Ó Á Æ ¿ À Ö Á À Û Û Ú Ç Æ Ù Ä Ô Á Ö Á Ô Õ Á À Û ¿ Õ À Æ Ô Ù À Æ Ä ¿ À ¿ Ä Ç Æà Ö Ç × Ö À Ó Ù ½ Ø Õ Á Ý Á à À Ö ¿ Ó Á Æ ¿ Ô Ç Á Ù Æ Ç ¿ Ç à Á Ö À ¿ Á À Æ ß à Ö Ç × Ö À Ó Ù ¿ Õ À ¿ À Ö Á Ä Æ ¿ Á Æ Ô Á Ô ¿ Ç Ö Á Ú Ç á Á Ö À Û Û Ç Ö ÀÙ Ä × Æ Ä Ð Ä Ú À Æ ¿ à Ç Ö ¿ Ä Ç Æ Ç Ð ¿ Õ Á Ä Ö Ú Ç Ù ¿ Ù ¿ Õ Ö Ç Ã × Õ Ã Ù Á Ö Ð Á Á Ù À Æ Ô Ú Õ À Ö × Á Ù ½Ø Õ Á × Ç á Á Ö Æ Ó Á Æ ¿ Ì Ò Ä Ô Á Ð Ä Æ À Æ Ú Ä À Û Ù ¿ À ¿ Á Ó Á Æ ¿ Ù Ä Æ Ú Û Ã Ô Á Ç Æ Û ß Ð Ä Æ À Æ Ú Ä À Û Ä Æ Ð Ç Ö Ó À ¿ Ä Ç Æ Ö Á Û À ¿ Á Ô ¿ Ç ¿ Õ Á È Ä Ô ÌÈ Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ 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× Ç á Á Ö Æ Ó Á Æ ¿ Ì Ò Ä Ô Á Ð Ä Æ À Æ Ú Ä À Û Ù ¿ À ¿ Á Ó Á Æ ¿ Ù ½ æ ßÔ Ç Ä Æ × Ù Ç Â Ö Á À Ô Á Ö Ù Ó À ß â Á ¿ ¿ Á Ö Ã Æ Ô Á Ö Ù ¿ À Æ Ô ¿ Õ Á Û Ç Æ × Ì ¿ Á Ö Ó Ä Ó à À Ú ¿ Ç Ð ¿ Õ Á × Ç á Á Ö Æ Ó Á Æ ¿ Ü Ù Æ Á À Ö Ì ¿ Á Ö Ó Ð Ä Æ À Æ Ú Ä Æ ×Ô Á Ú Ä Ù Ä Ç Æ Ù ½ æ Ç ¿ Õ ¿ Õ Á × Ç á Á Ö Æ Ó Á Æ ¿ À Û Ð Ã Æ Ô â À Û À Æ Ú Á Ù Õ Á Á ¿ À Æ Ô × Ç á Á Ö Æ Ó Á Æ ¿ À Û Ð Ã Æ Ô Ù ¿ À ¿ Á Ó Á Æ ¿ Ç Ð Ö Á á Á Æ Ã Á Ù ÂÁ Ñ à Á Æ Ô Ä ¿ Ã Ö Á Ù Â À Æ Ô Ú Õ À Æ × Á Ù Ä Æ Ð Ã Æ Ô â À Û À Æ Ú Á à Ö Ç á Ä Ô Á À Ö Á Ú Ç Æ Ú Ä Û Ä À ¿ Ä Ç Æ ¿ Ç Ð À Ú Ä Û Ä ¿ À ¿ Á ¿ Õ Ä Ù Ú Ç Ó à À Ö Ä Ù Ç Æâ Á ¿ Ò Á Á Æ × Ç á Á Ö Æ Ó Á Æ ¿ À Û Ð Ã Æ Ô Ù À Æ Ô × Ç á Á Ö Æ Ó Á Æ ¿ À Û À Ú ¿ Ä á Ä ¿ Ä Á Ù ½Ø Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ À Ô Ç à ¿ Ù À Æ À Æ Æ Ã À Û À à à Ö Ç à Ö Ä À ¿ Á Ô â Ã Ô × Á ¿ Ð Ç Ö Ä ¿ Ù � Á À Û ¿ Õì Ã Æ Ô ½ Þ â Ã Ô × Á ¿ À Ö ß Ú Ç Ó à À Ö Ä Ù Ç Æ Ù ¿ À ¿ Á Ó Á Æ ¿ Õ À Ù â Á Á Æ à Ö Ç á Ä Ô Á Ô Ð Ç Ö ¿ Õ Ä Ù Ð Ã Æ Ô ¿ Ç Ô Á Ó Ç Æ Ù ¿ Ö À ¿ Á Ú Ç Ó à Û Ä À Æ Ú ÁÒ Ä ¿ Õ ¿ Õ Ä Ù â Ã Ô × Á ¿ ½Ø Õ Á â À Ù Ä Ú Ð Ä Æ À Æ Ú Ä À Û Ù ¿ À ¿ Á Ó Á Æ ¿ Ù Ú À Æ â Á Ð Ç Ã Æ Ô Ç Æ à À × Á Ù º Ì ¹ Ç Ð ¿ Õ Ä Ù Ö Á à Ç Ö ¿ ½� � ÷ ý ø ÷ � ÷ ö ý î ï ð ñ ð ò ï ñ ó � ÷ ñ ÷ ý � ý ð ÷ ø � Ø Õ Á Æ Ç ¿ Á Ù à Ö Ç á Ä Ô Á À Ô Ô Ä ¿ Ä Ç Æ À Û Ä Æ Ð Ç Ö Ó À ¿ Ä Ç Æ ¿ Õ À ¿ Ä Ù Á Ù Ù Á Æ ¿ Ä À Û ¿ Ç À Ð Ã Û ÛÃ Æ Ô Á Ö Ù ¿ À Æ Ô Ä Æ × Ç Ð ¿ Õ Á Ô À ¿ À à Ö Ç á Ä Ô Á Ô Ä Æ ¿ Õ Á × Ç á Á Ö Æ Ó Á Æ ¿ Ì Ò Ä Ô Á À Æ Ô Ð Ã Æ Ô Ð Ä Æ À Æ Ú Ä À Û Ù ¿ À ¿ Á Ó Á Æ ¿ Ù ½ Ø Õ Á Æ Ç ¿ Á Ù¿ Ç ¿ Õ Á Ð Ä Æ À Æ Ú Ä À Û Ù ¿ À ¿ Á Ó Á Æ ¿ Ù Ú À Æ â Á Ð Ç Ã Æ Ô Ç Æ à À × Á Ù Ï Ì Å ã Ç Ð ¿ Õ Ä Ù Ö Á à Ç Ö ¿ ½û ÷ ö ý þ ð � � þ � ñ ÷ ï � ð � É Æ À Ô Ô Ä ¿ Ä Ç Æ ¿ Ç ¿ Õ Á â À Ù Ä Ú Ð Ä Æ À Æ Ú Ä À Û Ù ¿ À ¿ Á Ó Á Æ ¿ Ù À Æ Ô À Ú Ú Ç Ó à À Æ ß Ä Æ × Æ Ç ¿ Á Ù Â ¿ Õ Ä Ù Ö Á à Ç Ö ¿À Û Ù Ç à Ö Á Ù Á Æ ¿ Ù Ú Á Ö ¿ À Ä Æ Ö Á ä Ã Ä Ö Á Ô Ù Ã à à Û Á Ó Á Æ ¿ À Ö ß Ä Æ Ð Ç Ö Ó À ¿ Ä Ç Æ Ú Ç Æ Ú Á Ö Æ Ä Æ × â Ã Ô × Á ¿ Á Ô Ö Á á Á Æ Ã Á Ù À Æ ÔÁ Ñ à Á Æ Ô Ä ¿ Ã Ö Á Ù Ç Æ à À × Á Å º ½ ú ¿ Õ Á Ö Ù 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Page 55: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 56: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Ø Ç ¿ À Û Á Ñ à Á Æ Ù Á Ù Ä Æ Ú Ö Á À Ù Á Ô À à à Ö Ç Ñ Ä Ó À ¿ Á Û ß º ã à Á Ö Ú Á Æ ¿ Ç á Á Ö ¿ Õ Á à Ö Á á Ä Ç Ã Ù Ð Ä Ù Ú À Û ß Á À Ö Â Ó À Ä Æ Û ß Ô Ã Á ¿ Ç À ÆÄ Æ Ú Ö Á À Ù Á Ä Æ Á Ñ à Á Æ Ù Á Ö Á Û À ¿ Á Ô ¿ Ç Ú Ç Ó à Á Æ Ù À ¿ Á Ô À â Ù Á Æ Ú Á Ù À Æ Ô Ç ¿ Õ Á Ö à Ç Ù ¿ Ì Á Ó à Û Ç ß Ó Á Æ ¿ â Á Æ Á Ð Ä ¿ Ç â Û Ä × À ¿ Ä Ç Æ Ù ½Ø Ç ¿ À Û Ç à Á Ö À ¿ Ä Æ × × Ö À Æ ¿ Ù Ô Á Ú Ö Á À Ù Á Ô ù Î Ê Ï Â ã ã ¹ Ó À Ä Æ Û ß Ô Ã Á ¿ Ç À Ô Á Ú Ö Á À Ù Á Ä Æ ¿ Õ Á Ý Á Æ ¿ À Û È Á Ô Ú À Ä Ô ì Ã Û Û \ Ç Ù ¿] Á Ä Ó â Ã Ö Ù Á Ó Á Æ ¿ Ö Á Ú Á Ä á Á Ô Ä Æ Å ã º Å ½ Ø Õ Á À × Á Æ Ú ß Æ Ç Û Ç Æ × Á Ö Ç à Á Ö À ¿ Á Ù ¿ Õ Á Ô Á Æ ¿ À Û Ú Û Ä Æ Ä Ú Ù Â ¿ Õ Á Ö Á Ð Ç Ö Á Â Æ ÇÛ Ç Æ × Á Ö Ö Á Ú Á Ä á Á Ù ¿ Õ Ä Ù Ö Á Ä Ó â Ã Ö Ù Á Ó Á Æ ¿ ½î ï ð ñ ð ò ï ñ ó � ð ñ ó � ø ï ø � � ÷ ö ý � � ü ý þ ð � ý ð ÷ ^ ø î ð �Þ Ù Æ Ç ¿ Á Ô Á À Ö Û Ä Á Ö Â ¿ Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ à ٠Á Ù Ð Ã Æ Ô À Ú Ú Ç Ã Æ ¿ Ä Æ × ¿ Ç Á Æ Ù Ã Ö Á À Æ ÔÔ Á Ó Ç Æ Ù ¿ Ö À ¿ Á Ú Ç Ó à Û Ä À Æ Ú Á Ò Ä ¿ Õ Ð Ä Æ À Æ Ú Á Ì Ö Á Û À ¿ Á Ô Û Á × À Û Ö Á ä Ã Ä Ö Á Ó Á Æ ¿ Ù ½� � ü ý þ ð � ý ð ÷ ñ ó î ð � � Ø Õ Á Ð Ç Ú Ã Ù Ç Ð ¿ Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ Ü Ù × Ç á Á Ö Æ Ó Á Æ ¿ À ÛÐ Ã Æ Ô Ä Ù ¿ Ç à Ö Ç á Ä Ô Á Ä Æ Ð Ç Ö Ó À ¿ Ä Ç Æ Ç Æ Æ Á À Ö Ì ¿ Á Ö Ó Ä Æ Ð Û Ç Ò Ù Â Ç Ã ¿ Ð Û Ç Ò Ù Â À Æ Ô â À Û À Æ Ú Á Ù Ç Ð Ù à Á Æ Ô À â Û Á Ö Á Ù Ç Ã Ö Ú Á Ù ½¾ Ã Ú Õ Ä Æ Ð Ç Ö Ó À ¿ Ä Ç Æ Ä Ù Ã Ù Á Ð Ã Û Ä Æ À Ù Ù Á Ù Ù Ä Æ × ¿ Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ Ü Ù Ð Ä Æ À Æ Ú Ä Æ ×Ö Á ä Ã Ä Ö Á Ó Á Æ ¿ Ù ½ É Æ à À Ö ¿ Ä Ú Ã Û À Ö Â Ã Æ À Ù Ù Ä × Æ Á Ô Ð Ã Æ Ô â À Û À Æ Ú Á Ó À ß Ù Á Ö á Á À Ù À à ٠Á Ð Ã Û Ó Á À Ù Ã Ö Á Ç Ð À × Ç á Á Ö Æ Ó Á Æ ¿ Ü ÙÆ Á ¿ Ö Á Ù Ç Ã Ö Ú Á Ù À á À Ä Û À â Û Á Ð Ç Ö Ù à Á Æ Ô Ä Æ × À ¿ ¿ Õ Á Á Æ Ô Ç Ð ¿ Õ Á Ð Ä Ù Ú À Û ß Á À Ö ½Þ Ù Ç Ð ¿ Õ Á Á Æ Ô Ç Ð ¿ Õ Á Ú Ã Ö Ö Á Æ ¿ Ð Ä Ù Ú À Û ß Á À Ö Â ¿ Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ Ü Ù × Ç á Á Ö Æ Ó Á Æ ¿ À ÛÐ Ã Æ Ô Ö Á à Ç Ö ¿ Á Ô À ¿ Ç ¿ À Û Á Æ Ô Ä Æ × Ð Ã Æ Ô â À Û À Æ Ú Á Ç Ð ù º Â Ï ¹ Å Â » Å Ê _ À Æ Ä Æ Ú Ö Á À Ù Á Ç Ð ù º ¹ Í Â Ë Ë ã Ä Æ Ú Ç Ó à À Ö Ä Ù Ç Æ Ò Ä ¿ Õ¿ Õ Á à Ö Ä Ç Ö ß Á À Ö ½ \ Á Ö ¿ À Ä Æ Ú Ç Æ Ù ¿ Ö À Ä Æ ¿ Ù Õ À á Á â Á Á Æ à Û À Ú Á Ô Ç Æ Ð Ã Æ Ô â À Û À Æ Ú Á À ¿ ¾ Á à ¿ Á Ó â Á Ö Î ã  Š㠺 Î ½ Ø Õ Ç Ù ÁÚ Ç Æ Ù ¿ Ö À Ä Æ ¿ Ù Ú Ç Æ Ù Ä Ù ¿ Ç Ð ù º ã Å Â º ¹ ã Ä Æ à Ö Á à À Ä Ô Ù â Á Ä Æ × Ú Ç Æ Ù Ä Ô Á Ö Á Ô Æ Ç Æ Ù à Á Æ Ô À â Û Á À Æ Ô ù º Â Ê Ï ¹  » Ê ¹ Õ À á Ä Æ ×â Á Á Æ Ú Ç Ó Ó Ä ¿ ¿ Á Ô Ð Ç Ö Ù à Á Ú Ä Ð Ä Ú à Ã Ö à Ç Ù Á Ù ½ Ø Õ Á Ö Á Ó À Ä Æ Ä Æ × À Ó Ç Ã Æ ¿ Ç Ð ù º Ë Î Â Ë º Ë Ä Ù Ú Ç Æ Ù Ä Ô Á Ö Á Ô Ã Æ À Ù Ù Ä × Æ Á ÔÐ Ã Æ Ô â À Û À Æ Ú Á ½ ¾ Á Á ¼ Ç ¿ Á í Ð Ç Ö Ó Ç Ö Á Ä Æ Ð Ç Ö Ó À ¿ Ä Ç Æ Ç Æ Ð Ã Æ Ô â À Û À Æ Ú Á Ú Ç Æ Ù ¿ Ö À Ä Æ ¿ Ù ½Þ Ù À Ó Á À Ù Ã Ö Á Ç Ð ¿ Õ Á × Ç á Á Ö Æ Ó Á Æ ¿ À Û Ð Ã Æ Ô Ü Ù Û Ä ä Ã Ä Ô Ä ¿ ß Â Ä ¿ Ó À ß â Á à ٠Á Ð Ã Û ¿ Ç Ú Ç Ó à À Ö Á À Ù Ù Ä × Æ À â Û Á è Ú Ç Ó Ó Ä ¿ ¿ Á Ô ÂÀ Ù Ù Ä × Æ Á Ô Â À Æ Ô Ã Æ À Ù Ù Ä × Æ Á Ô ê Ð Ã Æ Ô â À Û À Æ Ú Á  ¿ Ç ¿ À Û Ð Ã Æ Ô â À Û À Æ Ú Á  À Æ Ô Ã Æ À Ù Ù Ä × Æ Á Ô Ð Ã Æ Ô â À Û À Æ Ú Á ¿ Ç ¿ Ç ¿ À Û Ð Ã Æ ÔÁ Ñ à Á Æ Ô Ä ¿ Ã Ö Á Ù ½ Þ Ù Ù Ä × Æ À â Û Á Ð Ã Æ Ô â À Û À Æ Ú Á è ù º  ¹ ¹ ã  Π¹ Ê ê À Æ Ô ¿ Ç ¿ À Û Ð Ã Æ Ô â À Û À Æ Ú Á è ù º Â Ï ¹ Å Â » Å Ê ê Ö Á à Ö Á Ù Á Æ ¿À à à Ö Ç Ñ Ä Ó À ¿ Á Û ß Î ã à Á Ö Ú Á Æ ¿ À Æ Ô Î Å à Á Ö Ú Á Æ ¿ Â Ö Á Ù à Á Ú ¿ Ä á Á Û ß Â Ç Ð ¿ Ç ¿ À Û Ð Ã Æ Ô Á Ñ à Á Æ Ô Ä ¿ Ã Ö Á Ù ½ 2 Æ À Ù Ù Ä × Æ Á Ô Ð Ã Æ Ôâ À Û À Æ Ú Á Ö Á à Ö Á Ù Á Æ ¿ Ù À à à Ö Ç Ñ Ä Ó À ¿ Á Û ß Î à Á Ö Ú Á Æ ¿ Ç Ð ¿ Ç ¿ À Û Á Ñ à Á Æ Ô Ä ¿ Ã Ö Á Ù ½� � ü ý þ ð � ý ð ÷ ñ ó î ð � ` � õ ý ÷ ñ þ � ô ï õ ö ó ï õ ö ÷ øú á Á Ö ¿ Õ Á Ú Ç Ã Ö Ù Á Ç Ð ¿ Õ Á ß Á À Ö Â ¿ Õ Á È Ä Ô Ì È Ä Ú Õ Ä × À Æ Ý Ä Ù ¿ Ö Ä Ú ¿ � Á À Û ¿ Õ Ý Á à À Ö ¿ Ó Á Æ ¿ Ü Ù æ Ç À Ö Ô Ç Ð � Á À Û ¿ Õ Ó À ßÀ Ó Á Æ Ô ¿ Õ Á â Ã Ô × Á ¿ ¿ Ç ¿ À � Á Ä Æ ¿ Ç À Ú Ú Ç Ã Æ ¿ Á á Á Æ ¿ Ù ¿ Õ À ¿ Ç Ú Ú Ã Ö Ô Ã Ö Ä Æ × ¿ Õ Á ß Á À Ö ½ ì Ç Ö ¿ Õ Á ß Á À Ö Á Æ Ô Á Ô ¾ Á à ¿ Á Ó â Á ÖÎ ã  Š㠺 Î Â â Ã Ô × Á ¿ À Ó Á Æ Ô Ó Á Æ ¿ Ù à Ö Ä Ó À Ö Ä Û ß Ä Æ Ú Ö Á À Ù Á Ô À Æ Ô Ô Á Ú Ö Á À Ù Á Ô Û Ä Ú Á Æ Ù Á Ù À Æ Ô à Á Ö Ó Ä ¿ Ù ÂÄ Æ ¿ Á Ö × Ç á Á Ö Æ Ó Á Æ ¿ À Û Â À Æ Ô Ú Õ À Ö × Á Ù Ð Ç Ö Ù Á Ö á Ä Ú Á Ù Ö Á á Á Æ Ã Á À Æ Ô Ú Á Ö ¿ À Ä Æ Á Ñ à Á Æ Ô Ä ¿ Ã Ö Á Û Ä Æ Á Ä ¿ Á Ó Ù â ß À Ó Ç Ã Æ ¿ ÙÆ Á Ú Á Ù Ù À Ö ß ¿ Ç Ó À Ä Æ ¿ À Ä Æ Ú Ç Æ Ù Ä Ù ¿ Á Æ Ú ß Ò Ä ¿ Õ À Ú ¿ à À Û À Ú ¿ Ä á Ä ¿ Ä Á Ù Ð Ç Ö ¿ Õ Á Ð Ä Ù Ú À Û ß Á À Ö ½ É Æ ¿ Ç ¿ À Û Â ¿ Õ Á Ý Á à À Ö ¿ Ó Á Æ ¿ Ü ÙÀ Ó Á Æ Ô Á Ô Á Ñ à Á Æ Ô Ä ¿ Ã Ö Á â Ã Ô × Á ¿ Ú Õ À Æ × Á Ô Ð Ö Ç Ó ù » Â Ï Ê »  ¹ Ê Ë ¿ Ç ù »  ¹ ¹ Í Â º Ï Å Â Ò Õ Ä Ú Õ Ö Á à Ö Á Ù Á Æ ¿ Á Ô Ç Æ Û ß ÀÖ Á Û À ¿ Ä á Á Û ß Ù Ó À Û Û Ô Á Ú Ö Á À Ù Á Ä Æ ¿ Õ Á Ç á Á Ö À Û Û À × Á Æ Ú ß â Ã Ô × Á ¿ ½56

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Page 59: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 60: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 61: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 62: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 68: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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Page 69: MID-MICHIGAN DISTRICT HEALTH DEPARTMENT · 2014. 3. 28. · 1. Finance Committee a. Mid-Michigan District Health Department's Monthly Balance Sheet, Revenue and Expenditure Report

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ABRAHAM & GAFFNEY, P.C. Certified Public Accountants

East Lansing Auburn Hills St. Johns B K M B

Principals ---———--—— Dale J. Abraham, CPA Michael T. Gaffney, CPA Steven R. Kirinovic, CPA Aaron M. Stevens, CPA Eric J. Glashouwer, CPA Alan D. Panter, CPA William I. Tucker IV, CPA

3511 Coolidge Road Suite 100

East Lansing, MI 48823 (517) 351-6836

FAX: (517) 351-6837

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

M E M O R A N D U M

TO: Board of Health

FROM: Mark W. (Marcus) Cheatham, Ph.D., Health Officer

DATE: March 21, 2014

SUBJECT: Hospital-Based Dental Services –Sheridan Community Hospital

There are a significant number of young children (under 5 years old) and developmentally disabled children and

adults who reside in Montcalm and Ionia Counties who are unable to receive dental care in a traditional

dentist’s office due to severe decay (Early Childhood Caries) and special needs. These individuals must be

served in a hospital setting. They and their families must travel considerable distances, often as far as Ann

Arbor to receive care. This distance is not only an inconvenience, but a significant barrier to necessary dental

care.

As you are aware, the Mid-Michigan District Health Department (MMDHD) helped Michigan Community

Dental Clinics (MCDC) win a Capital Region Community Foundation grant of $14,506 to launch a hospital-

based dental project at McLaren in Lansing. The first patient will be treated there on April 2, 2014.

Now MCDC is launching a hospital-based dental project at Sheridan Hospital with services provided by MCDC

dentists for young children and the disabled who are enrolled in Medicaid. It is estimated that the project will

serve between 48-72 individuals per year – with services being provided one day per month. It is estimated 80%

of those served will be children and 20% adults. It is also estimated 80% of patients will be from Montcalm

County and 20% from Ionia County, as most referrals will be initiated from the Montcalm Area Dental Clinic in

Sidney.

Nearly $40,000 needs to be raised for this project. MCDC has raised nearly all of the funds from other

community sources including the United Way of Montcalm and Ionia, Central Montcalm Community

Foundation, Ronald McDonald Foundation, the Greenville Area Community Foundation, etc. They need only

$3,788 to complete their fundraising. MMDHD has a reserve in Dental Outreach that could be used to support

this project. . This would be an appropriate use of those funds. I am requesting that the Board authorize $3,788

for MCDC to be used to support hospital-based dentistry at Sheridan Hospital.

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-------- Original Message --------

Subject: Board Coordinating Committee

From: Linda VanGills <[email protected]>

To: [email protected],Marcus Cheatham <[email protected]>

CC:

The letter to the DHD#10 Board Chair and Vice Chair from your two chairs representing the Mid-Central Coordinating

Committee was reviewed and discussed at the DHD#10 BOH last Friday. The Board voted to participate. I will send

formal communication to the representatives who sent the letter along with a copy to both of you, within the next week,

along with the representatives from the DHD#10 BOH.

No virus found in this message.

Checked by AVG - www.avg.com

Version: 2014.0.4259 / Virus Database: 3705/7150 - Release Date: 03/04/14

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Report to the Board of Health Robert Graham, DO, MPH

Medical Director Central Michigan District Health Department, March 26, 2014, Harrison

District Health Department 10, March 28, 2014, Cadillac Mid-Michigan District Health Department, March 28, 2014, Ithaca

Influenza

Pertussis

Update on PBB Study in Gratiot County

Influenza Individual and aggregate reports are significantly lower than levels seen during the same time period last year (early March). The Michigan Department of Community Health (MDCH) reported two pediatric deaths in Michigan due to influenza this influenza season. Pertussis Whooping cough continues to move amongst Michiganders. There have been cases in Gladwin, Clare, Isabella, and Clinton Counties. Fortunately, there have been no pediatric deaths. The last case of Pertussis in District 10 was reported back in October. Little kids, especially kids under the age of one year, are vulnerable to the ravages of Pertussis. Lung tissue is damaged and the ability to clear secretions is reduced. Pneumonia can develop and occasionally inflammation of the brain will occur. The best course of action is to prevent the disease before it can infect a child. Moms, dads, siblings, grandparents, and any care provider should have an up-to-date vaccination against whooping cough. If people in a child’s life are protected, then little kiddies whose immune systems aren’t developed are less likely to become infected with the Pertussis germ.i Update on PBB Study in Gratiot County Emory University in Atlanta, Georgia, is pursuing additional research on the possible health effects of PBB (Poly Brominated Biphenyls) on human health. PBB was added to children’s clothing, and added to plastics of all kinds as flame retardants. PBB was unknowingly distributed to Michigan farms in the 1970s. PBB was fed to cattle, chickens, and pigs by unsuspecting farmers. Farmers were devastated by the loss of their livestock and many lost their means of livelihood. PBB has been linked to decreased quality and number of lymphocytes in a person exposed to PBBii. Another established fact is that girls exposed to high levels of PBB while in utero are more likely to start their periods at an earlier ageiii. The current research project steps include collecting blood, urine, and semen samples, collecting body morphological measurements, and collecting detailed medical histories on volunteer subjects. At this time (March 14, 2014) there is no new information to share regarding the outcome of the project. Recommendation of the Board of Health Whooping cough continues to spread through our communities. Pregnant women, family members and care givers of newborns are urged to get vaccinated against whooping coughi.

i MMWR December 15, 2006 / 55(RR17); 1-33 ii Science 17 March 1978: Vol. 199 no. 4334 pp. 1207-1209 iii Blanck, HM, M Marcus, PE Tolbert, C Rubin, AK Henderson, VS Hertzberg, RH Zhang and L Cameron. 2000. Age at menarche and Tanner stage in girls exposed in utero and postnatally to polybrominated biphenyl. Epidemiology 11:641-647

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

M E M O R A N D U M TO: Board of Health FROM: Mark W. (Marcus) Cheatham, Ph.D., Health Officer and Melissa Bowerman, Director of Administrative Services DATE: March 18, 2014 SUBJECT: Continuity of Leadership Policy The Mid-Michigan District Health Department (MMDHD) is reviewing all polices to ensure that they are current and relevant. Additionally, the Public Health Accreditation Board (PHAB) requires all documents to be reviewed within the past five years. Most policies require approval by either the Health Officer or Medical Director, but in some cases, the nature of the policy requires Board of Health approval. The attached policy is one such case. It is the Continuity of Leadership Policy. The policy has been update to reflect the order of succession that will be used in the absence of the Health Officer. The policy will also be aligned with the Continuity of Operations Plan (COOP) that is in place for MMDHD. Therefore, I am requesting that the Board of Health approve the Continuity of Leadership Policy as of March 28, 2014.

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT

CONTINUITY OF LEADERSHIP POLICY

Policy Number: 006.0 Effective Date: 03/28/2014

Approved By: Last Review Date: 03/28/2014

Original Policy Date: Supersedes Policy Date: 11/23/11

Page 1 of 1

POLICY/PURPOSE

To provide for the continuity of leadership as defined in the Public Health Code in the event that the

Health Officer is temporarily unavailable to discharge his/her duties. The policy of the Mid-Michigan

District Health Department is to provide a plan that will ensure the continuity of leadership by

following the order of succession outlined in the procedure below.

PROCEDURE

If in the event that the Health Officer of the Mid-Michigan District Health Department is not

available to discharge the duties of the Health Officer, then the Mid-Michigan District Board of

Health directs the following to happen:

A member of the Administrative Staff of the Mid-Michigan District Health Department will

be temporarily appointed as Acting Health Officer.

The Acting Health Officer will perform the same duties as the regular Health Officer.

The Acting Health Officer will hold this title and perform the duties of the Health Officer

until the regular Health Officer is able to resume his/her duties.

The Acting Health Officer will work closely with the Chairperson of the Mid-Michigan

District Board of Health and maintain regular communications with the Chairperson.

The order of succession will be:

o Director of Environmental Health

o Director of Administrative Services

o Director of Community Health and Education

o Medical Director

o Health Officer of another local public health department

The persons listed above are authorized to act with the authority vested in the Health Officer pursuant

to Section 333.2428 of the Michigan Public Health Code (P.A. 368 of 1978, as amended).

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Mid-Michigan

District Health

Department DEPARTMENT POLICY

Number: 006.0

MMDHD Subject: Continuity of Leadership

Supersedes No.: 006.0 Dated:

06/01/0611/23/2011

Page 1 of 2

Review Date:

03/28/2014 Approved By: Board of Health Effective Date:

11/23/201103/28/20

14

Formatted Table

Formatted Table

Purpose:

To provide for the continuity of leadership as defined in the Public Health Code in the event that the

Health Officer is temporarily unavailable to discharge his/her duties. The policy of the Mid-Michigan

District Health Department is to provide a plan that will ensure the continuity of leadership by following

the order of succession outlined in the procedure below.

Policy Statement:

If in the event that the Health Officer of the Mid-Michigan District Health Department is not available to

discharge the duties of the Health Officer, then the Mid-Michigan District Board of Health directs the

following to happen:

A. If an emergency exists then . . .

A.

• A member of the Administrative Staff of the Mid-Michigan District Health Department

will be temporarily appointed as Acting Health Officer.

• The Acting Health Officer will perform the same duties as the regular Health Officer.

• The Acting Health Officer will hold this title and perform the duties of the Health Officer

until the regular Health Officer is able to resume his/her duties.

• The Acting Health Officer will work closely with the Chairperson of the Mid-Michigan

District Board of Health and maintain regular communications with the Chairperson.

The order of succession will be:

� Medical Director

� Director of Environmental Health

� Director of Administrative Services

� Director of Community Health and Education

� Medical Director

� Health Officer of another local public health department

B. During non-emergent situations, the order of succession will be . . .

• Director of Environmental Health

• Medical Director

• Health Officer of another local public health department

The persons listed above are authorized to act with the authority vested in the Health Officer pursuant to

Section 333.2428 of the Michigan Public Health Code (P.A. 368 of 1978, as amended).

Formatted: Numbered + Level: 1 +Numbering Style: A, B, C, … + Start at: 1 +

Alignment: Left + Aligned at: 0.25" + Tab

after: 0.5" + Indent at: 0.5"

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Mid-Michigan

District Health

Department DEPARTMENT POLICY

Number: 006.0

MMDHD Subject: Continuity of Leadership

Supersedes No.: 006.0 Dated:

06/01/0611/23/2011

Page 2 of 2

Review Date:

03/28/2014 Approved By: Board of Health Effective Date:

11/23/201103/28/20

14

Formatted Table

Formatted Table

References

Section 333.2428, Michigan Public Health Code

P.A. 368 of 1978, as amended.

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON Branch Office

1307 E. Townsend Rd. St. Johns, MI 48879-9036

(989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

M E M O R A N D U M

TO: Board of Health

FROM: Mark W. (Marcus) Cheatham, Ph.D., Health Officer

DATE: March 21, 2014

SUBJECT: Conference Report

This is a report on my participation in the Joint Public Health Informatics Task Force (JPHIT) Public Health

Informatics Summit in San Antonio, Texas, March 11-13, 2014.

I was very surprised by what happened at this JPHIT meeting. In the past, the Centers for Disease Control and

Prevention (CDC), which funds JPHIT, has used these meetings to negotiate with us about what they want us to

do. For example, they might ask us to gin up support for their Information Technology (IT) projects.

However, in this meeting, they asked us to help them solve problems related to the future of Meaningful Use

they admit they cannot; and have offered funding to the National Association of County and City Health

Officials (NACCHO) and Association of State and Territorial Health Officials (ASTHO) for this purpose. The

specific projects they want us to focus on include electronic lab reporting from EHRs to public health,

automated reports of notifiable conditions and syndromic surveillance. In side conversations with people close

to the CDC, I was told the CDC is realizing that many of their big data projects have struggled. There are many

reasons for this, including siloed funding and politically-driven budgets. The CDC asked JPHIT to convene this

summit to leverage existing public health technology projects to create better systems. There are lots of details

about this project—called the Public Health Platform—which I will spare you; however, this is a very

significant development because the CDC has not been open to funding IT projects outside its walls for years.

Why three days for this Summit? The first day was devoted to the conversation with the CDC, the second

involved reporting out to a diverse group of informatitions including state Chief Information Officers (CIO),

vendors and others whose support is required, and the third was the JPHIT business meeting dealing with staff,

budgets and planning.

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Stakeholder Group Salutation Name Title Organization Email

Realtors Ms. Laurie KoellingPublic Policy Committee forMichigan Assocation ofRealtors

Tomie Raines, Inc

Robin Kalnins Realtor Montcalm County Assocation of Realtors

Lenders/Banks Mr. Karl Yoder Chemical Bank (Montcalm) [email protected]/Banks Mr. Glenn Pung First Merit Bank (St Johns)

Well and Septic Inspectors Mr. Nathan Foote Health Services ExpeditorsWell Drillers Mr. Tom Jandernoa Jandernoa Well Drilling

Farm Interest Mr. Rob West (c/o) Pam Fabus (Administrative Manager)President Clinton Co Farm BureauFarm Interest Mr. Olan Humm

Excavator Mr. Don Potts Don's ContractingExcavators Mr. Ben Foster Foster Trenching [email protected]

Home Builders Mr. Tom Motz Tom Motz BuilderHome Builders Mr. Will Randle Community Development Mayberry Homes [email protected]

Property Owners/Lake Associations Mr. John Pohl Rainbow Lake Rainbow Lake; Retired Greenstone Regional [email protected]

Property Owners/Lake Associations Mr. Joe Latoff Citizen/Friends of the MapleRiver Friends of the Maple River [email protected]

Property Owners/Lake Associations Ms. Bonnie Kantiz Vice President Crystal Lake Association, [email protected] Commissioners Ms. Sandy Raines Drain Commissioner Montcalm Drain Commissioner [email protected] Commissioners Mr. Phil Hanses Drain Commissioner Clinton Drain Commissioner [email protected] Commissioners Mr. Brian Denman Drain Commissioner Gratiot Drain Commissioner [email protected]

Chambers of Commerce Jayne Norris Gratiot Chamber of Commerce Jayne Norris [email protected] Township Supervisors Mr. John Maahs Township Supervisor Watertown Township [email protected]

County Commissioners Mr. Jack Enderle Commissioner/MMDHD Clinton County Commissioner [email protected]

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CONSTITUTION HALL • 525 WEST ALLEGAN STREET • P.O. BOX 30473 • LANSING, MICHIGAN 48909-7973

www.michigan.gov/deq • (800) 662-9278

STATE OF MICHIGAN

DEPARTMENT OF ENVIRONMENTAL QUALITY

LANSING

RICK SNYDER

GOVERNOR

DAN WYANT

DIRECTOR

March 3, 2014 Bob Gouin, R.S., M.B.A., Environmental Health Division Director Mid-Michigan District Health Department 615 N. State Street Stanton, Michigan 48888 Dear Mr. Gouin: SUBJECT: Annual Self-Assessment of the On-Site Wastewater Treatment

Management Program This is to acknowledge receipt and acceptance by the Department of Environmental Quality (DEQ) of the annual self-assessment as completed by the Mid-Michigan District Health Department (MMDHD). The annual self-assessment was submitted in accordance with Section VI, On-Site Wastewater Treatment Management Program (OWTMP) of the Michigan Local Public Health Accreditation Program (MLPHAP) and the findings of our review are discussed in this correspondence. The annual self-assessment report from MMDHD was received on January 24, 2014, and the report was initially reviewed on February 20, 2014. Subsequently, on February 27, 2014 a teleconference was held with Lonnie Smith, R.S, of MMDHD and me. During a teleconference we discussed the review of the annual self-assessment and agreed with your agency findings of compliance being “Met” for all Indicators. The review findings for several of the Indicators were discussed in detail during the teleconference and pertinent comments are reiterated below. Indicator 2.1 – Site Evaluation Documentation: The agency self-assessment reported 93 percent compliance. The DEQ review resulted in agreement with agency findings. Indicator 2.2 – Sewage Permit Documentation: The agency self-assessment reported 89 percent compliance. The DEQ review the determined that the percentage of compliance for this Indicator may be higher than the 89 percent reported. More specifically, the DEQ review determined that the internal quality assurance process of MMDHD is likely exceeding the minimum measures required for compliance with this Indicator resulting in the potential for underreporting the compliance percentage.

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Bob Gouin, R.S., M.B.A. 2 March 3, 2014 Indicator 3.1 – Final Inspection Documentation: The agency self-assessment reported 93 percent compliance. The DEQ review the determined that the percentage of compliance for this Indicator may be higher than the 93 percent reported. More specifically, the DEQ review determined that the internal quality assurance process of MMDHD is likely exceeding the minimum measures required for compliance with this Indicator resulting in the potential for underreporting the compliance percentage. For all of the above Indicators, the DEQ review of representative documentation of site evaluations, sewage permits and final inspections generated by staff were categorized as very good to excellent. Based on our review of the self-assessment, we commend the agency for improving the on-site sewage program over the past year through the self-assessment process by means of enhanced internal program oversight. In closing, thank you for participating in the self-assessment review option. We appreciate the efforts of you and your staff in the pursuit of ongoing quality assurance in the OSTM Program. We further recognize Lonnie Smith as the key staff person within your agency assigned the responsibility for implementing activities integral to the self-assessment process. The efforts of Mr. Smith to provide program oversight, monitoring, and reporting as part of the annual self-assessment represents a sincere commitment to ongoing quality assurance on behalf of your agency. If you require further information, please contact me at 517-284-6534; [email protected]; or DEQ, Office of Drinking Water and Municipal Assistance, P.O. Box 30241, Lansing, Michigan, 48909-7741. Sincerely,

Dale R. Ladouceur, R.S. On-Site Wastewater Program Environmental Health Programs Unit Office of Drinking Water and Municipal Assistance cc: Mr. Marcus Cheatham, Health Officer, MMDHD Mr. Lonnie Smith, EH Supervisor, MMDHD Mr. Richard A. Falardeau, DEQ

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

M E M O R A N D U M

TO: Board of Health

FROM: Mark W. (Marcus) Cheatham, Ph.D., Health Officer

DATE: March 19, 2014

SUBJECT: Inspections for Low-Risk Food

Senator Thomas Casperson has introduced Senate Bill 0851 which makes several changes to the Food Law,

Public Act 92 of 2000. One of the changes would permit local health departments to exercise the option of

conducting an office-based food safety assessment instead of an on-site inspection for temporary food

establishments serving only low-risk food.

This bill is very popular in rural parts of the State where health departments do not want to have to pay someone

to drive 50 miles through the snow to conduct an on-site inspection at an event which has been conducted safely

for years and is serving only low-risk food like hot dogs.

The bill is unpopular in heavily-populated counties that have numerous dubious vendors. Pressure is expected

from the Restaurant Association to waive on-site inspections, even for vendors who have proven to be

unreliable in the past.

We expect the bill to pass. When it does you, may wish to consider establishing a different fee for office-based

assessments. At this time, the topic is informational.

The current language is as follows…

Temporary food establishments may receive an office-based food safety and sanitation assessment in lieu of

inspection, provided the establishment:

(a) Operates for a maximum of six contiguous hours in any single day and limits foods provided to one or

more of the following:

a. Serves or sells only raw or commercially packaged foods that are not potentially hazardous

(time/temperature control for safety) as defined in the Food Code adopted by this act.

b. Serves only commercially processed potentially hazardous foods. These foods shall be heated, if

necessary for food safety, but not further prepared, or cooled for later service.

c. Prepares only foods that are not potentially hazardous for immediate service.

117

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MID-MICHIGAN DISTRICT HEALTH DEPARTMENT An Accredited Local Public Health Department www.mmdhd.org

CLINTON

Branch Office 1307 E. Townsend Rd.

St. Johns, MI 48879-9036 (989) 224-2195

GRATIOT Branch Office

151 Commerce Drive Ithaca, MI 48847-1627

(989) 875-3681

MONTCALM Branch Office

615 N. State St., Ste. 1 Stanton, MI 48888-9702

(989) 831-5237

ADMINISTRATIVE OFFICES 615 N. State St. Ste. 2

Stanton, MI 48888-9702 (989) 831-5237

MARK W. (MARCUS) CHEATHAM

Health Officer ROBERT GRAHAM, DO, MPH, FAAFP

Medical Director

BOARD OF HEALTH Bruce Delong

Jack A. Enderle Betty Kellenberger

Tom Lindeman Laura McCollum

Donald Zinn

Your Public Health Team,

Connecting with our Communities to Achieve Healthier Outcomes.

M E M O R A N D U M

TO: Board of Health

FROM: Mark W. (Marcus) Cheatham, Ph.D., Health Officer

DATE: March 19, 2014

SUBJECT: Caseload Changes in Community Health and Education Division Due to Medicaid Expansion

An important emerging issue the health department is confronting is the impact of the expansion of Medicaid on

our caseloads and the consequences of State and Federal policy changes related to that.

When the Healthy Michigan Plan roles out, about 400,000 citizens with incomes below 138% of the Federal

Poverty Level (FPL) will be eligible for Medicaid (7,000 to 8,000 in our 3 counties). Many of these people

have been coming to us for services. When they have insurance they may no longer do so, meaning we will

need to adjust our programing.

More problematic are ongoing and potential changes to public health financing, anticipating that people will

have insurance when that may not be the case. Some people who do not get insurance may lose access to public

health services and end up with nothing.

One example is the Plan First! program. Plan First! supplements Title X reproductive health and family

planning services. In 2006, Michigan requested a waiver from the Centers for Medicare and Medicaid Services

(CMS) to obtain additional Medicaid funds to provide basic family planning services for people with incomes

below 185% of the FPL who did not qualify for Title X. The concept was ingenious. When a woman with an

income below 185% of the FPL gets pregnant, she qualified for Medicaid. Give someone a free condom and

save yourself taxpayers thousands of dollars in Medicaid costs. The Mid-Michigan District Health Department

(MMDHD) has around 350 Plan First! clients. The program has a budget of $60,000.

It is expected that about 80% of Plan First! clients will qualify for the Healthy Michigan Plan or the Affordable

Care Act (ACA) Marketplace. Either of these insurance plans will pay for their reproductive health services. In

anticipation of this, the State did not request a renewal of the waiver. Plan First! will end on June 30, 2014.

The impact on our budget is unknown. Will Plan First! clients who have insurance continue to use us for

services? What about women with incomes above 138% of the FPL? If they did not enroll in insurance

through the Marketplace, they will not have coverage.

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Board of Health

Page 2

March 19, 2014

These questions can be asked about other public health programs, too. Some suggest the Title X program itself

may be cut as insurance coverage expands. The same can be said about the Breast and Cervical Cancer Control

Program (BCCCP); although our caseload has been cut to the point that it is not a serious budget threat.

To deal with these issues, we are doing three things:

The Advisory Board of the Mid-Michigan Health Plan (MMHP) voted to continue MMHP through

September 30, 2014 reducing enrollment from 1,000 to 300. This will allow us to provide people with an

affordability or other exemption from the Marketplace or undocumented people with a basic health care

benefit.

As a standard practice, we will continue to try to enroll everyone we see in the Healthy Michigan Plan or

the Marketplace to ensure that the largest number of clients possible has insurance and we can bill for

our services.

We have begun discussing how we could launch a women’s health clinic providing a basic set of

reimbursable services. We would market the clinic to area physicians who cannot or will not take new

Medicaid clients. By encouraging these physicians to refer to us, we would be assuring accessible care is

available. We would start small to see if we could cover our costs of operation. If so, we could expand

our hours and services and try to fold in some uninsured people.

No Board action is requested; I just wanted to keep you informed.

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MID-MICHIGAN DISTRICT BOARD OF

HEALTH

Action Items February 2014

The Board of Health approved a change in a Clinton County Women, Infants, and Children’s

(WIC) Peer Counselor position from .4 FTE to .5 FTE effective February 25, 2014.

As the agency is now able to bill commercial insurances, reimbursement became available

for several different condyloma (genital warts) treatments. The Board of Health approved fees for the services provided for condyloma treatment effective March 1, 2014.

Ingham County has offered the agency a grant for a Community Health Worker for their

Ingham County HUB to connect Clinton County residents to needed services. The grant is for FY 14/15, with the possibility of additional funding in subsequent years. The Board of Health approved the Community Health Worker Job Description at the Teamsters Local 214, T4 lev-el.

The Board of Health approved the purchase of two modules (Case Management and Sexual-

ly-Transmitted Diseases) for the agency’s Insight Software at a cost of $15,000 to be paid from the Equipment/Technology fund balance. The modules will improve processes in the clinical programs.

The Board of Health approved the FY 14/15 Budget Development Timeline showing a pro-

posed FY 14/15 Budget being completed and approved by the Board of Health in late June.

The Board of Health approved the following Monthly Board of Health Healthy Living Recom-

mendation for the month of March:

Women planning to become pregnant should quit smoking and alcohol consumption,

eat food high in folic acid such as leafy green vegetables, fruits, dried beans, peas, nuts

Women planning pregnancy should see a doctor prior to conception for a health re-

view and prenatal testing and bring mom’s immunizations up to date

After delivery, parents should insist on a smoke-free environment1

1Evidence-Based Prenatal Care: Part I. General Prenatal Care and Counseling Issues, April 5, 2005, American Family Physician

Due to a conflict with Michigan’s Premier Public Health Conference, the Board of Health re-

schedule its October 22nd meeting held in Stanton to October 29th.

The Board of Health approved out-of-state travel for the Health Officer March 11-13, 2014.

All expenses will be paid by the Joint Public Health Information Task Force (JPHIT). The Board approved Bob Gouin, Director of Environmental Health, as Acting Health Officer dur-ing his absence.

As a component of the agency’s Performance Management System, the Quar-

terly Service Report was modified to make the report more useful and user-friendly. After review of the proposed changes to the Quarterly Service Report, the Board of Health gave their support for the new format.

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STAFFING CHANGES

MARCH - 2014

Page 1 of 1

AS

STATUS POSITION BRANCH

OFFICE

VACANCY FT Community Health Worker, Clinton Branch Office effective

March 6, 2014

Clinton

CHED

STATUS POSITION BRANCH

OFFICE

RETIREMENT Margaret Christensen, FT P.H. Representative II, Montcalm Branch

Office effective March 14, 2014

Montcalm

TRANSFER Erin Cambric, FT P.H. Representative II, Gratiot Branch Office transfer

to the Montcalm Branch Office effective March 17, 2014

Montcalm

VACANCY PT (0.7 FTE) P.H. Representative I/II, Gratiot Branch Office effective

March 20, 2014

Gratiot

STATUS

CHANGE

Stacey Peterman, PT (0.7 FTE) Hearing/Vision Technician/P.H.

Representative I to FT Hearing/Vision Technician (0.7 FTE) and

P.H. Representative I (0.3 FTE), Gratiot Branch Office effective

March 24, 2014

Gratiot

NEW HIRE Michelle Bailey, PT (0.7 FTE) P.H. Nurse I, Clinton Branch Office

effective March 24, 2014

Clinton

EH

STATUS POSITION BRANCH

OFFICE

No changes

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Copyright 2014 American Medical Association. All rights reserved.

A StatewideMedicaid Enhanced Prenatal Care Program

Impact on Birth Outcomes

LeeAnne Roman, MSN, PhD; Jennifer E. Raffo, MA; Qi Zhu, MS; Cristian I. Meghea, PhD

IMPORTANCE Policy makers and practitioners need rigorous evaluations of state-based

Medicaid enhanced prenatal care programs that provide home visiting to guide

improvements and inform future investments. Effects on adverse birth outcomes are of

particular interest.

OBJECTIVE To test if participation in theMichigan statewide enhanced prenatal care program,

theMaternal Infant Health Program (MIHP), accounting for program timing and dosage,

reduced risk for low birth weight (LBW) and preterm birth, particularly among black women

who are at greater risk for adverse outcomes.

DESIGN, SETTING, AND PARTICIPANTS Quasi-experimental cohort study. Data, including birth

records, Medicaid claims, andmonthly program participation, were extracted from the

Michigan Department of Community Health warehouse. Participants included all 60 653

pregnant womenwho had aMedicaid-insured singleton birth between January 1 and

December 31, 2010, in Michigan. TheMIHP participants were propensity score-matched with

nonparticipants based on demographics, previous pregnancies, socioeconomic status, and

chronic disease.

EXPOSURE An enhanced prenatal care program.

MAIN OUTCOMES ANDMEASURES Low birth weight, very low birth weight (VLBW), preterm

birth, and very preterm birth.

RESULTS In the propensity score–matchedmodels, black womenwho enrolled and were

screened in theMIHP by the end of the second trimester had lower odds of VLBW (odds ratio

[OR], 0.76; 95% CI, 0.59-0.97) and very preterm births (OR, 0.68; 95% CI, 0.54-0.85) than

matched nonparticipants. Black MIHP participants who enrolled and were screened in the

program by the second trimester and had at least 3 additional prenatal MIHP contacts had

lower odds of LBW (OR, 0.76; 95% CI, 0.65-0.89), VLBW (0.42; 0.30-0.61), preterm birth

(0.71; 0.61-0.83), and very preterm birth (0.41; 0.30-0.57) compared with matched

nonparticipants. TheMIHP participants of other races and ethnicities who enrolled and were

screened in the program by the second trimester and had at least 3 additional prenatal MIHP

contacts had lower odds of LBW (OR, 0.78; 95% CI, 0.66-0.93), VLBW (0.38; 0.22-0.66),

preterm birth (0.77; 0.66-0.89), and very preterm birth (0.63; 0.43-0.91) compared with

matched nonparticipants.

CONCLUSIONS AND RELEVANCE Participation inMIHP reduced the risk for adverse birth

outcomes in a diverse, disadvantaged population. The study adds to the evidence base for

enhanced prenatal care home visiting programs and informs state and federal investments.

JAMA Pediatr. 2014;168(3):220-227. doi:10.1001/jamapediatrics.2013.4347

Published online January 6, 2014.

Author Affiliations:Department of

Obstetrics, Gynecology, and

Reproductive Biology, College of

HumanMedicine, Michigan State

University, East Lansing (Roman,

Raffo, Meghea); SRO Technical

Service, University of Michigan, Ann

Arbor (Zhu); Institute for Health

Policy, College of HumanMedicine,

Michigan State University, East

Lansing (Meghea).

Corresponding Author: LeeAnne

Roman, MSN, PhD, Department of

Obstetrics, Gynecology, and

Reproductive Biology, Michigan State

University, 965 Fee Rd, Room A629B,

East Lansing, MI 48824

([email protected]).

Research

Original Investigation

220 jamapediatrics.com

Copyright 2014 American Medical Association. All rights reserved.� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �122