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Home My WebLink About20031301.tiff RESOLUTION RE: APPROVE APPLICATION FOR COMMUNITY HEALTH INVESTMENT PROGRAM AND AUTHORIZE CHAIR TO SIGN - PLATTE VALLEY MEDICAL CENTER WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with an Application for Community Health Investment Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Weld County Area Agency on Aging, and the Platte Valley Medical Center, with terms and conditions being as stated in said application, and WHEREAS, after review, the Board deems it advisable to approve said application, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Application for Community Health Investment Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services,Weld County Area Agency on Aging, and the Platte Valley Medical Center be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said application. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 21st day of May, A.D., 2003. BOA OF COUNTY COMMISS ONERS 7:'It' ti WEL OUNT , COLORADO faxe, /I' ' ATTEST: ,. • C vid E. Long, Chair Weld County Clerk to L, Robert D. Maibr?-Te m BY: Deputy Clerk to the Boaw� 1 . J. Bile 72OV1DASTOFO 11 William erke unty Attorney g 4 Glenn Vaad JJJ Date of signature: 2003-1301 HR0074 General Information Applicant geld County Area Agency on Aging Contact Person Eva Jewell, Director 80632 1551 N. 17th Ave. , PO Box 1805, Greeley, CO Address Phone (970) 353-3800. ext. 3331 Collaborating Organizations (priority will be given to projects involving collaborating organizations) Sunrise Community Health Center, Salud Family Health Clinic, Department of Social Services Old Age Pension Dental Program. Proposal On no an two (2)additional pages, describe the proposed project addressing the following: • Documented Need (i.e. research data, health statistics, etc...) ■ Expected Results of Project ■ _Specific Objectives, Timetables and Process utilized to research project goals ■ How Results will be Measured Financial Information Total Cost for Program $ 20,000.00 Grant Amount Requested $ 20,000.00 Amount of Funding Available from other Sources $ Give some details of how grant funds, if approved by the CHIP Committee, will be used: To continue assistance to seniors 60 years of age and older with dental, hearing and vision assistance in South Weld County. If the project or program is to continue beyond the time frame for which the grant is given, how will it be funded? We will use funds received from the state if they are available. This application, with at least one additional proposal page, and a copy of the following must be submitted to the CHIP Committee: 1) Names and addresses of applicant officers and members of its Board of Directors or governing body. 2) Articles of Incorporation and By-laws or other documents which define the applicant's purposes, membership, management and operation. 3) Statute, regulation or the applicant's Internal Revenue Service letter which shows the applicant is exempt from Federal income taxes, is not a private foundation and that donors may deduct contributions to the applicant as provided in Section 170 of the Internal Revenue Code. 4)A financial audit or other financial information for the most recent three fiscal years. 5)A detailed budget for the proposal. All applications must be submitted to the CHIP Committee no later than the month ending previous to scheduled CHIP Committee meetings (The Committee meets the second Wednesday every other month as follows: January, March, May,July, September and November). Platte Valley Medical Center Community Health Investment Program Application Guidelines and Procedures Criteria To be considered for a CHIP grant,your organization must meet most, if not all, of the following criteria: 1. Support the mission of Platte Valley Medical Center. 2. Serve a demonstrated need in the community which gives priority to the following program categories: Maternal/child needs, Seniors,Neighborhoods, Schools,Congregations. 3. Involve joint efforts with other community providers and organizations that are directly or indirectly involved with community health care concerns. 4. Have a reasonable financial request. 5. Reflect funding for"new"programs or additional efforts for existing programs. 6. Incorporate quality improvement principles that relate to the following categories: access, appropriateness, service quality, screening,project analysis and outcome,disease management,prevention,health status and finance. 7. Have an educational focus. 8. Serve a mutual constituency. Eligibility Requirements All grant recipients are considered health care partners with the hospital and as partners are accountable to the CHIP Committee for the use of all funds provided. Applicants for CHIP grants must meet the following minimum requirements: 1. Operate as a non-profit charitable, educational, civic, scientific,social welfare,religious,health care or health service organization,or as a governmental or quasi-governmental unit. 2. Operate under written Articles of Incorporation and By-laws or other written documents or statutes which define the applicant's purposes,membership,management and operation. 3. Operate on a non-discriminatory basis in employment,recruitment of volunteers and delivery of services. 4. Demonstrate effective program performance and financial responsibility and accountability. 5. Operate within the geographic area served by Platte Valley Medical Center. .� Limitations It is the CHIP policy not to approve grants for the following: 1. Political activities of any kind 2. Construction costs 3. Endowment programs 4. Request for more than 25 percent of CHIP funds available in one year for one project 5. Scholarships Operating Guidelines The following basic operating guidelines shall apply: 1. All grants must be approved by the CHIP Committee. 2. Grants shall be used solely for the requested purpose. 3. All funds received shall be used only within PVMC's service area. 4. No program or project shall be funded beyond three consecutive years. 5. Funded activities shall commence in a timely manner. 6. Grant recipients shall give proper credit to PVMC in all promotional materials,activities and programs funded with CHIP donations. 7. Grant recipients shall submit a project performance report and financial statement to the CHIP Committee indicating the actual use of the grant within 60 days of receiving grant money and at least annually for the life of the grant. 8. Random on-site CHIP Committee visits will be conducted as needed to assess the progress and effectiveness of projects or programs supported by CHIP grants. 9. Grant funds not used shall be returned. Application and Funding Procedure The following general procedure shall apply: 1. Applications should be submitted to the CHIP Committee, Platte Valley Medical Center,P.O.Box 98, Brighton,CO 80601, (303)659-1531. 2. Applications may be submitted at any time throughout the year. 3. The Committee will make decisions on grant requests at meetings held the second Wednesday of every other month. 4. Applicants will receive written notification of the Committee's decision. 5. Continued funding will be contingent upon adherence to CHIP policy,satisfactory program performance and use of funds. COMMUNITY HEALTH INVESTMENT PROGRAM GRANT REQUEST FOR PROGRAM YEAR BEGINNING AUGUST 1, 2003 AND ENDING JULY 31,2004. PROPOSAL: In August 2002, the CHIP Committee granted the Weld County Area Agency on Aging, $20,000 to expand our dental, hearing and vision program into South Weld County. The request for funding was due to the State of Colorado cutting back on the funds that we had been receiving. We believed that there was a need for these services in South Weld County, but did not have the funds to actively pursue eligible seniors. With the funding we are scheduled to get from the state (we are not sure how much will be received this year), and funding from the CHIP Grant, we hope to continue to offer the dental, hearing and vision services in Weld County. We are asking for your consideration to fund the programs for another year. DOCUMENTED NEED: We have found that the need for dental, hearing and vision services did exist in South Weld County. With the assistance of the Fort Lupton Senior Center, Salud Family Health Clinic and other agencies in South Weld County, we were able to provide information to seniors regarding the dental, hearing and vision programs. We also relied on the referrals provided by the agencies and from Salud Family Health Clinic. Seniors in South Weld County have also been instrumental in notifying other seniors about the services available. We have worked with over 20 seniors from South Weld County in the fiscal year beginning August 2002. We believe there are more seniors in need of services and will do all we can to promote the programs to these seniors. We have received calls from children in the Denver area requesting information on the dental, hearing and vision services for their parents who live in South Weld County. EXPECTED RESULTS OF THE PROGRAM: We are on track to expend the $20,000.00 grant award by August of 2003. By the end of the program year, which is July 31, 2003, we anticipate assisting between 25-30 participants. We believe that we can assist as many seniors in the program year beginning August 1, 2003. Because the programs are now available and more agencies are aware of the funding, there should be no problem in finding eligible seniors to assist. SPECIFIC OBJECTIVES, TIMETABLES AND PROCESS UTILIZED TO RESEARCH PROJECT GOALS. The goals for the programs will be the same as last year. We will try to reach and assist as many seniors in South Weld County as possible. We will continue to coordinate with Salud Family Health Clinic and the agencies in South Weld who work with or have access to seniors in need of services. HOW WILL RESULTS BE MEASURED: The participants and services provided are tracked using agency software. The data is entered into the same data base used to record the data being kept to report to the State of Colorado. The reporting to the State is mandatory for the funding we receive to coordinate a similar program in North Weld County. We will continue to submit progress reports as required by the CHIP Committee. We have also called clients to determine their level of satisfaction of services received. The participants assisted during the Program Year beginning July 1, 2002, showed a definite growth. Because of the funding received from the CHIP Committee we were able to expand our dental, hearing and vision programs into South Weld County. We have been able to contact providers in the area with a genuine interest in assisting seniors in need of the services offered through the three programs. It is because of the success we experienced, that we hope to continue providing services in South Weld County. We have not heard a definite answer as to how much funding the State will be providing this next fiscal year. With this in mind, we are again asking for assistance from the CHIP Committee to continue providing the dental, hearing and vision services in South Weld County. NAMES AND ADDRESSES OF APPLICANT AND MEMBERS OF ITS BOARD OF DIRECTORS OR GOVERNING BODY. BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, COLORADO 915 Tenth Street PO Box 758 Greeley, Colorado 80632 David E. Long, Chair M. J. Geile Robert D. Madsen Glenn Vaad, William "Bill" Jerke Page 1 of 2 itvii --- V l many,, o o n . . to c Home H Services l; Departments ;; About Weld ;i, Property Information H Conta' Home > Departments > County Commissioners County Commissioner District 1 District 2 District 3 In it It 4 ft S it David Long Glenn Vaad Rob Masden dlong@co.weld.co.us gvaad@co.weld.co.us rmasden@co.weld.co.us At-Lane At-Lane a : cell? At William "Bill" Jerke Mike Geile bjerke@co.weld.co.us mgeile@co.weld.co.us The five member Board of County Commissioners is the statutory head of Weld County's governme of the commissioners are elected at large and the other three are elected from the district in which reside. As is the case with all elected county officials, commissioners must be at least 21 years of a have resided in the county for at least one year prior to their election. Their elected position must t primary employment during the term they serve. As a board, the commissioners are required to establish a budget, levy taxes, appropriate funds for business, establish fees and licenses, purchase or otherwise acquire, own, sell, lease, trade, and of deal in real and personal property in the name of the county, receive gifts and grants for the count' approve and execute contracts and lawsuits in the name of the county. The board also is required to sit as a board of appeals to hear complaints on actions taken by count boards, commissions and departments, as a board of equalization to hear appeals on tax assessme a county board of welfare, and to make appointments to fill vacancies in all county offices except U board of commissioners and the county council. Each commissioner has primary responsibility for one of the county's five departments and serves t assistant in another. The five departments are communication services, health services, planning si engineering services, and finance, administration, central purchasing, and personnel. Their respons rotate each year. The chairman of the Board of County Commissioners is chosen by the commissioners each year am always serves as chairman of the finance and administration department during his tenure as chair file://C:\WINNT\temp\5GP 10P56.htm 4/4/2003 Page 2 of2 the board. Commissioners are only allowed to serve two complete elected terms under charter provisions. The board meets at 9:00 a.m. each Monday and Wednesday in the first floor meeting room at the Centennial Center Complex, 915 10th Street, Greeley. Agendas and minutes of the Board of County Commissioners can be obtained by calling this office 356-4000, extension 4217. Send correspondence to Weld County Commissioners at the following address: 915 Tenth Street P. O. Box 758 Greeley CO 80632 Phone: 970-336-7204 Fax: 970-352-0242 file://C:\WINNT\temp\5GP10P56.htm 4/4/2003 Area Agency on Aging Board Membership List Germaine (Geri) Arnt William Jerke 505- 2' Street Commissioner Ft. Lupton, CO. 80621 Centennial Complex Greeley, CO 80631 Don Beirbach 4292 W 14th Street Rd. Phyllis Rangel Greeley, CO 80634 2235 46th Avenue CT. #C Greeley, CO 80634 Harold Chadwick 2520 50th Avenue Josie Sanchez Greeley, CO 80634 PO Box 13 Pierce, CO 80650 Mary Pat Eastwood 3609 Marigold Street Phil Shover Evans, CO 80620 1805 19`h Avenue Greeley, CO 80631 Don Feldhaus 2038 27th Avenue Ct. #4 Diane Warren Greeley, CO 80634 1000 10`h Street Greeley, CO 80631 Ruth Gartrell 20076 Southgate Avenue Susan Bromley Lot#2 1621 13th Avenue LaSalle, CO 80645 Greeley, CO 80631 Patricia Graham 1638 27`h Avenue Greeley, CO 80634 Michelle Hernandez 3412 Trinidad Street Evans, CO 80620 Betty Jones 1959 26th Avenue Greeley, CO 80634 Mary Jones 30887 Road 88 Ault, CO 80610 • POLITICAL SUBDIVISION EXEMPTION CERTIFICATE • (For use by States, Territories, or Political • Subdivision thereof, or the District of Columbia) • • The undersigned hereby certifies that he is Comptroller Title of Officer . of Weld County Government State, Territory, or Political Subdivision, or District of Columbia and that be .is authorized to execute this certificate , and that the articles specified in the accompanying order or on the reverse side hereof, are purchased from • for the exclusive use of • Department of Weld County Government- Greeley, Colorado State, Territory, or Political Subdivision, or District of Columbia It is understood that the exemption from tax in the case of sales or articles under this exemption certificate tc the State, Territory, or Political Subdivision, or District of Columbia, is limited to the sale of the article purchased for their exclusive use, and it is agreed that if articles purchased tax-free under exemption certificates are used otherwise or are sold to employees or others, such fact must be reported to the manufacturer of the articles covered by this certificate. It is also understood that the fraudulent use of this certificate to secure exemption will subject the undersigned and all guilty parties to a fine of not more than $10,000.00 or to imprisonment for not more than five years, or both, together with costs of prosecution. COLORADO SALES TAX CERTIFICATION OF EXEMPTION NUMBER - 98-03551 0 FEDERAL TAX EXEMPTION NUMBER - 84-6000-813 STATE TAX EXEMPTION NUMBER - 14-02-101 /7 t Date • B;6/14, n MEMORANDUM it! III 1 DATE: May 12, 2003 David E. Long, Chair, Weld County Board of Wine TO: Commissioners. FROM: Walter Speckman, Executive Director, Weld County Division qf� COLORADO Human Services. 1� SUBJECT: Weld County Area Agency on Aging, Application for Dental, Hearing and Vision Program Funds. Enclosed for Board approval is the Area Agency on Aging request for additional funding of$20,000.00 for the Dental, Hearing and Vision Programs from Platte Valley Medical Center— Community Health Investment Program. The funding will be used to continue dental, hearing and vision services to seniors 60 years of age and older who live in South Weld County. You may address questions to Eva Jewell, Director of the Area Agency on Aging at extension 3331 or Pete Archuleta, Program Coordinator at extension 3330. 2003-1301 Hello