HomeMy WebLinkAbout20250644.tiffResolution
Approve Acceptance of Donation Pursuant to Restriction Letter Terms and
Conditions for $5,000.00 from Intermountain Health Platte Valley Hospital to Weld
County Department of Public Health and Environment for 2025 Community Health
Assessment Survey Reward Incentive Program
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, on the 30th day of December, 2024, the Board of County Commissioners of
Weld County, Colorado, approved Resolution #2024-3405, authorizing the Department of
Public Health and Environment to submit a Grant Application to Intermountain Health for
the 2025 Community Health Assessment Survey Reward Incentive Program for the Platte
Valley Hospital Service Area, and
Whereas, pursuant to said application, Intermountain Health Platte Valley Hospital,
1600 Prairie Center Parkway, Brighton, Colorado 80601, has provided a donation
pursuant to the Restriction Letter Terms and Conditions for $5,000.00 to the Weld County
Department of Public Health and Environment for the 2025 Community Health
Assessment Survey Reward Incentive Program, and
Whereas, it is the policy of Weld County to formally accept all donations via Resolution.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that the Donation Pursuant to the Restriction Letter Terms and Conditions for
$5,000.00 from Intermountain Health Platte Valley Hospital, be, and hereby is, accepted
and designated for use by the Weld County Department of Public Health and Environment
for the 2025 Community Health Assessment Survey Reward Incentive Program.
Be it further resolved by the Board that a copy of this Resolution, along with a letter of
appreciation, be forwarded to Intermountain Health Platte Valley Hospital.
cc . I-11.(3c/sv/sM), AGT(cP/RW/cD)
o4/03/25
2025-0644
HL0058
Acceptance of Donation Pursuant to Restriction Letter Terms and Conditions for
$5,000.00 from Intermountain Health Platte Valley Hospital to Weld County Department
of Public Health and Environment for 2025 Community Health Assessment Survey
Reward Incentive Program
Page 2
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 10th day of March, A.D., 2025:
Perry L. Buck, Chair: Aye
Scott K. James, Pro-Tem: Aye
Jason S. Maxey: Aye
Lynette Peppier: Aye
Kevin D. Ross: Aye
Approved as to Form:
Bruce Barker, County Attorney
Attest:
Esther E. Gesick, Clerk to the Board
2025-0644
HL0058
Con-hvae-' Gt ((09
Memorandum
TO: BOCC
FROM: Jason Chessher, Executive Director, Health
Dept.
DATE: 2/25/2025
SUBJECT: CHS Grant - Intermountain Health Restriction
Letter
This restriction letter from Intermountain Health accompanies their grant for the Weld
Community Health Survey. The letter is used as documentation for the donation, the intended
use of the funds, and requested outcome reporting. Intermountain Health has provided WCDPHE
with a grant for $5,000 is for the Weld County Department of Public Health and Environment's
new Reward Incentive Program for the 2025 Weld County Community Health Survey. Grant
funding from Intermountain Health will be used to support the administration of the Weld
Community Health Surveying including the Reward Incentive Program (a conditional monetary
reward once a participant completes their survey) within the Platte Valley Service Area.
The BOCC approved of the Reward Incentive Program at a Work Session on June 17, 2024 and
were updated on the progress of the 2025 Community Health Survey and Reward Incentive
Program at a Works Session on December 16, 2024. The BOCC approved the grant application for
the 2025 Community Health Assessment Survey Reward Incentive Program for Platte Valley
Hospital Service Area - Intermountain Health on 12/30/24.
Also included in the restriction letter are Intermountain Health's Additional Terms and
Conditions which have been reviewed by the Weld County attorney's office.
2025-0644
3A0 k1L005'
•
Intermountain
Health
2/24/2025
Perry L. Buck
Board of County Commissioners
Weld County Administration
1150 O Street
Greeley, CO 80631
Dear Commissioner Buck,
Intermountain Health is very pleased to provide Weld County Public Health and Environment
("Recipient") with a donation of $5,000 to support our mutual interest in enhancing public health. The
funds will provide support to the administration of the Weld Community Survey (Weld CHS) in the
Platte Valley Service Area to assess the health status, concerns and needs of the Weld County residents.
It is our hope that you will continue to work closely with me at peggy.jarrett@imail.org for any follow-
up or issues that may arise.
Please sign below on behalf of Weld County Public Health and Environment to accept this donation,
acknowledging your agreement to the "Additional Terms and Conditions" sheet enclosed with this
letter, and that Weld County Public Health and Environment agrees to use it for the intent stated above.
Please sign the document, then save a copy, and email the signed letter to peggy.jarrett@imail.org
following the instructions in the email that accompanied this letter. Upon receipt of the signed letter,
check processing will start. Once the check has printed, arrangements will be made for your check to be
delivered to you based on the delivery preferences stated in your vendor application.
This letter is used as documentation for the donation, the intended use of the funds, and requested
outcome reporting. A new request and letter of intent will need to be created for any future support.
We look forward to collaborating with you through this contribution to improve the health of our
community.
Sincerely,
ac,
Peggy Jarrett, MPH, BSN, RN
Intermountain Health Platte Valley Hospital
Perry L. BEk MAR 1 0 2025
Chair, Board of Weld County Commiss
Vddriteti Jeit,;(1
Attest:
Esther E. Gesick, Clerk to the Board
By: 1-671
DeP Y ut Cler to the Board
Intermountain Health Platte Valley Hospital
1600 Prairie Center Parkway . Brighton, CO 80601 ' P (303) 498-1600
In termountainHealthcare. org
20Z5 -0V44
ADDITIONAL TERMS AND
CONDITIONS
1. Restrictions as to Uses of the Donation Proceeds. Recipient will use the full amount of the donation
proceeds solely for the donation purposes identified in the attached letter. It is the responsibility of
Recipient to select appropriate means by which the donation Purposes are accomplished, whether
directly by its own use or by others selected by it. Recipient will repay any portion of the donation
proceeds which are not used for the donation purposes.
2. Compliance. Recipient will, and will cause its employees, other agents and contractors
(collectively, "Recipient Personnel") to, perform this Agreement in accordance with all federal,
state and local laws applicable to Recipient or Intermountain. Recipient and Intermountain agree
that: (a) no portion of the donation is intended, directly or indirectly, to compensate Recipient or
Recipient Personnel for purchasing, ordering, prescribing, using or recommending Intermountain's
products or services; (b) neither Recipient nor any of the Recipient Personnel is required to
purchase, use, prescribe, order or recommend Intermountain's products or services as a condition
of this Agreement; (c) Intermountain will not require Recipient or any Recipient Personnel to refer
patients to or restrict Recipient from referring patients to any particular individual or entity; (d) the
donation amount is not conditioned upon the volume or value of any federal health care program
business generated between Intermountain and Recipient; and (e) this Agreement will not restrict
Recipient's ability to enter into any other agreement for the receipt of donation proceeds.
3. Representations and Warranties. Recipient represents and warrants that Recipient is not: (a)
excluded from Federal Health Care Programs (42 U.S.C. Section 1320a-7b(f)); (b) debarred from
federal or state procurement or non -procurement programs; or (c) designated as a Specially
Designated National or Blocked Person by the Office of Foreign Asset Control of the U.S.
Department of the Treasury. Recipient further represents and warrants that (i) the Donation will
contribute meaningfully to Recipient's ability to maintain or increase the availability, or enhance
the quality, of health or wellness services provided to the community, and (ii) any compensation
from Recipient to a physician will not exceed fair market value and will not take into account the
volume or value of any referrals or any other business generated by the physician to Intermountain.
4. Recordkeeping. Recipient agrees to maintain its books and records in such a way that the Donation
proceeds will be shown separately on Recipient's books. Recipient will maintain records of its
expenditures in furtherance of the donation purposes to identify the use of the proceeds for the
donation purposes and to document Recipient's reasonable expectation that the donation proceeds
will contribute meaningfully to Recipient's ability to maintain or increase the availability, or
enhance the quality, of health or wellness services provided to the community.
5. Reports to Intermountain. At Intermountain's request, and not less than annually during the Term
of this Agreement, Recipient will supply Intermountain with a written report based upon the records
of Recipient showing the use of the donation proceeds in accordance with this Agreement.
6. Non -Discrimination. Recipient agrees not to discriminate against any individual, who otherwise
clinically qualifies for Recipient's services, on the basis of the individual's payor status or ability
to pay. Recipient will provide effective notification to clients of their freedom to choose any service
provider and will disclose, at the request of a client, the existence and nature of this Agreement, in
each case in a timely fashion and in a manner reasonably calculated to be effective and understood
by the patient.
7. Publicity. Recipient will acknowledge Intermountain's support of the donation purposes in all
publications related to the donation purposes and will provide Intermountain with a copy of any
such publication.
Intermountain Health Platte Valley Hospital
1600 Prairie Center Parkway • Brighton, CO 80601 • P (303) 498-1600
IntermountainHealthcare. org
Contract Form
Entity Information
Entity Name* Entity ID*
INTERMOUNTAIN HEALTH PLATTE @00049612
VALLEY HOSPITAL
Contract Name *
INTERMOUNTAIN HEALTH DONATION - WELD
COMMUNITY HEALTH SURVEY
Contract Status
CTB REVIEW
Q New Entity?
Contract ID
9169
Contract Lead *
KJAKUS-HOTCHKISS
Contract Lead Email
kjakus-
hotchkiss@weld.gov;Heal
th-Contracts@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description *
DONATION FROM INTERMOUNTAIN HEALTH FOR THE 2025 COMMUNITY HEALTH SURVEY REWARD INCENTIVE
PROGRAM
Contract Description 2
Contract Type*
GRANT
Amount*
$ 5,000.00
Renewable *
NO
Automatic Renewal
Grant
IGA
Department
HEALTH
Department Email
CM-Health@weld.gov
Department Head Email
CM -Health- Does Contract require Purchasing Dept. to be
DeptHead@weld.gov included?
Requested BOCC Agenda Due Date
Date* 03/06/2025
03/10/2025
Will a work session with BOCC be required?*
HAD
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
D.GOV
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Contact Info
Review Date*
12/31/2025
Committed Delivery Date
Renewal Date
Expiration Date*
12/31/2025
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JASON CHESSHER
DH Approved Date
02/28/2025
Final Approval
BOCC Approved
BOCC Signed Date
BOCC Agenda Date
03/10/2025
Finance Approver
CHERYL PATTELLI
Legal Counsel
BYRON HOWELL
Finance Approved Date Legal Counsel Approved Date
03/03/2025 03/03/2025
Tyler Ref*
AG 031025
Originator
KJAKUS-HOTCHKISS
Hello