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HomeMy WebLinkAboutHealth and Human Services 08-21-06 DR. KRETZ WILL REVIEW VOUCHERS NOTICE OF MEETING AND AGENDA ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD August 21, 2006 at 8:30 AM (Board Room, St. Croix County DHHS Building, New Richmond WI) CALL TO ORDER ROLL CALL REVIEW OF AGENDA CONSENT AGENDA APPROVAL OF MINUTES OF PREVIOUS MEETING - 07/19/06 and 08/09/06 DATE OF NEXT MEETING — 09118106 8:30 AM OLD AND NEW BUSINESS 1. Consideration of Claims and Vouchers 2. Financial Report • Application of surplus • Accounts Receivable - Collections update 3. Budget -most probable overview 4. Program reports a. Nursing Home Report • Ad Hoc Report • Census • IGT funding trend b. Public Health • Surgeon General's Report • Insurance trends 5. Personnel Issues • Springsted Safe manual overview • Health officer update (appointment) • Position request 6. Long Term Support-Long Term Care Reform 7. Family and Children's Non -primary Caregiver 8. Elert and Associates Telephone Study 9. Health and Human Services Governing Body By -laws Review 10. Strategic Planning report 11. Closed session per Wisconsin Statute 19.85 (1) (f)- Considering financial, medical, social or personal histories or disciplinary data of specific persons, preliminary consideration of specific personnel problems or the investigation of charges against specific person which would be likely to have a substantial adverse effect upon the reputation of any person referred to in such histories or data, or involved in such problems or investigations. 12. Reconvene into open session per Wisconsin Statute 19.85 (2) -return to open session. Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 8/15/2006 3:49 PM ti ADJOURN (Items may be taken in different order) ** Additions /Changes /Corrections Items for County Board approval must be submitted to the County Clerk's office by Wednesday morning preceding a County Board meeting. 8/15/2006 3:49 PM WV tS:L 900Z /0£ /8 •6urg99w P JP og Aq unOD E 6urpaoaad 6uruaow AvpsaupaM A q aoz ; ;o s,xzato AqunoD auq oq paggtwqns aq gsnw TPAOaddu papog AqunoD ao; swags suoil33.uoD /s35uvgD /suoiltppV (.zapzo luazajjip ui uoVj oq X uz suzall) Nuflorat' lsonboi joSpng LOOZ NIJO uoileluasa.zd '6 nnatna21 SMlej -,ig Kpog SunuanoD saoin. 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MEMBERS PRESENT: Esther Wentz, Chair Gordon Awsumb Leon Berenschot Lois Burri Tom Caflisch Dr. Michael Kretz Linda Luckey Deb Rasmussen Ronald Troyer MEMBERS ABSENT: None STAFF PRESENT: Fred Johnson, Health and Human Services Director Jennifer Pempek, Accountant /Fiscal Manager Ron Kiesler, Mental Health /AODA Coordinator Steve Kirt, Mental Health /AODA Clinical Services Supervisor Kathy Dunlap, Family and Children's Coordinator Wendy Kramer, Public Health Supervisor Bill Van Offeren, Nursing Home Administrator Kathy Dunlap, Family and Children's Coordinator Malva Berg, Secretary OTHERS PRESENT: Michelle Pietrick, Finance Director Buck Malick, County Board Chair Chuck Whiting, Administrative Coordinator Cathy Lins, Development Plus Chair Wentz called the meeting to order at 8:30 AM noting the meeting was properly and legally publicized. NEXT MEETING The next Health and Human Services Board meeting is scheduled for Wednesday, September 13, 2006 at 8:30 AM. Dr. Kretz will review September vouchers. AGENDA Motion A motion was introduced by Berenschot, seconded by Burri, and unanimously adopted: That the agenda be approved as circulated. MINUTES Motion A motion was introduced by Caflisch, seconded by Troyer, and unanimously adopted: That the minutes of the 07/19/06 Health and Human Services Board meeting approved with the following changes noted in italics: Page 3, paragraph 1, sentence 6 should read as follows: The Board moved money from the Nursing Home last year to cover DHHS deficit as well as moving money to the general fund, so the decision was made to utilize the general fund for working capital. Page 3, paragraph 2, should read as follows: The fund balance at the beginning of 2005 was (- $360,000) and it was $898,371 at the end of 2005. One of the reasons for this excess is Mental Health inpatient purchased services were less in 2005 than in 2004 due to fewer placements. There was an increase in WIMCR monies received in 2005 and these monies were budgeted for 2006. A portion of the WIMCR dollars were budgeted in the 2006 budget and will be transferred to 2006 budget. s St. Croix County Health and Human Services Board Page 2 August 21, 2006 Page 7, paragraph 4, should read as follows: Van Offeren reported as a result of the most recent State survey, that one of the cites went from a Level D to a Level G. The State has verified we are doing what we are supposed to do. This is a Class B cite with a possible forfeiture of up to $5,000 per day. There is an option to appeal the cite. Nothing more has been received and staff will continue to update the Board as information is received. Please see attached grid levels of cites. Page 7, paragraph 8 should read as follows: Luckey asked if a full report regarding the Nursing Home would be given to the County Board in August. It was the consensus the report should be delayed until September. MINUTES Motion A motion was introduced by Kretz, seconded by Troyer, and unanimously adopted: That the minutes of the 08/09/06 Health and Human Services Board meeting approved with the following change: Rasmussen did not receive notification of the meeting until after the meeting time so did not attend meeting. STRATEGIC PLANNING REPORT Cathy Lins was present to review the planning activities that have taken place for strategic planning and to give an overview of the Health and Human Services strategic plan. A steering committee consisting of Dr. Kretz, Wentz, Kirt, and Johnson was formed. She said the planning process follows five steps: 1) Setting the direction, 2) Assessing the environment, 3) Identifying issues, strategies, and priorities, 4) Developing and implementing the strategic plan, and 5) Monitoring and evaluating performance. Trend data was reviewed, community members were interviewed and staff were polled with 93% of staff participating. Two Board members participated. DHHS has a reputation for strong /quality service. A vision statement was developed, which is "Quality health and human services for everyone by everyone." The agency can't do everything with the resources available and will need to compliment other services to move forward. Diversification of funding will be needed in the future. There are grant monies available. Grants are for a limited period of time but then county levy needs to be utilized or other grants found to sustain or move the program forward. Accounts receivable monies need to be maximized. The report suggested community volunteers be utilized to expand the reach of the department programs. An annual report should be completed at least yearly to assess where the strategic plan is, with updates on the plan a couple of times a year. The next step is to develop an action plan for the next four to five years. CONSIDERATION OF CLAIMS Health and Human Services Board member Kretz reviewed the vouchers. Motion A motion was introduced by Kretz, seconded by Luckey, and unanimously adopted: That the following vouchers be approved and be made a part of the supplemental minute book: Human Services vouchers 79472 through 79477, dated July 20, 2006 in the amount of $21,404.96. Human Services vouchers 80497 through 80528, dated August 03, 2006 in the amount of $56,292.15. Human Services and Nursing Home vouchers 79336 through 79449, dated July 20, 2006 in the amount of $127,346.51. Human Services and Nursing Home vouchers 79450 through 79477, dated July 20, 2006 in the amount of $21,664.24. St. Croix County Health and Human Services Board Page 3 August 21, 2006 Human Services and Nursing Home vouchers 79760 through 79833, dated July 27, 2006 in the amount of $464,810.49. Human Services and Nursing Home vouchers 80133 through 80221, dated August 03, 2006 in the amount of $240,546.82. Human Services and Nursing Home vouchers 80885 through 81063, dated August 10, 2006 in the amount of $282,205.44. Human Services and Nursing Home vouchers 81064 through 81242, dated August 10, 2006 in the amount of $216,740.26. Nursing Home vouchers 81243 through 81276, dated August 10, 2006 in the amount of $17,563.54. Human Services, Workshop, Public Health, Social Services vouchers 435 through 464, dated July 25, 2006 in the amount of $353,776.62. Human Services, Workshop, Public Health, Social Services vouchers 465 through 496, dated August 08, 2006 in the amount of $361,884.89. Human Services and Nursing Home vouchers 457 through 488, dated July 27, 2006 in the amount of $171,858.46. Human Services and Nursing Home vouchers 489 through 520, dated August 10, 2006 in the amount of $163,362.13. Nursing Home vouchers 447 through 456, dated July 18, 2006 in the amount of $8,125.43. Workshop vouchers 85 through 90, dated July 25, 2006 in the amount of $9,355.96. Workshop vouchers 91 through 96, dated August 08, 2006 in the amount of $11,348.98. FINANCIAL REPORT Pempek distributed the following Health and Human Services financial report for January through June. She mentioned CFS is a grant funded program for which we have not yet received $87,000 in grant monies. There has been a change in administration charges. All supply charges were changed to one supply line to better track costs. St. Croix County Health and Human Services Board Page 4 August 21, 2006 HEALTH AND HUMAN SERVICES - 2006 SUMMARY Total OF REVENUES Budget Jan -June Balance % Administration 925.134.00 925.866.33 (732.33) 100.1% ACDAServices 649,146.01 331,209.33 317,936.68 51.0% Long Term Support 17,542,262.00 9,813,585.91 7,728,676.09 55.9% Mental Health 2,909,086.00 1,757,712.55 1,151,373.45 60.4% Family & Children's 3,120,265.00 2,178,507.94 941,757.06 69.8% SED 216.000.00 245,569.48 (29.569.48) 113.7% Public Health 1,537,680.00 765,039.68 772,640.32 49.8% Economic Support 1,010,360.00 574,481.74 435,878.26 56.9% General Relief 15,000.00 7,537.00 7,463.00 50.2% Coordinated Services 260,403.00 92,982.66 167,420.34 35.7% REVENUES HUMAN SERVICES PROGRAMS 28,185.336.01 16.692,492.62 11,492.843.39 59.2% SUMMARY Total OF EXPENDITURES Budget Jan - June Balance % Administration 925,134.00 502,615.88 422,518.12 543% Alcohol -Drug Abuse 649,146.01 324,767.05 324,378.96 50.0% Long Term Support 17,542,262.00 8,348,003.63 9,194,258.37 47.6% Mental Health 2,909,086.00 1,441,781.39 1,467,304.61 49.6% Family & Children's 3,120,265.00 1,514,115.27 1,606,149.73 48.5% SED 216,000.00 29.004.00 180.608.00 13.4% Public Health 1,537,680.00 754,331.08 783,348.92 49.1% Economic Support 1,010,360.00 510,349.17 500,010.83 50.5% General Relief 15,000.00 2,939.78 12,060.22 19.6% Coordinated Services 260,403.00 63,858.65 196,544.35 24.5% EXPENDITURES HUMAN SERVICES PROGRAMS 28,185,336.01 13,491,765.90 14,687,182.11 47.9% Excess Rev over Expenses S 3,200.726.72 Percentage of Budget: 49.98 `WIMCR revenues recorded $ 3,200,726.72 Revenues above include state advances Jan - May 06 $ 3,200,726.72 Pempek distributed the following Nursing Home report for January through June. Per patient day (PPD) has been added to the report for better tracking. $93,802 in IGT funds have been received so far this year. Pempek indicated no salary increases have been included in the following numbers. St. Croix County Health and Human Services Board Page 5 August 21, 2006 ST CROIX HEALTH CENTER OPERATIONS REPORT Jan - June 2006 Jan - June 2006 BUDGET ACTUAL DIFFERENCE PPD CENSUS 66 68 2 OPERATING REVENUE: MEDICARE $ 629,623.05 $ 545,165.02 $ 84,458.03 87% 3.76 MEDICAID $ 2,609,616.07 $ 1,086,997.55 $ 1,522,618.52 42% 9.13 PRIVATE PAY $ 547,475.00 $ 421,205.00 $ 126,270.00 77% 14.4 RATE APPEALS - ACTUAL $ 14,824.00 $ - $ 14,824.00 0% ALL OTHER SOURCES""" $ 220,453.00 $ 124,484.36 $ 95,968.64 56% 1.04 TRANSFER FROM CONTINGENCY $ - $ - $ - 0 TOTAL OPERATING REVENUE $ 4,021,991.12 $ 2,177,851.93 $ 1,844,139.19 54% 28.33 OPERATING EXPENSES: DAILY PATIENT SRVICES $ 3,363,410.47 $ 1,737,164.15 $ 1,626,246.32 52% 17.50 SPECIAL SERVICES $ 274,458.35 $ 132,067.42 $ 142,390.93 48% 1.33 GENERAL SERVICES $ 1,169,758.41 $ 554,753.14 $ 615,005.27 47% 5.59 ADMINISTRATIVE SERVICES $ 527,734.19 $ 256,015.47 $ 271,718.72 49% 2.58 UNASSIGNED: $ - 0.00 DEPRECIATION( °UBASED) $ - $ - $ - 0.00 OTHERS (INS-WC- CAP ITAL- UTIL) $ 373,372.00 $ 373,372.00 0% 0.00 Utilities $ 65,707.43 Workers Comp, Computer Tech $ 194,039.60 Insurance $ 56,542.00 $ 316 ,289.03 TOTAL OPERATING EXPENSES $ 5,708,733.42 $ 2,996,289.21 $ 2,712,444.21 52% 30.18 NET FROM OPERATIONS $ - $ (818,437.28) -6.61 (COST OF DOING BUSINESS PRIOR TO APPLYING LEVY & OUTSTANDING REV) EXTRAORDINARY REVENUES OUTSTANDING RATE APPEAL REV $ 14,824.00 $ - $ 14,624.00 0% % OF OUTSTANDING IGT REV $ 377,000.00 $ 93,802.00 $ 283,198.00 25% 00 ALLOCATIONS( %BASED) $ 1,309,742.30 $ 652,770.00 $ 656,972.30 50% TOTAL OUTSTANDING $ 1,701,566.30 $ 746,572.00 $ 954,99430 NET FROM ALL SOURCES $ (71.865.28 PERCENTAGE SHOULD BE 49.98% Potential Salary Increases: $16,856 - $50,567 annual projection APPLICATION OF SURPLUS Pietrick indicated the County's unwritten policy for excess budget funds is to apply surplus to the next year's budget. Surplus funds in the Nursing Home in 2005 were used to make Health and Human Services 6 St. Croix County Health and Human Services Board Page 6 August 21, 2006 whole and the rest was put in the county funds and applied to the fund balance of the next year to lower the levy. It was questioned why the surplus funds were not used to fund families on waiting lists. The services provided to clients on the waiting list do no go away when the calendar year is up and not all years have surplus funds. ACCOUNTS RECEIVABLE- COLLECTIONS UPDATE The ECHO updates are in a test file now. A custom report may be needed and Pempek is working with sales and technical support. Child Support has tax intercept in place and this is being investigated for Health and Human Services. Administration will continue to monitor the progress on receivables. BUDGET -MOST PROBABLE OVERVIEW There were problems with getting accurate employee information in the budget software so this report is not available. It is hoped this will be corrected soon. The report will be forwarded to Board members as soon as it is available. Pempek indicated Nursing Home numbers should be done by the end of this week. The Board recessed from 9:45 to 9:50 AM. AD HOC REPORT A Nursing Home report will be presented to the County Board on September 21. Implementation of WIPFLI recommendations regarding staffing have been made. Goal setting issues and mandates /unfunded mandates will be discussed in the report, also the recent incident in the Nursing Home. Malick questioned what it would cost to place those residents the county must care for in alternate placement. Van Offeren indicated the County is not fully responsible for funding any current resident in the Nursing Home. All residents in the Nursing Home are funded by private pay, Medicaid, Medicare or private insurance. Admission is determined by the facility's ability to care for the resident not ability to pay. Van Offeren reported there has to be a very just cause to deny admission to the nursing home. The report will be presented to the Health and Human Services Board on 09/13 before presenting to the County Board. Copies of the O'Keefe report will be made available to new Health and Human Services Board members. The current census in the Nursing Home is 67. IGT FUNDING TREND Johnson informed the Board of the IGT (Intergovernmental Transfer) Funding received in the past: 2001 $856,000 2002 766,000 2003 708,000 2004 706,000 2005 552,000 It is hoped that the funding trend will stabilize. The Nursing Home budget includes $377,000 in IGT funds for 2006. SURGEON GENERAL'S REPORT The six major conclusions of the Surgeon General's report were distributed to Board members last month, which include the following: 1. Millions are still exposed to secondhand smoke. 2. Secondhand smoke causes disease and death in non - smokers. 3. Children exposed to secondhand smoke are at risk for SIDS, asthma, ear infections and other respiratory symptoms. 4. Secondhand smoke has immediate effects on coronary arteries. 5. There is no risk -free level of exposure to secondhand smoke. 6. Exposure to secondhand smoke is not eliminated by ventilation. St. Croix County Health and Human Services Board Page 7 August 21, 2006 Dr. Kretz distributed potential specific responses the Board could make in response to the Surgeon General's report. A DVD entitled Breathe Easy 2006 was shown to members. Dr. Kretz prepared a power point presentation entitled Stopping the Harm regarding preventing exposure to secondhand smoke. Dr. Kretz pointed out that 19 states are totally smoke free in public places. Several municipalities, counties, villages in Wisconsin have gone smoke free in public places. LaCrosse County went smoke -free in 2003. Dr. Kretz indicated it is the Board's duty to prevent exposure to secondhand smoke. Dr. Kretz pointed out increased health care costs and its affect on government budgets and ultimately the taxpayer due to secondhand smoke. Awsumb said a policy should be developed within the Board's statutory authority and not go into people's homes. Communication will be held with LaCrosse County as to enforcement of their policy. Also, work will be done with the Tobacco Coalition and St. Croix County Public Health to develop a recommendation to bring back to the Board to present at the next meeting. POSITION REQUESTS Administration is requesting a 50% PHN (Public Health Nurse) position be increased to 100% position. The associated cost of this increase is approximately $35,200 which would come from county levy and possibly Aging and Disability Resource Centers (ADRC) funding, which is unknown at this time. Public Health is a population -based service. The State average for Public Health is 2.3 professional staff /10,000 population. St. Croix County is at 1.6/10,000. This increase in PHN time had been approved two previous years and then taken out of the final budget. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the Board approves increasing a 50% PHN position to 100% at a cost of approximately $35,200 as part of the 2007 budget process and forward to the Finance Committee. Administration is requesting to fill an Economic Support position at 100 %. The position already exists within the organizational structure. The cost of this position is approximately $51,000 with half of the position being federally funded and the other half from levy or ADRC. We have been informed there will be monies available for Economic Support from ADCR due to the LTC reform but the amount is unknown. Current caseloads in the unit are over 500 per worker. With LTC, the Economic Support Specialists are the only staff who can enroll all of the new clients. In the event LTC is not implemented, this position will not be filled. Motion A motion was introduced by Kretz, seconded by Rasmussen, and unanimously adopted: That the Board approves filling a 100% Economic Support Specialist position at a cost of approximately $51,000 as part of the 2007 budget process and forward to the Finance Committee. Administration is requesting a 100% Medical Records Technician Assistant position. This position already exists within our organizational structure. The cost of this position is approximately $52,800 to be funded by levy dollars. The department is not able to keep up with the increased demand for medical records needs due to county growth and increased cases. Some LTE contracting has been done but has not been sufficient. Kiesler proposed UWRF interns spend a portion of their internship in Medical Records. Motion A motion was introduced by Kretz, seconded by Rasmussen, and adopted with Luckey voting no: That the Board approves filling a 100% Medical Records Technician Assistant position at a cost of approximately $52,800 as part of the 2007 budget process and forward to the Finance Committee. Y St. Croix County Health and Human Services Board Page 8 August 21, 2006 Kiesler presented a realignment in Mental Health and Coordinated Family Services (CFS) to better meet unit demands due to more time needed in mobile crisis and also more time needed for CFS. Currently Mental Health is contracting 14 hours /week (35% time) with the jail for anger management and other training. That time would be put back in clinic hours due to demand for clinical services and Mental Health staff would assist the Sheriff's department to locate contract services from an outside vendor by January of 2007. Reorganization summary hand out provided to the Board. HEALTH OFFICER UPDATE (APPOINTMENT Johnson said Charlotte Sortedahl is recommended for the Health Officer /Public Health Coordinator position. Wentz and Berenschot participated in the interview process from the Board. Johnson will give a brief background of her education /experience when she is introduced to the County Board in September. Administration requests Board approval of Sortedahl as Health Officer /Public Health Coordinator to meet the requirements of 251.03 (2). Motion A motion was introduced by Berenschot, seconded by Troyer, and unanimously adopted: That the Board approves appointing Charlotte Sortedahl as Health Officer /Public Health Coordinator and to forward to the full County Board to meet the requirements of 251.03 (2). SPRINGSTED OVERVIEW Johnson presented a summary of how the Springsted study was conducted. He indicated skill level was important in affecting points in other categories. There are nine separate categories that are pointed. Johnson gave an example of pointing. Whiting explained the position administrative workgroup is made up of the highest paid positions in St. Croix County with county positions to be reviewed once a year at budget time. Considerable time has been spent with the committee on pointing. It is possible a new pay grid will result from this study. LONG TERM SUPPORT -LONG TERM CARE REFORM Johnson distributed a copy of the preliminary county contribution for Long Term Care Reform. When LaCrosse County started with Family Care, their contribution was approximately 22% of their basic county allocation. According to this document, St. Croix County's contribution would be approximately 150% of our basic allocation. Johnson said this number is being negotiated. Two implementation workgroups are moving forward in our consortium. One workgroup is focusing on a shared governance structure between the counties and the private providers, while the other workgroup is focusing on the private provider taking on the role of primary provider and risk bearing agency (Community Health Partners), while the county would focus on the role of running the Aging and Disability Resource Centers (ADRC). Long Term Support will budget for 2007 the same as 2006 as implementation of Long Term Care Reform has been pushed forward into next year. FAMILY AND CHILDREN'S NON - PRIMARY CAREGIVER Starting 10/01/06 according to Act 232 child protection investigations no longer need to be done for non - caregiver child abuse allegations. Law enforcement will be primary and Family and Children's will assist in investigations when asked. Dunlap reported this will not impact Family and Children's caseloads very much. ELERT AND ASSOCIATES TELEPHONE STUDY Elert and Associates completed a study regarding updating the New Richmond phone system. Manufacturer technical support for the current New Richmond telephone system ended in December of 2005. No upgrades have been made to the current system since it was installed St. Croix County Health and Human Services Board Page 9 August 21, 2006 in 1990. The study recommends upgrading the County Government's telephone system and extending services to New Richmond Department of Health and Human Services. By connecting with Hudson's system there would be one single telephone system to maintain. Also, toll calls would be eliminated between the two facilities and for county residents to call either facility from Hudson or New Richmond. Administration is recommending the capital outlay plan be modified to include $110,000 to upgrade the telephone system. Motion A motion was introduced by Troyer, seconded by Berenschot, and unanimously adopted: That the Board approves adding $110,000 to the capital outlay budget for upgrade of the telephone system. HEALTH AND HUMAN SERVICES GOVERNING BODY BY -LAWS REVIEW Will be delayed until the September meeting. Motion A motion was introduced by Caflisch, seconded by Kretz, That the Board enter closed session per Wisconsin Statute 19.85 (1) (f)- Considering financial, medical, social or personal histories or disciplinary data of specific persons, preliminary consideration of specific personnel problems or the investigation of charges against specific person which would be likely to have a substantial adverse effect upon the reputation of any person referred to in such histories or data, or involved in such problems or investigations. Roll call vote: Esther Wentz -yes Gordon Awsumb -yes Leon Berenschot -yes Lois Burri -yes Tom Caflisch -yes Dr. Kretz -yes Linda Luckey -yes Deb Rasmussen -yes Ronald Troyer -yes Nine yes, motion passed. The Board entered closed session at 12:05 PM. Whiting, Pempek and Malick remained in the meeting. Motion A motion was introduced by Troyer, seconded by Caflisch: That the Board reconvene into open session per Wisconsin Statute 19.85 (2). Roll call vote: Esther Wentz -yes Gordon Awsumb -yes Leon Berenschot -yes Lois Burri -yes Tom Caflisch -yes Dr. Kretz -yes Linda Luckey -yes Deb Rasmussen -yes Ronald Troyer -yes Nine yes, motion passed. St. Croix County Health and Human Services Board Page 10 August 21, 2006 The Board reconvened in open session at 1:17 PM. Wentz asked if there were any other issues to bring before the Board. Wentz adjourned the meeting. Time: 1:17 PM Chair: Attest: (secretary)