HomeMy WebLinkAboutHealth & Human Services 01-21-09 Roger Larson will review vouchers.
Revised 01/02/09
NOTICE OF MEETING AND AGENDA
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
January 21, 2009 at 8:30
(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 - 12/17/08
DATE OF NEXT MEETING — 02/18/09
OLD AND NEW BUSINESS
1. Consideration of Claims and Vouchers and appoint member to review vouchers at next meeting
2. Financial Report
a. Monthly financial report for Nursing Home and Health and Human Services
b. aged receivable report
3. County Board and Health and Human Services Strategic Initiatives
4. City Watch notification software
5. Nursing Home Report
6. Response to County Board on private pay rate increase to breakeven cost for Nursing Home **
7. Personnel Issues
a. New employees /vacancies
b. Review of Resolution requiring Board action before filling of personnel vacancies during
2009
8. Long Term Care Reform Transition —10:30 AM
9. Agency rate setting
10. Tobacco -free grounds resolution
11. Health and Human Services annual report planning
12. Closed session per Wisconsin Statutes 19.85 (1) (c) for Director's performance evaluation.
Reconvene in open session.
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.
1/2/2009 9:28 AM
ST. CROIX COUNTY HEALTH AND HUMAN SERVICES BOARD
January 21, 2009
The St. Croix County Health and Human Services Board met on January 21, 2009
at the St. Croix County Health and Human Services /Health Center complex.
MEMBERS PRESENT: Esther Wentz, Chair
Leon Berenschot
Charles Grant
Roger Larson
Linda Luckey
Richard Marzolf
Gerald Peterson
MEMBERS ABSENT: Deb Rasmussen, excused
STAFF PRESENT: Fred Johnson, Health and Human Services Director
Jennifer Pempek, Financial Manager
Steve Kirt, Behavioral Health Clinical Services Supervisor
Ron Lockwood, Long Term Support Coordinator
Dennis Reiman, Contracted Nursing Home Administrator
Malva Sirek, Secretary
OTHERS PRESENT: Tammy Funk, Human Resource Administrator
Chuck Whiting, Administrative Coordinator
Kim Dupre, Information Systems Analyst
Pete Kling, Resource Agent
Julie Speer
Norm Matzek
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, February 18, 2009 at 8:30 AM. Wentz will review vouchers.
AGENDA Motion A motion was introduced by Berenschot, seconded by Larson,
and unanimously adopted: That the agenda be approved as distributed.
MINUTES Motion A motion was introduced by Luckey, seconded by Peterson,
and unanimously adopted: That the minutes of the 12/17/08 Health and Human
Services Board meeting be approved as distributed.
COUNTY BOARD STRATEGIC INITIATIVES Kling presented a powerpoint presentation
regarding regional changes and connections in west central Wisconsin, which is
similar to what the County Board of Supervisors reviewed to develop plans for
the future of the County. Health and Human Services strategic initiatives are
being formatted similar to the County Board strategic initiatives. Marilyn
Pash, the same presenter used by the County Board, along with Kling, have been
used to facilitate planning for Health and Human Services. This should allow
plans to be congruent with County Board goal setting. Johnson thanked Steve
Kirt for assisting with the project and for his work on strategic planning.
Kling reported the process has opened lines of communication and expects more
growth in the future. He reported the County's comprehensive plan update is in
St. Croix County Health and Human Services Board
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January 21, 2009
process and is not yet complete.
Kling reported St. Croix County is in the top 100 in population growth
nationally with the western part of the County seeing the most population
growth. One of the impacts of population growth includes increases in county
services. He said the aging population is anticipated to put strain on County
services and the trend shows the aging population will continue to increase.
Johnson said the transition to implementing Long Term Care Reform moves towards
serving more seniors in their homes versus being on a waiting list or in a long
term care facility.
The Health and Human Services (HHS) Strategic Initiatives were reviewed.
Better use of technology is needed for the future. The initiatives looked at
projected population growth and the need to use technology to improve
efficiencies as increasing staff may not be possible due to budget concerns.
There is also a need to collaborate with community providers. One example of
this is the development of the Youth Community Support Services program.
Marzolf questioned no mention of the Nursing Home or building a new Nursing
Home in the initiatives. Johnson said this plan looks at Health and Human
Services and now that there appears to be a definitive direction with the
referendum outcome, the Nursing Home will have to be addressed and incorporated
into the plan. However, work on the Nursing Home has been completed over the
past several years as Wipfli completed an operational assessment around levels
of staffing, which was implemented. In addition, planning around the Nursing
Home was completed when the County Board voted to complete a request for
proposals related to the future operation of the facility. The County is
currently advertising for a Nursing Home Administrator and development of a
plan for future operations will be necessary. Marzolf said we are spinning
our wheels and talking in generalities. He indicated the Board is responsible
to act in a timely manner. Marzolf indicated #3 of the initiatives reads:
Implement facility /(ies) options (build, remodel, purchase, lease, etc.) that
will effectively and efficiently meet the needs of consumers and staff for the
next 15 to 20 years (2010). Marzolf wants the initiative to address building a
new Nursing Home. He wants to see action to follow through on the words spoken
this morning as the spoken word is very perishable. Johnson indicated that
based upon County Board action yesterday, the Administration Committee is
assigned to look at facilities countywide, which would include the Nursing
Home. Luckey indicated the strategic initiatives document is a general
document and is not a specific plan.
Johnson thanked Kling for his assistance with strategic planning.
CONSIDERATION OF CLAIMS Health and Human Services Board member Larson
reviewed the vouchers.
Motion A motion was introduced by Larson, seconded by Berenschot, and
unanimously adopted: That the following vouchers be approved and be made a
part of the supplemental minute book:
Human Services voucher 141669, dated December 31, 2008 in the amount of
$3,200.00.
Human Services voucher 141568, dated December 31, 2008 in the amount of
$15,000.00.
St. Croix County Health and Human Services Board
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January 21, 2009
Human Services vouchers 141737 through 141741, dated January 07, 2009 in the
amount of $3,375.50.
Human Services vouchers 141841 through 141878, dated January 07, 2009 in the
amount of $47,475.66.
Human Services vouchers 142765 through 142771, dated January 15, 2009 in the
amount of $48,539.77.
Human Services and Nursing Home vouchers 140736 through 140781, dated
December 19, 2008 in the amount of $209,182.48.
Human Services and Nursing Home vouchers 140782 through 140851, dated
December 19, 2008 in the amount of $29,756.18.
Human Services, ADRC and Nursing Home vouchers 141159 through 141222, dated
December 23, 2008 in the amount of $121,088.75.
Human Services, ADRC and Nursing Home vouchers 141574 through 141668, dated
December 31, 2008 in the amount of $153,859.23.
Human Services and Nursing Home vouchers 141671 through 141736, dated January
07, 2009 in the amount of $72,137.79.
Human Services and Nursing Home vouchers 141742 through 141747, dated January
07, 2009 in the amount of $2,216.50.
Human Services and Nursing Home vouchers 141748 through 141840, dated January
07, 2009 in the amount of $113,998.95.
Human Services, ADRC and Nursing Home vouchers 142645 through 142729, dated
January 15, 2009 in the amount of $68,830.60.
Human Services, ADRC and Nursing Home vouchers 142570 through 142644, dated
January 15, 2009 in the amount of $33,541.00.
Human Services, ADRC and Nursing Home vouchers 142772 through 142785, dated
January 15, 2009 in the amount of $12,973.93.
Nursing Home vouchers 142730 through 142764, dated January 15, 2009 in the
amount of $33,620.16.
Human Services, Workshop, Public Health, Social Services vouchers 763 through
790, dated December 23, 2008 in the amount of $390,483.01.
Human Services, Workshop, Public Health, Social Services vouchers 1 through
30, dated January 08, 2009 in the amount of $386,136.53.
Human Services, Workshop, Public Health, Social Services vouchers 31 through
36, dated January 15, 2009 in the amount of $74,559.05.
Human Services, Workshop, Public Health, Social Services vouchers 37 through
66, dated January 22, 2009 in the amount of $391,922.08.
Human Services and Nursing Home vouchers 750 through 777 dated December 23,
2008 in the amount of $148,929.81.
St. Croix County Health and Human Services Board
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January 21, 2009
Human Services and Nursing Home vouchers 1 through 29, dated January 08, 2009
in the amount of $167,669.08.
Human Services and Nursing Home vouchers 30 through 36, dated January 15,
2009 in the amount of $19,465.07.
Human Services and Nursing Home vouchers 37 through 66, dated January 22,
2009 in the amount of $157,394.14.
Workshop vouchers 152 through 157, dated December 23, 2008 in the amount of
$13,888.72.
Workshop vouchers 1 through 6, dated January 08, 2009 in the amount of
$11,585.60.
Workshop vouchers 7 through 12, dated January 22, 2009 in the amount of
$11,032.72.
FINANCIAL REPORT The following financial report for Health and Human Services
through November, 2008 was distributed. To be on budget, the percent should be
91.67 %. The Federal pass -thru monies for Economic Support have not been
received at this time. Prior year carryover funds will not be applied until
year end, which, at this time, if applied will result in a positive amount of
$182,189.91.
St. Croix County Health and Human Services Board
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January 21, 2009
HEALTH AND HUMAN SERVICES - 2008
SUMMARY Total
OF REVENUES Budget November 30, 2008 Balance %
Administration 1,117,400.00 171,963.28 945,436.72 15.4%
AODA Services 772,986.95 660,634.91 112,352.04 85.5%
Long Term Support 17,681,645.51 15,618,526.63 2,063,118.88 88.3%
Mental Health 3,303,479.98 2,579,779.88 723,700.10 78.1%
Family & Children's 3,037,821.28 2,770,622.39 267,198.89 91.2%
Public Health 1,678,621.37 1,547,981.07 130,640.30 92.2%
Economic Support 1,227,133.10 953,193.35 273,939.75 77.7%
General Relief 15,000.00 13,750.00 1,250.00 91.7%
Coordinated Services /SED 2,500,931.96 1,708,968.05 791,963.91 68.3%
REVENUES HUMAN
SERVICES PROGRAMS 31,335,020.15 26,025,419.56 5,309,600.59 83.1%
SUMMARY Total
OF EXPENDITURES Budget November 30, 2008 Balance %
Administration 1,117,400.00 996,728.03 120,671.97 89.2%
Alcohol -Drug Abuse 772,986.95 737,369.00 35,617.95 95.4%
Long Term Support 17,681,645.51 15,389,019.28 2,292,626.23 87.0%
Mental Health 3,303,479.98 2,801,246.90 502,233.08 84.8%
Family & Children's 3,037,821.28 2,620,324.58 417,496.70 86.3%
Public Health 1,678,621.37 1,512,419.71 166,201.66 90.1%
Economic Support 1,227,133.10 1,050,358.05 176,775.05 85.6%
General Relief 15,000.00 4,865.81 10,134.19 32.4%
Coordinated Service /SED 2,500,931.96 1,436,265.04 1,064,666.92 57.4%
EXPENDITURES HUMAN
SERVICES PROGRAMS 31,335,020.15 26,548,596.40 4,786,423.75 84.7%
Excess Rev over Expenses (523,176.84)
The following financial report for Nursing Home through November, 2008 was
distributed. To be on budget, the percent should be 91.670. IGT funds have
been received in the amount of $428,153. Prior year carryover funds will not
be applied until year end, which, at this time, if applied will result in a
positive amount of $18,049.72. Notification has been received from the State
that Medicaid rate appeal monies for the Nursing Home are gone and no funding
will be available for payments in the spring of 2009. Johnson warned funding
may be affected in other areas as cuts have been proposed in tobacco funding.
In addition Family Care and ADRC funding has been delayed two months for Long
Term Care Reform for Northern Bridges which is the care management organization
for northern Wisconsin counties.
St. Croix County Health and Human Services Board
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January 21, 2009
St. Croix Health Center
Novembe► 2008
Budget Actual Difference pelcentag�
Census 0
irperating Revenue:
Medicare $842,976.00 $832,131.32 $10,843.68 98.71%
Medicaid $2,431,627.00 $2,328,629.48 $103,097.52 96.76%
Private Pay $760,413.00 $675,633.00 $84,780.00 88.86%
All Other Sources $217,774.00 $213,838.98 $3,935.02 98.19%
Total �►perating Revenue $4.252.789.00 $4.050.132.78 $202.050.22 95.23
Opelatir►y Expenses
Daily Patient Services $3,081,764.76 $3,078,966.70 $2,799.06 99.91%
Special Services $284,616.00 $238,648.59 $45,867.41 83.88%
General Services $1,167,643.63 $997,866.43 $169,777.20 85.46%
Administrative Services $547,661.00 $658,105.39 - $110,644.39 120.19%
Unassigned:
Depreciation (% Based) $0.00
Others: $294,394.00 $214,095.03 $80,298.97 72.72%
Utilities $118,075.13
Workers Comp, Computer Tech $25,613.90
Insurance $70,406.00
Total Operating Expenses $5.375.879.39 $5.187.681.14 $188.198.25 96.50 °0
Net From Upelations 41.137.548.361
(Cost of doing business prior to
applying levy & outstanding rev)
►utstauding Revenues
Outstanding Rate Appeal rev $12,000.00 $446.00 $11,655.00 3.71%
Revenue - IGT Funds $318,000.00 $428,153.00
% of Outstanding IGT Rev $0.00 $0.00 #DIV/01
Co Allocations (% Based) $259,859.39 $238,205.00 $21,654.39 91.67%
Nursing Home Carry Over $533,231.00 $0.00
Total'Anstanding $1.123.090.39 $666.803.00 $33.209.39
Net from all Sources 1$470.745.361
AGED RECEIVABLE REPORT: The aging Accounts Receivable report for Health and
Human Services through November was reviewed. Progress is being made with debt
collection. If accounts are overdue, a letter goes out at 180 days, prior to
sending the account to a collection agency. Increased rates for the Birth to 3
Program will make a difference in receivables.
Pempek will be working with Pietrick on finance issues to realize possible
efficiencies and possibly reorganization within the finance unit. Pempek will
be spending more time in Hudson as Pietrick has requested a position with an
accountant degree background versus a financial assistant position. Other
options are being explored, including work with highway, accounts receivable,
St. Croix County Health and Human Services Board
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January 21, 2009
payroll, accounting and possible cross - training within the departments. Wentz
reported this is a trial situation as someone is needed at Health and Human
Services with accounting knowledge. The Board will be updated at future
meetings on how the pilot proceeds.
The Board recessed from 9:53 to 10:03 AM.
CITY WATCH NOTIFICATION SOFTWARE Purchase of the City Watch notification
system has been approved by the Finance Committee and is a coordinated effort
between various County departments including Health and Human Services and
Emergency Communications. This electronic notification software system will
meet multiple needs of various departments for emergency situations and will
free receptionist time by making reminder calls for Health and Human Services.
It should be in operation by February.
NURSING HOME ADMINISTRATOR'S REPORT Reiman distributed the Nursing Home
newsletter to Board members. The current Nursing Home census is 66 with one LOA
in the hospital. Reiman reported the December census average was 66 and the
2008 average census was 65.45.
Reiman reported the current contracted dietitian is overextended and needs to
cut back so the Nursing Home is looking for a replacement dietitian. Interest
in the position has been expressed by a previous dietitian and the option of
working with a Public Health dietitian will also be explored. The position is
about eight hours per month.
Reiman reported the survey window for the Nursing Home will start in April.
Reiman will work with Dana Baker regarding issuing RFP's for vendor contracts
for the Nursing Home.
Peterson said he reviewed the duties of the Health and Human Services (HHS)
Board and the Board's duties are described as follows: "Responsible for
providing oversight for all Health and Human Services controlled by Department
of Health and Family Services administrative rules and applicable Wisconsin
Statutes. In addition, the Board is responsible for policy direction for the
County Nursing Home; reviews the audit of bills and vouchers that relate to the
above departments; and the buildings and grounds of the Human Services Center
in New Richmond, and farm land and related buildings." He also reviewed the
advisory referendum and stated the HHS Board is not being aggressive enough to
proceed with the result of the referendum.
Motion A motion was introduced by Peterson, seconded by Marzolf: That an
agenda item be added to the February meeting that the Health and Human Services
Board discuss /consider construction of Nursing Home and apartments.
Whiting said this is a difficult item to view by the Board in a yes or no
fashion. No direction has been received from the County Board as to what to do
next regarding option with building. Whiting indicated a committee to address
building needs was appointed at County Board meeting on 01/20/09. Wentz
indicated a Nursing Home administrator should be on Board before anything is
done regarding the Nursing Home. Whiting indicated several items need to take
place before building a nursing home is put on the table, such as a market
study, cost, design, etc. He said building is the easy part; deciding what to
do is the hard part. Peterson said a program needs to be laid out to address
the issue as the Board is not addressing what the public told the Board to do
with the referendum. Whiting said the Building Committee was organized within
r
St. Croix County Health and Human Services Board
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January 21, 2009
the County structure to develop a plan, but it includes the entire County, not
just the Nursing Home. Peterson indicated he is not sure the Building Committee
should address the Nursing Home as he feels the Nursing Home falls under the
duties of the HHS Board.
Marzolf withdrew his second to the motion; Peterson withdrew the motion. Wentz
indicated the Health and Human Services Board discussing /considering
construction of a Nursing Home and apartments will be an agenda item on future
HHS Board agenda.
Board members were encouraged to attend the next Administration meeting
scheduled for 02/04/09. Johnson reiterated Whiting's comment regarding
facility planning is going to be looked at countywide. He expressed potential
confusion regarding how reporting on facility needs would be handled if the HHS
committee addresses Nursing Home building issues and facility needs for Health
and Human Services are addressed through the Administration committee.
RESPONSE TO COUNTY BOARD ON PRIVATE PAY RATE INCREASE TO BREAKEVEN COST FOR
NURSING HOME At the December 16 County Board meeting: "Supervisor Malick
stated pursuant to the County Board Rules and Bylaws he is requesting the
following question be referred to the Health and Human Services Board: "When
will the private pay rate at the Nursing Home be raised $58 per day to the
breakeven cost ?" Pursuant to the rules and bylaws, the Health and Human
Services Board shall report back to the County Board by the second meeting
following the meeting of referral." The County is currently subsidizing the
private pay rate at about $58 per day in 2009. In 2004 the subsidy for private
pay was approximately $46.20 per day. It has been a longstanding practice to
subsidize the private pay rate to remain competitive with area nursing home
private pay rates. If private pay rates are increased by $58 /day, the rates
will substantially exceed rates at other facilities in the County. Reiman
indicated if the private pay rate was increased dramatically in a short amount
of time people would likely choose to go where the nursing home stay is less
costly. Not only would the Nursing Home lose private pay revenue, they would
also likely lose Medicare revenue as well. Currently residents admitted with
Medicaid coverage, the County has a loss of $70.13 /day; for residents admitted
with Medicare coverage the County gains approximately $9.00 /day. Johnson
encouraged the Board to look at a long term payer mix as well as the residents
to be served. Johnson said a decision made in haste to increase private pay
rates could create more financial concerns for the Nursing Home in the long
run. Berenschot indicated the Nursing Home needs to be competitive in private
pay nursing home rates and requested a review of private pay rates for other
facilities in the County. A survey of private pay rates for area nursing homes
was provided to the Board. Marzolf requested an interpretation from
Corporation Counsel of the referral question timeline for reporting to County
Board.
Johnson and Reiman will develop a narrative to present at next month's meeting
to address the private pay rate issue. Luckey requested the average cost and
what the possible Medicare implications to be included, along with long range
implications to the Nursing Home if the rates were changed. It was also
suggested to include growth and aging of population detail in the narrative.
PERSONNEL ISSUES NEW - EMPLOYEES /VACANCIES Johnson announced the retirement of
Sandra Hohman, Behavioral Health Registered Nurse /Clinician and Cathy Drury,
RHIT, HIM Supervisor. He said Human Resources are recruiting for both
positions. Johnson said applications have been received for the open Public
St. Croix County Health and Human Services Board
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January 21, 2009
Health Supervisor position and several have been received for the open Social
Service Aide position. Funk reported eight applications have been received thus
far for the Nursing Home Administrator position plus five additional
applications have been mailed out. The close date for the Administrator
position is January 30 and applications will be reviewed next week.
REVIEW OF RESOLUTION REQUIRING BOARD ACTION BEFORE FILLING OF PERSONNEL
VACANCIES DURING 2009 No resolution was passed by Finance regarding this
subject. Funk will continue to update the Finance committee on vacancies in the
County and Funk will review positions before they are filled. Neither County
Board nor Finance Committee will review filling positions; that duty will be
left at the parent committee level and will continue as is.
LONG TERM CARE REFORM TRANSITION Lockwood reported the transition to Long
Term Care began September 1, 2008. There are now 304 clients enrolled in
Community Health Partners (CHP) or IRIS, which is an alternative to managed
care. IRIS is the opt -out of managed care required by the Federal government
because the state has selected only one qualified managed care entity. This
option provides a range of self directed choices for program participants
within the budget generated through the Long Term Care functional screen.
Lockwood said 263 of the 304 clients selected CHP. 90% of the clients selected
Family Care model. The other 10% chose the partnership model which coordinates
Long Term Care needs along with physician, hospital and pharmacy services. It
is more of a managed care model and participants receive a CHP insurance card.
Lockwood said IRIS is a statewide coordinated effort. St. Croix County
received information on IRIS in time for clients to choose IRIS before Pierce
and Dunn County did. Clients are able to switch plans between partnership,
Family Care model and IRIS at will; however, the changes need to be run through
ADRC. ADRC will continue to work on the waiting list.
Lockwood said Adult Protective Services and Elders at Risk are still in
transition to ADRC. The balance of the transitions will happen in the next few
months.
Johnson thanked Lockwood for the work he has done on Long Term Care Reform.
Lockwood's efforts are much appreciated.
AGENCY RATE SETTING There have been no rate increases for the Birth to 3
Program for many years. The rates proposed are consistent with the rates in
the WIMCR cost report and are a uniform fee. Charges for Birth to 3 services
go to a third party. The proposed rates for 2009 are as follows:
Case Management $150
Occupational Therapy $150
Contracted Speech Therapy $150
Fees for photocopying records were distributed. Rates are dictated by statute
and charged to the person requesting the record. Luckey questioned charging
more than the actual costs or making a profit off the copies. Johnson will
review this issue with Corporation Counsel.
TOBACCO -FREE GROUNDS RESOLUTION This will be delayed until next month.
HEALTH AND HUMAN SERVICES ANNUAL REPORT PLANNING It is proposed that each HHS
unit will give approximately a ten minute presentation at various County Board
meetings for each program.
St. Croix County Health and Human Services Board
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January 21, 2009
CLOSED SESSION PER WISCONSIN STATUTES 19.85 (1) (C) FOR DIRECTOR'S PERFORMANCE
EVALUATION. RECONVENE IN OPEN SESSION
Motion A motion was introduced by Berenschot, seconded by Larson, that the
Board enter closed session per Wisconsin Statutes 19.85 (1) (c) for Director's
performance evaluation.
Roll call vote:
Esther Wentz - yes
Leon Berenschot - yes
Charles Grant - yes
Roger Larson - yes
Linda Luckey - yes
Richard Marzolf - yes
Gerald Peterson - yes
Deb Rasmussen - absent
Seven yes, one absent, motion passed.
The Board entered closed session at 11:38 AM.
Motion A motion was introduced by Berenschot, seconded by Larson, and
unanimously adopted that the Board reconvene in open session. Time: 1:10 PM
Wentz asked if there were any other issues to bring before the Board.
Wentz adjourned the meeting.
Time: 1:10 PM
Chair:
Attest:
(Secretary)