M I N U T E S

Southern Nevada District Board of Health Meeting 495 S. Main Street Las Vegas, Nevada 89101 Las Vegas City Hall, Council Chambers

Thursday, May 24, 2012 – 8:30 A.M.

Chair Jones called the meeting of the Southern Nevada District Board of Health to order at 8:46 a.m. and led the Pledge of Allegiance. Annette Bradley, legal counsel, confirmed the meeting had been noticed in accordance with Nevada’s Open Meeting Law.

Chair Jones noted a quorum was present at the start of the meeting with Members Bateman, Beers, Christensen, Crowley, Litman, Menzel, Noonan, Onyema, Scow, Tarkanian and Woodbury seated.

Chair Jones noted the following: 1) Agenda items may be taken out of order at the discretion of the Chair; 2) the Board may combine two or more agenda items for consideration; and 3) the Board may remove an item from the agenda or delay discussion relating to an item on the agenda at any time

Board Members Present: Tim Jones Chair, At-Large Member, Regulated Business/Industry Sam Bateman Councilman, Henderson Bob Beers Councilman, Las Vegas Jim Christensen, MD At-Large Member, Physician Susan Crowley Alternate At-Large Member, Environmental Specialist Chris Giunchigliani Commissioner, Clark County Allan Litman Councilman, Mesquite Nancy Menzel, RN At-Large Member, Registered Nurse Bill Noonan At-Large Member, Gaming John Onyema, MD At-Large Member, Physician Mary Beth Scow Commissioner, Clark County Lois Tarkanian Councilwoman, Las Vegas Anita Wood Councilwoman, North Las Vegas Rod Woodbury Councilman, Boulder City

Absent: Jimmy Vigilante Secretary, At-Large Member, Environmental Specialist

Executive Secretary: Lawrence Sands, DO, MPH

Legal Counsel: Annette L. Bradley, Esq. Terry Coffing, Esq. Marquis, Aurbach & Coffing

Other SNHD Board of Health Members/Alternates Present: Michael Collins, RN Alternate At-Large Member, Registered Nurse

Other SNHD Board of Health Members/Alternates Not Present: Kam Brian Alternate At-Large Member, Regulated Business/Industry Pamela Goynes-Brown Alternate Councilman, North Las Vegas Karl Gustaveson Alternate Councilman, Mesquite Joseph Hardy, MD Alternate At-Large Member, Physician Peggy Leavitt Alternate Councilwoman, Boulder City John Marz Alternate Councilman, Henderson Frank Nemec, MD Alternate At-Large Member, Physician Steven Ross Alternate Councilman, Las Vegas Stan Smith Alternate At-Large Member, Gaming Lawrence Weekly Alternate Commissioner, Clark County

Staff: Rory Chetelat; Eddie Larsen; Angus MacEachern; John Middaugh; Glenn Savage; Jennifer Sizemore; Bonnie Sorenson; Kara Bennis; Stephanie Bethel; Phil Bondurant; Jerry Boyd; Mary Ellen Britt; Dennis Campbell; Mee Kee Chong-Dao; Alice Costello; Margarita DeSantos; Joanne Engler; Steve Goode; Forrest Hasselbauer; Amy Irani; Susan LaBay; Eric Lahr; John Lewis; Veronica Morata-Nichols; Michelle Nath; Robert Newton; Patricia O’Rourke-Langston; Jim Osti; Mars Patricio; Rick Reich; Jan Richardson; Jane Shunney; Chris Strickland; Marlo Tonge; Robert Urzi; Deborah Williams; Lourdes Yapjoco; Diana Lindquist and recording secretary, Shelli Clark CAP-OM

ATTENDANCE:

NAME REPRESENTING Alisha Barrett Clark County Social Service Brendan Bussmann UMC Jeff Gerber PGAL LLC Sharie Harvin 8 News Now Kaitlin Klein Roseman University student Paul Maffey Tiberti Company Ann Markle Self Carl Markle Self Patricia Martin Nevada State Health Division Al Martinez SEIU Jordan Miyamoto Self Jorge Montes KSNV CH-3 Rob Munoz News 3 Candice Nichols Gay & Lesbian Community Center Alfonso Noyola City of North Las Vegas Ozkar Palomo KTNV Kathleen Peterson ESH Manager, Adjunct Instructor Orlando Sanchez City of Las Vegas Larry Singer Grubb & Ellis Darcy Spears KTNV Mike Tabeek Grubb & Ellis Henry Takai KLAS-TV Diana Taylor Clark County School District Renaldo U. Tiberti The Tiberti Company Ken Zarembski Walter P Moore Beverly Zimmerman Rape Crisis Center Board of Health Minutes Page 3 of 38 May 24, 2012

Norine Clark SNHD / SEIU

Nancy Barry SNHD / Self Thomas Coleman, MD SNHD / Self Nancy Gerken SNHD / Self Gail Gholson SNHD / Self Kay Godby SNHD / Self John Hammond SNHD / Self Jane Kopczak SNHD / Self Linda Newton SNHD / Self Jeff Quinn SNHD / Self Shannon Randolph SNHD / Self Margo Slater SNHD / Self Leo Vega SNHD / Self Dennis Wu SNHD / Self

I. PUBLIC COMMENT Public comment is a period devoted to comments by the general public on items listed on the Agenda. All comments are limited to five (5) minutes.

Chair Jones asked if anyone wished to address the Board pertaining to items listed on the Agenda.

(Member Giunchigliani arrived and was seated at 8:47am)

Kathleen Peterson, addressed the board. She noted she had applied for an at-large member position in the past, was selected and received orientation, then was replaced by another person. She has continued to follow the proceedings of the Board. She noted on several occasions the Board was made aware of problems with the facility, as was she in her Board Orientation.

(Member Beers left the meeting at 8:48am)

She stressed that public health is a branch of the National Incident Management System, and as such is deemed a first responder. She said that employees must be co-located in order to deliver services and respond to emergencies as they occur.

(Member Wood arrived and was seated at 8:50am)

She questioned the reduction in funding to the district and why monies set aside for a building were to be used for operational expenses when a new building is desperately needed.

(Member Beers rejoined the meeting and was seated at 8:51am)

Candice Nichols, the executive director of the Gay & Lesbian Community Center of Southern Nevada addressed the Board. She expressed the center’s support for the district and its HIV/AIDS and STD clinics. She described the unique partnership between the district and the Center, and the comfort clients have in obtaining services at the district. She referenced the valuable testing services offered by the clinics and the need to continue these vital services to prevent further spread of sexually transmitted infections. She feels the district needs a permanent home in the medical corridor where clients have access to transportation and other medical services.

Alisha Barrett, grant administrator for the Ryan White Part A program addressed the Board. She expressed her support for the proposed lease for clinical space at 400 Shadow Lane. She also

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believes the district needs a home in the medical corridor as the community is familiar with this location and feel comfortable coming to the district for services.

Rick Reich, district employee, read a letter into the record addressed to the Southern Nevada District Board of Health dated May 23, 2012 from a local physician, Jerry Cade (attachment #1).

Dear Board: I apologize for not being able to personally express to you the importance of having the Southern Nevada Health District HIV program located closely to UMC’s Wellness Center. Despite the fact that Nevada has been hard hit by the AIDS crisis, we have been able to do an incredible job of ensuring that patients have access to care and access to therapy. The linchpin of that has been the relationship between the Clark County health district HIV program and UMC. Over the twenty-five plus years that I have been taking care of patients with HIV, I’ve had the opportunity to look at a number of communities throughout the country and see how they are providing HIV care. Unfortunately, in many of these communities across the country the care is fragmented; and therefore not efficient. That has never been the case here in Las Vegas! Since the beginning of the epidemic the Southern Nevada Health District and UMC have worked closely together to ensure that southern Nevada residents have access to the care they need and the support they deserve. Part of the reason for this has been a close location of Southern Nevada Health District Early Intervention Clinic with UMC’s Wellness Center. This has obvious advantages for patients for multiple reasons. Physical access to care has been complemented by the close collaboration between the health care staff at the Southern Nevada Health District and the Wellness Center. I will be happy to answer any questions that anyone might have. Please feel free to call me on my cell phone at 203-8022 or email me at [email protected]. I encourage you to support keeping the Early Intervention Clinic in the space in which it currently resides. Sincerely, Jerry Cade.

At the request of Chair Jones, Mrs. Clark read into the record a written comment submitted earlier in the week (attachment #2):

Chair Jones and members of the Board of Health, my name is Michael Lacy, 198 East Alma Overton, NV. I am currently a non-union employee of the Southern Nevada Health District with the Immunizations Project Team. Our team is currently housed in the Alternate District Operations Center (ADOC) at the Henderson Public Health Center. I am sending in my comments via email as I have a heavy workload and am unable to break away from my work location here in Henderson.

I would first like to thank Dr. Sands, Environmental Health Director Glenn Savage, and Board Member Woodbury for coming through the Henderson Public Health Center to observe our working situation. Mr. Savage did a great job explaining to Member Woodbury what is normally in the space where we are located and all three had good questions and took the time to find out what we needed here and what is lacking. We are by no means comfortable here and hopefully the observations of those board members that have been kind enough to travel and view the situation can be beneficial in helping us to at the very least find a better temporary space.

I am writing in regards to the search for a permanent replacement facility. As part of that conversation I would first like to address the various responses generated

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by my previous letter to the board. I have had several employees email, call, or walk up to me in the hall and thank me for standing up. They agree that the delays caused by some members of the board and some union representation have been detrimental. Several have expressed thanks for attempting to stick to the facts and quotes of others from previous meetings. I have encouraged them if they have concerns to address the board directly as they can be heard without fear of retaliation and the board will take their comments into consideration.

In regards to my comment about union representation, Ms. Evangelista in the last board of health meeting took issue with my letter and tried to paint what I said as both false and misleading or at the very least uninformed and misguided. She stated, “the union cannot be a union with only forty percent membership – we must be over fifty percent.” To quote directly from my previous letter, “In light of full disclosure, I am not a member of the union. This is true of forty plus percent of SNHD employees who for various reasons disagree with the union or feel they do not represent employees adequately.” If 40 plus percent of employees are not members of the union that still leaves more than 50% that are. Ms. Evangelista claimed my comments were pro-management. She also claims I said the union and the union members have stated that the building was in good repair and healthy. Neither of those statements have any truth to them. Even if I did write something that was decidedly pro-management, I have every right to voice my concerns to the board as I see them and not fear backlash from others. This includes public comment. The Southern Nevada Health District Board of Health Governance Document BGP-003: Public Hearings/Public Comments states under item number 3, “Comments may be prohibited if not relevant to, within the authority of the Board, or willfully disruptive of the meeting by being irrelevant, repetitious, slanderous, offensive, irrational, amounting to personal attacks, or interfering with the rights of other speakers.”

I have tried to go further and further back in publicly available Board of Health minutes to find discussions on the replacement facility. So far what has stuck out is the Board of Health Meeting held on August 26, 2010. In this meeting, Scott Weiss representing management and Chair Jones then serving as committee chair on the Replacement Facility Committee gave a report regarding the options to replace the Main Ravenholt Facility. This can be found under Petition #22-10.

The report, including the PowerPoint presentation that was given addressed a number of issues. One of the initial things pointed out was, “…the main facility is challenged with structural, plumbing and mechanical issues due to the age of the building.” The state of the building is something that has been a known issue for some time. This should have led to a greater urgency amongst the board to ensure that this process moved forward.

The following options were presented to the Board of Health.

1. Construct a new building. Construction costs were anticipated at $60 million. This was a reduction of the $87 million originally estimated for a new facility. At that time the building fund balance was $10,447,474. That would leave a balance of $49,552,526 that would require financing.

2. Acquisition of an Existing Building. The Replacement Committee asked the district’s broker to research properties within the following parameter (Buffalo Drive to the West; Cheyenne Avenue to the North; Paradise Road to the

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East; and Tropicana Avenue to the South). The Century Link Building fell within those parameters. It has easy access to I-95, is on 3 Bus lines. It would also ensure we are meeting the needs of our clientele. At the time of the report, 56% of all nursing and clinical services were provided at the Ravenholt Facility. Total cost for this option was estimated at $37,336,719. Minus the balance of the building fund ($10,447,474) would have left a balance of $26,889,245.

3. Option 3 was to remain in the Ravenholt Facility. That is obviously no longer an option. At the time of this board meeting, estimated known repair cost was $4,861,888. The total cost of repairs to the HR Annex itself was estimated at $805,000. It was noted in the report that other than the obvious building issues, there was inadequate space and storage. This created an issue where the district could not seek available grants for programs to serve the public because there was no space for the additional staff needed.

The report points out that the annual auditing process at that time showed an undesignated balance of approximately $34 million. Of that amount $6.1 million would be transferred, leaving approximately $27.9 million. If $14,747,530 were transferred to the building fund it would have kept reserves above the minimum set by the board and drop the ending balance on the Century Link building at $12,141,719. County management and financial services staff discussed the numbers with district staff. County staff indicated that irrespective of what the undesignated general fund balance was for FY 2010, the district could meet the debt service if the Century Link building was purchased.

Member Giunchigliani expressed a desire for clinic services to be spread out amongst UMC and other clinic locations. Member Jones pointed out that more than 50% of service delivery is provided at the Ravenholt facility and the public preferred that location to some of our outlying clinics. Having personally worked in the Ravenholt facility and assisted at the outlying clinics, including Mesquite, I can confirm Member Jones statement. Even though we have outlying clinics, the public seems to have a preference for the centralized location. Member Tarkanian also stated the district is already in the community providing services. Part of the work for the immunizations project team is to provide outreach clinics to the community. In the last 12 months we have provided over 132 outreach clinics to the community, from Laughlin to Mesquite. We are out in the community on a frequent basis. A large number of these clinics are in the schools. When Member Jones stated the public’s seeming preference for a centralized facility, Member Giunchigliani responded, “…this location is convenient for staff rather than the community.”

I do understand the concerns in that meeting brought up about ensuring the financial numbers were correct. This could have been easily accomplished at the finish of the FY 10 audit and brought to the replacement committee. Even allowing space and time for the work necessary to verify the numbers, get the Replacement Committee together to review, and then present to the Board the next month; this could have been accomplished a long time ago.

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have spent three days trying to get their health card, they’ve been offered a job, and that puts them at risk of losing the job.” Member Giunchigliani knows that the Ravenholt location is not the only location that health cards are offered at. At the time of the building closure health cards were attainable at our Cambridge and East Las Vegas Public Health Centers. The Henderson Public Health Center also offered Health Card services up until it was necessary to relocate some Environmental Health Services into that space. Board Governance Policy 006 says in part in regard to the conduct of Board Members, “Collective rather than individual decisions….Proactive conduct through express value statements versus conduct that is reactive to specific events/decisions…strategic leadership more than administrative detail…” She also stated it goes back to management and leadership. The management team at the district can only go so far with an issue before they need approval from the board. The same Board Governance Policy states, “Only officially passed motions of the Board are binding on the Executive Secretary and SNHD staff.” Essentially, if the board does not give approval for something as large as moving services into a new building, the hands of SNHD staff are tied.

The issue of a new building is something that has been around for some time. The first discussion of a new building occurred in October 2004 under Dr. Kwalick and Karl Munninger. This was before Dr. Sand’s was employed by the Health District in any capacity. The use of this situation by any party; whether it be management, the board, or the union, to further an agenda would be completely dishonest not only with staff but with the public we serve.

Once again, I appreciate the opportunity and time allowed for me to comment.

Norine Clark, chief steward of SEIU Local 1107, addressed the Board. She said that it is her responsibility to speak on behalf of all employees. She referenced Mr. Lacy’s comments to the Board and asked to redirect the focus to the issues at hand. She accused management of not taking action earlier to repair the main facility, and subsequently scattering employees across the valley further taxing the clients trying to obtain services. She said that we need numerous satellite clinics across the valley. She said a central location is not feasible to the community. Ms. Clark concluded by saying the district should be taking public health services to the people where they are – we need to be in the community.

Shelli Clark, employee, read her comments to the Board into the record (attachment #3):

Good morning. My name is Shelli Clark, and I am speaking to you today not as the clerk to the Board of Health, nor as Dr. Sands’ executive assistant; but as a member of this community, a tax payer, a client of the Southern Nevada Health District, as well as an employee of the Southern Nevada Health District. I would like to speak to the issue of relocating the district to a central facility, specifically the Valley View building.

(Member Beers left the meeting at 9:13am)

I further reference BGP-006: Board Governance Process which in part states: “in providing oversight, the Board will assess organizational performance in relation to the ends set by its policy goals and adherence to budget, rather than by examining or advising on day-to-day operations;” further the policy says: “Board governance will emphasize 1) outward vision rather than internal preoccupation; 2) strategic leadership rather than administrative details; 3)

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collective rather than individual decisions; 4) the future rather than the past or present; and 5) proactive conduct through express value statements versus conduct that is reactive to specific events/decisions.”

(Member Beers rejoined the meeting and was seated at 9:14am)

Recently members of this Board have expressly violated this policy in statements to the media and in open meetings by making various comments about the need for a replacement facility and closing the Ravenholt building while prefacing their statements with the fact that they sit on the Board. The Board adopted this policy at its June 23, 2011 meeting and there was lengthy discussion about the role of the Board. Member Scow herself stated: “The intent of the policy is that members of the Board adhere to speaking as one voice, and not speaking in public on behalf of the Board unless the Board has taken action to support or deny a specific item. When speaking publically a Board member should express that his/her opinion is that of an individual and not the Board as a collective. Member Scow further noted that Dr. Carver stresses the Board functions as a whole, not individuals.” In recent interviews, it was not noted that the Board members were expressing their personal opinions. For the record, the BGPs and meeting minutes are public information on our district’s website.

As a taxpayer, I ask why four of the six jurisdictions represented on this Board have fancy newer facilities, all built and/or remodeled at the taxpayers’ expense. North Las Vegas did not have enough employees to fill their new facility; construction could have been stopped or delayed, but the taxpayers continue to pay for a facility that was not needed. Also in terms of North Las Vegas, Member Wood went on the record at the April 23rd Board meeting stating that “the former city hall…was adequate for the City of North Las Vegas and does not have the same issues as the Ravenholt public health center.” Quite a different comment those at the October 3rd Board meeting where she stated: “the City of North Las Vegas took steps to address facility concerns as the current City Hall is the same age as this facility and has similar unsafe conditions; and the Council felt a new building was warranted.” City Hall was offered to the district with the City’s full knowledge of its existing problems. Taxpayer dollars would need to make this building habitable and functional for the district’s use; yet certain Board members have no qualms about using taxpayer dollars in this manner.

I am the mother of five children. As our health insurance plan, courtesy of Clark County, does not cover vaccinations, I bring my children to the health district for vaccinations. Recently my four-year old noticed the cracks in the walls and said “Mommy, you need a new building – this one’s broken.” We work in tight space, and now with the closure of the main facility, space is even tighter. Currently I sit in a small conference room with another employee; my “desk” is a credenza with less than 12 square inches of space to write. We have supplies stacked around us; I don’t have a confidential work area anymore; files are in the open because there is nowhere to file; there is no confidentiality as employees are right next to each other; we spend money to acquire supplies to perform daily functions on a routine basis, which is a waste of money. If this Board had taken action to relocate the health district months, or even years ago, this would not be an issue.

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to obtain a signature; items are lost when sent intra-district mail; meetings are impossible to schedule due to lack of meeting space; we have to allow for travel time between sites…the list is endless. I’ve received calls and emails from clients complaining about difficulty in obtaining services. A centrally located facility provides better service delivery to our clients and the community. We need a facility easily accessible from bus lines and freeways.

On a personal note, I find Dr. Sands to be a man of integrity and honesty. He and I do not always agree, but he has never given me reason not to trust him. I will state publically that I used to love working at the health district and found my job to be the most challenging yet rewarding work I’ve ever done. However in recent months this has not been the case. The lack of action of this Board, comments by union leadership claiming to represent “all employees,” and actions of key executive staff have changed my opinion of the district – this is not reflective of Dr. Sands and his leadership. Individuals are responsible for their own actions, their decisions and what they say; Dr. Sands is not responsible for the actions of others.

I respectfully request this Board take action today to relocate the district into a central facility that will benefit the community of southern Nevada and the health district. Thank you.

Chair Jones asked if anyone else wished to speak to items on the Agenda. Seeing no one, he closed the Public Comment portion of the meeting.

II. ADOPTION OF THE MAY 24, 2012 AGENDA Chair Jones called for a motion to adopt the agenda for the May 24, 2012 meeting as presented. Chair Jones requested to move the Closed Session to follow the Report/Discussion/Action section on the agenda.

A motion was made by Member Wood to adopt the May 24, 2012 Board of Health meeting agenda, noting the Closed Session will be heard after the Report/Discussion/Action section; seconded by Member Menzel and carried unanimously.

III. CONSENT AGENDA These are matters considered to be routine by the Southern Nevada District Board of Health and may be enacted by one motion. Any item, however, may be discussed separately per Board Member request before action. Any exceptions to the Consent Agenda must be stated prior to approval.

1. Approve Board of Health Meeting Minutes: 4/16/12 & 4/23/12

2. Approve Payroll / Overtime for Periods: 3/31/12 – 4/13/12 & 4/14/12 – 4/27/12

3. Approve Voluntary Furlough Program Reports for Periods: 3/31/12 – 4/13/12 & 4/14/12 – 4/27/12

4. Approve Accounts Payable Registers: #1349: 3/30/12 – 4/12/12 & #1351: 4/13/12 – 4/26/12

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5. Petition #24-12: Approval of Amendment Number 3 to Interlocal Agreement with Clark County on behalf of Clark County Department of Social Service for Funding for the Period March 1, 2012 through February 28, 2013 for Ryan White Part A Services (for possible action)

6. Petition #25-12: Approval of Interlocal Agreement with Clark County School District (CCSD) During a One Year Period for SNHD’s Provision of Services to Students, CCSD Staff and/or Members of the General Public Which May Include General Immunizations, Seasonal Influenza Clinics and Other Community Health Programs as Mutually Agreed Upon Held for separate discussion

Chair Jones asked if there were any discussion on the items brought forward on the Consent Agenda. Member Giunchigliani asked to hold item #6 on the Consent Agenda for discussion.

Member Giunchigliani asked for clarification on the term “may include immunizations” included in the interlocal agreement with the school district, and questioned if this language is different from prior years. Dr. Sands said this is a global agreement which will replace the past practice of a separate agreement for each function where the health district provides services on a school campus. This agreement has been discussed for at least a year, and the intent is to provide CCSD control as to who is on campus and who is actually providing services – the agreement will provide better security for the schools and provide better coordination between the different service providers and avoid competition.

Member Giunchigliani said the phrase “which may include immunizations, seasonal influenza clinics and other community health programs” refers to something we already do; she asked if more outreach opportunities were explored to as a vehicle to increase immunization rates when drafting the agreement language. Dr. Sands said the district has been providing immunization clinics on school campuses for some time, depending upon the need at a given time. The district administers Tdap clinics annually for incoming 7th graders to ensure compliance with Nevada state requirements. We have also implemented a “Vaccinate Before You Graduate” program to ensure graduating seniors are fully compliant with all immunization requirements prior to college entry.

Member Giunchigliani asked if we provide outreach at the beginning of the school year to target children as well. Dr. Sands said one way this is accomplished is through Kindergarten Round-up activities. Bonnie Sorenson, director of clinics and nursing services stated that staff provides outreach in the schools throughout the year. The school district is standardizing its forms and this umbrella agreement replaces previous forms used – nothing is being changed other than creating less paperwork for the health district to provide services on school campuses.

A motion was made by Member Giunchigliani to approve the Consent Agenda as presented, including item #6; seconded by Member Wood and carried unanimously

IV. PUBLIC HEARING / ACTION: No public hearings were scheduled

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VI. REPORT / DISCUSSION / ACTION 1. Receive Staff Report Regarding Ongoing Facility and Operational Needs; Authorize the Chief Health Officer and the Interim Director of Administration to Negotiate and Enter into Contracts for Lease Space as Needed to Address the District’s Facility and Operational Needs; or take any other action deemed appropriate

Dr. Sands expressed his appreciation to the Board for the opportunity to present on the facility needs of the district. The closure of the Ravenholt Public Health Center (RPHC) has caused the public health system in Southern Nevada to be in crisis over the past several weeks, and severely compromised the district’s capacity to deliver essential public health services effectively and efficiently to the community, particularly those in need of its services. The decision to suspend operations at the RPHC was solely based the findings of the structural engineering report assessment, conducted at the direction of the Board by a highly reputable engineering firm. The findings of the engineers were shared with city and county officials prior to the receipt of the final report and prior to the closure of the RPHC. The final decision to suspend operations and relocate staff was made in consultation with and with full support of the district’s executive management team to ensure the safety of district clients and staff. The loss of the district’s centrally-located flagship service delivery site has placed increased demands on the remaining public health centers, which themselves have limited capacity to accommodate increased client volume and subsequently severely restrict the public’s access to needed services. Many clients have been forced to travel further to access services at remote locations and others may be discouraged from accessing services altogether (attachment #4). The reduction of client volumes and loss of clinical space has impeded the district’s ability to accomplish several grant deliverables and will result in significant decreases in revenue by placing the community at risk for continued transmission of preventable diseases. The district’s executive management team provided the Board significant details on (attachment #5):

• the impact of the closure on staff, services, clients, the community and public health in general; • a plan for moving forward to address the immediate crisis, including an assessment of current space options available for relocating staff; and • staff’s recommendations for facility acquisition and financing

Dr. Sands summarized that the executive management team will ask the Board to take action today by approving staff’s recommendations and authorizing staff to move forward with the proposed leases necessary to address the district’s immediate facility and operational needs. District staff need a home to serve as a base of operations. Staff can no longer provide service delivery in temporary locations. Staff cannot continue to work under these conditions without the promise of an interim solution. Employees and the community ask the Board to take action so the district can return to the business of public health and providing essential public health services to the community at the fullest capacity possible (attachment #6).

Rory Chetelat, interim director of administration, thanked the Board for meeting with staff to brief them regarding the concerns and needs of the district. Action is necessary today, and executive staff needs authorization to negotiate lease agreements for space to continue to provide essential services to the community and the tourists visiting southern Nevada.

Mr. Chetelat said the most critical item today is approving additional lease space at 400 Shadow Lane for an additional 6,127 square feet of clinical space, which will allow the district to reestablish clinical services. This space can be operational as early as June 1st. Currently the district is not providing some services which are essential to protect the public’s health. This will be an amendment to an existing lease, which expires January 31, 2014; however the rent will

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increase by $10,408.79 per month. The lease includes an opt-out clause in the event we are able to relocate staff to a more centralized location.

Secondary to this request is a proposed lease agreement for a replacement facility for the main campus. While not new information, the Board did ask for additional information and facilities to consider. In February 2012 the Replacement Facility Committee recommended consideration two potential facilities: the former CenturyLink building on Valley View and the former IRS building on Oakey. Staff has also visited and assessed numerous other facilities across the valley including those owned by both Clark County and local entities, and the former North Las Vegas City Hall. Staff determined that the former IRS facility was not large enough to meet the needs of the district adequately, it would require extensive remodeling, parking was at a premium, and potential lease expenses brought the cost in line with the larger Valley View building.

Mr. Chetelat noted the Board has heard the benefits of the Valley View building several times, including the fact the footprint will meet the district’s operational and facility needs. The district can afford the proposed lease expense out of the current budget without drawing upon reserves; though future funding is in question, the actions by the Board of County Commissioners recently demonstrated more secure funding for FY13. Mr. Chetelat also stated that the proposed lease can be supported by lease savings from the closure of the Spring Valley and 400 Shadow Lane locations once the Valley View facility is fully built-out. Acquisition of the Valley View building will also allow community health partners that can assist the district in protecting the community to share mutual space.

In terms of space offered by the local jurisdictions, though the offers have been generous and at little or no cost, there are challenges with IT functionality and electrical connectivity. Upon further assessment of the former North Las Vegas City Hall, the primary property on the campus is not ideal and was only offered for a two-year period. In order to make IT connections for district needs there is a large expense, including running new electrical lines.

The lease for the Valley View facility is still under negotiation; however the current offer is sustainable with the district’s budget for the 166,000 square feet of space. With the proposed twelve-year lease, the first twelve months would be free; the second twelve months would be rented at $.065 per square feet per month; the third twelve months would be at the rate of $.085 per square feet per month; the balance of the lease would be adjusted annually at CPI with a three percent cap. There is also a cancellation option at eighteen months with a $900,000 buy- out, or the equivalent of six month’s rent. Mr. Chetelat stressed again the affordability of this lease without drawing upon any of the district’s reserves, but relying solely on the property tax allocation set aside for a building and potential lease savings. The existing building is pre-wired in a way that meets the needs of the district, is in good condition, and there is modular furniture throughout which we can use. Mr. Chetelat said we can begin relocating staff to this location within thirty days of signing the lease. We will need to do some build-outs for clinical space, which is why the amended lease agreement for the 400 Shadow Lane facility is of utmost importance. The cost of the move and initial build-out will be paid from the capital fund originally set aside for sewer and bathroom repairs at the RPHC. Mr. Chetelat said we are preparing for the Back-to-School immunization rush; this facility can be ready to accommodate the vast volume of clients requiring immunization services during the summer months.

Mr. Chetelat concluded his remarks by asking the Board for a motion and action relative to allowing the district to move forward in such a manner to fully protect the public’s health.

Bonnie Sorenson, director of clinics & nursing services stated the nursing division has several goals, the most important of which is to prevent, treat and control the spread of communicable

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disease in the community – this goal is also the one most impacted by the suspension of operations at the RPHC. Ms. Sorenson shared the following statistics related to immunizations prior to and since the closure of the RPHC:

Weekly Impact Ravenholt: East Las Vegas Henderson Total Pre closure: 680 258 190 1,128 Post-closure: 0 420 78 498

This reflects approximately $15,750 in lost revenue, and over 630 of possibly unvaccinated clients per week, resulting in potential outbreaks. The clinics are running at fifty percent of capacity as well. There is active Pertussis in northern Nevada and Arizona; deaths have occurred from Pertussis in Arizona and Utah; the state of Washington has declared an epidemic related to Pertussis; there is measles in Europe which can profoundly affect the Olympics this summer. Las Vegas is a plane ride away; Las Vegas is a tourist destination. We cannot afford to leave this community vulnerable to any type of an outbreak – any outbreak would be devastating to our already crippled economy. Putting Las Vegas on a travel advisory list would have dire consequence to our economy.

Nevada previously ranked 50th in the nation for immunizations; our most recent ranking was 45th. The Nevada State Health Division cautioned our ranking will drop as a result of the closure and decreased in immunizations. The Southern Nevada Health District provides fifty percent of vaccines in southern Nevada.

Ms. Sorenson provided statistics for immunizations at the various clinics for the first three weeks of May. Typically the district sees 1,128 clients on a weekly basis in comparison to the number of clients we are currently seeing:

Post-Closure Weekly Immunization Clients Week Ending East Las Vegas Henderson Total May 4 313 124 437 May 11 462 134 596 May 18 542 188 730

In the two weeks before school started in August 2011, the district administered 15,000 immunizations. In our current configuration we cannot handle this volume. Ms. Sorenson stressed that with the relocation to a new main facility, none of the outlying public health centers will be closed – all satellite facilities will remain in operation. Additional centers will be added in the future as resources became available. Ms. Sorenson further stated that a centralized base of operations is crucial, particularly to receive vaccine orders. If there were an outbreak today there is a strong possibility of not receiving vaccine in a timely manner.

Nursing staff administered 224 physical exams on a weekly basis prior to closure, which included sports physicals, Healthy Kids exams and day care exams. Since the closure we are performing six physical exams, resulting in approximately $4,000 of lost revenue. Impacts of the reduction in physical exams include:

• delays in sports participation • delays in day care entrance • missed opportunities to identify delays in growth and development, and • plummeting immunization rates

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Physical exam services were co-located with within the immunization clinic. Currently there is no space available to perform these types of examinations. At present there is only space available at the East Las Vegas PHC to conduct physical exams. These exams are vitally important to families without medical insurance or access to a medical provider. Some nurses previously assigned to this program have been transferred to other programs to utilize their nursing skills.

Week Ending East Las Vegas May 4 9 May 11 0 May 18 28

The Sexual Health Clinic is part of the proposed lease agreement at 400 Shadow Lane. The district is the home of the only free-standing sexual health clinic in the valley, which is similar to the configuration in most urban cities across the country. Pre-closure the clinic was seeing 406 clients on a weekly basis; post-closure our rates dropped fifty percent to only 220 clients per week. This results in approximately $5,580 in lost revenue. With the sharp decline in patients, there is increased incidence of disease in the community, as well as increased perinatal exposure.

Post-Closure STD Exams Week Ending East Las Vegas Henderson Total May 4 156 44 200 May 11 207 44 251 May 18 213 71 284

Historically the health district diagnoses and treats one-third of all STDs in the community. These types of diseases are asymptomatic and clients rely on district staff being out in the community to perform contact investigations. For every person identified with an STD, there are usually 3.25 additional people identified through contact investigations who will also require treatment.

The Southern Nevada Health District is the expert in the community in terms of syphilis. Many physicians have never seen a case of syphilis. National experts have provided education with new physicians in the community. The district has lost control of diagnosing and treating syphilis due to the closure of our facility. Nevada leads the nation in congenital syphilis cases, which is something that cannot continue.

The closure of the RPHC has impeded the delivery of HIV services, including ambulatory care, early intervention services and baseline case management. Staff has been working with local providers trying to persuade them to take on HIV cases in the community in general, which has proven to be quite difficult. The district is the safety net for the community in terms of HIV care. The lack of a centralized location for clients to enter into HIV care is creating additional barriers to client participation at community support agencies, such as the UMC Wellness Center, AFAN, Golden Rainbow, etc. Clinical services previously offered in Annex A included HIV diagnosis, confirmation testing, counseling, assessment, and referral for continued care – these services must be reestablished to meet the requirements of NAC 441A, which in part reads: “the health authority shall investigate, confirm, determine (possible) source, ensure case and contacts receive appropriate notification, counseling, testing and medical treatment.” We are not fulfilling these requirements at present.

As a result, grant funding is in jeopardy. Our HIV services are based on deliverables, and we could lose up to $190,732 in grant funding each month if we cannot meet our grant deliverables

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in the next few months; loss of this funding will also impact funding for community-based organizations.

Estimated Monthly Revenue Loss Immunizations $63,000 Physical Exams $16,000 Sexual Health Clinic $22,320 HIV/AIDS/STD (grant funding) $190,732 Total Lost Revenue: $292,052

(Member Christensen left the meeting at 9:42am)

John Middaugh, MD, director of community health stated the closure of the RPHC and current circumstances have resulted in a public health crisis. He said the directors, along with Dr. Sands, stand together and urge the Board to take action which will allow the district to return to full service and operation, and work with staff to address a longer term, more comprehensive plan to meet the public health needs in our community.

Prior to the closure, the community was not in a good place relative to public health. We have the lowest childhood immunization rates in the nation. We are among the poorest in prenatal care, with ten percent of pregnant women aged 15-19 receive no prenatal care; and only thirty- three percent of pregnant women aged 15-19 have only one prenatal care visit. We are the worst in the country in terms of incidence of congenital syphilis.

Dr. Middaugh referenced “never events,” which are medical actions which can be prevented, such as the amputation of an incorrect arm. Congenital syphilis is a never event in 2012 in the country; yet Clark County experienced two deaths in 2011. A never event is death from tuberculosis; yet a nine-year old girl succumbed to this disease in 2011 and Clark County continues to have the highest rate of tuberculosis in children in the nation.

Clark County had outbreaks of norovirus in seventeen long-term care facilities where 803 of 3,852 residents fell ill. We continue to rank among the highest of tobacco exposure and adult use. Clark County has a high prevalence of obesity where thirty-three percent of kindergarteners are overweight or obese; and we are experiencing a diabetes epidemic among ten-year old children. Most recently Clark County made headlines as multiple resorts on the Strip had outbreaks of Legionnaire’s Disease.

Dr. Middaugh shared a comparison of local public heath funding with that of Seattle-King County. The comparisons are limited as the local health jurisdictions have different responsibilities for different programs.

Public Health Funding Comparison SNHD Seattle-King County Population 1,934,871 1,931,249 Visitors 38,928,708 9,900,000 Budget $70,654,660 $198,918,179 Tax allocation $15,879,962 $25,041,950 FTEs 521 1,115

It was noted that Seattle-King County operates ten regional local public health clinics. If the district had additional resources we could potentially double the staff and open additional centers in the valley.

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Across the United States, the average state contribution to public health is $33.26 per capita; the state of Nevada contributes to the health district only $0.21 per capita. The property tax allocation for FY12 is $2.94 per capita; the proposed allocation for FY13 is $8.21 per capita. Dr. Middaugh shared an additional table with the property tax allocations for the last few fiscal years.

SNHD Property Tax Allocation per Fiscal Year FY 2010 $24,942,525 FY 2011 $21,406,846 FY 2012 $5,690,000 FY 2013 (projected) $15,879,962

Property Tax allocation if at US $64,353,809 Median ($33.26/person)

Public health is a responsibility of government. This community is ripe for outbreaks of Pertussis and measles. Public health continues to try and catch up for the population explosion in recent years. Staff has been conducting detailed analyses of demographic changes in the population. North Las Vegas has the worst socio-economic parameters and health status in the valley. The solution to these problems are not opening a few public health centers sporadically across the region, but rather all entities and public health partners and the medical community coming together to determine the best combination of services needed and how to best provide those services. Many zip codes in North Las Vegas do not have a bus route, which further impedes access to medical services.

Dr. Middaugh urged the Board to help the district, and southern Nevada, get out of the public health crisis and restore services by approving the proposed lease agreements presented today. The district is committed to providing services by working with the Board and community partners to develop a long-term viable plan to bring public health into the 21st century and the level of service we should be providing.

(Member Christensen rejoined the meeting and was seated at 9:45am)

He said again that we should double the public health staff and triple the budget and by so doing the residents and visitors of southern Nevada would be better served. Nevada would no longer rank at the bottom of so many public health indicators.

Glenn Savage, director of environmental health expressed his support for relocation of environmental health services to one building, specifically the Valley View facility. Mr. Savage noted that he carries a backpack from office to office, which serves as his working desk, in order to perform his duties as the director of environmental health and make decisions on a daily basis.

(Member Giunchigliani left the meeting at 9:48am)

He introduced three of his supervisors: Phil Bondurant, vector control supervisor; Susan LaBay, pool operations supervisor; and Robert Urzi, supervisor for the Strip Office.

Mr. Savage said the community continues to express concern about services being provided, and why services are spread across the valley. One operator from a downtown property has expressed support of a centrally located facility and to consolidate environmental health together as a working team. We are burdening industry, the bread and butter of our economy, as operators must travel from location to location to location in order to receive necessary permits for operations and special events.

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Mr. Bondurant read the following statement into the record (attachment #7):

Good morning, Board of Health members. My name is Phil Bondurant; I’m the EH Supervisor for the Southern Nevada Health District in the vector control program. I oversee the vector control program and those inspections that are conducted in public accommodations, as well as many of the landlord/tenant complaints that come in from your constituents.

(Members Beers and Wood left the meeting at 9:50am)

It is evident; space is tight for all of the SNHD. However, in the current working conditions personal space is not afforded to the 10 staff members of the Office of Vector Control. Currently, we are housed in the Office of Epidemiology’s Conference Room. With the cabinetry and equipment, there is roughly 300 sq. feet of useable space to conduct business. Within this space we are using six 6- ft banquet-style tables as desk space. This small desk space is the assigned work station for staff; therefore their computers desk phones, and associated paperwork all must be contained within their designated 6 square feet of desk space. For visual reference, this equates to a work area roughly the size of two pizza boxes, side by side, to conduct the business operations of the office that oversees the sanitation and safety one of the most critical components of our Las Vegas economy, the Hotel resort industry.

(Members Beers and Wood rejoined the meeting and were seated at 9:51am)

This minimized work space is nearly 30 sq. ft less than previously assigned work areas for staff. Without defined, adequate work space, staff are constantly stepping on one other’s toes and invading personal space, which has tested the patience of staff and causing staff to ‘lose it’ on occasion. Staff no longer enjoy the office atmosphere that once existed in our office.

With staff being forced to literally rub shoulders with their tablemate, day-to-day operations become a logistical nightmare. Phone calls, voicemails, and conversations quickly fill a room this size with organized chaos, similar to the bullpen seen on Wall Street. The presence of ten staff members in a confined space can make it tough to hold a conversation on the phone, listen to a voicemail, discuss an upcoming inspection or even hear yourself think.

(Member Scow left the meeting at 9:52am) (Member Giunchigliani rejoined the meeting and was seated at 9:52am)

Staff cannot conduct file reviews, public record requests become a 4-hour task for administrative staff, and paperwork reflecting completed inspections since the building closure is now beginning to pile up in an office that’s already short of space. We have no means of an organized filing system. And in the event the files could be moved, we don’t have the space to stores those files.

There are a number of smaller issues that we’re dealing with: room temperature, working with the lights off to limit heat production, bathroom facilities, lack of an

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office to address confidential staff issues, nowhere to meet the general public or conduct supervisory conferences…the list goes on. For this reason, I believe the Office of Vector Control is operating at 60-75% capacity and has been doing so for the last 39 days. Under the current situation, the Office of Vector Control will not be able to reach a 100% capacity. We will remain at partial capacity until staff are relocated to an office setting capable of meeting the demands of the program. At this time, we have exhausted the spatial and operational capacity of the Epi conference room and not much change should be expected, creating concern for completing all required inspections by the end of the calendar year.

Hopefully by highlighting some of the bigger issues at hand, members of the Board of Health can see the need for quick, decisive action. Our current office space does not allow for an extended stay of 6, 12, or 18 months. Staff, myself included, have come to quickly realize the need for office space, not as a luxury, but as a necessity to conduct business. The idea of positive change and progression towards a centrally located building has caught the attention of many staff, who are anxiously awaiting news from today’s meeting.

I hope I have been able to effectively describe our current situation and stress the need for office space that is able to meet the needs of the Vector Control Program. I support the concept of the health district having a central building and I believe that building to be the Valley View facility.

Thank you.

Ms. LaBay read the following statement into the record (attachment #8):

Hello. Good morning. I am Susan LaBay; I’m the environmental health supervisor of the pool ops program. Normally when I address the Board I have been critical of administration; however when faced with the current situation it is important that we band together as a district so I am here actually today to lend my support to the administration in the purchase or in the acquisition of the Century building.

(Member Tarkanian left the meeting at 9:55am)

When inspectors find themselves in disagreement on what is the proper enforcement of a particular violation, they simply walk back to the training office and confer with our resident FDA standard. Once the proper enforcement is determined the training officer will then add notes into the violation standards so that all inspectors are enforcing any given violation in a consistent manner across the valley.

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This is currently not the case in pools; our program is separated currently into two different locations and the communication between the two sites is frequently delayed. As a result we are finding ourselves doubling up on the same work. EH provides service to the community in an indirect way – the services we provide would be made more efficient in a centrally located location in the valley and located in the same building. Since we do not traditionally provide direct service to the community having EH located in several locations throughout the valley serves no real purpose. In fact it hampers services by delaying response to operators, creating inconsistency among our offices and inspectors, and increasing mileage that the district must reimburse. Currently in my office one of my inspectors is more than an hour from his assigned area; he works in the North Las Vegas area however he is out in the Henderson Public Health Center. Although we do try to economize his time, it is important that he has to come into the office to drop off paperwork as well as re-supply.

(Member Scow rejoined the meeting and was seated at 9:57am)

Many of us are working without our files, without plans and without equipment, which are still locked in the main building. Although we are, and will continue, to do our best to continue the services that we are currently providing, we are working in less than ideal conditions. We need access to those items which currently is just not an option because of the space issues that we have out in the areas where we are currently housed.

Members of the Board, we need this building. I strongly encourage you to support the purchase or acquisition of the Century building.

Mr. Urzi read the following statement into the record (attachment #9):

Good morning, everyone. My name’s Robert Urzi and I am the supervisor over the Strip and East offices in the food operations program. And like Susan before, you’ve probably seen me before at other meetings, but today I’m talking in support of centralizing environmental health in a central location. I don’t believe it’s a union or a non-union issue, but rather an issue of getting our work done.

What I’d like to say, again, a centralization and resolution of this building issue is critical to the operation of environmental health. I believe that my division director and my fellow supervisors have already spoken on a lot of the issues; I’m not going to repeat some of the things they have said, but I do like to add a few other issues that are at least to my office and some of the challenges we face in the food operations program.

A lot of this has to do with spacing for supervisory conferences and meetings. Myself, I have conducted many supervisory conferences with major casino properties – these include vice presidents, sometimes of operations along with executive chefs, executive stewards and so forth – some of the decisions that are made in these conferences involve not just hundreds, but thousands of dollars and sometimes with small operators the livelihoods of these operators. There is no space for these conferences so currently we have sometimes up to twelve people crammed around the table that’s meant for three people deciding the fate of some of these establishments. This is not the kind of professional image I think the health district would like to present to the community and to the public in general, especially when decisions of this magnitude are made. We need the

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appropriate space and present ourselves in the professional manner to conduct our business.

The loss of space has also resulted in the lack of privacy for supervisors and managers. Currently with no privacy a lot of business is done in the parking lot. Supervisors, including myself and others, have to go actually outdoors, outside, sometimes there’s other supervisors conducting private business and so I have to get into my personal vehicle, turn on the A/C and the ignition and actually make phone calls from the car for phone calls of a private nature because, again, there is no space to actually to conduct some of the sensitive business that we have to do in environmental health.

We have no longer have any staff meetings because there’s no longer any space, so communication has been hampered by this. Increased mileage for displaced staff. For example my office conducts inspections of 9,000 food establishments for food permits; 9,000 of the 17,000 that we currently have in the health district and more than fifty percent come to my office alone. The clientele that we inspect have to go all the way to Henderson from the Strip and downtown corridors. So with the closure of the Ravenholt Center, which was literally only a couple of miles away, they are now traveling eighteen, twenty plus miles or so approximately to conduct their business, and this includes not just my group but also involving plan review as well.

This also means displaced staff, too. We have to, when conducting inspections, increase our mileage and travel time to go to these locations for inspections. So this is actually resulting in additional revenue being paid to employees because of the extra mileage they have to drive. But also, more importantly, the loss of time during the day for driving. If we have an actual central location, those 9,000 permits or so along the Strip corridor alone will decrease travel time for all of the staff to allow them to get more inspections conducted.

As I have spoken here before, because my other hat is a union steward but today I’m an environmental health supervisor, I’ve spoken about the understaffing of environmental health. This is really critical right now that we be as productive as possible in environmental health with the staff we currently have; we can’t afford to waste time traveling from Henderson to the Strip corridor to our other locations without loss of time, because literally sometimes it takes forty-five minutes for an inspector to go from Henderson to the Strip corridor and then park at someplace like the Cosmopolitan. We can’t afford that loss of productivity, especially when you have so much to do and we’re getting mandated by state laws to get at least one inspection done a year which that is the minimum – we try to do more, much more than that.

Having a central location would better facilitate communication between supervisors, management and the director. Basically having plan review in Henderson, even though it’s inconvenient for the community, has actually shown that having plan review with operations has expedited a lot of communication between inspectors and plan review and I can’t imagine how great that will be once all of environmental health can be centrally located and how that will facilitate communication between my fellow supervisors and other food offices, plan review and vector control and so forth. I can imagine that, logically as well, will be improved – we can share supplies, we can share clerical staff, and again, resolve issues very quickly by being centrally located.

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So in conclusion, again, I’m in favor of a centrally located facility for environmental health. And I believe, again, this will increase productivity of environmental and facilitate better logistics and communications. Thank you.

Mr. Savage said a single building is needed to better utilize environmental health staff, as well as that of the other divisions. A single building will allow the district to operate more efficiently as a working team, provide consistent solutions to problems faced by the public and industry each and every day, to save expenses for environmental health – collapsing the lease space for environmental health alone will generate approximately $500,000 in lease savings annually. A single building will be recognizable to the community and symbolize where all public health services can be obtained.

Mr. Savage expressed his support for those staff who worked to research and assess the various buildings and space for relocation. Over fifty locations were evaluated and the Valley View facility continues to rise to the top as the best option. Mr. Savage put his trust in Mr. Chetelat and administration in determining availability of resources to ensure the district relocates to the best facility possible.

Mr. Savage said his mother charged him to always do his best in protecting the environment and the public’s health. He said this is his career choice, as well as that of the employees sitting in the audience. Health district employees are proud of the work they perform on a daily basis. He said that some fifteen years ago Dr. Ravenholt said to be successful in the community one must remember that public health is about protecting the environment, providing public health services to the community, providing the services to the people that cannot do so for themselves. Public employees must stand tall in their duties to protect the public. Mr. Savage asked the Board to stand tall and vote positively on the proposed lease agreement; he asked for staff to have an opportunity to perform their jobs and to allow the public to receive the services they desperately deserve.

Mr. Chetelat concluded by stating staff needs the assistance of the Board. He said the team of professionals who presented to the Board today said it best. The district needs to move forward to continue its mission to protect the community and tourists, as well as allowing the professional employees of the district to perform their jobs. He urged the Board to authorize Dr. Sands and himself to negotiate and enter into contracts for the two proposed lease agreements presented.

Member Christensen said he has personally experienced the decrement in service since the closure. There is a critical need to reestablish clinical services today. In his own practice he has had patients present with syphilis, which he can treat, but he cannot do the epidemiology of the disease that is required. He stressed that this is a crisis that no one could foresee coming with the downturn, the age of the building, and other various factors (attachment #10). The district needs to relocate; the clinics need to be reestablished and there must be long-term planning to more fully address the district’s growing needs. The immediate pressure must be relieved now. The Board has heard the voices of the employees demonstrating the need to get back to work. He said it is the community’s fault for underfunding public health services. In terms of health care spending, the high dollar items are very expensive and benefit only a few individuals at a time – the most effective use of funding is for public health. Public health creates health and protects the populations – the Board needs to get the district’s mission back online; this is mission critical. Member Christensen said he is a physician, and the at-large member physician on the Board and as such every citizen and visitor to Clark County is his patient when he is acting in the capacity as a Board member. He stressed the Board needs to take action today.

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Member Wood thanked staff for attending the meeting and stated the Board is fully aware of the scope of the current situation. She said she appreciates the comments of the executive team and Member Christensen that the situation must be resolved quickly. Member Wood said the City of North Las Vegas offered the former city hall as a temporary short-term location, and with minor modifications it could be functional for the district almost immediately. This would have then provided a centralized location, with conference rooms and office space readily available – she said the offer was analyzed and subsequently dismissed. The offer was made in friendship and was never intended as a long-term solution. She insisted the former building was no longer sufficient for the City’s growing needs and a new building was warranted. Member Wood said it would not be sufficient for the district either for a long-term period, but it would provide some relief for the present situation. She continued that the Board needs time to learn the outcomes of the lawsuits without having to make drastic decision on moment’s notice. She referenced the proposed lease agreement for the Valley View facility, and stated that the twelve-year lease will in fact come with a $20 million price tag to the taxpayers, and at the end of the lease the district will have nothing to show for this expense. The district can rebuild its current facility for only $18 million, which is still less than the proposed lease. She said the Board did not act quickly enough to find temporary space and is now being asked to make a desperate decision, which in her opinion, is not fiscally in the taxpayer’s best interest.

Chair Jones asked for clarification on the expenses which could be encountered by a potential move to the former city hall facility. Mr. Chetelat, on behalf of the executive management team, expressed his sincere appreciation to the City of North Las Vegas for the generous offer and noted the offer is still under consideration. In terms of relocating to this facility, there are issues of concern other than financial, such as time and effort. It would take several months to build the necessary IT infrastructure to meet the district’s technological needs and this is of primary concern. The leases presented to the Board, which also includes a purchase option for the Valley View building, as many members agree that a long-term solution should include the purchase of a facility. Member Wood interrupted by stating that it is still more feasible to rebuild the existing facility for $2 million less than the proposed lease agreement; and a purchase option would be for a thirty-year old facility, versus a new building. Mr. Chetelat said that a rebuilding of the existing facility for the projected $18 million would be for the same footprint as the current facility and would be only 60,000 square feet of space, which has been demonstrated time and time again as not sufficient for the district’s needs, or that of the community we serve. Member Wood asked for the exact square footage of the Valley View facility, noting that one document provided states the facility is 166,000 square feet while another specifies 82,000 square feet. Mr. Chetelat said the entire building is 166,000 square feet; the 82,000 square feet refers to one floor of the building, which at one time was presented as a lease option.

In looking at the option of relocating to the Valley View facility versus space offered by the various jurisdictions, Chair Jones noted that the cost would be greater to inhabit jurisdictional space over the first two years. Mr. Chetelat said staff reviewed the cost of preparing the former city hall and Valley View buildings for occupancy, and it would be approximately $500,000 difference in price. These are operating costs which are necessary to occupy either facility. He noted the proposed lease for the Valley View facility would include free rent for the first twelve months. Though city hall would be rent free for two years, the district would be required to expend dollars for building infrastructure in a facility that would be vacated after two years; this would then require the Board to expend additional dollars for a new facility in two year’s time. Staff can reconsider the City’s generous offer for the two-year relocation; however the Board has an option to consider for a twelve-year lease agreement. Recent construction projects, including new city halls in the valley, was done with the intent for long-term occupancy; it will take at least three to four years to secure financing and navigate the design process for a building of the size necessary for the district. The construction process would be an additional

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three to five years, which would fall within the terms of the proposed lease. The proposed lease would not lock the district or the Board into a long-term situation, but rather allow some flexibility. A buy-out clause is also included in the proposed lease if within eighteen months the lawsuit results in the inability to sustain the lease. However this will require further action by the Board at such time we cannot sustain the lease.

Member Scow also expressed her appreciation to staff for their comments. She said the impact of the closure has had serious impact on the community and staff alike. She said she feels pressured into a decision where she has no objective information in order to make an educated decision. She stressed that taxpayer dollars are impacted by the Board’s decision today. She said she specifically asked in her briefing to see the number of staff displaced by the relocation and the actual space needs – she said she has never received this information. Mr. Chetelat said this information was provided in the backup documentation, which include information specific to each division and a square footage comparison for each area both pre and post- relocation. Member Scow said she did not receive the email containing the backup documentation until last evening and therefore was unable to fully review the materials (attachment #11).

Member Scow stated the Valley View building is twenty-six years old; she stated her concern that no needs assessment has been completed, nor is there documentation of a detailed assessment of the Valley View facility, potential cost to replace/repair given items over the life of the lease, or any necessary build-outs to make the space functional for our needs. Mr. Chetelat said the architects have conducted an analysis of the facility. The original plans for a replacement facility to be constructed on the Shadow Lane property confirm nicely to the footprint of the Valley View building. Though the building is older, due diligence has been completed to ensure a sufficient lifespan exists to accommodate the needs of the district for some time into the future.

Dr. Sands said at the time the Valley View facility was first considered as a potential replacement facility, at the direction of the Board, staff obtained an appraisal and a building inspection. The building was found to be structurally sound, though there are some minor issues which will not impede occupancy of the building.

Jeff Gerber, CEO of PGAL, said in October 2010 his firm prepared an evaluation of the Valley View building, including its critical systems, physical conditions of the building, visual inspection of the underground plumbing, and conducted mechanical, structural and environmental assessments. The projected total project cost at that time in the amount of approximately $11.6 million was not for short-term occupancy, but rather for the long-term, and includes move-in expenses and the like. There was also a second phase figured in to relocate the balance of staff from the main facility for an additional $3.5 million. The purpose of the study at that time was consideration of the Valley View building as the permanent home for the Southern Nevada Health District.

Member Scow said there is no definitive dollar amount available for retrofitting the building to meet the needs of the district, including clinical build-outs and office space, which would be beneficial to the Board as it weighs the option of a twelve-year lease. Mr. Chetelat said the numbers provided by Mr. Gerber were anticipated costs in the event the district were to purchase the building outright. As the focus has shifted to a long-term lease agreement it does not make sense to invest that type of expenditure into a building we do not own. It will cost approximately $1 million to clean up the building and make it ready for occupancy and meet the initial demands for clinical services, such as immunizations, as well as to relieve the temporary relocation issues. Within the first twelve to eighteen months, if the pending litigation is resolved, we can invest additional resources to make more permanent fixtures and clinical settings.

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Jerry Boyd, facility services manager, reported the first floor of the building would encompass all clinical services, at an approximate cost of $6 million. This estimate was based upon purchase, not a lease agreement. The cost can be reduced under a lease scenario and dependent upon the amount of the time the district plans to occupy the facility.

Member Scow referenced the cost to establish the IT infrastructure; she noted the hardware and infrastructure could be removed from the Ravenholt facility and relocated to the Valley View building at very little cost. She questioned the immense cost difference between relocation to the former city hall and other governmental buildings.

Eddie Larsen, information technology manager, reported a move to the Valley View building will allow the use of existing equipment from the Ravenholt facility. If the district were to relocate to the former city hall there would be an enormous amount of work needed to make the building functional for our technological needs. Currently the district has switches which require 208 volts, and a large amount of cooling in the network closets. The city hall houses smaller switches and only 110 volts in each closet. A larger issue is the Demarc which comes into the main building itself; the Demarc contains networking equipment to connect with North Las Vegas metro, which will not be relocated. It would be necessary to fabricate an entirely new Demarc on the property for the district’s use, which would be extremely costly and is not included on the estimate provided. The physical size of the existing equipment in the Ravenholt facility is approximately 18 inches by 12 inches, compared to the smaller closets found in the city hall. The district would be required to purchase new hardware in order to install our equipment, including installation of cabling; however the known asbestos in the main building at the city hall location prohibits installation of cable. The district requires higher voltage for our network gear, and this would require new electrical power to be run to the building as well.

Chair Jones asked if the IT infrastructure at the Valley View facility could be characterized as more ready to go versus other locations. Mr. Larsen said staff evaluated all closets at each location, including the server rooms and cabling, and the Valley View facility has existing CAT-5 cabling; all closets are wired for both 110 and 208 volts, and have sufficient cooling for all existing hardware gear.

Member Scow referenced the comparison of the North Las Vegas offer of no rent for two years; even with the cost of approximately $700,000 in construction costs, it would still be less than the $1 million to retrofit the Valley View facility for occupancy. The lease amount would also need to be considered. The former city hall would continue to provide a centralized location, which meets the needs addressed by staff members today. She expressed support for the proposed lease agreement for clinical space at the 400 Shadow Lane building; however she feels that the Valley View building is going to result in a greater expense to the taxpayers when other space has been offered at substantially reduced cost.

Member Scow said the county manager offered yesterday to fund and construct a new building for the health district if all lawsuits are dropped. The district could relocate to the former city hall for two years for a much lower cost and the focus could then shift to accommodating the district’s long-term facility needs.

Member Noonan said there are two issues on the table today: one is the main campus relocation and the other is the need for clinical space. He said the Board needs to address clinical space first and foremost. He mentioned that he toured the district offices and the most immediate need is the lack of clinical space. Once the Board resolves this issue, the larger issue of relocation of the health district can be more fully discussed.

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Member Noonan motioned to move forward with the lease agreement at the 400 Shadow Lane facility for clinical space; however he would like to amend the proposed lease agreement to the end of 2013 versus 2014 as it will allow the district to realize long-term solutions more quickly. If additional time is needed, the lease can be renegotiated. Member Giunchigliani seconded this motion.

Mr. Chetelat said the proposed lease agreement is an amendment to the existing lease. The additional space would be added to the current lease agreement; the lease agreement includes a six-month buy-out as well. Rather than the creation of a new lease, staff recommends approval of the proposed lease agreement as presented, with the option of the six-month buy- out.

(Member Tarkanian rejoined the meeting and was seated at 10:29am)

Member Noonan agreed to amend his motion, and the second concurred, noting that clinical space is needed. This situation is not ideal, but will allow the district to resolve some of the more critical issues in terms of service delivery. It was noted the current lease expires on January 31, 2014. The additional lease space will be at the rate of $1.64 per square foot.

A motion was made by Member Noonan to approve the lease agreement for clinical space at 400 Shadow Lane; seconded by Member Giunchigliani and carried unanimously.

Chair Jones asked to focus the discussion on a potential replacement facility for the main building.

Member Onyema said there was mention of asbestos in the former city hall. He questioned the impact on the health district occupying a facility with asbestos. Mr. Boyd said he is in receipt of the asbestos survey from the City of North Las Vegas; in terms of the main city hall building Mr. Boyd noted “it is loaded with asbestos.” Asbestos can be found in the sheet rock, the sheet rock mud, the mastic under the carpet, the doors, the ceiling tiles, and throughout the exterior of the building. Member Onyema questioned the potential costs for liability of moving into a building known to contain high levels of asbestos.

Annette Bradley, board legal counsel, stated it is her understanding that the asbestos is encapsulated. However if the district were to occupy the facility and make modifications, including remodeling or puncturing any walls, there is potential for harm. Facility maintenance staff would need to attend trainings pertaining to the effective maintenance of an asbestos-laden facility. She is unable to quantify the risk; however she knows the asbestos is present. Ms. Bradley is unsure of the district’s ability to build-out the facility to make it functional for our needs or to even make standard improvements.

Mr. Boyd said to be compliant with OSHA standards all facility maintenance and janitorial staff would be required to attend a mandatory forty-hour training course, with an annual refresher; this would result in an expense of $12,500 per year for this training. There are two ways to handle asbestos: abatement or encapsulation. The city hall has vinyl asbestos floor tile throughout the facility, which can be encapsulated by installation of vinyl flooring over the top; so long as the original tile flooring is undisturbed there is no issue. Any modification to walls or the building itself would require a planned abatement for opening walls known to contain asbestos to run conduit or to address air conditioning issues, including duct work. An additional expense of $7,000 would result any time air monitoring is needed in a building containing asbestos – this is true of any building containing asbestos. All electrical panels are full and additional electrical service to the building is required, which comes through fiber lines run underground. Other issues with this facility included extremely limited parking, as there are only

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170 available parking spaces; the current Ravenholt facility has 535 parking spaces, and we experience issues with parking on a routine basis. The 170 parking spaces will not be sufficient for staff, let alone the clients coming to the health district for services.

Member Crowley said she has vast experience in working with asbestos and potential asbestos exposure to employees. She empathically stated her opposition to putting employees at risk for asbestos exposure, nor the public we serve – she said this does not make sense. While the Board genuinely appreciates the generous offer made by the City of North Las Vegas, she is fully understanding of staff’s reluctance to immediately accept this offer with the knowledge of the presence of asbestos and the lack of sufficient IT infrastructure. It is critical to more fully understand the risk, which seems quite high.

Member Giunchigliani said it is important not to lose sight of Member Scow’s conversation, which is key to the discussion at hand. We need to separate the long and short-term needs; and the Board just took action on the clinical needs by approving the lease space at 400 Shadow Lane. She suggested setting aside the North Las Vegas City Hall offer and the lease agreement for the Valley View facility for the time being. She said no one on the Board has ever said the main facility is not old and aging and should not be replaced – she maintained that all county commissioners sitting on the Board in recent years has supported a replacement facility, the solution lies in how to reach that decision. As policy makers it is part of what the discussion and debate has been and should continue to be. Though Board members may not agree, to Member Giunchigliani it is the antagonism, loss of faith, the impact to staff and the public that is troublesome. She said she believes we need to move forward, which would be agreement between Clark County and the health district to drop to lawsuits and allow the county to either build or purchase a building based on programming needs. The Board should then decide where an interim step should be. She offered this as a motion; there is an opportunity to resolve the issue in a way that is conducive for both the public and the employees outside of litigation.

Chair Jones acknowledged the generous offer by Clark County, but cautioned there are details which must be understood as to what the offer means. He recommended continuing the discussion with the acknowledgement of the offer on the table.

Member Tarkanian said there is no guarantee of moving forward with the offer as a vote by the Board of County Commissioners is needed. Member Giunchigliani said the commissioners on the Board have been authorized by the Commission and county management to extend this offer. Member Tarkanian asked if the offer was discussed in a public meeting. Member Giunchigliani said this has not occurred as yet. Member Tarkanian said she would be cautious as various boards can change their opinions. She said as during her tenure on the Board of Health a replacement facility has been a topic of discussion, and decisions have been delayed. She said employees have poor working conditions, and she expressed support for Member Crowley’s concerns about asbestos in the North Las Vegas City Hall and she stressed it is not worth the agony of exposure to asbestos. She urged the need to protect our staff and clients from exposure. Member Tarkanian said a move to the Valley View facility is a short move in the general area, to a facility which is easy to find with ample parking. She does not understand the delay in moving forward when the focus should be on the employees and the clients in need of public health services. She said her feeling is for people and working together for progress.

Member Menzel said as an occupational health nurse the minimum exposure to asbestos and potential for Mesothelioma is one fiber. She said in terms of offers of constructing new facilities, she herself was recruited to work at UNLV seven years ago with the promise of a new nursing school on Shadow Lane – this has not occurred.

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Member Giunchigliani said if there is concern about lack of a vote on the offer by the county in a public setting a special meeting can be convened. She said she believes the offer is being dismissed due to lack of good faith. She said the offer is being made in a public setting in front of the press, the public and the employees. She expressed support for the offer made by North Las Vegas and stated that Member Wood would not recommend anyone to work in an unhealthy situation. She stated that asbestos is also present in the Valley View facility and other buildings more than twenty years old.

Member Tarkanian said she believes no Board member would want to put employees in harm’s way.

Member Scow said school district staff also work in facilities filled with asbestos and have done so since the 1960s.

Dr. Sands said as a point of reference the Valley View facility was constructed long after 1978 and asbestos is not an issue.

Chair Jones noted that in terms of older buildings there is a difference in an existing building where operations are in place with basic maintenance versus a building where some construction or build-outs must occur which may cause disruption to the encapsulation, and will result in large expenses. He said this requires expertise; he would not recommend health district maintenance staff to be trained in construction and the handling of asbestos as it is such a specialty.

Mr. Boyd said dealing with asbestos in absence of specialized training results in increased liability.

Mr. Chetelat said the offer from the county needs to be discussed further; however action is needed today in terms of short-term lease to address the district’s current operational needs. Staff is asking for the ability to negotiate and executive a lease to meet current needs. He said different lease terms could be negotiated if the Board feels necessary. Back-to-school immunizations are looming on the horizon and nursing staff needs appropriate space to address the volume of clients utilizing health district services in the coming months. With the generous offer on the table, it would be years before solutions can be realized and a building cannot be constructed overnight.

Chair Jones concurred that the offer is fantastic but agreed that it would take time for realization. Staff has done due diligence in looking for a new facility to address short-terms needs. She said if the county were able to purchase a new facility, the chances are strong that the Valley View building would continue to rise to the top. Construction of a new building would take longer than three years.

Member Giunchigliani interrupted and stated that the county owns both the land and the current facility. She said the county could begin construction on the current site, which was part of the original plans and demolish the existing facility. She said the offer is an avenue to move past the antagonism and then address moving staff on an interim basis. There is an opportunity to put the lawsuits to rest, including whether or not the district can own real property. She said the Las Vegas Metropolitan Police Department cannot own property; the county owns the property and will bond or lease the facility to the agency. There is a way to bring closure to the issue and move forward; the district needs a building but the issue remains how to get there. No one has commented on the offer other than to recognize the generosity of the county.

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Member Bateman said lawsuits do not vanish quickly. The ownership of property must be addressed in the district courts as the summary judgment motion was not granted. In his opinion, unless the lawsuit before the Supreme Court is going to address the ownership of real property issue, the litigation will continue for some time. He would have liked to have resolved the issues with the county rather than litigate the matters. He said it does not bode well for municipalities to be in litigation with each other as there is too much uncertainty for the staff and the public, let alone the resulting expense to the taxpayers.

(Member Beers left the meeting at 10:48am)

Member Bateman continued by stating that the offer from the county is the direction in which we need to move; the resolution with the county and obtaining a permanent facility in cooperation with Clark County is warranted. The district should remain in its current location for the future is a good option. His policy preference would be to ask staff to continue to find resolve quickly and move in this direction. The next issue would be to find short-term space to resume full operation in a single facility. There is no question in his mind that the offer from the county is a better resolution than entering a long-term lease when the litigation remains unresolved. He said the offer is the resolution he had hoped for. He said a short-term lease is a good option in the interim. He would like to direct staff to further enter into negotiations to resolve the county matters and find global resolve in the county’s purchase of a facility; and then address short- term needs of the district.

(Member Beers rejoined the meeting and was seated at 10:52am)

Ms. Bradley stated the offer presented from Clark County today is the first time the district has heard about it. The offer needs to be fully vetted. When the Board first discussed possible litigation, the understanding was that the potential for resolution was in the forefront in terms of the dedicated funding stream and ownership of real property. Litigation is long-term and costly, and those resources, money and staff time can be utilized for other means. If resolution can be realized which is to both parties’ benefit that is optimal and the Board and district has been open to this option from the beginning. Counsel needs to fully explore the offer presented today. There continues to be the problem of fragmentation across the district which must be address and she recommended to the Board to allow staff to move on a parallel path: address short- term needs and vet the offer presented today.

Member Wood referenced the short-term lease agreement for the Valley View facility and asked if the owner would be agreeable to the existing terms outlined. Mr. Chetelat said that would be the district’s preference; but there needs to be consideration to the offer on the table by Clark County. Member Wood asked the timeframe to occupy the Valley View facility. Mr. Chetelat it would be approximately thirty days from the time signatures are obtained on the lease. Member Wood confirmed it would be thirty days to move-in from the time signatures are finalized on the lease agreement.

Member Wood moved to direct staff and counsel to enter into negotiations with Clark County based upon the offer to purchase or construct a new facility; she further moved to confer with the owners of the Valley View facility to procure a short-term lease for up to twenty-four months to relocate health district operations within thirty days. This motion was seconded by Member Crowley. Chair Jones asked for two separate motions.

Member Giunchigliani stated that Real Property Management expressed concern about the potential for long-term leases and suggested a twelve or eighteen month lease with the possibility of renewing or extending the lease as needed. She said in terms of construction the process could move quickly. She asked for clarification on the term “enter into negotiations with

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Clark County for settlement.” She asked what needed to be negotiated as the county is offering a settlement.

Chair Jones asked if the county is truly responsible for any lease agreements in which the health district has for facilities. Member Giunchigliani said the county is responsible as the district cannot own property; if any lease agreement includes the potential for purchase options the county is responsible. If the lease agreement is purely a tenant lease, the county has no responsibility.

Member Tarkanian asked if this is based upon the county’s belief that the district cannot own real property. Member Giunchigliani confirmed this assertion.

Member Crowley said it is important to remember that the twenty-four month lease includes lease payments for only twelve months. Mr. Chetelat intervened and said the lease terms will change drastically based upon the proposed shortened term of the lease.

Member Woodbury stated he is not opposed to discussions with Clark County in terms of the offer presented today; however he is skeptical of an offer with no strings attached. He said there are serious control issues and recent Board of County Commission meetings lead him to believe there are serious control issues attached. He questioned how much control Clark County would have over the health district as opposed to other jurisdictions. He asked if the multijurisdictional system currently in place would be lost. He said Member Scow’s constituents in Boulder City would be vigorously opposed to the county’s control of the health district. He is not opposed to regulation by the health district, but rather one jurisdiction’s putting specific conditions on the type of system in place for governing public health in southern Nevada. He said the cities of Henderson, Mesquite, North Las Vegas and Las Vegas would express similar concerns as well. He needs clarification on what rights would be surrendered by accepting the county’s offer. He said we need to negotiate with Clark County; however there are serious issues brought to light in terms of what rights would be lost. One issue in litigation is the ability to own real property, and this is a right in question with the offer and would the district surrender that right.

Member Woodbury continued that it is overly optimistic that the owner of the Valley View facility would maintain the same lease terms with a shorted lease agreement; it is more realistic that the terms would be more expensive and favor the landlord. There are a lot of questions raised if the Board pursues the path presented today. The issues need to be taken separately while understanding the need for ongoing negotiations with Clark County; he has serious concerns coupling the two issues. We need to move quickly to relocate the district’s operations. He said he did tour the Henderson Public Health Center and he feels employees put up a good front while he was on site. He saw first-hand the stress of relocation, close quarters, lack of workspace, lack of storage and lack of privacy. He said the united front of executive management today and all levels of employees and staff speaks volumes as to the need of centralized services, particularly for environmental health.

Member Woodbury summarized the need to move quickly to relieve the stress on staff and restore full district services. He said it is about people; we need to forget the rules and regulations and focus on the people impacted by the services the district provides, including children and employees. The Board needs to move quickly and decisively to establish the fact that lease negotiations are moving forward. If staff negotiates with Clark County simultaneously so be it, but it must be done recognizing that coupling the two issues brings about grave concerns of some Board members.

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Larry Singer, vice president of Grubb & Ellis, addressed the Board. He said the Board needs to be aware that it will take more than twenty-four months to construct a new facility, due to finalizing the offer with the county and the construction process itself. He recommended the motion for a short-term lease agreement include the actual time for construction; negotiations to extend the lease may be very costly as well. He further cautioned that the lease terms will not be as favorable as those presented today for a short-term lease agreement. Mr. Singer also said the proposed lease was for a period of at least twelve years; he said the district may wish to negotiate less lease space due to the shortened period of occupancy provided the owners can negotiate a lease financially beneficial to them as well.

Chair Jones asked the cost to buy-out the lease in the proposed lease agreement if a better opportunity presented itself. Mr. Singer said the intention was not to terminate the lease if a better offer arose; but the buy-out clause was for $900,000 for eighteen months. Chair Jones said this amount equated to approximately six month’s rent. Mr. Singer said negotiations are essentially starting over again, which must be considered.

Member Wood said that information provided today states an option for an eighteen-month lease and an extension clause will be necessary; and this eighteen-month lease would include a six-month rent free period and the rent amount would then increase incrementally. She asked if these terms will still available, with the potential extension, as these costs were known. Mr. Singer said we would need to start negotiations again and the owner would not be favorable to the existing terms, particularly in light of the discussion today. Mr. Singer said he represents tenants and seeks to obtain the most favorable lease terms possible, and he will continue to represent the district in this manner.

Member Wood asked if the information provided to the Board was based on negotiations with the owner. Mr. Chetelat said this was the last offer presented; if we are adding additional terms to the proposed agreement, this would require that we re-enter negotiations. Mr. Chetelat said we appreciate the offer presented today, and the split motion; he would like guidance on a comfortable range of lease terms for continued negotiations. He said that an eighteen-month period is not an adequate period of time to address some of the issues facing the district; he would like to see at least a thirty-six lease period and allow time to negotiate reasonable terms including enough space to alleviate the space crisis the district is currently facing due to relocation and to meet the needs of the community.

Ms. Bradley said the proposal is for two separate motions: one to allow staff to enter into negotiations with Clark County regarding the offer presented today; the other is to address lease space at the Valley View facility. As the county’s proposal has not been agendized for consideration, this action would be to direct staff versus a formal motion. Ms. Bradley maintained the Board has directed staff throughout the litigation process to seek opportunities for resolution with Clark County.

Member Crowley asked if Member Wood wished to modify her motions.

Chair Jones said the direction to staff would be to continue seeking an amicable resolution with Clark County.

Member Beers said he learned last night that Board members had not received an email from the City of Las Vegas to Dr. Sands last weekend. He said that city staff are unable to find reason to red tag the main facility, though staff has done so for other buildings as recently as yesterday. The city plans to contract with a third engineering firm to review the findings of Walter P. Moore and confirm the need to condemn the building, including the lack of a diaphragm which is needed to shore up a building against lateral forces. He shared copies of

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the email with Board members (attachment #12). An answer should be received within two weeks, and this could impact the short and/or long-term consideration of the Board today.

Member Tarkanian said she spoke with Mr. Knight earlier today and it will take until the end of June to complete the process and address specific items needed in order to condemn the facility. It is not his opinion that the building cannot be condemned, but rather there are certain items which must be addressed to take this action.

Dr. Sands said this information is consistent with that he received from the city manager last night. The city is being conservative in its estimate that it will take approximately forty-five days to complete the process for possible condemnation of the facility. Member Beers said the code addresses issues such as electricity and running water; the issue pertaining to the main facility is quite complex.

Chair Jones said without having reviewed the email previously, it is his opinion that the focus is on removing occupants from the building. We are unaware of the details surrounding this document.

Jeff Gerber, CEO of PGAL, said the ordinance in place contains eighteen points of evaluation for a building to be condemned. The procedure is a process by which a building owner can be compelled to take action to repair, abandon or demolish. Of the eighteen specific criteria, many are very general; however the standard specifies that if any of the eighteen fail, the building can be considered dangerous.

(Members Giunchigliani and Onyema left the meeting at 11:16am)

There are three of the eighteen that are quite specific and that have quantifiable components and by Walter P. Moore’s evaluation the building meets all three criteria. There are up to six remaining criteria which are more general and more subjective; however it can be argued that the building also meets these criteria. Mr. Gerber said the process will confirm the findings of Walter P. Moore.

Chair Jones said it would be a parallel action to move forward with the City’s process; it does not necessitate holding off on any potential decision pending today.

Member Litman said in his opinion this is an attempt to muddy the waters and detract from a decision. The Board continues to add additional things into the equation and no results are forthcoming. The Board needs to make a decision today.

Member Wood questioned if the decision needs to allow staff to negotiate the lease, or to bring the proposed lease back to the Board for further consideration. Chair Jones said staff needs to be allowed to negotiate the lease as due diligence has been met.

Member Wood rescinded her previous motion; the second concurred.

Member Wood motioned to authorize staff to begin negotiations for the Valley View facility for a short-term lease (between twelve and twenty-four months) with a possible extension/renewal if necessary for the best deal possible for the health district. Member Crowley seconded this motion.

Ms. Bradley asked for clarification with respect to the short-term lease and asked if the maximum period would be thirty-six months. The current lease negotiated has an out-clause after a certain number of months.

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(Member Onyema rejoined the meeting and was seated at 11:19am)

Mr. Chetelat said the out-clause was on the long-term lease was at eighteen-months with a ten- month notice. It would be helpful to include a timeframe, with the understanding that eighteen months is not optimal, but possibly include an extension of eighteen months. Ms. Bradley continued that finite limits are not desirable, but rather allow staff to negotiate the best deal given the circumstances, and bring those proposals back to the Board for consideration.

Member Wood modified her motion to authorize staff to negotiate the best deal possible for a short-term lease for the Valley View facility between twelve and thirty-six months; and to bring the lease agreement back to the Board for final approval, even if a special meeting is necessary.

(Member Giunchigliani rejoined the meeting and was seated at 11:21am)

Chair Jones asked why a final approval would be necessary, as we need to get moving on this decision. Member Wood said the Board needs to see the pricing for the lease.

Member Woodbury said he is reluctant to limit staff to a lease for only thirty-six months as we will not get the best deal possible. He said perhaps public comment is necessary, as well as that from staff.

Chair Jones said given the current proposal for a twelve year lease, the out-clause includes a payment of approximately six month’s rent, or $900,000, which is not that great a risk. Member Wood said the short-term lease contains no out-clause; the out-clause was only for the long- term lease. A short-term lease will cover the period for negotiations with Clark County; building a building and any due diligence for a permanent home for the district. If we need a twelve month lease with a two-year renewal option – this parameter will be left to staff’s discretion; however the Board needs to know the final commitment. Member Wood said she feels the Board needs to give the final approval. Member Crowley asked if she would be agreeable that if the lease is in-line with the current short-term proposal cost-wise that staff could move forward without having to come back to the Board for approval. Member Wood said she is comfortable with this; however she is not clear on how to make this part of the motion.

Dr. Sands said with this change, the lease terms would be different. Staff can negotiate better terms, as explained by Mr. Singer; however we need to be careful as whatever is negotiated should be the best terms for the district as well as giving the Board the most flexibility as circumstances change and allow changes as necessary.

Member Woodbury said if the lease agreement will come back to the Board for approval it is not necessary to include specific parameters other than providing a directive to continue negotiations. Options can then be provided to the Board, such as the possible terms. He said there is no reason to include specific parameters as the landlord will specify what he feels can be done for certain amounts of time on the lease. He feels the Board should not handcuff the negotiation process, as this will create further delays.

Dr. Sands said timing is crucial; the urgency remains to have staff working under reasonable conditions and returning operations fully across the district to the community. We owe it to staff and the community to fully understand the timeline.

Member Menzel stated this only kicks the can further down the road by having yet another Board meeting, which will then result in additional questions. There is an offer before the Board which should be voted up for down. Member Crowley agreed with this statement and

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suggested a parameter that if a lease agreement is reached better than what is on the table today staff can move forward and not have to come back to the Board for approval unless there is something specific the Board needs to consider.

Member Menzel said there is a proposed twelve-year lease agreement before the Board at present. No decision has been made on this at present.

Member Wood rescinded her motion.

(Member Beers left the meeting at 11:26am)

Member Noonan expressed his agreement with what has been said, including the need to move quickly. One concern is a long-term lease, which is causing some consternation among Board members. He motioned to give Dr. Sands the ability to enter into a 36-month lease for the Valley View facility under the best terms which can be negotiated by staff. Member Crowley seconded this month.

Member Giunchigliani said the language should be not to exceed thirty-six months, and that this is solely a tenant lease, not for purchase. The restriction allows for flexibility in the lease, including less square footage as a space needs assessment is warranted.

Dr. Sands said this is something staff can work with, and to also have options to extend or renew the lease if necessary if staff must remain on site longer than thirty-six months. Member Noonan agreed to this recommendation.

Member Wood asked that the Board see the lease to understand the final lease terms before it is finalized.

Chair Jones stated the motion before the Board is to allow staff to negotiate and enter into a thirty-six month lease at 330 S. Valley View with the option to renew and/or extend said lease.

Member Giunchigliani offered the have RPM staff work with district staff and Mr. Singer in drafting the final lease. This would help ensure we do not find ourselves in less than desirable lease conditions, if acceptable with staff. Dr. Sands said he appreciated the expertise of RPM staff and offered to meet with staff from each respective jurisdiction as well. Chair Jones clarified that this is an offer, but not required. Member Giunchigliani asked if this offer will be accepted; and Dr. Sands confirmed.

A motion was made by Member Noonan to negotiate and enter into a lease agreement not to exceed thirty-six months at 330 S. Valley View with the ability to renew and or extend the lease; seconded by Member Crowley and carried unanimously (Member Beers not present for the vote).

Chair Jones asked staff to move forward as quickly as possible. Dr. Sands noted that staff appreciates the action taken by the Board today.

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V. Pursuant to NRS 241.015(2)(b)(2), a meeting of the Board of Health as governing body to receive information from its attorneys regarding potential or existing litigation involving matters over which the Board has supervision, control, jurisdiction or advisory power and to deliberate toward a decision on the matter

Member Noonan moved to for the Board to enter into a Closed Session pursuant to NRS 241.015(2)(b)(2); seconded by Member Wood and carried unanimously.

CLOSED SESSION

The meeting recessed for the Southern Nevada District Board of Health to meet in Closed Session at 11:33am; Closed Session was called to order at 11:48am. Chair Jones reconvened the open session at 11:58am.

Chair Jones noted a quorum was present following the conclusion of the Closed Session with Members Bateman, Christensen, Menzel, Noonan, Onyema, Scow, Tarkanian, Wood and Woodbury seated.

VII. BOARD REPORTS Southern Nevada District Board of Health members may identify emerging issues to be addressed by staff or by the Board at future meetings, and direct staff accordingly. Comments made by individual Board members during this portion of the agenda will not be acted upon by the Southern Nevada District Board of Health unless that subject is on the agenda and scheduled for action.

Chair Jones asked Board members if there were any information to report.

Member Menzel asked for guidance on how to recommend change to Southern Nevada District Board of Health Bylaws. She would like to include language in Article III: Purpose and Function relative to ensuring the health district has adequate resources to fulfill its responsibilities. Ms. Bradley said this item can be agendized for discussion at the next meeting.

Member Wood addressed Dr. Middaugh and stated she agreed with comments he made earlier pertaining to the lack of adequate medical resources in North Las Vegas, and that the addition of multiple clinics alone will not resolve the issue but rather more community outreach. She said these statements are true for the entire valley. She said a good start would be a clinic in the mature, historic area of North Las Vegas. She said that no one is willing to address this need, and the focus has turned into establishment of a clinic in the Centennial and Losee area by SkyView; while worthwhile, this does not address the needs of the low-income, high priority need in the historic, mature area of town.

Dr. Middaugh said he is not completely familiar with the geography of the North Las Vegas region; however his staff has been compiling population-based data in terms of socio-economic, demographic, and the availability of clinics and services. Staff worked with the Clark County School District to develop a retrospective immunization survey which details the immunization levels of students as well as the inclusion of race, ethnicity, National School Lunch Program status, and zip code. Staff is working with Jeremy Aguero of Applied Analysis and the Las Vegas Perspective, as well as the state demographer, to create a synthesized amount of information. He offered to share this study with Member Wood. He expressed gratitude for the comments and information shared by a city staff member at a recent accreditation meeting. The work of the district supports the passion expressed by Member Wood in terms of needed public health services in North Las Vegas. In terms of the demographic explosion over the last fifteen years, it has drastically outpaced the infrastructure including that of medical, health, primary and public health care. The health district is

Board of Health Minutes Page 35 of 38 May 24, 2012

the authority and lead response agency for public health services; however there is another component of medical and health care access and services which is not part of public health. Public health can bring the necessary stakeholders together to determine the best partnership for a generic community-based medical care component for this area. There is no quick fix – it is a major challenge for all parties. We need to maximize the use of our resources by not putting a public health center directly across the street from a federally qualified health center (FQHC) and subsequently collapse that center. We need to determine the best mixture of health services and how to best build that critical medical infrastructure, and this will be an ongoing process with numerous partners.

Member Wood asked that Dr. Middaugh contact her office to schedule time to meet and discuss the survey.

Member Giunchigliani said the Board gave staff direction to reestablish the North Las Vegas Public Health Center and to include a line item in the budget. She asked if this is currently in progress or not. Member Wood said every follow-up conversation with staff is focused on establishment of a clinic in the Centennial/Losee area as opposed to the mature area of town. A further concern is the lack of bus routes in that particular area. The new VA hospital is also in this area, and the city is working with the RTC to establish bus routes to better serve this area. She stressed the focus needs to be on the area with the highest need for services, and which has been most impacted by the downturn in the economy.

Dr. Sands said funds have been allocated in the budget to reestablish a public health center for North Las Vegas, and our broker was actively looking for space; however the closure of the main facility hampered this effort. The direction from the Board was to use the modular located at C.P. Squires Elementary School to establish some nursing services. (Actual motion from the February 23, 2012 meeting: A motion was made by Member Giunchigliani to 1) utilize the vacated facility on the CP Squires Elementary School campus at no cost, 2) provide at least one nurse to provide immunizations, healthy kids exams and sports physicals on a short-term basis, 3) develop a community assessment to determine the best locations throughout the valley for providing health care services and 4) include a line item in the budget for a clinic in North Las Vegas; seconded by Member Noonan and carried unanimously (Members Anthony and Onyema not present for the vote).)

Bonnie Sorenson, director of clinics & nursing services said a meeting was held in conjunction with city officials from North Las Vegas and Tom Chase of Nevada Health Centers and there was confusion over ownership of the modular. It was determined that Nevada Health Centers currently has a contract with the City of North Las Vegas and HUD; this must be resolved before anything can occur at that site. Nevada Health Centers has offered to provide immunization services at the facility; however a new clinical site is only 500 feet from this facility as well. North Las Vegas residents desperately need primary care services, which can be provided by Nevada Health Centers. Mr. Chase’s organization can also provide VFC vaccinations. He is working with the city to develop an umbrella agreement similar to what the Board approved today so an additional school-based clinic can be operational once again. The district is committed to working with Nevada Health Centers to provide whatever services cannot be provided.

Member Giunchigliani expressed her support for Mr. Chase and is understanding of the need to over competition for services.

Member Giunchigliani said a council of executives was formed in partnership with United Way and Mayor Goodman. United Way is taking the lead to conduct a community-based assessment with Applied Analysis. She asked for input on questions that should be included on the assessment.

Board of Health Minutes Page 36 of 38 May 24, 2012

Dr. Sands said that he participated in a phone conference with Cass Palmer and Jeremy Aguero two weeks ago. He wants to ensure that there is no cross-over between this assessment and what the district will be doing as part of the preparation for accreditation. The district will need to know how the community is using the services provided by the health district, whether our services are being used and health status information.

Member Giunchigliani asked Board members to provide input as well as it pertains to their respective jurisdictions to ensure a more well-rounded assessment is conducted. The hope is to have the assessment completed by mid-June.

VIII. HEALTH OFFICER & STAFF REPORTS Chief Health Officer Update Dr. Sands said the main item pertaining to the building was the staff report.

Member Giunchigliani recognized Member Christensen was named one of the top physicians in the Las Vegas area. There are wonderful doctors in the community, and Member Christensen is well- deserving of this honor. She noted that he epitomizes quality care of a physician.

IX. INFORMATIONAL ITEMS DULY NOTED A. Chief Health Officer and Administration: 1. Monthly Activity Report, Mid-April 2012 – Mid-May 2012 a. Note of Appreciation from the Las Vegas Chamber of Commerce to Dr. Lawrence Sands b. Note of Appreciation from Vicky VanMeetren to Dr. Lawrence Sands regarding the district’s participation in Health Care Day for Leadership Las Vegas c. Notice of Certificate of Achievement for Excellence in Financial Reporting for the FY11 Comprehensive Annual Financial Report 2. Financial Data: Revenue and Expenditure Report for General Fund, Capital Reserve Fund, Bond Reserve Fund, Insurance Liability Reserve Fund, and Public Health Laboratory Fund for the Month of April 2012 a. Grant and Agreement Tracking Report, as of May 10, 2012 3. Public Information Monthly Report, April 2012

B. Community Health: 1. Monthly Activity Report, April 2012 a. PEWSS Bulletin 4-04-12 b. PEWSS Bulletin 4-11-12 c. PEWSS Bulletin 4-18-12 d. PEWSS Bulletin 4-25-12 e. April 12 Disease Statistics f. Certificate of Recognition from the Las Vegas Chamber of Commerce to Dale Klabacha, public health preparedness nurse g. Letter of Appreciation from Governor Brian Sandoval to Jane Shunney, public health preparedness manager h. Southern Nevada Influenza Surveillance Report #6s

Board of Health Minutes Page 37 of 38 May 24, 2012

C. Environmental Health: 1. Monthly Activity Report, April 2012 i. Letter of Appreciation from the Las Vegas Chamber of Commerce to Glenn Savage, director of environmental health ii. Letter of Appreciation from U.S. Micro Corporation regarding Dennis Campbell, solid waste and compliance manager; Walter Ross, EH engineer/supervisor; Eddie Ridenour, EH supervisor; and Adrian Brown, EH engineer II

D. Clinics and Nursing: 1. Monthly Activity Report, March 2012 a. In-service calendar b. 2012 CDC Childhood Immunization Champion Awards for Veronica Morata-Nichols, community health nurse manager; and Sheila Rivera, licensed practical nurse

X. PUBLIC COMMENT Public comment is a period devoted to comments by the general public, if any, and discussion of those comments, about matters relevant to the Board’s jurisdiction will be held. No action may be taken upon a matter raised under this item of this Agenda until the matter itself has been specifically included on an agenda as an item upon which action may be taken pursuant to NRS 241.020. All comments are limited to five (5) minutes.

Chair Jones asked if anyone wished to address the Board. He noted that speakers will be limited to five minutes.

Jordan Miyamoto, local physician, addressed the Board. She expressed concern about a tuberculosis investigation conducted earlier in the year in an adult day care facility. She referenced outbreaks in schools where everyone is notified of potential exposure to an infectious disease; this did not occur at a local adult day care facility. She expressed concern about the treatment of her mother and conflicting information shared with her by the tuberculosis clinic staff, including being accused of obtaining medical information illegally from the day care center. She is also concerned about the ability of obtaining information from staff in the tuberculosis clinic regarding her mother’s treatment when she has power of attorney for her mother’s health care. Dr. Miyamoto expressed her frustration with employees who dismiss her due to language barriers as well.

Member Giunchigliani asked staff to speak with Dr. Miyamoto and better delineate protocols for those with power of attorney and what is still protected under HIPAA. She asked that the Board also be provided with this information.

Member Tarkanian asked if there were other cases of TB identified at the adult day care center and ensure that anyone potentially infected was treated appropriately.

Chair Jones asked Dr. Sands, Ms. Bradley and Ms. Sorenson to stay after the meeting to discuss Dr. Miyamoto’s concerns and attempt to bring closure to the situation at hand.

Chair Jones asked if anyone wished to address the Board. Seeing no one, he closed the Public Comment portion of the meeting.

Board of Health Minutes Page 38 of 38 May 24, 2012

XI. ADJOURNMENT There being no further business to come before the Board, Chair Jones adjourned the meeting at 12:24 p.m.

SUBMITTED FOR BOARD APPROVAL

______Lawrence Sands, DO, MPH, Chief Health Officer Executive Secretary

/src attachments

Attachment #2

I am sending in my comments via email as I have a heavy workload and am unable to break away from my work location here in Henderson to attend the 8:30 Board of Health meeting.

I am writing in regards to the search for a permanent replacement facility. As part of that conversation I would first like to address the various responses generated by my previous letter to the board. I have had several employees email, call, or walk up to me in the hall and thank me for standing up. They agree that the delays caused by some members of the board and some union representation have been detrimental. Several have expressed thanks for attempting to stick to the facts and quotes of others from previous meetings. I have encouraged them if they have concerns to address the board directly as they can be heard without fear of retaliation and the board will take their comments into consideration.

In regards to my comment about union representation, Ms. Evangelista in the last board of health meeting took issue with my letter and tried to paint what I said as both false and misleading or at the very least uninformed and misguided. She stated, “the union cannot be a union with only forty percent membership – we must be over fifty percent.” To quote directly from my previous letter, “In light of full disclosure, I am not a member of the union. This is true of forty plus percent of SNHD employees who for various reasons disagree with the union or feel they do not represent employees adequately.” If 40 plus percent of employees are not members of the union that still leaves more than 50% that are. Ms. Evangelista claimed my comments were pro-management. She also claims I said the union and the union members have stated that the building was in good repair and healthy. Neither of those statements have any truth to them. Even if I did write something that was decidedly pro- management, I have every right to voice my concerns to the board as I see them and not fear backlash from others. This includes public comment. The Southern Nevada Health District Board of Health Governance Document BGP-003: Public Hearings/Public Comments states under item number 3, “Comments may be prohibited if not relevant to, within the authority of the Board, or willfully disruptive of the meeting by being irrelevant, repetitious, slanderous, offensive, irrational, amounting to personal attacks, or interfering with the rights of other speakers.”

The following options were presented to the Board of Health.

1. Construct a new building

Construction costs were anticipated at $60 million. This was a reduction of the $87 million originally estimated for a new facility. At that time the building fund balance was $10,447,474. That would leave a balance of $49,552,526 that would require financing.

2. Acquisition of an Existing Building

The Replacement Committee asked the district’s broker to research properties within the following parameter (Buffalo Drive to the West; Cheyenne Avenue to the North; Paradise Road to the East; and Tropicana Avenue to the South). The Century Link Building fell within those parameters. It has easy access to I-95, is on 3 Bus lines. It would also ensure we are meeting the needs of our clientele. At the time of the report, 56% of all nursing and clinical services were provided at the Ravenholt Facility.

Total cost for this option was estimated at $37,336,719. Minus the balance of the building fund ($10,447,474) would have left a balance of $26,889,245.

outreach clinics to the community. In the last 12 months we have provided over 132 outreach clinics to the community, from Laughlin to Mesquite. We are out in the community on a frequent basis. A large number of these clinics are in the schools. When Member Jones stated the public’s seeming preference for a centralized facility, Member Giunchigliani responded, “…this location is convenient for staff rather than the community.”

One point of concern to staff with the recent situation is the press coverage of it. Member Giunchigliani made statements of concern that aired in the Darcy Spears piece run by Channel 13. Such as, “I’ve had complaints from people who have spent three days trying to get their health card, they’ve been offered a job, and that puts them at risk of losing the job.” Member Giunchigliani knows that the Ravenholt location is not the only location that health cards are offered at. At the time of the building closure health cards were attainable at our Cambridge and East Las Vegas Public Health Centers. The Henderson Public Health Center also offered Health Card services up until it was necessary to relocate some Environmental Health Services into that space. Board Governance Policy 006 says in part in regard to the conduct of Board Members, “Collective rather than individual decisions….Proactive conduct through express value statements versus conduct that is reactive to specific events/decisions…strategic leadership more than administrative detail…” She also stated it goes back to management and leadership. The management team at the district can only go so far with an issue before they need approval from the board. The same Board Governance Policy states, “Only officially passed motions of the Board are binding on the Executive Secretary and SNHD staff.” Essentially, if the board does not give approval for something as large as moving services into a new building, the hands of SNHD staff are tied.

Once again, I appreciate the opportunity and time allowed for me to comment.

Michael Lacy

Attachment #3

Good morning. My name is Shelli Clark, and I am speaking to you today not as the clerk to the Board of Health, nor as Dr. Sands’ executive assistant; but as a member of this community, a tax payer, a client of the Southern Nevada Health District, as well as an employee. I would like to speak to the issue of relocating the district to a central facility, specifically the Valley View building.

BGP-006: Board Governance Process states in part: “in providing oversight, the Board will assess organizational performance in relation to the ends set by its policy goals and adherence to budget, rather than by examining or advising on day-to-day operations;” further: “Board governance will emphasize 1) outward vision rather than internal preoccupation; 2) strategic leadership rather than administrative details; 3) collective rather than individual decisions; 4) the future rather than the past or present; and 5) proactive conduct through express value statements versus conduct that is reactive to specific events/decisions.” Recently members of this Board have expressly violated this policy in statements to the media and in other open meetings by making various comments about the new for a replacement facility and closing the Ravenholt building while prefacing their statements with the fact that they sit on the Board. The Board adopted this policy at its June 23, 2011 meeting and there was lengthy discussion about the role of the Board. Member Scow herself stated: “The intent of the policy is that members of the Board adhere to speaking as one voice, and not speaking in public on behalf of the Board unless the Board has taken action to support or deny a specific item. When speaking publically a Board member should express that his/her opinion is that of an individual and not the Board as a collective. Member Scow further noted that “Dr. Carver stresses the Board functions as a whole, not individuals.” In recent interviews, it was not noted that the Board members were expressing their personal opinions. For the record, all BGPs and meeting minutes are public information and available on the district’s website.

As a taxpayer, I ask why four of the six jurisdictions represented on this Board have fancy newer facilities, all built and/or remodeled at the taxpayers’ expense. North Las Vegas does not have enough employees to fill their new facility; construction could have been stopped or delayed, but the taxpayers continue to pay for a facility that was not needed. Also in terms of North Las Vegas, Member Wood went on the record at the April 23rd Board meeting stating that “the former city hall…was adequate for the City of North Las Vegas and does not have the same issues as the Ravenholt PHC.” Quite a different comment those at the October 3rd Board meeting where she stated: “the City of North Las Vegas took steps to address facility concerns as the current City Hall is the same age as this facility and has similar unsafe conditions and the Council felt a new building was warranted.” City Hall was offered to the district with the City’s full knowledge of existing problems. Taxpayer dollars would be required to make this building habitable and functional for the district’s use; yet certain Board members have no qualms about using taxpayer dollars in this manner.

I am a mother of five children. As our health insurance plan, courtesy of Clark County, does not cover vaccinations, I bring my children to the health district for vaccinations. Recently my four-year old noticed the cracks in the walls and said “Mommy, you need a

Page 1 of 2

new building – this one’s broken.” We work in tight space, and now with the closure of the main facility, space is even tighter. Currently I sit in a small conference room with another employee; my “desk” is a credenza with less than 12 square inches of space to write; we have supplies stacked around us; I don’t have a confidential work area anymore; files are in the open because there is nowhere to file; there is no confidentiality as employees are right next to each other; we spend money to acquire supplies to perform daily functions on a routine basis, which is a waste of money. If this Board had taken action to relocate the health district months, or even years ago, this would not be an issue.

Some Board members claim that the district needs to be spread out across the community to better provide services. Well, we are spread across the community now and I will tell you that our current configuration is non-efficient. It takes days to obtain a signature; items are lost when sent intra-district mail; meetings are impossible to schedule due to lack of meeting space; we have to allow for travel time between sites…the list is endless. I’ve received calls and emails from clients complaining about the difficulty in obtaining services, as have other employees. A centrally located facility provides better service delivery to our clients and the community.

On a personal note, I find Dr. Sands to be a man of integrity and honesty. He and I do not always agree, but he has never given me reason not to trust him. I will state publically that I used to love working at the health district and found my job to be the most challenging yet rewarding work that I’ve ever done. However in recent months this has not been the case. The lack of action of this Board, comments by union leadership claiming to represent “all employees,” and actions of key executive staff have changed my opinion of the district – this is not reflective of Dr. Sands and his leadership. Individuals are responsible for their own actions, their decisions and what they say; Dr. Sands is not responsible for others’ actions.

I respectfully request that this Board take action today to relocate the district into a central facility that will benefit the community – the community of southern Nevada and the health district.

Thank you for your time.

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Southern Nevada Health District Service Locations (As of May 14, 2012) ***SUBJECT TO CHANGE***

CAMBRIDGE COMMUNITY • Special Programs...... 759-0677 • Public Accommodations OUTREACH CENTER • Child Care Facilities • Solid Waste Plan Review 3900 Cambridge St., #101 • Public Water Systems • Solid Waste and Compliance Las Vegas • Schools • Subdivision Plan Review Monday-Thursday, 7 a.m.-12 p.m.; • Tattoo, Permanent Makeup & • Landlord/Tenant Hotline.. 759-0697 12:45-4:30 p.m. Body Piercing • Vector Control Hotline.....759-1633 Friday, 8 a.m.-12 p.m.; 12:45-4:30 p.m. Nursing & Clinic Services...... 759-1040 • Mobile Home/RV Parks Health Cards*...... 759-1688 Monday-Thursday, 8 a.m.-5:30 p.m. • Public Accommodations • Summer Camps EAST LAS VEGAS • Birth Control (by appointment) PUBLIC HEALTH CENTER • Emergency Contraception SPRING VALLEY 560 N. Nellis Blvd., Suites D1 & E12 • Immunizations PUBLIC HEALTH CENTER Las Vegas • Adult and childhood 6330 W. Spring Mountain Rd. Las Vegas Monday-Thursday, 8 a.m.-5:30 p.m. • Travel vaccines (until 3 p.m.) Friday, 8 a.m.-4:30 p.m. • Pregnancy Testing (walk-in) Monday-Friday, 8 a.m.-4:30 p.m. • STD/HIV Testing** (until 3:30 p.m.) (unless otherwise noted) Environmental Health...... 759-0503 Friday services are limited to birth & death RAVENHOLT • Citizen Complaints certificates, health cards, immunizations and HIV/STD testing. PUBLIC HEALTH CENTER • Food & Beverage Establishments 625 Shadow Ln. • Pool Plan Review...... 759-0571 Birth & Death Certificates...... 759-1327 Las Vegas • Pool operator testing Health Cards*...... 759-1340 Monday-Friday, 8 a.m.-4:30 p.m. • Tuberculosis Testing (unless otherwise noted) *If your health card expired on or Emergency Medical Services...759-1050 Nursing & Clinic Services...... 759-0900 after April 16, 2012, you will have 60 Monday-Thursday, 7 a.m.-5:30 p.m. • Birth Control (by appointment) days to renew your card without being • Emergency Contraception Human Resources...... 759-1101 charged a late fee. If you received a • Immunizations • Job Hotline...... 759-1100 temporary health card on or after • Adult and childhood April 16, 2012, you have 60 days instead Nursing & Clinic Services • Travel vaccines (until 3:30 p.m.) of 30 days to see the food safety movie, if • Tuberculosis Clinic...... 759-1369 • Kids Clinic...... 759-0896 required. (by appointment) Public Health Preparedness...759-1671 **For results of a STD test given at • Pregnancy Testing (walk-in) • Medical Reserve Corps....759-0877 the STD Clinic, a clinic staff member will • STD/HIV Testing** (until 3:30 p.m.) Public Information Office...... 759-1390 contact all clients with positive results to arrange for treatment. Those clients with HENDERSON • Community Outreach/ Volunteer Services...... 759-0881 negative results will not be contacted. PUBLIC HEALTH CENTER If your contact information has changed • Medicare Counseling...... 759-0874 520 E. Lake Mead Pkwy. since your appointment, leave a message Henderson SHADOW PROFESSIONAL CENTER at 759-0807 with your name, date of birth, Monday-Friday, 8 a.m.-4:30 p.m. 400 Shadow Lane, Suites 104 & 206 date of visit and phone number. If you (unless otherwise noted) Las Vegas would like a printed copy of your results, go to the East Las Vegas or Henderson Monday-Friday, 8 a.m.-4:30 p.m. Birth & Death Certificates...... 759-1515 Public Health Center. You will need a valid Environmental Health Environmental Health...... 759-0600 photo ID and $3 per copy. For results of a HIV or STD test given at the Gay • Food & Beverage Establishments • Individual Sewage Disposal System Plan Review/Parcel and Lesbian Center or Richard Steele • East & Henderson....759-0501 Boxing, call the phone results line at Map Plan Review...... 759-0660 • Strip Properties...... 759-0620 759-0733. • Food Plan Review...... 759-1258 • Permitted Disposal Facilities Local Public Health Center Locations

CAMBRIDGE COMMUNITY EAST LAS VEGAS HENDERSON PUBLIC OUTREACH CENTER PUBLIC HEALTH CENTER HEALTH CENTER 3900 Cambridge St., #101 560 N. Nellis Blvd., Suite E-12 520 E. Lake Mead Pkwy. *Health card services only*

RAVENHOLT PUBLIC SHADOW PROFESSIONAL SPRING VALLEY HEALTH CENTER CENTER PUBLIC HEALTH CENTER 625 Shadow Lane 400 Shadow Lane 6330 W. Spring Mountain Rd., Suite C *Limited Services*

For up-to-date information, call (702) 759-INFO (available Monday-Friday, 9 a.m.-5 p.m.) or go to www.SouthernNevadaHealthDistrict.org/building-closure.php

Para información actualizada en español llame (702) 759-INFO (disponible de lunes a viernes de 9 a.m.-5 p.m.)

Updated 3:30 p.m. Attachment #5

Prepared for Southern Nevada District Board of Health May 24, 2012 Action Requested  Authorize the Chief Health Officer and the Director of Administration to Negotiate and Enter into Contracts for the two Leases presented to Address the District’s Facility and Operational Needs Clinic Space at 400 Shadow Lane  Immediate need to re-establish clinic services  Amending the current lease at 400 Shadow Lane  Move-in ready  Operational by June 1  6,127 sq. ft / $10,408.79 monthly rental cost Search and Options for Ravenholt Replacement Facility

 For the last several years actively searching:  Valley View building  Oakey building  Since the closure:  County and City locations  City of North Las Vegas Old City Hall 330 S. Valley View  12 year lease  166,409 sq. ft  First 12 months - free  Second 12 months - $0.65 per sq. ft. or $108,000 per month  Third 12 months - $0.85 per sq. ft. or $141,700 per month  Remainder of lease adjusted annually at CPI with 3 percent cap  Cancellation option currently at 18 months with a $900,000 buy-out 330 S. Valley View (cont’d)  Can occupy within 30 days of lease  Need additional build-out for clinical services  Cost of move and initial build-out from the capital fund originally earmarked for sewer and bathroom repairs in Ravenholt  Can be ready for “Back to School” immunizations Goal: To prevent, treat and control the spread of communicable disease in the community

Immunization Clinic Weekly Impact  Pre-closure total: 1,128  Ravenholt, 680  East Las Vegas, 258  Henderson, 190  Post closure total: 498  Ravenholt, 0  East Las Vegas 420  Henderson 78  Revenue loss: approximately $15,750  Impacts:  Total client loss, 630  Potential outbreaks Post Closure Weekly Immunization Clients

Weekly Immunization Clients Week Ending East Las Vegas Henderson Total May 4 313 124 437* May 11 462 134 596* May 18 542 188 730*

* Compared to 1,128 weekly clients for Ravenholt, East Las Vegas and Henderson Public Health Centers pre-closure Physical Exams Weekly Impact (Physical exams include sports physicals, Healthy Kids exams and day care exams)  Pre-closure: 224  Post closure: 6  Revenue loss: Approximately $4,000  Impacts:  Delay in sports participation  Delay in day care entrance  Missed opportunities to identify delays in growth and development  Immunization rates will fall Post Closure Weekly Physical Exam Clients

Weekly Physical Exam Clients Week Ending East Las Vegas May 4 9 May 11 0 May 18 28

At this point, East Las Vegas PHC is the only space we have to conduct exams. Sexual Health Clinic Weekly Impact  Pre-closure: 406 clients  Post closure: 220 clients  Revenue loss: approximately $5,580  Impacts:  More incidence of disease in the community  Increased perinatal exposure Post Closure Weekly STD Exams

Weekly STD Exams Week Ending East Las Vegas Henderson Total May 4 156 44 200 May 11 207 44 251 May 18 213 71 284 STD Morbidity  Historically SNHD diagnoses and treats 1/3 of all the STDs in the community.  Overall detection and treatment of STDs is at 50 percent of normal at this time.  For every person treated, 3.25 additional people are identified through contact investigations who will also require treatment.  At present, cases needing care are going longer without treatment, thus transmitting disease to more partners. Infectious Syphilis Primary & Secondary Morbidity

Offsite (Steele / G&L) 10

8 Ravenholt - Annex A 6

4 Ravenholt - STD

- Other Annex A HIV Services

 The building closure has impeded the delivery of HIV services, including ambulatory care, early intervention services and baseline case management.  The lack of a central location to begin/enter HIV care is creating further barriers to client participation at community support agencies (UMC Wellness, AFAN, Golden Rainbow, etc.)  Annex A clinical services, which include HIV diagnosis, confirmation testing, counseling, assessment and referral for continued care, must be re-established to meet the requirements of Revised Statute 441A.

To summarize: Within NAC 441A, the health authority shall investigate, confirm determine (possible) source, ensure case and contacts received appropriate notification, counseling, testing and medical treatment. Grant Funding for HIV/AIDS/STD Potential Revenue Loss:  $190,732 per month could be in jeopardy if we are unable to meet our grant deliverables in the coming months.  This will also impact funding for community-based organizations. Estimated Monthly Revenue Loss

Immunizations $63,000 Physical Exams $16,000 Sexual Health Clinic $22,320 HIV/AIDS/STD (grant funds) $190,732 Total Loss $292,052

Public Health Indicators

 Among lowest childhood immunization rates in US  Among poorest in prenatal care  10%of pregnant 15-19 year olds get no prenatal care  33% of pregnant 15-19 year olds get only one prenatal care visit  Among worst in congenital syphilis: 2 deaths in 2011  Among worst in tuberculosis  Death of 9 year old girl in 2011  Among highest rates of tuberculosis in children in US  Outbreaks of norovirus in 17 long term care facilities: 803 of 3852 residents ill  Among highest prevalence of tobacco exposure and adult use  High prevalence of obesity  33% of Clark County School District kindergartners are overweight or obese  Epidemic of diabetes among 10 year olds  Widely publicized outbreaks of Legionnaire’s Disease from hotels on strip Public Health Funding Comparison Southern Nevada Health District and Seattle-King County

Seattle-King SNHD County Population 1,934,871 1,931,249 Visitors 38,928,708 9,900,000 Budget $70,654,660 $198,918,179 Tax Allocation $15,879,962 $25,041,950 FTEs 521 1,115 Public Health Funding Comparisons (per person)  Median State Contribution for Public Health = $33.26  State of Nevada contribution to SNHD = $ 0.21  SNHD Property Tax Allocation (2012) = $2.94  SNHD Property Tax Allocation (2013) = $8.21

Public Health Funding Comparisons  Property Tax Allocation 2010 $24,942,525  Property Tax Allocation 2011 $21,406,846  Property Tax Allocation 2012 $5,690,000  Property Tax Allocation 2013 $15,879,962

 Property Tax Allocation $64,353,809 if at US Median ($33.26/person)

Attachment #7

It is evident; space is tight for all of the SNHD. However, in the current working conditions personal space is not afforded to the 10 staff members of the Office of Vector Control. Currently, we are housed in the Office of Epidemiology’s Conference Room. With the cabinetry and equipment, there is roughly 300 sq. feet of useable space to conduct business. Within this space we are using (6) 6-ft banquet-style tables as desk space. This small desk space is the assigned work station for staff; therefore their computers desk phones, and associated paperwork all must be contained within their designated 6 sq. feet of desk space. For visual reference, this equates to a work area roughly the size of two pizza boxes, side by side, to conduct the business operations of the office that oversees the sanitation and safety one of the most critical components of our Las Vegas economy, the Hotel resort industry. This minimized work space is nearly 30 sq. ft less than previously assigned work areas for staff. Without defined, adequate work space, staff are constantly stepping on one other’s toes and invading personal space, which has tested the patience of staff and causing staff to ‘lose it’ on occasion. Staff no longer enjoy the office atmosphere that once existed in our office.

Finally, this small amount of space has no room to keep and maintain files. All files, both confidential and available to the public, are still housed in the Ravenholt Building and are not easily accessible. Staff cannot conduct file reviews, public record requests become a 4-hour task for administrative staff, and paperwork reflecting completed inspections since the building closure is now beginning to pile up in an office that’s already short of space. We have no means of an organized filing system. And in the event the files could be moved, we don’t have the space to stores those files.

There are a number of smaller issues that we’re dealing with: room temperature, working with the lights off to limit heat production, bathroom facilities, lack of an office to address confidential staff issues, nowhere to meet the general public or conduct supervisory conferences…the list goes on. For this reason, I believe the Office of Vector Control is operating at 60-75% capacity and has been doing so for the last 39 days. Under the current situation, the Office of Vector Control will not be able to reach a 100% capacity. We will remain at partial capacity until staff are relocated to an office setting capable of meeting the demands of the program. At this time, we have exhausted the spatial and operational capacity of the Epi conference room and not much change should be expected, creating concern for completing all required inspections by the end of the calendar year.

Thank you. Attachment #8

Environmental health needs to be in a facility that would allow us to centralize our function in one location at the health district. Over the course of the last few weeks we have seen the benefit of having both food plan review and the training office located out in the Henderson Public Health Center. When operators have questions regarding plan reviews instead of the inspector emailing the questions to the plan review and then waiting for days for a response, an inspector can simply walk back to the plan review area and get an immediate response. This allows us to give better service to our permittees. When inspectors find themselves in disagreement on what is the proper enforcement of a particular violation, they simply walk back to the training office and confer with our resident FDA standard. Once the proper enforcement is determined the training officer will then add notes into the violation standards so that all inspectors are enforcing any given violation in a consistent manner across the valley.

This is currently not the case in pools; our program is separated currently into two different locations and the communication between the two sites is frequently delayed. As a result we are finding ourselves doubling up on the same work. EH provides service to the community in an indirect way – the services we provides would be made more efficient in a centrally located location in the valley and located in the same building. Since we do not traditionally provide direct service to the community having EH located in several locations throughout the valley serves no real purpose. In fact it hampers services by delaying response to operators, creating inconsistency among our offices and inspectors, and increasing mileage that the district must reimburse. Currently in my office one of my inspectors is more than an hour from his assigned area; he works in the North Las Vegas area however he is out in the Henderson Public Health Center. Although we do try to economize his time, it is important that he has to come into the office to drop off paperwork as well as re-supply.

Members of the Board, we need this building. I strongly encourage you to support the purchase or acquisition of the Century building.

Attachment #9

SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS October 28, 2004 Petition #40-04 (attachment #1) Donald S. Kwalick, MD, MPH Maker of Motion: Robert Eliason Chief Health Officer Second: Jim Christensen Karl Munninger Carried unanimously Director, Administrative Services

That the District Board of Health authorize staff to negotiate with an Board Members Present for vote: architectural firm to prepare a preliminary conceptual design for a new Gary Reese building at the main campus of the Clark County Health District Andrea Anderson Jim Christensen, MD Sherry Colquitt, RN Robert Eliason Donna Fairchild Joe Hardy, MD Steven Kirk Mary Jo Mattocks, RN Rory Reid March 24, 2005 Health Officer & Staff Reports: (attachment #2) Donald S. Kwalick, MD, MPH Discussion of AB380 and its potential impact on the make up of the District Chief Health Officer Board of Health and the organization of the District. Board Members Present: Gary Reese Andrea Anderson Jim Christensen, MD Tom Collins Sherry Colquitt, RN Susan Crowley Robert Eliason Donna Fairchild Mary Jo Mattocks, RN Donalene Ravitch Stephanie Smith

Page 1 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS April 28, 2005 Health Officer & Staff Reports: (attachment #2) Donald S. Kwalick, MD, MPH Discussion of AB380 and its potential impact on the make up of the District Chief Health Officer Board of Health and the organization of the District. Reported most recent reprint of AB380 allocates 3.25 cents per $100 of assessed valuation to be Board Members Present: placed in a fund in the county treasury for the Health District. Gary Reese Andrea Anderson Jim Christensen, MD Tom Collins Sherry Colquitt, RN Susan Crowley Donna Fairchild Steven Kirk Donalene Ravitch May 26, 2005 Health Officer & Staff Reports: (attachment #2) Donald S. Kwalick, MD, MPH Status report on AB380 which addresses structure of the Board of Health. Chief Health Officer Reported the amended bill would increase from 3.25 cents to 3.5 cents per $100 of assessed valuation the funding allocated to the district. Board Members Present: Gary Reese Andrea Anderson Jim Christensen Tom Collins Sherry Colquitt, RN Susan Crowley Robert Eliason Donna Fairchild Steven Kirk Mary Jo Mattocks, RN Stephanie Smith

Page 2 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS June 23, 2005 Health Officer & Staff Reports: (attachment #2) Donald S. Kwalick, MD, MPH Legislative session summarized by Bryan Gresh and Gary Milliken including Chief Health Officer history of AB 380. Reported that the County stepped up and offered a dedicated funding source which started at 3.25 cents per $100 assessed Board Members Present: valuation but was ultimately locked in at 3.50 cents per $100 assessed Gary Reese valuation; also that the county stated on the record that if the funding level is Andrea Anderson not sufficient to cover the health district’s budget, the county will make up Tom Collins the difference. Sherry Colquitt, RN Susan Crowley Robert Eliason Donna Fairchild Joe Hardy, MD Steven Kirk Mary Jo Mattocks, RN Stephanie Smith September 28, 2006 Petition #43-06 (attachment #3) Donald S. Kwalick, MD, MPH Maker of Motion: Gary Reese Chief Health Officer Second: Joe Hardy, MD Michael Walsh Carried unanimously Director of Administration

That the Southern Nevada District Board of Health approve the attached Board Members Present for vote: proposal (attachment A) for architectural services from PGAL LLC. Donna Fairchild Karla Burton Discussion included Chief Health Officer stating that we will certainly need Jim Christensen, MD assistance from the Board as we may need to approach the city to assist with Susan Crowley funding and that the County has not been approached in terms of funding, Robert Eliason however the health district is working with the County Manager and Joe Hardy, MD Director of Finance. Tim Jones Gary Reese Lawrence Weekly

Page 3 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS March 22, 2007 Report/Discussion/Action: Update on plans for a new main building - Donald S. Kwalick, MD, MPH PGAL LLC (attachment #4) Chief Health Officer Michael Walsh The Director of Administration indicated he has had several discussions with Director of Administration County management as this process has moved forward and he has been keeping George Stevens apprised of the progress. Member Giunchigliani Board Members Present for vote: suggested specifically listing this as a potential action item at the next board Donna Fairchild meeting and then make the request of Mr. Stevens to do the same at the Jim Christensen, MD County Commission meeting. The Chief Health Officer suggested using the Susan Crowley county bonding authority to pursue funding at this point in time. Robert Eliason Chris Giunchigliani Timothy Jones Steven Kirk Mary Jo Mattocks, RN John Onyema, MD Gary Reese Lawrence Weekly May 24, 2007 Petition #10-07 (attachment #5) Lawrence Sands, DO, MPH Maker of motion: Chris Giunchigliani Chief Health Officer Second: Lon Empey Michael Walsh Carried unanimously Director of Administration

That the Southern Nevada District Board of Health approve staff’s request to Board Members Present for vote: seek available funding sources for a new main campus. Donna Fairchild Karla Burton Petition states for fiscal year 2008, the approved Capital Budget included Jim Christensen, MD $1,900,000 for new main building design and engineering, and as the district Lon Empey is unable to incur debt or establish bond authority, staff has spoken with Chris Giunchigliani county finance director about different funding efforts. Timothy Jones Steven Kirk Discussion included Director of Administration stating that in his discussions John Onyema, MD with Mr. Stevens there was mention of a cost-share on potential funding, and Steven Ross that the dedicated funding stream from property tax dollars included a Debra Toney, RN quarter cent increase that was to be dedicated to capital. Lawrence Weekly

Page 4 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS July 3, 2007 Board of County Commissioners Presentation (attachment #6) Lawrence Sands, DO, MPH Chief Health Officer Item #110: Receive a report regarding development of a replacement health Michael Walsh district facility and direct staff accordingly Director of Administration Jeff Gerber Following the presentation of the proposed facility, Mr. Stevens discussed CEO, PGAL LLC the history of the health district dedicated funding stream implemented in George Stevens 2005. He stated that the county had historically provided the district with Chief Financial Officer, Clark County approximately 3.25 cents per $100 assessed valuation. Through discussion at both the local and legislative level, the legislature increased the funding County Commissioners Present: amount to 3.50 cents per $100 assessed valuation. Mr. Stevens stated that the Rory Reid additional quarter cent was to be used for a building, equating to Susan Brager approximately $1.9 million annually. Tom Collins Chris Giunchigliani The Board of County Commissioners asked Dr. Sands and Mr. Walsh to meet “Chip” Maxfield with all jurisdictional representatives to discuss the potential for additional Lawrence Weekly funding assistance. Bruce Woodbury

No formal action was taken on the item. July 26, 2007 Petition #30-07 (attachment #7) Lawrence Sands, DO, MPH Maker of motion: Chris Giunchigliani Chief Health Officer Second: Lawrence Weekly Michael Walsh Carried unanimously Director of Administration

That the Southern Nevada District Board of Health approve staff’s request to Board Members Present for vote: approach governmental units within Clark County to seek funding assistance Steven Kirk for the planned replacement building on Shadow Lane. Ricki Barlow Susan Crowley Minutes report Director of Administration stating: (O)ne funding alternative Chris Giunchigliani discussed by George Stevens at the commission meeting had to do with the Joseph Hardy, MD issuance of bonds. As a quarter cent of the property tax revenue allocated to Tim Jones the district are designated for capital, that dollar amount will increase Frank Nemec, MD annually. Over the life of the bond, we could pay for the building, and Gary Reese reimburse the county for money paid up front, which would be Bubba Smith approximately $4.5 million. Stephanie Smith Lawrence Weekly

Page 5 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS March 27, 2008 Petition #10-08, Resolution #01-08 (attachment #8) Lawrence Sands, DO, MPH Maker of motion: Tim Jones Chief Health Officer Second: Linda Strickland Michael Walsh Carried unanimously Director of Administration

That the District Board of Health approve Resolution #01-08 to establish a Board Members Voting Aye: debt service fund for Southern Nevada Health District Pursuant to NRS Ricki Barlow 354.612. Jim Christensen, MD Robert Eliason Approval of the Petition allowed for a reallocation from the Health District’s Chris Giunchigliani general fund of $1.0 million to be transferred to the Debt Service fund which Joseph Hardy, MD will be entitled “Bond Reserve Fund” for retention by the County Treasurer Tim Jones for the District Board of Health. Robert “Bubba” Smith Linda Strickland Debra Toney, RN Lawrence Weekly Members absent for vote: Steven Kirk Susan Crowley Gary Reese January 22, 2009 Petition #10-09 (attachment #9) Lawrence Sands, DO, MPH Maker of motion: Steven Kirk Chief Health Officer Second: Mary Jo Mattocks Scott Weiss Carried unanimously Director of Administration Kieawa Mason That the Southern Nevada District Board of Health approve transfer of funds Interim Financial Services Manager from Southern Nevada Health District’s FY09 beginning fund balance to the Bond Reserve Fund Board Members Present for vote: Chris Giunchigliani Approval of the Petition allowed for one twelfth of the annual allocation Jim Christensen, MD from Clark County to be placed in the Bond Reserve Fund, and a transfer of Susan Crowley $4,822,857 from the fund balance to be in compliance. Robert Eliason Tim Jones Approved minutes state: “Upon passage of AB380 in 2005, a dedicated Steven Kirk funding stream was enacted for the Southern Nevada Health District from Mary Jo Mattocks, RN Clark County property tax revenues. It was agreed that one quarter cent of Bubba Smith the three and a-half cents per $100 of assessed value be dedicated for facility David W. Steinman replacement.” Linda Strickland

Page 6 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS October 22, 2009 Petition #32-09 (attachment #10) Lawrence Sands, DO, MPH Maker of motion: Jim Christensen Chief Health Officer Second: Joe Hardy Scott Weiss Carried unanimously Director of Administration

That the District Board of Health authorize staff to negotiate with the City of Board Members Present for vote: Las Vegas, Clark County and other jurisdictions in acquiring a parcel of city Chris Giunchigliani property for the proposed Southern Nevada Health District replacement Stavros Anthony facility Kathleen Boutin Jim Christensen, MD Petition states: “The funding would include the Southern Nevada Health Susan Crowley District’s contribution of $.25 of a cent of our allocated property tax.” Robert Eliason Donna Fairchild Joseph Hardy, MD Tim Jones Linda Strickland Lawrence Weekly December 16, 2010 Petition #43-10, Resolution #03-10 (attachment #11) Lawrence Sands, DO, MPH Maker of motion: Donna Fairchild Chief Health Officer Second: Nancy Menzel Scott Weiss Carried with Members Giunchigliani, Vigilante and Weekly voting “nay” Director of Administration Mars Patricio, Jr. That the Southern Nevada District Board of Health approves Petition #43-10 Financial Services Manager and Resolution 03-10. This will amend Petition #10-08 with Resolution #01- 08 for the Southern Nevada Health District pursuant to NRS 354.612. The Board Members Voting Aye: petition and resolution would allow the Southern Nevada District Board of Linda Strickland Health to utilize the resources of the debt service fund for any identifiable Donna Fairchild projects at the discretion of the Board that benefits the public health of Clark Stavros Anthony County. Jim Christensen, MD Tim Jones Approved contingent upon the opinion of the District Attorney relative to Nancy Menzel the district owning real property and use of general funds. John Onyema, MD Lois Tarkanian Petition discussion states: “This amendment would allow the Southern Anita Wood Nevada Board of Health to utilize the funds in the Debt Service Fund for Board Members Voting Nay: costs associated with the purchase or acquisition and associated Chris Giunchigliani improvement to facilities (real property).” Jimmy Vigilante Lawrence Weekly Member absent for vote: Kathleen Boutin Page 7 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS December 16, 2010 Petition #44-10 (attachment #12) Lawrence Sands, DO, MPH Maker of motion: Tim Jones Chief Health Officer Second: Donna Fairchild Scott Weiss Carried with Members Giunchigliani, Vigilante and Weekly voting “nay” Director of Administration Mars Patricio, Jr. That the Southern Nevada District Board of Health authorize administrative Financial Services Manager staff to enter into initial negotiations to purchase property for the proposed Jerry Boyd replacement facility. The property is located at 330 S. Valley View, Las Vegas, Facilities Manager NV. Board Members Voting Aye: Approved as presented contingent upon a favorable opinion from the District Linda Strickland Attorney relative to the district owning real property and use of general Donna Fairchild funds. Stavros Anthony Jim Christensen, MD Petition discussion states: “After diligent search and unanimous approval Tim Jones and recommendation from the Replacement Facility Committee it was Nancy Menzel recommended that pursuing the acquisition of the Century Link Building at John Onyema, MD 330 S. Valley View Blvd., Las Vegas, NV was the best option.” Lois Tarkanian Anita Wood Board Members Voting Nay: Chris Giunchigliani Jimmy Vigilante Lawrence Weekly Members absent for vote: Stavros Anthony Kathleen Boutin

Page 8 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS February 24, 2011 Board Motion to revisit Petition #43-10, Resolution #03-10 and Petition Board Members Present for vote: #44-10 upon consideration of the Board’s decision at the March 24, 2011 Linda Strickland meeting regarding how to pursue and resolve the issue related to the Stavros Anthony dedicated funding stream (attachment #13) Michael Collins, RN Robert Eliason Maker of motion: Chris Giunchigliani Chris Giunchigliani Second: Lois Tarkanian Karl Gustaveson Carried unanimously Tim Jones John Onyema, MD Mary Beth Scow Lois Tarkanian Jimmy Vigilante Members absent for vote: Kathleen Boutin Jim Christensen June 23, 2011 Petition #32-11, Resolution #02-11 (attachment #14) Lawrence Sands, DO, MPH Maker of motion: Joe Hardy Chief Health Officer Second: Susan Crowley Scott Weiss Carried unanimously Director of Administration Mars Patricio, Jr. That the Southern Nevada District Board of Health approve Petition 32-11 Financial Services Manager and Resolution 02-11 to designate the ending fund balance in the Bond Reserve Fund as “committed” per Government Accounting Standards Board Board Members Voting Aye: (GASB) 54, or taking any other actions deemed necessary. Linda Strickland Stavros Anthony Jim Christensen, MD Susan Crowley Karl Gustaveson Joseph Hardy, MD Tim Jones Nancy Menzel, RN Mary Beth Scow Anita Wood Members absent for vote: Kathleen Boutin Chris Giunchigliani Lois Tarkanian

Page 9 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS October 3, 2011 Petition #42-11: (attachment #15) Lawrence Sands, DO, MPH Maker of motion: Lois Tarkanian Chief Health Officer Second: Anita Wood Scott Weiss Carried with Members Giunchigliani and Scow voting “nay” Director of Administration Mars Patricio, Jr. That the Southern Nevada District Board of Health approve Petition #42-11 Financial Services Manager to authorize administrative staff to enter into and/or renew negotiations to Jerry Boyd acquire property for the proposed replacement facility – the proposed Facilities Manager property is located at 330 S. Valley View, Las Vegas, NV, or other suitable location; or take other action deemed appropriate Board Members Voting Aye: Tim Jones Approved motion reads: A motion was made by Member Tarkanian to: 1) Karl Gustaveson authorize administrative staff to enter into, renew, and/or initiate negotiations to Nancy Menzel, RN acquire property for the proposed replacement facility, 2) and for staff to provide Frank Nemec, MD information as to where needed funds can be obtained, and 3) to provide at least three Bill Noonan separate options for a replacement facility for the Board’s consideration; seconded by John Onyema, MD Member Wood and carried with Members Giunchigliani and Scow opposed, and Lois Tarkanian Member Bateman abstaining (expressed prior to his departure). Jimmy Vigilante Anita Wood Rod Woodbury Board Members Voting Nay: Chris Giunchigliani Mary Beth Scow Members absent for vote: Stavros Anthony Members abstaining: Sam Bateman

Page 10 of 11 SOUTHERN NEVADA HEALTH DISTRICT Ravenholt Replacement Facility Planning & Funding TIMELINE

DATE ACTION RESPONSIBLE PERSONS January 26, 2012 Report/Discussion/Action: (attachment #16) Lawrence Sands, DO, MPH Receive update on status of main building assessment and potential Chief Health Officer replacement facilities; direct staff accordingly or take other action deemed Scott Weiss appropriate Director of Administration

Board Members Present: Tim Jones Stavros Anthony Sam Bateman Chris Giunchigliani Al Litman Nancy Menzel, RN Bill Noonan Mary Beth Scow Lois Tarkanian Anita Wood Rod Woodbury Members not present: Jim Christensen, MD John Onyema, MD Jimmy Vigilante February 23, 2012 REPORT / DISCUSSION / ACTION: (attachment #17) Lawrence Sands, DO, MPH Receive report and recommendations from the Southern Nevada District Chief Health Officer Board of Health Replacement Facility Committee; accept recommendations or take other action deemed appropriate Board Members Present: Tim Jones Stavros Anthony Approved motion reads: A motion was made by Member Anthony to accept the Sam Bateman recommendations brought forth by the Replacement Facility Committee to 1) conduct Jim Christensen, MD the Level One through Three structural engineering analysis; and 2) review the two Susan Crowley feasibility of the two sites selected as potential replacement facilities while continuing Chris Giunchigliani to participate in discussions related to development of a medical/academic center in Al Litman the immediate area; seconded by Member Wood and carried unanimously. Nancy Menzel, RN Bill Noonan John Onyema, MD Mary Beth Scow Lois Tarkanian Anita Wood Rod Woodbury

Page 11 of 11 Attachment #1

M I N U T E S

CLARK COUNTY HEALTH DISTRICT DISTRICT BOARD OF HEALTH MEETING 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room Thursday, October 28, 2004 - 8:00 A.M.

Board Members Present: Gary Reese Chairman, Councilman, Las Vegas Jim Christensen, MD Physician At-Large Sherry Colquitt, RN Appointee, Las Vegas Susan Crowley Appointee, Henderson Andrea Anderson Councilwoman, Boulder City Robert Eliason Councilman North Las Vegas Donna Fairchild Councilwoman, Mesquite Joe Hardy, MD Appointee, Boulder City Steven Kirk Councilman, Henderson Mary Jo Mattocks, RN Appointee, Mesquite Rory Reid Commissioner, Clark County

Absent: Chip Maxfield Commissioner, Clark County Stephanie Smith Councilwoman, North Las Vegas

I. CONSENT AGENDA These are matters considered to be routine by the District Board of Health and may be enacted by one motion. Any item, however, may be discussed separately per Board Member request before action. Any exceptions to the Consent Agenda must be stated prior to approval.

Member Eliason moved for approval of the following consent agenda. The motion was seconded by Member Christensen and carried unanimously.

4. Petition #40-04: Approval of Planning for a New Building at the Main Health Center Campus

Attachment #2

M I N U T E S

CLARK COUNTY HEALTH DISTRICT DISTRICT BOARD OF HEALTH MEETING 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room Thursday, March 24, 2005 - 8:00 A.M.

Board Members Present: Gary Reese Chairman, Councilman, Las Vegas Sherry Colquitt, RN Appointee, Las Vegas Susan Crowley Appointee, Henderson Robert Eliason Councilman, North Las Vegas Tom Collins Commissioner, Clark County Andrea Anderson Councilwoman, Boulder City Jim Christensen, MD Secretary, Physician-at-Large Donalene Ravitch Interim Appointee, Boulder City Donna Fairchild Vice Chair, Councilmember, Mesquite Stephanie Smith Councilwoman, North Las Vegas Mary Jo Mattocks, RN Appointee, Mesquite

Absent: Rory Reid Commissioner, Clark County Steven Kirk Councilman, Henderson

V. HEALTH OFFICER & STAFF REPORTS

Dr. Kwalick stated that today is World Tuberculosis Day. We will postpone the presentation on the Tuberculosis program until next month

Dr. Kwalick asked the Board for direction on how to address the proposed legislation contained in AB380. This bill proposes changes to the structure of the Board of Health and also would establish a citizen’s advisory committee and a health advisory committee adding to the bureaucracy of the Health District. As mentioned in our budget presentation, the funds the State is putting into public health at the local level comprise less than 1% of our total budget. Yet, this bill, if passed, would take away the authority of the local jurisdictions to constitute the Board. Representation would be cut to a total of eight members. There would be no physician representation. For those who represent the public health interests of the community at large, this is a poor proposal.

Chairman Reese stated his opposition to the restructuring of the Board of Health. He has been on the Board for ten years and has seen members make extreme efforts to attend and participate in the meetings. Chairman Reese stated he is opposed to removal of members. This board has been very successful and the bill appears to be a personal issue. Board of Health Minutes Page 2 of 2 March 24, 2005

Member Crowley mirrored Chairman Reese’s comment and stated that it does not make sense to change a structure that works.

Member Anderson stated that she appreciated having representation by those in the medical field as well as elected and appointed representation.

Vice Chair Fairchild also stated the commitment level of this board is very high and that the rural areas need to have representation and that it is unfair to remove rural representation.

Member Smith stated she was not necessarily against the committee portion of the structure; however, we have not asked for assistance yet things are being thrust upon us without any input. She does not agree with diminished representation.

Dr. Kwalick stated that he would keep the Board informed. Right now the budget goes to the County Treasurer who is the overseer of our funds at this time. Member Colquitt asked if the committee can take testimony locally. Member Anderson asked if the Board Chairman could possibly meet face to face with legislators. Member Collins stated that legislation may have been introduced because there is a segment of the population that is unhappy with the way services are provided (or not provided). Member Collins also suggested that if we wish to provide comment to the legislature we need to get videoconference scheduled to provide for local input as soon as possible. Member Smith stated that despite our best intentions, there can be political issues that appear that have nothing to do with delivery of services and public health functions. Member Smith stated this organization is run well and we continue to improve every year and have survived budget crises and continue to provide services well. Dr. Kwalick asked that Board members contact their representatives in the legislature and please inform him should they receive any further information. He stated he is meeting with our lobbyists, Bryan Gresh and Gary Milliken tomorrow at 1:00 pm regarding AB380 specifically and if any Board Member wishes to join, they may do so.

M I N U T E S

CLARK COUNTY HEALTH DISTRICT DISTRICT BOARD OF HEALTH MEETING 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room Thursday, April 28, 2005 - 8:00 A.M.

Board Members Present: Gary Reese Chairman, Councilman, Las Vegas Sherry Colquitt, RN Appointee, Las Vegas Susan Crowley Appointee, Henderson Tom Collins Commissioner, Clark County Andrea Anderson Councilwoman, Boulder City Jim Christensen, MD Secretary, Physician-at-Large Donalene Ravitch Interim Appointee, Boulder City Donna Fairchild Vice Chair, Councilmember, Mesquite Steven Kirk Councilman, Henderson

Absent: Mary Jo Mattocks, RN Appointee, Mesquite Stephanie Smith Councilwoman, North Las Vegas Rory Reid Commissioner, Clark County Robert Eliason Councilman, North Las Vegas

VI. HEALTH OFFICER & STAFF REPORTS

Dr. Kwalick spoke regarding AB 380 which is the bill that would reorganize the District Board of Health. The most recent reprint allocates 3.25 cents per $100 of assessed valuation to be placed in a fund in the county treasury for the Health District. The number of seats on the Board would remain the same; however, there would be two from the county, two from the City of Las Vegas, one each from the other four cities along with five appointed members selected by the eight elected representatives. Due to a drafting error, the bill sent over to the Senate provided that the five appointive seats would be chosen by the Board of County Commissioners. The County will be presenting an amendment on the Senate side that would allow the eight elected members to choose the five appointed members. The latter seats would include: two doctors, a nurse, an environmentalist and a new seat which would be representative of the business community. The bill passed the Assembly by a vote of 39-2-1, with Assemblywoman Angle and Assemblyman Christensen voting no and Assemblyman Joe Hardy abstaining because of his position on the Board of Health. The bill is scheduled to be heard before the Senate Taxation Committee on May 12 at 2:00 pm. The hearing will be videoconferenced at the Grant Sawyer building. Hopefully, the measure will pass with the County’s amendment as agreed upon by all parties and will move forward to the full Senate. There are still concerns that the 3.25 cents, which is predicated on $64 billion total assessed valuation, was determined before the 3 and 8 percent caps are applied. The caps could result in a budget shortfall of approximately $160,000 to $170,000. Total revenue to the District cannot be confirmed at this time. Board of Health Minutes Page 2 of 2 April 28, 2005

Chairman Reese asked Member Kirk if he had an issue with losing a member representative from the City of Henderson. Member Kirk stated that there wouldn’t necessarily be a loss of a member as Member Crowley, being an environmentalist, does fit that position. Chairman Reese felt that the City of Henderson has every right to have two members as representatives on the Board of Health. Member Kirk stated that he needed to give this item more thought.

Member Anderson stated that Boulder City would like to retain both representatives. She expressed concern for the rural areas. Chairman Reese indicated that he wanted all members to be assured that everyone has a voice about what is happening. Member Fairchild expressed her appreciation that a nurse from Mesquite was representing the health care needs of their community.

Further discussion of the representative issues ensued. Dr. Kwalick indicated that there will be a July organizational meeting of the Board of Health with operating procedures and bylaws to be set by the Board. The Board could entertain that the five selected seats would come from the county at large or specific municipalities. Chairman Reese stated that he could support these amendments if the Board so chooses, but he wanted to be sure that the eight member board has the ability to make the appointments rather than the County Commission.

M I N U T E S

CLARK COUNTY HEALTH DISTRICT DISTRICT BOARD OF HEALTH MEETING 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room Thursday, May 26, 2005 - 8:00 A.M.

Board Members Present: Gary Reese Chairman, Councilman, Las Vegas Sherry Colquitt, RN Appointee, Las Vegas Susan Crowley Appointee, Henderson Tom Collins Commissioner, Clark County Andrea Anderson Councilwoman, Boulder City Jim Christensen, MD Secretary, Physician-at-Large Donna Fairchild Vice Chair, Councilmember, Mesquite Steven Kirk Councilman, Henderson Robert Eliason Councilman, North Las Vegas Stephanie Smith Councilwoman, North Las Vegas Mary Jo Mattocks, RN Appointee, Mesquite

Absent: Rory Reid Commissioner, Clark County Donalene Ravitch Interim Appointee, Boulder City

VII. HEALTH OFFICER & STAFF REPORTS

Update on AB 380 – Board of Health Structure

Dr. Kwalick gave a brief status report on AB 380 which addresses structure of the Board of Health. He stated we have not received the reprint reflecting the final amendments; however, as it stands now there would be a 13-member Board, with eight electeds – two from the largest city, two from the county, and one each from the other cities in the county. The electeds would then select five members: two physicians, one nurse, one member with an environmental health background and one individual representing an association of the regulated community.

The other change to the bill would increase from 3.25 cents to 3.5 cents per $100 of assessed valuation the funding allocated to the district. Hopefully, the language will emerge as we expect. These changes may come into effect July 1 and the Board of Health could have an organizational committee appointed to provide recommendations as to how to proceed with the changes. The jurisdictions that are going to be losing a seat will have to decide which elected would remain on the Board. There could be a transitional period. We currently have two physicians that have been on our Board, Dr. Christensen and Dr. Hardy, two nurses, Mary Jo Mattocks and Sherry Colquitt. We also have an environmentalist, Susan Crowley. The mechanism to be used for the regulated community association representative would have to be decided upon by the Board. All thirteen members would be voting members. Dr. Kwalick stated that these changes appear to be proceeding in an acceptable manner. Board of Health Minutes Page 2 of 2 May 26, 2005

Chairman Reese indicated that he is uncomfortable with the fact that the County and the City of Las Vegas will have two elected members on the Board while the other entities will only have one. He stated that it was important to have equal representation on the Board.

Update on Program Services Exchange

Dr. Kwalick indicated we are now in the process of negotiating an exchange of program services with Clark County. Ryan White Title I Program Administration will be going to Clark County Social Services and Clark County Vector Control will be moved to the Clark County Health District. A conceptual plan for this exchange will be presented to the Clark County Board of Commissioners at their June 7 meeting. It will be finalized at their June 21 meeting and we will present the Board of Health with the Interlocal agreement that will include the financial details at the June 23, 2005 Board of Health meeting.

M I N U T E S

CLARK COUNTY HEALTH DISTRICT DISTRICT BOARD OF HEALTH MEETING 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room Thursday, June 23, 2005 - 8:00 A.M.

Board Members Present: Gary Reese Chairman, Councilman, Las Vegas Sherry Colquitt, RN Appointee, Las Vegas Susan Crowley Appointee, Henderson Tom Collins Commissioner, Clark County Andrea Anderson Councilwoman, Boulder City Donna Fairchild Vice Chair, Councilmember, Mesquite Steven Kirk Councilman, Henderson Robert Eliason Councilman, North Las Vegas Stephanie Smith Councilwoman, North Las Vegas Joe Hardy, MD Appointee, Boulder City Mary Jo Mattocks, RN Appointee, Mesquite

Absent: Rory Reid Commissioner, Clark County Jim Christensen, MD Secretary, Physician-at-Large

VIII. HEALTH OFFICER & STAFF REPORTS

Dr. Kwalick presented Bryan Gresh and Gary Milliken, legislative lobbyists, to summarize the legislative session. Mr. Gresh summarized the history of AB380. There were four reprints of this bill. This bill would have reorganized the makeup of the Board of Health to include only elected members consisting of two from Clark County, two from the City of Las Vegas, and one each from North Las Vegas, Henderson, Boulder City and Mesquite. The original intention of the bill was to have the chief health officer serve as an ex-officio non-voting member of the Board. A health advisory committee would have been created made up of non-voting health professionals selected by the new Board. A citizen’s advisory committee would be composed of members of the general public. The original bill made no mention of a specific funding source. The sponsor of the bill did indicate his willingness to work with the Health District. The county stepped up and offered a dedicated funding source which started at 3.25 cents per $100 assessed valuation but was ultimately locked in at 3.50 cents per $100 assessed valuation. Because this was the session containing the property tax cap, there is no history of what those funding levels will prove to be in actual dollars. The county stated on record that if the funding level is not sufficient to cover the health district’s budget, the county will make up the difference. The final version of the bill allows the health district board to remain fairly close to its current makeup: two elected members from the county, two from the largest city, and one each from the other cities in the county. The elected members of the board will also select as full voting members: five additional at-large experts, two physicians, one nurse, an environmental health specialist and a representative from an industry that is subject to regulation by the health district. The district’s chief health officer remains one position. Earlier versions had the position split in two, with both a chief health officer and a general manager. This bill was signed into law by the Governor on June 17.

Board of Health Minutes Page 2 of 2 June 23, 2005

Both AB 380 and AB 260 passed the full houses of the legislature with little opposition, AB 380 received just two ‘no’ votes and AB 260 passed both houses unanimously.

Attachment #3

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, September 28, 2006 - 8:00 A.M.

Board Members Present:

Donna Fairchild Chair, Council Member, Mesquite Gary Reese Secretary, Councilman, Las Vegas Karla Burton Council member, Boulder City Jim Christensen, MD At-Large Member, Physician Susan Crowley At-Large Member, Environmental Specialist Robert Eliason Councilman, North Las Vegas, Member Alternate Lon Empey At-Large Environmental Specialist Alternate Joseph Hardy, MD At-Large Member, Physician Tim Jones At-Large Member, Business/Industry Jimmy Vigilante At-Large Business/Industry Member Alternate Lawrence Weekly Councilman, Las Vegas

Absent: Lynette Boggs McDonald Commissioner, Clark County Tom Collins Commissioner, Clark County Steven Kirk Vice Chair, Councilman, Henderson Mary Jo Mattocks, RN At-Large Member, Registered Nurse Frank Nemec, MD At-Large Physician Member Alternate John Onyema, MD At-Large Physician Member Alternate Stephanie Smith Councilwoman, North Las Vegas

IV. REPORT / DISCUSSION / ACTION 1. Petition #43-06: Approval of Proposal for Architectural Services from PGAL LLC for new main building design

Mike Walsh, director of administration, recommended to the Board they approve PGAL to begin planning for a new facility. Mr. Walsh introduced Jeffrey Gerber, president of PGAL who, through a presentation will highlight the process to be used in planning for this project. Mr. Gerber introduced himself and David Moss as principals of PGAL. He explained the interactive approach their firm would take when designing the replacement facility. They specialize in health and public sector projects. A very interactive process will be used to engage the user groups at all levels. It is important that consensus from the numerous groups is obtained. A program will be developed which will identify the requirements of the facility. A single line drawing will be developed based on the program to test the planning assumptions and to ensure building flow has been maximized. A project budget will be determined, and if any adjustments need to be made they will be done at this time and not later on in the process. While the space requirements are being developed, the site will be studied for optimal uses and configurations. Operations will need to be maintained and the challenges will to be sure the facility has not been compromised because staff had to work around existing conditions. There are a number of options available. As part of the process each phase will be examined as to what happens to parking and what happens as various Board of Health Minutes Page 2 of 2 September 28, 2006

parts of the building are removed so that existing operations can be maintained. This will be a challenge. Maintaining the parking requirements alone will be a very difficult scenario.

PGAL wants to deliver a program and a concept that works, but that is also one that the health district’s team believes will satisfy all of staff needs and issues. The safety of the public while utilizing services is a major consideration. There are a number of configurations that have been offered utilizing this existing site. Mr. Gerber stated he and his staff look forward to determining which will work best. Ultimately, it is believed the Board will be reviewing additional graphics that might assist in establishing funding for this project. Examples of this have been brought today as well.

Mr. Gerber stated that they are pleased and excited to be working with the Board of Health.

Member Weekly asked about staff input regarding space, storage, etc. Member Weekly also asked that as various scenarios are presented to the Board what would be the proposed square footage and how that would apply to parking.

Dr. Kwalick responded that the facility will be approximately 150 – 200,000 sq. feet. Part of the process by PGAL is to meet with a team that will be representative of all the divisions and programs of the health district. Grassroots input will be received by the team in an effort to ensure that all space is utilized efficiently and effectively. Member Reese indicated that during these processes, local businesses and residents will be affected by the process and we will need to reach out to the community.

Dr. Kwalick stated that we will certainly need assistance from the Board as we may need to approach the city to assist with funding. We are currently working with the County. The initial construction estimates were $35 – 40 million when first addressed to the Board in 2004. Prices have risen bringing the estimate closer to the $55 – 60 million dollar range.

Member Weekly asked about the County response to funding. Dr. Kwalick stated that the County has not been approached in terms of funding; however; the health district is working with the County manager and Director of Finance.

Member Jones asked about the process in place for public comment. Dr. Kwalick responded that this is something that can certainly be built into the process.

Member Eliason asked about the length of time before the 150 – 200,000 sq. foot facility will be outgrown. Dr. Kwalick responded the existing campus is about 80,000 sq feet, plus another 15,400 sq. feet at 400 Shadow Lane. With the last 7 years of growth from 300 to 600 employees, the new facility could be outgrown in ten years. The plan would be to have the shell constructed and then build out as needed.

Member Weekly asked Dr. Hardy if this is something that could be brought up at the next legislative session. Dr. Hardy responded that yes, this will require some discussion at the state level regarding funding. It will require a cooperative effort with all parties. The academic medical center model will be examined as well. The public and private funding options will be examined. Member Weekly asked if there are partnerships developed or lobbyists within our local governments. Dr. Kwalick responded that The Gresh Group is the lobbyist for the health district. Bryan Gresh and Gary Milliken have represented us very well in the last legislative session.

A motion was made by Member Reese to approve PGAL as the architect and planning company; seconded by Member Hardy and was unanimously approved.

Attachment #4

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, March 22, 2007 - 9:00 A.M.

Board Members Present: Donna Fairchild Chair, Council Member, Mesquite Steven Kirk Vice Chair, Councilman, Henderson Gary Reese Secretary, Councilman, Las Vegas Jim Christensen, MD At-Large Member, Physician Susan Crowley At-Large Member, Environmental Specialist Chris Giunchigliani Commissioner, Clark County Timothy Jones At-Large Member, Business/Industry Mary Jo Mattocks, RN At-Large Member, Registered Nurse Lawrence Weekly Commissioner, Clark County Robert Eliason Councilman, North Las Vegas, Member Alternate Lon Empey At-Large Environmental Specialist Alternate John Onyema, MD At-Large Member, Physician Alternate Jimmy Vigilante At-Large Business/Industry Member Alternate

Absent: Karla Burton Councilwoman, Boulder City Joseph Hardy, MD At-Large Member, Physician Frank Nemec, MD At-Large Member, Physician Alternate Steven Ross Councilman, Las Vegas Alternate Stephanie Smith Councilwoman, North Las Vegas Debra Toney, RN At-Large Member, Registered Nurse Alternate

III. REPORT / DISCUSSION / ACTION 1. Update on plans for a new main building – PGAL LLC

A PowerPoint presentation was given by Jeff Gerber, President of PGAL LLC, and Sheree Ockman (attachment #2). The presentation outlined building plans for the three story, 175,500 square foot replacement facility. Fourteen steps were outlined, ten of which PGAL has completed, from project start up and data collection to final phasing and budget.

Commissioner Giunchigliani asked about the composition of the team that was involved in the input process. Mr. Gerber indicated they met with representatives from every division, the executive team and all the managers several times for the input phase. Commissioner Giunchigliani asked if rental space will be eliminated or reduced. Mr. Walsh responded there will still be neighborhood public health centers; however, the 17,000 square feet of rental space at Shadow Lane will be eliminated. There was discussion regarding construction of a parking garage. Mr. Walsh indicated a decision was made to maximize resources dedicated to the building of the facility structure.

Commissioner Weekly asked if there will be any variance requests. Mr. Gerber stated they have not started to have conversations with the City regarding variance requests. It was suggested we may wish to have initial conversations as projected dates have been discussed Board of Health Minutes Page 2 of 2 March 22, 2007

with respect to Project NEON and the widening of Martin Luther King Boulevard. Commissioner Weekly asked about funding of this facility. Mr. Walsh stated he wishes to hear from the Board regarding any recommendations or direction on how to proceed.

Mr. Walsh indicated he has had several discussions with County management as this process has moved forward and he has been keeping George Stevens apprised of the progress. Commissioner Giunchigliani suggested specifically listing this as a potential action item at the next board meeting and then make the request of Mr. Stevens to do the same at the County Commission meeting. Dr. Kwalick suggested using the county bonding authority to pursue funding at this point in time. Chair Fairchild suggested pursuing federal and state grants as well.

The board thanked Mr. Walsh, Mr. Gerber and Ms. Ockman for the update.

2. Petition #09-09, Memorandum #09-09: Approval of Tentative Budget for Fiscal Year 2008

Mike Walsh, director of administration, introduced Sylvia Claiborne, financial services manager, who gave an overview of the Tentative Budget for fiscal year 2008, including highlights (attachment #3). Chair Fairchild stated that an amended copy of page 11 was distributed to all members.

The estimated tentative budget revenue for FY 2007-2008 is $66,955,463 and proposed combined operating expenditures, capital reserve, liability reserve, and proprietary fund transfer dollars for the next fiscal year are $72,621,043. Total transfers to the capital reserve fund, liability reserve fund, and proprietary fund are budgeted for the amount of $5,788,613. The projected ending fund balance for FY 2007-2008 is $7,678,092, approximately 10.6 percent of projected annual expenditures, which is within the normally accepted practice of one-twelfth or more of expenditures for government agencies.

The FY 2007-2008 Tentative Budget provides for a realistic budget with an acceptable General Fund reserve and funds the expected increased service levels in all Divisions. Included in the Tentative Budget 2007–2008 are several graphs depicting revenue and expenditure relationships for FY 2007–2008. The Tentative Budget is a working document which proposes a fiscal solution to assure the provision of necessary public health activities during the coming year. The budget presented today is a balanced budget with a modest surplus of $123,033.

There was discussion as to methods to reduce current costs in the interim to building a new facility. A key feature within the budget are fee increases which allows the district to incorporate program overhead and hire much needed additional staff.

Member Crowley asked how the reserve fund will assist us in moving toward the direction of a new building and how that process fits into obtaining funding from other sources. Mr. Walsh stated the intention was to move forward and if there are delays or if the county cannot help us next year, but perhaps the year after, there would be enough funds set aside to start with the engineering drawings, etc., so we would not be looking at completing the project five years in the future. There was also discussion of the health cards issuance process and perhaps partnering with other agencies who also issue certain types of identity cards.

A motion was made by Member Jones to approve the Tentative Budget for Fiscal year 2007-2008; seconded by Member Crowley and was unanimously approved.

Attachment #5

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, May 24, 2007 - 9:00 A.M.

Board Members Present: Donna Fairchild Chair, Council Member, Mesquite Steven Kirk Vice Chair, Councilman, Henderson Karla Burton Councilwoman, Boulder City Jim Christensen, MD At-Large Member, Physician Chris Giunchigliani Commissioner, Clark County Timothy Jones At-Large Member, Business/Industry Lawrence Weekly Commissioner, Clark County Lon Empey At-Large Environmental Specialist Alternate John Onyema, MD At-Large Member, Physician Alternate Steven Ross Councilman, Las Vegas Alternate Debra Toney, RN At-Large Member, Registered Nurse Alternate

Absent: Tom Collins Commissioner, Clark County Alternate Susan Crowley At-Large Member, Environmental Specialist Robert Eliason Councilman, North Las Vegas, Member Alternate Joseph Hardy, MD At-Large Member, Physician Mary Jo Mattocks, RN At-Large Member, Registered Nurse Frank Nemec, MD At-Large Member, Physician Alternate Gary Reese Secretary, Councilman, Las Vegas Stephanie Smith Councilwoman, North Las Vegas

2. Petition #10-07: Approval to Seek Funding for New Main Campus

Mike Walsh said that at the March Board of Health meeting the architects presented the conceptual design for a new main campus and staff wanted direction at that time to seek funding for the new main campus. As that request was not agendized the matter was brought back to the Board for discussion and direction.

Chair Fairchild said that federal community block grants may be a possible source of funding as the district provides community services. She asked for suggestions from other Board members. Member Giunchigliani mentioned that discussions with George Stevens from the County occurred about receiving financial assistance for funding. She said that an idea came forward to relocate the UMC Wellness Center within the new facility, but not under the jurisdiction of the health district. She asked this information be brought forward publicly as this discussion may continue. Mr. Walsh said that exam rooms in the new design are for existing services and their future expansion, not for partnering with other entities for space. Member Giunchigliani said that this will be a discussion, and hoped that it would not affect the square footage dollar amount. Mr. Walsh said that in his discussions with Mr. Stevens there was mention of cost-share on potential funding. The dedicated funding stream from property tax dollars included a quarter cent increase that was to be dedicated to capital. Based on current tax revenues for the district, that equates to $1.7 million currently used for operations, that would need to be redirected. Member Burton asked to clarify that the decision to allocate the Board of Health Minutes Page 2 of 2 May 24, 2007

money for operational costs was internal. Mr. Walsh said that the district cannot manage the financing ourselves, and with the good faith and credit of the County the district would contribute as much as possible without compromising operations.

Chair Fairchild asked if a grant writer were researching available federal and state grants currently. Member Giunchigliani agreed that grant monies would be a worthwhile source of funding. The district is currently recruiting for this position, and this will be a task for the incumbent once hired. Mr. Walsh also said that the cap on the property tax has inhibited the district in such that an additional $9 million would have been allocated to the district which could have been used to fund a building if the cap were not in place.

Chair Fairchild asked for additional recommendations from the Board. She asked Mr. Walsh if he felt comfortable with the direction received. Mr. Walsh responded affirmatively. Chair Fairchild called for a motion.

A motion was made by Member Giunchigliani for staff to be directed to look at seeking funding for a new main campus; seconded by Member Empey and was unanimously approved.

Attachment #6 Board of County Commissioners Meeting – July 3, 2007 Excerpt from transcript provided by Clark County

>> Mr. Chairman.

>> Yes.

>> In our rush to have zoning today, I have neglected to give you the opportunity here on 110. So item 110 has received a report regarding development of replacement facility. Direct staff accordingly.

>> Good morning commissioners. Mike Walsh, director of administration, Nevada health district. With me, Dr. Larry Sams, chief health officer. Jeff Gerber, prosecute of PGL architects. Very early presentation of the building plans for the new health district building. The health district in 1962. In 1964, the current building, main building on shadow lane was built at that time the population of Clark County was about 190,000. That is rather approaching 2 million. The building that we are in is about 79,000 square feet. What we are proposing, significant increase. Not only meet the demands of today but through the next 10-15 years. Jeff Gerber will give you a quick presentation. >> Oh, I might add one thing, in looking at the building, we brought out a look for partners. Been approached by other agencies to partner. We are currently talking to university medical center about the relocation of the wellness program and we have had some conversations with Darryl Martin assistant county manager about the possibility of moving some of the Clark County social service operation specific to Ryan white into the building also. So, with that, Jeff.

>> Thank you, good morning.

>> As Mike said, we spend a little over 3 months working with staff developing a long term plan for the facility to provide at least ten year growth in terms of staff. And in front of you, it is site plan that resulted in a three story structure, little over 200,000 square feet. We have situated on the site, because we understand that the ongoing operations of the facility must be going on while the construction of a replacement facility has to occur so the building has been cited so that the main structure can remain in place and then operation during construction. Also age to accommodate what is beyond today. In terms of the users, this includes all of the users currently on the main campus and those that are in adjunct facilities that are located around the main campus. As Mike said, it includes the wellness center component for EMC. Real quickly, on level 1, we put all of the high volume traffic areas of the facility. There are a large number of people in the business facility in the day. We put a lot of vital records and health cards and immunization also the wellness center on the first floor as well as the public health lab. We also put a large conference space, to consolidate that throughout the building. Also located on the first floor, left hand side in the pink color. On level two, we put the environmental health group that is the largest user of foot traffic to try to minimize that throughout the building. As well as some other support facilities for the nursing units. On level three, we put the components up there, we have the very least amount of public traffic essentially the administration, a key group of that nature. So that we would be able to minimize the traffic through the building. This is a quick rendering that we did to illustrate what the building could look like. Again, it is a three story building. Located on the site with the parking fuel located in front. We also prepared a project budget that represents the work that has been completed and the party that is not is only in 2007 dollars and it does include not only our construction cost but self-cost, contingencies and represent as little over $60 million. So with that, I would be happy to answer any questions.

BCC meeting transcript Page 2 of 7 July 3, 2007

>> All right. Thank you. I think Mr. Stevens, did you have a comment or a question? All right. Mr. Chair.

>> Some point, I would like to talk about how a building like this might be financed. If you have questions on the specific project you might want to do that first.

>> I think that we have questions.

>> Commissioner, Brager and then commissioner.

>> I am really hoping this is not in a stage that I am not look fog vote today, tomorrow and next month possibly. I am going to be disappointed they are not meeting. So that we had an opportunity to be getting along with you or a concern in the type of environment where there is time to tear down a building antiquated to the placement of the community. I represent the southwest curb of California, so Blue Diamond in west point so my clients, constituents are knowing it is hard to get to the health district to do anything. Secret site. I don't know if anybody knows what it is or what it does, I have been here my whole life possibly. I tried to tell them about this. And where is it? What do they do there? Why to the health district? I'm going to everything right now with a very, very, very big concern. Big price tag. Concern that it is antiquated in placement of a community. I think we need to look at it in a different manner to serve the constituents of the whole committee. I would be happy to meet with you. There is nothing prepared. Due to not enough information on what I think. I totally think that the health district is important. I think it is in the anarch. I think you are fun people. I am not going to sit here, someone who represents 310,000 people and make a decision without the information I need.

>> again, commissioner weekly, commissioner wants a question.

>> Thank you. I was going to ask, I neglected this to do this at health district meeting. I think we should start adopting policies as a county, any public work project, that could actually look at environment, green building and so on and so forth. So, I was curious, I neglected to ask this, how this facility, does it adopt any environmentally saving of lighting of energy and so forth so we are moving towards that kind of, as we construct our new buildings.

>> We assume that our planning, that you, that the county would want to adopt as much green as possible.

>> Remember that in your square footage.

>> with $263 a square foot. 256?

>> In that range.

>> Which I think that was good. That is 2007. Who knows what will happen in the next few years. Whatever, whenever what building comes into play. So thank you. I think there has been a conversation that perhaps in the construction, we might look at the core location of the wellness center and that the warehouse might revert to the county based on that. It is a facility that we could maybe do something with. I wanted to note that for the record that those conversations have taken place.

>> Commissioner.

>> Thank you.

BCC meeting transcript Page 3 of 7 July 3, 2007

>> Thank you, I want to say, as gentleman is standing here, I want to say this expansion, the health dest ricket, is -- district, is very, very important and necessary especially with the -- based on the number of services that they do provide. Being a member on that board is what commissioner, this is a concern that I had, miss Valentine, as it relates to serving on boards that don't provide enough information to our colleagues. I am just kind of, listening to commissioner Brager here. I know that Dr. Sands just moved into his position. This concerns me. This is important project. Price tag looks hefty, commissioner Brager, but when you look at the research done, health district trying to relocate to other – another possible area, land costs, were just extraordinary. Trying to do much with very little to work with, this is what they have had to deal with. I know that we had our concerns. I'm serving on this board. I think based upon just again, some of the services and the number of men and women that provide the services and community, they want to say that I would like to maybe give direction here today that help. I am not sure if you had a chance to brief the commissioners. I think with this amount of money we are talking here today, I was under the assumption everyone was aware of this. And, I guess I want to apologize. As a board member, it is my place, if it is, to apologize. Think that these things ask to be discussed and board membership not caught off guard having to make a decision like this.

>> Commissioner, I want to tell you that we have had several meetings with Dr. Sands and certainly open to more communication. Trying to be respectful of the time knowing how many boards and commissions you do serve on. We will though, start periodically inviting him to some of the briefings at milestones and this project when other significant issues arise and we have had similar concerns with some commissioners wanting more information on RTC, and other issues. It is a -- it is something that we are aware of. With Dr. Sands leadership, that something will be able to improve on, the communications between health district activities because they are linked to Clark County and some of the services that we both provide or jointly provide together and certainly something to work on.

>> Yeah, I just don't want it to be misconstrued here, that the health district is standing here asking for something astronomical. Men and women over there, stacked on top of one another trying to make it work. I mean, before they can even open up the doors in the morning, there is a line outside of people there from everything you can possibly think of. So, you know, I want to go on record saying this is very, very necessary. And, you know, this is a site that, you know, they are staying there because they don't have any other choice. No money for them to possibly go anywhere else. There was a lot of research on trying to relocate them. I thought I would speak up as a board member and put that on the record. Thank you.

>> Commissioner Brager. Commissioner.

>> I don't want to be taken wrong. I'm not saying it is not needed but don't like to be hit with something that I have to be responsible without some insight as to why and how come. With this, it is a long drive. When you go, you have to take the day off work. With that person at 7 o'clock. Maybe get to work by 10-11. I'm looking at sites that if we could work hand in hand with, quick cares. Maybe partnership that people get shocked. Out in the southwest and valley and Goodsprings. Wherever it might be. Even in, you know, the fall. Off 215 corridor that we build some relationships. But haven't had that opportunity. I also ask questions and come to agenda. Sometime west are filled with other obligations. So I would have to meet, share some of the thoughts that I have and be supportive of endeavors that are important to the community. But the way that we are developing and drawing I want to make sure that all resources aren't in one place and the people really can't get there no matter what. It is like flu season, you can. I watched my parents at 88 and 85, my dad in a car because she couldn't stand there. I'm using it as an example. Because they couldn't stand for 4-5 hours to get a shot. Times, like other resources, drive-thru place that they can stay in their cars, our elderly people and we are to them. Really elderly when I say that. BCC meeting transcript Page 4 of 7 July 3, 2007

>> Yes.

>> So I think that there are things to work on together. I love being health. I respected commissioner weekly having always been there as a city person is why I relinquished my speed. Because it was one of my first places I wanted to be. Because I really have a deep desire for that. Out of respect for someone who has been there longer, I did give that up. In the future, it would be something. I am open and don't want to be taken as a negative factor. I thought to be accountable to people I represent.

>> I might add that we are not planning on eliminating the concept that we have started recently of satellite facilities. It is just that, you know, for example, the Henderson facility, we opened in September, is 23,000 square feet. It is rental expensive, half a million a year.

>> You are in a good position there.

>> Commissioner.

>> I was going to say, along commissioner weekly, we probably should have talked to folks, too. I see that on other commissioners and boards. Always have my reports. Always get my digs in when I can. Also, I think that commissioner Brager hit the nail on the head. 11 quick cares. Sometimes people don't look at the volume. Get the location to talk about in some cases where people who come in and get their shots or if they have -- just their -- yeah, TB test. Even their cards for their work cards. I mean, I know you have satellite applications, maybe as reviewing it, you still need the facility. I don't argue that. We just need to make sure what you have done and the staff, maintaining phenomenal. But maybe the satellite or co-locations in some cases could actually generate more visits in other things as quick care as doing expansion as we are looking out for some constituents where they don't have to drive across town to watch the movie or get the cards, health cards or so forth. As you look at that, Dr. Sands, might be another piece. I think the briefing wos be helpful. Darryl tried. Picking that up a regular series where a couple of us could join together. Because that might help with the timing part of it as well. So all valid issues that were brought up today.

>> We would be more than happy too. Anymore comments or questions from the commissioners? If not, George.

>> Commissioners, I thought it would be helpful to discuss a little bit of the history of how we thought this building might be funded. As you know, the counties the biggest source of funding as we give them 40% of the budget. Historically that was done through annual negotiation process if you will as part of the process. In 2005, the legislature changed the mayor which we funded the health des rec. Original proposal went to county would dedicate not to exceed 3.250% of property taxes. That amount was arrived at because it basically equaled what we were giving the health district at that time. Through discussions and the course of the legislature moved on, there were some discussion between Tom rally and Dr. Colic at the time that they had a need for some additional funding for a capitol program. And, ultimately what happened was the legislature actually increased the three and a quarter stand to 3.50 correct. Always that intent that extra quarter once said, only use ed for a building. That amount Jeb rates approximately 1.8 million. 1.9 million in the current year. Of course, we would expect it so that it would gloat some rate overtime. We can't expect what that is but expect it to go.

>> Somewhere in the neighborhood, 60-50 million would require annual debt service in the range of 4- 4.5 aer. Am of property tax that they currently have is not sufficient to fund the development of the building at least not in the early years of the building. We aped that perhaps what might have to occur, the county would subsidize the debt service in the early years and perhaps get pad back. The course BCC meeting transcript Page 5 of 7 July 3, 2007

of, unfortunately, the sorts of that, would be the intended 3 cent property tax and the 5% levee. To give.

>> Background on the property tax, generally $33.6 million. And while there is a statutory formula for dividing up that money, we amended the provision by going into local agreement. First in '91 and then again in early 2000s. And essentially what that local does, it gives 40% of the proceeds of the tax, from the top to the RCC of transportation improvements and next 25% goes to the county for what we consider to be county-wide services, the things that the city doesn't provide. That source of money is where we were thinking the health district building might get some funding from. And then the balance of the tax, is distributed to the incorporated cities and corporated Clark County based on it. The agreement effective until June 30, 2012. No cancellation provision for that local agreement although can be amended by all of the parties. Prior to AB595, the way that the distribution would work, well, next fiscal year would be 14.5 million off the top for the RTC. And then county portion would be approximately 13.9 million and 24 the balance of 7.9 million distributed to the cities. I think that it was believed that when 8595 passed that all of the 3 cents would actually -- all of the tax, the 2 cents to RTC and then 3 cents used to go to the incorporated city and county all for transportation. However, that is not what the interlocal calls for. The interlocal talks in terms of percentages. If the amount that the county receives to distribute is reduced to 2 cents, only 40% of that will actually go to RTC. If you see on the next slide, the way that the distribution will work under the interlocal agreement if it is not amendments, the R it C will receive $8 million. $5 million less than what it currently receives. The county from 13.9 to 5.5. And then see the effect on all of the other entities. So there is still, based on the interlocal currently is without it being changed there is still some money available in the property tax. However, one of the other issue west had, we intended to use a portion of the money for the development of low level facility which I believe that many of you feel is a significant priority to the county and so that, again, does, does cut into the funding that might be available for this building. We looked at a couple of different options on how this building could be funded, the preferably way to do issues, typically debt service, to pay the same amount every year. 25 If you have a dedicated funding source for that, that is really the most efficient way of doing it. The other possibility is to use a debt service level where you actually have the payments, the debt service payment increase overtime. In the early years, mostly paying interest and then the principle and interest escalates overtime as the property tax escalates and grows. The thing that is risky about that though, if you look at that, the two bottom lines of the slide, it is that in terms of total debt service, the increase in debt service cost the taxpayers essentially an extra $8 million over the life of the bond issue. And, it also increases the risk of the debt issue quite significantly because of instead of having maximum debt service payment of $4 million which when you compare that to the $2 million that roughly health dest ricket has, you can expect over the bond issue, you can grow into that $4 million. When you have to grow to a debt service page, some point of the future, $8 million, that increases the risk of that. I think that we need to do, what we need to do, health district needs to really finalize what they are doing with this building. There is obviously not to that point yet. Building is not designed. We really need to sit down and discuss how we might enter into some interlocal agreement with the health district to, to participate in that funding project. Probably what we ultimately will end up with, financial scenarios, somewhere in between the two that we see on this slide. So we can mitigate the risk of increasing debt payment service overtime.

>> Judge, when you are saying somewhere in between, come up with a different financing program that wouldn't be level but wouldn't be increasing?

>> Well, that is going to be increasing debt service schedule but probably with the county subsidizing it to some extent in the early years so that you don't have to get to the point where you need $8 million debt service payment. Some point in the future. And explain to me, how we missed it, what the effect of what you are talking about, funding, the health district facility would have on the low level?

BCC meeting transcript Page 6 of 7 July 3, 2007

>> Well, we are still in negotiations on the low level facility. We don't know where we will end up on that. Again, my sense is that the crisis in the detention bid is high priority for the county. That suggesting that we would take money from that project to give it to the health district.

>> That we would not.

>> Probably not.

>> and probably not what we recommend. Righted now, roughly 4 million the county could put towards it.

>> 1.9 million in property tacks going to the health district that can go towards that. I under stand that we have two commissioner, weekly and other to discuss the facility and I was on the board and certainly are verging on the seams and need the facilities. Other hand, RTC and flight control and other boards don't come back saying we need money for capital, the passengers, if you are going to have effect on Clark County and expect some participation, some source, I think we need to know, this is one way to we're not that to us, here, but certainly I am not comfortable and I know that we are not asked today to make a decision. You know, because we have X-amount of dollars and which have, you know, ten times the needs. I think we need more discussion. Dr. Sands you and your staff, manager's office about competing interest in needs and how we could go into other type of agreements whether that be the MC or quick care, whatever there. Whatever other options are available. Even beyond all of that, I think that we should be, instead of saying have a nice beautiful facility which is needed, all of those things are true, if you put in the cart before the horse, if you have about $1.9 million annual debt service ability and that could be phasing or targeting buildings or facilities to be incorporating that amount of dollars. Not to twice or more. The dollars. You can say the money is going to come from somewhere. I don't know where you started from. If pure space plan, we want a facility is that is expect-amount square foot and don't know how to pay for it. Or we need this facility and overtime, maybe start with this fading and that phasing and that phasing. It is not necessarily what we all like but the reality is, you know. We only have so many dollars. So, that is what the judges are doing. That is what the low level offender do. That is what they are doing. All doing because the reality is they only have so many dollars an George is very good in trying to figure out ways to finance things. We have competing interest and needs and we can't say that we are going to spend, $4.5 million a year for this facility and then if get low level or six judges by 2009 that we have to, have to accommodate. We don't have a choice. That is going to be tens of millions of dollars as well, too, for that. If we can fit them in the facilities we have. If we can't fit in the facility west have, it is going to be a lot more than tens of millions to house that. And I know that Mr. Walsh, you understand that very well. I think we need a little more, communication, discussion about alternatives and then perhaps either the other cities can step up more or you can phase or we can do a combination of all of those things.

>> Mr. chairman, that was one thing I did mention. We haven't had discussion with the city, so all ad representatives on the board, health district, as to whether they be interested in perhaps putting money in. Anything that put in, obviously would help to support the debt service in the early years. Absolutely. This is one thing that I notice, before I noted that the county pays the proportionate, the majority, the money from the health district torque the health district, majority of the Clark County and there is comments, years ago, about air quality. And concern that was, would be, with the region and I think that it worked out well, one of the comments back then, I hate to say it, I don't mean it with offense to the cities an that, but you have to pay to play. And, you know, this is a facility and called southern Nevada health facility. Southern Nevada, hopefully they recognize the fiduciary responsibility as well and not just come to Clark County thinking that we are going to pay for everything. I would expect to see equal participation because of board and the health district is made up of Clark County and the city and a few other folks, too. Commissioner weekly. BCC meeting transcript Page 7 of 7 July 3, 2007

>> Just in closing, I would he like to say that sounds, you know, I see that we have work that we have to do. From my perspective time I served on the board, I do understand, definitely the need for what you are asking for. I just want to say, since I have been here at Clark county, I understand, I met with the judges and I know that they are bursting at the seams from prosecutor office and DA office, child and family services, a lot of services here. I want to say to you, as we go back to our own board, maybe this is a discussion that we want to have on the agenda as to what type of strategic plan you will put in place. Because I want to see us be more aggressive. And, I have learned here, at the county, closed mouth don't get fed. Next time you come back, come back with fire and letting this board know that definitely what you are all needing. Again, you know, some of that health dest ricket is serious entity because it is something major, if it happens in the city or in southern Nevada as we are seeing, this town will be shut down. You are the first responders and I just think that we need to butt on the record how important this is. You are bursting at seams over there. If you have to come back next time with ugly ones and pretty picture, do what you gotta do.

>> Okay. Leading into the D.A., the public defenders and sheriffs much anyways. ( inaudible ).

>> You said that. I didn't say that. All right. Any other comments or questions? Thank you. Now.

>> That concludes your business agenda.

Attachment #7

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, July 26, 2007 - 9:00 A.M.

Board Members Present: Steven Kirk Vice Chair, Councilman, Henderson Gary Reese Secretary, Councilman, Las Vegas Ricki Barlow Councilman, Las Vegas Susan Crowley At-Large Member, Environmental Specialist Chris Giunchigliani Commissioner, Clark County Joseph Hardy, MD At-Large Member, Physician Tim Jones At-Large Member, Regulated Business/Industry Bubba Smith Councilmember, Mesquite Lawrence Weekly Commissioner, Clark County Frank Nemec, MD At-Large Member, Physician Alternate Stephanie Smith Councilwoman, North Las Vegas Alternate

Absent: Jim Christensen, MD At-Large Member, Physician Robert Eliason Councilman, North Las Vegas Mary Jo Mattocks, RN At-Large Member, Registered Nurse Linda Strickland Councilmember, Boulder City Tom Collins Commissioner, Clark County Alternate John Onyema, MD At-Large Member, Physician Alternate Steven Ross Councilman, Las Vegas Alternate Debra Toney, RN At-Large Member, Registered Nurse Alternate

III. REPORT / DISCUSSION / ACTION 1. Petition #30-07: Approval to Seek Funding Sources for the New Main Campus Building

Mike Walsh, director of administration, informed the Board that he along with Dr. Sands and Jeff Gerber from PGAL, made a presentation to the Clark County Board of Commissioners at their July 3rd meeting. As result the presentation and questions asked, the question of other entities participating in funding was raised. Based on that recommendation, and the support of Members Weekly and Giunchigliani, the district is asking for the Board’s guidance in approaching the different municipalities, either the city managers or councils, to present the plan and possibly ask for their assistance in funding the facility.

Member Hardy suggesting changing the name of the agency back to the Clark County Health District.

Member Stephanie Smith said that she lives in North Las Vegas, but also Clark County, and she pays Clark County taxes for these types of matters. She said that the county receives their money for these issues through the property taxes.

Board of Health Minutes Page 2 of 3 July 26, 2007

Member Weekly said that he supports staff on this issue. He was not happy with the presentation at the Commission meeting and the presentation was disappointing to his fellow commissioners hearing the plan for the first time. He suggested briefing council members before making a presentation. The commission would have liked a briefing prior to the presentation. The county is in agreement that the other jurisdictions should participate in funding the building. From a local government stand point, all jurisdictions should be involved. He said that a new facility and an expansion are very important. He feels that the local government is not taking this very seriously – it is more than just seeking a nice facility. It is about having the adequate space needed in order to put these services out to public. In types of emergency, the district is often a first responder, such as in time of a pandemic. He said that when the briefings and presentations occur, we need to say what we are asking for and what exactly is needed.

Mr. Walsh said that the district was the last item on the agenda and county staff asked him to shorten the presentation because the meeting was running late. Member Weekly said that this item was just as important as the items previously heard. The literature needs to be delivered in advance to staff, and personal appointments should be made.

Dr. Sands said that this was a lesson learned and it will not happen again. Arrangements have been made with Darryl Martin’s office to meet with the commissioners for a more detailed briefing. This item today was also agendized as an action item if the Board chooses to direct staff as to how to engage the other jurisdictions in this discussion and to share what our plan is at this point.

Member Barlow said that everyone understands and agrees that the health district needs to be expanded due to age and capacity of the existing building. He asked if the various municipalities will need to put forth dollars to build a new building as well as operational expenses. Mr. Walsh confirmed that this would be just to fund the building.

Member Giunchigliani said that the possibility of discussion for direction is needed. New members need to know what the plan is and see pictures of this building. They are not aware that the Wellness Center will also be part of a new facility. She suggested inviting members of the jurisdictions to tour the existing facility or see photos. She strongly encouraged having briefings beforehand. She commended the architect for doing an excellent job of bringing the new building in at a good cost per square foot. This lends to a good argument. She also suggested having staff brief the staff at the jurisdictions. She said that majority of the funding should come from the county. We should be more inviting of the jurisdictions and include them in discussions. Following this, the financial directors could meet with Mike and discuss the cost of the building, and have further discussion.

Chair Kirk agreed that each council member of the local entities should be briefed in detail. Member Weekly said that even though each jurisdiction has representation on the Board, they each sit on many other boards as well. Other council and commission members are not aware of what is going on and feel frustrated. He asked that the district keep the jurisdictions informed.

Member Hardy said that this opens a new aspect of revenue sharing. He is looking at the reality that in an open meeting the discussion be done not just in this forum, but with the Southern Nevada Planning Coalition and those kinds of things where discussion is held to develop a philosophy and process to determine how to meet and work together. He said that the public needs to have comment on the matter as well.

Member Giunchigliani said there have been two meetings on the facility already. However, once the various entities are briefed, a meeting should be held where the public can provide Board of Health Minutes Page 3 of 3 July 26, 2007

comment and hold a public hearing. The public needs to be aware that the building is needed and why.

Member Jones asked if public funding was the only acceptable venue, or if sponsorships and private input could be considered. Mr. Walsh said that this has not been investigated but staff could do this as well. He said that one funding alternative discussed by George Stevens at the commission meeting had to do with the issuance of bonds. As ¼ cent of the property tax revenue allocated to the district are designated for capital, that dollar amount will increase annually. Over the life of the bond, we could pay for the building, and reimburse the county for money paid up front, which would be approximately $4.5 million.

Member Bubba Smith said that most revenues from the cities do go to the county. He asked staff to come to Mesquite and brief city officials. He expressed concern about the lease agreement, and agrees that a new building is necessary. He said that the mayor authorized him to state that office space can be provided for the district to have a presence at least once a week in Mesquite. Mr. Walsh said that cost savings from leases would go back into paying for a building.

A motion was made by Member Giunchigliani to move forward with the development of the building and locate financing, that staff should brief the various councils and commissions, offer tours and such, involve staff and work with the financial groups and come back to the Board with an “A” and “B” process, to include a public hearing venue; seconded by Member Weekly and was unanimously approved.

Member Giunchigliani said that when exploring different options, because bonding could be a payback position, the entities should be aware of this as well.

Attachment #8

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, March 27, 2008 - 8:00 A.M.

Board Members Present: Steven Kirk Chair, Councilman, Henderson Chris Giunchigliani Vice Chair, Commissioner, Clark County Ricki Barlow Councilman, Las Vegas Jim Christensen, MD At-Large Member, Physician Robert Eliason Councilman, North Las Vegas Joseph Hardy, MD At-Large Member, Physician Tim Jones At-Large Member, Regulated Business/Industry Robert “Bubba” Smith Councilmember, Mesquite Linda Strickland Councilmember, Boulder City Debra Toney, RN Alternate At-Large Member, Registered Nurse Lawrence Weekly Commissioner, Clark County

Absent: Travis Chandler Councilmember, Boulder City Alternate Tom Collins Commissioner, Clark County Alternate Susan Crowley At-Large Member, Environmental Specialist Lonnie Empey Alternate At-Large Member, Environmental Specialist Mary Jo Mattocks, RN At-Large Member, Registered Nurse Frank Nemec, MD Alternate At-Large Member, Physician John Onyema, MD Alternate At-Large Member, Physician Gary Reese Secretary, Councilman, Las Vegas Steven Ross Councilman, Las Vegas Alternate Gerri Schroder Councilwoman, Henderson Alternate Stephanie Smith Councilwoman, North Las Vegas Alternate

III. REPORT / DISCUSSION / ACTION 1. Petition #08-08; Memorandum #10-08: Review and Approve the Tentative Budget for Fiscal Year 2008-2009 for Submission to Clark County and Forwarding to the Nevada Department of Taxation.

Michael Walsh, Director of Administration, introduced Sylvia Claiborne, Financial Services Manager, who provided an overview of the FY 2008-2009 Tentative Budget (attachment #1). The estimated tentative budget revenue for FY 2008-2009 is $73,502,713 and proposed combined operating expenditures, capital reserve, liability reserve, proprietary fund and proposed bond transfer dollars for the next fiscal year are $78,799,651. Total transfers to the capital reserve fund, liability reserve fund, proprietary fund and proposed bond reserve fund are budgeted for the amount of $7,240,436. The projected ending fund balance for FY 2008-2009 is $9,674,008 which is approximately 13.5% of projected annual expenditures budgeted in FY 2008-2009. The surplus has been created due to the cost-of-living adjustment (COLA) which has not been included in the budget for FY 2009 because the current collective bargaining agreement expiring on June 30, 2008. When negotiations are completed, an amended budget will be presented for board approval. Board of Health Minutes Page 2 of 3 March 27, 2008

The FY 2008-2009 Tentative Budget provides for a realistic budget with an acceptable General Fund reserve and funds the expected increased service levels in all Divisions. Included in the Tentative Budget 2008–2009 are several graphs depicting revenue and expenditure relationships for FY 2008–2009. The Tentative Budget is a working document which proposes a fiscal solution to assure the provision of necessary public health activities during the coming year.

Ms. Claiborne reported that the ordinary expenses are budgeted to deal with significant investigations like the current hepatitis C investigation and budgeted funds are sufficient to deal with the investigation, but most of the funds would be expended if the process continues over a long period of time. The state is awarding a sub-grant to the health district covering the first two invoices from the Poison Control Call Center for $175,000 and $38,000 submitted last week. She continued the budget review stating that upon Board of Health approval, a bond reserve fund will be established to enable the health district to pay bonded debt in the event the County issues bonds on our behalf to fund a new building. Ms. Claiborne reported that 25 additional positions are budgeted; 7 of these positions are to administer the immunization mandates at an approximate cost of salary and benefits of $1.6-1.7 million and 2 of the positions are covered by grant funding. Dr. Sands noted that some of the additional positions budgeted are in response to increased demands with many supported through regulatory fees and stated that the Environmental Health positions are fee based and a result of commercial construction and increased inspections. Member Giunchigliani requested a briefing on the budget and a flow chart or staffing chart of current and proposed positions. Chairman Kirk requested additional discussion about programs that may be impacted by state budget cuts as significant reductions in grant funding could impact balancing the budget. To date we have not received formal notification of reductions and have taken a conservative approach during the budgeting process as well as in projecting grant funds. Forty-four positions were originally requested and 25 approved with 17 of these positions generating revenue. Positions requested and approved are as follows:

• Environmental Health requested 23 positions -7 approved • Community Health requested 4 - 1 approved • Administration requested 8 - 6 approved (Administration includes Human Resources, Accounts Payable/Receivable, Purchasing, Shipping/Receiving, Cost Accountability, Financial Analysis, Internal Audit, Grant/Contract Administration, Health Cards, Vital Records, Public Information, Information Technology Services, General Supply, Mailroom and Print Shop Services) • Nursing requested 9 – 9 approved (7 positions to fulfill immunization mandates)

Angus MacEachern, Human Resources Administrator, stated that we have not received formal notice from employees who are leaving due to changes in the Public Employee Benefits Plan (PEBP) and reported that we are taking a number of different steps to address the issue that will be presented at the April Board of Health meeting. Member Giunchigliani asked where she would find the actual insurance costs for employees under the PEPB. Health insurance costs through PEBP are increasing significantly, particularly for non-state employees who are rated outside the state program. Legislature mandated that early retirees are included in ratings with active employees and Medicare retirees are rated separately. The labor contract requires appointing a health insurance committee and union approval to make changes to the health insurance and Mr. MacEachern is in the process of setting up meetings with Service Employees International Union (SEIU) representatives for this discussion. If a large number of employees would elect retirement in addition to loss of employee expertise, the district would feel the impact of them taking their accrued benefit time. Member Giunchigliani asked if the health district was represented by a labor law firm during negotiations and asked for this topic to be agenized for discussion and suggested working with various public entities for a plan of action. Board of Health Minutes Page 3 of 3 March 27, 2008

Mr. MacEachern stated that our program is designed to encourage employees to stay and reported that the timeline for the healthcare plan is to be presented at the April board of health meeting. The labor contract ends June 30 and he believes that he has a solution that will be presented to the union for their consideration, adding that all employees of the health district are covered by the same healthcare plan. He reported that PEBP requires 90 days notice to leave the insurance plan and non-state rates were available on March 7, 2008 and adopted March 13, 2008. Mr. Kirk closed in saying that timelines are critical and everyone must work in concert to accomplish the tasks at hand, adding that the Board would like to be kept informed on their progress.

Chair Kirk excused himself and Vice Chair Giunchigliani chaired the remainder of the meeting.

Review of the Information Technology budget showed the majority of funds budgeted for replacement of the VAX system and a new health card system. $350,000 was budgeted for remodeling costs with $170,000 budgeted for reconfiguration of space to handle the additional volumes in nursing as well as potential changes to the building’s structure that may be unavoidable due to cracks discovered in the building that will need to be inspected by a structural engineer.

Member Giunchigliani asked if a complaint system is in place, how it is accessed by the public and if they are tracked. Edward Larsen, Information Technology Manager, reported that the public can submit a complaint on the website, but a tracking system is not in place. Information is currently being gathered and a needs assessment is being done. The department is looking at integration of information into the various departments and Requests for Proposals will be issued.

Ms. Claiborne stated that $1,000,000 would be transferred to a newly established Bond Reserve Fund set aside to fund a new building that, upon approval, would be transferred and invested by the county finance department.

Vice Chair Giunchigliani stated that budget review would be accepted and approval of the tentative budget would be with the understanding that input or changes could occur.

A motion was made by Member Jones to approve the Tentative Budget for Fiscal year 2008-2009; seconded by Member Hardy and was unanimously approved.

3. Petition #10-08: Approve Resolution #01-08 to Establish a Debt Service Fund for Southern Nevada Health District Pursuant to Nevada Revised Statute (NRS) 354.612

Michael Walsh, Director of Administration, reiterated that $1,000,000 would be transferred to a newly established Bond Reserve Fund set aside to fund a new building, if approved by the Board of Health.

A motion was made by Member Jones, seconded by Member Strickland and unanimously approved to establish a debt service fund for Southern Nevada Health District.

Attachment #9

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, January 22, 2009 - 8:00 A.M.

Board Members Present: Chris Giunchigliani Chair, Commissioner, Clark County Steven Kirk Vice Chair, Councilman, Henderson Jim Christensen, MD At-Large Member, Physician Susan Crowley At-Large Member, Environmental Specialist Robert Eliason Councilman, North Las Vegas Tim Jones At-Large Member, Regulated Business/Industry Mary Jo Mattocks, RN At-Large Member, Registered Nurse Bubba Smith Councilmember, Mesquite David W. Steinman Councilman, Las Vegas Linda Strickland Councilmember, Boulder City

Absent: Ricki Barlow Secretary, Councilman, Las Vegas Joseph Hardy, MD At-Large Member, Physician Lawrence Weekly Commissioner, Clark County

III. REPORT / DISCUSSION / ACTION Due to potentially losing a quorum, Chair Giunchigliani took the agendized items out of order.

3. Petition #10-09: Approval of Bond Reserve Fund Catch-up Transfer

Upon passage of AB380 in 2005, a dedicated funding stream was enacted for the Southern Nevada Health District from Clark County property tax revenues. It was agreed that ¼ cent of the 3½ cents per $100 of assessed value be dedicated for facility replacement. Mr. Weiss calculated the amount necessary to build a bond reserve fund going back to FY06 and is requesting that funds be transferred from the general reserve fund to the bond reserve fund, in the amount of $4,822,857. The amount will be amended at the close of the fiscal year.

Chair Giunchigliani asked if the adjustment would be based on results of possible legislative action concerning property taxes. Mr. Weiss said that the funding stream from county property tax revenue is currently in statute.

A motion was made by Member Kirk to approve the transfer of $4,822,857 from the general reserve fund to the bond reserve fund; seconded by Member Mattocks and was unanimously approved.

Attachment #10

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, October 22, 2009 - 8:30 A.M.

Board Members Present: Chris Giunchigliani Chair, Commissioner, Clark County Linda Strickland Vice Chair, Councilmember, Boulder City Tim Jones Secretary, At-Large Member, Regulated Business/Industry Stavros Anthony Councilman, Las Vegas Kathleen Boutin Councilwoman, Henderson Jim Christensen, MD At-Large Member, Physician Susan Crowley At-Large Member, Environmental Specialist Robert Eliason Councilman, North Las Vegas Donna Fairchild Councilmember, Mesquite Joseph Hardy, MD At-Large Member, Physician Lawrence Weekly Commissioner, Clark County

Absent: Ricki Barlow Councilman, Las Vegas Mary Jo Mattocks, RN At-Large Member, Registered Nurse

As some Board members needed to leave the meeting Chair Giunchigliani took the next three items in one motion.

III. REPORT / DISCUSSION / ACTION 2. Petition #32-09: Proposal for a New Building Site at Martin Luther King Blvd. and West Lake Mead Blvd.

Dr. Sands noted this was a follow-up from discussion at the last Board meeting to receive authorization to peruse a new location for the main facility.

A motion was made by Member Christensen to approve the proposal for a new building site as presented; seconded by Member Hardy and was unanimously approved.

Chair Giunchigliani, in the absence of Member Barlow, remarked that a suggestion was made to relocate the main facility to North Las Vegas as a means to save money and use the existing land where the health district is located for other purposes.

3. Petition #33-09: Approval of a Flexible Spending Account (FSA) for the Employees of the Southern Nevada Health District, Effective January 1, 2010 through December 31, 2010

Additional documentation for the item was presented as an attachment (attachment #5).

A motion was made by Member Christensen to approve a Flexible Spending Account (FSA) for Employees as presented; seconded by Member Hardy and was unanimously approved.

Board of Health Minutes Page 2 of 2 October 22, 2009

4. Receive Report from the Southern Nevada District Board of Health Audit Committee (Committee: Committee Chair Jones and Members Barlow, Christensen, Crowley, Fairchild and Mattocks)

Member Jones asked for clarification on the items just approved. Mrs. Clark noted that the Audit Committee report was accepted but not heard. Member Jones, committee chair, noted that the committee met and the audit is on target for the Board’s consideration at the November meeting.

A motion was made by Member Hardy to accept the report from the Audit Committee by Member Christensen and was unanimously approved.

Attachment #11

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, December 16, 2010 - 8:30 A.M.

Board Members Present: Linda Strickland Chair, Councilmember, Boulder City Tim Jones Vice Chair, At-Large Member, Regulated Business/Industry Donna Fairchild Secretary, Councilmember, Mesquite Stavros Anthony Councilman, Las Vegas Jim Christensen, MD At-Large Member, Physician Chris Giunchigliani Chair, Commissioner, Clark County Nancy Menzel, RN At-Large Member, Registered Nurse John Onyema, MD At-Large Member, Physician Lois Tarkanian Councilwoman, Las Vegas Jimmy Vigilante At-Large Member, Environmental Specialist Lawrence Weekly Commissioner, Clark County Anita Wood Councilwoman, North Las Vegas Alternate

Absent: Kathleen Boutin Councilwoman, Henderson Robert Eliason Councilman, North Las Vegas

III. REPORT / DISCUSSION / ACTION 2. Petition #43-10, Resolution #03-10: Amendment of Petition #10-08 which was the Creation of a Bond Reserve Fund (Debt Service Fund) for the Southern Nevada Health District

Scott Weiss, director of administration presented this item.

In March 2008 the Board approved the initiation of the Bond Reserve Fund, and Resolution #01- 08 allows the funds to be used solely for debt service on bonds issued by Clark County. At the time the only option for financing a new facility was with the assistance of Clark County. In working with Warner Ambrose and Tom Gransbery of the Department of Taxation, as well as reviewing available funds for acquisition of a new facility, it was determined there are various options available to the district including to the Board to amend the previous Resolution to allow the dollars in the Bond Reserve Fund to be used for associated cost with any acquisition of any real property for the district.

Amending the Resolution does not allow the district to spend the accumulated dollars, it authorizes the Board to approve the use of these funds if the opportunity were to arise. The current Resolution is restricted to only debt service on bonds issued by Clark County. Staff requests the Board to amend the current Resolution to increase how the Board can use these funds.

Member Giunchigliani said the only option in 2008 was to work with Clark County to finance a new facility and believes that still holds true today. She said the County requested a legal opinion from the District Attorney about whether or not the district can own real property or if the district should be treated the same as other entities that fall under the county for this purpose. She said county financial services staff is also speaking with the Department of Taxation in Board of Health Minutes Page 2 of 6 December 16, 2010

regard to available financing options. She said it is premature to have this discussion, particularly because there continues to be dispute over the allocation of property tax revenue and the District Attorney is also providing an opinion on this matter. She feels a presentation by the District Attorney should come to the Board once the opinion is received. She will not support amending the Resolution without having all issues more fully addressed. If there is a dispute with the opinion from the District Attorney there is an appeal process to the Attorney General.

Chair Strickland asked if it would be detrimental to hold this item to the January meeting, pending word from the District Attorney’s office. Mr. Weiss said amending the Resolution will only allow the funds to be used for a new facility and no other purpose. He spoke with Mr. Gransbery and Mr. Ambrose this morning and was told the following:

• Approximately $6.5 million, the difference between the budgeted beginning fund balance and the actual per the FY10 CAFR, is available for use; • Approximately $3.2 million in the ending fund balance of the non-major capital projects fund at the end of FY10 is also available; and • Approximately $10.5 million in the bond reserve fund, which includes $1.5 million approved in the FY11 budget, can be dealt with in two ways: 1) approve the amendment to Resolution #01-08 today or 2) eliminate the bond reserve fund and transfer the balance into the capital fund

That said, there is approximately $22 million of agreeable funds available to the district to use to acquire a new facility. Ms. Bradley has been researching the legalities of the district owning real property and will provide an analysis of the 3.5 cent property tax allocation. The only delay in holding either of the two items coming before the Board today will prohibit the district from moving forward with contract discussions regarding the new facility. Mr. Weiss also reported that two building leases are expiring in January 2012, which could impact the Board’s decisions. There are potentially eight new staff members coming on Board in the coming weeks and there is little or no space for these new staff members at existing facilities – the district may need to lease additional space to accommodate new staff.

Member Fairchild asked if it were possible to approve the item contingent upon the decision of the District Attorney. If the opinion is favorable to the district staff can continue their efforts in obtaining a new facility; if the opinion is negative there is no harm, no foul.

Member Giunchigliani said this action would set the precedence of the intent of moving forward on the facility and she feels the Board needs to more fully discuss this issue. The correspondence from the Department of Taxation should be provided to the Board so a full and informed discussion can occur. She said without full information the Board cannot fully understand the ramifications of amending the current Resolution. She said in the current economic climate it is prudent to have month-to-month leases in order to obtain better rates and terms. She further suggested having George Stevens attend the January meeting so the Board can ask questions of county financial staff in a public setting. She said if there is the flexibility of not having to approve the item today it would not be a loss, particularly if there is no one else interested in the proposed facility. She wants to ensure we are doing our due diligence as well as knowing what the district will look like legislatively to better understand our obligations in terms of our constituents and employees.

Member Tarkanian asked for clarification on Member Giunchigliani’s comments on “intent,” and if it meant the intent to move or something else. She agrees that we must do our due diligence and a vote would be contingent upon the opinion from the District Attorney. She said it is her Board of Health Minutes Page 3 of 6 December 16, 2010

understanding that the health district should relocate its main campus and the proposed facility would be a good choice for a replacement facility.

Chair Strickland suggested holding discussion on this item and taking Item #5 first for discussion.

Discussion on Item #4 resumed at 10:46am.

Chair Strickland said the Board now knows the direction it is headed in relation to a new facility and asked how the Board would like to proceed with this item.

A motion was made by Member Fairchild to approve the amendment of Petition #10-08 contingent upon the opinion of the District Attorney relative to the district owning real property and use of general funds; seconded by Member Menzel and carried with Members Giunchigliani, Vigilante and Weekly opposed.

Member Giunchigliani expressed her appreciation for the contingency language.

Member Weekly said the Board would have continued discussion on all options if the opinion from the District Attorney comes back favorable. He noted he has been quite vocal about a new facility, but he is concerned about the terms of accomplishing this task. He indicated he asked Mr. Weiss during his briefing if a conversation had occurred with George Stevens regarding funding the building and learned this conversation had not occurred as of that date.

Member Giunchigliani said when the opinion comes back the District Attorney should be at the Board meeting to discuss the item, and George Stevens should also be present. She also asked that any correspondence Mr. Weiss has concerning the item be shared with the Board. This will help the Board make an educated decision.

Member Tarkanian said we do not want to circumvent due diligence in any way. Member Fairchild noted it is not about jurisdiction, but consideration of the employees served by the Board.

At the request of Chair Strickland, the following item was discussed prior to taking action on Item #4.

3. Petition #44-10: Authorize Administration Staff to Initiate Contact and Exploratory Negotiations for the Purchase of the Possible Replacement Facility

Scott Weiss, director of administration presented this item. The district currently owns real property and the petition before the Board is similar in nature to the petition used to seek authorization to purchase the parcel located at 700 Desert Lane in 1998. This petition would authorize administration staff to initiate negotiations, use a broker, use an attorney if needed, and put forth a refundable earnest money deposit to commence negotiations. Any terms of sale would come back to the Board for discussion and possible approval.

Chair Strickland clarified this item is asking if the Board has the desire to move forward with negotiations to purchase the possible replacement facility. There are potential issues which may arise but the Board needs to determine if it desires to move forward with a replacement facility. There is concern about possible legislative actions pertaining to operations; however the presentation earlier today provided useful information about district operations and community-based services for those Board members meeting with Senator Parks.

Board of Health Minutes Page 4 of 6 December 16, 2010

Member Giunchigliani referenced page 2 of the petition which states “adequate funding to encompass any future property acquisition would be budgeted from available Health Capital Reserve Funds, Bond Reserve Fund (Debt Service Fund), General Funds and possible RDA assistance from the City of Las Vegas.” She said the language pertaining to RDA assistance referred to another parcel and should not be included with this particular item. She also stated the phrase “adequate funding” refers to the discussion with the Department of Taxation which has yet to be resolved. She expressed her discomfort in voting on an item referencing “adequate funding” which is based on a presumption. She agrees the current building is “sick” and a new facility is needed in some fashion. The question remains how do we get there and there has been much discussion between the district and the county regarding funding and locations. She said the issue of the general funds must be addressed – in the desire to acquire a new location has the district forgone hiring staff to save monies to purchase a building. She said this discussion must occur before any decisions are made as to a new facility. The issue needs to be settled once and for all – what are our obligations, who owns what, what does the NRS specify and deal with the issues directly. She felt answers are needed before any action can be taken. She reiterated a new facility is needed, but the questions remain what should the facility look like and what should it contain remain unanswered.

Member Tarkanian said these are the types of questions answered when exploratory negotiations occur. She said the district has been exploring options for quite a long time and it raised the question if the district really does need a new facility. She said there are many variables but it could save time to provide authorization for staff to begin the exploratory process, which can provide more information, and so far as there is no obligation connected to the exploratory phase.

Member Giunchigliani said the petition infers explorations are complete and staff is ready to begin tenant improvements at $11.6 million and purchase of the building at $15.6 million, for a total of up to $32 million versus construction of an entirely new building. She said the Board approved staff to obtain an appraisal; but she is unaware if the Replacement Facility Committee has met to discuss further options.

Chair Strickland said the issue is with the understanding that the matters pending before the District Attorney will be resolved at a future date, should the Board take action contingent upon that pending resolution. Member Vigilante said he would prefer to wait until all information is presented to the Board to make an educated decision.

Chair Strickland said there has been discussion that if the funds set aside for replacement facility are not used there is the potential of the county making an argument that the district is not entitled to its full allocation of property tax revenue. Member Giunchigliani said she would personally argue against the county taking this action. Chair Strickland said the district has saved money to purchase a building. Member Giunchigliani said the county is aware of this action; however it is the discretionary funds that should have been used for staffing purposes which may raise questions at the county level. She said the bond fund ($1.5 million) and the difference in between the beginning fund balance and ending fund balance ($6.5 million) are not in question at this time – it is the additional revenue taken from the general fund to augment the funding for the building. She questioned why a certain amount was allocated from the general funds for a given purpose and subsequently the funds were used for other purposes.

Member Tarkanian asked if the state would be able to take the funds from the district’s reserve accounts. Member Giunchigliani said she did not believe the funds could be taken as they did from the county – in the previous session the county agreed to give the 4 cents of $100 of assessed value to the state with various conditions. The next legislative session will result in both the county and cities’ funds being scrutinized.

Board of Health Minutes Page 5 of 6 December 16, 2010

Dr. Sands said in various meetings it has been inferred that various state services will be pushed to the local level, and if the district is required to take on additional responsibilities we will need protection of the funding stream as well as funding in the reserves to maintain the needed infrastructure to deliver services. Member Giunchigliani agreed with Dr. Sands’ assessment and said we need to be at the table to ensure the health district has the necessary funding to provide services. This could also involve discussions with the state regarding direct funding versus pass-through funding.

Member Anthony inquired as to the potential timeframe to bring a full package to the Board for consideration. Mr. Weiss said it will take at least sixty days to complete the exploratory negotiations and the analysis of the tenant improvements. The architects are working with division directors to ensure adequate spacing planning needs are met. The only cost associated with the exploratory negotiations would be minimal for an attorney to review the sale agreement. The broker and the owner have agreed in principle that any broker’s fees would be paid by the seller, and it is a fixed dollar amount. The only costs at present are staff time and possibly some attorney fees. The earnest money is fully refundable. Member Anthony said if there is interest from the Board to relocate and this facility is a viable option, it is prudent to move forward. Staff can provide additional information as requested by the Board.

Chair Strickland asked if the legal review would be done in house or by outside counsel. Ms. Bradley said it is dependent upon the complexity of the issue. The district maintains a list of commercial real estate contacts for legal purposes.

Ms. Bradley said with respect to the allocation of property tax revenue, the district interprets this funding as a dedicated funding stream as NRS 439.365(2) states the district shall receive 3.5 cents per $100 of assessed value and the funds must be transferred from the county to the health district fund. She said this is mandatory language, not discretionary. With respect to owning real property the district has owned real property since 1998. That aside there is a statute under the local government budget act that states if there is a right to received tax assessments then those funds can be used for land, land improvements and the district falls into this category. Given this basic framework it is the position of the district that this is a dedicated funding source, and that the district has a right to own real property. She is not aware of the assessment of prior counsel who advised that property could be owned by the district – there is a statement in the record that counsel said the district could own real property, but there was no discussion noted.

Chair Strickland asked what would happen if the opinion of the District Attorney is contrary to that of Ms. Bradley, and if we would abide by the opinion of the District Attorney. Ms. Bradley said if the opinion is different we would explore our options at that point. Dr. Sands said further discussions will occur at that time.

Member Fairchild expressed concern over the length of time a replacement facility has been discussed – it is time to move forward and she noted this prospective facility is a great opportunity. Language could be included to protect the interests of the district moving forward. She stressed again it is time to move forward and get going; she said the time for discussion is over.

Member Giunchigliani said it is all on how we get there. She cannot support the approval due to the way the petition language reads; she said it is not to explore whether or not the tenant improvements are valued correctly. She said the item before the Board today is to move forward to the next phase of acquiring property. She said her argument is not whether or not a building is needed; she asked to exercise caution in proceeding. Entering into negotiations is very different terminology than finishing due diligence in determining whether or not the prospective facility is the right building to purchase. If the wording were modified to include Board of Health Minutes Page 6 of 6 December 16, 2010

language regarding feasibility of tenant improvements, including a phased approach, continue working with the Replacement Facility Committee, and bring back to the Board this information along with the opinion of the District Attorney to the January meeting.

Member Tarkanian said she is not entirely familiar with the history of the discussion, however more services may be put upon the district by the state, and with a large balance sitting in the reserves there is a high possibility that no funding will follow the redirected services. Making some sort of a positive step forward will demonstrate the district’s commitment to using the funds for a new facility.

Member Giunchigliani said both the capital and bond reserve fund are appropriate for this purpose and she feels the Board moved properly in establishing these funds. She is concerned over the high balance in the general fund and some may question from where the money came. She inferred the legislature may ask that question, and said the county is already asking about it. She is concerned we may have forgone services or staffing in order to build a budget to finance a new building.

Member Jones said the district has dedicated one quarter of one percent to the bond reserve fund for some time. The item before the Board today is allowing the district to receive more confirmed information in terms of the cost to move forward. There is no obligation to spend the funds, but it provides a basis for making a final decision including a more clear financial structure. He agreed that we need to include contingency language pending the opinion of the District Attorney. He expressed his support to proceed as long as there is no obligation.

A motion was made by Member Jones to approve the petition as presented contingent upon a favorable opinion from the District Attorney relative to the district owning real property and use of general funds; seconded by Member Fairchild and carried with Members Giunchigliani, Vigilante and Weekly opposed.

Member Giunchigliani said there would be no RDA funds coming from the City of Las Vegas and the language on the petition should be modified appropriately. Mr. Weiss said the language was included, not because there was a promise or guarantee of funding, but the City expressed interest in providing assistance if possible.

(Member Anthony left the meeting at 10:45am)

Member Giunchigliani said she assumed it was the land offered by the City previously in Councilman Barlow’s Ward.

Chair Strickland redirected discussion back to Item #4 at 10:46am.

Attachment #13

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, February 24, 2011 - 8:30 A.M.

Board Members Present: Linda Strickland Chair, Councilmember, Boulder City Tim Jones Vice Chair, At-Large Member, Regulated Business/Industry Stavros Anthony Councilman, Las Vegas Michael Collins, RN Alternate At-Large Member, Registered Nurse Robert Eliason Councilman, North Las Vegas Chris Giunchigliani Commissioner, Clark County Karl Gustaveson Councilman, Mesquite Alternate John Onyema, MD At-Large Member, Physician Mary Beth Scow Commissioner, Clark County Lois Tarkanian Councilwoman, Las Vegas Jimmy Vigilante At-Large Member, Environmental Specialist

Absent: Kathleen Boutin Councilwoman, Henderson Jim Christensen, MD At-Large Member, Physician Nancy Menzel, RN At-Large Member, Registered Nurse

III. REPORT / DISCUSSION / ACTION 1. Discussion of Petition #43-10, Resolution #03-10; and approve or take any action deemed appropriate: Amendment of Petition #10-08 which was the Creation of a Bond Reserve Fund (Debt Service Fund) for the Southern Nevada Health District, Previously Approved by the Southern Nevada District Board of Health on December 16, 2010 (requested by Chair Strickland)

2. Discussion of Petition #44-10; and approve or take any action deemed appropriate: Authorize Administration Staff to Initiate Contact and Exploratory Negotiations for the Purchase of the Possible Replacement Facility Previously Approved by the Southern Nevada District Board of Health on December 16, 2010 (requested by Chair Strickland)

Chair Strickland commented this item came about as a result of a Board action on December 16, 2010 to approve this item, contingent upon receipt of the District Attorney’s opinion relative to the district owning real property and use of general funds. Annette Bradley, legal counsel, stated the Board could motion to amend the motion previously adopted, suspend Robert’s Rules of Order and take this item as a motion to remove. It would take a majority vote to remove or modify the item.

Member Giunchigliani said with items #1 and #2, it is dependent upon what the Board discusses at the next meeting as neither item could stand alone without a decision on the dueling opinions. Chair Strickland said regardless of the Board’s decision in terms of the dueling opinions, she is uncertain whether the Board could move forward with either item at this time. Both items were contingent upon receipt of the opinion of the District Attorney relative to the issues.

Board of Health Minutes Page 2 of 2 February 24, 2011

Member Giunchigliani asked if the Board could motion to postpone, motion to reconsider at a later date, or a motion to table the items pending the decision of the Board at a future meeting in an effort to keep the items alive – she does not believe there is a crisis in timing for these items.

Member Anthony asked if there was a crisis in timing. Chair Strickland said the Board will make a decision at the next meeting on an agendized item.

Member Jones clarified item #1 allows the Board to use previously designated bond funds to purchase a facility. He noted this will not occur at this time, and suggested the item stand.

Scott Weiss, director of administration, stated the original petition allows for the funds to be used solely for bonds issued by Clark County. Petition #43-10, Resolution #03-10 provided for an expansion, allowing the funds to be used for costs associated with purchase or acquisition of property. It allows the Board more authority to use the funds, but only within the Board’s discretion.

Chair Strickland said these matters may not need to be addressed until after the resolution of the pending dispute.

Member Giunchigliani said the items go to the heart of the issue of acquisition. She said the Board would want to postpone pending resolution of the decision of the Board at the next meeting.

A motion was made by Member Giunchigliani to revisit Petition #43-10, Resolution #03-10 and Petition #44-10 upon conclusion of the Board’s decision at the March 24, 2011 meeting regarding how to pursue and resolve the issue related to the dedicated funding stream; seconded by Member Tarkanian and carried unanimously.

Dr. Sands reported the owners of the building we are considering for purchase have received an offer to lease a majority of the building; and there is a potential for the district to lose this opportunity at this time. Mr. Weiss confirmed a national company submitted an offer to lease the top floor of the facility. We asked the owners to provide us with potential terms and conditions of a lease for the district as well for the entire building. There is a strong possibility the owners may go with the other offer as we have not come to a resolve on the issue.

Chair Strickland recognized the Board cannot act on something that may no longer be available. Member Giunchigliani expressed delight that there was other activity surrounding the facility. As the issue is resolved as to bonds and ownership, this is county land and there is other land available where construction could occur as appropriate, which would provide the district a facility in a more appropriate manner and puts people to work in this economy. She said there are other opportunities other than this one facility being considered.

Attachment #14

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, June 23, 2011 - 8:30 A.M.

Board Members Present: Linda Strickland Chair, Councilmember, Boulder City Tim Jones Vice Chair, At-Large Member, Regulated Business/Industry Stavros Anthony Councilman, Las Vegas Jim Christensen, MD At-Large Member, Physician Susan Crowley Alternate At-Large Member, Environmental Specialist Karl Gustaveson Councilman, Mesquite Alternate Joseph Hardy, MD Alternate At-Large Member, Physician Nancy Menzel, RN At-Large Member, Registered Nurse Mary Beth Scow Commissioner, Clark County (telephonic) Anita Wood Councilwoman, North Las Vegas Alternate

Absent: Kathleen Boutin Councilwoman, Henderson Robert Eliason Councilman, North Las Vegas Chris Giunchigliani Commissioner, Clark County John Onyema, MD At-Large Member, Physician Lois Tarkanian Councilwoman, Las Vegas Jimmy Vigilante Secretary, At-Large Member, Environmental Specialist

III. REPORT / DISCUSSION / ACTION 4. Receive Report from the Southern Nevada District Board of Health Audit Committee; and direct staff accordingly

Chair Strickland reported the Audit Committee met on June 21st with a representative from Kafoury, Armstrong & Company pertaining to compliance with GASB 54. The committee accepted staff’s recommendation to develop a fund spending policy in accordance with GASB 54.

Scott Weiss, director of administration, stated the committee was asked to approve the spending mechanism presented and staff will memorialize said approval in a district policy. A draft policy was shared with the Board; however the Board is being asked to approve the actual spending mechanism. Mr. Weiss asked if both items #4 and #5 could be heard together as they are interrelated.

Chair Strickland asked to hear item #5 concurrently with item #4.

5. Request the Southern Nevada District Board of Health to Adopt the Fund Spending Policy per Governmental Accounting Standards Board (GASB) 54; or taken any other action as deemed necessary

Chair Strickland noted Mr. Weiss needed to explain the addition of this item after the agenda was posted. Mr. Weiss asked if item #6 could also be heard at this time.

Board of Health Minutes Page 2 of 4 February 24, 2011

Dr. Sands said the double asterisk on the agenda was intended to denote the revisions to the original agenda, however the items were not deemed emergency items. The emergency items were added to the top of the meeting agenda.

Chair Strickland asked to bring item #6 forward at this time as well, thereby hearing items #4-6 concurrently.

6. Petition #32-11, Resolution #02-11: Approval of the Designation of the Ending Fund Balance in the Bond Reserve Funds as “Committed” per Governmental Accounting Standards Board (GASB) 54; or take any other action deemed necessary

Mr. Weiss invited Mars Patricio, financial services manager, and Anna Danchick of Kafoury, Armstrong & Company forward to explain these items to the Board and answer any questions. As the provisions of GASB 54 are effective July 1, 2010 our previous auditors were asked to provide consultation on our existing fund balances and make recommendations on how best to proceed in regard to compliance with GASB 54. These changes will be reflected in the FY11 Comprehensive Annual Financial Report (CAFR).

Ms. Danchik stated as of June 30, 2010 the fund balances were shown as “reserved” and “unreserved.” The Governmental Standards Accounting Board issued a statement (GASB 54) modifying the categories for ending balances as of June 30, 2011 (attachment #1):

• Nonspendable: inventories, prepaid items, long-term receivables, or anything legally or contractually required to be maintained intact such as a corpus of a permanent fund. This category is basically for those items which cannot be converted to cash. • Restricted: amounts constrained to be used for specific purposes by external parties (such as grantors), constitutional provisions or enabling legislation. • Committed: amounts that can only be used for specific purposes pursuant to constraints imposed by formal action of the highest level of decision-making authority. The constraints can only be removed or changed by taking the same action, which should occur prior to the end of the reporting period. • Assigned: amounts constrained by management to be used for specific purposes, but neither restricted nor committed and the intent is expressed by the governing body itself to delegate the authority to assign amounts to be used for specific purposes. Currently the district has a general fund, a bond reserve fund and a capital project fund – any funds remaining in those areas after accounting for committed and restricted funds become assigned fund balance as management has defined the funds for specific purposes. • Unassigned: any leftover funds in the general fund which have not been committed, restricted nor assigned.

Chair Strickland stated the “committed” and “assigned” were quite similar. Ms. Danchick said the difference is that “committed” funds are committed solely by Board action; similarly the Board must take action to un-commit said funds. Presently the bond and capital reserve funds are considered “assigned” as no Board action has been taken to specifically commit the funds; they are left to management’s intent to use said funds for a specific purpose – there will be no unassigned funds in these categories.

Ms. Danchick said her firm reviewed the fund balances as of July 1, 2010 and assigned them to the appropriate categories as defined by GASB 54 (attachment #2). Other purposes refer to outstanding purchase orders (encumbrances) at the end of June 2010, approved by management. Total unassigned funds at the end of FY10 totaled $31,685,852.

Board of Health Minutes Page 3 of 4 February 24, 2011

Currently the Bond Reserve Fund is classified as “assigned” as there is no official action by the Board at this time to commit that particular fund balance; though there was a Resolution to create the fund it is not specific enough to meet GASB’s criteria for committed funds.

There are currently no formal commitments to projects in the Capital Projects Fund; the balance is reflected as assigned.

Major Funds Non-Major Funds Total Governmental General Fund Bond Reserve Fund Capital Project Fund Funds Nonspendable: Inventory $ 483,667 $ 483,667 Prepaid items 34,634 34,634 Assigned to: Other purpose $ 205,487 $ 205,487 Capital projects $ 8,908,045 $ 3,689,934 $12,597,979 Unassigned: $31,685,852 $31,685,852 TOTAL: $32,409,640 $ 8,908,045 $ 3,689,934 $45,007,619

Ms. Danchick recommended the district develop a spending policy defining how funds are to be spent and the manner in which it should be done, such as using restricted resources first followed by those which are unrestricted. GASB 54 provides for a default policy of spending restricted amounts first, followed by unrestricted; within the unrestricted category resources can be classified as committed, assigned and unassigned as well, and the default is to spend committed resources first.

Member Jones said part of the decision today is whether or not to agree to the default mechanisms defined by GASB 54. Mr. Weiss said staff’s recommendation, is to adopt the default spending mechanism per GASB 54 which allows for the use of most restrictive funds first, followed by those which are unrestricted, using the guideline of expending committed resources first, followed by assigned and unassigned. Chair Strickland said this is item #5 on the agenda.

Mr. Weiss recommended a motion to approve the fund spending mechanism and staff will then memorialize this approval in the form of a district spending policy.

Member Crowley asked if the action can occur at once or if each item must be approved separately. Chair Strickland said item #4 is to receive a report from the committee; item #5 requires adoption of the spending mechanism for staff to draft a policy; item #6 pertains to changing the Bond Reserve Fund to a Committed Fund.

Mr. Weiss recommends approving items #4 and #5 together and taking item #6 as a separate action.

A motion was made by Member Christensen to accept the report of the Southern Nevada District Board of Health Audit Committee (item #4) and adopt the Fund Spending Policy per Governmental Accounting Standards Board (GASB) 54 (item #5); seconded by Member Crowley and carried unanimously.

Chair Strickland noted item #6 is to change the Bond Reserve Fund from an “assigned” category to a “committed” category. Mr. Weiss said when the fund was created the provisions of GASB 54 were non-existent. Staff recommends changing the fund to “committed;” said funds can be uncommitted by Board action if the Board so desires.

Board of Health Minutes Page 4 of 4 February 24, 2011

Member Crowley asked if this action must be done on an annual basis. Mr. Weiss said the funds will remain “committed” until the Board takes action to un-commit the funds. Member Jones said funds can be added to this fund without further action as well.

Member Hardy said this action will assure a stable base in the Bond Reserve Fund which is not accessible by other means except by explicit action by the Board.

Mr. Weiss said the original Resolution was intended for a debt service for the replacement of the main facility. However an amendment was brought before the Board in December 2010 asking to modify the Resolution to allow those funds to be used for the acquisition of real property for the benefit of the district. By committing these funds, said funds can only be used for this specific purpose, by Board action. The intent of GASB 54 is to provide more transparency on financial reports and indicate the authority by which funds are assigned and used.

A motion was made by Member Hardy to adopt Resolution #02-11, Approval of the Designation of the Ending Fund Balance in the Bond Reserve Fund as “Committed” per GASB 54; seconded by Member Crowley and carried unanimously.

Attachment #15

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Monday, October 3, 2011 – 5:00 P.M.

Board Members Present: Tim Jones Chair, At-Large Member, Regulated Business/Industry Jimmy Vigilante Secretary, At-Large Member, Environmental Specialist (telephonic) Sam Bateman Councilman, Henderson Chris Giunchigliani Commissioner, Clark County Karl Gustaveson Alternate Councilman, Mesquite Nancy Menzel, RN At-Large Member, Registered Nurse Frank Nemec, MD Alternate At-Large Member, Physician Bill Noonan At-Large Member, Gaming John Onyema, MD At-Large Member, Physician Mary Beth Scow Commissioner, Clark County Lois Tarkanian Councilwoman, Las Vegas Anita Wood Councilwoman, North Las Vegas Rod Woodbury Councilman, Boulder City

Absent: Stavros Anthony Vice Chair, Councilman, Las Vegas Jim Christensen, MD At-Large Member, Physician Allan Litman Councilman, Mesquite

A. Petition #42-11: Authorizes Administrative Staff to Enter Into and/or Renew Negotiations to Acquire Property for the Proposed Replacement Facility – the Proposed Property is Located at 330 S. Valley View, Las Vegas, NV, or Other Suitable Location; or take other action deemed appropriate

Scott Weiss, director of administration, said an initial analysis was provided to the Board, following receipt of information from Larry Singer of Grubb & Ellis regarding available properties in the immediate area which would meet the service delivery needs of the district. Staff would ask permission to continue to work with Grubb & Ellis to find other suitable locations, if any, for consideration. All issues, including legal and funding, will be brought to the Board for consideration at a future date.

Chair Jones said this item stands separate and aside from the immediate repairs necessary for the main facility. Mr. Weiss agreed with this assessment and said that PGAL will continue to work on the assessment of the main facility and prioritize the required repairs, while developing an appropriate budget to address these repairs in a timely fashion. Staff will also engage engineers to complete the detailed structural analysis and expend the necessary funds to do so if so directed by the Board.

Member Wood said though not part of the agenda today, moving forward with the full structural analysis is prudent. She said she would like to have at least two or three options for a facility to Board of Health – Special Meeting Minutes Page 2 of 4 October 3, 2011

consider, though staff could state their preference for a facility. This would demonstrate to the public that more than one option was considered.

Dr. Sands said staff could not only bring forward additional options, but avenues in which we could fund a new facility. Member Wood said a full budget must be provided so the Board, and the public, can better understand how it will be funded.

Member Tarkanian noted the language on the agenda specifying the CenturyLink building is causing concern. She asked to have that language stricken. By so doing will allow more flexibility to staff to look at other options.

Member Wood supported Member Scow’s comments about acquisition of a thirty year old building as the only option. She would like to see other options available to better determine the total cost.

Member Giunchigliani expressed her appreciation for everyone’s comments. A new facility is warranted regardless of who has ownership. She cannot support a motion as it sends the wrong message relative to the County’s position. She believes that a funding mechanism must be fully expressed. The district has a capital bond, a bond reserve fund and the general funds, as well as possible RDA assistance from the City of Las Vegas. As the district is currently in negotiations with staff there could be concern expressed with reallocation of money from operations or services to funding a facility. Member Giunchigliani said the replacement facility was designed in accordance with current operations; we need to be more community-based in service delivery. She suggested scaling back the project for a smaller administrative site and consider co-located services for clinical services. She said the Board needs to discuss community-based healthcare delivery, which is what she feels the Board should consider. The facility should address space issues, as well as delivery of services and where would be the best place to do so. Member Giunchigliani expressed appreciation for inclusion of a structural analysis noting she could conduct a visual assessment herself and find problems with any building, including a brand new facility.

Ms. Bradley said the manner in which the agenda items were written the Board has the option to direct staff to move forward with the full structural engineering analysis it could do so. Mr. Weiss said the estimate from PGAL is such that the analysis will be approximately $200,000. Chair Jones said the Board could authorize that expenditure. Mr. Weiss said he can bring back the exact amount as an informational item at a future meeting.

Member Woodbury asked if the analysis would be for all systems. Mr. Gerber said it is assumed to be a structural analysis focusing on the lateral system and the capability of the building itself. If the Board wants to include detailed testing on the mechanical equipment the assessment can be modified accordingly.

Member Scow asked that a separate firm be retained that is independent of the design of the replacement facility and the visual assessment.

Member Gustaveson agreed a new facility is warranted. He expressed concern about a seamless move and that this will be considered. He is concerned about expending $200,000 for an analysis of something that is already known. The building is forty-eight years old and regardless of the amount of money spent to maintain the building it is not going to be up current code standards nor will it meet the space requirements of a growing district. He understands Member Giunchigliani’s comments but the building is past its life. Board of Health – Special Meeting Minutes Page 3 of 4 October 3, 2011

Member Noonan asked if the structural analysis will help the Board prioritize what needs to be tackled first in terms of immediate repairs. He asked for the benefit of expending the money knowing some of the recommended repairs must be done immediately.

(Member Nemec left the meeting at 7:22pm)

Mr. Gerber said the $200,000 is for a more detailed structural analysis and more precise calculations of the capacity of the building. The analysis will provide a “do this or do that” – not every system needs to be tested, or the Board could ask for additional systems to be tested. In terms of engineering costs for Phase I, these expenses are not included in the assessment. The estimated $2.5 million includes other design costs to pull permits.

Member Woodbury asked what the engineering analysis will ultimately provide. Mr. Gerber said the structural analysis will be more precise and specific about the structural condition of the building. The design for repairs is a separate issue and is required for pulling permits if necessary. The analysis will provide more precise information to better manage risk, or determining a high wind gust threshold whereby action must be taken.

Member Gustaveson said the items listed in Phase I are of the utmost concern to the architects. These are the items which must be done. We could forgo spending the money on analysis and put the money toward a new facility. Mr. Gerber said this argument could be made.

(Member Nemec returned to the meeting and was seated at 7:25pm)

Member Wood said the engineering report could help balance what needs to be done to ensure the safety of the employees while being fiscally responsible. She asked if it is necessary to expend $2.5 million for building repairs when the district may inhabit the building a year from now. The Board needs to know what is imminent or posing a threat that may need to be dealt with in the next six months to a year, while considering other alternatives for a new facility.

Mr. Gerber said this estimate can be modified depending upon what systems the Board would like to have tested. The initial estimate is based on coring and testing to provide real data for more precision. In terms of establishing a level of which systems need to be repaired dependent upon length of occupancy the estimate can be modified accordingly.

Chair Jones said the information will be provided by the engineering report, as well as provide a design process for needed repairs. Staff can report back to the Board with a proposal for eminent repairs. Mr. Weiss said staff will review NRS 358 to determine what constitutes an RFP based on the status of a public project.

Chair Jones said regardless of whether or not the district continues to occupy the building some items need to be addressed and the engineering analysis will be completed to help determine what needs to be repaired immediately.

Member Woodbury said he is not opposed to going down this road; however he would like a more detailed report at the next meeting as to what is being proposed and the money spent on the project. This will assist the Board in making an informed decision related to what systems to test and what repairs to make at this time. This is in relation to the $2.5 million in estimated repairs.

Board of Health – Special Meeting Minutes Page 4 of 4 October 3, 2011

Member Tarkanian motioned to modify the language of the petition to “authorize administrative staff to enter into and/or renew negotiations to acquire property for the proposed replacement facility.” She suggested adding “and for staff to provide information as to where needed funds can be obtained.” Member Wood seconded the motion with the addendum to provide at least three options for a proposed facility.

Member Giunchigliani expressed concern with the wording “enter into” which implies a specific person or agency. She said we need to consider the means by which property can be obtained. Mr. Weiss said staff will need to have preliminary negotiations prior to bringing any proposals to the Board for consideration. Any negotiations will be subject to Board approval.

Ms. Bradley suggested modifying the language of the motion to “enter into, renew, and/or initiate negotiations.” Member Tarkanian agreed to modify her motion accordingly, and Member Wood concurred as the second.

A motion was made by Member Tarkanian to: 1) authorize administrative staff to enter into, renew, and/or initiate negotiations to acquire property for the proposed replacement facility, 2) and for staff to provide information as to where needed funds can be obtained, and 3) to provide at least three separate options for a replacement facility for the Board’s consideration; seconded by Member Wood and carried with Members Giunchigliani and Scow opposed, and Member Bateman abstaining (expressed prior to his departure).

Attachment #16

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, January 26, 2012 - 8:30 A.M.

Board Members Present: Tim Jones Chair, At-Large Member, Regulated Business/Industry Stavros Anthony Vice Chair, Councilman, Las Vegas Jimmy Vigilante Secretary, At-Large Member, Environmental Specialist Jim Christensen, MD At-Large Member, Physician Chris Giunchigliani Commissioner, Clark County Allan Litman Councilman, Mesquite Nancy Menzel, RN At-Large Member, Registered Nurse Bill Noonan At-Large Member, Gaming John Onyema, MD At-Large Member, Physician Mary Beth Scow Commissioner, Clark County Lois Tarkanian Councilwoman, Las Vegas Anita Wood Councilwoman, North Las Vegas Rod Woodbury Councilman, Boulder City

Absent: Sam Bateman Councilman, Henderson

VI. REPORT / DISCUSSION / ACTION 5. Receive Update on Status of Main Building Assessment and Potential Replacement Facilities; direct staff accordingly or take other action deemed appropriate

Scott Weiss, director of administration and Larry Singer, broker from Grubb & Ellis presented on this item and presented at PowerPoint (attachment #5).

(Member Litman left the meeting at 12:42pm)

Mr. Singer said the district established search criteria to identify potential facilities to replace the current buildings located at the main campus, which included:

• All of Clark County bounded by the 215 beltway • All existing buildings in excess of 50,000 square feet of available space • Vacant land containing nine or more acres suitable for development • Properties for sale or leave • Government-owned properties

Board of Health Minutes Page 2 of 3 January 26, 2012

District staff also established evaluation criteria for each identified building in an effort to find the best possible facilities for the district. Due to timing and cost issues it was determined that vacant land should be excluded from consideration at this time.

• Central location (within three to five miles of Shadow Lane Campus) • Existing building • Building size (50,000 square feet or greater) • Site size (to accommodate district’s space and parking requirements) • Sales price ($120.00/square foot or less) • Lease rate ($2.00/square foot full service gross or less) • Parking (minimum ratio of 4.5 stalls/1000 square feet of space) • Ease of automobile/public transportation access to and from parking facilities • Primary street • Visible from primary street or freeway • Ability to add additional space or buildings • Owner control of property (no sublease of building or ground lease)

(Members Giunchigliani and Litman rejoined the meeting and were seated at 12:46pm)

• Single tenant building • No possible asbestos (built after 1976) • No use restrictions preventing district’s use or occupancy

Member Giunchigliani said the evaluation criteria should include a site that is conducive to the clients using our services – we do not want to lose sight of the client. Mr. Singer said a central location keeps the needs of our clients in mind, as well as access to both parking and public transportation.

As a result of the search the following were identified:

• Four existing buildings within three miles of the main campus • Nine existing buildings located between six and nine miles of the main campus • Seven existing buildings located more than nine miles from the main campus • Six existing buildings containing 50,000 square feet or less of available space • Eleven existing buildings containing between 50,000 and 100,000 square feet of available space • Three buildings with more than 100,000 square feet of available space

A total of eight properties were selected for inspection and tours were scheduled on three separate days, which included a mix of both government-owned and privately-owned properties. Next steps include continuing the due diligence based on the evaluation criteria as established. Mr. Singer will also work with staff to determine the possible structure of the project, including a detailed financial analysis.

Member Giunchigliani asked the status of the letter she and Member Scow sent to Dr. Sands concerning the facility study with the School of Medicine and UMC. Dr. Sands said he met with county staff, and also had discussion with Marcia Turner, vice chancellor of the Nevada System of Higher Education. We are waiting for additional word from Clark County concerning the study. Member Giunchigliani expressed pleasure in the district’s willingness to participate in the Board of Health Minutes Page 3 of 3 January 26, 2012

study, noting the need for a medical campus in the community. Dr. Sands he has always been willing to participate in this process.

Chair Jones asked if any new information has become available since the November meeting. Mr. Weiss said the evaluation criteria were developed so staff could tour the sites. A Replacement Facility Committee meeting is scheduled for February 8, 2012 where additional information will be provided for consideration. The funding issue, which is tied to current litigation, is curtailing development of any project proposal and a financial structure for the Board’s review.

Chair Jones noted he would not be available to meet on February 8, but expected the committee to meet and discuss the information as presented.

Member Giunchigliani asked if a formal motion regarding the health district’s participation in the medical campus discussion is necessary. Chair Jones said staff was asked to participate, which was accomplished and a willingness to continue further discussion was expressed. Dr. Sands said he is waiting for further communication from Clark County or the School of Medicine regarding this study.

Member Tarkanian asked for clarification on the matter Member Giunchigliani mentioned. The School of Medicine has committed to a presence in Southern Nevada, including a building. It was determined that a study needed to be conducted as to what is currently in place in the existing medical corridor, as well as the needs of all interested parties. This would include the needs of UMC and any resulting needed facilities. The health district building is county-owned, sitting on county property – if the health district leaves this location it can be used by another agency. It is important for the health district to participate in the facility planning to express its needs as well. Attachment #17

M I N U T E S

Southern Nevada District Board of Health Meeting 625 Shadow Lane Las Vegas, Nevada 89106 Clemens Room

Thursday, February 23, 2012 - 8:30 A.M.

Board Members Present: Tim Jones Chair, At-Large Member, Regulated Business/Industry Stavros Anthony Vice Chair, Councilman, Las Vegas Sam Bateman Councilman, Henderson Jim Christensen, MD At-Large Member, Physician Susan Crowley Alternate At-Large Member, Environmental Specialist Chris Giunchigliani Commissioner, Clark County Allan Litman Councilman, Mesquite Nancy Menzel, RN At-Large Member, Registered Nurse Bill Noonan At-Large Member, Gaming John Onyema, MD At-Large Member, Physician Mary Beth Scow Commissioner, Clark County Lois Tarkanian Councilwoman, Las Vegas Anita Wood Councilwoman, North Las Vegas Rod Woodbury Councilman, Boulder City

Absent: Jimmy Vigilante Secretary, At-Large Member, Environmental Specialist

VI. REPORT / DISCUSSION / ACTION 1. Receive Report and Recommendations from the Southern Nevada District Board of Health Replacement Facility Committee; accept recommendations or take other action deemed appropriate

Bill Noonan, acting chair of the Replacement Facility Committee, presented on this item. Member Noonan noted the meeting was very productive. Jeff Gerber from PGAL updated the committee on the status of the main facility, including the major outstanding issues which are of primary concern. Member Noonan hoped the full PowerPoint presentation would be made available to the complement of the Board. Larry Singer of Grubb & Ellis also updated the committee on twenty-eight possible alternative sites for the main facility. A matrix included numerous factors to consider including distance from current facility, access to public transportation lines, pedestrian access, number of available parking spots and many others. There were some sites designed as vacant lots as well. The committee selected two sites that meet the needs of the district: 4750 W. Oakey Boulevard, which is approximately 106,000 square feet of available space; and 330 S. Valley View, with approximately 166,000 square feet of available space. The committee felt that these two facilities, of the twenty-eight reviewed, had potential to meet the needs of the health district going forward.

Board of Health Minutes Page 2 of 3 February 23, 2012

A representative from Clark County Real Property Management (RPM) also attended the meeting, who shared his perceptions of the existing main facility and what can be done to assure interested parties that the visual inspection supports the claims of deteriorating structural integrity. The committee determined that Levels One through Three of the structural engineering analysis needed to be completed to support the outcome of the previous visual inspection, which will total approximately $54,500. The representative from RPM felt this necessary step was missing previously.

The committee recommended providing the full Board with the detailed engineering study presented by PGAL, as well as the matrix listing all facilities considered as viable options for a potential replacement facility including the rationale for selecting the two sites noted earlier.

Member Menzel said she voted to expend the funds for the structural analysis as the representative from RPM noted it was the only way he could agree that the building is deteriorating. She said the district outgrew the existing facility some time ago; it is an old building losing its structural integrity. She has reservations putting more money into a study to determine if the building will collapse sooner rather than later.

Member Giunchigliani asked if Levels One through Three of the structural analysis will provide answers as to the life cycle of the building and any urgency to vacate the premises. Member Noonan confirmed the more detailed analysis would address Member Giunchigliani’s concerns.

Dr. Sands said that Mr. Gerber was also present at the meeting to answer any questions of the Board.

Member Crowley clarified that the $55,000 would not encompass a full structural and engineering analysis, but rather would provide RPM the rationale to support a replacement facility for the health district. Member Noonan said it would be a more thorough analysis than the visual inspection conducted previously; he also noted Mr. Gerber’s presence at the meeting if the event further clarification was needed.

Member Giunchigliani said the county owns the existing building and needs confirmation as to whether or not the building is habitable if the health district were to vacate the premises. She said the $55,000 is a good investment and would help resolve the issue as to the building’s structural integrity. Chair Jones asked if the county were willing to pay the $55,000 expense.

Member Giunchigliani asked the status of discussions pertaining to development of a medical/academic district in the area. Dr. Sands said he received notice from Maria Turner of the Nevada System of Higher Education pertaining to a study conducted by FTI Consulting to identify how to enhance partnerships or establish new relationships with UMC and enhance the academic mission of UMC. Dr. Sands will be participating in this study. Member Giunchigliani said the health district’s main charge of duties fits within the medical/academic center model. She said the land where the health district is located is also owned by Clark County and could be used to construct residential housing for medical students and residents.

Member Tarkanian referenced an employee who cited a mold issue in the main facility caused his illness, and subsequent death. Member Giunchigliani said there is mold in the building, and lawsuits were filed. Dr. Sands said this was a worker’s compensation case.

Angus MacEachern, human resources administrator said the statement that mold was found in the building in inaccurate. There have been at least four indoor air quality studies conducted Board of Health Minutes Page 3 of 3 February 23, 2012

and results showed better air quality inside the building than outside. In the situation referenced by Member Tarkanian, there were a number of mitigating factors as to what precipitated the gentleman’s death. The litigation is currently at a stalemate as the plaintiff cannot retain counsel to litigate the matter. The matter is pending at the federal level and may be dismissed.

Dr. Sands said the Board needs to consider the two recommendations from the committee and determine how it would like to proceed. Member Noonan restated the two recommendations from the committee: 1) conduct the Level One through Three structural engineering analysis; and 2) review the feasibility of the two sites selected as potential replacement facilities.

Member Anthony motioned to accept the two recommendations from the Replacement Facility Committee which was seconded by Member Wood.

Member Giunchigliani said this should not be done in lieu of participation in the discussion pertaining to development of a medical/academic center. Dr. Sands said by approving this action it will not preclude the district’s participation in the medical site planning. Member Giunchigliani said she feels the district should remain in the medical corridor as it makes better sense. Member Noonan said the committee discussed this same issue and felt this could be accomplished on parallel tracks.

Member Anthony agreed to amend his motion to include this provision and the second concurred. Chair Jones asked to clarify the two sites under consideration. Dr. Sands said the two sites include the former IRS building located at 4750 W. Oakey Boulevard; and the former CenturyLink building, located at 330 S. Valley View.

A motion was made by Member Anthony to accept the recommendations brought forth by the Replacement Facility Committee to 1) conduct the Level One through Three structural engineering analysis; and 2) review the two feasibility of the two sites selected as potential replacement facilities while continuing to participate in discussions related to development of a medical/academic center in the immediate area; seconded by Member Wood and carried unanimously.

Site Inquiry Matrix

Evaluation Criteria 1 - Central Location (Within Three Miles of Shadow Lane 6 - Lease Rate (Under $2.00 Per Square Foot Full Service Gross) 11 - Ability to Add Additional Space or Buildings Campus) 7 - Parking (Minimum Ratio of 4.5 Stalls/1000 Square Feet of Space) 12 - Owner Control of Property (No Sublease of Building or 2 - Existing Building 8 - Ease of Automobile Access to and from Parking Facilities Ground Lease) 3 - Building Size (50,000 Square Feet or Greater) 9 - Primary Street 13 - Single Tenant Building 4 - Site Size (To Accommodate Districts Space and Parking 10 - Visible from Primary Street or Freeway 14 - No Possible Asbestos (Build After 1976) Requirements) 15 - No Use Restrictions Preventing Districts Use or 5 - Sales Price (Under $120.00 Per Square Foot) Occupancy

Good visibility and access to public transportation and good automobile access. Parking meets the needs of the Health Valley View Blvd. District. The property offers expansion capabilities. $19,500,000/$1.12/SF Less 1/2 mile from Three bus stops within 792 Feet and two stops within 1056 Building is in good condition and is competitively priced on 1 330 Valley View 166,409 SF 166,409 SF 10 Acres Triple Net 1983 Yes Yes Well Maintained 89107 1.98 Miles US 95 930 Spaces Feet. Concrete Tilt Up a per square foot basis.

The size and configuration accommodates the occupancy needs of the health district. Good visibility and access to Oakey Blvd. public transportation. The building appears to be in approximately .10 excellent condition. Asking sales and lease rates are within miles from Decatur an acceptable range. Median on Oakey prevents left turn 4740 West Oakey $19,950,000/$1.50/SF and approximately ingress and egress to visitor parking. Parking is a little light 2 Blvd. 106,625 SF 106,625 SF 3.19 Acres Triple Net 1988 Yes Yes Well Maintained 89102 3.03 Miles 2 miles from US 95 460 Spaces Three bus stops within 792 Feet. Steel Frame for the Districts needs.There are no expansion capabilities.

This property is centrally located however the building has significant deferred maintenance and would require extensive renovations. There are only 50 parking spaces Charleston Blvd. for this property. The building has good visibility, $8,900,000 $1.95/SF approximately 1.5 automobile access and access to public transportation. 3 700 East Charleston 63,598 SF 63,598 SF 1.46 Acres Full Service Gross 1987 Yes Yes Deteriorating 89104 1.49 Miles miles east of I-15. 50 Spaces Seven bus stops within 1320 Feet Concrete Asking lease rate is within an acceptable range.

Civic Center Drive approximately mid- way between Lake This property is owned by the City of North Las Vegas. It is Mead Blvd. and Las centrally located and has good access to public NLV City Hall Vegas Blvd. There transportation.The property is in poor condition and 2200 Constitution To Be is no freeway To Be requires extensive renovation. It has poor visibility and 4 Way 44,000 SF Determined 30 Acres No Price Set 1966 TBD TBD Deteriorating 89030 5.10 Miles access Determined Ten bus stops within 1056 Feet. appears to be too small.

This property has adequate parking and is priced significantly below market as a result of the short term left on the sublease. The building appears to be in very good condition. The property is in a poor location with no access No major access to to major roads or freeways. There is no visibility or public United Way Building 0.69 Per Square Foot major roads or transportation. It is not centrally located and is a short term 5 8290 Arville Street 30,000 SF 30,000 SF 5.17 Acres Net 2004 No Yes Well Maintained 89138 7.05 Miles freeways. 400 Spaces No bus stops within one mile. Concrete Tilt Up sublease. Therefore there is not adequate owner control.

Easy access from This property has good access to public Jones and transportation.Sublease through 2021. Therefore there is 6000 West Cheyenne. No free To Be no adequate owner control of the property. Multi-tenant 6 Cheyenne 72,000 SF 72,000 SF 6.71 Acres $7,000,000 1982 Yes No Deteriorating 89108 7.19 Miles way access Determined Eight bus stops within 1320 Feet Block Construction shopping center.

The size and configuration can accommodate most of the needs of the Health District. Asking sales price is within an No left turn ingress acceptable range. The property has high visibility and has or egress from good access to public transportation, however the building 4380 Boulder Boulder Highway. is in poor condition and would require extensive 7 Highway 71,769 SF 71,769 SF 4.75 Acres $2,500,000 1989 Yes No Deteriorating 89121 7.64 Miles No freeway access. 261 Spaces Two bus stops within 792 Feet. renovations. Grier Drive off of Sunset and Paradise Roads The size and configuration can accommodate most of the Hughes Airport approximately 1.5 needs of the Health District. The building appears to be in Center $8,900,000/$2.00/SF miles from Las good condition. Asking sales and lease rates are within an 8 880 Grier Drive 81,000 SF 81,000 SF 450 Acre Park Full Service Gross 1995 Yes Yes Well Maintained 89119 9.10 Miles Vegas Blvd. 370 Spaces Two bus stops within 1320 Feet. Concrete Tilt Up acceptable range. Off Summerlin Pkwy. And Town Center Drive there The size and configuration can accommodate most of the is no direct access Health District's needs. The lease rate is within an Hillshire Business to major roads. acceptable range. Access to public transportation is Center $2.00/SF Full Service There is no freeway poor.There is no visibility and the property is not easily 9 1551 Hillshire Drive 69,500 SF 69,500 SF 4.55 Acres Gross 1993 Yes Yes Well Maintained 89134 9.34 Miles access. 290 Spaces Four bus stops within 1320 Feet. Concrete Tilt Up accessible. The property is not centrally located. Site Inquiry Matrix

Distance From Site Number Location Building Size Available Space Property Size Price Building Age For Sale For Lease Building Condition Zip Code Shadow Lane Automobile Access Parking Distance From Public Transportation Type of Construction Comments South of 215 in a mixed use office/industrial This is a new building and has never been occupied. The park. Freeway size and configuration can accommodate most of the access is Health District's needs. It is highly visible and has good Beltway Business approximately one access to public transportation. The building is not Park $2.30/SF Modified mile from the centrally located and the property is not easily accessible. 10 6770 Edmond Street 72,283 SF 72,283 SF 8.75 Acres Gross 2008 No Yes Well Maintained 89118 9.35 Miles property. 324 Spaces Three bus stops within 1848 Feet Concrete Tilt Up The lease rate is out of an acceptable range. 1 - Central Location (Within Three Miles of Shadow Lane Campus) 6 - Lease Rate (Under $2.00 Per Square Foot Full Service Gross) 11 - Ability to Add Additional Space or Buildings 2 - Existing Building 7 - Parking (Minimum Ratio of 4.5 Stalls/1000 Square Feet of Space) 12 - Owner Control of Property (No Sublease of Building or 3 - Building Size (50,000 Square Feet or Greater) 8 - Ease of Automobile Access to and from Parking Facilities Ground Lease) 4 - Site Size (To Accommodate Districts Space and Parking 9 - Primary Street 13 - Single Tenant Building Requirements) 10 - Visible from Primary Street or Freeway 14 - No Possible Asbestos (Build After 1976) 5 - Sales Price (Under $120.00 Per Square Foot) 15 - No Use Restrictions Preventing Districts Use or Occupancy

Charleston Blvd.. And Grand Central Parkway. Close This property has good automobile access and access to Charleston and proximity to I 15 To Be public transportation.Vacant land. Development const and 11 Grand Central N/A N/A 9.29 Acres No Price Set N/A Yes No N/A 89106 .83 Miles and US 95 Determined Six bus stops within 1320 Feet N/A timing issues. Close proximity to This property has good automobile access and access to US 95. Just off To Be public transportation.Vacant land. Development const and 12 4300 Meadows Lane N/A N/A 10 Acres No Price Set N/A No Yes N/A 89107 2.02 Miles Valley View Blvd. Determined Two bus stops within 792 Feet. N/A timing issues. Access on Main This property has good automobile access and access to 1001 North Main Street and To Be public transportation.Vacant land. Development const and 13 Street N/A N/A 10.89 Acres $2,195,000 N/A Yes No N/A 89101 2.52 Miles Washington. Determined Two bus stops within 528 Feet N/A timing issues. Sahara and To Be 14 Sahara and Paradise N/A N/A 12.22 Acres No Price Set N/A Yes No N/A 89104 2.67 Miles Paradise Determined Seven bus stops within 1056 Feet N/A This is a gaming property and will be cost prohibitive This property has good automobile access and access to 2845 North Las Access on Las To Be public transportation.Vacant land. Development const and 15 Vegas Blvd. N/A N/A 12.12 Acres $2,500,000 N/A Yes No N/A 89030 2.74 Miles Vegas Blvd. Determined Four bus stops within 1056 Feet N/A timing issues. Cheyenne east of Decatur Blvd. No left tern ingress or Cheyenne And egress. No freeway To Be Vacant Land. Development costs and timing has 16 Decatur N/A N/A 10.84 Acres $9,200,000 N/A Yes No N/A 89032 4.02 Miles access. Determined Five bus stops within 634 Feet. N/A eliminated it from consideration at this time Las Vegas Blvd. To Be 17 Skyview N/A 147,000 SF 9.0 Acres No Price Set N/A No Yes N/A 89119 6.31 Miles South Determined Three bus stops within 634 Feet N/A This is a gaming property and will be cost prohibitive Access from Marnell Airport Russell Road and This is a build to suite. Timing and cost issues has 18 Center N/A 172,000 SF 14 Acres No Price Set N/A No Yes N/A 89119 8.58 Miles Spencer Street 688 Spaces Two bus stops within 792 Feet N/A eliminated it from consideration.

Attachment C

COST ANALYSIS BASED ON SHORT TERM OCCUPANCY OF 2 YEARS IT EQUIPMENT / SERVICE ESTIMATE COST OLD NLV CITY HALL EXPENSES CENTURY LINK EXPENSES Cisco 4507R+E switch $36,000 $36,000 $0 Batteries for Cisco 4507R+E switch $10,000 $10,000 $0 13 Cisco 3560x switches $78,000 $78,000 $0 Batteries for Cisco 3560x switches ($1000/closet) $7,000 $7,000 $0 Century Link network connection (1G link monthly) $2,800 $67,200 $67,200 Patch cables $3,000 $3,000 $0 Cisco annual warranty contracts $10,000 $20,000 $0 IT hardware build out costs $134,000 $134,000 $0 Annual network circuits and service contracts $43,600 $87,200 $0 TOTAL IT COST $442,400 $67,200 CENTURY LINK FACILITY WOULD UTILIZE EXISTING IT EQUIPMENT FROM 625 SHADOW LANE FACILITY; 625 SHADOW LANE IT EQUIPMENT IS INCOMPATIBLE FOR USE AT OLD NLV FACILITY

MAINTENANCE EQUIPMENT / SERVICE ESTIMATE COST OLD NLV CITY HALL EXPENSES CENTURY LINK EXPENSES Relocation costs $200,000 $200,000 $200,000 Asbestos Training (25 Mtn/Jan staff @ $500 each/yr) $12,500 $25,000 $0 Electrical Upgrade $45,000 $45,000 $0 Plumbing Upgrade $20,000 $20,000 $0 Paint $10000-$20000 $10,000 $20,000 Flooring $15000-$20000 $15,000 $20,000 Air Quality Testing $7,000 $7,000 $0 TOTAL MAINTENANCE COST $322,000 $240,000

TOTAL IT & MAINTENANCE RELOCATION COST $764,400 $307,200 $457,200 DIFFERENCE IN COST Attachment D

North Las Vegas – IT Assessment

In reference to the North Las Vegas location, IT has identified some items that would need addressing prior to relocating. When SNHD walked through the location we identified the wiring closets throughout all the buildings are small in size. The network gear we currently have will not fit in these locations due to the size of the switches. SNHD IT would have to purchase additional networking gear to accommodate these smaller closets. The order could take up to 4 to 6 weeks for delivery and IT would need 1 week to configure and install.

To add to the need to purchase additional network equipment these closets is the lack 208V power in almost all wiring closets. With both the lack of space and lack of power this would require additional wiring run and purchasing done. Existing wiring may not be in the optimal locations, and asbestos in the City Hall building will prevent us from adding new data lines.

The demark point is located in the City Hall building, which has the smallest wiring closet. This wiring closet is where we would need the most space for our equipment. However, the City of North Las Vegas will be leaving their hardware in that building as it is needed to connect their new building to the police department. This gives us even less room for our required hardware.

Cooling may be adequate for our equipment but it is unknown if we would be allowed to add additional cooling. Also, there is no backup generator for the 2 modular buildings and only a very minimal option for the City Hall building. Overall, the space for IT is limited with power and space. All new network gear would be required for this location which will add time and money.

From: Eddie Larsen Sent: Wednesday, May 09, 2012 4:41 PM To: Lawrence Sands, DO, MPH; Rory Chetelat Subject: FW: County Locations

All,

I asked Matt Colbert, our Network Administrator, to provide us with further details on adding us to Clark County’s various locations and network with a variety scenarios. It is not an easy or quick fix and see below for further information. If you need additional clarification please let me know.

Eddie

______Edward Larsen Manager, Information Technology Southern Nevada Health District (702) 759-1228 Office (702) 759-1401 Fax Email: [email protected]

From: Matthew Colbert Sent: Wednesday, May 09, 2012 4:04 PM To: Eddie Larsen Cc: Chris Strickland Subject: RE: County Locations

Eddie,

There will be numerous issues with housing our users at a county location. I will break it down into thee likely scenarios. The first is we are provided with a floor or entire building, but supply the network connections ourselves. The second is that we use our computers but their network. The last scenario would have our employees using Clark County’s computer equipment and network.

The first scenario would by far be the easiest and most secure. Clark County would have to give us space in a wiring closet and allow us to use our own network hardware. We would use their cables and connect them to our devices. We would also have to get a circuit connecting SNHD to whatever location we end up for our users. All applications and functionality for the users would be the same as any other remote location.

The main problem that would be encountered with the other scenarios is that our network is only partially accessible to Clark County and we are likewise mostly blocked from theirs. This is by design since we are not a county agency but do have some need to access a limited amount of county applications. Currently our internal IP address scheme is not compatible with theirs. We have conflicting IP addresses that normally never see each other in our current configuration. In order for our users to connect back to our applications and servers we would likely have to change a large portion of our network design. This would be a major undertaking and would require assistance from IBM and Dyntek, not to mention Clark County themselves. Clark County would have to allow our traffic to leave their network via the IGTnet network to come back into ours. Our Cisco phones will not work in their locations, requiring new phones and numbers to be provided by them. We would also need to max out our connections from Century Link to the county in order to connect faster, but it will still be much slower than we are used to at other remote locations.

If we bring our own computers and use their network we would also have to move all of our application servers, domain controllers, and databases to a network that is accessible to Clark County. This would be a huge undertaking and also opens multiple opportunities for conflicts between our servers and theirs. Our domain controllers, DHCP servers, email servers, etc would have to be configured to not interfere with Clark County’s. This would require significant amounts of downtime to accomplish on our side.

Using their computers we would have the same issues listed above in addition to a few others. Our users would have to get Clark County logins, software, licenses and security permissions on their computers in order to work. This would also present a huge burden on their IT department and likely incur costs from their vendors, which would no doubt be passed back to us. Our users would almost surely have less functionality and access to applications then they are accustomed to.

If we have to move users to Clark County we will need to start the planning process with all of the players involved well in advance of a move in date. This will be a huge undertaking that will take weeks if not months to accomplish. It would take a slightly less amount of time to undo if we were to move back into our own buildings.

Let me know if you need more specifics or if we need to start the planning process. ADMINISTRATION DIVISION (includes Admin, Finance, Health Cards/Vital Records, IT, PIO, and Security) # OF SQ FT / MAIN BUILDING SQ FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq Ft includes common areas (restrooms, conference rooms, break Administration 12,230 66 185 rooms, auditorium and waiting rooms). ADMINISTRATION STAFF FROM MAIN BUILDING RELOCATED TO THE FOLLOWING HEALTH DISTRICT FACILITIES: ADMINISTRATION HR ANNEX - 651 SHADOW LANE DIVISION SQ # OF SQ FT / (HUMAN RESOURCES) FOOTAGE EMPLOYEES EMPLOYEE COMMENTS

Sq Ft includes all common areas (restrooms, break rooms and conference rooms). 30 Employees relocated to the HR side of this PRIOR TO BUILDING CLOSURE 7,376 12 615 facility. HR lost all conference/training rooms. HR Conference Room 1 consists of 10 employees using 16 sq ft work stations each. HR Room 2 consists of 15 Finance employees with the same 16 sq ft work stations. Remaining staff has occupied file storage room; conference POST BUILDING CLOSURE 7,376 42 176 room and displaced HR staff from their offices.

COMMUNITY HR ANNEX - 651 SHADOW LANE HEALTH SQ # OF SQ FT / (COMMUNITY HEALTH) FOOTAGE EMPLOYEES EMPLOYEE COMMENTS

PRIOR TO BUILDING CLOSURE 6,480 23 282 Sq ft includes all common areas (restrooms, break rooms and conference rooms). 6 Employees relocated to the Community Health POST BUILDING CLOSURE 6,480 29 223 areas of the HR building. EMS lost their testing room.

Nine (9) IT staff members were transferred as follows: 6 - Telecommuting 2 - 400 Shadow Lane 1 - Henderson PHC

Five (5) Security staff were transferred to the Facilities location at 700 Desert Lane - Loss of surveillance and security office

Admin Page 1 HEALTH CARDS / VITAL RECORDS RELOCATED TO THE BELOW LISTED FACILITIES IN ADDITION TO MOVING TO THE HR BUILDING

EAST LAS VEGAS PHC DIVISION SQ # OF SQ FT / HEALTH CARDS / VITAL RECORDS FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq ft includes all common areas (waiting rooms, conference rooms PRIOR TO BUILDING CLOSURE 4,100 9 456 and restrooms). 9 Health cards/Vital records employees relocated to this facility. As a result of closing the main building and Henderson health cards operations, the ELV and Cambridge offices are POST BUILDING CLOSURE 4,100 18 228 overwhelmed with clients.

HENDERSON LAS VEGAS PHC DIVISION SQ # OF SQ FT / HEALTH CARDS / VITAL RECORDS FOOTAGE EMPLOYEES EMPLOYEE COMMENTS

PRIOR TO BUILDING CLOSURE 5,005 6 834 Sq ft includes all common areas (waiting rooms, conference rooms and restrooms). 6 Vital Records employees relocated to this facility. POST BUILDING CLOSURE 275 12 23 Health Cards operations cancelled and the space was given to EH.

CAMBRIDGE PHC DIVISION SQ # OF SQ FT / HEALTH CARDS / VITAL RECORDS FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq ft includes all common areas (waiting rooms, break room and PRIOR TO BUILDING CLOSURE 1,088 6 181 restrooms). 2 employees relocated to this facility. As a result of closing the main building and Henderson Health cards operations, the POST BUILDING CLOSURE 275 8 34 ELV and Cambridge offices are overwhelmed with clients.

Five (5) remaining Health Cards/Vital Records staff were transferred to the following locations: 3 - Coroner's office 1 - 400 Shadow Lane 1 - Spring Valley

Admin Page 2 NURSING DIVISION # OF SQ FT / MAIN BUILDING SQ FOOTAGE EMPLOYEES EMPLOYEE COMMENTS

Sq Ft includes common areas (restrooms, conference rooms, break rooms, Nursing 21,015 84 250 auditorium and waiting rooms) and doesn't include TB Clinic 2,100 sf . NURSING STAFF FROM MAIN BUILDING RELOCATED TO THE FOLLOWING HEALTH DISTRICT FACILITIES DIVISION SQ # OF SQ FT / HENDERSON PHC FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq ft includes common areas (restrooms, conference rooms, break rooms PRIOR TO BUILDING CLOSURE 6,032 19 317 and waiting areas). 24 Employees relocated to this facility. Loss of 830 sf to EH division; gained 684 sf from the Alternate District Operations Center however District lost its only Emergency Operations Center by giving up the POST BUILDING CLOSURE 5,886 43 137 ADOC.

DIVISION SQ # OF SQ FT / EAST LAS VEGAS PHC FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq ft includes all common areas (waiting rooms, conference rooms, 12 PRIOR TO BUILDING CLOSURE 15,400 27 570 Immunization rooms, 12 exam rooms and 6 restrooms). 36 Employees POST BUILDING CLOSURE 15,400 63 244 relocated to this facility.

DIVISION SQ # OF SQ FT / 400 SHADOW LANE OFFICE FOOTAGE EMPLOYEES EMPLOYEE COMMENTS PRIOR TO BUILDING CLOSURE 6,118 31 197 Sq ft includes commona areas (restrooms, conference rooms, and break POST BUILDING CLOSURE 6,118 45 136 rooms). 14 Employees relocated to this facility.

DIVISION SQ # OF SQ FT / TB CLINIC - MAIN CAMPUS FOOTAGE EMPLOYEES EMPLOYEE COMMENTS PRIOR TO BUILDING CLOSURE 2,100 11 191 Sq ft includes 4 exam rooms; 1 medicine room; waiting room and 2 POST BUILDING CLOSURE 2,100 16 131 restrooms. 5 Employees relocated to this facility.

Three (3) remaining staff members were transferred to the following locations: 1 - Child Protective Services 1 - SNPHL 1 - Facilities at 700 Desert Lane ENVIRONMENTAL HEALTH DIVISION # OF SQ FT / MAIN BUILDING SQ FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq Ft includes common areas (restrooms, conference rooms, break Environmental Health 10,926 48 228 rooms, auditorium and waiting rooms). EH STAFF FROM MAIN BUILDING RELOCATED TO THE FOLLOWING HEALTH DISTRICT FACILITIES: DIVISION SQ # OF SQ FT / HENDERSON PHC FOOTAGE EMPLOYEES EMPLOYEE COMMENTS

Sq ft includes common areas (restrooms, conference rooms, break PRIOR TO BUILDING CLOSURE 4,547 41 111 rooms and waiting areas). 18 Employees relocated to this facility. EH gained 3136 sq ft due to the closure of Health Cards operations POST BUILDING CLOSURE 7,683 59 130 and gaining additional sq ft from the Nursing conference room.

DIVISION SQ # OF SQ FT / SPRING VALLEY PHC FOOTAGE EMPLOYEES EMPLOYEE COMMENTS

PRIOR TO BUILDING CLOSURE 5,149 23 224 Sq ft includes all common areas (break room, conference room POST BUILDING CLOSURE 5,149 34 151 and restroom). 11 Employees relocated to this facility.

DIVISION SQ # OF SQ FT / 400 SHADOW LANE OFFICE FOOTAGE EMPLOYEES EMPLOYEE COMMENTS Sq ft includes common areas (restrooms, conference rooms, and PRIOR TO BUILDING CLOSURE 4,999 28 179 break rooms). 20 Employees relocated to this facility. EH gained 352 sq ft from the Epidemiology conference room which is staffed POST BUILDING CLOSURE 5,351 47 114 with 9 EH/Vector Control employees. Attachment G SNHD Organizational Charts as of May 25, 2012 Functional Overview by Location 5/25/2012 Chief Health Officer 901-1101 HR ANNEX Lawrence Sands, D.O., MPH

Executive Assistant Human Resources Administrator Shelli Clark 901-1050 HR CONF ROOM Angus MacEachern HR ANNEX

Information Technology Manager Administrative Secretary Attorney Edward Larsen OPHP ANNEX Diana Lindquist 901-1052 HR CONF ROOM Annette Bradley 901-1012 HR ANNEX Public Information Manager Associate Attorney Jennifer Sizemore OPHP Annex Vacant 901-9104

Acting, Director of Administration Director of Community Health Director of Environmental Health Director, Clinics and Nursing Svcs Rory Chetelat EMS Annex John Middaugh, MD 400 - Ste 202 Glenn Savage 400 - Ste 104 Bonnie Sorenson 400 - Ste 206 Vacant Weiss

901 Administration/Financial Svcs 400 So. NV. Public Health Laboratory 201 EH Administration 105 General Nursing 905 Health Records 601 Community Health Administration 205 Vector 107 Ryan White 906 Vital Records 602 Disease Prev/Health Promotion 205 Plan Review 109 Maternal Child Health 907 Facility Services/Maintenance 603 Epidemiology 205 Pool Inspection Program 110 Immunization Clinics 610 Office Public Hlth Preparedness 205 Food/Special Programs 121 Tuberculosis Clinic 611 Emerency Medical Svcs & Trauma 215/220/230 - Underground 140 Family Planning Systems Storage Tanks/Solid Waste/ 145 STD Safe Drinking Water 147 HIV/AIDs Prevention 148 SAPTA (BADA)

5/23/2012 O - 1 SNHD Functional Overview Administration Overview - By Location 5/25/2012

Acting, Director of Administration Rory Chetelat 611-0001 EMS Annex Vacant Weiss 901-1010

Administrative Assistant II Administrative Secretary Norma Jordan 901-0209 HR 1 Maria Cenabre 901-1015 HR 1

Facility Services Manager Jerry Boyd Warehouse

Acting, Health Records Manager Ray Chua HR 1

Financial Services Manager Marciano Patricio HR SCAN ROOM

5/23/2012 ADM - 1 SNHD Functional Overview Financial Services - By Location 5/25/2012 Acting, Director of Administration Rory Chetelat EMS Annex

Financial Services Manager Marciano Patricio 901-1015R SCAN ROOM

Sr. Administrative Assistant Ellen Gibbins 901-0004 HR 2

Grant Analyst Purchasing Agent Marlene Kolicius 901-0002 HR 1 Jesse Waite 901-9103 HR 1

Grants Development Supervisor Accounting Supervisor Vacant New 901-9122 Kieawa Mason 901-9102 HR 2

Accountant II Accountant II Accountant II Project Specialist Sheilamar Crippen 901-0003 HR 2 Robert Leavitt 901-0204 HR 2 Janet Webster 901-1032 HR 2 Sarah Ritchie 901-9110 HR 2 Betty-Jo Jaynes 610-0009 HR 2 Laurie Jones 901-9115 HR 2 Accounting Technician II Accounting Technician II Dahlia Keegan 901-0501 HR 2 Theresa Hizon 901-1031 HR 1 Pam Koffinke 901-0007 HR 2 Jeanne Isaac 901-1060 HR 2 Lynda Zielinski 901-1063 HR 2 Lan Lam 901-1062 HR 2 Catherine Reel 901-0006 HR 2 Accounting Technician I Bessie Aranaydo 901-0005 HR 2

Admin - Financial Services 5/23/2012 ADM - 2 Information Technology - By Location 5/25/2012

Chief Health Officer HR Annex Lawrence Sands, DO, MPH

Administrative Secretary Information Technology Mgr. Joanne Engler 908-0002 700 Desert Ln Edward Larsen 908-0001 OPHP Annex

Software Engineer Jay Boyer 908-0031 400 Shadow, Ste 202 Philip Fowler 908-0032 400 Shadow, Ste 202 Jason Frame 908-0009 Telecommuting

Project Management Infrastructure Business Applications Data Base Support Software Engineering

IT Project Coordinator IT Supervisor IS Supervisor Data Base Administrator Software Engineer Supervisor Steve Youles 908-0020 Telecommuting Chris Strickland 908-0019 OPHP Annex Stephen Griffin 908-0008 Telecommuting Vladimir Popangelov 908-0016 700 Desert Ln Vacant New 908-0033

Computer Systems Analyst Applications Programmer Analyst II Software Engineer Supervisor Software Engineer Todd Bonnett 610-0006 700 Desert Ln Marie Joven 908-0012 Telecommuting Vacant New 908-0033 FY13 Vacant New 908-0034 Tom Koebke 908-0003 700 Desert Ln Hetal Luhar 908-0011 Telecommuting Brian Spell 908-0014 Telecommuting Software Engineer Disaster Recovery Specialist Vacant New 908-0034 FY13 Romeo Ramos 908-0007 Henderson Applications Programmer Analyst I Julio Rivera-Hernandez 908-0017 Henderson IT Systems Administrator II Rich Hosey 610-0014 700 Desert Ln

Network Administrator Specialist Matthew Colbert 908-0018 700 Desert Ln

Communications Specialist Joseph Yumul 610-0044 700 Desert Ln

Program Systems Specialist II Darris Cole 908-0005 700 Desert Ln David Kuykendall908-0015 700 Desert Ln Timothy Ripp 908-0013 700 Desert Ln

Desktop Engineer Eric Lahr 908-0004 700 Desert Ln

Admin - IT 5/23/2012 ADM - 5 Health Cards/Vital Records - By Location 5/25/2012

Acting, Director of Administration Rory Chetelat EMS Annex

Acting, Health Records Manager Ray Chua 905-1000 HR 1

Sr. Health Records Assistant Sr. Health Records Assistant Sr. Health Records Assistant Sr. Health Records Assistant Health Records Assistant Delila Allen 905-9712 HR 1 Karen Berry 905-9713 Cambridge Cynthia Cunningham 905-1115 ELV Keri Price 905-0001 Henderson Marjorie Hanakeawe 905-1124 400 Shadow Debra Hargrove 905-9711 Spring Valley Health Records Lead Assistant Health Records Lead Assistant Health Records Lead Assistant Health Records Lead Assistant Nan Harrington 905-9709 Coroner's Office Anthony Cardona 905-9716 HR 1 Stephanie Poole 905-1135 Cambridge Erin O'Malley 905-0206 ELV Shannon Dickey 905-9602 Henderson

Sr. Health Records Assistant Health Records Assistant Health Records Clerk Health Records Clerk Sr. Health Records Assistant Elizabeth Munford 905-9705 Mesquite Mary Cooper 905-1126 Cambridge Gayle Beck 905-1128 ELV Nancy Larocco 905-9702 Henderson Carleen Moss 906-0005 Henderson Jessica Donnell 905-0201 Cambridge Patrick Decator 905-0007 ELV Cathy Lucia 905-1122 Henderson Health Records Assistant Deborah Reed 905-0202 Cambridge Rosemary Ensign 905-0002 ELV Edie Mattox 905-9704 Henderson Health Records Lead Assistant Lucinda Reid 905-0008 ELV Lester Rossi 905-9604 Cambridge Joseph Galapon 905-0009 ELV Mike Piontkowski 905-1125 Henderson Susan Zannis 906-9708 Coroner's Office Terri Welch 905-9735 Laughlin Lei Guiterrez 905-9707 Cambridge Laura Patterson 905-0005 ELV Mary Wilson 905-1121 ELV Health Records Assistant Health Records Assistant Administrative Aide Nancy Barry 905-9703 Henderson Christine Johnson 905-0204 Henderson Sadie Buehler 905-0010 ELV Health Records Assistant Corinne Henri 905-9719 Henderson Barbara Dean 905-9603 ELV Vicki Salomon 905-9710 Henderson Vital Records Clerk Yvonne Emry 905-0011 ELV Pamela Thomas 905-0004 Henderson Kathie Franklin 906-0006 Coroner's Office Tamara Jackson 905-1133 ELV Jane Van Ert 905-1129 ELV Nami Kremer 905-1134 ELV Catherine Poe 905-0003 ELV Tracey White 905-0012 ELV

5/23/2012 ADM - 3 Admin - Health Records Human Resources - By Location 5/25/2012

Chief Health Officer HR ANNEX Lawrence Sands, DO, MPH

Human Resources Administrator Angus MacEachern 909-0001 HR ANNEX

Administrative Secretary Jacqueline Wells 909-0002 HR ANNEX

Human Resources Supervisor Bob Gunnoe 909-0011 HR ANNEX Sr. Human Resources Asst Wanda Brown 909-0005 HR ANNEX

Human Resources Asst Charlotte Hoffman 909-0006 EMS ANNEX Scott Witherall 909-0003 HR ANNEX

Human Resources Analyst Human Resources Analyst Human Resources Analyst Human Resources Analyst Kelly Brinkhus 909-0009 HR ANNEX Susan Damitz 909-0007 HR ANNEX Kimberly DiPasquale 909-0015 HR ANNEX Montana Garcia 909-0008 HR ANNEX

5/23/2012 ADM - 4 Admin - Human Resources Facility Maintenance - By Location 5/25/2012

Acting, Director of Administration Rory Chetelat EMS Annex

Facility Services Manager Jerry Boyd 907-0001 Warehouse Safety Officer Administrative Secretary Vacant Stacy 909-0010 Warehouse Michelle Nath 907-0005 Warehouse

Security Specialist Maintenance Specialist Senior Janitor HVAC Technician Forrest Hasselbauer 907-0002 Warehouse Claude McMahan 907-0003 Warehouse Kenneth Mixter 907-0004 Warehouse Dennis Wu 907-0035 Warehouse

Security Aide Maintenance Technician Janitor Jeffrey Good 907-0011 Warehouse Michael Neszmery 907-0002 Warehouse Marco Aguilar 907-0039 Warehouse Landscape Technician Steven Haner 610-0016 Warehouse Leonardo Vega 907-0029 Warehouse Tammy Butler 907-0038 Warehouse Jose Moreno 907-0020 Warehouse Lance Johnson 907-0015 Warehouse Robert Chamberlain 907-0030 Warehouse Felix Landin 907-0055 Warehouse Maintenance Worker Raymund Andales 907-0018 Warehouse Central Supply Assistant Stephen Morris 907-0019 Warehouse Henry Brunk 907-0007 Warehouse Mable Gray 907-0012 Warehouse Tina Gilliam 907-0009 Warehouse Damjan Ristoski 907-0056 Warehouse Nelson Goo 907-0010 Warehouse Manuel Hoskinson 907-0008 Warehouse Debora Schmidt 907-0027 Warehouse George Ruiz 907-0037 Warehouse Michael Palmer 907-0024 Warehouse Jeffrey Johnson 907-0014 Warehouse Justin Scott 610-0015 Warehouse Christopher Schermuly 907-0026 Warehouse Santo Johnson 907-0058 Warehouse Marcus Lawson 907-0070 Warehouse Support Specialist Vacant Lawson 907-0036 TBD Jane Kopczak 907-0050 Warehouse Trayvon McClinton 907-0057 Warehouse Henry Medina 907-0023 Warehouse Administrative Assistant II Derrick Proctor 907-0060 Warehouse Deneen Locklear 110-5131 Warehouse Vacant Robinson 907-0059 TBD Laura Walls 907-0051 Warehouse Robert Smith 907-0025 Warehouse Michael Stevens 907-0040 Warehouse Fernando Tiznado 907-0028 Warehouse Larry Waller 907-0031 Warehouse Marilyn Wilson 907-0032 Warehouse

5/23/2012 ADM - 6 Admin - Facility Services Public Information Office - By Location 5/25/2012

Chief Health Officer HR Annex Lawrence Sands, D.O., MPH

Public Information Manager Jennifer Sizemore 904-0201 OPHP Annex Administrative Secretary Susan Eiselt 904-0203 HR 1

Public Info Officer Web Content Specialist Publication Specialist VOLUNTEER PROGRAM Stephanie Bethel 610-0010 OPHP Annex Jacqueline Wilson 610-0034 OPHP Annex Julie Hurd 904-0002 OPHP Annex Community Outreach Coordinator Jorge Viote 904-0206 EMS CONF RM

Community Outreach & Info Spec Rosanna Silva-Minnich 904-0205 EMS CONF RM

Sr. Administrative Assistant Richard Johnson 904-0204 HR 1

5/23/2012 ADM - 7 Admin - Public Info Community Health Overview - By Location 5/25/2012 Director Community Health John Middaugh 601-0001 400 Shadow, Ste 202 Public Health Informatics Scientist II Medical Epidemiologist Jeffrey Kriseman 601-0010 400 Shadow, Ste 202 Thomas Coleman 601-0011 400 Shadow, Ste 206

Public Health Informatics Scientist I Senior Scientist Vacant New 601-0013 Nancy Williams 601-0012 400 Shadow, Ste 206

Administrative Analyst James Osti 601-0002 400 Shadow, Ste 206

Administrative Secretary Valery Klaric 601-0003 400 Shadow, Ste 202

Chronic Disease Prevention Acting, Emergency Medical Services & Health Promotion Manager Epidemiology Manager and Trauma Systems Manager Public Health Preparedness Manager Laboratory Manager Deborah Williams 602-0001 Patricia Rowley 400 Shadow, Ste 206 Mary Ellen Britt EMS Annex Jane Shunney OPHP Annex Patricia Armour SNPHL

- Tobacco Program - Disease Surveillance - EMS Certification and Licensure - PHP Planning - Southern NV Public Health Lab

- Chronic Disease - Disease and Outbreak Investigation - EMS Vehicle Inspections - Program Development - Injury Prevention Injury Surveillance - EMS Quality Improvement - Training

- Biostatistics - Trauma System Oversight - Grant Proposal Management - BT Response (BioWatch) - Advisory Boards - Exercise Planning and Training - Medical Reserve Corp

5/23/2012 CHS - 1 Community Health Overview Emergency Medical Services and Trauma Systems - By Location 5/25/2012 Director, Community Health Services 400 Shadow, Ste 202 John Middaugh, MD

Acting, Emergency Medical Services and Trauma Systems Mgr

Mary Ellen Britt 611-0007 EMS Annex Vacant Chetelat 611-0001

Regional Trauma Coordinator Vacant Britt 611-0007

EMS Field Representative

Patricia Beckwith 611-0002 EMS Annex John Hammond 611-0003 EMS Annex

EMS Program/Project Coordinator

Moana Hanawahine-Yamamoto 611-0010 EMS Annex

Rae Pettie 611-0008 EMS Annex

Sr. Administrative Assistant Judith Tabat 611-0004 EMS Annex

CHS - EMS 5/23/2012 CHS - 2 Epidemiology - By Location 5/25/2012

Director, Community Health Services 400 Shadow, Ste 202

John Middaugh, MD

Senior Scientist 400 Shadow, Ste 206

Nancy Williams

Medical Epidemiologist 400 Shadow, Ste 206

Thomas Coleman

Epidemiologist

Wilbert Townsend 603-0011 400 Shadow, Ste 206

Michael Tsai 603-0007 400 Shadow, Ste 206

Epidemiology Manager

Patricia Rowley 608-0001 400 Shadow, Ste 206

Epidemiology Supervisor

Linda Verchick 603-0013 400 Shadow, Ste 206 Senior Epidemiologist

Brian Labus 610-0011 400 Shadow, Ste 206

Administrative Secretary Sr. Disease Invest/Interv Specialist

Melissa Constantin 610-0020 400 Shadow, Ste 206 Devin Barrett 603-0010 400 Shadow, Ste 206 Epidemiologist

Linh Nguyen 610-0031 400 Shadow, Ste 206

Administrative Assistant II Disease Invest/Interv Specialist II

Sandi Saito 603-0003 400 Shadow, Ste 206 Tami Bruno 610-0012 400 Shadow, Ste 206 Surveillance Biostatistician II

Vacant Ross 610-0045 G. Tony Fredrick 610-0022 400 Shadow, Ste 206 Jing Feng 603-0006 400 Shadow, Ste 206

Jennifer Harmon 603-0008 400 Shadow, Ste 206

Contract/Agency Funded Zuwen Qiu-Shultz 603-0002 400 Shadow, Ste 206 Senior Community Health Nurse

Pia Virag Data Coordinator Vacant Barrett 603-0004 Vacant Brilis 603-0020

5/23/2012 CHS - 3 CHS - Epidemiology Chronic Disease Prevention & Health Promotion - By Location 5/25/2012 Director Community Health S 400 Shadow, Ste 202 John Middaugh, MD

Chronic Disease Prevention & Health Promotion Manager Deborah Williams 602-0001 400 Shadow, Ste 101

Health Education Supervisor Nicole Bungum 602-0005 400 Shadow, Ste 101

Admin Asst II Sandy Luckett 602-0007 400 Shadow, Ste 101

Sr Admin Assistant Vacant D'Amours 602-0012

Tobacco Program Chronic Disease Injury Prevention

Senior Health Educator Health Educator II Health Educator II Maria Azzarelli 602-0003 400 Shadow, Ste 101 Aurora Buffington 602-0013 400 Shadow, Ste 101 Mike Bernstein 602-0004 400 Shadow, Ste 101 Rayleen Earney 602-0006 400 Shadow, Ste 101 Health Educator II Mindy Meacham 602-0008 400 Shadow, Ste 101 Malcolm Ahlo 602-0002 400 Shadow, Ste 101 Nicole Chacon 602-0011 400 Shadow, Ste 101 General Health Ed / OPHP Liaison Gail Muniz 602-0010 400 Shadow, Ste 101 Health Educator II Amanda Reichert 602-0009 400 Shadow, Ste 101

Contract/Agency Funded Shelia Clark Obesity Educator

CHS - CDPP 5/23/2012 CHS - 4 Office of Public Health Preparedness - By Location 5/25/2012

Director Community Health Svcs 400 Shadow, Ste 202 John Middaugh, MD

Public Health Preparedness Manager Jane Shunney 610-0047 OPHP Annex Administrative Secretary Public Health Preparedness Supervisor Shannon Randolph 610-0048 OPHP Annex Steven Kramer 610-0101 OPHP Annex Administrative Assistant II Mary Bulloch-Khayat 610-0035 OPHP Annex Deborah Moran 610-0033 OPHP Annex

Public Health Preparedness Nurse Dale Klabacha 610-0042 OPHP Annex

Program Project Coordinator Paula Martel 610-0049 OPHP Annex

Sr Public Health Preparedness Planner Kay Godby 610-0008 OPHP Annex Jeffrey Quinn 610-0200 OPHP Annex

Public Health Preparedness Planner II Misty Robinson 610-0036 OPHP Annex

PHP Training Officer Nancy Gerken 610-0007 OPHP Annex Linda Newton 610-0003 OPHP Annex

CHS-OPHP 5/23/2012 CHS - 5 Community Health - State of Nevada Public Health Laboratory 5/25/2012 Director Community Health Svcs 400 Shadow, Ste 202 John Middaugh, MD NV State Lab Program Director Dr. L. D. Brown Laboratory Manager Patricia Armour 400-0001 SNPHL

Laboratory Supervisor Laboratory Supervisor Sharon Johnson 400-0020 SNPHL Paul Hug 400-0013 SNPHL

Clinical Lab Scientist Clinical Lab Scientist Laboratory Tech II Laboratory Assistant Erin Buttery 400-0014 SNPHL Vincent Abitria 400-0002 SNPHL Daniel Brown 400-0016 SNPHL Kelli O'Connor 400-0008 SNPHL Angela Young 400-0012 SNPHL Susanne Quianzon 400-0003 SNPHL Victoria Legaspi 145-3081 SNPHL Betsy Sapp 400-0009 SNPHL Kenneth Stottler 400-0010 SNPHL Lourdes Romans 400-0017 SNPHL Sr. Administrative Asst Kathleen Apalategui 400-0007 SNPHL

Central Supply Asst Sumit Das 400-0004 SNPHL Francine Oakley 400-0011 SNPHL

5/23/2012 CHS - 6 CHS-SNPHL Environmental Health Overview - By Location 5/25/2012

Director Environmental Health Glenn Savage 205-1001 400 Shadow, Ste 104

EH Training Officer Administrative Assistant II Ellen Spears 205-1238 Henderson Melanie Munoz 205-1280 400 Shadow, Ste 104 Christinie Sylvis 205-5024 Henderson Roberta Young 205-1318 400 Shadow, Ste 104

EH Specialist I Administrative Clerk II Vacant Wudarski 205-1236 FY13 Dixie Amen 205-1316 Henderson Vacant Goodman 205-1413 FY13 Vacant Hulbert 205-5029 FY13 Chicozie Alexander 205-1261 Henderson Lauren DiPrete 205-1235 Henderson Vacant Stromberg 205-1362 TBD Vacant Harris 205-1268 TBD Vacant Earl 205-1387 TBD Jennifer Johnson 205-1290 Henderson

Sr. EH Specialist Food/Specialty Prg Manager EH Manager Nancy Hall 205-1282 400 Shadow, Ste 104 Steve Goode Spring Valley Amy Irani 205-1205 400 Shadow, Ste 104

Administrative Analyst EH Supervisors EH Supervisors Robert Newton 205-1222 400 Shadow, Ste 104 - Special Programs - Food Inspection - Pool Operations Spring Valley - Pool Plan Review North Las Vegas Solid Waste Compliance Manager Henderson Dennis Campbell 400 Shadow, Ste 104 Strip Corridor - Plan Review EH Supervisors - Solid Waste - Small Quantity Generator - Underground Storage Tanks - Subdivision Plan Review - Septic Systems - Safe Drinking Water

5/23/2012 EHS - 1 EH Functional Overview Vector Control - By Location 5/25/2012

Director, Environmental Health 400 Shadow, Ste 104 Glenn Savage

Vector Entomologist/Supervisor Phillip Bondurant 205-1400 400 Shadow, Ste 206 Sr. Administrative Assistant Sr. EH Specialist Heather Hanoff 205-5033 400 Shadow, Ste 206 Larry Rogers 205-5026 400 Shadow, Ste 206 Keith Zupnik 205-1415 400 Shadow, Ste 206

EH Specialist II Robert Cole 205-1411 400 Shadow, Ste 206 Theresa Daspit 205-1229 400 Shadow, Ste 206 Ignacio Leycegui 205-5020 400 Shadow, Ste 206 Vivek Raman 205-1412 400 Shadow, Ste 206 Vacant Ripp 205-5018

EH Specialist I Vacant Gore 205-5031 FY13

Administrative Asst II Garren Jakubiak 205-1416 400 Shadow, Ste 206 EH Food/Plan Review 5/25/2012 Director, Environmental Health 400 Shadow, Ste 104 Glenn Savage

Environmental Health Manager Amy Irani 205-1205 Spring Valley Administrative Secretary Admin Asst II Peggy Suiter 205-6006 0 Shadow, Ste 104 Sally Palmer 205-1314 Henderson Stacie Pinnock 205-1312 Henderson

EH Supervisor - Spring Valley EH Supervisor - Henderson EH Supervisor - Spring Valley EH Supervisor - Henderson Plan Review Spring Valley Team Henderson Team NLV Team Strip Team EH Supervisor Mary Hahn 205-1212 Spring Valley Rose Henderson 205-1210 Henderson Herbert Sequera 205-0202 Spring Valley Robert Urzi 205-0414 Henderson Paul Klouse 205-1390 Henderson

Senior EH Specialist Sr. EH Specialist Sr. EH Specialist Sr. EH Specialist Sr. EH Specialist Vacant Callen 205-1239 Mark Gillespie 205-0201 Spring Valley Belinda Bober 205-0204 Spring Valley Carolyn Culbert 205-1234 Henderson Patricia Hayde 205-1402 Spring Valley W. Dan Slater 205-0412 Henderson EH Specialist II Craig Bowman 205-1267 Henderson EH Specialist II EH Specialist II EH Specialist II EH Specialist II Jonathan Dalton 205-0404 Henderson Tanja Baldwin 205-1405 Spring Valley Gabriel Buenaventura 205-5015 Henderson Jodi Brounstein 205-0209 Spring Valley Brisa Soto 205-1408 Henderson Valerie Fidler 205-9504 Henderson Meredith Garman 205-1005 Spring Valley Tamara Giannini 205-1388 Henderson G. Larry Navarrete 205-5017 Spring Valley Nikki Burns-Savage 205-1407 Henderson Steve Humble 205-0403 Henderson Patricia Kaderlik 205-0402 Spring Valley Gracie Martucci 205-0411 Henderson Candice Sims 205-9702 Spring Valley Aaron DelCotto 205-1263 Henderson Larry Law 205-1269 Henderson Mitchell Mildon 205-1404 Spring Valley Miki Sakamura-Low 205-1363 Henderson Melissa Rascon 205-1380 Spring Valley Cara Evangelista 205-1401 Henderson Karla Shoup 205-1231 Henderson Christy Munaretto 205-1271 Spring Valley Brenda Welch 205-5014 Henderson Lyle Rohan 205-1386 Spring Valley Desiree Hiestand 205-1279 Henderson James Sladky 205-1409 Henderson Richard Ryu 205-1389 Spring Valley Marilou Siy 205-1272 Spring Valley Carolyn Ivey-Mitchell 205-0004 Henderson Victoria Wilson 205-5027 Henderson Al Sang-Chiang 205-5032 Spring Valley EH Specialists I George Taylor 205-1406 Spring Valley Lisa Locaynia 205-1275 Henderson Judy Tawatao 205-1283 Spring Valley John Greer 205-0401 Henderson Alicia Mitchell 205-5016 Henderson Sr. Administrative Assistant Kim Thompson 205-9801 Spring Valley Sr. Administrative Assistant Erin Riebe 205-6000 Henderson Donna Kurtti 205-1310 Henderson Sr. Administrative Assistant Karen Easterling 205-1384 Spring Valley Eduardo Rubic 205-1278 Henderson Sr. Administrative Assistant Lisa Galla-Ferrer 205-1330 Henderson Administrative Assistant II Christine Gish 205-1307 Spring Valley EH Specialist I Dustin Thibodeaux 205-1311 Henderson Sakena Alhassan 205-1230 Henderson Administrative Assistant II Jason Kelton 205-9505 pring Valley Kris Schamaun 205-1313 Spring Valley Aris So 205-1264 Henderson Ezra Tubig 205-1403 Henderson

Sr. Administrative Assistant Linda Centeno 205-0413 Henderson Sheila Harris 205-0007 Henderson Pool/Specialty Programs - By Location 5/25/2012

Director, Environmental Health 400 Shadow, Ste 104 Glenn Savage

Environmental Health Manager Steve Goode 205-0101 Spring Valley Administrative Secretary Phyllis Crittenden 205-1308 Spring Valley

Admin Asst II Aivelhyn Santos 205-0206 Spring Valley

Special Programs Pool Operations Pool Plan Review EH Supervisor EH Supervisor EH Supervisor Mark Bergtholdt 205-9701 Henderson Susan LaBay 205-1211 Henderson Angela Jones 205-6003 Spring Valley

Senior EH Specialist Senior EH Specialist EH Specialist II Vancant Sellers 205-1410 Jacque Raiche-Curl 205-9802 Henderson Joy Clark 205-5019 Spring Valley Valerie Hirata 205-0203 Spring Valley Alfred Karns 205-0003 Spring Valley EH Specialist II EH Specialist II Christina Kerr 205-5030 Spring Valley John Cataline 205-5023 Henderson Lorraine Forston 205-1221 Henderson Candice Stirling 205-1237 Spring Valley Karl Herz 205-1284 Henderson James Modico 205-6002 Henderson Susan Lane 205-1305 Henderson Ken Odom 205-1383 Henderson Sr. Administrative Assistant Chrissy Lin 205-1281 Henderson Whitnie Taylor 205-1360 Henderson Mallory Jett-Edwards 205-1414 Spring Valley Jessica Newberry 205-0006 Henderson Steven Zimmerman 205-6001 Henderson John Roberts 205-0410 Henderson Rebecca Schrader 230-4100 Henderson EH Specialist I Jeremy Harper 205-5021 Henderson EH Specialist I Kim Riley 205-0005 Henderson Charlene DeMarco 205-1262 Henderson Administrative Assistant II Sr. Administrative Assistant Korie Maxfield 205-1320 Henderson Jennifer Bowers 230-4120 Henderson

5/23/2012 EHS - 3 EH - Food Spec Programs Waste Management/Engineering - By Location 5/25/2012

Director, Environmental Health 400 Shadow, Ste 104 Glenn Savage

EH Mgr - Solid Waste Compliance Dennis Campbell 220-4100 400 Shadow, Ste 104

EH Supervisor - Solid Waste EH Supervisor - Solid Waste EH Engineer/Supervisor EH Engineer/Supervisor Vacant Irani 220-0006 Eddie Ridenour 220-0408 400 Shadow, Ste 104 Walter Ross 220-0409 400 Shadow, Ste 104 Daniel LaRubio 205-0207 400 Shadow, Ste 104

Senior EH Specialist Senior EH Specialist EH Engineer I EH Engineer II Vacant Bertoty 220-0214 Vacant Ridenour 215-4040 Chris Johnson 205-9703 400 Shadow, Ste 104 Adrian Brown 205-5011 400 Shadow, Ste 104

EH Specialist II EH Specialist II Sr. EH Specialist EH Specialist II Andrew Chaney 220-5005 400 Shadow, Ste 104 Gerald Bletsch 220-5002 400 Shadow, Ste 104 Arta Faraday 220-5014 400 Shadow, Ste 104 Jack Proud 205-1220 400 Shadow, Ste 104 Michelle Clarke 220-5050 400 Shadow, Ste 104 Brian Northam 220-5003 400 Shadow, Ste 104 Nadereh Ghamssari 220-5012 400 Shadow, Ste 104 John Wagner 215-4050 400 Shadow, Ste 104 EH Specialist II Administrative Assistant II Donna Houston 220-5006 400 Shadow, Ste 104 Edward Wynder 220-4153 400 Shadow, Ste 104 Dante Merriweather 220-5015 400 Shadow, Ste 104 Bonnie Archie 205-1317 400 Shadow, Ste 104 Barbara Johannessohn 220-0405 400 Shadow, Ste 104 Kent Wirtz 220-4050 400 Shadow, Ste 104 Diane Meyer 220-5008 400 Shadow, Ste 104 EH Specialist I Evan Rose 220-4051 400 Shadow, Ste 104 Jason Garcia 215-5022 400 Shadow, Ste 104 Administrative Assistant II Carol Clarke 205-5010 400 Shadow, Ste 104 EH Specialist I Sr. Administrative Assistant Rachel Lewison 220-5007 400 Shadow, Ste 104 Lynn Cintron 220-5009 400 Shadow, Ste 104 Bruno Stephani 220-5004 400 Shadow, Ste 104 Administrative Assistant II Sr. Administrative Assistant Diane Freeman 215-4020 400 Shadow, Ste 104 Amy Vega 220-5001 400 Shadow, Ste 104

Administrative Assistant II Kimberly Bond 220-0205 400 Shadow, Ste 104

EH - Solid Waste 5/23/2012 EHS - 4 Nursing Division Overview - By Location 5/25/2012

Director of Clinics and Nursing Bonnie Sorenson 105-1001 400 Shadow, Ste 206 Administrative Secretary Margo Slater 105-5111 400 Shadow, Ste 210 Pharmacist Vacant Gamage 105-1100 Christina Madison TB Clinic

Public Health Centers Communicable/Infectious Diseases Immunization/Child Health STD/TB Clinical Services Community Health Nursing Community Health Nurse Manager Acting, Community Health Nurse Manager Community Health Nurse Manager Community Health Nurse Manager Community Health Nurse Manager Alice Costello ELV Rick Reich 400 Shadow, Ste 210 Veronica Morata-Nichols 400 Shadow, Ste 204 Patricia O'Rourke-Langston TB Clinic Margarita DeSantos 400 Shadow, Ste 206 I. East Las Vegas Public Health Center I. HIV & STD Surveillance I. Immunizations I. STD Treatment and Follow-Up Clinical Svcs I. Community Health Nursing II. Henderson Public Health Center II. HIV Prevention A. Immunization Project II. TB Surveillance and Contact Investigation A. Maternal Child Health III. Mesquite Public Health Center III. Contact & Partner Notification 1. Vaccines for Children III. TB Clinical Services and Patient Monitoring B. Child Protective Services IV. Family Planning IV. Ryan White Part A 2. Perinatal Hepatitis B Program Patient Monitoring C. Nurse Family Partnership V. Delegate Oversight A. EIS Clinic 3. Adult Immunizations IV. Laboratory D. Refugee Health Program VI. Teen Pregnancy Prevention B. Nursing Case Management a. Workplace Vaccinations V. Quality Assurance E. CCHC C. HIV AIDS Treatment Services 4. Adolescent Program F. Healthy Kids Exams (HATS) 5. Child Care Program H. Lead Screening and Case Mgmt D. Out of Care 6. Community Outreach E. Jail Program 7. Shots 4 Tots V. Substance Abuse Prevention II. Immunization Clinical Services and Treatment Agency (SAPTA) A. Ravenholt B. Health Card Desk C. Boys & Girls Club D. Vaccine Inventory Control

5/23/2012 NSG - 1 Nursing Overview Community Health Nursing - By Location 5/25/2012

Director of Clinics and Nursing Bonnie Sorenson 400 Shadow, Ste 206

Community Health Nurse Manager Margarita DeSantos 105-5112 400 Shadow, Ste 206 Administrative Secretary Rose Marie Lee 105-5110 400 Shadow, Ste 210 Nursing Development & Community Outreach Educator Sherry Henninger 105-0001 TB Clinic

MCH Team Main NFP Team Special Projects Team Auxiliary Team

Sr. Community Health Nurse Sr. Community Health Nurse Sr. Community Health Nurse Comm Health Nurse II - Case Mgr Chris Mariano 109-5061 ELV M. Teresa Johnson 109-5019 ELV Edith Burns 109-5002 400 Shadow, Ste 208 Erin Connor 109-1068 ELV

Comm Health Nurse II - Case Mgr Comm Health Nurse II - Case Mgr Advanced Practitioner of Nursing Community Health Nurse II Tammie Cushman 109-1064 ELV Deyanira Goss 109-0002 ELV Daphne Hernandez 109-1005 ELV Marie Ricci 109-1066 ELV Lorraine Oliver 109-1078 ELV Patricia Montalvo 109-0003 ELV Jessie Vennie 109-1063 ELV Community Health Nurse II Community Health Nurse II Norine Clark 109-1061 400 Shadow, Ste 206 Administrative Assistant II Lourdes Bambilla 109-1016 ELV Community Health Nurse I Lynda McCarthy 109-5062 ELV Lori Dentice 109-1116 ELV Jill Perlstein 109-1036 ELV Stephanie Reformina 109-3030 ELV Teodorita Panaligan 109-1072 ELV Adelina Folkes 109-1151 ELV Madlyn Sparks 109-1019 ELV Community Health Nurse I Community Health Nurse II Merylin Yegon 109-1041 400 Shadow, Ste 208 Vacant Reyes 109-5003 Community Health Nurse Supervisor Vacant DeSantos 109-5063

5/23/2012 NSG-2 NSG-COMMUNITY HEALTH Immunization & Child Health - By Location 5/25/2012

Director of Clinics and Nursing Bonnie Sorenson 400 Shadow, Ste 206

Community Health Nurse Manager Veronica Morata-Nichols 105-0007 400 Shadow, Ste 204

Administrative Secretary Rose Marie Lee 105-5110 400 Shdw, Ste 210

Community Health Nurse Supervisor Community Health Nurse Supervisor Mee Kee Chong-Dao 105-5204 ELV Lourdes Yapjoco 105-0004 HDN

Sr. Community Health Nurse JoAnn Rupiper 105-1035 HDN

Immunization Clinic HC Desk Adolescent Program Vaccines For Children Community Health Nurse II Community Health Nurse II Community Health Nurse II Community Health Nurse II Jocelyn Castillo 110-4032 ELV Jessica Flores 145-3070 Cambridge Trinidad Gonzales 110-5201 HDN Ana Cabiling 110-4125 HDN Virtudes Gonzales 105-1060 ELV Simone Krieger 110-0204 HDN Lynda McCloskey 905-9714 HDN Carrie Jepson 110-4103 ELV Licensed Practical Nurse Mila Revilla 105-0013 HDN Margaret Meirs 110-3061 HDN Lee Edmonds 905-0006 ELV Childcare Program Vickie Swanson 110-0205 HDN Ann Marie Homer 905-1204 HDN Community Health Nurse II Administrative Assistant II Latorsha Latiker 905-9715 ELV Cheryl Dolesh 110-5202 HDN Michelle Stanton 110-5132 HDN Licensed Practical Nurse Charlene Reeger 905-1202 ELV Judith Flores 110-5203 HDN Rebecca Randle 110-4124 ELV Carolyn Sprance-Grogan 905-1117 ELV Hep B / Perinatal Prevent Sheila Rivera 110-1086 ELV Isabel Valdivieso-Estrada 905-1203 Cambridge Administrative Assistant II Community Health Nurse II Michael Lacy 110-5205 HDN Linda Rupert 110-4031 HDN Sr Administrative Assistant Christina Valdez 110-5206 ELV Jan Gladen 110-1112 ELV Administrative Assistant II Workplace Vaccinations Marisol Maciel-Perez 105-5000 ELV Sr Administrative Clerk Sr. Community Health Nurse Community Health Nurse II Anita Goodspeed 110-5115 HDN Vacant Chong-Dao 110-0201 Michelle Villanueva 110-0203 HDN Gloria Reta 105-1131 HDN Carolyn Seward 110-3120 ELV Community Health Nurse II Administrative Assistant II Jan Sredniawa 110-4122 ELV Vacant Osorio 110-5200 Rae Hannah 110-0202 HDN

Administrative Assistant II Licensed Practical Nurse Contract/Agency Funded Lizette Enzenauer 110-0601 HDN Vacant Mollett 905-1201 Emma Lee, RN

Contract/Agency Funded Ella Duhaime, RN

5/23/2012 NSG - 3 NSG - Ravenholt Clinic Svcs Outlying Clinical Services - By Location 5/25/2012 Director of Clinics and Nursing Bonnie Sorenson 400 Shadow, Ste 210

Community Health Nurse Manager Alice Costello 105-0005 ELV

Administrative Secretary Margaret Patterson 105-1160 400 Shadow, Ste 210

CHN Supervisor CHN Supervisor Karen Atkins 105-1013 ELV Norma Goode 105-1010 HDN

FAMILY PLANNING AND OVERSIGHT

East Las Vegas Clinic Henderson Clinic

Advanced Practitioner of Nursing Advanced Practitioner of Nursing Teen Pregnancy Grant Mary Ann Cole 140-5073 ELV Susan Kilburn 140-5057 HDN Sr. Health Educator Mee Hoe Han 140-3010 ELV Michelle Sotero 140-6000 Telecommuting Sr. Community Health Nurse Sr. Community Health Nurse Maria Gueco 105-1037 HDN Health Educator I Satoko Brilis 105-1038 ELV Amineh Harvey 140-6001 Telecommuting Community Health Nurse II Shawnta Jackson 140-6003 Telecommuting Community Health Nurse II Loriza Chongtai 140-5072 HDN Vacant Riley 140-6006 Maria Arias de Lujan 140-5071 ELV Bernadette Meily 105-0010 HDN Vacant Cull 140-6005 Yordanos Debesai 105-0011 ELV Marites Navarro 105-0012 HDN Vacant Milburn 140-6004 Roberta Gigear 105-0014 ELV Vacant Foster 140-6002 Laura Lopez 105-3040 ELV Administrative Assistant II Geralyn Benjamin 105-5001 HDN Administrative Assistant I Licensed Practical Nurse Krystal Camarena 140-3105 HDN Lucinda Badillo 140-6007 ELV Becky Aguilar 140-1083 ELV Victoria Hodge 105-1084 ELV Administrative Aide Lonita Brantner 140-5003 HDN Health Educator I Lisa Chase 140-5999 ELV Community Health Nurse II Vacant Haddock 105-4033 Sr. Administrative Clerk Vacant Buffington 105-1087 Caroline Westmorland 105-1117 ELV Vacant Gueco 110-4034

Administrative Assistant II Sr. Administrative Clerk Christian Hilario 105-1152 ELV Vacant King 105-4110 Kathleen Orner 105-4105 ELV Kim Patterson 105-3130 ELV Contract/Agency Funded Adina Ruiz 105-1114 ELV Jocelyn Arquette, RN Mesquite Maria Sanchez 105-0015 ELV

5/23/2012 NSG - 4 NSG - Outlying Clinical Svcs STD, Tuberculosis - By Location 5/25/2012

Director of Clinics and Nursing Bonnie Sorenson 400 Shadow, Ste 210

Community Health Nurse Manager Patricia O'Rourke-Langston 105-5113 TB Clinic

Administrative Secretary Diane Money 105-4120 400 Shadow, Ste 210

CHN Supervisor CHN Supervisor Kara Bennis 105-1015 TB Clinic John Lewis 105-1011 ELV

Tuberculosis Clinic STD Clinic & Epi Nurses TBD Laboratory

CDC Advisor Sr. Community Health Nurse Sr. Community Health Nurse Laboratory Assistant Maria Galvis Laurie Hickstein 121-4030 TB Clinic Yamileth Lionetti 145-5002 ELV Tabitha Ewing 145-3111 ELV

Community Health Nurse - Case Manager Community Health Nurse II Jacquline Arnold 121-4300 TB Clinic Ana Conroy 145-3000 TB Clinic Vacant Cascos 121-4040 Ina Fincher 145-1071 ELV Tina McMahon 145-5070 HDN Community Health Nurse II Linus Mubuifor 145-5100 ELV Maria Figgs 121-1062 TB Clinic Vacant Major 140-5080 Diana Valencia 121-1050 TB Clinic Vacant Lionetti 145-5074

Community Health Nurse I Administrative Assistant II Regena Ellis 121-4050 TB Clinic Lilia Burquez-Ahuja 145-1111 ELV Celeste Liston 121-4111 TB Clinic Donna Herrmann 145-1115 HDN Cynthia Robles-Soto 145-4123 TB Clinic Disease Invest/Interven Spec II Haley Blake 121-1065 TB Clinic Sage Nagai 121-4200 TB Clinic

Licensed Practical Nurse Sheila Gutierrez 121-1075 TB Clinic

Sr. Administration Clerk Kim Ogren 121-4110 TB Clinic

Administrative Assistant II Monique Johnson 121-4105 TB Clinic

5/23/2012 NSG-5 NSG-STD, TB, LAB Communicable Diseases - By Location 5/25/2012

Director of Clinics and Nursing Bonnie Sorenson 400 Shadow,Ste 210

Acting, Community Health Nurse Manager Rick Reich 147-4010 400 Shadow,Ste 210 Vacant Harrell 105-0006 Administrative Secretary Diane Money 145-4120 400 Shadow,Ste 210

Communicable Diseases Supervisor Grant Analyst Acting, Communicable Diseases Supervisor Marlo Tonge 147-6002 400 Shadow, Ste 210 Sabrina Hagan-Finks 147-0301 400 Shadow,Ste 210 Janice Richardson 127-1010 400 Shadow,Ste 210

Sr. Disease Invest/Interven Spec Sr. Disease Invest/Interven Spec Case Management - RWA Screening - SAPTA Victoria Burris 147-4036 400 Shadow, Ste 210 Robert Clarke 147-4040 400 Shadow,Ste 210 Comm Health Nurse II - Case Mgr Disease Invest/Interven Spec II Gail Gholson 127-4022 400 Shadow,Ste 210 Jennifer Gratzke 147-5001 400 Shadow,Ste 210 Surveillance HIV/STD Investigation/Intervention Joyce Palmer 127-1002 400 Shadow,Ste 210 Disease Data Collection Specialist Community Health Nurse II Licensed Practical Nurse Diana Hutchings 127-1011 400 Shadow, Ste 210 Cynthia Capurso 145-3090 400 Shadow,Ste 210 Community Health Nurse II Tanjara Bartley 107-0001 400 Shadow,Ste 210 Sandra King 147-0401 400 Shadow, Ste 210 Lorena Reyes-Corral 148-4024 400 Shadow,Ste 210 Christopher Pelt 147-3030 400 Shadow,Ste 210 Disease Invest/Interven Spec II Admin. Asst. II Elizabeth Adelman 147-6001 400 Shadow,Ste 210 Discharge Planning - RWA Sr Administrative Clerk Joyce Castro 148-5120 400 Shadow, Ste 210 Joey Arias 145-4030 400 Shadow, Ste 210 Community Health Nurse II Phyllis Ehinger 147-4130 400 Shadow,Ste 210 Eleanor Coscia 147-4132 400 Shadow, Ste 210 Jason Butts 147-0002 400 Shadow, Ste 210 Sheri Fritzman 147-3020 400 Shadow,Ste 210 Cheryl Radeloff 147-4021 400 Shadow, Ste 210 Contract/Agency Funded Data Collection - HIV FAST - RWA Kelly Aker, RN 400 Shadow,Ste 210 Admin. Asst. II Disease Invest/Interven Spec I Community Health Nurse II Chelsi Cheatom, File Clerk 400 Shadow,Ste 210 Kimberly Davidson 147-4106 400 Shadow, Ste 210 Zandt Acree 148-4141 400 Shadow,Ste 210 Teresa Schwartz 148-0201 400 Shadow,Ste 210 Kimberly Hertin 145-4031 400 Shadow, Ste 210 Theresia Younes 147-4035 400 Shadow,Ste 210 Data Collection - FAST Arthuro Mehretu 147-0304 400 Shadow, Ste 210 Disease Data Collection Specialist Katrina Miller 148-4135 400 Shadow, Ste 210 Administrative Assistant II Bethann Graham 107-0101 400 Shadow,Ste 210 Jermaine Simpkins 147-0001 400 Shadow,Ste 210 Marnita Smith-Dent 148-4131 400 Shadow,Ste 210 Candyce White 147-4045 400 Shadow,Ste 210 Administrative Assistant II Sandra Ross 127-1012 400 Shadow,Ste 210 Intervention/ARTIS Disease Invest/Interven Spec II CQM - RWA Laura Carrington 147-4030 400 Shadow,Ste 210 Disease Data Collection Specialist Cherie Filler-Maietta 147-4031 400 Shadow, Ste 210 Teresa Wilcox 107-0100 400 Shadow,Ste 210 Victoria Harding 147-4032 400 Shadow, Ste 210

Contract/Agency Funded Inez Staten, DIIS 400 Shadow,Ste 210

Attachment I

TIBERTI - 330 Valley View BL 166409 sq. ft. Accumulated Monthly Cost From To No. o f Mos. Total Lease per Month Total Lease per Sq. Ft. Notes FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 FY 2022 FY 2023 FY 2024 7.01.11-6.30.12 7.01.12-6.30.13 7.01.13-6.30.14 7.01.14-6.30.15 7.01.15-6.30.16 7.01.16-6.30.17 7.01.17-6.30.18 7.01.18-6.30.19 7.01.19-6.30.20 7.01.20-6.30.21 7.01.21-6.30.22 7.01.22-6.30.23 7.01.23-6.30.24 Short-Term Lease (18 Months) 07/01/12 12/31/2012 6 6 $0.00 - $ - - 01/01/13 6/30/2013 6 12 $75,000.00 450,000.00 $ 0.45 450,000 07/01/13 12/31/2013 6 18 $100,000.00 600,000.00 $ 0.60 - 600,000 Total 18 1,050,000.00 - 450,000 600,000 Lease Shadow Pro & Spring Valley (with CAM) (984,037.76) (416,705) (567,332) Funds Required 65,962.24 33,295 32,668

Long-Term Lease (144 Months)

7/1/2012 12/31/2012 12 $0.00 $ - $ - (a) - 7/1/2013 6/30/2014 12 24 $108,000.00 $ 1,296,000.00 $ 0.65 (b) 1,296,000 7/1/2014 6/30/2015 12 36 $141,700.00 $ 1,700,400.00 $ 0.85 © 1,700,400 7/1/2015 6/30/2016 12 48 $145,951.00 $ 1,751,412.00 $ 0.88 (d) 1,751,412 7/1/2016 6/30/2017 12 60 $150,329.53 $ 1,803,954.36 $ 0.90 (d) 1,803,954 7/1/2017 6/30/2018 12 72 $154,839.42 $ 1,858,072.99 $ 0.93 (d) 1,858,073 7/1/2018 6/30/2019 12 84 $159,484.60 $ 1,913,815.18 $ 0.96 (d) 1,913,815 7/1/2019 6/30/2020 12 96 $164,269.14 $ 1,971,229.64 $ 0.99 (d) 1,971,230 7/1/2020 6/30/2021 12 108 $169,197.21 $ 2,030,366.53 $ 1.02 (d) 2,030,367 7/1/2021 6/30/2022 12 120 $174,273.13 $ 2,091,277.52 $ 1.05 (d) 2,091,278 7/1/2022 6/30/2023 12 132 $179,501.32 $ 2,154,015.85 $ 1.08 (d) 2,154,016 7/1/2023 6/30/2024 12 144 $184,886.36 $ 2,218,636.32 $ 1.11 (d) 2,218,636 Total 144 $ 20,789,180.38 LEASE - VALLEY VIEW - 1,296,000 1,700,400 1,751,412 1,803,954 1,858,073 1,913,815 1,971,230 2,030,367 2,091,278 2,154,016 2,218,636 - Lease Shadow Pro & Spring Valley (with CAM) (7,682,983.59) LEASE SAVINGS (416,705) (567,332) (584,352) (601,883) (619,940) (638,538) (657,694) (677,425) (697,747) (718,680) (740,240) (762,447) - Funding Required: Bond (Building) Fund (13,979,561.21) BOND FUND (1,134,283) (1,180,928) (1,086,453) (999,537) (1,039,519) (1,081,099) (1,124,343) (1,169,317) (1,216,090) (1,264,733) (1,315,323) (1,367,936) Funding Required: General Fund (873,364.42) SAVINGS (1,550,988) (452,260) 29,594 149,992 144,496 138,436 131,778 124,488 116,529 107,864 98,453 88,253 -

Long-Term Lease Notes: - Notes Period Covered Lease/month (a) First 12 months $ - (b) 13th to 24th months $ 108,000.00 © 25th to 36th months $ 141,700.00 (d) 37th to 132th month CPI (no more than 3% increase). Prop Tax Allo $ 15,879,962 $ 16,532,987 $ 15,210,348 $ 13,993,520 14,553,261 15,135,391 15,740,807 16,370,439 17,025,257 17,706,267 18,414,518 19,151,099 Bond Fund 1,134,283 1,180,928 1,086,453 999,537 1,039,519 1,081,099 1,124,343 1,169,317 1,216,090 1,264,733 1,315,323 1,367,936

Notes on Property Tax Allocation: FY 2013 Prop Tax Allocation represents latest info from County as of 5/21/2012 FY 2014 to FY 2016 represents 8% decline per year. FY 2017 to FY 2024 represents 4% increase per year.

5/23/2012 4:42 PM Ammendment I Tiberti 330 Valley View BL with 9 months of FY13 2012 05 21.xlsx 1 Tiberti Proposal 3rd 1