1  Wilkes County Board of Health Meeting Minutes  December 11, 2023  The Wilkes County Board of Health held al regular business meeting Monday, December 11th, 2023, at 5:30, p.m. att the Wilkes County Health Department in the Ann Absher Conference Room. Board of Health  members in attendance were: Ms. Susan Bachmeier Dr. Sarah Miller-Wyatt Ms. Adina Watkins Mr. Casey Johnson Dr. Keaton Mash Mr. Chris Anderson Ms. Deborah Britton Ms. Marcia Reynolds  Ms. Rachel Willard, Mr. Jared Belk and Ms. Jenna Daye were also in attendance. Prior tot the August meeting, packets containing the materials tol be discussed were mailed and sent via email to each Wilkes  County Board member for review.  Meeting Called to Order: Ms. Susan Bachmeier called the meeting to order at 5:30 p.m.  1. Adoption of Agenda*: Commissioner Casey Johnson made the motion to adopt the agenda for the Board of Health meeting for October 9th, 2023; the motion was seconded by Ms. Deborah 2. Approval of Minutes*: Ms. Marcia Reynolds made the motion to approve the minutes from the October 9th, 2023 meeting; the motion was seconded by Ms. Sarah Miller-Wyatt, and unanimously  Britton, and unanimously approved.  approved. 3. New Business:  Dental Clinic Annual Report  Arden Jolley gave the Dental Clinic Annual Report starting with she has been at the clinic for a year and a half now. My first quarter at the dental clinic was pretty rocky, Ihad one dentist and she walked out onr me. I'm happy to say Ihave 31 full time dentists now and 1 part time dentist on staff, 41 full time hygienists, 8 certified dental assistants, 41 front office team members, my assistant director, and myself. la am actively seeking a 4th full time dentist; I've had some really great interviews. I've got ai few more coming this week, onei is from South Carolina and another from Arizona. The reason am seeking another full time dentist is because I am preparing for Medicaid expansion thatj just wenti into space. We are hoping to expand our clientele quickly. Fori fiscal year 20221 to 2023 we had over 13,000 encounters, SO far this fiscal year we have had over 7,000 74% oft these had Medicaid, 12% Sliding Fee: scale, 12% had private insurance which majority of that is Medicare and lastly 2% are self-pay. For our patients, 57% are children and the other percentage is adults. Ithink originally when the clinic was opened it was tos see more children and still that is our priority but now therei is other practices who accept Medicaid. Ato our last board meeting we spoke and our patient ratioi is pretty much 50/50 between children and adults. I am excited to say that we are    2  averaging 160 new patients ai month, when Ia arrived it was 10 new patients a month or even less than that. Idids send out ofe end ofy year donation letter and 'm already seeing donations come in, very excited about that. Last year when I camel la announced that our nominal feel had been lowered to $10, it was great for the patients buti it cost me more than $101 to put plastic on the chairs. It was really hurting the clinic and we have bumped it up to $30. It was $90 when came and that was extremely too high, $10 hurt us tremendously and $30i is ag good happy medium. We are still holding emergency clinic on most Thursday mornings, which is for patients who don'thave insurance andi need extractions; that's $190 cash. The mobile bus is still going out, you've probably seen it out in the community. It's going out 4 days a week and serves all oft the schools in the county. We also have an emergency fund, those arej just private donations given for dental care. We also get a grant from the community of Elkin, anyone who lives in that zip code who doesn't have insurance can come if they need help and we can use that. We also have the Delta Dental Grant Fund, and the Teeth in Need Fund for children without insurance who are unable to pay. Other than that things are great, we are fully staffed and things are moving right along. Dr. Sarah Miller- Wyatt asked, "are thei funds used until they are exhausted, and is there an evaluation to see howt those funds are used?" Ms. Jolley said yes, actually for all of the grants we receive we have to prove what we have done by giving invoices and receipts. The emergency fund is the only one where we don'thave to prove what we spent the money on. Ms. Bachmeier thanked Arden and said it looks like she has made al lot of progress. Ms. Willard added that she has done ai fantastic job with the clinic, thep patients that have visited the dental clinic come back with rave reviews. Ms. Jolley said they focused al lot this past year on building a positive work culture.Icome in my office and hear the staff laughing and the patients laughing. Coming to the dentist is tough andi if we can makei ita al little lighter we will. Ourr reviews online have really  improved as well and Ibelieve thati is because of the staff have.  2024 Board of Health Meeting Dates*:  Wilkes County Health! Department & Wilkes Community Health Center Promotingheamn: andpreventing diseasei noure Wilkes County Board ofHealth 2024F Regularly Scheduled! Meeting! Dates 5:30pminthel WCHDC G.A AnnA Absher Conference Room February1 12,2024 Apri/8,2024 June3,2 2024" August1 12,2 2024 October 14,2 2024 December9, 2024  VV/ILKES  306Colteges Saeet,w Wilkesboro,N NC28697 PHONE: 336-651-7450 FAX:336651-7813    3  Ms. Willard explained she wanted to go ahead and present the 2024 meeting dates to everyone, she explained she did move the June meeting from its original date of the 10th to the 3td, due to personal reasons. Ifiti is okay with the board lwould like to propose that, and if notl I will just have Chad bel here in Dr. Keaton Mash made the motion to adopt the 2024 meeting dates; the motion was seconded by Ms.  my place.  Marcia Reynolds, and unanimously approved.  Sliding Fee Scale*:  Ms. Willard presented the following sliding fee scale to the board with changes due to NC DPHI language  being requested.  WILKESHEALTH PolicyandProcedure  Manusl Administrative Tle: SlidingFee/Policy Chapier Wide oarddlHanChar OMFeePolicy, AccountsF Receivable Chair Procedures8 nlemal Controls! llective Dale: 12/11 2023 6/28/2021, income andi Discount (SFS). Policy: (Mikes CountyHealtho Counly wip providep primarycare andnonn nthe AdutHealhP Program, ChidH acceptance Heallh, Immunizstions, Commuricabl se Jaly ransmitted Disease Programs. subjectedioa anyy thelr Indvidualsn programs nsy N sticty confidentala services basedo np payor source. SlisingFeeD DiscountProgramo lleringo dscountedd dinicalcarek forp patients loapplylor provide! proofafincome olowing the incomey verificalionp procedureso outinedin discouriso patents arebetween1 101- pabents incomesalor abled flers quidance. Mores specilc programr aren wbinthis unlessi indicated. ooller tharges forr relerals servicesofiered thought theym miort thea SFSinhisp policy.  Purpose: Thsp pdicyisbe estabishs standardp procedresa andg guidelinesr delemminationaf  DISCOUNTI DEFIMITION:  ncluding lealths regardlessof  Thes 250%6FPL belowr1 pokcy. Thereis Healhd drecty.H However, Everye floitw through contractuala  languages anda levels fory Wikes ents byo wlbe the provider. However, everye cfiorty wilbe scale(s) leasta btaining patienti input, Chrughs surveys witha amalincomes: Gurelines( (FPG) mustn receive atvidscountfor applicable FPG, charges iscounledbase charyes ay, andin income tori individuaks. Fors 075irhy Foe eetc  TheSidingFees ScaleD rogram( (SFS)is sonlya applicablek thes services drectlyo offeredbyw Wikes    4  annualy, beginningin. Januarys year ollowingt theus askedtop lale. nadition patients askeda teach  Verification: Paperworktr fromthet Empioyments Securles Commission( (ESC) provingu unempicyments tus andt thez mountol mp pioymento compersationt beingre reoeived  every ndp iscount, regardlesso ofinsurances status. lowerd costsf fornono covered ind-partypayosf forwikes! Scate. lingl xount Scale andp preseningthis ocare. nformation,t theya ared decining slingiee students beings servedaly Wikes Counly Schools throughthe Jnith have beeng priorlizeda ashighr need. Sludenisn eceiving particip pationi inheFrees SchoolMeaisp programor CEP SFS. nexdedinooxibesshe eigibiity family (Famlys size)v working(5jdays aoprowed policy. Pasentsa arecorsidereds obed deci lobe documentalion (ncomea andta ize)ls lays. NCOME: grossi ckde: mings, unempioyment ompensaltion, vorkers' Searity) Income, publica assistance, veterans'p paymenis, dvdends, rents, royalies, from estates, trusts, educntionala ssis alimony, assistanceft fromoutside thefa family sizea sources. TANE, Food Slampsor desigatono uset thea each month slamps beused. family, thefamilys size. ncome. days.  Weeklya thea incomet federal povorty guidotneis amount Example: $310V wecky> x62woeks $16,120 thea me.). dunga monya Paperwork workd jocume disablity, 9SIb benefits. EmployerL ng fromt thep palients accepted. erifed. dollara ovided, thea applicantwilben requirdio orm. unemplcymenta agencyw will aagwithacompleleds Sell- IncomeF Form. TaxFoms: 3.Familys Size Determination: size who arep pooling financial resources, indutingn rooma andboarda andior ones fanilysize. laxn retums howing ard hlidron members. erified. size,  apply senvices. pande  anya dependentsor GROSSV wages, notnelpay. Grossw wagesincude stalement,n makes the benefits, notthenebeneits fromt theF Fomm 1040, notjust de: required. Youcanuseth Exampleaiisa  4.Calculating Grossl Income:  Proofofincome- thet bllowing area acceptablek komso ofprootlord delemining* income: CurentW-2ari Income TaxReum: Asignedo copyo ofthem mostn recentt taxr retums showing Total Paych Oneofther receni pays stubsi indicatinggrossp pay withint Social gencyie, TANF, Foods Stampsc  nes Socials Security) Administration, Veterans Adminstratonor  level.  Posces:  Incomel Inomationrepartedi Famly Planningfi financiale eligibiktys scraeningcanbe usedin (Retlevedt from: uidelnes, sectionB4: nttps Health! NOTE: orasFsDiscount: and ared detemineda atorbekw1 100%FPL perT Tiev gudelnes. Behavioral Health! NOTE: Thirpartypayersy wabebiledirought theb behavioralhealth; provider. OTE: services musto witht theNCA Admiristralive Rules 1DANCAC Mothers Healthy ChikdrenE Block Grantlu fundsfort thep provisiono ofChild Healths services. Diabelesa andN Nutitiono Center: ther nominalteepe perv VsIs$25.00. MIexpenbISEBeNU ndMNTS serviceso coukibew waivedifo coveredtya agranl. ControlProgram (BCCCP) Nor nominal VISIL Clients mustp provide program. Orugs and Devices: Wikes HealhbsN Medica adt the aoqustiono costo medicationor devices 40b0 Ar3 ngs ando devices arek denlfed tha 340b drugs andd devices arebilediol Thea NDCO Drugs 340ba otherr and 3408 aree atthe time sen  5.Calculating/ Annuall Incomeb basedo oninfommationp provided a.lfa Taweelyp pays stubis provided, thegrossw wagess shoukibem mulipledby 52weeks. Mutiplying monthly lolal, thenn mutiplyingby1 12months DOESNOTV 12=48). twowecks)pays stubisprovided, theg gross wagess shoudbemuitpledby:s PAYF PERIODS.K Mitiplngb NOTY munlypPiiweaamorhl ie. the1 mdasedhempws stubis provided, mulfiply theg grossy wagest 24PAYF PERIODS SLIDINGFEED DISCOUNTS SCALE: Seea attacheda annuallya approveds scalesforh Medical ndB BCCCPIFP. sidingleed discount doesn nota General Clinic (nursed onlyvisitss suchas pcines, ohers services providedbyt thenurse. Alservicesn relalediothed diagnosso treatmento apregnancy, famayp plaming, matemalh health, chidhealh, dabstesa andnuttion,o ora ad MOTE: ther nominalp per sitieels $25.00. There couldbea aminimumt feere requirementof  incomaorralys solelyonth thec finsaprilpdt) esv wbe heatho clients forr malemalh whohavea appled  lotal, enm mutiplyingbyt 12monlhs! DOES  onlyy Visits, Trave!  notes: perfomedthala thediagnosisa andb planfor hala reir nominal eewil bed and fleclive. July 1sofeveryy year. FamilyP Plannings NOTE: for funding, SecionE appropriatele leesa anda applicabled discounts: incomeisa below1 1006ofmeFaderalP Poverty! Level (FPL) charged, lthoughy jects must parties authorizeda obigated opay Act; 595(a)). (Non omin ne) schedvlec (aM9). ford for services ont the for services, There whether cient shovidt lding-le scale, lamily lients Ths, thes ilbe basad upony edared. Income muslbe assessed ning he pubicor nade thrdpartyp payment charged. regardioi insuredo cients, dientsw vhoset larily adtionalle than and2 Poverlyl evel ipaye bles ande laes thes henthes charye their  roviders applieda fort  oppropristen reimbursement sliing lee scour (whichis confmedby workng (Ive)dayso the unpaidt tromt payers. Othorwise, the  rbelow 250%F FPLS notpayr more whatheyy would thenwisep payv schedule oldiscountsisa applied. nsuredF amy    5  Refusalto Pay: ymentis celon) Example: Palent paykors uponothers fort basic  abouro outrescha  services olferedb byv Wikes  incudingk lamly Mht this detemination. PatientA seyst camnotpay Thise an  CommuntyH whoist trained oprowidei Care hatindudes infomationa aboula applyingt for Medicaida andinsurancep planst thatarepartol thelederaheathk insurancee exchange (healtcarego andChidrerfsH Applicablelaw, HedhPrgramR Rules and References: Rules, HRSAC NCGS1 Complancen 103A-39; Manual, NCA Amirisratvecoe, USFederalF Poverty TimeXRaguetions, Guidelines Women's Patient Pwnswrediypamaudns lofinandals stauso ocurs. Signediomsy Clientsy wilb lemaktimdhldmfsow wilsi signandd dalef fnancialelgbinyy eartyo henever  ResponsibleP complance, financed Person(sk drector, Registration,a chiefo Equipment Required: Electronicm medicalrecord Plansa  receivable,a adtthesithe carem managers, drectoro ofnursinga and  FeeF Palky, Accouns Receivables andintemal Conirols  loindivdualsy oyeda andlives abiity winhiss topaylbrs grandmothers services. who provides Hewilbe ood hasadontishabHybpa Mees, indudinga nomirallees. situationi including. butnotinitedto hoe, Higho Copay Amounts, Operaingo DcerV walvedf ees above. nd: heD  opays ood, amestic Abuse Costs(  leath  Ms. Deborah Britton made the motion to adopt the Sliding Fee Scale Policy; the motion was seconded by  Ms. Adina Watkins, and unanimously approved. 4. Old Business: None 5. Administrative Report: Departmental Update  Ms. Willard gave the departmental update starting with ther monthly newsletter. know! I have talked about howl lusually send out a weekly update to staff. Starting in November we moved to a monthly update, we created ar nice new newsletter; we just sent out our second issue this December. wanted to see ift the board wanted me to send it out to y'all as well. It briefly just talks about what's going on ine each department, we highlight an employee, key dates to have on your radar, birthdays and etc. l'm happy to forward it to you guys as wellj just to keep you in the loop. Dr. Mash statedi it would be nice tor read and have. He mentioned if he saw staff out, he could congratulate them or say hey I saw this in the newsletter good job. Thel board agreed tol havei its sent out. Ms. Willard, stated she would have. Jenna send itoutt tomorrow first thing. The big thing that It think is stressing everyone outi is Community Health is moving this week on Thursday and Friday. We are working very diligently to gett the West Park office up and ready, lots of last minute hiccups    6  but we are verye excited to get over there. WIC is third in the State for meeting caseload; were above Wake County and Mecklenburg. WIC is really killingi it, as we are moving to where that physical presence waiver is not in place they have gotten really creative with how to get people to come in. We are still offer our morning appointments and evening appointments by appointment only; we are trying to accommodate shift workers in the County. Wel have finally fixed our in-house billing issue that we have were having with our CLIA license. Luckily we have finally got thati issue paid, sO some of our denials that are at 150 days for our accounts receivable aging report are finally coming down. We are starting to collect that money which is really beneficial to our patient revenue and making sure we are bringing thati in. We didl lose a provider in November sO are recruiting for that, we dol have an interview set up tomorrow. Environmental Health has slowed down, we are in slow season. We are preparing for Marks retirement at the end of March SO we are doing al lot oft training with Mike and Matt. Mark's been with thei institution 30 years, he's our longest standing employee; he knows everything about every single piece of property in the County. That's nota a joke either, you can say what do you know about an address and he'll know exactly where it's at, where the septic and well is; he's going tol be al huge loss for us. Lastly, the end oft the yeari is here and we're ready for  2024.  Annual Board of Health Training  Mr. Jared Belk presented the Preparedness presentation tot thel board.  Presentation below.  PREPAREDNESS WILKISCOUNTYHEALTHDEPARIMENT  WHAT IS PREPAREDNESS  Public Health Preparedness and Response (PHP&R) isab branch of thel North Carolina Division of Public Health. Monitors ands strengthens public health and healthcare systems. Protects the publics' health in disaster situations. Le. disease epidemics, chemical and radiological releases, severe weather,and natural disasters.  EXERCISE PREPAREDNESS CYCLE  TRAIN    7  WHAT IS PREPAREDNESS  The mission is to promote andj protect the public's health before, during, and after all- Since the start in 2002, North Carolina has established ar multi-faceted public health preparedness and response infrastructure thati involves multiple agencies.  hazards events  PLAN  EKERCISE PREPAREONESS CYCLE  TRAIN  WHAT IS PREPAREDNESS  Regional PHP&R teams provide local support ande expertise to public health officials across the state. Public health epidemiologists based in our largest hospital systems. Public Health access to the Strategic National Stockpile (SNS) of emergency medicines and medical supplies.  PREPAREONESS CYCLE  WHAT IS PREPAREDNESS  Potassium iodide (KI) for persons in NC's nuclear emergency planning zones (EPZs). Public health laboratory for identifying biological agents, emerging pathogens and NCI Health Alert Network (NC HAN), system for health alerts and crisis communications between state and LHD's, ED's,and law enforcement officials.  chemical agents.  CYCLE    8  WHAT IS PREPAREDNESS Model practices for post-disaster epidemiological investigation and surveillance. As statewide Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) that monitors disease patterns in emergency department visits, EMS responses and poison  PREPAREDNESS CYCLE TRAIN  center calls.  WHAT IS PREPAREDNESS  Strategic partnerships with CDC, universities, hospitals, community-based organizations, state: and local agencies and other public health stakeholders. Training and capabilities assessments for local agencies.  PREPAREDNESS CYCLE  PREPAREDNESS CAPABILITIES Community Preparedness Community Recovery Emergency Operations Coordination Emergency Public Information and Warning Fatality Management Information Sharing Mass Care  Medical Countermeasure Dispensinga and Administration Medical Material Management: and Distribution Medical Surge Nonpharmaceutical Interventions Public Health Laboratory Testing Public Health Surveillance and Epidemiological Investigation Responder Health Safety Volunteer Management    9  PREPAREDNESS PLANS Isolation and Quarantine Plan Medical Countermeasures! Plan Ebola Plan COVID-191 Plan Responder Healtha and Safety Plan Pan Flu Plan AllH Hazards Plan Continuity of Operations Plan Commination Plan  We plan to ensure that we are prepared for any event. Incidents are unpredictable and could happen at any  time  STRATEGIC NATIONALSTOCKPLE  Strategic National Stockpile (SNS) CDC-managed stockpile of medicine and medical supplies to protect the public if there is a public health emergency severe enough to cause local supplies  to run out. Activation:  In the case ofa Bioterrorism. Attack, Natural Disaster,or Influenza Pandemic To prevent disease in those exposed but are not) yet sick  (antivirallvaccine)  STRATEGIC NATIONAL STOCKPILE Treatment for an infectious disease  Treatment would be limited to dispensing a specific medication.  Components  Push pack eta is 12 Hours  Vendor Managed Inventory eta is 24-36 hours    10  WHAT ISINTHE STRATEGIC NATIONAL STOCKPILE  Antibiotics Chemical Antidotes Vaccines IVMedications Airway Maintenance Supplies Items for radiation, burns, blast Wound care PPE  Alls supplies are delivered to our local  receiving site.  TRAININGS  FEMA Incident Command Trainings operations of an emergency response. Respirator FitT Testing Employees are accessed and fitted fora a N95 Just in Time Training precautions and how the clinic will be operated  Trains employees on the chain of command during an emergency,logistics: and  Before Wilkes Health opens up a POD the employees are trained on safety  EXERCISES  Wilkes Health conducts the following exercises to execute preparedness plans Every five yearsWilkes Health is required to conduct an exercise simulatinga disease outbreak and how wei mitigate the response ata al Point of Dispensing Preparedness Coordinator conducts this drill to test the time it takes for  Full Scale Exercise location. Notification Drill  employees to respond to a emergency.    11  MEDICAL COUNTERMEASURE (MCM) DISPENSING  Medical countermeasure, (MCM) dispensing is the abilityt to provide vaccines, antiviral drugs,antibiotics, antitoxin, etc. to thei identified population in accordance with public NC emergency, Management Responsible for receipt of SNS in NCI from CDC WCHD & WC Emergency Management: Responsible for coordinating the receipt, storage and distribution of SNS assets delivered toWilkes County. WCHD: Responsible for the management and control of the Wilkes County LRS  health Mselnefrecommendition, Responsibilities and delivery to Wilkes County.  and POD operations.  POINT OF DISPENSING  Point of dispensing (POD) a place where a vaccine, antibiotic or other medication is dispensed quickly to a large group of people. Open PODS Vaccinate the General Public Wilkes County middle schools Wilkes County Health Department Self Dispensing Sites or Closed PODS  (i.e., Hospital, Nursing Homes, etc.) vaccinate staff and internal clients  6. Committee Reports:  Nominating Committee - Elect Officers for 2023 Update on Board of Health reappointments Chair- Susan Bachmeier" iii. Vice Chair-I Marcia Reynolds*  Commissioner Casey Joe Shumate made the motion to approve Susan Bachmeier as Chair and Marcia Reynolds as Vice Chair; the motion was seconded by Ms. Deborah Britton, and unanimously approved.  7. Special Recognition of Board Member:  Ms. Rachel Willard recognized Teana Compeau, she nicely told us she wasn'tgoing here tonight andi it was her last meeting. We did get her a nice flower to take home, we will get thatt tol her. Teana did serve 9 years    12  on the Board of Health and she will be greatly missed. We hope that after at few years off she may come  back. She was a very helpful, vocal board member. 8. Public Concerns: None  Ms. Bachmeier said she did wantt to hear from Casey about the thinking and the position oft the commissioners on the Lowes building and thei impact that has on the Health Department andi the FQHC. Commissioner Casey Joe explained that currently iti has been requested that we do a study on the Lowes building. Wel have toured the building, but they want to see the structure ofita and possible economic possibilities; would itl be suitable for al Health Department and DSS. Ithink therei is al lot of information going around that was not shared at a commissioners meeting. Originally Lowes wanted 28 million for facility, then it came to 20 million but the papers said 61 to 8 million. Lowes wanted al letter ori intent toy pay 10r million and then do the study. Ifeel likei it's just kind of been all over the place, they did request that we do as study. At the last meeting, Idid request to look att the paperwork SO Imet with Johnt this afternoon and we talked about what would bei the besti interest and not be al burden on thei tax payers to try to pay fori it. Ms. Bachmeier asked whati the study ont the building would actually determine. Commissioner Casey, Joe explained that it would be about the structure oft the building; ift therei is mold or water damage. It has been empty since before covid but they have maintained it asi if people were: still there. That's another thing, it cost a million and al half a year to just maintain ite empty. One oft the biggest concerns if we purchased it, was itgoing tol be al burned ont the tax payers having to raise taxes SO we could payf fori it. As far as the study it would showi ifi it was suitable fori the Health department, DSS or any economic opportunities there. The state EDC did come in andl look ati it; there evaluation was not as positive as some were hoping for. Ms. Bachmeier did add thati it seems like it would bei ideal for al healthcare marketplace and services alli in one location; that would be really cool and super exciting tol have. Commissioner Casey Joe said initially when they wanted 20 million for thel building we did some numbers and it was going to cost another 20 million to update.. Also iti needed al new roof that was going tol bel between 10-121 million, by then you could havej just built ar new building. Borrowing money on an old building you cannot finance it as long, atr most 15 years sO that was going to be 2.5 million a year in payments. Al lot of what ifs and al lot of risks in buying the Lowes building. I will: say at first was very interestedi in thel building for a County Office, Health Department, DSS; we only need about half the square footage. lwent to EDC and asked if there was anything we could do with this building. They told me that day, there was veryl little use for the facility. Ms. Bachmeier asked if potentially depending what the study finds that could be a revenue generation for the county to rent out space in that building. Commissioner Casey Joe said possibly, but the concern that they told me that day was the ceiling heights were too low as far as industry, manufacturing go and that office space was a thing of the past since people work remote now. Ireadi in the newspaper on social media as far as retail, but again Idon't think thati is the best spot for retail; don'tknow. Ifit was going to be the best thing for Wilkes County, I'd! be all over it but up until now I have been hesitant. Ms. Willard asked where that puts the Health Department in phase three now. Commissioner Casey, Joe said he next dept to roll off would be the High Schools, they've been here 15 years or more. Ms. Willard said so potentially you're looking at another 15 years. Commissioner Casey, Joe asked ifity was standard for Health Departments and DSS to combine now. Ms. Willard asked him to explain what he means by combine, do your mean as a consolidated agency or in the same building. Commissioner Casey Joe saidi in the plans that we have drawn upi itl looks like it's going to be one facility. Ms. Willard explained thaty yes as new buildings are being built they are putting them together because we: see the same clients and for transportation purposes. Ms. Deborah Britton stated that the maintenance cost was very staggering, would there be any way to project what the new building willl be. Commissioner Casey Joe explained that tor maintain the County Officei itis $140,000 a year. They said the new County Office building would be lower at $4.45 per square foot was    13  whati it cost to maintain al building in' Wilkes County. Ms. Britton asked what thes square footage was at the mall. Commissioner Casey, Joe saidi ity was 440,000 square foot;t that was one of the concerns. It's definitely big enough tol house DSS and the Health Department buti if we can'tmarket the rest were just going to 9. Adjoumment": Mr. Keaton Mash made a motion to adjour; Ms. Adina Watkins seconded,  maintain empty space.  unanimously approved.  Next Meeting date: The next Board of Health Meeting willl be on February 12, 2024 at 5:30 p.m. int the Ann  Absher Conference Room at Wilkes County Health Department.  Minutes respectively submitted by: Jenna Daye, Administrative Assistant Exiner  Ms. Susan Bachmeier