December 12, 2017 - Regular Meeting Agenda Item #40

Subject Health Care Advisory Board - Appointments Briefings None Contact and/or Presenter Information

Joshua T. Barnett, Health Care Services Manager ext. 3978

Cheri Coryea, Department Director, Neighborhood Services

Action Requested

Commissioners to appoint for (4) positions to the Health Care Advisory Board in the following areas of:

1. Business 2. Health Care 3. Consumer of County Funded Healthcare 4. Consumer of County Funded Healthcare

Enabling/Regulating Authority Resolution R-17-035 Background Discussion

● Resolution R-17-035 establishes the roles and responsibilities of the Health Care Advisory Board (HCAB) as directed by the Board of County Commissioners (BOCC).

● The HCAB evaluates and monitors the Health Care System in Manatee County. ● The HCAB does not self -assign projects. ● The BOCC provides the HCAB with the top priority topics to work on annually and to report back to

them. ● When available County staff assist the HCAB. ● The HCAB reviews evidenced-based practices. ● The HCAB meets a minimum of eight times yearly. ● The HCAB provides written and or verbal reports to the BOCC to provide background into the research

they conduct and that may include recommendations.

Manatee County Government Administrative CenterCommission Chambers, First Floor

9:00 a.m. - December 12, 2017

County Attorney Review Not Reviewed (No apparent legal issues) Explanation of Other Reviewing Attorney N/A Instructions to Board Records

None.

Cost and Funds Source Account Number and Name NA Amount and Frequency of Recurring Costs NA Attachment:  R17-035 signed.pdf Attachment:  DOC051.pdf Attachment:  Daniel Austin.pdf Attachment:  Kristin Steffen.pdf Attachment:  Jill Ahern.pdf Attachment:  Diana Berry.pdf Attachment:  Reyna Bragg.pdf Attachment:  Arthur Cohen.pdf Attachment:  David Goldmann.pdf Attachment:  LaVerne Green.pdf Attachment:  Dominique Kohlenberger.pdf Attachment:  Matthew Thompson.pdf Attachment:  JoOni Jones Abnar.pdf Attachment:  Bonnie Ramseur.pdf Attachment:  DOC053.pdf

Manatee County Government Administrative CenterCommission Chambers, First Floor

9:00 a.m. - December 12, 2017

MANATEE COUNTYBOARD OF COUNTY COMMISSIONERS1112 Manatee Avenue West, Suite 902 Phone: (941) 745-3700Bradenton, FL 34205 Fax: (941) 745-3790www.mymanatee.org/advisory_boards

APPLICATION forADVISORY BOARDICOMMITTEEICOMMISSION

PLEASE TYPE OR PRINT IN INK

For which Advisory Board are you applying? Name of Advisory Board:A separate application is required for each advisoryboard. Health Care Advisory Board

Some advisory board positions have specific Please specify the seat you are interested in:requirements for applicants. For more informationplease click on this link to the Manatee County website Health Care ( term renewal)at: www.mymanatee.org/advisoryboards.

Name Dominique Kohienberger

Home Street Address 454 Firehouse CourtHome Mailing Address

City, State, Zip Longboat Key, FL, 34228Home Phone 941383O459jWork Phone Cell Phone 941 928-61 75Email address dkohlenberger@me.comOccupation (if retired, please indicate) Physcial Therapist/Certified Health CoachBusiness name Healthy LongevityBusiness street address same as above

City, State, Zip

Are you registered to vote in Manatee County? Yes 0 No(This is a requirement of certain boards/commissions)

I reside in County Commission District # 1 Q 2 0 3® 4 0 5 0(This can be found on your Voter Registration Card or click on this link to a County Commission District Map)

Do you reside in unincorporated Manatee County? Yes 0 No

If No, please indicate the City Longboat Key

The Board of County commissioners strives to ensure equal access for minorities and women to serve on advisory boerdslcommltteeslcommisslons.Providing this Information will help Manatee County compile information needed to comolv with the reoortlna requirement In Florida State Statute 760.60.

Gender Male 0 Female

RaceAfrican American 0 Asian American 0 Caucasian 0Hispanic American 0 Native American 0 Other 0

Application Form 2016 I

Please list any governmental Advisory Boards/Committees/Commissions on which you currently serve.

Health Care Advisory Board

Please list any Manatee County Advisory Boards/Committees/Commissions on which you have previouslyserved (include dates of your service).

Health Care Advisory Board (Jan 201 6-Sept 2017)Work Weliness task force (Sept 2015-May 2017)Health Care Alliance (Jan 2015-current)

Why do you want to serve on this Advisory Board or Committee?

I am applying to renew my term on this Committee. It’s a volunteer job that I love to serve at because it’s important tofind a balance to ensure access to Prevention and Health Care for all. After gaining knowledge, collecting info, factsand operation systems for the past 20 months and identifying the missing links, I feel that we have built an incrediblemomentum as a board, where I can be further instrumental to fine-tune our mutual mindsets for a vision forward.

Describe your education and experience that will provide a benefit to this Advisory Board.

see prior application

List your professional credentials, licenses or certificates that are relevant to this Advisory Board.

see prior application

List organizations and positions in which you serve in local civic or community groups.

see prior application

Do you or your immediate family members have or hold any employment or contractual relationship withany business entity or agency which does business with or receives funding from Manatee CountyGovernment? Yes 0 No 0 If yes, please explain.

Do you know of any other reason that would prohibit you from serving on this board that could be deemedas a conflict of interest? Yes 0 No 0 If yes, please explain.

If you are appointed, are there any days of the week or months of the year you will be unavailable to servedue to job or travel? Yes No Q If yes, please explain.

Prefer late afternoon and early evening meetings

Application Form 2016 2

IMPORTANT INFORMATION1. For questions regarding a specific advisory board, committee, or commission, including the duties and

requirements, please contact the County staff liaison listed on that board’s webpage.2. Certain advisory boards, committees, and commissions have specific membership requirements including a

valid voter registration card, financial disclosure and/or the submission of other information.3. Attendance is required at advisory board meetings. Three unexcused absences may be grounds for

removal.4. Florida State Statute 119.07 designates this application as a public document to be made available for

anyone requesting to view it. If you qualify for exemption from public disclosure under the terms of thisstatute, please explain:

5. Advisory boards, committees or commissions having the authority to make factual determinations, reviewpermit applications, issue permits, grant variances, or impose fines exercise a part of the County’s sovereignpowers and members are prohibited by Florida law from holding more than one such position. If youcurrently hold another state, municipal or county government appointment, County staff will assist inconfirming your eligibility to serve on the board for which you are applying.

NOTICEApplications must be complete and signed to be valid. Resumes may not be substituted for the sections on theapplication but you may include extra pages to provide additional information. Applications will not be processed unlesseach section has been completed and all supplemental information sought by County staff has been provided.Applicants will not be permitted to change information on their submitted application materials once they have beenreceived by the County.

The following advisory boards require a questionnaire that must also be completed and a current resume for theapplicant to be considered for appointment. See pages 4 and 5 of this form.

Children’s Services Advisory Board — page 4Healthcare Advisory Board — page 5

Please sign and date below

I have reviewed the qualifications of this position and the duties of the board or commission for which I am applyingand certify that I am fully able to serve. I agree to commit the necessary time to fulfill these responsibilities. Iunderstand that I am offering my service without compensation. I agree to abide by all Manatee County Commissionrules and policies either published or in effect by usage, and all regulations and laws of the State of Florida. I furtherhereby acknowledge that should my professional, residential or other status change subsequent to my appointmentto this board or commission, I have a continuing obligation to inform the County’s staff liaison of that change to theextent it may alter my eligibility to continue in service.

By typing my name and submitting this application, I confirm that the information provided in this application is trueand complete, and this constitutes my signature under the Florida Electronic Signature Act.

Electronic Signature Type or Sign Name Dominique Kohienberger Date 8/25/2017

Your application may be mailed to the address below. You may also fax or email your application, as follows:Mail: Board of County Commissioners Fax: 941-745-3790

1112 Manatee Avenue West, Suite 902 Email: Save this pdf form to your computer and thenATTN: Advisory Boards attach it to an email. Email to this address:Bradenton, FL 34205 advisoryboardsmymanatee.org

The Board of County Commissioners of Manatee County, Florida does not discriminate upon the basisof any individual’s disability status. This non-discrimination policy involves every aspect of theBoard’s functions including one’s access to, participation, employment, or treatment in its programsor activities. Anyone requiring reasonable accommodation for meetings as provided for in theAmericans with Disabilities Act should contact the Citizens Action Center, three days before a meetingat 742-5800; TDD ONLY 742-5802 and wait 60 seconds; or FAX 745-3790.

Application Form 2017 3

Supplemental Questions for Applicants to the Manatee CountyChildren’s Services Advisory Board

Please complete all questions with current and accurate information.

Are you affiliated with any agency that receives Children’s Services dedicated millage funds from ManateeCounty? Affiliated means: an employee of the agency; owner of the agency; voting member on the agency’sBoard of Directors; contract with the agency, or indirect contract with the agency.

Yes 0 No®

If yes, please select the agency from the list below. Check all that apply:

AMikids Manatee, Inc.

Big Brothers/Big Sisters of the Suncoast

Boys & Girls Clubs of Manatee

Centerstone of Florida

Community Haven

D.L. Randall Foundation

Early Learning Coalition of Manatee County

Easter Seals of SW Florida

Educational Consultants Consortium

Exchange Club Family Partnership Center

Family Network on Disabilities

Family Resources

Feeding Empty Little Tummies

Foundation for Dreams

Hope Family Services

Insight Counseling Services

U Manatee Children’s Services, Inc.

Manatee Community Action Agency

C Manatee County Girls Club (Just for Girls)

UI Meals on Wheels Plus of Manatee

Myakka City Community Center

J Pace Center for Girls

Li Palmetto Youth Center

U Sarasota Family YMCA

Li Sarasota Manatee Assn. for Riding Therapy

flSchool District of Manatee County

QSelah Freedom, Inc.

Tallevast Community Center

flThe Salvation Army

Q United Community Center

Please explain the affiliation you have with the above agencies:

An application to the Children’s Services Advisory Board requires a current and comprehensiveresume or curriculum vitae, which may be emailed along with your application toadvisoryboards(mvmanatee.orq, or may be mailed or faxed to Manatee County at the address andfax number provided on page 3.

CElCCLiCElULIUULIUUC

AppIicaton Form 2017 4

Supplemental Questions for Applicants to the Manatee CountyHealthcare Advisory Board.

Please complete all questions with current and accurate information.

What is your field of expertise? (Please indicate all that apply)

Healthcare

Behavioral/Mental Healthcare

Substance Abuse Care

Social Services

fl Higher Education

E1 Medically Needy Consumer of Healthcare

Representative of the business community not listed above (please explain below)

Are you an employee, contractor for, owner or voting member on the Board of Directors of any agency thatreceives funding from Manatee County directly or indirectly? Yes 0 No 0If Yes, please explain:

Do you currently, or have you in the past 5 years, participated in any community health care initiatives orcommittees (e.g.: Health Care Alliance, Chamber Health Care Committee, Acute Care Committee, etc.)?

Yes® N0Q

If yes, which ones? (include dates of service)

see listed above

An application to the Healthcare Advisory Board requires a current and comprehensive resume orcurriculum vitae, which may be emailed along with your application toadvisorvboards(mymanatee.org, or may be mailed or faxed to Manatee County at the address andfax number provided on page 3.

Application Form 2017 5

DOMINIQUE KOHLENBERGER 941-928-6175 (MobUe)941-383-0459 (Home)

454 Firehouse Ct. Longboat Key, Florida- dkohlenbarger@me.com

Accomplished, innovative multi-lingual medical professional with extensive managementexperience and a passion for business development. A successful track record as aclinician has enabled me to provide leadership at many levels in the medical arena. My2006 Gallup interview revealed that my work style is methodical and analytical withhigh scores in integrity, discipline, achievement and communication.

SELECTED HIGHLIGHTS:

Current board member (volunteer) of the Manatee County Healthcare Advisory Board(HCAB). The HCAB is to evaluate, monitor and discuss the healthcare system inManatee County, then make recommendations to the Board of County Commissioners;review evidence based practices and programs determining how they can be applied tothe County and perform other tasks as requested by the Board of County Commissioners.(www.mymanatee.org)

(Volunteer) Chair for the Health Initiative Program during the first Florida Remote AreaMedical (RAM) Expedition in Manatee County : Nov 2015. (www.RAMUSA.org)

President of the Stroke Association of Florida from 2011 -2013. (ww.SAF.org) Current SAFboard member.

Founder and leader of the Sarasota Peripheral Neuropathy resource group . This projectencompassed collaboration with medical and non-medical entities and facilitate monthlyspeakers to share knowledge to help PNP patients cope and manage their disease.

Spearheaded and co-founded the Manatee Falls Prevention Coalition to raise awarenessand provide education to the senior population and caregivers in order to help preventfalls in the elderly.

Health columnist for the Longboat Key Newspaper from 2012-20 15.

Public Speaking skills on a variety of health topics.

Multi-lingual: proficient in German, Dutch, French.

DOMINIQUE KOHLENBERGER 941-928-6175 (Mobile)941-383-0459 (Home)

EDUCATION: MS in Physical Therapy, Catholic University Belgium 1990.

CAREER TRACK:IIEALTHYLONGEVITY September 201 0-pesent

Business Owner: Certified Health Coach and Health CoachinglWellness Business Consultant.As a COPE Certified Health Coach, I work with individuals interested and ready to develop a healthylifestyle. I use an evidence based, physician-led, clinically proven system (no drugs) that helps people tocreate healthy habits that are necessary for longterm success with weight loss as a result. 1 have measurablesuccess with diabetics, obese patients as well as patients with sleep apnea, high-blood pressure, highcholesterol and other life-style induced diseases.As a Business Coach, I mentor Health Coaches to build a successful Global Health Coaching business sothey can also organize their career around what matters most, create a lifestyle that allows them to have abalanced life and enjoy the work they do.I am passionate about assisting Physicians and other Health Professionals to improve the overall health andfitness levels of their patients.

GENTIVA HOME HEALTH:

Specialty Rehabilitation Director: May 2006-2010Responsible for overall planning, organization, coordination, implementation and marketing support ofGentiva’s innovative Specialty programs in multiple branches.Clinician development through vestibular course teaching with on-site clinical support in orthopedics andneurology.Enabled the successful pilot-launch of Gentiva’s NeuroRehabilitation Program in multiple branches bytraining a team that effectively supported critical clinical quality issues, resulting in 1.1 million dollars inrevenue.Experience in public speaking with presentations to potential referral sources and education of thegeneral public regarding fall prevention and stroke prevention.

COAXIA MINNEAPOLISMedical Translator: January 2010-2013Translating medical patient files from Dutch, German, French into English. as part of an internationalresearch study that is currently seeking FDA approval

COASTAL ORTHOPEDICASSOCIATES (COA)**Group- Rehab Director: January 1999- May 2006Direct patient care in Outpatient Orthopedic Practice and overseeing management in 5 OutpatientOrthopedic Rehab facilities: Responsible for daily operations- budgeting- marketing —business expansion -

quality assurance and customer satisfaction-staff development and orientation- mentoring PT/PTA students.** Ownership of COASTAL ORTHOPEDICS ASSOCIATES changed to MDNETWORK in 2001 andownership of MDNETWORK changed to PHYSIOTHERAPY ASSOCIATES on 1/1/2005.

BOLLETTIERI SPORTS MEDICINE CENTER (at 1MG Academy)

Clinical Director Outpatient Orthopedic/Sports Medicine Therapy Practice: April 1993 — Dec. 1998Treated students and professional athletes from the academy in the various sports programs of tennis-soccerand baseball. Managerial responsibilities for daily operations. Conducted research study with professionalathletes in cooperation with the LIDO equipment company. Clinical Instructor for PT and PTA student forinternships from University of Saint Augustine and South Florida Community College.

ADDITIONAL REMARKS:Memberships: APTA (American Physical Therapy Association) MEMBER since I 995,Advisory BoardMember Manatee Community College since 2001,Alumni University St. Augustine since 1994.US Citizen since 2008.Lan2uae$: Fluent in French- German-Dutch.

REFERENCES: available upon request.1/Dr. Arthur Valadie (Coastal Orthopedics)2/ Dr. Steven Axeirod (CEO MD Network)3/ Joe Noel (Regional Director Physiotherapy Associates)