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OurCompany Profile™

Company: Collier County Government

Projects: 2016, 2014, 2012, 2010, 2009

The OurCompany Profile™ Report provides valuable, evidence-based insight designed tohelp guide your organization’s decisions around its health and wellness programs.

Clinical laboratory data and biometrics are key indicators of health status. In fact, 70% of allmedical decisions involve clinical laboratory results, yet these tests account for just three tofive percent of medical costs.

We are pleased to present your organization’s OurCompany Profile™.

Table of Contents

Executive Summary Report: A topline summary of your population that includes anoverview of wellness screening participation, risk factor scorecard, and population trends.

Metabolic Syndrome Report: Analysis of Lab & Biometric Data with Identification of Riskfor Metabolic Syndrome.

Clinical Data Report: A breakdown of most current year to date individual laboratory andbiometric results, including a comparison to Quest Diagnostics database averages foradded insight.

Cohort Clinical Data Report: An analysis that includes the historical clinical andbiometric results of those in your population who have consistently participated inscreenings for added insight to important trends in your population’s health.

Appendix A: Test results summary and comparison across cohorts.

Appendix B: Quest Diagnostics® Health & Wellness | OurCompany Profile FrequentlyAsked Questions

OurCompanyProfile | Executive Summary Report | Collier County Government | 12OCT16 1 OurCompanyProfile | Executive Summary Report | Collier County Government | 12OCT16 1

Executive Summary Report

A topline summary of your population that includes an overview of wellness screeningparticipation, risk factor scorecard, and population trends.

Participation

The Health & Wellness screening wasperformed on a total of 2,176 of 2,330eligible participants at Collier CountyGovernment in 2016. This is a participationrate of 93%.

• 100.0% (2,176) ofparticipants weretested using aVenipuncturemodality.

93%(2,176 of 2,330)

Participationrate for 2016

A participation rate higher than 50%realizes the highest risk factor perparticipant rate. This indicates thatscreening more than half the populationlikely is engaging the poorest healthsegment of the workforce. The data isricher as are the insights gathered from itsanalysis.

Participation in 2016

Female Male

46.6%

53.4%

Year Over Year Participation Rate

81%

56%

85% 85%93%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009

2010

2012

2014

2016

OurCompanyProfile | Executive Summary Report | Collier County Government | 12OCT16 2




Wellness Report Card

Your Wellness Report Card provides an at-a-glance overview of the health risk factors for Collier County Government employees. Based on the risk information collected, we recommendthat Collier County Government focus future health and wellness initiatives on BMI, BP, HBA1c.

Body Mass Index (BMI) BMI equals weight in kilograms divided by height in meterssquared (BMI=kg/m[sq]). A BMI of 25 to 29 is classified asoverweight. A BMI of 30 or greater is considered obese.

Blood Pressure (BP) High blood pressure is one of several risk factors associated withcardiovascular disease (CVD), which is the number one killer ofAmericans.

Hemoglobin A1C Hemoglobin A1C (also known simply as “A1c”) helps to monitorthe effectiveness of diabetes therapy. When diabetes is wellcontrolled, people feel better and suffer fewer complications ofdiabetes.





Wellness Report Card

The top 3 Risks identified for the Collier County Government population includeBMI, BP, HBA1c.

73%of the employeepopulation are atModerate or Highrisk for BMI.

56%are at Moderate orHigh risk for BP.

42%are at Moderate orHigh risk forHBA1c.

The table below describes the reference ranges for each risk factor.

Risk Factor Low/Acceptable Risk Moderate Risk High Risk

BMI 18.5-24.99 <18.5 or 25-29.99 30+

BP <=119 over <=79 120-139 over 80-89 >=140 over >=90

HBA1c <5.7 5.7-6.4 >6.4

Waist M(<=40in/102cm)/F(<=35in/88cm) M(>40in/102cm)/F(>35in/88cm)

Cholesterol <199 200-239 >=240

Glucose 65-99 100-125 >=126

LDL <=129 130-159 >=160

HDL M(>=40)/F(>=50) M(<40)/F(<50)

Triglycerides <150 150-199 >=200

HDL Ratio <=5 >5

Top Risks Of All Participants (N=2176)

Low Risk Moderate Risk High Risk

Ass

esed

Hea

lth F

acto

rs

HDL Ratio

Triglycerides

HDL

LDL

Glucose

Cholesterol

Waist

HBA1c

BP

BMI

Percent of Total Participants

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

27% 33% 40%

44% 46% 10%

60% 29% 11%

69% 25% 6%

58% 35% 7%

75% 25%

85% 15%

72% 20% 8%

76% 13% 11%

60% 40%





Multiple Risk Factors

The number of risk factors measured for each employee can be indicative and predictiveof employer expenditures. Employees with multiple risk factors cost employers moremoney in health care, absenteeism and overall productivity. Multiple studies have shownthat overall costs increase at a faster rate once an individual reaches and exceeds threerisk factors.

49% having 3+ riskfactors is more thanthe databaseaverage and is downfrom 53% in 2009.

Database Average is anaverage of allHealth & Wellness participantsover the past four quarters.

Multi-Year Trends

All Participants Initial to Current Year

Test Net Change % IN Range

Blood Pressure 8.3%

Body Mass Index ( 2.1%)

Glucose ( 2.0%)

LDL Cholesterol ( 4.8%)

Triglycerides 4.9%

Across all screenedparticipants, BloodPressure scoresimproved the most,while LDL Cholesterolscores decreased themost.

Cohort Participants Initial to Current YearCohort[N=600]

PotentialShift in Cost Risk

Test/Risk Net Change from Highest Risk Level HCUP* Dollars Saved

Blood Pressure 26 $5,342* $138,892

Glucose 1 $4,311* $4,311

LDL Cholesterol 18 $7,966* $143,388

Cohort table calculation derived by looking at the high risk participants that moved to a low riskstatus for LDL Cholesterol, Blood Pressure and Glucose.

$286,591Net Potential Cost Shift*

* Based on Healthcare Utilization Project (HCUP) Cost of One Hospitalization for Indicated Clinical Conditions.

Collier County Government Participantsby Number of Risk Factors

2009 2010 20122014 2016 DBAVG

0%

10%

20%

30%

40%

risks0 1 2 3 4 5

OurCompanyProfile | Metabolic Syndrome Report | Collier County Government | 12OCT16 5 OurCompanyProfile | Metabolic Syndrome Report | Collier County Government | 12OCT16 5

Metabolic Syndrome Report

Analysis of Lab & Biometric Data with Identification of Risk for Metabolic Syndrome.

Reference Ranges for Metabolic Syndrome are based upon the Third Report of the NationalCholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatmentof High Blood Cholesterol in Adults (Adult Treatment Panel III).

To raise awareness and educate employers about the effects of obesity we have includedan analysis of metabolic syndrome. Metabolic syndrome is defined by five health riskfactors. When three or more of these factors fall outside the target ranges, an individualhas a much greater chance of developing heart disease, diabetes, stroke and other healthproblems. For example, someone with metabolic syndrome is two times as likely to developheart disease, and five times as likely to develop diabetes as someone without it.

You may notice the target ranges for metabolic syndrome are different from some of thereference ranges listed elsewhere in this report. This is because metabolic syndrome hasbeen linked to these risk factors at the specific target ranges listed in this analysis. Metabolicsyndrome can only be diagnosed by a doctor. This analysis is an estimation of risk based onresults collected in this screening.

OurCompanyProfile | Metabolic Syndrome Report | Collier County Government | 12OCT16 6




Metabolic Syndrome Summary

Metabolic Syndrome has emerged as an accurate measurement of the disease risks associatedwith obesity. According to the CDC, we are facing an epidemic of obesity. The factors reflectedby Metabolic Syndrome include blood pressure, glucose, triglycerides, HDL cholesterol, andwaist circumference. BMI can be used in place of waist circumference if it is preferred.

When the values for 3 or more of these measures fall within targets established for MetabolicSyndrome by the American Heart Association, participants receive a “green light” and are lesslikely to be at risk for heart disease, diabetes and stroke. Participants with 2 or fewer targetvalues receive a “red light”, and are at greater risk. In fact, research indicates theseindividuals are 5 times more likely to become a diabetic and 2 to 3 times more likely to have acardiovascular event. By understanding their risk profiles, participants can make lifestylechanges to reduce or eliminate their risk of Metabolic Syndrome.

Percentage of Participants With and Without Metabolic Syndrome

Passed Metabolic Syndrome CriteriaFailed Metabolic Syndrome Criteria

77%

23%

- - - -Percentage of Participants- - - -by Number of Risks Failed

2%

7%

15%

22%24%

31%

0%

5%

10%

15%

20%

25%

30%

35%

Zero Risk

s

One Risk

Two Risk

s

Three Risk

s

Four Risk

s

Five Risk

s

- - - -Percentage of Participants- - - -that Failed MetS by Each Risk

26%31%

25% 24%

40%

0%

10%

20%

30%

40%

50%

Blood Pressure

Glucose

HDL Choleste

rol

Triglyc

erides

Waist





Metabolic Syndrome Age and Gender Breakouts

The average age of participants with 3 or more risk factors (Metabolic Syndrome) is 50.

The average age of participants with 2 or fewer risk factors is 46.

- - - -Metabolic Syndrome by Age Group

10%

24%26%

29%

21%

6%

0%

5%

10%

15%

20%

25%

30%

Age < 25

Age 25 - 34

Age 35 - 44

Age 45 - 54

Age 55 - 64

Age 65+

Percentage of Female- - - - -Participants with and without- - - - -

Metabolic Syndrome- - - - -

Without MetSWith MetS

82.1%

17.9%

Percentage of Male- - - - -Participants with and without- - - - -

Metabolic Syndrome- - - - -

Without MetSWith MetS

72.8%

27.2%





SummaryData

* Numberin 2016

(n)** % At Risk

MetS

SystolicBP>=130DiastolicBP>=85

Glucose>=100

HDL<40 M<50 F

Triglycerides>=150

Waist>40 M>35 F

All 2,171 22.8% 26.3% 31.2% 24.6% 24.4% 40.3%

Female 1,013 17.9% 17.7% 24.6% 21.9% 18.2% 43.2%

Male 1,158 27.2% 33.9% 37.0% 27.0% 29.8% 37.7%

Age < 25 63 6.3% 14.3% 1.6% 17.5% 9.5% 19.0%

Age 25 - 34 392 10.2% 14.3% 11.2% 27.0% 13.8% 27.8%

Age 35 - 44 431 24.1% 20.4% 25.1% 30.6% 30.6% 42.2%

Age 45 - 54 594 26.4% 28.8% 34.7% 23.2% 27.6% 42.6%

Age 55 - 64 592 28.7% 35.6% 46.1% 22.1% 26.9% 45.4%

Age 65+ 99 21.2% 36.4% 46.5% 17.2% 14.1% 50.5%

SummaryData

* Numberin 2016

(n)Zero RiskFactors

One RiskFactor

Two RiskFactors

Three RiskFactors

Four RiskFactors

Five RiskFactors

All 2,171 30.9% 24.2% 22.0% 14.5% 6.6% 1.7%

Female 1,013 38.2% 23.6% 20.3% 11.5% 4.9% 1.4%

Male 1,158 24.5% 24.8% 23.5% 17.1% 8.1% 2.0%

Age < 25 63 63.5% 17.5% 12.7% 6.3% 0.0% 0.0%

Age 25 - 34 392 46.9% 25.3% 17.6% 7.7% 2.0% 0.5%

Age 35 - 44 431 30.9% 25.1% 20.0% 14.2% 8.4% 1.6%

Age 45 - 54 594 28.3% 25.3% 20.0% 16.5% 7.6% 2.4%

Age 55 - 64 592 22.1% 21.3% 27.9% 18.1% 8.3% 2.4%

Age 65+ 99 15.2% 32.3% 31.3% 15.2% 6.1% 0.0%

* In order to be included in the Metabolic Syndrome analysis the participant had to have results for all 5 factors.

** The "At Risk" percentage represents participants who have 3 or more factors that fall outside the target ranges.





Database Average

SummaryData * (%)

** % At RiskMetS

BloodPressure(At Risk)

Glucose(At Risk)

HDL(At Risk)

Triglycerides(At Risk)

Waist(At Risk)

All 100.0% 21.2% 28.7% 23.7% 27.6% 25.4% 24.1%

Female 52.3% 17.4% 22.1% 18.4% 27.0% 19.1% 27.9%

Male 47.7% 25.4% 35.9% 29.5% 28.2% 32.3% 19.8%

SummaryData * (%)

Zero RiskFactors

One RiskFactor

Two RiskFactors

Three RiskFactors

Four RiskFactors

Five RiskFactors

All 100.0% 31.8% 26.6% 20.4% 12.9% 6.4% 1.9%

Female 52.3% 37.2% 26.8% 18.6% 10.9% 5.1% 1.4%

Male 47.7% 25.8% 26.5% 22.4% 15.1% 7.8% 2.5%

* In order to be included in the Metabolic Syndrome analysis the participant had to have results for all 5 factors.

** The "At Risk" percentage represents participants who have 3 or more factors that fall outside the target ranges.





Metabolic Syndrome Cohort Report Introduction

This report represents your participants’ Metabolic Syndrome status over multiple screeningperiods. Within this report you will first see an overview of your overall trend for your entirepopulation for each screening period represented, followed by a deeper focus on the populationcohort, meaning those that participated in every screening analyzed within this report.

Cohort: Those participants that took part in the screenings in 2009 and 2016 and had results for all 5 factors.

Total Participant Summary

The table below represents participants in each year of the program and the overall percent atrisk for Metabolic Syndrome for all participants as well as the cohort participants in bothscreening periods, by their number of risk factors for each screening period. The change inpercentage from 2009 to 2016 at each risk level is also displayed.

All Participants Cohort Participants

2009 2016 2009 2016 Change

Number of Participants 1,088 2,171 1,085 1,085

% at Risk for MetS 26.4% 22.8% 26.5% 28.0% +1.6%

Zero Risk Factors 24.1% 30.9% 24.1% 25.2% +1.1%

One Risk Factors 27.8% 24.2% 27.7% 23.5% -4.2%

Two Risk Factors 21.7% 22.0% 21.8% 23.3% +1.6%

Three Risk Factors 15.6% 14.5% 15.7% 17.7% +2.0%

Four Risk Factors 8.0% 6.6% 8.0% 8.6% +0.6%

Five Risk Factors 2.8% 1.7% 2.8% 1.8% -1.0%

Overall Cohort Participant Summary

In Collier County Government there were 1,085 participants that took part in both screeningperiods represented in this report. In 2009 26.5% of those were at risk for Metabolic Syndromeand in 2016, 28.0% were at risk which is an increase of 1.6% at risk and is considered negativemovement.





Change in Risk Status

Looking at overall risk migration of a population is important, however looking at the overall netchange can hide meaningful information about the changes occurring at each risk level. Keyinsights can be found in your cohort population’s risk migration from the following charts thatrepresent a breakout of the overall risk by looking at each risk level separately. The first bar ineach chart represents the number of participants in 2009 that fell into the specified riskcategory, while the second bar represents the movement in risk that may have occurred by2016.

Of those participants who failed orwere at risk for Metabolic Syndrome in

2009 110 or 38.3% improved to anin-range status in 2016 leaving 177 outof range.

Of those participants who passed orwere not at risk for Metabolic

Syndrome in 2009 127 or 15.9%of those fell to an at-risk status in 2016leaving 671 in range.

Tracking Participants That Failed Metabolic Syndrome in 2009(n=287)

PassFail

100.0%

38.3%

61.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2009 2016

Tracking Participants That Passed Metabolic Syndrome in 2009(n=798)

PassFail

100.0%

84.1%

15.9%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2009 2016





Risk Migration

The following chart illustrates the movement of risk from the initial screening period. The X-axisrepresents the number of risk factors the participant began with and the multiple bars at eachrisk level represent the migration of those participants to other risk levels, higher or lower. It isimportant to note the percentage of participants that move to different stages of MetabolicSyndrome risk and note the migration from one risk category to another.

2016

2009 Zero One Two Three Four Five

Zero 59.4% 25.3% 10.3% 4.2% 0.8% 0.0%

One 28.9% 29.6% 27.2% 11.0% 3.3% 0.0%

Two 11.4% 26.3% 32.2% 20.3% 9.3% 0.4%

Three 2.4% 18.2% 27.6% 32.4% 14.1% 5.3%

Four 0.0% 6.9% 16.1% 42.5% 29.9% 4.6%

Five 0.0% 3.3% 23.3% 26.7% 30.0% 16.7%

(chart reads from left to right - n=1,085)

2009 vs. 2016 Change in Number of Failed Factors(n=1,085)

2016 ZeroOneTwo

ThreeFourFive

59.4%

25.3%

10.3%

28.9%

29.6%

27.2%

11.0%

11.4%

26.3%

32.2%

20.3%

9.3%

18.2%

27.6%

32.4%

14.1%

6.9%

16.1%

42.5%

29.9%

23.3%

26.7%

30.0%

16.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2009

Zero One Two Three Four Five

OurCompanyProfile | Clinical Data Report | Collier County Government | 12OCT16 13 OurCompanyProfile | Clinical Data Report | Collier County Government | 12OCT16 13

Clinical Data Report

A breakdown of most current year to date individual laboratory and biometric results, includinga comparison to Quest Diagnostics database averages for added insight.

An Overview

Clinical laboratory testing gives important insight into what is happening within the body at thetime of the test, and what can happen in the future if action is not taken. Laboratory testingresults impact 70% of all health care decisions and spending. Within the continuum of care, byshifting resources from diagnosis to preventative care, health problems are caught before theybecome more serious. In this way, laboratory testing can be an important health care costcontainment tool.

Screening tests help identify health risks that employees may not know about thus enabling themto take appropriate actions. These tests also provide a benchmark for measuring future results. Screening tests can reinforce the importance of positive lifestyle factors while also serving as achange agent by identifying areas for improvement.

In this section, a summary of laboratory test results are presented. The summary of these testsare grouped by body system and disease and are followed by a detailed explanation of eachclinical test performed on each blood sample. All reference ranges and guidelines areestablished by Quest Diagnostics to interpret laboratory results.

OurCompanyProfile | Clinical Data Report | Collier County Government | 12OCT16 14




Understanding Clinical Laboratory Data

Biometrics

Blood Pressure (BP)

High blood pressure is one of several risk factors associated with cardiovascular disease (CVD),which is the number one killer of Americans. CVD claims the life of 1 American every 33seconds, and in 2003 CVD accounted for $142 billion lost in productivity due to morbidity andmortality. [10]

Blood Pressure Male FemaleNumberin Range

Percentin Range

DatabaseAverage

Normal (<=119 over <=79) 375 579 954 44.0% 40.9%

Prehypertensive (120-139 over 80-89) 642 362 1,004 46.3% 44.9%

Hypertensive (>=140 over >=90) 143 67 210 9.7% 14.2%

Blood pressure is the amount of stress or strain being placed on your veins and arteries thatcarry blood throughout your body. Increased pressure in your arteries and veins can causedamage to them and increase the risk of blockages that cause strokes and heart attacks. Formany people blood pressure can be controlled by losing weight, if you are overweight, andbecoming physically active. There are also pharmaceutical methods for controlling high bloodpressure.






Biometrics (continued)

Body Mass Index (BMI)

BMI equals weight in kilograms divided by height in meters squared ( BMI=kg/m2 ). A BMI of 25to 30 is classified as overweight. A BMI of 30 or greater is considered obese. According to theBRFSS, 36.6% of those surveyed have a BMI considered to be overweight and 26.6% had aBMI considered Obese or greater than 30. [9]

Body Mass Index Male FemaleNumberin Range

Percentin Range

DatabaseAverage

Underweight (<18.5) 7 14 21 1.0% 1.1%

Normal (18.5-24.99) 209 380 589 27.1% 29.6%

Overweight (25-29.99) 439 259 698 32.1% 34.5%

Obesity I (30-34.99) 296 199 495 22.8% 19.8%

Obesity II (35-39.99) 135 97 232 10.7% 8.9%

Extreme Obesity (>=40) 75 65 140 6.4% 6.2%

Weight plays an important role in managing risk for heart disease. Cholesterol and glucose havebeen shown to be significantly impacted by weight (American Heart, 2008). Weight can affectcholesterol, raising levels of LDL cholesterol (the harmful kind of cholesterol that clogs bloodvessels) and lowering levels of HDL cholesterol (the good kind of cholesterol that helps clearblood vessels).

The below chart represents the correlation between participant BMI and the percent of thoseparticipants with out-of-range test results.

BMI <25BMI 25-30BMI >30

14%

29%

57%

10%

27%

64%

22%

38% 40%

26%

42%

31%

Perc

ent O

ut o

f R

ange

0%

10%

20%

30%

40%

50%

60%

70%

Glucose(>=100)

HDL Cholesterol(M<40/F<50)

LDL Cholesterol(>=130)

Total Cholesterol(>199)






Biometrics (continued)

Waist Circumference

A waist circumference measurement can provide an independent prediction of risk above that ofbody mass index (BMI). It is especially useful in those who are categorized as normal oroverweight on the BMI scale.

A high waist circumference in a patient with a BMI in a range between 25 and 35 kg/m2 isassociated with an increase risk for:• Type 2 diabetes• Dyslipidemia• Hypertension• Cardiovascular disease

Waist circumference cut points can generally be applied to all adult ethnic or racial groups.

Waist Circumference Number in Range Percent in Range Database Average

Male Avg (<=102 cm or 40 in) 722 62.1% 69.8%

Male Above Avg (>102 cm or 40 in) 440 37.9% 30.2%

Female Avg (<= 88 cm or 35 in) 575 56.8% 58.6%

Female Above Avg (> 88cm or 35 in) 438 43.2% 41.4%





Understanding Clinical LaboratoryData

Heart

Coronary artery disease is the end result ofatherosclerosis and inflammation. Cholesterol(fatty material) accumulates within the artery walls,where it eventually hardens. Arteries subsequentlylose their normal elasticity and become narrow,restricting the passage of oxygen-rich blood to theheart. Lipid screening is the most commontechnique used to evaluate your cardiovascularsystem and measures the different types of fat inyour body. There are many different kinds of lipids,most of which are included in your total cholesterollevel.

Total Cholesterol: Cholesterol is an essentialbody fat needed to produce substances suchas hormones and bile. High levels ofcholesterol are usually associated with ahigher risk of heart disease and narrowedblood vessels. Lipids included in TotalCholesterol are HDL Cholesterol, LDLCholesterol, and Triglycerides.

High-Density Lipoprotein (HDL)Cholesterol: HDL cholesterol is commonlycalled “good” cholesterol because it can aid inthe removal of excess cholesterol in bodytissues and help prevent the accumulation ofLDL cholesterol in the arteries. Higher levels ofHDL cholesterol are desirable.

Low-Density Lipoprotein (LDL)Cholesterol: LDL cholesterol is considered“bad” cholesterol because it can accumulatein the inner walls of your arteries, narrowingthem and reducing blood flow. This result isnot measured directly; it is derived from thetotal cholesterol, HDL cholesterol, andtriglyceride results. Lower levels of LDLcholesterol are desirable.

Total Cholesterol/HDL-C Ratio: Thiscalculation is obtained by dividing thetotal cholesterol level by the HDLcholesterol level. The higher the number,the greater the risk of coronary heartdisease.

Triglycerides: Triglycerides are fatscomposed of fatty acids and glycerol.Triglycerides combine with proteins toform particles called lipoproteins thattransport fats through the bloodstream.These lipoproteins carry triglyceridesfrom the liver to other parts of the bodythat need this energy source.Triglycerides then return to the liverwhere they are removed from the body.The level of triglycerides in your bloodcan indicate how efficiently your bodyprocesses the fat in your diet. Accurateresults require a minimum of atwelve-hour fast (no food or drinkexcept water and medication) prior totesting.






Heart (continued)

What the results mean:

Optimal - Optimal levels of total and LDLcholesterol are associated with a low risk ofheart disease. Low levels of HDLcholesterol are considered undesirable andare associated with an increased risk ofheart disease.

High - High levels of total and LDLcholesterol are associated with a high riskof heart disease. High levels of HDLcholesterol are considered desirable andare associated with a decrease risk ofheart disease. Many other facts and testsare important in assessing heart disease,including smoking, diabetes and bloodpressure.

Test/Range Male FemaleNumberin Range

Percentin Range

DatabaseAverage

Triglycerides

Normal (<=149) 814 830 1,644 75.7% 75.5%

Borderline High (150-199) 183 100 283 13.0% 12.4%

High (>=200) 162 84 246 11.3% 12.1%

Total Cholesterol

Desirable (<=199) 712 591 1,303 60.0% 63.8%

Borderline High (200-239) 330 292 622 28.6% 27.0%

High (>=240) 117 131 248 11.4% 9.2%

HDL Cholesterol

High (Desirable) (>=60) 219 555 774 35.6% 33.0%

Acceptable M(40-59)/F(50-59) 627 237 864 39.8% 38.8%

Low M(<=39)/F(<=49) 313 222 535 24.6% 28.2%

LDL Cholesterol

Optimal (<100) 373 404 777 36.0% 39.0%

Near Optimal (<=129) 425 348 773 35.8% 35.3%

Borderline High (130-159) 241 188 429 19.9% 18.7%

High (>=160) 109 72 181 8.4% 7.1%

HDL Ratio

Normal (<=5) 881 955 1,836 84.6% 85.3%

High (>5) 277 57 334 15.4% 14.7%






Heart (continued)

Non-HDL Cholesterol

Non-HDL cholesterol is a calculated measurement used in the evaluation of cardiovascular healthand has a stronger relationship with heart disease risk than any other lipid measurement.


If triglycerides levels are higher than 199 mg/dL after reaching a physician determined LDLcholesterol goal, a doctor may use non-HDL cholesterol (total cholesterol-HDL cholesterol) asthe secondary goal for improving lipid measurements and cardiovascular health.

Non-HDL Male FemaleNumberin Range

Percentin Range

DatabaseAverage

Normal (<160) 814 795 1,609 74.2% 78.6%

High (>=160) 344 217 561 25.9% 21.4%






Thyroid

The thyroid is a small, butterfly-shaped gland located inthe lower part of the front of the neck. This glandreleases hormones into the blood stream. The levels ofthyroid hormones in the blood affect heart rate, musclestrength, bowel function, fat metabolism, energy level,hair growth, and mood. There are several different formsof hormones produced by the thyroid gland. The mostimportant one measured is thyroxine. The active formthat affects function is Free T4 abbreviated as “FT4”.

The production of hormones of the thyroid gland isstimulated by a hormone produced by a tiny pituitarygland that sits at the base of the brain. This hormone isthyroid stimulating hormone (TSH). TSH is the first-linetest to identify abnormalities of the thyroid gland. Whenthe TSH test results are significantly out of the normalrange, a second test, FT4, is performed and used tobetter understand the different possibilities that influencethe complex interrelationship among different glands.

TSH and Free T4

Thyroid Stimulating Hormone (TSH) is ahormone produced by the pituitary gland, asmall gland located at the base of thebrain, which controls the activity of thethyroid and many other body systems. TheTSH test is the best test to screen for anoveractive or underactive thyroid gland.

When the TSH test result is above or belowthe normal range, a Free Thyroxine (FT4) isperformed to help make an accuratediagnosis. Thyroxine (T4) can either bebound to proteins or be unbound. Theunbound portion is called Free T4 and isthe biologically active form of thyroidhormone that controls the rate ofmetabolism.

Test Gender Age Range

NumberOut ofRange

PercentOut ofRange

DatabaseAverage

TSH Male All 0.4-4.50 microUI/mL 40 3.5% 4.8%

TSH Female >20Y 0.4-4.50 microUI/mL 72 7.1% 7.5%

Free T4 Both All 0.8-1.8 ng/dL 11 9.8% 18.4%






Kidney

The kidney’s main function is to eliminate metabolicwaste products and to maintain balance of sodium,potassium, chloride, water and many other vitalelements in the body. Blood flows to the kidneyswhere over one million “filters” serve to removethese waste products from urine. The kidneys arealso important in the maintenance of blood pressureand in the production of a hormone that stimulatesproduction of the red blood cells.

Urea Nitrogen (BUN): Urea, Measured as BloodUrea Nitrogen (BUN), is a waste product derivedfrom the natural breakdown of protein in the liver.Urea is excreted in the urine after blood is filteredthrough the kidneys. The urea nitrogen level reflectsboth the metabolism of protein and the effectivenessof the kidneys in filtering blood.


Out of range: An out of range level ofurea nitrogen may be due to liverdisease, a low protein diet, pregnancyor excess water consumption. Alwaysseek the advice of your physician orqualified healthcare provider if youhave any questions about your result. Aslightly elevated level may be aconsequence of a high protein diet. Ahigh level of urea nitrogen may be dueto failure of the kidneys to adequatelyfilter the blood. Dehydration orbleeding into the stomach or intestinemay also cause an increase in the ureanitrogen concentration.


NumberOut ofRange

PercentOut ofRange

DatabaseAverage

Urea Nitrogen (BUN) Both All 7-25 mg/dL 62 2.9% 2.1%






Kidney (continued)

Creatinine: Creatinine is derived from muscles andreleased into the blood. It is removed from the bodyby the kidneys. When the creatinine level is elevated,a decrease in kidney function is suggested.


Out of range: Individuals with a large body musclemass may have a slight increase in creatinine. Highlevels typically reflect impaired kidney function.Always seek the advice of your physician or qualifiedhealthcare provider if you have any questions aboutyour result.

EGFR: Creatinine is not sensitive to early renaldamage since it varies with age, gender and ethnicbackground. The impact of these variables can bereduced by an estimation of the Glomerular FiltrationRate (EGFR) using an equation of serum creatinine,age and gender.

BUN: Creatinine Ratio: TheBUN/creatinine ratio is a calculatedvalue derived by dividing the ureanitrogen result by the creatinine result.This ratio can be helpful in determiningwhether an elevated urea nitrogen isdue to impaired kidney function or toother factors such as dehydration,urinary blockage, or excessive bloodloss.


Out of range: An out of rangeBUN/Creatinine Ratio may reflect a lowprotein diet or malnutrition. Pregnancyand liver disease may also beassociated with a low ratio. An out ofrange BUN/Creatinine Ratio can occurwhen there is excess urea productionas seen with bleeding into the stomachor intestine. Decreased blood ureaexcretion also results in a high ratio,and can be caused by reduced bloodflow to the kidney and is oftenassociated with heart failure.

Test Gender Age RangeNumber

Out of RangePercent

Out of RangeDatabaseAverage

Creatinine Male All 0.5-1.30 68 5.9% 5.0%

Creatinine Female All 0.5-1.20 15 1.5% 1.6%

BUN: Creatinine Ratio Both All 6-22 calculated 33 25.4% 22.5%

EGFR Both All >=60 68 3.2% 3.2%






Bone

The normal adult skeleton is made up of 206 bones. Bone is composed of specialized cells and proteinsas well as a hard mineral substance made ofcalcium phosphate and calcium carbonate. Boneserves as a reservoir of calcium for the body. Thebone marrow located in the center of many bonesproduces the red blood cells, white blood cells, andplatelets.


Out of range: An out of range value can indicateinadequate absorption, malnutrition, vitamin Ddeficiency, or low albumin (protein). Slightly out ofrange calcium levels may be due to dehydration. Out of range calcium levels may be caused by bonedisease, excess consumption of antacids and milk(sometimes seen with individuals with ulcerdisease), excess consumption of vitamin D, cancerand over activity or tumors of the parathyroidglands.

Calcium: Calcium is important in thefunction of muscles, the brain, andnervous system, enzymes, and bloodclotting. Calcium is released frombones or stored in bones based on thecalcium level in the blood. Calciumlevels are regulated by parathyroidhormone that is produced by four tinyglands located adjacent to the thyroidgland in the neck and by levels ofvitamin D and other factors.

Test Range Male Female

NumberOut ofRange

PercentOut ofRange

DatabaseAverage

Calcium 8.6-10.2 mg/dL 48 49 97 4.5% 3.0%






Pancreas

Glucose: Glucose is the chief source of energy for allcells in the body. This test measures the concentrationof glucose in your blood.


Low - A decreased level of glucose is calledhypoglycemia, or low blood sugar, which canprevent your body from functioning properly. Certainconditions such as liver disease and hypothyroidismcan contribute to low glucose levels. Medicationssuch as insulin may also lower blood glucose. It isrecommended that individuals seek the advice of adoctor or qualified healthcare provider if there areany questions about test results.

Impaired and High - A high glucose level suggests the possibility of diabetes. This is a potentiallyserious condition.

It is recommended by the American Diabetes Association that glucose levels be measured ontwo different occasions. Persistently elevated glucose levels are consistent with diabetes. Otherconditions that can elevate your glucose levels include inflammation of the pancreas, kidneyfailure, or stress from surgery or trauma. Medications, including steroid hormones and diuretics,can contribute to a high glucose level.

Glucose Male FemaleNumberin Range

Percentin Range

DatabaseAverage

Low (<65) 3 5 8 0.4% 0.5%

Normal (65-99) 728 760 1,488 68.5% 76.1%

Impaired (100-125) 335 208 543 25.0% 18.2%

High (>=126) 94 41 135 6.2% 5.2%






Pancreas (continued)

Hemoglobin A1c: Hemoglobin A1c (also knownsimply as “A1c”) helps to monitor the effectiveness ofdiabetes therapy. When diabetes is well controlled,people feel better and suffer fewer complications ofdiabetes.

The blood level of glucose is tightly controlled byhormones, especially insulin produced by thepancreas. In diabetes, insulin is either less effectiveor not produced in sufficient quantity. As a result, theglucose level has greater variation with elevatedlevels typically observed in individuals with diabetescompared to individuals without diabetes. Theexcess glucose binds onto proteins including themost abundant protein in the red blood cells,hemoglobin. The combination is known ashemoglobin A1c and results are reported as percentof the hemoglobin that has bound glucose.

Hemoglobin A1c has as its keyadvantage that it reflects the averagecontrol for the previous severalmonths, known as long-term control.In contrast, glucose levels reflectshort-term control, influenced by diet,activity, and the daily cycle of ourlives. Both tests are importantbecause they provide differentinformation essential to provide gooddiabetes control.

The American Diabetes Association(ADA) recommends that individualswith diabetes be tested at least twiceeach year for those in good controland quarterly for those whosediabetes is not well controlled orwhose therapy changes.

HemoglobinA1c Level Interpretation Male Female

Numberin

Range

Percentin

RangeDatabaseAverage

4.0-5.6% Consistent with controlled diabetes or absence of diabetes. May increase risk ofhypoglycemia (low glucose level) among those with diabetes.

626 629 1,255 57.8% 52.3%

5.7-6.4% If known to have diabetes,consistent with controlled diabetes.Suggests increasedfuture risk of diabetes if confirmed by elevated fasting glucose level.

435 332 767 35.3% 38.5%

6.5-6.9% If known to have diabetes, consistent with controlled diabetes. If not previouslydiagnosed, results of 6.5% and greater are consistent with diabetes if confirmedon repeat measurement or if non-fasting glucose 200 mg/dL or greater andsymptoms are present.

37 25 62 2.9% 3.2%

7.0-8.0% If not previously diagnosed, this result is consistent with diabetes if confirmed onrepeat measurement or if glucose 200 mg/dL or greater and symptoms arepresent.

35 13 48 2.2% 2.8%

>8.0% Consistent with poorly controlled diabetes that needs modified management. 26 14 40 1.8% 3.1%






Liver

The liver is the body’s chief “chemical factory” andperforms many varied and complex tasks. Theliver produces certain proteins such as albuminand the proteins that are involved with bloodclotting. The liver also produces about half of thetotal cholesterol in the body (the other half comesfrom food). The liver filters blood from all over thebody. Enzymes in the liver neutralize harmful ortoxic substances such as alcohol or medicationswhich are then eliminated in either bile or blood.The liver also serves as a storage site for sugarsand lipids, which can be released when needed.

Total Protein - Total protein has two maincomponents – albumin and globulin. The body’sprotein is derived from ingested food and therefore isinfluenced by the quality of diet, as well as by liver andkidney function.

Albumin - Approximately 60 percent of the totalprotein circulating in your blood is albumin. Thisimportant protein, produced in the liver, helps to keepwater inside your blood vessels. When your albuminlevel is too low, water is not retained within bloodvessels, and leaks out into body tissues, causingswelling called “edema”.

Globulin - Globulin is not measured directly. It iscalculated as the difference between the total proteinand the albumin levels. The globulins are a group ofabout 60 different proteins that are part of theimmune system, which helps to fight or preventinfections. They also play an important role in bloodclotting, and serve as carrier proteins for hormones.

Albumin:Globulin Ratio - Thealbumin:globulin ratio is derived bydividing the albumin result by theglobulin result. The calculated ratiosometimes highlights an abnormalitythat is not obvious by reviewing theindividual test results.

Total and Direct Bilirubin - Bilirubin isthe main pigment in bile and a majorproduct of normal red cell breakdown. It is helpful in evaluating liver function,various anemias and in evaluatingjaundice, yellowing of the skin.






Liver (continued)


Total Protein - An out of range totalprotein is seen in pregnancy, acute burns,severe dietary deficiency, chronic liverdisease and kidney disease. Increasedtotal protein is seen in some cancers of theimmune system such as multiple myelomaand lymphoma, some forms of liverdisease (cirrhosis), and some chronicdiseases, such as rheumatoid arthritis.

Total and Direct Bilirubin - An out ofrange bilirubin level in the blood mayindicate liver damage or obstruction ofbile ducts in the liver. High levels ofbilirubin may indicate excessivedestruction of red blood cells whichmay result in anemia. Slight elevationsof bilirubin can be seen in associationwith Gilbert’s disease, benign inheritedliver enzyme defect, and occasionallyas a result of fasting.

Albumin - An out of range albumin resultcan be caused by malnutrition, excess bodywater, pregnancy, liver disease, kidneydisease, severe injury such as burns ormajor bone fractures, and prolonged bloodloss. It can also often be a reflection ofdehydration.

Globulin - An out of range globulinlevel may be seen in the breakdown ofthe body associated with advancedcancers, kidney diseases, and someblood diseases, including lymphocyticleukemia, and lymphoma. An out ofrange globulin level may be seen insome types of myeloid leukemia,Hodgkin’s disease, cancers of theimmune system, lupus, and rheumatoidarthritis. Often, additional tests areperformed to determine which type ofglobulin is being produced in excess.

Albumin:Globulin Ratio - An out of rangeresult may be associated with severaldisease states such as chronic liverdisorders, chronic inflammatory diseases,rheumatoid arthritis, or some cancers.


NumberOut ofRange

PercentOut ofRange

DatabaseAverage

Total Protein Both All 6.2-8.3 g/dL 28 1.3% 1.5%

Albumin Both All 3.6-5.1 g/dL 31 1.4% 1.1%

Globulin Female All 2.2-3.9 g/dL 27 2.7% 3.2%

Globulin Male All 2.1-3.7 g/dL 36 3.1% 2.9%

Albumin: Globulin Ratio Both All 1.0-2.1 calculated 91 4.2% 3.1%

Total Bilirubin Both All 0.2-1.2 mg/dL 98 4.5% 4.3%

Direct Bilirubin Both All <=0.2 mg/dL 89 4.1% 3.7%






Liver (continued)

Alkaline Phosphatase - Alkalinephosphatase is an enzyme found primarily inbone and liver. Abnormalities can reflectincreased activity of bone forming cells orobstruction to bile flow in the liver.


Out of range: The most common reasonfor an out of range level of this enzyme isliver or bone injury or disease (for example,when bone is being repaired after afracture, or when the bile ducts are blockedby gallstones, or certain medications).

Gamma Glutamyltransferase (GGT) - GGTis produced in highest concentration withinbile ducts in the liver and can be used as anindicator of liver disease.


Out of range: Out of range levels of GGTmay be caused by use of alcohol or certaindrugs, inflammation, or obstruction of bileducts in the liver.


NumberOut ofRange

PercentOut ofRange

DatabaseAverage

Alkaline Phosphatase Male All 40-115 u/L 62 5.3% 5.2%

Alkaline Phosphatase Female 0-49Y 33-115 u/L 26 4.8% 4.1%

Alkaline Phosphatase Female >49Y 33-130 u/L 12 2.5% 2.6%

GGT Both All 3-70 u/L 100 4.6% 4.4%






Alanine Aminotransferase(ALT) & Aspartate Transaminase (AST):ALT and AST are enzymes producedprimarily in the liver, skeletal and heartmuscles. ALT is present in the liver in ahigher concentration than AST and is morespecific for differentiating liver injury frommuscle damage.


Out of range: High levels of both ALT andAST may signify liver disease. Results areusually interpreted together with otherlaboratory test results, history, and physicalfindings. If appropriate, additionallaboratory tests are ordered, such as testsfor hepatitis. Certain medications maycause toxicity to the liver resulting in highlevels of ALT and AST.


NumberOut ofRange

PercentOut ofRange

DatabaseAverage

ALT Male All 9-60 u/L 80 6.9% 4.8%

ALT Female All 6-40 u/L 48 4.7% 4.4%

AST Male All 10-35 u/L 67 5.8% 5.0%

AST Female 0-44Y 10-30 u/L 26 4.8% 4.3%

AST Female >44Y 10-35 u/L 23 4.9% 4.0%






Throughout the Body

Potassium, Sodium, and Chloride: Theseelements, collectively known as electrolytes, areimportant for salt and water balance. Imbalancesmay be due to problems with diet, fluid intake,medication, kidney disease, or lung disorders. Thesetests are interpreted together.

Sodium and Chloride


Out of range: An out of range level of sodium orchloride may be caused by excessive water intake,heart failure, kidney failure and certainhormone-producing tumors. These conditionsresult in fluid retention that may cause a low sodiumlevel by dilution. A low level may also be causedby excessive loss of sodium due to diarrhea orvomiting, or by low thyroid function. An out of rangesodium or chloride level may be caused by anexcessive intake of salt or by not drinking enoughwater.

Potassium


Out of range: An out of rangepotassium level may be due to diureticmedications or insufficient dietaryintake of potassium, generally found insuch foods as orange juice andbananas. A low level may causemuscle weakness and an irregularheart rhythm. An out of rangepotassium level can be caused bykidney disease, often in associationwith certain medications used to treathigh blood pressure. Certain disordersof the adrenal gland also causeelevation of potassium levels. Some“salt” substitutes contain potassiuminstead of sodium; an excessive use ofsuch substitutes may increase thepotassium level.


NumberOut ofRange

PercentOut ofRange

DatabaseAverage

Potassium Both All 3.5-5.3 mmol/L 47 2.2% 1.3%

Sodium Both All 135-146 mmol/L 46 2.1% 1.3%

Chloride Both All 98-110 mmol/L 34 1.6% 1.3%








Throughout the Body (continued)

Cotinine: Cotinine is a direct metabolite ofnicotine. Nicotine, a highly abused, highlytoxic alkaloid found in tobacco productssuch as cigars, cigarettes and chewingtobacco is metabolized into cotinine in thebody. In general, cotinine can be detectedbetween a few days and a week aftersmoking cessation.

Quest Diagnostics utilizes a veryspecific immunoassay to test for thepresence of cotinine. This test hasbeen validated with confirmationstudies utilizing GC/MS technology.The screening immunoassayevaluation employs a very specificantibody to cotinine and this antibodywill react with cotinine that is present inthe bodily fluids from someonesmoking or chewing tobacco, orwearing a nicotine patch.

Cotinine Male Female Number in Range Percent in Range Database Average

Negative 1,025 925 1,950 89.6% 87.1%

Positive 137 89 226 10.4% 12.5%

Comparison of Tobacco Users vs. Non-Tobacco Users(N=1686)

Positive Cotinine Negative Cotinine

18%21% 21% 21%

7.0% 5.8%

13%15% 15%

13% 12%

7.5%

15%16%

0.0%

5.0%

10%

15%

20%

25%

30%

35%

40%

45%

50%

BMI(>=30) High Waist(>40in M,>35in F)

HighTotal Chol.

(>=240)

BorderlineTotal Chol.(200-239)

Low HDL(<=39 M,<=49 F)

HDL Ratio(>=5.0)

ElevatedGlucose(>=100)







Complete Blood Count

The complete blood count (CBC) is a common screenfor anemia, infectious diseases and blood disorders. The CBC can provide evidence of silent conditions –disorders without symptoms – as well as theside-effects of certain therapeutic procedures.

Blood analysis examines:

Red blood cells (RBC) – The most abundant cells inthe blood – contain hemoglobin, the proteinresponsible for transporting oxygen from the lungs toall of the tissues and organs. The Red Blood CellCount, Hemoglobin and Hematocrit as well as theMCV, MCH, and MCHC quantify the red blood cells.

White blood cells (WBC) – are criticalto the body’s immune system. Thetotal white blood count can rise or fallwith certain conditions and diseases. In addition to indicating the health ofthe immune system, this set of testsmay provide evidence of existingdiseases and infections, as well asvaluable information about the body’sability to fight illness or infection.

Platelets – play a critical role in bloodclotting. When a person bleeds, thesesmall, cell-like structures clumptogether and form a sticky mass at thesite of injury. Platelet counts are oftenassessed for individuals scheduled forsurgery or for other medical proceduresthat may cause bleeding. This test canalso help indicate the health of thebone marrow and is frequently used tomonitor medications that can be toxicto this important tissue.







Test Reference Range Male Female

NumberOut ofRange

PercentOut ofRange

DatabaseAverage

Hemoglobin 11.7 - 15.5 g/dL 67 75 142 6.6% 7.8%

Hematocrit 35.0 - 45.0% 151 121 272 12.7% 13.3%

Red Blood Cell Count 3.80 - 5.10 Million/UL 74 75 149 7.0% 7.3%

MCV 80.0 - 100 fL 47 69 116 5.4% 7.0%

MCH 27.0 - 33.0 pg 68 106 174 8.1% 11.6%

MCHC 32.0 - 36.0 g/dL 134 199 333 15.6% 27.6%

RDW 11.0 - 15.0% 92 143 235 11.0% 17.7%

White Blood Cell Count 3.8 - 10.8 Thousand/uL 61 60 121 5.7% 6.1%

Platelet Count 140 - 400 Thousand/uL 50 27 77 3.6% 3.2%

Cohort Clinical Data Report

An analysis that includes the historical clinical and biometric results of those in your populationwho have consistently participated in screenings for added insight to important trends in yourpopulation’s health.

Cohort: Those participants that took part in the screenings in 2016, 2014, 2012, 2010 and2009.

The Lipid profile comparison charts represents the percent of cohort participants having a valuethat is out of range for the specified test. N=612.

20162014201220102009

32.8%30.1% 29.1% 28.4% 27.9%

42.6% 41.7%38.6%

42.8% 44.4%

25.0% 24.8% 23.3%

28.8% 29.8%26.5%

23.9%

28.0% 27.8%23.7%

20092010

20122014

20162009

20102012

20142016

20092010

20122014

20162009

20102012

20142016

0%

10%

20%

30%

40%

Triglycerides >149Total Cholesterol >199LDL >129HDL M(<40)/F(<50)

The Glucose comparison chart represents the percent of cohort participants having a value thatis out of range for glucose. N=612.

20162014201220102009

6.2% 7.4% 8.7% 9.2%11.6%

38.7%

29.2% 29.6%33.2% 35.1%

2009 2010 2012 2014 20162009 2010 2012 2014 2016

0%

10%

20%

30%

40%

>125 mg/dL (High)100-125 mg/dL (Impaired)

OurCompanyProfile | Cohort Clinical Data Report | Collier County Government | 12OCT16 34

Cohort Clinical Data ReportCohort Clinical Data Report

The Hemoglobin A1c comparison chart represents the percent of cohort participants having avalue that is out of range for HBA1c. N=612.

20162014201220102009

3.1%2.6% 2.5%

3.1%3.6%

1.8%

2.5%2.8%

4.4%

3.8%

2.9% 2.8% 2.6%

4.1% 4.1%

2009 2010 2012 2014 20162009 2010 2012 2014 20162009 2010 2012 2014 2016

0%

1%

2%

3%

4%

5%

>8.0% (Poorly controlled)7.0-8.0% (Not well controlled)6.5-6.9% (Controlled)

The Blood Pressure comparison chart represents the percent of cohort participants having avalue that is out of range for Blood Pressure. N=603.

20162014201220102009

22.1%15.9%

8.8%13.8% 12.9%

51.1% 53.7%49.3%

59.0%51.9%

2009 2010 2012 2014 20162009 2010 2012 2014 2016

0%

20%

40%

60%

Hypertensive (>=140 over >=90)Prehypertensive (120-139 over 80-89)

The BMI/Waist Circumference comparison chart represents the percent of cohort participantshaving a value that is out of range for BMI and Waist Circumference. N=606.

20162014201220102009

49.0% 46.8%42.5% 44.1%

49.7%

40.1% 41.7% 44.4% 45.0% 45.4%

2009 2010 2012 2014 20162009 2010 2012 2014 2016

0%

10%

20%

30%

40%

50%

60%

Waist M(>40in/102cm)/F(>35in/88cm)BMI >=30






Migration: Movement of cohort participants into or out of range from 2009 to 2016.

The two clinical results showing most improvement from 2009 to 2016 were:

Blood Pressure <=119 over <=79

(N=603)

Of 441 cohort participants whowere at risk in 2009, 130 (29%of the 441) moved to an in rangestatus in 2016.

Triglycerides <=149(N=612)

Of 201 cohort participants whowere at risk in 2009, 84 (42% ofthe 201) moved to an in rangestatus in 2016.

Out of Range Migrated In In Range and Stayed InIn Range Migrated Out Out of Range and Stayed Out

130 (22%)

82 (14%)

80 (13%)

311 (52%)

84 (14%)357 (58%)

54 (9%)

117 (19%)





Migration: Movement of cohort participants into or out of range from 2009 to 2016.

The clinical result showing least improvement from 2009 to 2016 were:

Body Mass Index 18.5-24.99

(N=606)

Of 443 cohort participants whowere at risk in 2009, 27 (6% ofthe 443) moved to an in rangestatus in 2016.

Out of Range Migrated In In Range and Stayed InIn Range Migrated Out Out of Range and Stayed Out

27 (4%)

123 (20%)

40 (7%)

416 (69%)





Table 1

The table below presents the number of participants in each range for the specified lab result in2009 and for the same population in 2016.

Test Name Test Name

Reference Range 2009 Reference Range 2016

Blood Pressure

Normal (<=119 over <=79) 162 Normal (<=119 over <=79) 82

Prehypertensive (120-139 over 80-89) 69Hypertensive (>=140 over >=90) 11

Prehypertensive (120-139 over 80-89) 308 Normal (<=119 over <=79) 104


Hypertensive (>=140 over >=90) 133 Normal (<=119 over <=79) 26


Body Mass Index Underweight (<18.5) 1 Ideal Weight (18.5-24.99) 1

Ideal Weight (18.5-24.99) 163 Underweight (<18.5) 2

Ideal Weight (18.5-24.99) 123

Overweight (25-29.99) 32

Obesity I (30-34.99) 4Obesity II (35-39.99) 2

Overweight (25-29.99) 199 Ideal Weight (18.5-24.99) 26

Overweight (25-29.99) 117

Obesity I (30-34.99) 53Obesity II (35-39.99) 3

Obesity I (30-34.99) 146 Overweight (25-29.99) 24

Obesity I (30-34.99) 84

Obesity II (35-39.99) 30Extreme Obesity (>=40) 8

Obesity II (35-39.99) 60 Overweight (25-29.99) 4

Obesity I (30-34.99) 15


Extreme Obesity (>=40) 37 Overweight (25-29.99) 2

Obesity I (30-34.99) 1






Table 1

Continued.

Test Name Test Name


Waist Circumference

Normal F(<=35in)/M(<=40in) 301 Normal F(<=35in)/M(<=40in) 244High F(>35in)/M(>40in) 57

High F(>35in)/M(>40in) 289 Normal F(<=35in)/M(<=40in) 53High F(>35in)/M(>40in) 236

Triglycerides

Normal (<=149) 411 Normal (<=149) 357

Borderline High (150-199) 37High (>=200) 17

Borderline High (150-199) 94 Normal (<=149) 51


High (>=200) 107 Normal (<=149) 33


Total Cholesterol

Low (<125) 13 Low (<125) 3

Desirable (125-199) 9Borderline High (200-239) 1

Desirable (125-199) 338 Low (<125) 9

Desirable (125-199) 238


Borderline High (200-239) 188 Low (<125) 2

Desirable (125-199) 60


High (>=240) 73 Desirable (125-199) 19






Table 1

Continued.

Test Name Test Name


HDL Cholesterol

High (Desirable) (>=60) 210 High (Desirable) (>=60) 164

Acceptable M(40-59)/F(50-59) 40Low M(<=39)/F(<=49) 6

Acceptable M(40-59)/F(50-59) 239 High (Desirable) (>=60) 53


Low M(<=39)/F(<=49) 162 High (Desirable) (>=60) 10


LDL Cholesterol

Optimal (<100) 220 Optimal (<100) 111

Near Optimal (<=129) 80


Near Optimal (<=129) 230 Optimal (<100) 62



Borderline High (130-159) 111 Optimal (<100) 20



High (>=160) 39 Optimal (<100) 7



Total Cholesterol: HDL Ratio

Normal (<=5) 512 Normal (<=5) 470High (>5) 42

High (>5) 97 Normal (<=5) 54High (>5) 43





Table 1

Continued.

Test Name Test Name


TSH

Low (<0.4) 10 Low (<0.4) 3

Normal (0.4-4.5) 5High (>4.5) 2

Normal (0.4-4.5) 554 Low (<0.4) 13

Normal (0.4-4.5) 521High (>4.5) 20

High (>4.5) 47 Low (<0.4) 6

Normal (0.4-4.5) 32High (>4.5) 9

Free T4

Normal (0.8-1.8) 9 Low (<0.8) 1Normal (0.8-1.8) 8

High (>1.8) 1 Normal (0.8-1.8) 1

Urea Nitrogen (BUN) Low (<7) 2 Normal (7-25) 2

Normal (7-25) 595 Low (<7) 3

Normal (7-25) 580High (>25) 12

High (>25) 15 Normal (7-25) 9High (>25) 6

Creatinine Female Low (<0.5) 1 Female Normal (0.5-1.2) 1

Female Normal (0.5-1.2) 303 Female Low (<0.5) 3

Female Normal (0.5-1.2) 295

Male Normal (0.5-1.3) 1Female High (>1.2) 4

Male Normal (0.5-1.3) 290 Male Normal (0.5-1.3) 278Male High (>1.3) 12

Male High (>1.3) 18 Male Normal (0.5-1.3) 4Male High (>1.3) 14





Table 1

Continued.

Test Name Test Name


EGFR

Low (<60) 41 Low (<60) 18Normal (>=60) 23

Normal (>=60) 554 Low (<60) 20Normal (>=60) 534

BUN: Creatinine Ratio

Normal (6-22) 5 Normal (6-22) 4High (>22) 1

High (>22) 2 Normal (6-22) 2

Calcium Low (<8.6) 1 Normal (8.6-10.2) 1

Normal (8.6-10.2) 595 Low (<8.6) 3

Normal (8.6-10.2) 564High (>10.2) 28

High (>10.2) 16 Normal (8.6-10.2) 8High (>10.2) 8

Glucose

Low (<65) 3 Low (<65) 1Normal (65-99) 2

Normal (65-99) 334 Low (<65) 2

Normal (65-99) 249

Impaired (100-125) 79High (>=126) 4

Impaired (100-125) 237 Low (<65) 1

Normal (65-99) 70

Impaired (100-125) 124High (>=126) 42

High (>=126) 38 Normal (65-99) 1

Impaired (100-125) 12High (>=126) 25





Table 1

Continued.

Test Name Test Name


Hemoglobin A1c

4.0-5.6% 325 4.0-5.6% 214

5.7-6.4% 106

6.5-6.9% 37.0-8.0% 2

5.7-6.4% 239 4.0-5.6% 37

5.7-6.4% 174

6.5-6.9% 14

7.0-8.0% 8>8.0% 6

6.5-6.9% 18 5.7-6.4% 8

6.5-6.9% 4

7.0-8.0% 4>8.0% 2

7.0-8.0% 11 5.7-6.4% 2

6.5-6.9% 2

7.0-8.0% 3>8.0% 4

>8.0% 19 5.7-6.4% 1

6.5-6.9% 2

7.0-8.0% 6>8.0% 10

Total Protein Low (<6.2) 2 Normal (6.2-8.3) 2

Normal (6.2-8.3) 606 Low (<6.2) 1Normal (6.2-8.3) 605

High (>8.3) 4 Normal (6.2-8.3) 3High (>8.3) 1





Table 1

Continued.

Test Name Test Name


Albumin Low (<3.6) 1 Normal (3.6-5.1) 1

Normal (3.6-5.1) 608 Low (<3.6) 3

Normal (3.6-5.1) 604High (>5.1) 1

High (>5.1) 3 Normal (3.6-5.1) 3

Globulin Female Low (<2.2) 3 Female Normal (2.2-3.9) 3 Male Low (<2.1) 6 Male Normal (2.1-3.7) 6




Male Normal (2.1-3.7) 300 Male Low (<2.1) 7Male Normal (2.1-3.7) 293

Female High (>3.9) 1 Female High (>3.9) 1


Albumin: Globulin Ratio Low (<1.0) 1 Normal (1.0-2.1) 1

Normal (1.0-2.1) 588 Normal (1.0-2.1) 572High (>2.1) 16

High (>2.1) 23 Normal (1.0-2.1) 18High (>2.1) 5

Total Bilirubin

Normal (0.2-1.2) 574 Normal (0.2-1.2) 560High (>1.2) 14

High (>1.2) 38 Normal (0.2-1.2) 16High (>1.2) 22





Table 1

Continued.

Test Name Test Name


Direct Bilirubin

Normal (<=0.2) 592 Normal (<=0.2) 568High (>0.2) 24

High (>0.2) 19 Normal (<=0.2) 8High (>0.2) 11

Alkaline Phosphatase

Female 50+ Low (<33) 2 Female 50+ Low (<33) 1Female 50+ High (>130) 1

Male Low (<40) 6 Male Low (<40) 5Male Normal (40-115) 1

Female 20-49 Normal (33-115) 110 Female 50+ Low (<33) 1

Female 20-49 Normal (33-115) 65

Female 50+ Normal (33-130) 42

Male Normal (40-115) 1Female 20-49 High (>115) 1

Female 50+ Normal (33-130) 189 Female 50+ Normal (33-130) 187Female 50+ High (>130) 2

Male Normal (40-115) 302 Male Low (<40) 14

Male Normal (40-115) 284Male High (>115) 4

Female 20-49 High (>115) 1 Female 50+ High (>130) 1

Female 50+ High (>130) 2 Female 50+ Normal (33-130) 1Female 50+ High (>130) 1





Table 1

Continued.

Test Name Test Name


GGT

Female 20-29 Normal (3-40) 15 Female 20-29 Normal (3-40) 2Female 30-39 Normal (3-50) 13

Female 30-39 Normal (3-50) 30 Female 30-39 Normal (3-50) 6Female 40-49 Normal (3-55) 24

Female 40-49 Normal (3-55) 61 Female 40-49 Normal (3-55) 18

Female 50-59 Normal (3-70) 41

Male 40-54 Normal (3-95) 1Female 40-49 High (>55) 1

Female 50-59 Normal (3-70) 169 Female 50-59 Normal (3-70) 71


Female 50-59 High (>70) 3Female 60+ High (>65) 3

Female 60+ Normal (3-65) 15 Female 60+ Normal (3-65) 14Female 60+ High (>65) 1

Male 20-29 Normal (3-70) 13 Male 30-39 Normal (3-90) 13


Male 40-54 Normal (3-95) 22Male 40-54 High (>95) 1


Male 55-59 Normal (3-85) 78

Male 60+ Normal (3-70) 36

Male 40-54 High (>95) 2Male 60+ High (>70) 1

Male 55-59 Normal (3-85) 58 Male 60+ Normal (3-70) 58 Male 60+ Normal (3-70) 28 Male 60+ Normal (3-70) 28 Female 20-29 High (>40) 1 Female 30-39 Normal (3-50) 1 Female 30-39 High (>50) 1 Female 40-49 Normal (3-55) 1 Female 40-49 High (>55) 3 Female 50-59 Normal (3-70) 3

Female 50-59 High (>70) 8 Female 50-59 Normal (3-70) 3







Table 1

Continued.

Test Name Test Name


GGT Female 60+ High (>65) 1 Female 60+ Normal (3-65) 1 Male 30-39 High (>90) 2 Male 40-54 Normal (3-95) 2

Male 40-54 High (>95) 12 Male 40-54 Normal (3-95) 2

Male 55-59 Normal (3-85) 3

Male 60+ Normal (3-70) 1


Male 55-59 High (>85) 3 Male 60+ High (>70) 3

Male 60+ High (>70) 2 Male 60+ Normal (3-70) 2





Table 1

Continued.

Test Name Test Name


AST Female 19-44 Low (<10) 1 Female 45+ Normal (10-35) 1 Female 45+ Low (<10) 1 Female 45+ Normal (10-35) 1

Female 19-44 Normal (10-30) 66 Female 19-44 Low (<10) 1

Female 19-44 Normal (10-30) 32



Female 45+ Normal (10-35) 224 Female 45+ Low (<10) 1


Male 50+ Normal (10-35) 1Female 45+ High (>35) 11


Male 50+ Normal (10-35) 42


Male 50+ Normal (10-35) 186 Male 50+ Normal (10-35) 180Male 50+ High (>35) 6

Female 19-44 High (>30) 3 Female 19-44 Normal (10-30) 3

Female 45+ High (>35) 9 Female 45+ Normal (10-35) 8Female 45+ High (>35) 1

Male 20-49 High (>40) 9 Male 20-49 Normal (10-40) 5

Male 50+ Normal (10-35) 2Male 50+ High (>35) 2

Male 50+ High (>35) 15 Male 50+ Normal (10-35) 10Male 50+ High (>35) 5





Table 1

Continued.

Test Name Test Name


ALT

Age 21+ Low M(<9)/F(<6) 3 Age 21+ Low M(<9)/F(<6) 1Age 21+ Normal M(9-60)/F(6-40) 2

Age 21+ Normal M(9-60)/F(6-40) 575 Age 21+ Normal M(9-60)/F(6-40) 549Age 21+ High M(>60)/F(>40) 26

Age 21+ High M(>60)/F(>40) 34 Age 21+ Normal M(9-60)/F(6-40) 26Age 21+ High M(>60)/F(>40) 8

Sodium

Low (<135) 5 Low (<135) 2Normal (135-146) 3

Normal (135-146) 604 Low (<135) 5

Normal (135-146) 588High (>146) 11

High (>146) 3 Normal (135-146) 3

Potassium Low (<3.5) 1 Normal (3.5-5.3) 1

Normal (3.5-5.3) 599 Low (<3.5) 3

Normal (3.5-5.3) 579High (>5.3) 17

High (>5.3) 12 Normal (3.5-5.3) 12

Chloride Low (<98) 2 Normal (98-110) 2

Normal (98-110) 610 Low (<98) 10

Normal (98-110) 598High (>110) 2

Cotinine

Negative 531 Negative 522Positive 9

Positive 82 Negative 40Positive 42





Table 1

Continued.

Test Name Test Name


White Blood Cell Count

Low (<3.8) 9 Low (<3.8) 5Normal (3.8-10.8) 4

Normal (3.8-10.8) 580 Low (<3.8) 16

Normal (3.8-10.8) 554High (>10.8) 10

High (>10.8) 13 Normal (3.8-10.8) 11High (>10.8) 2

Red Blood Cell Count

Female Low (<3.8) 11 Female Low (<3.8) 4Female Normal (3.8-5.1) 7

Male Low (<4.2) 12 Male Low (<4.2) 4Male Normal (4.2-5.8) 8


Female Normal (3.8-5.1) 268Female High (>5.1) 10

Male Normal (4.2-5.8) 293 Male Low (<4.2) 6

Male Normal (4.2-5.8) 275Male High (>5.8) 12

Female High (>5.1) 4 Female Normal (3.8-5.1) 1


Male High (>5.8) 2 Male High (>5.8) 2





Table 1

Continued.

Test Name Test Name


Hemoglobin

Female Low (<11.7) 17 Female Low (<11.7) 6Female Normal (11.7-15.5) 11

Male Low (<13.2) 10 Male Low (<13.2) 5





Male Normal (13.2-17.1) 292 Male Low (<13.2) 13


Female High (>15.5) 4 Female Low (<11.7) 1

Female Normal (11.7-15.5) 1Female High (>15.5) 2






Table 1

Continued.

Test Name Test Name


Hematocrit

Female Low (<35) 9 Female Low (<35) 2Female Normal (35-45) 7

Male Low (<38.5) 8 Male Low (<38.5) 3

Male Normal (38.5-50) 4Male High (>50) 1

Female Normal (35-45) 265 Female Low (<35) 2

Female Normal (35-45) 242Female High (>45) 21

Male Normal (38.5-50) 265 Male Low (<38.5) 9

Male Normal (38.5-50) 231Male High (>50) 25

Female High (>45) 21 Female Low (<35) 1

Female Normal (35-45) 8

Male Normal (38.5-50) 1Female High (>45) 11

Male High (>50) 34 Male Normal (38.5-50) 16Male High (>50) 18

MCV

Low (<80) 10 Low (<80) 4Normal (80-100) 6

Normal (80-100) 539 Low (<80) 8

Normal (80-100) 522High (>100) 9

High (>100) 53 Normal (80-100) 35High (>100) 18





Table 1

Continued.

Test Name Test Name


MCH

Low (<27) 18 Low (<27) 13Normal (27-33) 5

Normal (27-33) 531 Low (<27) 24

Normal (27-33) 505High (>33) 2

High (>33) 53 Low (<27) 1

Normal (27-33) 39High (>33) 13

MCHC

Low (<32) 51 Low (<32) 24Normal (32-36) 27

Normal (32-36) 551 Low (<32) 75Normal (32-36) 476

RDW

Normal (11-15) 394 Normal (11-15) 370High (>15) 24

High (>15) 208 Normal (11-15) 162High (>15) 46

Platelet Count

Low (<140) 10 Low (<140) 8Normal (140-400) 2

Normal (140-400) 579 Low (<140) 15

Normal (140-400) 561High (>400) 3

High (>400) 8 Normal (140-400) 6High (>400) 2

OurCompanyProfile | Appendix A | Collier County Government | 12OCT16 54 OurCompanyProfile | Appendix A | Collier County Government | 12OCT16 54

Appendix A: Non-Cohort Test Results Summary and Comparison

Laboratory tests were performed on 2,176 Collier County Government participants. Thefollowing is a summary of those results as compared to the Database Average.(This is anon-cohort comparison of aggregate participant data. Legacy wellness database years aredenoted by an asterisk.)

Percent of Each Test in Range

DatabaseAverage

|

Body Mass Index |

2016: Of 2,175 27.1% 29.6%

2014: Of 1,838 26.5%

2012: Of 1,829 26.8%

2010: Of 1,174 24.1%

2009: Of 1,954 27.8%

Glucose |

2016: Of 2,174 68.4% 76.1%

2014: Of 1,837 68.1%

2012: Of 1,829 68.8%

2010: Of 1,175 60.6%

2009: Of 1,974 63.1%

Urea Nitrogen (BUN) |

2016: Of 2,175 97.1% 97.9%

2014: Of 1,837 97.1%

2012: Of 1,829 97.5%

2010: Of 1,175 95.7%

2009: Of 1,974 97.1%


Appendix A: Non-Cohort Test Results Summary and Comparison(continued)


DatabaseAverage

|

Creatinine |

2016: Of 2,175 96.2% 96.9%

2014: Of 1,837 96.7%

2012: Of 1,829 95.9%

2010: Of 1,175 96.5%

2009: Of 1,974 96.3%

EGFR |

2016: Of 2,125 96.8% 96.8%

2014: Of 1,836 97.2%

2012: Of 1,828 95.2%

2010: Of 1,165 90.6%

2009: Of 1,971 92.1%

BUN: Creatinine Ratio |

2016: Of 130 74.6% 77.5%

2014: Of 114 74.6%

2012: Of 129 75.2%

2010: Of 102 52.9%

2009: Of 113 63.7%

Sodium |

2016: Of 2,175 97.9% 98.7%

2014: Of 1,837 98.3%

2012: Of 1,829 99.2%

2010: Of 1,175 98.6%

2009: Of 1,974 99.0%




DatabaseAverage

|

Potassium |

2016: Of 2,175 97.8% 98.7%

2014: Of 1,836 95.7%

2012: Of 1,829 97.2%

2010: Of 1,175 98.4%

2009: Of 1,974 98.4%

Chloride |

2016: Of 2,175 98.4% 98.7%

2014: Of 1,837 98.9%

2012: Of 1,829 99.0%

2010: Of 1,175 97.9%

2009: Of 1,974 98.9%

Calcium |

2016: Of 2,175 95.5% 97.0%

2014: Of 1,837 94.2%

2012: Of 1,829 94.2%

2010: Of 1,175 95.5%

2009: Of 1,974 96.6%

Total Protein |

2016: Of 2,175 98.7% 98.5%

2014: Of 1,837 99.1%

2012: Of 1,829 99.1%

2010: Of 1,175 98.7%

2009: Of 1,974 98.7%




DatabaseAverage

|

Albumin |

2016: Of 2,175 98.6% 98.9%

2014: Of 1,837 97.9%

2012: Of 1,829 98.2%

2010: Of 1,175 98.3%

2009: Of 1,974 97.8%

Globulin |

2016: Of 2,175 97.1% 96.9%

2014: Of 1,837 96.7%

2012: Of 1,829 89.3%

2010: Of 1,175 97.9%

2009: Of 1,974 96.6%

Albumin: Globulin Ratio |

2016: Of 2,175 95.8% 96.9%

2014: Of 1,837 94.8%

2012: Of 1,829 86.4%

2010: Of 1,175 96.6%

2009: Of 1,974 94.5%

Total Bilirubin |

2016: Of 2,175 95.5% 95.7%

2014: Of 1,837 95.6%

2012: Of 1,829 94.6%

2010: Of 1,175 95.2%

2009: Of 1,974 94.8%




DatabaseAverage

|

Direct Bilirubin |

2016: Of 2,173 95.9% 96.3%

2014: Of 1,835 94.8%

2012: Of 1,827 96.4%

2010: Of 1,175 96.8%

2009: Of 1,974 97.2%

Alkaline Phosphatase |

2016: Of 2,175 95.4% 95.7%

2014: Of 1,837 96.3%

2012: Of 1,829 96.1%

2010: Of 1,175 95.7%

2009: Of 1,974 95.8%

GGT |

2016: Of 2,173 95.4% 95.6%

2014: Of 1,837 95.0%

2012: Of 1,829 95.1%

2010: Of 1,175 94.6%

2009: Of 1,974 94.3%

AST |

2016: Of 2,175 94.7% 95.4%

2014: Of 1,836 93.5%

2012: Of 1,829 94.5%

2010: Of 1,175 93.1%

2009: Of 1,974 93.4%




DatabaseAverage

|

ALT |

2016: Of 2,175 94.1% 95.4%

2014: Of 1,837 94.6%

2012: Of 1,829 95.1%

2010: Of 1,175 94.8%

2009: Of 1,974 94.8%

Triglycerides |

2016: Of 2,173 75.7% 75.5%

2014: Of 1,837 74.0%

2012: Of 1,829 73.5%

2010: Of 1,175 70.0%

2009: Of 1,975 70.0%

Total Cholesterol |

2016: Of 2,173 60.0% 63.8%

2014: Of 1,837 61.5%

2012: Of 1,829 63.5%

2010: Of 1,175 60.3%

2009: Of 1,975 61.6%

HDL Cholesterol |

2016: Of 2,173 75.4% 71.8%

2014: Of 1,836 72.5%

2012: Of 1,829 74.0%

2010: Of 1,175 77.8%

2009: Of 1,975 75.4%




DatabaseAverage

|

LDL Cholesterol |

2016: Of 2,160 71.8% 74.3%

2014: Of 1,834 72.9%

2012: Of 1,827 76.2%

2010: Of 1,174 76.4%

2009: Of 1,946 74.8%

Total Cholesterol: HDL Ratio |

2016: Of 2,170 84.6% 85.3%

2014: Of 1,836 83.4%

2012: Of 1,829 85.5%

2010: Of 1,175 87.8%

2009: Of 1,974 85.4%

Hemoglobin A1c |

2016: Of 2,172 57.8% 52.4%

2014: Of 1,838 56.2%

2012: Of 1,829 64.0%

2010: Of 1,175 46.4%

2009: Of 1,972 57.6%

TSH |

2016: Of 2,172 94.8% 93.7%

2014: Of 1,837 94.7%

2012: Of 1,829 93.5%

2010: Of 1,175 92.3%

2009: Of 1,974 92.4%




DatabaseAverage

|

Cotinine |

2016: Of 2,176 89.6% 87.4%

2014: Of 1,836 87.6%

2012: Of 1,829 85.4%

2010: Of 1,175 86.9%

2009: Of 1,974 82.0%

Blood Pressure Systolic |

2016: Of 2,168 48.5% 46.4%

2014: Of 1,834 41.1%

2012: Of 1,828 46.1%

2010: Of 1,171 36.2%

2009: Of 1,963 35.7%

Blood Pressure Diastolic |

2016: Of 2,167 69.1% 62.7%

2014: Of 1,834 61.0%

2012: Of 1,828 66.7%

2010: Of 1,171 49.4%

2009: Of 1,961 49.4%

White Blood Cell Count |

2016: Of 2,141 94.3% 93.9%

2014: Of 1,837 94.9%

2012: Of 1,828 94.1%

2010: Of 1,168 94.9%

2009: Of 1,972 95.4%




DatabaseAverage

|

Red Blood Cell Count |

2016: Of 2,141 93.0% 92.7%

2014: Of 1,837 94.1%

2012: Of 1,828 94.1%

2010: Of 1,168 93.5%

2009: Of 1,972 94.4%

Hemoglobin |

2016: Of 2,141 93.4% 92.2%

2014: Of 1,837 93.6%

2012: Of 1,828 94.0%

2010: Of 1,168 94.3%

2009: Of 1,972 93.7%

Hematocrit |

2016: Of 2,141 87.3% 86.7%

2014: Of 1,837 90.6%

2012: Of 1,828 89.9%

2010: Of 1,168 88.2%

2009: Of 1,972 87.6%

MCV |

2016: Of 2,141 94.6% 93.0%

2014: Of 1,837 95.8%

2012: Of 1,828 89.9%

2010: Of 1,168 84.6%

2009: Of 1,972 90.7%




DatabaseAverage

|

MCH |

2016: Of 2,141 91.9% 88.4%

2014: Of 1,837 91.3%

2012: Of 1,828 87.7%

2010: Of 1,168 83.4%

2009: Of 1,972 89.2%

MCHC |

2016: Of 2,141 84.4% 72.4%

2014: Of 1,837 96.7%

2012: Of 1,828 89.8%

2010: Of 1,168 92.0%

2009: Of 1,972 90.7%

RDW |

2016: Of 2,141 89.0% 82.3%

2014: Of 1,837 90.9%

2012: Of 1,828 64.9%

2010: Of 1,168 67.9%

2009: Of 1,972 66.9%

Platelet Count |

2016: Of 2,134 96.4% 96.8%

2014: Of 1,834 97.0%

2012: Of 1,820 95.9%

2010: Of 1,166 95.2%

2009: Of 1,965 96.4%




DatabaseAverage

|

Free T4 |

2016: Of 112 90.2% 81.6%

2014: Of 98 90.8%

2012: Of 119 89.1%

2010: Of 90 93.3%

2009: Of 151 96.0%

Waist to Hip Ratio |

2016: Of 2,172 29.7% 29.8%

Waist Circumference |

2016: Of 2,175 59.6% 63.8%

2014: Of 1,834 59.5%

2012: Of 1,820 61.0%

2010: Of 1,166 54.8%

2009: Of 1,917 53.1%

Non-HDL Cholesterol |

2016: Of 2,170 74.1% 78.6%

OurCompanyProfile | Appendix B | Collier County Government | 12OCT16 65 OurCompanyProfile | Appendix B | Collier County Government | 12OCT16 65

Appendix B

Quest Diagnostics® Health & Wellness | OurCompany Profile Frequently Asked Questions

1. What does the “Clinical Data Report” include?The Clinical Data Report includes an analysis of current or most recent program year aggregatedata. Clinical data offers in and out of range status by individual laboratory and biometric results,including a comparison to Quest Diagnostics database averages for added insight.

2. What is “Cohort” data?Cohort data represents historical clinical and biometric results of those in the employer’s populationwho have consistently participated in screenings. Cohort data provides added insight to importantpopulation health trends.

3. What do the Executive Summary and Health Questionnaire Summary offer?The Executive Summary and Health Questionnaire Summary highlights the most significant insightsregarding a population, and includes participation and eligibility, male and female breakouts, and insome instances a financial savings analysis based on cohort results and change in risk status, whereappropriate.

4. What does “database average” mean?Database average refers to the trailing four quarters of data in Quest Diagnostics Health & Wellnessdatabase, which at this time numbers over 500,000 records each time the data is pulled.

5. What is the Health & Wellness database average for age of participants and averageparticipation rate?The average age of participants is 44 years of age. The average participation rate is 35% based onall customers’ average of participation.

6. Why do the sample sizes (n=) vary within the OurCompany Profile?Participation numbers may vary within each section of the report and within lab results. Differentsections of the report look at different populations and a cohort report may only look attime-over-time participants (repeat participants) vs. all participants. The Health Questionnaire sectiononly reviews data for those individuals with a scored Health Questionnaire while the lab section looksat all participants with a lab complete status. Sample sizes may vary by participant within tests, andmay be different. Only valid results for participants are shown and if it was a reflex test, age orgender test, or an invalid/non-given result the result will not be counted as valid to report at the testlevel.


Appendix B (continued)


7. Are the results age and gender adjusted?Lab tests are automatically age and gender adjusted by in and out of range. Result levels are notadjusted based on the employers’ average age or gender.

8. Why do my out of range blood pressure results appear so out of range?The guidelines for blood pressure include 120/80 being out of range. This is a very common bloodpressure result, although it has been deemed pre-hypertensive by the National Heart Lung andBlood Institute. To have a result in the normal range, a participant’s systolic (top number) result anddiastolic (bottom number) result must be below 120/80, respectively. If either of those results are atleast 120/80 or higher, a participant is placed into the higher risk level.

9. Can Health & Wellness reports be provided that address specific data variables?Health & Wellness reports provide insights to unique sub-populations based on eligibility data suchas location level, or custom codes such as job class. The insights from these reports can promptalternative intervention approaches based on risks identified in each sub-population. Breakoutreport variables that an employer wants included in the OurCompany Profile must be specified atthe time an eligibility file is created. A Client Engagement Specialist can provide further guidanceon the data variables required to pull this report. Eligibility data is used in a variety of ways withinthe reports. For example, the percent participation is calculated on the total eligible numberprovided. Age and gender breakouts are also provided within the reporting and are driven byeligibility information.

10. What insight can be shared on specific program additions/enhancements that other clientshave made based on aggregate data?Decisions clients have made based on insights gathered from aggregate reporting include, addingcovered spouses to an employee-only program. Many Employers also decide to offer HemoglobinA1c to assess diabetes risk as a replacement or in addition to fasting glucose screenings. Offeringnon-fasting A1c as a replacement option or discussion point as reflex for participants with diabetesis another common consideration. Employers have also made the decision to dig deeper into theirpopulation’s diabetes risk problems by offering up HBA1c instead of glucose only testing. Insightslike these have helped employers make more informed decisions about their wellness programing,future program interventions and overall employee health.




11. When is metabolic syndrome data analysis available and what does it provide?Metabolic syndrome is a cluster of clinical risks that are highly modifiable, and this risk analysisprovides additional insight into population risk for conditions like diabetes and cardiovasculardisease. Metabolic syndrome analysis is provided to employers who have chosen testing for BMI,Blood Pressure, Glucose, HDL Cholesterol and Triglycerides. All five tests are required formetabolic syndrome testing analysis. This data is especially valuable where metabolic syndromehas been chosen as a framework for understanding health risks in participant-directedcommunications and reporting, like the My5 to Health Profile and MyGuide to Health Profile.

12. How is the aggregate data included in the OurCompany Profile used to establish targets if anemployer wants to move toward an outcomes-based design next year?Aggregate data is intended to be used to drive program design in areas of greatest concern to thecompany and one of those programs could be outcomes based program to increase the rate ofimprovement in those problem areas as shown in the OurCompany Profile. If it’s available,aggregate data from previous program(s), can help determine the highest risk factors and costdrivers for your employee population. This information can be used to drive decision making aboutwhat measures to reward on as well as at what levels to set measures.

13. How many participants do I need to get an aggregate report?To protect the anonymity of a population, 40 participants are the minimum legal requirement forcompleting an aggregate report. For example, if there are only 33 participants at a location forwhich a report was requested, a report cannot be pulled for that location.

14. Can an OurCompany Profile report include both an employer’s Finger stick and Venipunctureparticipants?The OurCompany Profile report can reflect combined testing modalities for the current year, butcombined modalities for previous year's cohort data cannot be provided at this time.

15. Can comparative data against a select “Industry” be provided?An industry–specific comparative data analysis report can be generated. Employers should discussthis report request with their designated specialist, account manager or strategic account executiveas additional charges for this report will apply.




16. Why is the Metabolic Syndrome section calculating BMI instead of waist circumference (orvice versa) for customers who do not have a My5 report or a MyHealth with MetS?The Metabolic Syndrome section of the OurCompany Aggregate report automatically calculatesmetabolic syndrome risk for MyTest and MyHealth customers using either BMI or waistcircumference as the obesity risk factor. The obesity risk factor in these cases will be selectedbased on whichever metric has the higher number of participants regardless of which fasting panelthe customer has purchased*. My5 and MyHealth w/Mets customers will see metabolic syndromerisk in the OurCompany Profile using the obesity risk factor option (Metabolic – Use BMI or Waist)specified in their Master Service Agreement.

Customers that have not qualified to be a My5 or MyHealth w/MetS customer should note that BMIor Waist, whichever has the highest number of participants, will be used to calculate metabolicsyndrome in the OurCompany Profile. Additional Metabolic Syndrome analysis using waistcircumference or BMI should be requested with a designated Specialist, Account Manager orStrategic Account Executive as additional charges for this report will apply.

* Metabolic syndrome analysis is not available for non-fasting panels because results from the glucose and triglyceride risk factorsare required for metabolic syndrome analysis but are not provided in non-fasting panels.

OurCompanyProfile | Cohort Clinical Data Report | Collier County Government | 12OCT16 69 OurCompanyProfile | Cohort Clinical Data Report | Collier County Government | 12OCT16 69

References

1. Nicolaas P. Pronk; Michael J. Goodman; Patrick J. O’Connor; et al. Relationship BetweenModifiable Health Risks and Short-term Health Care Changes. JAMA. 1999; 282(23):2235-2239 (doi: 10.1001/jama.282.23.2235). [Retrieved 2008 Dec 4]. Available from:https://jama.ama-assn.org/cgi/content/full/282/23/2235.

2. Centers for Disease Control and Prevention (CDC). National Center for Chronic DiseasePrevention and Health Promotion. Chronic Disease Overview. Atlanta, Georgia: U.S.Department of Health and Human Services, Centers for Disease Control and Prevention.[Retrieved 2008 Dec 3]. Available from: https://www.cdc.gov/NCCdphp/overview.htm#2.

3. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor SurveillanceSystem Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centersfor Disease Control and Prevention, 2007.

4. Centers for Disease Control and Prevention (CDC). Alcohol & Public Health. Atlanta,Georgia: U.S. Department of Health and Human Services, Centers for Disease Control andPrevention. [Retrieved 2008 Dec 4]. Available from: https://www.cdc.gov/alcohol/.

5. U.S. Department of Health and Human Services. The Health Consequences of Smoking: AReport of the Surgeon General. U.S. Department of Health and Human Services, Centers forDisease Control and Prevention, National Center for Chronic Disease Prevention and HealthPromotion, Office on Smoking and Health, 2004. [Retrieved 2008 Dec 4]. Available from:https://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/index.htm.

6. American Heart Association. Physical Activity and Public Health: Updated Recommendationfor Adults from the American College of Sports Medicine and the American Heart Association.Circulation. 2007;116:1081-1093. [Retrieved 2008 Dec 4]. Available fromhttps://www.americanheart.org/presenter.jhtml?identifier=3051617.

7. Smith, Suzanne; Joe Pergola. Preventing Stress Through a Healthy Lifestyle. University ofFlorida, Florida Cooperative Extension Service. Fact Sheet HE-2090; November 1991.

8. U.S. Department of Health and Human Services and U.S. Department of Agriculture. DietaryGuidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office,January 2005.

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References (continued)

9. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor SurveillanceSystem Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centersfor Disease Control and Prevention, 2007.

10. Centers for Disease Control and Prevention (CDC). Fact Sheets and At-A-GlanceReports: High Blood Pressure Fact Sheet. Atlanta, Georgia: U.S. Department of Health andHuman Services, Centers for Disease Control and Prevention Division of Heart Disease andStroke Prevention. National Center for Chronic Disease Prevention and Health Promotion.[Retrieved 2008 Dec 5]. Available from:https://www.cdc.gov/dhdsp/library/fs_bloodpressure.htm.

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