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Election Preview: Health Dept. Bond Referendum


Tuesday's special election in Lee County includes a $2.6 million bond referendum to construct a new building for the county health department. The agency believes the building is needed because it has simply outgrown its current location.

The Lee County Health Department (LCHD) currently operates out of 2218 Avenue H in Fort Madison. The four-story brick building is owned by Kensington Fort Madison LLC, which is an assisted living facility.

Credit Midwest Construction Consultants
The Lee County Health Department building at 2218 Avenue H Fort Madison

Administrator Julie Schilling, RNC, MA, said when the department moved into the building in 1990, it had 22 employees and managed six programs. She said the department now has 36 employees, four contracted staff, and 19 programs.

Schilling said the extra employees are managing the extra programs with no additional space. She said her department operates on the 1st and 2nd floors of the building (roughly 6800 ft2).

Schilling said the lack of the space is just one of the issues facing the building her department:

  • Drinking water must be brought in for staff and clients
  • The elevator no longer works
  • Lack of private meeting space for HIPPA-related discussions
  • The front entrance is not handicapped-accessible

“If we do have someone [with mobility issues] who needs to come into our office for service or to meet with us, we have to instruct them to go around to the back of the [building]… and bring them back into the lower level and then we would meet with them at the lower level,” said Schilling.

Credit Midwest Construction Consultants
Inside the front door, which requires walking up a couple of steps, health department patrons must walk up or down a flight of steps.

She said the heating, electrical, and plumbing systems are also in serious need of repairs. And the challenge that faces the county is putting money into a building that it does not own.

FINANCES (provided by LCHD)

Money spent during past 30 years ($903,975 total)

  • Rent - $399,700
  • Remodel Kensington - $55,370
  • Building Repairs and Updates - $54,365
  • Electrical/Furnace/Air Conditioning Maintenance - $25,747
  • Elevator Maintenance - $27,759
  • Plumbing - $1,400
  • Drinking Water - $14,634
  • Services provided in lieu of rent (1989-1999) - $325,000

Anticipated Expenses 2017-2042 in same location

  • Rent - $1,448,400 (based on $300 increase every other year)
  • Repairs - $312,750
  • ADA Compliance - $25,000
Credit Midwest Construction Consultants
As the department has grown over the years, the need to double or triple up office space has increased.

Schilling said the Board of Health started looking for a new home for the LCHD about 15 years ago.

“That would be so that we would not be paying rent, we would be not using county tax dollars for maintenance of a building we do not own, but also to have our own site,” said Schilling.

She said the search has included more than 20 properties throughout the county, without ever finding a good fit.

“Some were way too small because we were looking for probably 9,000 square feet for our staff and then some were way too large like 24,000 square feet or 40,000 square feet, which is way more than we need,” said Schilling. “Some were not handicapped accessible and some did not have the adequate parking that we need.”

Schilling said the result was the Board of Health’s decision last fall to pursue the construction of a new building. The bond referendum was expected to run in 2016, but the county board’s decision to add the bond referendum for a new courthouse to the November general ballot delayed this process.

That’s how the May 2nd special election came to be.


The LCHD is working with Midwest Construction Consultants out of Houghton, Iowa on the project. The same group served as construction manager for the Lee County Jail expansion and the new Lee County Conservation building along Highway 61.

The bond referendum seeks up to $2.6 million. It requires 60% approval.

The new health building would be located on a piece of land owned by the county, several hundred yards from the jail and the juvenile detention center.

The one-story building would feature private office space for employees, a secured entrance to those offices for employees only, a meeting room, a separate area for environmental storage, and additional storage in the basement. It would total about 12,500 square feet of space.

Schilling said the more central location would also help her employees as they travel throughout the county to provide services. She said it would also help reduce the drive time for residents of Keokuk, Montrose, and Donnellson for example, by not needing to travel to Fort Madison for clinics or other services.



Schilling said the $2.6 million price tag could shrink if the construction bids are lower than anticipated as the estimate includes furnishings and exterior improvements. She said the Board of Supervisors could also help with the taxpayer commitment.

The health department estimates that the annual bond payment on a 20 year loan will be about $175,000. If that is the case, the cost to property owners would be:

  • $100,000 home - $7.57/year
  • $100,000 commercial property - $12.24/year
  • $100,000 ag land - $14.69/year

Schilling said those numbers could drop by 1/3 if the county board applies the roughly $50,000/year current spent on rent towards the annual bond payment. She said that is the preference of the health department, but the final decision sits with the county board.

Credit Jason Parrott / TSPR


Schilling said representatives of the LCHD and the Lee County Board of Health have toured more than 20 properties during the past 15 years or so.

One such property is a series of metal, industrial buildings in Montrose that are owned by Kathy Gabel. Gabel is a member of the Keokuk Economic Development Corporation and the Lee County Economic Development Group.

Several times, Gabel has pitched the idea of the county purchasing her buildings for use by the Lee County Health Department. She said the current asking price is $250,000.

She said what she calls “Building 1” could be ideal for office space at more than 9,000 square feet with “Building 2” offering several thousand square feet more for community meetings and storage.

“The reason I think it would be so good for the county is when I read their plan that they came out with, they had a brochure, that talked about their square footage needs, their privacy needs, their compliance needs,” said Gabel. “I thought it was just really ironic that our ‘Building 1’ was just a few hundred square feet shy of what they were asking for.”

Gabel said “Building 1” has four bathrooms, several offices with space for dozens more, an entrance ramp and what she describes as adequate parking. She’s confident her buildings could be renovated for a much cheaper price tag than the construction of a brand new health department building.

Gabel hosted an open house last month to show off the buildings for potential buyers.

“I just felt like when this came to my attention that we were supposed to voting on a $2.7 million building. I thought let’s just give people an opportunity to see there are other choices,” said Gabel. “I thought let’s get it out here now so they know they have a choice. We all want a new health center, we all know they need a new health center, but a $2.7 million office building, probably only Google or somebody could afford that. It’s not a practical price for an office building.”

Schilling said the LCHD and the Board of Health had not looked at the property recently. She said during two previous tours, it appeared it would take a lot of money to renovate the buildings for office use and to address parking and ADA needs.

Schilling said there were also concerns that the city of Montrose owned part of one of the buildings.

Credit Jason Parrott / Mr.


The LCHD planned to give the public the opportunity to see its current building, first-hand, during a public forum about the bond referendum on April 25. But the event had to be moved to the public library the following day.

The reason: County Attorney Ross Braden recommended the entire department vacate the building along Avenue H the week before. At first, no reason was given for the move, but eventually, Braden said an air quality concern was brought to the attention of the LCHD.

Schilling had to divide her staff between the north Lee County office building, a location in Keokuk and their homes.

The air quality was tested, but the results have not been made public. It’s also unclear when staff might be able to return.

Schilling said her department had nothing to do with the decision, adding that this is not a stunt to try to convince people to support the new building. She said the LCHD simply followed the advice of the county attorney.

Jason Parrott is a former reporter at Tri States Public Radio.