Mar 17 Regular Monthly Meeting: February 16, 2023
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
February 16, 2023 @ 4:00 PM
TRUSTEES: Karen Deigl William Cooney, M.D.
Marybeth Cunningham Paul Westcott
ABSENT: Kerry Bartlett Barb Bodnar
STAFF: Kate Voss Jennifer Frederick
Ann Marie Suriano Dawn Carboni
ZOOM: Jad Shalhoub Marie Andress
ATTENDEES: Kip Jacoby Philip Cromer
Igor Khromov Sabrina Cruz
Vicki Soule Marty Mercado
Anne Posey Elizabeth Appleton
Andrea Greenlee Linda Kloss
Convene Meeting, Invocation, Pledge & Consent Agenda– Marybeth Cunningham, Chair
Ms. Cunningham convened the regular monthly meeting of the IRCHD at 4:00 PM. Derrick West from Genesis Church provided the invocation and Ms. Cunningham led the group in the Pledge of Allegiance. Ms. Cunningham asked for a motion to approve the January meeting minutes and the February disbursement of $1,511,146.67. Mr. Kint stated that he would like to note a few changes to the minutes that needed to be made which included a correction to the date on the Chairman’s meeting minutes and the addition of Dr. Cooney as in attendance at the same. Also, Mr. Westcott asked that his comments in the regular monthly meeting minutes be changed to reflect his inquiring of Cleveland Clinic not releasing the property at 82nd Ave. Having noted those corrections, Ms. Deigl made a motion to approve the January meeting minutes and the February disbursement, which was seconded by Mr. Kint. The motion carried unanimously.
District Counsel Report- Sebastian Dimaio, Esq.
Mr. Dimaio addressed the board and stated he was filling in for Ms. Peshke, who is out of town. He provided an updated concerning the matters their office has been working on over the last month which included the matter with the Cleveland Clinic and the Human Services Building, and their future use of the same. They will provide further update when more information is received.
Financial Statement Review- Michael Kint, Treasurer
Mr. Kint provided his treasurer’s report and stated the financial report was included with the meeting materials, which shows that the District is in sound financial condition. After four months of the fiscal year, the District has received just under 90% of the total tax revenues. Also, both program and administrative expenses were under budget. He further explained that he had the opportunity to sit with the Districts CPA Cynthia Johnson and Ms. Suriano and they went through any questions he had concerning the Districts finances. Additionally, he met with Mr. Jacoby, and Ms. Suriano, to review the FY 21-22 audit. Lastly, he indicated that through these discussions it was suggested that the District created a finance committee to provide further review and oversight to the Districts investment portfolio and will bring forth that request for Trustee consideration later in the meeting. Ms. Cunningham asked for an update concerning the Districts investments and timeline for their maturity dates. Ms. Suriano stated that the District has several TBills which were purchased through Treasury Direct, with the first maturing in May, the second in September and the last two in December. The laddered investments which Deep Blue purchased on behalf of the District, will begin to mature in March and continue each of the remaining months just prior to the meeting held the third Thursday of each month.
Executive Director Report- Ann Marie Suriano, Executive Director
Ms. Suriano stated that Ms. Carboni has begun her Audit review of the District funded agencies and has purchased audit software to help further assist this process. Additionally, she attended a webinar hosted by the Florida Association of Special Districts that discussed the upcoming Florida Legislative session. She explained that there are two bills being discussed which pertain to Special Districts however neither of those bills would not directly impact our District, but she will maintain a review of the same. She further stated that one of the bills discussed the financial impact that the required performance review will have on smaller special districts and Ms. Cunningham asked for an update concerning our Districts search for a firm to conduct the review. Ms. Suriano indicated that District staff was conducting preliminary interviews with some qualified firms and will provide a summary of their findings for Ms. Suriano’s review and follow up. District staff then plans to bring a recommendation before the board for their consideration within the next few months. Ms. Suriano further explained that the process would begin at the beginning in 2024 and take 3-4 months to complete.
Funded Agency Semi Annual Report
Hope for Families Center- Marty Mercado, Executive Director
Ms. Mercado addressed the board and thanked them for their continued support of Hope for Families. She provided a review of their written report and began by discussing the resident population at the center and some of the challenges they are experiencing. She then reviewed data concerning mental/behavioral health issues and explained that the patient navigator case manager works with those clients who indicate they are experiencing mental health issues, by connecting them to services and scheduling appointments. They work collaboratively with Mental Health Collaborative, Suncoast Mental Health, TCCH, New Horizons, and Tykes & Teens. Next, she discussed operations at the center and stated there is still a waitlist of over 100 families and due to the affordable housing shortage, families are staying at the center for a minimum of 6 months. They are looking to expand their center and have been searching for viable property within the county. Lastly, she spoke of the increase in homelessness, specifically with families and that there are new homeless camps throughout the county, where families are residing. There was group discussion surrounding the reoccurring issue of affordable housing and what is being done to combat this issue.
Tykes & Teens- Anne Posey, CEO
Ms. Posey addressed the board and thanked them for their continued support of Tykes & Teens and stated that they have been providing services for 26 years, beginning in Martin County and expanded their services into Indian River County five year ago. She informed the Trustees that she has just completed 90 days as CEO at Tykes & Teens and is happy to be on board. She then introduced Andrea Greenlee, the Director of General Mental Health and School-Based Services; and Elizabeth Appleton, Director of Mental Health Consultation who will be providing updates on those programs, which the District currently funds. Also joining them is Tykes & Teens board chair Linda Kloss. First Ms. Posey informed the board that Tykes & Teens has acquired office space within the 787-building located on 37th street near the hospital. They have been sharing office space with the Mental Health Collaborative but have been looking for their own space and are please to have found affordable space. She then discussed some of the challenges the organization has been facing and explained that the biggest challenge has been securing and maintaining qualified clinical talent. Also, since Tykes & Teens operates heavily on grant funding, they are not able to meet the salary demands that other private for-profit entities are able to provide. Next, Ms. Greenlee provided an update concerning outpatient services and stated that they are seeing improvements within the clients being treated and continue to receive referrals from community organizations for those children needing services. Ms. Appleton then provided an update concerning Mental Health Consultation and stated that this program focusing on children age 0-5 in early childhood education centers. They have also seen positive outcomes from their efforts and there has been a reduction in challenging behavior and expulsion as reported by the education centers. They are also reaching their goals in providing support to the teachers at these centers and 60% of teachers have received a minimum of 6 months of support and completed assessments. Lastly there was discussion that they are working to develop social and emotional support groups for children and families, to provide further support.
Unfinished Business- Reallocation of MHA Funds- Jennifer Frederick, Program Liaison
Ms. Frederick stated that at the December regular monthly meeting, Mental Health Association (“MHA”) during their semi-annual report, notified the District of a challenge they were facing related to an overall decrease in billable services. She met with representatives from MHA to discuss the same and gain a better understanding of the issue. It was discovered that the reason for the decrease in billable services was due to a few factors. The first being that many clients have recently become insured with Marketplace insurance through the Affordable Health Care Act, which disqualifies them from the District financial assistance program. Also, while these clients now have health insurance, MHA is unable to bill the insurance company because the client was seen by a registered intern or license clinician who has not yet been credentialed through that particular insurance. Therefore, a recommendation and request is before the Trustees to support this shortfall. Ms. Frederick explained that a total of 84 clients have been identified who are below 200% of the Federal Poverty Level, and documentation has been provided to the District to demonstrate the deficit of billable services from Oct 1, 2022-Jan 31, 2023 in the amount of $52,910. There was Trustee discussion and clarified that these funds are within their budget for the current fiscal year, and not additional funds being requested. Ms. Deigl made a motion to approve the request, which was seconded by Dr. Cooney. The motion carried unanimously. Mr. Westcott stated that through his work in his private practice and dealing with insurance companies, he believes there are alternative ways of billing for these services and would like to work with Ms. Frederick to look further into this matter.
Presentation of FY 22-23 Audit & 2021 Agreed Upon Procedures- Kip Jacoby, CPA
Mr. Jacoby addressed the board and stated that he would be presenting a summary of the audit report and agreed upon procedures review. He began by stated that over the last week he met with Ms. Suriano and past treasurer Allen Jones, along with new treasurer Mr. Kint to work through the audits management discussion and analysis. All discussions were productive and he supports the creation of a finance committee for the District and would be happy to recommend a fellow CPA to also sit on the committee for further insight and support. He then provided a summary review of the audited financial statements and stated that it is a clean and unmodified report. He reviewed some highlights from the report including an overview of the taxable values and associated millage rates in Indian River County, which showed that the District represents just 4.9% of the total millage assessed in Indian River County. He then reviewed some financial highlights and stated that the Districts net position increased 56.7% to $11,181,689. This net increase was greater than planned due to a $4.5 million program expense decrease in CCIRH funding. He also briefly reviewed the revenues, expenses, and change in net position. He explained that the District revenues decreased by $1,258,277 or 8.2% due to a decrease in the net ad valorem taxes, resulting from an approximate 1 billion, or 5.2% increase in the final gross taxable value of the property values, which the millage rate decreased to .7144 in 2022 from .8011 in 2021. Next, he discussed a reporting change that has been implemented to the auditing process. The District implemented the accounting and financial reporting provisions of GASB Statement No. 87, Leases which states lessees are required to recognize a lease liability and an intangible right-use asset, and lessors are required to recognize a lease receivable and a deferred inflow of resources. This has resulted in additional reporting requirements to be included within the audit. Lastly, he discussed factors bearing on the future and plan for fiscal year 22-23 and stated that he looks forward to seeing the work the Trustees will do with regards to the strategic plan approved in 2022.
Next, he provided a review of the District Agreed Upon Procedure reports concerning indigent care. Mr. Jacoby stated that this is the best report to date with very few exceptions found. They conducted a review of each fee-for-service funded agency and sampled roughly 65 files from each. He was very pleased with the outcomes and says it’s a testament to the work staff has done in working with the funded agencies and financial assistance database which has been a good source of data collection for the District. There was Trustee discussion and Ms. Deigl made a motion to approve the FY 21-22 audit as reported, which was seconded by Mr. Kint. The motion carried unanimously.
Creation of IRCHD Finance Committee- Ann Marie Suriano, Executive Director
Ms. Suriano stated that with the change in the board and the addition of three new Trustees and now a change in the Treasurer position, she is recommending that the District create a Finance & Audit Committee. The committee would provide continuity and structure and further assure that the Districts finances and investment portfolio are closely and properly managed. She further explained that this would be an oversite committee which would include the current Treasurer, Michael Kint, a community member with banking and investment expertise, Allen Jones, and herself as Executive Director. The structure, roles and responsibilities, and recommendation and reporting process will be determined and come before the board for approval once the formulation of the committee is approved. Additionally, policies and procedures we be developed to support this initiative as well, and Ms. Cunningham asked that those be brought before the Trustees for consideration prior to approval. There was Trustee discussion and Mr. Kint made a motion to approve which was seconded by Ms. Deigl. The motion carried unanimously.
Appointment of Trustee to Partners Collaborative- Marybeth Cunningham, Chairwoman
Ms. Cunningham stated that the Partners Collaborative group has always included a District Trustee, which Allen Jones severed as the representative during his tenure on the board. Since he is no longer on the District board, the current Trustees will need to appoint a new representative to the group. She explained that Dr. Cooney has expressed his interest in fulfilling the role and given his medical background she feels he is qualified to support the role. Therefore, she made a motion to appoint Dr. Cooney as the District representative for the Partners Collaborative, which was seconded by Mr. Kint. The motion carried unanimously.