FY 23-24 Budget Discussion Meeting- July 11, 2023

FY 23-24 Budget Discussion Meeting- July 11, 2023

Indian River County Hospital District Conference Room/ Zoom
July 11, 2023
10:00 AM

TRUSTEES: Marybeth Cunningham Barbara Bodnar
Karen Deigl Michael Kint
Kerry Bartlett (via Zoom) Paul Westcott
William Cooney (via Zoom)

STAFF: Jennifer Frederick Kate Voss
Ann Marie Suriano Jennifer Peshke, Esq.

ZOOM: Anne Posey Ann Marie McCrystal
Megan McFall Jad Shalhoub

ATTENDEES: Pat Knipper Lundy Fields
Jennifer Jones Liz Adams
Carrie Lester Caryn Toole

Convene Meeting – Marybeth Cunningham, Chairwoman

Mrs. Cunningham convened the budget discussion meeting of the IRCHD Board of Trustees at 1:00 PM by welcoming those participating via Zoom and in person. She stated that the purpose of today’s meeting is for the Trustees to agree on a tentative budget, which will be approved at the July 20th regular meeting. She further explained that historically the Trustees have agreed to adopt a budget which is inclusive of all funding requests and the highest budget level, with the knowledge that further discussion will be had in the next months to make reductions before voting on the final budget in September. Additionally, the Trustee completed the funding request matrix and there will be discussion only on the items that the majority of the Trustees didn’t agree upon.

FY 23-24 Budget Discussion – Ann Marie Suriano, Executive Director

Ms. Suriano stated that she and Ms. Frederick prepared a second funding matrix which included the items that the majority of the Trustees were not in agreement to fund or had additional questions. She began discussions by asking for Trustee input concerning the funding request from Miss B’s Learning Bees. Four Trustees indicated that they were not in favor of funding the request and two responded requesting additional information. There was Trustee discussion and the Trustees felt that the program was not fully vetted and still need further development and oversight. They also felt that the services they are requesting funding to support could be provided by another community agency who is already providing the service. The Trustees requested that Ms. Frederick provide follow up correspondence to Ms. Bullard notifying her of their decision not to fund the request along with their comments and suggestions about seeking this service from another established community partner.

Next, Ms. Suriano led discussion concerning the funding request from RiteLife Services, Inc. Four Trustees were not in favor of funding or fully funding the program and others requested further information. There was Trustee discussion about how these are needed services within Indian River County and are not currently being offered by any other organization. However, due to the Trustees not being completely familiar with the organization and not receiving their audit, they had some concerns about fully funding the request. They further discussed allocating only $100,000 or half of the funding request, but questioned whether the organization would be able to carry out its proposal if full funding was not awarded. The Trustee agreed that they would like the organization to come back before the board and provide some additional follow up information. Ms. Frederick further indicated that she would follow up on the status of the completion of their audit.

The next discussion item was the request from the Learning Alliance which totaled $125,000, and three Trustees indicated that they were not comfortable with fully funding the request. Ms. Bartlett addressed the board and wanted to make clear that today’s Trustee discussions should not be considered by the public or organizations, as a negative reflection on the organization and that these organization all have value and their programs are worthy of support. However, she believes that they should be focusing on the bigger picture of finding partners whose mission aligns with the District and helps move the needle in moving the District’s vision forward. She believes the District has an opportunity to provide funding to an organization who could provide services to multiple community organizations looking for similar services. Further the Districts funding structure is much different than philanthropy and charity dollars, which are given freely by donors. The District operates utilizing tax dollars, given by tax payers who do not have a choice and the Trustees are given the authority to assign those tax dollars, which she feels can be allocated to organizations who can provide services to these smaller organizations who are requesting support. Ms. Cunningham stated that she agreed that some agencies who were looking for services on a part time basis could benefit from contracting with other community entities, but felt that agencies who need these services on a full-time scale need their own staff. There was further Trustee discussion surrounding the request and the connection of literacy and overall health. The Trustees agreed to allocate $100,000 in funding, which support the majority of the request, reducing it to not include support of conference fees and travel expenses.

Ms. Suriano reviewed the request from the Mental Health Court and explained that the original request has been reduced due to additional support the program is receiving from the Sheriff’s office, and the reduced amount of $658,086 is reflected in the tentative budget. She further explained that the request may be reduced further by some additional grant funding they applied for, and will know if those funds are awarded by the end of September. Ms. Suriano stated that she will provide updates to the Trustees with further information when it is available. The Trustees agreed to keep the reduced amount of $658,086 in the budget, with the understanding that it may be reduced further.

Next, there was discussion concerning the request from Treasure Coast Homeless Services (“TCHS”). Ms. Suriano stated that the Trustees were divided on the request and asked for discussion on the same. Ms. Bodnar stated that she was not comfortable with the request and there was Trustee discussion surrounding the same. Dr. Cooney felt that this was a strong organization and that the request should be supported as it is providing a much-needed service to the homeless population. There was also Trustee discussion surrounding the length of stay for these clients and they asked Ms. Frederick to request that a representative from TCHS address the Trustees again to clear up any confusion surrounding the request. Ms. Frederick stated that TCHS is also awaiting a decision on whether they have been awarded some additional grant funding they applied for, which would reduce the total request submitted to the District.
Next there was discussion surrounding New Horizons. All Trustees voiced their concern with the current status of the organization and there was lengthy discussion about how to move forward with supporting them. Ms. Bartlett recommended that the District form a task force inclusive of leadership from New Horizons, in order to develop a plan that would help them to achieve a sustainable and active presence within Indian River County. The Trustees also discussed the potential to have future conversations with representatives from the other counties that New Horizons serves, to gain a better understanding of the struggles they are encountering in working with the organization and how they can provide additional support. The Trustees agreed that New Horizons provides much needed services to the community and it is important to continue to support them, as long as they are willing to be active partners in the process.
Ms. Suriano then reviewed the request from Healthy Start to support the PEACE program. The majority of the Trustees were not in favor of funding the program fully and there was Trustee discussion surrounding the same. It was further discussed that the outcomes for the program were not clear and some felt that this training should be supported by Cleveland Clinic. Ms. McFall, addressed the group and spoke in detail regarding the training being offered and the caregivers that would benefit from it. She further stated that Cleveland Clinic has not historically provided financial support for the training but she would be willing to contact them to discuss the same. The Trustee requested that Ms. McFall come back before the board at another meeting to further discuss the program and its outcomes.

Next, there was discussion surrounding the request from Samaritan Center which four of the Trustees were in favor of funding. There was Trustee discussion surrounding the fact that their request is similar to what is being offered at Hope for Families, and Ms. Cunningham recommended that the representatives from Samaritan Center speak with Marty at Hope for Families to see if they really require a full-time position. It was further discussed that the District approved gap funding for this current fiscal year, to support partial funding for the position on a prorated basis.

Ms. Suriano then discussed the request from Sunshine Physical therapy. Many of the Trustees had concerns with the sustainability of the organization and oversight. There was also discussion surrounding the size of their staff and what changes could be made in order for the organization to have less overhead. Additionally, there was discussion surrounding the outcome measures which were provided to the Trustees and some felt they do not reflect the information they would like to have captured. There was also discussion surrounding their payor source mix and their lack of philanthropic support. After further Trustee discussion it was decided that they would approve funding of $225,000 which would cover the Medicaid shortfall for children only.

Next there was discussion surrounding the request from Hope for Families, specifically addressing the funding of $4,250 to support administrative, building and equipment expenses. There was Trustee discussion and they agreed that historically they have not supported these types of expenses. Ms. Suriano stated that she would update the budget to reflect the reduction of $4,250 from the request.

Ms. Suriano then reviewed the request from We Care and stated that a few Trustees had requested additional information. There was Trustee discussion and some felt there needed to be stronger outcomes measures captured, as well as additional support and clinics for other service lines. They also stated that they should work towards obtaining a more sustainable electronic health record system. However, they acknowledge the growth and improvement they have seen in the origination under the direction of the new executive director Jennifer Jones. It was agreed that the full funding request would be included in the budget and that the Trustees were supportive of We Cares new direction.

Next there was discussion surrounding the request from Substance Awareness Center for a data manager. Ms. Suriano stated that three Trustees were not in favor of funding the program fully and there was discussion on the same. Ms. Lester addressed the group and stated that the position of the data manager would help assist their organization to better manage and analyze the data they collect, which would improve their outcome measure tracking. There was further Trustee discussion and some felt this may set a precedent for other organizations to come to the District requesting the same, which would benefit many other organizations. It was agreed that they would fund the program for the first year, with the understanding that SAC would look at additional funding sources moving forward.

Next there was discussion surrounding the request from the VNA, specifically addressing the Mobile Health Unit. Most Trustee felt that over the last year the mobile unit has been an asset to the community by providing same day sick visits, as well as community out reach education. There was also discussion surrounding how it seems the VNA has shifted its focus from providing home health and hospice services, to a more community health approach. Ms. Knipper stated that with many changes to health care in recent years, specifically resulting from COVID, home health care is being prescribed less. The VNA continues to look for ways to further provide healthcare services and support, and has seen successful partnerships grow because of the outreach through the mobile unit. There was no further discussion and the amount requested was not modified or reduced by the Trustees.

Lastly, Mr. Westcott stated that he prepared a narrative with his comments relative to the budget for the Trustees to review and provided a handout of the same. He stated that he would like the Trustees to consider his comments and was hopeful that there could be further discussion prior to the budget hearings in September.

Ms. Suriano discussed the budget process and stated that she was pleased with the fact that the Trustees focused on the funding requests and not just the millage rate, which has been a point of contention in previous years. She explained that this budget will be approved as a tentative budget, which begins the process of approving a final budget in September. She noted a few items in the budget which included the line-item Capital Expenditures of District Properties and other income which included the proposed $3.5 million in revenues that will be received from the sale of the Hospice House parcel. It was further discussed that the Trustees would like the opportunity to have additional discussion surrounding other budget line items and it was agreed that this would take place at the August Chairman’s meeting. Lastly, Ms. Suriano stated that she would make the changes to the budget discussed during today’s meeting, but will maintain the millage at the current rate for approval at the July 20th meeting, with the understanding that it can be reduced further over the next months after further Trustee discussion.

Public Comment & Adjourn

Ms. Voss stated that there was a public comment made by Jad Shalhoub on Zoom chat which he asked whether the board would consider internal direct-to patient services to come along side partner agencies to help fill gaps, and that many other hospitals district in the state operate this way. Also, he stated that some people may view levying taxes against them solely for the money to go to non-profits and a non-efficient use of tax dollars. If the District provided direct services, they would be able to bill for them and potentially reduce tax payer burden further.

There was no further public comment and the meeting was adjourned at 12:30 PM.