Indian River County Hospital District

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.



William P Cooney MD is an orthopedic surgeon (retired) who has been a resident of Vero Beach since 2004. He practiced orthopedic surgery at Indian River Medical Center from 2006-2015 within the orthopedic practice of Prosports. He served on the IRMC Foundation for four years. Prior to this, he was a Professor of Orthopedics at Mayo Clinic in Rochester Minnesota, Chair of the Division of Hand Surgery and Vice president of the Department of Orthopedic Surgery. He served as the Vice Chairman of the Mayo Clinic Development Department. He has been President of the American Society for Surgery of the Hand, Orthopedic Research and Education Foundation, Consultant at Shrine Hospital systems. He was editor in chief of the Journal of Orthopedic Surgery and co-editor of the Journal of Hand Surgery. He held grants in hand and wrist surgery sponsored by National Institute of Health (NIH) and Stryker Orthopedics and has over 250 publications in the field of orthopedic surgery, hand, wrist and elbow surgery and microsurgery- free tissue transfers. Within Indian River County, he has served as Chairman of the Board and President of the Hope for Families Homeless Center, Board of the Indian River Hospital Foundation, We Care and Whole Family Health Center medical practices.

Term:  1/23-12/24

Origination: Elected (2 OC)

Occupation: Retired Surgeon



Kerry Bartlett,  of Vero Beach, has more than 30 years experience in philanthropy, including as vice president of the VNA & Hospice Foundation; VNA chief advancement officer from 2001-2007; and executive director of the Indian River Community Foundation from 2008-2014. Kerry is the founder of The Bartlett Company, which focuses on nonprofit and philanthropic consulting. She also is a managing director for Carter, a Vero Beach company that specializes in advancing philanthropy worldwide. Kerry has spent more than 25 years in the nonprofit sector as a fund development professional and has particular expertise in annual funds, major gifts, endowment campaigns and legacy giving. Kerry is also known for creating and implementing effective donor-centered stewardship programs that build, maintain and strengthen nonprofits’ relationships.

Term:  3/21-12/22   |   1/23-12/26

Origination: Appointed by Governor Ron DeSantis
Elected NOC

Occupation: Philanthropic Consultant/Managing Director



Karen has been President and CEO of Senior Resource Association, where she successfully advocates for older adults and their families, since 2006. In that role, she helps provide activities, education and services benefiting older and disabled adults in Indian River County. In addition, Karen provides oversight of the community mass transit system for residents and visitors of the county. As CEO, Karen is responsible for a $7 million operational annual budget and managing more than 100 employees. She ensures that fiscally sound and responsible solutions are created to provide healthcare and a better quality of life for all Indian River County residents. Karen earned a BS in Health Administration from Florida Atlantic University and an MHA from the University of Florida. She was elected to the Indian River County Hospital District Board of Trustees in 2016, and joined the Board in January 2017.

Term:  1/17-12/20   |   1/21-12/24

Origination: Elected 1 OC | Elected NOC

Occupation: President/CEO



Paul Westcott has been a Board Certified Workers' Compensation Attorney since 1999. In addition, Paul has earned his certification from the Florida Supreme Court as a Circuit Civil and Family Law Mediator. Receiving his Bachelor of Arts degree in both Economics and Political Science at Florida Southern College, he continued his education at Stetson University College of Law. He graduated from Stetson in 1988, having been a published member of the Stetson Law Review. Paul has been a member of the Florida Bar since 1988.  He began his practice in a combined civil litigation and transactional practice before serving as an Assistant State Attorney.  He began his career in Workers' Compensation with Rissman, Weisberg, Barrett, Hurt, Donahue & McClain P.A., where he handled Workers' Compensation cases at the trial and appellate levels.  In 1997, Paul opened the Ft. Pierce office of Hurley, Rogner, Miller, Cox, Waranch & Westcott P.A. handling workers' compensation cases at all levels throughout central and south Florida, while managing the operations of that office.  During his nearly 25 year career in Workers' Compensation, he lectured on a wide range of industry topics.

1/23-12/26   |   1/21-12/24

Origination: Elected 1 OC 

Occupation: Attorney & Mediator



Barbara has practiced physical therapy, specializing in orthopedics and sports medicine, in her hometown of Vero Beach since 1981. She was an integral part of the sports medicine team at Vero Beach High School for 35 years. Barbara completed the reserve police academy training, and served with the Vero Beach Police Department from 1982-1989. Her volunteer involvement in the community includes serving on the City of Vero Beach Recreation Committee, Arthritis Association of Indian River County, and the Senior Good Life Games. She and her husband, Michael, enjoy spending their free time traveling in their RV and training their Labradors, Gunner and Chase, in K-9 performance events, including agility and dock jumping. Barbara is a lifelong resident of Indian River County, and received her degree in physical therapy from Chattanooga State College. Barbara was elected to the Indian River County Hospital District Board of Trustees in 2016, and joined the Board in January 2017.

Term:  1/17-12/20   |   1/21-12/24

Origination: Elected 1 OC | Elected 1 OC

Occupation: Physical Therapist



Born and raised in Illinois, Michael was a Theatre and Speech Instructor at Lincoln College when he moved to Indian River County in 1984. He was the Director of Education for the Riverside Theatre for a decade, helping to build the Riverside Children’s Theatre and directing many productions. Michael is well known in the community for his 25 years of service at the United Way of Indian River County, 16 of those years as the CEO. He is very proud of his work with dozens of nonprofit agencies and his commitment to creating and strengthening community collaboratives. Michael was also an Adjunct Faculty member at Barry University for 20 years. He has served on many boards and committees over the years, including: Children’s Services Advisory Committee Needs Assessment, Chair of the Emergency Food and Shelter Program for many years, and he was a founding member of the Mental Health Collaborative, the Senior Collaborative of IRC and the IRC Executive Roundtable. As a Hospital District Trustee he is committed to serving all the citizens of our county. In particular, he hopes to see enhanced availability and affordability for behavioral/mental health for all in need.


Term: 1/23- 12/26

Origination: Elected 1 OC

Occupation: Retired CEO United Way



Marybeth’s professional career encompasses 34 years of working for GM/Delphi in a variety of positions. Starting out as a traffic claims clerk, she worked her way through the organization, with roles in Purchasing, Engineering, and Quality and Reliability. She retired in 2009 as the executive director of Global Operations for the Packard Electric Division of Delphi. In this position, she was responsible for 94 plants in 33 countries. Marybeth has served on the board of directors for numerous non-profits, including Northeast Ohio Adoption Agency; United Way of Warren Ohio, where she served as chairman of the annual campaign for two years; Up with People; Head, Heart and Hands of Indian River Club; Indian River Community Foundation, and the Indian River Mental Health Collaborative. She earned her B.A. in Political Science from Albion College. Marybeth was elected to the Indian River County Hospital District Board of Trustees in 2014, and joined the Board in January 2015. She currently serves as Chair.


Term:  1/15-12/18   |   1/19-12/22   |   1/23- 12/24

Origination: Elected 1 OC | Elected  NOC | Elected NOC

Occupation: Retired Executive GM