SUMMARY MINUTES
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
July 18, 2024 @ 4:00 PM
TRUSTEES: Karen Deigl (zoom) Michael Kint
Marybeth Cunningham Paul Westcott
Barb Bodnar Kerry Bartlett
William Cooney, M.D. (zoom)
STAFF: Kate Voss Jennifer Peshke, Esq.
Frank Isele Kaytlin Dickens Dawn Carboni Jennifer Frederick
ZOOM: Kim Jeansonne Anne Posey Jeff Pickering Deborah Shellenberger Lauretta Farrel Lisa Zahner
ATTENDEES: Ceclia Stalnaker Mike Cianci Geroge Pellington Vicki Soule
Convene Meeting, Invocation, Pledge & Consent Agenda
Ms. Cunningham convened the regular monthly meeting of the Indian River County Hospital District at 4:00 PM. Pastor Geroge Pellington provided the invocation and Ms. Cunnigham led the group in the Pledge of Allegiance.
Ms. Cunningham asked for a motion to approve the FY 24-25 funding request presentation meeting minutes dated June 6; chairman’s meeting minutes dated June 19, regular monthly meeting minutes dated June 20 and a July disbursement of $1,547,918.32. Ms. Bartlett stated that there was a typo on page four of the regular monthly meeting minutes and asked that the item be corrected. With those changes reflected, Mr. Kint made the motion which was seconded by Ms. Bodnar. The motion carried unanimously.
Ms. Cunningham stated that there will be a change to the agenda for tonight’s meeting. The approval of the FY 24-25 tentative budget action item will be moved and addressed with Mr. Kints treasurers report.
District Counsel Report- Jennifer Peshke, Esq.
Ms. Peshke stated that she continues to review the annual deadlines and deliverables due to the District under the Lease with CCIRH and has responded to Trustees with questions as they arise. She, Mr. Isele and Ms. Deigl continue their efforts to locate a suitable property for the use of a detox/women’s sober living facility. Additionally, she is also working with Mr. Isele and representatives from VCOM to finalize a lease agreement for the HSB. Lastly, she reviewed Mr. Westcott’s March 2024 memorandum and prepared a memo outlining the board’s statutory authorities as requested, which she circulated yesterday.
Financial Statement Review & Approval of Tentative FY 24-25 Budget- Michael Kint, Treasurer
Mr. Kint stated after nine months of the fiscal year, the District is in strong financial condition. He reviewed the year-to-date expenses verses the approved budget and the investment cash report. He reported that the District has received 102%, or $12,940,389 of the budgeted tax revenue and that the additional unplanned tax revenue received was from multiple back tax payments between 2007-2024 totaling $306,605.64. Next, he reviewed details from the investment report and stated that all investments total $14,537,238 and the Florida FIT accounts are earning 5.28% interest which increased from last month. He then discussed the total program spending and stated that there are a few agencies that were over their total budgeted amount. It was explained that those few agencies had approached the District mid-year and requested an increase in funding to cover those shortfalls. However, the budget will not reflect the additional funds approved which will result in the year to date being over budget. There was also discussion surrounding program funding versus fee-for-service and how funding more program expenses could skew the overall percentage of funds expensed for the year.
Next Mr. Kint reviewed the details of the FY 24-25 tentative budget. He explained that the Trustees’ primary obligation today is to approve a budget that includes a cap on the millage rate for the coming year. The Trustees agreed at their July 9th meeting to set the millage cap at .7650, however as the board continues to meet over the next several weeks, they can modify and reduce the budget and millage rate. He discussed the rationale used to calculate this millage which included $3,000,000 of current reserves to be set aside to cover two months operational expenses and the Healthcare Emergency Fund; $2,550,000 of current reserves to be set aside for continued investment as allowed by state statutes; A $4,000,000 placeholder line item in the budget for the purchase of a Women’s Sober Living Property, with $3.8 million of this amount are the funds the District received from the sale of the Hospice House Parcel to the VNA. He explained that with those factors in place, should the District fund all agency requests at full funding which is $23,320,567, it would require all of the remaining reserves which is approximately $3.5 million. Additionally, with this proposed millage rate, the anticipated gross tax revenue will be $22,445,137. This budget also anticipates commissions to the Property Appraiser and Tax Collector and uncollectable taxes which total $1,294,475 and leaves an anticipated net tax revenue to the District of $21,150,662. Lastly, he stated that the District will hold its first Public Budget Hearing on Thursday, September 5th, and the Final Public Budget Hearing for September 19th, at which time the budget will be finalized. Therefore, he made a motion to approve the proposed tentative budget, which was seconded by Ms. Bodnar. There was Trustee discussion clarifying some line items and figures. After no further discussion, the motion carried unanimously.
Executive Director Report- Frank Isele, Executive Director
Mr. Isele reviewed a few items for follow-up and stated that the work to bring in patient detox services to Indian River County continues and CCIRH is working on a detailed business plan and licensing requirements with DCF to provide this level of care at the Behavioral Health Center.
Next, he asked Ms. Dickens to present data related to the SNAP Up pilot program with United Against Poverty. Ms. Dickens explained that she created a dashboard which tracks the utilization of the program and reviewed data on the same. She further stated that the pilot program is set to wrap in August and Wendy from United Against Poverty has requested the opportunity to come back before the board to request additional funding to continue the program. There was Trustee discussion and they requested stronger outcomes and further explanation as to what items are being used and requested. Ms. Dickens also provided the Trustees with a walkthrough of the updated District Dashboard, specifically new data reflecting patient visits with the fee-for-service agencies and areas of service provided.
Mr. Isele provided the Trustees with an update regarding the Sebastian River Medical sale and stated that U.S. Bankruptcy Court approved Steward’s sale dates for Stewardship Health and its 31-hospitals. The sales would be conducted in two rounds. The second round, which comprises Steward’s Florida hospitals and four Texas facilities, has an Aug. 12 bid deadline and an Aug. 22 sale hearing. He also informed the board that Optum, a subsidiary of UnitedHealth Group has backed out of plans to acquire Stewardship Health in Late June. He will provide further details when they are available. Lastly, he stated that at the request of Dr. Cooney, they met with Vonda Sexton VP, Chief Strategy and Business Development Officer of Nemours. The meeting went well and provided them with a better understanding of Nemours operations and mission. It was further discussed that they have been contracted to provide peds services to IRMC and CCIRH since 2014 and are working to recruit more pediatric specialty care locally.
Funded Agency Semi Annual Reports- Crossover Mission
Cathy De Schouwer and Antoine Jennings addressed the board and thanked the Trustees for their support of the Healthy Kids program. They spoke about the recent decision the Trustees made at the July 9th budget meeting, in which they decided to not approve the fiscal year 24-25 funding request. Ms. De Schouwer and Mr. Jennings both expressed their disappointment and asked the Trustees to reconsider their decision. Ms. De Schouwer then provided the Trustees with an update concerning the organization and responded to the five questions which addressed challenges, changes and future trends they are experiencing. She stated that there is an increased need and demand for mental health services for their students but find it challenging for the students to open up to the mental health counselors. Many times, they do not feel comfortable sharing their trauma with those individuals and would prefer to connect with their mentors, who they work with on a daily basis. She also discussed the outcomes of the healthy kids program and stated that it is multifaceted providing a preventative and management approach to a child’s physical and social-emotional health. Next, she discussed some of the challenges their students face which included unstable home environments and lack of parental engagement. Next she discussed areas within the community and challenges she is seeing which include the lack of guidance counselors within the school system. Lastly, she discussed the challenges due to lack of physicians and access to primary care. She also reviewed data relative to student homelessness and economic disadvantage. The Trustees thanked them for their presentation and reiterated that they fully support Crossover Mission as an organization and asked that they look to see if there were any other ways that the District could support them moving forward.
Other Business
Mr. Westcott stated that the motion he made last month was tabled and to follow proper procedures, believes the Trustees should discuss the same. He explained that his original motion included language that referenced an audit, which he feels should be changed to state an inquiry. He also believes that after yesterday’s discussion at the Chairman’s meeting with Dr. Rothman, CCIRH is open to working with the District in fulfilling this request. Therefore, Mr. Westcott left his original motion tabled and made a new motion to reflect the following. A motion to inquire into the following areas of the indigent care program being performed by Cleveland Clinic, pursuant to contractual duties set forth in the lease agreement examining the following: 1. Application and approval process of indigent care patients; Length of time for a decision to be made regarding approval; Number of approvals and denials; Nature and effectiveness of any appeal process. 2. Evaluation of Outcomes and Admissions for Indigent Care Patients. 3. Assessment of the current need and anticipated growth in need. 4. Collection and understanding of data relating to acute care patients verses chronic patients; ER visits compared to admissions. 5. Demographic/Composition i.e. homelessness, age, family status, incomes. Ms. Bartlett seconded the motion for discussion. The majority of the Trustees felt that they should give CCIRH the opportunity to bring forth the information they indicated would provide in September, relative to this matter. The majority of the Trustee also felt that a letter from Mr. Isele memorizing this should be sent to Dr. Rothman. With those comments Mr. Westcott amended his motion to instruct Mr. Isele to draft correspondence to Dr. Rothman outlining this request. The motion was seconded by Dr. Cooney and passed unanimously. Mr. Isele stated that he would put a draft together and send the same to the Trustees for their review and input, prior to distribution to Dr. Rothman.
Public Comment/Adjourn
There was no further discussion or public comment, and the meeting was adjourned at 5:30 PM.
Respectfully Submitted,
Barb Bodnar, Secretary
