SUMMARY MINUTES
BOARD OF TRUSTEES
INDIAN RIVER COUNTY HOSPITAL DISTRICT
REGULAR MONTHLY MEETING
County Commissioner Chambers/ Zoom
June 19, 2025
TRUSTEES: Karen Deigl Michael Kint
Allen Jones Chuck Mackett, M.D.
William Cooney, M.D. Kerry Bartlett
ABSENT: Paul Westcott
STAFF: Shanen Cox Jennifer Peshke, Esq.
Kaytlin Dickens Jennifer Frederick Frank Isele Dawn Carboni
ATTENDEES: Wayne Creelman Marie Andress Laretta Farrell Colette Heid
ZOOM: Carrie Lester Cecelia Stalnaker Ginny Blossom Kellie Hensle Dana McNally Nancee Long
Convene Meeting, Pledge, Consent Agenda & Chairman’s Report
Dr. Cooney convened the regular monthly meeting of the Indian River County Hospital District at 4:00 PM. Mr. Isele provided the invocation, and Dr. Cooney led the group in the pledge of allegiance. Dr. Cooney asked for a motion to approve the consent agenda and a June disbursement of $1,415,750.04. However, before the approval of the minutes he clarified his comments within the Chairman’s meeting minutes and stated that while he would prefer board communication to CCIRH be done through Mr. Isele as executive director, he acknowledges that it is the prerogative of a Trustee to contact CCIRH staff as necessary. Mr. Kint also pointed out a typo within the Chairman’s minutes as well. With those corrections acknowledged, Mr. Kint made a motion to approve the minutes which was seconded by Ms. Deigl. The motion carried unanimously. Dr. Cooney acknowledged the District staff for their work on the fiscal year 25-26 budget funding cycle and Mr. Isele introduced the staff members present and also thanked them for their work and dedication. Next Dr. Cooney asked if any Trustees had conflicts of interest and there were none.
District Counsel Report- Jennifer Peshke, Esq.
Ms. Peshke brought attention to the conflict of interest form 8B, which will be available at each meeting and must be completed by the Trustee should a conflict arise to ensure transparency. The meeting packets will also include the attorney’s overview about public meeting practices and procedures for public reference. This resource outlines how public comments are handled, and she encourages the public to review them before attending meetings. Ms. Peshke stated that she continues to review annual deadlines and deliverables related to the lease with CCIRH and will report any questions or issues. She has assisted staff with updating internal policies to ensure compliance with current laws, and they are preparing a draft RFP and procurement policy for board approval. There may also be work on a letter of intent process with regard to the District owned property on 10th street. She is also maintaining a list of items that may require future changes to the District Bylaws. Additionally, she has reviewed the funding requests within the e-C Impact portal to better understand how information is presented to Trustees during the FY 25-26 budget process. Finally, she is involved with matters surrounding VCOM’s acquisition of the Human Service Building and its potential lease changes, with actions expected in the coming month.
Financial Statement Review
Mr. Kint provided the financial review and stated that after eight months of the fiscal year, the situation remains strong. At the end of May, the District collected $20,785,005 in ad valorem taxes, which is 98.3% of the budgeted amount. The anticipated outstanding collections for the year are $365,657. Next, he reviewed the investment snapshot highlighting the U. S. Treasury holdings of $8,092,985, with T-bills providing an average interest rate of 4.29%. Section 2 of the report shows the preferred deposit pool holding $6,074,485 and also earning 4.29% in interest. Section 3 details the local operating account at Seacoast Bank, which has $650,101 in cash holdings. Overall, the district’s total investments and cash are $14,817,571, with 90% invested for growth. Lastly, he reviewed the year-to-date expenses which are at 63.79% of the budget, with total program expenses at $12,072,821 and administrative expenses at $835,747, both under budget compared to last year’s figures. Dr. Mackett inquired about the expenses for We Care and Mr. Kint explained that the program has been absolved by TCCH and they are working on reconciling expense. A meeting has been arranged with Ms. Frederick and TCCH to discuss the same. Additionally, Mr. Kint pointed out that there have been some discrepancies with his year-to-date figures for administrative expenses and the District staff has set up a meeting to review those discrepancies for correction.
Executive Director Report & Staff Updates
Mr. Isele provided his report and highlighted some areas the District is currently working on to enhance partnerships, diversify funding, and promote legislative changes. Recently he has engaged the services of Jordan Flick to prepare a grant research report, focusing on federal grant opportunities for independent special districts. The aim is to identify federal funding that can benefit the county without competing with local partners. The report is expected by August, detailing state and federal grant opportunities to support health care and infrastructure. Additionally, there are legislative efforts being made at the Federal level with Special District Fairness and Accessibility Act (HR 2766), which seeks to define special districts officially. If passed, it would help independent hospital districts access federal financial assistance, removing barriers that hinder funding from agencies like HHS, FEMA, and USDA. He also prepared and sent support letters to the Florida House Select Committee on Property Taxes, and meetings have taken place with Congressman Mike Haridopolos regarding federal funding cuts and their impact on the community. Specific examples of the funding threats have been compiled and shared with his office, and he expressed support for the role of independent healthcare districts.
Additionally, he discussed mechanisms for drawing federal dollars through the low-income pool and county share of Medicaid. In FY 24, the District contributed $550,000 to the low-income pool and $594,000 towards Medicaid share at CCIRH, helping to secure over $1.5 million in federal funding. He further explained that while the county share of Medicaid is mandatory, low-income pool funding is optional, but valuable for maximizing federal support. There are ongoing efforts to explore partnerships with other Medicaid-enrolled providers to expand these funding opportunities. There was Trustee discussion surrounding the District’s participation in the LIP and Federal grant opportunities.
Next, District staff provided updates to the Trustees. Ms. Carboni began her recently completed audit reports for Dynamic Life, Thrive, and Sunshine Physical Therapy. She is in process of completing the final audit report for the 2022-2023 fiscal year for TCCH, which should be ready in 4 to 6 weeks. Each agency discussed must submit a corrective action plan by a set due date after receiving recommendations from the audit reports. She and Ms. Cox are ensuring these plans and any necessary policy changes are submitted on time. Ms. Cox has also assisted in reviewing, proofreading completed audits, working on compliance matters, revising audit schedules and forms for the 2023-2024 fiscal year. They have also developed a comprehensive purchasing and procurement policy and a fraud and false claims policy, which will go to the finance committee for review next month. Additionally, they are updating our internal audit policy and creating a cybersecurity policy.
Ms. Frederick then spoke to the FY 25-26 funding cycle and e-C Impact evaluation process. Following last year’s changes, the focus has been on aligning funding requests more closely with the District’s strategic goals set by Trustees and improving guidelines to ensure better compliance and accountability concerning taxpayer funds. The deadline for funding applications was March 28th, and 59 program funding requests from 21 partners were received and reviewed. She, Mr. Isele and Ms. Carboni spent time assessing these applications, often requesting more details to verify costs and budgets. A new alignment and impact framework was introduced to categorize programs based on their relevance to care delivery. Following their evaluations, further discussions with Trustees were conducted to address concerns. Lastly, she stated that a detailed report on funding recommendations will be completed by next Friday for further review and discussion.
Ms. Dickens provided the Trustees with an update on the District’s dashboard. She explained that most of the data doesn’t change significantly but the last three pages show monthly updates on visits broken down by service type and agency. Currently, there are around eight or nine agencies offering fee-for-service. Next year, this number will increase to over 20, which will likely affect data visualization. So far this fiscal year, there’s been an 8.74% increase in visits, and a projection suggests an 11.8% growth by the end of the fiscal year, compared to last year’s 8.8%. This rise may correlate with a decline in Medicaid enrollment, as individuals move to financial assistance programs. She also provided a walkthrough of a new dashboard she created with the annual health survey results, which has interactive charts and demographic data. The dashboard includes overall satisfaction rates with healthcare, affordability, availability, and preferences regarding doctors and dentists. The second page focuses on access to care and reveals that 18.8% of Indian River County residents had to visit the ER due to issues getting appointments. Additionally, all data can be filtered by categories, allowing specific demographic insights into responses, ensuring that stakeholders can analyze the information effectively. There was Trustee discussion surrounding the data within the dashboard and they were appreciative of Ms. Dickens efforts. There was also discussion surrounding the idea of raising the District’s Federal Poverty Guidelines to 250%.
Funded Agency Semi Annual Reports
Dr. Cooney referenced the written only funding agency semi-annual reports within the meeting packet and asked if there were any Trustee questions. Mr. Jones refenced the VNA reports, specifically addressing that the VNA hospice has exceeded its annual budget by 137% in just six months due to increased demand. He would like to obtain additional information from VNA of these metrics to understand the reasons behind the surge in hospice services. Mr. Jones also question patient volumes at Whole Family Health Center and referenced their different categories involved in patient care, like mobile medical offices and various assistants. He noted that the medical services are fee-for-service, making up only 40% of the budget over six months, despite a significant increase in patients. He would also like additional clarification on this matter from the agency. Mr. Isele stated that staff met with representatives from the VNA to discuss the hospice matter after noticing the large increase, which was due to a change in VNA’s billing and marketing of the program. It was questioned whether the VNA would need to come back before the Trustees to request additional funding for the current fiscal year. Ms. Frederick stated that she has spoken with Pat Knipper and they are closely monitoring their total budget to see if additional funds will be required. It was also clarified that an agency would need to have approval from the board to receive additional funds over their total approved fiscal year budget. However, staff may approve the reallocation of funds within an agency’s budget, to support one service line which is tracking higher than another. Additionally, Marie Andress was present at the meeting and spoke to Mr. Jones earlier question. She noted that they were under budget for Medicaid fee-for-service this year, unlike last year when they were over budget and requested an additional $275,000 from the District. This year, they may have exceeded the Medicaid budget again as there is higher no-show rate among patients, particularly undocumented individuals, and they are trying to find strategies to address this challenge.
Unfished Business
Dr. Cooney made mention of the memo Mr. Westcott prepared and circulated to the Trustees at yesterday’s Chairman’s meeting. There was Trustee discussion and the majority agreed with the sentiment of the memo with regard to funding and the Special Act. There was Trustee discussion and Mr. Kint requested Ms. Peshke provide the Trustees with her interpretation of the Special Act with regard to the scope of funding and definition of medical and healthcare services. Ms. Peshke stated she would work on providing the Trustee additional research and the Trustees agreed that continued discussions on this matter were appropriate
Public Comment/Adjourn
There was no further discussion or public comment. The meeting was adjourned at 5:15 PM.
Respectfully Submitted,
Karen Deigl, Secretary
