Bert Fish Medical Center/Bert Fish Medical Center/

Southeast Volusia Hospital Southeast Volusia Hospital

Special Taxing District Special Taxing District

Topics of DiscussionTopics of Discussion

2008 Property Tax2008 Property Tax Fact Fact Ad Valorem Tax RevenueAd Valorem Tax Revenue Financial ReviewFinancial Review Board of Directors Fiduciary Board of Directors Fiduciary

ResponsibilityResponsibility Citizens ReferendumCitizens Referendum

2008 Property Tax2008 Property Tax

27.7

38.5

19.2

12.2

2.5

County

School

Municipal

Hospital

Other

2008 Property Tax % New Smyrna Beach

Fact Fact

FactFact

– Bert Fish Medical Center is a Bert Fish Medical Center is a Community owned health care Community owned health care center, owned by the residents of center, owned by the residents of the Southeast Volusia Hospital the Southeast Volusia Hospital District. District.

– The Southeast Volusia Hospital The Southeast Volusia Hospital District is governed by a seven (7) District is governed by a seven (7) member Board of Commissionersmember Board of Commissioners

Source of data: Florida House Bill HB 0273Source of data: Florida House Bill HB 0273

Fact Fact

– Board of Commissioners shall be Board of Commissioners shall be a resident of the “Taxing District” a resident of the “Taxing District”

– Board of Commissioners are Board of Commissioners are political patronage appointees, political patronage appointees, appointed by the Governor & are appointed by the Governor & are accountable to “NO” one.accountable to “NO” one.

Source of data: Florida House Bill HB Source of data: Florida House Bill HB 02730273

FactFact

– According to The Florida According to The Florida Hospital Association there are Hospital Association there are 226 acute care hospitals in 226 acute care hospitals in FloridaFlorida

Source of Data: Florida Hospital Association—Source of Data: Florida Hospital Association—fla.orgfla.org

FactFact

– Of the 226 acute care Florida hospitals:Of the 226 acute care Florida hospitals: 34 are Special Districts Hospitals.34 are Special Districts Hospitals.

– 16 Ad Valorem Tax Authority16 Ad Valorem Tax Authority 12 Appointed Board of Directors12 Appointed Board of Directors 4 Elected Board of Directors4 Elected Board of Directors

– 18 Revenue Sources Varied.18 Revenue Sources Varied.

– 85% of all Florida Acute Care Hospitals are not 85% of all Florida Acute Care Hospitals are not " Special District Hospitals" they are Privately " Special District Hospitals" they are Privately held. held.

Source of data: MyFlorida.com & floridaspecialtaxingdistricts.orgSource of data: MyFlorida.com & floridaspecialtaxingdistricts.org

FactFact

– Of the 16 acute care hospitals with Ad Of the 16 acute care hospitals with Ad Valorem Source of Revenue in Florida, Valorem Source of Revenue in Florida, 3 are located in Volusia County.3 are located in Volusia County.

Halifax Hospital Medical CenterHalifax Hospital Medical Center SE Volusia / Bert Fish Medical CenterSE Volusia / Bert Fish Medical Center West Volusia Hospital AuthorityWest Volusia Hospital Authority

Source of data: Source of data: floridaspecialtaxingdistricts.orgfloridaspecialtaxingdistricts.org

FactFact

Florida Memorial located in Florida Memorial located in Daytona Beach, is owned by Daytona Beach, is owned by Adventist Health Care, is a Not Adventist Health Care, is a Not For Profit, Acute Care Hospital & For Profit, Acute Care Hospital & receives no Ad Valorem tax receives no Ad Valorem tax revenues.revenues.

Source of Data: Source of Data: Hospitalcompares.hhs.govHospitalcompares.hhs.gov

FactsFacts

In 2008 BFMC records show the In 2008 BFMC records show the Emergency Department Outpatient Emergency Department Outpatient Activity exceeded 31,952. National Activity exceeded 31,952. National statistics show 87% of the patients statistics show 87% of the patients in the Emergency room did not in the Emergency room did not require Emergency room services. require Emergency room services.

Source of Data: The Feasibility of a Managed Indigent Health Care Plan for Volusia County, Fl.; Source of Data: The Feasibility of a Managed Indigent Health Care Plan for Volusia County, Fl.; Prepared by:Prepared by:

Health Management Decisions. Inc. and Wittner Companies; October 1993 & BFMC DataHealth Management Decisions. Inc. and Wittner Companies; October 1993 & BFMC Data

Ad Valorem Tax Ad Valorem Tax Revenue Revenue

Ad Valorem Tax Ad Valorem Tax RevenueRevenue

– On September 17, 2008 the On September 17, 2008 the Southeast Volusia Hospital District Southeast Volusia Hospital District approved a 2.85 Millage rate for approved a 2.85 Millage rate for 2008-9. This will generate a Ad 2008-9. This will generate a Ad Valorem Tax revenues of $20.8 Valorem Tax revenues of $20.8 million.million.

– SEVHD reports these revenues are SEVHD reports these revenues are used to provide Indigent Care. used to provide Indigent Care.

Source of data: Florida House Bill HB 0273Source of data: Florida House Bill HB 0273

Ad Valorem Tax Ad Valorem Tax RevenueRevenue

Southeast Volusia Hospital Southeast Volusia Hospital District Ad Valorem Tax Revenues District Ad Valorem Tax Revenues can also be used for:can also be used for:

Debt Service Payment on Notes & Debt Service Payment on Notes & BondsBonds

Expenses of OperationExpenses of Operation MaintenanceMaintenance Construction & RepairsConstruction & Repairs Source of data: Florida House Bill HB Source of data: Florida House Bill HB

02730273

(Continued)(Continued) Payment of indebtednessPayment of indebtedness District expensesDistrict expenses Downtown redevelopment District Downtown redevelopment District

feesfees Tax collector fees.Tax collector fees. Source of data: Florida House Bill HB Source of data: Florida House Bill HB

02730273

Ad Valorem Tax Ad Valorem Tax RevenueRevenue

Southeast Volusia Hospital Southeast Volusia Hospital Taxing District Ad Valorem Taxing District Ad Valorem revenue is not the only source revenue is not the only source of revenue to pay for Indigent of revenue to pay for Indigent /Emergency Care. /Emergency Care.

Ad Valorem Tax Ad Valorem Tax RevenueRevenue

In 1986 Congress enacted the In 1986 Congress enacted the Emergency Medical Treatment & Emergency Medical Treatment & Labor Act (EMTALA) and in 2007 Labor Act (EMTALA) and in 2007 Florida Legislature passed Florida Legislature passed Statute 395.1041 which ensures Statute 395.1041 which ensures public access to emergency public access to emergency services & care regardless of services & care regardless of ability to pay.ability to pay.

Southeast Volusia Hospital Southeast Volusia Hospital Valorem Tax RevenueValorem Tax Revenue

2003 $8.5 Mil.2003 $8.5 Mil. 2004 $10.0 Mil.2004 $10.0 Mil. 2005 $11.5 Mil.2005 $11.5 Mil. 2006 $14.4 Mil.2006 $14.4 Mil. 2007 $17.8 Mil.2007 $17.8 Mil. 2008 $17.7 Mil.2008 $17.7 Mil. 2009 $20.8 Mil.2009 $20.8 Mil. Source of data: Southeast Volusia Source of data: Southeast Volusia

HospitalHospital

0

5

10

15

20

25

2003 2005 2007 2009

Ad Valorem Tax Ad Valorem Tax RevenueRevenue

From 2003 to 2009:From 2003 to 2009:– SEVHD Ad Valorem Tax Revenue SEVHD Ad Valorem Tax Revenue

increased 245%increased 245%– CPI increased 14.4% (2003 to CPI increased 14.4% (2003 to

2007)2007)

Source of data: BFMC provided dataSource of data: BFMC provided data

2003-09 Ad Valorem Tax Revenue/ CPI/ Home Value %

inc. / (dec.)Systemic Flawed Model

2006 Per Capita 2006 Per Capita Property Tax for Property Tax for Indigent CareIndigent Care

Volusia $131.00Volusia $131.00 Lee 6.00Lee 6.00 Pasco 11.00Pasco 11.00 Flagler 10.00Flagler 10.00 Brevard 10.00Brevard 10.00

State of Florida2008--09 Special Hospital Taxing District

Gross Ad Valorem Tax per capita

Appointed Boards:– Baker County $31.90– Graceville Hospital

$52.25– Citrus County $91.31– Halifax Hospital

$184.80– Lake County $72.79– Lower Florida Keys 0– Madison County 0– North Broward $153.67– North Sumpter– South Broward $98.18– South Lake $79.45– Southeast Volusia

$274.35

Elected Board:– Hendry Country

$151.34– Indian River County

$103.78– North Lake County

$84.23– West Volusia

$79.29

Ad Valorem Tax Ad Valorem Tax RevenueRevenue

2006 Indigent Care cost per 2006 Indigent Care cost per resident in Volusia County was resident in Volusia County was 13 times higher than counties 13 times higher than counties with approximately the same with approximately the same population.population.

2008-09 SEVHD Ad Valorem Tax 2008-09 SEVHD Ad Valorem Tax Revenue $20.8 Million.Revenue $20.8 Million.

In 2008-9 SEVHD Ad Valorem Tax In 2008-9 SEVHD Ad Valorem Tax is $ 274.35 per (special taxing is $ 274.35 per (special taxing district) capita.district) capita.

Source of data: December2, 2007 News Journal; BFMC 2008-09 Budget Source of data: December2, 2007 News Journal; BFMC 2008-09 Budget

Bert Fish Medical CenterBert Fish Medical Center

FINANCIAL REVIEWFINANCIAL REVIEW

BFMC 2008 Uses of Tax BFMC 2008 Uses of Tax Dollars.Dollars.

2008 Gross Ad Valorem Property Tax $17,702,3882008 Gross Ad Valorem Property Tax $17,702,388

Less:Less: Discounts & Uncollectible Tax ($885,119)Discounts & Uncollectible Tax ($885,119) Tax Collection & Appraiser Comm. ($686,853)Tax Collection & Appraiser Comm. ($686,853) Volusia County Medicare Assessment ($313,162)Volusia County Medicare Assessment ($313,162) Redevelopment Taxes paid to Cities: ($683,793)Redevelopment Taxes paid to Cities: ($683,793) TOTAL DEDUCTIONS: ($2,568,927)TOTAL DEDUCTIONS: ($2,568,927)

2008 Net Ad Valorem Property Tax to Halifax: 2008 Net Ad Valorem Property Tax to Halifax: $15,133,461$15,133,461 Sources of Data: BFMCSources of Data: BFMC

BFMC 2007 Profit BFMC 2007 Profit ReconciliationReconciliation

BFMC 2006-7 Profit / (Loss) (*) BFMC 2006-7 Profit / (Loss) (*) ($1,012,064)($1,012,064)

Less:Less:– 2006-7 Net Ad Valorem Property Tax 2006-7 Net Ad Valorem Property Tax

($15,395,964)($15,395,964) 2007 Pre Tax Profit W/O Ad Valorem Tax 2007 Pre Tax Profit W/O Ad Valorem Tax

($16,408,028)($16,408,028)

Source of Source of data: BFMC Datadata: BFMC Data

(*) Excess (Deficiency) of Revenue and Gains Over Expenses and Losses Including (*) Excess (Deficiency) of Revenue and Gains Over Expenses and Losses Including Net Ad Valorem Property Tax,Net Ad Valorem Property Tax,

2003 to 2007 BFMC Gains (Loss) 2003 to 2007 BFMC Gains (Loss) W/O Ad Valorem Property Tax-W/O Ad Valorem Property Tax-($)Millions($)Millions Sources of data: BFMCSources of data: BFMC

BFMC 2003-07 Profit BFMC 2003-07 Profit ReconciliationReconciliation BFMC Cumulative Excess (Deficiency) BFMC Cumulative Excess (Deficiency)

of Revenue and Gains Over Expenses of Revenue and Gains Over Expenses and Losses including Ad Valorem and Losses including Ad Valorem Property Tax $13,270,631.Property Tax $13,270,631.

BFMC Cumulative Net Ad Valorem BFMC Cumulative Net Ad Valorem Revenue (tax) $54,085,764.Revenue (tax) $54,085,764.

BFMC (Losses)W/O Ad Valorem Tax BFMC (Losses)W/O Ad Valorem Tax Revenue ($40,815,133)Revenue ($40,815,133)

Sources of data:BFMCSources of data:BFMC

Cumulative 2003-08 Gross Ad Valorem Tax Paid

$79,931,590

BFMC Board of Directors BFMC Board of Directors Fiduciary ResponsibilityFiduciary Responsibility

Fiduciary ResponsibilityFiduciary Responsibility

The Southeast Volusia Hospital The Southeast Volusia Hospital District Board of Directors has a District Board of Directors has a fiduciary responsibility to the fiduciary responsibility to the citizens they were appointed to citizens they were appointed to represent.represent.

“ “A fiduciary is someone who has A fiduciary is someone who has undertaken to act for and on undertaken to act for and on behalf of another in a particular behalf of another in a particular matter in circumstances which matter in circumstances which give rise to a relationship of trust give rise to a relationship of trust and confidence.”and confidence.”

Defination; Webster,s New Defination; Webster,s New Collegiate DictionaryCollegiate Dictionary

Fiduciary ResponsibilityFiduciary Responsibility ??

Has the SEVHD Board of Has the SEVHD Board of Directors operated in a Directors operated in a manner as to establish trust manner as to establish trust and confidence when they:and confidence when they:

Fiduciary Fiduciary Responsibility Responsibility ? ?

Consistently Approve Consistently Approve Administrative costs in excess Administrative costs in excess of 15% of gross revenue: 13% of 15% of gross revenue: 13% points higher than U.S. points higher than U.S. Medicare.Medicare.

Approve Increasing Ad Valorem Approve Increasing Ad Valorem tax revenues by 245% over five tax revenues by 245% over five years while CPI increased 14.4%years while CPI increased 14.4%

Fiduciary Fiduciary Responsibility Responsibility ??

Approve Indigent care costs of Approve Indigent care costs of $131 per capita: 13 times $131 per capita: 13 times comparable counties. comparable counties.

Failed to Implement 1993 Volusia Failed to Implement 1993 Volusia County Indigent Care Study.County Indigent Care Study.

Faduciary Faduciary ResponsibilityResponsibility For 2008-09 approved a 2.85 mil. For 2008-09 approved a 2.85 mil.

Ad Valorem tax on all taxable Ad Valorem tax on all taxable property within the taxing district.property within the taxing district.

$20.8 Million: $275.00 per capita$20.8 Million: $275.00 per capita Highest per capita Millage rate in Highest per capita Millage rate in

Florida Florida $89.55 Per Capita Greater that $89.55 Per Capita Greater that

Halifax Medical Center which is #2Halifax Medical Center which is #2

WHY the Per Capita differences within the three Volusia County Taxing Districts ????– Southeast Volusia $274.35– Halifax Health $184.80– West Volusia $79.29

The SEVHD Appointed The SEVHD Appointed Board of Commissioners Board of Commissioners have failed the citizens have failed the citizens they were appointed by they were appointed by the Governor to serve the Governor to serve ……

CITIZENS REFERENDUM

Citizens ReferendumCitizens Referendum

Reduce HB 0273 millage Reduce HB 0273 millage from 4 to .5 mills.from 4 to .5 mills.

Referendum Verbiage

Shall the maximum ad valorem property tax rate that can be levied by the Southeast Volusia Hospital District be reduced from 4 mills to .5 Mills?

Yes…. No….. Reference: Laws of Florida Ch. 2004-421: House Bill No. 837 Page

14, Section 8.