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IGT Provider Name: <br />Health Care Provider Name: <br />IGT Amount: <br />State Fiscal Year Ending: <br />Interaovernmental Transfers Questionnaire <br />Indian River County <br />N/A <br />$7,912,885 <br />6/30/2022 <br />A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH. CLERK <br />1. What type of governmental entity is your organization considered? (county, city, hospital taxing <br />district, or other) <br />County <br />If other, please explain <br />2. Does your organization have a relationship with the provider for which you contribute IGTs as named in <br />the preamble of the enclosed Letter of Agreement (LOA)? <br />No <br />If yes, please describe your relationship, including services provided to/by the provider to/by the <br />organization and any other financial transactions between the provider and the organization. <br />3. Please describe the source of the IGT funding for your organization, including whether the source is <br />from a tax, a provider donation, or other funds. Provide the amount of funding from each source. <br />Source Amount <br />Special Assessment $ 7,912,885 <br />If other, please explain <br />a. Verify whether the funds are public funds as defined by 42 CFR § 433.51, and exclude any federal <br />funds. <br />Yes <br />If no, please explain <br />4. Does your organization have taxing authority? <br />