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` yI" CARE 10 <br />C <br />ST�iIf OF FLOR��� <br />A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />RYAN L. BUTLER, CLERK <br />Intergovernmental Transfers Questionnaire <br />IGT Provider Name: Indian River Count <br />Health Care Provider Name: <br />IGT Amount: $363,337.25 <br />State Fiscal Year Ending: 6/30/2024 <br />1. What type of governmental entity is your organization considered? (county, city, hospital taxing district, <br />or other) <br />Count <br />It other, please explain <br />The Emergency Services District is a Dependent Special District of Indian River County <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 />Yes <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 />The District is both the provider of and the agency that will be making the required IGT. <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 />Ad Valorem Tax Revenue FY 23/24 Budget $ 363,337 <br />$ - <br />$ - <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 />Yes <br />