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A TPUE COPY <br />k t,� ICATION ON LASTP= <br />J1 FR, CLERK <br />cA, <br />Intergovernmental Transfers Questionnaire <br />IGT Provider Name: Indian River Count <br />Health Care Provider Name: N/A <br />IGT Amount: $ 3,476,012.00 <br />State Fiscal Year Ending: 6/30/2025 <br />1. What type of governmental entity is your organization considered? (county, city, hospital taxing district, <br />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 />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 for SFY 2025 $ 2,980,327 <br />LPPF rollover balance $ 570,048 <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 />