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If yes, please list the provider and payment amount. <br />Provider Name Funding Source Amount <br />$ <br />d. Does any portion of the provider donation constitute as a "bona fide donation" pursuant to 42 CFR <br />§ 433.54? 42 CFR § 433.54 requires donations will not be returned to the individual provider, the <br />provider class, or related entity under a hold harmless provision. <br />No <br />e. Is there an agreement between the IGT provider and the health care entity? If so, please specify <br />whether the agreement is written and provide the details. <br />In 2021, Indian River County obtained indemnity agreements from some of the hospitals, <br />committing that those hospitals agree to indemnify the county against any challenges to the <br />local special assessment that is the source of this IGT. <br />7. Were funds utilized for the IGT specifically appropriated by the organization's board? <br />No <br />If yes, provide the board minutes and date of the appropriation. <br />I r�' N • '' �k�"^• ��. certify that the statements and information contained <br />in thYs submittal are true, accurate, and complete. <br />nature of Officer or Administrator <br />County Administrator <br />Title <br />27 -Aug -24 <br />Date <br />STATE OF FLORIDA <br />MOIAN RIVER COUNTY <br />TMT$ IS TO CERTIFY THAT TMT$ IS A TRUE AND CORRECT <br />COPY OF THE ORWW4AL OU FLLE 16 OFFICE <br />RYAN BUT{ER K <br />D.C. <br />DAT <br />