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Home My WebLink About2024-244A TPUE COPY k t,� ICATION ON LASTP= J1 FR, CLERK cA, Intergovernmental Transfers Questionnaire IGT Provider Name: Indian River Count Health Care Provider Name: N/A IGT Amount: $ 3,476,012.00 State Fiscal Year Ending: 6/30/2025 1. What type of governmental entity is your organization considered? (county, city, hospital taxing district, or other) County If other, please explain 2. Does your organization have a relationship with the provider for which you contribute IGTs as named in the preamble of the enclosed Letter of Agreement (LOA)? No If yes, please describe your relationship, including services provided to/by the provider to/by the organization and any other financial transactions between the provider and the organization. Please describe the source of the IGT funding for your organization, including whether the source is from a tax, a provider donation, or other funds. Provide the amount of funding from each source. Source Amount Special assessment for SFY 2025 $ 2,980,327 LPPF rollover balance $ 570,048 If other, please explain a. Verify whether the funds are public funds as defined by 42 CFR § 433.51, and exclude any federal funds. Yes If no, please explain 4. Does your organization have taxing authority? Yes A TRUE COPY CERTIFICATION ON LAST PACE RYAN L. BUTLER, CLERK 5. If the source of IGT funding is from taxes, please answer the following questions: a. Is the tax a state, county, city, or hospital district tax? [— County If other, please explain b. What entities are taxed? c. Wt d. Wt -icensed non-public hospitals in Indian River County )t is the tax structure (i.e. property tax, percentage of revenue, assessment, etc.)? Special assessment 31 is the amount or percent of the tax? Tet Patient Revenue (inpatient hospital services): 0.56%. Net Patient Revenue (outpatient iospital services): 0.56% e. Does at least 85% of the burden of the tax revenue fall on health care providers as defined in 42 CFR §433.55? (Provide the total tax revenue and the health care provider tax burden) If so, please answer the following questions: Amount Total Tax Burden $ 2,980,327 Healthcare Provider Tax Burden $ 2,980,327 100.00% i) Is the tax broad based? A broad based tax can be defined as a tax that is imposed on at least all health care items or services in the class or providers of such items or services furnished by all non -Federal, non-public providers in the State, and is imposed uniformly, pursuant to 42 CFR § 433.68. Yes I no, please explain A TRUE COPY ^Tirrr ATION ON LAST PAGE TI ER, CLERK ii) Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care - related tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare payments (in whole or in part), or both; or in the case of health care -related tax based on revenue or receipts with respect to a class of items or services, if it excludes either Medicaid or Medicare revenue with respect to a class of items or services, or both. The exclusion of Medicaid revenue must be applied uniformly to all providers being taxed. Yes If no, please explain iii) Is the tax generally redistributive and a waiver of the broad-based or uniform tax requirement was granted in accordance with 42 CFR §433.68(e)? No If no, please explain No waiver was requested iv) Does the tax program comply with the hold harmless provisions included in 42 CFR § 433.68(f)? Yes It no, please explain v) Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost? If yes, please explain The county is not involved in the distribution of funds following federal match. The county is not in a position to speak to the ultimate distribution to hospitals from the managed care organizations. 6. Please answer the following regarding provider funds received from the healthcare entity and/or other health care entities. a. Are provider voluntary payments or in-kind services received by the organization as defined in 42 CFR § 433.52? No b. How much of the organization's revenue is received from provider -related donations (Provide the total revenue and the provider -related donation amounts)? Amount Total Revenu Is - Provider Related Donations 1 $ - c. Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care organizational entity? No If yes, please list the provider and payment amount. Provider Name Funding Source Amount $ d. Does any portion of the provider donation constitute as a "bona fide donation" pursuant to 42 CFR § 433.54? 42 CFR § 433.54 requires donations will not be returned to the individual provider, the provider class, or related entity under a hold harmless provision. No e. Is there an agreement between the IGT provider and the health care entity? If so, please specify whether the agreement is written and provide the details. In 2021, Indian River County obtained indemnity agreements from some of the hospitals, committing that those hospitals agree to indemnify the county against any challenges to the local special assessment that is the source of this IGT. 7. Were funds utilized for the IGT specifically appropriated by the organization's board? No If yes, provide the board minutes and date of the appropriation. I r�' N • '' �k�"^• ��. certify that the statements and information contained in thYs submittal are true, accurate, and complete. nature of Officer or Administrator County Administrator Title 27 -Aug -24 Date STATE OF FLORIDA MOIAN RIVER COUNTY TMT$ IS TO CERTIFY THAT TMT$ IS A TRUE AND CORRECT COPY OF THE ORWW4AL OU FLLE 16 OFFICE RYAN BUT{ER K D.C. DAT