Bert Fish Medical Center/ Southeast Volusia Hospital Special Taxing District

1. Bert Fish Medical Center/ Southeast Volusia Hospital Special Taxing District

2. Topics of Discussion 2008 Property Tax Fact Ad Valorem Tax Revenue Financial Review Board of Directors Fiduciary Responsibility Citizens Referendum

3. 2008 Property Tax

4. 2008 Property Tax % New Smyrna Beach

5. Fact

7. Fact Bert Fish Medical Center is a Community owned health care center, owned by the residents of the Southeast Volusia Hospital District. The Southeast Volusia Hospital District is governed by a seven (7) member Board of Commissioners Source of data: Florida House Bill HB 0273

8. Fact Board of Commissioners shall be a resident of the “Taxing District” Board of Commissioners are political patronage appointees, appointed by the Governor & are accountable to “NO” one. Source of data: Florida House Bill HB 0273

9. Fact According to The Florida Hospital Association there are 226 acute care hospitals in Florida Source of Data: Florida Hospital Association—fla.org

10. Fact Of the 226 acute care Florida hospitals: 34 are Special Districts Hospitals. 16 Ad Valorem Tax Authority 12 Appointed Board of Directors 4 Elected Board of Directors 18 Revenue Sources Varied. 85% of all Florida Acute Care Hospitals are not " Special District Hospitals" they are Privately held. Source of data: MyFlorida.com & floridaspecialtaxingdistricts.org

11. Fact Of the 16 acute care hospitals with Ad Valorem Source of Revenue in Florida, 3 are located in Volusia County. Halifax Hospital Medical Center SE Volusia / Bert Fish Medical Center West Volusia Hospital Authority Source of data: floridaspecialtaxingdistricts.org

12. Fact Florida Memorial located in Daytona Beach, is owned by Adventist Health Care, is a Not For Profit, Acute Care Hospital & receives no Ad Valorem tax revenues. Source of Data: Hospitalcompares.hhs.gov

13. Facts In 2008 BFMC records show the Emergency Department Outpatient Activity exceeded 31,952. National statistics show 87% of the patients in the Emergency room did not require Emergency room services. Source of Data: The Feasibility of a Managed Indigent Health Care Plan for Volusia County, Fl.; Prepared by: Health Management Decisions. Inc. and Wittner Companies; October 1993 & BFMC Data

14. Ad Valorem Tax Revenue

15. Ad Valorem Tax Revenue On September 17, 2008 the Southeast Volusia Hospital District approved a 2.85 Millage rate for 2008-9. This will generate a Ad Valorem Tax revenues of $20.8 million. SEVHD reports these revenues are used to provide Indigent Care. Source of data: Florida House Bill HB 0273

16. Ad Valorem Tax Revenue Southeast Volusia Hospital District Ad Valorem Tax Revenues can also be used for: Debt Service Payment on Notes & Bonds Expenses of Operation Maintenance Construction & Repairs Source of data: Florida House Bill HB 0273

17. (Continued) Payment of indebtedness District expenses Downtown redevelopment District fees Tax collector fees. Source of data: Florida House Bill HB 0273

18. Ad Valorem Tax Revenue Southeast Volusia Hospital Taxing District Ad Valorem revenue is not the only source of revenue to pay for Indigent /Emergency Care.

19. Ad Valorem Tax Revenue In 1986 Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) and in 2007 Florida Legislature passed Statute 395.1041 which ensures public access to emergency services & care regardless of ability to pay.

20. Southeast Volusia Hospital Valorem Tax Revenue 2003 $8.5 Mil. 2004 $10.0 Mil. 2005 $11.5 Mil. 2006 $14.4 Mil. 2007 $17.8 Mil. 2008 $17.7 Mil. 2009 $20.8 Mil. Source of data: Southeast Volusia Hospital

21. Ad Valorem Tax Revenue From 2003 to 2009: SEVHD Ad Valorem Tax Revenue increased 245% CPI increased 14.4% (2003 to 2007) Source of data: BFMC provided data

22. 2003-09 Ad Valorem Tax Revenue/ CPI/ Home Value % inc. / (dec.)Systemic Flawed Model

23. 2006 Per Capita Property Tax for Indigent Care Volusia $131.00 Lee 6.00 Pasco 11.00 Flagler 10.00 Brevard 10.00

24. State of Florida2008--09 Special Hospital Taxing DistrictGross Ad Valorem Tax per capita Appointed Boards: Baker County $31.90 Graceville Hospital $52.25 Citrus County $91.31 Halifax Hospital $184.80 Lake County $72.79 Lower Florida Keys 0 Madison County 0 North Broward $153.67 North Sumpter South Broward $98.18 South Lake $79.45 Southeast Volusia $274.35 Elected Board: Hendry Country $151.34 Indian River County $103.78 North Lake County $84.23 West Volusia $79.29

25. Ad Valorem Tax Revenue 2006 Indigent Care cost per resident in Volusia County was 13 times higher than counties with approximately the same population. 2008-09 SEVHD Ad Valorem Tax Revenue $20.8 Million. In 2008-9 SEVHD Ad Valorem Tax is $ 274.35 per (special taxing district) capita. Source of data: December2, 2007 News Journal; BFMC 2008-09 Budget

26. Bert Fish Medical Center FINANCIAL REVIEW

27. BFMC 2008 Uses of Tax Dollars. 2008 Gross Ad Valorem Property Tax $17,702,388 Less: Discounts & Uncollectible Tax ($885,119) Tax Collection & Appraiser Comm. ($686,853) Volusia County Medicare Assessment ($313,162) Redevelopment Taxes paid to Cities: ($683,793) TOTAL DEDUCTIONS: ($2,568,927) 2008 Net Ad Valorem Property Tax to Halifax: $15,133,461 Sources of Data: BFMC

28. BFMC 2007 Profit Reconciliation BFMC 2006-7 Profit / (Loss) (*) ($1,012,064) Less: 2006-7 Net Ad Valorem Property Tax ($15,395,964) 2007 Pre Tax Profit W/O Ad Valorem Tax ($16,408,028) Source of data: BFMC Data (*) Excess (Deficiency) of Revenue and Gains Over Expenses and Losses Including Net Ad Valorem Property Tax,

29. 2003 to 2007 BFMC Gains (Loss) W/O Ad Valorem Property Tax-($)MillionsSources of data: BFMC

30. BFMC 2003-07 Profit Reconciliation BFMC Cumulative Excess (Deficiency) of Revenue and Gains Over Expenses and Losses including Ad Valorem Property Tax $13,270,631. BFMC Cumulative Net Ad Valorem Revenue (tax) $54,085,764. BFMC (Losses)W/O Ad Valorem Tax Revenue ($40,815,133) Sources of data:BFMC

31. Cumulative 2003-08 Gross Ad Valorem Tax Paid $79,931,590

32. BFMC Board of Directors Fiduciary Responsibility

33. Fiduciary Responsibility The Southeast Volusia Hospital District Board of Directors has a fiduciary responsibility to the citizens they were appointed to represent. “A fiduciary is someone who has undertaken to act for and on behalf of another in a particular matter in circumstances which give rise to a relationship of trust and confidence.” Defination; Webster,s New Collegiate Dictionary

34. Fiduciary Responsibility? Has the SEVHD Board of Directors operated in a manner as to establish trust and confidence when they:

35. Fiduciary Responsibility ? Consistently Approve Administrative costs in excess of 15% of gross revenue: 13% points higher than U.S. Medicare. Approve Increasing Ad Valorem tax revenues by 245% over five years while CPI increased 14.4%

36. Fiduciary Responsibility ? Approve Indigent care costs of $131 per capita: 13 times comparable counties. Failed to Implement 1993 Volusia County Indigent Care Study.

37. Faduciary Responsibility For 2008-09 approved a 2.85 mil. Ad Valorem tax on all taxable property within the taxing district. $20.8 Million: $275.00 per capita Highest per capita Millage rate in Florida $89.55 Per Capita Greater that Halifax Medical Center which is #2

38. WHY the Per Capita differences within the three Volusia County Taxing Districts ???? • Southeast Volusia $274.35 • Halifax Health $184.80 • West Volusia $79.29

39. The SEVHD Appointed Board of Commissioners have failed the citizens they were appointed by the Governor to serve …

40. CITIZENS REFERENDUM

41. Citizens Referendum Reduce HB 0273 millage from 4 to .5 mills.

42. Referendum Verbiage Shall the maximum ad valorem property tax rate that can be levied by the Southeast Volusia Hospital District be reduced from 4 mills to .5 Mills? Yes…. No….. Reference: Laws of Florida Ch. 2004-421: House Bill No. 837 Page 14, Section 8.