Halifax Health

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• Halifax Health
• Special Taxing District
• Impact Study

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Topics of Discussion

• 2008 Property Tax
• Fact
• Ad Valorem Tax Revenue
• Halifax Health Waste
• Access to Cost of Health Care
• Financial Review
• Board of Directors Fiduciary Responsibility
• Citizens Referendum

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• 2008 Property Tax

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2008 Property Tax Daytona Beach District 4
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• Fact

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(No Transcript)
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Fact

• Halifax Hospital Medical Center is a Community
  owned health care center, owned by the residents
  of the Halifax Special Taxing District.
• The Halifax Special Taxing District is governed
  by a seven (7) member Board of Commissioners
• 
  Source of data Florida House Bill HB 1457

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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 1457

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Fact

• According to The Florida Hospital Association
  there are 226 acute care hospitals in Florida
• Source
  of Data Florida Hospital Associationfla.org

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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

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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 floridaspecialtaxingdistr
  icts.org

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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

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Facts

• In 2007 Halifax records show the Emergency
  Department Outpatient Activity exceeded 120,000.
  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 Halifax 8/05/08
  Financials

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• Ad Valorem Tax Revenue

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Ad Valorem Tax Revenue

• Halifax Medical Center approved Ad Valorem
  Taxing District revenues for 2008-9 is 41.6
  million. Halifax reports these revenues are used
  to provide Indigent Care.
• 
  Source of data
  Florida House Bill HB 1457

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Ad Valorem Tax Revenue

• District Ad Valorem Tax Revenues can be used
  for
• Debt Service Payment on Notes Bonds
• Expenses of Operation
• Maintenance
• Construction Repairs
• 
  Source of data Florida House Bill HB 1457

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• (Continued)
• Payment of indebtedness
• District expenses
• Downtown redevelopment District fees
• Tax collector fees.
• 
  Source of data Florida
  House Bill HB 1457

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Ad Valorem Tax Revenue

• Halifax Medical Center Taxing District Ad
  Valorem revenue is not the only source of revenue
  to pay for Indigent /Emergency Care.

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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.

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Halifax Health Ad Valorem Tax Revenue

• 2003 23.6 Mil.
• 2004 25.5 Mil.
• 2005 37.6 Mil.
• 2006 45.6 Mil.
• 2007 52.7 Mil.
• 2008 52.8 Mil.
• 2009 41.6 Mil.
• Source of data
  Halifax Health

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Ad Valorem Tax Revenue

• From 2003 to 2008
• Halifax Health Ad Valorem Tax Revenue increased
  224
• CPI increased 14.4 (2003 to 2007)
• Source of
  data Halifax 2006 Bonding Data Halifax Health

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2003-08 Ad Valorem Tax Revenue
Systemic Flawed Model
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Counties of Comparable Size- 2006 Per Capita
Property Tax for Indigent Care

• Volusia 131.00
• Lee 6.00
• Pasco 11.00
• Flagler 10.00
• Brevard 10.00

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2008--09 Special Hospital Taxing District Gross
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

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Ad Valorem Tax Revenue

• 2008-09 Halifax Health Ad Valorem Tax Revenue
  41.6 Million.
• For 2008-9 Halifax millage is 2.25 mills
  184.80 per (special taxing district) capita.
• Source of
  data December2, 2007 News Journal Halifax
  2008-09 Budget

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• Halifax Waste

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Halifax Waste

• Halifax Marketing expense are about twice what
  hospitals nationwide spend on average. Approx.
  1.1 of Gross Revenue.
• Halifax Spent about 1 million for TV
  advertisements
• 275,000 in salary for a chief marketing officer,
  twice what similar hospitals spend
• 40,000 signing bonus
• 127, 000 moving expense
• 101,666 severance
• 60,000 Country Club Membership
• 45,000 Butterfly Logo
• 
  
  Source of data The news Journal December 2, 2007.

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Halifax Waste

• 15 plus million for 220 acres of land on LPGA
  Blvd. (TNJ 1/04/08)
• Federal Medicare administrative costs are less
  than 2.0 of gross revenue.
• 
  ( Source of data TNJ July 1, 2008)
• In 2007 Halifax administrative cost exceeds 15
  of Gross Revenue.
• (2007 Deloitte Independent Audit Report)

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Halifax Waste

• 350,051.00 Tower Ground Breaking Ceremony. (
  Halifax internal Memorandum dated July 12, 2007)
• Halifax Appears to be in violation of Florida
  Code of Ethics. Will File a Form 50 with
  Commission on Ethics.
• Due to Halifax Medicare errors over-billing
  discovered as part of U.S. RAC Audit Program,
  Halifax was required to refund Medicade
  3,867,455.10.
• 
  (Halifax letter dated May 12 June 13, 2008)

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• Access to Cost of Health Care

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Access to Health Care

• For Humana Choice PPO HMO and Blue Cross Blue
  Shield Advantage Medicare Plans participants
  (approximately 35, 000 plan members in the
  Halifax Taxing District) Halifax is considered a
  Out of Network provider because Halifax
  Humana BC/BS can not agree to fee for services.
• 
  Source of data Humana, BC/BS
  Halifax Health

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Cost of Health Care

• Florida Ormond Memorial is the In Network
  Provider for these Medicare Plan Participants.
• With Insurance A Out of Network stay at Halifax
  will cost the patient 750.00 per day compared to
  Ormond Memorial In Network cost of 500.00
  regardless of length of stay.

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Cost of Health Care

• Medicare (HUMANA BC/BS) Plan Participants
  living in the Halifax Special Taxing District
  Paying Ad Valorem Property Taxes, to support the
  Hospital they own, can not utilize Halifax
  Hospital with out paying Out of Network
  charges.

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Cost of Health Care

• Additionally cost of Hospital services ONLY
  (Patient W/O insurance) depend on family size,
  patient net worth income level and vary
  significantly between Halifax Ormond Memorial.
• 
  Source of data Halifax
  Ormond Memorial Procedures.

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• HALIFAX HEALTH
• FINANCIAL REVIEW

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Halifax Health 2008 Uses of Tax Dollars.

• 2008 Gross Ad Valorem Property Tax
  52,720,269
• Less
• Discounts Uncollectible Tax
  (1,845,216)
• Tax Collection Appraiser Comm.
  (1,484,530)
• Volusia County Medicare Assessment
  (2,079,000)
• Redevelopment Taxes paid to Cities
  (3,333,356)
• TOTAL DEDUCTIONS
  (8,742,102)
• 2008 Net Ad Valorem Property Tax to Halifax
  43,978,166
• 
  
  Sources of Data Halifax Health

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Halifax 2007 Waste

• Interest on LPGA /Williamson property
  1,000,000
• US Government RAC Audit
  3,867,455
• TV Advertising Costs
  2,000,000
• Chief Marketing Officer
  563,000
• Butterfly Logo
  45,000
• Tower Project Groundbreaking
  350,000
• Excess Physicians Salaries (MGMA-95)
  2,061,796
• Senior Executive Excess Benefit Plan
  773,000
• Annual Car allowance for 19 Employees
  151,200
• TOTAL
  10,811,451
• 
  
  Source of Data Halifax
  Health , MGMAlt TNJ

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Halifax 2007 Profit Reconciliation

• Halifax Health 2006-7 Pre Tax Profit
  59,228,000
• Less
• 2006-7 Net Ad Valorem Property Tax
  (43,978,166)
• 2007 Pre Tax Profit W/O Ad Valorem Tax
  15,249,834
• 
  Source of data
  Halifax Health Fiscal 2008-09 Preliminary
  Operating Budget

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2004 to 2007 Halifax Gains W/O Ad Valorem
Property Tax-()Millions Sources of data 2008-9
Halifax preliminary budget
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Halifax 2004-07 Profit Reconciliation

• Halifax Cumulative Excess (Deficiency) of Revenue
  and Gains Over Expenses and Losses including Ad
  Valorem Property Tax 192,180,000
• Halifax Cumulative Net Ad Valorem Revenue (tax)
  132,841,000
• Halifax Gains W/O Ad Valorem Tax Revenue
  59,339,000
• Sources of data Halifax 2008-09
  Budget Preliminary Operating Budget

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With Out Ad Valorem Taxes--Cumulative 4 Year Tax
District Savings

• 161,540,000

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Use of Funds !!!

• Reduced Property Taxes
• City Infrastructure
• After School / Summer Programs
• Homeless Programs
• Additional Police
• Attracting New Businesses
• Drug rehabilitation
• ECT

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• Halifax Board of Directors Fiduciary
  Responsibility

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Fiduciary Responsibility

• The Halifax Board of Directors has a fiduciary
  responsibility to the citizens of the taxing
  district 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

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• The Governor Appointed Halifax Health Board of
  Commissioners has failed the citizens they were
  appointed to serve , when they

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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
  224 over five years while CPI increased 14.4

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Fiduciary Responsibility ?

• Approved 15 million purchase of land on
  LPGAApprox. 1 mill. annual Interest
• Approved Excessive Employment Agreement for
  Physicians Executives while reducing Nurses
  Compensation.
• 2007 Approved 773,383 for 3 Senior Executive
  Retirement Benefit Plans for 12 Senior
  Executives.

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Fiduciary Responsibility ?

• Approve Indigent care costs of 131 per capita
  13 times comparable counties.
• Failed to Implement 1993 Volusia County Indigent
  Care Study.

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Fiduciary Responsibility ?

• Approved construction of 200 million Tower
  Project creating the largest ER in Florida
  without addressing 87 of the ER patients that
  could have been treated in a less costly manner

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Fiduciary Responsibility ?

• Deny 35,000 Volusia County Residents Medicare
  patients in network fees because Halifax can
  not agree on fee for Service costs with Humana
  Blue Cross/Blue Shield.

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Faduciary Responsibility

• For 2008-09 approved a 2.25 mil. Ad Valorem tax
  on all taxable property within the taxing
  district.
• 41.6 Million 184.40 per capita
• 2.5 Greater than West Volusia
• Second highest in Florida

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• Legislative / Citizens Action ???

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Legislative Citizens Actions

• Citizens/Taxpayers have no input or oversight
  over the Halifax Special Taxing District.
• Governor Appointed Political Patronage Board of
  Directors
• Florida Statute 189.428 Special District
  Oversight, Review Process Excludes Health Special
  Districts.
• Florida Statutes 189.4051 189.408
  Referenda-Special Districts applies to Special
  Districts with elected Board of Directors
  excludes Governor appointed Board of Directors.

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Citizens Initiatives

• U.S Supreme Florida Court has ruled in numerous
  cases that taxation must be proportionate to
  representation

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Legislative Citizens Actions

• 2009 Florida Legislature to introduce / pass
  legislation to make all Florida Special District
  Boards with taxing authority elected.
• Failing to make Halifax Special Taxing District
  Board elected pursue legal action to make
  taxation proportionate to representation.
• Referendum to reduce Halifax Special Taxing
  District Ad Valorem Millage Rate form 4 mills to
  .25 mills.