This page is a living document containing issue information related to the North Lake County Hospital District. Created Jan. 14, 2009 and we will note updates here as we add them. If any reader has new facts to provide an objective overview, I will verify and add them. You can post comments to this document and I will add them to this document after review, if warranted. vj
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MOST RECENT updates are at top - to see an overview of the District and issues, start at the bottom of this document. Especially read the Jan 20 entries with a link to my blog entry on what happened at the Jan. 20 meeting. North Lake County property taxpayers need to monitor this situation because it costs them quite a bit of money. vj
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Updated August 24, 2009: The next Board meeting will be Sept. 10th at the County Commission offices (round building) in Tavares on Main Street. Marilyn Bainter was successful in moving the meeting location to this bigger facility. This meeting is NOT advertised according to the Board's CPA because they consider the meeting notice date in taxpayer's "trim notice" to be sufficient notice. We will post more details here soon. We also plan to rewrite the information below to provide a fresh overview of the issues. Last month Marilyn Bainter asked the County Republican Executive Committee (REC) to vote on a resolution to ask the County legislators to eliminate the Hospital District tax completely since the District Board had resisted all attempts to modify the existing law to allow setting the millage tax rate BETWEEN 0 and 1 mill, in comparison to the current 1 mill (always passed) or nothing. However, the Hospitals sent numerous supporters to the REC meeting and lobbied the uneducated enough so they didn't understand the issues and voted against the proposed resolution. Today I called both the District's retained attorney and the CPA. The CPA talked to me, but the attorney never returned the call. Maybe tomorrow? vj
vj
Update: April 9, 2009: The Orlando Sentinel published an article on Marilyn Bainter and the North Lake County Hospital District, including a brief quote from us. We wrote a blog entry HERE commenting on the article and provided info on issues not included in the newspaper's article. To see a clear list of all postings on this blog about the District, go to the right column and select "North Lake County Hospital District" which pulls up all the articles. Additionally, Marilyn Bainter provided us with a link to a Federal GAO investigation of non-profit hospitals, which is HERE (this link DOWNLOADS a pdf of the report, it does not open a webpage). Below is an interesting quote from that GAO report - basically, the Hospital and staff receive all sorts of benefits by being non-profit, including exclusion from income tax, property tax, etc. Thus, if they already benefit so much, why should the local taxpayers be taxed 1-mill MORE to provide them additional internal profits?
Update Feb. 16, 2009 - See our blog entry for this date. A public hearing in Tallahasee about our recommended changing of the allowable mill rate in the North Lake Hospital District law was canceled. Marilyn Bainter requests that all taxpayers interested in more transparency over the District tax collections and spending should call their legislator and ask for their stance on the change, and for notification when the public hearing will be held. Canceling public hearings is an old trick by paid lobbyists to wear out activists, and it should not be allowed to succeed. CLICK here to see the blog entry.
Update Feb. 12, 2009 - Regarding the separate issue of HB573 and "Health Facilities Authorities", Marilyn Bainter tracked down the "mystery" Health Facility Authority in Lake County, and it is organized under the City of Mt. Dora, and HERE is the webpage. There may not be a relationship to the Hospital District, but we are researching it. AND, HERE is an article in the Orlando Business Journal how the Adventist Hospital System is using "Health Facility Authority" methods in Orange County, and several cities to apparently float bonds to build hospitals, including Florida Hospital Orlando (which Waterman is a part of) . This gets interesting since O'Toole's bill apparently expands the definition of what the Health Facility Authorities can be used to finance (hospices, etc., rather than standard hospitals). Maybe this is nothing, but we will see. vj
Update Feb. 11, 2009 - 1) Watch for a Sentinel article by Christine Show about the North Lake Hospital District. She has talked to me, Marilyn Bainter and is trying to get some of the Board members to return calls (gee, I wonder why they won't call back...?) 2) I received the following info from Marilyn Bainter regarding HB573 that I discussed below on Feb. 2's update:
Vance, I am very suspicious of this bill. There is more to it than meets the eye if you will read F.S. 154.207. I called and haven’t gotten any answers yet. Who is expected to pay off these bonds? How much profit is there from hospice? If it sounds too good there is something wrong.
Later: I am more suspicious than ever about
this bill. Josh, in Marlene O’Toole’s office, told me we had a Health Care Facility in Mt. Dora.
Update Feb. 10, 2009 - I talked to a local elected official about the hospital district and he pointed out another issue - Leesburg Hospital, which receives over $5-million of the Hospital tax revenues, has a Villages hospital right on the county border, and apparently is building another also on the border next to Sumter County. It seems Lake County has a hospital district property tax on North Lake properties, but Sumter does not, which is where most of the new Villages homes are being built. So, any benefit to Leesburg Hospital customers from Sumter County that is provided by the Lake Property taxes will be shared with Sumter residents, who have no such Hospital tax. Thus Lake residents may be subsidizing hospital care for Villages residents in Sumter County. This is another possible issue that needs verification and investigation.
Update Feb 5, 2009 - At the last Board meeting, the issue came up about finding a larger facility, and here is an update email from the Board's CPA firm:
Subject: North Lake County
Hospital District meeting times and place
The County has stated that while the District could use the Commission chambers, since we meet after 5 P.M., there will be a $40/hour charge. Furthermore, the dates the Board set for its TRIM meetings (Sept 9th and 16th) are not available. I will investigate some other venues in the Tavares area such as the Ag Center and Tavares Chamber of Commerce to see if the District could rent those facilities for its meetings and have the use on the two September dates. Will keep you advised. We can change the Sept dates if need be as they were announced in January only so everyone could mark his/her calendar.
Patricia
A Sykes-Amos, CPA
Greenlee, Kurras, Rice & Brown PA
CPA’s
Update Feb. 4th - I revised my analysis of the Feb. 2 entry below regarding HB573. I also added detailed contact info for the NLCHD Board members at the bottom of this document (received from Marilyn Bainter).
Update Feb 2, 2009 - Florida Rep Marlene O'Toole (Villages area) filed a bill on the same day that the Hospital District Board met, Jan. 20 Initially, we thought it would affect usage of NLCHD funds, but see our analysis below where it seems it does not (added Feb. 4). The bill is HB573 , LOCATED HERE, and says this:
GENERAL BILL by O'Toole
Health Facilities: Redefines term "health facility" for purpose of allowing additional types of health facilities to receive assistance from a health facilities authority.
Effective Date: upon becoming a law
Last Event: Filed on Tuesday, January 20, 2009 4:08 PM
The full text of the proposed HB573 changes is HERE (Note: The text pages won't open in Firefox browsers, only Internet Explorer).
Analysis: Updated Feb. 4, 2009 - I talked to Rep. O'Toole's legislative assistant, Josh Blake about this. He says this bill has no relationship to the North Lake County Hospital District. It affects uses of funds raised through bonds by "health facility authorities" that are not the same as tax districts. The Authorities are bond raising entities in 23 counties and the redefinition allows added facilities, like hospices, to obtain funding through this type of financing entity. However, he could not say who requested the law. He also said there IS a Lake County "Health Facility Authority" but could not say who they were or whether they planned on using this financing method. Since this apparently doesn't affect taxes or the NLCHD, I consider this not to be a relevant issue. vj - Feb. 4, 2009
Update Jan 20, 2009 - We posted a report in the blog section dated Jan. 20, 2009 describing the results of the Board meeting. CLICK HERE to READ IT. It contains a very descriptive identification of the lack of cooperation by the Board regarding spending transparency. Here is a picture.
Update Jan 20, 2009
I wrote an overview of the issues that might be discussed at the Board meeting:
Download 2009-01-20 Discussion Issues Regarding North Lake County Hospital District
Update Jan 16, 2009 - I received call back from District's accountant, Patricia Sykes, and posted answers to my questions at bottom of this document, plus added another issue on rate calculations.
Update Jan. 15, 2009: There will be a semi-annual meeting of this District on January 20, 2009 - details are below, and readers are encouraged to attend. The board meets at 6pm on 20th of Jan at Lake County Water Authority (LCWA) office in Tavares at 107 No. Lake Ave. at Main St. - about two blocks from HWY 19 and Main. Marilyn asks voters to attend to show support for some changes needed.vj Readers can call Marilyn Bainter for more info at 483-0770.
This topic was first covered on the local WLBE 790am Radio Show Featuring Ralph Smith & Fred Johnson, plus we have met Marilyn Bainter for additional info. vj
North Lake County Hospital Property Tax District - Where does the $12-million in Tax Collections Go?
Marilyn Bainter called to the radio show on Jan. 14, 2009 about the North Lake County Hospital Taxation District (NLCHD). District is a 1 mill property tax on North Lake County property to provide funds to the two local hospitals, Leesburg & Florida Hospital/Waterman. Thus, an owner of a $400,000 valued house would pay $1 (i.e. 1 mill) per $1000 valuation, or $400. Someone with a business property valued at $2-million would pay a tax of $2000 to be paid to the hospitals.
Here is the most recent 2004 Bill HB 1609 that expanded the District to Florida Hospital/Waternman.
Marilyn was just elected to the Board and received 43,402 votes vs Carpenter got 30,875. She is aiming to identify where the funds go and reduce the tax.
According to Marilyn Bainter: Two board members were appointed to fill unexpired terms (Bowersox and Talley). Gaylord was elected by default. 1 new member (Beyers) was elected by default. Ken Carpenter and Marilyn Bainter are the first (real) elected members in contested elections in the last 18 years. The names appeared on the ballot so the voters could vote. It was a 3 person race with the incumbent Richard Paul being defeated.
The Board meets annually in January to elect officers and has 2 public tax hearings in September. The tax is already set at 1 mill so it is a very uneventful.
Wording in the District formation legislation is VAGUE, thus doesn't clearly specify purposes of the funds and how they are to be used.
The tax was originally created many years ago to help build Leesburg hospital, then expanded to include Florida Hospital/Waterman.
The District formation law set property tax at 1 mill, according to the existing District Board. They say they don't have authority to reduce it.
We are 1 of only 10 counties with such a property tax out of 67 counties in Florida. Thus 57 counties do not have such a hospital tax district. Doesn't exist in any of the surrounding counties. Not in OC, Osceola, Sumter, etc. You can see a list of Florida Districts HERE (This list may not be complete) or, HERE is a BETTER list of Special Districts.
The board meets at 6pm on 20th of Jan at Lake County Water Authority (LCWA) office in Tavares at 107 No. Lake Ave. at Main St. - about two blocks from HWY 19 and Main. Marilyn asks voters to attend to show support for some changes needed. (see my comments below - vj).
Legislation is very vague about how money is to be used. It just says funds are to be used for “continuous hospital services”. The hospital representatives will say it is for indigent care, but wording is too vague, and they cannot provide proof because according to Marilyn Bainter, neither hospital has separate accounting records or checking accounts for NLCHD tax proceeds, thus there is no audit trail. Thus voters don't know what the funds are being spent for. Anything said by the hospitals is hearsay.
Frank Gaylord is the Chair of the District.
Is Current Tax Rate Millage rate of 1 mill Justified? - Fred says the hospitals made $28-million in profit last year, thus tax should be cut in half. "We need the taxpayers to ask County Commissioners to request State legislators to introduce legislation to allow modification of law to allow the District Board to reduce the tax.
Per Fred: I can't understand why the legislators don't take action. Carey Baker, Alan Hays, Marlene O'Toole are our primary legislators.
Fiscal Ranger comments about the Hospital District
I was at a recent meeting with Marilyn Bainter regarding the Hospital District, and these items were not covered in the notes above.
- Commingling of Tax Funds and Lack of Evidence to Explain What the Tax funds were spent on: Marilyn and some other activists have been unable to get the hospitals to provide financial records showing where the $10+ million in funds are going. The hospitals are collecting their checks from the County (over $5-million for each hospital) and commingling the funds in a general checking account, so there is no audit trail. This needs to be changed and the board or citizens need to request an a Florida State Auditor General (AG) audit of where the funds went. Such requests have to go to legislators, who then make the request to the AG. This is another area where you can tell whether the legislators are supportive of Bainter's efforts for transparency. If they balk at this, it indicates they are backing the Hospitals rather than the voters.
- Is Legislation Needed to Allow Reduction of the 1 mill Tax? - The definition of whether the current Hospital District Board has the right to modify or reduce the 1 mill tax to a lower amount needs official State review. Hospital supporters claim the formation law says only 1 mill can be taxed, and the District Board does not have the right to reduce it. They can vote for NO tax, but not anything in between.
- Referendum needed to Approve Continued Taxation:
Currently, the voters have no say in approving the 1 mill tax. The
District's Board has the power. There needs to be a referendum to see
if voters really want the tax when according to Marilyn Bainter, both
"non-profit" hospitals in North Lake County (Leesburg Hospital &
Florida Hospital/Waterman) earned "profits" totaling $28.4-million in
2008. The original reasons for the tax, which were to help build
Leesburg's Hospital, seem to not exist anymore. You can see the 2004 legislation HERE
that defined that the funds are for "health care" without any more
specifics. However, according to Marilyn, the official stated purpose
is “continuous hospital
services”, which is also vague.
- Possible Illegal Tax of North EAST Lake County - The tax district was originally created through a voter referendum for North West Lake County and Leesburg Hospital. Then later, the North East had a District but never voted on a tax, was combined with the North West District and the residents of North East Lake County were subject to the tax without any referendum. The State Attorney General needs to issue a ruling on this issue. It may be possible that the North East residents have been taxed illegally if state law says that they should have been able to vote on the taxation, and they never had the chance to vote on it.
- NEW 1/16/09: Review needed of costing system used to calculate "indigent" or other charges offset by District funds. Are the charges calculated using the same rates used for Medicare or Insured patients, or are they higher "retail" hospital rates or are higher overhead charges allocated to the District funded invoices? The board is responsible to ensure that the district is not reimbursing the hospital at higher rates than normal paying customers.
- Legislative hearings & New "Local Ruling" Legislation Needed to Allow Hospital District Board to Reduce District's tax millage rate - At a recent hearing I attended that was held by five Lake County based State representatives for local officials and citizens, Marilyn Bainter asked them to initiate a local law to allow the District to reduce the tax millage rate. State Senator Carey Baker chaired the meeting, and pushed off public input from Marilyn and others until the end of the meeting and all reporters had left. None of the legislators committed to initiate the requested legislation. Magically, someone had warned the two hospitals to send representatives and they were allowed to talk, but anything they said could not be proved since there are no direct audit trails to show where the spending was made. Note: It is possible that Ocala area State Rep. Charles E. Van Zant may be initiating this - I have a call in to his office.
- Need to Request A District "Special Meeting" - Due to the sunshine laws, these issues cannot be added to the agenda of the Jan. 20 Board meeting. The board only meets twice a year, so Marilyn plans to request another "special meeting" in one month to have these items on the agenda. Attendance at the Jan. 20 meeting is important so the Board knows there is support for another meeting.
- Need for a Visible District Website with More Documentation - Until now, the District has operated invisibly to the voter. They need a website with all information on it, including meeting agendas, minutes, meeting calendars, financial statements, audit reports, budgets, check register, contacts, background and affiliations of all board members (most were appointed and not elected). Financial records should include both expenses of the Board, as well as those from both Hospitals. All tax revenues should have an audit trail over where they were spent.
- Efforts to Recover Expenditures - The Hospitals say that funding was needed for indigent care. However, what controls exist to ensure the hospitals DO initiate collection actions to recover the expenses. Or are they just passing off the costs to the District without any collection efforts?
- Legislation Defining Indigent Care Costs to be Absorbed by Non-profit Hospitals - I am sure there is legislation that says the hospitals must provide care without consideration of ability to pay. However, why can the hospitals in 57 counties absorb the cost, but not the local hospitals - instead expecting the Lake County residents to pay for a service not required of residents in other counties? If the hospitals are non-profits, why do they show a profit - what are the profits being used for? Waterman hospital is part of a much larger hospital chain, and are local taxes being used for Waterman & LRMC's big advertising programs?
Actions Planned by FiscalRangers - we stand for transparency in government spending, and there isn't any related to this District. There is no website and Marilyn Bainter has not been able to obtain adequate documentation for how the District funds are spent.
1. Attend the Jan 20 meeting and future meetings.
2. Contact all the related State legislators and get their stand on the proposed legislation that would allow a variable rate, AND requesting an Attorney General opinion on a) Whether the Board, using existing legislation, can reduce the tax, and 2) Whether the NorthEast residences are being taxed illegally.
3. Request evidence to support an audit trail of the spending, and continue until it is provided.
4. Establish a separate "page" on this blog just for the North Lake Hospital district (by this weekend) - there is NO website for the District.
5. Send out press releases to the press to encourage coverage at the meetings and in articles.
6. Support Marilyn Bainter in her actions to achieve transparency, public choice on the millage rate, better expense documentation and reform for the District.
vj
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Background Information:
Contact for District (accounting firm) - Patricia Sykes-Amos 352-383-6300 Mt. Dora
Questions of Sykes-Amos: Based upon our discussion 1/16/09 - vj
- What is website -is there one?? No - no website
- Get copy of agenda - attorney will send me one
- Roster of officers, contacts and affiliations - Patricia will send me one and I will post it on the page for this issue.
- Contacts for two hospitals receiving funds (or are there more?) - Will get that also
- Obtain copy of audited financial statement - They are available at 15 cents per page - I will look at Marilyn Bainter's copy.
- Fees - District minimizes costs so more is passed through to hospitals, thus no website or office, etc. A major fee is the 2% processing fee charged by Ed Havill's office for processing the taxes (need to clarify this, I would think it would be tax collector, not assessor).
- Lifestream receives payments also from District. Each hospital pays 5% of collections to Lifestream. No info on what this is used for.
- Discuss issue of commingling - The two hospitals don't
provide direct audit trail - they have audit reports supplied to
District Board that verify that more is spent on "charity" or indigent
care than they receive from District. Thus, hospitals have no
incentive to control such spending, and no research to ensure they are
taking any collection actions against recipients of care.
- Any legal analysis of addition of North East Lake County into
District without referendum? - The districts were combined in 1991 and
changed from "dependent" status where County maintained books, etc. to
"independent" status where the District pays the accounting firm for
services. No physical office or website is used.
- Better details on what funds are actually spent on... We would have to examine the hospital record keeping and walk through their system. A big issue to me is that getting $5-million plus without any service requirements, etc. means the hospitals can use it without any business controls. They could be allocating full rack (retail) rates and excess overhead to each case to pay for expensive machines, etc. and the taxpayer is absorbing the cost. I would want to confirm that medical service charges to the program were the same as those negotiated with private insurance plans.
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This contact list is from Marilyn Bainter:
William Bowersox work (787-3202)
Term ends 2010;
505 W. Gibson Street,
Leesburg, FL 34748
Frank Gaylord, Chairman work
(589-1731) Term ends 2010;
PO Drawer
2047,
Eustis, FL 32727
PO Box 490817
Leesburg, FL 34748
Kenneth W. Carpenter, Vice-Chairman,
(589-7579) Term ends 2012 kencarpenter@unitedsouthernbank.com
1504 Fahnstock Street
Eustis, FL 32726
Roger A. Beyers, Secretary,
(787-4343) Term ends 2012
1307 S. 9th Street
Leesburg, FL 34748
Marilyn Bainter (483-0770) Term
ends 2012
36811 N.
CR44A
Eustis, FL 32736
DaleHocking@LeesburgRegional.com
cdozier@lsbc.net
Fran.crunk@ahss.org
mmkirste@earthlink.net
Patricia
A Sykes-Amos, CPA - CPA for the Board
Greenlee, Kurras, Rice & Brown PA
CPA’s
PO
Box 8
Mount Dora, FL 32756
TEL: 
352 383-6300
FAX: 352 383-6356
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