Resolution 2025-189 RESOLUTION NO. 2025- 1 89
RESOLUTION OF THE 13OARI) OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA,TO AUTHORIZE COLLIER COUNTY
EMS TO PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS
WITH THE STATE OF FLORIDA AGENCY FOR HEALTH CARE
ADMINISTRATION AND THE SUPPLEMENTAL PAYMENT
PROGRAM FOR MEDICAID MANAGED CARE PATIENTS;
AUTHORIZING THE CHAIRMAN TO EXECUTE ALL REQUIRED
AGREEMENTS OR DOCUMENTS TO PARTICIPATE IN
INTERGOVERNMENTAL TRANSFERS AND THE SUPPLEMNTAL
PAYMENT PROGRAM FOR MEDICAID MANAGED CARE
PATIENTS SUBJECT TO BOARD RATIFICATION.
WHEREAS, Collier County provides emergency ambulance transportation services
throughout Collier County; and
WHEREAS, the State of Florida has created a supplemental payment program for
Medicaid managed care patients who arc transported to the hospital by public emergency
medical transportation providers and has appropriated an additional $54 million for this
program: and
WHEREAS, Collier County EMS transports more than 1,500 Medicaid managed care
patients annually to hospitals and receives approximately$163 per patient for this service; and
WHEREAS, by participating in the supplemental payment program for Medicaid
managed care patients, Collier County EMS can substantially increase its Medicaid managed
care patient transport revenue and provide better services to the community,
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
1. Authorizes Collier County EMS to participate in intergovernmental transfers
with the State of Florida Agency Health Care Administration and the supplemental payment
program for Medicaid managed care patients.
2. Authorizes the Collier County Chairman to execute any and all agreements or
documents necessary for Collier County EMS to participate in intergovernmental transfers or
the Medicaid managed care supplemental payment program subject to ratification by this Board.
'['his Resolution adopted on this 23"i day of September 2025 after motion, second and
majority vote favoring adopt ion.
ATTEST: B.000 BOARD OF COUNTY COMMISSIONERS
CRYST k- KINZEL9,4CLERK COLLIER COUNTY, FLORIDA
•
,
_Wr0141•04.--
,e +ity Clerk
Aftest as.to•Ch'alykan's Burt Saunders, Chairman
sign-ature nwy
Approved as to form and
legal sufficiency:
. .
RI(Je rey A, Klatzkow, County Attorney (LID
(4/16/76-
:
Letter of Agreement Amendment
This Amendment is made to the 2024-2025 Public Emergency Medical Transportation Letter
of Agreement previously executed by and between the Collier County (the"IGT Provider") on
behalf of Collier County EMS and the Agency for Health Care Administration, with an effective
date of 9/24/2024.
It is mutually understood and agreed upon by and between the undersigned contracting parties
to amend the previously executed Agreement dated December 2, 2024, as follows:
General Provisions
Deleted: 7. This LOA covers the period of July 1, 2024, through June 30, 2025, and shall be
terminated September 30, 2025, which includes the states certified forward period.
Inserted: 7. This LOA covers the period of July 1, 2024, through June 30, 2026, and shall be
terminated September 30, 2026, which includes the states certified forward period.
All provisions not in conflict with this amendment remain in effect. This amendment is hereby
made a part of the Letter of Agreement.
COLLIER COUNTY STATE OF FLORIDA,AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: Aff,4%..."40(4411.44- BY:
Burt Saunders, Chairman NAME: Stephanie Scanlon
TITLE: Chief of Medicaid Program
/ Finance
DATE: IP-3 /25 DATE:
ATTEST:
CRYSTAL I': ' L ERK
�. . / 1 .
i 'aeputy Cler
Attest as to Chairman's
Signature only
CM)
Public Emergency Medical Transportation Letter of Agreement
tci
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the ,-r
day of 504', 2025, by and between Collier County (the"IGT Provider") on behalf of Collier
County EMS, and the State of Florida, Agency for Health Care Administration (the
"Agency"), for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local
government) to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
"Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act,
Laws of Florida 2025-198 is the program that provides supplemental payments for eligible Public
Emergency Medical Transportation (PEMT)entities that meet specified requirements and provide
emergency medical transportation services to Medicaid beneficiaries.
A. GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2025-2026,
passed by the 2025 Florida Legislature, the IGT Provider and the Agency agree that the
IGT Provider will remit IGT funds to the Agency in an amount not to exceed the total of
$708,054.21.The IGT Provider and the Agency have agreed that these IGT funds will only
be used for the PEMT program.
2. The IGT Provider will return the signed LOA to the Agency.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of$708,054.21. The IGT Provider will transfer payments to the Agency in the following
manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2025
through June 2025 are due to the Agency no later than October 31, 2025, unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due.
4. The IGT Provider and the Agency agree that the Agency will maintain necessary records
and supporting documentation applicable to health services covered by this LOA in
accordance with public records laws and established retention schedules.
a. AUDITS AND RECORDS
Collier County_Collier County EMS_PEM LOA_SFY 2025-26
CAO
i. The IGT Provider agrees to maintain books, records, and documents (including
electronic storage media) pertinent to performance under this LOA in accordance
with generally accepted accounting procedures and practices, which sufficiently
and properly reflect all revenues and expenditures of funds provided.
ii. The IGT Provider agrees to assure that these records shall be subject at all
reasonable times to inspection, review, or audit by state personnel and other
personnel duly authorized by the Agency, as well as by federal personnel.
iii. The IGT Provider agrees to comply with public record laws as outlined in section
119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The IGT Provider agrees to retain all financial records, supporting documents,
statistical records, and any other documents (including electronic storage media)
pertinent to performance under this LOA for a period of six (6) years after
termination of this LOA, or if an audit has been initiated and audit findings have not
been resolved at the end of six (6) years, the records shall be retained until
resolution of the audit findings.
ii. Persons duly authorized by the Agency and federal auditors shall have full access
to and the right to examine any of said records and documents.
iii. The rights of access in this section must not be limited to the required retention
period but shall last as long as the records are retained.
c. MONITORING
i. The IGT Provider agrees to permit persons duly authorized by the Agency to inspect
any records, papers, and documents of the IGT Provider which are relevant to this
LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The IGT Provider agrees to neither assign the responsibility of this LOA to another
party nor subcontract for any of the work contemplated under this LOA without prior
written approval of the Agency. No such approval by the Agency of any assignment
or subcontract shall be deemed in any event or in any manner to provide for the
incurrence of any obligation of the Agency in addition to the total dollar amount
agreed upon in this LOA. All such assignments or subcontracts shall be subject to
the conditions of this LOA and to any conditions of approval that the Agency shall
deem necessary.
5. This LOA may only be amended upon written agreement signed by both parties.
The IGT Provider and the Agency agree that any modifications to this LOA shall be in the
same form, namely the exchange of signed copies of a revised LOA.
6. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
Collier County_Collier County EMS_PEM LOA SFY 2025-26
CAC)
direct any portion of these aforementioned supplemental payments in order to satisfy non-
Medicaid, non-uninsured, and non-underinsured activities.
7. The IGT Provider agrees the following provision shall be included in any agreements
between IGT Provider and local providers where IGT funding is provided pursuant to this
LOA. Funding provided in this agreement shall be prioritized so that designated IGT
funding shall first be used to fund the Medicaid program and used secondarily for other
purposes.
8. This LOA covers the period of July 1, 2025, through June 30, 2025, and shall be
terminated September 30, 2026, which includes the state's certified forward period.
9. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at least one
counterpart.
PEMT Local Intergovernmental Transfers
Program 1 Amount State Fiscal Year 2025-2026
Estimated IGTs $708,054.21
Total Funding Not to Exceed $708,054.21
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
COLLIER COUNTY STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: Ar4,,f:.0,4ClgslgpkoAZ-- BY:
Burt Saunders, Chairman NAME: Stephanie Scanlon
TITLE: Chief of Medicaid Program
Finance
DATE: //23 Z S DATE:
AT;i'ES o '
YSTAL K.- I . rL, ERK
eputy Clerk
Attest as le Cttgirman's
sio'i`N'tgf -only
Collier County_Collier County EMS_PEM LOA_SFY 2025-26
Goo;
SFY 2025-26 PEMT MCO Allotments
Medicaid s Net New Federal
Number Provider Region Total Allotment Total IGTs Needed Funding
000683100 Marion County Fire Rescue B $ 8.755.918.21 $ 3,745,781.81 $ 5,010,136.40
125443300 City of Femardna Beach Fire Dept B 5 52.392.55 S 22.413.53 S 29,979.02
003458200 Winter Park Fire-Rescue E 5 274,811.41 S 117,564.32 $ 157,247.09
003655700 Orlando Fire Department E , 4,447,628.73 $ 1,902,695.57 S 2,544,933.16
003997800 Coolly ofValusia B 7.138.485.27 $ 3,053,844.00 $ 4,084,641.27
008855600 City of Ocoee Fire Department E $ 934.458.60 5 399,761.39 S 534,697.21
124356900 Bay County EMS Division A 5 2.360.783,46 S 1,009,943.17 $ 1,350,840.29
014564900 _City of Key West Fire Department I S 238,261.37 S 101,928.21 5 136,333.16
017422000 Okafoosa County EMS A 5 3,793,969.26 $ 1,623,060.05 5 2,170,909.21
018248400 Palm Beach Gardens Fire Rescue G $ 541,514.45 S 231,659.88 $ 309,854.57
020395700 Defray Beach Fire Rescue G S 658.399.74 S 281,663.41 5 376,736.33
022548000 W City of Tampa Fke Department D $ 4.656.824 70 5 1,992,189.61 5 2,664,635.09
023813300 Walton County Fire Rescue A S 1,703,631.16 § 728,813.41 5 974,817.75
083899301 Miami-Dade Court,'Fire Rescue I 5 13.819.371.49 S 5,911,927.13 $ 7,907,444.36
083903500 Marlin County Fire Rescue G 3 1,040,366.40 5 445,068.75 $ 595,297.65
084438100 Klssinmee Fire Department E 5 1,595,727.45 S 682,652.21 S 913,075.24
084662700 Sarasota County Fire Department F 5 2.957.933.82 S 1,265,404,09 $ 1,692,529.73
084839500 Hendry County F 5 611.620.68 S 261,651.33 5 349,969.35
085063200 Pembroke Pines Fire Rescue H 5 1.634.772.38 S 699,355.62 $ 935,416.76
087475200 City of Miami Fre Rescue Department I 5 8,047,995.03 $ 3,442,932.27 $ 4,605,462.76
087678000 Pinellas County EMS Authority dha Su C 5 22.869.473.89 5 9,783,560.93 5 13,085,912.96
087736100 Monroe County Fre Rescue(MCFR) I $ 205.827.88 5 88,053.17 S 117,774.71
087867700 West Palm Beach Fee Rescue G 3 597.524.59 $ 255,621.02 $ 341,903,57
088015900 Poor County Board of County Commissi D S 11,664,079.10 5 4,989,893.04 S 6,674,186.06
110095100 Baker County Fire Rescue B $ 234.519.04 $ 100,327.25 $ 134.191.79
088022100 Lee County EMS F 5 6,350,601.08 S 2,716,787.14 S 3,633,813.94
088024800 Jackson County Fre Rescue A 5 1.308.940.60 5 559.964.79 $ 748,975.81
088030200 Manatee County Department of Public D 5 3,320,689.87 S 1,420,591.13 5 1,900,098.74
088031100 Hollywood Fire Rescue&Beach Safety H S 1,062,820,35 S 454.674.55 $ 608,145.80
088042600 Madison County A 5 679.731.00 S 290,788.92 $ 388,942.08
088046900 Okeechobee County Fire Rescue G 5 725,387.36 S 310,320.71 $ 415,066.65
088048500 North Port Fre Rescue F ,§ 684.346.53 S 292,763.45 S 391,583.08
088051500 Lew County Department of Public Sal B 5 1.137.417.36 5 486.587.15 $ 650,830.21
088053100 Hamilton County Ambulance Service B S 397.559.68 S 170.076.03 S 227,483.65
088061200 Jefferson County Ambulance Service A S 389.326.56 S 166,553.90 5 222,772.66
088065500 SI.Lune County Fire District G 5 6,396,631.68 5 2,736,479.03 S 3,660,152.65
088070100 City of Miramar Fire Rvr+w H 5 434,109.72 5 185,712.14 S 248,397.58�
c
088084100 Hiilsborou_h County Fire Rescue D S 8,095,647.31 S 3,463,317.92 S 4,632,329.39
088085000 Suwannee County Fire Rescue B 5 802.354 52 5 343.247.26 S 459,107.26
088086800 Nassau County Fie Rescue B 5 1,281,746.37 S 548,331.10 5 733,415.27
088087600 Flajer County Fire Rescue Departmen B $ 927,472.92 5 396,772.92 S 530,700.00
088100700 County of Desoto BCC-Desoto County F 5 336,809_27 S 144,087.00 5 192,722.27
088103100 Clay CBOCC•Clay County Fie Rescue B S 1.721.344.84 5 736,391.32 5 984,953.52
088104000 _City of Jackso cite Fie and Rescue B 5 12.975,015,61 5 5,550,711.68 5 7,424,303.93
_ 088105800 Wakolla County Fire Rescue A S 675.739.18 S 289,081.22 5 386,657.96
088120100 Pasco County Board of County Commiss C 5 9.869.384.70 5 4.222.122.77 5 5,647,261.93
111363700 Highlands County EMS D 5 1.587.120.11 5 678,969.98 5 908,150.13
088137600 Brevard County Fire Rescue E 5 3269,794.25 5 1,398,817.98 S 1,870,976.27
088173200 .dachua County Fre Rescue B 5 5.924.973.96 5 2,534,703.86 S 3,390,270.10
088175900 Dixie Coady BOCC-Di.ie County ES B 5 459.058.55 S 196,385.25 S 262,673.30
088224100 mdlat River County Department of Em G S 1.335.635,85 5 571.385.02 $ 764,250.83
088499500 St.Cloud Fire Rescue E S 760,315.73 5 325.263.07 3 435,052.66
088723400 union County Fire Rescue B § 472.530.93 S 202,148.73 S 270,382.20+
089085500 Osceola County Fre Dept E S 3,426,597.67 S 1,465,898.49 5 1,960,699.18
089269600 Temple Terrace Fire Department D S 556.483 75 5 238,063.75 S 318,420.00
089282300 City of Maroate H $ 527.168.87 S 225.522.84 $ 301,646.03
089707800 Collier County EMS Department F $ 1.655.105.68 S 708,054.21 S 947.051.47
089871600 Gilchrist County B S 549.872,31 5 235.235.38 $ 314,636.93
089925900 Charlotte County Fire&EMS Deparhne F 5 1,863,428.45 S 797,174.69 $ 1,066,253.76
099404900 Bradford County EMS B 5 1.042.112.82 S 445,815.86 $ 596,296.96
103181100 Lake Emer_ency Medical Services B S 4,057,304.21 S 1,735,714.74 $ 2,321,589.47
109865100 Gadsden County EMS A S 1.916.694.21 S 819.961.78 $ 1,096,732.43
110344600 Miami Beach Fire Rescue Department I $ 533,780.31 S 228,351.22 5 305,429.09
111179500 South Walton Fire District , A $ 483.258.92 $ 206,738.17 y,,,S 276,520.75
111779200 Wider Garden Fire Rescue Department E S 546,878.45 S 233,954.60 $ 312,923.85
112349200 Hernando County and Fire Rescue Dist B $ 5.383.085.28 $ 2,302,883.88 S 3,080,201.40
112679700 City of Coconut Creels-Fie Rescue H 5 216.056.91 S 92,429.14 $ 123,627.7,
113723400 City of Sunrise Fre Rescue H $ 1,304,948.79 5 558,257.09 $ 746,691.70
113731200 Plant City Fie Rescue D $ 778.403.64 5 333,001.08 $ 445,402.5.i
113842700 Citrus County Fire Rescue B S 3,131,328.22 S 1,339,582.21 5 1,791,746.0r
.
114515300 Holmes Canty A S 628,710.63 S 268.962.41 S 359,748.22
116069400 Sumter County Fre&EMS B $ 1.369.815.76 S 586,007.18 $ 783,808.58
117949700 Li,,hthause Point H 3 72.351.62 5 30,952.02 5 41,399.60
400001300 Boynton Beach Fre Rescue G 5 1.145.77522 5 490,162.64 5 655.612,58
400002100 Pompano Beach Fre Rescue H $ 2,113,790.00 S 904,279.36 $ 1,209,510.64
400006400 Oakland Park Fire Rescue H $ 266,453.55 S 113,988.83 S 152,464,72
400007200 City of Hialeah Fire Department I $ 957.661.01 S 409,687.38 $ 547,973.63
400009900 City of Greenacres G S 434.858.19 5 186,032.33 S 248,825.86
400021800 Riviera Beach Fire Department G S 1.084.650.58 S 464,013.52 $ 620,637,06
400024200 Lehigh Acres Fire Control and Rescue F $ 1,695.398.05_5,,,,,, 725,291.29 5 970,106.76
400028500 Palm Beach County Fire Rescue G 5 9,086,116.04 $ 3.887.040.44 5 5,199,075.60
400032300 Oviedo Fire Department E S 179.132.63 S 76,632.94 S 102,499.69
400035800 ,Longwood Fre Department E S 300.009,73 $ 128.344.16 S 171,665.57
400037400 Gay of Lauderhill Fire Rescue Depar H S 1,817,896.83 S 777,696.26 $ 1,040,200.57
400038200 Orange County Fire Rescue EMS Bureau E 5 12,301,896.06 5 5,262,751.13 5 7,039,144.93
400039100 City of Coral Sprinys Fire Deparimen H $ 999.325.57 5 427,511.48 S 571,814.09
400040400 City of Plarda6on H S 668,005.04 $ 285,772.56 5 382,232.48
400041200 City of Tamarac Fire Department H $ 679.980.48 $ 290,895.65 $ 389,084.83
400042100 &oward Sheriffs Fie Rescue H $ 4,443.013,19 5 1,900,721.04 $ 2,542,29215
400045500 Fort Myers Beach Fire Department F S 9.979.53 $ 4,269.24 $ 5,710.29
400046300 Seminole County'MS/Fire Rescue Divi E 5 2,956,312,14 $ 1,264,710.34 S 1,691,601.80
400047100 Sanford Fre Department E 5 1,042,861.28 S 446,136.06 S 596,725.22
400050100 North Lauderdale Fire Rescue H 5 609.624.77 5 260,797.48 $ 348,827.29
400051000 The Town of Davie Fre Rescue H 5 815.078.42 S 348.690.55 $ 466,387.87
400057900 City of Stuart Fire Rescue G $ 225.537.46 $ 96,43,4.93 S 129,052.53
400063300 Fort Lauderdale Fire Department Resc H 5 3,128,958.08 5 1.338,56827 $ 1,790,3139.81
400064100 Maitland Fre Rescue Department E S 203,083.51 S 86,879.13 5 116.204.38
400101000 Leon County EMS A $ 8,082,424.42 S 3,457,661.17 5 4,624,763.25
400105200 Lake Mary Fre Department , E $ 265,455.60 S 113,561.91 $ 151,893.69
400115000 Hardee Canty Board of County Commis D S 224.539.51 5 96,058.00 $ 128,481.51,
...$ 260,000,000.00 $ 111,228,000-02 $ 148,771,999.98+
Agency for Health Care Administration
Bureau of Medicaid Program Finance
I of 1 9/8/2025
Intergovernmental Transfers Questionnaire
IGT Provider Name: Collier County Emergency Medical Services
Health Care Provider Name:
IGT Amount: $ 708,054.21
State Fiscal Year Ending: 6/30/2026
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)?
Yes
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.
Yes,we are the provider
3. 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
Ad Valorem $ 708,054
$
If other, please explain
a. Verify whether the funds are public funds as defined by 42 CFR §433.51, and exclude any federal
funds.
No
If no, please explain
4. Does your organization have taxing authority?
Yes
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?
Property Owners in Collier County
c, What is the tax structure(i.e. property tax, percentage of revenue, assessment, etc.)?
Ad Valorem/Property Tax
d. What is the amount or percent of the tax?
3.0107 per$1000 value
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 $
Healthcare Provider Tax Burden $
0.00%
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.
If no, please explain
CA 0
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.
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)?
If no, please explain
iv) Does the tax program comply with the hold harmless provisions included in 42 CFR §
433.68(f)?
If no, please explain
v) Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost?
If yes, please explain
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 Revenue $
Provider Related Donations $ -
c. Do individual provider donations exceed $5,000 per year or$50,000 per year for a health care
organizational entity?
No
,A r)
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.
7. Were funds utilized for the IGT specifically appropriated by the organization's board?
Yes
If yes, provide the board minutes and date of the appropriation.
I certify that the statements and information contained
in this submittal are true, accurate, and complete.
Signature of Officer or Administrator
Title
Date