Budget still fuzzy for emerging county EMS service


LEE COUNTY – The financial picture of a county run EMS ambulance service is starting to take shape but almost half the revenues are classified as “Miscellaneous reimbursements”.

At Monday’s regular meeting of the Lee County Board of Supervisors, the board got an update on funding the purchase of six new ambulances.

The county is entering into a six-year lease agreement with North Central Emergency Vehicles to purchase three Type II and three Type III ambulances at a total cost of $1,089,399.

According to Lee County Auditor Denise Fraise, the annual payment on that lease would be $199,914 for six years at 1.64% interest for a total cost of $1,199,484.

Supervisors thought last week that the lease agreement would have to go in front of voters, under the same guidelines as a general obligation bond, but Iowa Code 331.301 says as long as total county lease payments don’t annually equate to more than 10% of the last certified budget, the county can enter into the agreement without voter approval. The last county budget was certified at approximately $17 million.

“If we enter into that lease agreement it can’t be 10% over the last certified budget balance which was about $17 million, Fraise said.

“This won’t be that much so we just need to have a public hearing.”

According to a preliminary budget worksheet presented to supervisors last week, an advisory board working to bring the ambulance service under county operations is projecting a $300,000 shortfall in the first year of operations.

County Budget Director Cindy Renstrom told Pen City Current that $300,000 would be made up out of the $900,000 used to subsidize the current Lee County EMS operations through June 30, 2021.

That would make a total annual county contribution of about $500,000 for the first six years until the lease payments drop off. Prior to the 2020-21 current fiscal year, the county had contributed $421,000 to subsidize Lee County EMS Ambulance, Inc. operations.

The county is also currently negotiating a purchase price for Lee County EMS Ambulance Inc. with negotiations scheduled in the next few weeks. No dollar value has been estimated publicly on the cost of that acquisition. Six ambulances, property, and equipment could all be part of the assets of the acquisition.

The proposed budget shows projected expenses at approximately $2.8 million, while revenues come in at $2.5 million. The expenses did not reflect the lease payments on the ambulance nor the estimated cost of acquiring the business.

However, $1.24 million of the revenues are categorized as “miscellaneous reimbursement.”

Renstrom said that would be revenues from the current ambulance service that would be paid to the county.

Calls to Lee County EMS Director Dennis Cosby to clarify what revenues made up the miscellaneous line went unreturned Monday.

Other revenues for 2021-22 Fiscal year include $113,490 in Medicaid reimbursement, $683,773 in Medicare reimbursement, $427,629 in private reimbursements, and $85,259 in “insurance from individuals.”

A line item for Miscellaneous Federal grants and reimbursements was left blank.

One such grant revenue stream could include the state’s Ground Emergency Medical Transportation Program (GEMT) that provides subsidies from the Iowa Department of Human Services for certain medical transports under federal Medicaid, Title 19, and Affordable Care Act programs.

The program is only available to publicly owned ambulance and EMS services.

Supervisor Ron Fedler said things were looking bad on last Wednesday following the ambulance budget workshop.

As the previous chair, Fedler ushered in the move to a county-owned service last year.

Keokuk and Fort Madison city officials tried to put together a proposal to run EMS services in the county, as Lee County EMS Ambulance Inc, faced financial failure.

“After Wednesday’s meeting it was looking pretty grim and we were looking at a vote of the people. I didn’t sleep very well,” Fedler said.

“This was my main concern that we could not get into this bind of not having service. I was so relieved that we are now going to have service offered by the county. In the long run this will save the county money.”

In other action, supervisors:
• approved a 2% across the board increase increase for elected officials in the county. Chair Matt Pflug said supervisors haven’t taken a pay raise in more than six years.
• heard discussion on savings from the solar panels that were placed at three county buildings in 2020 of more than $20,000 and an additional $12,000 in savings from lighting upgrades at the Lee County Jail and Keokuk Heritage Center.

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