CS/CS/HB 1043

1
A bill to be entitled
2An act relating to Citrus County; providing for
3codification of special laws relating to the Citrus County
4Hospital Board, an independent special district in Citrus
5County; codifying, amending, reenacting, and repealing
6chapters 99-442 and 2001-308, Laws of Florida, as the
7"Citrus County Hospital and Medical Nursing and
8Convalescent Home Act"; deleting obsolete provisions;
9making technical revisions; providing definitions;
10authorizing the board to enter into a lease or contract
11with a not-for-profit corporation for the purpose of
12operating and managing the hospital and its facilities;
13declaring a need for governance authority to fulfill the
14hospital board's public responsibilities; providing for a
15board of directors; providing for membership; requiring
16that the not-for-profit corporation conform all governance
17documents to certain requirements, if necessary;
18authorizing ad valorem taxation; requiring that the not-
19for-profit corporation separately account for the
20expenditure of all ad valorem tax moneys provided by the
21hospital board; requiring that the expenditure of all
22public tax funds be approved in a public meeting and
23maintained in a separate account; providing for the
24hospital board's approval or rejection of the not-for-
25profit corporation's articles of incorporation or bylaws,
26selection of a chief executive officer or renewal of his
27or her employment contract, the annual operating and
28capital budgets, additional loan indebtedness or leases in
29excess of a specified amount, and the not-for-profit
30corporation's policies for travel reimbursements and
31contract bid procedures; providing that all records of the
32not-for-profit corporation are public records unless
33exempt; providing that any dispute between the hospital
34board and the not-for-profit corporation is subject to
35court action; providing for a future operational audit of
36the hospital board; providing application; repealing
37chapters 99-442 and 2001-308, Laws of Florida, relating to
38the Citrus County Hospital Board; providing severability;
39providing an effective date.
40
41     WHEREAS, the Citrus County Hospital Board was created by
42the Legislature in 1949 as a special taxing district and a
43public nonprofit corporation for the purpose of acquiring,
44building, constructing, maintaining, and operating a public
45hospital in Citrus County; and, in 1965, the Legislature
46expanded the purpose of the hospital board to include operating
47public hospitals, medical nursing homes, and convalescent homes
48in Citrus County, and
49     WHEREAS, in 1987, the hospital board caused to be
50incorporated a not-for-profit management corporation with the
51original purpose of operating exclusively for the benefit of and
52carrying out the purposes of the Citrus County Hospital Board
53and, in 1990, entered into a long-term lease agreement with the
54not-for-profit management corporation pursuant to section
55155.40, Florida Statutes, leasing all public assets, operations,
56and management of Citrus Memorial Hospital to the not-for-profit
57management corporation, and
58     WHEREAS, meaningful oversight by the hospital board is
59necessitated in light of the not-for-profit corporation's status
60as an instrumentality of the hospital district, and
61     WHEREAS, restoration of meaningful hospital board
62representation on the board of the lessee corporation and
63implementation of appropriate accountability and oversight by
64the hospital board are necessitated in order to ensure the
65sovereign immunity status of the not-for-profit corporation as
66an instrumentality of the hospital district, and
67     WHEREAS, the ability of the hospital board to continue to
68act in the public interest on behalf of the taxpayers of Citrus
69County requires mechanisms to ensure adherence to the hospital
70board's public responsibilities, and
71     WHEREAS, this act provides an appropriate and effective
72means of addressing the lessee's performance of its
73responsibilities to the public and to the taxpayers of Citrus
74County, NOW, THEREFORE,
75
76Be It Enacted by the Legislature of the State of Florida:
77
78     Section 1.  This act constitutes the codification of all
79special acts relating to the Citrus County Hospital Board. It is
80the intent of the Legislature in enacting this law to provide a
81single, comprehensive special act charter for the district,
82including all current authority granted to the district by its
83several legislative enactments and any additional authority
84granted by this act.
85     Section 2.  Chapters 99-442 and 2001-308, Laws of Florida,
86relating to the Citrus County Hospital Board, are codified,
87reenacted, amended, and repealed as provided in this act.
88     Section 3.  The Citrus County Hospital Board is re-created,
89and the charter is re-created and reenacted to read:
90     Section 1.  This act may be cited as the "Citrus County
91Hospital and Medical Nursing and Convalescent Home Act."
92     Section 2.  As used in this act, the following words and
93terms have the following meanings:
94     (1)  "Citrus County Hospital Board," "hospital board," and
95"board" means the Citrus County Hospital Board.
96     (2)  "County" means Citrus County.
97     (3)  "County hospital and medical nursing and convalescent
98homes" includes hospitals, medical care facilities, clinics, and
99other allied medical care units.
100     (4)  "Indigent care" means medically necessary health care
101provided to Citrus County residents who are determined to be
102qualified pursuant to the provisions of the Florida Health Care
103Responsibility Act, section 154.304(9), Florida Statutes, and
104the Florida Health Care Indigency Eligibility Certification
105Standards, Florida Administrative Code, rule 59H-1.0035(30).
106     (5)  "Operate" includes build, construct, maintain, repair,
107alter, expand, equip, lease pursuant to and consistent with the
108provisions of this act, finance, and operate.
109     (6)  "Property" means real and personal property of every
110nature whatsoever.
111     (7)  "State" means the State of Florida.
112     Section 3.  (1)  There is hereby created the Citrus County
113Hospital Board, an independent special district, and by that
114name the board may sue and be sued, plead and be impleaded,
115contract and be contracted with, acquire and dispose of property
116or any interest therein, and have an official seal. The board is
117created as a public nonprofit corporation without stock and is
118composed of and governed by the five members herein provided
119for, to be known as trustees. The hospital board is hereby
120constituted and declared to be an agency of the county and
121incorporated for the purpose of operating hospitals, medical
122nursing homes, and convalescent homes in the county. The
123hospital board shall consist of five trustees appointed by the
124Governor, and, upon this act becoming a law, the present members
125will automatically become trustees and shall constitute the
126board. Their respective terms of office shall be the term each
127member is presently serving. All subsequent appointments, upon
128the expiration of the present terms, shall be for terms of 4
129years each. Upon the expiration of the term of each trustee, the
130successor shall be appointed by the Governor. Likewise, any
131vacancy occurring shall be filled by appointment by the Governor
132for the unexpired term. Each appointment by the Governor is
133subject to approval and confirmation by the Senate.
134     (2)  The trustees of the board shall elect from among its
135members a chair, a vice chair, and a secretary-treasurer, who
136shall each hold office for a period of 1 year. Each trustee
137shall execute a bond in the penal sum of $5,000 with a good and
138sufficient surety of a surety company authorized under the laws
139of the state to become surety, payable to the Citrus County
140Hospital Board, conditioned upon the faithful performance of the
141duties of the trustee, which bonds shall be approved by the
142remaining trustees of the board and shall be filed with the
143Board of County Commissioners of Citrus County. The premiums on
144such bonds shall be paid by the hospital board.
145     (3)  The hospital board shall comply with the applicable
146requirements of chapter 280, Florida Statutes, and part IV of
147chapter 218, Florida Statutes.
148     (4)  Any and all funds so deposited shall be withdrawn by a
149check or warrant signed by two trustees of the hospital board,
150of which one shall be the chair, vice chair, or secretary-
151treasurer. No check or warrant exceeding the sum of $25,000
152shall be delivered to the payee without approval thereof shown
153in the minutes of the hospital board meeting.
154     Section 4.  The trustees of the board shall receive no
155compensation for their services. Three trustees shall constitute
156a quorum of the hospital board for the purpose of conducting its
157business and exercising its powers and for all other purposes.
158Action may be taken by the board only upon a vote in the
159affirmative of three trustees thereof.
160     Section 5.  The Citrus County Hospital Board as hereby
161created shall be for the purpose of operating, in Citrus County,
162public hospitals, medical nursing homes, and convalescent homes,
163primarily and chiefly for the benefit of the citizens and
164residents of Citrus County. Authority is hereby given to the
165board to build, erect, expand, equip, maintain, operate, alter,
166change, lease pursuant to and consistent with the provisions of
167this act, and repair public hospitals, medical nursing homes,
168and convalescent homes in Citrus County. The corporation is
169authorized, when rooms and services are available, without
170detriment or deprivation to the citizens and residents of Citrus
171County, to extend the hospitalization and medical nursing home
172and convalescent home services provided by such hospitals,
173medical nursing homes, and convalescent homes to patients from
174adjoining and other counties of Florida and from other states,
175upon the payment of the cost of such hospitalization, medical
176nursing home services, and convalescent home services as may be
177determined by the trustees of the hospital board. The board
178shall have the power and authority to operate an ambulance
179system and ambulance services and to charge all patients for all
180services rendered in any facility owned or operated by the
181hospital board, including the ambulance facility. The board may
182charge a patient interest on the patient's account; sell,
183discount, or assign such account to a bank, finance company,
184collection agency, or other type of collection facility; accept
185promissory notes or other types of debt obligations from a
186patient; assign or discount such accounts receivable, notes, or
187other obligations; require a patient to guarantee the payment of
188an existing account or note; require a guarantee of payment
189before admitting a patient; and receive and assign any
190assignment of all types of insurance proceeds. In addition to
191all other powers, the board shall have the power and authority
192to:
193     (1)  Provide for the payment of indigent care services by
194private health care providers in the county, or to partner with
195other entities such as the Department of Health, in furtherance
196of the hospital board's public purpose and the necessity for the
197preservation of the public health and welfare of the residents
198of the county by the hospital board.
199     (2)  Develop and implement a county health plan.
200     Section 6.  The board of county commissioners shall levy or
201cause to be levied each year beginning July 1, 1965, the millage
202certified to the board of county commissioners by the trustees
203of the board upon all taxable real and personal property in
204Citrus County, not including, however, homestead property that
205is exempt from general taxation by the Constitution of the State
206of Florida, for the purpose of erecting, building, equipping,
207maintaining, changing, altering, repairing, leasing, and
208operating the public hospital provided for in this act. Such tax
209shall be known as the hospital tax, and the property appraiser
210shall make such assessments and the tax collector shall collect
211such assessments when made. The money collected shall be paid
212monthly to the board. However, the annual tax levied under this
213section may not exceed 3 mills.
214     Section 7.  The hospital board is hereby authorized and
215empowered to own and acquire property by purchase, lease, gift,
216grant, or transfer from the county, the state, or the Federal
217Government, or any subdivision or agency thereof, or from any
218municipality, person, partnership, or corporation and to
219acquire, construct, maintain, operate, expand, alter, repair,
220change, lease, finance, and equip hospitals, medical nursing
221homes, convalescent homes, medical care facilities, and clinics
222in the county.
223     Section 8.  The hospital board is authorized and empowered
224to enter into contracts with individuals, partnerships,
225corporations, municipalities, the county, the state or any
226subdivision or agency thereof, or the United States of America
227or any subdivision or agency thereof to carry out the purposes
228of this act.
229     Section 9.  The hospital board is empowered to and shall
230adopt all necessary rules, regulations, and bylaws for the
231operation of hospitals, medical nursing homes, and convalescent
232homes; provide for the admission thereto and treatment of such
233charity patients who are citizens of the state and residents of
234the county for the preceding 2 years; set the fees and charges
235to be made for the admission and treatment therein of all
236patients; and establish the qualifications for members of the
237medical profession to be entitled to practice therein.
238     Section 10.  The hospital board shall have the power to
239purchase any and all equipment that may be needed for the
240operation of hospitals, medical nursing homes, and convalescent
241homes and shall have the power to appoint and hire such agent or
242agents, technical experts, attorneys, and all other employees as
243are necessary for carrying out the purposes of this act,
244regardless of any lease to a not-for-profit corporation,
245including the hiring and maintenance of staff personnel as it
246may deem appropriate to assist the board in the discharge of its
247operational, financial, and statutory responsibilities, and in
248carrying out its fiduciary duties to the taxpayers of Citrus
249County, and to prescribe their salaries and duties. The board
250shall have the power to discharge all employees or agents when
251deemed necessary by the board for the carrying out of the
252purposes of this act.
253     Section 11.  At the end of each fiscal year, the Citrus
254County Hospital Board shall within 30 days file with the Clerk
255of the Circuit Court of Citrus County a full, complete, and
256detailed accounting of the preceding year and at the same time
257shall file a certified copy of such financial report with the
258Board of County Commissioners of Citrus County, which report
259shall be recorded in the minutes of the board of county
260commissioners. The board of county commissioners, at its
261discretion and at the expense of the county, may publish and
262report an accounting in a newspaper of general circulation in
263Citrus County.
264     Section 12.  In addition to all other implied and express
265powers contained in this act, the board shall have the express
266authority to negotiate loans to borrow money from any state or
267federal agency for the purpose or purposes of constructing,
268maintaining, repairing, altering, expanding, equipping, leasing,
269and operating county hospitals, medical nursing homes,
270convalescent homes, medical care facilities, clinics, and all
271other types of allied medical care units.
272     Section 13.  (1)  In addition to all other implied and
273express powers contained in this act, the board shall have the
274express authority to borrow money, with or without issuing notes
275therefor, for the purpose or purposes of constructing,
276maintaining, repairing, altering, expanding, equipping, leasing,
277and operating county hospitals, medical nursing homes,
278convalescent homes, medical care facilities, clinics, and all
279other types of allied medical care units. The board's authority
280to borrow money, with or without issuing notes, shall be subject
281to the conditions of this act applying to the board's right to
282issue revenue bonds.
283     (2)  The board shall have express authority to issue bonds,
284subject to approval at a referendum of the voters of the county,
285and to issue revenue bonds, without a referendum of the voters
286of the county, the proceeds of which shall be used for erecting,
287equipping, building, expanding, altering, changing, maintaining,
288operating, leasing, and repairing such hospitals, medical
289nursing homes, and convalescent homes. Such bonds, federal or
290state hospital loans, notes, or revenue bonds shall mature
291within 30 years after the year in which they are issued or made
292and shall be payable in such years and amounts as shall be
293approved by the board.
294     (3)  The board shall determine the form of the loans,
295notes, bonds, and revenue bonds, including any interest coupons
296to be attached thereto, and the manner of executing them, and
297shall fix the denomination or denominations thereof and the
298place or places of payment of principal and interest, which may
299be at any bank or trust company within or without the state. In
300case a trustee whose signature or a facsimile of whose signature
301appears on any loan, note, bond, or revenue certificate or
302coupon ceases to be such trustee before the delivery thereof,
303such signature or facsimile shall nevertheless be valid and
304sufficient for all purposes the same as if the trustee had
305remained in office until such delivery. All loan agreements,
306notes, bonds, and revenue bonds issued hereunder shall have and
307are hereby declared to have all the qualities and incidents of
308negotiable instruments under the negotiable instruments law of
309the state.
310     (4)  Whenever the board passes a resolution approving the
311issuance of such bonds, the board shall call for an election
312and, subject to such election, permit the repayment of the bonds
313out of an annual levy not to exceed 1.5 mills per year. Such
314millage is included in the maximum millage of 3 mills per year.
315Subject to such limitations, such bonds shall be payable from
316the full faith and credit of the board.
317     (5)  The loans, notes, and revenue bonds, together with the
318interest, shall be payable from gross or net receipts of the
319hospital board or any portion thereof.
320     (6)  Such loans, notes, bonds, or revenue bonds shall not
321bear interest in excess of the maximum rate permitted by the
322laws of the state.
323     (7)  The board may sell bonds, loans, notes, or revenue
324bonds in such manner, either at public or private sale, and for
325such price as it may determine to be for the best interest of
326the hospital board.
327     Section 14.  The total amount of outstanding bonds of the
328hospital payable from ad valorem taxation at any one time shall
329not exceed an amount equal to 6 times the annual hospital tax,
330assuming such tax is based upon the yearly millage of 3 mills.
331     Section 15.  (1)  The Citrus County Hospital Board shall
332have the authority to enter into leases or contracts with a not-
333for-profit Florida corporation for the purpose of operating and
334managing the hospital and any or all of its facilities of any
335kind and nature.
336     (2)  The Citrus County Hospital Board shall have the power
337and authority to:
338     (a)  Provide health care services to residents of the
339county through the use of health care facilities not owned and
340operated by the hospital board. The provision of such care is
341hereby found and declared to be a public purpose and necessary
342for the preservation of the public health and welfare of the
343residents of the county.
344     (b)  Maintain an office.
345     (c)  Provide for reimbursement to hospitals, physicians, or
346other health care providers or facilities, whether public or
347private, and pay private physicians for indigent care.
348     (3)  The hospital board is hereby restricted from
349reimbursing any health care providers or facilities, including
350hospitals and physicians, for their bad debts arising from those
351patients who are not eligible for reimbursement under hospital
352board guidelines. The hospital board, however, shall continue to
353reimburse such health care providers for the medical care of
354medically needy patients, to the extent of the hospital board's
355financial resources, taking into account funds available from
356other sources, including other governmental funding sources.
357     Section 16.  To ensure public oversight, accountability,
358and public benefit, in addition to the requirements for any such
359lease set forth in section 155.40, Florida Statutes:
360     (1)  The not-for-profit corporation shall separately
361account for the expenditure of all ad valorem tax moneys
362provided to it by the Citrus County Hospital Board, including
363maintaining them in a separate accounting fund. The expenditure
364for all such public tax funds shall be approved in a public
365meeting and separately accounted for annually by the not-for-
366profit corporation in a report provided to the Citrus County
367Hospital Board.
368     (2)  The articles of incorporation, all amendments or
369restatements of the articles of incorporation, all corporate
370bylaws, all amendments or restatements of the corporate bylaws,
371and all other governing documents of the not-for-profit
372corporation shall be subject to the approval of the hospital
373board, and any such documents that have not heretofore been
374approved by the hospital board shall be submitted forthwith to
375the hospital board for approval.
376     (3)  The hospital board shall be the sole member of the
377not-for-profit corporation.
378     (4)  The hospital board shall independently approve any
379plan of merger or dissolution of the not-for-profit corporation
380pursuant to sections 617.1103 and 617.1402, Florida Statutes,
381and may reject any such plan in its sole discretion.
382     (5)  The members of the hospital board shall be voting
383directors of the not-for-profit board of directors who
384constitute a majority of the voting directors of the not-for-
385profit corporation; and, to the extent that any governance
386documents of the not-for-profit corporation do not so presently
387provide, the not-for-profit corporation shall forthwith take all
388steps necessary to bring them into conformity with this majority
389membership requirement.
390     (6)  All members of the not-for-profit board of directors
391shall be subject to approval by the hospital board, and any
392board members presently serving who have not heretofore been
393approved by the hospital board shall be submitted forthwith to
394the hospital board for approval.
395     (7)  The chief executive officer of the not-for-profit
396corporation and his or her term of office and any extensions
397thereof shall be approved by the hospital board, and the
398hospital board may terminate the term of the chief executive
399officer of the not-for-profit corporation with or without cause
400in its sole discretion, subject to the terms of any and all
401then-existing contracts.
402     (8)  The hospital board shall approve all borrowing of
403money by the not-for-profit corporation in any form and for any
404reason in an amount exceeding $100,000, any additional loan
405indebtedness or leases in excess of $1.25 million per instrument
406or contract, and all policies of the not-for-profit corporation
407that govern travel reimbursements and contract bid procedures.
408     (9)  No annual operating and capital budget of the not-for-
409profit corporation shall become effective until approved by the
410hospital board.
411     (10)  Any capital project of the not-for-profit corporation
412having a value in excess of $250,000 per project, and any
413nonbudgeted operative expenditure in excess of $125,000 in the
414per annum aggregate, shall be approved by the hospital board.
415     (11)  At the discretion of the hospital board, each and
416every year the not-for-profit corporation shall complete an
417independent audit of the fiscal management of the hospital by an
418auditor chosen by the hospital board, with the audit to be paid
419for by the not-for-profit corporation.
420     (12)  All records of the not-for-profit corporation shall
421be public records unless exempt by law.
422     (13)  Subject to the annual approved budget, the hospital
423board shall reimburse the not-for-profit corporation for
424indigent care pursuant to the Florida Health Care Responsibility
425Act and the Florida Indigent Certification Standards and shall
426take into account funds available from other sources, including
427other governmental funding sources.
428     (14)  The provisions in this act and the hospital board's
429lease with the not-for-profit corporation shall be construed and
430interpreted as furthering the public health and welfare and the
431open government requirements of s. 24, Art. I of the State
432Constitution and sections 119.01 and 286.011, Florida Statutes.
433     (15)  Any dispute between the hospital board and the not-
434for-profit corporation shall be subject to any court action
435pursuant to sections 164.101-164.1065, Florida Statutes.
436     Section 4.  Three years after the effective date of this
437act, the Citrus County Hospital Board shall submit a request to
438the Joint Legislative Auditing Committee for an operational
439audit of the hospital board and the not-for-profit corporation
440to be conducted by the Auditor General. The board should include
441specific areas to be addressed in the audit, including, but not
442limited to, review of internal controls over financial related
443operations.
444     Section 5.  This act shall apply to existing and future
445leases and amendments, revisions, and restatements thereto, and
446to existing and future agreements for hospital care and
447amendments, revisions, and restatements thereto. However, this
448act does not apply to the term of any existing contract entered
449into by the not-for-profit corporation with a third party, to
450any existing contract for the borrowing of money in excess of
451$100,000, to any additional loan indebtedness or leases in
452excess of $1.25 million for which the hospital board has not
453previously given its approval, or to any existing contract for a
454capital project in excess of $250,000 per project, and any
455nonbudgeted operative expenditure in excess of $125,000 in the
456per annum aggregate, for which the hospital board has not
457previously given its approval.
458     Section 6.  Chapters 99-442 and 2001-308, Laws of Florida,
459are repealed.
460     Section 7.  If any provision of this act or its application
461to any person or circumstance is held invalid or
462unconstitutional by a court of competent jurisdiction, the
463invalidity shall not affect other provisions or applications of
464the act which can be given effect without the invalid provision
465or application, and to this end the provisions of this act are
466severable.
467     Section 8.  This act shall take effect July 1, 2011.


CODING: Words stricken are deletions; words underlined are additions.