As we gather this day, we offer our gratitude for all who give of themselves in trusteeship of the work that we do in this community in labor at the side of those in need and all of those who provide the information that is vital for decisions to be made.

May wisdom this day be found in this place.

May our resources be directed toward the common good.

And so may we find health, healing, and strength for all whom we serve.

Amen.

Thank you, Bishop Rob.

I'll begin by call call meeting to order.

Vice Chairperson Drummer.

President.

Trustee Du Set is not with us today.

Trustee Dr.

Fish.

Present.

Trustee Hannafee.

Present.

Trustee Horn.

Present.

Trustee O'Brien.

Present.

And Chairman Lazard is here as well.

The first item of business is the consent agenda, which consists of the the uh board minutes from uh June 16, 2026.

Um the memorandum of executive session from June 16, 2026.

Our uh Treasurer and CFO report, which includes the June 2026 cash disbursements, client privilege forms, uh the advanced practice registered uh nurse, physician assistant, obstetric synacology, or orthopeediatrics, radiology, radiology, and associate staff's surgery, surgery, associate staff, also medical staff appointments, reappointments, and changes to privileges, and the medical staff policies number 700-103 medical education, patient care involvement, and number 700-114 board certification.

Uh is there a motion to approve the consent agenda?

I'll move it.

It's been been moved by Trustee Hannafee, seconded by Trustee O'Brien.

Are there any comments from any of the board at this time?

Uh hearing no comments, uh, we'll do a uh roll call vote.

Uh uh Vice Chairperson Drummer.

Yes.

Uh Trustee De said is absent.

Uh Trustee uh Dr.

Fish.

Yes.

Trustee uh Hannafee.

Yes.

Trustee Horn.

Yes.

Trustee O'Brien.

Yes.

Trustee Lazard votes yes.

Motion carries six zero one not here.

Uh so the consent agenda is approved.

Uh that takes us to the next matter on our our agenda, the general ordinance number one-2026, the adoption of the Marion County Public Health uh fee schedule.

Um which is that uh the ordinance uh will now be read uh for a second time.

Um it was read the first time at our June 16, 2026 board meeting, and we now read by uh our general counsel, Ann O'Connor.

Number one-2026 adoption of MCPHDB schedule.

Uh next we will hear uh an overview of the ordinance presented by Tara Parkman Parchman, uh Director of Finance, Marion County Public Health Department.

You have a microphone near you, Tara.

Good afternoon, thank you, trustee.

Um in terms of the ordinance for um the public health department, we uh looked at our fees that we currently have, in particular related to our immunization services, and uh what we are currently charging.

A lot of our fees have been steady and level over the past few years, and of course, as um our supply increases and also the cost of those vaccines increases, increase.

We looked at what uh vaccines we needed to reassess and look at increase in those fees in terms of the cost that we're actually charging to our patients at our um clinic operations.

We also looked at expanding our services as it relates to our dental um health department, our dental services department, and one area that we looked at was providing crowns to our patients.

Um, and so what you see before you is a recommendation to provide crowns um at the amount that's stated in the fee schedule, so we can offer that service um to the clients that we serve as well too.

So combine between our immunizations that we uh receive and those that we felt like we needed to increase because of the supply cost increases over the years, as well as offering the new services for uh dental for crowns.

We are recommended before the board the adoption of the uh current fee schedule before you thank you, uh Tara.

Uh no one signed up for public comment.

Um so are there any comments from any of the board members at this time questions?

Um Chair Lazard, you need to open the public hearing on this matter and close it since there's no signal.

That's in conflict with what I was just told earlier.

All right, we'll open up a uh a public hearing, but there's no one who is signed up for public hearing.

Are you satisfied with that, General Counsel?

Yes, very good.

You have to close the public hearing.

All right, so we'll close the public hearing.

It is now closed.

Um I've already not heard from the board that there are any comments, so we'll close that portion.

Uh and we'll now consider the uh ordinance for adoption.

Uh is there a motion to uh approve the ordinance.

So moved.

It's been moved by trustee horn.

Is there a second?

Seconded by trustee vice chairperson drummer.

Okay.

Um we'll do a roll call vote uh unless there's any further discussion uh once the ordinance has been uh seconded.

Vice Chairperson Drummer.

Yes.

Trustee Du Set is not not with us today.

Uh Trustee Dr.

Fish.

Yes.

Trustee Annae.

Yes, Trustee Horn.

Yes.

Trustee O'Brien.

Yes.

Chairperson Lazard votes yes.

It brings us to the uh the next matter on our agenda, which is the general ordinance number two-226 of the 27 2027 budget, uh, which is being introduced for the uh uh first reading, and I'll look to general counsel to keep us on track here.

Thank you.

Chair Lazard, I have your letter to the board that reads as follows.

Dear trustees, general ordinance number two-2026, 2027 budget was posted on Tuesday, July 21st, 2026, in the board effect.

HHC's online platform for Board of Trustees documents.

The ordinance encompasses HHC's 2027 budget for your review and approval.

Sincerely, Robert W.

Lazard, Chairperson.

Chair Lazard, I request that uh general ordinance number two-2026 be received for introduction and ordered read for the first time by title.

Which I'll turn back to general counsel to read by title.

Number two-2026, 2027 budget.

Next, we will hear an overview of the ordinance presented by uh James Simpson, our uh chief financial officer and assistant treasurer.

Uh and I'll turn the floor over to uh to Paul Babcock to introduce this with a few comments.

Thank you, Mr.

Chair, and this will just for the record reflect my report so you can skip over me.

Um first thing I want to do is thank the team as well as the board for uh supporting us through this process, the strategic plan which has really informed this budget.

As James will get into more details, the organization is facing headwinds.

I think um they're challenging headwinds uh financially.

We know uh the state as well as the federal governor are making some significant changes in the way in which we're reimbursed for the care that we provide.

Um, but we believe that this budget reflects an ability, at least in 2027, to navigate through those headwinds and allow us to continue our capital projects, which will include new spaces at PCAR, finishing the Hasbrook building, and then our continued partnership with the Parks Department.

Um over the course of the next couple years or months, I'm sorry, not years, uh, we will be coming to the board with a few resolutions to help set us up at the end of 2026 for the 2027 budget years and to be successful in that year.

And finally, I just want to say to the trustees that as James will explain in this budget, we spent a lot of time trying to think of ways in which we can ensure that we presented as close to a balanced budget as possible.

I think as most of you know in this room that went in 2012, uh the organization passed a um property tax referendum to support the construction of the hospital.

That referendum and that levy has never been put in place, but we did explore the possibility of what would happen if we needed to and how that would impact the taxpayers of Marion County.

We do not do that in this budget.

Uh, and if we were ever to do that, we'd have serious discussions with the board before going forward.

Um but we did take that seriously, and that's I think shows the extent to which were the headwinds we're facing here uh as a corporation.

So James Thank you, uh Paul.

It's all echo what Paul said too.

You know, we I appreciate the opportunity to present the 2027 budget to the to the trustees today, and um there was a lot of effort that went in this from many departments, uh, both financial and also just leadership uh roles as well.

The total budget that I'm gonna present is just under three billion dollars when you add up all the funds together, it's 2.95 billion in expenditures, and that's up just about 200 million from 2.78 billion in 2026.

Um, this is a complex uh budget.

You look at the ordinance, it's it's kind of tough to follow.

So what we're trying to do here is summarize the budget so it's clear so the board can be comfortable as we go along this budget process, and we have a second or the the hearing on August 11th, and then we ask the board to to vote on the budget on the 25th of August.

Um, all the numbers in this report are whole numbers, there's no thousands removed.

So just wanted to point that out as you're looking at these numbers, because other other reports we do exclude the thousands.

And then before I get into the slides, I would say just the future dates for reference.

I just mentioned August 11th is the the first hearing, then the 25th is the second hearing in August, and that's when we'll ask to vote of the board to vote on that budget.

And then in September on the 14th, the city county council will introduce this budget.

The 23rd of September will present to the municipal corporation committee.

October 1st, the municipal corporation committee will do a budget review and analysis, then followed by October 5th, the city county council have a public hearing, and then October 19th, the city county council vote to pass the Muni Corps budgets.

And then in December of this year to January of next year is when we would get the the actual budget notice from the DLGF Department of Local Government Finance.

So this first slide here is our uh 27 budget advertisement summary.

It's all of our governmental funds.

The uh the enterprise funds as well, did they do not have any levy, so we we left them off of this.

But the general fund um you'll see here the property tax levy without circuit breaker is just over 164 million.

Then we have local option income tax of 10.6 million.

Um this is the last 27 will be the last year for this local option income tax.

So in 28, we would expect that 10.6 million to move over to that left column to be part of the property uh tax levy to get to the grand total advertised tax levy on the far right.

So there will no be there will no longer be low at or HCI in 2028.

Um our special revenue Health First Indiana Fund has no tax levy, no tax rate.

The bond retirement, the smaller one.

This does assume that we will issue approximately 25 million dollars in general obligation uh bonds at the end of this year, and that we'll have a presentation on that after this budget presentation.

Uh the bond retirement Eskenazi fund that you know Mr.

Baupak just mentioned, we are not levying the property tax there, so it shows zero property tax rate or levy.

And then finally, the cumulative building fund, it shows a property tax levy of just under 400,000.

This is the de minimis um rate that you have to have in place in order for the fund to remain active.

It is um six hundredths of a cent uh is the tax rate.

And Paul had mentioned in the when this budget was presented to the finance and external audit committee this morning, and uh Paul had mentioned that you know we we do have the ability to levy a higher tax rate now on the cumulative building fund.

We've always elected to try to kind of pay as you go, put in the dollars with transfers from the general fund to cover the expenditures on the cumulative building fund.

But I think it was a good point to point that out that you know we we do the the minimum there, um but we do have some flexibility there to potentially um have a slightly higher tax rate, but that would impact you know our general fund and other taxing units as that would be subject to circuit breaker.

And lastly, I would just say we have worked with policy analytics the last few years to make sure that our assumptions and projections are accurate, and so we feel very comfortable that we'll we'll hit these property tax levy amounts with the circuit breaker.

We feel like these are very uh reasonable estimates.

Then the headwinds that um Paul had mentioned the challenges that we're facing on the on the Eskenazi Health Enterprise Fund.

We're facing about 155 million in revenue losses or reductions, and this is on a 1.1 billion dollar um net patient service revenue total revenue.

So you have like a picture of the size of that to the hospital operations, and of the 155 million, 70 million of that is directed is related to the state directed payment plan.

We do see or we expect to see increased patient reimbursement with the SDPP, however, it is it's more than offset by increased intergovernmental transfers or IGTs, as well as decreased uh dish payments.

We're expecting about a 25 million dollar uh headwind or negative impact uh for 340B, the state plan amendment and hospital outpatient prospective payment systems, 22 million dollar shift in payer mix and managed care entity changes or MCE changes, and this is related to both federal and state legislative changes that are impacting Medicaid enrollment, and then also uh contracting and coverage related, you know, medwise they lost a contract with the state.

Then we also recognize some challenges on the anthem and care source side.

Then lastly, you know, we we do this happened in 2026, but we did lose the 38 million of HCI.

Um the state removed that from the budget.

That is something that we're you know, we're working through how do we operate you know in the future with with this you know one additional uh less revenue stream coming in.

So then the opportunities that we feel like we have on the HHC side or for HHC.

We're continuing to maximize our general fund operating levy.

We're gonna continue to advocate for HHC on federal and state special revenue programs for both uh changes or redesigns, and on the general fund side, we're continuing to support the uh Eskenazi Health Enterprise Fund.

And this year, the capital outlays that we're supporting are 51.9 million, operational transfers or operational support transfers of 48.6 million, and then we're funding the bond retirement, the Eskenazzi bond retirement uh debt service with transfers from the general fund.

This is 43.1 million.

Roughly the same amount of transfers from prior years, but now we no longer have the BAB subsidies there after we've refunded those bonds in in 2025.

Next is this slide here shows all proposed um governmental fund budgets.

And so here we'll show we'll start with the general fund on the far left.

It is a balanced budget compared to the 25 million dollar budget deficit we reported in 2026.

Um Luke Davison and the decision support team, they were able to identify 5.2 million in expense reduction for the headquarters operating expenses, and that's on the statutory budget process.

In the fall, we'll go into the operating budget process, and we're gonna work with the departments to see what additional savings efficiencies we can bake into this budget as we get to the operating budget.

This budget does include merit uh increases in the personal services line for the 27 budget.

Uh we do expect a little bit of an uptick for hospital dish settlements uh for 2026, and this is related to a 2025 final settlement.

So we're a couple years behind on the those hospital settlements, but it does like we'll get a little bit more than we received for the 24 final settlement.

Long-term care transfers in are projected to increase by approximately 10.6 million compared to 26.

And then Eskenazi transfers out are projected to increase just under 30 million.

Uh, the capital outlays in the general fund are the operating related capital spend.

I want to just point that out.

The larger construction projects like the health department lab, IMS headquarters, um, they're accounted for on the cumulative building fund.

So when you see that the 14.5 million of capital there, I just wanted to point out those larger spends are over on the cumulative building fund.

Uh special revenue health first Indiana fund is balanced budget, and it's at approximately the same level as 26.

Uh both bond retirement funds are balanced or have a slight surplus.

The slight surplus is related to the operating balance calculation for for debt service.

And then there's again there's no tax levy on the bond retirement Eskenazi Health Fund.

You do see property taxes on the smaller bond retirement fund.

Cumulative building fund does have a 51.7 million dollar deficit.

And the next chart will show what how we plan to fund that deficit in 2027.

Paul did um in his comments, he mentioned the major projects that we're covering with the cumulative building fund in 27.

It's Hasbrook Renovation Project, the car expansion, and the park partnership construction projects, as well as some strategic growth initiatives.

And here's the the cumulative building fund.

This is historical data from just after we constructed the hospital campus here from 2013 to 2027.

The top graph shows the growth and the operating uh sorry, the fund balance.

And then the bottom chart shows the revenues that we put in the transfers in or property taxes into cumulative building, less the expense expenditures by year.

So the green line in the bottom chart is the revenues, the orange is the expenses, and the difference is that increase or decrease year over year on the top chart.

So what you'll see in 21, which is just slightly to the right of the the midpoint.

That's when we we asked to spin down some of the fund balance in 22 to um to fund the East 38th Street, the Grande Clinic campus or clinic, sorry.

And now after that, 23 through 26, the operating balance continued to grow.

And now we're asking again to use some of that fund balance to fund the 2027 expenditure on the cumulative building fund.

So next we have the proposed budgets for the enterprise funds.

And you'll notice both of these are balanced, a slight surplus on the Eskenazi Health Enterprise Fund.

Uh despite funding challenges that we just mentioned for SDPP 340B in the payer mix shift.

Uh Eskenazi was able to produce a balanced budget, and that's through 32.7 million in reduction of operating expenditures, as well as a 3%, and this this budget also reflects a 3% reduction in volume.

Removal of half expenditures due to the implementation of SDPP, and around a six percent expense reduction in improvements.

Long-term care was able to achieve a balanced budget.

Uh current long-term care occupancy averages 76.5% through June 2026.

And it's expected to increase slightly in 27 to about 77.7%.

And in their highlights, the total operating revenues projected to increase 86.3% or 8.8 or sorry, 86.3 million, or 8.8% versus 2026 budget.

Operating expenditures are projected to increase 75.8 million or 9.1% versus 26.

And then their transfers to the general fund increase 10.6 million.

And long-term care achieved this through the three new facilities being added to the Omega portfolio in mid-2026.

Approved statutory budget.

Pathways reimbursement methodology will be 100% fully adopted starting in July of 2027 for long-term care.

And so that's how they were able to achieve that their balanced budget.

The other two appendix just show approved budget 26 compared to the proposed budget 27.

So you can see that growth on each fund or you know, increase or decrease by fund.

Then the second appendix is transfers in and out by fund.

So let me uh advance it one more.

Positive or transfers in, negative or transfers out, and it shows the activity for each each fund.

So that would conclude the presentation unless there's any questions from the trustees.

One right.

Hearing none, uh, the ordinance will be presented for public hearing at the August 11th 2026 Board of Trustees meeting.

And uh that takes us to the uh our next uh agenda item, which is the preliminary determination of the bond uh uh issue of bonds.

Uh it's a first hearing, and so I'll once again uh uh turn it over to uh to James.

Thank you, Chairman Lazard.

And um I was told to just repeat that this is a public hearing for this uh the preliminary determination.

Um this will be a much it'll be a briefer presentation in the budget.

Uh I appreciate the the time to present the budget.

Uh the public hearing for the preliminary determination to issue bonds.

Uh Mr.

Babcock, he has shared in his past the most recent monthly updates that we were working through this bond issuance.

And so this isn't this isn't a um something new, but it says that when we're formally starting the process.

So this bond issuance establishes a levy on our bond retirement fund for 2027 and after, as the current 2024 bonds, the final payment scheduled for December of 2026.

So with us today from the finance team, in case there's any questions from the the board.

We have Joe Glass, executive director and general counsel of the bond bank, Brad Bingham, partner with Barnes and Thornburg, and then Becca Helmick, municipal advisor with Crow.

And then we also asked uh Pink Bassette, VP for real estate or facility service in real estate with HHC to be in attendance.

Oh sorry.

No, not up yet.

We'll get the presentation, give us just a second on the presentation.

Um I can start talking about a little bit, yeah, because I know we'll um we'll be okay.

So on here, and we'll we'll advance slides is when that when they pull up.

So we're asking for the board's approval to issue 25 million dollars of general obligation bonds, and the things we've mentioned we're gonna cover are we're gonna do the construction or renovation for three ambulance stations.

Um we expect that to be the bulk of the funding.

If there are any uh bond proceeds left over after we fund these three ambulance stations, then we would look to potentially purchase real estate around the Hasbrook campus, and also we also have a security system upgrade at facilities owned or operated by HHC that we'd also look at to fully utilize those bond proceeds.

The three ambulance stations will house four ambulances or four trucks now.

So it's ambulance three, ambulance thirteen, ambulance fourteen, and then uh medic twenty-six and then the so the the reason for the the public hearing the preliminary determination is when we look at these individual projects, we have to look at the the value of each project, and there's a threshold for if an independent capital project can be financed if it's a controlled project or not, and that the minimum value is just under 6.9 million, but not more than 20.6 million.

And we're we're just not sure at this point where each ambulance station the total cost is gonna be.

Originally we were thinking could be close to four million, but we're also not sure if we have to acquire land if there's an existing facility there and we we have to renovate.

So we wanted to err on the side of caution and go ahead and move forward as it if it is within this limit and it's uh considered a control project.

And so we may not impose property tax to pay for debt service on bond issued or can issued for a controlled project without completing the following procedures advertising conducting two public hearings.

This is the first public hearing, making a preliminary determination to issue such bonds, presenting certain financial information, which we'll present here shortly at both public hearings, making a preliminary determination after two public hearings, and providing notice of a preliminary determination.

Oh here we go.

Awesome.

Thank you, Joe.

All right.

So now we're to the parameters on the bonds.

And so we're looking to issue bonds totaling 25 million with a maximum term of 20 years.

We've set a maximum interest rate, kind of a worst case scenario of 6%.

And that would have maximum interest cost of just over 17.4 million.

Estimated maximum debt service levy of 2.56 million, and then a uh estimated maximum debt service tax rate of 39 hundredths of a cent uh for each hundred thousand value.

And then below the notes, this is more like what we're seeing in the market today, or like recently, expected interest rate of closer to 4.05%, and that would lower the interest cost to 11 million and the tax levy to closer to 2.1 million annually with a tax rate of 0.0033.

And this doesn't include there will be some smaller, some other uh miscellaneous taxes when we levy the tax.

So that would that would impact the levy slightly.

This next slide shows uh current and estimated levy and tax rates, the years on the left-hand side, and so and also below on the no, I do want to point out again that the 2024 bonds uh will be fully paid at the end of this year.

So when you look at the levy and the rate with no issuance, so in column two and then uh column four, they're all zeros.

So if we don't move forward, that's that's what our levy and our tax rate would be.

Then column three and five.

This shows our levy, which we uh provide the amount on the previous slide of around 2.5 2.6 million with a rate of 0.0039 maximum.

Some more summary information on the right, comparing current tax levy of 1.9 million and a rate of 0.0028 on the far right to what we're projecting now, kind of worst case scenario.

Then the notice to property owners and registered voters, any owners of property within HHC's political subdivision or registered voters within HHC's political subdivision who want to initiate a petition and remonstrous process against the proposed debt service must file a petition that compli complies with Indiana Code 6-1.1-20-3.1 B4 and B5.

No later than 30 days after the publication of a notice or preliminary determination in accordance with Indiana Code 5-3-1.

And then I did mention the finance team that was here and uh here with us today.

This is the full list of everyone that's involved, like all the uh entities that are helping us in this process.

We have the issuer of the bond bank, the qualified entity is us, bond counsel Barnes and Thornburg, municipal advisor crow, and underwriter placement agent of Stiefle.

And you'll see this timeline very closely mirrors the budget timeline.

So today we're doing the first public hearing on August 25th.

We're gonna uh complete the second public hearing and the adoption of the adoption of the bond issuance and the preliminary termination resolutions.

September 14th, the city county council would introduce the the resolution for these bonds.

September 23rd, the city county council municipal corporation committee would hear they would consider these.

October 5th, the city county council would approve.

October 19th, the bond bank board would consider approval of these bonds.

Then we look to go to market in November.

So this will conclude this report unless there's any questions or presentation, sorry.

So our script says that uh it's now when I open the public comment.

If there was someone who signed up for public comment, which there is no one that has signed up for public comment.

Public hearing, thank you.

And uh so I'll close the public hearing as no one is signed up.

Uh are there any comments or any questions from board members at this time not appearing the preliminary uh determination of to issue bonds uh will be presented for a second public hearing at the August 25th 2026 Board of Trustees meeting.

And with that uh Mr.

Simpson, I'll let you off the hook for the rest of the meeting.

Uh well, most of the meeting uh anyway.

Uh our next uh item on the agenda is the uh nomination of the Sandra Eskenazi Mental Health Center uh advisory board member, and uh I'll turn it over to uh uh uh Dr.

Overly in just a second, but I understand that uh we we have a nomination of Abigail Lewis, and I'll let you uh introduce for board members that information is is on page uh uh sixty two, I believe, of your two hundred and thirty-five of your um of your board book uh for 62 and 63.

So I'll turn it over to Dr.

Overly at this point.

Thank you, Chairman Lazard.

Um, June 24th uh meeting of the Sandra Eskenazi Mental Health Center Advisory Board.

Our advisory board voted unanimously to recommend Abigail Lewis um to be formally appointed and approved by um your board of trustees to the Sandra Escanazi Mental Health Center Advisory Board.

Um Abigail Lewis is a lived experienced mental health advocate.

She is currently the manager of programs and training for NAMI.

That's the innational the National Alliance on Mental Illness, Indiana.

Um there she oversees the implementation and expansion of mental health education programs, peer support initiatives, volunteer training, and community outreach efforts throughout the state.

Um prior to joining NAMI Indiana, she served as the long-term services and supports care coordinator with El Avance Health, where she coordinated care and community resources for older adults and individuals with complex mental health needs.

Prior to that, she worked with Adventist Health Care in Maryland as a certified peer recovery specialist and psychiatric technician.

So she also has experience volunteering for a variety of different NAMI programs and has facilitated NAMI support groups, um, including a NAMI program called In Our Own Voice that includes presentation of uh individuals with their own experience of lived recovery from mental illness.

Um so Abigail is a very passionate mental health advocate, and we are also very grateful for the connection with NAMI, um, who has been a great partner, and many of our patients and families benefit from the interactions with NAMI.

So we are very enthusiastic about her uh candidacy um for and her willingness to participate on our board, um, and so I submit her to you for consideration.

So even though uh my uh instructions uh uh I'll open it up for a nomination in a second, and then discussion from the board.

So it's been so moved by uh Dr.

Fish uh trustee.

Is there a second from our representative and Sandra?

Former representative.

So I'll second seconded by Tom Hannafi, trustee.

Um are there any questions or any other comments from the board.

With that, I'll do a roll call vote, which to approve the uh position.

Uh Vice Chairperson Drummer.

Yes.

Uh Trustee Du said is absent today.

Uh Trustee Dr.

Fish.

Yes.

Trustee uh Hannafee.

Yes.

Trustee Horn.

Yes.

Trustee O'Brien.

Yes.

And the chair votes yes.

Motion carries 601.

Uh with that, uh, we'll move into the report section uh of our uh and our our CEO has already given his report.

And uh so I'll once again go back to uh our uh our CFO and uh assistant treasurer to uh uh give us an update on the financial information that was in the uh consent agenda.

Thank you, Chairman Lazard.

So now we'll um appreciate the brief moment to rest my voice too.

So uh I'll be I'll be pretty brief.

First, I'll cover the general fund budget basis, revenue expenditures as of June 30th.

There wasn't a substantial change from the the information I we reported in May or for May in June.

Or sorry, yeah, for May.

So through June 2026, the general fund is reporting a decrease in fund balance of 11.5 million, and this position is favorable to budget by 4.6 million.

Remember, we have a projected deficit of 25 million on the general fund.

Financial highlights through June include the following.

Public health revenue collections through June 2026 of 5.3 million remain 400,000 favorable to budget.

Um grant revenues and expenditures are slightly they're below budget, 5.8 million.

Personal services of 45.7 million are favorable to budget.

We do expect this air position to move more towards budget as seasonal summer staff expenses continue to be incurred in the coming months, and open positions are filled.

For the expenditure categories or the additional expenditure categories, supplies of 5.4 million, or 1.1 million unfavorable to budget.

But I would point out that we have $3 million of open POs.

So at this point of the year, we're always starting to look at those open POs to see how many of them we'll use fully or if they need adjusted at all.

But that that does justify or kind of rationalize why there is that unfavorable position year to date.

Other charges and services of 144.1 million are unfavorable to budget, but it's only by 400,000.

It's a very small percentage.

And we have 22.6 million of open commitments at the end of June in other charges and services.

Capital outlays of 2.5 million are favorable to budget by 4.7 million.

This spend will increase in the coming months as we project this to end at budget.

And then support and transfers are approximately at budget, except for the Eskenazi and IMS operating capital transfers.

That's really just a timing thing.

What we do there is we fund the capital expenditures as they uh commit those dollars.

And so through the end of June, we've funded capital support of 22.4 million that Eskenazi Health has requested through the monthly invoicing process.

Then year-in 2026 projection, we currently project to end 26 with a reduction fund balance of 15.7 million as compared to the budget deficit of 25.1 million.

This is driven by current projections for personal services at end of the year slightly favorable to budget.

Um and then also we have when we mentioned earlier the the refunding of the BABS.

We did find some savings there when we were able to do that.

Um then also the unfavorable position on grant receipts is offset by favorable position on the other charges and services.

So that's uh that would explain the the year-in projection of the 15.7 million uh deficit.

If there's any questions, I could answer those now, or I can do the um the update for the finance and external audit committee.

The update for the committee, and then we'll we'll see if there are any questions.

Sure, thank you.

And I'll be brief here because there were only a few items in that meeting.

Uh we did the the budget presentation.

I did have some help in that uh the early meeting this morning.

We had Tar Parchman from Marion County Public Health Department Director of Finance, Nicole Harper, CEO for Eskenazi, and then Mark Dice, the or CFO for Eskonazi, sorry, I think I said CEO, and then Mark Dice, the CFO for American Senior Communities.

So they helped uh with that.

The committee did have a couple questions and comments, which we answered during the presentation.

And then the second item we was the report for the preliminary determination to issue bonds.

So I gave that uh a brief presentation there also in the meeting.

Uh, the only other item was the uh the prior meeting minutes were approved, and that would conclude the report for for that committee meeting this morning.

Are there any questions for for James?

Thank you.

Uh thank you.

Hearing none, we'll move on to the uh Mary County Public Health Department, and I believe we have uh Karen Holly, our director of operations sitting here.

Good afternoon, thank you.

As Dr.

Kane shared with you last month, the health department kicked off the community health improvement plan June 25th, which is the third phase of mobilizing action through planning and partnership, otherwise known as MAP 2.0.

The health department has engaged partners and defined a shared vision.

They've conducted a community health assessment, and now we're working to set shared goals and long-term measures in five priority areas that we will work to achieve in the next three to five years.

We hope to have the completed plan by early November and share with you in 2027.

The Health Department has continued to participate in community health events across the county this summer, including the Marion County Fair covering kids and family back to school community resource day and Indiana Black Expo.

As we prepare for back to school, the health department will host various clinics, vaccine clinics through August the 26th at various locations.

These clinics are for all children entering kindergarten through 12th grade.

It is requested that the families bring a copy of vaccine records if you have it, the guardian's photo ID, an insurance card if available.

Please know that having insurance is not a requirement to get your kids' vaccines up to date.

The clinic information can be found on the Marion Health.org website.

And that leads into the next announcement, or my last.

We are excited to announce that we have redesigned Marian Health website, and it has been launched.

The goal was to create an enhanced online experience that better served our clients, visitors, providers, and community members.

The new website features updated content, improved navigation, enhanced accessibility, and a modern design that makes it easier for information and services to be provided.

We invite you to visit the redesigned workshop website at Marionhealth.org and explore everything it has to offer.

And that's all.

Thank you.

Are there any questions for uh for Karen?

Not hearing any.

We'll move on to uh Eskenazi Health and I'll introduce our uh CEO and uh Dr.

Harris.

Thank you, Chair and um members of the board.

I have also have a handful of announcements.

First off, our registration is open at this point for the 2026 Burn Symposium that is hosted by the Richard M.

Fairbanks Burn Center at Eskenazi Health.

And this is a two-day in-person event that has become a must-attend affair for individuals engaged in this work for health professionals.

Um it will take place September 17th through the 18th here on our downtown campus.

Uh individuals who participate have the opportunity to receive their ABLS uh certification, also uh to learn how to manage uh burn care for patients during the critical first 24 hours.

This is important because a number of individuals are cared for initially in other systems and then transferred to us, so that first 24 hours before transport is is really uh important to ultimate outcomes.

Uh, then we then there's just a host of presentations in the second day related to uh trauma, palliative care, pharmacy emergency medical services, emergency response planning in the case of mass uh casualty events.

Um, and then I one of the highlights is always a panel of burn survivors who uh actually uh discuss their stories of recovery, and this is something that's encouraging not just to uh individuals who uh have survived burns but those who have cared for them.

So a highly impactful uh couple of days, always well attended.

Again, the registration is open and the uh information is available on our website, www.eskinazi health.edu.

Um just a general uh announcement.

Anybody uh coming to our campus, we are working to upgrade our parking equipment in the Eskenazi Health Parking Garage.

Um we uh the parking garage and all the lots will remain open and fully available during this time.

We're working to manage this with minimal disruptions, but there may be some temporary changes to entry and exit lanes.

We just want to alert people to.

Um, that we are now recruiting uh participants here uh for this program, and this is designed to meet the needs of pregnant individuals living in the Northeast Indianapolis neighborhoods, ensuring access to medical, emotional, and uh and um social support uh all required for healthy pregnancy.

This is uh is just one aspect of Eskenazi Health's commitment to uh improving infant mortality and maternal health across the county.

So uh participants will be invited to an upcoming resource fair and have the ability to uh register for group OB appointments.

There are also obviously individual appointments, but there's a lot of they can be gained from the support of a group as individuals are uh navigating the complexities of pregnancy.

So those who are interested in becoming a NES participant participant who want to register for these uh maternal health resources also can visit our website again, www.eskinazzi health.edu.

Uh we always love to celebrate uh individuals who have uh achieved uh recognition, who have achieved important recognition across our organization, and in that vein, we're happy to announce that Todd Walroath, who is our pharmacy manager of acute care services at Eskenazzi Health, has received the title of fellow of ASHP, and this is in recognition of excellence achieved in pharmacy practice and his contributions to the American Society of Health System Pharmacists.

This is the largest association of pharmacy professionals in the U.S.

representing more than 65,000 pharmacists, student pharmacists, and pharmacy technicians across all patient care settings.

Individuals who achieve this recognition get the recognition for having demonstrated sustained commitment or contribution to excellence and practice for at least 10 years, contributing to the total body of knowledge through publications, demonstrating active involvement, leadership in the organization, and being actively involved in a committing to committed to educating practitioners and others.

So again, congratulations to Todd Walworth for this designation.

And then finally, I just want to make some comments about the experiences that are what we're seeing in terms of some changes in payer mix that are affecting the health system.

Our CFO, Nicole Harper talked about this in the finance committee earlier today, and she discussed the financial impact of increases in numbers of uninsured individuals presenting for care at Eskenazi Health.

So I want to follow on that by making sure that we keep top of mind and at the fore the most important issue here, which is the challenges that patients are facing, and what we're doing to help mitigate those challenges.

And this is part in part a follow-on from the report I gave to the board in more depth last month.

So just as an update, from April of 2025 to June of 2026, this is just the last month, Medicaid enrollment has declined by 29% in Marion County.

When I reported before, we were at 25%.

Now we're at 29%.

And this is importantly before the federal legislation, HR1, also referred to as the one big beautiful bill act, kicks in January of 2027.

At that point, there will be additional requirements.

Right now, what we're seeing is the effect of redetermination that was paused during COVID and what and the effect of bringing that back.

But effective in January, individuals will also be required to prove on a quarterly basis that they are meeting work requirements and prove on a biannual basis that they are still eligible for Medicaid.

So even before that part kicks in, we've already seen a 29% decrease in individuals enrolled in Medicaid.

And according to CMS, over 95% of those disenrollments since the latter part of 2025 and the early months of 2026 are not because people are ineligible for Medicaid, but they are for procedural reasons.

So it's the it's the challenges of actually meeting the requirements of filling out the paperwork and and getting and just the procedural requirements in staying enrolled.

And so to help our patients through that, we have a team of over 90 financial eligibility specialists who are available to offer support in every way imagined, certainly answering questions, providing just we have content experts helping individuals get and maintain access.

We are working proactively to spread the word throughout the community.

We were present at the IBE Minority Health Fair, also a big event at New Directions Church.

There are lots of these events occurring across the city.

We are part of part of those events, and for any for individuals who want to know where they might be able to go to get more information at a community event.

Again, the information is available on our website, uh Eskenazi Health.edu.

For patients in our system, we are also working to deploy my chart, uh, which is our electronic medical record in using the patient portal to send targeted communications to our patients, informing them of the requirements in general, and also reminding them of upcoming dates and offering assistance and helping navigate the process.

But right now, what we see right now is that we are seeing significant uh decreases in individuals who are enrolled, and that is translating into significant decreases in individuals with Medicaid coverage seeking primary care and coming to the emergency department.

And unsurprisingly, along with that, a significant increase in uninsured individuals seeking care in the emergency department, which of course represents an increased burden of disease and health challenges for our patients and also significant financial pressure on the health systems like us that serve patients no matter what.

So it's just something that we want to keep top of mind, and we're just to make sure that the community knows that we're doing everything we can to help people stay make sure that the benefits that are available to them are stay available to them.

So happy to answer any questions about that.

Thank you, Dr.

Harrison.

For those of you who uh don't get the IBJ hard copy or don't read it online Saturday when I sat down to read mine.

I I saw once again in the Indiana 250 that Dr.

Harris was uh recognized as part of that uh part of that uh esteemed group in in our community.

With that, I'm gonna turn it over to another esteemed member of the uh uh Eskenazi team, uh Dr.

Ashley Overly, who heads up our Sandra Eskenazi Mental Health Center.

Thank you, Chairman Lazard.

Um, thank you, board, for the approval of Abigail Lewis to the advisory board.

We believe she'll bring great experience to our advisory group.

So today would like to update you on our transition between uh taking over services previously provided by community fair banks behavioral health for Warren and Lawrence Townships.

I am very pleased to report that we are on time and on track for the transition dates that we have set of August 17th and September 14th.

So this is very very soon.

On August 17th, we will transition the Forge Ahead Clubhouse and two residential sites, Harmony House and Stepping Stones to come under Sandra Eskenazi Mental Health Center Management.

And then on September 14th, we will transition the outpatient clinic building on East 16th Street to Sandra Eskenazi Mental Health Center management.

Um so we also later in the fall will be adding an Eskenazzi Health Pharmacy location in the East Six East 16th Street Clinic location.

There's currently a pharmacy there run by Genoa, and we will be transitioning that to an Eskenazi Health Pharmacy this fall as well.

This transition will require adding about 60 FTEs to manage those programs, and the hopefully the transition of about 500 patients who are currently receiving services in those locations right now.

I am very pleased to report that all of the management positions have been filled with people who are incumbent leaders in the community programs right now.

I take that actually as a great testimony to our team's ability to recruit those leaders and retain them through this transition.

About 90% of the community staff who are currently working in those locations have applied so far for positions with us, and we are on on track to be fully staffed by the time that we open.

So I believe that's also a great testimony to the our team and being able to recruit and retain the community staff as well.

So I feel like our directors have done a really great job of getting those positions filled and creating transitional employment plans and transitional operations plans because these this is not creating new programs or opening new programs.

These are programs that are currently running.

And so our priorities are to make sure that there's no gaps in services for patients and that there's no gaps in employment for employees who want to continue to serve those programs.

Additionally, um beyond those specific buildings, we also have added 14 schools for school-based counseling that previously were served by community health network.

Um so that's also a significant part of this transition.

Um we are also working on a plan to continue to be able to provide supervision to psychiatry residents who are currently with um they are residents with community health network, but they do their community-based psychiatry rotation at the East 16th Street Clinic, and so we are working on a plan to be able to continue to provide them supervision in that same location.

And so really I am very, very grateful to the huge system effort and to support from leaders across Eskenazi Health that have really come together to accomplish this transition and keep this on track.

So as you might imagine, this truly does require leadership and effort from across the entire system.

So patient access, revenue cycle, IT, security facilities, environmental services, project management, finance, pharmacy, legal, risk and regulatory communications, HR, talent acquisition supply chain, operational leaders, clinic leaders, and that's just the internal people.

So outside the system, we have the state division of mental health and addiction.

We have, of course, the leaders at community, we have our city county council, we have Lutheran Child and Family Services.

So it truly is an enormous project.

Um being uh it's so dedicated to the people that we're serving.

So that is my report, and so I'm very hopeful that at our next board meeting, I will let you know that we are uh fully operational at at least three of the locations.

So and that concludes my report for today.

Thank you, Dr.

Orley.

Are there any questions or comments for Dr.

Oberley?

With that, we'll uh we'll move on to the uh our uh chief of the uh Indianapolis Emergency Medical Services uh back from uh European vacation.

I am back.

Thank you, Mr.

Chair, and actually in Europe where they wear uh their EMS uniforms are just like that.

So again, I I think we are fashioned forward here in Indianapolis.

We're very European.

Uh so a couple things to report.

First, we recently celebrated the successful completion of our most recent recruit academy.

We swore in 23 new EMTs and paramedic uh this past July 3rd.

The group's working through their field training officer process before being released.

Uh just a fun story with this.

One of our newest providers, Alana Magnus, is followed in the EMS footsteps of her grandfather Larry, who began his EMS career with the Wishard Memorial Hospital in 1959 and was part of the security team and an EMT until he retired in 1981.

Additionally, we just got done onboarding two new full-time employees who've joined our HR and fleet teams, which will be a great help for both those sections.

We are currently preparing, always preparing for our next paramedic science class, which will begin in early 2027.

Uh again, that will start with intro introduction information sessions, uh, then completion of anatomy and physiology.

But again, this is gonna go a long way to meet uh the large paramedic need here in the uh here with IEMS.

Uh the heat impact uh definitely took uh the country, it had a large impact and impacted us here in Indianapolis.

We were front and series front and center for a variety of uh um news stories uh and oh we found that in the two heat waves we responded to over 131 heat related calls, which is actually higher than uh a normal summer for us.

So again, quite busy.

And on top of that, during the heat wave, uh as if that wasn't enough, we set a single day response record on July 15th with 474 responses, uh, which was more, which was two more than the previous single day record, which was set July 5th last year.

So again, we see a pattern here.

Um we are uh excited to be upgrading our fleet with three new district lieutenant vehicles and new ambulances.

Uh again, this goes a long way to ensuring that we're providing continue to provide the high level of care uh that we expect here at IMS.

Looking ahead in August, uh we do have uh our coverage of the Indiana State Fair.

We cover each and every day uh starting August 7th through the 23rd, so we'll be out there covering the various fair activities as well as covering Colts games, Garth Brooks concerts, the Velodrome, and everything else that may be happening in August.

And finally, we are preparing up for our annual IMS awards banquet, which will which will be happened September 14th and 16th at the Raskeller, and have invited the HOC board to attend if you like.

Uh this event is casual.

I want to put the emphasis in casual.

Um, it's a great time to come together.

The reason we do have it on two days is that this allows for all four of our shifts to be able to be celebrated together.

So with that, it can concludes my report.

Are there any questions?

Yeah, why do we refer to Dr.

Harris in 1959?

What was that about?

We weren't even more than 50 minutes.

I'm just telling you are there are there any appropriate comments or questions from any of the board members?

Hearing none, I'm gonna quickly move on to uh our uh vice president of long-term care, Julie White.

So thank you, Chairman Lazard and trustees.

Earlier today during our long-term care committee, the long-term care division shared the following quarter one data.

The quarterly review team completed 22 clinical and administrative and 20 additional environmental and life safety and emergency preparedness visits.

81 of 85 are 95 percent of residents and families interviewed were satisfied with care.

HHC averaged 3.3 deficiencies per survey compared to state and national averages of 5.8 and 7.4 deficiencies respectively.

60 facilities achieved a three-star or above for their overall CMS five-star rating.

This is an improvement from 57 facilities in 2025.

Andy Shane, ASC COO presented a 2025 and 2026 capital expenditure summary.

25 million was budgeted for capital expenditures with 19 million for planned facility and equipment upgrades and an additional six million for emergencies.

Mark Dice, ASC CFO presented the quarter one financial report, gross operating income and net operating income were favorable to budget with revenue and census, right at budget and net operating income, four million ahead of budget.

Mindy Shapiro, Chief Compliance Officer, presented the ASC quarter one and quarter two compliance report.

ASC received 765 compliance calls through quarter two, which is similar to 2025.

Areas covered included compliance case data, privacy, and documentation audits.

Steve Van Camp, ASC CEO shared that ASC is pleased with quarter one and quarter two performance and remains focused on census, employment retention, and quality improvement.

Paul Babcock shared that HHC and ASC are in discussion with our facility landlord Rothner regarding lease extensions as part of the strategic plan.

Our June long-term care updates include daily facility census average 6165 residents and increase with the acquisition of three facilities in March and April.

Five facilities were recently named as American Health Care Association Bronze Quality Award winners, and four additional facilities received the Silver Quality Award for 2026.

Finally, AHCA recently conducted an on-site visit to evaluate Todd Dickey, one of our facilities in Leavenworth, Indiana, for a gold quality award.

If they receive this award, it will be the first gold winner in Indiana.

This concludes my report.

Any questions?

Any questions for Julie?

Thank you, Julie.

Um, and with that, I'll turn it over to the our uh CEO of president of uh Eskenazi Health Foundation, uh Angel White.

Thank you, Chairman Lazard.

Just want to share a few updates on numbers here.

Um so as we look at our two goals, supporting Eskenazi Health and Community Partners by disbursements and then raising philanthropic revenue.

You'll see that as of June 1st, our grants committee had awarded about 27 percent of available funds.

Um we have another grants committee in August, and then as needed, probably a third grants committee meeting before December, and so I'll speak a little bit about that in a minute.

Um, and then dispersed from funds that we hold in restriction.

We're ahead of schedule, so I'm expecting that we're going to exceed the projected four million dollars again of dispersing funds to the health system.

So we've dispersed about 69 percent of the funds uh from restricted right now, 69 percent of our projection.

And then on the raising of the money, we are um at about 44 percent of our goal as of July 7th.

The first half of the year is really the slowest half for us.

Right now, we are gearing up with our corporate giving circle solicitations.

We have 3.6 million dollars pending right now in major requests, which by that I would define as 100,000 dollars and up either to individuals or foundations.

So second half of the year for us is definitely um a larger portion, uh securing a larger portion of our uh fundraising goal.

I want to back up to the grants committee just one minute and say that uh as you've heard me say in every meeting this year.

Our goal is how much can we help the health system in terms of the budget situation that we're in.

And so one of the things that um working with Dr.

Harris and Nicole Harper that will come to the grants committee for the August meeting is a proposal to help bring more training and resources to the financial counseling team to make sure that our team is ready and able to continue to assist our patients in Medicare enrollment, so whatever other things they might need to be up to speed in working with our patients.

So again, we're anxious to continue to get resources to the health system, either for immediate need and/or to leverage revenue in support of our patients.

So when I'm talking about all these numbers, what kind of impact are we talking about?

So I just wanted to share a few things.

Um thanks to Dr.

Overly who had to had to step out.

Um we secured 250,000 from a first-time donor who is really interested in funding the evaluation metrics for the CCBHC.

That's like a dream come true.

You don't find a lot of donors who are really excited about funding evaluation metrics.

And the beauty of this gift is that it aligns perfectly with the fact that we need these evaluation metrics.

We need an outside resource to validate them to leverage continued funding for the CCBHC, but there's not a source of revenue to pay for those evaluations.

So we're very grateful.

This is a two-year grant that will do just that.

We received a grant for medical legal partnership work to continue that.

Um we had an individual donor who wanted to provide art to the West 38th Street Clinic.

So we've gotten a $25,000 gift to do that.

Um that clinic would like more art, and so we're able to provide that.

And then a $20,000 gift again from an individual to support prescription for hope, which is our violence intervention and reduction program.

And we also just applied um to renew our half a million dollar grant with the Lilly Endowment for this program after a very favorable grant review meeting with them.

So I just thought it might help add a little flavor to the numbers to give you some idea of the type of gifts that we have received.

So that concludes my report, unless you have questions.

Are there any questions for uh Angela?

Thank you.

Thank you, Angela.

Hearing none, I'll ask the board if there's any unfinished business that anybody wants to bring up or any new business that anybody would like to bring up.

Hearing none, we'll move into the public comment portion of a meeting, and we have one individual who has signed up to make a comment uh Bob Urban, and while he's uh well, Amanda's helping him.

The public comment portion of this meeting uh on the agenda is the board's opportunity to hear opinions and comments from the public.

While there is no legal requirement that the board take public comments at this time, it is the board's practice to do so.

This opportunity is to provide opinions and comments.

It is a privilege and is offered under the condition that members of the public provide their opinions and comments in a respectful manner and without boundaries of uh uh within the boundaries of professional meeting decorum.

Uh any any individuals uh abusing that will be uh can be asked by the chair to to uh stand down.

Members of the public will each have two-minute time limit uh and uh shall avoid raising their voices, speak only when recognized and not display any behavior disruptive to the professional decorum of the meeting.

So with that, I'll uh uh mandate what we um have chosen not to chosen not to give comment.

We're gonna talk to them afterwards.

So I understand the individual is declined now to make a comment and will be meeting with a couple of individuals after the meeting.

Very good.

All right.

Well, thank you for the update.

Um glad I read through that.

Um with that, uh, our next meeting date uh is uh Tuesday, August uh 11th on 2026.

And the purpose, primary purpose of that meeting is a very short meeting, is uh to conduct the uh public uh the public hearing of the General Ordinance 2 226, which was read for the first time today.

And with that, I'll ask for a motion to adjourn.

So it's been moved by Trustee Horn, and we are adjourned.