chair amadeo lopez castro calling past chair amadeo lopez castro before we call the meeting to order we wanted to recognize a special person that's in the audience amadeo lopez castro the third fourth the fourth welcome all right well we'll go ahead and uh get the meeting call to order um reverend kelly is not with us this afternoon so we've asked dr richardson to lead us in the invocation theologian by the name of brian hope he wrote a prayer national favor god grant me the serenity to accept the things i cannot change the courage to change those things that i can and the wisdom to know the difference this is um the opportunity for the public to be heard is there anyone okay thank you lord is um the first item on the agenda is the approval of the minutes from august 27th 2025 so moved madam chair is there a second second okay all those in favor aye all right um so we will call the the the purpose of this uh meeting is really to um review the proposed budget present um presentation uh zuzel jimenez associate vice president of budget financial planning and analysis will um present the budget as is required by miami-dade county thank you good afternoon thank you for the opportunity to present a jackson health system proposed fiscal year 27 operating and capital budget i will start with the key volume assumption supporting our operating budget for fiscal year 27 we anticipate that overall patient volumes are going to be are going to remain stable while we continue to see growth across several jackson strategic clinical programs with we expect continued growth in service lines such as cardiac thoracic transplant and neurosciences we also continue to expect uh growth continue growth in jackson memorial hospital with the opening of a new emergency department which represents an important investment in expanding access to emergency care and supporting future patient demand within our ambulatory network we also continue growth continue to respect growth at the christine lean rehabilitation center the miami transplant institute and the recently opened jackson south beach express express care clinic these positive trends are slightly partially upset by anticipating declines in some areas including orthopedic procedures are jackson south and also the competitive that competitive impact of nicholas opening a second um uh pediatric unit and moncyna also opening opening opening a new freestanding ed in the westchester area the next slide illustrates how these assumptions compare with our current year projection which is 2026 and it also shows two additional closed fiscal years 2024 and 2025 so we can look now how these assumptions translate into revenues we anticipate continued growth in net patient service revenue primarily driven by a better payer mix especially in managed care and medicare also higher acuity across our health system the volume assumptions at jackson memorial are also driving some of these increases as well as the continued improvements and efforts to improve cash collections denials reductions and clinical documentation improvement initiatives we also have incorporated into the budget of 5.2 million associated with managed care contract rate improvement resulting from negotiated reimbursement increases beyond patient revenue we also anticipate a modest growth in our other operating revenue this increase is primarily driven by higher provider billing collections within our jackson medical group as well as continue expansion of grant funded programs that support several important clinical initiatives on the other hand our sales tax is expected to be reduced by 8.4 million dollars and this is reflecting current economic forecasts available during the budget development process by our by the county non-operating revenue continues to include important for these funding sources for jackson jackson which is our graduate medical education and our indirect medical education as well as um the interest income that we have in that in that bucket as well if we turn now to the expenses our largest component of our upper our expenses are salary wages and benefits and in 2027 we have incorporated 296 additional full-time equivalents primarily to support anticipated patient volume growth the expansion of clinical programs in the opening of new services we have also incorporated like in every other year annual employee merit increases the cost of leaving adjustment that was implemented in april of 2026 and anticipated increases that we have also in health insurance and retirement benefit costs purchase services is also showing that it's increasing in 2027 and this is due to higher maintenance contracts associated with new facilities and equipment increase in growth in organ acquisition costs to support our transplant program expanded value of services agreement higher dialysis service costs and additional marketing initiatives our supply expense it's including a two percent inflationary increase across all our major supply categories as well as changes in utilization associated with our projected patient volumes finally depreciation and interest expense are increasing as well depreciation because of the addition of the um of the new emergency department at jackson memorial and interest income is increasing because of the 2026 revenue bond issuance so what you see on the screen right now is a slide that brings together our expenses and revenue so is a summary of our proposed operating budget which was presented on a balanced basis with our with our operating expenses or our expenses being covered by our revenues so that's why you see a zero bottom line total income and loss equals zero for 2027 okay so we can move now to capital the proposed capital plan for 2027 is 251.5 million and it includes projects across entire health system involving patient care areas diagnostic equipment information technology facility improvement and infrastructure upgrades each project has been carefully evaluated and prioritized based on a strategic importance operational necessity patient safety and of course available financial resources there is an appendix that shows two additional schedules and these are the schedules required by the county that we have to submit along with our budget so this basically concludes my presentation for today thank you for your time and attention and i'll be happy to take any questions you may have thank you suzelle do we have any questions okay yeah this presentation is consistent with the presentation that we had last month um so no no changes um as presented by suzelle madam chair yes i have a question i just wanted to um thank you suzelle and mark and your entire team um being overseeing a budget of this magnitude is no small thing and um just super grateful to have your professionalism and responsibility in doing it thank you thank you very much suzelle can you maybe um and i know i've asked you this in the past but for the benefit of everyone walk through your process and how many team members you have and and how you um coordinate with the different ceos sure so the whole financial planning and analysis team we're a total of ten six of them are primarily focusing on the budget and every year we start the budget around january i want to say that's when we start there is a lot of preparation prior to that so we have to get our systems ready we have to talk to hr we have to talk to the different areas so to get the volume assumptions that we need to incorporate into our tool by volume assumptions i mean are we going to have any managed care rate increases in our in our budget are we going to have increases in health insurance and reimburse and i'm sorry in retirement costs all of that get gets put into the system before we open the plan files for the areas to start input in their budget so you know it's about a month that areas go in and put together their budget they submit their budget to us then the budget goes through a significant process of review between the whole executive team so start with mark and myself and then it goes to david and there have meetings that happen so it uh the budget starts every every submit to it starts with a number and then it ends up in a completely different number so mark does a great job making sure that everybody keep us on a on a financial stable position uh moving forward so we look at volume assumptions so it gets very intensive and very labor intensive so after all so we put together what we call it consolidated budget and that's that's what you guys are reviewing today how accurate are the sales tax revenue estimates from the county historically so that what you see today in the presentation is the most updated numbers that we receive from the county uh at the time that we put together our budget there are reconciliations that i understand it happens based on actuals and then that number gets finally adjusted so that you could see a variance between our actuals and our budget but i'm just saying like historically mark do you know do we come under over there's all we generally pick up so we stick with like the most conservative yeah right so their revenue estimating tends to be conservative and then there's a quarterly reconciliation based on actual cash receipts and then we get a year-end adjustment so right now we're up about eight million dollars to what you see recorded on a year-to-date basis because we wait until it's flushed out last year the net pickup was 18 million so historically there's always a positive adjustment when the actual comes in yes so county all kind of use conservative numbers when they issue their estimates yes so this this happens to be unusual that we would see a decrease from current year projection to budget but we are uh the one pen the half penny sales tax is the county uses that also for their transit so it's the same number that they use in their projections and we are um our process is to record it to their number but there are two half penny sales taxes one is ours one is transportation or yeah so it's one penny yes correct and moj we covered last month that a there's an inflation assumption for supplies if that inflation assumption changes by one percent it's an additional five million dollars i i recall you sharing with us supplies no is that where it is yeah yeah so if that number were to increase so there's headwinds and there's um right i think i've lived the budgeting process long enough to know that there's you know some fluidity and variation and then you know unfortunately sometimes unexpected things but generally inflationary numbers are just trending up and up so yeah it's just part and parcel thank you all right any additional comments or questions mark if i could just interject um i want to thank zuzelle she's done an incredible job i i think you probably know that the last few years our budget process has been very clean much more efficient she's identified a lot of process improvements unfortunately i'm sorry to report that this will be zuzelle's last budget she is moving on to different uh opportunities she has been with jackson for 15 plus years and i've known her for 20 years she has continued to demonstrate increased responsibility and significant performance of opportunities so just wanted to take the opportunity to thank her and uh for her efforts in this budget thank you you will be missed i'll miss everybody as well okay thank you thank you so much suzanne and best of luck um so in front of us we have a resolution to make a recommendation to the county for the budget as um presented to chris do you want to walk us through that please sure so yeah you've got um the only item item 8a resolution approving the operating and capital budgets for the health system fiscal year 26 27 do we have a motion all those in favor hi great okay that adjourns our meeting thank you so much have a great afternoon