Item H2
BOARD OF GOVERNORS
LOWER AND MIDDLE KEYS FIRE AND AMBULANCE DISTRICT
AGENDA ITEM SUMMARY
Meeting Date: March 21-22.2001
Division: Public Safety
Bulk Item: Yes
No X
Department: Emergency Medical Services
AGENDA ITEM WORDING: Approval of Resolution authorizing the write off of EMS Accounts
Receivable, in the total amount of$I,281.47
ITEM BACKGROUND: The attached Resolution requests to write off the balances of the patient
accounts that are listed on Exhibit A, in the total amount of $1 ,281. 47. Correspondence relating to
each account is attached.
PREVIOUS REVELANT BOCC ACTION: None
CONTRACTIAGREEMENTCHANGES:N/A
STAFF RECOMMENDATIONS: Approval
TOTAL COST:
BUDGETED: Yes
No
COST TO COUNTY:
REVENUE PRODUCING: Yes
No
AMOUNTPERMONTH_ Year
APPROVED BY: County Attorney YES OMB/Purchasing N/A Risk Management N/A
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION:
Included X
To Follow
Not Required_
AGENDA ITEM#m
DISPOSITION:
Revised 2/27/01
Emergency Medical Services
RESOLUTION NO. .2001
A RESOLUTION OF THE BOARD OF GOVERNORS OF THE
LOWER AND MIDDLE KEYS FlRE AND AMBULANCE DISTRICT
OF MONROE COUNTY, FLORIDA AUTHORIZING THE WRlTE-
OFF OF EMS ACCOUNTS RECEIVABLE
WHEREAS, Monroe County Emergency Medical Services provides ambulance service; and
WHEREAS, attempts to collect the full amount from the service recipients have been made; and
WHEREAS, it has been determined that further collection efforts are fruitless and would only incur
additional costs to continue to bill the recipients; and
WHEREAS. it is desired to WTite off the accounts receivable because patients have no resources to pay;
now, therefore
BE IT RESOL YEn BY TIm BOARD OF GOVERNORS OF THE LOWER AND MIDDLE KEYS
FIRE AND AMBULANCE DISTRICT OF MONROE COUNTY, FLORIDA:
. Service recipients listed on attached Exhibit A accounts receivable in the amount of $1,281.47 be
deleted from the County's Emergency Medical Services Department accounts receivable list.
PASSED AND ADOPTED by the Board of Governors of the Lower and Middle Keys Fire and
Ambulance District of Monroe County, Florida, at a regular meeting of said Board held on the day of
, 2001.
Chairperson Yvonne Harper
Mayor George Neugent
Commissioner Nora Williams
Commissioner Munay Nelson
Commissioner Dixie Spehar
BOARD OF GOVERNORS OF TIm LOWER
AND MIDDLE KEYS FIRE AND
AMBULANCE DISTRICf
OF MONROE COUNTY, FLORIDA
(SEAL)
Attest: DANNY L.KO.LHAGE, Clerk
By:
Mayor/Chairperson
By
Deputy Clerk
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September 19, 2000
Focus Financial Services
Post Office Box 2196
Delray Beach, FL 33447-2196
RE: James Smith
Dear Sir/Madam:
! am writing on behalf of this client, who used EMS services on
August 31, 1999. This client continues to be ill, is awaiting Social Security
Disability determination, has obtained Medicaid, but continues not to have
an income. There is little, to no chance of this man paying for the services
received. There is no dispute of the validity of the claim, but there is no
ability to pay for the services received.
If further information is needed, please do not hesitate in telephoning
me.
Yours truly,
~dC7
William Bell Wolfolk U-
Case Manager
Xc: Monroe County EMS
James Smith
P.O.Box 4374, Key West, FL 33041-4374
(305) 296-6196 · FAX: (305) 296-6337
Printed on Recycled Paper
(561)265-0405
Focus
Financial
Services
PO Box 2196
Delray Beach, FI 33447-2 I 96
Personal and Confidential
ADDRESS SERVICE REQUESTED
Account # 001220265 01
Amount: $408.88
#BWNBZWJ
#FFSIE2JX038912# /3*OO/220265*L1
1111111111111111.111111,".1111111.1111111111,".11111".1..11
JAMES SMITH
410 COUNTY RD
KEY WEST FL 33040.5703
May 3,2000
Important Notice
Dear James Smith,
The following account(s) have been referred for collection.
We have been authorized to use any means at our dispusal, within the iimiLs of the law, necessa..y to collect the
full balance.
Amount
$408.88
$0.00
$0.00
$0.00
$0.00
Client
Monroe County Ems (Ambulance)
cJ;/3 I/'i'i
Pay in full or call this office for payment arrangements.
Sincerely,
Focus Financial Services
Chris Mann
(561) 265-0405
This is an attempt to collect a debt and any information obtained will be used for that purpose. Unless you notify
this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion
thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from
receiving this notice, this office will: obtain verification of the debt or obtain a copy of a judgment and mail you
a copy of such judgment or verification. If you request, in writing within 30 days after receiving this notice, this
office will provide you with the name and address of the original creditor, if different from the current creditor.
LI
Visa/MasterCard
Check/Money Order accepted
JAIVIES SMITH
410 COUNTY RD
KEY WEST Fl 33040-5703
Account#: 001220265 01
Amount: $408.88
I authorize my creditor to charge my obligation to the charge:
Visa Mastercard (Circle One)
To ensure proper credit is given, please
return this portion with your payment to:
Card #:
Exp. Date:
Cardholder Name:
Cardholder Signature:
Mail to:
FOCUS FINANCIAL SERVICES
POBOX2196
DELRAY BEACH FL 3J447.2196
1111111111111111111111,11111111111111,1,1111111111111111.11.
02l12~_O~_ l~ 48 _FAX .78~.64.3...~44J!.
ACT OF LOVE ADOPT.CTR.
~003
ACT ref"\.,.
OF. J~
LOVE -'- ~
ADO P t ION'S
734 Mass.achusetts Ave.
Arlington, ~ Olot~er 30, 2000
TEL 781.643.3443
FAX 781.643.3449
Fire Chief of Monroe County
Monroe County E~S
P.O. Box 026011
Miami, FL 33102-6011
. RE: Account Number 906122-01
TO WHOM IT MAY CONCERN:
I
Mary Holder required emergency transport on the ev~ning of June 6, 2QOO because she
was in laDor and had no way to get to the hospital. . Ms. Holder did in f~ct have her bab-y
. . which she placed for adoption with a family from Massachusetts. She in fact had to be
transferred from one hospital to another by ambulance. Her total hospital bills (including
ambulances) totals over $8,000.
Ms. Holder had no insurance. The family is trying to pay the medical bills for Ms..
Holder and the baby. As.an Agency Director of a Non":Profit Mass. Adoption Agency:.on
their behalf, I have been contacting health providers to help in requesting notable
deductions as a self-pay. This is a family who is becoming more and more stress~d as
bills continue to coine in because of the nature of the birth.
I .
We would hope you could consider a reduction in this bill, and I will assure you that the
bill wi~l be paid promPl1Y. Unfortunately we have just now been given this bill to pay. .
The famil y would like to honor all charges and leave ,nothing hanging over Ms. Holder's.
head. '
You could fax me or write me your decision. I would ask that you do not continue to bill .
Ms. Holder, as the family is responsible for her bills. You could send ariy infonnation to
the address listed above, or as I mentioned, fax me 'at the number listed above also.
We thank you for you time and consid~ration:
Sincerely
Ann~te
Adoption. Coordinator
02/12/01 14: 48 FAX 781.!i.~3!H49
ACT OF LOVE ADOPT.CTR.
~004
MONROE COUNTY ~MS
PO BOX 026011
MIAMI, rL 33102-6011
DATE
ACCOUNT I
NUMBER
P.04
9/29/00 1
906122-01 1
o-ct-27-00 ~~:~8A T:C1 - 57804STATEMENT
3057430398
90612~.-O 1
OUR PHONE: NUMB&:R IS...
1-800-417'-2165
AMOUNT PAID S
MAKL CHtCKS PAYAAI ~ IN U.S, DOlLAI~S 10:
A- tCT ~t- J-c.J-c A~7.""iASMONROE
N. Il.lIS #8 7.3if mIKS~ A-V(PO BOX
.URADA. F'L 33036 AI!I-I~ '12JAJ, MA MIAMI,
1 ~~l/7h
COUNi'.Y EMS
026011
FL 33102-6011
TO I""SU~F MC'>PEI? Cf~WII 10 YOUR ACCOllNT . PlE:ASE IXTACtt AND r?ETUI~ THIS STUB WITH VOU~ CHECK
PATIENT NAME:
PHONE NUMBER:
REFERr?lNG DR.:
MARY HOLDER
305-1;,64-8208
PIACF OF SEIMCE:
PVT
;~:.: ::---: c)~.
DESCRIPlION Of SERVICE
.. CJlAR~ES.
. P"''f.M~t~::i~.:::::.
6/06/00 FIRE RFSCU~ TRANSPORT
MILrAGE CHAROE 54.0 ~ $ 7.14
:352.6i
385. 51."
IF YIJu
PLEASE
YOU r-3Y
NOT HAVE MEDICARE, MEDICAID, OR ANY PRIVAT
AY THE AMOUNT INDICA 'rED. PAYMENT PLANS CAN a
ONrACTING OUR OFFICE AT 1-800-417-2165.
***.q..lt*.;~***
i{.****** **., .........*.......***********....**************************
IF YOU AVE MEDICARE. MEDICAID. OR ANY PRIVATE INSUR
*
.;:;.
1.
PLE SE. CAl.L US, OIi CiJMPLETE THE IN9URANCt;: ....ORM 0 THE F"RONT
OF" 'j HIS STArEMENT. A COpy OF YOUR HEALTH INSURANl ~ CA~D IS H
..
...
"*
2. MAIL IT aACK TO us IN THE WHITE ENVELOPE PROVIDE AND WE WIL FILE A ~
CLA. M ON YOLJR BEHALF. ...
INSURANCE,
ARRANGED T
*
ASSIST *
"*
v
.,..
. ~~******~. *.~*****...**********.************************ *********~* *****~.***
PAY
THIS
AMOUNT
738. 17
PfltNr YO\.J1l Ml:DlCAAF NIJM{ILII HERE'
MEDICAl/) ,
prdNT YOlJlll~ PHONf NI.IMBl;R HFAr BUSlNF~.s PIIONE, _.
IF YOU HAVE INSURANCE OR PARJlCIPATE IN ANV PROGRAM WHICH WILL PAY FOR
lHESl SERVICES, PLEASE COMPlETE AND S1QN THE REVERSE SIDE OF Tt1tS IIIU ANO
RETURN IN THE ENCLOSED ENVElOPE.
Ir HiERF IS ANY P~ORlEM RrCArI()ING lItF PAYMLNT t')F HilS Bill. CONI^CT OU~ A<;,~g~~~ l'i'06122-.01]
nrnCE Al ( I.-BOO ..41 7 -;~ 1 t. ~ ) WITtilN ~ UAY$ TO MAI([ ^r?RAN(;CMENTS ._
PlF.ASE SHOW ACCOUNT NUMBFr~ ON ALL CHf:CKS, .
IMPORTANT YOU MUST SIGN REVERSE SID~ TO RECEIVE INSURANCE PAYMEN r
02l1.:/l!...1 _1~:.4~~AX_?8l. ~!3 ~4~ _ __ ACT OF LOVE ADOPT.CTR.
Sent By: HP LaserJet 3100j JetSuitej Feb-9-01 10:05AMj
~005
Page 1/1
,
C: OUNTY o.('MONROE
; KEY WEST J I FLORIDA 33040
: (305) 294-4641
PUBLIC SAFETY DIVISION
Jamn R,"Rergie" Pfuo., DiNcto,
49U 63111 Street, Suite 140
Marathon, FL 33050
Telephone: (305) 289-6no:z
Fu: (305) 189-6336
ME1\10RANDUM
ROAR)) 01" COUNTY COMMI!;SIONERS
M^ YOR, G\:orgc Neugent, Di!;tricl 2
Muyor Pro Tern, Nora Williams. Di~trjcl 4
Dixie M. Spehar, DilitricT J
Charles "Sonny" McCoy, District 3
Murrny c. Nelson, nisrrlcl 5
Ann M. White. Adoption Coordinator
Act of Love Adoptions
FAX: 781-643~3~v
Stacy DeVan~tive Assi!.unt
Public Safety Division
TO:
FROM:
SUBJECT:
Patient Name: Mary Holder
Patient Account: 906122-01
DATE:
FebNaIy 8, 2001
Please be advised that your letter dated October 30, 2000. concerning the bill for
the ambulance transport ofMmy Holder. in the amount of$738.17, has been reviewed by
our County Attorney.
Since the ambulance service is a County service. supported by tax dollars. any
reduction of fees for service must be approved in the fonn of a Resolution by our Board of
County Conunissioners. As you have justified this request as 8. hardship case. at this time.
please submit the amount for the Board's consideration as settlement of the bill. It should
be addressed to: Monroe COWlty EMS, 490 63rd Street, Suite 140, Marathon, Ft. 33050.
Your request) along with your original letter, wiD be presented to the Board of County
Commissioners for their consideration.
Please tax your request to my attention as soon as possible and I will prepare the
resolution tbrthe next scheduled meeting.
Tfyou have any questions. please feel free to t.-all me at (305) 289-6002. My fax
number is: (305) 289-6336.
__ U~~.1 ~'t :...!o_rft~!S~_~J J~4l:1
Al;T U". LUVE AlJOPT.CTR.
~002
- .
t~T (D
LOVE .,,- ~
ADOPTIONS
734 Massachusetts Ave.
Arlington, MA 02476
TEL 781.643.3443
FAX 781.643.3449
February 12,2001
Monroe County. EMS
490 63RD Street
Suite 140
Marathon, FL 33050
, SUBJECT: Mary Holder.
Patient Acct. #906122-01
TO WHOMIT MAY CONCERN:
. This is a follow-up to our atta9h~d request of October 30, 2000, requesting consideration
for a reduction in fees of an ambulance transport bi~ for one of our clients, Mary Holder.
. .
This agency is prepared to settle the bill in the amount of $400. If this is acceptable,
upon hearing from you, the family is prepared to pay this bill immediately. If this is not
an acceptable amount, please let us know how what would be acceptable, so the family
can put this to rest and continue with the joy of caring for their adopted child.
We app~eciate your tolerance and await to hear from you.
Sincerel y,
~M,~
Ann M. White
Adoption Coordinator
Stacey DeVane, EMS
Suzanne A. Hutton, Assistant County Attorney ~
October 20,2000
O~~~~~E
(305)214-4641
Office of the County Attorney
P.O. Box 1026
Key West. FL 33041-1026
305/292-3470 - Phone
305/292-3516 - Fax
TO:
FROM:
DATE:
BOARD OF COUNTY COMMISSIONERS
MAYOR Shirley freernCl'l. District 3
M~r Pro tern 6eorge Neugent. District 2
Wilhelmina HQl"Vey, District 1
Nora Williams. District 4
Mary Kay Reich, District 5
MEMottUM
{~llfb
RE:
Dia Tamva Peralto
File No. 98-63-CP-10
Enclosed please fine a check in the amount of $20.29. This check was sent
to the Clerk's Office and returned to the payer so I just received it. It is in
settlement of the amount owed by Dia Tamya Peralto. Basically all creditors got
approximately 10% on the amount of their outstanding accounts. Accordingly, it
will be necessary to write off the remainder of Ms. Peralto's account.
Please call if you have any additional questions.
Enclosure
SAH/ak
MONROE COUNTY E.M;S., 141-0-115001-0
490 63RD ST OCEAN"
SUITE 175
MARATHON, FL 33050
PHONE #(305)289-6003
CREDIT STATEMENT
10/27/2000
DIA PERALTA
9000 E CALUSA CLUB DRIVE
MIAMI, FL 33186-1819
ACCOUNT #
980056630
PHONE #(305)745-9456
PATIENT: PERALTA, DIA
CALL # 696589
DATE 01/05/1998
SCHEDULE Y
EVENT UNCO
LAST SERVICE DATE 01/05/1998
LAST PAYMENT DATE 10/27/2000
CREDIT DESCRIPTION RECEIPT DATE AMOUNT
------------------------------- ---------- ---------- ------------
PRIVATE PAYMENT-CHECK 1261 10/27/2000 20.29
PRIOR CREDITS RECORDED
0.00
TOTAL CREDITS AS OF 10/27/2000
TOTAL CHARGES AS OF 10/27/2000
20.29
554.71
CURRENT BALANCE
534.42