Audit: County's ambulance fund $500K in the red

Audit: County's ambulance fund $500K in the red

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ELKO – Elko County’s ambulance fund had a $540,000 deficit in the fiscal year ending June 30, 2019, according an audit report that shows the county had overall revenue of $68.89 million and expenses of $60.2 million.

“The ambulance fund jumps out,” Elko County Commissioner Delmo Andreozzi said at a recent county meeting as Teri Gage, a partner in Eide Bailly LLP, went over the audit.

Cash Minor, assistant county manager and chief financial officer, said the ambulance service lost roughly $66,000 in cash and the remainder of the deficit is for an allowance for “doubtful accounts” and depreciation.

He sees the need for a new look at the ambulance service.

“It may not be capable of paying for itself,” he said via telephone after the meeting. “We might need general fund money to keep it whole.”

Minor said even if rates were increased, Medicare and Medicaid pay set amounts, the county must pay into the employees’ retirement accounts, and revenue from services must be collected. He said the county uses a third party for bill collections, which are getting caught up.

One problem that Minor and Gage pointed out is that ambulance employees sometimes don’t fill out their run reports in a timely manner, which affects billing. The faster bills go out, the easier it is to get payment, Minor said.

The audit report states that two of 25 billing claims tested were not completed for submittal to billing, and “upon further examination, it was noted that there were 46 charts for the year ended June 30, 2019, that were not completed for billing.”

The report says that the ambulance service director, Lee Cabaniss, reported additional controls have been put into place to keep track of charts, and there would be an increased percentage of weekly review of all charts to “allow for increased transparency and identifying charts pending completion.”

He also stated that an update of the chart completion policy was pending and would clarify time to file and time to edit charts after review, as well as penalties for incompletion.

Gage outlined the ambulance fund for the fiscal year 2018-2019 in an April 2 email:

“For the Elko Ambulance Fund, the fund ended the year with a negative net position of $540,057; however, the statement of cash flows had an increase in cash of $257,866, most of which was from a $300,000 transfer in from the general fund to help fund operations. Net position includes capital assets and the related depreciation expense; depreciation does not impact the cash flows.

“In addition, this fund has an allowance account on the ambulance receivables which fluctuates each year based on collectability projections. This allowance amount impacts the net position of the fund,” Gage wrote.

Other problems

Her report to commissioners also found problems with entities in the county failing to go back to commissioners for final action on large purchases after acquiring the required three bids. She said the Elko County Fire Protection District bought fire trucks and other equipment without board action.

Although the fire district is a separate entity, Gage said the district is a “blended component unit of Elko County and the county commission serves as their board. Therefore, the district is included in the audit report of Elko County.”

It wasn’t just the fire district that Gage singled out. She said there were several incidents where vehicles and equipment purchases didn’t have final approval required by state statute.

“They were all over the board with these,” Gage said.

Minor said the purchases had budget approval, however, he “agreed with Teri” that purchases should come back to the commissioners for final action.

County entities also must come to the county commissioners for approval before selling county assets, she said.

Other problems found in the audit have been fixed, according to Minor. He said that with the retirement of longtime comptroller Debbie Armuth and the 14 months it took to replace her, there were difficulties with compliance that wouldn’t otherwise have occurred.

The audit report includes a warning for the current and upcoming fiscal-year budgets that with the COVID-19 pandemic, the county’s investments may take a hit, Gage said. The stock market has plummeted since the coronavirus became widespread.

The report states that sales tax revenues also will be impacted by the pandemic.

Enterprise funds

The audit report also shows that the smaller enterprise funds for the county had losses, except for Montello’s water and sewer fund, which benefited from a $565,000 grant for a water project.

All total the county received $3.5 million in grants for the 2018-2019 fiscal year, up from $2.4 million the prior year. The grants went for such things as transit buses and firefighter equipment.

The overall revenues for the county of $68.89 million compared with $61.51 million in the 2017-2018 fiscal year, and the expenses of $60.2 million compared with $59 million the prior year. The excess revenues totaled $8.69 million at the end of the 2019 fiscal year, up from $2.46 million in the 2018 fiscal year.

Elko County’s net position in the fiscal year ending June 30, 2019, was $75 million, up $8.7 million, Gage told commissioners.

A break down of expenses shows that general government cost: $9.9 million, down from nearly $10.27 million in the 2018 fiscal year; judicial nearly $12.87 million, down from $12.93 million; public safety, $17.68 million, up from nearly $17.09 million; public works, $8.12 million, down from $8.62 million; health, nearly $1.09 million, up from $1 million; welfare, nearly $2.63 million, up from $2.35 million; culture and recreation, nearly $2.13 million, up from $1.09 million; community support, $549,041, up from $474,569; interest, $4,830, down from $7,422; and intergovernmental, $725,000, compared with zero.

Business-type activities costs included: water, $631,725, up from $601,517 in the 2018 fiscal year; sewer, $292,892, up from $281,377; ambulance, $2.36 million, up from nearly $2.18 million; transit services, $956,593, up from $875,617; and solid waste, $269,454, down from nearly $2.97 million.


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