Now that the Indian River County Hospital District has reluctantly approved a lower property tax rate than the majority or trustees wanted to charge homeowners this fall, the next thing to watch out for in the coming year is extra spending that's not in the approved budget.

During the 2025-26 fiscal year ending on Wednesday, local nonprofits asked for more than $2 million above their initial, budgeted awards, and district trustees approved more than $1.7 million in mid-year, supplemental funding requests, according to a spreadsheet created by district staff obtained via a public records request.

Trustees work from April to July or August – the regular funding cycle – evaluating applications for the coming year. The seven elected but unpaid board members spend dozens of hours evaluating, ranking, scoring and often debating the dollars requested and the programs to be funded. It is a thorough process.

But then those same trustees approve what the district calls "off-cycle" requests with one simple vote, creating an open back-door around the regular funding process.

Organizations come back to the board throughout the spring and summer, outside the regular funding cycle, to say they've already spent all or most the money granted to them with several months to go in the fiscal year.

The pleas of the nonprofit leaders are compelling. They often pose a dilemma to district trustees, a choice between turning sick people away or even shuttering a program if it doesn't get additional taxpayer dollars. Trustees seldom ask the nonprofit manager or board chair if they've tried to raise the needed money by putting out an urgent call to their private donors before coming back to the taxpayers for more money.

One organization, Treasure Coast Community Health, received more than $960,000 in off-cycle requests during the 2025-26 fiscal year. That's above and beyond the $4.2 million initially awarded. TCCH was placed on a 12-month probationary status for its struggling finances this spring after being called to a district meeting to answer questions about its finances and operations.

A Caring Center for Women asked for $560,000 extra in February and received $560,000.

Sunshine Physical Therapy asked for $150,000 in July and received $81,000.

Trustees are placed in an unenviable position, and almost always approve all or part of the request. Other organizations see this strategy working and ask for more money themselves. Just last week three organizations asked for a total of $405,000 and got $335,000. The other $70,000 which was not voted on was a second off-cycle request from an organization which had been granted an extra $95,000 in August.

In certain cases, the increased demand has been a self-created problem due to organizations overcommitting resources or creating a successful advertising campaign or outreach program that attracts additional indigent or uninsured clients. But the nonprofits typically blame changes in federal law and people losing coverage.

Exercising discipline with these urgent off-cycle requests will be especially tough this coming year with millions of extra cash in the bank.

The district just sold a $4.65 million taxpayer-owned property adjacent to Cleveland Clinic Indian River Hospital to the Edward Via College of Osteopathic Medicine, or VCOM. That money from the VCOM sale was not needed to balance the 2026-27 budget. It was added to the district's hefty reserves – taxpayer money kept for a rainy day and invested.

"I'll make the obvious comment," Trustee and Treasurer Michael Kint said last week in the midst of approving hundreds of thousands in off-cycle requests. "Fundamentally, we carry reserves for this kind of circumstance. I mean, that's what we're talking about doing. There are reserves."

District Executive Director Frank Isele justifies huge reserves of $8 million to $10 million or more saying the funds are needed for disaster recovery and to pay the district's operating expenses in the event of a major hurricane.

The district's chief budget hawk, Trustee Paul Westcott, won't be around when next year's off-cycle requests start rolling in, as his term ends after the December district meeting. Westcott has moved the district toward greater transparency and accountability during the last two years of his four-year term after getting to know all the players, systems and maneuvers, but much of that progress could evaporate in 2027 and beyond.

Trustee Dr. Chuck Mackett and Trustee Allen Jones are the two most likely to try to build the incremental progress that's been made on budgetary discipline. And Trustee-elect Dr. Wayne Creelman will be added to the mix in January to replace Westcott.

Creelman, the former longtime director of the now-defunct University of Florida behavioral health clinic in Vero, won his seat by default as he ran unopposed.

Gov. Ron DeSantis has not yet appointed a person to fill the seat vacated by Dr. Bill Cooney and the governor's staff has given no indication that the appointment is a priority.

On June 12, this newspaper requested a list of applicants, which are public record, but DeSantis' office never provided the information.