BLANDFORD – Angela Mulkerin, service director and paramedic for the Hilltown Community Ambulance Association came before the Blandford Board of Selectmen on Monday evening to answer financial questions about the association and its impending $220,000 capital campaign to purchase a new ambulance. HCAA is a non-profit organization providing EMS services to the communities of Blandford, Chester, Huntington, Montgomery, Russell and Worthington since 2002.
Many of the initial questions directed at Mulkerin concerned the need for updated financial statements and accounts receivables. Handing out annual reports for 2014, she said that the medical billing process takes a long time, and they are still collecting on accounts from 2010. She said HCAA policy is to keep accounts active if patients are making monthly payments, and not send them to collections. She also said they do not collect on deceased patients. Over time, they end up collecting 82% of what they bill.
Mulkerin said their Comstar Ambulance Billing Service representative, who does all their billing and follow up, told them they are being as aggressive as they can be. She also said their collections are average among ambulance services in the state.
Angela Mulkerin, second from right, came before the Blandford Board of Selectman on Monday to discuss Hilltown Community Ambulance Association’s capital drive. (Photo by Amy Porter)
Blandford selectman Andy Montanaro asked if Mulkerin had the same data for 2015 and 2016. She said to keep in mind that their service data is on a calendar year, while their accounting is on a fiscal year. She said that last year, HCAA expenses were $13,000 less than collections.
Mulkerin reported that she applied this year for an AFG (Assistance to Firefighters) grant through FEMA for $210,000 for an ambulance. She said that HCAA hit high in priority for a lot of the categories, but was turned down. She said they expect to get a reason for the denial in the next 30 days, and will try again.
She said the next step for them is to implement the three-year plan she submitted to member towns last year, which contains a $20,000 to $30,000 per year increase divided among the six towns for an ambulance.
Blandford selectman Bill Levakis asked whether HCAA had to buy a new ambulance, or if they could lease one. Mulkerin responded that they could lease one, and also have the option to buy a demo. She said they are also looking at loans from traditional banks, and also non-profit lenders. She said no decisions have been made.
When asked what is the life expectancy for an ambulance, Mulkerin said, “We think we can keep it for 10 years.” She said currently their front line ambulance is a 2008 model, and their second ambulance is a 2002. She added that if the organization is successful in obtaining grant money, the grant may dictate the disposition of their ambulances.
When asked if the towns would only have to pay for the time the ambulance is financed, Mulkerin said that once an ambulance hits 10 or 12 years, they would be in the market for a new one. Mulkerin said they need to bring in $20,000 to $30,000 additional dollars per year for capital expenditures.
Blandford finance committee member Linda Smith then launched into an intensive series of questions, prefaced with the statement that she very much desired HCAA’s continued success. Smith said she was a founding director of the service, which had a goal of providing the best EMS service that the hilltowns could afford. She added that due to the time invested, she considers herself a stakeholder, but as a member of the finance committee, she has a fiduciary responsibility to the town.
Many of Smith’s questions were about the composition of the HCAA board of directors, and how they are appointed. Mulkerin said the board meets monthly, and has representatives from each of the towns on it. They have a secretary who reads minutes at every meeting, and a personnel committee.
In response to several more questions, Mulkerin said that the treasurer’s report is a part of the service director’s report, and is voted on as a part of the minutes. Besides Comstar doing the billing and follow up, Dove Business Association in Williamsburg does paychecks which require two board member signatures. Mulkerin does the payroll.
Asked about audits, Mulkerin said they have a CPA firm that does financial reviews. Smith suggested looking into getting a full audit, and also said that the financial reviews should be going to the towns yearly.
She also commented about HCAA not having a plan in place to replace ambulances. “You’re asking the towns to purchase a vehicle for you without control of the company,” Smith said.
“Unfortunately, all of our revenue comes from the towns and the taxpayers. The next possibility would be to raise the rates for taxpayers,” Mulkerin responded. She said they can set any rate they want, but Medicare dictates how successful they would be. She said 30% of HCAA calls are Medicare, so they generally follow Medicare rates, because that’s what they are going to get. She said they get $860 for an average ambulance call.
Currently, HCAA is housed in the old electric company building on 1 Bromley Road in Huntington. Mulkerin said they are happy there, that it is a good central location for their service area, and has heat and hot water, and she knows they are “getting it for a steal” from the town.
She said they have 24/7 coverage, with two people in the building at all times. HCAA has 30 professional staff, 15 of which are paramedics, and the others basic EMTs. Most work full-time at other organizations and take part-time shifts at HCAA. There are five full-time HCAA employees, including herself and four basic EMTs.
Levakis asked if the town of Huntington is responsible for the location.
Representatives from several HCAA member towns were present at the Blandford meeting on Monday. (Photo by Amy Porter)
Huntington selectman Ed Renauld, one of several officials from other member towns present at the meeting, responded that the town rented it to HCAA as a garage for ambulances only, not for residential or business use, and a lease was signed.
Mulkerin said that OSHA has clear rules about eating and sleeping on site. She said employees on duty should not be sleeping, and should only be bringing food in. She said she has worked in many bases, and Huntington’s is one of the nicer ones.
Blandford selectmen chair Adam Dolby asked if Huntington wants to continue to offer the building.
Renauld said the town bought the building to give HCAA a place, but not to be a landford. He said the rent remains the same as the former lease from the utility.
Both Renauld and Russell selectman Keith Cortis were asked by Dolby about a Request for Proposal (RFP) for ambulance services that the two towns have been working on.
Renauld said that there had been “bad blood” developing between town officials and the HCAA. He said they’ve talked about sending out an RFP that would allow them to choose services they could afford. He said if HCAA doesn’t put in for the RFP, they wouldn’t be able to be considered.
Cortis said the conversations have been going on for months, and no one wants HCAA to fail. He said the two towns were hoping that HCAA would bid on the RFP. Later, he clarified that the RFP is still in draft form and has not been sent out.
“We can’t have a contractual obligation with two towns, when we represent six towns,” Mulkerin said, asking, “How can we have two sets of standards?”
Renauld agreed that the six towns couldn’t afford two ambulance services, and that is why the member towns needed to talk together.
“I see a problem of budgeting. I’m sure the service level is top notch,” Renauld said. He said the business is run by EMTs, not business people. “When you come to member towns and ask for 15% increases because you never budgeted for capital expenses, it makes poor business sense. You don’t hit the towns that are already at levy limit with 15 to 25% increases over two to three years,” he added. Renauld said that every dollar the town has, he has to allocate.
Mulkerin said HCAA could do the same thing. Reallocate money into capital expenditures, which would mean lower service, and a lower level of care.
Dolby asked Renauld if this dialogue had been started with HCAA.
“Twice. They came in once and we got into an argument, and they cancelled the second time,” he said. Renauld said the town asked for a contract. Mulkerin said HCAA’s attorney is working on a contract.
Renauld said the town then appointed Ernie Smith as their representative to the Board, and they were asked who appointed him.
Cortis also said that he has been a selectman for six years, and didn’t know until this year who represented Russell on the HCAA board, had never heard from him, and had never been involved in the selection.
Mulkerin said later that some of the HCAA board members report to the towns at regular intervals. “We don’t manage those relationships,” she said. She said they’ve also talked about formalizing their roles.
“Tonight, my personal goal was to get a dialogue going. No one complains about service, but it must be run as a business. I believe what you’re doing is excellent,” Smith said. She said that Mulkerin needs more financial people on the board of directors.
Blandford finance committee member Tony van Werkhooven suggested that HCAA schedule a meeting for select boards and finance committees on an annual basis.
Angie Ellison, who started on Monday as Blandford’s new town administrator, asked the towns to clarify the issues that needed to be addressed. She said she would be willing, with the board’s approval, to get a meeting of the towns and HCAA together and to facilitate it.
Dolby said that Blandford would work on a follow-up meeting.
After the meeting, HCAA board member Ernie Smith said he thought the meeting was productive. He agreed that there needed to be more financial people on the board, but said that it is difficult to get people to volunteer for any town government job.
Mulkerin also said that the meeting had been a good one.
“One of the things my organization has been talking about over the last nine months is a communications plan that works, and carrying it to the communities. (At the meeting), we heard from some of the communities. One of the things we heard is that they are happy with the patient care we’re providing. We do so much right, if this is what it takes to put everyone on the same page, then we’ll be good,” Mulkerin said.
She also said she understands that it’s the responsibility of the towns to make sure they’re spending taxpayers’ money responsibly, and their requests are reasonable. She said HCAA’s goal is to be as transparent as possible.
“It was a good step forward,” she said.
