Fall 2025 Levy Lid Lift

Overview
Finances
About the District/Learn More

Overview

In the Special Board Meeting that took place on July 10^th, 2025, San Juan County Public Hospital District No. 1’s Board of Commissioners voted to present a ballot measure for a levy lid lift. This lid lift will appear on the Fall 2025 ballot.

The decision to lid lift, or ask the public for further funding, was made due to the growing needs of our Island community. With recent federal changes leading to a potential reduction in healthcare coverage—particularly in Medicare— the District is taking proactive steps to bridge the increasing gap between our community’s healthcare needs and their access to essential services. Commissioner Trish Lehman noted in the special board meeting that, “On this island we need to be prepared to take care of each other. I’m concerned about vulnerable populations.”

If the lid lift is approved, the District plans to add Medicaid for home care, work on converting short term rentals into long term housing for healthcare workers, and expand the scope of San Juan Island EMS’s community paramedicine program.

Financial Assistance Program: In 2024, the District launched Village at Home, which provides healthcare and companionship services to Island residents who wish to age in the comfort of their home. If the levy lid lift is approved, the District intends to launch a financial assistance program to ensure that Island residents without adequate insurance or financial resources can still receive essential healthcare services in the comfort of their home.

Housing for Healthcare Workers: There is a clear need in our community for more housing, especially for essential workers. The District currently employes over 70 employees, all of whom are crucial to providing emergency care and support. If voters approve the lid lift, the District intends to purchase short-term rentals and convert them into long term housing for healthcare workers. This would help ensure our workforce can continue to live in the community they serve.

Community Paramedicine: San Juan Island EMS’s Community Paramedicine Program helps Island residents avoid using 911 and the Emergency Room (ER) for preventable health care services. While the District is already taking steps to expand this vital service, approval of a lid lift would allow for a broader reach and greater impact—bringing more care directly to those who need it most.

The choice to expand services is a decision the community can make through voting in the upcoming local election. Superintendent Nathan Butler noted that, “We always approach asking the public for funding with caution. Ultimately the public decides what matters to them.”

Finances

Core Services

The Board determined that the following considerations should be the primary focus of our future focus:

• Select EMS infrastructure and equipment needs
• A simplified Housing for Healthcare project
• Select Village at the Harbor infrastructure projects and ensuring that there are reserve funds for future capital expenditures
• Village at Home overhead costs
• Expansion of charity care and community paramedicine
• Administrative support for expanding services
• Staffing to support infrastructure

Please see below for a breakdown of the specific projects and their cost breakdown.

Proposed Projects and Cost Breakdown

PROPOSED PROJECT	BOND YIELD REQUIREMENT (COST)	ANNUAL COST	LEVY RATE CHANGE IMPACT
Expansion of Charity Care and Home Care		$423,600	0.06
Additional home care worker dedicated to low income (annually)	NA	$110,000
Nurse for Community Paramedicine Program (annually)	NA	$150,000
Additional administrative costs and overhead (annually)	NA	$150,000
Vehicle – van or truck (5 yr loan)	$60,000	$13,600
Housing for Healthcare – Simplified Plan		$532,029	0.08
Purchase of property (one-time expense)	$4,000,000	$329,600
Renovation, $1 million total (one-time expense)	$1,000,000	$82,429
Additional staffing needs (annually)	NA	$120,000
Village at the Harbor Infrastructure Investments		$72,330	0.01
Roof replacement (one-time expense)	$250,000	$21,165
Install electronic locking systems (one-time expense)	$250,000	$21,165
Increase capital reserves (annually)	NA	$30,000
Growth Package (Admin Support)		$236,000	0.03
Leadership/project mgmt (annually)		$220,000
Admin office/conference space remodel (one-time expense)	$200,000	$16,000
EMS infrastructure and Equipment **		$77,370	0.01
Air conditioning and heat pumps (one-time expense; financed through Opalco Switch It Up Program or similar — 3% / 10 yrs.	$250,000	$29,370
Life Pak monitors (One-time expense; financed through Washington State LOCAL Program or similar — 3.38% / 10 yrs.	$400,000	$48,000
TOTAL ASK		$1,341,329	0.20

*Based in part on 20 year general obligation bond or similar instrument
** Covered for first three years under general levy then transferred to renewed EMS levy

About the District