Economic Impact Analysis of the Martin Health System on Martin County & St. Lucie County

Transcription

1 Economic Impact Analysis of the Martin Health System on Martin County & St. Lucie County July 21, 2015 PREPARED BY: Prepared by: The research and analysis division of NCDS Inc Roswell Road, Suite 230, Atlanta, GA * Page 1

2 Contents Introduction. 3 Executive Summary... 4 Economic Impact Analysis A. Martin County and St. Lucie County. 5 B. Martin Health System 8 C. Martin County and St. Lucie County Top Private Employers. 9 D. The Input/Output Model 10 E. Martin Health System Local Spending Impacts F. New Construction at Tradition Impacts Appendix I State and Local Tax Impacts.. 30 Appendix II Spending Impacts by Category Appendix III Output by Sector Appendix IV Martin Health System Facilities 35 Appendix V Martin Health System Spending by Category 39 Appendix VI Methodology Appendix V II NCDS and the Economic Strategy Center. 41 Page 2

3 Introduction The following Economic Impact Analysis EIA, shows the impact of the Martin Health System on Martin County and St. Lucie County. Martin Health System based in Stuart, Florida includes three hospitals, one MediCenter, a free-standing emergency center, and numerous outpatient centers and clinics. Annual impacts are computed from MHS spending for hospital employees, including physicians and contract employees working in Martin County and St. Lucie County. Annual impacts also include MHS local spending for operations, and the projected annual impact of a major expansion to Tradition Medical Center in St. Lucie County. The annual impact of an expansion to Tradition Medical Center is based on a projection to full utilization of the new facility that includes additional spending for employees and operations. Construction is planned to begin in November of 2015 and continue until March of The total project is estimated to cost $110,894,831, and the construction of the hospital addition is projected to cost $67,655,352, not including $22,379,313 of equipment and furnishings. Economic impacts were computed by an Input/Output, I/O model, created for Martin County and St. Lucie County. The I/O model is based on sectors. Sectors are used for both inputs and outputs. The model is based on the latest data available from IMPLAN, the most widely used system to compute impacts (see Appendix VI). This analysis incorporates a major revision of IMPLAN to increase industry details and incorporate newly released 2014 data and benchmarks for I/O tables from all U. S. data reporting agencies. The revised IMPLAN data has 536 possible sectors, up from 440. The Martin and St. Lucie Counties model has 310 sectors, and after entering spending by MHS employees and MHS local spending for operations, 294 sectors were impacted. Table 1 shows total economic impacts measured by: jobs, income, value added, output, income, spending, potential new savings deposits, sales and property taxes. Total Impact Table 1 Economic Impact Summary Martin Health System - Annual Local Impacts Construction = 40 Months MHS Annually $2015 Construction 40 Months New Annual Impacts From Tradition Expansion MHS Annually With Tradition Expansion Jobs 2,550 1, ,779 Income $76,428,943 $49,739,942 $2,771,475 $79,200,418 Value Added $138,004,393 $72,157,205 $3,979,106 $141,983,499 Output $254,821,440 $171,421,728 $7,315,607 $262,137,047 Disposable Income $68,029,402 $44,273,522 $2,466,890 $70,496,292 Consumer Spending $62,219,691 $40,492,564 $2,256,218 $64,475,909 Savings Deposits $4,057,954 $2,640,916 $147,150 $4,205,104 Sales Taxes $7,112,023 $1,937,535 $145,219 $7,257,242 Property Taxes $5,172,801 $1,409,231 $105,622 $5,278,423 Source: NCDS, ESC, Input/Output model for Martin County & St. Lucie County. Page 3

4 Executive Summary Martin Health System, MHS local spending by 3,481 employees, contract employees, physicians and dozens of vendors from Martin and St. Lucie Counties creates an additional 2,550 jobs, $76.4 million of additional income and $254.8 million of output (new business) each year. Current economic impacts will increase because MHS is about to construct a 170,000 s.f. second phase of Tradition Medical Center in Port St Lucie, Florida. The new construction will have short-term and long-term impacts on Martin and St. Lucie Counties. Short-term construction impacts begin in November of 2015 and continue until March of The total project is estimated to cost $110,894,831, and the construction of the hospital addition is projected to cost $67,655,352, not including $22,379,313 of equipment and furnishings. Short-term impacts of construction are equal to 1,034 jobs. Permanent annual impacts will be created by additional employees and local vendor spending. This spending will increase MHS local impacts by 229 jobs (+8.98%) and $2,771,475 of additional income. Martin County and St. Lucie County form the St. Lucie Metropolitan Statistical Area, but both counties, especially Martin County, have strong economic relationships with Palm Beach County. St. Lucie County also has economic ties to Indian River and Okeechobee Counties. This means that while all direct impacts due to MHS local spending will occur in Martin County and St. Lucie County there will be some indirect and induced impacts elsewhere, especially in Palm Beach County. MHS is the largest private employer in the two-county area with 3,481 employees. Lawnwood Regional Medical Center & Heart Institute ranks 2 nd with 1,339 employees. The Top 20 employers range is size from MHS to the 271 employees of the Fort Pierce Utilities Authority. MHS is spending $517.6 million this fiscal year for the entire system of hospitals, centers and clinics and corporate personnel. This does not include new spending from the addition to Tradition. MHS local spending includes $181.1 million of spendable income for employees and contract employees and $32.5 million that MHS spends on local vendors from Martin and St. Lucie Counties. MHS spent $3.9 million on local services from offices of physicians this past fiscal year, more than any other sector. Maintaining and supplying the MHS requires large amounts of spending for maintenance and repair, $3.5 million, facilities support services, $2.1 million, and business support services, $1.5 million. All of these sectors are in the Top 10 sectors for annual MHS spending. Other sectors in the Top 10 include medical and diagnostic laboratories, ambulatory health care services and legal services. Other non Top 10 vendors include: construction, printing, and sign making. Almost all retail sectors are impacted, from furniture, where MHS spent $1,317,000 to health and personal care stores where MHS spent $137,078. Other non Top 10 sectors with a large amount of spending include: transportation, newspapers, telecommunications, architectural and engineering services and education. MHS also spends $158,319 on contributions to grant making, giving and social advocacy organizations and $245,383 on business and professional associations. MHS spends $1,303,009 on local taxes and other local government enterprises like fiber optics, fire and rescue, and security. Page 4

5 Economic Impact Analysis A. Martin County and St. Lucie County This Economic Impact Analysis computes the impact of Martin Health System, MHS on Martin County and St. Lucie County. The Florida land boom that started in 1922 led to the creation of Martin County in Growth in the area created a need to carve Martin County from St. Lucie County to the north and Palm Beach County to the south. Today, Martin County is part of the St. Lucie Metropolitan Statistical Area, but is still has close ties to Palm Beach County. According to historians, it is believed that the name, "St. Lucie" was first given to the St. Lucie County area by the Spanish after they constructed a fort on December 13, the feast day of the Roman Catholic Saint Lucia. The "Santa Lucia" colony was established somewhere between Vero Beach and Stuart around On July 1, 1905, St. Lucie County was established with Fort Pierce serving as its county seat. The town was previously part of Brevard County. At the time what is now Indian River, Okeechobee, and northern Martin counties were all part of the new St. Lucie County. St. Lucie County is approximately 600 square miles and includes; Fort Pierce, Port St. Lucie and St. Lucie Village. Martin County is approximately 550 square miles includes Stuart and the towns of Jupiter Island and Sewall s Point. Martin County and St. Lucie County form the St. Lucie Metropolitan Statistical Area, but both counties, especially Martin County, have strong economic relationships with Palm Beach County. St. Lucie County also has economic ties to Indian River and Okeechobee Counties. Table 2 shows the population and number of non-farm employees for Martin County and St. Lucie County and also Palm Beach, Indian River, and Okeechobee Counties. Palm Beach County with a population of 1,397,710 has 69.0% of the five-county population. St. Lucie with 291,028 persons is a distant 2 nd with 14.4%. Martin County and Indian River County are similar is size with 7.6% and 7.1% of the total five-county population. Okeechobee County is the smallest of the five with 1.9% of the population. When the population percentages are compared to each county s non-farm employment, Palm Beach County also has a greater share, 75.8% of non-farm employment than its share of population. Martin County, although much smaller also has a greater share of non-farm employment 8.1% versus 7.6%. That means both Palm Beach and Martin Counties are employment centers, but Palm Beach is a much larger employment center. Page 5

6 Table 2 County Populations and Non-Farm Employees County Martin St. Lucie Okeechobee Indian River Palm Beach Las Total Population Estimates , ,028 39, ,755 1,397,710 2,026,034 % of Population 7.6% 14.4% 1.9% 7.1% 69.0% 100.0% Non-Farm Employees ,754 53,629 6,486 39, , ,640 % of Non-Farm Employees 8.1% 8.7% 1.1% 6.4% 75.8% 100.1% Source: U.S. Census, 2014 population estimates, Non-Farm Employees, So Palm Beach County and to a lesser extent Martin County are employment centers, while St. Lucie County and Okeechobee County have a relatively greater share of population than non-farm employment. Martin County is more balanced with a share of population, 7.6% that is about the same as its share of non-farm employment, 8.1%. This means that while all direct impacts due to MHS will occur in Martin County and St. Lucie County there will be some indirect and induced impacts elsewhere, especially in Palm Beach County which is large employment and commercial center. Chart 1 illustrates the relative population size of the five counties. Chart 1 Source: Table 2. Page 6

7 County populations and non-farm employees give some indication of where economic impacts may occur, but commuting patterns provide a more detailed analysis of how MHS impacts are affected by employment and commuting patterns. Table 3 shows the number of commuters by residence-county and the total number commuting to each of the 5 counties bordering Martin County and St. Lucie County. When commuters in these five counties are totaled by County, 99.0% of Palm Beach County commuters work in Palm Beach County. So among these five counties Palm Beach ranks 1 st in terms of the percent of commuters who work in the county where they live. Indian River ranks 2 nd with 90.1 % of commuters who work where they live, and Okeechobee ranks 3 rd with 84.0%. Both Martin County (68.5%) and St. Lucie County (67.5%) have a similar percentage of commuters working where they live. Table 3 Commuting Patterns Residence County to Workplace County 2006 to 2010 Residence County Work in Martin Work in Palm Beach Work in St. Lucie Work in Indian River Work In Okeechobee Total Commu ting* Work in Residence County % Martin 38,492 12,055 5, , % Palm Beach 3, ,778 1, , % St. Lucie 17,970 9,371 68,835 5, , % Indian River ,864 44, , % Okeechobee ,292 14, % Source: American Community Survey interviews from January 1, 2006 through December 31, Data confidence level is greater than 90%. Notes: * Total commuting in the five counties. So about one-third of the study area commuters in Martin County and St. Lucie County commute to other surrounding counties for work. These commuters will spend some income in other counties where they work, and this also indicates that there are significant business-to-business relationships in neighboring counties. This means that while all direct impacts due to MHS will happen in Martin County and St. Lucie County some indirect and induced impacts will occur outside the two-county area. So there will be some leakage of MHS direct impacts into other counties. Table 3 also shows that Martin County imports 3,531 commuters from Palm Beach County and 17,970 commuters from St. Lucie County, but only 421 and 436 from Indian River and Okeechobee. Outside these 5 counties, an additional 46,086 Palm Beach County residents commute to Broward and 7,730 commute to Miami-Dade. So Palm Beach County has some commuting to other counties but mostly to the south. Chart 2 illustrates the last column of Table 3, the percent of commuters who work in the county where they live. Based on the total commuting in these five counties, Palm Beach leads with 99.0% and St. Lucie County with 67.5% working where they live, ranks 5 th. Page 7

8 Chart 2 Source: Table 3. B. Martin Health System Martin Health System was founded in 1939 with an original hospital on the banks of the St. Lucie River that had 23 beds, three physicians, and 10 employees. Today, Martin Health System based in Stuart, Florida includes Martin Medical Center, Martin Hospital South, Tradition Medical Center in St. Lucie County, Martin MediCenter of Palm City, a free-standing emergency center, and numerous outpatient centers and clinics (see Appendix IV). Last fiscal year, Martin Health reported 20,300 patient admissions and 88,000 emergency department visits. The three hospitals have 434 hospital beds. MHS has 3,481 full time equivalent employees and physicians. Volunteers give more than 187,000 hours annually, the equivalent of 97 full-time employees. MHS is a not-for-profit, community-based health care organization that offers preventive, primary and acute hospital care, as well as cancer care, a heart center, wellness and rehabilitation services, and more. MHS services provide care for residents throughout the Treasure Coast, including Stuart, Jensen Beach, Hobe Sound, Palm City and Port St. Lucie. Clinical research is a key element in Martin Health s efforts to improve the treatments and lives of people in the community and includes an affiliation with Moffitt Cancer Center. Since 2001, more than 75 oncology clinical trials have been conducted through the Robert and Carol Weissman Cancer Center. Martin Health is continuing to expand its research capabilities into fields other than cancer, ranging from rheumatology to cardiology and infectious diseases. In addition, Martin Health is a member of the Tradition Center for Innovation at Port St. Lucie, which includes Torrey Pines Institute for Molecular Studies, the Vaccine and Gene Therapy Institute (VGTI Florida) and the Mann Research Center. Page 8

9 MHS is accredited by The Joint Commission, one of the most respected accreditations in the nation and has won numerous national awards for top ranked hospitals. C. Martin County and St. Lucie County Top Private Employers MHS is the largest private employer in the two-county area with 3,481 employees. Table 4 shows how MHS ranks first, followed by Lawnwood Regional Medical Center & Heart Institute with 1,339 emloyees. Table 4 shows how the Top 20 employers range is size from MHS to the 271 employees of the Fort Pierce Utilities Authority. Table 4 Martin County and St. Lucie County Top 20 Private 1 Employers: 2015 Company Name Employees Product/Service Location 1. Martin Health System 3,481 2 Healthcare Stuart 2. Lawnwood Regional Medical 1,339 Healthcare Fort Pierce Center & Heart Institute 3. Indian River State College 1,996 3 Higher education Fort Pierce 4. Florida Power & Light Company 1,131 4 Electric Utility Port St. Lucie 5. QVC St. Lucie, Inc. 994 Call center Port St. Lucie 6. Convey Health Solutions 950 Call center Fort Pierce 7. Liberty Healthcare Group, Inc. 920 Medical supplies Port St. Lucie 8. St. Lucie Medical Center 850 Healthcare Port St. Lucie 9. Teleperformance (Aegis 800 Call center Port St. Lucie Communications) 10. Wal-Mart Distribution Center 720 Dry goods distribution Fort Pierce center 11. Paradigm Precision 369 Machined components, Stuart gas turbine engines 12. New Horizons of the Treasure 360 Healthcare St. Lucie County Coast 13. Tropicana Products, Inc. 330 Fruit juice mfg. Fort Pierce 14. Triumph Group - Vought 324 Aerospace structures, Stuart Aerostructures systems & components 15. Liberator Medical Supply 316 Medical supplies Stuart 16. Seacoast National Bank 302 Banking Stuart 17. Blue Goose 300 Agriculture/contractors Fort Pierce Growers/Construction 18. Pursuit Boats 289 Boat mfg. Fort Pierce 19. MAXIMUS 280 Call center Fort Pierce 20. Fort Pierce Utilities Authority 271 Utilities Fort Pierce Sources: Economic Development Council of St. Lucie County, Business Development Board of Martin County. Notes: 1) Private employers list excludes school boards, and municipalities. 2) Martin Health System: 3,379 FTEs employed physicians = 3,481. 3) Indian River State College: 1,996 employees includes 797 full-time and 1,199 part-time. 4) Florida Power & Light: 829 employees in St. Lucie and 302 employees in Martin. Page 9

10 D. The Input/Output Model This analysis quantifies the annual economic impacts of Martin Health System on the 2-county area defined by Martin County and St. Lucie County. It includes the projected annual impact of a new facility at Tradition Medical Center at full utilization, and the short-term impact of $110 to $116 million of construction for the project Input/Output models are typically based on either the impact of jobs or the impact of spending. The I/O model built for Martin and St. Lucie Counties is based on spending. Spending by MHS employees (including physicians) and spending for operations, have a very large economic impact on the 2-county area. MHS attracts vendors, consultants and other professional service visitors as well as patient visitors, but visitor spending impacts are not included in this analysis. An analysis of MHS local spending based on zip codes in the 2-county area made it possible to combine this with employee (including physicians), and contract employee spending in the 2- county area to achieve an accurate measure of local impacts. Table 5 Martin County & St. Lucie County Input/Output Model Model year 2013 Counties Martin County, St. Lucie County Gross regional product $12,454,076,652 Total personal income $17,200,530,000 Total employment 192,179 Number of possible sectors 536 Number of sectors (industries) used 310 Number of sectors with new output 294 Land area (square miles) 1,128 Population 438,095 Total households 171,276 Average household income* $100,426 Source: NCDS, ESC. MIG, Inc., IMPLAN, 2013, released January, Note: * Average household income in this model is much different than U.S. Census definitions for median household income. This is because IMPLAN data used in the model includes other forms of income. It includes imputed income resulting from home ownership (the biggest portion by far), free checking, services provided by non-profits to households and some other income type items. The model, summarized in Table 5 above is based on data for IMPLAN released in January, IMPLAN is the most widely used system to compute impacts. This analysis incorporates a major revision of IMPLAN to increase industry details and incorporate newly released data. The I/O model uses Bureau of Economic Analysis BEA data and benchmarks for I/O tables just released in It also incorporates revisions to the National Income and Product Accounts, and new data from the Census Bureau. It includes the latest regional accounts, and latest results from the Census of Agriculture, Bureau of Labor Statistics Survey and Commodity Flow Survey. The revised IMPLAN system has 536 possible sectors, up from 440. Page 10

11 The Input/Output or O/I model is based on the 2-county area. Spending inputs to the I/O model create outputs or impacts as measured by jobs, income, value added and output. Income includes both wage and salary income from direct and indirect jobs, and proprietor income to those owners and self employed persons affected by indirect and induced spending. Value added includes labor income and indirect business taxes, like sales taxes. Value added also includes other income, such as rent. Output is like a country s gross national product GNP, and is the total of value added (e.g. labor) and the value of all goods used in production. Impacts also include spending and savings from disposable income, and new sales and property taxes. Sectors are used to define inputs and outputs. Sectors in the model are defined by groups of NAICS (North American Industry Classification System) codes. The model contains all the linkages in the 2-county area economy. There were dozens of spending inputs to the model that defined MHS spending by its employees and contract employees, and MHS spending locally for operations. The I/O model for the 2-county area used 310 sectors and it computed impacts on 294 sectors. E. MHS Local Spending Impacts Before Tradition Expansion MHS spends $517.6 million per year for the entire MHS including three hospitals, one MediCenter, a free-standing emergency center, numerous outpatient centers and clinics and corporate personnel (please see Appendix V). Table 6 (from Appendix V) shows that $181.1 million of MHS local spending is spendable income for employees and contract employees. MHS local spending impacts create jobs, income, value added and new output (new business). MHS local spending is the input to the I/O model and there are two different spending categories: 1) hospital employees (including 378 physicians) and contract employees, and 2) hospital operations spending in the 2-county area. In order to create the input side of the model, it was necessary to put all spending into sectors. To allocate spending into sectors, the I/O model used existing data on MHS salaries and wages and spending for contract employees supplied by agencies. 1) Hospital employees and contract employees have similar spending patterns based on national surveys of consumer spending. 2) Hospital operations include local spending in the 2-county area for: maintenance and repair, retail merchandise, professional services, local government, facilities support, utilities, social advocacy organizations and professional associations. 1) Hospital Employees (including physicians) and Contract Employee Spending Table 6 shows two spending categories that are included in local spending; 1) MHS employee salaries and wages, and 2) contract employees (nurse agency contracts). Both of these categories can be used as inputs based on income. Salaries and wages are income. Nurse agency and physician salaries via contracts are also income. Table 6 shows how income can be converted to net income, then disposable income and then spending. Personal income is converted to disposable income, and then disposable income is converted to spending. Salary and wage income for hospital employees of $222,194,003 was Page 11

12 converted to disposable income of $197,774,882 and then to spending of $180,884,907 using Bureau of Economic Analysis national averages (see footnotes). For nurse agency and physicians through contracts, MHS spending is converted to personal income by allocating 7.5% of $347,354 spent on agency employees to net profit for the vendor. The 7.5% is based on Yahoo Finance net profit margins for the business services group as of January So estimated income for contract employees is $321,302 and this was also converted to disposable income and $261,567 of spendable income. So total spending from MHS employees and contract employees is $181,146,474. Table 6 Martin Health System Employee Salaries October 14, September 15, 2015 Budget Spending 2 Spending Category Personal Income Disposable Income 1 Salaries & wages $222,194,003 $197,774,882 $180,884,907 Nurse agency & physician $321,302 $285,991 $261,567 salaries 3 TOTAL $181,146,474 Sources: Martin Health System, spending by category. Bureau of Economic Analysis. Notes: 1) Disposable Personal Income: Personal income less taxes. Computed from U.S. 10-year average annual percent, Bureau of Economic Analysis, September ) Consumer Spending: Disposable personal income less interest, personal transfer payments, and personal savings. U.S. 10-year average annual percent, Bureau of Economic Analysis, September ) MHS personnel working on per diem and supplied by agency companies. Total MHS spending of $347,354 was converted to $321,302 to estimate net payments to personnel. $347,354 x 7.5% net profit margin for business services (Yahoo Finance, January 2015) = $26,052. $347,354 - $26,052 = $321,354. Table 7 shows how total spending of $181,146,474 is allocated to sectors using spending patterns by category and the percent (%) of spending for each category. This percentage distribution was calculated for the south region by the Bureau of Labor Statistics based on average annual spending. Table 7 also shows how different sectors were assigned to various spending categories. In most cases spending categories are comparable to sectors. For example, in Table 7 food away from home is well defined by sectors 501, 502 and 503, various types of restaurants. In some cases, like the entertainment category, it was necessary to assign entertainment sectors to this category because details are not available from the Bureau of Labor Statistics. In these cases, allocations of spending percentages were based on employment statistics in the I/O model for those sectors. Page 12

13 Spending Types 1 Table 7 Martin Health System Employee and Contract Employee Annual Spending by Sector FY 2015 % of Spending Spending of $181,146,474 Sector Sector Defined FOOD 13.2% Food at home 7.8% $14,129, Food & beverage stores Food away from home 2 5.3% 2.65% $4,800, Full service restaurants 1.96% $3,550, Limited service restaurants.69% $1,249, All other food and drinking places HOUSING 32.6% Shelter: Owned dwellings 11.2% $20,288, Real estate Rented & other 6.9% $12,499, Real estate Utilities, fuels, services: Electricity 3.7% $6,702, Electric power transmission Natural gas.5% $905, Natural gas distribution Fuel oil & other.1% $181, Wholesale trade: petroleum products Telephone services 2.8% 2.52% $4,564, Wired telecommunications.28% $507, Wireless telecommunications Water, sewer, other 1.1% $1,992, Water, sewage and other systems Household furnishings, equip. 2.9% $5,253, Retail stores - furniture, furnishings Household operations 3.6% $6,521, Retain stores - misc. APPAREL 3.2% $5,796, Retail stores - clothing, etc. TRANSPORTATION 18.9% Vehicle purchases 7.0% $12,680, Retail stores - motor vehicles, parts Gasoline & motor oil 5.9% $10,687, Retail stores - gasoline stations Other vehicle expense: Maintenance, repairs 1.7% $3,079, Automotive repair & maintenance Insurance 2.3% $4,166, Insurance agencies, brokers Rentals, leases.8% $1,449, Automotive equipment rental, leasing Public transportation.7% $1,268, Transit & ground transportation INSURANCE/PENSIONS 10.8% Life & other personal ins..7% $1,268, Insurance agencies, brokers Pensions, private retirement 5.1% $9,238, Securities, investments Social security 5.1% $9,238, Other federal government HEALTH CARE 7.2% Health insurance 4.6% $8,332, Insurance agencies, brokers Medical services 1.3% Physicians, dentists etc..34% $615, Offices of physicians, dentists, etc. Home health care.03% $54, Home health care services Medical & diagnostic.19% $344, Medical & diagnostic labs Hospitals.43% $778, Hospitals Nursing & residential.32% $579, Nursing & residential care Drug stores, medical 1.1% $1,992, Misc. store retailers Personal care products 1.2% $2,173, Health and personal care stores ENTERTAINMENT 4.7% Page 13

14 Sporting events 1.03% $1,865, Commercial sports except racing Promoters, arts, sports 2.12% $3,840, Promoters of performing arts, sports Fitness centers.80% $1,449, Fitness and recreational sports facilities Amusement, gambling.33% $597, Gambling Other amusement.42% $760, Other amusement and recreation EDUCATION 1.6% $2,898, Private educational services ALL OTHER 3.4% Alcoholic beverages.93% $1,684, Retail stores: food and beverage Reading, tobacco.69% $1,249, Retail stores: book stores Miscellaneous 1.78% $3,224, Retail stores: general merchandise CASH CONTRIBUTIONS 3.7% Giving 2.04% $3,695, Giving & social advocacy Civic 1.66% $3,007, Civic, social & professional orgs. Source: Bureau of Labor Statistics, Consumer Expenditure Survey, 2013, Region of Residence, South. BLS data released September NCDS, ESC I/O model for Martin County and St. Lucie County, FL. Notes: 1) Some spending types combined because they are covered by the same sector. Spending categories requiring allocation of totals to sectors were allocated by current employment in the sector in the I/O model using two decimal points for accuracy. Total all major sectors (shaded) = 99.3% due to rounding. 2) Restaurants, both full-service and fast food, account for about three quarters of all food away from home, according to the USDA s Economic Research Service. This data and actual employment in sectors 501, 502, and 503 allowed for the calculation of % by sector based on the 5.3% total for food away from home. 3) Social Security SS, accounts for approximately 50% of retirement benefits (private pensions, 30% and government pensions, 20%), so investment spending allocated at 50% for SS. Pensions and SS are 10.2% combined in the BLS survey. SS taxes are not local and are not included in the I/O model. 2) Martin Health Systems Local Spending MHS spending for operations, not including projected new spending for the addition to Tradition Medical Center, are primarily for supplies and drugs and a wide range of other operating expenses. In order to calculate the impact of MHS local spending, a zip code analysis of all vendor payments in Martin County and St. Lucie County resulted in 1100 local vendor payments. These 1100 payments were then allocated to sectors in the I/O model. $12,434 in vendor payments to Okeechobee County were not in the study area and not included. Table 8 shows that $32,456,272 was spent locally on a wide range of services, supplies and materials. Table 8 allocates this spending into industrial groups and sectors of the I/O model. MHS spending by industrial group range from utilities and construction to government. MHS local spending affects a large number of sectors in these groups, from sector 51, where MHS spent $496,013 for water, sewage, and other systems to sector 526 where MHS spent $1,303,009 on local taxes and other local government enterprises like fiber optics, fire and rescue, and security. Table 8 shows how MHS spending benefits a very large part of the local business community. Many sectors benefit, from $565,919 in construction (sector 52) to printing and sign and furniture making. Almost all retail sectors are impacted, from furniture, where MHS spent $1,317,000 to health and personal care stores where MHS spent $137,078. Other sectors where there was a large amount of spending include: transportation, newspapers, telecommunications, architectural and engineering services and education. In keeping with its role as a community-based health care organization, MHS also spends $158,319 on contributions to grant making, giving and social advocacy organizations and $245,383 on business and professional associations. Page 14

15 Table 8 MHS Local Spending by Industrial Group & Sector FY 2014: 10/01/13 to 9/30/2014 Bold = Top 10 Amount Sector Industrial Group/Sector Defined Utilities & Construction $496, Water, sewage and other systems $565, Health care structures construction $3,456, Non-residential maintenance & repair Printing & Manufacturing $256, Printing $1, Other fabricated metal manufacturing $143, Wood office furniture manufacturing $278, Sign mfg. Wholesale & Retail Trade $267, Wholesale trade $314, Motor vehicle and parts dealers $1,317, Furniture and home furnishings stores $32, Retail, electronics and appliances $15, Building material and garden equipment and supplies stores $137, Health and personal care stores $81, Clothing and clothing accessories stores $3, Sporting goods, hobby, musical instrument and book stores $36, General merchandise stores $1,629, Misc store retailers Transportation $203, Truck transportation $11, Transit and ground passenger transportation $29, Couriers and messengers Publishing & Communications $144, Newspaper publishers $12, Periodical publishers $42, Directory, mailing list, and other publishers $ 1, Radio and television broadcasting $139, Wired telecommunications carriers $92, Wireless telecommunications carriers (except satellite) Finance, Real Estate & Rentals $ Banks & CUs $1,946, Real estate 239, General consumer goods rentals Professional & Support Services $2,497, Legal services $29, Accounting, tax preparation, bookkeeping, and payroll services $397, Architectural, engineering, and related services $33, Specialized design services $362, Commercial & Industrial machinery & equipment leasing $20, Advertising, public relations, and related services $37, Photographic services $2,139, Facilities support services $1,541, Business support services Page 15

16 $129, Travel arrangement and reservation services $93, Other support services $68, Waste management and remediation services Education $126, Colleges, universities, professional schools Medical Services $3,899, Offices of physicians $8, Offices of dentists $2,962, Medical and diagnostic laboratories $2,855, Other ambulatory health care services $1,404, Hospitals Personal Services Child day care services $35, Other amusement and recreation industries Hotels & Restaurants $26, Hotels and motels, including casino hotels $27, Full-service restaurants $5, Limited service restaurants $95, Other food services Professional Organizations $3, Religious organizations $158, Grant-making, giving, and social advocacy organizations $245, Business and professional associations Government $29, Postal service $1,321, Local taxes and other local government enterprises $32,456,272 Total 6 Source: Martin Health System Notes: 1) Does not include $12,434 in vendor payments in Okeechobee County, which are the only vendor payments to Okeechobee County. 2) Miscellaneous store retailers includes $197,198 in professional service and other reimbursements. Professional service and other reimbursements actual total was $262,390, and reimbursements are typically local spending or professional dues, so 75% ($197,198) is a conservative estimate of local spending via reimbursements. 3) The Medical Centers at SLW and Hobe Sound are real state subsidiaries of the Medical Center, so sector 440 includes MHS payments for renting space. 4) Sector 482, hospitals, includes payments from associates for medical bills, funds put away for medical expenses locally and medical expenses covered by claim settlements. 5) Includes other federal and state government enterprises. 6) Total does not include Okeechobee County (see note #1), and does not include $65,732 (25%) of professional service and travel reimbursements (see note #2). MHS spent $3,899,292 on local services from offices of physicians (sector 475) this past fiscal year, more than any other sector. Table 9 shows how the Top 10 spending sectors rank. Each of the Top 10 include more than $1.4 million in spending. Maintaining and supplying the MHS requires large amounts of spending for maintenance and repair (sector 62), facilities support services (sector 463), and business support services (sector 465). Professional services in the Top 10 include medical and diagnostic laboratories, ambulatory health care services and legal services. MHS pays rent to itself and others so real estate (sector 440) ranks 7 th. Sector 482, hospitals, ranks 10 th because this sector includes payments from associates for medical bills, and funds put away for local medical expenses. Page 16

17 Table 9 MHS Local Spending Top 10 Sectors FY 2013/14 Rank Local Sector Sector Defined Spending 1 $3,899, Offices of physicians 2 $3,456, Non-residential maintenance & repair 3 $2,962, Medical and diagnostic laboratories 4 $2,855, Other ambulatory health care services 5 $2,497, Legal services 6 $2,139, Facilities support services 7 $1,946, Real estate 8 $1,629, Misc store retailers 9 $1,541, Business support services 10 $1,404, Hospitals Source: Table 8. Note: See Table 8 for notes on sectors 62, 406, 440 and 482. MHS local spending by employees and contract employees totals $181,146,474 in the budget for this fiscal year ending September 15, MHS local vendor spending totaled $32,456,272 in the previous fiscal year. The I/O model adjusted all impacts to calendar Table 10 shows that these two types of local spending total $213,602,746. Table 10 MHS Local Spending Employees & Vendors MHS Spending Type Amount Percent of Total MHS employees and contract employees $181,146, % MHS local vendor spending $32,456, % Total $213,602, % Source: Table 6, Table 8. Chart 3 shows that MHS employees and contract employees represent 84.8% of all local spending and MHS local vendor spending of $32,456,272 represents 15.2% of total local spending. Page 17

18 Chart 3 Source: Table 10. 3) Economic Impact of MHS Local Spending The result of inputs from Table 7 and Table 8 were very significant impacts (outputs) on additional jobs, income and output. Table 11, which follows shows a summary of the impacts created by MHS local spending. Table 11 shows the direct job totals and the total of direct, indirect, and induced impacts. The direct impact is the equivalent of 1,700 jobs. Indirect impacts come from the purchases of goods and services, business-to-business. As all those impacted by the new jobs spend their earnings, there are induced impacts. Direct, indirect and induced impacts in Table 11 are measured by: jobs, income, value added, and output. Income includes both wage and salary income from direct and indirect jobs, and proprietor income to those owners and self employed persons affected by indirect and induced spending. Value added includes labor income and indirect business taxes, like sales taxes. Value added also includes other income, such as rent. Output is like a country s gross national product GNP at the local level, and is the total of value added (e.g. labor) and the value of all goods used in production. The total impact of MHS local spending in 2015 is equal to 2,550 jobs, $76.4 million of income, $138.0 million of value added, and $254 million of output (new business). Page 18

19 Table 11 Annual Impact of MHS Local Spending Martin County & St. Lucie County $2015 Impact Type Jobs Income 4 Value Added 5 Output 6 Direct Impact 1 1,700 $48,988,894 $86,083,706 $156,362,356 Indirect Impact $15,187,527 $28,462,521 $57,535,855 Induced Impact $12,252,522 $23,458,167 $40,923,229 Total Impact 2,550 $76,428,943 $138,004,393 $254,821,440 Sources: NCDS Input/Output model for Martin and St. Lucie Counties, FL. County data, MIG, Inc., IMPLAN. Notes: 1. Direct Impact: Impact generated directly from the jobs created. 2. Indirect Impact: Changes in employment, income, and output (business sales) in various industry sectors of the local economy supplying goods and services to the companies that expanded. 3. Induced Impact: The ripple effect of increased income as employees spend. 4. Income: Employee compensation + proprietor income (owner wages). 5. Value Added: Labor income + indirect business taxes Chart 4 + other property type income. 6. Output: Value Added + intermediate inputs (goods used in production). Chart 4 shows how 1,700 jobs will multiply through indirect and induced jobs to total 2,550 new jobs in the community. Source: Table 11. Page 19

20 4) Jobs Multiply Through the Economy The ripple effect of MHS local spending is computed based on multipliers. These multipliers show the effects of sales, income, spending and saving, which in turn increase the employment and earnings of other business sectors. Table 12, below, shows that 1,700 direct jobs creates income of $49.0 million, value added of $86.1 million and output of $156.4 million. Table 12 New Jobs, Income, Value Added and Output Multiply for Greater Annual Impact: 2015 Jobs Income Value Added Output Direct Impact 1,700 $48,988,894 $86,083,706 $156,362,356 Multiplier Total Impact 2,550 $76,428,943 $138,004,393 $254,821,440 Sources: NCDS I/O model for Martin and St. Lucie Counties. County data, MIG, Inc., IMPLAN. These are the initial and direct impacts. Then as indirect impacts accumulate through businessto-business purchasing, and all those affected spend new income (induced impacts), the initial impacts multiply to create 2,550 new jobs, a multiplier of 1.50, and $76.4 million of new income, a multiplier of Value added multiplies by 1.60 to total $138.0 million and output by 1.62 to total $254.8 million. Chart 5 Chart 5 illustrates the multiplier effects for income, value added and output. The fact that the multipliers increase from 1.50 to 1.62 means MHS local spending is tending to stay in Martin and St. Lucie Counties. Decreasing multipliers would indicate leakage in spending to other counties. Source: Table 12. Page 20

21 5) MHS Local Spending - Making an Impact Annual income of $76,428,943 from MHS local spending means additional disposable income, spending and savings. New income and spending also creates more sales and property taxes. Table 13 shows that income will create disposable income of $68,029,402. This disposable income creates $62,219,691 in consumer expenditures and $4,057,954 in savings deposit potential. Table 13 also shows that additional sales taxes are $7,112,023 and property taxes are $5,172,801. The detailed impact of jobs on annual state and local tax revenue appear in Appendix I. In addition to new sales and property taxes, these include: excise taxes, customs duties, motor vehicle licenses, severance taxes; and other taxes, fees and special assessments. Table 13 Martin Health System Local Spending Generates Annual Spending, Savings, and Taxes $2015 Total New Income (see Tables 11, 12) $76,428,943 Disposable Personal Income 1 $68,029,402 Consumer Expenditures 2 $62,219,691 Savings Deposit Potential 3 $4,057,954 Sales Taxes 4 $7,112,023 Property Taxes 4 $5,172,801 Sources: National Community Development Services Input/Output model for Martin and St. Lucie Counties, FL. County data, MIG, Inc., IMPLAN. DPI, PCE and savings deposit percent of income, Bureau of Economic Analysis, Last revision, December, Notes: 1. Disposable Personal Income: Personal income less taxes. U.S. 10-year average annual percent, Bureau of Economic Analysis. 2. Consumer Expenditures: Disposable personal income less interest, personal transfer payments, and personal savings. U.S. 10-year average annual percent, Bureau of Economic Analysis. 3. Savings Deposit Potential: Personal savings rate computed from 10-year average of both National Income and Product Accounts NIPAs and Flow of Funds Accounts FFAs = 5.965% of disposable personal income. 4. State and local tax impacts: computed from I/O model, see Appendix I. Page 21

22 The impact of MHS local spending increases consumer expenditures in Martin and St. Lucie Counties by $62,219,691 annually, a benefit to all businesses. Table 14 shows how the 10 major spending categories rank in Table 14 Annual Spending Impacts by Category: $2015 Rank Spending Category Spending in Millions 1 Housing $20,283,619 2 Transportation $11,759,522 3 Food $8,212,999 4 Personal insurance and pensions $6,719,727 5 Health care $4,479,818 6 Entertainment $2,924,325 7 Cash contributions $2,302,129 8 Apparel and services $1,991,030 9 Education $995, Personal care $746,636 Sources: NCDS Input/Output model for Martin and St. Lucie Counties, FL. Bureau of Labor Statistics, Consumer Expenditure Survey, South, Data released in September, See Appendix II. Housing with $20.3 million of new annual spending is the largest of the ten spending categories followed by transportation with $11.8 million of new spending. Chart 6 illustrates the distribution of spending by category based on regional spending patterns. For detailed spending by category, please see Appendix II. Chart 6 Source: Table 14. See Appendix II. Page 22

23 6) New Output by Sector Detailed outputs by sector from jobs are computed from the I/O model built for Martin and St. Lucie Counties. Output by sector differs from spending categories due to definitions and the way data is collected and structured. For example, housing is the largest spending category with $20.3 million (see Table 14) based on Bureau of Labor Statistics BLS, surveys, and in Table 15 ranks 1 st with $6.3 million in new output based on the way the National Income and Product Accounts (NIPAs) are assembled and what is included in housing. The definitions of housing spending and housing output are much different. Housing spending, as defined by the BLS, is larger than output because it includes spending for utilities, operations, supplies, furnishings and equipment. The model computed total output for 294 business sectors that had new business (new output) adjusted to Total output is the best way to see total impacts because it captures everything, like Gross Domestic Product. Output is the sum of all labor income, indirect business taxes, other property type income and all the intermediate inputs, i.e. goods used in production. Table 15 Annual Output by Sector Top 10 Business-to-Business Impacts 2015 Rank Sector Output Sector Output Housing $6,264, Banks and credit unions $2,352, Employment services $1,548, Insurance carriers $790, Retail - Non-store retailers $784, Commercial and industrial machinery and equipment rental and leasing $657, Lessors of non-financial intangible assets $548, Outpatient care centers $545, Support activities for transportation $538, Funds, trusts, and other financial vehicles $526,680 Sources: NCDS, ESC Input/Output model for Martin and St. Lucie Counties. See Appendix III. The Top 10 outputs in Table 15, illustrate very important impacts from MHS local spending inputs. Housing, with $6.3 million in output ranks 1 st followed by the banking sector with $2.4 million. Employment services ranks 3 rd with $1.5 million of output. Other Top 10 sectors show strong relationships to MHS, like: commercial equipment leasing and outpatient care. Other sectors not in the Top 10 also have strong relationships to MHS like: professional and scientific services, other health practitioners, technical consulting services, security services, equipment repair and maintenance, and data processing (see Appendix III). Chart 7 was created from Table 15, and illustrates the top 10 business-to-business impacts by sector from MHS local spending ranked by total output. Sectors with direct impacts from MHS local spending are not included in the table or the chart because they are used to create indirect and induced impacts, the very important business-to-business impacts (see Appendix III). Page 23

24 Chart 7 Source: Table 15. F. New Construction at Tradition Medical Center Martin Health Systems is about to construct a second phase of Tradition Medical Center in Port St Lucie, Florida. The project is a vertical and horizontal expansion to the existing hospital campus. The existing hospital, constructed as Phase I, is located on approximately 20 acres of land within the Tradition Center for Innovation. Phase II encompasses north and south horizontal expansions, a 3-floor vertical expansion, interior renovations, and parking. The additions to the facility total 170,000 s.f., and will increase the facility to a 9-story hospital with a mechanical penthouse. The new construction will have very large short-term and long-term impacts on St. Lucie County and Martin County. Short-term impacts include construction and related one time costs like equipment and furnishings, permits and professional fees. Short-term construction impacts begin in November of 2015 and continue until March of The total project is estimated to cost $110,894,831, and the construction of the hospital addition is projected to cost $67,655,352, not including $22,379,313 of equipment and furnishings. Long-term impacts are defined by the annual impact of the expansion to Tradition Medical Center based on a projection to full utilization of the new facility. These permanent annual impacts will be created by additional: hospital employees, contract employees, and local vendor spending. 1) Short-Term Impacts Short-term impacts include spending for construction and design, equipment and furnishings and payments for fees, testing and inspections. Table 16 shows this planned spending by category and sector. Sectors are used to allocate spending inputs to the I/O model. For example, sector 449, architectural and engineering services covers both site assessment and design consultants. Page 24

25 Table 16 Tradition Medical Center - Phase II Estimated Costs 1 by Category Category Sector Sector Defined Amount Construction 52 Construction of health care structures 2 $67,880,352 Site Assessment 449 Architectural, engineering, and related $181,888 services Design and consultants 449 Architectural, engineering, and related $10,575,006 services Equipment & Furnishings 3 Medical equipment 379 Surgical and medical instrument mfg. $15,200,000 Tech, equipment, systems 463 Facilities support services $5,435,778 Furniture, accessories 397 Furniture and home furnishings stores $1,363,895 Artwork 406 Misc. store retailers $166,040 Signage & graphics 450 Specialized design services $213,600 Fees, testing, inspections 526 Local government enterprises $4,932,232 Contingency (6%) 3 - $6,007,336 Tax reimbursement (1%) 3 - +$1,061,296 $110,894,831 Source: Martin Health System, GMP Baseline Summary 7/15/15. Notes: 1) Costs = guaranteed maximum price GMP. 2) Includes $225,000 of non-gmp costs. 3) Not all equipment and furnishings will be purchased locally. 4) Not included as inputs Short-term impacts of the Phase II expansion will give a boost to the St. Lucie and Martin County economies. Table 17 shows how spending for construction, equipment, furnishings and related expenses has an impact equivalent to 1,034 jobs, and $49,739,942 of new income. Other impact measures such as output, consumer spending, savings deposit potential, sales and property taxes are also shown. Table 17 Martin Health System Construction Impact 1 Compared to MHS Annual Impact Total Impact MHS Annually $2015 Construction 40 Months 2 $2018 Construction Percent of MHS Annual Jobs 2,550 1, % Income $76,428,943 $49,739, % Value Added $138,004,393 $72,157, % Output $254,821,440 $171,421, % Disposable Income $68,029,402 $44,273, % Consumer Spending $62,219,691 $40,492, % Savings Deposits $4,057,954 $2,640, % Sales Taxes $7,112,023 $1,937, % Property Taxes $5,172,801 $1,409, % Source: NCDS, ESC, Input/Output model for Martin County & St. Lucie County. Notes: 1) Construction impacts in $ ) Construction from November 2015 to March 2018 Page 25

26 When construction impacts are compared to MHS annual local impacts, Table 17 also shows that construction impacts are equal to 40.55% of MHS annual local impacts for jobs, 65.08% for income, spending, and savings, and 27.24% for sales and property taxes. 2) Long-Term Impacts of Increased Local Spending There are two types of long term local spending affected by the Tradition expansion. First, MHS spending on salaries and wages for employees and contract employees will increase. Table 18 shows the net increase in spending for both employees and contract employees. Table 18 Martin Health System Increased Spending for Employees Tradition Expansion at Full Capacity Spending 2 Spending Category Personal Income Disposable Income 1 Salaries & wages $22,000,000 3 $19,582,200 $17,909,880 Nurse agency & physician $31,802 4 $28,307 $25,890 salaries 3 TOTAL $17,935,770 Sources: Martin Health System, spending by category. Bureau of Economic Analysis. Notes: 1) Disposable Personal Income: Personal income less taxes. Computed from U.S. 10-year average annual percent, Bureau of Economic Analysis, September ) Consumer Spending: Disposable personal income less interest, personal transfer payments, and personal savings. U.S. 10-year average annual percent, Bureau of Economic Analysis, September ) The Tradition expansion will hire an estimated 400+ new associates at an average salary of $55,000 (400 x $55,000 = $22,000,000). 4) MHS personnel working on per diem and supplied by agency companies is.1446% of S&W during the current budget year (see Table 6) so.1446% x $22,000,000 = $31,802 in estimated agency personnel. In addition to employees and contract employees, the Tradition Medical Center expansion will increase local vendor spending. The Tradition Medical Center was included in the analysis of MHS local vendor spending. This annual local vendor spending shown in Table 8 totaled $32,456,272. The question is what portion of this can be attributed to Tradition Medical Center? Based on employment, Tradition Medical Center is 14.03% of the total Martin Health System. Table 19 shows how 3, full time equivalent MHS employees FTEs are distributed by cost center. Martin Memorial Medical Center, with 1,281.7 FTEs leads the other cost centers. Tradition Medical Center has FTEs, which is 14.03% of the MHS total. So if Tradition Medical Center is 14.03% of MHS, then local vendor spending at Tradition Medical Center can be estimated at $4,553,615 ($32,456,272 x 14.03% = $4,553,615). Page 26

27 Table 19 Martin Health System Full Time Equivalent Employees By Cost Center Cost Center Sum of Full Time Percent of Total Equivalent Coastal Care Corporation % Martin Memorial Foundation 14.41% Martin Memorial Hospital South % Martin Memorial Medical Center 1, % Martin Memorial Physician Corp % Medical and Financial Mgt % Medical Center Corporate % St. Lucie West % Tradition Medical Center % Grand Total 3, = 3, % Source: Martin Health System. Operating expenses at Tradition Medical Center without salaries and wages are expected to increase by 35% due to the expansion. Therefore, local vendor spending, estimated at $4,553,615 will increase by an estimated $1,593,765 ($4,553,615 x 35% = $1,593,765). Table 20 summarizes the increases in local spending from the Tradition expansion due to additional employees and contract employees, and additional local vendor spending. Overall, local spending by MHS will increase by 9.14% from $213,602,746 in this budget year to an additional $19,529,535 and will total $233,132,281 when the Tradition Medical Center is completed and fully utilized. Most of the increase in MHS local spending will come from 400 new employees who will spend $17,935,770, a 9.90% increase, and MHS local vendor spending is projected to increase by $1,593,765 (4.91%). Table 20 Martin Health System Tradition Expansion Increases Local Spending Employees & Vendors MHS Local Spending Type Current Budget Year Current Spending Amount Increase: Tradition Expansion Increase MHS employees and contract employees $181,146,474 $17,935, % MHS local vendor spending $32,456,272 $1,593, % Total $213,602,746 $19,529, % Total MHS local spending + Tradition $233,132,281 Source: Table 18, MHS estimate. Page 27

28 Table 21 shows the new annual local impacts from the Tradition Medical Center and the impact on all MHS local spending. New annual impacts from the Tradition Medical Center expansion are equal to 229 additional jobs, $2,771,475 in new income, $2,256,218 in new consumer spending, $147,150 in new savings deposit potential, $145,219 in new sales taxes and $105,622 in new property taxes. Total MHS annual local spending will increase as a result of the Tradition expansion as shown in Table 21. MHS local spending has an impact equivalent to 2,550 jobs today, but will increase by 229 additional jobs supported by new local spending at Tradition to total 2,779 jobs. As shown in Table 21 all of the other impact measures of MHS local spending will increase. The largest percent increase in impacts from the Tradition expansion is on jobs, where 229 additional jobs in the community is an 8.98% increase. Total Impact Table 21 Martin Health System New Annual Local Impacts Tradition Medical Center MHS Local Spending Annually $2015 New Annual Impacts From Tradition Expansion MHS Local Spending Annually With Tradition Percent Increase Jobs 2, , % Income $76,428,943 $2,771,475 $79,200, % Value Added $138,004,393 $3,979,106 $141,983, % Output $254,821,440 $7,315,607 $262,137, % Disposable Income $68,029,402 $2,466,890 $70,496, % Consumer Spending $62,219,691 $2,256,218 $64,475, % Savings Deposits $4,057,954 $147,150 $4,205, % Sales Taxes $7,112,023 $145,219 $7,257, % Property Taxes $5,172,801 $105,622 $5,278, % Source: NCDS, ESC, Input/Output model for Martin County & St. Lucie County. The 229 additional jobs in the community due to the Tradition expansion are very important because these 229 jobs remain in the community every year. Additional jobs created by construction are much higher at 1,034, but these jobs are temporary. Table 22 summarizes the impact on jobs from MHS annual spending and the new jobs from the Tradition expansion, including construction. Total Impact Table 22 MHS Local Economic Impact on Jobs MHS Annually $2015 Construction 40 Months New Annual Impacts From Tradition Expansion MHS Annually With Tradition Expansion Jobs 2,550 1, ,779 Source: Table 12, Table 17, Table 21. Page 28

29 Chart 8 illustrates the relative impact of MHS spending on Jobs. During this budget year MHS local spending has an impact equivalent to 2,550 additional jobs in the community. New construction at Tradition Medical Center will add 1,034 jobs, but this total is temporary and spread out over 40 months. The Tradition expansion will add 229 new jobs each year making the total new annual impact of MHS equal to 2,779 additional jobs in the community. Chart 8 Source: Table 22. Page 29