A.R.S. tit. 48 ch. 16 — Arizona Revised Statutes Title 48 Chapter 16 — Health Service Districts

48-2202. Establishment of health service district; purpose; limitations; definition A. Health service districts may be established only: 1. For the purpose of purchasing, leasing, lease-purchasing, constructing, establishing, equipping, operating or maintaining an ambulance service, a medical clinic or clinics or a combined medical clinic and ambulance service. 2. In areas designated by the department of health services as medically-underserved pursuant to section 36-2352. 3. If the district area is greater than six hundred forty acres. 4. If more than three hundred qualified electors reside within the district. B. For purposes of this section, a "medical clinic" means a facility which provides for the physical evaluation, diagnosis and treatment of patients and which does not keep patients overnight as bed patients or treat patients under general anesthesia. A medical clinic does not include an urgent care center. 48-2203. Formation of district; district impact statement; petition; hearing; notice; definition A. Any person proposing to create a district shall prepare a district impact statement and submit the statement, with the petition prescribed in subsection B of this section, to the board of supervisors of the county in which the district is to be located. If a proposed district is located in more than one county, the impact statement shall be submitted to the board of supervisors of the county in which the majority of the assessed valuation of the property within the area of the proposed district is located. The boards of supervisors of any other counties in which a portion of the district is located shall provide information and assistance to the responsible board of supervisors. If the person proposing to create a district pursuant to this section is unable to complete the district impact statement, the board of supervisors may assist in the completion of the impact statement if requested to do so, provided the bond required in section 48-2204 is in an amount sufficient to cover any additional cost to the county. The district impact statement shall contain at least the following information: 1. A description of the boundaries of the proposed district and a detailed, accurate map of the area to be included in the district. 2. An estimate of the assessed valuation within the proposed district. 3. An estimate of the change in the property tax liability, as a result of the proposed district, of a typical resident of the proposed district. 4. A list and explanation of benefits that will result from the proposed district. 5. A list and explanation of the injuries that will result from the proposed district. B. A petition requesting that a health service district be established by the board of supervisors in the county in which the district is to be located shall be filed with the clerk of the board if signed by ten per cent of the qualified electors within the proposed district and signed by persons owning collectively more than ten per cent of the assessed valuation of the property in the area of the proposed district. The petition shall be verified by one of the petitioners and shall be accompanied by a plat or sketch indicating the approximate areas and boundaries of the district. C. The petition shall set forth: 1. The name of the proposed district. 2. That the public health, comfort, convenience, necessity or welfare will be promoted by the establishment of the district. 3. The boundaries of the district. 4. A general outline of the facilities and services to be offered by the district. 5. Other matters as required by this article. D. Additional petitions with additional signatures may be filed before the hearing on the original petition and shall be considered as having been filed with the original petition. E. A petition with the required number of signatures shall not be declared void on account of alleged defect, but the board of supervisors shall permit a petition to be amended in form and substance to conform to the facts and requirements of this section. F. The clerk of each county shall maintain a list of property owners in the county who want to be notified of any proposed health service district affecting their current tax structure. G. The petition shall be presented to the board of supervisors, and the board shall enter an order setting the time, at least three but not more than five weeks from the date of the order, at which time a hearing on the petition shall be held by the board, and directing that notice of the hearing shall be published once a week for at least two consecutive weeks before the date of the hearing in a newspaper of general circulation in the proposed district. H. The clerk shall notify all property owners on the list regarding the pending hearing at least two but not more than three weeks from the date the board of supervisors ordered the hearing. I. For purposes of this section "assessed valuation" does not include the assessed valuation of property that is owned by a county. 48-2204. Bond of petitioners At the time of filing a petition for the establishment of a health service district, or at any time thereafter but before publication of the notice of the hearing on the petition, a bond or cash deposit shall be filed by the petitioners, with security approved by the board of supervisors sufficient to pay the expenses connected with the proceedings in case the board of supervisors refuses to establish the district. 48-2205. Hearing on petition A. At the hearing all interested property owners and electors may appear and be heard on any matter relating to the establishment of the proposed district. Before the date set for the hearing, any person wishing to object to the establishment of the district may file written objections with the clerk of the board of supervisors. B. At the hearing the board shall consider the petition and shall hear evidence in favor of or against the proposal. The board may make any changes in the district boundaries that it deems advisable. All decisions and determinations made at the hearing shall be entered in the minutes of the board. If the board approves the establishment of the district, the minutes shall set forth the particular description of the boundaries of the district as approved by the board. C. If the board finds that the territory set out in the petition should not be incorporated into a health service district, it shall dismiss the proceedings and tax the costs against the signers of the petition and may collect the cost against the bond or cash deposit of the petitioners. 48-2206. Election to determine organization of district; notice of election; qualifications of voters A. Notwithstanding the provisions in sections 16-225 and 16-226, the board of supervisors may order formation of a health service district, the board shall give notice as prescribed by this section of an election to be held within the proposed district for the purpose of determining whether the district shall be organized. The board shall set the date of the election. B. The notice shall: 1. Designate a name for the proposed district. 2. Describe the boundaries of the district. 3. Designate the polling places to be established within the district for the election. 4. Be published once a week for at least two consecutive weeks immediately preceding the election in a newspaper of general circulation in the proposed district. C. Notwithstanding the provisions in sections 16-225 and 16-226, the election shall be conducted as nearly as practicable in accordance with the general election laws of this state. The notice and time periods prescribed by this article apply instead of title 16, chapter 2, article 3. D. Election ballots shall contain the words "health service district -- yes" and "health service district -- no". E. Eligibility to vote in the election shall be determined by section 16-120. F. The county recorder or elections director shall be designated the person in charge of the election and shall supply all election materials, ballots and election officers. 48-2207. Declaration of election result and recording order A. The board of supervisors shall canvass the votes cast at the election at its next succeeding regular or special meeting. If it appears that a majority of the voters voting favors formation of the district, the board by order shall declare the district duly organized and shall cause a certified copy of the order to be filed in the office of the county recorder. B. If the district is established, certified bills covering the costs of the board, the person in charge of the election and the disbursements of the petitioners and costs associated with the district impact statement shall be presented to the board of directors of the district and paid from monies of the district as they become available. 48-2207.01. Territory of health service district; additions and deletions; notice and hearing A. If it appears at the hearing for establishment of a health service district that territory not included in the petition should be included in the district, notice shall be given in the manner provided for the original hearing and a subsequent hearing shall be held on the question of including the additional territory. B. Annexations to the territory of a health service district shall be made in the manner provided for establishment of a health service district, but the petition to annex need only be signed by ten per cent of the qualified electors and signed by persons owning collectively more than one-half of the assessed valuation of the property of the area sought to be annexed to the district and the election shall be conducted only within the area sought to be annexed. Annexed territory need not be contiguous to the annexing district. No territory may be added to or deleted from a district without consent of the board of directors of the district evidenced by a resolution adopted by the majority vote of the board of directors. C. For purposes of this section "assessed valuation" does not include the assessed valuation of property that is owned by a county. D. If an area wishes to withdraw property from a district and the board of supervisors determines that such withdrawal is appropriate, the board shall enter an order separating the area from the balance of the district. E. If an area is separated from the balance of the district pursuant to subsection D, the following provisions must be met: 1. The property withdrawn from the district shall remain subject to taxes, special assessments or fees levied or collected to meet the contracts and covenants of the bonds. The board of supervisors shall provide for the levy and collection of such taxes, special assessments or fees. 2. The board of directors shall: (a) Annually determine the amount of special property taxes, special assessments, or fees that must be levied and collected from property withdrawn from the district and the mechanism by which such amount is to be collected. (b) Notify the board of supervisors on or before the third Monday in July of the amount determined in subdivision (a). 3. Property withdrawn from an existing district shall not be subject to any further taxes, special assessments or fees arising from the indebtedness of such district except as provided in this subsection. F. Not later than twenty days after the final determination by the board of directors or the board of supervisors, a party aggrieved by an act of one of the boards in the establishment of, annexation to, or withdrawal from, a health service district may bring an action in the superior court in the county in which the district is located in the manner prescribed by title 12, chapter 7, article 6. The appellant shall post a bond equal to the probable costs conditioned that the appellant will prosecute his appeal and will pay all costs that accrue in the court if a judgment is rendered affirming the decision of one or both boards. The court shall require the district board of directors to pay all costs that accrue in the court, including reasonable attorney fees, and the bond shall be returned to the appellant, if a judgment is rendered in favor of the appellant. 48-2208. Board of directors; selection; qualifications; terms; compensation; expenses; restrictions A. A health service district shall be governed by a board of directors of at least three members. B. At the election to determine whether a district shall be formed, as provided in section 48-2203, the ballot shall contain the names of three or more persons to be elected to the board of directors. These persons may be nominated in the petition for formation of a district or by fifty or more persons qualified to vote in the election. C. Members of the board of directors shall be qualified electors of the district as prescribed by section 48-2206. No member may be an elective or appointive state, county, city or town official or a member of the governing board of any other medical clinic as defined in section 48-2202, subsection B or other health care institution as defined in section 36-401. D. Immediately after the election and qualification of the first directors, the directors shall meet and divide themselves by lot into two classes as nearly equal in number as possible. Directors of the first class shall serve for a term of four years, and directors of the second class shall serve for a term of two years, and until the director's successors are elected and qualified. Thereafter at each regular election one director for each expired term shall be elected and shall hold office for a term of four years, and until the director's successor is elected and qualified. The dates of elections and of expiration of terms of the directors shall be specified in the petition for establishment of the district. Candidates for the office of director shall file nominating petitions with the board of supervisors as prescribed by title 16, chapter 3. If only one person files or no person files a nominating petition for an election to fill a district office, the board of supervisors may cancel the election for the position and appoint the person who filed the nominating petition to fill the position. If no person files a nominating petition for an election to fill a district office, the board of supervisors may cancel the election for that office and that office is deemed vacant and shall be filled as otherwise provided by law. A person who is appointed pursuant to this section is fully vested with the powers and duties of the office as if elected to that office. E. A director who resides in an area that is deleted from the health service district during the director's term of office shall continue to serve until the next regular election, and until the director's successor is elected and qualified. If the director's term does not expire at that time, a new qualified director shall be elected to serve out the unexpired portion of the term. F. Each director of a health service district shall receive not more than fifteen dollars for each meeting of the board of directors attended by him and reimbursement for necessary travel expenses. No director is eligible to receive compensation, other than expenses, for attending more than four meetings of the board of directors during a calendar month. 48-2209. Powers of health service district A. In addition to the powers specifically granted, a health service district may, acting through its board of directors: 1. Sue and be sued in all courts and places and in all actions and proceedings whatever. 2. Construct, establish, maintain and operate an ambulance service, a medical clinic or clinics, or combined medical clinic and ambulance service in order to provide ambulance service, ambulatory care or other nonhospital-based medical services. 3. Acquire in the name of the district any real or personal property or interest therein by gift, purchase, or otherwise, and own, control, manage or dispose of such property or interest when necessary or convenient for the purposes stated in paragraph 2. Private funds or contributions received by a health service district for the purpose of defraying expenses of work done or services rendered under its direction may be expended by the district in compliance with the terms and conditions under which such funds are received, if the terms and conditions meet the approval of the board of directors of the district and are within the scope of the statutory powers and duties of the district. 4. Sell, lease or otherwise dispose of any property of the district or interest therein if such property is no longer required for the purposes of the district or if use of it may be permitted without interfering with the use to which it is put by the district. 5. Pay expenses incidental to the exercise of its powers. 6. Employ physicians, physician assistants, professional nurses, counsel and other persons as are necessary in the exercise of its powers. 7. Formulate and adopt rules and regulations governing service charges and other allocable costs to residents and nonresidents of the district for services and supplies rendered or used in treating such persons pursuant to paragraph 2 to defray the operating costs of the district. 8. Prepare a survey and report of the ambulance service, ambulatory care and other nonhospital-based medical services as they exist in the district and formulate a proposal to facilitate the delivery of services described in paragraph 2. 9. Contract for the purposes of providing the services or facilities described in paragraph 2. B. As a condition for operating an ambulance service or combined medical clinic and ambulance service, the district shall apply for, obtain, maintain and comply with the terms and conditions of all required licenses and certificates of necessity under title 36, chapter 21.1. If an area is annexed to or deleted from or withdraws from the district, the board shall immediately notify the department of health services and shall comply with all applicable statutes and rules regarding those changes. C. The board shall establish a schedule of authorized fees for any ambulance services provided by the district that, together with other sources of revenue, will pay for the costs of establishing, providing, maintaining and operating the respective services. These fees shall be submitted to the department of health services pursuant to section 36-2239 and shall be approved by the department before their implementation. D. A district may operate an ambulance service only if there is no private ambulance company certificated pursuant to title 36, chapter 21.1 that is willing to provide ambulance services and there is not a private ambulance company that is willing to become certificated by the department of health services pursuant to title 36, chapter 21.1. 48-2210. Health services survey and report; review by department A. When a health services district is established, the board of directors shall conduct or cause to be conducted a survey of the ambulance service, ambulatory or other nonhospital-based medical service problems within the district. B. Upon the completion of the survey, there shall be prepared and filed with the board of directors, the organizing board and the department a report setting forth: 1. A description of existing services and facilities available within the district. 2. A description of recommended services and facilities with plans and specifications for carrying out the purposes of the district. 3. A description of the arrangements which have been made or are in the process of being made to ensure that staff and a coordinating medical provider, as defined pursuant to section 36-2351, are available for the district. 4. A description of the property proposed to be acquired for implementation of the recommendations. 5. A map showing the boundaries of the district and in general the location of work proposed to be done, property taken or damages and other information useful to an understanding of the proposed work. 6. An estimate of the cost of the proposed recommendation including: (a) First year capital costs in implementing the plan. (b) Additional capital costs expected to be incurred in the first five years of implementation and for the subsequent five years. (c) Yearly expected operating costs for the first three years of implementation. (d) Proposed sources of funds and amounts to be received from each source during the first three years of operation. C. Expenses of the survey and report shall be a charge against the district. D. The department shall review the survey and report and provide the board of directors with written comments within thirty days of receiving the report. 48-2211. Health services survey report; hearings; approval A. When the health services survey report is filed, the board of directors may reject such report and direct that a new report be prepared or that changes be made. If the report complies with the provisions of section 48-2210 and is satisfactory to the board, the board of directors shall hold a hearing on any objections to the report or to the performance of the proposed work. Notice of the hearing shall be given by publication five times in a daily or twice in a weekly newspaper of general circulation in the health service district. B. The department shall be notified by the board of directors of the date of the hearing within five days after the date is set and at least ten days prior to the hearing date. The department shall be represented at the hearing and shall advise the board. C. At the conclusion of the hearing the board of directors shall order the report to be changed, or shall approve it as made. If changes are ordered, further hearings shall be held thereon until the board of directors approves the report. Upon approval by the board of directors, the report or a summary thereof shall be published for distribution to the public. 48-2212. Construction of facilities; provision of services; methods; contracting for services A. The board of directors shall superintend the construction of medical facilities and the delivery of ambulatory medical services and ambulance service, if any, as specified in the approved report of the health services survey. B. The construction of medical facilities or any portion thereof may be performed under the direction of the board of directors in consultation with the department and in any of the following ways, as ordered by the board of directors: 1. By purchasing the material and performing the work. 2. By purchasing the material and letting a contract for performance of the work. 3. By purchasing a portion or none of the material and letting a contract for furnishing the balance or all of the material and performance of the work. C. Services authorized pursuant to subsection A may be performed, as ordered by the board, in any of the following ways, either singly or in combination: 1. By providing the facility and performing the services. 2. By supplying all, none or a portion of the facilities and letting a contract for the balance of the facilities, and providing the services. 3. By supplying the facility and providing all, none, or a portion of the services and letting a contract for the balance of the services. D. All contracts shall be let to the lowest responsible bidder submitting a sealed bid in response to a call for bids published once each week for two consecutive weeks in a newspaper of general circulation in the county. The call for bids shall include a detailed description of the services required. If materials to be purchased without the letting of a contract cost one thousand dollars or more, they shall be purchased from the lowest responsible bidder after publication of a call for bids as provided by this subsection. E. All work recommended in the approved report shall be performed in conformity with the plans and specifications contained in the report unless the board of directors by a two-thirds vote adopts a resolution declaring that the interest of the district requires a modification of or departure from the report, and specifying the modification or departure. F. Contracts for direct health services provided by physicians, professional nurses, or physician assistants licensed or certified pursuant to title 32 shall be exempt from the bidding requirements prescribed by subsection D. G. Among the medical services provided at such medical clinics, there shall be no drug, surgical procedure or other service provision administered or prescribed for the purpose of causing, directly or indirectly, an abortion of an unborn embryo or fetus at any stage of development. Neither shall such service be contracted to any other medical or paramedical group to be performed. 48-2213. Elections; qualifications of voters; affidavit; challenges A. Elections held pursuant to this article, except as otherwise specified, shall be conducted as nearly as practicable in accordance with the general election laws of the state. Returns shall be canvassed by the board of directors within ten days after the election is held. B. Only qualified electors of the state who reside within the health service district are qualified electors for the purpose of an election held pursuant to this article. C. For the purposes of an election the board of directors may consolidate into one precinct several precincts established for general election purposes, and may describe precincts by reference to the general election precincts. D. An election board consisting of one inspector, one judge and one clerk shall be appointed by the board of directors for each precinct. E. A person offering to vote at such election shall sign an affidavit stating his address and swearing he is an elector qualified to vote in the election and has not voted at the election being held. A person offering to vote may be challenged, and the election officers shall thereupon have the powers and duties of general election officers. 48-2214. Bond election; subsequent bond election A. After approval of the health service survey report the board of directors of the district shall submit to the qualified electors of the district the proposition of incurring bonded indebtedness to obtain funds with which to acquire the property and perform the work set forth by the report. Elections under this subsection must be held on the first Tuesday following the first Monday in November as prescribed by section 16-204, subsection B, paragraph 1, subdivision (d). The resolution calling the election shall set forth: 1. The purposes of the proposed indebtedness. 2. A reference to the report for particulars. 3. The amount of the proposed indebtedness. 4. The maximum numbers of years for which the bonds may be outstanding. 5. The maximum rate of interest to be paid. 6. The date of the election. 7. The election precincts and polling places. B. The resolution shall be published once each week for three successive weeks in a newspaper of general circulation in the district. C. If the proposition of issuing bonds fails to receive a majority of the votes cast at the election to authorize issuance of the bonds, the board of directors, not less than six months after that election, may call another election on the question of issuing bonds under the terms of this article, either for the same purposes or for any lawful purpose of the district. D. No bond election shall take place until the board of directors has demonstrated to the department that contractual arrangements have been made for staff and a coordinating medical provider, as defined in section 36-2351, and the department has certified to the board of directors and to the organizing board that the above arrangements are sufficient to ensure that ambulatory care services will be available to the district for a period of at least one year of medical clinic operation. 48-2215. Issuance of bonds; subsequent bond issues A. If a majority of the votes cast at a bond election favors the bonded indebtedness proposed, bonds of the district for the amount stated shall be issued and sold. B. The board of directors shall, subject to the provisions of this article, prescribe by resolution the form of the bonds and interest coupons attached thereto. The bonds shall be payable over a period of not more than twenty years from the date thereof at a place fixed by the board and designated in the bonds, together with the interest thereon from the date of the bonds until paid. Interest shall be payable semiannually at the rate or rates set by the accepted bid which shall not exceed the maximum rate of interest set forth in the resolution calling the election. C. The bonds may be issued in such denominations as the board of directors determines. Each bond shall be signed by the chairman of the board of directors and countersigned by the clerk or secretary of the health service district. The interest coupons of the bonds shall be numbered consecutively and shall be signed by the chairman of the board of directors and the clerk or secretary of the district by their engraved or lithographed signatures. If any officer whose signature or countersignature appears on a bond or interest coupon ceases to be such officer, either before or after delivery of the bond to the purchaser, the signature or countersignature shall be valid for all purposes as if the officer had remained in office. D. The validity of the bonds, after their issuance, shall not be questioned in any court except on the ground that a provision of this article authorizing their issuance is unconstitutional. E. When bonds have been issued by a health service district and the proceeds of the sale thereof have been expended as authorized by this article, the board of directors may by resolution passed by a majority vote of its members, determine that additional bonds for carrying out the purposes of the district should be issued. Thereupon the board of directors shall cause another survey and report to be made. Upon approval thereof as provided by this article for an original report, the board shall submit to the qualified electors of the district, in the manner prescribed by section 48-2213, the question of issuing additional bonds. If a majority of the votes cast thereon is in favor of issuing the additional bonds, they may be issued and sold and the proceeds disposed of in the manner prescribed by subsections A through C of this section and by section 48-2216. 48-2216. Sale of bonds; disposition of proceeds A. The board of directors of a health service district shall sell bonds issued pursuant to section 48-2215, subsections A through C at not less than par value, and the proceeds shall be placed in the county treasury of the organizing county to the credit of the district. The county treasurer shall keep an accurate record of all monies of the district paid to him. B. The fund shall be used exclusively for the purposes mentioned in the resolution calling the bond election. Payments from the fund shall be made upon claims allowed by the board of directors of the district, prepared, presented and audited in the same manner as claims upon county funds. 48-2217. Limit of bonded indebtedness No health service district shall incur a bonded indebtedness exceeding five per cent of the assessed value of all taxable property in the district as shown by the last assessment roll of the county. 48-2218. Tax exemption of bonds Bonds issued pursuant to this article are not taxable by the state or by any county, city, town or other political subdivision of the state. 48-2219. Bonds Any bonds issued under this article may contain a provision requiring the establishment of a reserve or reserves in an amount equal to the requirements of principal and interest payments for the two years during the life of the bonds requiring the largest amount of principal and interest payments, and the district shall maintain the reserve during the life of the bond issue for the purpose of protecting against any deficiency in rental payments or tax collections. If it becomes necessary to withdraw funds from the reserve to protect against any deficiency, the board of directors of the district shall levy a tax on all the taxable property in the district or utilize service or rental charges accruing to the district sufficient to maintain the reserve fund in an amount equal to the original amount thereof. In making the levy for the payment of principal and interest for the last year when the bonds mature, the board of directors shall take into consideration the amount of money then in the reserve fund and shall levy an amount sufficient to pay the principal and interest on the bonds, less the amount then in the reserve fund. 48-2220. Tax levy to pay principal and interest of bonds A. The principal of and interest on bonds issued pursuant to this article shall be paid from the following, either singly or in combination: 1. Revenue derived from an annual tax on the real property within the health service district issuing them, and such real property shall remain liable to taxes for payment of the bonds and interest until paid in full. 2. Rental from an organization that has contracted for the facilities with the district in order to provide for contracted services pursuant to section 48-2212, or from service charges made to clients of the medical clinic or clinics. B. The board of directors of a health service district shall annually, on or before August 15, certify to the board of supervisors the amount necessary to pay interest on and the portion of principal which will become due on bonds of the district during the ensuing year. C. The board of supervisors, at the time of levying county taxes, shall levy and cause to be collected in the manner prescribed by law for county taxes, a tax upon the real property within the health service district, based upon the current assessment roll, sufficient to pay the amount certified by the board of directors. If the board of directors of a health service district fails to certify to the board of supervisors the amount necessary, the board of supervisors shall ascertain the amount which should have been certified and shall levy and cause to be collected a tax sufficient to produce that amount. D. The tax, when collected, shall be paid into the county treasury to the credit of the bond fund of the health service district, and shall be used solely for payment of the principal of and interest on the bonds. The county treasurer shall pay the principal and interest on the dates and at the places specified in the bonds in the manner provided by law for the payment of principal of and interest on county bonds. E. If a district lies in more than one county, the amount necessary to pay interest on and the portion of the principal which will become due on bonds during the ensuing year shall be apportioned to each county on the basis of the value of real property included within the district from each county. Each board of supervisors shall levy and collect a tax sufficient to pay the amount apportioned to their county, and all such taxes shall be paid to the county treasury of the organizing county. When such a division is to be made, the board of directors shall furnish to the boards of supervisors of the respective counties a written statement of the apportionment and the basis on which it was made. 48-2221. Rentals and service charges The board of directors of a health service district may charge and collect rentals and service charges for any service performed or property furnished by the district. Revenue therefrom shall be paid into the organizing county treasury to the credit of the operating fund or bond redemption fund of the district. 48-2222. Leases of medical clinic and equipment; provisions; cancellation for failure to pay rent; release; auction; notice A. A lease of a district-owned medical clinic and its equipment executed by the board of directors of the district, shall: 1. Extend for a term to be determined by the board, but not less than five nor more than ten years. 2. Be executed for the purpose of providing ambulatory medical services. 3. Provide for a rental upon terms and in an amount which will provide a fair return to the district on its investment and be sufficient to meet part or all of the payments of principal and interest of bonds issued under this article. B. If a lessee of the medical clinic and its equipment fails to make the payment of rental immediately required by the lease, the board of directors of the district shall cancel the lease for such failure. If then unable to lease the medical clinic and its equipment to a lessee qualified under the provisions of this article at a rental sufficient to provide a fair return to the district and meet part or all of the payments of principal and interest on any bonds issued by the district, the board may, at public auction, offer to lease the medical clinic and its equipment to the highest responsible qualified bidder for such terms as the board prescribes, and shall lease the medical clinic and its equipment to the bidder who bids the highest rental for the prescribed period and who also agrees to provide the services required by this article. The board of directors may, at any time, implement a plan to provide ambulatory medical services on its own accord. C. If the board of directors determines that an auction should be held, notice of the auction shall be given in a newspaper of general circulation within the district at least once each week for four weeks immediately preceding the auction. 48-2223. Tax levy for current expenses A. The board of directors of a health service district, at the time of certifying the amount required for payment of principal and interest on bonds, may certify to the board of supervisors the amount necessary to maintain and operate the health service system of the district during the ensuing year, and to defray all other expenses incidental to the exercise of powers granted by this article, together with an estimate of the revenue which will be received from rentals and service charges. In that event, the board of supervisors, at the time of levying county taxes, shall levy and cause to be collected in the manner prescribed by law for county taxes, a tax on real property within the health service district based on the current assessment roll, sufficient to pay the amount certified, less the amount estimated to be received from rentals and service charges. The levy for operational purposes shall not exceed seventy-five cents per one hundred dollars of assessed valuation except for a district that provides for ambulance service or a combined medical clinic and ambulance service as prescribed by section 48-2209. B. The board of directors of a health service district may certify to the board of supervisors an amount to levy on all taxable property within the district for the purpose of funding the operation and maintenance of ambulance service or combined medical clinic and ambulance service that is owned or operated by the district or to pay the cost of an ambulance service contract entered into pursuant to section 48-2209. The amount of the levy necessary for the operation and maintenance of the ambulance service, if any, shall be separately stated in the levy. Before the initial imposition of such a tax, a majority of the qualified electors voting in an election conducted in the same manner provided in section 48-2213 must approve the initial imposition. The election must be held on the first Tuesday following the first Monday in November as prescribed by section 16-204, subsection B, paragraph 1, subdivision (d). The levy under this subsection for operation of ambulance service pursuant to this subsection shall not exceed seventy-five cents per one hundred dollars of assessed valuation, or one hundred thousand dollars, whichever is less. The one hundred thousand dollar limit in this subsection shall be adjusted annually from a 1991 base year according to the health services component of the metropolitan Phoenix consumer price index published by the bureau of business and economic research, college of business administration, Arizona state university or its successor. C. The tax, when collected, shall be paid into the county treasury to the credit of the operating fund of the district, and the board of directors may order expenditure of the fund for the purposes for which levied. Payments from the operating fund shall be made upon claims allowed by the board of directors prepared, presented and audited in the same manner as claims against the county. D. Not less than twenty nor more than thirty days prior to making the certification to the board of supervisors provided by subsections A and B of this section, the board of directors shall publish in a newspaper of general circulation in the district an itemized statement of the amounts proposed to be certified, and the statement shall contain notice of a meeting to be held by the board of directors prior to the time for the certification. At that meeting, any owner of real property within the district may appear and present objections to any item of the amount proposed to be certified. E. If a district lies in more than one county the amount necessary to maintain and operate the health service system of the district during the ensuing year shall be apportioned and the tax levied and collected in the same manner as established in section 48-2220, subsection E. 48-2224. Dissolution of health service district A. A health service district organized under this article which has no bonded indebtedness may, when all legal indebtedness of the district has been discharged, be dissolved on the vote of a majority of the qualified electors of the district at a special election called by the board of directors upon the question of dissolution. If a majority of the votes cast favors dissolution, the board of directors shall, by resolution, declare the district dissolved. A certified copy of the resolution shall, within fifteen days after its adoption, be filed with the clerk of the organizing board. If the organizing board is an incorporated city or town a copy of the resolution shall be filed with the clerk of the board of supervisors. B. Upon dissolution of a health service district the property of the district which is located within the corporate limits of a city or town shall vest in that city or town. Other property of the district shall vest in the county. Any funds of the district at the time of dissolution shall be transferred to the incorporated city or town and to the county in proportion to the assessed valuation of taxable real property within the city or town and within the county, respectively, as it appears on the current assessment roll. C. If, after dissolution of a health service district, it is found that there remains unpaid a legal indebtedness of the district, the board of supervisors of the county in which the district was located shall levy a tax upon the real property within the district as it existed at the time of dissolution, sufficient to meet the indebtedness and interest thereon, and shall pay the indebtedness and interest from the proceeds of the tax. If the district is located in more than one county, apportionment of indebtedness and interest thereon and any levy and collection of taxes to meet this indebtedness shall be performed as set forth in section 48-2220, subsection E. 48-2225. Jurisdiction of the department of health services Nothing in this article shall in any way limit or authorize the limitation of the jurisdiction of the department or the director of the department as established under any other authority including, but not limited to, sections 36-132 and 36-136. 48-2226. Reimbursement for county services Services provided by a county to a health service district are subject to reimbursement pursuant to section 11-251.06. 48-2227. Incorporated area in the district; withdrawal A. The district may be established or the boundaries changed pursuant to section 48-262 to include incorporated cities or towns as well as unincorporated areas. B. Notwithstanding section 48-262, the governing body of an incorporated city or town that desires to withdraw from the district shall notify the board of directors and publish a notice once each week for three consecutive weeks in a newspaper of general circulation in the district. The municipal governing body shall hold at least one hearing on the issue of withdrawing from the district and shall receive all written and oral comments presented at the hearing. The municipal governing body shall vote on the issue at the conclusion of the hearing, and if the vote is to withdraw from the district, the withdrawal is effective ninety days after the hearing. C. On withdrawal, property located in the city or town is subject to section 48-262, subsection F and the incorporated area of the city or town is not entitled to health service district services.