Ozark County voters to decide on use tax for ambulance in April 7 Election

On General Municipal Election ballots across Ozark County, voters will see a question asking whether or not to pass a local “use tax” for the Ozark County Ambulance District. 

If you’re going into the voting box without much research, it may be hard to make an informed decision based on the tangled language. We’re hoping to break it down, so you can fully understand what you’re voting on.

What in the world is a ‘use tax?’

A use tax is basically the equivalent of a sales tax - but for items purchased online or in a catalog instead of in a store. 

A sales tax is charged on items you buy at brick and mortar stores or businesses within the county like Dollar General, Town & Country Supermarket, Cash Saver Pantry or Deb’s Diner, for example (however, sales tax is generally not charged for most services, like getting a haircut.) The money that is collected from the sales tax is broken down with a portion going to various government entities.

The vast majority goes to the state of Missouri, but smaller portions of the sales tax go to fund Ozark County law enforcement/sheriff’s department, the county’s road and bridge crews, the Ozark County Ambulance district and the Ozark County General Revenue fund, which is used for courthouse offices, the recycling center and other county facilities/expenditures.

If an item is purchased within the city limits of Gainesville, Bakersfield or Theodosia, an additional smaller portion of sales tax is added, with the money going to those municipalities for its water, sewer or other city services.

When those same items are purchased online, the state is able to collect its portion of the sales tax, but the other county, city or special entities (such as the ambulance district) are not able to collect the sales tax unless they put a measure on the ballot asking voters to approve a “use tax.” If passed, it will be collected at the same rate as that entity’s sales tax. If the sales tax ever increases, the tax on goods purchased online or in a catalog would also increase to the same rate. 

While the terminology can be confusing, its helpful to imagine the use tax is implemented on items purchased while “using” the internet or a catalog.

What other ‘use taxes’ are in play in Ozark County?

Each entity that collects sales tax must pass the use tax measure for its particular portion of sales tax. The question on the ballot this time refers to the half-cent per $1 sold that goes to the Ozark County Ambulance District, which is a separate entity than the county itself. “Ozark County” instead refers to the general revenue fund, which supports courthouse offices and general items, county road and bridge crews and Ozark County Sheriff’s Department.

Two local entities have previously passed use tax measures and now collect it for sales made online or in catalogs. 

Ozark County (which includes the county’s general revenue fund, law enforcement fund and road and bridge funds) first placed a measure on the ballot in 2020, and it failed. It was put back on the ballot in April 2024, and it passed and was implemented in 2025. The county now collects 2.5 cents per $1 spent on items no matter if they are purchased online or in a store. 

The Village of Theodosia put a use tax measure on the ballot in August 2024, and it was approved, allowing the city to collect its 1.5 cents per $1 spent for items purchased within the city limits or by residents who live in the city limits while they shop online or from catalogs. 

Now, the Ozark County Ambulance District is asking the same question. Can it begin implementing a use tax, allowing it to collect sales tax on items no matter if they are purchased within a local store or by a local resident online or in a catalog.

The Ozark County Ambulance District collects a half-cent of sales tax per $1 spent. So, that means if you spend $10, it collects 5 cents. If you spent $100, it collects 50 cents. If you spent $1,000, it collects $5. 

As of now, the other local sales tax-collecting entities, which includes the City of Gainesville and the Village of Bakersfield, have not put a use tax question put on the ballot; therefore, they do not collect their sales tax on purchases residents made online and catalog. 

The local impact for Ozark County residents

Ozark County Ambulance Administrator Nathan Boone says the proposed use tax on the ballot is a practical step toward closing a widening gap between the revenue the ambulance district brings in and rising costs it takes to operate the facility. 

Based on last year’s figures at the county level, Boone says the measure would generate an estimated $106,000 annually for the district if passed, funding that would go directly toward maintaining and improving emergency medical services.

“What many people don’t realize,” Boone explained, “is that as more purchases shift online, traditional local sales tax revenue continues to decline. At the same time, inflation has significantly increased the cost of providing emergency medical services. This creates a growing gap between revenue and operational costs.”

That gap is becoming increasingly visible in the equipment Ozark County crews rely on every day. In 2018, a fully outfitted ambulance cost around $275,000, Boone said. Today, that same vehicle can cost between $450,000 and $500,000. 

“This includes cardiac monitors, stretchers, power loaders, ventilators, medications and other items inside,” he explained. “But it doesn’t include the hourly rate required to staff it.”

Many of the district’s current ambulances have exceeded 300,000 miles, even after major repairs such as engine replacements. Critical tools are also aging, and prices are going up. A single cardiac monitor now carries a price tag of roughly $65,000.

Despite these pressures, Boone emphasized that the district has worked to limit the burden on taxpayers. 

Although voters approved a property tax levy increase for the ambulance district in 2018, the district has never fully implemented its allowable rate in order to lessen the tax burden on Ozark County residents. Currently, the ambulance district’s levy is .2405; however, the 2018 decision allows it to be set as high as 0.2800.

While it is not related to its sales tax collection (or potential use tax passage), the property tax revenue serves as another element of its funding. 

“We have stretched every dollar as far as possible,” Boone said. “Each year that [the property tax levy] rate is not fully utilized, the levy effectively decreases.”

The proposed use tax, he noted, is not a new tax, but rather a way to capture revenue already being collected on out-of-state and online purchases, funds the ambulance district currently does not receive. As a political subdivision, the district does not benefit from county use tax revenue unless voters approve this measure, specific to the ambulance district itself. 

“This is not double taxation,” Boone said. “It ensures that as buying habits change, our community’s emergency services do not fall behind.”

The local impact of that funding extends beyond equipment. It directly affects staffing and the level of care available to residents. 

When Boone began his tenure at the ambulance district earlier this year, the facility operated with one Advanced Life Support (ALS) unit and one Basic Life Support (BLS) unit, and at one point faced a severe staffing shortage with only two paramedics covering the region.

Since then, the district has rebuilt its workforce, hiring six additional paramedics and bringing the total to eight. Today, Ozark County operates two ALS ambulances daily, meaning a paramedic is on board every truck responding to a call.

That progress comes at a time when emergency medical services nationwide are grappling with a growing paramedic shortage. Boone said maintaining modern equipment, competitive resources, and strong operational support will be key to retaining staff locally.

“We are fully staffed for the first time in years,” he said. “Our goal is to keep it that way.”

If approved, the additional revenue would help ensure that goal remains within reach, supporting not just the equipment on the road, but the people behind it, and ultimately, the care available to every resident who may one day depend on it.

Find out more

The Ozark County Ambulance District maintains an active Facebook page with more information about the ballot measure and the ambulance district as a whole. Follow along with the page for continued information. 

Boone also welcomes questions and discussions from local residents who may want more information. You can reach him by calling 417-679-3624 or emailing nathan.boone4242@gmail.com.