Five core borings were taken on and around Boo Bee Patch Reef to better understand the origin of such shelf lagoon reefs. The cores reveal 4 stages of development: (1) subaerial exposure of a Pleistocene "high" having about 8 meters of relief, possibly a Pleistocene patch reef; (2) deposition of peat and impermeable terrigenous clay 3 meters thick around the high; (3) initiation of carbonate sediment production by corals and algae on the remaining 5 meters of hard Pleistocene topography and carbonate mud on the surrounding terrigenous clay; and (4) accelerated organic accumulation on the patch reef. Estimates of patch reef sedimentation rates (1.6 m/1000 years) are 3 to 4 times greater than off-reef sedimentation rates (0.4-0.5 m/1000 years). During periods of Pleistocene sedimentation on the Belize shelf, lagoon patch reefs may have grown above one another, stacking up to form reef accumulation of considerable thickness.