STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION r• sZ. Q 2021 JULU 2`0 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-0094 AHCA NO.: 2019003368 RENDITION NO.: AHCA-21 - 180 -S-OLC CONCORDIA OF FLORIDA, INC. d/ b/ a CONCORDIA VILLAGE OF TAMPA, Respondent. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-1063 AHCA NO.: 2019001114 V. JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/ b/ a JOHN KNOX VILLAGE MED CENTER, Respondent. FINAL ORDER Having reviewed the Administrative Complaints, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency issued the attached Administrative Complaints and Election of Rights forms to the respective Respondent. ( Ex. 1) The parties have since entered into the attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. ( Ex. 2) 2. The Respondent [ in AHCA No. 2019003368] shall pay the Agency $ 3, 000.00 and is assigned conditional licensure status effective January 28, 2019, and ending January 28, 2019. If full payment has been made, the cancelled check acts as receipt ofpayment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the " Agencyfor Health Care Administration" and containing the AHCA ten -digit case number should be sent to: Central Intake Unit Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61 Tallahassee, Florida 32308 3. The Administrative Complaint in AHCA No. 2019001114 is withdrawn. ORDERED at Tallahassee, Florida, on this / ~ ~ day of ~""b 1 , 2021. --'1'+"1j"'"---'yl:-1---- . Smoak, Deputy Se retary Agency for Health Care Administration NOTICE OF RIGHT TO JUDICIAL REVIEW A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy ofa notice ofappeal with the Agency Clerk ofAHCA, and a second copy, along with filing fee as prescribed by law, with the District Court ofAppeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition ofthe order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct-G!WY of this Final Order was served on the below-named persons by the method designated on this 2t1t~y of .--J ~ ,2021. . hoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Telephone: (850) 412-3630 Facilities Intake Unit Central Intake Unit Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) 2 Maurice Boetger, Senior Attorney Office ofthe General Counsel Agency for Health Care Administration (Electronic Mail) Shaddrick A. Haston, Esquire Ullman Bursa Law 3812 Coconut Palm Drive, Suite 200 Tampa, Florida 33619 shaston@ublawoffices.com (Electronic Mail) Jodi-Ann V. Livingstone Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Electronic Filing) J. Bruce Culpepper Administrative Law Judge Division ofAdministrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Electronic Filing) 3

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 4Z_ 28 2021 psi U i ' STATE OF FLORIDA, AGENCY FOR AHCA NOS.: 2017005962 HEALTH CARE ADMINISTRATION, 2017007374 2018001027 Petitioner, 2018001134 2018001136 VS. 2019017938 2020005675 QUIET WHISPER ASSISTED 2020005683 LIVING FACILITY, LLC. 2020005687 RENDITION NO.: AHCA-21 -8 01 H -S-OIC Respondent. AHCA NOS.: 2018005528 QUIET WHISPER ASSISTED 2020006372 LIVING FACILITY, LLC, Petitioner, VS. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER Having reviewed the Administrative Complaints and Notices of Intent to Deny, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: I. The Agency issued the attached Administrative Complaints and Notices of Intent to Deny The parties have since entered into the license renewal applications to the Provider. ( Composite Ex. 1) attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. Ex. 2) If the 2. The Notices of Intent to Deny the license renewal applications are withdrawn. Agency has not already completed its review of the renewal applications, it shall resume its review of the applications. The Provider shall pay the Agency $ 10,000.00 and agrees they will not be eligible to hold Extended Congregate Care and Limited Nursing Services specialty license in the future and further agrees not to apply for such licensure. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within nine (9) months of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the " Agency for Health Care Administration" and containing the AHCA ten -digit case number should be sent to: Central Intake Unit Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61 Tallahassee, Florida 32308 ~ ORDERED at Tallahassee, Florida, on this l4E day of_-----L--=~~------' 2021. NOTICE OF RIGHT TO JUDICIAL REVIEW A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court ofAppeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition ofthe order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct~y Qf_this Final ~y~e2:2 on the below-named persons by the method designated on this ~of --:]. 7 ,2021 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Telephone: (850) 412-3630 Facilities Intake Unit Central Intake Unit Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) 2 D. Carlton Enfinger, Attorney Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Keisha Woods, Unit Manager Licensure Unit Agency for Health Care Administration (Electronic Mail) Rickey L. Strong, Esquire Phipps and Howell 201 South Monroe Street, 4111 Floor Tallahassee, Florida 32301 rick@jsh-pa.com (Electronic Mail) 3

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 4Z_ 28 2021 psi U i ' STATE OF FLORIDA, AGENCY FOR AHCA NOS.: 2017005962 HEALTH CARE ADMINISTRATION, 2017007374 2018001027 Petitioner, 2018001134 2018001136 VS. 2019017938 2020005675 QUIET WHISPER ASSISTED 2020005683 LIVING FACILITY, LLC. 2020005687 RENDITION NO.: AHCA-21 -8 01 H -S-OIC Respondent. AHCA NOS.: 2018005528 QUIET WHISPER ASSISTED 2020006372 LIVING FACILITY, LLC, Petitioner, VS. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. FINAL ORDER Having reviewed the Administrative Complaints and Notices of Intent to Deny, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: I. The Agency issued the attached Administrative Complaints and Notices of Intent to Deny The parties have since entered into the license renewal applications to the Provider. ( Composite Ex. 1) attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. Ex. 2) If the 2. The Notices of Intent to Deny the license renewal applications are withdrawn. Agency has not already completed its review of the renewal applications, it shall resume its review of the applications. The Provider shall pay the Agency $ 10,000.00 and agrees they will not be eligible to hold Extended Congregate Care and Limited Nursing Services specialty license in the future and further agrees not to apply for such licensure. If full payment has been made, the cancelled check acts as receipt of payment and no further payment is required. If full payment has not been made, payment is due within nine (9) months of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the " Agency for Health Care Administration" and containing the AHCA ten -digit case number should be sent to: Central Intake Unit Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61 Tallahassee, Florida 32308 ~ ORDERED at Tallahassee, Florida, on this l4E day of_-----L--=~~------' 2021. NOTICE OF RIGHT TO JUDICIAL REVIEW A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy, along with filing fee as prescribed by law, with the District Court ofAppeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition ofthe order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct~y Qf_this Final ~y~e2:2 on the below-named persons by the method designated on this ~of --:]. 7 ,2021 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Telephone: (850) 412-3630 Facilities Intake Unit Central Intake Unit Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) 2 D. Carlton Enfinger, Attorney Office of the General Counsel Agency for Health Care Administration (Electronic Mail) Keisha Woods, Unit Manager Licensure Unit Agency for Health Care Administration (Electronic Mail) Rickey L. Strong, Esquire Phipps and Howell 201 South Monroe Street, 4111 Floor Tallahassee, Florida 32301 rick@jsh-pa.com (Electronic Mail) 3

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION r• sZ. Q 2021 JULU 2`0 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-0094 AHCA NO.: 2019003368 RENDITION NO.: AHCA-21 - 180 -S-OLC CONCORDIA OF FLORIDA, INC. d/ b/ a CONCORDIA VILLAGE OF TAMPA, Respondent. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-1063 AHCA NO.: 2019001114 V. JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/ b/ a JOHN KNOX VILLAGE MED CENTER, Respondent. FINAL ORDER Having reviewed the Administrative Complaints, and all other matters of record, the Agency for Health Care Administration finds and concludes as follows: 1. The Agency issued the attached Administrative Complaints and Election of Rights forms to the respective Respondent. ( Ex. 1) The parties have since entered into the attached Settlement Agreement, which is adopted and incorporated by reference into this Final Order. ( Ex. 2) 2. The Respondent [ in AHCA No. 2019003368] shall pay the Agency $ 3, 000.00 and is assigned conditional licensure status effective January 28, 2019, and ending January 28, 2019. If full payment has been made, the cancelled check acts as receipt ofpayment and no further payment is required. If full payment has not been made, payment is due within 30 days of the Final Order. Overdue amounts are subject to statutory interest and may be referred to collections. A check made payable to the " Agencyfor Health Care Administration" and containing the AHCA ten -digit case number should be sent to: Central Intake Unit Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 61 Tallahassee, Florida 32308 3. The Administrative Complaint in AHCA No. 2019001114 is withdrawn. ORDERED at Tallahassee, Florida, on this / ~ ~ day of ~""b 1 , 2021. --'1'+"1j"'"---'yl:-1---- . Smoak, Deputy Se retary Agency for Health Care Administration NOTICE OF RIGHT TO JUDICIAL REVIEW A party who is adversely affected by this Final Order is entitled to judicial review, which shall be instituted by filing one copy ofa notice ofappeal with the Agency Clerk ofAHCA, and a second copy, along with filing fee as prescribed by law, with the District Court ofAppeal in the appellate district where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30 days of rendition ofthe order to be reviewed. CERTIFICATE OF SERVICE I CERTIFY that a true and correct-G!WY of this Final Order was served on the below-named persons by the method designated on this 2t1t~y of .--J ~ ,2021. . hoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308 Telephone: (850) 412-3630 Facilities Intake Unit Central Intake Unit Agency for Health Care Administration Agency for Health Care Administration (Electronic Mail) (Electronic Mail) 2 Maurice Boetger, Senior Attorney Office ofthe General Counsel Agency for Health Care Administration (Electronic Mail) Shaddrick A. Haston, Esquire Ullman Bursa Law 3812 Coconut Palm Drive, Suite 200 Tampa, Florida 33619 shaston@ublawoffices.com (Electronic Mail) Jodi-Ann V. Livingstone Administrative Law Judge Division of Administrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Electronic Filing) J. Bruce Culpepper Administrative Law Judge Division ofAdministrative Hearings 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (Electronic Filing) 3 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-0094 vs. AHCA No. 2019003368 CONCORDIA OF FLORIDA, INC. d/b/a CONCORDIA VILLAGE OF TAMPA, Respondent. ----------------------------~/ STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, DOAH No.: 20-1 063 vs. AHCA No. 2019001114 JOHN KNOX VILLAGE OF TAMPA BAY, INC. f/d/b/a JOHN KNOX VILLAGE MED CENTER, Respondent. ----------------------------~/ SETTLEMENT AGREEMENT The Petitioner, State of Florida, Agency for Health Care Administration ("the Agency"), and the Respondents, Concordia ofFlorida, Inc. d/b/a Concordia Village ofTampa and John Knox Village of Tampa Bay, Inc. f/d/b/a John Knox Village Med Center ( coJiectively or individually "the Respondent"), pursuant to Section 120.57(4), Florida Statutes, enter into this Settlement Agreement ("Agreement") and agree as follows: WHEREAS, the Agency is the licensing and regulatory authority over the Respondent pursuant to Chapter 408, Part II, and Chapter 400, Part II, Florida Statutes; and Page I of6 EXHIBIT 2 WHEREAS, the Respondent is a nursing home licensed pursuant to Chapter 408, Part II, Chapter 400, Part II, Florida Statutes, and Chapter 59A-4, Florida Administrative Code; and WHEREAS, the Agency issued the Respondent an Administrative Complaint (AHCA No. 2019003368) seeking to impose an administrative fine of $3,000.00 and to assign conditional licensure status effective January 28, 2019 and ending January 28, 20 19; and WHEREAS, the Agency issued the Respondent an Administrative Complaint (AHCA No. 2019001114) seeking to impose an administrative fine of $1,000.00 and to assign conditional licensure status effective November 27, 2017 and ending November 30, 20 17; and WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of these disputes would avoid the expenditure of substantial sums to litigate these disputes; and WHEREAS, the parties have negotiated in good faith and agreed that the best interest of all the parties will be served by a settlement ofthese proceedings; NOW THEREFORE, in consideration ofthese mutual promises and recitals, the parties, intending to be legally bound, agree as follows: I. All of the above recitals are true and correct and are expressly incorporated into this Agreement. 2. The above "whereas" clauses are binding findings on the parties. 3. Upon full execution ofthis Agreement, the Respondent waives any and all appeals and proceedings to which it may be entitled including, but not limited to, informal proceedings under Subsection 120.57(2), Florida Statutes, formal proceedings under Subsection 120.57(1), Florida Statutes, appeals under Section 120.68, Florida Statutes; and further waives compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled. Provided, however, this Agreement shall not be deemed a waiver by any party of its right Page2of6 to the judicial enforcement ofthis Agreement. 4. Upon full execution ofthis Agreement, in AHCA No. 2019003368, the Respondent agrees to pay the Agency $3,000.00 within 30 days ofthe entry of the Final Order adopting this Agreement. 5. Upon full execution ofthis Agreement, in AHCA No. 2019003368, the Respondent is assigned conditional licensure status effective January 28, 2019 and ending January 28, 20 I9. 6. Upon full execution of this Agreement, the Agency agrees to withdraw the Administrative Complaint in AHCA No. 2019001 I14. 7. Venue for any action brought to interpret, enforce, or challenge the terms of this Agreement and adopting Final Order shall lie solely in the Circuit Court ofLeon County, Florida. 8. By entering into this Agreement, the Respondent continues to deny the allegations set forth in the Administrative Complaints, but recognizes that the Agency continues in good faith to assert the validity of the allegations. This Agreement shall not preclude the Agency from imposing any penalty against the Respondent for any other deficiency identified in any other survey ofthe Respondent. This Agreement shall not preclude the Agency from using the deficiencies from the surveys identified in the Administrative Complaint (AHCA # 2019003368) in any decision regarding licensure of the Respondent. In the event the Agency takes such action in the future, nothing in this Agreement shaH serve as a waiver of the Respondent's rights under Chapter 120, Florida Statutes, or other applicable law. In addition, this Agreement shall not preclude or estop any federal, other state agency, or local agency from taking any action against the Respondent based upon, in whole or in part, the allegations set forth in the Administrative Complaints. 9. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating this Agreement and closing the above-styled cases. Page 3 of6 10. Each party shall bear its own costs and attorney's fees. 1I. This Agreement shall become effective on the date upon which it is fully executed by all parties designated below. 12. The Respondent, for itself and for its related or resulting organizations, entities, successors, and transferees, attorneys, and heirs, discharges the Agency, its agents, representatives, and attorneys, from all claims, demands, actions, causes of action, suits, damages, losses, and expenses, of any and every nature whatsoever, arising out of or in any way related to this matter and the Agency's actions, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including any claims arising out of this Agreement, by or on behalf ofthe Respondent or related entities. 13. This Agreement is binding upon all parties and those persons and entities that are identified in the above paragraph ofthis Agreement. 14. In the event that the Respondent was a Medicaid provider at the time of the occurrences alleged in the Administrative Complaints, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any further sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any pending or potential federal issues against the Respondent. This Agreement does not prohibit the Agency from taking any action regarding the Respondent's Medicaid provider status, conditions, requirements or contract, if applicable. 15. The undersigned have read and understand this Agreement and have the authority and legal capacity to bind their respective principals. The Respondent acknowledges the right to retain independent counsel and has either obtained its own counsel or voluntarily waived the right to counsel. The Respondent understands that counsel for the Agency represents solely the Agency Page 4 of6 and that counsel for the Agency has not provided any legal advice to, or influenced, the Respondent in the decision to enter into this Agreement. 16. This Agreement contains the entire understandings and agreements of the parties. This Agreement supersedes any prior oral or written agreement that may have existed between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 17. All parties agree that an electronic or facsimile signature suffices for an original signature, that an electronic or facsimile copy suffices for an original document, and that this agreement may be executed in counterparts. 18. This Agreement shall be effective upon full execution by all parties and adoption into a Final Order. After full execution of this Agreement, the Agency will enter a Final Order adopting this agreement and closing this case. The following representatives acknowledge that they are duly authorized to enter into this Agreement. . Sm ak, Deputy Secretary Health Quality Assurance Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 Concordia ofFlorida, Inc. /a Concordia Village of Tampa (Licensee at the time of the Agency action commenced) 41 00 E. Fletcher Ave Tampa, Florida 33613 DATED: '~[ Hlzt Page 5 of6 Tallahassee, Fl~~~ 3t3l8' . I I ' I I DATED:__ '·. · ~ Maurice T. Boetger, Senior Attorney Office of the General Counsel Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: !)/)h., I Shaddrick A Haston, Esquire Ullman Bursa Law 3812 Coconut Palm Drive, Suite 200 Tampa, Florida 33619 Attorney for Concordia Village DATED: ___7_/1_4/_2_1_____ Page 6 of6