STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

THE WOODS OF MANATEE SPRINGS,

2015 SEP I 8 P 2: 0 I

Petitioner, ENGAGEMENT NO. NH07-063G

V.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

                                                                     I

FINAL ORDER

THIS CAUSE concerns a request for a formal administrative hearing ("Request") that the Agency for Health Care Administration ("Agency") received pertaining to the Agency ' s Medicaid cost report audit of Petitioner (Exhibit A).

On October 17, 2008, Petitioner filed its Request (Exhibit B), challenging some of the Agency' s adjustments to Requester's Medicaid cost report. The case was then held in abeyance at the request of the parties in order to pursue settlement negotiations.

On September I , 2015, Petitioner filed a Notice of Voluntary Dismissal (Exhibit

C).

Based on the foregoing,

IT IS THEREFORE ORDERED AND ADJUDGED THAT:

The Agency hereby acknowledges Petitioner' s dismissal of its Request. The Agency's Medicaid cost report audit of Petitioner is hereby upheld as final and this matter is now closed. The parties shall govern themselves accordingly.

Filed September 24, 2015 8:00 AM Division of Administrative Hearings

day of                        

DONE and ORDERED this f/th

Sqtkrn6.U , 2015, in Tallahassee,

Florida.

ELIZA RETARY

AGEN H CARE ADMINISTRATION

NOTICE OF RIGHT TO JUDICIAL REVIEW

A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER OF DISMISSAL WITH PREJUDICE IS ENTITLED TO JUDICIAL REVIEW, WHICH SHALL BE INSTITUTED BY FILING THE ORIGINAL NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A COPY, ALONG WITH THE FILING FEE PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF THE RENDITION OF THE ORDER TO BE REVIEWED.

2

CERTIFICATE OF SERVICE

c9

:J?, ·-

I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been furnished to the persons named below by the method designated on this {%_L·day of l5.

RICHARD J. SHOOP, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, MS #3

Tallahassee, FL 32308

(850) 412-3689

COPIES FURNISHED TO:

Richard A. Feldman, Esquire 5627 9th Street East Bradenton, Florida 34203

(via electronic mail to feldman_richard@yahoo.com)

Katharine B. Heyward, Esquire Assistant General Counsel

(via electronic mail to Katharine.Heyward@ahca.myflorida.com)

Zainab Day

Medicaid Program Finance

(via electronic mail to Zainab.Day@ahca.myflorida.com)

3

CHARLIE CRIST GOVERNOR

FLOfl,IDA  

MEDICAID'

HOLLY BENSON SECRETAAY

WOODS OF MANATEE SPRINGS, THE 5627 9TH STREET, EAST BRADENTON, FL 34203

Provider No.: 260321

September 24, 2008 Return Receipt No.

7005 3110 0001 6523 3399

Audit Period/Engagement No.: September 30, 2004/NH07-063G Dear Administrator:

We have completed the audit of your facility's Medicaid cost report for the period specified above. A copy of the audit report is attached for your information. ·

Audit adjustments result from the application of Medicaid reimbursement principles to costs as reported on the Medicaid cost report for the period specified. You have the right to request

a formal or informal hearing pursuant to Section 120.57, Florida Statutes. If a petition for a formal hearing is made, the petition must be made in compliance with Section 28-106.201, Florida Administrative Code. Please note that Section 28-106.201(2) specifies that the petition shall contain a concise discussion

of specific items in dispute. Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within· twenty-one (21) days of your receipt of this letter, and that failure to timely request a hearing shall be deemed a waiver of your right to a hearing.

Please address all petitions for a hearing and/or questions to 2727 Mahan Drive, Mail Stop 21, Tallahassee, FL. 32308.

Sincerely,

()}

Lisa D. Milton

Administrator of Audit Services Medicaid Program _Analysis

(850) 487-1240

Attachment(s):

cc: STERLING HEALTHCARE, INC.

•

16 NORCROSS STREET, SUITE 50-B ROSWELL, GA 30075

2727 Mahan Drive, MS# 21

Tallahassee, Florida 32308

Visit AHCA online at http://ahca.myflorida.com

EXHIBIT A

The Woods at Manatee Springs, Inc.

Medicaid Audit Report

            For the Period from April 1, 2003 to September 30, 2004           

Gabriel & Associates, CPAs, PA

Certified Public Accountants Jacksonville, Florida

Gabriel & Associates, CPAs, PA

Certified Public Accountants l0117 St. Augustine Rd. Suite l 00 Jacksonville, Florida 32257

Phone (904) 260-3820

Fax (904) 260-9725

John J. Gabriel, CPA, MBA, MIS email JGabriel@GACPAS.ORG

Members

Victoria L. Hodgins, CPA, MA email VHodgins@GACPAS.ORG Harold Bachner, CPA, MBA email HBachner@GACPAS.ORG

Florida Institute of Certified Public Accountants American Institute of Certified Public Accountants

INDEPENDENT ACCOUNTA,.1'JTS' REPORT

Secretary

Agency for Health Care Administration

We have examined the accompanying schedules and statistical data, as listed in the Table of Contents, which were derived from the Cost Report for Florida Medicaid Program Nursing Home Services Providers (the "Cost Report") of The Woods of Manatee Springs, foe. (the "Provider") for the period from April 1, 2003 to September 30, 2004. These schedules and statistical data are the responsibility of the Provider's management. Our responsibility is to express an opinion on the schedules and statistical data based on our examination.

Except as discussed in the following paragraph, our examination was conducted in accordance with attestation standards established by the American Institute of Certified Public Accountants and, accordingly, included examination on test basis, evidence supporting the accompanying schedules and statistical data and performing such other procedures as we considered necessary in the circumstances. We believe that our examination provides a reasonable basis for our opinion.

The Provider is reimbursed under the Fair Rental Value System ("FRVS"). Accordingly, property cost information for depreciation, interest and rent included on the Schedule of Costs, equity capital information on the Schedule of Statistics and Equity Capital, capital replacement and equity in capital assets information on the Schedule of Fair Rental Value System Data and related per diem information on the Schedule of Allowable Medicaid Costs have not been subjected to examination procedures.

Attachment A to this report includes adjustments which, in our opinion, should be recorded in order for the data, as reported, in the accompanying schedules for the period from April 1, 2003 to September 30, 2004, to be presented in conformity with federal and state Medicaid reimbursement principles as described in Note l. To quantify the effect of the required adjustments, we have applied the adjustments described in Attachment A to the amounts and statistical data, as reported, in the accompanying schedules.

In our opinion, except for the effects of such adjustments as might have been determined to be necessary had amounts and data described in the third paragraph above been examined , and for the effects of not recording adjustments as discussed in the preceding paragraph, the accompanying schedules and statistical data, as listed in the Table of Contents present, in all material respects, the amounts and statistical data derived from the Cost Report of The Woods at Manatee Springs, Inc., for the penod from April 1, 2003 to September 30, 2004, are presented, in conformity with federal and state Medicaid reimbursement principles as described in Note 1.

This report in intended solely for the information and use of the State of Florida Agency for Health Care Administration and management of The Woods at Manatee Springs, Inc. and is not intended to be used by anyone other than these specified parties.

August 31, 2007

The Woods at Manatee Springs, Inc.

Schedule of Costs

For the Period from April 1, 2003 to September 30, 2004

Beauty and Barber Shop Other

The accompanying notes are an integral part of this schedule.

2

NH07-063G

26032-1

The Woods at Manatee Springs, Inc.

Schedule of Charges

For the Period from April 1, 2003 to September 30, 2004

Increase

.A!.Bgported (Decrease} As Adjusted

Usual and Customary Daily Rate $ 310.29 $ $ 310.29

Patient Charges: Medicaid:

The accompanying notes are an integral part of this schedule.

NH07-063G

3 26032-1

The Woods at Manatee Springs, Inc. Schedule of Statistics and Equity Capital

For the Period from April 1, 2003 to September 30, 2004

Statistics

Increase

As Re orted (Decrease} As Adjusted

Type of ownership:

Date cost report accepted:

Corporation September 6, 2006

The accompanying notes are an integral part of this schedule.

NH07-063G

4 26032-1

The Woods at Manatee Springs, Inc. Schedule of Allowable Medicaid Costs

For the Period from April 1, 2003 to September 30, 2004

Total Costs

Allocations & Costs After Costs as Apportionment Allocations &

            Reimbursement Class           Adjusted (Note 2) Apportionment

Allowable Medicaid Costs:

Increase (Decrease)

        Reimbursement Class     As Reported (Note 1} As Adjusted

Allowable Medicaid Per Diem Costs:

Increase (Decrease)

Reimbursement Class As Reported (Note 1)           As Adjusted

Initial Medicaid Per Diem (Note 3) $                  183.87     $                      !0,34)             $                  183.53

The accompanying notes are an integral part of this schedule.

NH07-063G

5 26032-1

The Woods at Manatee Springs, Inc. Schedule of Fair Rental Value System Data

For the Period from April 1, 2003 to September 30, 2004

Equity in Capital Assets: (not examined)

Mortgage Interest Rates:

No Mortgage

The accompanying notes are an integral part of this schedule.

NH07-063G

6 26032·1

RN Data

The Woods at Manatee Springs, Inc.

Schedule of Direct Patient Care

For the Period from April 1, 2003 to September 30, 2004

LPN Data

The accompanying note is an integral part of this schedule.

NH07-063G

7 26032-1

The Woods at Manatee Springs, Inc.

Schedule of Direct Patient Care

For the Period from April 1, 2003 to September 30, 2004

C

Agency Data

RN Costs $ $ $

LPN Costs

CNA Costs                                                                                       

Total Agency Costs $ $ $

RN Hours LPN Hours CNA Hours

Total Agency Hours

Productive Hours

Non-Productive Hours

Total Hours

The accompanying note is an integral part of this schedule.

NH07-063G

8 26032-1

The Woods at Manatee Springs, Inc.

Schedule of Direct Patient Care

For the Period from April 1, 2003 to September 30, 2004

As Increase As Reeorted {Decrease) Adjusted

Pediatric Offset • LPN

Productive Salaries $ $ $

Non-Productive Salaries                                                                                         

Total Salaries $ $ $

Productive Hours

Non-Productive Hours                                                                                         

Total Hours

Total Agency Hours AIDS Offset • RN

Productive Salaries $ $ $

Non-Productive Salaries                                                                                    

Total Salaries $ $ $

Productive Hours

Non-Productive Hours                                                                                    

Total Hours

The accompanying note is an integral part of this schedule.

NH07-063G

9 26032-1

The Woods at Manatee Springs, Inc.

Schedule of Direct Patient Care

For the Period from April 1, 2003 to September 30, 2004

AIDS Offset - LPN

Productive Salaries

Non-Productive Salaries

Total Salaries

Productive Hours

Non-Productive Hours

Total Hours

AIDS Offset - CNA

Productive Salaries $ $ $

Non-Productive Salaries

Total Salaries $ $ $

Productive Hours

Non-Productive Hours

Total Hours AIDS Offset - Agency

RN Hours LPN Hours CNA Hours

Total Agency Hours

Data for All Departments

The accompanying note is an integral part of thi.s schedule.

NH07-063G

10 26032-1

The Woods at Manatee Springs, Inc.

Notes to Schedules

For the Period April 1, 2003 to September 30, 2004

Note 1 - Basis of Presentation

The Schedules, which were derived from the Cost Report for Florida Medicaid Program Nursing Home Services Providers (Cost Report) for the current period, have been prepared in conformity with federal and state Medicaid reimbursement principles, as specified in the State of Florida Medicaid Program and as defined by applicable cost reimbursement principles, policies and regulations according to Medicare reimbursement principles as interpreted by Provider Reimbursement Manual (CMS Pub. 15-1), Florida Title XIX Long-Term Care Reimbursement Plan and the policies and procedures manuals for Nursing Home Services of the Agency for Health Care Administration of the State of Florida.

The balances in the "As Reported" columns of the schedules are the assertions and responsibility of the management of the nursing home. The balances in the "As Adjusted" columns are the result of applying the adjustments reflected in the "Increase/(Decrease)" columns to the balances in the ''As Reported" columns.

Note 2 - Allocations and Apportionment

Schedules G, G-1 and H of the cost report allocate allowable administrative, plant operation and housekeeping costs to allowable and nonallowable ancillary, patient care, laundry and linen and nonreimbursable cost centers based on predetermined statistical bases, such as square footage or total costs, as explained in the Cost Report. These schedules t en apportion allowable costs after allocations to the Medicaid program based on other statistical bases, such as patient care days or ancillary charges, as explained in the cost report. The net effect of such allocations and apportionment on each reimbursement class is presented in the Schedule of Allowable Medicaid Costs.

Note 3 - Initial Medicaid Per Diem

Medicaid per diem costs for property and return on equity have been calculated under the provisions of the Florida Title XIX Long-Term Care Reimbursement Plan, excluding fair rental value provisions. The effect, if any, of the fair rental value system, will be determined during the rate setting process, and where applicable, prospective rates will be calculated by applying inflation factors, incentives, low utilization penalties and reimbursement ceilings.

Note 4 - Capital Replacement Pass-through Costs

Capital Replacement pass-through costs in the form of depreciation and interest are presented without regard to the number of years remaining, if any, to full fair rental value system phase-in. Accordingly, pass-through reimbursement will be calculated based on the amounts equal to or less than fifty percent of the costs presented herein as capital replacement pass-through costs. Once full fair rental value system phase-in has occurred, no capital replacement costs are allowed to be passed-through.

NH07-063G

11 26032-1

The Woods at Manatee Springs, Inc.

Attachment A-Audit Adjustments

For the Period from April 1, 2003 to September 30, 2004

NH07-063G

12 26032-1

The Woods at Manatee Springs, Inc. Attachment A-Audit Adjustments

For the Period from April 1, 2003 to September 30, 2004

Classification

Property:

1. Home Office

   
   

2. Home Office

   
   

   Net Adjustment to Costs

   Account Increase

   Number Comment (Decrease)

   930940 To reclassify Home Office costs. $ 554

   (Section 2150, CMS Pub 15-1)

   
   

   930940 To record adjustment to Home Office (554) costs.

   (Section 2150, CMS Pub 15-1)                              

   
   

   
   

   $ \59,481)

   
   

   Adjustments to Ending Equity Capital (page 4l No Adjuslmenls

   
   

   Adjustments to Slatistics (page 4l

   
   

   Facility Square Footage

3. Physical Therapy Occupational Therapy Medical Supplies Laundry and Linen

   Net Adjustment to Facility Square Footage

   
   

   To adjust to audit findings. (Section 2304, CMS Pub. 15-1)

   
   

   (167)

   167

   77

   140

   217

   
   

   Adjustments affecting Direct Patient Care Information (pages 7-10)

   
   

   RN Salaries

4. Productive

   Non-productive

   
   

   To adjust salaries per audit findings. (Florida Title XIX Long-Term Care

   
   

   $ 25,987

   18,393

   
   

   RN Fringe Benefits

   Reimbursement Plan, Section V.B.)                                  

   $                  44,380

5. FICA

   Unemployment Insurance

   To adjust benefits per audit findings. (Florida Title XIX Long-Term Care

   $ {6,553)

   6,553

   
   

   RN Hours

   Reimbursement Plan, Section V.B.)                                  

   $                                   

6. Productive

   Non-productive

   To adjust hours per audit findings.

   {Florida Tille XIX Long-Term Care

   (246)

   246

   Reimbursement Plan, Seclion V.B.)                                      

   
   

   LPN Salaries

7. Productive

Non-productive

To adjust salaries per audit findings. (Florida Title XIX Long-Term Care Reimbursement Plan, Section V.B.)

$ {20,121)

26,688

  $                    6,567  

NH07-063G

13 26032-1

The Woods at Manatee Springs, Inc. Attachment A • Audit Adjustments

For the Period from April 1, 2003 to September 30, 2004

Classification Comment

Increase (Decrease)

Adjustments affecting Direct Patient Care Information (continued) LPN Fringe Benefits

17 FICA

Unemployment Insurance

LPN Hours

18. Productive Non-productive

To adjust benefits per audit findings. (Florida.Title XIX Long-Term Care Reimbursement Plan, Section V.B.)

To adjust hours per audit findings. (Florida Title XIX Long-Term Care

$ (19,869)

19,869

955

698

CNA Salaries

Reimbursement Plan, Section V.B.)                                   

                      1,653

1. Productive

   Non-productive

   To adjust salaries per audit findings. (Florida Title XIX Long-Term Care

   $ (72,679)

   40,196

   
   

   CNA Fringe Benefits

   Reimbursement Plan, Section VB)                                

   $ (32,483)

   
   

2. FICA

   Unemployment Insurance

   To adjust benefits per audit findings. (Florida Title XIX Long-Term Care

   $ (23,209)

   23,209

   
   

   CNA Hours

   Reimbursement Plan. Section V.B.)                                   

   $                              

3. Productive

   Non-productive

   To adjust hours per audit findings. (Florida Title XIX Long-Term Care

   (4,868)

   3,191

   Reimbursement Plan, Section V.B.)                                 (1,677)

   
   

   All Departments - Fringe Benefits

4. FICA

   Unemployment Insurance

   
   

   To adjust benefits per audit findings. (Florida Title XIX Long-Term Care

   
   

   $ (48,103)

   48,103

   Reimbursement Pian, Section V.B.)                                   

     $                                

   
   

   NH07-063G

   14 26032-1

   
   

   
   

   The Woods at Manatee Springs, Inc.

   Attachment A-Audit Adjustments

   For the Period from April 1, 2003 to September 30, 2004

   
   

   The following adjustments reported in the Schedule of Fair Rental Value System Data are in accordance with the fair rental value system provisions of the Florida Title XIX

   Long-Term Care Reimbursement Plan and, where appropriate, the applicable sections of Chapter 100, Depreciation and 2300, Adequate Cost Data and Cost Findings, of the Provider Reimbursement Manual (CMS Pub. 15-1). The Provider has been furnished with schedules developed during the course of the audit which detail allowable components of the fair rental value system.

   
   

   Fair Rental Value System Data

   
   

   Increase

   {Decrease)

   
   

   
   

   Classification

   
   

   Capital Additions and Improvements:

   
   

   1. Acquisition Costs $

      
      

   2. Retirements $

      
      

      
      

      Capital Replacements:

      
      

   3. Acquisition Costs

      
      

   4. Pass-through Costs Equity in Capital Assets:

      
      

      (not examined)

      
      

      $

      
      

      $

      
      

      (not examined)

   5. Ending Equity $

      
      

   6. Average Equity $

      
      

   7. Return on Equity Before Apportionment

      
      

   8. Return on Equity Apportioned to Medicaid

1,899

  $                        589

NH07-063G

15 26032-1

The Woods at Manatee Springs, Inc.

Sterling Healthcare, Inc. (Home Office) Attachment A • Audit Adjustments • Home Office

For the Period from April 1, 2003 to September 30, 2004

Net Adjustment affecting Administrative Costs Portion allocated to The Woods at Manatee Springs

Adiustments to Home Office Property Costs

$ (1,130,039)

$ j41,642)

7. Leases NonRelated Party 730510

To adjust to examined amount.

$ (23,510)

Net Adjustment affecting Property Costs

(Section 2304, CMS Pub 15-1)                                     

$ (23,510)

Portion allocated to The Woods at Manatee Springs

Adjustments to Home Office Ending Equity Capital No Adjustments

$ (554)

NH07-063G

16 26032-1

COMPLETE THIS SECTION ON DELIVERY

.

1

l ..

:

I (rransfE

7005 3110 0001 6523 3399

! 2. Article I

;PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 1

j _;

)

ealthca

12: 28

October 15, 2008

Ms. Lisa Milton, Administrator

Florida Agency for Health Care Administration Medicaid Audit Services

2727 Mahan Drive

Building 3, Mail Stop 21

Tallahassee, Florida 32308

CERTIFIED MAIL:

Provider Name: Provider Number: Audit Engagement: Fiscal Year Ended:

The Woods of Manatee Springs 260321

NH07-063G

September 30, 2004

Dear Ms. Milton:

We are in receipt of the audit report for the Woods of Manatee Springs for the period April 1, 2003 through September 30, 2004. We have reviewed the audit report and the related adjustments and believe that the auditor posted an adjustment based, not on fact but, on misjudgment and that two other adjustments made for lack of supporting documentation do, in fact, have supporting documentation.

Therefore, please accept this letter as our request for an appeal of the aforementioned cost report audit. We wish to have the actual appeal held in abeyance as we believe that the issues can be worked out through concerted teamwork on both our parts.

Please contact me as soon as possible to conform acceptance of this appeal and so that we may arrange for copies of the work papers to be sent to us and/or our cost report preparer for further review.

7;;;;/(d/4'

Thank you for your assistance in this matter. Sincerely,

f

Robert Hagan President

16 Norcross Street, Suite 100, Roswell, GA 30075

Telephone: 770-993-4000 • Fax: 770-993-9014

RECEIVED

OCT 1 6 2008

EXrlIBIT B

IIJl I 6  -\:i_,        ;;_v_,_,.

October 15, 2008

Ms. Lisa Milton, Administrator

Florida Agency for Health Care Administration

Medic"id Audit Services

2727 Mahan Drive

Building 3, Mail Stop 21

Tallahassee, Florida 32308

CERTIFIED MAIL

Provider Name: Provide, Number: Audit Engagement: Fiscal Year Ended:

The Woods of Manatee Springs · 260321

NH07"063G

S"Ptember 30, 2004

Dear Ms. Milton:

We are in receipt ofth.e audit report for the Woods of Manatee Springs for the period April 1, 2003 through September 30, 2004. We h&ve reviewed the audit report and the related adjustmc:mts and believe that the auditor posted an adjustment based, not 011 fact but, on misjudgment and that two other adjustme11ts made for lack of supporting documentation do, in fact, have supporting documentation.

Therefore, please accept this letter as our request for an appeal of the aforementiom. d cost report audit. We wish to have the actual appeal held in abeyanco a1:o we belfave that the issues can be worked out through concerted teamwork on both our parts.

Please contact me as soon as pos1:oible to conform acceptance of this appeal and so that we may arrange for copic:s of the work papers to be sent to us and/or our cost report preparcrr for fur1her review.

Thank you for your assistance in this matter.

Sincerely,

(LJl/4-ay--

PumaryCouncil, Inc.

/);; ,!))

Robert Hagan

President

16 Norcross Street, Suite 100, Roswell, GA 30075

Telephone: 770-993-4000 • Fax: 770-993-9014

Costs may vary from one institution to another because of scope of services, level of care, geographical location, and utilization. It is the intent of the program that providers are reimbursed the actual costs of providing high quality care, regardless of how widely they may vary from provider to provider, except wliere a particular institution's costs are found to be substantially out ofline with other institutions in the same area which are similar in size, scope of services, utilization, and other relevant factors. Utilization, for this Plll'}'Ose, refers not to the provider's occupancy rate but rather to the ma11ner in which the institution is used as determined by the characteristics of the patients treated (i.e., its patient mix - age of patients, type of illness, etc.).

Implicit in the intention that actual costs be paid to the extent they are reasonable is the expectation that the provider seeks to minimize its costs and that its actual costs do not exceed what a prudent and cost conscious buyer pays for a given item or service. (See

§2103.) If costs are determined to exceed the level that such buyers incur, in the absence of clear evidence that the higher costs were unavoidable, the excess costs are not reimbursable under the program.

In the event that a provider undergoes bankruptcy proceedings the program makes payment to the provider based on the reasonable or actual cost of services rendered to Medicare beneficiaries and not on the basis of costs adjusted by bankruptcy arrangements.

The Provider subsequently provided copies of the contracts and paid invoices that clearly indicate these are legitimate services and that the invoices were paid on a timely basis. The Provider contends that tl1ese services were not duplicative (otherwise a binding l1:1gal contracl would not have been entered) and are necessary and prudent in order to maintain a clean and healthy building which leads, in tum, to cleaner and more comfortable residents.

We are again including copies of the contracts and letters from Healthcare Services, an unrelated party, discussing the services they provide.

Adjustment 9:

Allowable Ancilhuy; To adjust due to lack of documentation (Section 2304,

CMS Pub. 15-1)

<13,050>

Copy of invoice attached.

16 Norcross Street, Suite 100, Roswell, GA 30075

Telephone: 770-993-4000 • Fax: 770-993-9014

Whitley Bros. Construction

6432 Tamiami Trai South Sarasota, FL 34321

941-923-2884.

4/12/04

Woods of Mana.tee Nursing Center 16 Norcross Street, Suite 50

Roswell, GA 30075

R9ofrepair:

Labor and materials ··· $4,235.00 ..·•

Whitley Bros. Construction

6432 Tamiami Trail, South Sarasota, FL 34321

941 923-2884.

4/12/04

Woods of Manatee Nursing Center

16 Norcross Street, Suite 50

Roswell, GA 30075

Roof repair;

Labor and materials - .",. -· .. -· ··--- .. ,_ $4,235.00 ·- · ..

September 6, 2007

Mr. John Gabriel

Gabr.id & Associates CPA Medicare/112 -A&R Reopening Mutual of Omaha

Mutual of Omaha Plaza Omaha, NE 68175

John:

STERLING HEALTHCAB INC.

16 Norcross Su,,ei, Suil 100

Roawoll,OA30075 Williijltl S hwam

C11111rollcr (77D) llJ-.4000-Phone (770)993-9014-Fax

lmhwartwi)ng;ljng.-hee,lth-sow

We have been reviewing and evaluating your fax that we received the afternoon of Friday August 31)

2007.

While we have not completed our evaluation, I wanted to fully respond to your denial of the $5,000 monthly contractual payments for HealthCare Services Laundry Services at Woods of Manatee. ($90,000 for the 18 months of the audit)

I believe that thtu·e was some confusion because Woods of Manatee utilizes two contractors for Laundry

. Services (Angelica Textile and HealthCare Services).

Angelica Textile provides the linen services for Woods of Manatee, which Donna Steiennann detailed in her note to you.

HealthCare Services has provided laundry services at the Woods ofManat since April, 2003.. The Laundry services provided.are specifically detaileci under the "Scope of Work" in the Housekeeping and Laundry service agreement. Health Care Services has provided s ices to wash, dry fold and deliver persona1 clothes for the residents, as well as laundering other facility items such as tablecloths, mop heads, residents' blankets and other miscellaneous itt:rns as requested by Woods of Manatee personnel.

HealthCare Services also sorts the clean linen itMs that come into the building from the other outside Laundry Service, lulgelica Textile, and picks up and delivers all laundry items to tbe floors for use by musing and residents. The laundry at the facility operates every day> and is .staffed by a full time Health Care Servlce employee, and requires regular oversight by the Health Care Service Executive Housekeeper.

I am also faxing the copy of the contract. Note that Exhibit I of the Woods of Manatee Springs and Health Care Services details that Health Care Services provided all laundry staffing and laundry supplies to the 120 bed facility.

We will let you know of any other audit issues, Please contact me if you have any questions prior to our Monday September 10, 2007 10:00 AM exit conference.

Woods of Manatee

.Exhibit m

Healthcare Services Group will provide the following laundiy services: Wash. dry, fold. and deliver personal clothing for residents oftms facility Wa.sh, dry, fold, and deliver tablecloths as needed to Dietary Dept

Wash and dry bed blankets and other misc. items that do not get sent out to an outside service

Wash soiled mop heads as needed

Sort dean linens as they are delivered from the outside service to the facility

Deliver clean linen items to the floors for use by nursing and residents

Sterling Health Care .

HEALTHCARE SERVICES GROUP, INC.

THE WOODS OF MANATEE SPRINGS HOUSEKEEPING

APRIL 1, 2003

Olvlslonal Office: 16 Norcross Street • Suite 200 • Ro w111/, GA 30075 • (800) 433-2710 • (770) 5B7-3580 • Fax (770) 587-3623

Corporate Office: 3220 Tillman Drive • Suite 300 • Bensalem, PA 19020 • (215) 639-4274 • (800) 523·2248 , Fax: {215) 639-2152

T7

HEALTHCARE SERVICES GROUP, INC.

SERVICE AGREEMENT

AGREEMENT, made this 1st day of April, 2003 by and between HEALTHCARE SERVICES GROUP, INC. (hereinafter referred to as "Healthcare")i a Pennsylvania corporation, with offices at 3220 Tillman Drive, Suite 300, Glenview Corporate Center, Bensalem, PA 19020,

and

The Woods of Manatee Springs, Inc., A Fl corporation, which operates a Nursing Home known as The Woods of Manatee Springs located at 5627 9th Street East, Bradenton, FL, 34203 (hereinafter referred to as "Facility").

The parties hereto, intending to be legally bound hereby agree as follows:

1. SCOPE OF WORK:

   Healthcare will provide all necessary management, supervision, labor and materials necessary to perfonn the housekeeping and Jaund,y services on the premises of the Facility, All existing hOusekeeping equipment will be assumed by Healthcare In performing its duties. Any repair of, r&placement of, or addition to, housekeeping equipment will be Healthcare's responsibility, The value and utilization of the existing housekeeping equipment was a consideration in determlning the service price. The scope of work described will be In compliance with the specifications and schedules attached hereto as Exhibits I and II to this Service Agreement

2. CONTRACT AMOUNT: .

   1. In consideration of Healthcare providing the aforesaid seNices, the Facility will pay to Healthcate the sum of Three Hundred Forty Eight Thousand and no/100 dollars {$348,000.00} per year, said sum to be po1ld in twelve payments, with each pa mant due In the amouht ofTwenty Nine Thousand and no/100

      dollars> {S?Q,eeo:®,) 91'1 the d1/'t services re ran ered through. Sales tax, if appffcable, will be added to

      n')

      the service blllfgJ tmO O

3. TERM: ;. '

   The tenn of this Service Agreement shall commemce on April 1, 2003 and will continue unless canceled in accordance with the provi$ions contained herein. This Service Agreement can be canceled by either party One hundred twenty (120) days after services begin provided a ninety (90) day written notice has been given.

   
   

   Dlv!slonal Olflce: 18 Norcros StrBijl • Suit11 200 • F!oswt/1, GA 30075 • (800) 433-2710 • (770) 587-35FJO ■ Fax (770) 587-3623

   Corporal Office: 3220 Til!man Drive • Suite 300 • Bensalem, PA 19020 • {215) 639-4274 • (BOO) 523·2248, Fax: (215) li89·2152

   ..

   
   

   
   

4. INSURANCE COVERAGEf EMPLOYEE TAXES, RATES AND BENEFITS:

   Healthcare will provide and pay Workmen's Compensation, General Liability, FICA, Federal and Sti!te Unemployment, manager.:; salary, employee hourly wages and benefits for it's employees. Should any rate increase occur in any of these categories, the billing will be adjusted to reflect th.ese changes. . Healthcare will notify the Facility in writing of the increases and effective dates of these changes.

   
   

5. CUSTOMER COOPERATION:

   1. During the term of this Service Agreement, the Facility will make all of its facilities available to Healthcare so that the aforesaid services may be performed by Healthcare. Further, during the term of this Service Agreement the Fac:Hlty will provide Healthcare personnel With the necessary utilities, lncludlng but not lirnitoo to electricity and water, so that its services may be performed by Healthcare.

   2. The proposal price is based upon the ongoing operation of the existing laundry equipment of similar

      or greater capacity to that of the facility at the time of the proposal presentation.

      
      

6. GENERAL PROVISIONS:

   1. Any notices given either party may be given by mail, registered or qertified, postage prepaid, with return receipt requested. Mailed notices shall be deemed communicated .thirty (30) days after maiJing and should be addressed to the parties at the addresses in the introductory paragraph of this Service Agreement, but each party may change its address by written notice in accordance with this paragraph.

   2. This Seivice Agreement supersedes any and all other agreements, either oral or written, between the piu1ies hereto with respect to the engagement of Healthcare by the Facility and contains all the covenants i:lnd agreements between the p;artles wlth respect to its subject matter. This Service Agreement shall not affect or modify any other agreements bi,tween the parties with respect to the payment of any existing debts or obligations owed by the Facility to Healthcare.

   3. This Service Agreement shallbe governed and construed in accordance with the laws of the State of the commonwealth of Pennsylvania.

   4. To the best of Healthcare's ability, the housekeeping and laundry departments will be in complete compliance with all state and federal regulatory agencies.

   5. Neither party, in the performance of this Service Agreement, shall discriminate against any patient employee, or other person because of race, color, creed, sex, ancestry, national ori91n, or handicap. Both parties to this Seivice Agreement shall comply with the requlrements of Title VJ of the Civil Rights Act of 1964 and Section 504 of the Rehablllt!tion Act of 1973.

   6. Healthcare shall, until the expiration of four years after the furnishing of services pursuant to this Service Agreernent, upon written request. make available to the Secretary of the Department of Health and Human Services (HHS), or the Secretary's duly authorized representatives, or upon request to the Comptroller General or the Comptroller General's duly authorized representatives, this Service Agraement and such books, documents and records that are necessaiy to certify the nature and extent of costs under this Service Agreement. This provision shall apply ff the amounts paid under the Seivice Agreement are$ 10,000 or more over a twelve month period. The availability of Healthcare's books, documents and records shall be subject at al/ times to such criteria and procedures for seeking or obtaining access as rnay be promulgated' by the Secretary of HHS in regulations and other ijpplicable laws. Haalthcare's disclosure under this paragn:iph shall not be construed as a waiver of any other legal rights to which Healthcare or the Facility rnay be entitled. Each party will notify the other within 10 days of receipt of a request for access.

      
      

      If pursuant to this Service Agreement, any of Healthcare's duties .and obligations are to be carried out by any individual or entity under a contract with Healthcare with a value of $10,000 or more, over a twelve month period, The avallability of Healthcare's books, documents and records shall be

      subject at all times to such criteria and procedures for seeking or obtaining access as may be promulgated by the Secretary of HHS in regulations and other applicable laws. Healthcare's disclosure under this paragraph shall net be cronstrued as a waiver of any other legal rights to which Healthcare or the Facility may be entitled. each party will notify the other within 10 days of receipt of a request for

      access.

      If pursuant to this Service Agreement, any of Healthcare's duties and obligations are to be earned out by any individual or entity under a contract with Healthcare with a value of $10,000 or more, over a twelve month period. and that subcontractor is to a significant extent, associated or affiliated with. owns. or is owned by or has control of or is controlled by Healthcare, each such subcontractor shall itself by subject to the access requirements and Healthcare shall require such subcontractor to meet the access requirements.

   7. This Service Agreement shall be binding upon. and inure to the benefit of, the parties and their

      respective heirs, successors, personal representatives and assigns.

   8. During the term of this Agreement, and for a period of one year after the termination of this Agreement, neither party shall hire management personnel (I.e., managers or supervisors) (a)still employed by the other; or (b)who had been employed by the other at any time within one year before or after the termination of this Agreement.

IN WITNESS WHEREOF, the parties hereto, or their duly authorized officers or agents, have executed, sealed and delivered this Service Agreement, ln duplicate, intending to be legally bound hereby.

Print Name: Brian Waters

Title: Vice President Operations

Print

Full Name: Bob Hagan

Title: President

HEALTHCARE SERVICES GROUP, INC.

E'.XHIBJT I

The Woods of Manatee Springs

PROPOSAL

HEALTHCARE SERVICES GROUP, lNC. will provide the following:

Full time executive housekeeper

• District Manager ta oversee operation

• All staffing and payroll responsibilities for housekeeping and laundry

  • salaries

  • taxes and insurance

  • fringe benefits

• All laundry supplies to indude the following:

  • detergent - softener

    bleach - sour

• All housekeeping supplies listed

• Heavy housekeeping equipment - Floor machines etc.

• Employee advertising Uniforms

• Monthly unit inspections and regular district manager visits

• Regular employee in-service program

• All housekeeping equipment necessary for start up

#,;25

The cost of this service will be: /Month.

The above cost does not include the outside laundry service.

Olvlslonal Of/lea: 16 Norcross Street • Sui[a 200 • Ro well, GA 3007,5 (800) 413-2710 • (770) 587-3580 • Fax (770) 587-362/J

Corporal& Office; 3220 Tlllman Drive • Suite 300 • Bensalem, PA 19020 • (2t5) 689-4274 • (800) 523-2248 • Fax: (215) QS9"2f 52

HEALTHCARE SERVICES GROUP, INC.

The Woqgs of Manatee Springs

EXHIBIT II

SUPPLIES

The following is a list of supplies and chemicals provided by Healthcare Services Group, Inc.

Germicidal Detergent All Purpose Degreaser Degreaser Ammoniated Stripper Floor Finish

Sealer (22% Solid) Glass Cleaner Ammonia Cleanser

Bowl Cleaner Furniture Cleaner Furniture Polish Metal Polish Carpet Shampoo

Dust Mops and Handles Dust Cloths

Mops and Mop Handles Buff Pads

Stripping Pads

All Supplementary Tools For Light Housekeeping

All Laundry Chemicals

The client will be responsible for the following supplies:

All Paper and plastic for housekeeping All Hand Soap

All Laundry Equipment Repair

All Hampers, Bins & Racks For The Laundry

All Spreads y Curtains Pillows Blankets etc.

Clvlslonal Ottice: 16 Norcross Street • Suits 200 • Roswell, GA 30075 • (800) 433-2710 • (770) 5B7-3580 • Fax (770) SS'T-3823

Corporate O!tice: 3220 TIiiman Drive • Sulie 300 • Bensalem, PA 19020 • (215) 639-4274 • (BOO) 523-224S • Fax: (215) 639,2152

HEALTHCARE SERVICES GROUP, INC.

THE WOODS OF MANATEE SPRINGS

HOUSEKEEPING

APRIL 1, 2003

Dlvlslonal 01flce: 16 Norcros. Street • Suite 200 • Roswell, GA 30075 • (BOO) 433,2710 • (110) 587'-3580 • Fax (770) 587•3623

Corporate Ottice: :3220 TIiiman Drive • Suite 300 • Bensalem, PA Hl□2D • (215) 639-4274 • (800) 523-2248 • F ,;: (215) 639-2152

T7

HEALTHCARE SERVICES GROUP, INC.

EXHIBIT I

The Woods of Manatee Springs PROPOSAL

HEALTHCARE SERVICES GROUP, INC. will provide the following:

• FuII time executive housekeeper

• District Manager to oversee operation

  -All staffing and payroll responsibilities for housekeeping and laundry

  • salaries

  • taxes and insurance

  • fringe benefits

• All laundry supplies to include the following: detergent - softener

  • bleach - sour

    w All housekeeping supplies listed

• Heavy housekeeping equipment - Floor machines etc.

• Employee advertising

• Uniforms

• Monthly unit inspections and regular district manager visits

• Regular employee in•service program

All housekeeping equipment necessary for start up

#%'q-r:ro

The cost of this service will be: $...2-nn I /Month.

The above cost does not include the outside laundry service.

Olvlslonal Otflce: 16 Norcross Street • Suite 200 • Roswell, GA 30075 • (800) 483-2110 • (770) 587-3580 • Fax (710) 587-3623

Corporaoo Office: 3220 TIiiman Drive • Suite 300 • Bensaljj!m, PA 190 0 • (215) 839-4274 • (800) 5 3-2248 • Fax: (215) 639-2152

12:/91 39 d

HEALTHCARE SERVICES GROUP, INC.

SERVICE AGREEMENT

AGREEMENT, made this 1st day of April, 2003 by and between HEALTHCARE

) ,

SERVICES GROUP, INC. (hereinafter referred to as 1'Healthcare11 a Pennsylvania

corporation, with offices at 3220 Tillman Drive, Suite 300, Glenview Corporate Center, Bensalem, PA 19020,

and

) .

The Woods of Manatee Springs, Inc., A FL corporation, which operates a Nursing Home known as The Woods of Manatee Springs located at 5627 9th Street East1 Bradenton, FL, 34203 (hereinafter referred to as 11F acility11

The parties hereto, intending to be legally bound hereby agree as follows:

1. SCOPE OF WORK:

   Healthcare will provide all necessary management, supervision, labor and materials neoess.ary to perform the housekeeping and laundry services on the premises of the Facility. All existing housskeaping equipment will be assumed by Healthcare in pertorming its duties. Any repair of, replacement of, or addition to, housekeeping equipment will be Healthcare·s responsibility. The value and utilization of the existing housekeeping equipment was a consideration in determinlng the service price. The scope of work deecribed will be in compliance with the specifications and schedules attached hereto aij Exhibits I a11d II to this Servlce Agreement.

   
   

2. CONTRACT AMOUNT:

   dt

   1. In conslderatlon of Healthcare providing the aforesaid sefVices, the Facmty will pay to Healthcare the sum of Three Hundred Forty Eight Thousand and no/100 dollars ($34B, 000.00) per year, said sum to be paid In twelve payments, with each payment due in the amount of Twenty Nine Thousand and no/100

      dollars £$2Q;B6C11t}.) .eA-the

      services were ren ered through. Sales tax, if applicable, will be added to

      A)..!

      the service bill(g. J.otf() ff)0 n

3. TERM: 1 Iv

   The term of this Service Agreement shall commence on April 1, 2003 and will continue unless canceled in acc:ordance with the provisions contained herein. This Servlc:e Agreement can be canceled by either party One hundred twenty (120) days after services begIn provided a ninety (90) day written notice has been given.

   
   

   Dlvlslonal Office: 16 Norcross Street • Suite 200 • Roawell, GA 3007!i • (800) 435-2710 • (770) 6B1•3j80 • Fax (170} 587-3623

   Corporate Office; 3220 Tillman Drive • Sul!e 30D • Bensalem, PA 190W • (215) 839-4274 • (800) 523-2248 • F6x: /215) 839·2152

   
   

   T7

   
   

   
   

4. INSURANCE COVERAGE, EMPLOYEE TAXES, RATES AND BENEFITS

   Healthcare will provide and pay Workmen's Compensation, General Liability, FICA, Federal and State Unemployment. managers salary, employee hourly wages and benefits for it's employees. Should any rate increase occur in any of these categories, the billing will be adjusted to reflect these changes. Healthcare will notify the Facility in writing of the increases and effective dates of these changes.

   
   

5. CUSTOMER COOPERATION:

   1. During the term of this Service Agreement, the Facfllty will make all of its facilities available to Healthcare so that the aforesaid services may be performed by Healthcare. Further, during the tern, of this Service Agreement, the Facility Will provide Healthcare personnel with the necessary utilities, including but not limited to electricity and water, so that it's services may be performed by Healthcare.

   2. The proposal price is based upon the ongoing operation of the existing laundry equipment of similar

      or greater capacity to that of the facility at the time of the proposal presentation.

      
      

6. GENERAL PROVISIONS:

   1. Any notices given either party may be given by mail, registered or certified, postage prepaid, with return receipt requested. Mailed notices shall be deemed communicated thirty (30) days after mailing and should be addressed to the parties at the addresses in the introductory paragraph of thii:; Service Agreement, but each party may change its address by written notice in accordance with this paragraph.

   2. This Service Agreement supersedes any and all other agreements, either oral or written, between the parties hereto with respect to the engagement of Healthcare by the Facility and contains all the covenants and agreements between the parties with respect to its subject matter. This SfflVice Agreement shall not affect or modify any other agreem£,llts between the parties with rt1spect to the payment of any e,dsting debts or obligations owed by the Facility to HeaJ-thcar "

   3. This Service Agreement shall be governed and construed in accordance with the laws of the State of the commonwealth of Pennsylvania.

   4. To the best of Healthcare's ability, the housekeeping and laundry departments will be in cornplete compliance with all state and federal regulatory agenci1:1s.

   5. Neither party, in the.perform;:;ince of this Service Agreement, shall discriminate against any patient, ernployee, or other person because of race, color, creed, sex, ancestry, national origin, or handicap. Beth parties to this Service Agreement shall comply with the requlrernents of Title VI of the Civil Rights /J,.,ct of 1964 and Section 504 of the Rehabilitation Act of 1973.

   6. Healthcare shall, until the expiration of four years after the furnishing of services pursuant to this Service Agraement, upon written request, make available to the Secretary of the Department of Health and Human Services (HHS), or the Secretary's duly authorized repre8entatives, or upon request to the Comptroller General or the Comptroller General's duly authorized representatives, this Service Agreement and such books, documents and records that are necessary to certify the nature and extent of costs under this Service Agreement. This provision shall apply if the amounts paid under the Service Agreement are$ 10,000 or more over a twelve month period. Th& availability of Healthcare's books, documents and records shall be subject at all times to such criteria and procedures for seeking or obtaining access as may be promulgated by the Secretary of HHS in regulations and other applii;;i3ble laws. Healthcare's disclosure under this paragraph shall not be construed as a waiver of any other legal rights to which Healthcar or the Facility may be entitled. Each party will notify the other within 1o days of receipt of a request for access.

      
      

      T.7:/R T. -=Jt:)\:1,-l T7

      
      

      lf pursuant to this Setvice Agreement, any of Healthcare·s duties and obligations are to be carried out by any individual or entity under a contract with Healthcata with a value of $10,000 or more, over a twa!,;e _month period. The availability of Healthcare's books, documents and records shall be

      subject at a!I times to such criteria and procedures for seelcin!;J or obtaining acces as may be promulgated by the Secretary of HHS in regulations and other applicable laws. Hei:ilthcareis disclosure under this paragraph shall not be construed as a waiver of any other legal rights to which Healthcare or

      the Facility may be entitled, each party will nolify the other within 10 days of receipt of a request for

      access.

      If pursuant to this Service Agreement,. any of Healthcare's duties and obligations are to be carried out by any individual or entity under a contract with Healthcare with a value of $10,000 or more, over a twelve month perfod, and that subcontractor is to a significant extent, associated or affiliated with, owns. or is owned by or has control of or is controlled by Healthcare, each such subcontractor shall itself by subject to the access requirements and Healthcare shall require such subcontractor to meet the access requirements.

   7. This Service Agreement shall be binding upon, and Inure to the benefit of, the parties and their respective heirs, successors, personal representatives and assigns.

   8. During the tenn of this Agreement, and for a period of one year after the termination of this Agreement, neither party shall hire management personnel {i.e.1 managers or supervisors) {a)still employed by the other; or (b)who had been employed by the other at any trme within one year before or after the termination of this Agreement.

IN WITNESS WHEREOF, the parties hereto, or their duly authorized officers or agents, have executed, sealed and delivered this Service Agreement, in duplicate, intending to be legally bound hereby.

HEA S OUP, INC.

8           

Print Name: Brian Waters

Title: Vice President 0Rerations

Print

Full Name: Bob Hagan

Title: President

T7

HEALTHCARE SERVICES GROUP, INC.

Th& Wuog§ of M@natee Springs

EXHIBIT II

SUPPLIES

The following is a list of supplies and chemicals provided by Healthcare Services Group, Inc.

Germicidal Detergent All Purpose Degreaser Degreaser Ammoniated Stripper Floor Finish

Sealer (22% Solid) Glass Cleaner Ammonia Cleanser

Bowl Cleaner Furniture Cleaner Furniture Polish Metal Polish Carpet Shampoo

Dust Mops and Handles Dust Cloths

Mops and Mop Handles

Buff Pads Stripping Pads

All Supplementary Tools For Light Housekeeping

All Laundry Chemicals

The client will be responsible for the following supplies:

All Paper and plastic for housekeeping All Hand Soap

All Laundry Equipment Repair

All Hampers, Bins & Racks For The Laundry

All Spreads Curtains - Pillows Blankets etc.

Dlv!slonal Offloe: 16 Norcros Street • Suite 200 • Roswell, GA 30075 • (800) 433-2710 • ('T"I0) 581"3580 • Fax (770) 587·3823

Corporate Office: 3220 Tillman Driv,e

Sui1s 300 • Bensalem, PA 19020.• (215) 639"4274 • (BOO) :23,2248 • Fax: (215) 639-2152

T7

FROM :MANATEESPRINGSCAREANDREHAB FAX NO, :9417559365 Oct. 09 2008 02:45PM P2

f!l,.EASE 8!iMIT A QQPV QE THE f!MI PAGE QE THI§ IHYP i WITH

YQUR PA)'MENT 98 WRITE THE INVOJCE NUMBER (LQ.<cATED AJ THE

B•SHI roP cQBNEB QF vouR1Nyo1ce1 oN xouR£HecK. tHANK voy

SUNDANCE REHABILITATION THERAPY SERVICES INVOICE

Sorvicos fer M11rch, 2004

FucIIIt y: Woods of Manatee Spring$ 5827 Ninlh Street f:BSt Bradenton , F\. 34203

--Cat

April 2, 2004

lrwoioo: 1ooorate

Remit: SUNDANCE REHABILITATION -

P.O. Bo:,; 18072

A&hbum, VA 20146

Speec:h Total: 513,050.44

INVOICE TOTAL: $135,415.17

1Z: / u; 38t'd

09/01/2015 11:44 7709339014 STERLING PAGE 02/02

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION THE WOODS OF MANATEE SPRINGS,

rr.··,ir Lt•".' .u:""i

t\HCA

AGENCY CLERK

2815 SEP - I P 3: I 5

Petitioner,

vs. Engagement No.: NH07-063G

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,

Respondent.

                                                                             ;!

NOTICE OF VOLUNTARY DISMISSAL

Petitioner, The Woods of Manatee Springs) by and through its undersigned counsel, hereby gives Notice of Voluntary Dismissal the above styled action. Each party will bear their own attorney's fees and costs.

 as...£L.J

Respectfully submitted,

RichardAFeldman, Esq.

· 5627 9th St. East Bradenton, FL 34203 FL Bar No.: 024130

Email: feldman richard@yahoo.com Attorney for Petitioner

CERTIFICATE OF SERVICE

.I HER.EBY CERTIFY that a true and correct copy of the foregoing was furnished by facsimile to the Agency Clerk for the Respondent, at facsimile number (850) 921-0158 and to Katharine B. Heyward, Esq.,

Richard A. Feldman, Esq. Attorney for Petitioner

Assistant General Counsel for the Respondent, by email to Katt,.arinc.Heyward@ahs;a.myflorida.com this g/ day of September, 2015.

EXHIBrr C

Docket for Case No: 14-002175

Orders for Case No: 14-002175