. STATE OF FLORIDA COT 17 C2 AGENCY FOR HEALTH. CARE ADMINISTRATION ae DIVERSICARE LEASING CORPORATION, | PLERK d/b/a HARDEE MANOR CARE CENTER, SIZ Petitioner, -? A 00-ad el Ae vs. AHCA CASE NO: 06-00-491 2002046435 S|? RENDITION NO. AHCA-02-".- -S=OLG = =] STATE OF FLORIDA, ; AGENCY FOR HEALTH CARE ADMINISTRATION, : Respondent. __/ AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA CASE NO: 06-00-081-NH 2002046991 DIVERSICARE LEASING CORPORATION, d/b/a HARDEE MANOR CARE CENTER, Respondent. _—/ FINAL ORDER The Agency for Health Care Administration, having entered into a Joint * Stipulation and Settlement Agreement with DIVERSICARE LEASING CORPORATION, d/b/a HARDEE MANOR CARE CENTER, RESPONDENT, and the parties being otherwise fully advised in the premises, determines as follows: The attached Joint Stipulation and Settlement Agreement is approved and adopted as a part of this Final Order and the parties are directed to comply with the terms of the Joint Stipulation and Settlement Agreement. THEREFORE, it is ORDERED and ADJUDGED that the parties hereto are directed to comply with terms of the Joint Stipulation and Settlement Agreement. DONE and ORDERED this johny of LD, , 2002, in Tallahassee, Leon County, Florida. Aes M,. ie Mo Secretary Agency for Health Care Administration 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 AGENCY CLERK AND A SECOND COPY, ALONG WITH FILING FEE AS PRESCRIBED BY LAW, IN THE DISTRICT COURT OF APPEAL 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 THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. CERTIFICATE OF SERVICE © I HEREBY CERTIFY that a true copy of the foregoing was mailed to the following on this |) day of CCtoler _, 2002. Jerome W. Hoffman, Esquire Holland & Knight LLP Attorney for Respondent 315 S. Calhoun Street, Suite 600 P.O. Drawer 810 Tallahassee, FL. 32301 (850)224-7000 Valda Clark Christian, Esquire General Counsel, Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) Gloria Collins Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (Interoffice Mail) Michael Mathis, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive Building #3 Mail Stop #3 Tallahassee, Florida 32308 (Interoffice Mail) Charlare Trattpsdsn Ape Leland McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 TALI #254139 v3 10 STATE OF FLORIDA oo vp . AGENCY FOR HEALTH CARE ADMINISTRATION: 2; oa : Ai °°. !9 DIVERSICARE LEASING CORPORATION, d/b/a HARDEE MANOR CARE CENTER, Petitioner, vs. AHCA CASE NO: 06-00-191 2002046435 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. a AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA CASE NO: 06-00-081-NH 2002046991 DIVERSICARE LEASING CORPORATION, d/b/a HARDEE MANOR CARE CENTER, Respondent. oe / JOINT STIPULATION AND SETTLEMENT AGREEMENT State of Florida, Agency for Health Care Administration (hereinafter the “Agency”) through its undersigned representatives, and Diversicare Leasing Corporation d/b/a Hardee Manor Care Center, (hereinafter referred to as RESPONDENT), through its undersigned representatives, pursuant to Sec. 120.57(4), Florida Statutes (2002) each individually, a “party,” collectively as “parties,” hereby enter into this Joint Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Respondent operates a nursing home licensed pursuant to Chapter 400 Part II, Florida Statutes (2002), and Chapter 59 A-4, Florida Administrative Code, (2001); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over Respondent pursuant to sections 120.569 and 120.57, Florida Statutes; and WHEREAS, the Agency served Respondent with an Administrative Complaint on or about May 5, 2000, notifying Respondent of its intent to revoke Respondent's license pursuant to Section 400.179(5)(d)(5), Florida Statutes; and WHEREAS, the Agency served Respondent with a Notice of Intent to Deny on or about August 16, 2000, notifying Respondent of its intent to deny renewal of Respondent's license because of the cancellation of Respondent’s lease bond; and WHEREAS, Respondent provided AHCA with a lease bond with an effective date of March 2, 2002; and WHEREAS, the parties have negotiated and agreed that the best interest of all the parties will be served by a settlement of this proceeding; and NOW THEREFORE, in consideration of the mutual promises and recitals herein, the parties intending -to be legally bound, agree as follows: 1. All recitals are true and correct and are expressly incorporated herein. 2. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 3. Upon full execution of this Agreement, RESPONDENT, agrees to waive any and all appeals and proceedings regarding this matter; agrees to waive compliance with the form of the Final Order (findings of fact and conclusions of law) to which it may be entitled including, but not limited to, an informal proceeding under Subsection 120.57(2), a formal proceeding under Subsection 120.57(1), appeals under Section 120.68, Florida Statutes; and declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction. 4. Pursuant to Section 400.179(5)(d)2, Florida Statutes, Respondent agrees to pay the sum of thirteen thousand three hundred twenty dollars ($13,320) to the Agency within thirty (30) days of ~ Respondent’s receipt of the Final Order in satisfaction of Respondent's Medicaid lease bond obligations for the period prior to March 2, 2002. 5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto shall vest in the Circuit Court in Leon County, Florida. 6. Respondent neither admits nor denies the allegations set forth within any prior filings by the Agency in this matter. 7. The Agency agrees that it will not impose any further penalty against Respondent as a result of the cancellation of Respondent’s lease bond and Respondent's operation of its nursing home without a lease bond until March 2, 2002. The Agency further agrees that it will renew Respondent's license within 30 days following the entry of the Final Order in this matter and such license shall expire no earlier than one year from the effective date of the Final Order. 8. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement. 9. Each party shall bear its own costs and attorney fees. 10. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 11. Respondent for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, Agency for Health Care Administration, and its agents, representatives, and attorneys of and 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 of Respondent or related facilities. 12. This Agreement is binding upon all parties herein. 13. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 14. This Agreement contains and incorporates the entire understandings and agreements of the parties regarding this matter. 15. This Agreement supercedes any prior oral or written agreements between the parties regarding this matter. 16. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 17. The parties agree that AHCA is authorized to and shall submit a Final Order adopting and incorporating the terms and conditions of this settlement agreement without notice of hearing and that this settlement agreement shall be attached to the Final Order. 18. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement on behalf of the respective "parties. daar Jerome W. Hoffman, Esquire Shannon B. Hartsfield, Esquire Holland & Knight LLP Attorneys for Respondent 315 S. Calhoun Street, Suite 600 ~ DATED [O/%/o a Tallahassee, FL. 32301 (850)224-7000 Avlucets Kygo fe DATED “LY 7/2. Elizabeth Dudek Deputy Secretary, Managed Care and Health Quality Assurance Agency for Health Care Administration Yu lit be Valda Clark Christian, Esquire General Counsel, Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 A j Michael Mathis, Esquire Assistant General Counsel Agency for Health Care Administration 2727 Mahan Drive Bldg. #3 Mail Stop #3 Tallahassee, Florida 32308 DATED Wet 4 [92 pateo__ Of 2

Docket for Case No: 00-004033