STATE OF FLORIDA . AGENCY FOR HEALTH CARE ADMINISTRATION 007 22 02 A AHCA STATE OF FLORIDA, AGENCY FOR DEPARTMENT CLERK HEALTH CARE ADMINISTRATION, : TDP chred Petitioner, DOAH Case no. 02-0682 AHCA no. 2001076261 VS. GJS HOLDINGS, INC., d/b/a HALLANDALE REHABILITATION CENTER, Respondent. FINAL ORDER This case is before the Agency for Health Care Administration (Agency) for issuance of a final order. In a “Notice of Intent to Deny” dated December 28, 2001, the Respondent was informed of the Agency's initial decision to deny their renewal application. FINDINGS OF FACT 1. The Respondent received the decision letter and requested an administrative hearing. Subsequently, the Respondent agreed to withdraw its request for an administrative hearing upon execution of the Stipulation and Settlement Agreement (erroneously numbered 2002076261, which is correctly referenced now as 2001076261). The Division of Administrative Hearings (division) closed his file based upon the Respondent’s motion to relinquish jurisdiction. The division’s order of March 29, 2002, and the Respondent’s motion to relinquish jurisdiction are incorporated by reference. CONCLUSIONS OF LAW The Agency has jurisdiction over the parties and subject matter pursuant to Section 120.57(1), Florida Statutes (2001). BASED on the foregoing, the request for a formal hearing is dismissed, this matter is moot, and the Agency's filed is CLOSED. DONE and ORDERED this /O__ day of OCctp Db , 2002, in Tallahassee, Florida. Rhonda M. A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH IS INSTITUTED BY FILING A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AGENCY FOR HEALTH CARE ADMINISTRATION, AND A COPY ALONG WITH THE FILING FEE WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS ARE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THIS ORDER. Copies furnished to: J. D. Parrish Wendy Adam’s Administrative Law Judge MSC #3 Division of Administrative Hearings (by Interoffice Mail) The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (by U.S. Mail) Peter A. Lewis, Esquire Goldsmith, Grout & Lewis, P.A. Michael ©. Mathis, Esq. 307 West Park Avenue, Suite 200 MSC #3 Tallahassee, Florida 32308 (by Interoffice Mail) (by U.S. Mail) Elizabeth Dudek Gloria Collins MSC #9 MSC #14 (by interoffice Mail) (by interoffice Mail) CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing was served on the above named persons by U.S. Mail or by interoffice mail as indicated this D2 2s of Obtobe, 2002. elene IRpaesdn So & ealand McCharen, Agency Clerk State of Florida, Agency for Health Care Administration Fort Knox Bldg., 3, MS#3 2727 Mahan Dr., Suite 3402 Tallahassee, FL 32308-5403 (850) 921-8177 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, Case no. 02-0682 AHCA Case no. 2002076261 vs. GJS HOLDINGS, INC., d/b/a HALLANDALE REHABILITATION CENTER, Respondent. STIPULATION AND SETTLEMENT AGREEMENT The Petitioner, AGENCY FOR HEALTH CARE ADMINISTRATION, and Respondent, HALLANDALE REHABILITATION CENTER, pursuant to Section 120.57(4), Fla. Stat., enter into this Stipulation and Settlement Agreement and agree as follows. WHEREAS, AHCA is the Florida state agency with jurisdiction and authority over skilled nursing facilities pursuant to Chapter 400, Fla. Stat; and WHEREAS, Respondent are applicants for renewal of their licenses as a skilled nursing facilities; and WHEREAS, AHCA, has given notice of its intent to deny Respondent’s for license renewal due to failure to supply the “lease bond” referred to by Section 400.179, Fla. Stat.; and WHEREAS, Respondents have requested a formal administrative hearings to contest AHCA’s proposed action; and WHEREAS, the parties have negotiated and agreed that the best interests of all parties will be served by a fair, efficient, and cost effective resolution of this dispute, NOW, THEREFORE, AHCA and Respondent agree as follows: 1. Execution of this Stipulation and Settlement Agreement by Respondent shall constitute withdrawal of their Petition for formal administrative proceedings, which withdrawal shall become effective upon full execution of this Stipulation and Settlement Agreement by AHCA. 2. AHCA agrees that, upon payment of the fees provided in Paragraph 3 herein, the license renewal applications for HALLANDALE REHABILITATION CENTER, which AHCA had proposed to deny, shall be deemed to be approved without further action. 3. Respondents agree that they shall, in accordance with Section 400.419(9)(d) 2, Fla. Stat., pay a two percent (2%) fee which represents two percent of the total Medicaid lease bond as required in Section 400.419, Fla. Stat. For HALLANDALE REHABILITATION CENTER, the fee shall be $6,180.00. 4. Respondent has paid the agreed two percent (2%) lease bond fee in the amount of $6,180.00. 5. AHCA shall enter a Final Order adopting and incorporating the terms of this Stipulation and Settlement Agreement and dismissing Respondents Petitions. 6. Each party shall bear its own costs and attorney fees. 7. Except as provided herein, this Stipulation and Settlement Agreement shall become effective on the date upon which it is fully executed by all parties. 8. HALLANDALE REHABILITATION CENTER for themselves And for their successors or transferees, attorneys, heirs, and executors and administrators, does hereby discharge the STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTATION, and its agents, representatives, and attorneys of and from all claims, demands actions, causes of action, suites, damages losses, and expenses, of any and every nature whatsoever , arising out of or in any way related to AHCA’s proposed denial of Respondent’s applications for license renewal, including, but not limited to, any claims that were or may be asserted in any federal or state court or administrative forum, including claims arising out of this Agreement, by or on behalf of HALLANDALE REHABILITATION center or related facilities. 9. The undersigned have read and understand this agreement and have authority to bind their respective principals. DATED:_shyrkmuber ¥ leoZ- bbB Hore Lehr bh 17, wee DWAWADWAAR AL Counsel for Respondent Peter A. Lewis, Esquire 307 West Park Avenue Post Office Box 1017 Tallahassee, FL 32301-1017 DATED: LED _ Elizabeth Dudek /ofte/o Ze Deputy Secretary 9, Health Quality Assurance Michael O. Mathis, Esquire Senior Attorney Agency for Health Care Administration DATED: pie Gulf Valda Clark Christian General Counsel Agency for Health Care Administration Wi 3 o/b 2

Docket for Case No: 02-000682