STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AGENCY FOR HEALTH CARE ADMINISTRATION, AID ~ Chee Petitioner, y . - Vv. i. - yore ote CR -AVEG AHCA CASE NO: 2002048189 Pyawietay KO Are OS BP be NORTHWEST ADULT DAY CARE CENTER OF JACKSONVILLE, INC A/K/A NORTHWEST ADULT DAY CARE CENTER OF JACKSONVILLE, FLORIDA, INC Respondent. / FINAL ORDER The Agency for Health Care Administration, having entered into a Joint Stipulation and Settlement Agreement with the parties to these proceedings, and being otherwise well advised in the premises, decides 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 /Vday of Llblieaeey , 2003, in Tallahassee, Leon County, Florida. Rhonda M. Medows, MD, Secretary Agency fok 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. Copies furnished to: Elizabeth Dudek Jean Lombardi Deputy Secretary Finance & Accounting Agency for Health Care Administration Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop 2727 Mahan Drive Mail Stop Code #14 Code #9 Tallahassee, Florida 32308 Tallahassee, Florida 32308 (Interoffice Mail) (Intero ffice Mail) NORTHWEST ADULT DAY CARE Richard Saliba, Esq. CENTER OF JACKSONVILLE Agency for Health Care Administration FLORIDA, INC. 2727 Mahan Drive Bidg #1 MS #3 C/o James M. Barclay, Esquire Tallahassee, Florida 32308 Ruden, McClosky, Smith, Schuster & (Interoffice Mail) Russell PA 215 S Monroe Street Suite 815 Tallahassee, F1 32301 (U.S. Mail) THE NORTHWEST ADULT DAYCARE Wendy Adams CENTER OF JACKSONVILLE (Interoffice Mail) FLORIDA, INC. 1500 Rowe Avenue Tye tt Jacksonville, Fl 32208 Attn: Administrator (U.S. Mail) CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of this Final Order was served on the above-named person(s) by U.S. Mail, or the method designated, on this the Lad (Ve, 2003. : day of \¢21NC! Cee ey) “(LX Lealand McCharen, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 Q STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION 4g: AGENCY FOR HEALTH CARE Hy: aa ADMINISTRATION, MAGS Petitioner, , AHCA CASE NO: 2002048189 DOAH CASE NO: 02-4790 THE NORTHWEST ADULT DAY CARE CENTER OF JACKSONVILLE, INC. Respondent. JOINT STIPULATION AND SETTLEMENT AGREEMENT SEA LIUN AND SETTLEMENT AGREEMENT Petitioner, Agency for Health Care Administration (hereinafter referred to as the “Agency”) through their undersigned representatives, and THE NORTHWEST ADULT DAY CARE CENTER OF JACKSONVILLE, INC., . (hereinafter referred to as the “Respondent”) pursuant to See, 120.57(4), Florida Statutes each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, RESPONDENT is an Adult Day Care Center licensed pursuant to Chapter 400, Florida Statutes (2002), and applicable rules under Florida Administrative Code, (2002); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over the Respondent pursuant to Chapter 400, Florida Statutes; and; WHEREAS, the Agency served Respondent with a Second Amended Notice of License Revocation pursuant to authority of Chapter 400,556 et al Florida Statutes and pursuant to Florida Administrative Code upon basis incorporating allegations relative to the Respondent’s having been excluded, from participation in Medicare, Medicaid and all Federal Health care programs pursuant to notices dated September 30, 2002, and pursuant to notice dated October 9, 2002, from the Department of Health and Human Services.: WHEREAS, the Respondent requested a formal administrative hearing denying the allegations of the Agency’s TAL:40455:1 Notices and challenging the Notice of Intent to Deny received by the Agency, and; WHEREAS, Respondent desires to surrender its license to facilitate the issuance of an Adult Day Care License to Jacksonville Adult Day Care Center, Inc., and; NOW THEREFORE, in consideration of the mutual promises covenants and recitals contained herein, and for other valuable consideration to which the parties stipulate, the parties intend to be legally bound, and agree as follows: 1, All recitals are true and correct and are expressly incorporated herein. Both parties agree that the “whereas” clauses incorporated herein are binding findings of the parties. 2. Respondent further agrees to a withdrawal of its Request for Formal Hearing and to a withdrawal of each and all of it’s pending motions before DOAH and agrees that Petitioner may represent within a Motion to Remand or to Abate that the Petitioner has the authorized consent of the Respondent to seek remand predicated upon basis that the issues have been resolved, such consent to be reflected within a Motion to Remand and/or Abate and such Motion to be filed, entertained and heard without notice and hearing based upon the fact that a contemplated settlement has been entered rendering the issues before the Division moot. Respondent further 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 relative to these particular above referenced case numbers between these parties. It is specifically agreed by each of the parties, however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this stipulation. "3. Upon full execution of this Agreement, the Agency will proceed to enter a Final Order adopting and incorporate the terms of this Agreement. 4. Each party shall be solely and completely responsible for all of it’s associated costs and attorney fees and each specifically waives any such opportunity and/or right to seek attorneys’ fees and costs from the other party relative to this above referenced matter. 5. Respondent for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the 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 TAL:40455:1 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 the Respondent or the Respondent's related facilities. Neither this Paragraph nor this Agreement shall be deemed to affect or prejudice the pending appeal of Mildred Badger (OIG File No. 4-02-40554-9), in HHS Appeals Board Docket Number C-03-088. 6. This Agreement is binding upon each party herein and all those identified within this Agreement. 7. Each of the undersigned represents by his/her signature that each has read and that each understands the nature and content of this Agreement. Further each represents that he/she has authority from theft respective principals to bind their respective principals to the terms and conditions of this agreement. Each of the undersigned specifically acknowledges that he/she is authorized to execute this agreement and to bind the principals as an authorized representative of the party he/she is associated with and/or representing. 8. This Agreement contains and constitutes the entire understandings and agreements of each of the parties. 9. Each party agrees and represents that this Agreement supercedes any prior oral or written agreements between the parties and that agreement may not be amended except in writing signed by all parties. Further, any attempted assignment of this Agreement shall be void, and unenforceable. 10. The following representatives, by their signatures, hereby acknowledge that they are duly authorized to enter into this Agreement. ORTHWEST ADULT DAYYCARE CENTER Managed Care and OF JACKSONVILLE FLORIDA, INC. Health Quality Assurance Spondent Agency for Health Care Administration James M. Barclay, Esquire Ruden, McClosky, Smith, Schuster & Russell PA DATED: 2 215 S$ Monroe Street Suite 815 Tallahassee, Fl 32301 2 & O Valda Clark Christian DATED; fer a 4 wo Stes jt pe 7 ie Agency for Health Care Administration 2727 Mahan Drive Tallahassee FL, 3238 DATED;__* /y, TAL:40455:1

Docket for Case No: 02-004790