STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION: 7/200") IMB JS AT 09 GLOBAL NURSING HOME EN 19 P 2 13 HEALTH, INC., Petitioner, v. DOAH NO: 08-1216 RENDITION NO.: AHCA-08-0587-S-OLC STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review, dated February 12, 2008, attached hereto and-incorporated herein (Ex. 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Ex. 2) with the other party to these proceedings, and being otherwise well-advised in the premises, finds and concludes as follows: ORDERED: 1. The attached Settlement Agreement is approved and adopted as part of this Final Order, and the parties are directed to comply with the terms of the Settlement Agreement. 2. Petitioner shall pay administrative costs in the amount of $1,000.00, due and payable within thirty (30) days of the date of rendition of this Order. 3. Checks should be made payable to the “Agency for Health Care Administration.” The: check, along with a reference to this case number, should be sent directly to: Agency for Health Care Administration Office of Finance and Accounting Revenue Management Unit 2727 Mahan Drive, MS# 14 Tallahassee, Florida 32308 4. Unpaid fees pursuant to this Order will be subject to statutory interest and may be collected by all methods legally available. . 5. Petitioner's petition for formal administrative proceedings is hereby dismissed. 6. Each party shall bear its own costs-and attorney’s fees. 7. The above-styled case is hereby closed. DONE and ORDERED this 42day of Gua , 2088, in Tallahassee, Leon County, Florida. idetus Za Hoily Benson, Sectet 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 THE AGENCY CLERK OF AHCA, AND A SECOND COPY, ALONG WITH FILING FEE AS 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 OF PROCEEDINGS SHALL BE CONDUCTED IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: Christopher A, Perrella, J.D. The Health Law of Anthony C. Vitale, P.A. — 2333 Brickell Avenue, S-A-1 Miami, Florida 33129 (U.S. Mail) Finance & Accounting Agency for Health Care Administration Revenue Management Unit 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Interoffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) Nelson E. Rodney Assistant General Counsel Agency for Health Care Administration 8350 NW 52™ Terrace, Suite 103 Miami, Florida 33166 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 (Interoffice Mail) Hon. John G. Van Laningham Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (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) and entities by U.S. Mail, or the method designated, on this the /& Gay of _ Vane , 200% el Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 7160 3901 984s 443 Le4b FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION CHARLIE CRIST ANDREW C. AGWUNOBI, M.D. GOVERNOR . . SECRETARY February 12, 2008 a Co : / CERTIFIED MAIL / RETURN RECEIPT REQUESTED Antonio Herrera Global Nursing Home Health Inc” : 1756 Sw 8th St Ste 205 Miami, F1 33135-3544 License Number: 299992292 Case #: 2008001813 NOTICE OF INTENT TO DEEM APPLICATION INCOMPLETE AND WITHDRAWN FROM FURTHER REVIEW Your application for license is deemed incomplete and withdrawn from further consideration pursuant to Section 408.806(3)(b), Florida Statutes, which states that “Requested information omitted from an application for licensure, license renewal, or change of ownership, other than an inspection, must be filed with the agency within 21 days after the agency’s request for omitted information or the application shall be deemed incomplete and shall be withdrawn from further consideration and the fees shall be forfeited”’. You were notified by correspondence dated November 9, 2007 to provide further information addressing identified apparent errors or omissions within twenty-one days from the receipt of the Agency’s correspondence. Our records indicate you received this correspondence by certified mail on November 15, 2007. As this requested information was not timely received by the Agency, your application is deemed incomplete and withdrawn from further consideration. The outstanding issues remaining for licensure are: 1. The individual listed as the alternate administrator does not qualify. The experience listed for the individual included six years as the alternate administrator for Suky Health Care Services. This AHCA Home Care Unit is required to review resumes; approve applicants for the position of alternate administrators and enter the information on the qualified individual in the database. The individual proposed as the alternate administrator, Natacha Gainza, has never been listed in the AHCA database as an alternate administrator for Suky Health Care Services. She does not appear in any administrative position in the database. The pertinent statutes and rules that apply include the following: Section 408.806 (1), Florida Statutes (FS.), “An application for licensure must be made to the agency on forms furnished by the agency, submitted under oath, and accompanied by the appropriate fee in order to be accepted and considered timely.-The application must contain information required by authorizing statutes and applicable rules...” Section 400.462 (1), F.S.,"Administrator" means a direct employee, as defined in subsection (9). The administrator must be a licensed physician, physician assistant, or registered nurse licensed to practice in this state or an individual having at least 1 year of supervisory or administrative experience in home health care or in a facility licensed under chapter 395, under part II of this 2727 Mahan Drive,MS#34 Tallahassee, Florida 32308 Visit AHCA online at http://ahea.myflorida.com EXHIBIT 4 Page 2 February 12, 2008 chapter, or under part I of chapter 429. An administrator may manage a maximum of five licensed home health agencies located within one agency service district or within an immediately contiguous county. If the home health agency is licensed under this chapter and is part of a retirement community that provides multiple levels of care, an employee of the retirement community may administer the home health agency and up to a maximum of four entities licensed under this chapter or chapter 429 that are owned, operated, or managed by the same corporate entity. An administrator shall designate, in writing, for each licensed entity, a qualified alternate administrator to serve during absences.” Section 59A-8.0095 (1) (a) (2), Florida Administrative Code (F.A.C_), (1) “Administrator. (a) The administrator of the agency shall: 2. Designate, in writing a direct employee or an individual covered under a management company contract to manage the home health agency or an employee leasing contract, pursuant to Section 468.520, F'S., that provides the agency with full control over all operational duties and responsibilities to serve as an on-site altemate administrator during absences of the administrator. This person will be available during designated business hours, when the administrator ‘is not available. Available during designated business hours means being readily available on the premises or by telecommunications. During the absence of the administrator, the on-site alternate administrator will have the responsibility and authority for the daily operation of the agency: The alternate administrator must meet qualifications as stated in Section 400.462(1), F.S.” Section 408.815 (1) (a), F.S., “In addition to the grounds provided in authorizing statutes, grounds that may be used by the agency for denying and revoking a license or change of ownership application include any of the following actions by a controlling interest: (a) False representation of a material fact in the license application or omission of any material fact from the application.” EXPLANATION OF RIGHTS Pursuant to Section 120.569, F.S., you bave the right to request an administrative hearing. In order to obtain a formal proceeding before the Division of Administrative Hearings under Section 120.57(1), F.S., your request for an administrative hearing must conform to the requirements in Section 28-106.201, Florida Administrative Code (F.A.C), and must state the material facts you dispute. : SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS. Anne Menard, Manager Home Care Unit cc: Agency Clerk, Mail Stop 3 Legal Intake Unit, Mail Stop 3 “ STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION GLOBAL NURSING HOME HEALTH, INC., Petitioner, vs. Case No: 2008001813 DOAH No: 08-1216 STATE OF FLORIDA, AGENCY FOR HEALTH CARE AMINISTRATION, Respondent. / SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Petitioner, Global Nursing -Home Home Health, Inc. (hereinafter “Petitioner”), pursuant to Section 120.57(4), Florida Statutes, each individually, a “party,” collectively as “parties,” hereby enter into this Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, the Petitioner is a Home Health Agency licensed pursuant to Chapters 400, Part III, 408, Part II, Florida Statutes, Section 20.42, Florida Statutes, and Chapter 59A-8, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure of Petitioner; and WHEREAS, the Agency served. the Petitioner with a Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review; WHEREAS, the Petitioner requested an administrative hearing by filing an election of rights form or petition; and WHEREAS, the parties have agreed that a fair, efficient, and cost effective resolution of this dispute would avoid the expenditure of substantial sums to litigate the dispute; and WHEREAS, the parties stipulate to the adequacy of considerations to be exchanged; 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, Petitioner agrees to pay $1,000.00; agrees to a withdrawal of its request for an administrative proceeding; agrees to waive any and all proceedings and appeals to which it may be entitled regarding the Notice of Intent to Deem Application Incomplete and Withdrawn 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 Page 2of 8 declaratory and all writs of relief in any court or quasi-court (DOAH) of competent jurisdiction; and 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. Provided, however, that no agreement herein, shall be deemed a waiver by either party of its right to judicial enforcement of this Agreement. The Petitioner shall remit to the Agency, within thirty (30) days of the entry of Final Order adopting this Agreement, administrative costs in the sum of $1,000.00. The Petitioner shall submit to the Agency a completed license renewal application with an appropriate alternate administrator named thereon. The Agency may, within 60 days of the submittal of the complete license renewal application, conduct a licensure survey of the Petitioner facility. Should the Petitioner be cited for the deficient practice as identified in the Notice of Intent to Deem Application Incomplete and Withdrawn herein, specifically, that the facility does not have a qualified alternate administrator, the Agency shall deny the Petitioner’s application for licensure without further. notice. Page 3o0f 8 Should the Petitioner’s application for licensure be denied based upon the existence of a deficient practice or practices as identified in paragraph (4)(c) above, Petitioner, on behalf of itself and any related or resulting organizations, affirmatively waives any right to challenge said denial in any forum, judicial or quasi-judicial, including any rights under the Florida Administrative Procedures Act, Chapter 120, Florida Statutes, or pursue any claim, including, but not limited to, a claim for damages, injunctive relief, attorney’s fees, and costs, in any forum, judicial or quasi-judicial. In addition, should the Petitioner or any of its related or resulting organizations challenge the actions of the Agency under | this Agreement or seek affirmative relief, monetary or injunctive, Petitioner agrees to indemnify the Agency for any resulting judgment and any attorney’s fees or costs incurred by the Agency in defense of such a claim or action. The Notice of Intent to Deny is deemed superseded by this Agreement. The Petitioner affirmatively waives any right or entitlement to deemed licensure as identified by Florida Page 4of 8 law, including but not limited to, of Chapters 120, 400, 429 and 408, Florida Statutes. g. Nothing in this Agreement shall prohibit the Agency from denying the Petitioner's application for licensure based upon any statutory and/or regulatory provision not identified in the Notice of Intent herein and the surveys referenced therein, including but not limited to, the failure of Petitioner to satisfactorily complete a survey reflecting compliance will all statutory and rule provisions as required by law. 4. Venue for any action brought to interpret, challenge, or enforce the terms of this Agreement or the Final Order entered pursuant hereto shall lie solely in the Circuit Court in Leon County, Florida. 5. By executing this Agreement, the Petitioner neither admits nor denies the facts and legal conclusions raised in the Notice of Intent to Deem Application Incomplete and Withdrawn referenced herein. The Agency agrees that it will not impose any further penalty against the Petitioner as a result of the allegations of its Notice of Intent. However, nothing in this Agreement shall be deemed to preclude the Agency from using this assessment of fines in weighing future administrative actions regarding the Petitioner including, but not limited to, decisions regarding the licensure of Petitioner, including, but not limited to, licensure for Page Sof 8 limited mental health, limited nursing services, or extended congregate care. The Agency is not precluded from using the subject events for any purpose within the jurisdiction of the Agency. Further, Petitioner acknowledges and agrees that this Agreement shall not preclude or estop any other federal, state or local agency or office from pursuing any cause of action or taking any action, even if based on or arising from, in whole or in part, the facts raised in the Notice of Intent. 6. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and closing the above-styled case. 7. Each party shall bear its own costs and attorney’s fees. 8. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 9. The Petitioner, for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the Agency, 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, Page 6of 8 including any claims arising out of this Agreement, by or on behalf of the Petitioner or related or resulting organizations. 10. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph of this Agreement. 11. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 12. In the event that Petitioner was a Medicaid provider at the subject time of the actions alleged in the Notice of Intent referenced herein, this Agreement does not prevent the Agency from seeking Medicaid overpayments related to the subject issues or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This Agreement does not settle any federal issues pending against Petitioner. This agreement does not prohibit the Agency from taking action regarding Petitioner’s Medicaid provider status, conditions, requirements or contract. 13. Petitioner agrees that if any funds to be paid under this agreement to the Agency are not paid within thirty-one (31) days of entry of the Final Order in this matter, the Agency may deduct the amounts assessed against Petitioner in the Final Order, or any portion thereof, owed by Petitioner to the Agency from any present or future funds owed to Petitioner by the Agency, and that the Agency shall hold a lien against present and future funds owed to Petitioner by the Agency for said amounts until paid. Page Jof 8 May Uc cuuse +:1arn Are LAde Ret FHA 14. This Agreement contains the entire understandings and agreements of the parties. 15. This Agreement supersedes any prior oral or written agreements between the parties. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. 16. All parties agree that a facsimile signature suffices for an original signature. 17. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Elizabeth Dudek ; HQA, Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bidg #1 Tallahassee, Florida 32308 Craig H. Smith, General Counsel Florida Bar No. 96598 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: _ 6/+4/of Christopher A. Parrella, J.D. The Health Law of Anthony C. Vitale, P.A. 2333 Brickell Avenue, S-A-1 Miami, Florida 33129 DATED: S-Z-OF Nelson E. Rodney Assistant General Counsel Agency for Health Care . Administration 8350 NW 52" Terrace, S-103 Miami, Florida 33166 DATED: Sfx Page 80f 8

Docket for Case No: 08-001216