FILED anes STATE OF FLORIDA __AGENCY CLERK AGENCY FOR HEALTH CARE ADMINISTRATION [0M JAN -b A 10 11: FOREVER YOUNG HOME HEALTH AGENCY INC., ; “b, we AHCA No.: 2008041093, Petitioner, DOAH No.: 08-53257;%, ° RENDITION NO.: AHCA-08- 1 A4O2S: vs. 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 FINAL ORDER Having reviewed the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review dated September 25, 2008, attached hereto and incorporated herein (Exhibit 1), and all other matters of record, the Agency for Health Care Administration (“Agency”) has entered into a Settlement Agreement (Exhibit 2) with the parties 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. Upon full execution of this Agreement, the parties agree to the following: a. Petitioner agrees to pay $500.00 in administrative fees to the Agency within thirty (30) days of the entry of the Final Order. b. The Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review is deemed superseded by this Agreement. c. The Petitioner’s request for formal administrative proceedings is withdrawn. d. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner’s application. e. Nothing in this Agreement shall prohibit the Agency from denying Petitioner’s application for licensure based upon any statutory and/or regulatory provision, including, but not limited to, the failure of Petitioner to satisfactorily complete a survey reflecting compliance with all statutory and rule provisions as required by law. 3. Each party shall bear its own costs and attorney’s fees. 4. The above-styled case is hereby closed. DONE and ORDERED this 2 4ay of inhi! , 2008, in Tallahassee, Leon County, Florida. OLA Holly Benson, Secretafy 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. Parrella, JD, CHC, CPC The Health Law Offices of Anthony C. Vitale, P.A. 2333 Brickell Avenue Suite A-1 Miami, Florida 33129 (U. S. Certified Mail) Lourdes A. Naranjo, Esq. Assistant General Counsel Agency for Health Care Administration 8350 N. W. 52 Terrace — Suite 103 Miami, Florida 33166 (Interoffice Mail) Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive, MS #14 Tallahassee, Florida 32308 (Interoffice Mail) Elizabeth Dudek Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32308 (Interoffice Mail) Jan Mills Agency for Health Care Administration 2727 Mahan Drive, Bldg #3, MS #3 Tallahassee, Florida 32308 (Interoffice Mail) June C. McKinney Administrative Law Judge Division of Administrative Hearing 1230 Apalachee Parkway Tallahassee, Florida 32399 (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_G day of __C ezwery , 2008. Richard J. Shoop Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308 (850) 922-5873 FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION, CHARLIE CRIST HOLLY BENSON GOVERNOR Certified Article Number: SECRETARY - 7b 3903 9848 LOWS 988? September 25, 2008 : ' . pemqemeny RN RECEIPT REQUESTED . » SENDERS.RECORD Gcorge Lazaro Jaffe : Forever Young Home Health Agency Inc File Number: 19966187 2721 Sw 137 Ave # 117 . Miami, F133175 Case #: 2008011093 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 2] 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 July 22, 2008 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 July 25, 2008. 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 applicant did not prove financial ability to operate. Florida Statutes requires the applicant to show anticipated provider revenue and expenditures, the basis for financing anticipated cash-flow requirements of the provider, and an applicant’s access to contingency financing. According to the applicant’s response to the July 7, 2008, inter-office omissions memo, Schedule 1 shows the total funding needed for cash-flow (including pre-opening costs), and contingency is $55,648. The applicant only provided proof of funding in the amount of $44,000. Therefore, the applicant has not basis for financing anticipated cash-flow requirements of the provider, and an applicant’s access to contingency financing. The pertinent statutes and niles that apply include the following: Section 408.810 (8), Florida Statutes (F.S.), “Upon application for initial licensure..., the applicant shall furnish satisfactory proof of the applicant’s financial ability to operate in accordance with the requirements of this part, authorizing statutes, and applicable rules...” Section 408.806 (1), F.S., “An application for licensure must be made to the agehey 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...” 2727 Mahan Drive, MS#34 Visit AHCA online at Tallahassee, Florida 32308 ea http:Vahca.myflorida.com ON. EXHIBIT Forever Young Home Health Agen 1c Page 2 September 25, 2008 Section 400.471 (2), (e) and (f), F.S., “Each applicant for licensure must comply with all provisions of this part and part I] of chapter 408. (e) Evidence of contingency funding equal to | month's average operating expenses during the first year of operation. (f) A balance sheet, income and expense statement, and statement of cash flows for the first 2 years of operation which provide evidence of having sufficient assets, credit, and projected revenues to cover liabilities and expenses. The applicant has demonstrated financial ability to operate if the applicant's assets, credit, and projected revenues meet or exceed projected liabilities and expenses. An applicant may not project an operating margin of 15 percent or greater for any month in the first year of operation. All documents required under this paragraph must be prepared in accordance with generally accepted accounting principles and compiled and signed by a certified public accountant.” Section 59A-8.004(5), Florida Administrative Code (F.A.C.), “For initial applications, including changes of ownership, the applicant must submit proof of financial ability to operate...” EXPLANATION OF RIGHTS Pursuant to Section 120.569, F.S., you have 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. Cn, Lé Mbriade Anne Menard, Manager Home Care Unit ce: Agency Clerk, Mail Stop 3 Lega! Intake Unit, Mail Stop 3 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION FOREVER YOUNG HOME HEALTH AGENCY INC. , AHCA No.: 2008011093 Petitioner, DOAH No.: 08-5325 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ; / SETTLEMENT AGREEMENT Respondent, State of Florida, Agency for Health Care Administration (nereinafter the “Agency”), through its undersigned representatives, and Petitioner, Forever Young Home Health Agency In. (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 an applicant for home health agency licensure pursuant to Chapter 400, Part III, Florida Statutes (2007), Section 20.42, Florida Statutes (2007), Chapter 408, Part II, Florida Statutes (2007), and Chapter 59A-8, Florida Administrative Code; and EXHIBIT iy WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure sought by Petitioner; and WHEREAS, the Agency served the Petitioner with a Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review notifying the party of its intent to deny Petitioner’s application for licensure; and WHEREAS, the Petitioner requested a formal administrative hearing by filing an election of rights form or by 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 exchanged; and WHEREAS, the parties have negotiated in good faith 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. Page 2 of 6 3. Upon full execution of this Agreement, Petitioner 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 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; 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. 4. Upon full execution of this Agreement, the parties agree to the following: a. Petitioner agrees to pay $500.00 in administrative fees to the Agency within thirty (30) days of the entry of the Final Order. b. The Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review is deemed superseded by this Agreement. c. The Petitioner's request for formal administrative proceedings is withdrawn. d. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner’s application. Page 3 of 6 e. Nothing in this Agreement shall prohibit the Agency from denying Petitioner’s application for licensure based upon any statutory and/or regulatory provision, including, but not limited to, the failure of Petitioner to satisfactorily complete a survey reflecting compliance with all statutory and rule provisions as required by law. 5. 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. 6. By executing this Agreement, the Petitioner admits the allegations raised in the Notice of Intent to Deem Application Incomplete and Withdrawn from Further Review referenced herein. 7. 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. 8. Bach party shall bear its own costs and attorney’s fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 10. 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 all claims, demands, actions, causes of action, Page 4 of 6 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 the Petitioner or related or resulting organizations. 11. This Agreement is binding upon all parties. herein and those identified in the aforementioned paragraph of this Agreement. 12. In the event that Petitioner is or was a Medicaid provider, this settlement does not prevent the Agency from seeking Medicaid overpayments or from imposing any sanctions pursuant to Rule 59G-9.070, Florida Administrative Code. This agreement does not prohibit the Agency from taking action regarding Petitioner’s Medicaid provider status, conditions, requirements or contract. 13. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. 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 Page 5 of 6 amended except in writing. Agreement shall be void. attemoted assignment of this 16. All parties agree that a facsimile signature suffices for an original signature. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. he “en M4 “of Deputy Secretary Division of Health Quality Assurance. Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Dated: lad bp IEA Justin M. Senior, Esq. Acting General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 pated: ro asley 4 Christopher A. Parrella, JD, CHC, CPC The Health Law Offices of Anthony C. Vitale, P.A. 2333 Brickell Avenue Suite A-1 Miami, Florida 33129 Dated: /Z2-$-O% fico b, bear ourdes A. Naranjo, Esq. Assistant General Counsel Agency for Health Care Administration 8350 N.W. 52 Terrace - #103 Miami, Florida 33166 Dated: /?- (2-08 Page 6 of 6

Docket for Case No: 08-005325