STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION FLORIDA HEALTH CARE PARTNERSHP, d/b/a Jefferson Nursing Center and parties was executed which dismissed the Petitioners case against the Agency. On April 17, 2001, an Order Closing File was entered by the Division of Administrative Hearings, returning jurisdiction | to the Agency: for final disposition. 2. There are no remaining disputed i issues of fact or law. Pine Lake Nursing Home, Petitioner, fen a oy 2 | : vs. CASE NO.: 01-0780 Mposww dt < RENDITION NO. AHCA 01-44¢S-MDA STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER This cause came before me for the purpose of issuing a final agency order, it appearing from the Stipulation and Settlement Agreement, attached and incorporated herein, that there are no remaining disputed issues of fact. FINDINGS OF FACT 1. On October 25, 2001, a Stipulation and Settlement Agreement between the “The ‘Agency has j juris ‘ction 07 over the parties an subj ect matter pursuant to Section 120.57, Fla. Stat. (2000). The parties are directed to comply with the terms of the a Stipulation, Settlement and Dismissal. The petition is dismissed and the file is closed this Bt 2 day of Novato , 2001. Pawe fi Lay Rhonda Medows, MD. Secretary Agency for Health Care Administration A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK, 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 THE RENDITION OF THE ORDER TO BE REVIEWED. Copies Furnished to: Daniel Manry Mary Stewart, CPA Administrative Law Judge Manager, Audit Services DOAH AHCA, Bldg. #3 1230 Apalachee Parkway 2727 Mahan Drive Tallahassee, FL 32399-3060 Tallahassee, FL 32308 Steven Grigas, Esquire ' Willie Bivens AHCA, Bidg. #3 Finance & Accounting, AHCA 2727 Mahan Drive 2727 Mahan Drive Tallahassee, FL 32308 Tallahassee, FL 32308 Michael Bittmen, Esquire Gray HArsris & Robinson, P.A. 301 East Pine Street, Suite 1400 Orlando, Fl 32801 ~! CERTIFICATE OF SERVICE J HEREBY CERTIFY that a true and correct copy of the foregoing has been th furnished to the above named addressees by U.S. Mail on this the Af*day of Noutenbgsr0. Diane CAGE — Agency Clerk State of Florida as STATE OF FLORIDA _ DIVISION OF ADMINISTRATIVE HEARINGS FLORIDA HEALTH CARE PARTNERSHIP, d/b/a JEFFERSON NURSING CENTER, and PINE LAKE NURSING HOME Petitioner, vs. CASE NO. 01-0780 AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. STIPULATION AND SETTLEMENT AGREEMENT This stipulation and settlement agreement is entered into by and between the Agency for Health Care Administration (“Agency”), and Florida Health Care Partnership, d/b/a Jefferson Nursing Center and Pine Lake Nursing Home. WHEREAS, Petitioner filed a petition with the Division of Administrative Hearings (DOAN) challenging the Agency's audits of the Jefferson Nursing Center and Pine Lake Nursing Home Medicaid cost reports for the periods ending June 30, 1997; and WHEREAS, the parties entered into settlement negotiations and as a result of those negotiations, the undersigned parties now desire to resolve this ‘proceeding without the necessity of future litigation and expense; and WHEREAS, the parties agree that upon execution of this stipulation and settlement agreement, this proceeding will be voluntarily dismissed with prejudice. spun °° ers epee carte t's cymes NOW THEREFORE, in consideration of the mutual covenants contained herein, the sufficiency of which is acknowledged by all parties, it is hereby stipulated and agreed by and between the parties as follows: 1. This agreement resoives all issues in this proceeding and is based in part on the agreement reached between representatives of the parties, namely Pat Patterson, AHCA Audit Evaluation and Review Analyst, and Joseph D. Mitchell, CPA. The parties agree to the disposition of certain audit adjustments to the Jefferson Nursing Center and Pine Lake Nursing Home Medicaid audit reports for the cost reporting periods ended June 30, 1997, and the Agency agrees to make the following changes to the audit reports: JEFFERSON NURSING CENTER a. Adjustment 19 on page 11 of the audit report to administration — home office in the amount of ($45,899) will be decreased by $36,927 to ($8,972). b. Adjustment 73 on page19 of the audit report to property costs — book depreciation in the amount of ($22,189) will decreased by $22,189 to $0. PINE LAKE NURSING HOME Cc. Adjustment 15 on page 10 of the audit report to administration — home office in the amount of ($43, 976) will be decreased by $35, 379 to (86, 597). d. " Adjustment 53 on page 15 of the audit report to patient care costs — supplies-medical records i in the amount of ($4,518) will be decreased by $4, 518 to $0. ee. - Add a new positive a jus men “for administration expense in the amount of $16,122 to expense abandoned planning costs that were previously capitalized and disallowed as acquisition costs (adjustment 79). 2 -! 2. The home office adjustments referenced above in paragraph 1a and 1c are the result of the following agreed upon revisions to schedule of home office adjustments: JEFFERSON NURSING CENTER a. Adjustment 7 on page 24 of the audit report to home office costs — salaries and wages in the amount of ($60,690) shall be decreased by $60,690 to $0. _b. Adjustment 14 on page 25 of the audit report to administration — computer and software maintenance in the amount of ($11,616) shall be decreased by $11,616 to $0. PINE LAKE NURSING HOME Cc. Adjustment 6 on page 22 of the audit report to home office costs — computer and software maintenance in the amount of ($11,616) shall be decreased by $11,616 to $0. d. Adjustment 19 on page 24 of the audit report to administration — salaries and wages in the amount of ($60,690) shall be decreased by $60,690 to $0. 3. The parties agree that the changes referenced in this agreement are the only changes to be made to the Jefferson Nursing Center and Pine Lake Nursing Home audit reports for the cost reporting periods ended June 30, 1997, other than adjustments affecting ending equity capital, if any, resulting from the r revisions in paragraphs‘ and 2 above. 4. ; The Agency agrees to revise son Nursing Center and Pine Lake Nursing Home audit reports for the periods e ended June 30, 1997, to reflect the above changes ‘and will mail to Jefferson Nursing Center and Pine Lake Nursing Home the 3 de yer were ge tame peas mcmama ee pee ac ree reer wee revised audit reports within a reasonable period of time after execution of this agreement. The Agency will also revise Jefferson Nursing Center's and Pine Lake Nursing Home’s Medicaid reimbursement rate(s) in accordance with this agreement. 5. The parties agree that no modification or waiver of any term of this agreement shall be valid unless made in writing, and signed by both parties. No waiver of any breach or default hereunder shail be deemed a waiver of any subsequent breach or — default. 6. The signatories hereto represent and warrant that they are vested with the authority to execute this stipulation and settlement agreement on behalf of their respective principals and as duly designated representatives, to fully bind such principals, their successors and assigns. 7. Each party shall bear its own attorney’s fees and costs. The allowability of Jefferson Nursing Center’s and Pine Lake Nursing Home's attorney’s fees and costs in subsequent cost reporting periods shall be governed by the Florida Title XIX Long-Term Care Reimbursement Plan. THE PETITIONER, . THE PETITIONER, ‘FLORIDAHEALTHCARE =——S—S_ FLORIDA HEALTH CARE ‘PARTNERSHIP, d/b/a “PARTNERSHIP, d/b/a JEFFERSON NURSING CENTER: PINE LAKE NURSING HOME Bye By Se John L. Suter, €P#& John L. Suter, GPA MARAG ING DI ECTON MAvAgist& Dilecroe— Dated: , 2001 Dated:__ , 2001 By: cle : Wee MICHAEL J. BITYMAN Florida Bar No. 0347132 Gray, Harris & Robinson, P.A. 301 E. Pine Street, Suite 1400 Post Office Box 3068 Orlando, FL 32802-3068 (407) 843-8880 Telephone (407) 244-5690 Facsimile Attorneys for Petitioner Dated: J-_! , 2001 THE RESPONDENT, AGENCY FOR HEALTH CARE ADMINISTRATION Bob Sharpe Its: Rep cia Medicaid Dated: , 2001 By: . STEVEN A. GRIGAS Florida Bar No. 0981818 Senior Attorney Agency for Health Care Administration 2727 Mahan Drive Fort Knox III, Suite 3431 Tallahassee, FL 32308-5403 (850) 921-0056 Telephone (850) 413-9313 Facsimile Dated: , 2001 By" Zz Le ML a ‘WILLIAM H. ROBERTS ~ General Counsel, Acting Agency for Health Care Administration 2727 Mahan Drive Fort Knox Ill Tallahassee rae Tallahassee, FL 32308" ° ~ (850) 922-5873 Telephone ‘Dated: 2/25 , 2001

Docket for Case No: 01-000780