STATE OF FLORIDA _ AGENCY FOR HEALTH CARE ADMINISTRATION'S | AGENCY FOR HEALTH CARE ADMINISTRATION, Petitioner, AHCA Nos: 2004005979 vs. DOAH No: 05-2719 AYINTOVE ASSOCIATES, LLC, d/b/a HARMONY HEALTH CENTER, Ss 3 aA rei € = = Respondent. Bey Tf / BLS Peed , 0 BER FINAL ORDER “oo, 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, finds and concludes as follows: It is ORDERED that: 1. 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 its terms. 2. Ayintove Associates, LLC, d/b/a Harmony Health Center shall pay a late fee of $3,750.00 to the Agency within 30 days of the entry of the Final Order. The payment is 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: Jean Lombardi Agency for Health Care Administration Office of Finance & Accounting 2727 Mahan Drive, Mail Stop #14 Tallahassee, FL 32308 4. The above-stated fine shall be subject to statutory interest, and may be collected by all methods legally available if unpaid within the 30-day time frame. 5. The above styled case is hereby dismissed. DONE and ORDERED this -25day of Sian ; 2005, in Tallahassee, Leon County, Florida. a bobht. Ductile Alan Levine, Secretary a? Agency f ealth 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 Deputy Secretary Agency for Health Care Administration 2727 Mahan Drive Bldg #1 Mail Stop Code #9 Tallahassee, Florida 32308 (Interoffice Mail) Jean Lombardi Finance & Accounting Agency for Health Care Administration 2727 Mahan Drive Mail Stop Code #14 Tallahassee, Florida 32308 (Interoffice Mail) Theodore E. Mack, Esq. Powell & Mack 803 North Calhoun Street Tallahassee, Florida 32308 (U.S. Certified Mail) Nelson E. Rodney Assistant General Counsel Agency for Health Care Administrator 8350 NW 52™ Terrace, Suite #103 Miami, Florida 33166 (Interoffice Mail) Hon. Stuart M. Lerner Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (U.S. Mail) Wendy Adams Intake CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was mailed aan an 1 to the above-named addressees on this 22" day of 2005. Lo > a Richard Shoop, Agency Clerk Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32303 (850) 922-5873 STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION Fil EN AGENCY FOR HEALTH CARE ms ADMINISTRATION, 2005 JUN 29 p 225 Petitioner, AHCA No.: 2004005979 iVISign GF DOAH No: 04-2719 ADMINISTRATIVE v. HEARINGS AYINTOVE ASSOCIATES, LLC, d/b/a HARMONY HEALTH CENTER, Respondent. / STIPULATION AND SETTLEMENT AGREEMENT Petitioner, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), by and through their undersigned representatives, and Ayintove Associates, LLC, d/b/a Harmony Health Center (hereinafter “Harmony Health Center”) pursuant to Section 120.57(4), Florida Statutes (2004) each individually, a “party”, collectively as “parties,” hereby enter into this Stipulation and Settlement Agreement (“Agreement”) and agree as follows: WHEREAS, Harmony Health Center is a skilled nursing facility licensed pursuant to Chapter 400, Part II, Florida Statutes (2004) and Chapter 59A-4, Florida Administrative Code, (2004); and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over assisted living facilities pursuant to Chapter 400, Part II, Florida Statutes; and WHEREAS, the Agency served Harmony Health Center with a notice of intent to impose late fine on June 29, 2004 notifying the party of its intent to impose a late fee of $5,000.00 for a late filed application; and WHEREAS, Harmony Health Center requested a formal administrative hearing in a petition to the Agency on July 12, 2004; 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 have negotiated 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. 3. Upon full execution of this Agreement, Harmony Health Center agrees to a withdrawal of its Petition for Formal Administrative Proceedings; agrees to waive any and all appeals and proceedings; 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 alli writs of relief in any court or quasi-court (DOAH) of competent jurisdiction. 4. Upon full execution of this Agreement, Harmony Health Center agrees to pay Three Thousand Seven Hundred Fifty Dollars ($3,750.00) in administrative fines to the Agency within 30 days of the entry of the Final Order. 5. Venue for any action brought to enforce the terms of this Agreement or the Final Order entered pursuant hereto snall lie in the Circuit Court in Leon County, Florida. 6. Harmony Health Center neither admits nor denies the allegations in the notice of intent to impose late fee. The Agency agrees that it will not impose any further penalty against Harmony Health Center as a result of the alleged late filed application, however, no agreement made herein shall preclude the Agency from imposing a penalty against Harmony Health Center for any other application that is filed late. ivr) 7. Upon full execution of this Agreement, the Agency shall enter a Final Order adopting and incorporating the terms of this Agreement and dismissing the above-styled case. 8. Each party shall bear its own costs and attorney fees. 9. This Agreement shall become effective on the date upon which it is fully executed by all the parties. 10. Harmony Health Center for itself and for its related or resulting organizations, its successors or transferees, attorneys, heirs, and executors or administrators, does hereby discharge the State of Florida, 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 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 Harmony Health Center or related facilities. 11. This Agreement is binding upon all parties herein and those identified in the aforementioned paragraph eight (10) of this Agreement. 12. The undersigned have read and understand this Agreement and have authority to bind their respective principais to it. 13. This Agreement contains the entire understandings and agreements of the parties. 14. This Agreement supercedes any prior oral or written agreements between the parties. 15. This Agreement may not be amended except in writing. Any attempted assignment of this Agreement shall be void. The following representatives hereby acknowledge that they are duly authorized to enter into this Agreement. Chae b&b Lie Ze Elizabéth Dudek Theodore E. Mack, Esq. Depu Secretary Attorney for Division of Health Quality Harmony Health Center Assurance. Powell & Mack Agency for Health Care 803 North Calhoun Street Administration Tallahassee, Florida 32308 2727 Mahan Drive Tallahassee, Florida 32308 Dated: Hine 45 OOS Dated: Seyler William Roberts Acting General Counsel Agency for Health Care Administration 2727 Mahan Drive Tallahassee, Florida 32308 Dated: ofa wa

Docket for Case No: 04-002719