STATE OF FLORIDA aan AGENCY FOR HEALTH CARE ADMINISTRATION fhul t BIDWELL HOME CARE SERVICE, LLC * are ITA Gof. d/b/a HOME INSTEAD SENIOR CARE, Petitioner, CASE NO(s): 07-5015 v. 2007010636 RENDITION NO.: AHCA-07- O770 -S-OLC STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER Having reviewed the Notice Of Intent To Deny dated October 1, 2007, 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’s petition for formal administrative proceedings is hereby dismissed. 3. Each party shall bear its own costs and attorney’s fees. 4. The above-styled case is hereby closed. DONE and ORDERED this _/Axay of _M¢eerieber , 2007 in Tallahassee, Leon County, Florida. Andrew C. Agwinobi, M.D., Secretary 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: William Bidwell, Owner Mary Daley Jacobs Bidwell Home Care Service, LLC Senior Attorney d/b/a Home Instead Senior Care Agency for Health Care 1912 Empress Court Administration Naples, Florida 34110 2295 Victoria Avenue, Room 346C (U.S. Mail) Fort Myers, Florida 33901 Interoffice Mail) Daniel S. Kilbride Elizabeth Dudek Administrative Law Judge Deputy Secretary Division of Administrative Hearings Agency for Health Care The DeSoto Building Administration 1230 Apalachee Parkway 2727 Mahan Drive, Bldg #1, MS #9 Tallahassee, Florida 32399-3060 Tallahassee, Florida 32308 | (U.S. Mail (Interoffice Mail) Jan Mills Anne Menard Agency for Health Care Unit Manager, Home Care Unit Administration Agency for Health Care 2727 Mahan Drive, Bldg #3, MS #3 ° | Administration Tallahassee, Florida 32308 2727 Mahan Drive, MS#34 (Interoffice Mail) Tallahassee, Florida 32308 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 [? day of —— 9 — Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 FLORIOA AGENCY FOR HEATH CARE ADMINISTRATION CHARLIE CRIST ANDREW C. AGWUNOBI, M.D. GOVERNOR SECRETARY October 1, 2007 CERTIFIED MAIL RETURNED RECEIPT REQUESTED "Certified Article Number Administrator Home Instead Senior Care 10621 Airport Pulling Rd #8 Naples, F1 34109 RE: Initial application for license Complaint # 2007010636 NOTICE OF INTENT TO DENY As per Section 408.806(3)(b), Florida Statutes, (F.S.) the application for home health agency initial licensure of July 23, 2007 submitted by Home Instead Senior Care is DENIED for the following omissions: 1. The applicant did not provide adequate evidence of financial ability to operate. The applicant failed to provide sufficient proof of adequate funding for start-up costs, working capital, and contingency financing. Below is an analysis of the reason for the denial. The funding required for proof of financial ability is the amount needed to cover start-up costs working capital, and contingency financing. Schedule 1 indicates that start-up costs are $11,800. Working capital is defined on Schedule 1 as the largest cumulative cash need from Schedule 7, Line 21. The largest cumulative cash need on Schedule 7, Line 21 is $4,248. This amount may appear low for a new agency, however, this applicant is affiliated with an existing homemaker companion service. Section 408,810(8), Florida Statutes, requires an applicant’s access to contingency financing in addition to funding anticipated cash flows. The contingency financing is meant to cover extraordinary occurrences that are not otherwise considered in the projections, The agency has defined contingency financing as one month’s average operating expense over the first year of operations. The total annual operating expense in year one is $478,082; therefore, one month’s average operating expense would be $39,840 ($478,082 + 12 months). The contingency financing was described in the omissions letter. The total combined funding needed for proof of financial ability to operate is $55,888 ($11,800 + $4,248 + $39,840). The applicant only provided proof of funding in the amount of $41,500 resulting in a funding shortfall of $14,388. DRIDA | Visit AHCA online at | SE ARE . | Health Gare in the Sunshina http://ahca.myflorida.com 2727 Nahan Drive, MS#34 Tallahassee, Flosida 32308 Lf www FloridaCompareCare.gov EXHIBIT 2 Home Instead Senior Care The pertinent statutes and rules 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 tules...” Section 59-A.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,.. The compliance is demonstrated by completion of AHCA Form 3110-1013, December 2004...” Section 408.806 (1), F.S., “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..” The applicant did not provide evidence of their Fictitious Name filing with the Department of State, Division of Corporations as requested in the application. The application submitted was for Bidwell Home Care Services, LLC d/b/a Home Instead Senior Care, An agency using a d/b/a (doing business as) is required to submit a copy of the Fictitious Name Affidavit obtained from the Department of State, Division of Corporations. The pertinent statutes and rules that apply include the following: Section 408.806 (1) (c), F.S., “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 and must include (c) The name by which the provider is to be known.” Section 59-8.004 (4), F.A.C., “For initial and change of ownership applications and name changes, an affidavit of fictitious name is required when the home health agency chooses to operate under a name other than the name of the partnership or corporation, pursuant to Section 865.09, F.S.” The applicant did not provide evidence that liability insurance had been obtained in the _ name of the agency as requested in the application and required in Florida Statutes. The pertinent statutes and rules that apply include the following: Section 400.471 (3), F.S., In addition to the requirements of s. 408.810, the home health agency must also obtain and maintain the following insurance coverage in an amount of not less than $250,000 per claim, and the home health agency must submit proof of coverage with an initial application for licensure and with each application for license renewal: (a) Malpractice insurance as defined in s. 624.605(1)(k).; (b) Liability insurance as defined in s. 624.605(1)(b). Home Instead Senior Car Section 408.806 (1), F.S., “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..” 4. The applicant did not submit the correct Affidavit of Good Moral Character, AHCA Form 3110-0001 Revised December 2006 for the Alternate Administrator as requested in the application and required in Florida Statutes. The pertinent statutes and rules that apply include the following: Section 59A-8,0095 (1) (b), F.A.C., “If an agency changes administrator or alternate administrator the agency shall notify AHCA Licensed Home health Programs Unit office in Tallahassee prior to or on the date of the change. Notification shall consist of submission of the person’s name, professional resume, professional license, if applicable, and a copy of the Affidavit of good Moral Character.” . Section 408.806 (1), F.S., “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.. 5. The applicant did not submit all of the items requested in the omission letter within the 21 days required in statute. The pertinent statutes and rules that apply include: Section 408.806 (3) (b), F.S., “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 certified mail dated August 21, 2007 to provide this required documentation within twenty-one days from the receipt of the letter as noted in the United States Postal Service Search Results as August 23, 2007. As this information was not received timely by the Agency, the application is deemed incomplete and withdrawn from further consideration. EXPLANATION OF RIGHTS Pursuant to Section 120.569, Florida Statutes, (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 ntaisrial facts you dispute. SEE ATTACHED ELECTION AND EXPLANATION OF RIGHTS FORMS Agency for Health Care Administration Home Instead Senior Care By lon ne track. Anne Menard as Unit Manager Home Care Unit Health Facility Regulation Copy: Agency Clerk, MS 3 Janice K. Mills, MS 3 AHCA Ft Myers Field Office Enclosed: Election of Rights Form STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS BIDWELL HOME CARE SERVICE, LLC d/b/a HOME INSTEAD SENIOR CARE, Petitioner, vs. Case No(s): 07-5015 2007010636 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. ETTLEMENT A MENT Respondent, State of Florida, Agency for Health Care Administration (hereinafter the “Agency”), through its undersigned representatives, and Petitioner, Bidwell Home Care Service, LLC d/b/a Home Instead Senior Care (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 and Chapter 408, Part I, Florida Statutes (2007); Section 20.42, Florida Statutes (2007) and Chapter 59A-8, Florida Administrative Code; and WHEREAS, the Agency has jurisdiction by virtue of being the regulatory and licensing authority over licensure sought by Petitioner; and EXHIBIT 4 WHEREAS, the Agency served the Petitioner with a Notice of Intent to Deny 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 récitals 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 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. The Notice of Intent to Deny is deemed superseded. b. The Petitioner’s request for formal administrative proceedings is withdrawn. Cc. Upon the full execution of this Agreement, the Agency shall begin processing Petitioner’s application. d. 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 tie 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 Deny 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(s). 8. Each 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, 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. Inthe 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. 13. The undersigned have read and understand this Agreement and have authority to bind their respective principals to it. Petitioner’s representative has the capacity to execute this Agreement and has done so without the advice of counsel. The Petitioner understands that it has the right to consult with counsel and has knowingly and freely entered into this Agreement without exercising its right to consult with counsel. The Petitioner fully understands that counsel for the Agency represents solely the Agency and Agency counsel has not provided legal advice to or influenced the Petitioner in its decision to enter into this Agreement. 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 shail be void. 16. All parties agree that a facsimile signature suffices for an original signature. 12/04/2007 13:41 2396436966 BIDWELL SERVICE CARB #0937 P,007 /008 17. The following representatives hereby acknowledge that they are (VD. Debem— dek William Bidwell, Owner Secretary Bidwell Home Care Service, LLC duly authorized to enter into this Agreement. Elizabeth HQA, Depu Agency fer’Health Care Administration d/b/a Home Instead Senior Care 2727 Mahan Drive, Bldg #1 1912 Empress Court Tallahassee, Florida 32308 Naples, Florida 34110 DATED: Aefle L202 7 DATED: Zz 0 Craig H. Smith, General Counsel Florida Bar No, 96598 Agency for Health Care Administration 2727 Mahan Drive, Mail Stop #3 Tallahassee, Florida 32308 DATED: La-}3-07 fet andisspater Senior Attorney Florida Bar No. 0355712 Agency for Health Care Administration 2295 Victoria Avenue, Room 346C Fort Myers, Florida 33901 DATED: talllo7

Docket for Case No: 07-005015