Home » MEDICAL CLINIC AHCA PROOF OF FINANCIAL ABILITY TO OPERATE

MEDICAL CLINIC AHCA PROOF OF FINANCIAL ABILITY TO OPERATE

MEDICAL CLINIC AHCA PROOF OF FINANCIAL ABILITY TO OPERATE

TERMS & CONDITIONS

The Medical Clinic and entity name above shall be referred to herein as “THE MEDICAL CLINIC” and includes its management and founding team. This letter is to confirm and specify the terms of my engagement with “THE  MEDICAL  CLINIC” for the preparation of the Proof of Financial Ability to Operate. We make no guarantee that AHCA, CMS, or other Federal or State agencies will approve your application. My engagement will be designed to perform the following services:
  1. Initial teleconference with “THE  MEDICAL  CLINIC” to explain the data required by us, as well as the format in which it’s required. The data shall be referred to herein as the “ MEDICAL  CLINIC Data Request”, an Excel-based Q&A format.
  2. “THE  MEDICAL  CLINIC” is solely responsible for the content and accuracy of all data including but not limited too, and financial data, projected revenue/hours, projected labor cost, narratives, and all other data.
  3. Gustavo A Viera PA is engaged to compile the Proof of Financial Ability to Operate, from the data you provide using oral statements, emails, and the “ MEDICAL CLINIC Data Request”.
  4. We may require additional information and will request it via email if required. Your response to these inquires must be submitted to us within 5 working days from the date of the request. Any failure to provide requested data, and to do so on a timely basis as noted above, will impede our services and may require us to suspend our services or withdraw from the engagement.
  5. Gustavo A Viera PA sole responsibility is the compilation of “THE  MEDICAL  CLINIC” data in an accepted format as requested by AHCA, CMS, or other Federal or State Agency, and in accordance to Generally Accepted Accounting Principles (GAAP).
  6. “THE  MEDICAL  CLINIC” is engaging Accountants in Miami for his compilation expertise, and not the actual content creation(i.e. business plan and financial data and drivers)
  7. This engagement is limited to two (1) draft of the Proof of Financial Ability to Operate, and FINAL version. Any further revisions shall be billed at an hourly rate of $250.00 per hour, payable in advance with a 1-hour minimum referred to as a retainer. If the retainer is fully utilized, subsequent retainers will be requested and paid in advance before work is continued. No refunds will be given for unused retainers.
  8. Each draft (including final) shall be submitted to “THE  MEDICAL  CLINIC” for review, edits, and or modifications in PDF format. Accountants in Miami reserves the right to reject any edits or modifications if they do not conform with GAAP or his knowledge of accepted State accreditation standards, Medicare standards, Medicaid standards, or Insurance or Private Pay standards.
  9. “THE  MEDICAL  CLINIC” submission of the Proof of Financial Ability to Operate whether in the draft or final form, to AHCA, CMS, or other Federal or State Agency constitutes “THE  MEDICAL  CLINIC” acceptance, acknowledgment, and sole responsibility for its accuracy and completeness.
10. Omission Letters shall be brought to the attention of Accountants in Miami within 72 hours of receipt.  Accountants in Miami will be happy to assist you with any corrections or edits as described in the Omission Letter. An hourly rate of $250.00 per hour, payable in advance with a 1-hour minimum referred to as a retainer. If the retainer is fully utilized, subsequent retainers will be requested and paid in advance before work is continued. No refunds will be given for unused retainers. 11. Accountants in Miami reserves the right to refuse to assist “THE  MEDICAL  CLINIC” with a response to the Omission Letter for any reason including but not limited to “THE  MEDICAL  CLINIC” acceptance, acknowledgment, and submission of the Proof of Financial Ability to Operate as described in point 9 above. 12. Accountants in Miami shall make best efforts to complete “THE  MEDICAL  CLINIC” Proof of Financial Ability to Operate within 5 working days referred to herein as Turn-Around-Time (TAT) from the date receipt of all required data by us. We will inform you when all data required is received, until which time, the 5-day TAT does not commence. 13. Any failure to provide requested data, and to do so on a timely basis as noted above, will impede our services and may require us to suspend our services or withdraw from the engagement and subject to terms and conditions as described in this engagement letter. 14. Our fees for this engagement are not Contingent on Approval from AHCA, CMS, or other Federal or State Agency.  Rather, our fees for this engagement will $__________ payable upfront and non-Refundable. Should you decide to terminate our engagement for any reason, including your refusal to provide the information requested or accept the outcome of the “Total Source and Amount of Funds” required, no refunds will be given nor will the Proof of Financial Ability to Operate be issued. The information you provide will be incorporated into the AHCA prepared spreadsheet for the Proof of Financial Ability to Operate. We do not have control over the final amount for “Total Source and Amount of Funds”. 15. You are responsible for adopting sound accounting policies, including management assumptions, when submitting your estimates for the financial projections, proposed services to be performed, and an estimate of annual billable hours in year 1 and 2 for proposed services, and the labor cost per each job function. 16. At a minimum, you must supply to AHCA (from a financial perspective) the following data below. Your Consultant will also provide you with a list of other non-financial data that you must submit. If you do not have a Consultant assisting you through the application process, we highly recommend hiring one. Failure to submit all required data will result in an Omission Letter from AHCA. You understand and acknowledge the AHCA will only allow you to submit your application twice. If you receive two Omission Letters, your application will be rejected and your only recourse will be to appeal the decision, which may result in hiring an attorney to represent you and incurring additional cost.                                            Minimum financially related information “THE  MEDICAL  CLINIC” must supply: (Please note the list may not be all-inclusive as requirements vary among applicants & States)
  • Proof of Financial Ability to Operate form 3100-0009
  • A detailed list of Pre-Opening Cost and copies of paid receipts, canceled checks or other proof of payment for the Pre-Opening Cost you have paid for prior to submitting the application and as noted in Data Sheet Below. You must you a format similar the Exhibit A for each category of expense.
  • Bank Statement reflecting the required amount of “Total Funds Required” or greater. The date of the bank statement cannot be older than 10 days from the date you mail the application to AHCA.
  • Copy of your office lease
  • Copy of purchase contract if this is a CHAO
  • Copy (front & back) of payments to seller if this is a CHAO
The distribution of our report is restricted to it’s intended use, and user(s) (i.e. accrediting State Agency) and internal management of your company. Accordingly, you agree not to distribute to outside parties to obtain credit or for any other purpose without our prior express written consent.  Our engagement will not be planned or conducted in contemplation of reliance by any other party or with respect to any specific transaction and is not intended to benefit or influence any other party.  Therefore, items of possible interest to a third party may not be specifically addressed or matters may exist that could be assessed differently by a third party. Our engagement cannot be relied upon to disclose errors, fraud, or other illegal acts that may exist.  However, we will inform you of any material errors that come to our attention and any fraud or other illegal acts that come to our attention, unless they are clearly inconsequential.  In addition, we have no responsibility to identify and communicate significant deficiencies or material weaknesses in your internal controls as part of this engagement, and our engagement cannot be relied upon to disclose the same. In order for us to complete this engagement, and to do so efficiently, we require unrestricted and timely access to the documents requested herein. In addition, we require access to individuals within your company, or external to like consultants, brokers, bankers, or attorneys who may have the information required to complete this engagement.  Any failure to provide such cooperation, and to do so on a timely basis, will impede our services and may require us to suspend our services or withdraw from the engagement.  If for any reason we are unable to complete the PROOF OF FINANCIAL ABILITY TO OPERATE, we will not issue a report on such statements as a result of this engagement. The engagement will have deemed to be complete, and no refunds or credits given. Mr. Viera is the engagement partner and is responsible for the engagement. Additionally, Mr. Viera is the only authorized employee of Accountants in Miami to:
  • Sign and release the any Reports
  • Authorize the release of original or copies of any Reports
  • Authorize the release of any original or copies of any other document(s) not specifically listed herein
No documents will be released directly to your attorney, bankers, insurance agents, an unauthorized employee of “THE  MEDICAL  CLINIC” or another party including Local, State & Federal governmental agencies. All requests for copies shall be addressed to Mr. Viera in writing (email, fax, or mail) and the requested documents will be sent to “THE  MEDICAL  CLINIC” directly. No documents shall be submitted to any third party directly. These requests are handled as expediently as possible. However, circumstances such as vacations or holidays may delay the turnaround time, so please plan accordingly. If Mr. Viera is out of the office, employees are forbidden to release documents for “THE  MEDICAL  CLINIC” protection and security. You are responsible for adopting sound accounting policies, for maintaining an adequate and efficient accounting system, for safeguarding assets, for authorizing transactions, for retaining supporting documentation for those transactions, and for devising a system of internal controls that will, among other things, help assure the preparation of proper financial statements.  Furthermore, you are responsible for management decisions and functions, for designating a competent employee to oversee any of the services we provide, and for evaluating the adequacy and results of those services. You are responsible for the design and implementation of programs and controls to prevent and detect fraud, and for informing us about all known or suspected fraud affecting the Company involving (a) management (b) employees who have significant roles in internal control, and (c) others where the fraud could have a material effect on the financial statements.  You are also responsible for informing us of your knowledge of any allegations of fraud or suspected fraud affecting the Company received in communications from employees, former employees, regulators, or others.  In addition, you are responsible for identifying and ensuring that the entity complies with applicable laws and regulations. Unforeseen Events – In the normal course of day-to-day operations, unforeseen events may arise which you may require or request additional services or representation not foreseen or contemplated during the preparation and execution of this engagement letter. Since these events may or may not come to fruition, we do not add a cost component as a contingency. We will be happy to assist you at our standard hourly rates. We reserve the right to suspend our services or to withdraw from this engagement in the event that any of our invoices are deemed delinquent or payments are bounced.  In the event that any collection action is required to collect unpaid balances due to us, you agree to reimburse us for our costs of collection, including attorneys’ fees.  If we elect to terminate our services for nonpayment, or for any other reason provided for in this letter, our engagement will be deemed to have been completed upon written notification of termination, even if we have not completed our report.  You will be obligated to compensate us for all time expended, and to reimburse us for all of our out-of-pocket costs, through the date of termination. In connection with this engagement, we may communicate with you or others via email transmission.  As emails can be intercepted and read, disclosed, or otherwise used or communicated by an unintended third party, or may not be delivered to each of the parties to whom they are directed and only to such parties, we cannot guarantee or warrant that emails from us will be properly delivered and read-only by the addressee.  Therefore, we specifically disclaim and waive any liability or responsibility whatsoever for the interception or unintentional disclosure of emails transmitted by us in connection with the performance of this engagement.  In that regard, you agree that we shall have no liability for any loss or damage to any person or entity resulting from the use of email transmissions, including any consequential, incidental, direct, indirect, or special damages, such as loss of revenues or anticipated profits, or disclosure or communication of confidential or proprietary information. It is our policy to retain engagement documentation for a period of three years, after which time we will commence the process of destroying the contents of our engagement files.  To the extent we accumulate any of your original records during the engagement, those documents will be returned to you promptly upon completion of the engagement, and you will provide us with a receipt for the return of such records.  The balance of our engagement file, other than the Proof of Financial Ability to Operate, which we will provide to you at the conclusion of the engagement, is our property, and we will not provide copies of such documents considered as Intellectual Property on the “How To” aspects and “Know-How”. In the event we are required to respond to a subpoena, court order, or other legal processes for the production of documents and/or testimony relative to information we obtained and/or prepared during the course of this engagement, you agree to compensate us at our hourly rates, as set forth above, for the time we expend in connection with such response, and to reimburse us for all of our out-of-pocket costs incurred in that regard. In the event that we are or may be obligated to pay any cost, settlement, judgment, fine, penalty, or similar award or sanction as a result of a claim, investigation, or other proceeding instituted by any third party, then to the extent that such obligation is or maybe a direct or indirect result of your intentional or knowing misrepresentation or provision to us of inaccurate or incomplete information in connection with this engagement, and not any failure on our part to comply with professional standards, you agree to indemnify us, defend us, and hold us harmless as against such obligations. You agree that any dispute (other than our efforts to collect any outstanding invoice) that may arise regarding the meaning, performance, or enforcement of this engagement or any prior engagement that we have performed for you, will, prior to resorting to litigation, be submitted to mediation and that the parties will engage in the mediation process in good faith once a written request to mediate has been given by any party to the engagement.  Any mediation initiated as a result of this engagement shall be administered within the county of Miami-Dade Florida, by Mediation Services Inc. according to its mediation rules, and any ensuing litigation shall be conducted within said county, according to Florida law.  The results of any such mediation shall be binding only upon agreement of each party to be bound.  The costs of any mediation proceeding shall be shared equally by the participating parties. Any litigation arising out of this engagement, except actions by us to enforce payment of our professional invoices, must be asserted within one year from the date any such cause of action accrues, or within three years from the completion of the engagement, whichever is earlier, notwithstanding any statutory provision to the contrary. This engagement letter is contractual in nature and includes all of the relevant terms that will govern the engagement for which it has been prepared.  The terms of this letter supersede any prior oral or written representations or commitments by or between the parties.  Any material changes or additions to the terms set forth in this letter will only become effective if evidenced by a written amendment to this letter, signed by all of the parties.  If you would like us to provide you with any other services not specifically outlined in this engagement letter or attached rate sheet, you must make that request of us in writing.  If we agree to provide the requested additional services, we will create a separate engagement letter specifically addressing the same, and that engagement letter, upon your signature, will govern our provision of those additional services. If, after full consideration and consultation with counsel if so desired, you agree that the foregoing terms shall govern this engagement, please sign the copy of this letter in the space provided and return the original signed letter to me, keeping a fully-executed copy for your records.

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