RICK SCOTT GOVERNOR JUSTIN M. SENIOR SECRETARY

April 10, 2018

RICK SCOTT GOVERNOR

JUSTIN M. SENIOR SECRETARY

Edward Hubel Baptist Medical Center - Nassau 1250 South 18th Street Fernandina Beach, Florida 32034-3098

RE: State Fiscal Year 2017 - 2018 First Scheduled Low Income Pool (LIP) Group 1, Tier 1 Payment Medicaid Number:010123100

Dear Mr. Hubel: Your facility has been deemed eligible to receive the associated payment under proviso language contained in the General Appropriations Act for state fiscal year 2017 - 2018. This proviso language directs payments to be made to facilities meeting eligibility criteria. The amounts of such payments are calculated according to the distribution methodology defined in the proviso.

Your first scheduled payment represents 75% (rounded) of your specified annual amount $1,412,844 for state fiscal year 2017 - 2018. The formula used to determine the amount of your payment is shown on the enclosed calculation sheet.

I would like to take this opportunity to thank you for your ongoing commitment to Medicaid beneficiaries and indigent persons in Florida. Your contributions to the provision of adequate and appropriate health care to Floridians in need are truly appreciated.

If you have any questions regarding the above, please call T. K. Feehrer or Ryan Perry of my staff at (850) 412-4131. Sincerely,

Tom Wallace, Assistant Deputy Secretary Medicaid Program Finance and Analytics

TW:rp

Enclosure:

2727 Mahan Drive Mail Stop # 23 Tallahassee, FL 32308 AHCA.

AHCAFlorida AHCAFlorida AHCA_FL

AHCAFlorida

State of Florida Agency for Health Care Administration

Medicaid Program Finance

Low Income Pool (LIP) Group 1, Tier 1 State Fiscal Year 2017 - 2018 First Payment

Medicaid Number : 010123100 Facility Name (current) : Baptist Medical Center - Nassau

Annual LIP Group 1, Tier 1 distribution to your facility Amount being withheld from distribution in anticipation of funding reductions Total of your facility's annual LIP Group 1, Tier 1 Payments

Total of your LIP Group 1, Tier 1 Payments previously paid in this fiscal year Your First Scheduled LIP Group 1, Tier 1 Payment [1]

(A) (B) (A ? B) = (C)

(D) ((C x .75) ? D) = (E)

[1] This payment may be made by check or transferred electronically.

$1,412,844 $0

$1,412,844

$0 $1,059,633

April 10, 2018

RICK SCOTT GOVERNOR

JUSTIN M. SENIOR SECRETARY

Charles Durant Calhoun Liberty Hospital 20370 Northeast Burns Avenue Blountstown, Florida 32424-0419

RE: State Fiscal Year 2017 - 2018 First Scheduled Low Income Pool (LIP) Group 1, Tier 1 Payment Medicaid Number:010026900

Dear Mr. Durant: Your facility has been deemed eligible to receive the associated payment under proviso language contained in the General Appropriations Act for state fiscal year 2017 - 2018. This proviso language directs payments to be made to facilities meeting eligibility criteria. The amounts of such payments are calculated according to the distribution methodology defined in the proviso.

Your first scheduled payment represents 75% (rounded) of your specified annual amount $111,631 for state fiscal year 2017 - 2018. The formula used to determine the amount of your payment is shown on the enclosed calculation sheet.

I would like to take this opportunity to thank you for your ongoing commitment to Medicaid beneficiaries and indigent persons in Florida. Your contributions to the provision of adequate and appropriate health care to Floridians in need are truly appreciated.

If you have any questions regarding the above, please call T. K. Feehrer or Ryan Perry of my staff at (850) 412-4131. Sincerely,

Tom Wallace, Assistant Deputy Secretary Medicaid Program Finance and Analytics

TW:rp

Enclosure:

2727 Mahan Drive Mail Stop # 23 Tallahassee, FL 32308 AHCA.

AHCAFlorida AHCAFlorida AHCA_FL

AHCAFlorida

State of Florida Agency for Health Care Administration

Medicaid Program Finance

Low Income Pool (LIP) Group 1, Tier 1 State Fiscal Year 2017 - 2018 First Payment

Medicaid Number : 010026900 Facility Name (current) : Calhoun Liberty Hospital

Annual LIP Group 1, Tier 1 distribution to your facility Amount being withheld from distribution in anticipation of funding reductions Total of your facility's annual LIP Group 1, Tier 1 Payments

Total of your LIP Group 1, Tier 1 Payments previously paid in this fiscal year Your First Scheduled LIP Group 1, Tier 1 Payment [1]

(A) (B) (A ? B) = (C)

(D) ((C x .75) ? D) = (E)

[1] This payment may be made by check or transferred electronically.

$111,631 $0

$111,631

$0 $83,723

April 10, 2018

RICK SCOTT GOVERNOR

JUSTIN M. SENIOR SECRETARY

Aaron Robinson Cape Canaveral Hospital 701 West Cocoa Beach Causeway Cocoa Beach, Florida 32931

RE: State Fiscal Year 2017 - 2018 First Scheduled Low Income Pool (LIP) Group 1, Tier 1 Payment Medicaid Number:010009900

Dear Mr. Robinson: Your facility has been deemed eligible to receive the associated payment under proviso language contained in the General Appropriations Act for state fiscal year 2017 - 2018. This proviso language directs payments to be made to facilities meeting eligibility criteria. The amounts of such payments are calculated according to the distribution methodology defined in the proviso.

Your first scheduled payment represents 75% (rounded) of your specified annual amount $1,754,600 for state fiscal year 2017 - 2018. The formula used to determine the amount of your payment is shown on the enclosed calculation sheet.

I would like to take this opportunity to thank you for your ongoing commitment to Medicaid beneficiaries and indigent persons in Florida. Your contributions to the provision of adequate and appropriate health care to Floridians in need are truly appreciated.

If you have any questions regarding the above, please call T. K. Feehrer or Ryan Perry of my staff at (850) 412-4131. Sincerely,

Tom Wallace, Assistant Deputy Secretary Medicaid Program Finance and Analytics

TW:rp

Enclosure:

2727 Mahan Drive Mail Stop # 23 Tallahassee, FL 32308 AHCA.

AHCAFlorida AHCAFlorida AHCA_FL

AHCAFlorida

State of Florida Agency for Health Care Administration

Medicaid Program Finance

Low Income Pool (LIP) Group 1, Tier 1 State Fiscal Year 2017 - 2018 First Payment

Medicaid Number : 010009900 Facility Name (current) : Cape Canaveral Hospital

Annual LIP Group 1, Tier 1 distribution to your facility Amount being withheld from distribution in anticipation of funding reductions Total of your facility's annual LIP Group 1, Tier 1 Payments

Total of your LIP Group 1, Tier 1 Payments previously paid in this fiscal year Your First Scheduled LIP Group 1, Tier 1 Payment [1]

(A) (B) (A ? B) = (C)

(D) ((C x .75) ? D) = (E)

[1] This payment may be made by check or transferred electronically.

$1,754,600 $0

$1,754,600

$0 $1,315,950

April 10, 2018

RICK SCOTT GOVERNOR

JUSTIN M. SENIOR SECRETARY

Thomas J. Stone Doctor's Memorial Hospital Inc. P.O. Box 1847 Perry, Florida 32347-2104

RE: State Fiscal Year 2017 - 2018 First Scheduled Low Income Pool (LIP) Group 1, Tier 1 Payment Medicaid Number:010180000

Dear Mr. Stone: Your facility has been deemed eligible to receive the associated payment under proviso language contained in the General Appropriations Act for state fiscal year 2017 - 2018. This proviso language directs payments to be made to facilities meeting eligibility criteria. The amounts of such payments are calculated according to the distribution methodology defined in the proviso.

Your first scheduled payment represents 75% (rounded) of your specified annual amount $207,304 for state fiscal year 2017 - 2018. The formula used to determine the amount of your payment is shown on the enclosed calculation sheet.

I would like to take this opportunity to thank you for your ongoing commitment to Medicaid beneficiaries and indigent persons in Florida. Your contributions to the provision of adequate and appropriate health care to Floridians in need are truly appreciated.

If you have any questions regarding the above, please call T. K. Feehrer or Ryan Perry of my staff at (850) 412-4131. Sincerely,

Tom Wallace, Assistant Deputy Secretary Medicaid Program Finance and Analytics

TW:rp

Enclosure:

2727 Mahan Drive Mail Stop # 23 Tallahassee, FL 32308 AHCA.

AHCAFlorida AHCAFlorida AHCA_FL

AHCAFlorida

State of Florida Agency for Health Care Administration

Medicaid Program Finance

Low Income Pool (LIP) Group 1, Tier 1 State Fiscal Year 2017 - 2018 First Payment

Medicaid Number : 010180000 Facility Name (current) : Doctor's Memorial Hospital Inc.

Annual LIP Group 1, Tier 1 distribution to your facility Amount being withheld from distribution in anticipation of funding reductions Total of your facility's annual LIP Group 1, Tier 1 Payments

Total of your LIP Group 1, Tier 1 Payments previously paid in this fiscal year Your First Scheduled LIP Group 1, Tier 1 Payment [1]

(A) (B) (A ? B) = (C)

(D) ((C x .75) ? D) = (E)

[1] This payment may be made by check or transferred electronically.

$207,304 $0

$207,304

$0 $155,478

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