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Agenda 09/25/2012 Item #11D Proposed Agenda Changes Board of County Commissioners Meeting September 25,2012 Request to hear Item 10A immediately before Item 14A1. (Commissioner Hiller's request) Add Item 10K: Consideration of impending vacancy on the Collier County Planning Commission for District 5 representative. (Commissioner Coletta's request) Withdraw Item 11D:This is a quasi judicial hearing. This item requires that ex parte disclosure be provided by Commission members and all participants are required to be sworn in. Recommendation to hear testimony from American Medical Transport and the public to determine the need for an additional Class 2 post-hospital inter-facility transport ambulance transfer service in Collier County. (Applicant's request) Withdraw Item 11E: Recommendation to approve the Site Improvement Plan and authorize the Chair to sign the Compliance Agreement for Star Mobile Home Park located at 1507 Immokalee Drive,Immokalee, Florida. (Staff's request on behalf of property owner) Move Item 16A7 to Item 11J: Recommendation to accept a schedule to review past staff clarifications of the Land Development Code(LDC)and to accept specific Staff Clarifications attached to this Executive Summary. (Commissioner Hiller's request) Add Item 11K: Recommendation to continue the Fiscal Year 2012 Pay and Classification Plan for the Board of County Commissioners and Office of the County Attorney into Fiscal Year 2013,allowing for final revisions to the proposed Fiscal Year 2013 plan which will be brought forward for consideration at the Board meeting of October 9, 2012. (Staff's request) Withdraw Item 16C1: Recommendation to approve a time and materials contract with Agnoli Barber& Brundage in the not-to-exceed amount of$243,631 for Request for Proposal No. 12-5883, "Master Pumping Station 312 Professional Services During Construction," Project Number 72549. (Staffs request pending resolution of a bid protest) Continue Item 16D5 to the October 9,2012 BCC Meeting: Recommendation to accept the Conservation Collier Annual Report. (Staffs request) Continue Item 16D6 to the October 9,2012 BCC Meeting: Recommendation to approve and authorize the Chairman to execute a Resolution repealing Resolution No.2009-296 and a Resolution establishing a revised Collier County Public Library Fees and Fines Schedule. (Staffs request) Move Item 16D9 to Item 11L: Recommendation to comply with a Housing and Urban Development(HUD) payback disbursement directive of federal funds in the amount of$500,000 for a Community Development Block Grant(CDBG)project subawarded to Habitat for Humanity(HFH)and authorize any necessary budget amendments. (Commissioner Hiller's request) Withdraw Item 16G1: Recommendation to approve a License Agreement with United Circus Operating Co.,Inc. d/b/a The Kings Bros Circus at the Immokalee Airport for a one(1)day circus event. (Staffs request) Proposed Agenda Changes Board of County Commissioners Meeting September 25,2012 Page 2 Withdraw Item 17C: Recommendation to adopt proposed changes to Ordinance No.91-65,of the Affordable Housing Advisory Committee Ordinance to incorporate statutory requirements and otherwise clarify terms. (Staffs request) Note: Item 16D2: The second sentence in the Considerations section of the Executive Summary should read: "Per Florida Statutes subsection 39.304(5),the parents, legal guardians,or legal custodians are required to reimburse the County for the costs of such initial allowable examinations". (Staff's request) Time Certain Items: Item 9B to be heard at 5:05 p.m.(Bayshore Triangle CRA Amendments and Wellfield and related Amendments) Item 10I to be heard at 1:05 p.m. Item 11C to be heard at 10:00 a.m. Item 12A to be heard at 11:30 a.m. Item 12B to be heard at 12:00 noon in a Closed Session Item 12C to be heard at 1:00 p.m. in an Open Session 9/25/2012 9:37 AM 9/25/2012 Item 11 .D. EXECUTIVE SUMMARY Recommendation to hear testimony from American Medical Transport and the public to determine the need for an additional Class 2 post-hospital inter-facility transport ambulance transfer service in Collier County. OBJECTIVE: To proceed in the best interest of the public health, safety and welfare by conducting a Public Hearing to hear testimony from American Medical Transport, the public, and staff to determine the need for an additional Class 2 inter-facility medical transport provider. CONSIDERATIONS: Chapter 50 of the County's Code of Ordinances—Emergency Services defines the process by which a Certificate of Public Convenience and Necessity (COPCN) may be obtained. In accordance with the provisions of this chapter, American Medical Transport, a company operating in Connecticut for the past 10 years submitted an application to provide Class 2 (post-hospital inter-facility transport) services. On July 16, 2012 staff deemed the application received by American Medical Transport as being complete. Staff has two major concerns with this application: First, is whether the granting of a certificate to American Medical Transport dilute the transport volume for the current provider (Ambitrans) to the extent that the current level of service by Ambitrans is negatively affected. Staff contends that in the absence of the potential of a diminished call volume or lack of volume for multiple providers, there could be a degradation of services in either response times or quality. Second, and more important, American Medical Transport is new to Florida therefore staff has no ability to gauge their performance under Florida medical transportation regulations. Prior experience in Florida would be helpful to allow staff to evaluate performance in Collier County with similar service delivery efforts. Staff has identified that an average of 174 non-emergency inter-facility transports are conducted by the current provider (Ambitrans) on a monthly basis with a minimum of (3) three ALS ambulances based in Collier County. The seasonal demand for services varies greatly. Additional ambulances servicing Lee County and Charlotte County operated by the current provider (Ambitrans) allows for some surge capacity in service delivery during season to the county if not to regional facilities as well. The Ordinance provides that the Board shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: 1. That there is a public necessity for the service. In making such determination, the Board of County Commissioners shall consider, as a minimum the following factors: a. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the County. b. The effect of the proposed service on existing services with respect to quality of service and cost of service. Packet Page -1519- 9/25/2012 Item 11 .D. c. The effect of the proposed service on the overall cost of EMS service in the county. d. The effect of the proposed service on existing hospitals and other health care facilities. e. The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. 2. That the applicant has sufficient knowledge and experience to properly operate the proposed service. 3. That, if applicable, there is an adequate revenue base for the proposed service. 4. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. Staff provides the following discussion as it relates to the Standards referenced above: Standard Number: 1(a). It is the opinion of staff that the current needs of the interfacility transport resources locally provided by Ambitrans are being reasonably met. Collier County Emergency Medical Services has a monthly average of assisting the current interfacility transport provider totaling about 12 calls per month as a back-up to the Ambitrans organization or when calls for service require more advanced assistance. These occasional transports as a back-up to Ambitran while not our core mission has had little negative impact on our pre-hospital care emergency delivery. Staff and Ambitrans work closely to address these rare instances of back-up services. 1(b). The addition of a second transport provider has no effect on Collier County's Emergency Medical Services Department. The current provider (Amibtrans) would likely be impacted by a loss of revenue with an additional provider in the marketplace. Collier County has no experience with two private providers in the same class. Since this environment is new to Collier County we have no models nor since it's a private operation, any grounds to formally evaluate this business environment. 1(c). It is the opinion of staff that the effect of the proposed service on the overall cost of EMS service in the county would not be impacted. In the case of interfacility transport services, those services are billed directly to the patient, as there is no subsidy by the,..Cdunty to a private interfacility transport provider. 1(d). The effect of the proposed service on existing hospitals and health care facilities. Packet Page-1520- 9/25/2012 Item 11 .D. Hospitals and health care facilities would likely not be impacted unless a situation occurred whereby competition for transports negatively impacted the number of ambulance vehicles available for average demands. The provision of multiple providers, timely response or other rate and service-quality issues could evolve due to impacts on profitability with multiple providers. 1(e). The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. Staff is of the opinion that the effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services would not be impacted. In the previous application for Ambitrans, the Board requested a local office of operations and local hiring if possible. (2) That the applicant has sufficient knowledge and experience to properly operate the proposed service.. Staff is of the opinion that the applicant has sufficient experience as a provider in the State of Connecticut. It is fair to make the Board aware that the provider has not done business in the State of Florida thereby making it difficult to evaluate operations under Florida emergency medical transportation requirements. (3) That, if applicable, there is an adequate revenue base for the proposed service. Staff deems this standard as not applicable, since the service does not receive a subsidy from Collier County and the profitability or revenue is dependent upon calls for service requested by the patient or their designee. (4) That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. The number of vehicles, personnel and the desire for a local office as referenced in the application are essentially proposed upon the granting of the COCPN under conditions typically agreed upon by the applicant during the Board's hearing on the matter. The application did not mention whether or not the provider would be seeking authority to work in nearby counties or Collier County exclusively. Providing services regionally with a local base of operations in Collier County is desirable as we observe a need for Class 2 transport services both inbound and outbound to serve patients throughout the region. Staff has not placed any requirements or conditions upon the applicant other than to request clarification to the application provided. Staff would recommend denial of the application unless the Board placed stipulations and the applicant agreed to the following: Packet Page -1521- 9/25/2012 Item 11 .D. 1. The provider should confirm that he would place a minimum of two ambulances in service within 60 days of his certificate date issuance from Collier County should the Board determine that there is a public need and necessity for the service. 2. The provider will have a local business location suitable to assist clients with billing matters and that his dispatch operations are local so as to work cooperatively with Collier County Emergency Medical Services. 3. Operations will not begin until he has approval and received inspections from the Florida Bureau of Emergency Medical Services. 4. The provider will take reasonable measures to hire locally. 5. The certificate, if granted to the provider, shall be for a period of one year. 6. A commitment from the Provider that the services provided are limited to Class 2 operations consisting of Advanced Life Support as noted in Florida regulation. 7. The provider employs the services of a licensed Florida physician actively engaged in emergency medicine or general medicine to serve as the Providers medical director. The Providers' medical director will be required to have frequent communications, coordination and approval processes with Collier County's EMS Medical Director regarding protocols and quality assurance matters. FISCAL IMPACT: There is no fiscal impact to the Board for the granting of this certificate. The Board is requested to accept the $250.00 application fee with the corresponding application. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is legally sufficient, and requires majority support for approval. -JAK APitz GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this executive summary. STAFF RECOMMENDATION: That the Board of County Commissioners conduct the required public hearing and determine the public necessity and convenience for an additional Class 2 inter-facility transport organization. Should such a need be approved by the Board, the Board shall grant a one year Certificate of Public Necessity and Convenience to American Medical Transport. PREPARED BY: Dan E. Summers, Director of Emergency Services Packet Page-1522- 9/25/2012 Item 11 .D. COLLIER COUNTY Board of County Commissioners Item Number: 11.D. Item Summary: This is a quasi judicialhearing.This item requires that ex parte disclosure be provided by Commission members andall participants are required to be sworn in. Recommendation to hear testimony from American Medical Transport and the public to determine the need for an additional Class 2 post-hospital inter-facility transport ambulance transfer service in Collier County. (Dan Summers, Bureau of Emergency Services) Meeting Date: 9/25/2012 Prepared By Name: BoniChristine Title: Administrative Assistant, Senior, 9/13/2012 3:47:23 PM Submitted by Title: Administrative Assistant, Senior, Name: BoniChristine 9/13/2012 3:47:26 PM Approved By Name: SummersDan Title: Director-Bureau of Emergency Services, Date: 9/18/2012 10:13:54 AM Name: KlatzkowJeff Title: County Attorney Date: 9/18/2012 11:19:28 AM Name: PriceLen Title: Administrator, Administrative Services Date: 9/18/2012 1:20:39 PM Name: FinnEd Title: Senior Budget Analyst, OMB Packet Page-1523- 9/25/2012 Item 11 .D. Date: 9/18/2012 3:14:11 PM Name: KlatzkowJeff Title: County Attorney Date: 9/18/2012 3:23:13 PM Name: OchsLeo Title: County Manager Date: 9/19/2012 12:56:44 PM Atook Packet Page -1524- . , 9/25/2012 Item 11 D . 1 , . 1 ,i- , ...... ,,, r.i. .3.-- .. , =.1-. . = Ordinance CO PN • ., . ..-; . •,:, .":'; .i.-, .. .; . ...4, . 1") .. :7-. "'. • .:.*., = . ....i I ., _'• .' '.. ".•.., ..;' . t. I R . ' . k• .., .•• •,z , .. • -•• '•,-.•. ;•,'' -.•.'■ . .-- '-'''''■ • "-..,'.' .-, 1 t• ., '''.■ ,,f ) ,. . ' ., .- ■ , t. -.. .'..'t Packet Page -1525- Municode 9/25/2012 Item 11 .D. 4111, 4.00 Collier County, Florida, Code of Ordinances>> PART I -CODE>> Chapter 50 -EMERGENCY SERVICES»ARTICLE III.-MEDICAL TRANSPORTATION SERVICES>> ARTICLE III. - MEDICAL TRANSPORTATION SERVICES cf Sec.50-51.-Purpose. Sec.50-52,-Definitions. Sec.50-53,-Reauirements for certificate. Sec.50-54.-Exemptions and exclusions from certificate requirement. Sec.50-55.-Procedure for obtaining certificate. Sec.50-56.-Review of application. Sec.50-57.-Requirement for board approval in granting certificate. Sec.50-58.-Appointment of hearing officer. Sec.50-59.-Rights and duties granted by certificate. Sec.50-60.-Renewal of certificate. Sec.50-61.-Emeraencv provisions. Sec.50-62.-Classifications of certificates. Sec,50-63.-Transfer or assignment of certificates. Sec.50-64.-Revocation.alteration or suspension grounds. Sec.50-65.-General operating regulations. Sec.50-66.-Place of business. • Sec.50-67.-Records to be kept. Atagt Sec.50-68.-Rates. Sec,50-69.-Operator's insurance. Sec.50-70.-Conduct of drivers and attendants. Sec. 50-71.-Passengers. Sec. 50-72.-Obedience to traffic laws.ordinances or regulations. Sec. 50-73.-Violations. Sec, 50-74.-Uniformity of application. Sec.50-75.-Authority to enforce. Secs.50-76-50-100.-Reserved. Sec. 50-51. - Purpose. This article is adopted pursuant to F.S. chs. 125 and 401. The purpose of this article is to provide better protection for the health, safety and welfare of the residents of Collier County, in ambulance and ALS matters, by establishing uniform county-wide standards for certification of ambulance or advanced life support or services,or operations by promulgating complete and clear rules and regulations for operation of all ambulance or rescue companies or services i in Collier County. (Ord. No. 04-12, § 1) Sec. 50-52. - Definitions. http://library.municode.com/print.aspx?cli Packet Page 1526-IRequest=http%3a%2f%2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. The following words,terms and phrases,when used in this article, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning: Administrator shall mean the County Manager or his designee. Advanced Life Support(ALS)shall mean procedures conducted as defined in applicable Florida Statutes and Florida Administrative Code, and the Collier County Medical Director's protocol. 1 Ambulance means any privately or publicly owned land, air, or water vehicle that is designed, constructed, reconstructed, maintained, equipped or operated, and is used for or intended to be used for air, land, or water transportation of persons,who are sick, injured, or otherwise helpless. Board shall mean the Collier County Board of County Commissioner$. Certificate means a certificate of public convenience and necessity as authorized in F.S. §401.25(2)(d). Emergency Call shall mean the transit of an ambulance under conditions which warrants travel with flashing lights and siren operating. Operator shall mean any person, organization or governmental entity providing ambulance or ALS services. Patient shall mean an individual who is ill, sick, injured, wounded, or otherwise incapacitated or helpless. Rescue Service (Non-ALS) shall mean first response treatment of patients but does not include Advanced Life Support(ALS) or transport. Routine Call or Routine Transfer shall mean the transportation of a patient under non- emergency call conditions. (Ord. No. 04-12, §2;Ord. No. 2011-36, § 1) Sec. 50-53. - Requirements for certificate. It shall be unlawful for any person,firm, agency, or any other entity, including governmental units, to provide an ambulance service or provide advanced life support without first obtaining a certificate therefore from the Board of County Commissioners of Collier County. (Ord. No. 04-12, §3) Sec. 50-54. - Exemptions and exclusions from certificate requirement. Certificates shall not be required for: • (1) Rescue Services (Non-ALS). (2) The use of a non-ambulance for any transport of a patient pursuant to the Good Samaritan Act, F.S. §768.13. http://library.municode.com/print.aspx?clip Packet Page-1527-IRequest=http%3a%2f%2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. (3) Vehicles rendering ambulance-type services when requested to do so by the Board of County Commissioners or County Manager in the event of a major • catastrophe or other such emergency which requires more ambulances than are available in the county. (4) Ambulances based outside the county which pick up a patient in the county and 1 transport him out of the county, or which pick up a patient out of the county and transport him into the county. (5) Vehicles used to transport persons for routine scheduled medical treatments. Vehicles transporting persons who require services en route are not covered by this exemption. (Ord. No. 04-12, §4;Ord. No. 05-16, §4;Ord. No. 2011-36, §2) Sec. 50-55. - Procedure for obtaining certificate. An applicant for a certificate shall provide the Administrator with the fallowing information in order for a request for a certificate to be considered. Each request shall contain: (1) The name, age, and address of the owner of the ambulance or ALS Operator, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more than 25%of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. (2) The boundaries of the territory desired to be served. (3) The number and brief description of the ambulances or other vehicles the • applicant will have available. (4) The address of the intended headquarters and any substations. • (5) The training and experience of the applicant. (6) The names and addresses of three Collier County residents who will act as references for the applicant. (7) A schedule of rates which the service intends to charge. (8) Such other pertinent information as the administrator may require. (9) An application or renewal fee of$250.00. (Exception Collier County EMS). (10) Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. (Ord. No. 04-12, §5;Ord. No.2011-36, §3) Sec.. 50-56. - Review of application. The administrator shall review each application and shall investigate the applicants reputation, competence, financial responsibility, and any other relevant factors. The administrator shall also make an investigation as to the public necessity for an ambulance or ALS operation in the territory requested, and shall then make a report to the board containing his recommendation whether to grant a certificate to the applicant within 60 days of the time the administrator determines the application is complete. (Ord. No. 0412, §6) • Sec. 50-57. - Requirement for board approval in granting certificate. http://library.municode.com/print.aspx?cli Packet Page -1528-[Request=http%3a%o2f%2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: (1) That there is a public necessity for the service. In making such determination, the Board of County Commissioners shall consider, as a minimum, the.following factors: a. The extent to which the proposed service is needed to improve the overall emergency medical services (EMS) capabilities of the County. b. The effect of the proposed service on existing services with respect to quality of service and cost of service. c. The effect of the proposed service on the overall cost of EMS service in the county. d. The effect of the proposed service on existing hospitals end other health care facilities. e. The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. (2) That the applicant has sufficient knowledge and experience to properly operate the proposed service. (3) That, if applicable, there is an adequate revenue base for the proposed service. (4) That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area. (Ord. No. 04-12, § 7; Ord. No.2011-36, §4) Sec. 50-58. -Appointment of hearing officer. In making the determinations provided for in section 50-57 above,the board may, in its sole discretion, appoint a hearing officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said hearing officer shall render a written report to the board within 30 days of the hearing, which report shall contain the officers findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the board, but the recommended order shall be advisory only. (Ord.No. 04-12, §8) Sec. 50-59. - Rights and duties granted by certificate. (a) The certificate granted by the Board shall be valid for one calendar year and shall be personal to the applicant and not transferable. In the case of a corporation, if there occurs such a transfer of stock or other incidents of ownership as to change the majority or largest stockholder, a new certificate must be applied for. Changes in the officers of the corporation will not require a new certificate. (b)' Acceptance of the certificate by the applicant shall obligate the applicant to: (1) Service the entire zone granted to the applicant. • (2) Provide coverage to adjoining zones, if available, when requested to do so by emergency dispatch for emergency calls when the certificate holder for that zone is unable to respond. http://libr .municode.com/print.aspx?clip Packet Page-1529-[Request=http%3a%o2P/o2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. (3) Keep posted at his place of business a copy of the fee schedule,which must be filed with the Administrator(if applicable). • (4) Operate in accordance with the rules and regulations adopted `pursuant to this Aye Ordinance and any applicable County Ordinances, and F.S. ch. 401, and any administrative regulations adopted pursuant thereto. (5) Employ at all times sufficient personnel experienced in operation and management of emergency medical services to ensure properand efficient operation. (Ord. No. 04-12, §9; O . No. 2011-36,§5) Sec. 50-60. - Renewal of certificate. Each certificate holder shall file within 90 days of expiration,an application for renewal of his certificate. Renewals shall be based upon the same standards, as thegranting of the original certificate along with such other factors as may be relevant. The renewal application shall be accompanied by a$250.00 renewal fee. The renewal certificate may be approved routinely by the board, upon advice of the administrator, or the board may hold a hearing on same. (Ord. No. 04-12, § 10) Sec. 50-61. - Emergency provisions. The Board may modify, suspend or revoke a certificate in the interest of the public • health, safety and welfare,only at public hearing and after reasonable notice has been given Ark to the certificate holder affected. However, if a situation exists which poses a serious threat that the Operator will not be available to any certain area of Collier County, the Administrator shall have such temporary emergency powers as are necessary to provide that service.These temporary powers are intended to provide interim protection until such time as the Board meets to resolve the emergency. (Ord. No. 04-12, § 11;Ord,No. 2011-36, §6) Sec. 50-62. - Classifications of certificates. There shall be three(3) classifications of service in Collier County, as follows: (1) Class 1:ALS Transport:ALS Rescue:An EMS Operator with the capability of rendering on the scene prehospital ALS services with transportt capability and who may or may not elect to transport patients based on medical necessity.An EMS Operator rendering this level of service for a governmental entity shall be deemed to be operating under the Class 1 -ALS rescue certificate of public convenience and necessity held by the governmental entity. An EMS Operator holding a Class 1 —ALS rescue certificate may provide post-hospital interfacility medical transfer services and routine ALS and BLS calls withiih the County. A certificate of public convenience and necessity must be obtained from the County before engaging in this level of medical service. • (2) Class 2: Collier County Inter-Facility Transport Services:ALS Transfer: An EMS Operator who provides post-hospital inter-facility medical transfer services, both Auk within and outside the County. If requested by the appropriate!Class 1 -ALS http://library.municode.com/print.aspx?cliff Packet Page 1530 IRequest=http%3a%2f%2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. Rescue Operator,will provide emergency pre-hospital backup service. ALS transfer certificate holders may provide post-hospital medical transfer services for routine and emergency ALS and BLS patients. Class-2 transfer certificate holders must either provide for their own medical director or contract with the County Medical Director, and will operate under protocols approved by the County Medical Director. If the Operator provides for its own medical director, that medical director shall work cooperatively with the County's Office of the Medical Director to ensure continuity of care. Class 2 Operator shall comply with all guidelines and policies approved by the Board of County Commissioners, and shall notify and work with all hospitals and facilities to educate them as to the services Operator provides. The County reserves the right to review and evaluate all calls made by the Operator to ensure that the appropriate level of personnel, supplies, equipment and vehicles are being utilized; as set forth in Florida Statute and Florida Administrative Code. (3) Class 3:ALS Non-Transport: a. ALS Non-Transport:An EMS Operator who renders Advanced Life Support pre-hospital services without transport capability. b. Class 3 certificate holders work in concert with applicable Class 1 providers to assure adequate and timely response to prehospital incidents with the intent to either reduce applicable response times or otherwise augment the level of services as requested by the associated Class 1 Operator. Unless an EMS Operator possesses a Class 41 —ALS Rescue certificate issued by the County, a certificate of public cbnvenience and necessity must be obtained from the County before engaging in this level of medical service. C. Class-3 certificate holders shall contract with the County for a negotiated amount per year for administrative services offered by the Office of the Medical Director for the creation and update of medical protocol; and other general support as requested by the Class-3 certificate holder. The Office of the Medical Director shall not be considered the medical director for a Class-3 Operator for purposes of this Ordinance or Florida Statutes unless the Class-3 Operator separately contracts with the County in order for the'County's Medical Director to serve as its medical director for the performance of services set forth in F.S. §401.265, and Chapter 64J- 2.004(4)(a), Florida Administrative Code. d. The medical director for the Class-3 certificate holder shall work cooperatively with the County's Office of the Medical Director to ensure continuity of care.The medical director for the Class-3 certificate holder shall not delegate or relinquish any responsibilities identified in F.S. § 401.265, and associated Florida Administrative Code rules. (Ord. No. 04-12, § 12:Ord.No. 2011-36, §7;Ord. No. 2012-04, § 1) Sec. 50-63. -Transfer or assignment of certificates. No certificate issued under this article shall be assignable or transferable by the person to whom issued except unless approval is obtained from the board in the same manner and • subject to the same application, investigation,fees and public hearing as original applications for certificates. Any majority transfer of shares or stock or interest of any person or operator so as to cause a change in the directors, officers, majority stockholders or managers of such http://library.municode.com/print.aspx?cli(Packet Page -1531-IRequest=http%3a°o2f%2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. person or operator shall be deemed a transfer or assignment as contemplated in this article and subject to the same rules and regulations as any other transfer or assignment. • (Ord. No. 04-12, § 13) Sec. 50-64. - Revocation, alteration or suspension grounds. (a) Every certificate issued under this article shall be subject to revocation, alteration and/or suspension of operation, buy[by]the board, for a period of up to one year, where it shall appear that: (1) The operator has failed or neglected for a period of 30 days during any calendar year to render all services authorized by his certificate. (2) The operator has been convicted of a felony or any criminal offense involving moral turpitude. (3) The certificate was obtained by an application in which any material fact was omitted or falsely stated. (4) The operator has knowingly permitted any of its motor vehicles to be operated in violation the laws which result in conviction of the driver or operator of a misdemeanor:in the second degree or greater, or has knowingly permitted a driver with more than two previous convictions to operate emergency vehicles. (5) The operator has failed to comply with any of the provisions of this article. (6) The public interest will best be served by revocation, alteration, or suspension of any certificate upon good cause shown. (7) The operator or his agent has demanded money or compensation other that • established and prescribed under this article(if applicable). (8) The operator has without sufficient justification failed or refused to furnish emergency care and/or transportation promptly for a sick or injured person. (9) The operator or his agent has been found guilty of malpractice or willful and wanton misconduct in the operation of its service. (b) All complaints shall be investigated and a report thereon made to the board,together with findings and recommendations, within 15 days. If revocation, suspension or alteration of any certificate appears warranted, the board shall give notice to the operator holding the certificate that the same will be considered at a Specific commission meeting, provided the date of such meeting shall not be less than five days from the date of the notice.The board shall thereupon consider the complaint and either revoke, suspend or alter the certificate or dismiss the complaint. (Ord. No. 04-12, § 14) Sec. 50-65. - General operating regulations. All certificate holders, operators, and drivers shall comply with all state statutes and administrative regulations as following regulations: (1) Twenty-four Hour Service. Every certificate holder shall be required to operate sufficient ambulances, or relevant apparatus, as stated on the vehicle permit issued by the State Department of Health, Bureau of Emergency Medical • Services and permit issued by the Board, on immediate call at all times. (2) Prompt Service Required. Every call for service shall be answered promptly. Patients shall be appropriately assessed,treated, packaged, loaded and http://library.municode.com/print.aspx?cli,Packet Page-1532-IRequest=http%3aolo2Wo2fli... 4/24/2012 Municode 9/25/2012 Item 11 .D. transported by an Operator that is licensed to transport without being subject to unreasonable delays. All calls for emergency assistance requiring over twenty (20) minutes from time of notification to arrival on scene shall be reported to the Administrator with complete documentation of the circumstances, which delayed the response. Those instances where more than three(3) minutes elapse between receipt of an emergency call and dispatch of an emergency vehicle shall also be reported to the Administrator with documentation of circumstances. (3) Bed Linens. Every Operator transporting patients shall provide clean and sanitary bed linens for each patient carried which shall be changed as soon as practicable after the discharge of the patient. (4) Daily Log. Every Operator transporting patients shall maintain in a daily log upon which shall be recorded the place or origin,time of call,time of dispatch,time of arrival at scene, time left for hospital,time of arrival at hospital, and charges for each trip made and such other operating and patient information as may be required by Ordinance. Every Operator shall retain and preserve all daily logs for at least two (2)years, and such logs shall be available for inspection by the Administrator. (5) Communications. Each emergency vehicle shall maintain two-way radio communication with the location of primary dispatch from which it operates, as well as any additional communication capabilities required by Ordinance or state law. (6) Vehicles and Equipment. Each Operator's vehicles shall be equipped with the proper medical and emergency equipment as jointly agreed to by the medical director of each licensed provider and the laws of the State of Florida. (7) Certification. a. In addition to the State of Florida Department of Health,Bureau of Emergency Medical Services requirements for certification, each Collier County EMS paramedic, Class-2 Operator's paramedic, and Class-3 Operator that has separately entered into a contract with the County in order for the County's Medical Director to serve as its medical director for the performance of services set forth in F.S. §401.265,`and Chapter 64J- 2.004(4)(a), Florida Administrative Code, must be certified by the County Medical Director. Each Collier County EMS paramedic and Class-2 Operator paramedic,that contracts with the County for Medical Director services, must work with a Collier County EMS ambulance for a sufficient length of time pursuant to subsection (8)for the County's Medical Director to properly judge the paramedic's capability. Salaries of other than Collier County EMS paramedics will be paid by the agency seeking the Medical Director Certification. b. All Operators, shall certify its paramedics pursuant to F.S. §401.265, and Chapter 64J-2.004(4)(a), Florida Administrative Code. c. Class-2 and Class-3 Operators that have separately entered into a contract with the County in order for the County's Medical Director to serve as its medical director for the performance of services set forth in F.S. §401.265, and Chapter 64J-2.004(4)(a), Florida Administrative Code,shall be certified pursuant to the terms of such contract. • (8) Ride Time Requirement. Each paramedic employed by a Collier County EMS, a Class-1 Operator or Operator that has entered into a contract with the County for http://library.municode.com/print.aspx?cli,Packet Page-1533-[Request=http%3ao2f%2fli... 4/24/201 Municode 9/25/2012 Item 11.D. Medical Director services must work, at a minimum, with a Class-1 Operator's ambulance not less than one full month's work shift annually. Each paramedic employed by a Class-3 Operator that has its own medical director must accompany a patient on the Collier County EMS ALS transport from scene to hospital when the paramedic for such Class-3 Operator initiates ALS services on a patient prior to Collier County EMS transport arrival or if the patient's condition requires that additional level of expertise. Each paramedic employed by a Class- 3 Operator that has separately entered into a contract with the!County in order for the County's Medical Director to serve as its medical director for the performance of services set forth in F.S. §401.265, and Chapter 64J-2.004(4) (a), Florida Administrative Code, shall either work with a Collier County EMS ambulance not less than one full month's work shift annually of must accompany a patient on the Collier County EMS ALS transport from scene to hospital when the paramedic for such Class-3 Operator initiates ALS serviceS on a patient prior to a Collier County EMS transport arrival or if the patient's condition requires that additional level of expertise, as provided for in its contract with the County. (9) Application. Each ambulance or ALS service shall be subject to those rules and regulation as promulgated by Ordinances of the Board for the purpose of carrying out this ordinance. (Ord. No. 04-12, § 15; Ord. No.2011-36, §8; Ord. No. 2012-04, §2) Sec. 50-66. - Place of business. Within 90 days of Certificate issuance, each Operator shall maintain a place of business which shall be entirely within his designated operating zone, at which place he shall provide communication with his vehicles, the Collier County Emergency Medical Services Alb Department, and his place of business, a properly listed telephone for receiving all calls for service and at which place of business he shall keep such business records, training records, vehicles, and daily logs available for inspection or audit by the Administrator. Every Operator shall keep on file with the Administrator and the County Emergency Medical Services Department a business address and telephone number at which the Operator may be reached at all times. This information will be maintained at the Emergency Medical Services Department. (O,ti. No. 04-12, § 16, Ord.No.2012-04, §3) Sec. 50-67. - Records to be kept. Every operator shall keep accurate records of receipts from operations, operating and other expenses, capital expenditure and such other operating and patient information as may be required by the board. (Ord. No. 04-12, § 17) Sec. 50-68. - Rates. Every operator shall file with the board a schedule of the rates. Such,rates shall be filed as a part of each new or renewal application, and a rate schedule shall also be filed when changes in rates are proposed. All such rates shall be subject to review and approval by the board. Ask http://library.municode.com/print.aspx?cli Packet Page-1534-[Request=http%3a%2f%2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. (Orel. No. 04-12, § 18) Seca 50-69. - Operator's insurance. Every ambulance operator shall carry bodily injury and property damage insurance with solvent and responsible insurers authorized to transact business in the State of Florida to secure payment for any loss or damage resulting from any occurrence arising out of or caused by the operation or use of any of the operator's motor vehicles. Each vehicle shall be insured for the sum of at least$100,000.00 for injuries to or death of any one person arising out of any one accident and the sum of at least$300,000.00 for injuries to or death or more than one person in any one accident and for the sum of at least$50,000.00 for damage to property arising from any one accident. They shall also have malpractice insurance. Every insurance policy or contract for such insurance shall provide for the payment and satisfaction of any financial judgment entered against the operator and present insured or any person driving the insured vehicle. Such insurance shall be obtained and certificates or certified copies of such policies shall be filed with the board. All such insurance policies, certificates'thereof or certified copies of such insurance policies shall provide for a 30-day cancellation notice to the board. (Ord. No. 04-12, § 19) Sec. 50-70. - Conduct of drivers and attendants. All drivers, EMT's and paramedics shall comply with the laws of the State of Florida, in order to meet the requirements set out in this Ordinance and no driver, EMT or paramedic registered hereunder shall: Pik (1) Fail or refuse to promptly transport, if applicable, or attend any sick or injured person after responding to a call. (2) Demand or receive compensation other that established and approved in accordance with this article or fail to give a receipt for moneys received (if applicable). (3) Give or allow rebate, commission, discount or any reduced rate not provided in the established rate (if applicable.) (4) At any time induce or seek to induce any person engaging an ambulance or ALS service to patronize or retain the services of any hospital, convalescent home, mortuary, cemetery, attorney, accident investigator, nurse, medical doctor or other service occupation or profession. (5) At any time release his patient from his care until he is assured that some responsible person is available to receive such patient. (6) At any time use a siren or flashing red light unless on an emergency call. (7) Disobey the lawful orders of the law enforcement officer at the scene of an accident, or other similar such emergency or at a fire scene,the fire officer in charge. (8) -Smoke while within the confines of an ambulance. (9) Operate or ride in a vehicle without using seatbelts. (Personnel attending patients are exempt.) • (Ord. No. 04-12, §20;Ord. No. 2011-36, §9) Sec. 50-71. - Passengers. http://library.municode.com/print.aspx?cliu Packet Page 1535-[Request=http%3a%o2fD/o2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. No person shall be aboard ambulances when engaged in emergency or routine calls except the following: • (1) Driver, attendants and fire or law enforcement personnel; (2) Patients; (3) Relatives or close friends of the patient when authorized by and EMS Battalion Chief or position of a higher rank.These requests will only be granted under exceptional circumstances; (4) Physicians and nurses; (5) Personnel in an observing capacity that are being trained for ambulance or ALS service; or (6) Operator's supervisory personnel. (Ord. No. 04-12, §21; Ord. No. 2011-36, § 10) Sec. 50-72. - Obedience to traffic laws, ordinances or regulations. (a) Under the provisions of Florida State law, the driver of an ambulanceor ALS vehicle when responding to an emergency call or while transporting a patient may exercise the following privileges when such driver has reasonable grounds to believe that an emergency in fact exists requiring the exercise of such privileges: (1) Park or stand, irrespective of the otherwise applicable provisions of law, ordinance or regulations. (2) Proceed past a red light or stop signal or stop sign, but only after slowing down as may be necessary for safe operations. • (3) Exceed the maximum speed limits permitted by law so long a$he does not endanger life or property. (4) Disregard laws, ordinances or regulations governing direction or movement or turning in specified directions so long as he does not endanger life or property. (b) The exemptions herein granted shall apply only when such vehicle is making use of audible and/or visible signals meeting the requirements of this article, (c) The foregoing provisions shall not relieve the driver of a vehicle from!the duty to drive with due regard for the safety of all persons, nor shall such provision$ protect the driver from the consequences of his reckless disregard for the safety of others. (Ord. No. 04-12, §22;Ord. No. 2011-36, §11) Sec: 50-73. -Violations. In addition to the remedies provided herein, a violation of any provision of this article shall be punishable as provided by law for the violation of county ordinances. (Orri.No. 04-12, §23) Sec. 50-74. - Uniformity,of application: The article shall constitute a uniform law applicable in all of Collier County. • (Ord. No, 04-12,§24) Sec. 50-75. -Authority to enforce. http://libr• .municode.com/printaspx?cli,Packet Page-1536-Request=http%3a%o2fD/o2fli... 4/24/201 Municode 9/25/2012 Item 11 .D. It is hereby declared to be the duty of the Board of County Commissioners of Collier County, its officers, agents, employees and other governmental agencies, the sheriffs department of Collier County, its deputies and agents, fire departments, as well as the police departments of the various municipalities falling under the provisions of this article to strictly enforce the provisions of this article. (Ord. No. 04-12, §25) Secs. 50-76-50-100. - Reserved. FOOTNOTE(S): (66)Editor's note—Ord.No. 04-12,§26, adopted Feb. 24,2004, repealed divs. 1 and 2 of art.Ill, §§50-51-50-68, 50-76-50-86. in their entirety. Sections 1-25 of said ordinance enacted similar provisions to read as herein set out.(Sack) (66)Cross reference—Businesses, ch. 22;health and sanitation. ch. 66. (Back) (65)State Law reference—Medical transportation services, F.S. §401.2101 of seq. (Back) • http://librarfy.municode.com/print.aspx?cli Packet Page-1537-(Request=http%3a%2f%2fli... 4/24/201 1 9/25/2012 Item 11 .D. T ., 01 { f It • i I Corres •orideHce j T' S `k . E I f kl I i n I I. I "z t PacketPage-1538- 9/25/2012 Item 11.D. { ca ,er co-�.nty Bureau of Emergency Services March 27,2012 Mr.Joseph DeSimone Safe Care Medical Transport 14 Walnut Street Danbury,CT 06811 Phone:203-748-7574 RE: Collier County Certificate of Public Convenience and Necessity Dear Mr.DeSimone, Collier County has received your application for a Certificate of Public.Convenience and Necessity for ambulance services in Collier County.. Additionally we have received your check for the application fee. We have reviewed your application,and I have the following questions that we request a written reply and/or amendment to your application. 1. It is not clear to us in your submission what Class service you are applying for. Please clarify. 2. The application denotes that you will provide services to the entirety of Collier County. We would appreciate clarification as to whether you will be transporting patients in-bound to Collier County from other facilities in the region as well as out-bound patients. 3. We only see one ambulance vehicle noted in your application referenced as a 2007 Uplander ambulance with an out-of-service notation. Is this the only vehicle that you intend to provide services within Collier County? What is the status of that vehicle and is it licensed with the State of Florida Bureau of Emergency Medical Services? If other vehicles are to be used, please describe and provide a VIN. 4. The application denotes that you will be using your dispatch center in Danbury,CT to dispatch and manage calls for service in Collier County. From a customer service view,this causes concerns as to how local residents or.facilities will call for service and coordinate the deployment of vehicles and address billing issues. We would appreciate more information as to how this dispatch and customer service effort will be managed. • 5. We note in the application that you will be doing business as Safe-Care Medical Transport, located in Ft. Myers, Florida. It would be helpful to know the extent of your operations and services in the Ft. Myers area and if you are providing services to Lee County,Florida. B'S 8075 Lely Cultural Parkway•Naples,Florida 34113 239-252-3600•FAX 239-252-3700•www.collierem.org Packet Page-1539- 9/25/2012 Item 11 .D. Letter to Safe Care Medical Transport �.. March 27,2012 Page 2 6. Your rate structure denotes a "Base-Rate"for Advanced Life Support and a higher"Level-2" rate. Please clarify what constitutes a Level 2 charge. 7. While referenced in the Ordinance and Florida Statute,we would appreciate additional information regarding specifics as to who will be serving as your Medical Director and his/her experience and license to practice in the State of Florida. 8. In your application you reference the availability of a bariatric-capable ambulance based on need. Please explain how you would quantify the need and availability of the bariatric ambulance. Thank you for your assistance in this matter. Should you have additional questions or concerns, please feel free to call. Sincerely, Dan E.Summers,CEM,FPEM Aellot Director Packet Page -1540- , 9/25/2012 Item 11 .D. y E Safe-Care Medical Transport Inc. i 3581 Veronica Shoemaker Blvd. Unit B Ft. Myers, FL 33916 1 April 9, 2012 1 1 Mr. Dan E. Summers 4,f ` rt '° �� Bureau of Emergency Services 8075 Lely Cultural Parkway Naples, Fl 34113 '' 4 \s, RE: Rea ► r ,£, r g t ,ns dated March 4 12 '""„:,'r„`# ` } ` i G w 1. a -60,4.4. J� - a c �° r g Y -_ , Y � ,- '. u, , 'l In t' Y?Y��Y"�pp �,b'ti ��'�Y15Ti� � -f ,, Cr #-: ly..r” L ,, - .,.t1X v. ;, -, �..4"'Si'.f„.�Jl'+? X 177 1�r r'~ 4 r r('1 rs++� �' �a n,v �d* ' se 4 gf J"�W, . ,,,,s,! ,„ yt .. i Dear s E fl g r f. ,e��, r v _ s Y w, tv 1` e,-a�r '"p .N. r c i aPl _ '.r ..41- r t.iz-4,4 W +45 , x ? 4ubWs+ E ",tM. ., t ii.. C� , '"_ 3 '''-\.1 ,fin rr Jx', Y't 1 Y ,''-', �. f n•I have received4 ` ° "'for your review w �' �; � _,. �,�, 2012 I � ,1� P a of the application I 'r f $' , k iii ate of ' h x . -',ce . - ter, ce and Necessity. 7i 2F i I will attempt to as tho ,. - f ,ll list them in a the same order t ,b !' -4 j 4 ,.. rr' F ''1,TO ,7,f,' `,--,'''' 4.:O'^ i t J C``) ,.`, `12 � ra ,S�k� 1 a ratio a . i ;.Elymg oa mod+ r. 4-. ' 4,, t, b ¢ 1 , . will aj 1 ry "fir z 1:-:� L • ..t?.� � • r. r ,:.:.r., ,y, -+ YS .x�.r r "vs tW r� 3 vt t� a .� e 3'RS i-b.' 4� jM1}3F ,k� + 1 a 7'€ sir e t a •',;z emu s neea °C g!s ,,,:111111u,tl e n in • �' d out L; the need 3) The_ i•ulance you have ,r:.ill l d from our flee ` =."er. I do have 2 other Ambulances that 'is provi," ,transportation, both of which will be registered with the Fiona- 1 of _-,,t...--,..• ,- a cy Services upon approval of said application: >i T; _ 1 a. 2006 Ford Type 2 "' . ., , z... ' 12 b. 2006 Ford Type 2 1 N. S34P61 'it 2911 4) The dispatch center that we will be utilizing will be located at the approved location within Collier County to better serve the residents of that county. The Danbury Connecticut center will only be utilized as a back-up center in cases of catastrophic failure of the primary center. This will allow us to have several i IIImeans of back-up systems in place. The center will be staffed 24-7 with a 1 1 , Packet Page-1541- ; 9/25/2012 Item 11 .D. Cl" 4 i e° 1 4 , 1 I • highly trained dispatcher that will serve as a call taker and dispatch the ,• , Amok ,. -o,od ; appropriate staffed ambulance to complete the request for service. 1 5) At this point Safe-Care Medical Transport Inc. has a location within Lee County that has no activity.A future application for a Certificate of Public .; Convenience and Necessity may be submitted however, upon the approval of the certificate in Collier County Safe-Care Medical Transportation Inc. will ... . . ,. . . locate the headquarters tarfittk''' site within Collier County to service '. .,..' 4. .:„.-i.,....-!..... ....; the county to the best of ..--, ,,..,,,,. -..•,.??.,,,,k ..:;...1.,,at-,,,,,.,,L. 1 . 6) Advanced Life Support -7-7*--1--'--_'.-;:;-(rAL -.;'; .''''''M-6ans either transportation by groundi ' .;„,no...... „•.,:k44. ambulance vehicle, supp c?-•:.---;.,,`. serviiritts.ond the administration of at least . •;y . i ... sit‘litis ., . • three medications by in. .•-:' ., ,;.,• pu or by continuous*fusion -;. „ -- . ;44.- . . xel o - - - cryli6--' /- ;- ' crystalloid, h r. 5 I MC, 1., ,pwiand hypertatnc,.. ;‘,:_,, ...,:, (Dextrose, ] ' ,,,,'-.•,.-'1.:,-S*7;.- -, 4i::.:'r ,5■LL'f':;";.;:i-.:.3 . ,:::',', :I NM. :10.: ; Rimers Lactate); or triefortation, 0,;- ',;.„...- •-, :': ' -. 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" ,-.7..,:it.:4,.- • ,,,,z;.4•F?.., ..•;4.. 41, ' g,Vu.-;:;',•''• .cal 1;;t' '' -4 - ,03.4?.c, k::' 'wag in o,.. .,olerg- („ , 44,-, 14,441 at Co u .4 ...-,,--4"•!. : ,-••• '•,, -I cal t,,.,,,..,..;.,.:4,... :.,,. At.6.1,,,,,,,H- .• -1,i.-.1/4, . &'C'`I''''':4-:':g11144-171.-c1124:1 4 ,,"'1,7t..,...'': 7', .:74*^44-44 V f,,,-tP*7tr:,',---" ,... ...., 8) A !J ‘.,...,,' •g trend through.-:,;,'4,,,•-.ine ' rtation servic need for 1 -;.i,;•-,;:4:4:?..:10%:.:This bariatric transportation s ,;,,,-:.:;i- i rideitas strained the ambulance services 1 . -N', ,.,;','-':::- . 4---:-?, due to the special equi. • ; -,,,,,;,,,; is o - --", -o -: to assure the safe transportation 11 . .•-•:L=-.=;.;;-',-; ,1 for every patient that is s- -,-:',-..- o in-;;.-;..,,,•,.:=.'-''.- ; er.Also maintaining a high level „.... .; ,-,;---,',. 7,1 ,•';.;;;‘-i-,-•; of safety for the crew that -,,$--43e. , •,t,.,; .. I. the transportation is vital as well. I 41.i••.„.•....•., ' - • '-4” 1 ,,.;,,-;.7 • Safe-Care Medical will re y on e person requesting transport to communicate I patient details and through the interview process completed by our dispatcher the need for bariatric services will be assessed. If bariatric services are requested only personnel that have been tram' ed to this level will then be • dispatched to complete the call. ; i ommot, 11 i , i Packet Page -1542- . 9/25/2012 Item 11.D. Co per'County Bureau of Emergency Services May 29,2012 Mr.Joseph DeSimone SafeCare Medical Transport,DBA American Medical Transport 14 Walnut Street Danbury,CT 06811 RE: Amended-Collier County Certificate of Public Convenience and Necessity(COPCN) Dear Mr.DeSimone, I received your letter dated May 14,2012 on or about May 21,2012 regarding your amended application for a Certificate of Public Convenience and Necessity for Collier County intra-facility transports. Your amended application via cover letter advises that your previous application under the business name of SafeCare Medical Transport,a Florida Corporation,was dormant and you have elected not to use that business name for your application. You have clarified that you will operate under the name of American Medical Transport(Company or Inc.)that you will establish within 90 days. You will operate that organization with your personal line of credit based on the information you have provided. It is my understanding that you do not have a local place of business established yet,but that it s your intention do so in accordance with local business regulations if a certificate is granted. As we have discussed,should your organization be granted a COPCN in Collier County by the Board of County Commissioners you would have your organization ready for business operations within 90 days of the granting with rates posted,localized dispatch operations,confirmation of a Medical Director,and a certificate of insurance and other requirements met as noted in the ordinance. While not required at this time,I would ask you to consider submitting a new application packet that provides clarity with regard to the agency name and other items corrected in the original application as we have discussed.This new application would help eliminate any confusion between your original submittal and these latest revisions such as name change,line of credit and vehicles,etc. There would be no additional fee for a corrected new submittal. Please advise me in writing,should there be any clarification or further amendment to the recently amended application or your intentions to provide a new submittal. Sincerely, Dan E.Summers Director • Bateau dBnegenrySwims INIIMMIS • 8075 Lely Cultural Parkway•Naples,Florida 34113.239-252-3600•FAX 239-252-3700•www.collierem.org Packet Page -1543- 9/25/2012 Item 11 .D. Co -te-r County Bureau of Emergency Services July 24, 2012 Mr.Joseph DeSimone SafeCare Medical Transport, DBA American Medical Transport 14 Walnut Street Danbury, CT 06811 RE: Final Collier County Certificate of Public Convenience and Necessity(COPCN) 1 1 Dear Mr. DeSimone, Since our last correspondence and telephone communications, I am noting your application as your final submission. I will be moving the application through our agenda system for presentation to the Board of County Commissioner for a future hearing date. I cannot guarantee in this correspondence j when the Board will hear the application; however, it is my personal goal to have this heard in September. Our Board meets on September 11th and September 25th. 1 am sensitive to your travel plans, and I will do my best to verify the meeting date with you as soon as possible. Sincerely, Dan E. Summers, CEM, FPEM Director e w o.cys•^10.=� SES 8075 Lely Cultural Parkway•Naples,Florida 34113.239-252-3600•FAX 239-252-3700•www.collierem.org Packet Page-1544- r 9/25/2012 Item 11 .D. a r !kk t f F 4. R erenIces f t t 4 h Y I k• k t I 1 i ti , k • .a N ,I Packet Page-1545- k .-,1,.4• : :: { Apr, 11. 2012 5: 10PM DANBURY AMB BILLING N 9/25/2012 Item 11 .D. 14 Walnut St Danbury Ct 06811 Danbury Aft 203 748-3433 Ambulance ,a 203 790 6562 fax Service Fax a Pax: Z 3 9 - a 5-2_- 3 20 c> Pages: Phone; pate: 1/// f/ { Re; cc: r !1 0 Urgent or Review 0 Please Comment 0 Please Reply 0 Please Recycle II J 12_4 G 1,n�e C c ECG c ! N/ C'rh e iio • p 2/i-Pg. 1 o s7 . 1\1aVl �i FLa . •3cv/i6 Zv7 - 2 ! )- 5-9 G ItegivA 6- f,To i . L 61-v t SaK-". /Ja, 1les pig 3VIvZ 4.39 _ 001 -7 pit `.har' 5°„f t, Thank You S G0 (1 i Nix s, %�6i • 3 4/ ate' C7� O • , d j • ql■ a39 I O i r Packet Page-1546- 9/25/2012 Item 11 .D. Certificate of Public Convenience and Necessity-Application Safe Care Ambulance Service—Notes-des • Reference checks completed on April 24th General questions were asked: • How do you know the applicant? • What experience do you have or can you relate to the applicant with respect to ambulance service or business. How long have you known the applicant? Approximately a year. • In your opinion,does the applicant in your opinion have enough experience and capital to properly operate an ambulance service in Collier County? Thought the applicant had experience and capital. • May I contact you if I have any additional questions? Yes. 1 • Do you have any other comments you would like to offer about the applicant. No other comments. 15L Reference: Michael Slade: • How do you know the applicant?Serves as his commercial real estate agent.'; • What experience do you have or can you relate to the applicant with respect to ambulance service or business?Only worked commercial real estate with the applicant was aware that he operated an ambulance service and was working to do business in Lee County. • How long have you known the applicant? Approximately a year. • In your opinion,does the applicant in your opinion have enough experience and capital to properly operate an ambulance service in Collier County? Thought the applicant had experience and capital. • May I contact you if I have any additional questions?Yes • Do you have any other comments you would like to offer about the applicant? No other comments. Packet Page-1547- 9/25/2012 Item 11 .D. 2"a Reference: Deborah Galdehue: • • How do you know the applicant? Does not know the applicant very-well, wotked on a referral from a commercial realtor to assist in possible selling of a residence in Collier County. • What experience do you have or can you relate to the applicant with respect to ambulance service or business? No knowledge of the details of his ambulance service. • How long have you known the applicant? Approximately 1 year. • In your opinion,does the applicant in your opinion have enough experience and capital to properly operate an ambulance service in Collier County? Could not comment,but knew he was busy with phone contact of his ambulance service up north. • May I contact you if I have any additional questions? Yes. • Do you have any other comments you would like to offer about the applicant.—No other comments. 3rd. Rachael Cuccinchellio • How do you know the applicant? Family member-His brother, married her sister. • • What experience do you have or can you relate to the applicant with respect to ambulance service or business. Has not been a client, but knows that Joe is kind and caring. • How long have you known the applicant? Over 15 years. • In your opinion, does the applicant in your opinion have enough experience and capital to properly operate an ambulance service in Collier County?Stated he was very experienced in ambulance service up north and wanted to move to Florida. • May i contact you if I have any additional questions? Yes • Do you have any other comments you would like to offer about the applicant. Has done a good job up north for years. Danbury EMS Director was contacted and a call-back is pending: • Packet Page -1548- 9/25/2012 Item 11 .D. 4 C 1 f Y� Y,r Arnendw°• Application & Nam ; Chage • • • Packet Page-1549- _ ■ . ; . . .. .....,....„,... . 9/25/2012 Item 11 .D. . • 4 .. 4.., / 1 i s 1 AM* American Medical Transport May 14, 2012 RECEIVED mg 21 201Z ., 4 Mr. Dan E. Summers ! --,.T.,,,,,,.---. ,,,,...,-.;.--i-5 -.1 Bureau of Emergency Services ,:-.k??.,.,;,,,.,,,,.?:,.5,::,,,,,44;?- ;,,,,,s-,... 4, 8075 Lely Cultural Parkway EMERGENCY MANAGEMENT , - ,..:_i;Y---'''"'-----'1,;T:ei..f.-.:_..:,:::,f.:4_ Naples, Fl 34113 v-4,,;*:.-;:::',,,!.:•,.-. ':9`,,, ',...--,--,..:-. I ....v.k.'-:., RE: Reply to g, ow up questions 4 ;.:4- ..';:-;"::;...;,i.1".....'.1:',',--..- ::y?;..„2:-. -',7.,-e.:(VA.;,,":1;;',•:: 4-:,.:,;;:ii; '44:C*01- DearMr. .., , .t‘,,-,,:,,..5,...,.:,e,---.,. ,.,, ',,,,i -,:',..,- ,...-.:::1,-„,,.-1-,:,.,,,,,2' _4„1-,,..,.,,,,:,,s4:4-.00;;.,,,,,,,,,row.4;14:, •• , ..i.:,,i,, ;',,i.:::::,-.'..':-....-...:,....-;:•, ::1-.5.:-.,,,-,.':;„:::.,.,:,: :-r,:-..•,,,,,„.,,. :...; ,,,<, ....., . ..,,,;.-.,,,..:-.1,,,,,,,.:4-T,,,,..,,,,, “.,-, , I do e 7-. :..:i.i,,,,i.,.,??\0,1,.14,4,,t,“k: ..i 1 to the are.- '±itsintlir4,k7;4,kv,, ,,4....,,, !,.... ,, a..,. , . ..-f: '-.' . . . . , ,-IP,--_,i,.:6-4--,-,i,,,i4f..4k7, i'4^'"' r-'' ''''"%3', '''.'''';'.k'' ..':'''''rt- ion wi,' -,-5 t t ' ,., ,. - s . .`0,,y ,''':'I* .t" ;1'. ,-' ';'°' ', ',,, !..'',.,.',... ',1;:.,..4: 'Ir'!4.,-!;' ;:,::..,,,,^4,p...; will --*t-:-:..X--, ;.,..".; ,i ,,- -',. -:, .t_:.:--',' .. 9-1.....; ':-. 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"..--;:-':;.:4,..!:'.7.,-1-„`44 .'•'..,,z,.7*:-: at i . -,--,...- ..:,3ti'V:;' ,;:' -.1.pli;T:Pkt,': '' .-ff:P:‘.. ,01.0.4:'-i.1(f.r.:,0,5gOr anytime. =:-...,::.,,...,,-7,4,-'',,- , , ,-- ' . ,, :f ,••ki,--',-,:',:,!:,-.::--',:-: -,,,,,,,,T,-. 401,!.;,•4,I•n...:- - .,)'[ 1174,,,ikg .; i .,.., i . ....-.-':: .‘..::::rigZi2-',.- :,;.•..,..):i-f-::',:;: ,-:f.--,..., .:-.*Ii.t..3::-..::;',.',..,?--:;i:. Sincerely' n 13,..4:g.t4- ';',,:..,:: :::=;::::: 1 , i Joseph DeSirn. one President • American Medical Transportation 1 F 239-259-7042 k , , 1 i Packet Page -1550- , 9/25/2012 Item 11 D . I 1 i ( i 1 As you are aware Medicare and Medicaid regulations require that health care providers give a choice to users for non-emergency BLS services. Safe-Care Medical Transport Inc. would like to fill that requirement and create competition within the county ultimately mandating competitors to provide better care, higher quality of service at a lower cost which would only benefit the residents of the county. The high quality of service fostered by the competition to best serve the citizens of the county. ',1. I ,4.1::ZI"J.=,4r,i ...:,,, Again thank you for your time and.-:."-_;-,,r...,:: Ice with this application review. 1 i .-.. . :::Y::„.,4-,_:‘-. I Please feel free- • contact me at . 1,t.,... ,,, if you-Should have any further4Oestions or 1 . .,... .-..,:--.----- . .. , c questions,...... ......„ concemsJ I :t.t..',;-.--t 4', ard to speaking-to you soOrt,1;.,-:!'::::. ..,,, -;--,,it. ii:4-',7:= i -'`,;..,..;`;,,,-....'f,,,,':!;-.!;.-.',.' . ,,,,,,,„z•iiiYti,: 4%,,,It,,,.A.,, ,,,,,,,, ,::;;;‘,:.,;;;;;;„;.......'„:,,k,f,..",,i,1:::,,,;-,!;.1:',f:::;;1'.'::::::!..'7,:11•;..-, s,,,,...:,,,;:,.„ ,i::',,.. -, ,iiiii;:,,;;;':::;,;.:,-,43,,'," ,,..,. ti_,,,,;-:,,,;,- ,,..,.:21.i$7,:i.:7./.4,7;71:.cr,-71.:4,,:ii,'v,--;.:14:4041.1..t,,,:$2,4.:::,, 1 -:..,.--,.:' ,,,,,I.il!,,:v;i",„;,.';',:. .,,1-_-:,:.:',...'.,:::-,;:,;_.-....,,,,_^',* :'I.::,. ..;,:::f.;;: i.L,:".....,:::: ...,,:.,,..44;';;'±',14 ,;1';'. .,::,-41;"''!`.1.,454Pi'g'• - 1 Since i;4'-';'. • .., 14H...g.-.rei :,.,:,44:#:14:',''. T!,;1 ., -l''' ', ■47.','':'?''''.-2-•,,"..7%-;V7i747 ...4.4";;;',,.:',r1.": C:'• -''".4'.4. -''''''4.;;:',1-'7":\ el',.'-r-gtt4,:"TS'4Y7SY4ft441;X:: •70'.'7'44,44';',A'!"'. , 1 fif''':'-'7 ":::.,-.V. ,-;Of.:4!g-7.. '..,-,3?...;::4. 47,;,',,,,:''''ff... ;-''',... ',':';':',.-1::16,44" ,;g:4;1;t:,,,t,1":;1■P''''''' 1 ----- '.:-:,''‘.'•!?,$-. , , Joseph DeSimorte,,,,-,:;:::'=: .,40,:i: T,--_:::. ' N Presidento . , .-7:::;;:-._,-,...!*/,,,-6::-..::_ti:-‘• ,..'4?.-::"-,:=3/41.-11_,... --,-.:: 21;?:.'... ':.:..e..-.-'.''''7.-`4%4:14:■i"rii%"0'. . .4%,-'..4''' ,,. ,.. ,-.,;.;:` :■.^4.3".•:,-,',.4''' '''''',...;"i".:':'!:.,;::, ;;;',:'''':,,f.' '..;:t3.." '-',;',ii,,:.,:1, :?-''.,.!..2,:,.,=..'' .1 :` '' .8,e:Ei“..,PZ;ifl,..:,::-t-t4.Wetato-4 i` i sate-t.;. -,,.:-,-,..,:.,-.'.-_-:fl.tr.t.,,,,,,,..,', 7? l'7'.'',''"'7. 1.,./.;,F.v- ''',:q.:,:.':--4:7;7.-7';';':S.:24'4'''''''4*.'-' :','.0..c,74*iq4i,,,;:liet t'!.■54:74.,7!t''''',0'..,,,,a,.; 203-,--..;'.:•-.'_. 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Savings Bank Amok May 11,2012 To Whom This May Concern, Please be advised Joseph De Simone has a Home Equity Line of Credit with Union Savings Bank. The HtLOC was opened May 6,2010. Sincerely, 4 1 , -4440 4111%, .4111 ota, Stacy Ashby Assistant Manager 203 730-6377 79 Stony Hill Road Bethel,CT 06801 I 01110 .5V-r:>-,Zgattei*ig}Atgtlai*j-,R%IWWIKN,?VhiSkkr*WiirOW,i,:W-InZOR:';L 1 1 Packet Page-1552- aMay. 14. 201251 5:36PNb0372DANBURY AMB BILLING CURTIS,_I INANCIAL. SER N 9/25/2012 Item 11 .D. D NBLE MIBaLmcE MOE INC NAM COiaLA ,+M,�IP�►T Retirement Account Update M AXA EQUITABLE BANBI�YGTO6R,1•A62, redeftrlag/standards January 1, 2012 -March 31,2012 DANBURY AMBULANCE SERVICE,INC FlatklpentManbf COW Your Ref.et nrasre PWezrrsso WAYNE CURTIS,CHFC,CLu Ortredr f0 AXA ADVISORS,LLC 014976 1266 EAST MN STREET 8TH FLOOR JOSEPH DE SIMONE AXA EQUITABLE STAMFORD CT 06902-3546 31 SHELLEYRO 203-731-3084 gE1HE1 Cr 06801.3215 waynaatrtlethera-advlsorecam Adtakw/Atstsun,fd AradabFe 1y lbndeitg www.axe-equ)table.com 1-800.528.0204 Automated Telephone Service(1 s) Your Retirement Account At A Glance Plan News L .. Account Value on March 3112012 $115,592.63 Asset Allocation:A Smart Strategy far Managing Your •aro nor rued eaieodo red,-lo-om Investments Beginning Value $115,249.83 $115,249.83 Allocate-Asset allocation Is a way to help diversify your + Investments among assets to help manage risk,potentially enhance returns,and to help meet your long-term Investment EfilladAilaglaring 1, ,, Diversify-A diversified asset allocation portfolio consisting of asF_ va rious asset classes,such as stocks,bonds,and cash equivalents, - ,...- can help balance returns over the long term.This Is possible maw - S because the returns from better perforating asset classes offset the - e 14,713.58 14 713.5;. returns of poorly performing asset classes, Ending Value $11 4iwa!: Rebalance-Over time,your portfolio could drift from Its target Personal Rate of Return' 14,40% 14,40i allocation.Therefore,your portfolio,as Well as Individual Mgr... lees,Whet deafeennaedts investment products,should be periodically rebalanced. Includes teen repermeds If applicable AXA Equitable Ufa Insurance Company 1Y,NY). Distributors:AXA Advisors,LLC and AM Distributors,LIC, GE-67443(3112) For plans that offer the Guaranteed Interest Option(010)as an Investment option under their contract,the transfer restriction for funds out of the 010 to another investment option offered in the .. contract will continue to be waived end Will remain In effect until further notice. • If you believe that there is any Inaccuracy or discrepancy in your account,you should report It to us immediately.You can Inform us by telephone at 1-800-528-0204 or In Writing or contact your broker-dealer,However,If you report the Inaccuracy or discrepancy by telephone,you should reconfirm In writing to further protect your tights,Including rights under the Securities Investor Protection Act (SIPA). 1 1 MT 0:1067d se April s,2012 Page 1018 AXX..00100'.011Se/5004.339 09_SA999.TRCAXXOI.CLVP0000000007 81+606....0000000007JOSEPII.OE.SIMONF Packet Page-1553- ■ 9/25/2012 Item 11 .D. 2011 FOR PROFIT CORPORATION ANNUAL REPORT FILED Mar 08, 2011 DOCUMENT# P95000019134 Secretary of State Entity Name: SAFE-CARE MEDICAL TRANSPORT, INC. Current Principal Place of Business: New Principal Place of Business: 3581 VERONICA S SHOE MAKER BLVD FT. MYERS, FL 33901 US Current Mailing Address: New Mailing Address: 14 WALNUT STREET DANBURY,CT 06811 US FEI Number:65-0565806 FEI Number Applied For( ) FEI Number Not Applicable( ) Certificate of Status Desired Name and Address of Current Registered Agent: Name and Address of New Registered Agent: DESIMONE,JOSEPH 1333 MONARCH CIRCLE NAPLES, FL 34116 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date OFFICERS AND DIRECTORS: Title: PRES Name: DESIMONE,JOSEPH Address: 1333 MONARCH CIRCLE City-St-Zip: NAPLES,FL 34118 US I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes;and that my name appears above,or 1 on an attachment with all other like empowered. SIGNATURE: JOSEPH DESIMONE MR. 03/08/2011 Electronic Signature of Signing Officer or Director Date Packet Page-1554- 1 9/25/2012 Item 11 .D. • . 11 • • • t;S Application • Packet Page -1555- .ate m�.x:. - wee...._saa�,a..ar. ..�e,ern. �,,.re ., ... �.,. .•,,;,., _..:.., ,��, ,�. -.. .. �.,�.�..�r - n- _: .... „„„a.... 9/25/2012 Item 11 .D. 1 • APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY FOR AMBULANCE SERVICE • COLLIER COUNTY APPLICANT: Safe-Care Medical Transport, Inc. . 3581 Veronica S Shoe Maker Blvd • FT. Myers,FL 33901 Packet Page-1556- • 9/25/2012 Item 11 .D. Safe-Care Medical Transport, Inc.—Collier County COPCN ��... 5/»...,.. I. INTRODUCTION. `.- In accordance with Collier County Ordinance, Section 50-55, Safe-Care Medical Transport, Inc. ("Safe-Care")hereby requests a Certificate of Public Convenience and Necessity ("COPCN") for a Class 1 Advanced Life Support Ambulance Service. Safe-Care is wholly owned by Joseph, Victor and Angelo DeSimone who are also the owners of Danbury Ambulance Service, Inc. ("DAS"), 14 Walnut Street, Danbury, Connecticut. In 1978, Joseph founded DAS and for the last 34 years following, has successfully served the residents of the Greater Danbury area with the highest quality of pre-hospital care the industry affords. In 1996, Mr. DeSimone purchased a home in Naples, Florida. Recent experiences in his Florida community have compelled him to action and resulted in this Application. As the following information describes, Mr. DeSimone has a long and proud history.of developing and maintaining vital pre- and post-hospital Basic and Advance Life Support ambulance services. This Application seeks to bring Mr. DeSimone's experience and expertise to the residents of Collier County while enhancing and stabilizing the availability and accessibility of pre-and post- hospital ambulance transportation resources. { 7t 1 1 Packet Page -1557- 9/25/2012 Item 11 .D. 1�1 Safe-Care Medical Transport,Inc. —Collier County COPC /25/2 _..�. H. APPLICATION INFORMATION. 1 i 1 The name, age,-and address of the owner of the Operator, or if viorsiv the owner is a:corporation, then of the directors of the corporation and of-all the stockholders holding more than 25% of the outstanding shares or governmental unlit;ihiv:infotmatioteshalL be supphed-for members of the gove:; g body. Response: Safe-Care Medical Transportation, Inc. 3581 Veronica S Shoe Maker Blvd Ft. Myers,FL 33901 Joseph DeSimone, President 1333 Monarch Circle Naples,FL 34116 33-1/3%Shareholder Angelo DeSimone 519 Winding Brook Farm Road Watertown, CT 06795 33-1/3% Shareholder Victor DeSimone • 1353 Purchase Brook Rd. Southbury, CT 06488 1 Ala* 33-1/3% Shareholder • Ask 2 Packet Page -1558- 9/25/2012 Item 11 .D. Safe-Care Medical Trans. I rt.Inc.— Collier ounty COPCN Z. The boundaries of the territory desired to be served. Response: The entirety of Collier County,Florida. • • • • { 1 3 • Packet Pag e-1559- Y 9/25/2012 Item 11 .D. Safe-Care'Medical Transport, Inc.— Collier County COPCrJ hppu‘aL1vu 3 The number and brief description'of the ambulances or other vehicles the applicant Adoma will have available: •' Response: Safe-Care proposes one Advanced Life Support ("ALS") ambulance, to be staffed by one Emergency Medical Technician ("EMT") and one Paramedic, twenty-four hours per day, seven days per week. This ALS ambulance will be available for Basic Life Support("BLS") and ALS emergency pre-hospital transport as well as post-hospital BLS and ALS transport. Additionally, ; Safe-Care expects staffing one BLS Ambulance as call volume warrants. Depending upon need, Safe-Care anticipates providing a bariatric-equipped ambulance for patients that exceed 500 pounds. Upon the granting of this Application, Safe-Care will immediately, publish and actively solicit the employment of four full-time and three part-time EMT's as well as four full-time and three part-time paramedics. It will also allocate and deploy available resources and equipment from DAS to supplement those resources needed in Collier County. 1111k Ank • 4 • Packet Page-1560- 9/25/2012 Item 11 .D. Safe-Care Medical Trans•ort. Inc.—Collier Co tv COPCN 4. The address of the intended headquarters and any substations; Response: Safe-Care intends to identify a location within Collier County upon the granting of this Application,but not greater than 90 days after such application is granted. 5 Packet Page-1561- 9/25/2012 Item 11 .D. Safe-Care Medical Transport, Inc.—Collier County COPCN 5 The training and experience of the applicant. Response: 1 Overview The principals of Safe-Care are the founders and owner/operators of DAS, a private ambulance service serving the Greater Danbury, Connecticut area since 1978. Currently, DAS employs more than seventy paramedics, emergency medical technicians; dispatchers and administrative support personnel. Additionally, DAS provides on-station paramedic staffing to supplement volunteer organizations in Newtown and Trumbull, Connecticut. Ambulance Transport Services DAS is the primary ambulance resource for Danbury and New Milford Hospitals,both of which are located within the DAS catchment area. The services provided include emergency and non-emergency inter-facility ambulance transportation, wheel chair/invalid coach transportation, discharge transfers to patients' homes and other EMS, resource services. In 2011, DAS transported 3,672 discharges from Danbury Hospital and 1,119 discharges from New Milford I Hospital. Amidst the performance of these high-demand transportation services, DAS also I provided emergency and non-emergency transports into each of these facilities. In 2011, DAS' completed 15,575 total calls. Paramedic Level Care For more than 14 years, DAS has been providing the Town of Trumbull, Connecticut with on-station paramedic staffing, 24-hour per day, 7-day per week, as well as all equipment and supplies necessary for the delivery of ALS care. The DAS paramedic is dispatched Ssimultaneously with the local Trumbull Volunteer EMS ambulance according to an established algorithmic protocol. Geographically, Trumbull is approximately 23 square miles and, in 2010, had 36,018 residents. Trumbull EMS responded to over 3,500 calls for service in 2010, 1700 of which required ALS intervention by DAS personnel. Since October 2006, DAS has been providing the Town of Newtown, Connecticut with on-station paramedic staffing, 24-hour per day, 7-day per week, as well as the non-transport vehicle and all equipment and supplies necessary for the delivery of ALS care. The DAS paramedic is dispatched simultaneously with the local Newtown Volunteer EMS ambulance according to an established algorithmic protocol. Geographically,Newtown is approximately 60 square miles and, in 2010, had 27,560 residents. Newtown EMS responded to over 2,000 calls for service in 2010, with more than 1000 requiring ALS intervention by DAS personnel. Additionally, DAS provides emergency ambulance back-up services to Newtown when Newtown EMS is occupied on another call for service, or, the incident requires more resources then its service can provide. Historically, DAS has provided on-site services to Ridgefield, Connecticut similar to the towns of Trumbull and Newtown. It has also, from time-to-time, provided paramedic intercept services to the towns of Bethel, Redding and New Fairfield, Connecticut, though due to budgetary considerations and/or competitive bidding processes, these programs are currently either serviced in-house or by another provider at this time. oak 6 Packet Page -1562- j _ _ , 9/25/2012 Item 11 .D. Safe-Care Medical Transport, Inc.— Collier County COPCN tiu 11113711.1011 Deployment of Resources and Personnel DAS operates its own call and dispatch center at its headquarters in Danbury, Connecticut using Computer Aided Dispatching ("CAD"). DAS's dispatch center is staffed 24- hours a day, 7-days a week. Its CAD system automatically cross-references the incident location with the closest available DAS resource. The CAD integrated mapping system also displays the incident location on a map and transmits the information to a Mobile Data Terminal to the dispatched ambulance and/or paramedic vehicle. Each ambulance and paramedic vehicle are equipped with GPS systems allowing the dispatcher to always know the locality of DAS resources. The same device reports all other aspects of vehicle monitoring such speed, emergency lighting and siren activation,and route. Billing and Administrative Services DAS performs all of its patient and account billing in-house through its administrative and support office. Here,DAS bills emergency and non-emergency ambulance transports,wheel chair/invalid coach services, paramedic intercept services and contract installation agreements. Insurance payors include Medicare,Medicaid,Blue Cross and other third party insurers. Performance-Proven Results DAS has demonstrated a relentless effort to perfect the patient transportation experience. Most recently, DAS appointed a Hospital Liaison to work in conjunction with Danbury Hospital. The Liaison is the sole point of contact for Hospital administrators when booking a patient transportation. The Liaison will take all of the patient's booking information and remotely access the CAD system. Through quality assurance measures, including monitoring of response, appointment arrival and departure times,DAS currently meets and/or exceeds Hospital discharge appointment criteria 96.24% of the time all while continuing to service the area's emergency service needs. The continued tracking of performance standards and responsive operational implementation has led DAS to nearly three-and-a-half decades of proven performance in the medical transportation and EMS industry. DAS intends to bring all of its training and experience to Collier County by its Application. • 1 7 Packet Page -1563- 9/25/2012 Item 11 .D. Safe-Care Medical Transport,Inc. —Collier County COPCIN.tsppin.auutt 6 The names and addresses three Collier County residents who! will act as 41, references for the applicant Response: Cuccinchello 1510-C Trafalgar Square Naples,FL 34116 Deborah Galdchue 550 5th Ave. South Naples,FL 34102 Michael Slade 560 9th Street South Naples,FL 34102 • Aft, Via. 8 Packet Page -1564- 9/25/2012 Item 11 .D. • a_ • M• ._'cal _ 'us i_ _ i c. • 'er o_ u i ' h. . uca 7 A,schedule of rates which the service intends to charge. Response: fB Basic Life Support Transportation—Base Rate $375.00 Advanced Life Support—Base Rate $375.00 Advanced Life Support—Level 2 $595.00 Specialty Care Transportation-Base Rate $725.00 Surcharges Mileage(loaded per mile) $10.00 Oxygen $40.00 Medication Administration $17.50 IV Supplies $20.00 r1/4 1 9 Packet Page-1565- 9/25/2012 Item 11 .D. Safe-Care Medical Tran port, Inc.—Collier County COPCN tippu.:atrim 8 Such other pertinent information as the administrator may.require. 4101 Response: Safe-Care will execute'its action plan to commence ambulance operations within 180 days of the granting of its Application. The action plan includes advertisement and employment of personnel, securing a strategic location within Collier County for optimal and efficient service delivery, and securing of equipment, including two ambulances for operation. Further, it 1 anticipates using DAS' Connecticut-based dispatch facility as its call center for non-emergency transportation through Voice over Internet Protocol phones and a radio repeater system in Collier County. Connecticut-based dispatchers will be trained in the deployment of Collier County resources for this purpose and the software systems integrated to assure proper and effective response consistent with its current operating protocol. Any emergency requests for service will be dispatched in accordance with a protocol to be established through the governmental entity contracting the service. Safe-Care is prepared to answer all questions/concerns of the Board of County Commissioners and supplement this Application with any and all information it may deem relevant and/or required. Al 410 AI* • 10 Packet Page -1566- 9/25/2012 Item 11 .D. e- a_ • e' .1 •nss . f Inc — . _'er i _ ' I ' -- 9. din application or renewal fee of$250.00. (Exception Col ier,County EMS). Response: The application fee of$250.00 is attached hereto. Oki 11 � Packet Page-1567- _. 9/25/2012 Item 11 .D. Safe-Care Medical Transport, Inc.—Collier County COP iw u4"sLL1UH 10 Financial data including assets -and liabilities of the operator. A schedule of all lb debts encumbering any equipment shall be included. Response: Please see attached financial statement. • • 12 11=11.111111111111.111111111=111.111111111111111Millillill11 Packet Page -1568 www.sunbiz.org-Department of State Page 1 of 21 9/25/2012 Item 11 .D. FLU B 11) E P R T M I'VI 01 : 't'A'1` F � DIyh1 y )1 Coiti- it AI Home Contact Us E-Filing Services Document Searches Forms Help Previous on List Next on List Return To List Entity Name Search No Events No Name History Submli Detail by Entity Name Florida Profit Corporation SAFE-CARE MEDICAL TRANSPORT, INC. Filing Information Document Number P95000019134 FEl/EIN Number 650565606 Date Filed 03/06/1995 State FL Status ACTIVE Principal Address 3581 VERONICA S SHOE MAKER BLVD FT.MYERS FL 33901 US emN Changed 03/30/2010 Mailing Address • 14 WALNUT STREET DANBURY CT 06811 US Changed 08/27/2008 Registered Agent Name & Address DESIMONE,JOSEPH 1333 MONARCH CIRCLE NAPLES FL 34116 US Name Changed:03/23/2006 Address Changed:03/23/2006 Officer/Director Detail Name&Address Title PRES DESIMONE,JOSEPH 1333 MONARCH CIRCLE NAPLES FL 34116 US Annual Reports Report Year Filed Date 2009 04/29/2009 2010 03/30/2010 al 2011 03/08/2011 http://www.sunbiz.org/scripts/cordet.exe?-"!--_"-r-En D''"'q.doc_number=P9500001913... 3/2/201 Packet Page-1569- www.sunbiz.org -Department of State Page 2 of 21 9/25/2012 Item 11 .D. Document Images • 03/08/2011-ANNUAL REPORT [; ___ Image ip PDF formats AMP 03/30/2010-ANNUAL REPORT •r .,.�.._yrew ima e m PDT#ormat? . .: y/ 04/29/2009-ANNUAL REPORT U„jevy tnage-ln PDF format 08/27/2008-ANNUAL REPORT 4G. V.ieyJamag2 m RDF format:: k.., 09/13/2007-ANNUAL REPORT ;; .. Giew ima a in i?DE forrnatn 03/23/2006-ANNUAL REPORT Ylew ir.>tage in PDF fo, ; 05/01/2005-ANNUAL REPORT Vi w.image rn PDF format;_; 04/15/2004-ANNUAL REPORT z. _mew image in,.PDF format , 04/16/2003-ANNUAL REPORT Vlew Image in PDT format,: wy 04/29/2002-ANNUAL REPORT :View Image in PD,F form at, -,A,-,, 05/22/2001 -ANNUAL REPORT yiew.irna ern FDE,format 04/06/2000-ANNUAL REPORT View•Image m PDF fofmaf 04/13/1999-ANNUAL REPORT ,iew image In PD.F format.; ' - r 04/13/1998-ANNUAL REPORT i mew Image In PDg format: 01/22/1997-ANNUAL REPORT Uiew ima+ern PDE format 07/11/1996-ANNUAL REPORT y2ew image In PDF format< .. . { 03/06/1995-DOCUMENTS PRIOR TO 1997: View image rn PDF..format; • Note:This is not official record. See documents if question or confliet. Previous on List. Next on List Return To List me - 1 Entity.Name Search i No Events No Name History Home I Contact us I Document Searches I E-Fllino Services I Forms I Heip Copyright()and Privacy Policies State of Florida,Department of State • http://www.sunbiz.org/scripts/cordet.exe?7-`=-__T,D'TrTT D_:-q_doc_number=P9500001913... 3/2/201 Packet Page-1570- �. , 9/25/2012 Item 11.D. Danbury Health Systems if Emergency Medical Services Matthew Cassavechia, ENT-P Director Danbury Health Care Affiliates Please be advised that Danbury Ambulance Service, has entered into an ambulance and transports ion service agreement with the Danbury hospital, a 371 licensed bed tax exempt general hos ital corporation having it's office and principal place of business at 24 Hospital Ave Danbury, CT. Mr. Joseph. De Simone, president and owner of Danbury Ambulance Service has indicated that his rm would like to enhance their ability to service your healthcare institution located in the State of Flo ida through one of his other operations. It has been our experience that Danbury Ambulance Service has consistently adhered to our ambulance standards and has taken any and all measures to service ur institution at the highest level we expect. Please don't hesitate to contact if you require any additi nal information as I have provided my contact information below.Thank you. 11 1 I a .Avenue • Danbury, CT 06810 • Tel: (203)797-7493 • Fax: (203)739-6472 • matt.cassavechia udanhosp. rg \ Packet Page -1571- i 9/25/2012 Item 11 .D. • , ) --1 ' SAFECARE MED/CAL TRANSPORT INC. Danbury Ambulance Service Inc. (DAS),founded by Joseph DeSimone has been providing ambulance service to the greater Danbury area since July, 7, 1978. DAS is a stable growing business headquartered in Danbury and is located at 14 Walnut Street with branch operations in Trumbull and Newtown,CT. DAS employs more than;seventy six men and women throughout t, the area.At present DAS employs Forty Five EMTs and:thrty one Paramedics. Many of these employees are volunteer providers within the communities we serve. In the Town of Trumbull, DAS provides-on station paramedic staffing on a 24 7 basis.and supplies all related ALS equipment and supplies to the Trumbull program Th paramedic is dispatched simultaneously with the local EMS providers according to established dispatch protocols and responds either in the ambulance as part of the,crew or in a,n.n transport paramedic vehicle supplied and maintained by the Town of Trumbull The Tq n Qf Tru`mbull covers an area of'23 square riles and, in 2010 had a resident population of 6,018.Trumbull EMS responded to 3,500±cabs for service in 2010. 1700+of these calls resulted in ALS . transportation to the hospital. DAS has been providing this service to the Town of Trumbull for years. past also provided the backup BLS and ALS.service td the Town of over 14 ears. In the ast we Trumbull, however.with.the's ' sale of`our Bridgeport diuisron,we no Ion erwe a able to effectively provide these services due the geographical'location of our resou •ces j In the Town of Newtown, DAS provides on station paramedic stafing on a 2 7 basis and supplies all related ALS equipment and supplies to the' ewtown program .T,e paramedic is dispatched simultaneously with the local-EMS providers according to establr hed dispatch protocols and responds in a non-transport tparamedic vehicle supplied and"maintained by DAS. The Town of Newtown covers an area of 60.38 square:miles and, in 201.0 had a resident population of 27,560. Newtown EMS responded to 2000+`calls for service in!201.0. 1000+of these calls resulted in ALS transports to the hospital. DAS has been providing this service to the Town of Newtown since October, 2006. DAS also provides backup ALS and BLS services to the Town of Newtown from out Danbury location. Starting in 1999 DAS provided a regional paramedic intercept program to the area. Originally the region covered the towns of Newtown, Bethel,and Redding. With the start of the Newtown on station program, Newtown had separated itself from that program. Bethel and Redding then soon followed with their own on station program in 2008. During those years DAS provided • Packet Page -1572- , , i 9/25/2012 Item 11 .D. 100%of first call and 90%second call coverage with the regional intercept program. In 2007 the regional paramedic was activated 1292 times and resulted in 747 ALS transports to the hospital. Until the Town of Ridgefield hired its own paramedics, DAS provided an on station paramedic on a 24-7 basis.This program lasted for four years. DAS provided all ALS equipment and supplies as well as the non-transport intercept vehicle for the Ridgefield program. DAS has previously provided primary paramedic intercept services for the Towns of Brookfield and New Fairfield. Currently DAS is the provider for backup ALS and BLS services to the Town of Brookfield, Newtown, and the City of Danbury.-,.-. DAS has been handling all billing functions for our service:operations since 1978.This includes emergent and non-emergent ambulance,transports,wheelchair transports, and paramedic intercepts with our billing department located at ourWalnut Street operations facility. We currently submit claims to,Medicare, Medicaid, and other;private insurance companies on a daily basis. In addition-we are the local primary service provider for several insurance companies. We have provided"the billing services for the Town of Trumbull' S forthe last 14 .y years. v DAS currently holds medical control authorization from Danbury Hospital,arijd has an excellent working relationship with its medical director and EMS coordinator.-A large number of our P4 - - ,.- .. ., , - , - ..,- paramedics hold medical control in the Southwest region out of Bridgeport Hospital as well as Northwest region 5 medical control out of Danbury hospital All of DAS dispatching is done,,through a computer aided dispatching(CAD).,:,-,f- enter This center is• staffed by a full time dispatcher twenty four:hours a day seven daysa week polite', dispatcher entering a call in to the systeni,a cross reference is done'automatically by the software to locate the incident address and find the closest in service car.A mapping system will then show the location on a map. Upon assigning the call to an ambulan a the software then automatically sends the call information to the Mobile Data Terminal( DT) in the assigned ambulance. All ambulances, chair cars and paramedic intercept vehicles are also equipped with global positioning satellite (GPS) hardware;;This allows our dispatcher to know exactly at all times where every company vehicle is located. Along with vehicle positioning all vehicle trends ie: speed,route, lights/siren activation are all recorded and can be referenced at any time. Danbury Ambulance Service Inc. also holds a contractual agreement with Danbury Hospital and New Milford Hospital to operate as the preferred transportation provider for inter-facility transfers as well as discharges from each facility at the ALS, BLS and chair car levels. In both agreements performance standards have been set as to assure smooth patient discharges and IIItransportation. On time performance and patient satisfaction are among some of the standards Packet Page-1573- a 9/25/2012 Item 11 .D. that have to be met to satisfy the agreement. DAS has exceeded these standards in all aspects • and continues to meet with the •hospital staff on a monthly basis to insure compliance and j satisfaction. In 2011 DAS handled 3672 discharges from Danbury Hospital and 1119 discharges from New Milford Hospital. The total yearly call volume for the 2011 year was 15,575. The performance rating for DAS in 2011 with discharges from both hospitals was a 96.24%average. Striving for better patient service has allowed DAS to work closely with Danbury Hospital and together the position of Transport Coordinator/Hospital Liaison has been created. DAS has position a dedicated staff member insideof Danbury Hospital to facilitate all of the discharge transfers that DAS will be assigned to. Hospital staff phone the coordinator through the hospitals in house secure phone system and disclose tf a`information needed to complete the , transfer.The coordinator then remotely accesses the DAS CAD system and r;.--:- inputs the call for dispatch at the appropriate time.The coordinator also acts as the had on between DAS and the hospital as well as the patients.The coordinator is also medicallytrained'as an EMT as to assure proper care'and treatment is always priorityin the minds of staff. 4 t� t Danbury.Ambulance Servic tic has always and will continue to place the reeds of every patient that we transport onhe highest level to assure the gr_eatest_and safst care is always rendered. ._ • F, _ _ o Ask r • Packet Page-1574 9/25/2012 Item 11 .D. 2 `, L STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH 4 LICENSE L034P1 FOR Danbury Ambulance Service/aka Danbury Medi-Car Located at 14 Walnut Street, Danbury, CT 06811 is hereby authorized to operate 19 VEHICLE(S) in a BA/MIC-P/IC category beginning 1/1/2012 and ending 12/31/2012. The licensed ambulance service, which the licensee is authorized to operate, shall consist of the provision of all forms of medical service allowed by law through the use of the following ambulance vehicles: Of the 19 authorized vehicles, the licensee will be permitted to , equip and use not more than 9 as Ambulance(s), 6 as Invalid Coach (es), as defined by Chapter 368d, Section 19a-175 of the Connecticut General Statues, and 4 as Non-Transporting Emergency Medical Service VehicIe(s) as defined in Section 19a-180-1(b)(4) of the Regulations of Connecticut State Agencies. Applicant is also authorized to operate 2 branch locations.Addresses of the authorized branch locations are on file in the Department of Public Health This license is transferable only with the prior approval of the Department of Public Health and is issued subject to payment of such fees as required by law, compliance by licensee with all motor vehicle laws and statutes of the State of Connecticut,and orders as the State Department of Public Health may from time to time promulgate.' The licensee above-named is permitted by this license to operate emergency medical service from its principal place of business at 14 Walnut Street,Danbury, CT. A copy of this certificate shall be displayed prominently in the above stated operational headquarters and at each location from which the provider is granted to operate under this certificate. Dated: October 27,2011 / / / / , ! ICI Jewel Mullen,M:D.,M.P.H.,M.P.A.,Commissioner Phone: Telephone Device for the Dead(860)509-7191 410 Capitol Avenue-MS P.O.Boz " ",r_ .-- .—,-„C'34 - .` Afi:...,,d,o 4,.,Packet Page-1575- F„,nrn„ar 9/25/2012 Item 11.D. BUDWITZ & MEYEKJACK,P.C. Weiqied Alia oiccocuitem4 1122 HIGHLAND AVENUE CHESHIRE,CT 06410 • DANIEL C.VOLLARO,CPA (203)272-1621 FARMINGTON OF E MICHAEL A ZIEBKA CPA FAX(203)272-1623 - 1334 Oft DAVID A.PELLETIER,CPA 322 MAIN STRE MICHAEL J.ALFIERI,CPA CPA@budwitzmeyerjack.com FARMINGTON,CT SCOTT R.BURLEIGH,CPA LAURIE E.ABERIZK,CPA KATHLEEN A.DAMM,CPA LESLEY A.NAPPI.CPA JESSICA L SIPERAS,CPA PETER M.WEED III,CPA KATHERINE 0.WILLIAMS,CPA PETER A.BUDWITZ.CPA-RETIRED i WILLIAM P.MEYERJACK,CPA-RETIRED 33 3 Dan E.Summers Director Bureau of Emergency Medical Services Collier County 8075 Lely Cultural Parkway Suite 445 Naples, FL 34413 1 1 Dear Mr.Summers: At the request of the President of Safe-Care Medical Transport, Inc.,Joseph DeSimone, enclosed please l • find copies of the company Federal Corporate income tax returns for the reporting period 2009 and 2010.The company is a startup ambulance transport service provider.The company shareholders have over 30 years of experience in providing emergency medical services in the ambulance transport industry, as well as currently own and operate Danbury Ambulance Services, Inc. a Connecticut corporation which they have owned and operated since its inception July 7, 1978. Should have any questions or required additional information please do not hesitate to contact me. 1 i Sincerely, 1 (\ttAdkik 3 60 , 1 Michael J.Alfieri,C.P.A. • 1 r 1 1 1 1 Packet Page-1576 I 9/25/2012 Item 11.D. x 1 H 0 aco Ei H V) W %.o A Gti g o W A E — Z G1 E U aa V] W u. Nr 04 •• I U• 0 W• 0 Z (21x caw N H H nC$ N [I� P4r-IU • • PacketPage -1577- - j BUDWITZ & MEYERJACK, P.C. 9/25/2012 Item 11 .D. 1122 HIGHLAND AVE CHESHIRE, CT 06410-1654 203-272-1621 44" March 11,2010 I CONFIDENTIAL SAFE-CARE MEDICAL TRANSPORT, INC C/O JOESPH DESIMONE 14 WALNUT STREET DANBURY, CT 06811 Dear SHAREHOLDERS: ll We have prepared the following returns from information provided by you without verification or audit: U.S. Income Tax Return for an S Corporation(Form 1120S) We suggest that you examine these returns carefully to fully acquaint yourself with all items contained therein to ensure that there are no omissions or misstatements. Attached are instructions for signing and filing each return. Please follow those instructions carefully. Also enclosed is any material you furnished for use in preparing the returns. If the returns are • examined, requests may be made for supporting documentation. Therefore,we recommend that you retain all pertinent records for at least seven years. ! ► *woo In order that we may properly advise you of tax considerations,please keep us informed of any significant changes in your financial affairs or of any correspondence received from taxing authorities. If you have any questions,or if we can be of assistance in any way,please call. Sincerely, BUDWITZ&MEYERJACK,P.C. • Packet Page-1578- J • 9/25/2012 Item 11.D. Filing Instructions SAFE-CARE MEDICAL TRANSPORT, INC Form 1120S U.S. Income Tax Return for an S Corporation Taxable Year Ended December 31, 2009 Date Due: March 15, 2010 Remittance: None is required. No amount is due or overpaid. Mail To: Department of the Treasury Internal Revenue Service Center Cincinnati,OH 45999-0013 Signature: The return should be signed and dated by an authorized officer of the corporation. Other: Initial and date the copy,and retain it for your records. • Packet Page -1579- 11964 03/11/201018:58 PM rm 1 1 Z0S 9/25/2012 Item 11 .D. Fo U.S. Income Tax Return for an S Corporation OMB NO.1'4 1'° ►Do not file this form unless the corporation has filed or is noo Department of the Treasury attaching Form 2553 to elect to be an S corporation. ` Internal Revenue Service ■See separate instructions. etcalendar year 2009 or tax year beginning ending election effective date Use Name Di Employer identification numbe 03/01/95 IRS SAFE-CARE MEDICAL TRANSPORT, INC B Business activity code label. Number,street,and mom or suite no.If a P.O.box,see instructions. E Date incorporated number(see instructions) Other- C/O JOESPH DESIMONE wise, 14 WALNUT STREET 03/01/1995 print or C Check If Sch.M-3 City or town,state,and ZIP code F Total assets(see instructions) attached ❑ ty�' DANBURY CT 06811 $ 13, 036 G Is the corporation electing to be an S corporation beginning with this tax year? lEl Yes © No If"Yes,"attach Form 2553 if not already fil • H Check if. (1) _ Final return (2) ❑ Name change (3) El Address change (4) _ Amended return (5) ❑ S election termination or revocation I Enter the number of shareholders who were shareholders during any part of the tax year ■ 3 Caution.Include only trade or business income and expenses on lines la through 21.See the instructions for more information. 1a Gross receipts or sales I b Less returns and allowances I c Bal If 1c m 2 Cost of goods sold(Schedule A,line 8) 2 E 3 Gross profit.Subtract line 2 fromline lc 3 O 4 Net gain(loss)from Form 4797,Part II,line 17(attach Form 4797) 4 c 5 Other income(loss)(see instructions—attach statement) 5 6 Total income(loss).Add lines 3 through 5 ► 6 7 Compensation of officers 7 • 8 Salaries and wages(less employment credits) 8 ▪ 9 Repairs and maintenance 9 43 s 10 Bad debts 10 11 Rents 11 € 12 Taxes and licenses 12 2, 90 13 Interest 13 99 Depreciation not claimed on Schedule A or elsewhere on return(attach Form 4562) 14 5,1363 ,15 Depletion(Do not deduct oil and gas depletion.) 15 1 to 16 Advertising 16 r. . O• 17 Pension,profit-sharing,etc.,plans 17 18 Employee benefit programs 18 19 Other deductions(attach statement) SEE STMT 1 19 4, 60 or C1 20 Total deductions.Add lines 7 through 19 ■ 20 13, 55 21 Ordinary business Income(loss).Subtract line 20 from line 6 21 -13, 55 22a Excess net passive income or LIFO recapture tax(see instructions) 22a b Tax from Schedule D(Form 1120S) 22b y• c Add lines 22a and 22b(see instructions for additional taxes) 22c E 23a 2009 estimated tax payments and 2008 overpayment credited to 2009 23a :::..... >, b Tax deposited with Form 7004 23b a c Credit for federal tax paid on fuels(attach Form 4136) 23c c d Add lines 23a through 23c 23d m 24 Estimated tax penalty(see instructions).Check if Form 2220 is attached ■ ❑ 24 X ca 25 Amount owed.If line 23d is smaller than the total of lines 22c and 24,enter amount owed 25 I- 26 Overpayment.If line 23d is larger than the total of lines 22c and 24,enter amount overpaid 26 27 Enter amount from line 26 Credited to 2010 estimated tax I. Refunded ■ _ 27 Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements, May the IRS discuss this return with the preparer and to the best of my knowledge and belief,it is true,correct,and complete.Declaration of preparer(other than taxpayer) � Sig fl is based on all information of which preparer has any knowledge. shown below(see instructions)? I5El Yes No Here ' 1 Signature of officer Date Title Preparers Date Check if set- Preparer s SSN or TIN Paid signature , 0 3/11/10 employed 11 arer's BUDWITZ & MEYERJACR, P.C. EI Finn's nae(or Only yoursrf self m employed), , 1122 HIGHLAND AVE Phone no. address,and ZIP code CHESHIRE, CT 06410-1654 203-272-162 Aft For Privacy Act and Paperwork Reduction Act Notice,see separate instructions. Form 1120 (2009) DAA Packet Page -1580- II i 11964 03/11/20100:58 PM Form 1120S(2009) SAFE-CARE MEDICAL TRANSPORT, INC 9/25/2012 Item 11 .D. S hEdU A> Cost of Goods Sold (see instructions) 1 Inventory at beginning of year 1 2 Purchases 2 , Cost of labor 3 Additional section 263A costs(attach statement) - 4 5 Other costs(attach statement) 5 1 6 Total.Add lines 1 through 5 6 7 Inventory at end of year 7 8 Cost of goods sold.Subtract line 7 from line 6.Enter here and on page 1,line 2 8 9a Check all methods used for valuing closing inventory:, (i) ❑ Cost as described in Regulations section 1.471-3 (ii) Lower of cost or market as described in Regulations section 1.471-4 (iii) Other(Specify method used and attach explanation.) • b Check if there was awritedown of subnormal goods as described in Regulations section 1.471-2(c) M _ c Check if the LIFO inventory method was adopted this tax year for any goods(if checked,attach Form 970) r _ d If the LIFO inventory method was used for this tax year,enter percentage(or amounts)of closing inventory computed under LIFO 19d I - e If property is produced or acquired for resale,do the rules of section 263A apply to the corporation? J Yes No f Was there any change in determining quantities,cost,or valuations between opening and closing inventory? ! Yes No If"Yes,"attach explanation. hedul B Other Information (see instructions) 1 Yes No 1 Check accounting method: a Li Cash b U Accrual c U Other(specify)► 2 See the instructions and enter the a Business activity► MEDICAL TRANSPORT b Product or service► AMBULANCE SERVICES .,,... .......... 3 At the end of the taxyear,did the corporation own,directly or indirectly,50%or more of the voting stock of a domestic corporation?(For rules of attribution,see section 267(c).) If"Yes,"attach a statement showing:(a)name and employer identification number(EIN),(b)percentage owned,and(c)if 100%owned,was a QSub election made? X 4 Has this corporation filed,or is it required to file,a return under section 6111 to provide information on any reportable transaction? X 5 Check this box if the corporation issued publicly offered debt instruments with original issue discount ► ❑ MIN ".....\If checked,the corporation may have to file Form 8281,Information Return for Publicly Offered Original Issue Discount Instruments. 6 If the corporation:(a)was a C corporation before it elected to be an S corporation or the corporation acquired an asset with a basis determined by reference to its basis(or the basis of any other property)in the hands of a > "> ?i C corporation and(b)has net unrealized built-in gain(defined in section 1374(d)(1))in excess of the net recognized v( ::: ;: built-in gain from prior years,enter the net unrealized built-in gain reduced by net recognized built-in gain from prior :' .. ........ years 7 Enter the accumulated earnings and profits of the corporation at the end of the tax year. $ :::,'' .. .„ 8 Are the corporation's total receipts(see instructions)for the tax year and its total assets at the end of the tax year less than$250,000?If"Yes,"the corporation is not required to complete Schedules L and M-1. X Sitiiiitigelt Shareholders' Pro Rata Share Items Total amount 1 Ordinary business income(loss)(page 1,line 21) 1 —13, : 5 5 2 Net rental real estate income(loss)(attach Form 8825) 2 3a Other gross rental income(loss) 3a b Expenses from other rental activities(attach statement) 13b .......... c Other net rental income(loss).Subtract line 3b from line 3a 3c c4 Interest income 4 5 Dividends: a Ordinary dividends 5a E b Qualified dividends 1 5b i .......... 0 c 6 Royalties 7 Net short-term capital gain(loss)(attach Schedule D(Form 1120S)) 7 8a Net long-term capital gain(loss)(attach Schedule D(Form 1120S)) 8a b Collectibles(28%)gain(loss) . 1 8b c Unrecaptured section 1250 gain(attach statement) 8c 9 Net section 1231 gain(loss)(attach Form 4797) 9 • 10 Other income(loss)(see instructions) Type► 10 Form 1120(2009) :DI, A Packet Page-1581- 11964 03/11/2010:58 PM Form 1120S(2009) SAFE-CARE MEDICAL TRANSPORT, INC M 9/25/2012 Item 11 .D. Shareholders'Pro Rata Share Items(continued) Total amount 1 11 Section 179 deduction(attach Form 4562) 11 u 12a Contributions 12a 0 b Investment interest expense 12b c Section 59(e)(2)expenditures (1)Type• (2)Amount ► 12c(2) V, d Other deductions(see instructions) Type• 12d 13a Low-income housing credit(section 42Q)(5)) , 1 3 a b Low-income housing credit(other) 13b S c Qualified rehabilitation expenditures(rental real estate)(attach Form 3468) 13c m d Other rental real estate credits(see instructions) Type•► 13d 0 a Other rental credits(see instructions) Type■ 13e • f Alcohol and cellulosic biofuel fuels credit(attach form 6478) . , 13f g Other credits(see instructions) Type► 13g 14a Name of country or U.S.possession• . b Gross income from all sources 14b c Gross income sourced at shareholder level 14c Foreign gross income sourced at corporate level .,.,.,..,... d Passive category 14d c a General category 14e u f Other(attach statement) 14f a Deductions allocated and apportioned at shareholder level : `>.... itg Interest expense 14g as h Other 14h m Deductions allocated and apportioned at corporate level to foreign source income .............. aL i Passive category 14i j General category 14j k Other(attach statement) 14k Other information .... •• - I Total foreign taxes(check one):• ❑ Paid ❑ Accrued 141 • m Reduction in taxes available for credit(attach statement) 14m <:Er:?Ear::::::>'::»s's::;::;>;:>::>?:<:5 n Other foreign tax information(attach statement) r:».::<; r>: :<::>. = >:z.:•. :.;:.:;.::.: 15a Post-1986 depreciation adjustment 15a le e :AI E b Adjusted gain or loss , 15b c g^ c Depletion(other than oil and gas) 15c wEl- d Oil,gas,and geothermal properties—gross income 15d r c a2 e Oil,gas,and geothermal properties—deductions 15e , f Other AMT items(attach statement) 15f m._ 16a Tax-exempt interest income 16a 1 m a o'� b Other tax-exempt income 16b 4 Q`m c Nondeductible expenses 16c E= d Property distributions 16d i «N e Repayment of loans from shareholders 16e w c 17a Investment income 17a a IF,E b Investment expenses 17b O`o c Dividend distributions paid from accumulated earnings and profits 17c , E .... unts(attach statement)d Other items and amo { ) ''"''r��'`'`''` c dco 18 Income/loss reconciliation.Combine the amounts on lines 1 through 10 in the far right o:v column.From the result,subtract the sum of the amounts on lines 11 through 12d and 141 . 18 -13,1155 Form 11205 (2009) • DAA • Packet Page -1582- II i , 11964 03/11/201018'.58 PM , Amimillillillingui, Form 11203(2009) SAFE-CARE MEDICAL TRANSPORT, INC ....i.....IngsgwollE 9/25/2012 Item 1 1.D. Setouttilat.i:: Balance Sheets per Books Beginning of tax year - : End of tax year Assets (a)... (b) • ... .. , (d) 1- 1 Cash giltiligiiiiiiiiiii l 432 IiiiiS;I:::ii::::::::::::::::ggid:::::::::i::::::::::::::::• 3, 91 Trade notes and accounts receivable Less allowance for bad debts ( ; . ( : , 3 Inventories :::::::ffigagEtaa;;I::::•;:gi:;:: 4 U.S.government obligations !!!!!!t.;!!!::•:!:.e3g:::!:::.!:i4:::::::: 5 Tax-exempt securities(see instructions) ... ;i4i10;:;::]:ig:iiiii:ai:ii*::tx::::1:',::?i:i:ir?•i:?i::. 6 Other current assets(attach statement) 7 Loans to shareholders ..„.,,.............,....................... •••••••••••••••"""""""••••••••••••••••••••,\ i ••••••••••••—,,:,,,• .......•••••••••••. 8 Mortgage and real estate loans ;:::;:;:::;:::::;:::::::::•ii;i1::::::::::::]::::::::;:;;;:i1:::::;:;:;:a::::;;::::;:::::.:. ...............,.....-...................... 9 her investments(attach statement) ................................................ 10a Buildings and other depreciable assets 17,960:;I:Iii:::::::Mglegini;:i11:i,::::::::i::::::::::::::::;:::::::::: 17 I 960 b Less accumulated depreciation ( 3,352; 14, 608( 8, 715; 9, 45 ha Depletable assets b Less accumulated depletion (.- .. . ....... ( ,..,.......1 12 Land net of any amortization) •••,..--......,.......••••••••.„.....- 13a Intangible assets(amortizable only) b Less accumulated amortization ( , ' ( . • , :„„„„•:g„„:„:....g„i„:0„„„„f„„ „„0„„„„„„ 14 Other assets(attach statement) •.„..:...:!:,:!i::!:::::?•i.::,•:ii:::.:,•,::,•:Aii;iiiiiiigi.:i...i:i:i!:::Eniii::]::;•.:::::‘ :::::::::::::::::::::::::::::::::::::::::::::::::::::::f::::.;::::::::::::!::::::::n:!:!: 15 Total assets ••::N•a:§!ii.::•: i: : • 15, 040:.::]ii:',:iiiii:::]ii:if:iniP.M.:::::::::::rgi::i.::::::;:;,::::::::: 13, )36 ---....,..............--------........................,.., ,....... .„.....:.:.„..:.......:„.....„.:.. .. .......,...„...............................„-...........„................„...-„y„...„-...........„--„.......„—......„—....-.:-...„:„.„:„.„:„2::::::::,:„:„„::::,:::„:„:::::::::::„:„::;:::::::::::::::: Liabilities and Shareholders Equity :::::!::::::::::!:!::::::ilii!iiiirill:::iiii:illii:iyi::::i::::i:1?ii;:ii.iiiT:::::::::::::::::::::::::::::i::::::::::::::::::::::iii::::::::::;::::::*::':::::::::::::::::•::::i::::::::::::::::::;.:::::,i,?::::i:i:i:::::::::::::ii::::::::::::r.:::::::ii ::::::::::::::::u::*:::::::::::::,:::::::::,::::::::::::::::::: ::::::::::::::::::: 16 Accounts payable Mithi:i';:::::::i•THEME::::..i.:: ...........,..................._...............,,......... ::::::::::]:•::::!:%•:::::::::::%,:*!*::::No:;1:!..:::.,::::!:!:::::::::::. .......--..........-...................„ 17 Mortgages,notes,bonds payable in less than 1 year :•IT.1:!;;;;;:::;,,,:::':;:ii]:::::::::::::ii:?:::::::::::::::::::!::;::,':i.::i::::::::::!: 17, 563 g::::::•;::::::::::.,:::::::::::::::::::::::::::::::::€:::::Mii::::0::::::E:: 18, 62 18 Other current liabilities(attach statement) ......................................-- .....................—..............-........... 19 Loans from shareholders 52, 211,:*.:*::::::::>:*:::*m*:::::::::::*::...,..:.:.::::.:::::::.:.:::.:„ 62, 63 20 Mortgages notes bonds payable in 1 year or more :::::::::::,diiiii.::•:iii:',:i:ii.:*if:,ii:',:ig:i*,Kiiii•:"ii:::i:??:',:if,:i:iii ............................................... 21 Other liabilities(attach statement) -...........................--------, . 1. . . ,:::,.....::::.....,..,..:.„,.:...,.... /Li., Capital stock ?:ii:i:::1:W•igi?:i?::•!iiii:•iiiigi:•jiMi:?:•;:iii',iiiilii.'• 1 000.:::iiiii3.ii:i:::iii:i:i'i:ii,::::N:M::::?::::::::::"::::::::::::::::::::::::::::: ' .. . . 1,. 00 - P-N Additional paid in capital . .....„.•,-„...„.„.„.„.„,.,.„.„--„.„. •••-••••••••••••••••••••••••.,,,,,,,,,,,,: Retained earnings iliN:iiinig:•aill:Mi:::•,::::;;;;:iggei -5 5,7 3 41:agaiiii:iingiii,;:::Mr;:::::c:::::::::;: -69, 89 ...„..„..............„„.........,.......... Zu Adjustments to sharehdders' equity(attach statement) ............................................... 26 Less cost of treasury stock ',::::::::::::::::::::;::::::::::::::::,•::::::::::• •:•::::::::::::::::::::::::::•::::::•::( --..:,........... 27 Total liabilities and shareholders'equity iiii:ii",:i:ii;:p:::::::::::,:,:::::::::*?:*;.•::*:*:.,:,:,:,,,,,:mi*:, 15, 040MANC:;:::ilni:::0:::::::::::N::::::.i:::::;::::::: 13, )36) ..,sobettawm* Reconciliation of income(Loss) per Books With Income (Loss) per Return Note:Schedule M-3 required instead of Schedule M-1 if total assets are$10 million or more—see instructions 1 Net income(loss)per books -13,455 5 Income recorded on books this year not included 2 Income included on Schedule K,lines 1,2,3c,4, on Schedule K,lines 1 through 10(itemize): 5a,6,7,8a,9,and 10,not recorded on books this a Tax-exempt interest $ year(Itemize): . 3 Expenses recorded on books this year not 6 Deductions included on Schedule K,lines included on Schedule K,lines 1 through 12 1 through 12 and 141,not charged against and 141(itemize): book income this year(itemize): a Depreciation $ a Depreciation $ b Travel and $ 7 Add lines 5 and 6 4 Add lines 1 through 3 -13,455 8 Income(loss)(Schedule K,line 18).Line 4 less line 7 -13,A 55 .§0hoowyw Analysis of Accumulated Adjustments Account, Other Adjustments Account, and Shareholders Undistributed Taxable Income Previously Taxed (see instructions) (a)Accumulated (b)Other adjustments . (C)Shareholders'undistributet adjustments account account taxabte income previously tax.d 1 Balance at beginning of tax year -48,447 •:.r,,,.......„..........„.„.„......„...„.„...„.„..„......„...„......,.. „:„..„,:„: 2 Ordinary income from page 1 line 21 • .,,,x,.,.,:: 0W ,-. 0 , ....................................................... .......... 3 Other additions ::::::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,.„••:,,,,,:,. ......••••••••-.......•••••••......................,----, aii Loss from page 1,line 21 ( 13,455',.:;:::.i:::::::::::;:ii.i:i:.:::::::;;:i:.ffigi;:;:ii.Nin;:;:::::gi:::::;E;:;:;:;::::;:iit:::;.:;:;::::::::::::::::;•:;$::::::::::;gia::::::::;::;:i::;:g::::::;:::;:::::;:;:ii;:;:g.ii. ..................................................— ......,- WOther reductions ( -61, 902 jiii.i::.i.:1::,::Ma:::-.M.R3M;E::::':.::::Mi;;:!'W•ME Combine lines 1 through 5 4 • . Distributions other than dividend distributions 8 Balance at end of tax year.Subtract line 7 from line 6 -61,902 DM Form 11204(2009) . . Packet Page -1583- ; , 11964 03/11/2018:58 PM 9/25/2012 Item 11 .D. Final K-1 Amended K-1 OMB No.154 -0130 :s:'. 2009 :<:;::....... ;.: ... Schedule K-1 .:.: -� i: .:8r�i)�s;ef�'�:.a,�.(�€t:o, .>:� � ��I�?G;°:.;;, ;i€ � .�•.� (Form 11205 For calendar year 2009,or tax .,,.,,.,,,�, ,,,,,,,,,,,,;,;;�if�E�;. 'E�ti e*dttiiiii rtment of the Treasury year beginning 1 Ordinary business income(loss) 13 Credits AIM I Revenue Service ending -4,485 2 Net rental real estate income(loss) Shareholder's Share of Income,Deductions, 3 Other net rental income(loss) Credits, etc. 1 See back of form and separate instructions. 4 Interest income A Corporation'symployer identification number 5a Ordinary dividends 8 r---Corporation's name,address,city,state,and ZIP code 5b Qualified dividends 14' Foreign transactions SAFE-CARE MEDICAL TRANSPORT, INC C/O_ JOESPH DESIMONE 6 Royalties 14 WALNUT STREET DANBURY CT 06811 7 Net short-term capital gain(loss) C IRS Center where corporation filed return 8a Net long-term capital gain(loss) CINCINNATI, OH 45999 ::::;::::::::::i:::::;::::: ;5s?:><:>::>::>i:.::3:.:::::a•:;•:::::.::::::::¢::•::::::.:.. Sb Collectibles(28%) in(loss) :: PLi ,,lntt iMn bout t e 8ha m I de D Shareholder's identifying number 8c Unrecaptured section 1250 gain 046-52-8212 E Shareholder's name,address,city,state,and ZIP code 9 Net section 1231 gain(loss) VICTOR DESIMONE 1353 PURCHASE BROOK RD. 10 Other income(loss) 15 Alternative minimum tax(AMT)hems apOUTHBURY CT 06488 • F Shareholder's percentage of stock ownership for tax year 33 .333300 % l Section 179 deduction 16, Items affecting shareholder basis I ' r ' i i 12 Other deductions p 17 Other information u_ • * See attached statement for additional information. ; For Paperwork Reduction Act Notice,see Instructions for Form 1120S. Schedule K-1(Form 1120 2009 DAA Packet Page -1584- 11964 03111!201018:58 PM 9/25/2012 Item 11 .D. Final K-1 _ Amended K-1 OMB No.154 0130 III 2009 ...: :::•;:. . ' . "ilk"�5::'$ BEk' FFIl ` .::::.: :::,::;.: 200 �:: ..... . .... ... Schedule t:�:,P.l�r.11..:.. ..:..,: :::::..• .:..�:>. •::..:...;:... •_;..::..: r- m 1120S) For calendar year 2009,or tax •„::... ::::::::::::::•.�� 8:' rent of the Treasury year beginning 1 Ordinary business income(loss) 13'' Credits Revenue Service ending -4,485 2 Net rental real estate income(loss) Shareholder's Share of Income, Deductions, 3 Other net rental income(loss) Credits, etc. ■See back of form and separate instructions. ..... ................. 4 Interest income A Cor^ ---'"”'r.identification number 5a Ordinary dividends B Corporation's name,address,city,state,and ZIP code 5b Qualiified.dividends 14, Foreign transactions SAFE-CARE MEDICAL TRANSPORT, INC C/O JOESPH DESIMONE 6 Royalties 14 WALNUT STREET DANBURY CT 06811 7 Net short-term capital gain(loss) C IRS Center where corporation filed return 8a Net long-term capital gain(loss) CINCINNATI, OH 45999 :':�'':`':"f`iii'"3f`is :::r: +r:: :;;:':° k:;'++;i:'::::::::;:%':h:":G: :::'+2''':ir i:•::::::::5;:::t:Ji#:::::;;::::<::;;`><::;: 8b Collectibles(28%)gam(los ) D... Shareholder's identifying number 8c Unrecaptured section 1250 gain 045-48-5445 E Shareholder's name,address,city,state,and ZIP code 9 Net section 1231 gain(loss) JOSEPH DESIMONE 31 SHELLEY ROAD 10 Other income(loss) 15 Alternative minimum tax(AMT)items 3ETHEL CT 06801 F Shareholder's percentage of stock 33 .333300 ownership for tax year 11 Section 179 deduction 16 Items affecting shareholder basis • l• 12 Other deductions c O • m N 7 1 11 Other information * See attached statement for additional information. For Paperwork Reduction Act Notice,see Instructions for Form 1120S. Schedule K-1(Form 11209'2009 DM PacketPage -1585- 11964 03/11(20108:58 PM • 9/25/2012 Item 11 .D. • Final K-1 Amended K-1 OMB No.1540-0130 2009 �� :>:<:>:::::::::j<>> ;::<::::::::::�>::::;..:>: �<:>::::::: :':::�: :>>::><><:::::::< . ::::;::> «;:::;«:::::«::::. ;«_ Schedule K-1 <;.:::i';I :Ii :::: #`t4#10>13E'' .•.l-g.,.#alka Crti'� 1Ir lac. * (Form 1120S) For calendar year 2009,or tax .:;.;:.:�:.;;:::>::.:::.::::.:.:..>;;:. fife`�If<.f^v > .:: >� f`; !��:.;:.;:,�::•:;>:•;:>., ;;::.;;:;:: erinFetevnteofnutheesTerervacseury year beginning 1 Ordinary business income(loss) 13 Credits 'I s ending -4,485 2 Net rental real estate income(loss) Shareholder's Share of Income, Deductions r s 3 Other net rental income(loss) Credits, etc. ■See back of form and separate Instructions. :: : i sit; i>..`,:'•j.?. :iii•.`•. 'pR. ' '.:.:.:.:::. E' S•. '.:::..f::: .: ` ;.::.; : : : i.i.;•:; <: : 4 Ines nco �$Et it zii :g} • .a. i • �rty :�16j" ` i ii A Corpoggian's ernialgekartification number 5a Ordinary dividends B Corporation's name,address,city,state,and ZIP code 5b Qualified dividends 14 Foreign transactions SAFE-CARE MEDICAL TRANSPORT, INC C/O JOESPH DESIMONE 6 Royalties 14 WALNUT STREET DANBURY CT 06811 7 Net short-term capital gain(loss) C IRS Center where corporation filed return 8a Net long-term capital gain(loss) CINCINNATI, OH 45999 8b Collectibles(28%)gain(loss) pp ( )9 ( D Shareholder's identifying number 8c Unrecaptured section 1250 gain 044-42-0333 • E Shareholder's name,address,city,state,and ZIP code 9 Net section 1231 gain(loss) ANGELO DESIMONE 519 WINDING BROOK FARM ROAD 10 Other income(loss) 15` Alternative minimum tax(AMT)Items likATERTOWN CT 06795 • F Shareholder's percentageof stock ownership for tax year 33 .333400 % • 11 Section 179 deduction 16 Items affecting shareholder ba r 12 Other deductions 0 • co CGv U, 17 Other information • * See attached statement for additional information. For Paperwork Reduction Act Notice,see Instructions for Form 1120S. Schedule K-1(Form 1120$2009 <: DAA Packet Page -1586- ,_ a 11964 SAFE-CARE MEDICAL TRANSPORT, INC 9/25/2012 Item 11 .D. Federal Statements FYE: 12/31/2009 Statement 1 -Form 1120S, Page 1, Line 19 -Other Deductions Description Amount BANK CHARGES $ 71 INSURANCE 551 UTILITIES 150 TELEPHONE 1, 863 LEGAL & ACCOUNTING 1, 625 TOTAL $ 4, 260 011% 1 Packet Page-1587- — I Year Ending: December 31,2009 9/25/2012 Item 11 .D. SAFE-CARE MEDICAL TRANSPORT, INC 14 WALNUT STREET • DANBURY, CT 06811 Electing out of the 50% Bonus Depreciation Allowance for All Eligible Depreciable Property The taxpayer elects out of the 50%first-year bonus depreciation allowance under IRC Section 168(k)for all eligible asset classes of depreciable property acquired after December 31,2007. This election applies to all eligible depreciable property placed in service after December 31, 2007. • 1 Allik 1 • immimmimmumi....immmmmmimimmiLi Amillibt Packet Page -1588- i, t 11964 SAFE-CARE MEDICAL TRANSPORT, INC 9/25/2012 Item 11 .D. - Federal Asset Report FYE: 12/31/2009 Form 1120S, Page 1 Date Bus Sec Basis at Description In Service Cost % 179 Bonus for Depr PerConv Meth Prior Currant Prior MACRS: 1 EQUIPMENT 12/31/06 1,200 1,200 5 HY 200DB 0 0 Out Of Service: 12/31/06 2 2007 CHEVY UPLANDER TRANSPORT 1/23/08 16,760 16,760 5 HY 200DB 3,352 363 17,960 17,960 3,352 363 Grand Totals 17,960 17,960 3,352 5 363 Less:Dispositions and Transfers 0 0 0 0 Less:Start-up/Org Expense 0 0 0 0 Net Grand Totals 17,960 17,960 3,352 1363 011ik i • 1 i Packet Page-1589- 'I I 11964 SAFE-CARE MEDICAL TRANSPORT, INC 9/25/2012 Item 11 .D. f- — - AMT Asset Report FYE: 12/31/2009 Form 1120S, Page 1 1 Date Bus Sec Basis IlkDescription In Service Cost % 179Bonus for Depr PerConv Meth Prior Cu nt Prior MACRS: 1 EQUIPMENT 12/31/06 1,200 1,200 5 HY 150DB 0 0 Out Of Service: 12/31/06 2 2007 CHEVY UPLANDER TRANSPORT 1/23/08 16,760 16,760 5 HY 200DB 3,352 363 17,960 17,960 3,352 363 Grand Totals 17,960 17,960 3,352 363 Less:Dispositions and Transfers 0 0 0 0 Net Grand Totals 17,960 17,960 3,352 363 • Allik • Packet Page -1590- , I 1 11964 SAFE-CARE MEDICAL TRANSPORT, INC 9/25/2012 Item 11 .D. ACE Asset Report Form 1120S, Page 1 Date Bus Sec Basis .et Description In Service Cost % 179Bonus for Depr PerConv Meth Prior Curr t Prior MACRS: 1 EQUIPMENT 12/31/06 1,200 1,200 5 HY 150DB 0 0 Out Of Service: 12/31/06 2 2007 CHEVY UPLANDER TRANSPORT 1/23/08 16,760 16,760 5 HY 200DB 3,352 5 363 17,960 17,960 3,352 5 363 Grand Totals 17,960 17,960 3,352 5 363 Less:Dispositions and Transfers 0 0 0 0 Net Grand Totals 17,960 17,960 3,352 5 363 PacketPage -1591- 11964 SAFE-CARE MEDICAL TRANSPORT, INC 9/25/2012 Item 11 .D. Depreciation Adjustment Report FYE: 12/31/2009 All Business Activities • Adjustme AMT s/ j Form Unit Asset Description Tax AMT Preferen s MACRS Adjustments: Page 1 1 1 EQUIPMENT 0 0 0 Page 1 1 2 2007 CHEVY UPLANDER TRANSPORT VEH 5,363 5,363 0 5,363 5,363 0 • Amok • Amok 4 Packet Page -1592- 110Rd ngHU7ninls•FR PM 9/25/2012 Item 11 .D. Retained Earnings Reconciliation Worksheet 1111200t .: ;;Form 1120S I For calendar year 2009 or tax year beginning ,ending : :....: Name Employer Identification Num r ,._AFE-CARE MEDICAL TRANSPORT, INC Schedule L- Retained Earnings Retained Earnings-Unappropriated -7,287 Accumulated Adjustments Account —61, 902 Other Adjustments Account 0 Undistributed Previously Taxed Income 0 Schedule L,Line 24-Retained Earnings —6 9,18 9 Schedule M-2 - Retained Earnings Accumulated Other Adjustments Undistributed Previously Taxed R tain ed E amin s Ti�mrtmp p Wces Total Retained d ccount Account Earnings BegYrBal —48,447 0 0 -7,287 -55,7 Ordinary Inc(Loss) -13,455 -13,45 Other Additions Other.Reductions Distributions All YrBal -61, 902 0 0 -7,.287 -69, 18P 1 • Packet Page-1593- f 11964 03/11/2010 ft 58 PM 9/25/2012 Item 11 .D. Form 1120S I Schedule K-1 Summary Worksheet Name Employer Identification Number OAFE—CARE MEDICAL TRANSPORT, INC Shareholder Name SSN/EIN Column A VICTOR DESIMONE Column B JOSEPH DESIMONE Column C ANGELO DESIMONE Column D Schedule K Column A Column B Column C Column fl SCH K TOTAL Items 1 Ordinary income -4,485 -4,485 -4,485 -13,455 2 Net rental RE inc +_ 3c Net other rental inc 4 Interest income 5a Ordinary dividends 5b Qualified dividends 6 Royalties 7 Net ST capital gain 1 8a Net LT capital gain 8b Collectibles 28%gain 8c Unrecap Sec 1250 9 Net.Sec 1231 gain 10 Other income(loss) 11 Sec 179 deduction 1 Contributions 7 Invest interest exp . 1 c Sec 59(e)(2)exp 12d Other deductions 13a,c Low-inc house 42j5 13b,d Low-inc house other 13e Qualif rehab exp 13f Rental RE credits 13g Other rental credits 13h Fuel alcohol credit 13i Other credits 14b Gross inc all arc 14d-f Total foreign inc 14g-k Total foreign deds 141 Total foreign taxes 14m Reduct in taxes 15a Depr adjustment 15b Adjusted gain(loss) 15c Depletion 15d Inc-oil/gas/geoth 15e Ded-oilgas/geoth 15f Other AMT items 16a Tax-exempt interest 16b Other tax-exempt 16c Nonded expense 16d Total property dist Shr loan repmts investment income 17b Investment expense -13, 5 5 18 Income(loss) -4,485 -4,485 -4,485 Packet Page-1594- l laC4 nail imini9t58 PM 9/25/2012 Item 11.D. Form 1120S Two Year Comparison Worksheet Page 1 [[ 008 2 .9: N: { Employer Identification Al r � iliv !E-CARE MEDICAL TRANSPORT, INC 1 2008 2009 Dlnere,u.....j Gross profit percentage Gross receipts less returns and allowances Cost of goods sold Income Gross profit Net gain(loss)from Form 4797 Other income(loss) j Total income(loss) Compensation of officers Salaries and wages less employment credits 843 -6, $3 4 Repairs and maintenance 7, 67 7 Bad debts Rents , 090 2, 90 Taxes and licenses 804 8 9 9 95 Deprecc Deductions Interest 3, 352 5, 363 2, 11 Deiation Depletion Advertising Pension,profit-sharing,etc.,plans Employee benefit programs 4, 260 1, 10 Other deductions 2,7 5 0 Total deductions 14, 583 13,455 -1, 28 Ordinary business income(loss) -14, 583 -13, 455 1, j28 Excess net passive income or LIFO recapture tax Tax from Schedule D 0 0 0 Total tax Estimated tax and prior year overpayment credited Tax deposited with Form 7004 Tax and Credit for federal tax paid on fuels ) Payments Refund applied for on Form 4466 ( )( Total payments and credits 0 i 0 Tax due(overpayment) Estimated tax penalty from Form 2220 i Penalties and interest 0 0 0 Net tax due(overpayment) Overpayment credited to next year's estimated tax ' Overpayment refunded ' 1 a I 1 Packet Page-1595- 11964 03/11/201018:56 PM 9/25/2012 Item 11 .D. Fore 1120S I Two Year Comparison Worksheet Page 2 [2008:4:2::�. :9 Name I Employer lrt ntifiration Num. r "'APE-CARE MEDICAL TRANSPORT, INC 1 ,4 2008 2009 ...,.,,...,tcr:il Ordinary business income(loss) -14, 583 -13, 455 1428 8 Net rental real estate income(loss) Other net rental income(loss) I Interest income I Income Dividend income (Loss) Royalties 1 Net short-term capital gain(loss) Net long-term capital gain(loss) Net Section 1231 gain(loss) Other income(loss) _ . .. . .. . Section 179 deduction Charitable contributions Deductions Investment interest expense Section 59(e)(2)expenditures Other deductions .. . Low-income housing credit(Section 42(j)(5)) Low-income housing credit(other) Qualified rehabilitation expenditures(rental real estate) • Credits Other rental real estate credits Other rental credits Alcohol and cellulosic biofuel fuels credit i Other credits i Total foreign gross income oregn Total foreign deductions • - ilsactions Total foreign taxes Reduction in taxes available for credit Post-1986 depreciation adjustment Adjusted gain or loss AMT Depletion(other than oil and gas) Items Oil,gas,and geothermal properties-gross income Oil,gas,and geothermal properties-deductions Other AMT items a Tax-exempt interest income Items Other tax-exempt income Affecting Nondeductible expenses ; S!H Basis Property distributions Repayment of loans from shareholders Investment income Other Investment expenses Information Dividend distributions paid from accumulated E&P Income(loss)(if Schedule M-1 is required) _ -14, 583 — -13,455 1,128 • Packet Page -1596- 9/25/2012 Item 11 .D. Form 1120S Two Year Comparison Worksheet Page 3 Employer Identification Num r N- alio FE-CARE MEDICAL TRANSPORT, INC Differed 2008 2009 Beginning assets 3,328 15, 040 11, 12 Schedule Beginning liabilities and equity 3,328 15, 0 4 0 11, 12 15,040 13, 036 -2, 04 L Ending assets 15, 040 13, 036 -2,2, 0 4 Ending liabilities and equity 0 4 Net income(loss)per books -14, 583 -13,455 1. Taxable income not on books Schedule Book expenses not deducted M-1 Income on books not on return Return deductions not on books 2 8 Income(loss)per return -14, 583 -13,455 1, Balance at beginning of year -33, 864 -48,447 -14, 83 Ordinary income(loss)from page 1,line 21 -14,583 — -13,455 1, 28 Schedule M-2 Other additions AAA Other reductions Distributions other than dividend distributions Balance at end of year -48,447 -61, 902 -13, 55 Balance at beginning of year Schedule Other additions M-2 Other reductions OAA Distributions other than dividend distributions Balance at end of year Schedule Balance at beginning of year ^2 Distributions other than dividend distributions Balance at end of year Total incoM elo (loss)item Income(loss)per income statement Temporary difference Permanent difference Inc (loss)per tax return .:.......; Total expense/deduction items: Expense per income statement Temporary difference Schedule Permanent difference M-3 return :::..::::•:.:::::::...:>;:<.;;;:;;:,:.;•;;:-;::.:::::»>:saxa:<a:: >;»asi:ip:»>::::`•3iii;: xs::«:r.::: Deduction per tax retu Other items with no differences: Income(loss)per income statement per tax return .; Income(loss) In Pe Reconciliation totals: Income(loss)per income statement Temporary difference Permanent difference Income(loss)per tax return • Packet Page-1597- 11oRd,v Iil/9ninip•cg PM 9/25/2012 Item 11 .D. Form 1120S Return Summary For calendar year 2009 or tax year beginning ,ending SAFE-CARE MEDICAL TRANSPORT, INC l Ordinary Business Income(Loss) Total income Total deductions 13,455 Ordinary business income(loss) -13, 455 Total S Corporation taxes 0 Schedule K,Line 18 Ordinary business income(loss) -13,455 Net rental real estate income(loss) Other net rental income(loss) Interest income Dividends Royalties Short-term capital gain(loss) Long-term capital gain(loss) Net Section 1231 gain(loss) Other income(loss) Section 179 deduction Contributions Investment interest expense Section 59(e)(2)expenditures Other deductions SI Foreign taxes paid or accrued Income(loss)reconciliation(Schedule K,Line 18) —13,455 Alb 1 j{ Schedule L Schedule M-1 i Prior Year Current Year 111 Assets 15, 040 13, 036 Schedule M-1 -13,455 Liabilities 15, 040 13, 036 Schedule K,Line 18 —13,455 Difference 0 0 Difference 0 - Retained Earnings Schedule M-3 Schedule L Schedule M-2 AAA -61, 902 -61, 9 0 2 Schedule M-3 1 OM Schedule K,Line 18 a UTI Difference 0 R.E.Unapprop -7,287 -7,2 87 Total -69, 189 -69, 189 Total number of shareholders 3 1 Total ownership percentage( 100.000000 • 1 I 1 Allik Packet Page-1598- •