Agenda 10/10/2017 Item #16F1110/10/2017
EXECUTIVE SUMMARY
Recommendation to approve the updated request for Certificate of Public Convenience and
Necessity (COPCN), for Just Like Family Concierge Medical Transport Services, LLC., DBA
Concierge Medical Transport (CMT), to provide Class 2 Advanced Life Support (ALS) inter-
facility transport ambulance service for a period of one year.
OBJECTIVE: To provide access to Class 2 ALS inter-facility transport services within Collier County.
CONSIDERATIONS: A COPCN may be approved by the Board as provided by Section 50-57 of the
Collier County Code of Laws and Ordinances governing medical transportation services. On October 27,
2015 CMT was granted an annual inter-facility transport service Certificate of Public Convenience and
Necessity by the BCC, which was timely renewed on October 11, 2016. On September 26, 2017 the
Board was scheduled to consider the renewal of the application. The item was deferred to a later Board
meeting due to new information regarding a transfer in ownership.
On September 28, 2017, the application was updated with additional information regarding the transfer in
ownership. Due to the death of the owner, Elisabeth Nassberg, one hundred percent (100%) ownership of
the CMT was transferred to Jacob Nassberg on July 14, 2017. T his new information triggers the need for
the application to be considered a new application rather than a renewal application under Section 50-63.
Section 50-63 of the Code of Laws and Ordinances provides:
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 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.
No other aspects of the application have changed. With the updated ownership information, the
Administrator deems the application complete under the provisions of Section 50-55 of the Code of Laws
and Ordinances and recommends under Section 50-56 of the Code of Laws and Ordinances that a
COPCN be issued for one year. A Class 2 operator provides post-hospital inter-facility medical transfer
services, both within and outside the County.
The Emergency Medical Authority is aware of the circumstances surrounding the change in ownership
and expressed no concerns. An item advising the EMA of the official change has been added to their
October 11, 2017 meeting.
Section Sec. 50-56 of the Code of Laws and Ordinance states that:
The administrator shall review each application and shall investigate the applicant's 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.
FISCAL IMPACT: There is no fiscal impact to the Board for the granting of this certificate. The Board
10/10/2017
is requested to accept and recognize as revenue in Fund (490) the $250.00 application fee with the
corresponding application.
GROWTH MANAGEMENT IMPACT: There are no Growth Management Impacts associated with
this action.
LEGAL CONSIDERATIONS: The Board must find that the standards set forth in Section 50-57 of the
Code of Laws and Ordinances have been satisfied based on competent evidence as follows:
(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 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.
In accordance with Section 50-58 of the Code of Laws and Ordinances, 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 officer's 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.
Accordingly, this item is approved as to form and legality and requires a majority vote for approval. -
JAB
RECOMMENDATION: That the Board issues a Class 2 Certificate of Public Convenience and
Necessity to Just Like Family Concierge Transport Services, LLC., DBA Concierge Medical Transport
(CMT) Just Like Family Concierge Medical Transport Services, LLC., for a period of one year.
Prepared by: Dan E. Summers, Director, Bureau of Emergency Services
ATTACHMENT(S)
1. COPCN Permit (PDF)
2. COPCN Vehicles (PDF)
3. Just Like Family Owner Change 2017 (PDF)
4. C Bacon Cover Letter 2017 (PDF)
5. 2017-18 Just Like Family COPCN (PDF)
10/10/2017
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.F.11
Doc ID: 3840
Item Summary: ***This item was continued from the September 26, 2017 BCC Meeting***
Recommendation to approve the updated request for Certificate of Public Convenience and Necessity
(COPCN), for Just Like Family Concierge Medical Transport Services, LLC., DBA Concierge Medical
Transport (CMT), to provide Class 2 Advanced Life Support (ALS) inter-facility transport ambulance
service for a period of one year.
Meeting Date: 10/10/2017
Prepared by:
Title: Department Head - Administrative Svc – Administrative Services Department
Name: Len Price
09/29/2017 10:01 AM
Submitted by:
Title: Department Head - Administrative Svc – Administrative Services Department
Name: Len Price
09/29/2017 10:01 AM
Approved By:
Review:
Administrative Services Department Paula Brethauer Level 1 Division Reviewer Completed 09/29/2017 2:25 PM
Emergency Management Daniel Summers Additional Reviewer Completed 09/29/2017 3:51 PM
Administrative Services Department Len Price Level 2 Division Administrator Review Completed 10/01/2017 10:55 PM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 10/02/2017 8:09 AM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 10/02/2017 11:22 AM
Office of Management and Budget Laura Wells Additional Reviewer Completed 10/02/2017 12:29 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 10/03/2017 8:56 AM
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 10/03/2017 3:11 PM
Board of County Commissioners MaryJo Brock Meeting Pending 10/10/2017 9:00 AM
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COLLIER COUNTY FLORIDA
Class "2" COPCN
Name of Service: Just Like Family Concierge Medical Transport, Inc.
Name of Owner: Jacob Nassberg
Principle Address of Service: 3200 Bailey Lane
Suite 117
Naples, , FL 34105
Business Telephone: (239) 682-8907
Description of Service: Inter -facility for Collier County
Number of Ambulances: (3) Three
See attachment: "A" for description of vehicles
This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above
named Ambulance Service to operate inter -facility and out of county transports for a fee
or charge for the following area(s): Collier County for one year from the date executed
hereon, except that this permit may be revoked by the Board of County Commissioners
of Collier County at any time the service named herein shall fail to comply with any
local, state or federal laws or regulation application to the provisions of Emergency
Medical Services.
Issued and approved this day of
ATTEST:
DWIGHT E. BROCK, CLERK
,Deputy Clerk
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney
2017
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Penny Taylor, Chairman
EXHIBIT
Page _..._._..... of ....�......-
JUST LIKE FAMILY, LLC
LIST OF VEHICLES IN FLEET — 2017-18
MERCEDES
WD3PE7CD8FP118959
ALS
PERMIT#019703
2015
SPRINTER
MERCEDES
WD3PE7CD9FP121112
ALS
PERMIT#019641
2015
SPRINTER
FORD TRANSIT
1FDYR2CM1HKA15492
ALS
PERMIT#020462
2017
LAW OFFICE OF JEFF NOVATT, P.A.
1415 Panther Lane, Suite 327
Naples, Florida 34109
Telephone: (239) 591-6781
Fax: (239) 591-6782
Email: jeff(abusinesslawnanles.com
www.businesslawnaples.com
September 26, 2017
Mr. Dan Summers
Collier County Emergency Management
8075 Lely Cultural Parkway
Naples, Florida 34113
VIA EMAIL
Re: Just Like Family Concierge Medical Transport Services, LLC (the "Company")
Dear Mr. Summers:
My firm represents the Company in connection with business law matters.
Pursuant to your request, the purpose of this letter is to summarize the legal steps that have occurred
in order to effectuate the change of one hundred percent (100%) of the ownership of the Company from
Elisabeth Nassberg ("Lis"), deceased, to Jacob Nassberg ("Jacob"), as follows:
(i) Attached is a copy of the Order Admitting Will to Probate and Appointing Personal
Representative (self -proved) dated July 13, 2017, which admits Lis's Will to probate and appoints Jacob as
the Personal Representative of Lis's estate.
(ii) Attached is a copy of the Letters of Administration (single personal representative)
dated July 13, 2017, whereby Judge Brodie declares that Jacob is duly qualified under the laws of the State
of Florida to act as personal representative of Lis's estate and conveys upon him the power to administer
Lis's estate as set forth therein.
(iii) Attached is a copy of the Assignment of Membership Interest dated July 14, 2017, that
effectuated the transfer of the one hundred percent (100%) membership interest in the Company from
Jacob B. Nassberg, as personal representative of Lis's estate, to Jacob.
(iv) Attached is a copy of the Company's 2017 Florida Limited Liability Company
Amended Annual Reportthat was filed with the Florida Secretary of State on July 26, 2017, to remove Lis
as the Manager and to add Jacob as the sole Manager of the Company, as reflected in the attached Detail by
Entity Name page for the Company.
Mr. Dan Summers
September 26, 2017
Page 2
Please do not hesitate to contact me if you have any questions or need any additional information or
documents. Thank you.
Veryly yours,
Jeff Novatt
Law Office of Jeff Novatt, P.A.
Enclosures
cc: Mr. Jacob Nassberg (via email) (w/encls.)
IN THE CIRCUIT COURT FOR COLLIER COUNTY,
FLORIDA PROBATE DIVISION
IN RE: ESTATE OF
ELISABETH A. NASSBERG
(
File Nm 17 -1490 -CP
Division Probate
ORDER ADMITTING WILL TO PROBATE
AND APPOINTING PERSONAL REPRESENTATIVE
(self -proved)
The instrument presented to this court as the last will of Elisabeth A. Nassherg, deceased.
having been executed in conformity with law, and made self -proved by the acknowledgment of
the decedent and the affidavits of the witnesses, made before an officer authorized to administer
oaths and evidenced by the officer's certificate attached to or following the will in the form
required by law, and no objection having been made to its probate, and the court finding that the
decedent died on June 19, 2017, and that Jacob B. Nassberg is entitled and qualified to be
personal representative, it is
ADJUDGED that the will dated August 3, 2010, and attested by Rhonda Dowdy and
Brandon Dowdy as subscribing and attesting witnesses, is admitted to probate according to law
as the last will of the decedent, and it is further
ADJUDGED that Jacob B. Nassberg is personal representative of the estate of the
decedent, and that upon taking the prescribed oath. filing designation and acceptance of resident
agent, and entering into bond in the suntof f ItJ add esr I A WJJ. Letters of Administration
shall be issued.
ORDERED on 3 , 2017.
��.11A4,fI�
Honorable Lateen L. Brodie
Circuit Court Judge
FILID67/13i'171444Co111r Cu
IN THE CIRCUIT COURT FOR COLLIER COUNTY,
FLORIDA PROBATE DIVISION
IN RE: ESTATE OF
ELISABETH A. NASSBERG
Deceased.
File No. 17-14WCP
Division Probate
LETTERS OF ADMINISTRATION
(single personal representative)
TO ALL WHOM IT MAY CONCERN
WHEREAS, Elisabeth A. Nassberg, a resident of Collier County, Florida, died on June
19, 2017 owning assets in the State of Florida and
WHEREAS, Jacob B. Nassberg has been appointed personal representative of the estate
of the decedent and has performed all acts prerequisite to issuance of Letters of Administration
in the estate.
NOW. THEREFORE, 1, the undersigned circuit judge, declare Jacob B. Nassberg duly
qualified under the laws of the State of Florida to act as personal representative of the estate of
Elisabeth A. Nassberg, deceased, with full power to administer the estate according to law; to
ask, demand, sue for, recover and receive the property of the decedent; to pay the debts of the
decedent as far as the assets of the estate will permit and the law directs; and to make distribution
of the estate according to law.
ORDERED onof , 2017.
Honorable Lauren L. Brodie
Circuit Judge
FILH07,13/'171444 011-C°
ASSIGNMENT
OF
MEMBERSHIP INTEREST
Jacob B. Nassberg, as personal representative of the estate of Elisabeth A. Nassberg,
deceased, hereby assigns and transfers the estate's entire one hundred percent (100%) membership
interest in Just Like Family Concierge Medical Transport Services, LLC, a Florida limited liability
company (the "Company"), to Jacob Nassberg, effective as of the 14th day of July, 2017, and
authorizes Jeff Novatt, Esq. to effectuate such assignment and transfer in the books and records of
the Company. J '�
JACOB .hYASSBERG,
as personal representative of the estate
of Elisabeth A. Nassberg, deceased
2017 FLORIDA LIMITED LIABILITY COMPANY AMENDED ANNUAL REPORT
FILED
DOCUMENT# -15000086517
Jul 26, 2017
Secretary of State
Entity Name: JUST LIKE FAMILY CONCIERGE MEDICAL TRANSPORT
SERVICES, LLC
CC4812514789
Current Principal Place of Business:
3200 BAILEY LANE,
SUITE 117
NAPLES, FL 34105
Current Mailing Address:
3200 BAILEY LANE,
SUITE 117
NAPLES, FL 34105 US
FEI Number: 47-4035850 Certificate
of Status Desired: No
Name and Address of Current Registered Agent:
NOVATT, JEFF ESQ.
1415 PANTHER LANE
SUITE 327
NAPLES, FL 34109 US
The above namedentity sabmtls this statement for the purpose of cbsmm itsmgleleredo/&a or registeretl apenf, ofbdh. in Me&Nd of Fla l..
SIGNATURE:
Electronic Signature of Registered Agent
Date
Authorized Person(s) Detail
Title MGR
Name NASSBERG, JACOB
Address 3200 BAILEY LANE,
SUITE 117
City -State -Zip: NAPLES FL 34105
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SIGNATURE: JACOB NASSBERG MGR 07/26/2017
Electronic Signature of Signing Authorized Person(s) Detail Data
Detail by Entity Name
DepaMmat of State i D'vgon or Qom s / saarm Remrde i Deus By Dowmem NumearI
Detail by Entity Name
Florda Limited Liability Company
JUST LIKE FAMILY CONCIERGE MEDICAL TRANSPORT SERVICES, LLC
Fume Information
Document Number
FEI/EIN Number
Date Filed
State
Status
Last Event
Event Date Filed
Event Effective Data
Princioal Address
3200 BAILEY LANE,
SUITE 117
NAPLES, FL 34105
Changed: 05/09/2016
Mallin Addreac
3200 BAILEY LANE,
SUITE 117
NAPLES, FL 34105
L15000086517
474035850
05/15/2015
FL
ACTIVE
CORPORATE MERGER
05/16/2016
NONE
Changed: 05/09/2016
Registered Arent Name & Address
NOVAT7, JEFF, ESO.
1415 PANTHER LANE
SUITE 327
NAPLES, FL 34109
Authori Pere mis) Detail
Name & Address
Thle MGR
NASSBERG,JACOS
3200 BAILEY LANE,
SUITE 117
NAPLES, FL 34105
Page 1 of 2
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MEDICA• LUXURY ,
l RANSPOI"fl- SI-RNCES
September 28, 2017
Mr. Dan Summers
Collier County Emergency Management
8075 Lely Cultural Parkway
Naples, FL 34113
RE: Application for renewal for Certificate of Public Convenience and Necessity —Class2 Advanced Life
Support Transfer.
Dear Mr. Summers,
Enclosed please find the Concierge Medical Transport, LLC application for a Certificate of Public
Convenience and Necessity (COPCN) Class 2 Advanced Life Support Transfer. This application is
substantially the same as a new COPCN application.
We have attached a letter and documentation from our attorney administratively clarifying the current
ownership of Concierge Medical Transport.
Concierge Medical Transport is a healthy and strong company that has been providing excellent
uninterrupted services to Collier County, we look forward to continuing this service for many years to
come.
If you need any additional information, or find something to be missing in our application, please do not
hesitate to contact me.
With ki 6wrds,
Charles Bacon
Chief Operating Officer
Concierge Medical Transport
August 8,2017
Mr. Dan Summers
Collier County Emergency Management
8075 Lely Cultural Parkway
Naples, FL 34113
Charles Bacon
Ch ief Operating Officer
Concierge Medica I Tra nsport
32OO BAILEY LANE SUITE 117 NAPLES, FL 34105
RECEIVED
AUG i 5 2017
EMERGENCY IVTANAGEMENT
Re: Application for Renewal for Certificate of Public Convenience and
Necessity- Class 2 ALS Transfer
Dear Mr. Summers,
Enclosed please find the Just Like Family Concierge Medical Transport, LLq., DBA
Concierge Medical Transport (or CMT) application for renewal for a Certificate of
Public Cbnvenience and Necessity (COPCN) Class 2 ALS Transfer.
I would like to inform you that with Elisabeth Nassberg's passing we have been
diligently working with Probate to harmonize Elisabeth's estate. Jacob Nassberg
is currently overseeing Elisabeth's estate which includes Concierge Medical
Transport. I will assure that Mr. Summers is formally notified of any changes that
take pilace within the organization of Concierge Medical Transport.'
Concierge Medical Transport is a healthy and strong company that has been
providing excellent uninterrupted services to Collier County, we look forward to
continuing this service for many years to come.
lf you need any additional information, orfind somethingto be missing in our
application, please do not hesitate to contact me.
JUSr L'KE FAMTLY , *concteroe
medicaltransport v
Phone: 239.682.8907 Email: info@llfcmt.com
APPLICATION FOR CERTIFICATE OF PUBLIC CONVEN!ENCE AND NECESSITY
CLASS 2 AIS TRANSFER
An applicant for a certificate shall obtain forms from the department to be
completed and returned to the division administrator. Each application shaIl
contain:
1. The name, age, and address of the owner of the ambulance or AlS
Operator, oiif 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
Owner Name and Age
. Jacob Nassberg, 42 years old, 1,OO% Owner of LLC
o Just Like Family Concierge Medical Transport, LLC DBA Concierge
Medical Transport (CMT)
o 3200 Bailey Ln.
Suite #1,!7
\/ Naples, FL 34105
o (239) 682-8907 www.ilfcmt.com
(Attachment #1)
2. The boundaries of the territory desired to be served.
CMT currently services Collier County as a Class ll Advanced Life Support
provider.
3. The number and brief description of the ambulances or other vehicles
the applicant will have available
CMT currently has three Type llAdvanced Life Support ambulances
available within Collier County. They are available 24 hours a day, 365
days per year. CMT has the ability to purchase additional ambulances to
meet the needs of a growing population.
We have contracted Dr. Richard Juda, to oversee CMT's Critical Care
Training. lt is our plan to have a Critical Care /Specialty CareTransport
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
L
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 AI-S TMNSFER
Unit available in Collier County as the need for this type of transport is
increasing.
The address of the intended headquarters and any substations
Concierge Medical Transport is located at:
32OO Bailey Ln.
Suite #L1,7
Naples, FL 34105
4. The training and experience of the applicant.
Owner: Jacob Nassberg, Owner of Concierge Medical Transport
(Attachment #3)
Chief Operating Officer: Chuck Bacon, (Attachment #4)
Medical Director: Jeffrey A. Panozzo, D.O., FACEP, serves as Medical
Di rector (Attach ment #5)
\/'5. The names and addresses of three Collier County residents who will
act as references for the applicant. (Letters available in Attachments)
Betsy Novakovich, Director of Emergenry Services
NCH Healthcare Services
35O Seventh Street North
Naples, FL34LO2
(Attachment #6)
Allen Weiss, MD, FACP, FACR
NCH Healthcare System
35O Seventh Street North
Naples, FL34!02
(Attachment #7)
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
2
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CI.ASS 2 Al5 TMNSFER
Jimmy Dascani, CEO
Landmark Hospita!
L285 Creekside Blvd.
Naples, FL 34109
(Attachment #B)
6. A schedule of rates which the service intends to charge.
Code Service Description
AO428 Basic Life Support Rate (Non-emergenry)
AO429 Basic Life Support Rate (Emergenry)
AC,426 Advanced Life Support (Non-emergenry)
AO427 Advanced Life Support (Emergenry AI5 Level 1)
AO433 Advanced Life Support (Al5 Level 2)
AO434 Specialty Care Transport Rate
AO425 Mileage (Per loaded mile)
AO999 O4ygen
Rate
s 3es.oo
s 42s.OO
s 3ss.oo
s soo.oo
s 72s.OO
s soo.oo
S 1o.oo
S 4s.oo
7. Such other pertinent information as the administrator may require.
No additional information was requested from the administrator at the
time of submission.
An application or renewal fee of S25O.OO. (Exception Collier County
EMS).
(See Attachment #9)
Financial data including assets and liabilities of the operator. A
schedule of all debts encumbering any equipment shall be included.
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (2391682-8907
3
8.
9.
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CIASS 2 ALS TMNSFER
(See Attachment #1O)
ATTACHMENTS
Attachment #1
Just Like Family Concierge Medical Transport Services, LLC
Articles of Organization
Attachment #2
ALS License
COPCN Collier County
Attachment #3
Resume, Owner
Jacob Nassberg
Attachme nl #4
Resume, Chief Operating Officer
Charles Bacon
Attachment #5
Resume, Medical Director
Jeffrey A. Panozzo, D.O., FACEP
Attachment #6
Reference letter Betsy Novakovich, Director of Emergency Services
Lee Memorial Health System
Attachme nt #7
Reference letter Dr. Allen Weiss, President & CEO
NCH Healthcare System
Attachment #8
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
4
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CTASS 2 ALs TMNSFER
Reference letter Mr. Jimmy Dascani, CEO
Landmark Hospitals of Southwest Florida
Attachment #9
Application Renewal Fee
S25o check
Attachment #10
Balance Sheet to date
Profit & Loss Statement to date
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (Z3gl682-8907
5
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
Attachment #1
Just Like Family Concierge Medical Transport Services
Articles of Orga n ization
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (2391682-8907
6
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CIASS 2 ALS TMNSFER
2D17 FLORtr'A UXITED LIABIL]TY COilPAIIY Af,E}TDED AIITTI'AL REPQEI
DOCUMENT# 115fin0865r7
Entlly llamo: JUST LllG FAMILY CONCIERGE iTED|CAL TRAISPORT
SEFMrcES, tI-C
Cuncnt Prlndprl Plece ol Bu.lnoo:
OOOBAILEYUTE,
sutlE 117
NAREq FL 34106
Currunt llalling Mdresr:
32M BALEYI.ANE,
sutTE 117
NAPLES, FL 34105 US
FEI ilumb.c a7{O:I6850
Namc rnd Addn r o( CLrr.nt fught rrd AeDril:
I{oVATT, JEFF ESO
l4t0P lrTtcRur€
slrnE 3gt
rlAPtEs,FL s{10e us
Certlflcate of Status Dcslrgd: No
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SIGNATURE: JACOB NASSBERG a7D612017
Elclrmlc Slgmstu € oa Sl$rlrlg Authdlzed Prscn(s) Dolal
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (2391682-8907
7
FILED
Jul 26,2017
Sectttary of State
cc4812514789
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
Attachment #2
ALS License
COPCN Collier County
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
8
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CIASS 2 ALs TMNSFER
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
9
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APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
Attachment #3
Resume, Owner
Jacob Nassberg
3200 Bailey Lane, Suite 11-7 Naples, Florida 34105 (239')682-8907
72
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CTASS 2 ALS TMNSFER
1066 ASPEN CHASE DRIVE. NAPLES FLORID^ 31IT9
pHoNE (239) 218-0056 . JNASSEERGCJLFSERvTCES.COM
JACOB NASSBERG
7f20/l7.present Just Uke Famlly Conclergo tledlcd Tranrporl Servlces
O*nerlUanager
Naples, FL
r Owmee tre operdkn of provkllrg medkd fanspoil servi€s nih he administraliye and manageftl
$ppod of he Chid Operditg Offcer and he tledial Diecbr
o Oversee ongoirq efiorts to comply with d lkxrsing and oher regdatory mqdrennnls related to he
provision of medbal trrtspot sewices
. Overcee efuit O erpage wih hoEtibts and ofier faclilies lo rn€ot tE needs of patients requiing ir&r-
facility tansporb
2006?resent Jurt Like Family Home Care Naples, FL
OwnulWanagero Parfrered with ElMbeh t{assberg to open and operais a rurso rcsistry in Napht h May 2006
o Olercee [ra day-today aclivities rd#d to mamging patiant refunals as ulell as I rBgistry of quafi'fied
caregivers b refur sudt caregivers to patbnh rmeding home healtr care
. Direct the marketir{ efforb wflh dirtnrge planners and oher rebnal sorces to ident'fy patients needing
home health carc services and to rebr registered caregivers b assi$ ttme palienls udh daily living
ativities at thah phe of rcsilence
o Participated as a memberof ttn Private Cars Association, a natbnal organizatix fur private home cara
companies
. Serrrcd in a numberof wfunEry activiti€s in ha conmunity, irrludiry e)tbnsiy€ inrmlwment in he Pace
Center br Glrls - Colller d lmrokalee
1S97.200S Sale3 Poaitions
Sales Represenlallve
. Worked as a salee GpretEntati\€ to pmcue new hrsiness, b negotbte conbac,ls, and b develop
rranagiernent sdulim hr a nurtsr of compan'ns, ffitding Konba l&tolta Business Softrtiom sd
Ameri:an General Financbl Gmup
Educrtlon:
tlova Soulheastem thivqsity, Davh FL
Euslness Mnrhblratbn
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
13
Southeast Florida
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSIW
CI-ASS 2 ALS TMNSFER
Attachment #4
Resume, Chief Operating Officer
Charles Bacon
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (2391682-8907
L4
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CIASS 2 Als TMNSFER
C HAR LES BACO N
PHONE (239) 231_6IO1 . CBACON@JLFSERVICES.COM
PROFESSIONAL EXPERI ENCE
2016-present Concierge Medical Transport, Naples, FL
Chief Operating Officer
. Oversees Quality Assurance Committee.
. Oversee all operations.
. Keep up to date on all state rules and regulations to
keep license current and in compliance. (401, 64J)
. Work with hospitals and facilities on all contractual and
insurance needs with Medicare and lnter-facility
transport needs
. Oversees EMSTARS
. Works directly with Medical Director for Protocol
Development, training, and future projects and
education.
2006-2016 North Collier Fire Rescue District Naples, FL
Captain EMS Coordinator
. Oversees the operational component of the Advanced
Life Support program within the District.
. Oversee medical supply purchasing and budget.
. Oversees and develops lncident Action Plans for all
special events within the district
. Works with Medical Director as part of the Quality
Assurance Committee
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
15
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CIASS 2 ALS TRANSFER
. Provides lncident Command at complex high acuity 91 1
calls for service.
. Sits and has chaired on multiple regional comities,
councils that steer pre hospital emergency mediclne.
2000-2006 North Naples Fire Rescue District, Naples, FL
Fire Fighter Paramedic
. Provided Fire Fighter Paramedic duties.
. lnvolved in Quality Assurance Committee.
1994-2000 Hingham Fire Rescue, Hingham, MA
Fire Fighter Paramedic Assistant EMS Coordinator
. Provided Fire Fighter Paramedic Dutles
. Assisted in Quality Assurance, Protocol Development
. lmplemented new software for EPCR documentation
. Maintalned State Compliancy for Medical Supply.
1994-2000 South Shore Hospital, Weymouth, MA
Paramedic
. Provided Paramedic duties that included pre hospital
and hospital based services.
1989-1994 Fallon Ambulance Service, Milton MA
EMT/Paramedic
. Provided EMT and Paramedic services. This included
9'l I calls for service as well as lnter Facility transports.
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
16
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALs TMNSFER
Attachment #5
Resume, Medical Director
Jeffrey A. Panozzo, D.O.,FACEP
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
L7
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 Als TMNSFER
Curuiculum Vitae
4726Turnstone Ct.
Naples, Fl 34119
Phone: 239-877-7778
JPDO@aol.com
Euuc.luox
Doctor of Osteopathic Medicine
Chicago College of Osteopathic Medicine
Bachelor of Science
Loyola University
Chicago, Illinois
PnorpsstoNa.r, TR a.Ixrxc
June 1989
May 1981
Internship
Chicago College of Osteopathic Medicine
Chicago, Illinois
Emergency Medicine Residency
Cook County Hospital
Chicago, Illinois
CanruR ExpnrunNces
1989-1990
1990-1993
Chairman of Emergency Medicine
Medical Director of the Emergency Department
NCH North Collier/TEAMHealth FMD
Naples Florida
A high acuity, high volume comprehensive Emergency Department
Chairman of Emergency Medicine
Medical Director of the Emergency Department
PRMC
2012-present
2006-2012
2006-2012
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
18
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TRANSFER
Naples, Florida
EMS Medical Director 2007-present
North Collier Fire and Rescue District (formerly North Naples Fire)
Naples, Florida
Senior Staff Physician- ER Doctors, Ltd. 1995-2006
Community Hospital of Ottawa, Mendota Community Hospital,
Sandwich Hospital, Illinois Valley Hospital
Ottawa, Mendota, Sandwich, and Princeton, Illinois
Assistant Medical Director of the Emergency Department 1993-2004
Gottlieb Memorial Hospital
Melrose Park, Illinois
PnorussroNAl CREDENTIALS
Fellow of the American College of Emergency Medicine 1994-present
Osteopathic Physician and Surgeon 1993-present
Member of Numerous Professional Medical Organizations
Hrcsr-rcnrED CAREER SUMMATIoN
Ctinical Instructor- Emergency Medicine Residencies 1993-2004
Cook County Hospital and University of Chicago
EMS Medical Director Gotllieb Memorial Hospital 1997-2004
Affiliated with Loyola, Edward and Downers Grove EMS Programs
Vice Chief of Staff 2009-2011
PRMC
Active Member and Chair of Numerous Hospital Based Committees 1993-present
Multiple Presentations, Lectures and Educational Preceptorships
Certified FF II, NREMT-P, ERT, Flight Paramedic 1981-1990
Clinical Affiliate- Emergency Medicine. Nova Southeastern 2007-present
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
19
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CIASS 2 4l5 TMNSFER
University College of Medicine and Health Care Sciences
Teaching Emergency Medicine to Medical and PA Students
Board Member- Collier Drug Free 2014-2015
Board Member Collier County EMS Advisory Board/?ublic Service 2006-2014
Authority
Founding Member, Step Wise Collier- Fall Prevention Coalition 2014-present
Rnnrnnxces
Personal and Professional References available upon request
3200 Bailey Lane, Suite 1-17 Naples, Florida 34105 (2391652-8907
20
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
AC#
The OSTEOPATHIC PHYSICIAN
named below has met all requirements of
the laws and rules of the state of Florida.
Expiratbn Date: MARCH 31,2018
JEFFREY A" PANOZZO
ATTN: ETIIERGENCY MEDICINE
NAPLES COMMUNITY HOSPITAL
NAPLES, FL 34119
STATE OF FLORIDA
DEPARTMENT OF HEALTH
DIVISION OF MEDICAL QUALITY ASSURANCE
IF REOUIRED BY LAW
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
27
DATE LICENSE NO.CONTROL NO
0711412016 os 9974 59219
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
PANOZZO, JEFFREYA DO
JUST LIKE FAMILY MEDICAL CONSIERGE TRANS
15OO EXECUTIVE DR.
SUITE 205
NAPLES, FL 31i 19-0000-000 ffitiH
l,,ltr,l,r!,,rll,,,tllrl,,ll,,,ll,,,lt,,,tl,,,ll,,,lt,,,tl,,,Effi
JZL,\., DdilEy LdilE, JUrLE rJ./ rrdptEs, rr(Jr rud JrrvJ \zJJl voz-oJvt
22
COi{IROI,IEO qf,srurcE NCOEiTR'$KN CERNEC^TE
TTIITED ATA?EA OCPARTTETTOf JUSIICE
oRt o EllFff CEllEir Aoat{stRATloN
IIASH|ISTO}I D.C. 206'
6dor Oa rnd 106 8t USC !24 urd gjo ot Ue C(lirobEuBrEr Acr o, re70, I mard.d, paqb tld !\r AlbmqG!,rf il, ,aru! c ugdro I EOrrIEn b mrra(tri
6airbr., d.9.na.. hgqt r @ar t da!5 ubfanca
rflE ctitrlc lE t8 l(,T ttaLlFER^Et ! olt ol^rEE cowrEilf, cilTrcL LOGATE|I Oi at'atrctr Act|ytTy,
A'{D I' II i'O' YAT' rfTEN TIC EXPNArIOT' OATE
LIKE FAMILY MEDICAI. CONSJERGE TRANSPORT
/1500 EXECUTIVE DR
NAPLES. FL 341 19{OOO
01-1
CONIROLLED ST.,BETANCE REGISTRATIOII CERNFICATE
UNITED STATES OEPARTMENT OF I,STICE
ORIJG ENFORCEilENT AOM N ETRATIOITI
VUASHT\GTO{ D.C.20537
o€A RCOrSrnAltOX
M.rOEF
Nls R€O'8TR^Irc}I
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FP5736585 03€1-2019 $731
Fe;
do
EL
JUST LIKE FAMILY MEDICAL CONSIERGE TMNSPORT
45OO EXECUTIVE DR.
NAPLES, FL 3411SO000
Soctlons 30.1 and 1008 (21 USC E2/t arxl 958) ol$c
CmtolLd Subol,enc.s A.t d 1970, a! snBndad,
provldc lhat tha Alto.ncy Gal.rC mey rEvolo or
tulpc.rd . rogbbellon io manursctu,!, dileibuta,
dhgorl! , ,npon or cxpo.i r contmllad subatSnca.
THIS CERTIFICATE IS NOT TRANSFERAELE ON CHANGE OF OV${ERSHIP. CONTROL. LOCATION. OR BTJSINESS ACTMTY.
AIIO IT IS M)T VruD AFIER THE EXPIRATION OATE.
PRACTITIONER 01.,t
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSIW
CIASS 2 Als TMNSFER
Attachment # 6
Betsy Novakovich RN MSN CEN EMT-P
Director of Emergency Care Services
NCH Healthcare System
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
23
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TRANSFER
NOI od|ntown N.Cs H6pital
150 56trnth sr.et N.
N.pl6, tt 34102
(219) 4t&5000 Healthcare
System
8/15n6
Dear Chuck.
Plcase accept this lener of support on behalf of NCH Healthcare Systern for Concierge
Ambulancc Service (Just Like Family's) application of its Certificatc of Public Convcnicncc
(COPCN) to provide Advanced Lifc Supporr scrvices in Collicr Counry.
We bclieve that thc services and treatrncnt that Concicrgc will be providing to the rcsidcots
within this area are in the public's best interest. We havc parmcrcd with Concicrge to advancc
the transfer care scrvices in northcm Collier Counry this past Decernber when we opcncd our
new freestanding Emergency departmcnt. NCH idcntified that we would have an inseasc in the
atnount of or:r transfers and would be placing the currcnt systan under 8 gr€at strain. Concicrgc
has worked with us and the other transport servicc in Collicr Counry to asisure that all paticnt's
that require transport are bcing handled in a timely and skilled manner. Thc scrvice has workod
collaboratively with us and has been responsivc !o our nccds. Concicrge has zupplied rs with
additional support in the movemcnt of patient's throughour our healthcare systcm. In closing I
fully suppon thc approval of the COPCN for Conciergc Ambulancc Servicc in Collicr County.
NCH
'b,1 It rua-.t"
BetsyNovakovictr. RN, MSN, CEN, EMT-P
Dircctor Emergancy Services
NCH Healthcare Systcnt
.VH EALTH G RADES.
aulolrC .rartar to aartaa ra.ttra.ta-
ffi.t{Cxmd.org
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239')682-8907
24
NOI iln$ iLpl6lbrpitd
t ! l9O lh.hhpIl thd.
il.C6, tl3'll l0
o39) 552-7000
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CI-ASS 2 ALs TRANSFER
Attachment#7
Reference letter Dr. Allen Weiss, President & CEO
NCH Healthcare System
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
25
NCH Domtffi NaPL3 HosPltal
35o s*nth streGt N.
Napbs, FL 34102
(239) 624-5000
,'-':.j€*..""' Healthcare -SYstem
June 13, 2016
To Whom It MaY Concern:
This is a letter to strongly support Jasl /i ke -Familywhich is-a very successful transportation and
orivate nursing busin*i=i" s'.rir,n*est Florida tt.lt trus supplied exemplaSr service to the NCH
^Healthcare System for the past few years'
AsNCHhasgrowngeographically,wehaveneededmorerobusttranspodationamongourmany
locations for critically ifiJJto.rti"o patients. j,tilie Famity has exceeded our expectations in
terms of se.rice, efficiency, cost, and overall excellence' Jusi ltke Family has grown with us
andcipating our and the cJmmunity,s ever growing needs. At all timesjust like Family
personnel have bcen #;il;ly;;"i.""iorrlt, com"petent, and caring in providing services for
NCH Patients.
Having choice is always advantages for consumers. Having multiple transportation options for
all patients ranging frJm routine io emergent will benefit alt concerned' If I can provide any
;;;;; "6p"itoitu"t like Familv please let me know'
RespecttullY,
/.fur* S- (),.'}-)YlL.o.
-orr.n S. Weiss, MD, MBA, rAcP' FACR
President and CEO
M.NCHmd.org
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (2391682-8907
26
NCH
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
NCH North Nrples Hosplt l
t 1 190 Healthpark Blvd.
Naples, FL 341 10
(239) ssz-7ooo
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALs TMNSFER
Attachment #8
Reference letter Jimmy Dascani, CEO
Landmark Hospitals of Southwest Florida
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
27
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
LANOMARK
HOSPITAL
To whorn tt rnay csloafn,
Jurt Lile Flrly lbrp Cre b e loct$y ilm€d small br,r*pr trrI hr baen povif,tB hotlE
hedth cara servi5r b ros0ur* FbflL rirce 2O(8. ln 2014. Jtd utr Fjtnfy Cmoergp
Trenryort Servi*r w:r eddrd !o rddra the tE* otps6stE in need dbott cribcal
care/bdvmoed 5e 8lpport il<! rcnenegancy fmsporttbon. Tlrcfi ap9rovd and srcc€ts h
CoI€r Cqrnty b ffiy .ppt nl erd c treirg uced rsgdrrty by 3n.rd no+f* md ofinr
hrtlse fac{lbc Aa a rpr sp€d*y tngat l ln Sa.dxnd FlqU., f b irportml b tloE
thil t-*rffir Hapfi hr a r€elmel inrped. Yer-todb, wr hrY3 rGc.*Y€d 35!6 of our
modEaly cdrpk dmirrirrrr lionr tcc Cor*y Sde and timef fanrpat B ctftcal wlran
g,.6319rrng curpler p€tbnG. G th. rilc crt rfttact tnrr crti(d d*r3 -xl danFal otlcocEa'
Thr mrdcrl &(mnd8 dorr cofrmrriy sra nc,llrsilg n Sorlf,nred Fbrita dti tO
popnlrin grsr1l t errd 0E iulessd rntlr;al canpbrity d @snis rtd vBlfl. TtIrE, ddng
to O|. comptoxtv of trrl8go.Etfun bgitilix ad ncn*ng th€ need for heeltlrcgc fovlle.3
E td terrdbs b tEv€ eddilbrd opbotB in ordsr to pravont unrFosssary rtd oody debys h
crilic.l crnlrdnrrcad Iia srpport end non dnarggrcY tslsnegoft f the ed(lbrtC frmp0fl
jjrrpaa rea.rded, theCynaic of[p dr$in and thchrge Pro66a6 imptgire
!t nificinty ror all *treho.de{B. The gfiectg of lrrvirrg "'cond
oprim sll 'io cofitih'tt b
rore appropnaF use d 9t I rrvrca&trorroeo srtt irprorrr EMS'r -fify to manage hr
g'rrrg6yr*lc. I am corfderilOr.f harhg I 3€cond Atim h Saltltwt Flillrr Ei b*l€fit
rll reaiieilg and vidbrt, n addlbofi El fEFrlg fE bcel h€elthcrro pfovtdm mPfsuE
frrqrg|"U .nd fEr overd peirUmy crpctrtfr
Il6;ng e 31pporb, of lalrndl busirecrc, I rm.dh,xaeni].Iy €rdortit! JrrGt Llka farray
Conciergr T6ncpoa Sarvi-e b be ryporrcd by lh. BoId oa Coutty Cmriraom6 fo;
critic€l crerrdyl1cot ltf€ sfporf and nonsrrgfrcf Ulmpofttim in L* Courty. Florlda
I arn in tt apport of sfb,tB to h€ts locd rciJcntr hlc hetnhier and nrcre tunhg h,E, whfg
prwng6ing local hr*ras grqtrtt Ouor4h tip crsdkm olpbo and oppootnfb- lb.li.wOls
r€qLE6t br addlto.nl cncixc of Flhl fampotmn b vblb tln canmufti ll'o ErYs.
Thrk yqr Elnf conadrdin
4,;*?/,*)-- -Jtrrrry Drant
Chbl Erccufrrc OfEcor
sly/zotg
28
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APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CLASS 2 ALS TMNSFER
Attachment #9
Payment for Renewal of COPCN
S25o check
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (2391682-8907
29
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CI.ASS 2 AI.S TRANSFER
Staple Check here
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) G82-9907
30
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CI.ASS 2 ALS TMNSFER
Attachment #10
Balance Sheet
Profit & Loss Statement
3200 Bailey Lane, Suite 117 Naples, Florida 34105 (239) 682-8907
31
APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY
CI.ASS 2 AI.S TMNSFER
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