1. STATE OF FLORIDA
AGENCY FOR HEALTH CARE ADMINISTRATION
Party 1, ALJ3, Inc,
Petitioner,
vs. ACHA No. 0000054872
State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION
Respondent,
___________________________________________________/
PETITION FOR FORMAL ADMINISTRATIVE HEARING
Petitioner, Party 1, by and through their undersigned consultant and pursuant to
Sections 120.569 and 120.57(1), Florida Statutes and Rules 28­106.201, 28­106.2015,
Florida Administrative Code, file this petition for formal administrative proceeding and state:
1. The affected agency is The Agency for Health Care Administration, 2727 Mahan
Drive, Mail Stop #3, Tallahassee, Florida 32308. The ACHA No. is 00000548872.
2. Petitioner is Party 1, ALJ3, Inc., 7421 XXXX Court, Jacksonville, Florida 32210.
Petitioners are being represented in this proceeding by Tucker Contract Consulting, 5606
Chirping Way West, Jacksonville, Florida 32222; Telephone (904) 469­6741; Facsimile
(904) XXX­XXXX.
PETITIONER SUBSTANTIAL INTERESTS ARE AFFECTED
3. AJL3, Inc. was formed and registered with the State of Florida on October 18,
2012, by Party 2, 7530 103rd Street, Suite 8, Jacksonville, Florida. (Exhibit A). Petitioner’s
substantial interests are affected by being listed as a last director of ALJ3, Inc. which affects
Petitioner’s ability to apply for licensure with the Agency for Health Care Administration in the
future.

2. 4. On March 7, 2015, the Petitioner received an Administrative Complaint by
Certified Mail regarding an administratively dissolved corporation, ALJ3, Inc. On March 24,
2015, Party 1’ consultant responded to the Administrative Complaint by fax and U.S. Express
Mail admitting to some of the allegations of facts contained in the Administrative Complaint
and requesting an Informal Hearing. On March 27, 2015, Petitioner’s Consultant received
Order of Dismissal Without Prejudice To Allow For Amendment and Resubmission of Petition
(Exhibit B) advising that respondent’s response was legally insufficient and advising
Respondent to file a Petition for Formal Administrative Hearing within fifteen (15) days of
rendition of the Order of Dismissal Without Prejudice To Allow For Amendment and
Resubmission of Petition. Petitioner is filing this Petition for a Formal Administrative Hearing
in accordance with the Order of Dismissal Without Prejudice To Allow For Amendment and
Resubmission of Petition.
​DISPUTED ISSUES OF MATERIAL FACT
5. Petitioner was not the last director or principal of ALJ3, Inc. Petitioner was not
aware she was listed as a principal on the incorporation registration with the State of Florida.
The Registered Agent on the Divisions of Corporations registration is Party 2. Petitioner was
fraudulently listed without her consent or knowledge. Petitioner was not aware that ALJ3,
Inc., was not licensed by the Agency for Health Care Administration. Petitioner initially agreed
to function as the Facility Administrator under the ownership of Party 2 when Ms. Croker
initially approached Petitioner regarding ALJ3, Inc. and worked in that capacity for the
duration of the operations of the facility.
6. Ms. Croker approached Petitioner regarding a partnership when she could not
qualify for the lease of the facility independently. Ms. Croker advised that she would have her
attorney prepare a partnership agreement for both partners to sign to make the partnership

3. official. Ms. Croker advised Petitioner that ALJ3, Inc., was licensed by the State of Florida
Agency of Health Care Administration and asked Petitioner to procure an Occupational
License. Petitioner procured an Occupational License as requested by Ms. Croker (Exhibit
C). Petitioner also signed the lease to procure the property but was never presented with the
promised partnership agreement after the lease was signed. Therefore, Petitioner continued
to operate in the capacity of Facility Administrator under the ownership of Party 2.
7. Ms. Croker presented the following documents to Petitioner:
● AHCA Local Zoning Form for ALJ3, Inc Living and Adult Family Care Homes
(Exhibit D)
● Fire Alarm System Record of Completion (Exhibit E)
● Inspection and Testing Form (Exhibit F)
● Fire Safety Inspection (Exhibit G)
Exhibit E list Party 2 as the property representative and advise the system operation and
maintenance manuals are located with the owner. Exhibit F list Party 2 as the Owner
Contact. Exhibit G lists Party 2 as the Owner/Manager and receipt is acknowledged by
signature of Party 2 dated May 6, 2013.
8. The facility was abandoned by Ms. Croker on or about May 2014 and Petitioner
continued to provide care for the residents of ALJ3, Inc. in a desperate attempt to provide
interim care for residents until she could either (1) licence the facility in her name alone or (2)
find suitable placements for the residents and close the facility. Party 2 abandoned Petitioner
with seven months remaining on the lease, which Petitioner honored independently.
Petitioner was not paid after Ms. Croker abandoned the facility and financed the daily living
necessities of residents and the monthly rent for the property out of her personal funds. Ms.
Croker wanted to start another business and publicly demanded several times that Petitioner

4. remove her from the lease. The Lessor would not allow Ms. Croker to be removed from the
lease.
9. ALJ3, Inc. received payments for residents from Lutheran Social Services
which inclined Petitioner to belief ALJ3, Inc. was licensed by the Agency of Health Care
Administration. Petitioner based this belief on her previous experience as owner of licensed
facility HH Community Center which was a vendor of Lutheran Social Services. HH
Community Center was provided the attached letter after providing licensure proof to become
a vendor for Lutheran Social Services (Exhibit H).
10. Petitioner also had consistent communication and interaction with resident(s)
case managers which led her to also believe ALJ3, Inc. was licensed by the Agency For
Health Care Administration because Chapters 429.08 (d) specifically states “The employer of
any person who is under contract with the agency or department, or the Department of
Children and Families, and who knowingly refers a person for residency to an unlicensed
facility; to a facility the license of which is under denial or has been suspended or revoked;or
to a facility that has a moratorium pursuant to part II of chapter 408 shall be fined and required
to prepare a corrective action plan designed to prevent such referrals.” Petitioner had a
reasonable expectation that if ALJ3, Inc. was not licensed with the Agency For Health Care
Administration, that the case managers would not have allowed or referred residents to be
placed in the Facility.
11. Petitioner was not notified or aware that ALJ3, Inc. had been administratively
dissolved by Florida Department of State, Division of Corporations, on September 27, 2013.
12. Petitioner was made aware that ALJ3, Inc. was not properly licensed by the
Agency For Health Care Administration on September 12, 2014, when the Agency surveyor

5. advised her that the ALJ3, Inc. was unlicensed during a telephone call. Petitioner did not
admit by telephone that the ALJ3, Inc. was operating as an unlicensed facility.
13. Petitioner was never interviewed by Agency surveyor during Agency surveyor’s
October 21, 2014 review. Petitioner has never met Agency surveyor on either occasion
he/she visited the ALJ3, Inc.
STATEMENTS OF ULTIMATE FACTS
14. Party 2 was the only and last director of the ALJ3, Inc.
15. Petitioner never signed a partnership agreement with Party 2 and never
became a partner or director of ALJ3, Inc.
16. Party 2 owned and operated ALJ3, Inc. unlicensed in violation of Section
408.812, Florida Statutes.
17. Petitioner facilitated the facility from October 2013 through September 12, 2014
without knowledge that the ALJ3, Inc. was not licensed by The Agency For Health Care
Administration.
18. Petitioner had difficulty finding suitable placement for residents after Petitioner
received cease and desist notice and Petitioner could not and would not abandon the
residents or allow the residents to become homeless without shelter and therefore, Petitioner
continued to provide care for residents until October 21, 2014, when adequate placement
could be found.
RULES AND STATUTES ENTITLING PETITIONER TO RELIEF​ ​_
19. Petitioner is entitled to relief pursuant to Sections 120.569 and 120.57(1),
Florida Statute and Chapter 58A­5.016, Florida Administrative Code.
DEMAND FOR RELIEF
​WHEREFORE​, Petitioner respectfully prays for the following relief:

6. A. The Agency for Health Care Administration grants Petitioner’s request for a formal
hearing.
B. This Petition be forwarded to the Division of Administrative Hearings for assignment to
an Administrative Law Judge and, after a formal administrative proceeding, enter a
final order dismissing Petitioner, as the last director of the ALJ3, Inc.
C. The findings of undisputed facts be accepted as ultimate facts and conclusions of law
be consistent with Florida Statutes and Florida Administrative Code as cited in this
Petition.
D. Petitioner’s fine for operating an unlicensed facility from September 12, 2014 to
October 21, 2014 be overturned due to extenuating circumstances.
RESPECTFULLY SUBMITTED​ this 31st day of March, 2015
Tucker Contract Consulting, LLC
______________________________
Yolanda M. Tucker
5606 Chirping Way West
Jacksonville, Florida 32222
Telephone (904) 469­6741
Facsimile (904) 672­7654
CONSULTANT FOR PETITIONER
CERTIFICATE OF SERVICE
I, ​HEREBY CERTIFY that a copy of the foregoing Petition for Formal
Administrative Proceeding has been furnished by US Mail to Richard J. Shoop,
Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop
#3, Tallahassee, Florida 32308.

7.
________________________________________
Yolanda M. Tucker
COPIES FURNISHED TO:
Warren Bird, Esquire
State of Florida, Agency for
Health Care Administration
2727 Mahan Drive, MS 3
Tallahassee, Florida 32308
Party 2
ALJ3, Inc
XXXX 103rd Street, Suite X
Jacksonville, Florida 32210