How to Complete AHCA Form 3100-0009: Proof of Financial Ability to Operate

AHCA Form 3100-0009, the Proof of Financial Ability to Operate, is the spreadsheet Florida’s Agency for Health Care Administration uses to confirm that a new or newly-acquired health care facility can pay its bills through its first two years. You download it as an Excel file from AHCA’s licensure applications page, fill in projected balance sheets, income statements, and cash flow for a 24-month horizon, attach supporting documents, and submit it with your initial license or change-of-ownership application.¹²³

Who Has to File It

Rule 59A-35.062 lists the provider types that must submit Form 3100-0009 with an initial or change-of-ownership application:³

Nursing home facilities
Assisted living facilities
Home health agencies
Hospices
Adult day care centers
Prescribed pediatric extended care centers
Home medical equipment providers
Intermediate care facilities for the developmentally disabled
Health care clinics

Nurse registries also owe AHCA proof of financial ability, but they file a different form, 3110-7004A, and are not covered by these instructions.⁴

Straight renewals do not normally require the form. Two situations pull it back in. First, a change of ownership: the new owner must file a full CHOW application, including 3100-0009, at least 60 days before the transfer date.⁵²⁴

Documents to Gather Before You Open the Spreadsheet

The form asks for numbers that have to reconcile against source documents. Collect these first, then build the spreadsheet:

Recent bank statements from established financial institutions showing cash reserves.
Statements or account confirmations for other liquid assets recognized by the rule: publicly traded stocks, bonds, certificates of deposit, and money market accounts.⁴
Signed loan agreements or formal letters of credit for any external financing you’re counting on.
Proof of a contingency fund equal to at least one month’s average operating expense over the first year. The rule frames this fund as coverage for events outside your projections, such as a drop in patient volume, delays in Medicare or Medicaid certification, or major repairs.³
Documentation for your revenue assumptions: expected patient volumes, payer mix, and reimbursement rates from insurers and government programs, along with the basis for each figure.

Whether You Need a CPA

Every set of financials filed under Rule 59A-35.062 must follow generally accepted accounting principles. Beyond that, the CPA compilation requirement applies to three provider types only: home health agencies, home medical equipment providers, and health care clinics. For those, a certified public accountant must compile and sign the financial documents.³ Nursing homes, assisted living facilities, hospices, and the other covered types are not required to use a CPA, though inconsistencies between the form and its supporting documents are one of the more frequent reasons AHCA issues a deficiency notice.

What the Form Asks For

Form 3100-0009 is organized into schedules that mirror standard financial statements. You complete a pro forma balance sheet, a pro forma cash flow statement, and a pro forma income and expense statement covering the first two years of operations. Taken together, these have to show enough assets, credit, and projected revenue to cover your liabilities and expenses over the projection period.³

Revenue

Break projected revenue down by payer type — Medicare, Medicaid, private insurance, and self-pay — and apply the contractual adjustments for each. The rule defines contractual adjustments as the difference between your established charges and the rates actually negotiated with Medicare, Medicaid, HMOs, PPOs, and commercial insurers.⁴ Account for charity care separately if your facility will provide it. Overstated revenue is a common trigger for reviewer follow-up.

Operating Expenses

Itemize staff salaries and benefits, rent or mortgage payments, utilities, insurance premiums, supplies, and administrative overhead. Every line should tie to a stated assumption. Salary projections, for example, should match the staff positions you plan to fill and reasonable wage rates for your area.

Pre-Opening Costs

Pre-opening costs get their own treatment. The rule defines them broadly to include advertising, equipment purchases, legal and accounting fees, consulting fees, prepaid insurance and rent, licensure fees, utility deposits, and recruitment, staffing, and training expenses.³ Keep these separate from ongoing operating expenses so the reviewer can see how your initial capital is being deployed.

Contingency Fund and First-Year Losses

New facilities often lose money early. The form expects a clearly identified funding source that will carry the facility through those months. The contingency fund — one month’s average operating expense at minimum — must appear on the form, and it needs to be backed by documentation showing the money exists and is accessible.⁴ If your first-year projections show net losses, the contingency fund plus any additional reserves or credit lines has to be large enough to absorb them. A contingency fund that’s too small relative to the projected shortfall will draw a deficiency notice.

Liabilities

Report all outstanding obligations: loans, lines of credit, deferred payments, and anything else owed. These figures, read against your assets and revenue, are what AHCA uses to judge two-year viability.

How to Submit the Form

The AHCA Online Licensing System is the primary submission method for initial and change-of-ownership applications. You upload Form 3100-0009 with your bank statements, credit agreements, and CPA certification if one is required.¹ Register an AHCA Portal account before you start.

Mail submission is still available for initial and CHOW filings; physical copies go to the appropriate AHCA unit in Tallahassee. As of September 2024, AHCA no longer accepts mailed renewal applications, so any renewal-triggered financial submission must go through the portal.⁶

Application fees must accompany the submission. Make checks or money orders payable to the Agency for Health Care Administration. Payments made out to “State of Florida” are returned.¹ Keep a copy of the full package and any confirmation receipts.

The Review Clock: 30 Days In, 21 Days to Cure

AHCA has 30 days from receipt to examine your application and notify you in writing of errors or omissions.⁵ If the reviewer finds missing documents or inconsistent numbers, you get an omissions letter listing exactly what to fix.

You then have 21 days from the date you receive that letter to respond. If you miss the window, the application is deemed incomplete, is withdrawn from further consideration, and your fees are forfeited.⁵ The statute builds in no extension.

Mistakes That Trigger Deficiency Notices

Because the 21-day clock is unforgiving, the safer path is submitting cleanly. The recurring problems are these:

Contingency fund short of one month’s average operating expense, or undocumented. If your monthly operating costs average $80,000, the fund needs to be at least $80,000 and backed by evidence the money exists and is accessible.
Revenue assumptions with no stated basis. The form requires you to explain the rationale behind every projection. Market data, referral agreements, or historical volume at comparable facilities all work; bare numbers do not.
Figures that don’t reconcile with the attachments. A balance sheet showing $200,000 in cash paired with bank statements showing $150,000 gets flagged.
Missing CPA compilation from a home health agency, home medical equipment provider, or health care clinic. Without a compiled, signed set of financials, the application is incomplete on arrival.
Financials not presented under GAAP. Internal bookkeeping formats or informal spreadsheets will not pass review.

If AHCA denies the application because the financials don’t demonstrate viability, the facility cannot legally begin operating, and the agency retains authority to deny, suspend, or revoke a license.² Given that losing a filing means starting over and forfeiting the fee, the time spent reconciling numbers to source documents before you hit submit is time well spent.

1
Agency for Health Care Administration. HQA Applications for Licensure
2
Florida Statutes. Florida Code 408810 – Minimum Licensure Requirements
3
Legal Information Institute. Florida Code 59A-35062 – Proof of Financial Ability to Operate
4
Florida Administrative Code. 59A-35062 Proof of Financial Ability to Operate
5
Florida Statutes. Florida Code 408806 – License Application Process
6
Agency for Health Care Administration. Laboratory and In-Home Services