14-002810 Agency For Health Care Administration vs. Southern Breeze Living, Llc Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Monday, August 25, 2014.

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STATE STATE OF OF FLORIDA FLORIDA

AGENCY AGENCY FOR FOR HEALTH HEALTH CARE CARE ADMINISTRATION ADMINISTRATION

STATE STATE OF OF FLORIDA, FLORIDA, AGENCY AGENCY FOR FOR 2014 2614 ~[ SEP P 22 22 All: A H: 1.1 40 0

HEALTH HEALTH CARE CARE ADMINISTRATION, ADMINISTRATION,

Petitioner, Petitioner,

vs. VS. AHCA AHCA No.: No.: 2013010759 2013010759

RENDITION RENDITION NO.: NO.: ,c\\"CA- AHCA- ILf - ()lq I -S-OlC S- OLC

SOUTHERN SOUTHERN BREEZE BREEZE LIVING, LIVING, LLC, LLC,

Respondent. Respondent.

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FINAL FINAL ORDER ORDER

Having Having reviewed reviewed the the Amended Amended Administrative Administrative Complaint, Complaint, and and all all other other matters matters of of record, record, the the

Agency Agency for for Health Health Care Care Administration Administration finds finds and and concludes concludes as as follows: follows:

1. 1. The The Agency Agency has has jurisdiction jurisdiction over over the the above-named above- named Respondent Respondent pursuant pursuant to to Chapter Chapter 408, 408,

Part Part 11, II, Florida Florida Statutes, Statutes, and and the the applicable applicable authorizing authorizing statutes statutes and and administrative administrative code code provisions. provisions.

2. 2. The The Agency Agency issued issued the the attached attached Amended Amended Administrative Administrative Complaint Complaint and and Election Election of of

Rights Rights form form to to the the Respondent. Respondent. Ex. (Ex. 1) 1) The The Election Election of of Rights Rights form form advised advised of of the the right right to to an an

administrative administrative hearing. hearing.

3. 3. The The parties parties havesince have since entered entered into into the the attached attached Settlement Settlement Agreement. ( Agreement. Ex. (Ex. 2) 2)

Based Based upon upon the the foregoing, foregoing, it it is is ORDERED: ORDERED:

1. 1. The The Settlement Settlement Agreement Agreement is is adopted adopted and and incorporated incorporated by by reference reference into into this this Final Final Order. Order.

The The parties parties shall shall comply comply with with the the terms terms of of the the Settlement Settlement Agreement. Agreement.

2. 2. The The Respondent Respondent shall shall pay pay the the Agency $ Agency 00. 1, $1,500.00. 500. If If full full payment payment has has been been made, made, the the

cancelled cancelled check check acts acts as as receipt receipt of of payment payment and and no no further further payment payment is is required. required. If If full full payment payment has has not not

been been made, made, payment payment is is due due within within 30 30 days days of of the the Final Final Order. Order. Overdue Overdue amounts amounts are are subject subject to to statutory statutory

interest interest and and may may be be referred referred to to collections. collections. A A check check made made payable payable to to the " the Agency "Agency for for Health Health Care Care

Administration" Administration" and and containing containing the the AHCA AHCA ten- ten-digit digit case case number number should should be be sent sent to: to:

Office Office of of Finance Finance and and Accounting Accounting

Revenue Revenue Management Management Unit Unit

Agency Agency for for Health Health Care Care Administration Administration

2727 2727 Mahan Mahan Drive, Drive, MS MS 14 14

Tallahassee, Tallahassee, Florida Florida 32308 32308

1 1

ORDERED at Tallahassee, Florida, on this , 2014.

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely affected by this Final Order is entitled to judicial review, which shall be

instituted by filing one copy of a notice of appeal with the Agency Clerk of AHCA, and a second copy,

along with filing fee as prescribed by law, with the District Court of Appeal in the appellate district

where the Agency maintains its headquarters or where a party resides. Review of proceedings shall be

conducted in accordance with the Florida appellate rules. The Notice of Appeal must be filed within 30

days of rendition of the order to be reviewed.

CERTIFICATE OF SERVICE

I CERTIFY that a true and this Final Order 'Yas the below-named

persons by the method designated on this ,2014.

Clerk

Agency for Health Care Administration

2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: [phone]

Jan Mills Finance & Accounting

Facilities Intake Unit Revenue Management Unit

(Electronic Mail) (Electronic Mail)

John E Bradley Ted Mack

Office of the General Counsel Counsel for Petitioner

Agency for Health Care Administration Powell and Mack

(Electronic Mail) 3700 Bellwood Drive

Tallahassee, Florida 32303

(U.S. Mail)