14-005088 Agency For Health Care Administration vs. Evangelical Lutheran Good Samaritan Society, D/B/A Good Samaritan Society - Kissimmee Village Status: Closed Settled and/or Dismissed prior to entry of RO/FO on Tuesday, January 6, 2015.

STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION r··i

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION,

Petitioner,

vs. AHCA No. 2014003542

RENDITION NO.: AHCA· 15 • OO'&l ·S·OLC

EVANGELICAL LUTHERAN GOOD

SAMARITAN SOCIETY d/b/a

GOOD SAMARITAN

SOCIETY-KISSIMMEE VILLAGE

Respondent.

FINAL ORDER

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

Health Care Administration finds and concludes as follows:

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

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

2. The Agency issued the attached Administrative Complaint and Election of Rights form to

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

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

Based upon the foregoing, it is ORDERED:

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

The parties shall comply with the terms ofthe Settlement Agreement.

2. The Respondent shall pay the Agency $43,500.00. If full payment has been made, the

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

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

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

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

Office of Finance and Accounting

Revenue Management Unit

Agency for Health Care Administration

2727 Mahan Drive, MS 14

Tallahassee, Florida 32308

3. Conditional licensure status is imposed on the Respondent beginning February 14, 2014,

and ending April 8, 2014.

ORDERED at Tallahassee, Florida, on this ___jJ_ day 2015.

, Secretary

ea th Care Administration

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 _Qf_!his Final Order was served on the below-named

persons by the method designated on of -;;:;J:-

Richard Shoop, Agency Clerk

Agency for Health Care Administration

2727 Mahan Drive, 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, Assistant General Counsel Jonathon Grout, Esquire

Office of the General Counsel Goldsmith & Grout, P .A.

Agency for Health Care Administration Post Office Box 2011

(Electronic Mail) Winter Park, Florida 32790-2011

(U.S. Mail)