FILED SEP 27 2002 THE TREASURER OF THE STATE OF FLORIDA DEPARTMENT OF INSURANCE TOM GALLAGHER Docketed by: IN THE MATTER OF: WILLIAM GUS BELCHER CASE NO.: 61656- 02% 09-4787 PL ADMINISTRATIVE COMPLAINT TO: WILLIAM GUS BELCHER Belcher Funeral Home 4275 State Route 544 Box 2969 Winter Haven, FL 33883-2969 WILLIAM GUS BELCHER 345 23rd Street Southwest Winter Haven, FL 33880-2526 You, WILLIAM GUS BELCHER, are hereby notified that the Insurance Commissioner of the State of Florida has caused to be made an investigation of your activities while licensed as an insurance agent in this state, as a result of which it is alleged: GENERAL ALLEGATIONS 1. Pursuant to Chapter 626, Florida Statutes, you, WILLIAM GUS BELCHER, License LD. #A018016, are currently licensed in this state as a Life (2-16) insurance agent. 2. At all times pertinent to the dates and occurrences referred to herein, you, WILLIAM GUS BELCHER, were licensed in this state as a Life (2-16) insurance agent. 3, Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance (hereinafter “Department”) has jurisdiction over your insurance licenses and appointments. 4. At all times relevant to the dates and occurrences referred to herein you, WILLIAM GUS BELCHER, were engaged in business as an insurance agent representing Security Life Insurance Company of America (hereinafter referred to as “Security Life”). 5. At all times relevant to the dates and occurrences refetred to herein, all funds received by you, WILLIAM GUS BELCHER, from consumers or on behalf of consumers representing premiums for insurance policies, were trust funds pursuant to Section 626.561(1), Florida Statutes, and were received in a fiduciary capacity and were to be accounted for and paid over to the insurer, insured or other persons entitled thereto in the regular course of business. COUNT 1 6. The above general allegations are hereby realleged and fully incorporated herein by reference. 7. On or about February 11, 1998, you, WILLIAM GUS BELCHER, met with Vernon W. Fairbanks, Jr., and completed and signed a “Guaranteed Pre-Need Agreement” dated February 11, 1998, for a guaranteed pre-need cremation policy, for the benefit of Ruth F. Jessee of 1301 Polk City Rd., Haines City, Florida 33844, to be issued by Security Life Insurance Company of America. 8. On or about February 11, 1998, you, WILLIAM GUS BELCHER, accepted check number 1230 made payable to Lake Wales Funeral Home for “Funeral Arrangements” dated February 11, 1998, in the amount of SIX HUNDRED EIGHTY-ONE DOLLARS ($681.00) from Vernon W. Fairbanks, Jr., as payment of the premium of the policy covering the pre-need cremation plan purchased by Vernon W. Fairbanks, Jr., on behalf of his sister, Ruth F. Jessee. 9. Check number 1230, was deposited on February 11, 1998, in the account owned by you, WILLIAM GUS BELCHER, or Lake Wales Funeral Home. 10. You, WILLIAM GUS BELCHER, did not submit this money or the policy application to Security Life or any insurer for the purchase of insurance coverage of the pre-need cremation plan paid for by Vernon W. Fairbanks, Jr. 11. You, WILLIAM GUS BELCHER, did not refund the $681.00 premium payment made by Vernon W. Fairbanks, Jr. until on or about March 18, 2002, after an investigation of this matter by the Department of Banking and Finance. IT IS THEREFORE CHARGED that you, WILLIAM GUS BELCHER, have violated or are accountable under the following provisions of the Florida Insurance Code and Rules of the Department of Insurance which constitute grounds for the suspension or revocation of your license and appointments: (a) All premiums, return premiums, or other funds belonging to insurers or others received by an agent, customer representative, solicitor, or adjuster in transactions under his or her license are trust funds received by the licensee in a fiduciary capacity. An agent shall keep the funds belonging to each insurer for which he or she is not appointed, other than a surplus lines insurer, in a separate account so as to allow the department to properly audit such funds. The licensee in the applicable regular course of business shall account for and pay the same to the insurer, insured, or other person entitled thereto. [Section 626.651(1), Florida Statutes]; (b) Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. [Section 626.611(5), Florida Statutes]; (c) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes}; (d) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida'Statutes]; (e) Misappropriation, conversion, or unlawful withholding of moneys belonging to insurers or insureds or beneficiaries or to others and received in conduct of business under the license or appointment. [Section 626.611(10), Florida Statutes.]; (f) Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. [Section 626.621(2), Florida Statutes]. WHEREFORE, you, WILLIAM GUS BELCHER, are hereby notified that the Treasurer and Insurance Commissioner intends to enter an Order suspending or revoking your licenses and appointments as an insurance agent or to impose such penalties as may be provided under the provisions of Sections 626.611, 626.621, 626.681, 626.691, and 626.9521, Florida Statutes, and under the other referenced sections of the Florida Statutes as set out in this Administrative Complaint. NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Department pursuant to sections 120.569 and 120.57, Florida Statutes, and Rule 28-107, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be filed with the Department within twenty-one (21) days of your receipt of this notice. Completion of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with the General Counsel as acting 7 to emt RCS er“ A Agency Clerk, at the Florida Department of Insurance, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0333. Your written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after your receipt of this notice. Mailing the response on the twenty-first day will not preserve your right to a hearing. YOUR FAILURE TO RESPOND IN WRITING WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU. If you request a proceeding, you must provide information that complies with the requirements of Rule 28-107.004, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements. Specifically, your response must contain: (a) The name and address of the party making the request, for purpose of service; (b) A statement that the party is requesting a hearing involving disputed issues of material fact, or a hearing not involving disputed issues of material fact; and (c) A reference to the notice, order to show cause, administrative complaint, or other communication that the party has received from the agency. If a hearing of any type is requested, you have the right to be represented by counsel or other qualified representative at your expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. Ifa proceeding is requested and there is no dispute of material fact, the provisions of section 120.57(2), Florida Statutes, apply. In this regard, you may submit oral or written evidence in opposition to the action taken by the Department or a written statement challenging the grounds upon which the Department has relied. While a hearing is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary, one will be conducted in Tallahassee, Florida, or by telephonic conference call upon your request. However, if you dispute material facts which are the basis for the Department’s action, you must request an adversarial proceeding pursuant to sections 120.569 and 120.57(1), Florida Statutes. These proceedings are held before a State administrative law judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere, the Department will request that the hearing be conducted in Tallahassee, Florida. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding. Any request for an administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. Mediation of this matter pursuant to section 120.573, Florida Statutes, is not available. No Department attorney will discuss this matter with you until the response has been received by the Department of Insurance. DATED and SIGNED this 27th_ day of SEPTEMBER, 2002. KENNEY SHIPLEY Ome Deputy Insurance Commissioner of on Pes tery we : CERTIFICATE OF SERVICE 1 HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF RIGHTS has been furnished to: WILLIAM GUS BELCHER, Belcher Funeral Home, 4275 State Route 544 Box 2969, Winter Haven, FL 33883- 2969; WILLIAM GUS BELCHER, 345 23rd Street Southwest, Winter Haven, FL 33880-2526 by Certified Mail this_27. day of __ SEPTEMBER , 2002. ‘ R. Terry But Florida Bar Division of Legal Ices 612 Larson Building 200 East Gaines Street Tallahassee, Florida 32399-033 Phone: (850) 413-4236 Fax: (850) 488-0697

Docket for Case No: 02-004787PL