STATE OF FLORIDA

AGENCY FOR HEALTH CARE ADMINISTRATION

STATE OF FLORIDA, AGENCY FOR

HEALTH CARE ADMINISTRATION, l l NOV 20 A CJ; LJ9

vs.

Petitioner,

DOAH No. 12-2531

AHCA No. 2012006509

2012006510

RENDITION NO.: AHCA - 12- I l :)0 -5-0LC

FKP FORT WALTON BEACH SENIOR LIVING TENANT, LLC d/b/a BELVEDERE COMMONS OF FORT WALTON BEACH,

Respondent.

                                                                               I

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 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.

   
   

2. 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 of the Settlement Agreement.

   
   

2. The Respondent shall pay the Agency $21,000.00. 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 120 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

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Filed November 27, 2012 10:11 AM Division of Administrative Hearings

ORDERED at Tallahassee, Florida, on this day ofN----'D' ' 2012.

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 correc!...WPLQ.Lthis Fi er was served on the below-named persons by the method designated on this;?t?Ycfay of W--- , 2012.

Richard Shoop, Agency Clerk

Agency for Health Care Administration 2727 Mahan Drive, Bldg. #3, Mail Stop #3

Tallahassee, Florida 32308-5403

Telephone: (850) 412-3630

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Docket for Case No: 12-002531

Orders for Case No: 12-002531