() C) FILED ~apwe ss MAY 0.4 CHIEF FINANCIAL OFFICER fo TEE or MOMa Docketed by, IN THE MATTER OF: CASE NO.: 159812-14-FC GRAMKOW FUNERAL HOME & CREMATORY (License Number: F039906) a ADMINISTRATIVE COMPLAINT TO: Gramkow Funeral Home & Crematory 500 East Airport Boulevard Sanford, FL 32773 Gramkow Funeral Home & Crematory (the “Licensee”) is hereby notified that the Division of Funeral, Cemetery, and Consumer Services (the “Division”) has directed an investigation in connection with the license issued to the Licensee to operate as a Funeral Establishment. The allegations below are based on the investigation. GENERAL ALLEGATIONS 1. The Board of Funeral, Cemetery, and Consumer Services (the “Board”), created within the Division, and the Department of Financial Services (the “Department”) have jurisdiction over the Licensee’s license as a Funeral Establishment and the subject matter of this proceeding, pursuant to the provisions of section 20.121 and chapter 497, Florida Statutes (2014).' 2. The Board has the authority to determine through probable cause panels whether * Unless otherwise specified, all statutory references are to the 2014 version of the Florida Statutes. C) C) probable cause exists to believe a violation of chapter 497, Florida Statutes, has occurred and whether a proposed administrative prosecution of a licensee shall go forward, pursuant to sections 497.103(1)(v) and 497.153(3), Florida Statutes. 3. A probable cause panel on January 20, 2015, found probable cause to charge the Licensee with violations of chapter 497, Florida Statutes, and chapter 69K, Florida Administrative Code, and directed the Department to prosecute the matter. 4. At all times relevant to the allegations of this Administrative Complaint, the Licensee was licensed as a Funeral Establishment, license number F039906, pursuant to the provisions of chapter 497, Florida Statutes. 5. At all times relevant to the allegations of this Administrative Complaint, Gramkow Funeral Home & Crematory, Inc., was located at 500 East Airport Boulevard, Sanford, FL 32773. 6. At all times relevant to the allegations in this Administrative Complaint, Patrick Fulton was a licensed Funeral Director and Embalmer. 7. At all times relevant to the allegations in this Administrative Complaint, Patrick Fulton was employed at Gramkow Funeral Home & Crematory, Inc. 8. Pursuant to section 497.005(40), Florida Statutes, “License” includes all authorizations required or issued under this chapter, except where expressly indicated otherwise, and shall be understood to include authorizations previously referred to as registrations or certificates of authority in chapters 470 and 497, Florida Statutes. 9. Pursuant to section 497.005(41), Florida Statutes, “Licensee” means the person or entity holding any license or other authorization issued under this chapter, except where expressly indicated otherwise. 10. Pursuant to section 497.153(7), Florida Statutes, the acts or omissions of any 2 () C) person employed by or under contract to the licensee shall be treated as acts or omissions of the licensee. COUNT I 11. The above General Allegations are restated as if fully set forth herein. 12. On or about April 11, 2014, the wife of LRD passed away. 13. Onor about April 12, 2014, Patrick Fulton, an employee of the Licensee, met with LRD to discuss at-need funeral service arrangements. 14. During that meeting, Patrick Fulton, on behalf of the Licensee, and LRD executed a services and merchandise contract. 15. On or about April 15, 2014, C&J Financial received an assignment of insurance from the Licensee. 16. Subsequently, C&J Financial requested proof that LRD was the beneficiary of his wife’s insurance policy. 17. LRD’s financial advisor informed LRD of C&J Financial’s request. LRD was unaware of any assignment of insurance provided to C&J Financial. 18. After further investigation, it was determined that an Irrevocable Power of Attorney and a second services and merchandise contract bore LRD’s signature. 19. LRD discovered that Patrick Fulton forged LRD’s signature on the Irrevocable Power of Attorney and second services and merchandise contract. The documents were then provided to C&J Financial. 20. Patrick Fulton failed to obtain the consent of LRD before signing LRD’s name on a ( C) C) the Irrevocable Power of Attorney and second services and merchandise contract. 21. The Licensee is responsible for all acts committed by employees. More specifically, the Licensee is responsible for Patrick Fulton’s forgery of LRD’s documents. IT IS THEREFORE CHARGED that Gramkow Funeral Home & Crematory has violated one or more of the following provisions of the Florida Statutes, which constitutes sufficient grounds for the suspension or revocation of its license as a Funeral Establishment in this state: (a) Section 497.152(1)(a), Florida Statutes, which provides that it is a violation to fail to comply with any provision of chapter 497 or any lawful order of the board or department or of the statutory predecessors to the board or department. (b) Section 497.152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under chapter 497, (c) Section 497.152(9)(f), Florida Statutes, which provides it is a violation to directly or indirectly [make] any deceptive, misleading, or untrue representations, whether oral or written, or employing any trick, scheme, or artifice, in or related to the practice of a profession or occupation regulated under this chapter, including in the advertising or sale of any merchandise or services related to the practice of the profession or occupation. C) C) WHEREFORE, the Department respectfully requests the Board enter an order imposing one or more of the following penalties upon Gramkow Funeral Home & Crematory: revocation or suspension of license; imposition of an administrative fine not to exceed five thousand dollars ($5,000) for each count or separate offense; issuance of a written reprimand; placement of Gramkow Funeral Home & Crematory on probation; assessment of costs associated with investigation and prosecution; requirement that Gramkow Funeral Home & Crematory make restitution; and/or such other penalty or condition as is authorized under section 497.153(5), Florida Statutes. DATED and SIGNED this “7 He day of Mag » 2015. 1 Whitfield Deputy Chief Financigf Officer NOTICE OF RIGHTS The Licensee has the right to request a proceeding to contest this action by the Board pursuant to sections 120.569 and 120.57, Florida Statutes, and Rule 28-106, Florida Administrative Code. The proceeding request must be in writing, signed by a representative for the Licensee, and must be filed with the Department within twenty-one (21) days of 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 Department Agency Clerk, Julie Jones, Florida Department of Financial Services, 200 East 5 -) C) os Gaines Street, Tallahassee, Florida 32399-0390. The Licensee’s written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after receipt of this notice. Mailing the response on the twenty-first day will not preserve the right to a hearing. FAILURE TO RESPOND IN WRITING WITHIN TWENTY- ONE (21) DAYS OF RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF THE RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF SUSPENSION OR REVOCATION WILL BE ENTERED. If the Licensee requests a proceeding, information must be provided that complies with the requirements of Rule 28-106.2015, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements. Specifically, the response must contain: (a) The name, address, and telephone number, and facsimile number (if any) of the respondent (for the purpose of requesting a hearing in this matter the Licensee is the "Respondent"). (b) The name, address, telephone number, facsimile number of the attorney or qualified representative of the respondent (if any) upon whom service of pleadings and other papers shall be made. . (c) A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. (d) A statement of when the respondent received notice of the administrative complaint. (e) A statement including the file number to the administrative complaint. If a hearing of any type is requested the Licensee has the right to be represented by 6 C) C) counsel or other qualified representative at its own 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. If a proceeding is requested and there is no dispute of material fact, the provisions of section 120.57(2), Florida Statutes, apply. Oral or written evidence may be submitted in opposition to the action taken by the Board or a written statement challenging the grounds upon which the Board has relied. While a hearing is normally not required in the absence of a dispute of fact, if the Licensee feels that a hearing is necessary, one will be conducted in Tallahassee, Florida, or by telephonic conference call upon request. However, if the Licensee disputes material facts which are the basis for the Board’s action, an adversarial proceeding must be requested 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 the 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 (2014), is not available. No Department attorney will discuss this matter with you or your representative during the time frame in which you have to request a hearing. STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF LEGAL SERVICES IN THE MATTER OF: GRAMKOW FUNERAL HOME & CREMATORY CASE NO.:: 159812-14-FC (License Number: F039906), ELECTION OF PROCEEDING Gramkow Funeral Home and Crematory (the “Licensee”) has received and has read the Administrative Complaint filed by the Florida Department of Financial Services (the "Department") against it, including the Notice of Rights contained therein, and understands the options. The Licensee is requesting disposition of this matter as indicated below. (CHOOSE ONE) Lt] 3.0] The Licensee does not dispute any of the Departments factual allegations and does not desire a hearing. It is understood that by waiving the right to a hearing, the Board of Funeral, Cemetery and Consumer Services (“Board”) may enter a final order that adopts the Administrative Complaint and imposes the sanctions sought, including suspending or revoking the Licensee’s license(s) as may be appropriate. The Licensee_does not dispute any of the Department's factual allegations and hereby elects a proceeding to be conducted in accordance with ss. 120.57(2) and 497.153(4)(b), Florida Statutes. In this regard, the Licensee desires to: [] Submit a written statement and documentary evidence to the Board in lieu of a hearing; or {] Personally attend a hearing conducted by the Board at the location of a regularly scheduled Board meeting. The Licensee does dispute one or more of the Department's factual allegations, and hereby requests a hearing pursuant to section 120.57(1), Florida Statutes, to be held before the Division of Administrative Hearings. Attached to this election form is the information required by Rule 28-106.2015, Florida Administrative Code, as specified in subparagraph (c) of the Notice of Rights. Specifically, disputed issues of material fact have been identified in the response attached hereto. TO PRESERVE THE RIGHT TO A HEARING, A RESPONSE MUST BE FILED WITH THE DEPARTMENT OF FINANCIAL SERVICES WITHIN TWENTY-ONE (21) DAYS OF RECEIPT OF THE ADMINISTRATIVE COMPLAINT. THE RESPONSE MUST BE RECEIVED BY THE DEPARTMENT NO LATER THAN 5:00 P.M. ON THE TWENTY-FIRST DAY AFTER RECEIPT OF THE ADMINISTRATIVE COMPLAINT. The address for filing is: DFS Agency Clerk, Julie Jones, Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0390. Signature Print Name Date: Address: Date Administrative Complaint Received: If represented by an attorney or qualified Phone No.: representative, please attach to this election form his or her name, address, telephone and fax numbers Fax No.: aa 7 a -S CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF PROCEEDING FORM has been furnished by U.S. Certified Mail, return receipt requested, this Y¥ day of Mow » 2015, to: Gramkow Funeral Home & Crematory 500 East Airport Boulevard Sanford, FL 32773 Th 7199 9991 2032 7b? 8311 Linje oan Ze Florida Department of Financial Services 200 E. Gaines St., 6" Floor Tallahassee, FL 32399-0390 Phone (850) 413-4230 Fax: (850) 488-0697 Counsel for the Department

Docket for Case No: 15-003405