HomeMy WebLinkAbout00-03364
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HCR MANORCARE, INC.,
s1b/m/t MANORCARE HEALTH
SERVICES, INC.,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff,
NO. tb. "3:?&tf ~
V.
CIVIL ACTION-LAW
WILLIAM RHOADS,
Defendant.
JURY TRIAL DEMANDED
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NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this complaint and notice are
served, by entering a written appearance personally or by an attorney and filing in writing with the
court, your defenses or objections to the claims set forth against you. You are warned that if you
fail to do so, the case may proceed without you and a judgment may be entered against you by the
court without further notice for any money claimed in the complaint or for any other claim or
relief requested by the plaintiff. You may lose money or property or other rights important to
you.
YOU SHOULD TAKE TillS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, Pennsylvania 17013
(717) 249-3166
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HCR MANORCARE, INC.,
s1b/m/t MANORCARE HEALTH
SERVICES, INC.,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff,
NO. 0-0- 33~'I ~ tu--
v.
CIVIL ACTION-LAW
WILLIAM RHOADS,
Defendant.
JURY TRIAL DEMANDED
COMPLAINT
NOW, comes plaintiff, HCR ManorCare, Inc. by and through its attorneys, O'BRIEN,
BARIC & SCHERER, and files the within complaint and, in support thereof, sets forth the
following:
1. PlaintiffHCR ManorCare, Inc. ("Manor") is an Ohio corporation, duly authorized
to conduct business in Pennsylvania and having offices at 940 Walnut Bottom Road, Carlisle,
Cumberland County, Pennsylvania. HCR ManorCare, Inc. is the successor by merger to
ManorCare Health Services, Inc..
2. Defendant, William Rhoads is an adult individual residing at 12 Michaux Drive,
Newville, Pennsylvania.
3. On or about April 15, 1996, William Rhoads executed an Admission Agreement
Contract Between Resident and Facility ("Admission Agreement") on behalf of Anna Rhoads. A
copy of the Admission Agreement is attached hereto as Exhibit A and is incorporated.
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4. The Admission Agreement bound Anna Rhoads to pay for the cost of her care at
the Manor facility located at 945 Walnut Bottom Road, Carlisle, Pennsylvania in accordance with
its terms.
5. Anna Rhoads became a resident of the Manor facility on or about April 15, 1996.
6. Anna Rhoads remains a resident of the Manor facility at present.
7. During the years Anna Rhoads has been a resident, she has been receiving medical
assistance to pay, in part, for her cost of care.
8. At least annually, the Department of Public Welfare reviews the income level of
Anna Rhoads and, based upon that income, sets a private pay portion that requires a portion of
Anna Rhoads annual income to be used to pay for her cost of care at Manor.
9. In calendar year 1996, Anna Rhoads private pay portion was $650.73 per month,
in 1997 it was $658.73, in 1998 it was $769.04 per month and in 1999 it was $875.06.
10. William Rhoads has been receiving the social security and pension benefits of Anna
Rhoads since the time of Anna's admission to the Manor facility.
11. The social security and pension benefits of Anna Rhoads were used to calculate the
private pay portion of the cost of Anna Rhoad's care throughout her stay at Manor.
12. William Rhoads has, from time to time, failed to tender to Manor the private pay
portion of the cost of Anna Rhoads care from the social security and pension benefits of Anna
Rhoads which come to William Rhoads.
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13. In January, 1998, Manor initiated an action against William Rhoads based upon the
outstanding balance due for the private pay portion of Anna Rhoad's cost of care at that time.
The amount due was $3,143.78. That claim has been reduced to a judgment docketed to No.
2000-2692 Civil in the Court of Common Pleas of Cumberland County, Pennsylvania.
14. Since entry of the judgment referenced above, an additional balance has accrued in
the amount of$9,360.11 which balance arises from the further failure of William Rhoads to tender
to Manor the private pay portion for Anna Rhoads cost of care from the social security benefits
and pension benefits of Anna Rhoads being received by William Rhoads.
COUNT I
MANORCARE v. WILLIAM RHOADS
CONVERSION
15. Plaintiff incorporates by reference paragraphs one through fourteen as though set
forth at length.
16. William Rhoads has appropriated to his own use those funds of Anna Rhoads
which should rightfully have been paid to Manor as the private pay portion of the costs associated
with the care of Anna Rhoads.
17. William Rhoads has wrongfully and intentionally interfered with the right of Manor
to have paid to it those funds of Anna Rhoads representing her private pay portion of costs
associated with her care at Manor.
18. William Rhoads has no rights to or interest in the funds of Anna Rhoads.
19. As a direct and proximate result of the actions of William Rhoads, Manor has been
unable toreceive payment for the accrued amount of $9,360.11.
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WHEREFORE, plaintiff requests judgment in its favor and against William Rhoads for the
sum of $9, 360.11 plus interest, expenses, attorney fees and punitive damages.
COUNT IT
MANORCARE v. WILLIAM RHOADS
INTENTIONAL INTERFERENCE WITH CONTRACT
20. Plaintiff incorporates by reference paragraphs one through nineteen as though set
forth at length.
21. William Rhoads has intentionally interfered with the Admissions Agreement by
preventing the use of the funds of Anna Rhoads to be used to pay for the private pay portion of
Anna Rhoad's cost of care as required by the Admissions Agreement.
22. William Rhoads is aware of the requirements and covenants of the Admissions
Agreement having executed it on behalf of Anna Rhoads.
23. As a direct and proximate result of the acts of William Rhoads, Manor has been
unable to obtain payment of the private pay portion from the funds of Anna Rhoads.
WHEREFORE, plaintiff requests in its favor and against William Rhoads for the sum of
$9,360.11, interest, costs, expenses, attorney fees and punitive damages.
Respectfully submitted,
David A. Baric, Esquire
ill # 44853
17 West South Street
Carlisle, PA 17013
(717) 249-6873
Attorney for Plaintiff
dab.dirllitigationlmanor/rhoadslcomplaint.pld
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VERIFICATION
I verifY that the statements made in the foregoing Complaint are true and correct. I
understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 94904,
relating to unsworn falsification to authorities.
~rj {)ntiPniM\ {!-,~
athy Cervenak (
. B . ess Office Manager
DATED: 5- d'S -0/)
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ADMISSION ~GREEMENT
CONTRACT BETWEEN RESIDENT AND FACILITY
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THISLADMISSIQ,N AGREEMENT (the "Agreement") is entered into this ~ day of
19 l1 ,between Leader - Carlil?le _. Uhe "Facility"),
. (the "Resident"), and/or U)I II l Gm Ql"l:t:illS. (the
"Responsible Party"). As used herein, the term "Resident" shall also mean the Responsible
Party, if any. The parties agree as follows:
1. Commencement. This Agreement shall begin on the date of admission of the Resident
to the Facility.
2. Termination of Agreement, Discharge and Transfer.
a. Termination by Resident. The Resident may terminate this Agreement by giving
the Facility at least five (5) days advance written notice. The Resident is responsible for
payment of all charges for five (5) days after notice is given, or until the Resident actually
leaves the Facility whichever is last. If the Resident leaves the Facility (i) before the attending
physician discharges the Resident, or (ii) against medical advice, the Resident and Respon-
sible Party agree to assume all responsibility for injury or harm to the Resident, and hereby
release the Facility, its employees and agents, from all liability connected with such
departure.
b. Termination by Facility. The Facility may terminate this Agreement and discharge
the Resident upon at least thirty (30) days prior written notice if (1) the Resident's needs
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cannot be met; (2) the Resident presents a danger to the health or safety of other indivi-
duals; (3) the Resident fails to pay charges for supplies or services after notice; (4) the
Resident's health has improveg sufficiently so that the Resident no longer needs the
services provided; or (5) the Facility ceases to operate. However, the Resident may be
transferred or discharged upon less than thirty (30) days notice if: (1) an immediate trans-
fer or discharge is required due to the Resident's medical needs; (2) the Resident presents
a threat to the health and safety of individuals in the Facility; or (3) the Resident has not
resided in the Facility for thirty (30) days. Such notice shall be given as soon as practicable.
The Resident acknowledges receipt from the Facility of materials as to the Resident's right
to appeal a discharge decision with State authorities and the appeals process. If this
Agreement is terminated and/or the Resident is discharged by the Facility, the Respon-
sible Party agrees to accept custody of the Resident upon discharge and cooperate with
the Facility to facilitate the Resident's discharge.
3. Responsible Party. The Resident's Responsible Party may be any person legally
responsible for the Resident, including a court-appointed guardian or conservator, or a
person holding a power of attorney. A Responsible Party who is also a guardian, conser-
vator, or holder of a power of attorney must execute this Agreement and the Resident's
Responsible Party Authorization and Agreement attached as Exhibit A, and must provide
the Facility with a copy of legal documentation regarding his/her appointment.
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MANOR HEALTHCARE
MANOR CARE. LfADER. AMERICANA .IOURSEASONS
Quality ~ IrnprOOngQuality ofUfe-
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EXHIBIT A
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(AdmIS$lOn Afl(eernent cant)
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If the Resident does not have a legally appointed representative and the Resident wishes
.to give responsibility to someone else, Doth this Agreement and the Resident's Resp'pnsible.
Party Appointment and Agreement attached as Exhibit B must be signed by the Resident and
Responsible Party.
If the Resident is competent and does not have a court.appointed guardian, conservator
or power of attorney, and has not appointed a Responsible Party, the Resident alone shall
execute this Agreement and Exhibit C, A competent resident shall not be required 10 designate
a Responsible Party.
If th~ Resident does not have a guardian or conservator, or a durable power of attorney,
and is mentally Incompetent or otherwise Incapable of executing this Agreement, handling
his/ner awn affairs, or appointing a Responsible Party, a family member acting as a respon-
sible party, shall execute Ihis Agreement on the Resident's behalf, execute the Agreement To
Be Resppl')sible Party attached as Exhibit D, and serve as Responsible Party. The Resident's
attending physician shall certify In writing that the Resident is incapable of executing this
Agreement and that placement in the Facility is appropriate.
4. Non.Discrimination. It is the pOlicy of the Facility to admit to and to treat all residents
without r~gard to race, creed, color. national origin, sex, handicap or age. The Facility Admini-
strator is the Section 504 (handicap) grievance coordinator,
5. Resident's Rights. The Resident shali receive and execute the Resident's Righls attached
as Exhibit E and Exhibit E-1 upon admission, acknowledging that the Federal and State Resi-
~ dent rights have been read and given to the Resident. The Facility will amend the Resident
Rights Agreements, as necessary, to comply with applicable law.
6. Residllnt Funds and Valuables. The Resident may elect to keep personal funds in a system
arranged by the Facility. The Resident releases the Facility from all responsibility for money,
valuables or belongings retained in the Resident's room or on the Resident's person. Attached
as Exhibit F is the Resident Personal Fund Account Procedure.
7. Fees and Payments.
a. Private Pay Residents. The Resident agrees to pay. each month, in advance, a sum
equal to one month's daily rate, as provided in the Fee Schedule attached as Exhibit G. for
those services and supplies listed under the daily rate. The daily rate may change if the Resi-
dent is transferred to a different room or the level of care changes. The Resident and/or
Responsible Party will be notified of the rate change.
The Resident may receive supplemental services and supplies not included in the daily
rate. The Resident is responsible for payment of ali charges for such supplemental services
and supplies as stated in the Fee Schedule, as well as all expenses of discharge or transfer. If
the Resident or Respol:1sible Party refuses such supplemental services and supplies or to make
payment tor them. the Resident and Responsible Party release the Facility from all liability for
harm whioh may result.
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b. Medicare Beneficiaries. The services and supplies included in the Facility's daily rate
will be provided to Medicare residents, as well as services and supplies noted on the Fee
Schedule as being included in the Medicare rate. The Resident is responsible for paying any
Medicare co-insurance amounts. The Resident understands that Medicare eligibility and
coverage is established by federal guidelines which currently limit payment to a fixed number
of days. If the Resident enters the Facility and the Medicare application is denied, the Resident
shall be liable for all Charges as provided in the Fee Schedule. The Resident is responsible for
payment for items covered by Medicare supplemental insurance, and the Resident is respon-
sible for applying for reimbursement from his/her insurer.
(Choose one and cross out, date, and all parties initial the inapplicable Section 7(c).)
. Medicaid Beneficiaries. The Facility does not currently participate i Medicaid
pro m. Accordingly, persons who are admitted as private pay reside will be unable' to
convert ro er disch lng, the Resident and/or
. Responsible Part a ree to rovi at leas months prior written notice
of the ent's becoming eligible for coverage under the MediCi' ~ m or their not being
abl 0 pay privately. Initial Date '-l
or
c. Medicaid Beneficiaries. If required by the Medicaid program,a Resident must have
pre-admission approval. If the Resident believes he/she qualifies as a Medicaid Resident,
he/she shall promptly complete and submit all documents necessary to apply for Medicaid
coverage. If Medicaid coverage is denied, the Resident will be liable for all charges as provided
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in the Fee Schedule, from the admission date. When Medicaid pays for only a portion of the
incurred charges, the Resident is responsible for paying his/her portion, as determined by state
Medicaid regulatiol,Js. This charge will be billed to the Resident by the Facility and shall be paid
in accordance with Section 7(a). The Resident shall also be responsible for payment of Facility's'
current charges for any requested non-Medicaid covered services or supplies. The services
and supplies included in the Facility's daily rate, and all other services and supplies noted on
the Fee Change Sheet as being included in the Medicaid rate, will be so provided. If the Resi-
dent is a Medicaid resident, he/she will provide financial information regarding monthly credits,
increases or decreases in the Resident's bank account(s), and other assets to the Facility to
e~~ble tht.,Fncll:~ {oo>rovide request~~ f!.oj1J1cjal data to Medicaid representatives.
Initial ~ Date 1tt.Lf~
d. Insurance Coverage. The Resident is responsible for, and shall pay, the daily rate
and charges for supplemental services and supplies not timely paid by any insurer, as well as
applicable co-insurance and deductible amounts.
e. Rate Adjustments. The Facility may adjust the daily rate or the charges for supple-
mental services or supplies for any or all residents, with at least thirty (30) days' written
advance notice or, in the event of an emergency or in the event the level of care changes, with
as much notice as is reasonably possible. Any such adjustment shall be deemed agreed to by
the Resident or Responsible Party unless the Facility is notified in writing to the contrary within
ten (10) days after mailing such a notice. If the Resident does not consent to the rate adjust-
"'-. ment, the Resident agrees to leave the Facility no later than the day before the rate increase is
effective.
3 of 7
Rev. 1194 A4 ~ A5
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f. Guarantee of Payment. The Responsible Party, or any other third party, may per-
!lOnally and voluntarily guarantee payment.of the F.lesident's account by executing Ihe Gu.~ranlee ,
Agreement attached as Exhibit H. While the Facility does require assurances that payment for
services will be made from s'omesource, the Facility does not require a third party guarantee
of payment as a condition of admission, or expedited admission, when an adequate primary
source of payment has been identified.
g. Refunds. Any refund owed to the Resident shall be paid by the Facility within thirty
(30) days after discharge or transfer.
h. Fundln!:! Sources. The Fac!llty makes no assurance of any kind that the Resident's
care will be covered by Medicare, Insurance Companies or any other third party payor.
8. Payment Policy. All amounts due shall be paid promptly when billed and in all cases shall
be paid within ten ( 1 0) days of billing. Failure to pay any amount when due is a breach of this
Agreement for non-payment of stay and grounds for termination of this Agreement and discharge
of the Resident. A'I't1 account not paid in full shall be subject to a one and one-half percent
(1'12%) service charge on the past due balance each month until the balance due is paid
in full. This service charge amounts to eighteen percent (18%) annually on the unpaid
balance. If the maximum service charge allowed by state law is less than eighteen percent
(18%) per annum, the maximum interest rate allowed by law shall apply, Should the Resi-
dent's account be turned over for collection to an attorney or collection agency, or should
the Facility seek to Interpret or enforce any other provision of this Agreement, the Resi-
dent agrees to pay all court costs and reasonable attorney's fees of the Facility if the
Facility prevails.
9. Release of Information. The Resident authorizes the release of records or information to
any health care institution to which the Resident may be transferred, any provider involved in
the care of the Resident, any third party payor, or any other person entitled or authorized to
receive such information by law or by the Resident.
10. Bed Hold. The Facility charges a daily fee for reserving a bed whenever a resident leaves
the Facility ("Bed Hold Fee") as stated on the Fee Schedule, Bed holds for Medicaid residents
'shall be in accordance with applicable law.
11. Tobacco Policy. Any resident or guest who wishes to smoke and/or chew tobacco must
follow all Facility smoking rules. The Resident or ResponSible Party agree that they, and not
the FaCility, shall be responsible for any injury or liability which may be caused by the Resi-
dent's smoking.
12. Personal Laundry. The Resident acknowledges receipt of the Facility's laundry policy
and charges. The Facility shall not be responsible for the deterioration of the Resident's clothing
as a result of routine washing.
4 of 7
Rev. 1/94 ^6
(AdmissIon AgIO.mont conti
13, Beauty I Barher Services, Where available, Independent licensed beauticians and barbers
. provide serYicesat the Facility. ihe charges for'these $ervices are stated on the Fee S.chedule:
and are not included in the daily rate. The Resident shall be responsible for payment for such
services to the extent not covered by Medicare, Medicaid, or other third party payor. and shall
be billed for such services on a monthly basis. The Resident and Responsible Party acknowledge
and agree that all such beauticians/barbers are independent contractors and are not empioyees
or agents of the Facility, and the Facility shall not be responsible for their acts or omissions.
14, Consent to Open Mail. The Facility will send and receive mail for the Resident. which
shall be unopened unless the Resident requests otherwise In writing.
15, Atlendi"9 P\w$ician. The Resident is solely responsible for selection of a licensed
attending physician. The Resident agrees that the Facility may require the Resident to utilize
another physician If the attending physician (1) has hlslher own professional license limited,
suspended or revoked; (2) fails to follow the Facility's rules and regulations, or (3) is unavailable
in case of emergency. The Resident is responsible for payment of all charges for physician
services.
16. Dental, Vision and Hearing Services. The Facility shall make emergency and routine dental
services available, and shall assist the Resk:lent in obtaining vision and hearing services, The
Resident shall be responsible for payment for any such services rendered, if not covered by a
third party payment source.
17. Independent Contractors. The Resi.dent acknowledges and agrees that all physiCians and
dentists, including those whose services are arranged for by the Facility, are independent
contractors and are not employees or agents of the Facility, and the Facility shall not be respon-
sible for their acts or omissions or for the consequences of following physician or dentist
orders.
18. Private Duty Personnel. The Resident acknowledges that all private duty personnel that
Ihe Resident utilizes are net employees or agents ofihe Facility and that the Facility is not
liable for acts or omissions of such personnel. Employees of the Facility may not be employed
as private dUty personnel at the Facility. AU private duty personnel shall comply with all policies
and procedures of the Facility as may be amended from time to time without notice. Failure of
pri'lale duty personnel to follow such poliCies and procedures may result in their being denisd
access to the Facility, Resident and Responsible Party shall be solely responsible for the cost
of pri'late duty personnel.
19. Consent to Treatment. Resident acknowledges that he/she is under the medical treat-
ment and care of an attending physician, and consents to the Facility rendering nursing care
and treatment under the general or special instructions of said physician or in case of emer-
gency.
20. Pharmacy. The Facility has developed pOlicies and procedures for drug therapy, ~~stribu-
lion and control which provide for a uniform medication distribution system. The FaCilIty has
selected a pharmacy (the "Designated Pharmacy") to provide medication under such distribu-
tion system. The Facility reserves the right to change the Designated Pharmacy at any time.
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Rev. t/1:I4 t.7
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The Resident has the right to use any other pharmacy so long all that pharmacy will furnish
t~e same medication distribution system to meet the Resident's total drug needs, and comply
witn the Facility's policies and procedures and all applicable laws and regulations. The Resi-
dent shall execute the Pharmacy Agreement attached as Exhibit I.
For Medicaid residents, the Designated Pharmacy will file claims for payment directly with
the Medicaid program for any covered claims. If the Resident utilizes a different pharmacy, the
Resident must make arrangements with such pharmacy for similar filing of claims for payment.
If the Resident is not covered by Medicaid, all charges shall be billed to the Resident and
shall be payable in full. The Designated Pharmacy reserves the right to terminate any account
for any reason after written notice of such intent has been given to the Resident.
21. MedlcallNurslng Education. The Resident recognizes that the Facility may become
involved in medical or nursing education programs through which future health care professionals
gain experience. The Resident consents to be cared for by such students unless he/she later
and in writing denies permission to student health care personnel to become involved in the
Resident's care.
22. Facility Guidelines for "No Heroics" Requests. Decisions regarding life support shouid be
considered by each Resident or his/her authorized surrogate decision-maker. The Resident
. .
acknowledges receipt of rights under state law to make decisions about medical care, including
rights to accept or refuse care and rights to make an advance decision about care. The Resi-
dent acknowledges receipt of a summary of the "Facility Guidelines for No Heroics Requests"
(the "Guidelines"). A full text of the Guidelines will be provided upon request. In part, the
Guidelines provide that the Facility will not withhold or withdraw life-sustaining or life-prolonging
measures from a Resident without a written and legally sufficient authorization of a competent
Resident or legally authorized surrogate decision-maker and a physician order. The Resident
agrees to comply with the Guidelines.
23. Liability and Indemnification. The Resident understands that the Facility is liable only for
injuries caused by the neQIiQent acts or omissions of the Facility and as required by law. The
Resident shall indemnify and hold the Facility harmless from any and all claims, suits and actions
made against the Facility by any person resulting from any damage or injury caused by the
Resident to any person or the property of any person or entity (including the Facility).
24. Resident's Handbook. The Resident and his/her Responsible Party acknowledge receipt
of the Facility's Resident's Handbook and agree to comply with such Ruies and Regulations.
25. GOVERNING LAW. THIS AGREEMENT SHALL BE GOVERNED AND CONSTRUED IN
ACCORDANCE WITH THE LAWS AND REGULATIONS OF THE STATE WHeRE THE FACILITY
IS LOCATED. TO THE EXTENT ANY PROVISION HEREOF CONFLICTS WITH STATE LAW,
STATE LAW SHALL CONTROL. THE STATe LAW ADDENDUM ATTACHED HERETO AS
EXHIBIT J SETS FORTH ANY DELETIONS FROM, OR ADDITIONS TO, THIS AGREEMENT
REQUIRED BY STATE 'LAW, WHICH AMENDMENTS SHALL BE A PART OF THIS AGREE-
MENT.
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(Admission Agreement conI.)
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26. Miscellaneous. The provisions of this Agreement.shaU bind the parties. their respective
executors. administrators, heirs,beneficiaries, and assigns. The waiver by either party of any.
breach or default of this Agreeh1ent shall not operate as a waiver of any subsequent breach
or default. The provisions of this Agreement shall be severable and the invalidity or unenforce-
ability of any provision shall not affect the validity and enforceability of any other provision. .
This Agreement and all Exhibits are the entire agreement, and any changes shall be in writing
and signed by both parties.
IN WITNESS WHEREOF. the parties hereto have executed this Admission Agreement as
of the day and year first above written.
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Resident - Signature
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Resident. Printed Name
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Date
- Signature
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Rev.1/94 A9 - A10
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SHERIFF'S RETURN - REGULAR
CASE NO: 2000-03364 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
HCR MANORCARE INC ET AL
VS
RHOADS WILLIAM
DAWN KELL
, Sheriff or Deputy Sheriff of
Cumberland County, pensylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE
was served upon
RHOADS WILLIAM
the
DEFENDANT
, at 0012:33 HOURS, on the 12th day of June
, 2000
at 12 MICHAUX DRIVE
NEWVILLE, PA 17241
by handing to
JEN MCKEEHAN (GIRLFRIEND)
a true and attested copy of COMPLAINT & NOTICE
together with
and at the same time directing His attention to the contents thereof.
Sheriff's Costs:
Docketing
Service
Affidavit
Surcharge
18.00
6.82
.00
10.00
.00
34.82
So Answe.rs: ~
r~"""<-r .Af'. (
R. Thomas Kline
Sworn and Subscribed to before
06/13/2000
O'BRIEN, BARIC & SCHERER
By: \JQWYl{. tLJL
Deputy Sheriff
me this ~o~ day of
~ .L(J1J1) A. D.
~Qftu'ff. J ~
Prothonotary r
,
HCR MANORCARE, INC.,
s/b/m/t MANORCARE HEALTH
SERVICES, INC.,
Plaintiff,
v.
WILLIAM RHOADS,
Defendant.
^,',"--CL<
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 00-3364 CIVIL
CIVIL ACTION-LAW
JURY TRIAL DEMANDED
PRAECIPE TO ENTER DEFAULT JUDGMENT
PURSUANT TO Pa.R.C.P. 1037
TO THE PROTHONOTARY:
Please enter judgment in favor of Plaintiff, HCR ManorCare, Inc. and against the
Defendant, William Rhoads, for failure to file an answer to the Complaint of Plaintiff. A true and
correct copy of the return of service from the Sheriff of Cumberland County is appended hereto
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as Exhibit "A."
A true and correct copy of the Notice of Default is appended hereto as Exhibit "B."
A true and correct copy of the Certificate of Mailing for the Notice of Default is appended
hereto as Exhibit "C." I certifY that the Notice of Default was given in accordance with Pa.R.C.P.
237.1.
Plaintiff requests judgment in the amount of $9,360.11 as set forth in the complaint.
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Respectfully submitted,
David A. Baric, Esquire
LD. # 44853
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
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SHERIFF'S RETURN - REGULAR
, CASE NO: 2000-03364 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
HCR MANORCARE INC ET AL
VS
RHOADS WILLIAM
DAWN KELL
, Sheriff or Deputy Sheriff of
Cumberland County, Pensyl vania , who being duly sworn according to law,
says, the within COMPLAINT & NOTICE
was served upon
RHOADS WILLIAM
the
DEFENDANT
, at 0012:33 HOURS, on the 12th day of June
, 2000
at 12 MICHAUX DRIVE
NEWVILLE, PA 17241
JEN MCKEEHAN (GIRLFRIEND)
by handing to
a true and attested copy of COMPLAINT & NOTICE
together with
and at the same time directing His attention to the contents thereof.
Sheriff's Costs:
Docketing
Service
Affidavit
Surcharge
18.00
6.82
.00
10.00
.00
34.82
sO;:~~f
R. Thomas Kline
06/13/2000
O'BRIEN, BARIC & SCHERER
Sworn and Subscribed to before
By:
\J~-!. ILlL
Deputy Sheriff
day of
me this
A.D.
Prothonotary
EXHIBIT "A"
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!I ~CP.~.1:':;'JRCARE, INC.,
II s/b/m/t MANORCARE HEALTH
SERVICES, INC.,
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IN THE COURT OF C011MON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiff,
NO. 00-3364 CIVIL
V.
CIVIL ACTION-LAW
WILLIAM RHOADS,
Defendant.
JURY TRIAL DEMANDED
TO: William Rhoads
12 Michaux Drive
Newville, P A 17241
DATE OF NOTICE: July 6, 2000
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN THE WRITING WITH
THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH
AGAINST YOu. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF TillS
NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING
ANY YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU
SHOULD TAKE TillS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A
LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING
OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP:
CUMBERLAND COUNTY BAR ASSOCIATION
2 LffiERTY AVENUE
CARLISLE, PENNSYLVANIA 17013 cf
(717) 249-3166
~4 ,
David A. Baric. Esquire
Attorney for Plaintiff
17 West South Street
Carlisle, P A 17013
(717) 249-6873
EXHIBIT "B"
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U.S. POSTAL SERVICE CERTIFICATE OF MAILING
MAY BE USED FOR DOMESTIC AND INTERNA TIONAl MAil, DOES NOT
PROVIDE FOR INSURANCE-POSTMASTER
Received Ftom:
0' 6ne:n , Bon c ~ Scherer
'Po ~i~f:, fJA~ 1~~~~:i~T;
0;9 pieSl9 of ol;,dinary m'i1addressed to: /::::J("'o ..~\',\/
J6J.lllla rYl ~ct"5 ;~t i y'"
l1..N\ [Chaux Dri vc \f~' "
N t-\'\IJLlllc. PA liL-L/ t"~
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PS Form 3817, Mar. 19B9
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EXHIBIT "C"
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I Affix fee here in stamps
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CERTIFICATE OF SERVICE
I hereby certify that on September 0 ,2000, I, David A. Baric, Esquire, of O'Brien,
Baric & Scherer did serve a copy of the Praecipe To Enter Default Judgment Pursuant To
PaRC.P. 1037, by first class U.S. mail, postage prepaid, to the parties listed below, as follows:
William Rhoads
12 Michaux Drive
Newville, Pennsylvania 17241
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David A. Baric, Esquire
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