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Home My WebLink About00-03367 ..... HCR MANORCARE, INC. sIblm/t MANORCARE HEALTH SERVICES, Plaintiff, V. SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants. .... . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA NO. 00-3367 EQUITY JURY TRIAL DEMANDED PRAECIPE FOR LIS PENDENS TO: CURTIS LONG, PROTHONOTARY Please enter the above-captioned action as a lis pendens against the property located at 2171 Newville Road, Carlisle, Cumberland County, Pennsylvania. II Respectfully submitted, ^ O'BRIEN, BARIC wmRER ~bJ(a. David A. Baric, Esquire J.D. # 44853 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 ~ - '... - . CERTIFICATE OF SERVICE I hereby certify that on June 20, 2000, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy ofthe Praecipe For Lis Pendens, by first class U.S. mail, postage prepaid, to the parties listed below, as follows: SaraHom 940 Walnut Bottom Road Carlisle, Pennsylvania 17013 Traci L. Halter 7043 Carlisle Pike Carlisle, Pennsylvania 17013 Sandra K. Mullins 124 Conodoguinet Mobile Estates Newville, Pennsylvania 17241 David A. Baric, Esquire 11 _'r.,_" , '~,. ~, l' ,. ~ SHERIFF'S RETURN - REGULAR t~, CASE NO: 2000-03367 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HCR MANORCARE INC VS HORN SARA E ET AL KENNETH GOSSERT , Sheriff or Deputy Sheriff of Cumberland County, Pensyl vania , who being duly sworn according to law, says, the within NOTICE & COMPLAINT was served upon }lORN SARA E the DEFENDANT , at 0016:00 HOURS, on the 7th day of June 2000 at 940 WALNUT BOTTOM ROAD MANOR CARE NURSING HOME CARLISLE, PA 17013 by handing to JODI GAS LOR (DIRECTOR OF SOCIAL SERVICES) a true and attested copy of NOTICE & COMPLAINT together with IN EQUITY and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 3.10 .00 10.00 .00 31.l0 .:c-~~r~~ . ~ R. Thomas Kline 06/16/2000 O'BRIEN, BARIC & SCHERER Sworn and Subscribed to before By: me this .:bJ -e day of ~ ~ A.D. ~ f2 ~,~ Prothonotary =~~ ". . '~ ,i. ~ " SHERIFF'S RETURN - REGULAR CASE NO: 2000-03367 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HCR MANOR CARE INC VS HORN SARA E ET AL BRIAN BARRICK , Sheriff or Deputy Sheriff of Cumberland County, Pensylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon HALTER TRACI L the DEFENDANT , at 0018:13 HOURS, on the 15th day of June at 2171 NEWVILLE ROAD NEWVILLE, PA l7241 , 2000 TRACI HALTER by handing to a true and attested copy of COMPLAINT - EQUITY together with NOTICE and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Aff idavi t Surcharge 6.00 4.34 .00 10.00 .00 20.34 Sworn and Subscribed to before me this OLO!;: day of &; ~ A.D Q.~.~ Prothonotary So Answers: ;!'~~<~~ R. Thomas Kline 06/16/2000 O'BRIEN, BARIC & SC~HERER By : /J....... 11/ /'rfiN) 111( Deputy Sheriff - SHERIFF'S RETURN - REGULAR ~ ;. ,. , CASE NO: 2000-03367 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HCR MANORCARE INC VS HORN SARA E ET AL WILLIAM DIEHL , Sheriff or Deputy Sheriff of Cumberland County, Pensylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon MULLINS SANDRA K the DEFENDANT , 2000 , at 00l3:00 HOURS, on the 14th day of June at 124 CONODOGUINET MOBILE EST NEWVILLE, PA 17241 DENNIS MULLINS (HUSBAND) by handing to a true and attested copy of COMPLAINT - EQUITY Non CE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 7.44 .00 10.00 .00 23.44 Sworn and Subscribed to before me this ~ ~ day of ~ ;LomJ A.D. ~.O ~"d'",~ thonotary So An~ ~ :t'J -r~ R. Thomas Kline 06/16/2000 O'BRIEN, BARIC & SCHERER By: Ji!=2~ '~"". I. HCR MANORCARE, INC. s/blm/t MANORCARE HEALTH SERVICES, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA Plaintiff, NO. tb- .33t> / H 'N-EQUITY V. c SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants. JURY TRIAL DEMANDED 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 , 1 II '1''' c HCR MANORCARE, INC. sIblm/t MANORCARE HEALTH SERVICES, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA Plaintiff, NO. tHJ~ :33(..'7 ~ I~ CIVIL ACTION-EQUITY v. SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants. JURY TRIAL DEMANDED COMPLAINT NOW, comes plaintiff, HCR ManorCare, Inc., s/blm/t ManorCare Health Services, Inc., by and through its attorneys, O'BRIEN, BARIC & SCHERER, and files the within complaint and, in support thereof, sets forth the following: I. 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, Sara Horn, is an adult individual residing at 940 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania. 3. Defendant, Traci Halter, is an adult individual residing at 7043 Carlisle Pike, Carlisle, Cumberland County, Pennsylvania. I Ii 4. Defendant, Sandra MuJlins, is an adult individual residing at 124 Conodoguinet Mobile Estates, Newville, Cumberland County, Pennsylvania. 5. On or about February 18, 1995, Sara E. Horn executed a power of attorney appointing Traci Halter as her attorney in fact. A true and correct copy of the power of attorney is attached hereto as Exhibit A and is incorporated. 6. On or about June 11, 1998, Traci Halter executed an Admission Agreement Contract Between PatientlResident and Facility ("Admission Agreement") on behalf of Sara Horn. A true and correct copy of the Admission Agreement is attached hereto as Exhibit B and is incorporated. 7. The Admission Agreement bound Sara Horn 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. 8. Sara Horn became a resident of the Manor facility on or about June 11, 1998. 9. On or about March 23, 1998, Sara Horn conveyed certain real property owned by her to Traci L. Halter for and in consideration of the sum of one dollar. Said deed of conveyance is recorded in the office for the Recorder of Deeds of Cumberland County at Book 174, page 5 et seq. and is incorporated herein by reference. 10. On or about February 6, 1998, Sara Horn conveyed certain real property owned by her to Sandra K. MuJlins for and in consideration of the sum of one dollar. Said deed of conveyance is recorded in the office of the Recorder of Deeds of Cumberland County at Book 171, page 1065 et seq. and is incorporated herein by reference. 2 II ~i I. I 11. Upon information and belief, the property conveyed by Sara Horn to Traci Halter has a value of $93,529.00 and the property conveyed by Sara Horn to Sandra K. Mullins has a value of $24,705.00. 12. Upon information and belief, shortly before Traci Halter made application to Manor to have Sara Horn admitted as a resident, Traci Halter caused to be redeemed several certificates of deposit held in the name of Sara Horn at Mellon Bank, York Federal Savings and Loan and Corestates Bank. 13. Sara Horn remains a resident of the Manor facility in Carlisle. 14. The Pennsylvania Department of Public Welfare conducted an investigation of the assets and property of Sara Horn and disallowed Sara Horn as eligible for medical assistance based at least in part upon the transfer to the real property described above for less than fair market value and a failure of Traci Horn to account for proceeds of certificates of deposit previously held by Sara Horn. 15. During her residency, Sara Horn has failed and refused to pay for all of the services and care rendered to her by Manor. 16. As of March 31, 2000, there remained due and owing the sum of$50,277.87 on I the account of Sara Horn for her care at Manor. , II " :i , 17. The Admission Agreement provides for interest to accrue on outstanding balances due in the amount of 18% per annum or 1.5% per month. Interest on the principal balance due and owing is $1,512.46 as ofJune 1, 2000 with a per diem of $24.79. 3 II /. 18. The Admission Agreement provides for the recovery of attorney fees by Manor incurred in the collection of a debt due and owing. COUNT~BREACHOFCONTRACT MANOR V. SARA HORN 19. Plaintiff incorporates by reference paragraphs one through eighteen as though set forth at length. 20. Despite demand therefore, Sara Horn has failed and refused to pay to Manor the sum of $50,277.87 due for the costs of care provided by Manor to Sara Horn. 21. All conditions precedent to recovery under the Admission Agreement have been fulfilled. 22. Sara Horn has breached the Admission Agreement by failing to pay to Manor the amount due and owing for the cost of her care. WHEREFORE, plaintiff demands judgment in its favor and against Sara Horn for the sum of$50.277.87 plus costs, interest, expenses and attorney fees. COUNT 11- FRAUDULENT CONVEYANCE MANOR v. SARA HORN, TRACI HALTER AND SANDRA MULLINS 23. Plaintiff incorporates by reference paragraphs one through twenty-two as though set forth at length. i i .1 II 24. The transfers of real property made by Sara Horn to Traci Halter and Sandra Mullins were made without receiving reasonably equivalent value in exchange. 4 II /' 25. The transfers ofreal property were made when Sara Horn, Traci Halter and/or Sandra Mullins were about to engage in making application for Sara Horn to become a resident of the Manor facility. 26. The transfers of real property were made when Sara Horn, Traci Halter and/or Sandra Mullins intended to incur, believed, or reasonably should have believed that Sara Horn would incur debts through her residency at Manor beyond her ability to pay as they became due. 27. Traci Halter and Sandra Mullins are the granddaughter and daughter, respectively, of Sara Horn. WHEREFORE, plaintiff requests the following: a) avoidance of the transfers to the extent necessary to satisfy the claim of Manor; b) an attachment or other provisional remedy against the assets transferred; c) appointment of a receiver to take charge of the assets transferred; d) any other relief the circumstances may require. COUNT 11- BREACH OF FIDUCIARY DUTY MANOR v. TRACI HALTER 28. Plaintiff incorporates by reference paragraphs one through twenty-seven as though set forth at length. 29. Defendant, Traci Halter has been and is serving in a fiduciary capacity by virtue of serving as Sara Horn's attorney in fact since February 18, 1995. 5 Ii ",""" '<; v.- ';~- 30. While holding the power of attorney, Traci Halter did participate in the conveyance of property of Sara Horn to herself and others which conveyances were for less than fair market value. 31. At or about the time of these conveyances, Traci Halter was aware that Sara Horn would need the intensive care provided by a nursing facility. 32. Despite this knowledge, Traci Halter acted with Sara Horn to render Sara Horn without sufficient assets to provide for anticipated care. 33. Traci Halter had a fiduciary duty to preserve and protect the assets of Sara Horn so those assets could be used for the cost of Sara Horn's care and medical necessities. 34. Traci Halter misapplied entrusted property in breach of her fiduciary duties. 35. Traci Halter was aware that she had a legal obligation to dispose of the funds of Sara Horn to or for the benefit of Sara Horn. 36. Knowing that she had the aforesaid obligation, Traci Halter appropriated funds and property of Sara Horn to her own use and benefit. WHEREFORE, plaintiff requests judgment against Traci Halter for the sum of $50,277.87 plus interest, costs, expenses, punitive damages and attorney fees. COUNT-IV CONCERTED ACTION MANOR v. SARA HORN, TRACI HALTER AND SANDRA MULLINS 37. Plaintiff incorporates by reference paragraphs one through thirty-six as though set forth at length. 6 Ii '--',/, ,,"~,"" '..... I 38. Defendants, Sara Horn, Traci Halter and Sandra Mullins acted in concert with one another pursuant to a common design to remove assets from Sara Horn rendering Sara Horn unable to pay her anticipated charges at Manor for no consideration. 39. Defendants, Traci Halter and Sandra Mullins knew or reasonably should have known that Sara Horn would be making application to a skilled nursing facility for her care. 40. Defendants, Traci Halter and Sandra Mullins knew or reasonably should have known that charges would arise and accrue for the costs of Sara Horn's care and that Sara Horn would be unable to pay for these costs having conveyed for no consideration her real property to Defendants Traci Halter and Sandra Mullins. 41. Sara Horn, Traci Halter and Sandra Mullins gave substantial assistance or encouragement to one another to so conduct themselves, including, but not limited to the following: (a) designing a plan to convey for no consideration the real property of Sara Horn to Traci Halter and Sandra Mullins shortly before making application to Manor for Sara Horn's care; (b) assisting in the preparation of the documents of conveyance; ( c) applying for the care of Sara Horn at Manor; (d) cashing in certain certificates of deposit held by Sara Horn; (e) and otherwise rendering Sara Horn unable to meet her debts. 7 1\ , , i~; I I ,. 42. As a direct and proximate result of these actions, Sara Horn was unable to obtain Medical Assistance for her care and these assets became unavailable to pay for the costs of the care of Sara Horn at Manor. WHEREFORE, Manor requests judgment in its favor and against the defendants in an amount in excess of$25,000.00 and for an accounting for the reasonable value of the property conveyed, costs and expenses and punitive damages. Respectfully submitted, );::;;~ David A. Baric, Esquire ID#44853 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Attorney for Plaintiff 1I 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. ~ 4904, relating to unsworn falsification to authorities. DATED: S /,"?J) J 0 J I I ~'J ; ) }L ) \ ;' . -I ~, -~ . DURABLE POWER OF ATTORNEY ~. SARA,E: HORN. a res~den~ of cumberland County. Pennsylvania. wl~h a mall1ng address ot 2171 Newville Road. Carlisle, PA 17013 do ~er:by appoint ~CI L. HALTER 0: 704~ Carlisle Pike ~ot ~ 302. Q~,l;"....;!,.g~._?.1L.J. 7013 <'nerelnaf~er reterrea to as II my agent") as my agen:: wit:n :ull power or subst::,:ut:ion. tor me and .in my name to ::ransact all of my business and :0 manage aLl my propeny and arfairs as I might do if personally present, including ~Ut not: Ilmited to the rollowlng powers: . Durable Power or Attorney Tnls power of attorney shall not be affected by my s~osequent disao111 ty or incap.aci r.y. All acts done' oy my agent pursuant: .to tnls power durlng any period of my disability or incapacity shall have the same er::ect and enure to my oener:. t and bind .me and my s~ccessors in interest: as if I were competent and not disabled. Management or Assets 1. Cash Ac~ounts: To collect and recelve any money and assets to wnlcb I may be entitled: to deposit cash and checks in any of my accounts; to endorse for deposit. transfer or collectlon. in mYJ.name and ror my account any checks payable to my order; and to-I.- draw and sign checks for me and in my name, including any accoun~s opened by my agent in my name at any bank or banks. savings society or elsewhere; and to receive and apply the proceeds of such checks as ~y agent d~ems .best; and to act as my representative payee for all Social Security. Medicare, and other federal and state benefi ts . 2. sr.ocks ana Bonds: To take custody of my stocks. bonds and o~~er investment.s or a: 1 kinds, ~o give orders =or :~e sal e, exchange or s~rrender of any s~cr. ~nvestments ana to recelve the ?roceeds thereror; to Sign anddel~ver assignments. stock and bond powers ana other such documents requlred :cr any assignmen~. sale. exchange or surrender: to give orders ror the purchase or stocKS,. oonds and other investments 0: any kind and to settle for the same; ~o glve .nstr~ct~ons as ~o the regis~ra~ion t~ereof and the ~ai:ing thereof anc. the mailinc 0: divldends and interest; to cllp and deposi~ coupons attache; to anY coupon bonds. whether now owned by. me 'or hereafter acauired: tore-Drese-nt me at shareholders' meetings::. . and. vote ?rOXleS o"n my benal:; - and generall y to manage and. handl.~ :', ~ my lnvestments. 3. Personal ?ro~ertv: for cash or credit or by disoose ct. repalr. a:ter or ~ny interests therein. :,.;..,--.y.. - :'0 buy or se~. at public or privatesal.e:~:;:~ any other means whatsoever;.':o acquire/V or manage my tangible. personal property." ,:', . h'LwLc- ~,,_ -SARA E. HORN ,.. EXHIBIT A .:,':':-,';;';~ '-:"~- . w~ ~ .i".. ~ . t":j " ., -. 4 Real Property: To lease, sell, release, convey, extinguish or mon:gag~ any interest in any real estate I may own. on such terms as my agent deems advisable, and to purchase or otherwise' acquire any interest ln and acquire possession of real property and to accept all deeds for such property: and to manage. repa=.::- ,,'- improve. maintain. restore, build or develop any real property in wh~c~ : now have or may later acquire an interest. S. Safp. ~eoosit Boxes: To ~ave access to all safe deposit hoxes now or herea~ter s~andi~g in my name: and to add to and to remove all the- contents thereof: and to enter into leases for sucns'a'fe"T deposit boxes or surrender them. 6. Insurance: To procure. change, car~y or cancel insurance of. such kind and in such, amounts against any and all risks affecting property or persons against liability, damage or claim of any sort. 7. Benefit Plans: To apply for and receive any government. insurance and retirement benefits to which I may be entitled and to exercise any right to elect benefits or payment options: to terminate, t.o change beneficiaries or ownership, to assign rights, to borrow or receive cash value in return for the surrender of any or all rights I may have in life insurance policies or benefits. annuity policies, plans or benefits, mutual fund and other divid,end _I- investment plans and retirement, profitsharing and emp!byee welfare plans and benefits. _L ) :- S. ~~~es: To represent me in all tax matters: to prepare, sign and fi:-e federal. st:ate and/or local income, gift and other tax. returns of all kinds, including all Internal Revenue Service forms numbered :. through lO. 000, joint returns, cl aims for refunds "C requests for extens~ons of time, petitions to tax courts or other cou=:s regarding tax matters, and any and all other tax related documents. including out not limited to. consents and agreements u~d~: S~c~~on 2032A or tne Internal Revenue Code or any successor sect~on thereto and consents to gifts, closing agreements and any l:lOINe>: ')~ ac":ornev form reauired bv. the Internal Service ~uthorizat:ion forms", nos. 2848,- or its equivalent and/or any state .. anoior local taxing authority with respect to any tax year between ~ne years 1970 anc. 2040: to pay taxes due. coll ect and make dis?csition 0:: ::efunds as my agent shall deem appropriate: post bonc::.s. receJ.ve confidentia,- inrormation and contest deficiencie~,.". cetermined by the rnternal Revenue Service and/or any state and~or.' . loca: tax~ng authorJ.ty: to exercise any elections I may have unQ~~~~ feaerai st.ate or loca: tax 1 aws: and general ~ y to represent m7 .~~~~w". a:: tax ':nat ters ane: pl."oce'ecings of al: kinds and for al: per,~,og:.",;~-,." ." ~ ;,~;,~.f:.."~/ -' . '~\Mn,.> " '., ':.1 .,,~~:,,~- ,) s.;~('t P ~l..._ SARA E. HORN .'."', . "-'.' , . .~<'" ,.n- ~e~ween the years 1970 and 2020 before all officers of the Internal R~vent;e Service ane. state ane. local authorities; to engage co~pensa~e.and discharge attor~eys, accountants and other tax and financial advisers ane consultants to represent and/or assist me in connection with any and all tax matters involving or in any interest or responsibility. ... ,. 9. Borrow: To borrow money for my account on whatever terms and co::c:i ::ions :ny agent deems advisabl e, including the right to borrow money on any ins~rance policy issued on my life for any purpose; '1nc ;-'0 pledge, ~ssign, and deliver such policies as security. without any obligation whatsoever on the part of such insuranc~ company to de~ermine the purpose for such loan or the application of the proceeds. 10. Emnlovment of ot~e!"s: To employ lawyers, i:westment cO\lns~:, accounta::ts. custoe.ians, physicians, dentists. nurses, ~~e~apists and o~~er persons to render services for or to me or my estate and to pay the usua~ ane. reasonable fees and compensation of i~ch persons fer ~heir services. Disclaimer of :nterests: bena~= any interest in property. ':'0 release or disclaim on my Eeal~~ Care ?ro~rsions --l- ::1. ':.he e:-:ercise of the following powers the decision of my agent wi i 1 be ':ieterT.'linat~ ve. _- : :2. Access to Mv Medical and other Personal Information: To reques:, review, anu receive any information, verbal or written; ::ega.:ding my personal affairs or my physical or mental health, inc~uding medical ane hospital records, and to execute any release 0= i~to~~ation for the same. :3. ;'!ec:.ca~_..Rrocedures-: To arrange for Wl. ~hh.o ~ d t:e.:fit:;:::;::: ~he~a~el.ltical. and surgical including the administratiou of drugs. and consent to or. procedures for me, :~. Acmission :nto Facil~ties: To apply for my admission into mec~ca:! ~ursi~g: residential, rehabilitation, conva:escent or 0""'0'. -,~-:-.- "'-c"'"~.;es 0- ~v "ehal~ ane. to Sl.''''n any consent or. ....,;,l."'_ ~.r..~.......c._ I..c:L ___.,.... ..... ..Il~_ _.. _, '::II.. _', '." ad:r.:s:ii::.~ =~;::::lS ::f:"quireo ~y such facilit1.es whic~ are"cc:lsis,~en;;;r,.' ..,..... ""'s ~"'..." ar>c "0 e~-~-- l.'n"o a"'reements fo~ my car..e bv s'...lC:l.!':"....'.. w_ w... ......._ ::,1 W _... ......... ..."-...._ ... :J . '" . .. :'...' ...~"...,~~~;; :a(".::. t:. *5 .n: .=: s..wnere dur=.:ng my : ifetime or for lesser per3..~~~_,~; v: '::x.e as mv ager.~ fTl&l'. ces:.gnc.~e. inc:uding t!1e rE-tention:.,~O~,.,::e ntJ~:s~$ =o~ -;:'Y-'=Cl:'-~. ','.. ,~J~'--". .!-,. ~. -1~ f.-.. JJ. ~..j SARA :::. HORN -- ~'<. , 1iIIi!~"""-""~"il!lll~i!iir~!l:EiMi:li)'1i1 -r"","l-iil~~,;;tl!iM~JlO;\lO!lIdi!@r f '" fI1 ". ..~ ~ ,,,,,,,,,~~IIIi,,"~li 'Ii Ii I: I 'I II l'l 1 I fl " 1 I" Ii ,I I' II II II II \I Ii I i -,,' - ,~ j; \ ':'5. Reliance on Power: This power may be accepted and relied upon by anyone to whom it is presented until such person either receives wr'itten notice of revocation bv me or a guardian or similar fiduciary of my estate or has actuai knowledge of my death. 16. ti,.91q_tf_~r1l)J.ess: A~l actions of my agent shall bind me and my :tei rs, distributees, 1 egal representatives, successors and assigns, and f or the p1.:rpose of incl uchng anyone to act in accordance loll. th 1:he powers I have granted herein, ..' hereby represent, war=ant and .agree that if this power of attorney is te!:::U.nated or amended for any reason ,:(~,,,and !IIY heirs, distributees. i egal representatives, successors and assigns will hold such party ~= par~ies harmless from any loss suffered or liability incurred by s1.&ch party or parties while acting in acgordance with this power p..-ior to that party's receipt of written notice of any such termination or amendment. :7. Severahiiitv" Il"~validitv: I di'rect that if any specific power in this declaration be held to be invalid. that invalidity will not: offset other powers which can be effectuated without the :a.nval id power. 1.8. Entire Aareement: The prOVl.sJ.ons encompassed in this c.oc=ent: numbe,red pages :i. through -1-4 and incorporated by reference constitute the entire agreemen~~ 19 _ :::>...nns vi vani a Law Govern~: Questions pertaining to the validity, construction and powers create~ ander this instrument s:,a:: ;,e determined in accordance with the-laws of the Commonwealth ~ - .. . c= :ennsYJ.vanJ.a. - - eve sig~€"d ~.:-l:;'S power of at~orney this -pi.. ,g , day of 9.d. - "'0.'".:' -.,..;.. . d/U.4-- B ~-e-r-~ SARA E. HORN /99- r;J7.tJ Ii ~ Social Security Number ;;i tn€'ss-:-s: y:.~</'UA. t< 7)/'_~~';":'~ ::aiT;e .one. A(~J.r-:-.5s . t1 .t;. rut.. Add:.7ess I ptJ ).'1131E /3t.;'i) tHK.l../SLE flJ. J;Jc J...~eu; di...t lit ..;.... ,,". ,?*' " i_;-;#~~:(:'- '.,'., ' . :~. ''''-. '-r~~ .; .- ,. ) ) 'J ~ j 1':lJ -.'- -" -'!It.:.:~ :''''.{~;,~.'..~:-- . Acknowledgement Commonwealth of Pennsylvania County of ~"'w;~n C;)P1./F.eUM.:l> Tit . 1::"' On this IS day of ~, 199~personallY appeared before me, a Notary Public in and for the said County and state, the above- named individual, SARA E, HORN, who acknowledged the foregoing Power of Attorney to be her act and deed and desires the same might be recorded as such according to law. I have Signed my name and affixed my seal on the day ancl year aforesaid. -~ttJ/ ..P. %. L . Notary Publ i c '.q , My Commission Expires: NOTARIAL SEAL SU~M'J r. HOl'CHiON. Nc-tl!ry Pub!Je (f.~!. i G~";. C:..ft'::tr~'fr'" r." '~'Y PI !i1 i.....,.~j.;.~ "J:ll~)if#i ;!;;"1 i;, ;.~~~._ ~ -J- ." .'1 '.. ::;..'...,:.. ::.4,;,{f~f.~i~~t~ ,. ,..) - ; ~~.- . \t:'; . -~" .';';'" .... . ','Y ~~:.' t;. . ,. . '\' ' ...-.<...;_;l.......'...;..L.!F_..:i'_..~:?\{:,~'.!j.'.~..~,.:' ;..~.fI:. ;.,.".";.... ,'::' ..' ~/, :".~.,' ~:":i\':\:'"" t' .~y:~~..i:~i~~~,_ .,t:,~,-,{.":..... .;,..,. .": :~:~'~1{~>:", ".7 r:i~:i ':('-f ~ "~~ - -- ~- ~.~ ,..j,~'""'= . . .',~~~~vAD"I$SIQr.tM..GBEEIYI. .' CONTRACT~iE:T:wi~mPA-li'ENflRE~1!D . ; " '.. ,', -, ','., ',-, ~ ManorCare ' Health Services THIS ADMISSION AGREEMENT (the "Agreement") is entered into this U day of ...:......11 ~ _" ' 19 qg ,between ManorCare Health servi~es (the "Facility"), and SL'L~ tiDRI-.) (the "Patient/Resident"), and/or!'R{)('J ~ (the "Responsible Party"). As used herein, the term "Patient/Resident" shall also mean the Responsible Party, if any. The parties agree as follows: r 1. Commencement. This Agreement shall begin on the date of admission of the Patient/Resident to the Facility. 2. Termination of Agreement, Discharge and Transfer. a. Termination by Patient/Resident. The Patient/Resident may terminate this Agreement by giving the Facility at least five (5) days advance written notice. The Patient/Resident is responsible for payment of all charges for five (5) days after notice is given, or until the Patient/Resident actually leaves the Facility, whichever is last. If the Patient/Resident leaves the Facility (i) before the attending physician discharges the Patient/Resident, or (ii) against medical advice, the Patient/Resident and Responsible Party agree to assume all responsibility for injury or harm to the Patient/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 Pat- ient/Resident upon at least thirty (30) days prior written notice if (1) the Patient/Resident's needs cannot be met; (2) the Patient/Resident presents a danger to the health or safety of other indivi- duals; (3) the Patient/Resident fails to pay charges for supplies or services after notice; (4) the Patient/Resident's health has improved sufficiently so that the Patient/Resident no longe,"-needs the services provided; or (5) the Facility ceases to operate. However, the Patient/Resident may be tra,,!sferred or discharged upon less than thirty (30) days notice 'if: (1) an immediate transfer or discharge is required due to the Patient/Resident's medical needs; (2) the Patient/Resident presents a threat to the health and safety of individuals in the Facility; or (3) the Patient/Resident has not resided in the Facility for thirty (30) days. Such notice shall be given as soon as practical. The Patient/Resident acknowledges receipt from the Facility of materials as to the Patient/Resident's right to appeal a discharge decision with State authorities and the appeals process. If this Agreement is terminated and/or the Patient/ Resident is discharged by the Facility, the Responsible Party agrees to accept custody of the Patient/Resident upon discharge and cooperate with the Facility to facilitate the Patient/Residenfs discharge. 3. Responsible Party. The Patient/Resident shall execute Exhibit A regarding Responsible Party appointment. 4. Fees & Payments. The Patient/Resident is responsible for, and shall pay, the daily rate and charges for supplemental services and supplies not paid by any third party as described in the Fee Schedule, attached as Exhibit S, as well as applicable co-insurance and deductible, amounts and all expenses of discharge or transfer. 5. Release of Information. The Patient/Resident hereby authorizes all persons and/or entities to release all or any part of his/her medical/health records to the Facility. The Patient/Resident also authorizes the release of records or information to any health care institution to which the Patient/ Resident may be transferred, any provider involved in the care of the Patient/Resident, any third party payor, including, but not limited to, government and private .insurers, or any other person entitled or authorized to receive such information by law or by the Patient/Resident. IlIHCwOO8.20 (Rev. 7/96l pg 3 1 of 3 EXHIBIT B .." ~,.. '" 7. Attending Physician. The Patient/Resident is solely responsible for selection of 'alicensed attending physician. The Patient/Resident agrees that the Facility may require the Patient/Resident to utilize another physician If the attending physician (1) has hiS/her own professional license limited, suspended or revoked; (2) falls to follow the Facility's rules and regulations; or (3) Is unavailable in case of emergency. The Patient/Resident is responsible for all charges for physician services. a. Pharmacy. The Patient/Resident shall execute the Pharmacy Agreement attached as Exhibit C. 9. Independent Contractors. The Patient/Resident acknowledges and agrees that all physicians, dentists and barbers/beauticians, including those whose services are arranged by the Facility, are independent contractors and are not employees or agents of the Facility, and the Facility shall not be responsible for their acts or omissions or for the consequences of following physiCian or dentist orders. 10. Private Duty Personnel. The Patient/Resident acknOWledges that all private duty personnel that the Patient/Resident utilizes are not employees or agents of the Facility and that the Facility is not liable for acts or omissions by such personnel. Employees of the Facility may not be employed as private duty personnel at the Facility. All private duty personnel shall comply with all policies and procedures of the FaCility as may be amended from time to time without notice. Failure to do so may result in their being denied access to the Facility. Patlent/Residen! and Responsible Party shall be Solely responsible for the cost of private duty personnel. 11. Facility Guidelines for "No Heroics" ReQuests. Decisions regarding life support should be considered by each Patient/Resident or his/her authorjzed surrogate decision-maker. The Patient! Resident acknowledges receipt of rights uncier state law to make decisions about medical care, in- cluding rights to acoept or refuse care and rights to make an advance decision about care. The Patient/Resident acknowledges receipt of a summary of the "Facility Gudellnes 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 Patient/Resident without a written and legally sufficient authorization of a oompetent Patient/Resident or legally authorized surrogate deoision-maker and a physician order. The Patient! Resident agrees to comply with the Guidelines, 12. liability and Indemnification. The Patient/Resident understands that the Facility is liable only for Injuries C8U$ed by the negligent acts or omissions of the Facility and as require~ by law" The Patient/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 Patient/Resident to any person or the prop&rty of any person or entity (Including the Facility). 13. Patiel't/Resident's Handbook. The Patient/Resident acknowledges reeeipt of the Faeillty's Resi- dent's Handbook and agrees to comply wnh such Rules and Regulations eantained therein. The Patient/ReSident acknowledges and agrees that he/she shall be responsible for and shall hold the Faoility harmless for any injuries or damages which are caused by the Patient/Resident's failure to comply with such rules and regulations. The policies, procedures, rules and regulations regarding the following areas, among others, are detailed In the Resident's Handbook: Mtte,OO'.'O (Rev.4/96) pg 4 2 of 3 ~~",~""'.J_~~. ." ,., .~ ~ ' ~- " '.'iW"'~,; . Federal Resident Rights . Resident Responsibilities . Life Sustaining Treatment Policy . Medical/Nursing Education . Dental, Vision and Hearing Services . Interdisciplinary Care Conference . Utilization Review Meetings (if applicable) . Personal Laundry Policy . Barber/Beauty Services . Mail Policy, . Voting Materials . Photo/Media Events . Personal Fund Account Procedure . Tobacco Policy . Grievance Procedures ' . State Resident Rights (if applicable) 14. 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 D SETS FORTH ANY DELETIONS FROM OR ADDITIONS TO, THIS AGREEMENT REQUIRED BY STATE LAW, WHICH AMENDMENTS SHALL BE A PART OF THIS AGREEMENT, 15. Miscellaneous. The provisions of this Agreement shall bind the parties, their respective executors, administrators, heirs, beneficiaries, and assigns. The waiver by either party of any breach or default of this Agreement shall not operate as a waiver of any subsequent breach or default. The provisions of this Agreement shall be severable and the invalidity or unenforceability of any provision shall not affect the validity or 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 AdJDission Agreement as of the day and year above written. .' e Party - Signature _=rmt \ tk!J..tt R- Responsible Party - Printed Name ....11 {(If'- ltJQ9g Date &w A!..&- Facility RepresentatIVe - Signature c..l~'re 1:xlltl \.9..j.b. Facility Representative Printed Name & Title " \\1 (\f> UJ99~ Date MHC-ooa-oo (Rev.4/96) pg 5 30f3 HCR MANORCARE, INC. s/blm/t MANORCARE HEALTH SERVICES, Plaintiff, v. SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants. "-'."--,'-, r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 00-3367 EQUITY PRAECIPE TO ENTER DEFAULT JUDGMENT PURSUANT TO Pa.R.C.P. 1037 Please enter judgment in favor ofPlaintitr, HCRManorCare, Inc. and against the 237.1. Defendant, Sara Horn, for failure to file an answer to the Complaint of Plaintiff. A true and ,I II correct copy of the return of service from the Sheriff of Cumberland County is appended hereto 'I 'I A true and correct copy of the Notice of Default is appended hereto as Exhibit "B." :1 1 , ! A true and correct copy of the Certificate of Mailing for the Notice of Default is appended TO THE PROTHONOTARY: as Exhibit "A." hereto as Exhibit "C." I certify that the Notice of Default was given in: accordance with Pa.R.C.P. Plaintiff requests judgment in the amount of $53,277. 73 as set forth in the complaint. Respectfully submitted, O'BRIEN, BARIC & S ~() t. David A. Baric, Esquire J.D. # 44853 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 ",;I'_~'_.___1l<~'~' . SHERIFF'S RETURN - REGULAR CASE NO: 2000-03367 P , CO~10N1vEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HCR MANORCARE INC VS HORN SARA E ET AL KENNETH GOSSERT , Sheriff or Deputy Sheriff of Cumberland County, Pensylvania, who being duly sworn according to law, says, the within NOTICE & COMPLAINT was served upon HORN SARA E the DEFENDANT , at 0016:00 HOURS, on the 7th day of June , 2000 at 940 WALNUT BOTTOM ROAD MANOR CARE NURSING HOME CARLISLE, PA 17013 JODI GAS LOR (DIRECTOR OF by handing to SOCIAL SERVICES) a true and attested copy of NOTICE & COMPLAINT together with IN EQUITY and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 3.10 .00 10.00 .00 31.10 ~~L~<t:~~ R. Thomas Kline 06/16/2000 O'BRIEN, BARIC & SCHERER A.D. Sworn and Subscribed to before By: day of me this Prothonotary EXlfIBtT "A" !""""""~~. ~ i! II II 11 HCRMANORCARE, INC. slb/m/t MANORCARE HEALTH SERVICES, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, NO. 00-3367 EQUITY V. " SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants. TO: Sara Horn 940 Walnut Bottom Road Carlisle, Pennsylvania 17013 Date of Notice: August 1, 2000 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITInN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND 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 Liberty Avenue Carlisle, Pennsylvania 17013 Telephone: (717) 249-3166 ~BRlEN, B, ARIC AND S~, R ~bJd(~J David A. Baric, Esquire 17 West South Street Carlisle, PA 17013 (717) 249-6873 EXHIBIT "B" I, - us. POSTA S VICE CERTIFI ATE OF MAIL NG _,.,...._..' '---..;.. ortamDS ~AY BE USED FOR DOMESTIC AND' INTERNATIONAL MAil, DOES NOt ,,'" ,-' ". " "., PROVIDE FOR INSURANCE POSTMASTER "~t~;;-~I~I""" Re.~ived From: ~~ -'i...gi"f o G' ~",';:;S <,ft./~Ji~k J 'J 0>.<:),":- .,; /, j , '!1-/.,'~ Q ,:,.' ",Q 2;1'"10 c: -,oli't "'.::DC' :0 . tiiC::)'i!':.-~"Y' - c:.....~::t> (O~ C!:-~....-o .;:t..t ~~wmOC <:)"'--' Q ~ en tV Q " ~ '" Iil PS Form 3817. Mar. 1989 ~ EXHIBIT "c" I I I j , I i \ i I ! ...- -'ij 1 ! ~ CERTIFICATE OF SERVICE I hereby certify that on August Z. 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 Pa,Rep, 1037, by first class US, mail, postage prepaid, to the parties listed below, as follows: Sara E. Horn 940 Walnut Bottom Road Carlisle, Pennsylvania 17013 Traci L. Halter 2171 Newville Road Carlisle, Pennsylvania 17013 Sandra K Mullins 124 Conodoguinet Mobile Estates Newville, Pennsylvania 17241 ~VI ,- r f: 'Ii :. II i ~ 11 ) David A Baric, Esquire II - :--1 , , '. HCR MANORCARE, INC sfb/mlt MANORCARE HEALTH SERVICES, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANlA Plaintiff, NO, 00-3367 EQUITY v. SARA E, HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants. PRAECIPE TO ENTER DEFAULT JUDGMENT PURSUANT TO Pa.RC.P. 1037 TO THE PROTHONOTARY: Please enter judgment in favor of Plaintiff, HCR ManorCare, Inc, and against the Defendant, Traci L. Halter, 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 as Exhibit "A" " A true and correct copy ofthe Notice of Default is appended hereto as Exhibit "R." A true and correct copy ofthe 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,RCP, 2371. Plaintiff requests judgment in the amount of $53,277, 73 as set forth in the complaint. Respectfully submitted, O'BRIEN, BARIC & SC," L ~ ~ ~ . ,I ,I David A Baric, Esquire LD, # 44853 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 . ~~ --~ ~ _...,,~-- " , Mmhh' s il:];'Tu~-IHJ!f'fDaR' ~' '1;~_ CASE NO: 2000-03367 P .- COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND " " * " HCR MANORCARE INC VS HORN SARA E ET AL BRIAN BARR I CK " , Sheriff or Deputy Sheriff of Cumberland County, Pensylvania, who being duly sworn according to law, says, the within COMPLAINT - EQUITY was served upon HALTER TRACI L the DEFENDANT , at 0018:13 HOURS, on the 15th day of June , 2000 at 2171 NEWVILLE ROAD " NEWVILLE, PA 17241 by handing to TRACI HALTER a,true and attested copy of COMPLAINT - EQUITY together with NOTICE and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 6.00 4.34 ,00 10.00 ,00 20.34 So Answers: ~~~/<~ R. Thomas Kline me this day of 06/16/2000 O'B",:., ~~r:1 Deputy Sheriff Sworn and subscribed to before A,D. Prothonotary EXHIBIT "A" ~"~ ~~ .~ I _~I" ~~ ~ ~"~ ~-~." ~"..-;.' , ., '''" .. '.-, HCR MANORCARE, INC" s/b/mlt MANORCARE HEALTH SERVICES, INC" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff, NO, 00-3367 EQUITY V. EQUITY SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K, MULLINS, Defendants, TO: Traci Ui Halter 7043 Carlisle Pike Lot #302 Carlisle, PA 17013 DATE OF NOTICE: July 13, 2000 IMPORTANT NOTICE YOU ARE IN DEF AUL T 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 THIS NOTICE, A JUDGMENT MAYBE ENTERED AGAINST YOU WITHOUT A HEARING ANY YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS, YOU SHOULD TAKE THIS 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 LIBERTY AVENUE CARLISLE, PENNSYLVANIA 17013 (717) 249-316 t:~ David A, Baric, Esquire Attorney for Plaintiff 17 West South Street Carlisle, P A 17013 (717) 249-6873 EXHIBIT "B" ~ " ',. ",S, POSTAL SERVIC< CERTIFICATE OF MAILING MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAil. DOES NOT PROVIDE FOR INSURANCE POSTMASTER I 'I Received Frpm: . 01 Bn e(), B::ulG ~ SC/'W\.eJ\. /7 V\Je~t Sourh ~rrecr CiM-l is-It -PA L ,1Tl3 One piece of ordinary mail addressed to: ]]]JGl l, italtu 70t-j Q C,ar1tY1{j Pi~6 -bQ.tft30Z, ~\tSl(J PA 1{6/3 PS Form 3817. Mar, 1989 . EXHIBIT "c" a: '" UJ '" ~ ~ 0 J- 0:: 0 (f) a..Ujo- ~ ~EtI)~v~ <J::>-r---O '0..-1- E: ~ cl 5<<: ::> :r -, J- >= 1\\\ , c::J'f t.O~ oC> c::J~ (;A-g I " - """,--w 'po \ ~~ nt " o " " .... " CERTIFICATE OF SERVICE ,"-,-_.",', I hereby certify that on July ~ I , 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: Sara E, Horn 940 Walnut Bottom Road Carlisle, Pennsylvania 17013 Traci L. Halter 7043 Carlisle Pike, Lot #302 Carlisle, Pennsylvania 17013 Sandra K Mullins 124 Conodqguinet Mobile Estates Newville, Pennsylvania 17241 ~~k.i David A. Baric, Esquire II ., , I I I I I i I I I i I ~''''I'-~~~" , , ,,;,' "jl ,? " HCR MANOR CARE, INC. : IN THE COURT OF COMMON PLEAS OF sIb/mlt MANORCARE HEALTH : CUMBERLAND COUNTY, PENNSYLVANIA SERVICES, : Plaintiff : NO. 00-3367 EQUITY . . SARA E. HORN, TRACI L. HALTER, individually and as attorney-in-fact for Sara Horn, and SANDRA K. MULLINS, Defendants . . RELEASE OF JUDGMENT LIEN The following premises are he'i-eby released and forever discharged from the lien of the judgment entered in the above captioned matter: ALL THOSE TWO CERTAIN tracts of land together with improvements erected thereon situate in West Pennsboro Township, Cumberland County, Pennsylvania known and numbered as 2171 Newville Road, Carlisle, Pennsylvania 17013 and as further set forth and described in the Deed dated March 23, 1998 and recorded March 24, 1998 in the Cumberland County Recorder of Deeds office at Deed Book 174, Page S. Nothing herein shall invalidate the lien or security of the Judgment upon any other real estate of Defendants' Traci L. Halter, Sara E. Horn and Sandra K. Mullins. ~~. Robert L. O'Brien, Esquire Legal Counsel for Plaintiff, HCR Manor Care, Inc. 1\';j-~"~ >Ol ~" u-. , ~Ol.j . . COMMONWEALTH OF PENNSYLVANIA: : ss. COUNTY OF I-~ j tumva lana On the ~nddaY of QWAMd:J . 2001, before me personally came Robert L. O'Brien known to me.(otfs~tisfactori1Y proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. (SEAL) My Commission Expires: Notarial Seal , Jennifer s, Lindsay, Notary Public Carlisle BOlO, Cumberiand ~~U~~03 I My Commission Expires No"" . , Member, PennsylvaOlaAssociatiOnof Notaries "~ .O~' ""-~JIiLi:lLclllililiflM:ih~~f>U"*;'i~4."""'~i!ilf~4\~~&iIli-""",,,,"III~rj,ljll,j$'~~ ..".:.--"" )J It- ~ "-J ~ ~ -~"'"""'" AUG - 3 2001 (-J .tq, ~ ~ ~ ~ ""Vb ~ '--Z. o C 7' -off rnr;: z~, ffi~, -< ~c' 2;:c:: ..._..~' >~! L_ Z -< -< C) CI ~i"1 ,:::;) C'') --l I n'{') ~~C~: ~-,.. IT ~~ -< ...c,.,. k') vl .. . I