HomeMy WebLinkAbout00-03937
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BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
Petitioners
v.
CIVIL ACTION - LAW
NO. fn) - :3 f37
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EUGENE S. ZEIDERS, SIllRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFILINGER,
Respondents
ORDER
AND NOW, tlri, g MY of _~ ' 2000, , h""'ng " h:: ~
consider for approval of the Minor's Compromise. The hearing will be h~ld befer<', 1:h~ IIeJll6Illel€ .
vn ('.h11~ If.o.~on ~J ~ '7 , ,2000, at J- -00 p.m.la.Ht. ' I
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BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
Petitioners
v.
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFILINGER,
Respondents
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO.
ORDER
AND NOW, this day of ,2000, upon consideration of the attached
Petition to Approve Minor's Settlement, said Petition is granted and Defendant is ordered to pay
Petitioners in the amount of$34,738.05 funds to be deposited into a federally insured account, with
the restriction that said funds may not be withdrawn until or until further Order of the
Court. Petitioners shall file proof of deposition with the Prothonotary within 30 days ofthis Order.
BY THE COURT,
J.
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F; \FILES\DA T AFILE\Travdoc,cur\670-pet2ljadlnhn
Created: 04126/0004:38:51 pM
Revised: <06f07/00 08:35:49 AM:
3090.670
BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
Petitioners
v.
CNIL ACTION - LAW
NO. ffb-39.3'1 ~ IJ-<.-..
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFILINGER,
Respondents
PETITION TO APPROVE MINOR'S COMPROMISE
AND NOW, comes Petitioners, Bonita Murphy, as parent and legal guardian of Minor
Petitioner Gregory Kell, and file this Petition to Approve Minor's Compromise and in support
thereof, avers as follows:
1. Petitioner, Mrs. Bonita Murphy, is parent and legal guardian of Minor Petitioner,
Gregory Kell.
2. Respondents Eugene S. and Shirley Zeiders are adult individuals residing at 7321
Wertzville Road, Carlisle, Pennsylvania and are the parents and legal guardian of the minor
Respondent Robert Zeiders.
3. Respondent Travelers Insurance Company is an insurance carrier licensed to do
business in Pennsylvania with an address of One Tower Square, Hartford, CT 06115.
4. Respondent Jamie Greene is an adult individual residing at 1374 Old Willow Mill
Road, Mechanicsburg, Pennsylvania and is the mother and legal guardian of minor Respondent Ryan
Greene.
5. Respondent Daria Doerfilinger is an adult individual residing at 12 West Terrace
Drive, Mechanicsburg, P A 17055 and is the parent and legal guardian of the minor Respondent
Brandy Doerfilinger.
6. Minor Petitioner, Gregory Kell, whose date of birth is June 10, 1983, was injured as
a result of a one car accident that occurred on September 15, 1999.
7. At the time of the accident, the Minor was a passenger in a vehicle owned by Eugene
S. Zeiders and Shirley Zeiders, and operated by Defendant Robert Zeiders.
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8. At the time of the collision, the Zeiders' vehicle was covered by a Travelers policy
providing the Zeiders had a $35,000.00 single limit, of which they paid $261.95 for property
damages as a result of the accident. A copy of the declarations sheet is hereby attached as Exhibit
"A".
9. As a result ofthe accident, Gregory Kell sustained severe injuries, including a closed
head trauma resulting in brain damage. Atthe time of the accident, minors Ryan Greene and Brandy
Doerfilinger were also passengers in the vehicle owned by Eugene S. Zeiders and Shirley Zeiders,
and operated by Defendant Robert Zeiders, and also sustained minor injuries.
10. Minors Brandy Doerfilinger and Ryan Greene have indicated that they will not be
submitting claims for the insignificant personal injuries against Respondents Zeiders as a result of
this accident. They are joined as parties to this action since the policy provided a single limit of
coverage.
II. Minor Gregory Kell received pediatric intensive care from September 15, 1999,
through September 21, 1999, and physical therapy upon his discharge.
12. The insurance carrier for Defendant Zeiders, Travelers Property Casualty, has reached
a settlelnent in the amount of Thirty-Four Thousand Seven Hundred ThirtyCEight and 05/100
($34,738.05) Dollars with Minor Petitioner to compromise any and all claims in the above captioned
action. (A copy of the Release is attached hereto as Exhibit "B").
13. Progressive Insurance Company, the under insurance carrier for minor Petitioner
Gregory Kell has consented to the settlement of the liability limits and waived its subrogation rights.
14. Allstate Insurance Company which provided coverage for the minor Petitioners
father, Richard E. O'Hara, and for which a claim has been made for under insured motorist benefits,
has also granted consent to settle with a waiver of subrogation rights with regard to the above
referenced claim. (A copy of the March 20, 2000 letter is hereby attached as Exhibit "C").
15. As Petitioner does not desire to retain counsel, this Petition has been prepared by
counsel for the Respondents Zeiders.
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WHEREFORE, Petitioners respectfully request this Court to approve the foregoing
compromise on behalf of Minor Petitioner, Gregory Kell.
Respectfully submitted,
MARTSO DEARDORFF WILLIAMS & OTTO
Date: &(;;"S/oO
By
George ler, Jr.,
LD. No. 49813
Ten East High Street
Carlisle, P A 17013-3093
(717) 243-3341
Attorneys for Respondents
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1~1 IN~3URE[); EUGENE S ZEIDERS
AD11RESS: 7321 WEi~'I'ZV:[(..LE 1~(JAD
[:j':":<1 i~L I BL.E I
PIN: 0,JA290-()07473390-1()1'-:l EDt 6
PRODU~:El~: ~1DOPY INSIJRANCE AGENCY
CGVE~R~GE PERIOD: 08/<)1./99 ".0 02/01/00
DA1'E ()I~ LOSS: 09/15/99
t)EHIC[~E i :::,~ 90 FGJ;;:O
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ADDRESS: PO BlJX 4()
******* 001 CL"AIMAN'['S EXIS"r WI1'H SUI"r'S ACTIVE ***~k**
DEDUCTIBL.E
COVER{iG~~S ;
CODE DESCRIP1'IVE
81 8(JDILY ]:N~URY L.IABILI1'Y
PO PROPERTY DAMAGE:
UM_ UNINSUI~J~D MOTORIS'f<NOT STACKEO~
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F:\FILES\'DA r AFILE\Travdoc.cur\670-re1.1/nlm
Created: 05/30f0003:1l:24PM
Revised: 05131/0007:53:26AM
3090,670
GENERAL RELEASE
FOR AND IN CONSIDERATION OF the payment to BONITA MURPHY, as Parent and
Legal Guardian of Minor GREGORY KELL and GREGORY KELL, a minor of the sum THIRTY
FOUR THOUSAND SEVEN HUNDRED THIRTY EIGHT DOLLARS and 051100, ($34,738.05),
and other good and valuable consideration, the receipt whereof is hereby acknowledged, we, being of
lawful age, have released and discharged, and by these presents do for ourselves, our heirs, executors,
administrators, successors and assigns, release, acquit and forever discharge EUGENE ZEIDERS,
SHIRLEY ZEIDERS, ROBERT ZEIDERS, TRAVELERS INSURANCE COMPANY, JAMIE
GREENE and RYAN GREENE, and any and all other persons, fIrms, insurers, and corporations, of
and from any and all past, present and future actions, causes of action, claims, demands, damages,
medical payments, costs, loss of services, insurance benefIts, expenses, compensation, third party
actions, suits at law or in equity, including claims or suits for contribution and/or indemnity, of
whatever nature, and all consequential damage on account of, or in any way growing out of any and
all known and unknown personal injuries and/or property damage resulting or to result from an alleged
accident that occurred on or about September 15, 1999.
We do hereby declare and represent that the injuries sustained may be permanent and
progressive and that recovery therefrom is uncertain and indefmite, and in making this release and
agreement it is understood and agreed that we rely wholly upon our own judgment, belief and
knowledge of the nature, extent and duration of said injuries.
We understand that this settlement is the compromise of a doubtful and disputed claim, and
that the payment is not to be construed as an admission of liability on the part of the persons, fIrms
and/or corporations hereby released by whom liability is expressly denied.
It is understood and agreed that this Release is executed in connection with the settlement of
the clauns of the undersigned as set forth in a Civil Action entered to No. in the
Court of Common Pleas of Cumberland County, Pennsylvania, which action is to be marked as
discontinued, settled and withdrawn.
It is further understood, and agreed, that this is the complete release agreement, and that there
are no written or oral understandings, or agreements, directly or indirectly connected with this release
and settlement that are not incorporated herein. This agreement shall be binding upon and inure to the
successors, assigns, heirs, executors, administrators, and legal representatives of the respective parties
hereto.
We fully understand that any person knowingly and with intent to defraud any insurance
Exhibit "B"
.
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company or other person files a statement of claim containing any materially false information or
conceals, for the purpose of misleading, information concerning any fact material thereto, commits a
fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
The existence of this settlement and the amount paid pursuant hereto shall be kept in strictest
confidence and shall not be disclosed to any other person. Neither we nor our attorneys or other
representatives will in any way publicize or cause to be publicized, in any news or communications
media, including but not limited to newspapers, magazines, journals, radio or television, the facts of
or the terms and conditions of this settlement. All parties to this agreement expressly agree to decline
comment on any aspect of this settlement to any member of the news media. This paragraph is
intended to become part of the consideration for settlement of this case.
This Release is not intended to release any claims which the Plaintiffs may have for medical
malpractice, first party benefits, any other health insurance benefits or under insured motorist claims.
THE UNDERSIGNED HEREBY DECLARES that the terms of this settlement have been
completely read and are fully understood and voluntarily accepted for the purpose of making a full and
final compromise adjustment and settlement of any and all claims on account of the injuries and
damages above-mentioned, and for the express purpose of precluding forever any legal actions arising
out of the aforesaid claims, and that George B. Faller, Jr., Esquire, has explained to my satisfaction
and understanding the full legal effect of this release to me and I am satisfied that this is fair, just and
in my own best interests.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
, 2000, intending to be legally bound thereby.
day of
WITNESS:
(SEAL)
Bonita Murphy
As Parent and Legal Guardian of
Minor, Gregory Kell
COMMONWEALTH OF PENNSYL VANIA )
:SS.
COUNTY OF )
On this day of , 2000, before me personally appeared Bonita Murphy, known
to me to be the person whose name is subscribed to the within Release and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
Notary Public
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AHstate .Insurance Company
6345 Flank Drive, Suite 1000
Harrisburg, Pa. 17112
Fax: 717-540-7540
ALLSTATE
You're in good hands.
Tel: 800-726-8890
717-540-7500
March 20, 2000
Travelers Insurance
Attention: Suzanne Tonch
POBox 13485
Reading PA 19612-3485
Your Insured:
. Your Claim:
Our Insured:
Our Claim:
Eugene and Robert Zeiders
S3B8797
Richard E. O'Hara
15536-7215-3 UPH
)
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Dear Suzanne:
Please be advised we grant our consenl to settle with waiver of our subrogation rights with
reference to the above referenced claim.
Please feel free to contact me if you have any questions in this regard.
O. rely,
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PATRICIA mCKE
~r. Staff Claim Rep
phis
Exhibit "C"
-",,'
VERIFICATION
The foregoing Petition to Approve Minor's Settlement is based upon infonnation which has
been gathered by counsel in the preparation of the lawsuit. The language of the document is that of
counsel and not my own. I have read the document and to the extent that it is based upon
infonnation which I have given to my counsel, it is true and correct to the best of my knowledge,
infonnation and belief. To the extent that the content of the document is that of counsel, I have
relied upon counsel in making this verification.
This statement and verification are made subject to the penalties of 18 Pa. C.S. Section 4904
relating to unsworil falsification to authorities, which provides that if I make knowingly false
.vom_, I ~y bo ....j"" 00 ,rimIMI p",,""~~ /~
Jtonita Murpl'iy c:r---
BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
Petitioners
v.
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFILINGER,
Respondents
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CNIL ACTION - LAW
NO.
CONSENT OF PETITIONER AND LEGAL GUARDIAN
The undersigned, Bonita Murphy, Petitioner in the above captioned action and parent of
Gregory Kell, a minor, have read the foregoing Petition to Approve Minor's Settlement and have
reviewed the terms of said Petition and settlement and hereby consent to the Petition and agree to
said settlement.
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B6nita Murphy .
..
CERTIFICATE OF SERVICE
I, Jacqueline A. Decker, an authorized agent of Marts on Deardorff Williams & Otto, hereby
certify that a copy of the foregoing Petition to Approve Minor's Compromise was served this date
by depositing same in the Post Office at Carlisle, P A, fIrst class mail, postage prepaid, addressed as
follows:
Ms. Bonita Murphy
7358 Wertzville Road
Carlisle, PA 17013
MARTS ON DEARDORFF WILLIAMS & OTTO
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Carlisle, P A 17013
(717) 243-3341
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F:\FILESIDA TAFO-E\Travdoc.cw'\670-pra.l!jlk
Created: 08/15!0002:14:16PM
Revised: 09112/00 08:59:57 AM
3090.670
BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
Petitioners
CIVIL ACTION - LAW
v.
NO. 2000-3937 CIVIL ACTION - LAW
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFLINGER, as parent and
legal guardian ofBRANDYDOERFLINGER
Respondents
PRAECIPE
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
You are hereby directed to file the attached proof of deposit regarding the settlement funds for
the court approved settlement as ordered by Judge Hoffer. The Orrstown Bank custodian account, which
is attached hereto as Exhibit A, represents the deposit of the funds of actions docketed at:
BONITA MURPHY and GREGORY KELL v. PROGRESSIVE INSURANCE COMPANY
NO. 00-3938
-and-
GREGORY KELL v. ROBERT ZEIDERS
NO. 2000-3937
totaling $49, 738.05.
Respectfully submitted,
RFF WILLIAMS & OTTO
eorge B. Faller, Jr.,
LD. No. 49813
Ten East High Street
Carlisle, P A 17013
(717) 243-3341
By
Attorneys for Defendants
Dated: September 12, 2000
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CERTIFICATE OF SERVICE
I, Jennifer 1. Kelley, an authorized agent for Martson Deardorff Williams & Otto, hereby certify
that a copy of the foregoing Praecipe was served this date by depositing same in the Post Office at
Carlisle, P A, first class mail, postage prepaid, addressed as follows:
Judge Oler
Cumberland County Courthouse
Carlisle, PAl 70 13
Bonita Murphy
7358 Wertzville Road
Carlisle, PA 17013
MARTSON DEARDORFF WILLIAMS & OTTO
nnifer . Kelley
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
By,
Dated: September 12, 2000
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BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
Petitioners
CNIL ACTION - LAW
v.
NO. 2000-3937 CIVIL ACTION - LAW
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFLINGER, as parent arJd
legal guardian of BRANDY
DOERFLINGER
Respondents
i;
AND NOW, this day of 000, upon consideration of the attached
Petition to Approve Mino s Settlement, said Pe tion is granted and Defendant is ordered to pay
Petitioners in the amount of$34, 738.05 funds to be deposited into a federally insured account, with
the restriction that said funds may not be withdrawn until June 10,2001 or until further Order of the
Court. Petitioners shall file proof of deposit with the Prothonotary within 30 days of this Order.
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F:\FILES\DA TAFILE\Ttavdoc:.cw\670-pra IIjlk
Created: OBllSfOO02:14:16PM
Revised: 09fl2/0008:S9:S7AM
3090.670
,
BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYL VANIA
Petitioners
CIVIL ACTION - LAW
v.
NO. 2000-3937 CIVIL ACTION - LAW
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARIA DOERFLINGER, as parent and
legal guardian ofBRANDYDOERFLINGER :
Respondents
PRAECIPE
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
You are hereby directed to file the attached proof of deposit regarding the settlement funds for
the court approved settlement as ordered by Judge Hoffer. The Orrstown Bank custodian account, which
is attached hereto as Exhibit A, represents the deposit of the funds of actions docketed at:
BONITA MURPHY and GREGORY KELL v. PROGRESSIVE INSURANCE COMPANY
NO. 00-3938
-and-
GREGORY KELL v. ROBERT ZEIDERS
NO. 2000-3937
totaling $49, 738.05.
Respectfully submitted,
MARTSON DEARDORFF WILLIAMS & OITO
BYGe~ale~
I.D. No. 49813
Ten East High Street
Carlisle, P A 17013
(717) 243-3341
Attorneys for Defendants
Dated: September 12, 2000
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CERTIFICATE OF SERVICE
I, Jennifer L. Kelley, an authorized agent for Martson Deardorff Williams & Otto, hereby certify
that a copy of the foregoing Praecipe was served this date by depositing same in the Post Office at
Carlisle, P A, first class mail, postage prepaid, addressed as follows:
Judge Oler
Cumberland County Courthouse
Carlisle, PA 17013
Bonita Murphy
7358 Wertzville Road
Carlisle, PA 17013
MARTSON DEARDORFF WILLIAMS & OTTO
nnifer . Kelley
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
By
Dated: September 12, 2000
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Created: 08/15lOOo2:17:46PM
Revised; 09l121ODD9:07:48AM
7837.119
BONITA MURPHY, as parent and legal
guardian of Minor Plaintiff, Gregory Kell,
and GREGORY KELL, a minor,
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CNIL ACTION - LAW
NO. 00-3938
v.
PROGRESSIVE INSURANCE
COMPANY,
Defendant
PRAECIPE
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
You are hereby directed to file the attached proof of deposit regarding the settlement funds for
the court approved settlement as ordered by Judge Hoffer. The Orrstown Bank custodian account,
which is attached hereto as Exhibit A, represents the deposit of the funds of actions docketed at:
BONITA MURPHY and GREGORY KELL v. PROGRESSNE INSURANCE COMPANY
NO. 00-3938
-and-
GREGORY KELL v. ROBERT ZEIDERS
NO. 2000-3937
totaling $49, 738.05.
Respectfully submitted,
MARTS ON DEARDORFF WILLIAMS & OTTO
By
George . Faller, Jr., Esq e
J.D. No. 49813
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Defendants
Dated: September 12, 2000
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CERTIFICATE OF SERVICE
I, Jennifer L. Kelley, an authorized agent for Martson Deardorff Williams & Otto, hereby
certify that a copy ofthe foregoing Praecipe was served this date by depositing same in the Post Office
at Carlisle, P A, fIrst class mail, postage prepaid, addressed as follows:
Judge Oler
Cumberland County Courthouse
Carlisle, PA 17013
Bonita Murphy
7358 Wertzville Road
Carlisle, P A 17013
MARTSON DEARDORFF WILLIAMS & OTTO
Dated: September 12, 2000
April 9, 2001
Bonita Murphy
165 Church Road
Carlisle, PA 17013-9360
Re: BONITA MURPHY, as parent and legal guardian of
Minor petitioner, GREGORY KELL
v.
ORRSTOWN BANK
Dear Ms. Murphy:
We are in receipt of your Petition to Approve Release of Money from
Insured Account. Judge Hoffer is requesting that you submit copies of the
bills before he can approve the petition.
Thank you,
Sandra S. Gobrecht
Secretary
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COMMONWEALTH OF PENNSYLVANIA
NINTH JUDIC::II'L DISTRICT
CLJMIU,~l.AND COUNTY
G~O~GE E, HOFFER
P~ES'DENT JUDGE
COIJRTHQUSE
ONE COURTHOUSe: SQUARE
CA'lLISLE. PA 17013.3ge7
(717\ 2.40.62.92
FAX (717) 240-6462
April 9, 2001
Bonita Murphy
165 Church Road
Carlisle. PA 17013~9360
Re: BONITA MURPHY. as parent and legal guardian of
Minor petitioner, GREGORY KELL
v.
ORRSTOWN BANK
Dear Ms. Murphy:
We are in receipt of your Petition. to Approve Release of Money from
Insured Account. Judge Hoffer is requesting that you submit copies of the
bills before he can approve the petition.
Thank you,
~./}.~u-
,Sandra S. Gobrecht
Secretary
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Carlisle Hospital
A Sorvice of Carll/lle H06pltal ttnd Health 81!1mcsII
Page 1 of
7
TO:
FROM:
DATE:
RE:
FAX COVER SHEET
Patient Education
Fax: (717)245-5930
~ SOvv\drOl c'obore.c.h f-
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:MESSAGE:
CONFIDENTIALITY STATEMENT
This message is intended only fOI" the use of the individual orentity to which it is
addl"essed and roay contain information that is privileged, confidential and exempt
from disclosul"e undel" applicable law.
If the reader of this message is Dot the intended recipient, Oll' the employee 01" agent
responsible for delivering the m~sage to the intended recipient, your al"e hereby
notified tbat any dissemination, distribution or copying of this communication is
strictly prohibited. !frou have received this communication in errOr, please notify
us immediately by telephone.
If you have a problem receiving/reading this fax, please call sender at
number listed below:
Tel~llhone Numbers:
Bonita MUlphy, Patient Education Office Coordinator
Debra Moyer, Diabetes Educator
Christine Anderson, Diabetes Educator
Mary Howe, Enterosromal Therapy Nurse
Judith Vema, Enterostomal Therapy Nurse
Barbara Rigney, Nutrition Clinic
Nicole Benner, Nutrition Clinic
(717)245-5592
(717)245-5462
(717)245-5332
(717)245-5283
(717)245-5283
(717)245-5245
(717)245-5245
246 f.ri<. S_. P.O. 8.. 310. Carl"I., fA 17013-0310.717-249.1212
4450 RIVER GREEN PARKWAY A
P.O. BOX 105083
ATl.A!lTA, GA 30348
ADDRESS SERVICE REQUESTED
RISK r:lANAGEMENT
ALTERNATIVES, :r.1JC.
1500 COMMERCE DRIVE
MENDOTA HEIGHTS, ~ 55JZO-10Z5
800-788-8870
03'09'01
RP!A, INO. - l'lEDICAL
P.O. BOX 105003
ATLANTA, GA 30348-5003
1..11.11.....11..1..11..\,,1.1...11...1.1...11..1.1...11I..1,1
tBWCGGR'
.5D6~~KGPH1FGHl19t 01270
BONITA MURPHY
165, CHURCH RD
CARLISLE PA 17013-9360
:Ql;FEllENCE 1, 287933
- - - - - - - - - ~ - - - - - - -
- - - - ~ - - - - - -
..-g~r.t.CK UPPER PQRTIOK JoJm ItETURK MInI P"'mEI<1'_
RE,
. MILTON S.. HERSHEY !IEDlCAL CT
287933'
TOTAL Al'iOUNT DUE, $11 66. 10
RISK I'IANAGEIl.EN'l'
ALTEJl.IfATIVES, INC.
1500 COMMERCE DRIVE.
HENDOTA HEIGHTS, 1'1II 55120-1025
800-788-8610.
',.
Dear. BORITA .KURPHY,
I'm ~1ting to toll you that ~i1t~n S. Hershay Medical C1; has
autho~1zod Risk Man.gemen~ ~~e~Arive.~ Inc. ~o collect your
ou'bhndinll bal..........f $1166.lIL : . ...: .
For1:_a.ta~I' B01\:l.1:.. l'Iurph7' your d.lin.quant a..eoun-t: woo.' only
r.8c"1\1:1y P Acod wi'th our agency... You ean ",.1;op tb.. co11..ct10n
proceas .~ ~hi. pb1n~. ,.,
'Your naa.. ..111 bo 1...dia1:01y'r~.ov.d rroa Our eleb1:or rocord. as'
soon .. .0 recoive your p.~ent in full.
To ensure p~o.p~ proeess1n~ of your paya.n~; wr.i~e '~our .~coun~
nuabe~ on yo,uz check/.oney ord.~ payable ~o
Kilton S.. He~$hey Medical Ct and 8ail in the enclo.ed on~lop..
. Thank ,",ouo for your C!Qoper.t:1"n~ '
Sincerely'~
L Leib.l'
Account Rapre..n~a~ive
800-788-8870
~ '. '
Pursuan1: to p~ovisio.,s in the Fede~al Pair Debt Collection
Practices Act, unlos. you n01:ify this office within 30 days aft....
reeoi~ing this notico.that: you eli,put.. the validi1:y' of the dobt or
any por1:ion thereof this offico will a.,umo this dabt is valid. If
you notify 1:his office in writing wi1:hin 30 day.. fr08 recaj.ving
this n01:ice, this offico will, obtain verification of 1:h.. debt or
obtain a copy of a JUdg..ont and .ail you . copy of .uch Judge.ont
or ~er1fica1:ion, Also, if you roques1: th1. office in wri1:ing
wi1:hin 30 days after recei~ing this notico, 1:hi. o l' rice w~l
prOVide you with 1:he ""0 and addr.... of the original creditor if
d1ffer.n~ fro. the eurren~ c~edi~or. Th~. eoaaunication is fro. .
dehi:: coll.ec::tor and ia an a:t'toap"t 1:() co11ee1: a dobi:. Any
informa~ion ob~ained will be u.ed fQr ~hA~ purpo...
Off1co hours (C.S.T.> Mon.-Thur. 7,30 A.P1.-9,00 P.P!.
I'r1 1,30 A.P1. - 8,00 P.P!. Sat 1,00 A.If. - 1Z,00 P'.I'!.
S.lanee _hewn aay no~ r.fl.e~ ~ny ~~er..t cha~ged b~ your
cr..di-tor.
0P8]6Q530~D9'Dl~a\n
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PENN$TATE
~ The Milton S. Hershey MediCal Cenler
. The College of Medicme
GREG e kl:LL
1115 CHURcH AD
CARLISLE PA 17013
PAGE
1 .,
ACCOUNT # 1019538
~ IF AllY QUESTIONS. PLEASE CONTAcT: HERSHEY MEDICAL CENTER BILLING SERVIcES
DATE PROCEDURE DIAC nrr DESCRIPTION
COPE CODE ..
,>> PATIENT, GREG E KEll 1019538
STATEMENT
DATE: 08/14/00
lAST STATEME'H
DATE: 07/11100
FED TAX ID #0 251857035
CHARGE PAYMENTI GUAFlANTl
ADJU$lI'lfENT BALAI\ICI
. 11/09/99 99Z03.GC 854.00
Ii 06/09/00
. 11/09/99 7Z100Z' 7Z4.Z
* Oalol/oO
* 08101/00
. oalol/oo
01/06/00 78300Z6
06/16100
724.Z
01106/00 7844526
06116/00
724.2
01/0'/00 71320Z6
06116100
7Z4.Z
INS
393039
PERFORIIED BY' DEPT OF ORTIlDPAEDICS
PLACE OF SVC: DP PHYSICIAN
PERFORMED AT: HR ~ - REHAB
HUSHEY PA
REHAB Dl1TPT YISIT NEW
INSURAIlCE PA'I1'IENT
PERfORnED BY: DIY OF DIAG RADIOLOGY
PERfORMED AT I HR HMe - REHAB
HERSHEY P A
SPINE llJllQS ANT/POST lAT
INSURAIlCE PAYMENT
ACT 6 AUTO AllQ4A1CE
BAlAlCE AFTER IN$Jf
TEA
81.00
26.1Z-
CAR
70.00
1Z.DZ-
57.98
45.96
501161
PERFORMED BY: DIY OF ~lEAR MEDltINE
PLACE OF SVC: OP HOsPITAL
PERFORMED AT: HH HERSHEY MEDICAL CENTER
HERSHEY P A 17033
BONE/JOINT IMAG LIKIT ARE
BALANCE TRANSfER TO GUAR
PERfORMED AT: 11M' IllRSHEY MEDICAL CENTER
HERSHEY Pi 17033
ANGlO BfS IN CDNJ iii IHAS
BALANcE TRANSFEIl TO GUll
PERfORMED AT: HH HERSHEY MEDICAL CENTER
HERSHEY P A 17D33
BONE seAN TlItlGRAPHV
BALANCE TR~FER to GUAR
BALAIlCE: GREG E KELl $532.96
115.00
115. 00
14S. 00
145.00
227.00
ZZ7.00
* INDICATES NEW fINANCIAL ACTIVITY SINCE l~T IIll.
OTHER CHARSES BIllED TO YOUR INSURANCE COMPANY. 89.16-
. . . PAST DUE . . . PLEASE REIIJ'r IrllEDUTELY.
tHANl YOU FOR CHgQSING A HERSHEY HEDICAl CENTER PROVIDER.
qUESTI~. PLEASE CALL: (7171 531-5069 DR 1-80o-254-t619
HDN-WED 1,00 - 5:30 PM -- THUR-FRI 8:00 - 4:30 PH
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9 The Milton S, Hershey Medical CeJ1ler
.. The College of Medicme
GFlEG E I(ELL
165 CHURCH RD
CARLISLE PA 17013
PAGE
2 of 2
QIT
INS
STATEMENT
llATE; 08/14/00
lAST ST4TEMENT
DATE; 07/17/00
o TAX 10 # 251857 35
PAYMENTI GUARANtoR
ADJUSTMENT BAlANCe
DATE
NY QUES NS, PLEAS CONTACT:
PRoCEDURE DIAG
CODE coDe
1019538
ILLlNG
RVICES
CHARGE
BALANCE SlR'1HARY
RESPONSI8LE PARTY
CAR AUTO INSURANCE E
TEA TEAI'tSTERS
~~ GUARANTOR RESPONSI8ILITY
POLICY .
993571121~00000
16740183303_PLAN 13
TOTAL
s 70.00
S 54.88
S 53Z.96
8F6 1019538
MSHMC PHYSICIANS GROUP
BILLING SERVICES
P 0 80)( 854
HERSHEY PA 17033.0854
J .l~f'gf!!. AM,T;. !':!-:.; ~,~~. P_~J: ~ C.ff .N~!?.IJ_~.r.#~M. ~.9rJ'.9.'" ,~.g,,~r.t.9.rt~'-_~t~_1:gME..!'!!_~~T_~ .!9.!-:'~_'-~.~_~~~r..nt. ...,.... .",,".,'_"_""m_
STAHMiNT DATE: GUARANTOR RESPONSIBILI"fY~
08/14/00 $ 532.96
00001019538 UP
0000000000053296081400
Mall
To;
MSHMC PHYSICIANS GROUP
MsHMC PHYSICIANS GROUP
POBOX 828611
PHILA PA 19182-8611
00015882 1 SP 0.330 02
GREG E KELL
165 CHURCH RD
CARLISLE FA 17013
IC~ USE O~L Y
./CHfiCP;, ONE:
FOR CRE,DIT CA~D PAYM~Nt. PLEASE FIL,l, IN UIFiORMATION BEL.OW
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532.96
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El\p DATE
09/08/00
F6BO
CARDHOLOER N"ME (PRINT)
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PENNSTATE
B TI\e Milten S. Hers'iicy Medical C~ot,,;--~-
. "1'he College of ~1~.dj,c~ne !::' rArEMENT Of: HOSPITAL ACCOU"I r
t:-i'Ei__~._~~EG ;A1I"JT_::~_-'~=:::::~::::::::::I::=~___ ;'~~~:::--:::=I:::~:~:[~~d=='~~:;'"~i~~lg'I:;~:i:~_~'~T;_
IiILLlO
llaAt<E ct/,Cc~ ~V~N.E 'To. I
GREG j(ELL
165 CHURCH RD
CARLlSU" PA 1701~1-"0000
MS HERSHEY MEDICAL CENTER
P 0_ BOX 8286:32
PHrLADELP~IA. PA 19182-8632
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pati~nt Inquiry R6pre5entative~ aro av~11able
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Created: OS/15/0002:14:16PM
Revised: 08115/00 02:19:17 PM
BONITA MURPHY, as parent and legal
guardian of Minor Petitioner, GREGORY,
KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Petitioners
CNIL ACTION - LAW
v.
NO. 2000-3937 CIVIL ACTION - LAW
EUGENE S. ZEIDERS, SHIRLEY
ZEIDERS, ROBERT ZEIDERS,
TRAVELERS INSURANCE COMPANY,
JAMIE GREENE, as parent and legal
guardian ofRY AN GREENE, a minor, and
DARLA DOERFLINGER, as parent and
legal guardian ofBRANDYDOERFLINGER:
Respondents
PRAECIPE
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
Please mark the above captioned matter settled and discontinued and issue a certificate
reflecting same.
~/;L~
Bonita MUI]'ll1y -
7358 Wertzville Road
Carlisle, PA 17013
Petitioner
Dated:
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SHERIFF'S RETURN - REGULAR
CASE NO: 2000-03937 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
MURPHY BONITA A ET AL
VS
ZEIDERS EUGENE S ET AL
SHANNON SUNDAY
, Sheriff or Deputy Sheriff of
Cumberland County, Pensyl vania , who being duly sworn according to law,
says, the within SUBPOENA, ORDER & PETITIO was served upon
GREENE JAMIE
the
DEFENDANT
, at 0020:40 HOURS, on the 6th day of July
, 2000
at 1374 OLD WILLOW MILL ROAD
MECHANICSBURG, PA 17055
by handing to
JAMIE GREENE
a true and attested copy of SUBPOENA, ORDER & PETITIO together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing
Service
Affidavit
surcharge
18.00
7.44
.00
10.00
.00
35.44
SO;;~4<~t
R. Thomas Kline
before
07/27/2000
MARTSON, DEARDORFF, WILLIAMS
('f ~
By: ~rn. .
Deputy Sheriff
of
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SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2000-03937 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
MURPHY BONITA A ET AL
VS
ZEIDERS EUGENE S ET AL
R. Thomas Kline
, Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent search and
and inquiry for the within named DEFENDANT
, to wit:
DOERFILINGER DARLA
but was unable to locate Her
in his bailiwick. He therefore
deputized the sheriff of YORK
County, Pennsylvania, to
serve the within SUBPOENA, ORDER & PETITIO
On July
27th , 2000 , this office was in receipt of the
attached return from YORK
Sheriff's Costs:
Docketing
Out of County
Surcharge
Dep. York Co
18.00
9.00
10.00
51.20
.00
88.20
07/27/2000
MARTSON, DEARDORFF,
S;e~~
R. omas Kline
Sheriff of cumberland County
WILLIAMS
Sworn and subscribed to before me
this ~ day of
~
COUNTY UF YLlm,
OFFICE OF THE SHERIFF
SKRVICE: CALL
('717) 771-9601
28 EAST MAR!~,ET ST, YORK, PA 17.101
----h---h--------------------~~~-~;~~-~-~~~-I~~----------------------------------r-----h-------------------iNSTRUciiONS--------------------------]
PROCESS RECEIPT and AFFIDAVIT OF RETURN PLEASE TYPE ONLY LINES 1 TO 12 i
-------- -- . - --- '- - ------- --- -- -------------- ... . ----------!:)()i- NQ.!PJ:::r~9tt~~Y_~O'_P!~~_______..J
:__P_~:~l~-~___fl()_fl_i_t_iJ___f.l_U_':!)_lJ?_,____:: t :___iJ_1__._____________________________________________________ : ;~:~~l~'~R~:~R !~~~p3]tirdT7 - C i v 3.-J.______
~:; DEFEND..\Nf SI ::iu Jpoena, Ore (~r &
Euqt.~ne S. Ze iders f e t. cJ!. _"_.___~_____ _.___.____ ___~:~~ i t.iOD. _ _ _ _____
S.ERVE {____:__:~_::"'~J;.~~;~J;,~~.:'(;;:;:~~::;:'~;~;~ ETC. TO_:::: a.R DES:::=T"'.:J~~~:R-::E~~<-Ta::~~I::~':~HED:OR C~)~:_
t:1.. ADDRESS (STREf:.T OR RfD WITH BOX NUMBER AF'l NO., GlfY, Bono, lWf'., SIAlt. ,L>.NU Lit"' COOE
AT_----1_1_1____~_'__._i:;j,_1<e.Y_~lLRoa.d -'--__p_t:\J.~J:,lJ.:<:g_!____~_~___L:?SU_?'_________________________________________
7. INDICATE SERVICE.; 0 PERSONAL Q PERSON IN CHARGE JD OEPUTlZECUmboBRT.BJ.'Id C11S'f CLASS MAiL Cl P STED I:J OTHER
~~~;=~~;~~~~~~~~~~:::::~~:~~Tt~i;;~~e~~~~~~~:~~~;!~!~~~?~P_S~~~~~~__~=
B. SPECIAL INSTRUCTIONS o'RciTt'iER-iNFoRMAnoN'THAT'wiii-Assiiir'IN"-iixPED1TINGSEFiviCE.~.-...........--.._-___\ili&..n.lt.~..__g...~._.-C ~~b' Q.~~.!'L~.]t"!..L_._._.._]._._._._......_._._..._._____
urn er..anc
OUT OF COUNTY
CUMBERLAND
ADVANCE: FE!'; PAW BY CUMBl':Rl.AfllD COUN'ry
NOTE ONLY APPLICABLE ON WRIT OF EXE.CUTION: N.B. WAiVER OF WATCHMAN. Any deputy sheriff levying upon or attaching any pmperty I.mdoSr within Writ m<)'i !Q,av~~
~ams wiihout a watchman, In custody 0/ whomow.:lr is !fJI_lIid in PfJ$s{lssl<m, aflf.:r notifving p.r.-.mon ClII.r.-.vV or am~(:;mli('}nt, witt"iC;Il,Jt l1.abiJity .mlll;.; part l)f such deputy or I~I~:~ l-:.tlefiti 10 <'my
pL.'iinlitf tl9t1~in tor any loss, destruc1icJl1. or- r<tmoval of finy pwperty befara is'heriff's sale thoreof.
gTt~Sl~-Af:j.;~-A~~'fe~~;AT!M~'EYiOiiiG;NATOii "od S'''NAruii'E-------------.---------------------------------.[i-O.:i-.--.ti.EPHciNE Nuii;;BEi''-Til--C;;\TE-FiiED--''---
10 E. HIGH ST., CARI_.rsr.,E:, PII. 17013 (717) 2~3'-3341 ~/29/(1)
'12. SEND NOTicE OF SERVICE coP\>";'""' TO NAME AND AODHESS BELOW: (This area must be compiefetfii"notice-is"to"be .maiied),---.----'---.--- --.--.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-
CUMBERLAND COUNTY SHERIFF
SPACE BELOW FOR'i.lseCoFfHe-s'HeRIFF oNLY = ooN'ot-wFlffE'-seLowfHis-UN e---~-----------------
.-----------------------------------------..-------------------------------------------------.......------..-----------------------------------.....---.-.----------.---------------.----..---------...------------------------------)----------.---.------~--------[------~c---
t ~l. I a~:;knowledge receipt of the wril SIGNATURE OF AUTHORIZED CLERK 14_ Date Reci5't1.'(ld 15. Ex.J.wal,on/~-h~~1fIng Dalt,
OI't."OI'flpJ;:..inlaslndicah.dab0\...... ~J. :Llll:::M1.IG 7/.1.2/00 7/29/00
,~.~_:_~~~?~:.I_~~~~~~~?:~::::~~~~~-.-'-.-.-.-.-.-.R.~~:?i~?~Kt_._._._._._._._._.~?._~:.:~._~._._~_._._._.:~:~:::::::~~~~~::i~~!~~.-...-.-.-.-.-.-.-SH.Ei:~i.F-;;~S-(~~~~___!_____--OTH[R..(--..)----------------SE-E-P.8:~:\;;S
17.01 [.el'e-by c(~Jtify and return a NOT FOUND bel~m.!s,~ I am unabl'tl h'J Itll,";l1te thl:l individual, company. corporaJiOl'1. etc. named above_ (See romadis l'l0tow,)
1ti~..-.-.~.ME.ANij"TITLE-e.-.-F--.Il1\VI[,-UAI. SERVEO;'lisTAOORESS'j:iiiAE-i"F'-i-lOT'SHOWt."i"ABOV'E'i,Reiai.on;hll:l to ~ft'.-.nlia-;~1r---~-rg. [j,'ll': of i,:" ViCf: 20. Time of Sl::r\l.!Ce ---
~ 'I "'i 7."7 -" ^ J-~ "--'I '"",
, .. ,-, . I 0.. -" '\" ," ; --r II' "!'-, ..-'.J t. j--
" i'~' --C' .-,- 'i --,_ _, . ./ _,.v ,.,~-.
21 _ A1TEM~ -"~~'tJ: - .me Mil."," , Da'., .". ~i;;i:- -"aiejTimeliiiie'riiii:- -iiSieIT"""rMliO'Tnl D.toTimOlMliear-;iii:---O'''--fim;;jM'i.'-i--;;'':''-
__________________'.!.tb b?"t._q5;~f_ __Lt_ '-11 1_____1______1_________________.1_____________________,__J_J_____L_____I______l____________.l_______
22. REMARKS,:
'.'._.._..' ('/,?~M)'
~ , "'",' t :!:~;''''~I r.~'I:,,'
i :19ro~"" t~_~.~~:~_~:'_;~_I~5__~~~J_~~_;~~:?Qt:_'__PI;;s~:I~~~:L:~~ill>I"~~~~~r~F..t--~uIr.::.::.~~::~.j-;:.i.::?~.~Io:;~~r~t~~J
~ 34. Foreign C.OUl1ly Costs 35, Advanee Cosls ::iti. Service CostlS 37. Notary Cart '3R Mileage/Pu$tage/N,F. :39. Total C(,l:.>-t~i 40. C(:rsl D\:H or H(~tufllj
.... ---24th---T::.:=-----------:~-=--=-=-:=:==---_:;QMj~WgL::::::=:::::::::::::::---::::::::::=--==--:::::
41. AfHRMEO m.d 'Slih,.(~HI~(~ to bl~lon;nne thi~; __..._._._.__ 44, Signa~lre. ?f ~ri"",'-:r:; .,"'. 47. D.:tt~ /1 -, It? "",
..........__".......,.~...,.........._~........._.....".__..............~.) I, . ....' ~,.. '7 _.tL.J.__J..:;
4') I J: _ . ~J'(1lGT.. A. PUlI,[..' ,SEAl.~ 45. SilJnalUll:! or Y~)rY. 4B. Date
...tay I ~. ..1!!l11\fl't<I'\;-~", --'M . CQ"'''ISherllf ~..;" . i
43 _~_, ',;.,: ,:." - :{9",-_. "'~;;","__. '.:.'.,~' / _~ILL 1 AM FN: HOSE__",-?"' ':::~?::::;f::.2;..::(~.2-<'_o..______ 14-9--~. D~"'/'--'O, ~_____
" .--- _~..M~'_~~_~'O ",'-'.-_. ~~~ 45,&lgnatumot OfGlgn "'"
MY.gQ~:t~l_€itQ!:L€:it'.Lii~JL._._._._._._._._. ._._._.~~:'~._...C!__._,.~_.. ._.__._._G.9_W)Jl'._!it:!~.r.iJL_____.__ ____________________
50. I ACKNOW1.EDGE RECEIPT OF TI-IE SHERIFF'S RETURN SIGNATURE ~:.I.O-ate FlBceiv..l'd
OF AUTHORIZED ISSUING AUTHORITY AND TIIl.E
'1. WHITE '. t"~itling Authmity 2. PINK. P,ttnmev a. CANARY ~ Sheriffs Oi''lice 4. BLUE. Sheriff's Offi(:i.:'
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BONITA MURPHY, as parent and legal guardian
of Minor Petitioner, GREGORY KELL,
Petitioners
v.
OITstown Bank
~
AND NOW, this ~ day of
Approve Release of Money From Insure
release in the amount of$3057.68.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 00-3937
ORDER
2001, upon consideration of the attached Petition to
Account, said Petition is granted and Defendant is ordered to
BY THE COURT,
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BONITA MURPHY, as parent and legal guardian
of Minor Petitioner, GREGORY KELL,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Petitioners
CIVIL ACTION - LAW
v.
NO. 00-3937
Orrstown Bank
PETITION TO APPROVE RELEASE OF MONEY FROM INSURED ACCOUNT
AND NOW, comes Petitioners, Bonita Murphy, as parent and legal guardian of Minor Petitioner Gregory
Kell, and file this Petition to Approve Release of Money from Insured Account, to pay medical bills.
1. Petitioner, Ms. Bonita Murphy, is parent and legal guardian of Minor Petitioner, Gregory Kell.
2. Respondent, Orrstown Bank, place of Federally Insured Account
3. We have exhausted our insurance benefits, The bills have been turned over to collectors_ The bills
total $3057.68.
WHEREFORE, Petitioners respectfully request this Court to approve the release of the requested amount of
$3057.68 to pay these bills,
Respectfully submitted,
4rJ1/~:;;/7:r-
Bonita Murphy
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