Loading...
HomeMy WebLinkAbout01-04634PINNACLE HEALTH SYSTEMS, INC Plaintiff V. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendant IN THE COURT OF COMMON PLEAS COUNTY PENNSYLVANIA CUMBERLAND NOTICE CIVIL ACTION - LAW ~ -- 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 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 judgment may be entered against you by the court without further notice for any money claimed in the Complaint 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 THIS 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. LAWYER REFERRAL Cumberlamd County Court Administrator 4th Floor, Cumberland County Courthouse One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 Dated: Respectfully submitted: HUR i ESQUIRE 4201 Crums Mill Road Post Office Box 67015 Harrisburg, PA 17112 (717) 540-5610 SUPREME COURT NO. 07207 ATTORNEY FOR PLAINTIFF ,. PINNACLE HEALTH SYSTEMS, INC IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA Plaintiff v. GARRY ALBRIGHT and BOBBIE L. ALBRIGHT Defendant CIVIL ACTION - LAW ~ NO.©I-~1(Q3`i l,,(U!(, `fit NOTICIA Le han demandado a usted en la torte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) Bias de plazo al partir presentar una apariencia escrita o en persona o por abogado y archivar en la torte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la torte tomara medidas y puede entrar una Orden contra usted sin previo aviso o notification y por cualquier queja o alivio que es pedido en la petition de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI NO TIENE ABOGADO U SI NO 7IENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SU PUEDE CONSEGUIR ASISTENCIA LEGAL: LAWYER REFERRAL Cumberland County Court Administrator Respectfully submitted: 4th Floor, Cumberalnd County Courthouse One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 ARTH KUS C7UIRE 4201 Crums Mill Road Post Office Box 67015 Harrisburg, PA 17112 {717) 540-5610 SUPREME COURT NO. 07207 ATTORNEY FOR PLAINTIFF Dated: PINNACLE HEALTH SYSTEM, INC., Plsiatiff V. CARRY ALBRIGHT aad BONNIE L. ALBRTGHT, Defendants IM THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. of - y~3 ~{ ~~~~~'z-Y'-1 COMPLAINT AND NOW comes Plaintiff by and through its attorney, Arthur A. Kusic, Esquire, and respectfully represents the following: 1. Plaintiff, Pinnacle Health System, Inc., is a hospital facility organized and existing under the laws of the Commonwealth of Pennsylvania with a mailing address of P.O. Box 2353, Harrisburg, Dauphin County, Pennsylvania, 17105. 2. Defendants, Garry Albright and Bonnie L. Albright are adult married individuals residing at 128 Herman Avenue, Lemoyne, Cumberland County, Pennsylvania, 17043-1935. COUNT I (Plaintiff v. Garry Albright) 3. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 2. 4. On or about April 8, 2000, Plaintiff, at the Defendant's request, provided health care services to the Defendant and thereafter billed the Defendant it usual and customary charges for such services rendered. A copy of the Summary of Charges is attached hereto, made a part hereof, and marked Exhibit "A". 5. Plaintiff did render health care services to the Defendant with the reasonable expectation that payment for such services would be made by the party benefited. 6. Should Defendant not be required to pay for the service rendered, Defendant would be unjustly enriched at the Plaintiff s expense by having received services without paying for the rendered services. 7. Plaintiff has granted Defendant credit for all payments received on this account, leaving a balance due and owing of $466.00. 8. Plaintiff has made demands upon the Defendant for the balance due and owing of $466.00, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $466.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT II (Plaintiff v. Bonnie L. Albright) 9. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 8. 10. On or about March 14, 2000 and continuing from time to time through to on or about April 20, 2000, Plaintiff, at the Defendant's request, provided health care services to the Defendant and thereafter billed the Defendant it usual and customary charges for such services rendered. A copy of the Summary of Charges is attached hereto, made a part hereof, and marked Exhibit "B". 11. Plaintiff did render health care services to the Defendant with the reasonable expectation that payment for such services would be made by the party benefited. 12. Should Defendant not be required to pay for the services rendered, Defendant would be unjustly enriched at the Plaintiff's expense by having received services without paying for the rendered services. 13. Plaintiff has granted Defendant credit for all payments received on these accounts, leaving a balance due and owing of $19,812.93. 14. Plaintiff has made demands upon the Defendant for the balance due and owing of $19,812.93, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $19,812.93 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT III (Plaintiff v. Bonnie L. Albright) (Doctrine of Necessaries) 15. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 14. 16. Plaintiff believes and therefore avers that the health care services rendered upon request to Defendant Garry Albright, husband of Defendant Bonnie L. Albright, were necessary for his benefit and welfare. 17. Pursuant to the "doctrine of necessaries", codified under 23Pa.C.S. X4201, where debts are contracted for necessaries by either spouse, a creditor may institute suit against husband and wife for the price of the necessaries. 18. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Bonnie L. Albright, is liable to the Plaintiff for the necessary health care services rendered to her husband Garry Albright. 19. Plaintiff has made demands upon the Defendant for the balance due of $466.00, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $466.00 along with interest at the rate of 6% per annum. COUNT IV (Plaintiff v. Garry Albright) (Doctrine of Necessaries) 20. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 19. 21. Plaintiff believes and therefore avers that the health care services rendered upon request to Defendant Bonnie L. Albright, wife of Defendant Garry Albright, were necessary for her benefit and welfare. 22. Pursuant to the "doctrine of necessaries", codified under 23Pa.C.S. §4201, where debts are contracted for necessaries by either spouse, a creditor may institute suit against husband and wife for the price of the necessaries. 23. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Garry Albright, is liable to the Plaintiff for the necessary health care services rendered to his wife, Bonnie L. Albright. 24. Plaintiff has made demands upon the Defendant for the balance due of $19,812.93, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $19,812.93 along with interest at the rate of 6% per annum. COUNT V (Joint and Several) 25. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 24. 26. Plaintiff believes and therefore avers that the Defendants are jointly and severally liable to the Plaintiff for the balance due of $20,278.93. 27. Plaintiff has granted Defendants credit for all payments received on these accounts, leaving a balance due and owing of $20,278.93. 28. Plaintiff has made demands upon the Defendants for payment of the balance of $20,278.93, which demands remain unheeded. 29. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbitration referral by local rule. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendants in the amount of $20,278.93 along with interest at the rate of 6% per annum. RESPECTFULLY SUBMITTED: Arthur A.'Kusic, Esquire 4201 Crums Mill Rnad Harrisburg, PA 17108 (717) 540-5610 Supreme Court Number Attorney for Plaintiff PINNACLE HEALTH SYSTEM, INC., Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defeadants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW . NO. VERIFICATION I ~hq~r~ ~1E59'f ,the ~+9~ b~~Soe Y~enT ~inAne~~JL ~~'ioeT~~O/%Ti°''s' of PINNACLE HEALTH SYSTEM, INC. verify that the statements made in the COMPLAINT are true and correct and that I am authorized to make this Verification on behalf of PINNACLE HEALTH SYSTEM, INC. I understand that false statements herein are subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authority. PINNACLE HEALTH SYSTEM, INC. gy. ~ ~~U'.~2P K~ /ql Title: Sa~XUlS°yG gTenT FU9AfIC/AL ~o~J"4[01~~5 Date: G~i/©/ EXHIBIT "A" CYCLE p4/21/00 S E PAICEN! RAME PATIFM NIMPFP SIX ADE A-NCRS ION -AiE ~-IgENARDE DAIS pATg [NSIIRANCE COYPABY NAME ~-RpllP N°NBER unRAermR GARRY ALBRI GHT NAdE 829 FISHING CREEK RD ANo A-nNess NEW CUMBERLAND PA 17070 CARLO J PAY10?NT °F 1 ~~ ~~ AiE OF DESCRSPSION OF SEEVICE TOIAL E3F. COVEpAGE ESI. CGVE&lOE COVERADE ESL F6I- CGVFRAGE PAII NP gFRV ICE NGSP [TAC SERVICES COGS CHARNEg IN$, CD. HD. I tNS.C-. tl0. 2 tNS.C-. tlD. ) INS.CO. dD. AHOVNF DETA L OF CURRENT CHARGES, PAY ENTS AN ADJUSTME TS 04/06 7411145 001 93.25 93.25 WD EP II<2.5 CM P/F 12011 04/08 7413538 001 WD EP II<2.5 CM * 12011 04/08 7427036 001 93.75 93.75 REP IR SIMPLE /INTERMED00000 04/08 7411229 001 108.25 108.25 EME MED VISIT III P/F99283 04/08 7413647 001 EME MED VISIT III * 99283 04/06 7425388 001 161.25 161.25 EME MED VISIT IV 00000 04/08 7427033 001 9.50 9.50 SMA L DRESSING 00000 FORWARD OF CURRENT CHARGES 20 SURGICAL 60 EMER DEPT o.oo 279.OOI I ( I 279.00 IUB- OTAL OF CURR. CHARGES 466.00 ' 460`.00 GU RELATIONSHIP: S SEX: M UAR NO: 2045409 9 ACC DATE: 04/06/00 TYPE: 5 TI E: 1:30 AM PL CE: EMPL REL: DIA NOSIS: 873.92 673.42 PAliENI N N NBER pEGgE REFER iD pASIFN[ y a ~y Y ~'~ QO 6 "iG~L~ :: AbGR CORRESP-NDENCEUIRI Eg PINNACLE HL TH HOSP HARRISBURG[ PA A-DIiIpNAC PA"fIENI HILL[NC NAY RE NFCESEARY FOR ANY CHARGEg NOT PGSFfD YIN@I 1XI5 S[AIE- NFNT NAE PR¢PARED. O0. iF INSDIWSCE CARR1 ¢RS -O NOI PAY AW PARI OF ENE ARODNIS gHDNN RNpEA Egl"IMATEp INHNRANCP COVEMGE. EXHIBIT "B" FINAL ennear ea+a: ~,uAnARmal BONNIE L ALBRI GHT ""'~ 829 FISHING CREEK RD aao "nn~ NEW CUMBERLAND PA 17070 xosenAC Reavnns I eooe DETA L OF CURRENT CHARGES, PAY 03/14 001 EMER MED VISI 7411230 03(14 001 EMER MED VISI 7413648 03/14 001 EMER MED VISI 7425388 03/14 001 VENIPUNCTURE 7427061 03/14 001 NIBP 7427074 03/14 001 CBC & AUTO D1 0115071 03114 001 CBC & RUTO DI 0115071 03/14 001 DRUG SCREEN U 0115098 03/14 001 DRUG SCREEN U 0115099 03/14 001 DRUG SCREEN U 0115100 03/14 001 DRUG SCREEN U 0115101 03/14 001 DRUG SCREEN U 0115102 03/14 001 DRUG SCREEN U 0115103 03/14 001 DRUG SCREEN U 0115104 03/14 001 DRUG SCREEN U 0115105 03/14 001 DRUG SCREEN U 0115106 03/14 001 DRUG SCREEN U 0115107 03/14 001 DRUG SCREEN U 0115108 03/14 001 CBC(HEMOGRAM) 0115174 03/14 001 URINE MICROSC 0115189 03/14 001 URINE DIPSTIC 0115222 03/14 001 ACETONE SERUM 0115988 03/14 001 AMMONIA 0116003 03/14 001 HCG 0116087 03/14 001 MANUAL DIFF 0116130 03/14 001 BASIC METABOL 0117038 03/14 001 HEPATIC FUNCT 0117042 03/14 001 CHEST 2V 7310347 03/14 001 BRAIN UNENHAN 7672452 03/14 002 APAP 325MG TA 7350005 03/14 001 DEX 50$ SYR 7350372 03/14 001 INS N 100UN/M 7357187 03/14 001 EKG 7380695 NdYB~ eEEnse REEER xo PAnERr aD11BE8 Ptl ACC IRQa1RIE5 AHP CORReSPORpENCE. Roimea {soe {Aee 1AOxtssloa nme 1AlscenRaz nAte CUES I x~.cocovEaeaE3 I xas.co~ xooEZ I Ias.ca NTS AN~ ADJUS TM 163.50 163.50 161.25 8.25 35.25 41.50 41.50 16.00 16.00 15.50 16.00 16.00 16.00 16.00 16.00 16.00 16.00 38.00 13.00 16.00 20.75 75.75 59.75 15.00 52.00 62.25 115.50 761.00 6.00 14.50 7.25 136.00 161.25 8.25 35.25 41.50 41.50 16.00 16.00 15.50 16.00 16.00 16.00 16.00 16.00 16.00 16.00 38.00 13.00 16.00 20.75 75.75 59.75 15.00 52.00 62.25 115.50 761.00 6.00 14.50 7.25 136.00 Annlna®a. eaxxevr nxauaa !WF ee aeeeesAaY FOH ARY C®RRS% ROT YOS® Na® 1HI3 SIA18- I®I VAS PIff;PAR®. OR IP IRSRp9RCe CARIIIERS RO ROI PAY Ally PdaT OF 11@ AROI@CS SROFH U1ID8R ESIIMATeO ItS1OLWCe COYEM6e. Ias.rn. aP. q AaouRr FINAL b4/24/ PAR83e RA118 IPAYIDII RID®E0. uxARARmR BONNIE L ALBRI GHT A~RR 829 FISHING CREEK RD wnaess NEW CUMBERLAND PA 17070 se3vxcE ~ ~~I'~ seRPivs ~ cooE ~ DraAOes 03/14 001 EKG 7360695 136.00 03/14 OD1 NURSING UNIT 6191235 30.50 03/14 001 ROOM N955 6195137 668.00 03/15 001 CBC(HEMOGRAM) 0115174 38.00 03/15 001 SEDIMENTATION 0115216 24.00 03/15 001 INSUL NPH VL 7350683 72.40 03/15 001 HOSP INITIAL- 1459222 196.25 03/15 001 EEG-AWP.KE 7390799 334.75 03/15 001 MR BRAIN S CO 0660551 935.00 03/15 005 BGM 6191417 41.25 ACIQSSIOR SATE pISCflAPDE OAIe 136.00- 30.50 668.00 38.00 24.00 72.40 196.25 334.75 935.00 41.25 PASSERS N{MEER pr rnaF REPER TD YATIEYP ADDITfOBAE pAYI83I BILLING [AY S8 NECESSARY ~d [y C.y .. HBINIFA UR lCL INQPIRIES YpA A1R CfORf.LS BSi YOSlED N11~ 1HI3 BIASE- SS pe:J.L ~ ARp CSPRFSPORBERCE. 1@R' RA.4 pREpARBN. OR SP INSUBARL'e CADRIENS -0 NSS PAY ANY PART OP ER: AROINRb SIHIHN ' PINNACLE HEALTH HOSPITALS 'w°~ PsPI"'''~N IRS.Nw"E `°°HNANe' HARRISBURGI PA FINAL b4/24/ PREV.BICC eanHHr Ram RDlmea Isez 1 ace I M1RSSi-H DATE I oismas-e Date uaPAxloal BONNIE L ALBRI GHT ""'¢ 829 FISHING CREEK RD a-o xnnlGSS NEW CUMBERLAND PA 17070 I651WARCE C01@ARP HAHE Oe-UP HWHEP POLICY YIII®e L (B. O. USE ON 190143725 JOSEPH R sewmH xoseltAi seRYlces cooE S Y OF CHARGES R&C EMI-PR 1DAY5@ 668.00 EMER DEPT 60 LABORATORY 69 RADIOLOGY RD C.A.T. SCAN RD PHARMACY PHYSICIAN VISIT 60 MEDICAL DIAG AZ MRI RD SPECIAL CARE UNIT OF CHARGES - ;i ~ ARo :. .: :.. enxla:Hr '+~'~ Esr. cweeAGH esr. coveeneE Esr. ewHeADE PST. cweRACe eaneR clmReFS iRS.co, ao. z IRS.co. ea. z iRS.cc. RG. s i-s.co. eo. aRCUHr 668.00 668.00 368.25 366.25 574.00 574.00 115.50 115.50 761.00 761.00 100.15 100.15 196.25 .196.25 334.75 334.75 935.00 935.00 71.75 71.75 4124„65 ( 4124. RELATIONSHIP: S SEX: F SATE: TYPE: B TI E: FINAL DIAGNOSIS: 250.81 DIAGNOSIS: 251.2 NO: 1159488 THIS BILL IS FOR YOUR NFORMAT ON ONLY A REQUIR BY ACT 89-COST CONTAI ENT CO CIL. IT I NOT INTENDED FOR INSURANCE PURPOSE AND IS N T TO BE PAID BY YOU. YOU WILL ECE IVE SEPARATE BILLING FOR ANY BALANC DUE AF ER THE IN URANCE COMPANY HAS PROCESSED OUR BIL . FAnOIL ~p yH;NIDBR PLEBSE BEFER t0 PAI[P8L ii ~ `~v ~' ~: ~: A~HpE C0RRE5e0WERC~MRIEB PINNACLE HEALTH HOSPITALS HARRISBURG, PA ADDIttpHAC PAtI[IR HICLDI6 1pF HH p8CH86ARY POR AHY CI1AR885 RDt YOSIYD 1iH~ tl([S SAte- M~l' NAS PRMARBD_ OR IF IHSDRARCH CaRRI6RH -R 9VI PAY lRY PART CP IHH ARDHRB S80W HIIDHf ESPIIptHD IR9HITNCH COVERAGE. RE ~._~ FINAL eAnear uAnAaraa BONNIE L ALBRIGHT AFRO 829 FISHING CREEK RD wnRess NEW CUMBERLAND PA 17070 OF ueacaaeu x ur nv~a e xos¢nu semnces cone BI AIIIQSSSOH DAE DIDCCBIDOB D(18 (B.O. USE 143725 ~;,~CARLISI JOSEPH R II AaR11aI OF g ~~ IOTAE PST. COVERAGE PAIIE9: . .. ...._.. ESI. CppERADF EHL....COVEHME ESS. COVERAGE HanRRas IDS.co. ao. a Ias.HD. ao. z IRS.cD. w. z Ias. cD. ea. AaDDar OSIS AND PROCEDURES: MITTING DIAGNOSIS: 251.2 HYPOGLYCEMIA OS SCHARGE/FINAL DIAGNOSIS: 250.81 *DM1 W MANIFES NEC, 784.3 APHASIA 305.1 TOBACCO USE D SORDE HATE CARE: SCHARGE DESTINATION: AHR SSES: TIENT: BONNIE L ALBRIGHT 829 FISHING CREEK RD NEW CUMBERLAND PA 17 . EMPLOYER: HOMEMAKER 00000 PAiIp1C RORHER pCfdHE RCFER i0 PA'CIEGI HWfHFR OR ACC IHQDIRIC$ ADDISIOaA[ HAiIRNi HIISSHC aAY HH HECHSSARY PO8 AHY CHSRGCS ROI p08L® aa® iaCS gFAig- ''i ARO CORRE3POHOCaCE. 1®E VAH PRHPAR®. OR IP IRS9IRARCH CAppICRS DO Rbt PAY AHY HART Op 1aC Aa01RRH RHOSH DIIDER L1T1141AT IRSIHNBCe COV£MCE. FINAL p4/2 PREV.dICC .5 PAIIe~ ~'~ IYAYIENI NIH®ER ~$EY I AGE ~ Mlfl$$IGH PAIY ~ ai$CHAMC UAIY ~ ALBRIGHT ,BONNIE L X200646951 ~F~28 ~03/14/00~03/15/00 ~ 1~ ~ _...... e H ei=. INSI@2NCE 4olreacx NAME oaoue d411BEe eoLl4x Rulmea Gunnurr4a BONNIE L ALBRIGHT .::,1'" HL (B.O. USE ON 090143725 9dre 629 FISHING CREEK RD Aco APH~ NEW CUMBERLAND PA 17070 ~`.. ARLISI JOSEPH R .: ~:::: AIW4dF of $ ;. PAYMENS A~ Gp .......... dE$CAIPiIPH OF BENICE IOIAC ESI ..........:: CWEMGE ...v e$I COVERAGE E$I'. COVEPAGE . eSf. CYV¢RAGE ..:::: PAIIEHI SFHYICE dGEPIYAi SERVICPS COUC CFGRGE$ I{~,Cp, d0. 1 Ia$.CC. d0. 3 Ia3.C0. d0. 3 ING.CO. d0. AMOddI URRENT GROUPER USED: M 99 #: 295 MDC #: 10 RATE PER CASE: 3404 47 BIER VALUE: 'PER USED: P 9 (5 0) #: 295 MDC #: 10 RATE PER CASE: 2789 20 ~.IER VALUE: PAiIEIR HIpCER pLEA$E PPFER iG PAIIEdI AHHIYICNAC pASIINf dILLItlG 10Y $C HEC¢S$ARY 8dtl$EH OH AC[ IHpUIRIE$ FYIH AHY CFPPdE$ aGY PCSCCp SiHp] 'pQ$ $fASP- .i AHO CO$PE$PGdYEdCE. 1491 YA$ ppCpAREP. OR IP ICSGRdRCC CdARIERS Oo HOY PAY ANY PARt OP lNC AH4HRI$ SIWFN 4RllCH Sf[MA'CID IH9@ANCE COVCRAGC. --TV"`. _ _. _ _ _. ~ TYPE OF DATE OF BILL DATE OF BILL PREY, BILL 18AUD 05/16/01 INP. R{R AI ~ C PATIENT NAME PAGE NO. HOSP. NO. PATIENT NUMBER ~BEx~ AGE ~ ADMISSION GATE ~ DISCHARGE DATE ~ DAYS 'GjQB~ INSURANCE COMPANY NAME GUARANTOR BONNIE L ALBRIGHT I OTHER INSURANCE NAME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS <;'GOLDMAN JOHN POLICV NUMBER AMOUNT OF C PAYMENT 9 DATE DESCRIPTION OF SERVICE TOTAL HOSPITAL SERVICES CODE CHARGES DETAIL OF CURRENT CHARGES, PAYMENTS AN 03/29 001 EMER MED VISI 7411228 85.00 03/29 01 EMER MED VISI 7413646 03/29 01 URINARY CATH 7427004 17.75 03/29 01 BLOOD GLUCOSE 7427057 52.50 03/29 01 VENIPUNCTURE 7427060 7.25 03/29 001 OXYGEN SET-UP 7427063 4.25 03/29 101 CARDIAC MONIT 7427072 86.00 03/29 X01 NIBP 7427074 35.25 03/29 X03 NON CRIT OBSE 7427082 81.00 03/29 03 EMER MED VISI 7428279 592.50 03/29 01 CBC & AUTO DI 0115071 41.50 03/29 01 CBC & AUTO DI 0115071 41.50 03/29 01 CBC HEMOGRAM 0115174 38.00 03/29 •01 GLUCOSE 0115216 24.00 03/29 X01 CBC & MANUAL 0116023 53.00 03/29 01 DRUG SCREEN S 0116051 03/29 01 DRUG SCREEN S 0116052 34.75 03/29 01 DRUG SCREEN S 0116053 34.75 03/29 001 DRUG SCREEN S 0116054 34.75 03/29 01 DRUG SCREEN S 0116055 34.75 03/29 01 DRUG SCREEN S 0116056 34.75 03129 01 DRUG SCREEN S 0116057 34.75 03/29 01 DRUG SCREEN S 0116058 34.75 03/29 01 DRUG SCREEN S 0116059 34.75 03/29 01 MAGNESIUM 0116128 19.00 03/29 01 MANUAL DIFF 0116130 15.00 03/29 001 SALICYLATE 0116168 41.00 03/29 001 BASIC METABOL 0117038 52.00 03/29 X01 DEX 5 -100 BG 7350368 18.05 03/29 01 NSS-100 BG 7357014 18.05 03/29 04 MG 0.5 GM/ML 7357110 17.00 03/29 04 MG 0.5 GM/ML 7357110 17.00 03/29 001 INSUL R 1000/ 7357113 17.35 EST. COVERAGE EST. COVERAGE INS. CO.vNOA 9 MS. CO.vNOA 4 iNS. CO. NO. t INS. CO. NO. 2 ADJUSTMEINTS NUMBER ON ALL MQtIIRIES AuumONAt PATIENT BILLING MAY BE NECESSARY AND CORRESPONDErvCE. FOR ANY CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOVNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. BILL F ~ DATE OF BILL PREY BILL INP DI05/16/0 PAGE NO. 2 HOSP. NO. N S PATIENT NAME PATIENT NUMBER SEX AGE ADMISSION DATE DISCHARGE DATE DAYS ALBRIGHT ,BONNIE L 20066257D F 29 03/29/00 04/11/00 13 GUkR FH 7't;7 ~}3~-"~494 G,t},g' INSURANCE COMPANY NAME GROUP NUMBER POLICY NUMBER GunftnntoR BONNIE L ALBRIGHT ? OTHER INSURANCE rvaME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS GOLDMAN JOHN PLEASE RETLl~fiN TNC~ F'~RTC€fN V!![TH YQIJR' PAYM ': AMOUNT OF PAYMENT ENT. DATE DESCRIPtION OF~ ~ SERVICE iOTAL~ EST. CO CODE VERAGE EST. COVERAGE~~~ EST. COVERAGE EST. COVERAGE Pq TIE NT HOSPITAL SERV{CES CHARGES INS. CO . NO, I INS. CO. NO. 2 INS. CO. NO. 3 INS. CO. NO. 4 AMOUNT 03/29 X01 DEX 5 NSS 100 7357167 17.00 17.00 03(29 01 HOSP INITIAL- 1454222 196.25 146.25 03/29 01 PULSE OXIMETR 7427073 93.50 93.50 03/29 001 IV PUMP DAILY 6308087 66.75 66.75 03129 01 IV PUMP DAILY 6308087 66.75 66.75 03/29 01 IV PUMP DAILY 6308087 66.75 66.75 03/29 01 SETUP IV PUMP 6308291 24.50 24.50 03J29 01 SETUP IV PUMP 6308291 24.50 24.50 03/29 01 SETUP IV PUMP 6308291 24.50 24.50 03/29 01 NURSING UNIT 6021235 49.50 49.50 03/29 003 BGM 6021411 24.75 ~ 24.75 03/29 •01 ROOM M522 6025102 668.00 668.00 03/30 01 CBC HEMOGRAM 0115174 38.00 38.00 03/30 001 PHOSPHOROUS 0115199 29.00 29.00 03/30 001 MAGNESIUM 0116128 19.00 19.00 03/30 001 BASIC METABOL 0117038 52.00 52.00 03/30 001 VENIPUNCTURE 0151500 5.25 5.25 03/30 01 GASTRIC EMPTY 7348426 426.00 426.00 03/30 116 NACL 4ME4/ML 7351238 70.43 70.43 03/30 001 NSS-100 BG 7357014 18.D5 18.05 03/30 01 INSUL R 1000/ 7357113 17.35 17,35 03!30 D3 DEX 10 -1000 7357162 51.D0 ~ 51.OD 03/30 001 INSUL ULTRA V 7359105 72.40 72.40 03/30 01 HOSP SUBSQ-LE 1459232 92.00 92.00 03130 D1 EEG-AWAKE 7390799 334.75 334.75 03/30 001 IV PUMP DAILY 6308087 66.75 66.75 03/30 001 IV PUMP DAILY 6308087 66.75 66.75 03/30 •01 IV PUMP DAILY 6308087 66.75 66.75 03/30 001 IV OR IPID CH 6290909 17.75 17.75 03/30 01 PULSE OXIMETR 6020911 93.50 93.50 03/30 001 NURSING UNIT 6021235 49.50 49.50 03/30 109 BGM 6021411 74.25 74.25 03/30 101 ROOM M522 6025102 668.00 668.00 03/31 01 TSH 0115112 60.50 60.50 Aumllonnl PATIENT BII IING MAY BE NECESSARY FOR ANY CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. '. F'1PdtvA~;.E HEALTrI F€OSP3 TA L,S' PACE NO. TYPE OF DATE OF Blll DATE OF ~D'i ~~~~, BILL PREV, Bill ~ ~ HA <$B{.IRG FA 171!#5 18A UD 05/16/01 , 717 230-3717: B.t`C Hose No INP. A/R ~Gb X51778$44 N S PATIENT NAME PATIENT NUMBER BEx AGE ADMISSION DATE DISCHARGE DATE DAYS ALBRIGHT BONNIE L 200662570 F 29 03 /2_9/00 04/11/00 13 r GUAR #?H 7'[7 938-1;494 - C.QB: INSURANCE COMPANY NAME ~~ GROUP NUMBER POLICY NUMBER cunannr oR BONNIE L ALBRI GHT OTHER INSURANCE "AME 829 FISHING CR EEK RD AND NEW CUMBERLAND PA 17070 ADDRESS ;;I` GOLDMAN JOHN : ~ 11 r PLEX~E L~~a THES. l~R~ ~~~ Y~~ nEi~~ - ~-: AMOUNT OF PAYMENT ... $ .:::: _. :... DATE DESCRIPTION OF HOSPITAL SERVICES SERVICE CODE TOTAL CHARGES EST. COVERAGE IN EST. COVERAGE ~ EST. COVERAGE EST. COVERAGE ~~ PATIENT S. CO. N0. 1 INS. CO. N0. 2 INS. CO. NO. 3 INS. CO. NO. 4 AMOUNT 03/31 01 T4 FREE 0115175 51.00 51.OD 03/31 01 BASIC METABOL 0117038 52.00 52.00 03/31 01 VENIPUNCTURE 0151500 5.25 5.25 03/31 001 SC 99MTC 7342656 36.25 36.25 03/31 001 INSUL REG VL 7350685 72.40 72.40 03/31 116 NACL 4ME4/ML 7351238 70.43 70.43 03/31 01 NSS-100 BG 7357014 18.05- 18.05• 03/31 01 INSUL R 1000/ 7357113 17.35- 17.35- 03/31 003 DEX 10 -1000 7357162 51.00 51.00 03/31 01 HOSP SUBSO-LE 1459232 92.00 92.00 03/31 X01 IV PUMP DAILY 6308087 66.75 66.75 03/31 01 IV PUMP DAILY 6308087 66.75 66.75 03/31 01 RSTART VENIPU 6290903 78.75 78.75 03/31 01 NURSING UNIT 6021235 49.50 49.50 03/31 01 BGM 6021411 8.25 8 25 03/31 01 ROOM M522 6025102 668.00 668.00 04/01 •01 BASIC METABOL 0117038 52.00 52.00 04/01 01 VENIPUNCTURE 0151500 5.25 5 25 04/01 077 NACL 4ME4/ML 7351238 46.95 . 46.95 04/01 154 NACL 4ME4/ML 7351238 93.90- 93 90- 04/01 002 DEX 10 -1000 7357162 34.OD . 34 00 04/01 004 DEX 10 -1000 7357162 68.00- . 68.00- 04/01 001 IV PUMP DAILY 63D8087 66.75 66.75 04/01 X01 IV PUMP DAILY 6308087 66.75 66 75 04/01 01 NURSING UNIT 6021235 49.50 . 49 50 04/01 04 BGM 6021411 33.00 . 33 00 04/01 01 ROOM M522 6025102 668.00 . 668 00 04/02 01 HEPATITIS C A 0140754 59.25- . 59 25 04102 01 INS LISPRO VL 7354264 163.60 ~ . 163 60 04/02 01 NURSING UNIT 6021235 49 50 . 04/02 •04 BGM 6021411 . 33 00 49.50 04/02 X04 BGM 6021411 . 33 00 33.00 04/02 001 ROOM M522 , 6025102 . 668 00 33.00 04/03 39 NACL 4ME0/ML 7351238 . 23 48- 668.00 . 23.48- NUMBER ~ON qll INQl11R IES ADDITIONAL PATIENT BILLING MAY BE NECESSARY AND CORRESPONDENCE FOR ANY CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PAV ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. TYPE OF DATE OF BILL DATE OF BILI PREY, Blll INP PAGE N0. HOSP. ryO N S PATIENT NAME PATIENT NUMBER SEX AGE PDMISSION DATE DISCHARGE DATE DAYS ALBRIGHT ,BONNIE L 200662570 F 29 03/29/00 04/11/00 13 i GUAR AN ~~:~ 9~~ Tti9b ~ G,QB' INSURANCE COMPANY NAME cFOUP rvUMBER POLICY NUMBER GUARANTOR gONNIE L ALBRIGHT OTHER INSURANCE rvAME 829 FISHING CREEK RD ""D NEW CUMBERLAND PA 17070 ADDRESS • GOLDMAN JOHN i' LEASE RETURN THf~ t'+~RTt£IN:LRITH YOUR PAYMENT. ' APa~MEN°F S PATE DESCRIPTION OF~ ~~ SERVICE TOTAL Eii. COVERAGE EST, COVERAGE EST. COVERAGE ESL COVERAGE PATIE Ni CODE T HOSPI AL SEftvIC ES CHARGES INS. CO. N0. t INS. CO. N0. Z INS. CO. N0. 3 INS. CO. NO. A AMOUNT 04/03 X01 DEX 10 -1000 7357162 17.00- 17.00- 04/03 01 RSTAR7 VENIPU 6290903 78.75 78.75 04103 001 NURSING UNIT 6021235 49.50 49.50 04/03 /05 BGM 6021411 41.25 41.25 04/03 01 ROOM M522 6025102 668.00 I 668.00 04/04 01 D!C IV,IPID,P 6290910 17.25 17.25 04/04 •01 NURSING UNIT 6021235 49.50 49.50 04/04 X05 BGM 6021411 41.25 41.25 04/04 01 ROOM M522 6025102 668.00 I 668.00 04!05 01 INS LISPRO VL 7354264 163.60 163.60 04/05 •01 RSTAR7 VENIPU 6290903 78.75 78.75 04/05 01 NURSING UNIT 6021235 49.50 49.50 04/05 006 BGM 6021411 49.50 49.50 04/05 •03 BGM 6021411 24.75 24.75 04/05 X01 ROOM M522 6025102 668.00 668.00 04/06 01 DEX 50 SYR 7350372 14.50 14.50 04/06 01 DEX 50 SYR 7350372 14.50 14.50 04/06 01 NURSING UNIT 6021235 49.50 49.50 04/06 •04 BGM 6021411 33.00 33.00 04/0 6 01 ROOM M522 6025102 668.00 ~ 668.00 04(07 001 EEG-AWAKE 7390799 334.75 334.75 04/07 101 NURSING UNIT 6021235 49.50 49.50 04/07 04 BGM 6021411 33.00 33.00 04/07 01 ROOM M522 6025102 668.00 668.00 04/08 01 NURSING UNIT 6021235 49.50 49.50 04/08 003 BGM 6021411 24.75 24.75 04108 01 ROOM M522 6025102 668.00 668.00 04/09 101 GLUCAGON UL 7350573 329.00 I 329.00 04/09 01 D/C IV,IPID,P 6290910 17.25 17.25 04/09 X01 NURSING UNIT 6021235 49.50 49.50 04/09 004 BGM 6021411 33.00 33.00 04/09 01 ROOM M522 6025102 668.00 668.00 04/10 001 NURSING UNIT 6021235 49.50 49.50 04/10 04 BGM 6021411 33.00 33.00 NUMBER ON Alt INQUIRIES Aum uunAl PA U£NT BILLING MAY BE NECESSARY AND CORRESPONDENCE. FOR ANY CHARGES NOT POSTED WNEN THIS BILL WAS PREPARED Oft IF INSURANCE CARRIERS DO NOT PAY ANV PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. ,.,a"aM .. .. _. .......... .. .................................... H ,.'::.7 f ~. ................. ................. J~. PLBRIGHT ,BONNIE L GUAR Arl 717 938-1ts9. _.. __ _.. _ - _ _. _. GuARAnTOR gONNIE L ALBRIGHT PATIENT NUMBER NAME 829 FISHING CREEK RD ANO NEW CUMBERLAND PA 17070 pDDRE SS ~ PAGE N0. 5 HOSP. N0, AGE ~ ADMISSION DATE ~ DISCHARGE DATE ~ DAYS INSURANCE COMPANY NAME OTHER INSURANCE POLICY NUMBER GOLDMAN JOHN PLEASE RETURN Tti[S F'QRT[£~N N-ITH ~O1.1R PAxF#V [ENT. :~ AMOUNT OF PAYMENT I p P PATE DESCRIPTION OF~ ~ SERVICE TOTAL~~ EST. COVERAGE EST. COVERAGE ~~ ESt. COVERAGE EST.~C OVERAGE PATIENT HOSPITAL SERVICES CODE CHARGES INS. CO. NO. 1 INS. CO. NO. 2 INS. CO. NO. 3 INS. CO. N0. 0 AMOUNT 04/10 001 BGM 6021411 8.25 8.25 04110 01 R06M M522 6025102 668.00 668.00 ~~ ULTRA V 0 O O 2 60214 11 16.50 16.50 BALAN E IC FORWARD P[xTiENT NSSMBER -~ij NUMBER ON ALL INQUIRIES ADDITIONAL PATIENT BILLING MAY 8E NECESSARY AND CORRESPONDENCE. FOR ANY CHARGES NOT POSTED WHEN THIS BILL 200662570 was PREPARED oR IF INSURANCE CARRIERS DO PAY THIS AMOUNT 15638.78 NOT PAV ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. PINNACLE HEALTH HOSPITALS HARRISBURG, PA :=N~ _ TYPE OF DATE OE BILL DATE OF BILL PREV, BILL 18AUD 05/16/01 INP. AIR PATIENT NAME PAGE N0. 6 ................. ................. NOSP. NO. PATIENT NUMBER cunRANroR BONNIE L ALBRIGHT NAME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS 15638.78 { { I { {15638.78 GOLDMAN JOHN POLICY NUMBER f~ Y.f {~p~y {{i+ ~f tf { -. PI»EASE iK~{.iAtV ~E~ F~ilT4~ Y fn ~l~ ~(l 2fw i~•~T S'T4Gt~1. ' AMOUNT OF PAYMENT ~ ~ ~~ ~ DATE 4ERVICE DESCRIPTION OF TOTAL EST, COVERAGE ES i. COVERAGE ES i. COVERAGE EST. COVERAGE PATIENT HOSPITAL SERVICES CODE CHARGES INS. CO. N0. 1 INS. CO. NO. 2 INS. CO. N0. 3 INS. CO. NO. 9 AMOUNT SUMMA RY OF CHARGES R&C S EMI-PR 13DAYS 668.00 8684.00 8684.00 EMER DEPT 60 961.50 961.50 LABORATORY 89 948.50 948.50 NUCLEAR MED RN 462.25 462.25 PHARMACY 1128.28 1128.28 PHYSICIAN. VISIT 60 380.25 380.25 MEDICAL DIAG AZ 669.50 669.50 PULMONARY AZ 93.50 93.50 MED/BURG SUPPLIES 741.00 741.00 IV SOL/SUPPLIES 288.50 288.50 NURSING ADM 1281.50 1281.50 SU9-T TAL OF CHARGES BA4ANCE FORWARD GUAR RELATIONSHIP S DIAGNOSIS 250.83 780.9 C ORRESPONOENCE. AGE ADMISSION GATE I DISCHARGE DATE DAVS VNSURANCE COMPANY NAME OTHER INSURANCE SEX F GUAR NO 1594881 Auuu lunAL PATIENT BILLING MAY BE NECESSARY FOR ANY CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. A TYPE OF DATE OF BILL DATE OE BILL PRE V. BILL 18AUD 05/16/01 INP. AfR PATIENT NAME PAGE NO. 7 ................ ............... ................ ............... HOSP. N0. AGE ~ ADMISSION DATE ~ DISCHARGE DATE ~ DAYS PATIENT NUMBER cuARANTOR BONNIE L ALBRI6HT NAME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS INSURANCE COMPANY NAME OTHER INSURANCE GOLDMAN JOHN POLICY NUMBER PLEASE RE?URN TH[5 PQRTtC3N :WITH YOIiR PAYMENT i AMOUNT OE PAYMENT C V . ~ ~~ DATE DESCRIPTION OF SERVICE TOTAL EST. COVERAGE EST. COVERAGE EST, COVERAGE EST COVERAGE PATIENT HOSPITAL SERVICES CODE CHARGES INS. CO. N0. 1 INS. CO. N0. 2 INS. CO. NO. 3 INS. CO. N0. 4 AMOUNT DRG-PA GE CO NCURRENT GROUPER USED M C99 DR G 295 MDC 10 DR G-RATE-PER-CASE 3404 .47 OU TLIER VALUE _.___ .._ ~.~ ' NUMBER ON ALL INQUIRIES ZONAL PATIENT BILLING MAY BE NECESSARY 20O662S7O AND CORRESPONDENCE WAS PREPARED Oft NOTNSORANDE CARR ERS DOL NoT PAV Arvr PART oP THE AMOUNTS seowrv PAY THI S AMOUNT 15638 78 UNDER ESTIMATED INSURANCE COVERAGE. PINNACLE HEALTH HOSPITALS HARRISBURG, PA _ >~~ CYCLE p4/27/00 C eAxlEar aNre cuARAamRI BONNIE L ALBRI GHT ""'~ 829 FISHING CREEK RD AW xenRess NEW CUMBERLAND PA 17070 SEEVICC 'i~OSP[IAL SERVICES COOC DETA.L OF CURRENT CHARGES, P 04/20 1211244 001 VIS T-PROB FOCUS EST P 04/20 1211245 001 VIS T-PROB FOCUS EST P99212 04/20 1211246 001 VIS T-PROB FOCUS EST P99212 BA CE FORWARD OF CURRENT CHARGES 60 OUTPATIENT VST AL OF CURR. CHARGES OA1Y OISCFIAH6E OpTE 299BA9CE dIMPAPY aAbE ~REOW a0t19EQ cxARNES xes.co. ao. L Ies.cN. ao. NT5 A ADJUSTME TS 40.75 8.75 0.00 ` 49..50 49.50 ACC IDATLATIONSHIP: S TYKE: ~~B STI~E:F DIAGNOSIS: 250.01 NO: 115948 PAIIFHI H@®EP PLEASE REPEE IO PAIIFHC yiy~ Y.E~~~ ,.. lf F] ! 2 H01HEE Oa ACL [94ULHIE3 AHO CORIIE3PONOEeCE. PINNACLE HL TH HOSP ARRISBURG, A-OYYIOIIAL PAYI[af HILC[NO 1pY He NECESSARY POa AHY CBEEGE3 60i POSL'Ep MIEN THIS SAIE- M'M VAS PpppAREp. OE IP INSNNAHCE CAPHIEN3 00 Htl[ PAY AYY PARY 0Y '3VE AHOlINI6 SNllVN Imoee esrIHAIBH IasMUNre c°°E°ACe' PA Aa011pi OF S y ennrear [SI. ~~~COVERAOE ESL-~~ COOCRAOF ~~~~PAIIEH tRS.co. ae. a INS.ce, Ho. ANOUar 40.75 8.75 49.50 49.50 /~ 1,l ,~ ,a ~ ~ i~ c rr i .~ J c> a -7 fi.. "2 ~2 4 ~ 3 ~ ~ c~ ~ h ~} ._ ~~~ ~U ~ 3 ,~, ~~ ~ ~ j !l 1 '~ /\' j, hhV ~ ~ `~' Z C Z G~~ . r1 C~ PINNACLE HEALTH SYSTEMS, INC. Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defendants * IN THE COURT OF COMMON PLEAS * CUMBERLAND COUNTY, PENNSYLVANIA * * CIVIL ACTION -LAW * NO. 01-4634 CIVIL TERM * * * PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Please reinstate the Complaint heretofore filed on August 2, 2001 with regard to the above captioned matter. RESPECTFULLY SUBMITTED: ART KUSIC, 4201 Crums Mill Road Harrisburg, PA 17112 (717)540-5610 Supreme Court No. 07207 Attorney for Attorney ' , i r:: __ PINNACLE HEALTH SYSTEMS, INC. Plaintiff V. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendant IN THE COURT OF COMMON PLEAS COUNTY PENNSYLVANIA CUMBERLAND CIVIL ACTION - LAW NOTICE You have been sued in court. If you wish u> defend against the claims set forth in the following pages. you must take action within twenty 120) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or c:D~ect ons to the claims set forth against you. You are warred tf"'a* ir" yot! fail to do so, the case may proceed without you and -jUda~m:~~~t may be entered against you by the court without further not+;e =.r an•: money claimed in the Complaint for any other claim _ elief requested by the Plaintiff. You may lose money or pr;o~r-, ^r other rights important t.o you. YOU SHOULD TAKE THIS PAPER TO YOUR LAbiYER AT OIaCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GC TO OR T~=LEPHONE THE OFFICE SET FORTH 9ELOW TO FIND OUT WHERE YOU CAt: SET LEGAI- HELP. LAWYER REFERRAL Cumberlamd County Court Administrator 4th Floor, Cumberland County Courthouse One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 Dated: .; _ .. Respectfully subn~ rred: - HUR -. IC, ESOUiRE 4201 Crurra Mi 11 Rcad Post Office Bor ~.7~n~ Harrisb,-irg, PA 7~1' (7171 b40-.`,670 SUPREME COURT N0. 072u7 ATTORNEY FOR PLAIPITIFF ., .,. PINNACLE HEALTH SYSTEMS, INC. IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY PENNSYLVANIA Plaintiff V. CIVIL ACTION - LAW GARRY ALBRIGHT and BOBBIE L. N0. ALBRIGHT Defendant NOTICIA t_e han demandado a usted en la torte. Si usted quiere de *.encerse de estas demandas expuestas en las paginas siguientes, usted gene v~ente i20) dias de plazo al partir presentar una apanencia escrita o en persona o por abogado y arch~var en la Corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que s~.usted no se defiende, la torte tomara medidas y puede entrar una Orden contra usted sin previo aviso o notification y por cualquier queja o a1~vio que es redid: e: la pet~cion de demanda. Usted puede perder d~nero o sus pro„~eda~.7es o otros derechos !mportantes para usted. !EVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENT`t. `'I NO ?IE't!: .~EOGADO 0 Sl NO TIENE EL DINERO SUFICIENTE DE PAGAP, TAL oEP.vI:,IO. VAVA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVEFIGUAR DONDE SU PUEDE CONSE•~'~~iR a.SISTENCIA LEGAL' LAWYER REFERRAL Cumberland County Court Administrator Respectfully submi~ted: 4th Floor, Cumberalnd County Courthouse One Courthouse Square ~ '-'~ Carlisle, PA 17103-3387 , (717) 240-6200 =~.~ ___ ________- ARTH k.US ,_-ESQUIRE 4201 Crums Mill Road Post Office Box 67015 Hare sburc, PA '711? (717) 540-56?0 SL!aREME COURT N0. 07207 ATTORNEY FOR PLAINTIFF Dated: PIPTNACLE HEALTH SYSTEM, INC., Plaintiff v. GARRY ALBRiGHT aad BONNIE L. ALBRIGHT, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. COMPLAINT AND NOW comes Plaintiff by and through its attorney, Arthur A. Kusic, Esquire, and respectfully represents the following: 1. Plaintiff, Pinnacle Health System, Inc., is a hospital facility organized and existing under the laws of the Commonwealth of Pennsylvania with a mailing address of P.O. Box 2353, Harrisburg, Dauphin County, Pennsylvania, 17105. 2. Defendants, Garry Albright and Bonnie L. Albright are adult married individuals residing at 128 Herman Avenue, Lemoyne, Cumberland County, Pennsylvania, 17043-1935. 1 COUNT I (Plaintiff v. Garry Albright) 3. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 2. 4. On or about April 8, 2000, Plaintiff, at the Defendant's request, provided health care services to the Defendant and thereafter billed the Defendant it usual and customary charges for such services rendered. A copy of the Summary of Charges is attached hereto, made a part hereof, and marked Exhibit "A". 5. Plaintiff did render health care services to the Defendant with the reasonable expectation that payment for such services would be made by the party benefited. 6. Should Defendant not be required to pay for the service rendered, Defendant would be unjustly enriched at the Plaintiff's expense by having received services without paying for the rendered services. 7. Plaintiff has granted Defendant credit for all payments received on this account, leaving a balance due and owing of $466.00. 8. Plaintiff has made demands upon the Defendant for the balance due and owing of $466.00, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $466.00 along with interest at the rate of 6% per annum and the costs of this proceeding. t COUNT II (Plaintiff v. Bonnie L. Albright) 9. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 8. 10. On or about March 14, 2000 and continuing from time to time through to on or about April 20, 2000, Plaintiff, at the Defendant's request, provided health care services to the Defendant and thereafter billed the Defendant it usual and customary charges for such services rendered. A copy of the Summary of Charges is attached hereto, made a part hereof, and marked Exhibit "B". 11. Plaintiff did render health care services to the Defendant with the reasonable expectation that payment for such services would be made by the party benefited. 12. Should Defendant not be required to pay for the services rendered, Defendant would be unjustly enriched at the Plaintiffls expense by having received services without paying for the rendered services. 13. Plaintiff has granted Defendant credit for all payments received on these accounts, leaving a balance due and owing of $19,812.93. 14. Plaintiff has made demands upon the Defendant for the balance due and owing of $19,812.93, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $19,812.93 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT III (Plaintiff v. Bonnie L. Albright) (Doctrine of Necessaries) 15. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 14. 16. Plaintiff believes and therefore avers that the health care services rendered upon request to Defendant Garry Albright, husband of Defendant Bonnie L. Albright, were necessary for his benefit and welfare. 17. Pursuant to the "doctrine of necessaries", codified under 23Pa.C.S. §4201, where debts are contracted for necessaries by either spouse, a creditor may institute suit against husband and wife for the price of the necessaries. 18. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Bonnie L. Albright, is liable to the Plaintiff for the necessary health care services rendered to her husband Garry Albright. 19. Plaintiff has made demands upon the Defendant for the balance due of $466.00, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $466.00 along with interest at the rate of 6% per annum. COUNT IV (Plaintiff v. Garry Albright) (Doctrine of Necessaries) 20. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 19. 21. Plaintiff believes and therefore avers that the health care services rendered upon request to Defendant Bonnie L. Albright, wife of Defendant Garry Albright, were necessary for her benefit and welfare. 22. Pursuant to the "doctrine of necessaries", codified under 23Pa.C.S. §4201, where debts are contracted for necessaries by either spouse, a creditor may institute suit against husband and wife for the price of the necessaries. 23. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Garry Albright, is liable to the Plaintiff for the necessary health care services rendered to his wife, Bonnie L. Albright. 24. Plaintiff has made demands upon the Defendant for the balance due of $19,812.93, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $19,812.93 along with interest at the rate of 6% per annum. COUNT V (Joint and Several) 25. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 24. 26. Plaintiff believes and therefore avers that the Defendants are jointly and severally liable to the Plaintiff for the balance due of $20,278.93. 27. Plaintiff has granted Defendants credit for all payments received on these accounts, leaving a balance due and owing of $20,278.93. 28. Plaintiff has made demands upon the Defendants for payment of the balance of $20,278.93, which demands remain unheeded. 29. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbitration referral by local rule. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendants in the amount of $20,278.93 along with interest at the rate of 6% per annum. RESPECTFULLY SUBMITTED Arthur A. "Kusic, Esquire 4201 Crums Mill Road Harrisburg, PA 17108 (717) 540-5610 Supreme Court Number 0767 Attorney for Plaintiff PINNACLE HEALTH SYSTEM, INC., Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. VERIFICATION i7 I, ~h/>~€-,~ E~7~ ~ the Su t-~ia5u~ iAT~e~~T ~nFn~«i17L V~/x~nr.1 % ~D/%c=!'iii'^s of PINNACLE HEALTH SYSTEM, INC. verify that the statements made in the COMPLAINT are true and correct and that I am authorized to make this Verification on behalf of PINNACLE HEALTH SYSTEM, INC. I understand that false statements herein are subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authority. PINNACLE HEALTH SYSTEM. INC. B ~~tD.«~ ~~~ y: Title: •1« LiSo2 ~/}iie~)T Fa~r.~Eir"t Jtc~u~T7~~i~U/c, Date: G/i/D j EXHIBIT "A" .~ RILC U[CL PREV-BILL CYCLE 4'/21/00 S E PI'T[ENF NAME PATIFM NNXO ER SIX AC[ I AD NISSEDN OpTE OISCIIAROE OAlE DAYS "" ___ NONP FR OVARANrOR GARRY ALBRIGHT ""'E 829 FISHING CREEK AD AND ADDRESS NEW CUMBERLAND PA 17070 ~pEAUGUSTINE CARLO J ANauNr oe s PAYMEIFT `. ~: .. . " " AiE OF DESC0.f YT10N 0! SE¢VICE TOTAL E3C. CDVE MDf E4i- COVERADE COVERAGE ESL FST. COV[WCF FATTEN $f PV ICE HOSPITAL SERVICES CO DC CHARGES (HS, CO. HD. 1 1NS.C0. HD. 2 INS.CD. N0. J IRS.CD. N0. AI(01Mt DETA L OF CURRENT CHARGES, PAY ENTS AN ADJUSTME TS 09/08 7911145 001 93.25 93.25 WD EP II<2.5 CM P/F 12011 04/08 7913538 001 WD EP II<2.5 CM * 12011 09/08 7427036 001 93.75 93.75 REP IR SIMPLE/INTERME D00000 09/08 7911229 001 108.25 108.2 `_~ EME MED VISIT III P/F99283 04/08 7913647 001 EME MED VISIT III 99283 04/06 7425388 001 161.25 161.25 EME MED VISIT IV 00000 09/08 742?033 001 9.50 9.SC SMAL L DRESSING 00000 CE FORWARD OF CURRENT CHARGES 20 SURGICAL 60 EMER DEPT OF CURR. CHARGES 0.00 187. 00 187. OC 279. 00 I 279. 00 466. 00 I I 1 I I 400. uv GU RELATIONSHIP: S SEX: M UAR NO P.CC DATE: 09/08/00 TYPE: 5 TI E: 1:30 AM DIA NOSIS: 873.42 873.42 2095409 RE -~T O .F fi. L S :... .:. , ..: : 966. 0'.0 • ~:- ;::. ~:. :.:..466i~Q0 PRryTIENF /NIUX B}ER p[EpgE AE FER TO PAT IENE AU OlTIONAL PATIENT PI LL INC XAy PF. NEC ES EARY :...: " LDO 67 42:I1 ~:- ANOP CORRES PONO ENCEVIAI ES FOR ANY CNARC ES NOT POSTEU 4N EN l'II[S SITTE X4It VA$ PREPARED. OR IF I4SVppN[E [p0.R lk RS AY TH I.S .AMOUNT '9 6 6 . D 0 DO NOT PAV ANY PART OF THE NIOVNES SNOXN PINNACLE H LTH HOS P NN DER ESTI MAT£D IxsLxaucE cov ERAC E. HARRISBURG, PA EXHIBIT "B" :~, FINAL S L Aoiuss]dH oAFe o]scMR6e DA1H ~ OATS eof]cE WANE ARo ADDRESS BONNIE L ALBRIGHT 829 FISHING CREEK RD NEW CUMBERLAND PA 17070 90143725 p.~ i[OF I umc~uu. n ov I n~acc I avau. I ESI, [OefRAOE I EELC COVFB.\OE I fTT. COVERAGE I oi. cu ExnOE~ c.u.m. Fw f dOSP FIAT SERVIGS CODC CfWLLiFS ]NS.m. -O 1 i9S a. d0. 2 INS .CO. d0. I IRS.fL. H0. AHOOFl DETR L OF CURRENT CHARGES] PAY ENTS ADJUSTME 03/14 001 EMER MED VZSZ 7411230 163.50 163.50 03/14 001 EMER MED VISI 7413646 03/14 001 EMER MED VISI 7425388 161.25 161.25 03/14 001 VENIPUNCTURE 7427061 8.25 8.25 03/14 001 NIBP 7427074 35.25 35.25 03/14 001 CBC ~ AUTO DI 0115071 41.50 41.50- 03/14 001 CBC & AUTO DI 0115071 41.50 41.50 03/14 001 DRUG SCREEN U 0115098 03/14 001 DRUG SCREEN U 0115099 16.00 16.00 03/14 001 DRUG SCREEN U 0115100 16.00 16.00 03/14 001 DRUG SCREEN U 0115101 15.50 15.50 03/14 001 DRUG SCREEN U 0115102 16.00 16.00 03/14 001 DRUG SCREEN U 0115103 16.00 16.00 03/14 001 DRUG SCREEN U 0115104 16.00 16.00 03/14 001 DRUG SCREEN U 0115105 16.00 16.00 03/14 001 DRUG SCREEN U 0115106 16.00 16.00 03/14 001 DRUG SCREEN U 0115107 16.00 16.00 03/14 001 DRUG SCREEN U 0115108 16.00 16.00 03/14 001 CBC(HEMOGRAM) 0115174 38.00 38.00 03/14 001 URINE MI CROSC 0115189 13.00 13.00 03/14 001 URINE DIPS TIC 0115222 16.00 16.00 03/14 001 ACETONE SERUM 0115988 20.75 20.75 03/14 001 AMMONIA 0116003 75.75 75.75 03/14 001 HCG 0116087 59.75 59.75 03/14 001 MANUAL DIFF 0116130 15.00 15.00 03/19 001 BASIC METABOL 0117038 52.00 52.00 03/14 001 HEPATIC FUNCT 0117042 62.25 62.25 03/14 001 CHEST 2V 7310347 115.50 115.50 03/14 001 BRAIN UNENHAN 7672452 761.00 761.00 03/14 002 APAP 325MG TA 7350005 6.00 6.00 03/19 001 DEX SOo SYR 7350372 14.50 14.50 03/14 001 INS N 100UN/M 7357187 7.25 7.25 03/19 001 EKG 7380695 136.00 136.00 PATIF1iI MIHBER pCFASE REFER SO PASIFHL A-p]SIONAI. PAiIERI HILCIRC HAV BE RECESSMY RIBIBER OH ALL ItlOVI RZES FOA ARY CHARGES RQI POSTED RHEH lH]5 61TIE_ :~ ARO CORR6P09OENCE. IVHL YAS PREPARED, OR IF IRSVRARCE CARRIERS -0 ROS PAY ARY PARS OF lHE AMOllHIS SHOF4 VNpER 6ZIMA"[ED [ICJIRAR6 COVERAVE_ T'PE OF OAIE BILL ~ DI FINAL 4/2 PAITPM dA16 ,BONNIE L' PIII®ER Al1lRSxod OAE 1 oxsONPOE oASE cuARpdroa BONNIE L ALBRI GHT AND 829 FISHING CREEK RD ADnms NEW CUMBERLAND PA 17070 INSUaANCE COI@ARY dAVe oROdP dfdREe eo LI CY d1MBE L (B.O. USE' ON 90143725 ISI JOSEPH R Ai£ OF ............. ... ........ .u.w SERVICE NOSTFLAE SERVICES COO[ CIIAAAEs 03/14 001 EKG 7380695 136.00 03/14 001 NURSING UNIT 6191235 30.50 03/14 001 ROOM N955 6195137 668.00 03/15 001 CBC(HEMOGRAM) 0115174 38.00 03/15 001 SEDIMENTATION 0115218 24.00 03/15 001 INSUL NPH VL 7350683 72.40 03/15 001 HOSP INITIAL- 1459222 196.25 03/15 001 EEG-AWAKE 7390799 334.75 03/15 001 MR BRAIN S CO 0680551 935.00 03/15 ODS BGM 6191417 41.25 PASIENS }NNDER ~pGFASE REFER SO PAFIFM ': IDdpEP ON ALL INQUI R3E5 ~~~~~ ~~~~ ''i AHO [ORR£SPONO FNCF. PINNACLE HEALTH HOSPITALS HARRISBURG, PA 136.00 30.50 668.00 38.00 24.00 72.40 196.25 334.75 935.00 41.25 A-DIIIONAL PpTf ENI BILLING NA4 HE NECESSARY FOA ANY CJIAAGES NO]' POSfEO WIEN 'IRIS SLAFE- NENF YAE PREPARED. OR IP INSdIW1CE CAIIRI ERS -11 d01' PAY ANT PARL OF INE AY01MI5 6HOfN IWDER ESEIMASEp 1lbtHIWCE COVERAGE. „•,.,P FINAL. b4/24/00 g eanEPlt NA1Q: wAnAaloal BONN~ZE L ALBRI GHT ~.w I 629 FISHING CREEK RD AND ADDaESS NEW CUMBERLAND PA 17070 AiE OF SEPVICE doSPIIAL SEPVICES EDD[ S Y OF CHARGES R&C EMI-PR 1DAYS@ 668.00 EMER DEPT 60 LABORATORY 89 RADIOLOGY RD C.A.T. SCAN RD PHARMACY PHYSICIAN VISIT 60 MEDICAL DIAG AZ MRI RD SPECIAL CARE UN IT OF CHARGES Ao1Q43Iad HR2E IDIS[PAHH¢ DATE RAaCC 6t1RAFe HANE DPOUP d61BCR PDLICY R1D0E0. (B.O. USE ON 90143725 ~ARLISI JOSEPH R -: AMaudr oe s ~. ;' :~ PAY16aT~ v .......... i9iAE EA'. CWEWDE ESE CDVERAOE ESI COVEPADE PSf. COVEWCE PAFIEN oD~ROm IRS.m. aD. I Ias.ca. do. z INx.cR. ao. I INS.ra. aD. Axoddr 668.00 668.00 368.25 368.25 574.00 574.00 115.50 115.50 761.00 761.00 100.15 100.15 196.25 196.25 334.75 334.75 935.00 935.00 71.75 71.75 4124,651 4129. RELATIONSHIP: S SEX: F DATE: TYPE: B TI E: /fiINAL DIAGNOSIS: 250.81 DIAGNOSIS: 251.2 NO: ~ 159488 THIS SILL IS FOR YOUR- NFORMAT ON ONLY A REQUIR BY ACT 89-COST CONTAI ENT CO CIL. IT I NOT INTENDED FOR INSURANCE PURPOSE AND IS N T TO BE PAID BY YOU. YOU WILL ECEIVE SEPARATE BILLING FOR ANY BALANC DUE AF ER THE IN URANCE COMPANY HAS PROCESSED OUR BIL . PATIENT NfppER IpLCASC AEFER i0 pAiIEIR '~U~P4.y.J~1 ~i A9U CDFAESPDaDEaCEUIRIES PINNACLE HEALTH HOSPITALS HARRISBURG, PA ADDIFIDdAI. PATIEdf HILLIdU MAY PE NECESSARY FDR ANY CHARfES pOi PDSLEa Mlm TH35 SIATE- MtM YA5 PIIEPARLT. DN SP ]NHURAN[e CARNIf0.4 DO dd2 PAY AdY PART OF THC AMDUdIS HNDW udom EnIMAEm INSIRNNCE covEanoe. PR£V.BILC FINAL 4/24/00~~ :.7.1•_7 ~.~6^-'~~~7 _ - F33.R1i9= ,W¢YA Ns xose.NO. __ _ _ _. n .S' PAi[EYF aAIIE PA2SEH[ NUMBER AEC ADIQSSEDR pAiP DISC®ROE DAiC DAYS Ovncnenva~ BONNIE L ALBRIGHT """E 829 FISHING CREEK RD ANo ADDS NEW CUMBERLAND PA 17'070 I4411GNCE Cp@F11Y NAME O40VP NIdNE4 L (B. O. USE ON 0143725 ~ARLISI JOSEPH R ~ ~ OF~~... 5 f .- :. .. _: . _ ~ .: ~ .' - :. - .i: . PAYI2NF OF . :.. ~ OESC 0.IPSIOM OF SE 0.V (Cf ...... ...... .. 30YAL ... ._..__ FgE. COVEPAOE FSI [OVERAGE ESI~CWERAOE c ES[- COV ERACC ._........ PASIEN ,E NOSP RAC EERVICFS COO[ CIIA0.UEN IIS.CO. tl0. 1 IRS.CO. tl0. 3 INg_CU. D0. ] IpS. CO. NO. .V10UYI S AND PROCEDURES: TING DIAGNOSIS: 251.2 HYPOGLYCEMIA OS ARGE/FINAL DIAGNOSIS: 250.81 *DM1 W MANZFES NEC, 784.3 APHASIA 305.1 TOBACCO USE D BORDER NATE CARE: SCHARGE DESTINATION: AHR SSES: TIENT: BONNIE L ALBRIGHT 829 FISHING CREEK RD NEW CUMBERLAND PA 1707 . EMPLOYER: HOMEMAKER 00000 PAIiFFE N@IDER p(EAgE REFER SO PpiIFYE ADDLSIOHAG PASIENI BFLLIND Mpy NE NECESSARY NUROCR ON ALL IYpUIR1 Eg FOR .WY CIV.RGES NOT POS[PD MIEN INIS S[AiY- .i AND CD PASS PDNDFNCE. IRNF VAE ppEpAREO. DR SF IRSDRANCE CABBIE qS DO NOS pAY ANY PAW OF lHE ANDWLS FNOVN iMDER ESTIMATED 11IDIIVACE COVEMOE. :3"kaA rxeE oe oAIE e eiCL HILC PREV HICC FINAL q/24/00 ~::;:E ~ARLISI JOSEPR {yR MOUNT OF 5 ............. A$ OF GESCRIPTI N ~ OF SERVICE ]OIAC ESI. CpvEMOE ESL COVEHAOE ESE. COVEBAOE EST- COVEMGE PAIIEN SE WICE NOSP COAL SEHVI CFS Lp pC CFWtOEH IIS.CO. tl0. I IIS.[O. NO. 3 I16.C0. NO. ) IIS.CO. NO. AI[OVISI BILLIN URRENT GROUPER USED: M 99 #: 295 MDC #: 10 RATE PER CASE: 3404 47 IER VALUE: PER USED: P 9 #: 295 MDC #: 10 RATE PER CASE: 2789 20 IER VALUE: PATIENL NYMBER pLCASE REFER i0 PA2IEY! YUMBCR OY A[L IYVOI RIES :i AYR CORAESPOYBEYC C. (5~0) AD-ECIONAL PAII FNI' B[GLINO NAY BE NECESSARY FOA ANY CXA0.pE5 NOI' POSR- hNEN Ti1H S[AFE- 1@II NA5 PNEPANEO. OR 1P INSGRANCE CARNI ERS -O NVF PAY ANY PARF OF T1E ANpIRNS SNOVN UN-ER ESFIMA]Y- IIRINNNCE COVERAGE. Fi kL~k r,XA~i-i rubNtih4.., T YPE OF DATE OF •B Gf '3l3 Y ~ BILL DATE Of BILL PREY BILL - '- • Hk: ,SO(IRG~ Pk 1710 , 18AU D 05/16/01 `717 230 3717 B~#T HOSP "` INP. ASR ` >FEI 21778644 N S PATIENT NAME PATIENT NUMBER SEX AGE ADMISSION DATE DISCHARGE GATE DAYS ALBRIGHT BONNIE L 200662570 ~ 29 ~ 03 /29/00~04/11/OOj 13~ GUAR ~ P`H 7"~ 93$-1'494 ~ ~ ~ ~~ ?C0.6:. INSURANCE COMPANY NAME GROUP NUNIBCR POLICY NUMBER GUARANTOR BONNIE L ALBRIGHT !. OTHER INSURANCE "AME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS ' GOLDMAN JOHN " ' AMOUNT OF ~ PLEASE RETURPI TFitS PQRTiON WI TH YOUR PAYMENT. PAYMENT ~ D ATE DESCRIPTIONOF S=RVICC LOiAI ES'. COVERAGE EST [OVERA GC `ST COVERAGc' ~ c5 ' COVERAGE ~ Pe-ENi ' HOSPITAL SER ACES COO- CnAAGES INS CO. NC i IxS INS CO NO 2 ~ v5 CO nO_ CO. NO A 4MOUx - >ETAI L O F CURRENT CHARGES, PAY ME NTS AND ADJUSTME ! NTS 1/29 01 EMER MED VISI 7411228 85.00 '! 1 85.00 3/29 01 EMER MED VISI 7413646 i I 1/29 01 URINARY CATH 7427004] 17.75 I. j 17.75 1/29 001 BLOOD GLUCOSE 7427057 52.50 i I I I '~ 52.50 1/29 01 VENIPUNCTURE 7427060! 7.25 ! ' ~ 7.25 1/29 01 OXYGEN SET-UP 74270631 4.25 I, ~ ~ 4.25 8/29 01 CARDIAC MONIT 7427072, 86.00 '~ 86.00 1/29 01 NIBP 7427074. 35.25 i 'I ~ I 35.25 8/29 03 NON CRIT OBSE 7427082' 81.00 ~ I 81.OC 1/29 03 EMER MED VISI 7428279 592.50 i j , 592.SC 8/29 X001 CBC & AUTO DI 0115071'. 41.50-! ~ i 41.SC 8/29 1001 CBC & AUTO DI 01150711 41.50 I ~ I I 41.SC 8/29 01 CBC HEM06RAM 0115174', 38.00 II 38.OC 3/29 •01 GLUCOSE 0115216'' 24.00 I 1 24.OC 8/29 001 CBC & MANUAL 0116023: 53.00 I; I ' S3.OC 8/29 01 DRUG SCREEN S 0116051; ! 3/29. 01 DRUG SCREEN S 01160521 34.75 i ~I 34.7`_ 3/29 01 DRUG SCREEN S 0116053' 34.75 i I 34.7`_ 1/29 01 DRUG SCREEN S 0116054 ] 34.75 i I ~~ 34.7`_ 3!29 01 DRUG SCREEN S 0116055 34.75 ! I 34.7`_ 3/29 01 DRUG SCREEN S 0116056 34.75 ~ j ~ I 34.7` 3/29 01 DRUG SCREEN S 0116057 1 34.75 i 34.7; 3/29 01 DRUG SCREEN S 0116058 ! 34.75 I j 34.7` 3/29 01 DRUG SCREEN S 0116059 34.75 j 1 ' 34.7` 3/29 01 MAGNESIUM 0116128 ] 19.00 ! 19.0C 3/29 01 MANUAL DIFF 0116130 1 15.00 , j 15.0( 3/29 01 SALICYLATE 0116168 41.00 ! '• ! 41.0C 3/29 01 BASIC METABOL 0117038 52.00 i II ! 52.0( 3/29 01 DEX S -100 BG 7350368 18.05 ', I I ~I 18.0` 3/29 01 NSS-100 BG 7357014 18.05 i ~ 18.0: 3/29 04 MG 0.5 6M/ML 7357110 . 17.00 j 1 17,0( 3/29' 04 MG 0.5 GM/ML 7357110 17.00 i j 17.0( 3/29 01 INSUL R 1000/ 7357113 j 17.35 j I 17.3: I ~ PATIENT NUMBER I ~ - PLEASEREFER i0 PATIENT NUM9ER Ox ALL In Ol11RIFS ADDITIONAL PATIENT BII LING MAY BE NECESSARY AND CORRESPONDENC E FOR ANV CHARGES NOT POSTED WHEN THIS BILL wAi PREPARED OR IF INSURANCE CARRIERS DO I NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. ttPE OF PATE OF BILL DATE OF BILL PRE V, BILL 18AUD 05/16/01 INP. PATIENT~flAME MOSP. M1 PATIENT xUMBER ISEZI AGE I wDMISSION DATE ~ DISCHARGE DATE ~ DAVS cuARANTOR BONNIE L ALBRIGHT """E 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS INSURANCE COMPANY NAME OTHER INSURANCE GOLDMAN JOHN POIICY YUMBER PLEASE RETURN THIS PORTCON Y@ITH YOUR PAYNtENT. APO M=„aE $ - _ ~ DATE DESCRIPD ON OF SERVICE " EST COVERAGE EST. CO.PftAGE I~ TOTAI EST. COVERAGE EST COVERAGE - :IENT HOSPITAL SERVICES COD c CHARGES MS. CO NO I INS CO NO. 2 IvS CO. NO. 3 INS CO rv0 d ', aMOUni ~ 3/29 601 DEX 5 NSS 100 7357167 17.00 ~ 17.OC 3/29 01 HOSP INITIAL- 1459222 196.25 I ! 196.25 3/29 ~01 PULSE OXIMETR 7427073 93.50 ~ ~ ' 93_SC 3/29 1601 IV PUMP DAILY 6308087 66.75 ! i , 66.7 3/29 I~bg01 IV PUMP DAILY 6308087• 66.75 ~ ! 66.7_ 3/29 1001 IV PUMP DAILY 6308087 66.75 ' 66.7` 3/29 001 SETUP IV PUMP 6308291 24.50 ', ~ 24.SC 3/29 101 SETUP IV PUMP 6308291 24.50 I 24.5C 3/29 01 SETUP IV PUMP 63082911 24.50 ~' ~ 24.SC 3/29 01 NURSING UNIT 6021235 49.50 ~ 1 49.SC 3/29 03 BGM 6021411 24.75 'i 24.7` 3/29 01 ROOM M522 6025102 668.00 ! I 668.OC 3/30 001 CBC HEMOGRAM 0115174 38.00 38.OC 3/30 01 PHOSPHOROUS 0115199 29.00 I ' j 29.OC 3/30 01 MAGNESIUM 0116128 19.00 '; ! 19.OC 3/30 01 BASIC METABOL 0117D38 52.00 ' I, I 52.OC 3/30 01 VENIPUNCTURE 0151500 5.25 I ~ ' S.2`_ 3/30 001 GASTRIC EMPTY 7348426 426.00 j 426.OC 3/30 116 NACL 4ME4/ML 7351238 70.43 I ' 1 70 4' 3/30 j001 NSS-100 BG 7357014 18.05 ~ f . 18.0`_ 3/30 01 INSUL R 1000/ 1 7357113 17.35 ~ I 17.3` 3/30 003 DEX 10 -1000 7357162 51.00 51.0( 3/30 01 INSUL ULTRA V 7359105 72.40 ~ 72.40 3/30 01 HOSP SUBS4-LE 1459232 92.00 j i I j 92.OC 3/30 01 EEG-AWAKE 7390799 334.75 ~I 1 ~, 1 334.7` 3/30 601 IV PUMP DAILY 6308087 1 66.75 '; 66.7`_ 3/30 01 IV PUMP DAILY 6308087 66.75 ~ 66.7` 3/3D 01 IV PUMP DAILY 6308087 66.75 i ' 66.7`_ 3/30 01 IV OR IPID CH 6290909 17.75 ~ 17.7` 3/30 01 PULSE OXIMETR 6020911 93.50 ~ j 1 93.SC 3/30 01 NURSING UNIT 6021235 49.50 1 i 49.5C 3/30 ~09 BGM 6021411 74.25 ~ ~ 74.2` 3/30 01 ROOM M522 6025102) 668.00 ~ ~ ~ 668.OC 3/31 ~01 TSH 0115112 60.50 I ~ H..._ _. k 60.5C . NUNREfE SON ALl INQUIF iES AUUIFIONAL PATIENT RILL ING MAY BE NECESSARY AND CORRE SP ONpENCE. FOR qNY CHARGES NOT POSTED WHEN THIS BILL wA5 PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. rwE-oF .... rl I.LG rLHl 11 '7 F`VSYLIhI.,v '. I -...onre or - F gd X35:3 - - I T _ 3 BILL . on BIU _ Eo PREY Bill ~ - 17105 E L~ Hk .SB JRG, PA 18AUD 05/16/01 71r 230 3717 I B,','i' Hose. Ni INP. A?R =EI 2$1778644 N S PATIENT NAME ~ PATIENT NUMBER ~ GEx AGE ADMISSION DATE DISCHARGE DATE DAYS I GUARANTOR BONNIE L ALBRIGHT """E 829 FISHING CREEK RD ""D NEW CUMBERLAND PA 17070 ADDRESS ........... ............. .. . INSURANCE COMPANY .4.tME OTHER INSURANCE POLICY NUMBER GOLDMAN JOHN PLEASE RETURN THlS POPTION 11V(TH YQt1R PAYM ENT. AMOUNT OF PAYMENT $ DATE DESCRIPTIONOG ~ S_RVICF ! 1014E FS' COTE RA GE EST. COVERAGE S COVE RAG, EST COVERAGE aArIE NT HOSPITAL SERVICES ~ CODE CHARGES 11.5 CO. NO 1 INS_ CO NO. 2 I \S CO x0. ? n5 CO. NO ~ AMOUxi 131 901 T4 FREE 0115175 51.00 I ~ li ~ 51.00 /31 01 ~ BASIC METABOL 0117038 52.00 ~ 52.00 /31 01 VENIPUNCTURE 0151500 5.25 I 5.25 /31 Q01 SC 99MTC 7342656] 36.25 j 36.25 /31 6001 INSUL REG VL 7350685 72.40 I 72.40 /31 1116 NACL 4MEQ/ML 73512381 70.43 ~ ~ ! I 70.43 /31 1001 NSS-100 BG 7357014] 18.05- ~ 18.05 /31 01 INSUL R 1000/ 7357113', 17.35- I 17.35 /31 •03 DEX 10 -1000 73571621 51.00 51.00 /31 01 HOSP SUBSQ-LE 1459232' 92.00 i I I 92.00 /31 1001 IV PUMP DAILY 6308087:. 66.75 I i i 66.75 /31 601 IV PUMP DAILY 6308087 66.75 ~ 66.75 /31 601 RSTART VENIPU 6290903 78.75 i ~ 78 75 /31 (001 NURSING UNIT 6021235; 49.50 ~ . 49.50 /31 901 BGM 6021411', 8.25 ' g_25 /31 01 ROOM M522 6025102! 668.00 % 668.00 /01 D1 BASIC METABOL 01170381 52.00 52.00 /01 01 VENIPUNCTURE 0151500! 5.25 I ', 5 25 /01 77 NACL 4MEQ/ML 7351238; 46.95 1 , 46.95 /01 154 NACL 4MEQlML 7351238! 93.90- 93.90 /01 02 DEx 10 -1000 73571621, 34.00 34,0n /01 04 DEX 10 -1000 73571621 68.00- I I 68.00 /01 01 IV PUMP DAILY 6308087 66.75 66.75 /01 01 IV PUMP DAILY 63080871 66.75 ' 66.75 /01 01 NURSING UNIT 6021235 49.50 49.50 /01 04 N BGM 6021411 33.00 33.OC /01 p01 ROOM M522 6025102 668.00 ! 668.00 /02 601 HEPATITIS C A 0140754 59.25 I I 59,25 /02 01 INS LISPRO VL 73542641 163.60 I I i 163.60 /02 01 NURSING UNIT 60212351 49.50 i , 49.50 /02 04 BGM 6021411! 33.00 j ~ I 33.00 /02 ~ 04 BGM 6021411' 33.00 ~ 33.00 /02 OD1 ROOM M522 6025102] 668.00 ~ ~ I 668.00 /03 ~39 NACL 4MEQ/ML 73512381 23.48- I j j 23.48 AND CORRE SPONOE NCf ADDiiIONAI PATIENT~BIIt ING MAY RE NECESSARY FOR ANT CHARGES NOT POSTED WHEN THIS Bill WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PqY ANY PART OF THE AMOUNTS SHOwN UNDER ESTIMATED INSURANCE COVERAGE. ,. - r L. 4. ni„h4En rs4f clY1lhu:% n4 TYPE OF DATE OF DILL DATE OF ! g y c ~ f~ ~_ G3 .. 4 BILL PREV BIIL _ , HA KK ISRtIRG, Pn 17'fQ5 18AUD 05/16/01 71[ 2~0 37'€7; g.7T Hose INP. A/R z€I ~~17~8647. N S PATIENT NAME I PATIENT NUMBE0. SEx AGE ADMISSION PATE DISCHARGE DATE DAYS i GUARANT OR BONNIE L ALBRIGHT ' """E 829 FISHING CREEK RD °"D NEW CUMBERLAND PA 17070 ADDRESS INSURANCE COMPANY NAME OTHER INSURANCE POLICY NUMBER GOLDMAN JOHN PLEASE RETUEiN TktS PORTION WtTH YOUR PAYM ENT. AMOUNT OF PAYMENT ~ DATE OESCRIP iION OF HOSPIT AI SERVICES $ERV~CE COCE TOTAL CHAflGES EST. COVERAGE INS. LO. N0. 1 ESi. CCVERAGE EST COVERAGE ES i. COVERAGE INS. CO. NO. ] I ~N S. CO. NO. 3 INS. CO. NO ~ P 'IE N! AMO{,~Y' 4/03 01 DEX 10 -1000 7357162 17.00- ~ ~ 17.OC 4/03 01 RSTART VENIPU 6290903 78.75 ! i 78.75 4/03 01 NURSING UNIT 6021235 49.50 ~ 49.50 4/03 OS BGM 6021411 41.25 j I 41.25 4/03 01 ROOM M522 6025102 668.00 ~ 668.OC 4/04 p01 D/C IV,IPID,P 6290910 17.25 I ! ~ 17.25 4/04 1001 NURSING UNIT 6021235 49.50 ' 49.50 4/04 1005 BGM 6021411 41.25 1 ! 41.25 4/04 001 ROOM M522 6025102 668.00 I ~ 668.OC 4/05 I1p001 INS LISPRO UL 7354264 163.60 I 163.60 4J05 601 RSTART VENIPU 6290903 78.75 I ! 78.75 4/05 601 NURSING UNIT 6021235 1 49.50 I ~ 49.50 :/OS 606 BGM 6021411 1 49.50 j i 49.50 /OS 1003 BGM 6021411 1 24.75 i 24.75 :/OS 001 ROOM M522 6025102 668.00 668.OC 4/Ob 1001 DEX 50 SYR 7350372 14.50 I ~ 14.50 4/Ob 01 DEX 50 SYR 7350372 14.50 ~ 1 14.50 4/06 01 NURSING UNIT 6021235 49.50 i I 1 49. SC 4/06 04 BGM 6021411 33.00 ' I ~ 33.OC 4/06 01 ROOM M522 6025102' I 668.00 I 668.OC 4/07 01 EEG-AWAKE 7390799 334.75 1 I I 334 75 4/07 1 001 NURSING UNIT 6021235 49.50 ~ ! . 49.50 4/07 004 BGM 60214111 33.00 ~ 33.OC +/07 1 601 ROOM M522 6025102 668.00 : i ' i 668.OC 4/08 1 1 001 NURSING UNIT 6D21235 49.50 ~ I 49.50 4/08 003 BGM 6021411, 24.75 24.75 4/08 01 ROOM M522 60251021 668.00 i i 668.OC ./09 •01 GLUCAGON VL 7350573 329.00 ~ ~ ~ 329.OC :/09 01 D/C IV,IPID,P 6290910 17.25 ' j I ~ 17.25 6/09 01 NURSING UNIT 6021235 49.50 ! i ~ j 49 50 4/09 04 BGM 6021411 33.00 ~ ~ I i . 33 OC 4/09 01 ROOM M522 6025102 668.00 j I ~ I . 668.OG +/10 01 NURSING UNIT 6021235 49.50 ' ' 49 50 4/10 04 BGM 6021411 33.00 j i I . 33.OC ANJ AUp1IlONAL PATIENT BILLING MAY BE NECESSARY FOR ANY CHARGES NOT POSTED WHEN THIS Bill WA$ PREPARED Oft IF INSURANCE CARRIERS DO NOT PAY qNY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. xeR9. I \ M:4 L L Fl c: lta T VPE OF - DATE OF - _ gG 7 33 5 ~ B IIL DATE OF BILL PREV BILL , _:_ HA [ y ( ~ 3;{JU RG~ ~~ 18AUD 05/16/01 <-7.17 ....23:0._.3723: INP. It•!R P„1 € 26177: ~ N~ PA iIENT NAME C j PATIENT NUMBER GUARANTOR BONNIE L ALBRIGHT "AME 829 FISHING CREEK RD °N0 NEW CUMBERLAND PA 17070 ADDRESS Hose. n POLICY NUMBER AGE ADMISSION DATE DISCHARGE DATE DAYS 29 03/29/00 04/11/00 1`. : EipiBi INSURANCE COMPANY NAME GHi :: OTHER INSURANCE GOLDMAN JOHN PLEA E RETt S AMOUNT OF n S 1RN THt PORTtON VG kTH YOUR PAYNSENT. PAYMENT 9 m*E ~ DescRlPTlon of SERVICE I rorAL Es r. eovERgcE EST COVERAGEI Si, CO'+ERAGE ~Si COVERAGE NOS PIi AL SE R'aICES CODE CrygRGES INS. CO NG. 1 INS CO NO T ~ LYS CO NO. 3 MS CO. NO. ° x/10 ~~001 BGM 6021411 8.25 :/10 '001 ROOM M522 60251021 668.00 :/11 101 INSUL ULTRA V 73591051 72.40 ;/11 1002 BGM 6021411; 16.50 I 1 3ALANjCE FORWARD PA nEN~ AMCL NS 8.25 668.OC 72.4C 16.SC - -. '.' r1 TYPE of DarE of BnL oaTe oP -~Q Hc.:;t rLt i:L 4-1 731 3 - FsV bh'.l.IAL~ ~ - PACT xc 6 BILL PREY BILL HA ~;BORIi , P!t 17105 18AUD 05/16/01 717 . 230-3717 83T: HoSP. Nc INP. A/R * I Z~177$bd4 N S PATIENT NAME PATIENT NUMBER SE% AGE ADMISSION DATE DISCHARGE DATE DAYS ALBRIGHT ,BONNIE L 200662570 F 29 03/29/00 104/11/00 13 :':GUAR PEI 717::93$-1L94 J~Q,Bi. INSURANCE COMPANY KAME GROUP NUMBEfl POLICY NUMBER 'uARANroR BONNIE L ALBRIGHT 'i OTHER INSURANCE ""ME 829 FISHING CREEK RD ""D NEW CUMBERLAND PA 17 070 ADDRESS GOLDMAN JOHN PLEASE RETURN THIS PORTION iNETH YOi1R PAYMENT, nMOUNr of $ P4VME NT DESCRIPTION OF D4TE ~ HOS?li ql SERVICES ~ SERVICE CODE TOTAL EST, COVERAGE EST. COVERAGE °' CCVERA GC '~ EST rDyE RAGE j PAT°NT CHARGES INS. CO. nO. t INS. CO. NC 2 '+'- =0 NO 3 INS CO. NO < AMOUNT UMMAiRY OF CHARGES i~ &C S~iEMI-PR 13DAYS 668.00 18684.00 ; 8684.00 EMER DEPT 60 ~ 961.50 961.50 LABORATORY 89 i 948.50 ' 948.50 NUCLEAR MED RN 462.25 I 462.25 PHARMACY 1128.28 ', 1128.28 PHYSICIAN VISIT 60 380.25 380.25 MEDICAL DIAG AZ 669.50 669.50 PULMONARY AZ 93.50 93.50 MED/BURG SUPPLI ES j 741.00 , 741.00 IV SOL/SUPPLIES 288.50 288.50 NURSING ADM 1281.50 1281.50 UB-TIOTAL OF CHARGES ALAN!CE FORWARD SUA R~ RELATIONSHIP S DIAGNOSIS 250.83 780.9 ~, NuM AND 115638.78 I SEX I i F 4UUIilONAI PATIENT BILLING MAY BE NECESSARY FOR ANY CHARGES NOT POSTED WHEN THIS Blll Wai PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE A!lOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. 15638.78 r TYPE OF DATE OF ':B BILL DATE OF BILL PREP BILL 18AUD OS/16/01 ,:Z INP. ASR t u C PATIENT NAME PATIENT NUMBER SEx AGE ADMISSION DATE DR:CNARGE DATE GAYS 00662570 F 29 03/29/00 04/11/00 1: 'L ` HOSRN( POLICY NUMBER 0; T A'L S ~15b38..7$ ] { '€5b38.7?~ PkTIENi NUMBER- - NLm35R ON ALLY PpUR EST ADDITIONAL PATIENT RILL ING MqY ~BE NECESSARY t 'f ..ND :ORRESPONDE NCE fOR ANY CHARGES NOi POSTED WHEN THIS BILL 20O662S7O V+AS PREPARED OR IF INSURANCE CARRIERS DO pAY THIS AMOUNT 15638.7 NOT PqY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. ,v.~. °s. OASE 0 9[Lt HILL CYCLE 4/27/ AIINISSION OAIE ~-ISCMAROE -Ai£ uAgANmgl BONNIE L ALBRIGHT E'''"E If 829 FISHING CREEK RD um A0°~ NEW CUMBERLAND PA 17070 JOHN SEDViCE {WSP F£AL SERVSCES COOL DETA L OF CURRENT CHARGES, P 04120 1211244 001 VIS T-PROS FOCUS EST P 04/20 1211245 001 VIS T-PROS FOCUS EST P99212 04/20 1211246 001 VIS T-PROS FOCUS EST P99212 FORWARD OF CURRENT CHARGES 60 OUTPATIENT VST AL OF CURR. CHARGES AMavM oe 5 " - :. PATMENE - _. . IOLA[ ESe. ,. COVEMOE ESL. COVERAGE FSL COVEGOE ENI. - _. C VEG C[ ~[EM [IUAOES INS. CO_ Y0. ] I95.<0. YO. 2 INS.CO, tl0. ] INS.[O. N0. -M1OONL" VTS AN ADJUSTME TS 40.75 ~ 40. 75 8.75 8. 75 0.00 99.50 I 49.50 49.50 49.50 ACC IDATLATIONSHI P; S TYPE. IB STI~E.F ~UAR NOpL~2CE594881 DIA NOSIS: 250.01 I RE L'' T O fi 12;0; 5 ~ :~ PA'I I ENL N(-1HER pCGSE gEFER LO ppiIFNL rr nn y E ~u~O07~~ ~ YOUI qI ES R . AN° COAR£5P°HO£Y INNACLE HL ~: 99.50 -: ~. ;? ?f9.5A -, A--IiIONAC pA'f{EN! BILLING MAY HE NECEHSARY ~' ,C FjQHI YAS EPrtEpAgED MDR IF£I NSODANCC ICAMIE0.5 AY TH1B AMQUNT 'S 9.SO DO NOI PAY AYY PAq]' OF iM£ AXDVNFS SNaFN TH HOS P 1RipER aTI"^~D IxsnuxcE rovERSCE. HARRISBURG, pA ., SHERIFF'S RETURN - REGULAR CASE NO: 2001-04634 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND PINNACL$ HEALTH SYSTEMS INC VS ALBRIGHT CARRY ET AL SHANNON SUNDAY Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon ALBRIGHT' CARRY the DEFENDANT at 0021:05 HOURS, on the 10th day of August 2001 at 128 HERMAN AVENUE LEMOYNE, PA 17043-1935 by handing to GINA BELICIC (ROOMATE) a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriffs Costs Docketing 18.00 Service 10.40 Affidavit .00 Surcharge 10.00 .00 38.40 Sworn and Subscribed to before me th's ,~~ `"~ day of ~~atsr9 A.DA.D. Prothonotary So s R. Thomas Kline 09/17/2001 ARTUR KUSIC Deputy Sheriff SHERIFF'S RETURN - NOT SERVED CASE NO: 2001-04634 P COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND PINNACLE HEALTH SYSTEMS INC VS ALBRIGHT GARRY ET AL R. THOMAS KLINE Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named DEFENDANT to wit: ALBRIGHT BONNIE L unable to locate Her in his bailiwick COMPLAINT & NOTICE but was He therefore returns the NOT SERVED as to the within named DEFENDANT ALBRIGHT BONNIE L DEFENDANT DOES NOT RESIDE AT ADDRESS STATED ATTY DID NOT FORWARD ADVANCE COSTS TO DEPUTIZE PRIOR TO EXP. DATE Sheriff's Costs: Docketing 6.00 Service .00 Affidavit .00 Surcharge 10.00 .00 16.00 So answer d R. HOMAS KLINE SHERIFF OF CUMBERLAND COUNTY ARTHUR KUSIC 09/17/2001 Sworn and subscribed to before me this ;L7 ~ day of 26v~ A.D. ~ - Proth notary ' ~..~», PINNACLE HEALTH SYSTEMS, INC Plaintiff V. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendant IN THE COURT OF COMMON PLEAS COUNTY PENNSYLVANIA COMBERLAND NOTICE CIVIL ACTION - LAW No. Ot- 443y 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 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 judgment may be entered against you by the court without further notice ror anv money claimed in the Complaint for any other claim or relief requested by the Plaintiff. You may lose rnonev or prcpert~ or other rights important to you. YOU SHOULD TAF:E THIS PAPER TO YOUR LAWYER AT ON~~E. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO UR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CA"J CET LEGAL HELP. LAWYER REFERRAL Cumberland County Court Administrator 4th Floor, Cumberland County Courthouse One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 Dated: Respectfully subml~ted: HUR r. IC, ESOUIRE 4201 Crums Mill Road Post Office Box 67015 Harrisburg, PA 17112 (717) 540-5610 SUPREME COURT N0. 07207 ATTORNEY FOR PLAIIJTTFF TRUE ~PY FR®~ 'R~CiORQ In Testimony whereoY, I here unio set my hard and the. saa ;~ - :-. ' Y )Y_ ~ ~~ PINNACLE HEALTH SYSTEMS, INC. IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY PENNSYLVANIA Plaintiff V. CIVIL ACTION - LAW GARRY ALBRIGHT and BOBBIE L. N0. ALBRIGHT Defendant NOTICIA Le han demandado a usted en la torte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene viente (20) dias de plazo al partir presentar una apariencia escrita o en persona o por abogado y archivar en la torte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la torte tomara medidas y puede entrar una Orden contra usted sin previo aviso o notification y por cualquier queja o alivio que es pedido eri la petition de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDI.ATAMENTE. SI NO TIENE ,4BOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA U LLAME POR TELEFOf~~O A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVEF.IGUAR DONDE SU PUEDE CONSEGUIR ASISTENCIA LEGAL: LAWYER REFERRAL Cumberland County Court Administrator Respectfully submitted: 4th Floor, Cumberalnd County Courthouse One Courthouse Square Carlisle, PA 17103-3387 (71 7 ) 240-6200 ___ _ ~.__ - ARTH - k.US ;-ESQUIRE 4201 Crums Mill Rcad Post Office Box 67015 Harrisburg, PA 17112 (717) 540-5610 SUaREME COURT NO. 07207 ATTORNEY FOR PLAINTIFF Dated: PINNACLE HEALTH 3YSTEM, INC., Plaintiff v. CARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defendaats IN THE COURT OF COMMON PLEA CUMBERLAND COUNTY, PENN3YLVANIA CIVIL ACTION -LAW NO. COMPLAINT AND NOW comes Plaintiff by and through its attorney, Arthur A. Kusic, Esquire, and respectfully represents the following: 1. Plaintiff, Pinnacle Health System, Inc., is a hospital facility organized and existing under the laws of the Commonwealth of Pennsylvania with a mailing address of P.O. Box 2353, Harrisburg, Dauphin County, Pennsylvania, 17105. 2. Defendants, Garry Albright and Bonnie L. Albright are adult married individuals residing at 128 Herman Avenue, Lemoyne, Cumberland County, Pennsylvania, 17043-1935. COUNTI (Plaintiff v. Garry Albright) 3. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 2. 4. On or about April 8, 2000, Plaintiff, at the Defendant's request, provided health care services to the Defendant and thereafter billed the Defendant it usual and customary charges for such services rendered. A copy of the Summary of Charges is attached hereto, made a part hereof, and marked Exhibit "A". 5. Plaintiff did render health care services to the Defendant with the reasonable expectation that payment for such services would be made by the party benefited. 6. Should Defendant not be required to pay for the service rendered, Defendant would be unjustly enriched at the Plaintiffs expense by having received services without paying for the rendered services. 7. Plaintiff has granted Defendant credit for all payments received on this account, leaving a balance due and owing of $466.00. 8. Plaintiff has made demands upon the Defendant for the balance due and owing of $466.00, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $466.00 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT II (Plaintiff v. Bonnie L. Albright) 9. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 8. 10. On or about March 14, 2000 and continuing from time to time through to on or about Apri120, 2000, Plaintiff, at the Defendant's request, provided health care services to the Defendant and thereafter billed the Defendant it usual and customary charges for such services rendered. A copy of the Summary of Charges is attached hereto, made a part hereof, and marked Exhibit "B". 11. Plaintiff did render health care services to the Defendant with the reasonable expectation that payment for such services would be made by the party benefited. 12. Should Defendant not be required to pay for the services rendered, Defendant would be unjustly enriched at the Plaintiffs expense by having received services without paying for the rendered services. 13. Plaintiff has granted Defendant credit for all payments received on these accounts, leaving a balance due and owing of $19,812.93. 14. Plaintiff has made demands upon the Defendant for the balance due and owing of $19,812.93, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $19,812.93 along with interest at the rate of 6% per annum and the costs of this proceeding. COUNT III (Plaintiff v. Bonnie L. Albright) (Doctrine of Necessaries) 15. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 14. 16. Plaintiff believes and therefore avers that the health care services rendered upon request to Defendant Garry Albright, husband of Defendant Bonnie L. Albright, were necessary for his benefit and welfare. 17. Pursuant to the "doctrine of necessaries", codified under 23Pa.C.S. §4201, where debts are contracted for necessaries by either spouse, a creditor may institute suit against husband and wife for the price of the necessaries. 18. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Bonnie L. Albright, is liable to the Plaintiff for the necessary health care services rendered to her husband Garry Albright. 19. Plaintiff has made demands upon the Defendant for the balance due of $466.00, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $466.00 along with interest at the rate of 6% per annum. k COUNT IV (Plaintiff v. Garry Albright) (Doctrine of Necessaries) 20. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 19. 21. Plaintiff believes and therefore avers that the health care services rendered upon request to Defendant Bonnie L. Albright, wife of Defendant Garry Albright, were necessary for her benefit and welfare. 22. Pursuant to the "doctrine of necessaries", codified under 23Pa.C.S. §4201, where debts are contracted for necessaries by either spouse, a creditor may institute suit against husband and wife for the price of the necessaries. 23. Plaintiff believes and therefore avers that pursuant to the "doctrine of necessaries", Defendant Garry Albright, is liable to the Plaintiff for the necessary health care services rendered to his wife, Bonnie L. Albright. 24. Plaintiff has made demands upon the Defendant for the balance due of $19,812.93, which demands remain unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendant in the amount of $19,812.93 along with interest at the rate of b% per annum. COUNT V (Joint and Several) 25. Plaintiff incorporates herein by reference thereto the averments hereinabove set forth in paragraphs 1 through 24. 26. Plaintiff believes and therefore avers that the Defendants are jointly and severally liable to the Plaintiff for the balance due of $20,278.93. 27. Plaintiff has granted Defendants credit for all payments received on these accounts, leaving a balance due and owing of $20,278.93. 28. Plaintiff has made demands upon the Defendants for payment of the balance of $20,278.93, which demands remain unheeded. 29. Plaintiff avers that the amount due and owing does not exceed the jurisdictional amount requiring arbitration referral by local rule. WHEREFORE, Plaintiff prays your Honorable Court to enter Judgment in its favor and against the Defendants in the amount of $20,278.93 along with interest at the rate of 6% per annum. RESPECTFULLY SUBMITTED ~ i Arthur A. Kusic, Esquire 4201 Crums Mill Road Harrisburg, PA 17108 (717) 540-5610 Supreme Court Number Q7~07 Attorney for Plaintiff _,ro PINNACLE HEALTH 3Y8TEM, INC., Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defeadants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENN8YLVANIA CIVIL ACTION -LAW NO. VERIFICATION I ~h/lr-ems ~1~3~ ,the ~tt~tTUiSur~ Q~9Teri~ inane/AL V~<-,~~f'T~ ~~i~~~r/~°`s of PINNACLE HEALTH SYSTEM, INC. verify that the statements made in the COMPLAINT are true and correct and that I am authorized to make this Verification on behalf of PINNACLE HEALTH SYSTEM, INC. I understand that false statements herein are subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authority. PINNACLLE HEALT/H SYSTEM, INC. f2Gt ~Un~ ~j~ ~ By: // Title: 5.cc~JJ(.Sv2 q~ir~~T ~u~Aner~rL. Ste~a~TryLO~~tT/o. Date: G~//D j :~~-,. EXHIBIT "A" INSURANCE LURPANY NARANraa GARRY ALBRI GHT """E 829 FISHING CREEK RD ARP p Rp AES'S NEW CUMBERLAND PA 17 D70 "~~ ~7EAUGUSTINE CARLO J :: : ': " AI(pVNL OF S "' . ~ .. : :. PAYMEIII ..... _ ..........: ._..... ........ _.: ACE OF SERVILE OE$CAIYTION OP SEFV [CE HOSP [TAE SERVICES Cp pE TOTAL CXAgpE$ ISE, COV ERApE 1HS. CO. XO. 1 EST. COVEFApE 2115.[ 0. NO. 2 ESS. COVEM OE INS.Cp. N9. J EST'. COVERAGE INS.CO. d0. PA TENT !J(pIME DETA L OF CURRENT CHARGES, PAY ENTS AN ADJUSTME TS 04/08 7411145 001 93.25 93.25 WD EP II<2.5 CM P/F 12011 04/08 7413538 001 WD EP II<2.5 CM * 12011 09/08 7427036 001 93.75 93.75 REP IR SIMPLE/INTERMED00000 09/08 7411229 001 108.25 108.25 EME MED VISIT III PIF99283 04/08 7913647 001 EME MED VISIT III * 99283 04(06 7425388 001 161.25 161.25 EME MED VISIT IV 00000 04/08 7927033 001 9.50 9.50 SMA L DRESSING 00000 FORWARD OF CURRENT CHARGES 20 SURGICAL 60 EMER DEPT 0.00 289.001 ~ 1 1 1 289.00 SUB- OTAL OF CURB. CHARGES 466.00 GU RE LATIONSHZ P: S SEX: M UAR NO: 2095409 ACC DATE: 04/08/00 TYPE: 5 TI E: 1:30 AM PL CE: DIA NOS IS: 873.42 873.42 460`.00 r O"t"A L S . ! 46fi.Di0 - 466.!TJO PATI ENC NUX BER pC EASE AEEER i0 PAI TEN[ AppITIONAL FATTEN[ BILL [tlC NAY BE NECESS A0.Y 2 Dy~6ry4r~ly HIRiB ER ON ALL INQU I R3 E5 FOA ANY [Np0.GEE NOT POSFEp XN EN TNCS STATE AY 11y IS :. ALVIQ ~NT 466. DD "" V I L. 1 :' pNp COPAESP ONO ENC E. XENE XAS P0.EPAREO. OP IP [RS URg1ICE [q RR IEPS p0 NOT PAY ANY Fp0.T OF 111E AMOUNTS SXONN UNO ER ESEIMATEO INSUAANCE COVE RAO E. PINNACLE HLTH HOSP HARRISBURG, PA EXHIBIT "B" FINAL OF MOSPISAG SERVICES ~ CODE DETA L OF CURRENT CHARGES, PAY 03/14 001 EMER MED VISI 7411230 03/14 001 EMER MED VISI 7413646 03/14 001 EMER MED VISI 7425388 03/14 001 VENIPUNCTURE 7427061 03/14 001 NIBP 7427074 03/14 001 CBC & AUTO DI 0115071 03/14 001 CBC & AUTO DI 0115071 03/14 001 DRUG SCREEN U 0115098 03/14 001 DRUG SCREEN U 0115099 03/14 001 DRUG SCREEN U 0115100 03/14 001 DRUG SCREEN U 0115101 03/14 001 DRUG SCREEN U 0115102 03/14 001 DRUG SCREEN U 0115103 03/14 001 DRUG SCREEN U 0115104 03/14 001 DRUG SCREEN U 0115105 03/14 001 DRUG SCREEN U 0115106 03/14 001 DRUG SCREEN U 0115107 03/14 001 DRUG SCREEN U 0115108 03/14 001 CBC(HEMOGRAM) 0115174 03/14 001 URINE MICROSC 0115189 03/14 001 URZNE DIPSTIC 0115222 03/14 001 ACETONE SERUM 0115988 03/14 001 AMMONIA 0116003 03/14 001 HCG 0116087 03/14 001 MANUAL DIFF 0116130 03/14 001 BASIC METABOL 0117038 03/14 001 HEPATIC FUNCT 0117042 03/14 001 CHEST 2V 7310347 03/14 001 BRAIN UNENHAN 7672452 03/14 002 APAP 325MG TA 7350005 03/14 001 DEX SOo SYR 7350372 03/14 001 INS N 100UN/M 7357187 03/14 001 EKG 7380695 CRMU6 I I[6.CO OPEP90El I I-S.Cp~ W.-3 I INS.CO.wNO.UEI I ~-CDw-O.SE~ANOUHt 163.50 163.50 161.25 161.25 8.25 8.25 35.25 35.25 41.50 41.50 41.50 41.50 16.00 16.00 15.50 16.00 16.00 16.00 16.00 16.00 16.00 16.00 36.00 13.00 16.00 20.75 75.75 59.75 15.00 52.00 62.25 115.50 761.00 6.00 14.50 7.25 136.00 16.00 16.00 15.50 16.00 16.00 16.00 16.00 16.00 16.00 16.00 38.00 13.00 16.00 20.75 75.75 59.75 15.00 52.00 62.25 115.50 761.00 6.00 14.50 7.25 136.00 PA1'IFFL H@IBER pCE89E REFER Yp pAiIEM A-DITIOHAC ppY'IEY[ HIItIRC NAY SE VECYSSMY '; .: HUMBER -N ACC INpUIR[ES YOR ANy CUARUES ROT POSgR NN@1 11(IS SIAIY- ' A-O CURRESPONOERCE. MHRI YM PREPAI®, OR IP IRSUPARCE CARNEPS -O HOT PAY AHY PARS OY TIE AMOIpI[S SHOFN UNUFR CCIINASED iNSURARCE COVERAP.E. FINAL b4/24/ MIQSSiap pA1t pisCIRRDe pAtC :uARAYrpR BONNIE L ALBRI GHT 829 FISHING CREEK RD Ann~ss NEW CUMBERLAND PA 17070 IR9WMCE (d1@AHY N/:M DP-OP RDM6E4 PpC[CF MD'9E L (B.O. USE ON 90143725 Z JOSEPH R AxpuRt oe I S seRVUe 11psPPEAL seavi~ eopE auppes 03/14 001 EKG 7380695 136.D0 03/14 001 NURSING UNIT 6191235 30.50 03/14 001 ROOM N955 6195137 668.00 03/15 001 CBC(HEMOGRAM) 0115174 38.00 03/15 001 SEDIMENTATION 0115218 24.00 03/15 001 INSUL NPH VL 7350683 72.40 03/15 001 HOSP INITIAL- 1459222 196.25 03/15 001 EEG-AWAKE 7390799 334.75 03/15 001 MR BRAIN S co 0680551 935.00 03/15 005 BGM 6191417 41.25 ETT~_~ ov~ aea I aus.cD~ Ro.c z I aRS. ca.~RO.D ~ I I~.m ovERACE~ ~ac~E~Y. 136.00 30.50 666.00 38.00 24.00 72.40 196.25 334.75 935.00 41.25 PARP~E,BY~Iy! ~~pp yH!I!-~IHLER pCEA9E REFER t0 PAYIPHY Ap-ISIp&V. PA'FIFlII HIILIIIC 1@Y HE NECEEEARY YFL.C}Y p:95~. .: _ ANp-CpRRE5POR4FMCEDi4IE3 YRR ARY CINNCPS RpP POSIYD MH® 1RI5 SEAYE- _... ...:.........::::......__.. ... IDILF YAE PIIEPARHD. pR IF IRHDRARCE CAARIERH ~_~ -0 YOT PAY ARY PART OP 11@ AHDIffiIS SRO41I PINNACLE HEALTH HOSPITALS 1°'0~ miYAtzD iRSUZwcE covHRACE. HARRISBURG, PA DRL HILL FINAL 4/24/00 cuARANroaI BONNIE L ALBRI GHT ,""'@~ 829 FISHING CREEK RD ADDS NEW CUMBERLAND PA 17070 eulmEa ~IX ( ANe ~ ADx-ssroa RAVE ~ -ISCNAaoe RAIY JOSEPH R aP I s senvxcE x-seerAL sES°ICes eooe S Y OF CHARGES R6C EMI-PR 1DAYS@ 668.00 EMER DEPT 60 LABORATORY 89 RADIOLOGY RD C.A.T. SCAN RD PHARMACY PHYSICIAN VISIT 60 MEDICAL DIAG AZ MRI RD SPECIAL CARE UNIT OF CHARGES L-LU ~ luc rD ~c~0ea I IRS.c-. YR~o.NEZ ( LRS.cP wao uE' I INS.cD ~rNO ucq ANOUNr cenxars __ . 668.00 668.00 368.25 368.25 574.00 574.00 115.50 115.50 761.00 761.00 100.15 100.15 196.25 196.25 334.75 334.75 935.00 935.00 71.75 71.75 4124,65 ~ 4124. RELATIONSHIP: S SEX: F DATE: TYPE: B TI E: /FINAL DIAGNOSIS: 250.81 DIAGNOSIS: 251.2 THIS BILL IS FOR YOUR BY ACT 89-COST CONTAI: INTENDED FOR INSURANC PAID BY YOU. YOU WILL BILLING FOR ANY BALAN COMPANY HAS PROCESSED PAT1EIff N10(HEa 1 pLFAgE PEFEA i0 PARFNf ~v4~6•A ~ay~y :: 9UNBER OR ALL INpOLRIES UU YY~~ J .l [( AHO WRRESPOdPENCE. PINNACLE HEALTH HOSPITALS HARRISBURG, PA FORMAT ON ONLY NT CO CIL. IT URPOSE AND IS CEIVE SE PARR DUE AF ER THE IImmAR¢ C01@ARY vANE maIRER PoL[cx NalmeR L(B.O. USE ON 90143725 NO: NOT ' TO BE A--ISIONAL PAiIE[:l' HILLItlC NAY HE NECEESARY FOA AAY CIRRNES a0S POSFEII MIEN INIE SFAFE- 1mlF MAE PREPARED. OR IP INSURANCE GRAIEAS DO NOF PAY AN4 PA0.1' OP ll2 ANONNIN 6HORA VNNffi YSTINAIH- INSN4VICE COVERAGE. ' 159488 E: "^3w a RILL BILL PREP.PILL ,~~ I~BGF. ~~ ...-... .. _.- ~.'~ FINAL Q/24/00 ~~,~- x 34 3'~~7- ~_; -- - AEI #.:_:=~SI~78~~~ ~. _._...._.:.:.--_.._...... - .:...E.._ ......: _...._....--......._.:._: D S PAIL CNT ~~ PfSffiIL BOMBER RIX AGC ARIQSSIRR RAE RISt'EIRRE RAiE ,C, ~,O_,H@ IYAIPAYI.E IVIQ'AYF YAM¢ DROOP YUXtl clt POLICY pRYRE0. wuuRPDa BONNIE L ALBRI GHT ...1!' : HL (B.O. USE ON 0 90143725 YN6 829 FISHING CREEK RD : e ~--~~' ANO _' AnnRSR NEW CUMBERLAND PA 17070 _ - .......=.:_' ARLISI JOSEPH R c ' ~ AIE OF BFSCRIPSIOY OF ~~ REHVECE LOSAC ESE, CWEEIOE ESI. COVEYAOE F3I. COVEPAOE ESf. wVERAGC PAIIEIIL SEINICE YOSPISAL SEaVICES CDOC CIP.RDES I~,CD. YD. 1 IPS.CO. YD. 3 INS.CO. Y0. D SYS. CO. YD, ANDOYI OSZS AND PROCEDURES: MITTING DIAGNOSIS: 251.2 HYPOGLYCEMIA OS SCHARGE/FINAL DIAGNOSIS: 250,81 *DMl W MANIFES NEC, 784.3 APHASIA 305.1 TOBACCO USE D BORDER ATE CARE: CHARGE DESTINATION: AHR ES: ENT: BONNIE L ALBRI GHT 829 FISHING CREEK RD NEW CUMBERLAND PA 1707 EMPLOYER: HOMEMAKER 00000 PAILEHI RUBBER PLEASE REFER i0 PAiIEYL ADHILIO[AL PA2I@T HRLEC MAY HE NECCSCARY - _ RIpBFR DR ALC INpUIRIES FBR ARY [IRRGFS NDH POSER yHFN TfIS SCASE- :. ,,,,,,, :. AtlD wRPESPOpDEYCE. MEM yA5 pRFPARCD. OR IP INSNUNCC CARRICRH 00 NDI PAY ANY PARS NP IHE AMDIRIIS SYOGN NNCR ESIINASED INSURANCE COVERAGE. acct atu eREV.eIEC _ S~$li$Gk ~~ _ .:~:y FINAL 74/24/06 '~~"~ 2~{I X77,7 . +- - ~~T~I-. ~~~.778644 D S p'~~ NANE PATIENL N111®E0. SE% AOE APIYSSION GATE OISCflARUE aAR C O 9-_ INARANCE COIRANY NAME ovoW pYN9 E¢ pOCFM pIMBE wARAxroR BONNIE L ALBRI GHT L~ HL (B. O. USE ON 90143725 ""'~ 829 FISHING CREEK RD ~~ AND --- ADDS NEW CUMBERLAND PA 17070 ~~~ ARLISI JOSEPH R - ..: rrrW:4W.W AN-DNr De 5 ~~~ ~ :: ~. PAYNENt ATE OF -FSCRIPITON ~ OF EEeVtCE TOTAL ESL. COVEpAOE FSI. CtlVE&NIE ESI. COVERAGE ESL COVERAGE PAIIEtl< SEN[<E tlOSPISAC EERVI[ES CODE CHARGES INS.CO. N-. 1 INS.CO. tlD. S IHS.CO. tl0. ] [NS.CD. ND. AMDVIIS BILLIN ABST CT C NCURRENT GROUPER USED: M 99 D G #: 295 MDC #: 10 D G RATE PER CASE: 3404 47 O TLIER VALUE: G DUPER USED: P 9 (5 O) D G #: 295 MDC #: 10 D G RATE PER CASE: 2789 20 O TLIER VALUE: PAS[EFL NIpOEN pCEASE NEFER SO PAIIENE ADOII'IONAL. PAiIEH[ DICLIND XAY EE NECESSARY .. :: NVaDE0. ON ACC INpUIRIES FOR ANY CHA0.GEE NOS POSEED NNEN IHLE SLATE- ': Atl0 CORRESPONDENCE. N@R' NAS PREPARED, 00. IF IRSIIpBNCE CARRIEPS ~~~~~ -O NO[ PAY ANY PARY OF ]NE AMDVNIS SNOY[1 NNDER £S[INATED IH9IWWCE COVERAGE. ' TYPE OF DATE OF BILL DATE DF B0.L PREY, BIIL 18AUD 05/16/01 ' INP. A~12 N C PATIENT NAME PATIENT NUMRER )BEX~ AGE ~ ADMISSION DATE ~ DISCHARGE GATE DAYS PAGE NO. 1 HOSP. NO DATE DESCRIP iION OF HOSPITAL SERVICES SERVICE CODE TOTAL CHARGES ES T.COVERAGE INS. CO. NO. t EST COVERAGE ~ EST COVERAGE 1 EST.~COVERAGE INS. CO. rvO. 2 INS. CO. NO. 3 INS. CO. NO. a PATIENT 4M0UnT DETAI L OF CURRENT CHARGES, PAY MENTS AND ADJUSTME NTS )3129 01 EMER MED VISI 7411228 85.00 I ~ 85.00 )3/29 01 EMER MED VISI 7413646 I ~ 1 )3/29 01 URINARY CATH 7427004 17.75 I ~ 17.75 )3/29 01 BLOOD GLUCOSE 7427D57 52.50 ~ ~ I 52.50 )3/29 01 VENIPUNCTURE 7427060 7.25 ~ ~ 7,25 )3/29 •01 OXYGEN SET-UP 7427063 4.25 ~ II ~ 4.25 )3/29 •D1 CARDIAC MONIT 7427072 86.00 I i 86.00 )3/29 i01 NIBP 7427074 35.25 ~ II ~ 35.25 )3/29 03 NON CRIT OBSE 7427082 81.00 I I 81.00 )3/29 03 EMER MED VISI 7428279 592.50 i I 592.SC )3/29 01 CBC & AUTO DI 0115071 41.50-I I i 41.50 >3/29 •01 CBC & AUTO DI 0115071 41.50 I 1 ~ I I 41.50 )3/29 01 CBC HEMOGRAM 0115174 38.00 1 i i 38.00 )3/29 01 GLUCOSE 0115216 24.00 II I 24.00 )3/29 001 CBC & MANUAL 0116023 1 53.00 1 53.OC )3/29 01 DRUG SCREEN S 0116051 ~ ~ )3/29 01 DRUG SCREEN S 0116052 34.75 ( I I I 34.75 13/29 01 DRUG SCREEN S 0116053 34.75 1 I 34.75 13/29 01 DRUG SCREEN S 0116054 5 34.75 1 ~I 34.75 13!29 01 DRUG SCREEN S 011605 34.75 ~ ~ ! 34.75 13/29 01 DRUG SCREEN S 0116056 34.75 i 1 ~ 34.75 )3/29 01 DRUG SCREEN S 0116057 34.75 ~ ~ ~ 34.75 13/29 01 DRUG SCREEN S 0116058 34.75 ~ I 34.75 13/29 01 DRUG SCREEN S 0116059 34.75 ! ~ 34.75 13/29 01 MAGNESIUM 0116128 19.00 i 11 I I 19.00 13/29 01 MANUAL DIFF 0116130 15.00 I ii 1 ' 15.00 13/29 01 SALICYLATE 0116168 41.00 I I I I 41.00 13/29 01 BASIC METABOL 0117038 52.00 ~ I I 52 00 3129 01 DEX 5 -100 BG 7350368 18.05 ~ ~ . 18.05 3/29 01 NSS-100 BG 7357014 18.05 ~ ~ 18.05 3/29 04 MG 0.5 GM/ML 7357110 17.00 '1 17.00 3/29 04 MG 0.5 GM/ML 7357110 17.00 i i ~ 17.00 3/29 01 INSUL R 1000/ 7357113 17.35 17.35 PATIENT RDMB R ~ _. PLEASE REFER TO PgTIENi NUMBEft Orv All InOUIR IES ADDRIONAL PATIENT BILLING MAY BE NECESSARY i AND CORRESPONDENCE. FOR qNY CHARGES NOT POSTED WHEN TH6 Rlll wAS PREPARED OR IF INSURANCE CARRIERS DO I PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. NUN dER ON ALL INpUIRIES ADDITIONAL PATIENT BILLING MAY BE NECESSARY AND CORRESPONDENCE. fOR ANY CHARGES NOT POSTED WHEN iH15 BILL WAS PREPARED OR If INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UxDER ESTIMATED INSURANCE COVERAGE. __ ', PACE NO ' TYPE OF DATE OF BILL DATE OF BILL pREV. BILL 18AUD 05./16/01 INP. ~~/R PATIENT NAME PATIENT NUMBER GUARANTOR BONNIE L ALBRIGHT "AME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17D70 pDDREiS GOLDMAN .JOHN ;gMOUNT OF~ PAVMENI HOSP. NC pATE ~~DESCRIP TION OF ~ SERVICE TOTAL EST COVERAGE EST. COVERAGE 'S COVERAGE EST. COVERAGE PATIENT HOSPITAL SERVICES CODE CHARGES INS. CO. NO. 1 INS. CO. NO. 2 55 CO. rv0. 3 INS. CO. NO. A 4MOUNi 3/31 01 T4 FREE 0115175 51.00 51.00 3/31 01 BASIC METABOL 0117038 52.00 52.00 3/31 01 VENIPUNCTURE 0151500 5.25 i 5.25 3/31 01 SC 99MTC 7342656 36.25 ~ ~ 36.25 3/31 01 INSUL REG VL 7350685 72.40 I I 72.40 3131 I 11b NACL 4ME4lML 7351238 70.43 ~ f 70.43 3/31 1 01 NSS-100 BG 7357014 18.05- I, ! ~ 18.05 3/31 01 INSUL R 1000/ 7357113 17.35- ~ ~ j 17.35 3{31 003 DEX 10 -1000 73571b2 ~ 51.00 `~ I 51.00 3/31 01 HOSP SUBS4-LE 1459232 92.00 ~ 92.00 3/31 01 IV PUMP DAILY 6308087 1 66.75 i 66.75 3/31 01 IV PUMP DAILY 6308087 66.75 I 66.75 3/31 01 RSTART VENIPU 6290903 78.75 ! ! 78.75 3/31 01 NURSING UNIT 60212351 49.50 ~ ~ i 49.50 3131 01 BGM 6021411 , ` 8.25 I ~ i 8.25 3/31 01 ROOM M522 6025102 668.00 I ! ~ 668.00 4/01 •01 BASIC METABOL 0117038 52.00 52.00 4/01 X01 VENIPUNCTURE 01515D0 5.25 I ~ 5.25 4/01 77 NACL 4ME4/ML 7351238; 46.95 ~ ~ 46.95 4/01 154 NACL 4ME4/ML 73512381 93.90- ~ 93.90 4/01 02 DEX 1D -1000 7357162 ) 34.00 ~ ~ 34.00 4/01 04 DEX 10 -1000 7357162 1 68.00- ~ 68.00 4/01 01 IV PUMP DAILY 6308087 66.75 ~ ~ i 66.75 4/01 01 IV PUMP DAILY 6308087 1 66.75 ; ~, 66.75 4/01 01 NURSING UNIT 6021235 49.50 ~I 49.50 4/01 04 BGM 6021411 33.00 ~ ! 33.00 4101 01 ROOM M522 6025102 668.00 ~ j 668.00 4/02 01 HEPATITIS C A 0140754 59.25 ~ 59.25 4/02 01 INS LISPRO VL 7354264 163.60 I i 163.60 4102 01 NURSING UNIT 6021235 49.50 I 49.50 4/02 04 BGM 6021411 33.00 33.00 4/02 004 BGM 6021411 33.00 33.00 4/02 •01 ROOM M522 6025102 668.00 , 668.00 4/03 39 NACL 4MEQ/ML 7351238 1 23.48- 23.48- PATIENT NUMBER ! PLEASEREFER TO PATIE rvi NUMBER ON ALL INOUIR IES ADDITIONAL PATIENT BILLING MgYBE NECESSARY I l AND CORRESPONDENCE FOR ANY CHARGES NOT POSTED WHEN THIS BILi wA5 PREPARED OR IF INSURANCE CARRIERS DO FIY1 YAHI Vh IHt AMVNNIS SH(JWf UNDER ESTIMATED INSURANCE COVERAGE. TYPE OF DaiE OF BILL DATE OF BILL PRE V, BILL I I N P . ['. 05/16/01! PAGE N( HOSP, N N S PATIE Ni NAME PATIENT NUMBER SEX AGE ADMISSION DATE DISCHARGE DATE DAVS ALBRIGHT BONNIE L 200662570 F 29 03/29/00 04/11/00 13 _ GUAk`PH X17 938=1&$~ ~ Cd,Bi. INB URANCE COMPANY NAME GROUP NUMBER POLICY NUMBER Guaaa"ioR gONNIE L ALBRIGHT J.; OTHER INSURANCE "AME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS ' ,i GOLDMAN JOHN C p~~{ p [' l'~ .Tf n ~j i I] /. PLEASE RC.1 ~4A~ T(lEJ I'~A~f~1\ ~i~ ~~R f'f1E~F. ! - AMOUNT OF PAYMENT DATE DESCftIP LIONOF HOSPITAL SERVICES SEflVICE CODE TOTAL CHAR E ES i. COVERAGE EST. COVERAGE ES i. COVERAGE ESt.~CCVERAGE PATIENT G S INS. CO. NO. I INS_ CO. NO 2 iNS CO. rvO 3 INS. CO. nO. A AM DENT 04/03 01 DEX 10 -1000 7357162 17.00- ~ 17.00 04/03 01 RSTART VENIPU 6290903 78.75 I. 78.75 04/03 01 NURSING UNIT 6021235 49.50 ~ 49.50 04/03 OS BGM 6021411 41.25 I 41.25 04/03 01 ROOM M522 6025102 668.00 ~ ~ ' j 668.00 04/04 01 D/C IV,IPID,P 6290910 17.25 ~ 17.25 04104 01 NURSING UNIT 6021235 49.50 ~i I 49.50 04/04 SOS BGM 6021411 41.25 I I I 41.25 04/D4 01 ROOM M522 6025102 668.00 ~ ! ~ , 668.00 04/05 X01 INS LISPRO VL 7354264 163.60 ~ I ! 163.60 04/05 001 RSTART VENIPU 6290903 78.75 ~ 78.75 04/05 ~0001 NURSING UNIT 6021235 49.50 ~ 49.50 04/05 j006 BGM 6021411 49.50 ~ ' ' 49.50 04/05 ~1 p003 BGM 6021411 24.75 I i 24.75 04/05 01 ROOM M522 6025102 668.00 I II 668.00 04/06 01 DEX 50 SYR 7350372 14.50 I 14 50 04/06 01 DEX 50 SYR 7350372 14.50 ~ ~ . ~! 14 50 04/06 01 NURSING UNIT 6021235 49.50 '1 I . ~ 49 50 04!06 04 BGM 6021411 33.00 j . j 33 00 04/06 01 ROOM M522 6025102 ~ 668.00 ~ . 668 00 04/07 01 EEG-AWAKE 7390799 334.75 ~ ~ I . ' 334 75 04/07 01 NURSING UNIT 6021235 49.50 ; . I 49 50 04/07 04 BGM 6021411 33.00 I . 33 00 04/07 01 ROOM M522 6025102 668.00 I . 668 00 04/08 01 NURSING UNIT 6021235 49.50 . 49 50 04/08 03 BGM 6021411 24.75 ~ I 1 ~ . i 24 75 04/08 01 ROOM M522 6025102 . 668.00 i i . 668 00 04/09 001 GLUCAGON VL 7350573 329.00 I ~ . j 329 00 04/09 D1 D/C IV,IPID,P 6290910 25 j 17 . 04/09 01 NURSING UNIT 6021235 . 49 50 17.25 04/09 04 BGM 6021411 . 33 D0 49.50 04/09 01 ROOM M522 6025102 . 668 00 I I 33.00 04/10 01 NURSING UNIT 6021235 . 49 50 '' j 668.00 04/10 004 BGM 6021411 . 33 00 j 49.50 . i j 33.00 AND ADDITIONAL PATIENT BILLING MAV BE NECESSARY FOR ANY CHARGES NOT POSTED WHEN THIS BILL wAS PREPARED OR IF INSURANCE [ARRIERS DO NOT PAY ANT PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. :rT. _, ' TYPE OF GATE OP BILL DATE OF Blll PRE V, BILL 18AUD 05/16/01 . INP. `A/R PATIENT NAME PATIENT NUMBER cuARANTDR BONNIE L ALBRIGHT "AME 829 FISHING CREEK RD AND NEW CUMBERLAND PA 17070 ADDRESS AGE ADMISSION DATE DISCHARGE DATE DAYS 29 03/29/00 04/11/00 1: C,4,BINSURANCE COMPaNr rvAME GR~ ;'iOTHER INSURANCE PAGE N( HOSP, N POLICY NUMBER I GOLDMAN JOHN PLEASE RETi3RN THtS PORTEON WITH YOUR PAYM ENT. AMOUNT OE PAYMENT S ~ DATE i DESCRIPTION OF HOSPITAL SERVICES SERVICE i CODE TOTAL EST, COVERAGE EST. COVERAGE i -ST, COVERAGE EST. COVERa G`.~ PATIENT CHARGES INS CO. NO. 1 INS. CO. NO. 2 I VS CO. NC 3 INS. CO. NO 6 qM OL'NT 04/10 001 BGM 6021411 8.25 ! 8.25 04/10 001 ROOM M522 6025102 668.00 668.00 04/11 ~01 INSUL ULTRA V 7359105 72.40 ~ ~ 72.40 04/11 602 BALANCE BGM FORWARD 6021411] 16.50 ' ~I 16.50 I -:-.:-II1v.~ua.,r o :: ::: ::115638::7$ -PATIENT NBMBE8 - - PLEASE REFER i0 PATIENT ADDITIONAL PATIENT BILLING MAY eE NECESSARY NVMBER ON ALL INQUIRIES FOR ANY CHARGES NOT POSTED WHEN THIS BILL 200662570 ANO CORRESPONDENCE. wA5 PREPARED OR IF INSURANCE CARRIERS DO P A Y T H I S A M O U N T 1 5 6 3 8. 7 NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE PINNACLE HEALTH HOSPITALS HARRISBURG, PA I cuARANTOR BONNIE L ALBRI6HT "AME 829 FISHING CREEK RD ""D NEW CUMBERLAND PA 17070 qDD RES$ INSURANCE COMPANY NAME OTHER INSURANCE POUCY NUMBER t ,~ GOLDMAN JOHN Pi.EASE RETURN THtS PC)RTkON YUtTH YOilR PAYM ENT . qPO MFNTOF [. S __ SERVICE ' DATE DESCRIPTION OP TOTAL E$T. CONE RAGE ES i. COVERAGE S' CO YERAGE ES i, COV'cRAGE PATIENT HOSPIi AL SERVICES CODE CHARGES INS. CO. N0. 1 INS. CO. NO. 2 n5. CO NO 3 INS CO NO A AMOUNT SUMMARY OF CHARGES R&C SEMI-PR 13DAYS 668.00 8684.00 ~ 8684.00 EMER DEPT 60 461.50 ~ 461.50 LABORATORY 89 948.50 i I ~ 948.50 NUCLEAR MED RN 462.25 I I 462.25 ~, PHARMACY 1128.28 ~ ; i 1128.28 PHYSICIAN VISIT 60 380.25 I I 380.25 MEDICAL DIAG AZ 669.50 669.50 ~, PULMONARY AZ 93.50 ' ~ 93.50 ', MED/SURG SUPPLIES 741.00 ~ j ~ 741.00 IV SOL/SUPPLIES 288.50 ~~ I 288.50 I NURSING ADM 1281.50 I i 1281.50 SUB-TOTAL OF CHARGES BALANCE FORWARD GUAR RELATIONSHIP S DIAGNOSIS 250.83 780.9 15638.78 SEXY F GIUAR NO i i 1594881217 i 15638.78 i~c~zs.ra ( <563t±.78 :E REFER i0 PATiENT 4DDIT IONAL PAifENT BILLING MAYBE NECESSARY ER ON ALL INpUfR IES FOR ANY CHARGES NOT POSTED WHEN THIS BILL C ORRESPONOENCE. WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE CO`/ERAGE. TYPE OF DATE Of RILL ppiE OF BILL PREY, BILL 18AUD OS/16/01 - INP_ AfR NI C PATIENT NAME GunRANTDR BONNIE L ALBRIGHT "AME 829 FISHING CREEK RD ""D NEW CUMBERLAND PA 17070 4ODRESS B3TIENi NUMBER PLEASE REFER TO PATIENT ADDITIONAL PATIENT BllllnG MAY BE NECESSARY NUMBER ON ALL INQUIRIES 4ND CORRESPONDENCE. FOR ANY CHARGES NOT POSTED WHEN THIS Blll 200662570 WAS PREPARED OR IF INSURANCE CARRIERS DO pAY THIS AMOUN NOi PAY ANY PART OF THc AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE. PINNACLE HEALTH HOSPITALS HARRISBURG, PA PAGt NO 7 HOSP, NC AGE ADMISSION DATE DISCHARGE DATE PAYS ?9 03/29/00 04/11/00 13 C.O;Bi INSURANCE COMPANY NAME Gfl OUP NUMBER POIICY NUMBER ::'OTHER INSURANCE PATIENT NBMBEB 38.7F', CYCLE p4/27/00 L A~INIEEIDtl oAFE lo[scHAWE oA1E IdSIRA4CE COMPANY HALE IDRDOP dtOIRER uaenamal BONNIE L ALBRI GHT """E I` 829 FISHING CREEK RD ARo Aonaess NEW CUMBERLAND PA 17070 JOHN E OF SERVICE DESCIpp110R ~ OF SERVICE HDSPIiN- SERVICES CODE ]9IAL CINROER SL. CWERAOE IIS.CO. tl0. 1 . ESS. CDVERAOE INS.CO. dp. 3 : AXOIMI pF 5 'i PAYXENF ESE. CDVEPAVE ESE COVERAGE PASIEdL INS.CO. tlO. ] INS.FA. d0. AdODdI DETA L OF CURRENT CHARGES, PAY ENTS AN ADJUS THE TS 04/20 1211244 001 VIS T-PROS FOCUS EST P 04/20 1211245 001 40.75 40.75 VIS T-PROS FOCUS E5T P99212 04/20 1211246 001 8.75 8.75 VIS T-PROS FOCUS EST P99212 BA CE FORWARD 0.00 SU Y OF CURRENT CHARGES 60 OUTPATIENT VST 49.50 g9,g0 SUB- OTAL OF CURR. CHARGES 49.50 49.50 GU RELATIONSHIP: S SEX: F UAR NO: 1594881 7 ACC DATE: TXPE: B TI E: P CE: EMPL RE L : ..DIA NOSIS: 250.01 .~ ~: PAFIEdt HIpDE0. ~pLEASE REFER tp PAIIFISI ~~~~ ~~~~ :: ~CORRES PONDENCE~RI ES PINNACLE HLTH HOSP HARRISBURG, PA ADDIiFpdAL PAiIOIF BILLING RNY BE DECFSSARY FGp ANY CHARGES ROT Pp5[IIp NBEI] iNIS SFAtE- RLVF (0.S PREPARID. OR IF {DSUYARCE GRRIERS pll 8pI PAY ARY PARS OF THE AMOIIHPS SHOFN RRO® L4CINATED IIIDRNRCE COVERAGE. _n~ v~ ~~~ ~~~~~ ~~~ ,,~,~ spa ~ ~, t~, :, .:.;,a ~,i~.,: .. ;~. ~ni~aa 33ii~~4a„ , . 1 Arthur A. Kusic, Esquire Supreme Court Number 07207 4201 Crums Mill Road Harrisburg, PA 17112 (717) 540-5610 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS PINNACLE HEALTH SYSTEMS, INC CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. :CIVIL ACTION -LAW GARRY ALBRIGHT and BORI~CE L. ; ALBRIGHT NO;01-4634 Civil Defendant IMPORTANT NOTICE TO:GARY ALBRIGHT DATE OF NOTICE: Septe>eber 28, 2001 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 WITHIN 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 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. LAWYER REFERRAL RESPECTFULLY CUMBERLAND COUNTY COURT ADMINISTRATOR 4th FLOOR, CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUP.RE CARLISLE, PA 17103-3387 (717) 240-6200 L Arthur A, Kusic, Esquire Supreme Court No: 07207 4201 Cruets Mi71 Road Harrisburg, PA 17112 (7i7) 540-5610 PINNACLE HEALTH SYSTEMS, INC Plaintiff v. GARRY ALBRIGHT AND BOE L ALBRIGHT Defendant Attorney for Plaintiff : IN THE COURT OF COMMON PLEAS :cuMBERLANn::COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 01-4634 Civil NOTICIA IMPORTANTE A: GARRY ALBRIGHT FECHA DE NOTICIA: September 28, 2001 USTED NO HA COMPLIDO CON EL AVISO ANTERIOR PROOUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI USTED NO ACTUA DENTRO DE DIEZ (f0) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA LISTED SIN UNA AUDIENCIA Y LISTED PODRIA PERDER SU PROPIEDAD O OTROS DERECHOS IMPORATANTES. LISTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEQUIDA. SI LISTED NO TIENNE ABOGADO O NO TIENE CON QUE PAGAR LOS SERVIDIOS DE UN ABOGADO, VAYA O LLAME A LA OFICIAN ESCRITA ABA/O PARR AVERIGUAR A DONDE LISTED PUEDE OBTENER LA AYUDA LEGAL: LAWYER REFERRAL CUMBERLAND COUNTY COURT ADMINISTRATOR 4th FLOOR, CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA -17103-3387 (717) 240-6200 RESPECTFULLY SUBMITTED: ARTH - K IC, ESQUIRE PINNACLE ~-IEALTH *IN THE COURT OF COMMON PLEAS SYSTEMS, INC., *CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff * v. CIVIL ACTION -LAW * NO. 01-4634 civil CARRY ALBRIGHT and *, BONNIE L. ALBRIGHT, Defendants CERTIFICATE OF SERVICE I, Catherine St. Pierre, paralegal for Arthur A. Kusic, Esquire, do hereby certify that on this 28th day of September, 2001, I placed in the United States mail true and correct copies of the Important Ten Day Notice with fast class postage affixed and addressed to the following: Garry Albright 128 Kerman Avenue Lemoyne, PA 17043-1935 Catherine St. Pierre, Paralegal ARTHUR A. KUSIC, P.C. 4201 Crums Mill Road Harrisburg, PA 17112 (717) 540-5610 _ y ,» Ci r.-, =- -,~; =~ ~~"~ `~ ~ - r ~ P „s , --- yc __ { ~t~ SHERIFF'S RETURN - OUT OF COUNTY E CASE N0: 2001-04634 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND PINNACLE HEALTH SYSTEMS VS ALBRIGHT GARRY 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: ALBRIGHT BONNIE L but was unable to locate Her deputized the sheriff of LEBANON in his bailiwick. He therefore serve the within COMPLAINT & NOTICE County, Pennsylvania, to On November 21st 2001 this office was in receipt of the attached return from LEBANON Sheriff's Costs: Docketing 18.00 Out of County 9.00 Surcharge 10.00 Dep Lebanon Co 28.23 .00 65.23 11/212001 ARTHUR KUSIC So answe . Thomas Kline Sheriff of Cumberland County Sworn and subscribed to before me this d4 t` day of 72~,~w o2 ov( A.D~~11. Prothonota~~ CIVIL COMPLAINT No. 01-4634 PINNACLE HEALTH SYSTEMS, INC vs. BONNIE L. ALBRIGHT Lebanon, PA, November 19, 2001 ARTHUR A. KUSIC, P.C. 4201 Crums Mill Road P.O. Box 67015 Harrisburg, PA 17112 (717) 540-5610 (RETURN TO CUMBERLAND CO. SHERIFF) DOCKET PAGE 16999 STATE OF PENNSYLVANIA } COUNTY OF LEBANON } SS: Ferdinand J. Sammer, Deputy Sheriff, being duly sworn according to law, deposes and says that he served the within REINSTATED CIVIL COMPLAINT upon BONNIE L. ALBRIGHT, the within named DEFENDANT, by handing a true and attested copy thereof, personally to her, on October 8, 2001, at 11:01 o'clock A.M., at 4 Daniel Drive, Lebanon (S. Lebanon Twp.), Lebanon County, Pennsylvania, and by making known to her the contents of the same. Sworn to and subscribed before me this 19th day of November, A.D., 2001 Notary Public l N~IARIAL SEAL. NA GY L. S1AftNER. Notary Publie Lebanon. Lebanon County. Pe, Mr Commission Expires August 8, ~OOg SHERIFF'S COSTS IN ABOVE PROCEEDINGS Advanced costs paid on 10/5/01 Check No. 4915 Amount 100.00 Costs incurred: Amount 28.23 Refund: Check No. 10773 Amount 71.77 All Sheriff's Costs shall be due and payable when services are performed, and it shall be lawful for him to demand and receive from the party instituting the proceedings, or any party liable for the costs thereof, all unpaid sheriff's .fees on the same before he shall be obligated by law to make return thereof. _Sec. 2; Act of June 20, 1911, P.L. 1072 In The C®urt ®f Carnin®n fleas ®f Ca~merland County, Penla~sylvariia Pinnacle Health Systems Inc. VS. Gary Albright et al SERVE: Bonnie L. Albright O1 4634 civil No. Now, October 2, 2001 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputi2e the Sheriff of Lebanon County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. ~'y"'~~°° w, Sheriff of Cumberland County, PA Afi"idavit of Service Now, within upon at by handing to a copy of the original and made known tc the contents thereof. So answers, Sheriff of County, PA COSTS Sworn and subscribed before SERVICE $ me this _ day of , 20 MILEAGE AFFIDAVIT 20 , at o'clock M. served the ,m~,~~ Arthur A. Kusic, Esquire Supreme Court Number 07207 4201 Cruets Mitt Raad Harrisburg, PA 17112 (717} 540-5610 Attorney for Plaintiff PINNACLE HEALTH SYSTEMS, INC: IN THE COURT OF COMMON PLEAS ~CUMBERLANDOUNTY, PENNSYLVANIA Plaintiff v. :CIVIL ACTION -LAW GARRY ALBRIGHT and BONNIE L. ALBRIGHT NO: 01-4634 Civil Defendant IMPORTANT NOTICE TO:gONNIE L. ALBRIGHT DATE OF NOTICE: xNQX~~~gxx8$~Cxg88# December 3 2001 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 WITHIN 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 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. LAWYER REFERRAL RESPECTFULLY SUBMITTEA: Cumberland County Court Administrator 4th Floor, One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 ARTHUR ~~S1~1a/ QUIR Arthur A. Kusic, Esquire Supreme Court No: 07207 4201 Crums Mi11 Road Harrisburg, PA 17112 (717) 540-5610 PINNACLE HEALTH SYSTEMS, INC Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendant Attorney for Plaintiff IN THE COURT OF COMMON PLEAS COUNTY, PENNSYL VANIA CUMBERLAND CIVZL ACTION - LAW NO. 01-4634 Civil NOTICIA_ IMPORT_ANTE A: BONNIE L. ALBRIGHT FECHA DE NOTICIA: x December 3, 2001 USTED NO HA COMPLIDO CON EL AVISO ANTERIOR PROQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTD A ESTE CASO. SI USTED NO ACTUA DENTRO DE DIEZ (10) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA LISTED SIN UNA AUDIENCIA Y USTED PODRIA PERDER SU PROPIEDAD O 07ROS DERECHOS IMPORATANTES. USTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEQUIDA. SI LISTED NO TIENNE ABOGADO O NO TIENE CON QUE PAGAR LOS SERVIDIOS DE UN ABOGADO, VAYA O LLAME A LA OFICIAN ESCRITA ABAJO PARA AVERIGUAR A DONDE LISTED PUEDE OBTENER LA AYUDA LEGAL: LAWYER REFERRAL Cumberland County Court Administrator Cumberland County Courthouse 4th Floor, One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 RESPECTFULLY SUBMITTED: PINNACLE HEALTH SYSTEMS, INC., Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defendants * IN THE COURT OF ~ONFMON PLEAS *CUMBERLAND COUNTY, PENNSYLVANIA * CIVIL ACTION -LAW * NO. 01-4634 CERTIFICATE OF SERVICE I, Catherine St. Pierre, paralegal for Arthur A. Kusic, Esquire, do hereby certify that on this 3rd day of December, 2001, I placed in the United States mail true and correct copies of the Important Ten Day Notice with first class postage affixed and addressed to the following: Bonnie L. Albright 4 Daniel Avenue Lebanon, PA 17042 -- 6 --- - Catherine St. Pierre, Paralegal ARTHUR A. KUSIC, P.C. 4201 Crums Mill Road Harrisburg, PA 17112 (717) 540-5610 ~, <-, - ~~ ' ~_ 1. e ~ ` . (fj t'. ~ ... ~ L ~~ ~ - ~ ~~ . ~ _~~ ._ . ~1 _ l _ . ~ (__~ ~~~ /:Y. -[ (i~ ~~~ 6 - - epees .. _,~a,a!a~a~l~~' .~' .~,~. t.~ ,.. .:.-.n« _, ..~_ .,~.~ ,e~ x ~.,r,.~a-w,,T, jai., _ r PINNACLE HEALTH SYSTEMS, INC. Plaintiff V. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendants TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS COUNTY PENNSYLVANIA .CUMBERLAND CIVIL ACTION - LAW NO. 01-4634 Civil P_R A_E C _I P_E Pursuant to Rule 237.1 of the Pennsylvania Rules of Civil Procedure, Notice of Praecipe for Entry of Default Judgment has been given to the Defendants; a copy of said notice is attached hereto. Please enter Judgment in favor of the Plaintiff and Garry Albright only against Defendantp. in the amount of$?0,278.93' _ along with interest at the rate of6~ per ann~~om August 2, 2001 _, and the costs of this proceeding for failure to enter a defense or otherwise file a responsive pleading in the above captioned matter. RESPECTFULLY SUBMITTED: DATE:November 29, 2001 (.A-R'fHUR Pr SI~,~-3@UIRE 4201 ums Mill Road P.O. Box 67015 Harrisburg PA 17106 (717) 540-5610 ATTORNEY FOR PLAINTIFF SUPREME COURT NO. 07207 r.. I ~ Defendants TO: GARRY ALBRIGHT Defendants CIVIL ACTION - LAW NO. 01-4634 Civil You are hereby notified that on ___ the following Judgment has been entered against you in the above- captioned case. Amount:$20,278.93 along with interest at the rate of 6~ per annum and costs PINNACLE HEALTH SYSTEMS, INC. Plaintiff V. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Date: IN THE COURT OF COMMON PLEAS COUNTY PENNSYLVANIA CUMBERLAND Prothonotary I hereby certify that the name and address of the proper person(s) to receive this Notice under Pa.R.Civ.P. Section 236 is: Garry Albright 128 Herman Avenue Lemoyne, PA 17043-1935 Defendants .. 7 ~ r Arthur A. Kusic, Esquire Supreme Court Number 07207 4201 Crums Mill Road Harrisburg, PA 17112 (717) 540-5610 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS PINNACLE HEALTH SYSTEMS, INC .CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff ~? ~' ; , v. :CIVIL ACTION -LAW ~ ?_ GARRY ALBRIGHT and BOR~CE L. ~r`1~=~' ~"'i - - ALBRIGxT jJO; 01-4634 Civil coo--,~~- ~~- 1 Defendant z°~~ - ~- :D C .. - =', - _ _ ~ cn ~~ IMPORTANT NOTICE TO:GARY ALBRIGHT DATE OF NOTICE: Septe®ber 28, 2001 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 WITHIN 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 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. LAWYER REFERRAL RESPECTFULLY CUMBERLAND COUNTY COURT ADMINISTRATOR 4th FLOOR, CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17103-3387 (717) zno-62oo UR A. US Arthur A. Kusic, Esquire Supreme Court No: 07207 4201 Crums Mi11 Road Harrisburg, PA 17112 (717) 540-56f0 PINNACLE HEALTH SYSTEMS, INC Plaintiff v. GARRY ALBRIGHT AND BOE L ALBRIGHT Defendant A: GARRY ALBRIGHT FECHA DE NOTICIA: f , Attorney for Plaintiff IN THE COURT OF COMMON PLEAS :CUMBERLAND .COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 01-4634 Civil NOTICIA _IMPORTANTE September 28, 2001 LISTED NO HA COMPLIDO CON E~ AVISO ANTERIOR PROQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI LISTED NO ACTUA DENTRO DE DIEZ (10) DIAS DESDE LA FECHA DE ES TA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA US TED SIN UNA AUDIENCIA Y LISTED PODRIA PERDER SU PROPIEDAD O OTROS DERECHOS IMPORATANTES. LISTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEQUIDA. SI LISTED NO TIENNE ABOGADO O ND TIENE CON qUE PAGAR LOS SERVIDIOS DE UN ABOGADO, VAYA O LLAME A LA OFICIAN ESCRITA ABAJO PARA AVERIGUAR A DONDE LISTED PUEDE OBTENER LA .4YUDA LEGAL: LAWYER REFERRAL CUMBERLAND COUNTY COURT ADMINISTRATOR 4th FLOOR, CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17103-3387 (717) 240-6200 RESPECTFULLY SUBMITTED: ARTH K SIC, ESQUIRE - PINNACLE HEALTH SYSTEMS, INC., Plaintiff v. *IN THE COURT OF COMMON PLEAS *CUMBERLAND COUNTY, PENNSYLVANIA * * * CIVIL ACTION -LAW * NO. 01-4634 civil CARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defendants CERTIFICATE OF SERVICE I, Catherine St. Pierre, paralegal for Arthur A. Kusic, Esquire, do hereby certify that on this 28th day of September, 2001, I placed in the United States mail true and correct copies of the Important Ten Day Notice with first class postage affixed and addressed to the following: Garry Albright 128 herman Avenue Lemoyne, PA 17043-1935 - - --------- ---~7~' ~ ~C Catherine St. Pierre, Paralegal ARTHUR A. KUSIC, P.C. 4201 Crums Mill Road Harrisburg, PA 17112 (717) 540-5610 .~ , n~~~ ~ ~. ~_ ~ ~ 1^~y V L_ V +~ ~_~ ('._ ~~ ~. ~_. , -~' ~ 1 ~~i: ~+ i ~ ~~~ ~..'' ~~ Z .", rl~.i 15 ~f' r' °~ c~ ~ 7~~~ ~~ .. .~s , _.._.- sRk~iwgtrt~aaa' eavA~w>s ~. c;,F .~~: a'~~s w~.x#e~e&rr ~ m~ve'~a~~~rrF ~3-, . r f PINNACLE HEALTH SYSTEMS, INC. Plaintiff V. GARRY ALBRIGHT and BONNIE L ALBRIGHT Defendants TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS =CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW N0.01-4634 Civil P _R A E C I _P_ _E Pursuant to Rule 237.1 of the Pennsylvania Rules of Civil Procedure, Notice of Praecipe for Entry of Default Judgment has been given to the Defendants; a copy of said notice is attached hereto. Please enter Judgment in favor of the Plaintiff and Bonnie L. Albright (ohly) against Defendants in the amount of ~_Q,~$,y~__ along with interest at the rate of 6_~_pa~ann$Cnom guq~~G} 2_t__2,0__ 0d and the costs of this proceeding for failure to enter a defense or otherwise file a responsive pleading in the above captioned matter. RESPECTFULLY SUBMITTED: DATE: THUR KUS ESQUIRE 4201 Crums Mill Road P.O. Box 67015 Harrisburg PA 17106 (717) 540-5610 ATTORNEY FOR PLAINTIFF SUPREME COURT NO. 07207 ~ ~+~ PINNACLE HEALTH SYSTEMS, INC. Plaintiff Y_ GARRY ALBRIGHT and BONNIE L ALBRIGHT Defendants TO:BONNIE L. ALBRIGHT Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY PENNSYLVANIA CIVIL ACTION - LAW NO. 01-4634 Civil You are hereby notified that on ~_~e~ ~~ ~j~! the following Judgment has been entered against you in the above- captioned case. Amount: $20,278.93 along with interest at the rate of 6~ per annum plus costs Date: _f~,( Prothonotary I hereby certify that the name and address of the proper person(s) to receive this Notice under Pa.R.Civ.P. Section 236 is: Bonnie L. Albright A Daniel Avenue L~b?non, PA 17042 Defendants Arthur A. Kusic, Esquire Supreane Court Number 07207 4201 Crams Mill Raad Harrisburg, PA 17112 (717) 540-5610 Attorney for Plaintiff PINNACLE HEALTH SYSTEMS, INC: IN THE COURT OF COMMON PLEAS Plaintiff a. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendant DOUNTY, PENNSYLVANIA ~ CUMBERLAN C> r, c~ :CIVIL ACTION -LAW c ~ -'l J C~.% m. rr; rl _-~ -.-~'i NO: 01-4634 Civil ~ !-~% ._ ._ i ~? ~ -.. ~~, -~~ ~" c~ rv .. ;`~ri :~ _, cn IMPORTANT NOTICE TO~BONNIE L. ALBRIGHT DATE OF NOTICE: xN4tX~~~gxxg$~xg$$* December 3 2001 YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE III WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGATAiST YOU. UNLESS YOU ACT WITHIN 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 THIS NOTIGE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TQ FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL RESPECTFULLY SUBMITTED: Cumberland County Court Administrator 4th Floor, One Courthouse Square Carlisle, PA 17103-3387 (717) 2 4 0- 6 z o o ARTHUR S QUIR Arthur A. Kusic, Esquire Supreme Court No: 07207 4201 Crums Mi11 Road Harrisburg, PA 17112 (717) 540-5610 PINNACLE HEALTH SYSTEMS, INC. Plaintiff v. GARRY ALBRIGHT and BONNIE L. ALBRIGHT Defendant Attorney for Plaintiff IN THE COURT OF COMMON PLEAS COUNTY, PENNSYL VANIA CUMBERLAND CIVIL ACTIDN - LAW NO. 01-4634 Civil NO_TICZA IMPOR_TANTE A: BONNIE L. ALBRIGHT FECHA DE NOTICIA: ~;~~ December 3, 2001 USTED NO HA COMPLIDD CON EL AVISO ANTERIOR PROQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI USTED NO ACTUA DENTRO DE DIEZ (10) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA LISTED SIN UNA AUDIENCIA Y LISTED PODRIA PERDER SU PROPIEDAD O OTROS DERECHOS IMPORATANTES. LISTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEQUIDA. SI USTED NO TIENNE ABOGADD O NO TIENE CON QUE PAGAR LOS SERVIDIOS DE UN ABOGADO, VAYA O LLAME A LA OFICIAN ESCRITA ABAJO PARR AVERIGUAR A DONDE USTED PUEDE OBTENER LA AYUDA LEGAL: LAWYER REFERRAL Cumberland County Court Administrator Cumberland County Courthouse 4th Floor, One Courthouse Square Carlisle, PA 17103-3387 (717) 240-6200 a~• RESPECTFULLY SUBMITTED: PINNACLE HEALTH SYSTEMS, INC., Plaintiff v. CARRY ALBRIGHT and BONNIE L. ALBRIGHT, Defendants ~3 * IN THE COURT OF COMMON FLEAS *CUMBERLAND COUNTY, PENNSYLVANIA * * CIVIL ACTION - LAw * NO. O1-4634 * * * * CERTIFICATE OF SERVICE I, Catherine St. Pierre, paralegal for Arthur A. Kusic, Esquire, do hereby certify that on this 3rd day of December,. 2001, I placed in the United States mail true and correct copies of the Important Ten Day Notice with first class postage affixed and addressed to the following: Bonxue L. Albright 4 Daniel Avenue Lebanon, PA 17042 Catherine St. Pierre, Paralegal ARTHUR A. KUS1C, P.C. 4201 Cruets Mill Road Harrisburg, PA 17112 (717) 540-5610 l~~ • ~ ~~: ~{ j (1 i. f © __~ ^~ C aj7~~r_= , ~ y -.p '~1 Z # ~ ~~ sJ-~ ~r c ' ~``~ ~- -<' n +.. .,user~r~a~~sRS u+aossm~~naww .,, , . _..~° ~~" ~. .-.~ . ~ ,.~ Y,rt ,~wo nu~a~uax'