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HomeMy WebLinkAbout01-04773IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, NO. ®`o L`773 C,G/f~- Plaintiff vs. CIVIL ACTION -LAW ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Defendants NOTICE You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice is served, by entering a written appearance, personally of by attorney, and filing in waiting with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so, the case may proceed'without you and a judglnent may be entered against you by the Court without further notice for any money claimed in the Complaint, or document, or for any other claim or relief requested by he Plaintiff. You may lose money or property or other right 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 TO FITID OUT WHERE YOU CAN GET LEGAL HELP. NOTICIA Le han demandado a used en la torte. Si usted quaere defensas de esas demandas expuestas en las paginas, siguientes, usted Ciene viente (20) dias de plazo al partir de la fecha de lademanda y la notifiation. Usted debe presentar una apariencia escrita o en persona o por abogado y archivar en la torte en forma escrita sus defensas o'sus objeciones a last demandas en contra de su persona. Se avisado que si usted no se defienda, la torte tomara medidas y psedido entrar una Orden contra used 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 used. LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATAMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFFICIENTE DE PAGAR TAL SERVlClO VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARR AVERIGUAR DONDE SE PUEDE CONSEGUIR ASSITANCIA LEGAL. Lawyer Referral Service Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennrylvanla 17013 F ,- ~_.. _.._ _ ._. _ .. s (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, NO. Q/, y7 ~ ~,~ ' ,9 Plaintiff u~ vs. CIVIL ACTION -LAW ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Defendants COMPLAINT AND NOW, this ~,~ day of ~~ 2001, comes the Plaintiff, HCR Manor Care, by and through its attorney, Daniel F. Wolfson, Esquire, and the law firm of Wolfson 8i Associates, P.C., and files the within Complaint and in support avers as follows: 1. Plaintiff, HCR Manor Care is a health care provider qualified to conduct business in the Commonwealth of Pennsylvania with offices and/or a place of business situate at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Defendant, Elwood Gower, is an adult individual with a current address of 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011. 1 3. Defendant, Craig Gower, is an adult individual with a fast known address of Rollo Court LT 88, Mechanicsburg, Cumberland County, Pennsylvania 17055. 4. That Defendant Craig Gower represented himself to be the Legal Representative and/or Responsible Party for Defendant Elwood Gower. Defendant Craig Gower is the son of Defendant Elwood Gower. 5. That on or about April 11, 2000, through the present, Defendant Elwood Gower was a health care resident of Plaintiff, where he did receive various necessary residential health care services and health care treatment by Plaintiff. An itemization of said services is attached hereto, incorporated herein, and collectively marked as Exhibit "A". 6. That on or about April 11, 2000, Defendant Craig Gower executed an Admission Agreement on behalf of Defendant Elwood Gower, which Agreement outlined various terms of residential health care services to be provided by Plaintiff and the Responsible Party therefor. A true and correct copy of the Admission Agreement is attached hereto, incorporated herein, and marked as Exhibit "B". 7. By executing said Admission Agreement, Defendant Craig Gower did assume and accept responsibility for the debt to be incurred by Defendant Elwood Gower in the event of a breach of the duty to provide payment from the Defendant Elwood Gower's income or resources for the fees and charges provided for in the 2 :.,~ Admission Agreement. See Exhibit "B" as previously identified and incorporated herein. 8. That Plaintiff submitted to Defendants a copy of the itemization of services accurately showing all debits and credits for transactions with Plaintiff. 9. That Defendants have not objected to the above-mentioned Statement of Account submitted by Plaintiff to Defendants. 10. Plaintiff has made numerous requests to Defendant Craig Gower, as the Legal Representative and/or Responsible Party for Defendant Elwood Gower, demaning that he sums due and owing to Plaintiff be paid, and Defendant Craig Gower, as the Legal Representative and/or Responsible Party for Defendant Elwood Gower, has refused his fiduciary obligation to pay necessary and appropriate bills and obligations for his father, Defendant Elwood Gower. 11. That Defendant Craig Gower submitted an application for medical assistance on behalf of his father, Elwood Gower, on or about November 27, 2000. 12. That pursuant to the above mentioned application, Defendant Craig Gower was notified of discontinued benefits due to excess of resources of Defendant Elwood Gower. A true and correct copy of the notice of discontinued benefits is attached hereto, incorporated herein, and marked as Exhibit "C". 3 13. That pursuant to said discontinuation of benefits, Defendant Craig Gower filed an appeal with the Department of Public Welfare. See Exhibit "C" as previously identified and incorporated herein. 14. That the appeal hearing, which occurred on or about June 27, 2001 upheld the prior decision of the Department of Public Welfare that benefits were to be discontinued. 15. That pursuant to the appeal decision, Defendant Craig Gower failed to appropriately utilize the assets of his father, Defendant Elwood Gower, to pay for the residential health care services which were being provided to Defendant Elwood Gower. 16. That Plaintiff alleges, and therefore avers, that Defendant Craig Gower is receiving Defendant Elwood Gower's social security benefit checks and expending said funds for his own use instead of using said funds to pay Plaintiff for the amount due and owing on Defendant Elwood Gower's account balance with Plaintiff. 17. That Defendant Craig Gower violated his fiduciary duty and responsibilities as the Legal Representative and/or Responsible Party for Defendant Elwood Gower by utilizing Defendant Elwood Gower's social security benefits for his own purposes when he know or should have known there were outstanding medical bills for his father, Defendant Elwood Gower. 4 18. That Defendant Craig Gower wrongfully converted the funds of his father's social security benefits, without authority or justification, into his own possession and for his own personal use to prevent said social security benefits from being applied to the necessary and medical needs of his father, Defendant Elwood Gower. 19. That the funds of said social security benefits rightfully belonged to Defendant Elwood Gower and Plaintiff for his necessary and appropriate medical services and treatment rendered by Plaintiff to Defendant Elwood Gower. 20. That recovery for unjust enrichment is proper if one party is enriched by another, and injustice would result if recovery for the enrichment is denied. 21. That Defendant Craig Gower was enriched by the use of the social security benefits, which rightfully belonged to Defendant Elwood Gower, and injustice would result if recovery for enrichment was denied as said benefits were to be used to pay Plaintiff for the medical services it rendered to Defendant Elwood Gower. 22. As of the date of filing of the Complaint, the balance due, owing, and unpaid on Defendant Elwood Gower's account as a result of said charges is the sum of Forty-Eight Thousand Two and 18/100 Dollars ($48,002.18). See Exhibit "A" as previously identified and incorporated herein. 5 >~«~ . 23. Despite Plaintiff's reasonable and repeated demands for payment, Defendants have failed, refused and continue to refuse to pay all sums due and owing on Defendant Elwood Gower's account balance, all to the damage and detriment of the Plaintiff. 24. Pursuant to Section 1, Paragraph 1.03, of the Admission Agreement, Plaintiff is entitled to receive and Defendants have agreed to pay interest at a rate of eighteen percent (18%) per year on past due balances. See Exhibit "B" as previously identified and incorporated herein. 25. As of the date of the within Complaint, the amount of interest that has accrued on the past due balance is the sum of Two Thousand Six Hundred Thirteen and O6/100 Dollars ($2,613.06). 26. Plaintiff has retained the services of the law firm of Wolfson 8i Associates, P.C., in the collection of the amounts due from Defendants. 27. Pursuant to Section 1, Paragraph 1.03, of the Admission Agreement, Plaintiff is entitled to receive and Defendants have agreed to pay reasonable attorney fees and atl court costs if the account is referred to an attorney for collection. See Exhibit "B" as previously identified and incorporated herein. 28. As of the filing of this Complaint, Plaintiff has incurred reasonable attorney's fees from the law office of Wolfson st Associates, P.C., in the collection of the amounts due and owing by Defendants incident to the within action, and 6 Plaintiff shall continue to incur such attorney's fees throughout the conclusion of the proceedings in the amount of thirty percent (30%) of the principal balance which is due and owing. 29. That the amount of attorney's fees which represents thrity percent (30%) of the principal amount due and owing is the sun of Fourteen Thousand Four Hundred and 65/100 Dollars ($14,400.65). 30. Any and all conditions precedent to the bringing of this action have been performed by Plaintiff. 31. The amount in controversy exceeds the jurisdictional amount requiring compulsory arbitration. WHEREFORE, Plaintiff, HCR Manor Care, respectfully requests this Honorable Court enter judgment in favor of Plaintiff and against Defendants, Elwood Gower, Individually, and Craig Gower, Individually, and on Behalf of Elwood Gower, in the amount of Forty-Eight Thousand Two and 18/100 Dollars ($48,002.18), contractual interest in the amount of Two Thousand Six Hundred Thirteen and 06/100 Dollars ($2,613.06), reasonable attorney's fees in the amount of Twelve Thousand Four Hundred Seventy-Four and 35/100 Dollars ($12,474.35), the costs of this action, and such other relief as the Court deems proper and just. Respectfully Submitted, Daniel F. Wolfson, Esquire WOLFSON at ASSOCIATES, .C. 267 East Market Street York, PA 17403 (717)846-1252 I.D. No. 20617 Attorney for Plaintiff VERIFICATION I, Michelle Thureson, Senior Financial Services Consultant for HCR Manor Care, verify that the statements made in the foregoing Complaint are true and correct to the best of my information and belief. I understand that false statemenu herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. DATE: Michelle Thureson, Senior Financial Services Consultant ~. ~.~ EXHIBIT "A" ~~ • ~ `'„O~'r-~,"~ Statement MANORCARE CAMP HILL 583 1700 MARKET STREET CAMP HILL, PA 17011 (717)-737-8551 CRAIG GOWER FOR ELWOOD GOWER ROLLO CT LT 88 Please Return This Ponion MECHANICSBURG, PA 17055 With your Payment PRIVATE ROOM 224 -A GOWER, ELWOOD C 45 04/11/00 02/28/01 -----------------------------------------------------------=--------------- DATE OF SERVICE CODE SERVICE RENDERED CHARGES CREDITS '~ 02/01/01 BALANCE FORWARD 41,581.16 02/28/01 51801 TOTAL INCONT-DLY FEE ( QTY 28 ) 84.00 02/28/01 99610 OXYGEN CONCENT RENTAL ( QTY 1 ) 504.00 02/28/01 11600 CABLE RENTAL ( QTY 1 ) 5.00 03/01-03/31/01 ADV ROOM CHARGE a 5,828.00 PAYMENT DUE BY THE 10TH ~` AMOUNT DUE y y. 48,002.18 03!29181 RESIDENT LEDGER R& OF DATE OF FIRST ACTIYITY PAGE 6 (AR56~ RESIDENT RESIDENT RESIDENT G!L -- ACCOUNTS RBCSIVABLE -- NUNBBR TYPE NANB DATB QTY ACCOUNT C8ARG8S CREDITS BALANCB 45 PRIVATB GOWER, ELWOOD C 04111/00 ADK CNTR RATS: 5020.00 ROOM 224 -A LEVEL 1 DIS PRIM PORT: 0.08 "NBDICARB B -JAN 01 (CONY( "ENDING BALANCE 1144.24 "PRIVATB - FEB 01 BAL FWD -LN- -30- -68- -90- -120+- 11599.61 29401.51 41501.18 51081 TOTAL INCONT-DLY FEE 02101101 -- 02128!01 28 56151881120 84.08 99610 OXYGEN CONCBNT RENTAL 02/01/81 -- 02!20/81 1 55353601120 SB4.B0 11600 CABLE RENTAL 02120/01 1 59150401120 5.00 ft8Y LAST NO RC 02101181 13211800000 SB28.00 ft00K CRARGE AT 020.00 02101101 -- 02/20101 20 51350801120 5828.00 ADV BOON CHARGE 03!81181 -- 83131!81 13211000000 5020,00 "ENDING BALANCB 48002.18 "INSURANCE - FBB 01 BAL FWD -LK- -38- -68- -90- -120+- 141.49- .8B 190.69 "ENDING BALANCE 140.fi9- "NCR CO INS -FEB 01 BAL FWD -LN- -30- -60- -90- -120+- 206.05 206.85 "ENDING BALANCB 286.05 "NBDICARB A - F8B 81 PAYNBNT NCR-9100 02113101 11210002800 522.00 PAYNBNT 02113181 11218882880 522.88 "ENDING BALANCB .00 "NBDICARE B - F8B 01 BAL FWD -LN- -30- -60- -90- -120+- 1144.Z4 1144.24 PRYKBNT KCB-9100 02!13!01 11210802080 522.08 "ENDING BALANCE 622.24 ~- W~ 03129/01 (ARS6~ RESIDENT LBDGBR AR OR DATE OF RIRST ACTIVITY FAGS 1 RBSIDBNT RBSIDENT RBSIDBNT GIL -- ACCOUNTS RECEIVABLE -- NUNBBR TYPE NANE DATE QTY ACCOUNT CBARGBS CREDITS BRLANCB 45 PRIVATE GOWER, 8LWO0D C 04/11100 ADN CNTR RATE: 5628.00 BOON 224 -A LBVBL 1 DIS PBIV PORT: 0.00 *'PBIVATB - APB 00 11600 CABLE RENTAL 04111180 -- 04130100 1 59158401120 5.00 11100 BEAUTY AND BARBER 04120180 1 59158181120 10,00 "ENDING BRLANCB "INSURANCE -APR 00 29002 PBARNACY LEGEND 04!11100 -- 04138100 1 S4SS1201128 2S2.S9 S15B2 WOUND TR8RTN8NT 04!11100 -- 04115100 S 54151587128 48.88 53202 NTRTNLIENTRL 68RV GRP 2 04/11100 -- 04130(00 20 56153201120 40.00 14101 PHYSICAL TflBflAPY VISIT 04112100 -- 84/13/08 4 52150201120 100.88 14401 PBYSICAL TBBRRPY BVAL 04(12100 2 52150201120 50.00 20182 SP88CR TflBRRPY VISIT 04/15108 - - 04130188 14 52950481128 358,80 20402 SPEECH THERAPY BVAL 04l1S100 1 52950407120 25.00 51581 CATBETBR TRAY 04!10100 1 54151501120 18.00 ANCILLARY WRITE ORR 04130/00 51551501120 BOON GRANGE AT 23fi.00 04111100 - - 04/30/08 20 51358881120 4120.08 "ENDING BRLANCB "PRIVATE - NAY 08 BAL RWD -LN- -30- -60- -90- -120+- 15.08 1S,B0 PAYNBNR 05/22/00 11600 CABLE RBNTAL 05101100 -- 05131100 1 "ENDING BRLANCB "INSURANCE -NAY 08 BAL RWD -LM- -30- -60- -90- 5427.59 29009 PBARNACY LBGBND 05/01108 -- 05/25100 1 53202 NTBTNLtBNTRL SBRV GRP 2 05181100 -- 05/31/00 112 99610 OXYGEN CONCBNT RENTAL 05101100 -- 05/31100 1 ROOK CNARGB AT 236.00 05/01100 -- 05131100 31 "ENDING BALANCE " PRIVATE - JUN A0 BAL RWD -LN- -30- -60- -90- 5.00 10.00- 11600 CABLE RBNTAL 06101108 1 "ENDING BRLANCB "INSURANCE -JUN 00 BAL RWD -LN- -30- -60- -40- B4B2.55 5421.59 53202 NTRTNLIBNTRL SBRV GRP Z 06/01100 -- 06130!00 100 99610 OXYGEN CONCBNT RBNTAL 06!01100 -- 06130!08 30 29001 PBARNACY LBGBND 06180100 -- 06128!00 1 30881 PBARNACY NON LBGBND 06/00100 -- 06104100 1 ANCILLARY WRITE ORF 06130100 BOON C8RRG6 AT 236.80 06101108 -- 06!30!80 30 160.00 15.00 5421.59 11210002000 25.00 59150401120 5.00 -120+- 5421.59 54551201120 304.55 56153201120 224.00 55353601120 558.00 51350801120 1316.00 5.00- 13910.14 120+- 59156401120 5.00 5.ee 120+- 13410.14 56153207120 360.00 S53S36B1120 540.00 54551207120 221.61 54951307120 29.04 57551507120 256.65 51350081120 1080.00 00 03/29101 R6SID8NT LEDGER AS OF DATE OB FIRST ACTIVITY PAGE 2 ~AR56~ RESIDENT RB6ID8NT R6SID8NT GIL -- ACCOUNTS R6C8IVABLB -- NUNBBR TYPE NAME DATE QTY ACCOUNT CflARGBS CR86IT6 BALANCE 45 PRIVATE GOWER, BLNOOD C 04/11/00 ADN CNTR RATS: 582@.00 BOON 224 -A L8V6L 1 DIS PRIV PORT: @.B0 ""INSURANCE -JUN 00 (CONY) ""ENDING BALANCE 21090.14 "'PRIVATE - JUL 00 BAL FWp -LN- -30- -60- -90- -12@+- S,8@ 5.00 10.00- .0@ 11180 BBAUTY AND BARBER 07!06100 1 5915@101120 10.00 ""ENDING BALANCE 10.08 "IN8URANCB -JUL 80 BAL FNO -LN- -30- -60- -98- -120+- 1900.00 0482.55 5421,59 21090.14 53202 NTRTNLlBNTRL SBRV GRP 2 071@11@0 -- 01/31/00 106 5615320712@ 312.00 49610 OXYGEN CONC6NT RENTAL 01101188 -- @1131!@0 1 55353601120 558.00 29009 PHARMACY L6GBN0 01/0510@ -- 0i 111100 1 S4S51281120 67.59 17402 OCCUP T88RAPY BVAL 07107/88 1 5255BbB7120 25.00 17102 OCCUP T88RAPY VISIT 0111@100 1 S2S5@607120 25.00 30009 PHARMACY NONLBGBND 81!11!80 1 5495130112@ 21,21 20402 SP88C8 T88RAPY BVAL 011311@0 1 52950401128 50.00 ROOM CAARGB AT 236,0@ 07181!00 -- 07131/80 31 51350001120 7316.00 '"ENDING BALANCE 30324,94 "*PRIVAPB - AUG 00 BAL END -LM- -38- -6@- -90- -120+- 10.00 5,0@ 5,08 1@,00- 1@,00 PAYMENT @8!16180 11210002080 10.00 PAYMENT 08116108 11210002@0@ 1525,00 ROLL CREDIT (BLIND) 07101100 14411058000 10.00 ROLL CR80IT ~BLIND~ 011@1100 14411058800 5.08 ROLL CREDIT ~BLIND~ 07101100 14411850800 5.@0 "'ENDING BALANCE 1S2S,00- ::INSURANCE -AUG 00 BAL FWD -LM- -30- -68- -90- -120+- 8434.80 1980,00 84@2.55 5427.59 30324.94 201@2 SPEBCW T88RAPY VISIT 081811@0 -- 08103!00 3 S24SO407120 100.00 53282 NTRTNLlBNTRL SBRV GRP 2 0818118@ -- 0@131100 186 56153201120 372.@0 99610 OXYGEN CONC6NT RBNTAL 08/01/00 -- 08131!08 1 55353601120 558.00 17102 OCCUF TRERAPY VISIT 08(02100 -- 08/15/88 4 52550607120 300.0@ 290@2 PHARMACY L6G8ND 08103/00 -- 08128/@8 1 54551207120 59.18 2@1@2 SP88C8 TMBEAPY VISIT 08118/80 -- 88/31/00 10 529504@7128 525,00 20402 SP88C8 TRERAPY BVAL 08/18100 1 52950407120 25.00 ROOM CNARGB AT 236,@0 08181/00 -- 08131/00 31 51350001120 1316.08 '"ENDING BALANCE 39588.12 ""PRIVATE - S8P 00 BAL FWD -LN- -30- -60- -90- -12@+- 1525.00- 1525,00 11608 CABLE RBNTAL 09/01!00 -- 09/30/00 1 S91SO401120 5.00 ""ENDING BALANCE IS20.00- 03/29101 RESIDENT LEDGER AS OF RATS OF FIRST ACTIVITY PAGE 3 (AR56 i R86ID8NT R86IDBNT RBSIDBNT GIL -- ACCOUNTS RBCEIYABLE -- NUNBER TYPE NANB DATE QTY ACCOUNT CflARG88 CREDITS BRLANCB 45 PRIYATB GOWER, BLWOOD C 04!11108 ADN CNTR RATS: 5828.08 ROOM 224 -A LEVEL 1 DIB PRIV PORT; 8.08 "INSURANCE - SEP 08 BAL FWD -LN- -38- -60- -98- -120+- 9255.18 8434.88 1988.08 8482.55 5427.59 39588,12 PAYMENT CBC NAJ NBD 04105108 11210882800 16611.45 20102 SP88CH THERAPY VISIT 89181!80 -- 89121108 14 52950487120 775.88 29082 PHARMACY LEGEND 09/01188 -- 09115/00 1 54551207120 43.10 53202 NTRTNLfBNTRL 38RY GRP 2 09101100 -- 09/30100 180 56153281128 360.80 49610 OXYGEN CONCENR RBNTAL 89101100 -- 89130108 1 55353607120 540.08 ROOK CHARGE AT 236.08 04101/00 -- 09130100 38 51358801120 7888,80 "ENDING BRLANCB 31701.31 "PRIVATE - OCt 00 BAL FWD -LM- -30- -60- -98- -120+- 5.88 1525.80- 1528.80 24082 PflARWACY LEGEND 89130!00 -- 18123108 1 54551201120 61.40 99610 OXYGEN CONCBNT RBNTAL 10101108 -- 10(31180 31 55353601128 558,88 30882 PBRRNACY NON LEGEND 10105108 1 54951301120 21.21 11188 BEAUTY AND BARBER 10!24!08 1 54158101128 10.08 51501 6NALL OXYGEN TANX 18I2S180 1 54151501120 23.88 11608 CABLE RBNTAL 10/31/80 1 59158481128 5.88 ROOK CHARGE AT 828.00 10101100 -- 10!31108 31 51358001120 5828.08 ADV ROOM CAARGB 11/01/80 -- 11(38/00 13211808008 S82B.80 "ENDING BRLANCB 10820.61 "INBURANCB - OCT 00 BAL FWD -LN- -30- -60- -90- -128+- 8198,18 9255.18 8434.88 8691.45- 13910.14 31101.37 '*BNDING BRLANCB 31707.31 "FRIVATB - NOY 00 BAL FWD -LN- -38- -60- -90- -120+- 12348.61 5,88 1525,00- 10828.61 PAYMENT 11/21108 11210082000 4992.61 PRYNBNT 11/21(08 11218082088 6081.39 30809 PBRRNACY NONLBGEND 10105100 1 54951301120 21.21 30809 PHARMACY NONLBGBND 10185100 1 S49S1381120 21.21 11600 CABLE BBNTAL 11101100 1 54158481120 5.00 99618 OXYGEN CONCENT RBNTAL 11101!88 -- 11138100 1 S53S3681120 548,88 RBV LAST MO RC 11/01100 13211800800 5828.00 BOON CHARGE RT 828.88 11101180 -• 11!30100 30 S135B081120 5828.00 ADV ROOM CBARGB 12!01!00 -- 12/31!00 13211080080 5828.00 "BNDING BRLANCB 6143.61 "INBURANCB - NOV 08 BAL FND -LN- -30- -68- -90- -128+- 8198.70 92SS.18 8434,88 5218.69 31181.37 29889 PAARNACY 18GBND 09101100 1 54551207120 170.28 38089 PAARNACY NONLBGEND 10105(08 I S49S13B7120 21,21 ,,•~~ 03(29(01 (AR56~ RESIDENT RBSIDBNT R86IDBNT NUNBBR TYPS MANS 4S PRIVATE GOWER, BLNOOD C ROOK 224 -A LEVEL 1 "INSURANCE - NOV B0 (CONT~ "ENDING BALANCB "PRIVATE - DBC 00 RBSIDBNT LBDGBR AS OF DATE OF FIRST ACTIVITY PAGE 4 GIL -- ACCOUNTS RBCBIVABLB -- DATE QTY ACCOUNT C8ARG8S CREDITS BALANCB 04111100 ADN CNTN RATE: 5828.00 DIS PRIM PORT; 8,08 BAL FWD -LN- -30- -60- -98- -120+- 6193.61 1528,00 5.88 1525.00- 6193.61 PAYNBNT MAJOR NBDICAL CA 09(05100 11218002000 16671.45 PAYNBNT 12118/80 11210802888 365.61 PAYNBNT 12(18188 11210882008 1134.39 11608 CABLE RBNTAL 12!81!00 1 S91SB401120 5.80 51881 TOTAL INCONT-DLY F68 12101100 -- 12/31/80 31 56151801120 31.00 99618 OXYGEN CONCBNT RBNTAL 12181108 -- 12131(00 1 SS3S3601120 SSB.00 RBV LASR MO RC 12101100 13211008008 5828.80 ROOM CBARGB Af 828.08 12101/00 -- 12/31100 31 51350081120 5828.88 ADV BOON CBARGB 01181181 -- 01/31!01 13211080000 5828.00 INS TO PRTVATB 84130!80 14411850088 5421.59 IN6 TO PRIVATR 05131100 14411850800 8482.55 INS TO PRTVATB 06/30180 14411850080 1980.00 INS TO PRTVATB 01/31/00 14411050000 8434.00 INS TO PRTVATB 88!31100 S61S3207120 312.88 RBV OXGYBN 08/31100 51557509108 558.00 R8V LBGBND 88/31/00 S1SS1509108 59,18 R8V RAB 08131/00 51350881128 1316.00 R8V LBGEHb 89115188 S4SS1201128 43.78 RBV NUTRI 09!38108 56153201120 360.00 R8V OXYGEN 89130180 51557509100 548.88 R8V B & B 09!30(00 51358001120 1080.00 CRBDIT ROLL (BLIND) 12181108 14411850800 1525,88 CRBDIT ROLL ~BLINO~ 12!01100 14411850008 5.08 CRBDIT ROLL ~BLIND~ 12!81108 14411058808 1520.08 "ENDING $ALANCE "INSURANCE - DBC 00 BAL FND -LN- -30- -60- -90- -120+- 191.49- 8148.10 9255.18 13653,49 31515.88 PAYNBNT MAJOR NBDICAL CA 09185!00 1121008200816611.45 INS TO PRIVATE 04/30/00 14411050080 5421.59 INS TO PRIVATR 05/31100 14411850000 8482.55 INS TO PRIVATE 06/30180 14411058080 1980.08 INS TO PRIVATE 07131100 14411850880 8434.08 RBV OT 08lIS/00 52SS0607120 300.00 INS TO PRIVATR 08/31100 56153207120 372.00 R8Y OXGYBN 88!31188 S7SS1S8910B SS8.00 REV LBGBND 88!31!08 51551509180 59.18 R8V RAB 08131188 51350881120 1316.80 REV LEGEND 09/15(80 54SS1281120 43.70 R8V SP TO N8D B 89/21(88 S29SO401120 175.08 RBV SP TO MBD B 09121!00 52958407128 650.00 31515.88 35097.18 03/29181 R@SIDBNT LEOGB@ AS OF DATE OF FIRST ACTIVITY PAGE 5 (AR56( RESIDENT RESIDENT RESIDENT GIL -- ACCOUNTS RECEIVABLE -- NUNBBR TYPE NANB DATE QTY ACCOUNT CAA@GES C@BDITS BALANCB 45 PRIVATE GOWER, ELWOOD C 04111180 ADN CNTR @ATB: 5820.00 ROOK 224 -A LRVBL 1 DIS PRIV PO@T: 0.00 "INSURANCE -DEC 00 (CONY( REV NUTRI 09130180 56153201128 360.08 @EV O%YGBN 09130100 57551509100 548.00 REV B & B 09130180 51350007120 7800.80 "ENDING BALANCB 198.69- "NCR CO INS -DEC 00 CO INS OT 00131100 52550611120 56.39 CO INS PART B SP 88/31/00 52950411128 99.16 SP PART B 09130100 529.50411120 130.58 "ENDING BALANCB 286.05 "NBDICARE B - D6C 80 NED B OT 08131100 52550611120 225.58 08!31!88 52550611128 18.03 CIA INS 08131106 52550611128 18.@3 SP PART B 08(31188 52950411128 346.66 SP PART B 88131100 52958411120 154.18 CIA PART B 08131!88 51557511120 154,18 SP PART B 09138180 52958411120 522.00 NBD B SP88C8 09/38100 52450411128 122,58 CIA SP88C8 09/30/00 57557511120 122.50 "6NOING BALANCB 1144.24 "PRIVATE - JAN B1 BAL FWD -LN- -30- -60- -98- -128+- 5115,61 29981.51 35041.18 51801 TOTAL INCONT-DLY FE8 01101/81 -- 01131!01 31 56151881120 43.80 99618 08YGHN CONCRNT RENTAL 01101101 -- 81131101 1 553S36B1120 558.00 11680 CASLB RENTAL 81/31/01 1 59158401120 5.80 R8V LAST NO RC B1/01181 13211880880 5828.08 ROOK CRARGE AT 828.08 01!01101 -- 01131/01 31 51350801120 5828.00 ADV ROON CRARGB 82101/81 -- 82(28101 13211008008 5828.80 CREDIT ROLL (BLIND( 01/01101 14411058080 112.34 CREDIT ROLL (BLIND( 01101181 14411858888 712.34 CREDIT ROLL (BLIND( 01101181 14411058008 8647.15 CR@DIT ROLL (BLIND( 01101181 14411858880 8647.75 "ENDING BALANCB 41581.18 ""INSURANCE -JAN 81 BRL FWD -LN- -30- -68- -90- -120t- 191.44 - 8198.18 8191.40- 148,69 "ENDING BALANCE 190.69- "NCR CO INS -JAN 01 RAL FWD -LN- -38- -60- -90- -120+- 286.05 286.05 '*ENDING BALANCB 266.05 "N6DICARE B -JAN 81 BAL FWD -LN- -30- -60- -90- -128+- 1144,24 1144.24 EXHIBIT "B" ~ r~rye HCR Manor Care ADMISSION AGREEMENT This Agreement is entered into by and among HCR Manor Care, the Resident, and the Legal Representative, for the purpose of providing for the rights and responsibilities of the parties with respect to the Resident's stay at this HCR Manor Care's Health Care Center ("Center"). Center: NCR ~Qrtor CQY2 Resident: ~~W C~ C Go'vteR Admission Date: ~ ~ ~ ~ I ~ Deposit: $ Term: This Agreement shall begin on the day the Resident enters the Center and end on the day the Resident is dischazged. I. RIGHTS AND RESPONSIBILITIES OF THE RESIDENT 1.01 Room and Boazd Rate. For the basic services provided for in Section 3.01, the Resident agrees to pay the applicable Room and Boazd Rate set forth on Attachment A hereto. The Room and Board Rate is subject to change upon thirty (30) days written notice. The Room and Boazd Rate set fdrth in Attachment A is payable in advance and is due by the tenth (10`") day of each month. The Resident shall be responsible for the Room and Boazd Rate for the day of admission as well as the day of dischazge. This Section shall not apply if the Resident is covered under a Governmental Program (see Section 1.05) or by a Third Party Payor or Managed Caze Organization (see Section 1.06). 1.02 Ancillary Charges. The Resident further agrees to pay to the Center all chazges for additional medical, therapeutic, or personal Caze services or supplies that may be requested by the Resident, ordered by the attending physician, or provided in the Resident's Plan of Caze. The Center reserves the right to chazge for personal caze items of the Resident if necessary for the well-being of the Resident. Such "Ancillary Chazges" are described on Attachment B hereto, and a current ancillary charge list is maintained at the Center's business office for review during regular business hours. Ancillary Charges shall be included in the Resident's statement for the succeeding month, and aze payable in full, along with the Room and Board Rate by the tenth (10th) day of the month 1.03 Late Payments. Accounts not paid in full within thirty (30) days of billing shall be subject to a service chazge equal to the highest legal rate of interest permitted by State law as set forth in Attachment A on the past due balance each month until such time as the balance due is paid in full. Should the Resident's account for any reason be turned over for collection, the Resident agrees to pay the Center's collection costs, including attorney's fees. 1.04 Independent Providers. The Resident shall be directly responsible to independent providers, including but not limited to, the Resident's attending physician for any health or personal program in accordance with the terms of the program. I.OS Governmental Pro rams. If the Resident is eligible for coverage under any governmental program, such as Medicaze, Medicaid, or through the Veterans Administration, and the Center participates in such program, the Center shall accept payments under such program in accordance with the terms of the program on the contract the Center has with the program. The Resident shall be responsible for any co-insurance, deductibles or non-covered chazges, according to the same terms and conditions applicable to private pay residents. The Resident must comply with all program requirements. In the event the Resident's coverage under the governmental program(s) cease for any reason, the Resident will be charged at the Center's rate for private pay residents in accordance with Sections 1.01 and' 1.02. The Center participates in the following programs: /Medicaze, Medicaid and/or ~VA. Medicaze may pay for some or all of the Resident's care. If Medicare agrees to pay for the Resident's caze, there is a required co-payment, which Medicaze updates yearly. If the Resident also participates in Medicare Part B, for physical, occupational, or speech therapy or other billable charges (which aze not covered by Medicaze Part A), the Resident and/or Legal Representative agree to pay any required deductible, any required co-insurance, and any non-covered services according to the same terms and conditions applicabl8 to private pay residents. For Medicaid, see Attachment L for additional information. The Resident and/or Legal Representative aze responsible for applying for Medicaid. If the Resident receives Medicaid, most of the Center chazges such as Room and Boazd and nursing services aze covered, although Medicaid may require the Resident to pay a portion of the Room and Boazd Rate from their monthly income. The Resident and/or Legal Representative agree to pay on a timely basis, as set forth in this Agreement, the contribution amount as determined and periodically adjusted by the State and/or local department(s) handling Medicaid. If the Resident and/or Legal Representative fail to pay the contribution amount, the Center may take such legal action as necessary, including requesting a court to order such payment. 1.06 Third Party Payors and Managed Care Organizations. If a Resident is a participant in a plan offered by a third party payor such as a Health Maintenance Organization ("HMO"), Preferred Provider Organization ("PPO"), Provider Sponsored Organization ("PSO"), or Physician Hospital Organization ("PHO"), indemnity plan or another similar entity with which the Center has executed a provider agreement, the charges are governed by the applicable agreement. The Resident shall be responsible for any co-payments, deductibles or non-covered charges, according to the same terms and conditions applicable to private pay residents. If the Center has not executed a provider agreement with the Resident's third party payor, the Center 2 will bill the Resident's third party payor as a service, but the Resident remains liable for chazges not paid or covered by that third party payor including charges not paid within a reasonable period oftime. 1.07 Private Pav Resident. The Resident and/or Legal Representative acknowledge that they are responsible for paying the Center for items and services provided during the stay at the Center and during which time the Resident has not been determined to be eligible for Medicaid. The Resident and/or Legal Representative agree to notify the Center promptly if there is insufficient income or assets to meet the financial obligations to the Center or to make prompt application to Medicaid for benefits. The Resident and/or Legal Representative agree to notify the Center in writing when application to Medicaid is made. The Resident and/or Legal Representative agree to cooperate fully in applying for Medicaid and in the eligibility determination process. If the Resident is no longer able to pay for care at the Center and the Resident is not eligible for Medicaid, the Resident will be notified of the Center's intention to discharge the Resident for non-payment in accordance with the Agreement, Resident Handbook and State and federal taws. 1.08 Admission Information. It shall be the responsibility of the Resident and/or Legal Representative to notify the Center and to provide any needed information regarding all third party payors or governmental coverages on admission and throughout the stay including copies of insurance cazds, identification or verification of eligibility and coverage information. The Resident and/or Legal Representative agree to provide the Center with notice within five (5) davs bf the Resident's disenrolhnent, enrollment, change in health caze coverage, failure to pay premium(s) or renewal of insurance coverage and any cancellations in coverage as the Center relies on the information supplied regarding such coverage. The Resident and/or Legal Representative acknowledge that if they fail to provide such information, they may be responsible for any denied chazges due to lack of authorization, ineligibility, non-coverage or other costs associated with the failure to provide such notice in accordance with the terms and conditions of this Agreement. 1.09 A~piication for Benefits. It shall be the responsibility of the Resident and/or Legal Representative to apply for coverage and to establish eligibility under any governmental, third parry payor, managed caze or private insurance program. The Center shall be under no obligation to bill any third party payor other than the Legal Representative and, when applicable, a governmental program third party payor or managed care organization with which the Center is under contract. L 10 Primary Responsibility for Payment Except for payments for services covered under governmental programs or provider agreements, the Resident shall remain primarily liable for any and all charges for which the Center may agree to bill a third party. The Resident and/or Legal Representative acknowledge that the insurance company, HMO, PPO, PSO, PHO or managed care provider may not pay for non-covered services, supplies, equipment, medications, and other caze and services which may be delivered by the Center or its subcontractors. This 3 Agreement serves as a written notice that the Center has notified the Resident and/or Legal Representative that services provided at the Center may not be covered by a governmental payor, third party payor or managed caze organization. The Resident and/or Legal Representative agrees to be responsible for non-covered services. A price list of services is always available at the business office upon request. 1.11 Personal Ph siv cian• The Resident has the right to choose a personal physician, provided that the physician selected is properly licensed and agrees to abide by applicable law and the rules and policies of the Center. At the time of admission, the Resident must supply the Center with the name of his/her personal physician. If the Resident changes physicians at any time after admission, the Resident and/or Legal Representative must immediately notify the Center of the new physician's name. If the physician chosen by the Resident fails to provide needed coverage and attendance or fails to abide by applicable laws and regulations, the Center shall have the right to call another physician to attend the Resident and the fees chazged by such physician shall be borne by the Resident. 1.12 Pharmacy. The Resident and/or Legal Representative acknowledge the right to choose a pharmacy of choice, provided the pharmacy selected is properly licensed, packages and supplies pharmaceuticals in accordance with State law and agrees to abide by the Center's policies and procedures and the pharmacy has a medication distribution system similaz to the Center's ancillary pharmacy's medication distribution system II. RIGHTS AND RESPONSIBILITY OF THE LEGAL REPRESENTATIVE 2.01 Legal Authority. The Legal Representative hereby represents that he/she has legal access to the Resident's income or resources and that the documents supporting such authority, if any, have been delivered to the Center. 2.02 Agreement to Make Payments on Behalf of Resident. The Legal Representative agrees to pay promptly from the Resident's income or resources all fees and charges for which the Resident is liable under this Agreement. The Legal Representative shall not incur personal liability on behalf of the Resident except for a breach of the duty to provide payment from the Resident's income or resources for the fees and charges provided for in this Agreement. 2.03 Requested Items. The Legal Representative shall be personally liable for any services or products specifically requested by the Legal Representative to be supplied to the Resident, unless such services or products are covered by a governmental program 2.04 Exhaustion of Resident's Funds. If the Resident's financial resources change such that the Resident may be eligible for Medicaid, the Resident and/or Legal Representative must notify the Center in writing when the application for Medicaid is made. If the Legal Representative fails to notify the Center in writing or fails to file for Medicaid in a timely and proper manner, the Legal Representative shall be personally liable for all charges and fees not covered by Medicaid which otherwise would have been covered had application been made in a timely and proper manner. a 2.05 Cooperation for Financial Assistance. If the Resident is eligible for Medicaid, the Legal Representative shall provide such information about the Resident's finances as Medicaid representative shall require for contiriued coverage of the Resident and be personally responsible for any charges denied the Center due to any lack of cooperation. 2.06 AcceQtance Upon Dischazee. Upon termination of this Agreement as provided in the Resident Handbook, the Legal Representative agrees to arrange and pay for the departure of the Resident from the Center. If after notice the Resident is not removed as requested, then the Center is authorized and empowered to remove the Resident by reasonable means of transportation and to deliver the Resident to the residence address of the Legal Representative, if the Resident's condition permits, who shall unconditionally be obligated to accept the Resident and to pay promptly all charges. 2.07 Additional Responsibilities. The Legal Representative acknowledges the other duties and responsibilities for the Resident and to the Center as set forth in this Agreement and Attachments. III. RIGHTS AND RESPONSIBILITIES OF THE CENTER 3.01 Room and Standazd Services. As part of the Room and Board Rate, the Center shall funvsh basic room, boazd, common facilities, housekeeping, laundered bed linens and bedding, general nursing Gaze, personal assessment, social services, and such other personal services as may be required pursuant to the plan of caze prepazed by the Resident's physician and the Center, with the Resident's consent, .for the health, safety and general well-being of the Resident. 3.02 Other Services. The Center shall acf in accordance with the Resident Handbook, which is incorporated by reference in this Agreement. 3.03 Deposit• The Center hereby acknowledges receipt of the Deposit, if any, noted at the beginning of this Agreement. The Deposit shall be applied to the charges for the first month of the Resident's stay at the Center. 3.04 Refunds. Any refund owed to the Resident for advance payments shall be paid by the Center within thirty (30) days after discharge or transfer or within the time frame required by State law. In the case of Medicaid Residents, any such refund shall be paid within thirty (30) days of the Center's receipt of the final Medicaid payment for care of the Resident. IV. GENERAL PROVISIONS 4.01 Consent to Release of Information. The Resident and/or Legal Representative hereby consents to the release of his/her medical records to the following persons: Center personnel, attending physicians and consultants; and person, firm, government entity, third party payor or managed caze organization responsible for all or any party of the payment or reimbursement of the Resident's chazges, including any utilization review or quality assurance 5 t ~ ~ reviews or payment audits performed by such; the personnel of any hospital or other health Gaze facility or provider to whom or which the Resident may be transferred; the Center's Lability insurance carrier; and any person authorized by law to review the medical records. 4.02 Consent to Treat. The Resident and/or Legal Representative, by signing this Agreement, hereby authorizes the appropriate staff of the Center to perform such functions, care and services (hereinafter "Treatment") as are necessary to maintain the well-being of the Resident, including but not limited to, assistance with bathing, hygiene, dressing, toiletry, and daily activities; and general nursing caze, the administration of medications and treatments, and the performance of therapies, as prescribed by the Resident's personal physician in the Resident's Plan of Caze, or as required from time to time in the exercise of good nursing judgment, subject to any rights provided to the Resident by federal and/or state law. As applicable, the undersigned Legal Representative hereby represents that he/she has the legal authority to make health caze decisions on behalf of the Resident, that documents supporting such authority have been delivered to the Center, and that such Legal Representative hereby consents on behalf of the Resident to the Treatment described above. 4.03 Consent to Photoeraoh. The Resident and/or Legal Representative agree to consent to the Center taking a photograph of Resident for use in identifying the Resident, for placement of the photograph in the Medication Administration Record or other records and for any other similaz uses of the photograph for Center and staffto identify the Resident. 4.04 Notice of Services, Policies and Additional Information. The Resident and/or Legal Representative; acknowledge that the items listed below have been explained and have received copies of the items or policies and procedures, if applicable. The Resident and/or Legal Representative acknowledge they have had the opportunity to ask questions and questions have been answered satisfactorily. a. Authorization for Release or Review of Medical Information. See Attachment C. b. Authorization for Payment of Benefits. See Attachment D. c. Social Security Administration Appointment. See Attachment E. d. SNF Medicaze Determination Notice. See Attachment F. e. Medicaze Secondary Payor Questionnaire. See Attachment G. f. At the request of the Resident and/or Legal Representative, the Center shall maintain the Resident's personal funds in compliance with the laws and regulations relating to the Center's management of such funds. A description and/or policies and procedures of protection of resident funds and the Personal Trust Fund Agreement, Resident Personal Funds 6 Authorization and any other related documents. See Attachment H-1 and H-2. g. The Center's policy and procedure on bedholds, election of bedholds and readmission. See Attachment I (Center Supplement). h. Social Service Agencies and Advocacy Groups addresses and phone numbers. See Attachment I (Center Supplement). i. Name, address and phone number of Ombudsman. See Attachment I (Center Supplement). j. The location in the Center where the names, addresses and telephone numbers of state client advocacy groups, state survey and certification agency, the state licensure office, the state ombudsman program, the protection and advocacy network and the Medicaid fraud control unit. See Attachment I (Center Supplement). k. The name, specialty and way of contacting the attending physician, medical duector and other physicians who serve the Center. See Attachment I (Center Supplement). Procedures, name, address and phone number on how to file a complaint with the state survey and certification agency concerning resident abuse, neglect, mistreatment and misappropriation of property. See Attachment I (Center Supplement). m The Resident Handbook. See Attachment J. n. Resident/Patient Rights. See Attachment K. o. Medicaze/Medicaid information and display of such information including how to apply for and use Medicaze and Medicaid benefits, and how to receive refunds for previous payments. See Attachment L. p. Receipt of information on advance directives including a copy of "Refusal of Life Sustaining Treatment", which snmmari~es HCR Manor Care's Limited Treatment Practices and "No Cazdiopuhnonary Resuscitation Orders" and a copy of the State summary of its laws governing the Resident's right to direct hislher medical treatment. See Attachment M-1 and M-2. q. Privacy Act Notification. See Attachment N. r. Inventory sheet and/or policy of personal items. See Attachment 0. 7 f -~ e s. ASM Form. See attachment P. t, See Attachment Q. u, See Attachment R. v, See Attachment S. w, See Attachment T. x, See Attachment U. y. See Attachment V. z, See Attachment W. 4.05 Assig_mnent of Benefits. The Resident and/or Legal Representative hereby requests that payment of authorized government and/or third party payor benefits as described in Sections 1.05 and 1.06, if any, be made as set forth in Attachment D to this Agreement either to me or on my behalf for any service furnished by or in the Center. The Resident and/or Legal Representative hereby authorizes the Center and any holder of medical or other information to release such information to the Health Care Financing Administration and its agents and to third parry payors any information needed to determine these benefits or benefits for related services. 4.06 Termination, Dischazg_e and Transfer. This Agreement may be terminated as set forth below and as set forth in the Resident Handbook under the Section Heading "Discharge". The Resident and/or Legal Representative may terminate this Agreement before the Resident's discharge from the Center by providing the Center written notice of the Resident's desire to leave at least seven (7) days in advance of the Resident's departure. If the Resident leaves before the end of that time, the Resident must still pay for each day of the required notice unless the Center fills the bed before the end of the notice period. Except in the event of an emergency or death, the Resident shall be responsible for all charges for the Room and Boazd Rate and for all services performed up to the end of the day that the Admission ends. Dischazge from the specialized units such as the Transitional Care Unit or Subacute Unit may require less tharr seven (7) days notice. If discharge or transfer becomes necessary because the Resident and/or Legal Representative or someone else abused the Resident's funds, the Center will request that local, state and federal authorities, as appropriate investigate, which may result in prosecution. 4.07 Indemnification. The Resident shall defend, indemnify and hold the Center hazmless from any and all claims, demands, suit and actions made against the Center by any person resulting from any damage or injury caused by the Resident to any person or the property 8 of any person or entity (including the Center), except in the case of negligence of the Center's employees and agents. 4.08 Changes in the Law. Any provision of the Agreement that is found to be invalid or unenforceable as a result of a change in State or Federal law will not invalidate the remaining provisions of this Agreement and, it is agreed that to the extent possible, the Resident and the Center will continue to fulfill their respective obligations under this Agreement consistent with the law. THE UNDERSIGNED HEREBY CERTIFY AND ACKNOWLEDGE THAT THEY HAVE EACH READ AND UNDERSTOOD THE FOREGOING AGREEMENT, AND THAT THEY HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS AND THAT ANY SUCH QUESTIONS HAVE BEEN ANSWERED TO THEHi SATISFACTION. Signature of Resident: Date: Signature of Legal Representative, if signing on behalf of Resident: Date: Q-~ ~ ( ~~ Signature of Legal Representative, signing on his/her own behalf: Date: Center Representative: -- r~ Date: EXHIBIT "C" :_...~. FF.QM FAX N0. 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NAME h5 PO CN K STAMPS ST. SEAVICE I I I i7 H~ / I i I ! ~ • r Aaguienon y~.7/ Aessaa ~pliGaridr4 r-+k".~Pd.. `~~7'lD ~r~16GL. dti2. BaCFSS r.~l1U~*'S . ,~ld^rC~.a CarrX.irt BfCePGL~ Ihilih jr'rnrlEe f~ '~a7~1GYI•CEd.~t "tP.r 1&••e~+'n>l balevsa~ D1'' ^~'.+831L1. 35 ~itca Cexth !J©IGCP o~ fi r rDSC~L y~yyy,,~~P. pPF~` '~5'~f5f:!•'r'7n s ciE.3'~`{.' t ~j/u/. '~ tw r-~Jtd2ta~ cA/t..~. ,t'YL~E/~Ft~• /assr~'-G'EXJOGt-TYLE. ll'~/CE4 /~(i~l~YG' ~5• F "$7AMF?3. ;:• Number aF Par4Eyxs~ -~ r] ,'~ ^ `~ ~ ~ e9rof.Pel~ons~ p MONTHLY Name I AN ! IN M ° GRO ' MOfJTN~v SAN - WCOM _ (~o ~~~/~. 5 j;'~j//j, I ~. s 1, ll, $ ,,~ ±lii 6MONiN>_Y NemC ~i~R NC-O INIbME Nang ROS MV HL U EAR EO IN e I s , /'ijr; I s /~ TOTAL GROSS MONTHLY fNCDME 3 7tlTA4 GROSS MONTHLY INCOME $ GROSS MONTHLY CEPEHDFNT CARE CDSTS 3 GROS6 MONTHLY OEPENCENT CARE C06'TS $ GAp65 MEDICAL COST$ S 7cla7,ngne WazeryGewagg • ~'i MEDICAL ASSESTANCE Nurn6er of persons Jr ' EleCtri< _ _ i GarOaSe/iresn Name aoss M NTNLr .~ RNE I C ME Ga; Utility InsCSllati0n _ ' $ 'i~/ 1 i / Dtl ~•-~ - Olnef y ' T '---~ ~ I a V' ~j ~% r GRD85 UTiL1TY COST$1U71LITY 3TANDAAD• { S RENTlM4RTGAGE 'S f/,~j jj 1 NAme ~$ j 7 ~! jj , I ['nV U EARN OiNCCME raxES i$ V/;,'~f, !N$URANGE COST DN HOMH ,- 15 _- __ Yi j r:l r T II', lj,, Y I a y~! ~ ' f i TOTAL SHELTER C05T 1 5 I $ I '% '',/ Aj `The howsehald may switch between the aGtu31 utiLty msts and the TCTAL GAOAS MONTHLY INCOME ~ S StdRdard UCility SlMHr3f7C8 a1 fha EfIA6 Of rB6pjrlfCStion and oae NET MONTHLY 1NCOMFINtT SEMI-ANNUAL INCDME S additions! time during each tweNe•yrmnth period. INCOME uMl7 i S CO REC O NUMBER CAT CTF 016 tl16, ~ , ~*~J ..7] ~_ I ~7A~ ~(~ / f~ ~ ,~ _ orkers Sgn• ed,+' a Date Talearrone NumDCr / F~ ~?xrrzr Carte damp Nyjl A~ 17c/! doer do naturldetstarhdaardeCisian er nave any quasliorxs, contact your worker. L=cYaL sERVtcES. INC_ 81RVINE ROW CARUSIE PA 17013-3019 717.2433!00 777.7E5S475 Elwood Gower 1700 Market Str, Camp Hill, Pa 17011 Sun. 21 2881 04:41RM .P3„ , C4A+lIviCNWEAI.TFI QF PENN$YI,'trANIA DEF'AYi.TMENT OF PUBLIC WELFARE }3uresu of Hearings ant} Appeals 1401 North Seventh Street, First Floor Harrisbnrg,Penasylvania 17105-2675 Case Na_ 210089227-001 Nfri'1CF QF SCf1EpZT1,EDIiEAR1N[1 Dear Mr. Gower: FAX N0. lte: PA/FS162 OlOl16 Handwritten appeal 02!06/41 This notice acknowledges the retelpt of your request for a fair hearing. Because you have chosen a telephone hearing, your hearing will be conducted by a hearing o~3cer, who acts as a,~udge-. The hearing aft7cer will call you at the telephone number you provided on your appeal aatiCe at the date --' ' acid time specified below- Please notify the hearing ofl'icar imanediately i£the number has chaaged or is incorrect, or if you would like to change your heAtirg to a #ace-to-face h~T~9 izt Harrisburg. Hearing Date: Wednesday, ,lone 27, 2001 Time: 09:00 a. m. YourpheneNumber. (717y'766-9255 Name and Fhone of Welfare 1Flearing DScer 2: F~reeda M- Prunty, (717? 783-3950 *L~RTANT: I#you or arepresentative Yar you 3s not available #or the heating, you wilt lose the ease. 7ftha reason for your unavailability is deemed acceptable, you may have the hearing postponed- *ACKNOWLEDGEMF,NTCARDJBROCIIt)1tE: Au~lf-addressed,postage-paidpostcardhashcen irxcluded with this notice. Please read the postcard carefully, check the appropriate 188x, and. return the card to the Bureau of Hearings and Appeals as soon as possible. A brochure has also been included with this notice which provides s summary of the hearing process and information regarding optional hearing methods. if you have any questions regarding the contents of this notice or the brochure, please contact the hearing olTicer_ The Bureau of Hearings and Agpeals complies with the Americans with Disabilities Act. We will provide reasonable aecommodationa upon request. Please contact the hearing officer at the above address ar telephone number upon receipt ofthis correspondence if you require special accommodations. Sincerely, l~'reeda M. Prunty, Welfare Hearing Oi£tcer 2 ec: Cumberland CAO Craig S. Gower ]kn ., . ~. ~ ~ ~ .~ ~~~ U~ `I `; m Y °~ ~ n - _ -, , T -~ iu ~ r - f r i ~~ , ~ I z r ~ - ~.y u~ •~. . = _i [,j r 1 C . ^ \) i T-i f,n) -:: Il ~ ~~s]i1/sea¢x~~ 3 ,e,>Yi 'k4i~bfNi'cu:'3<{3u~JffjjR311[N9."1{ SHERIFF'S RETURN - REGULAR CASE NO: 2001-04773 P *~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HCR MANOR CARE VS GOWER ELWOOD ET AL DOUG DONSEN Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon GOWER ELWOOD the DEFENDANT at 1950:00 HOURS, on the 16th day of August 2001 at 1700 MARKET STREET CAMP HILL, PA 17011 by handing to ELWOOD GOWER a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 9.75 Affidavit .00 Surcharge 10.00 .00 37.75 Sworn and Subscribed to before me this 3d `z' day of / A.D. r thonotary So Answers: R. Thomas Kline 08/17/2001 WOLFSON & ASSOC. By. ~~ UY~~~ Deputy Sheriff Y\ SHERIFF'S RETURN - REGULAR CASE NO: 2001-04773 P " COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND HCR MANOR CARE VS GOWER ELWOOD ET AL DOUG DONSEN Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon GOWER CRAIG the DEFENDANT at 2100:00 HOURS, on the 16th day of August 2001 at ROLLO COURT, LOT 88 MECHANICSBURG, PA 17055 CRAIG GOWER by handing to a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 6.00 Service 5.85 Affidavit .00 Surcharge 10.00 .00 21.85 Sworn and Subscribed to before me/~this 30~`- day of thonotary So Answers: R. Thomas Kline 08/17/2001 WOLFSON & ASSOC. By: Deput Sheriff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, vs. ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Defendants CIVIL ACTION -LAW PRELIMINARY OBJECTIONS TO PLAINTIFF'S COMPLAINT AND NOW, this ~ day of September, 2001, comes Craig Gower, individually and on behalf of Elwood Gower, through his attorney Michael D. Rentschler, Esquire, who files the within Preliminary Objections, as follows: Preliminary Objections in the Form of A Motion to Strike Scandalous or Impertinent Matter Pursuant to Pa. Rule of Civil Procedure Rule 1028(a)(2) 1. On or about August 13, 2001, HCR Manor Care, Plaintiff, filed a complaint against Elwood Gower, individually, and, his son, Craig Gower, individually, and on behalf of Elwood Gower. 2. The Complaint ostensibly is for the collection of amounts of money allegedly owed to Plaintiff by Defendant for alleged nursing home health care purportedly provided to Defendant Elwood Gower. 3. Paragraph 11 through 21, inclusive, contain allegations which are irrelevant, inappropriate, immaterial, scandalous, or impertinent. 4. Paragraphs 11 through 21, inclusive, of Plaintiffs complaint state as follows: Plaintiff N0. 01-4773 CIVIL 1 11. That Defendant Craig Gower submitted an application for medical assistance on behalf of his father, Elwood Gower, on or about November 27, 2000. 12. That pursuant to the above mentioned application, Defendant Craig Gower was notified of discontinued benefits due to excess of resources of Defendant Elwood Gower. A true and correct copy of the notice of discontinued benefits is attached hereto, incorporated herein, and marked as Exhibit "C". 13. That pursuant to said discontinuation of benefits, Defendant Craig Gower filed an appeal with the Department of Public Welfare. See Exhibit "C" as previously identified and incorporated herein. 14. That the appeal hearing, which occurred on or about June 27, 2001 upheld the prior decision of the Department of Public Welfare that benefits were to be discontinued. 15. That pursuant to the appeal decision, Defendant Craig Gower failed to appropriately utilize the assets of his father, Defendant Elwood Gower, to pay for the residential health care services which were being provided to Defendant Elwood Gower. 16. That Plaintiff alleges, and therefore avers, that Defendant Craig Gower is receiving Defendant Elwood Gower's social security benefit checks and expending said funds for his own use instead of using said funds to pay Plaintiff for the amount due and owing on Defendant Elwood Gower's account balance with Plaintiff. 17. That Defendant Craig Gower violated his fiduciary duty and responsibilities as the Legal Representative and/or Responsible Party for Defendant Elwood Gower by utilizing Defendant Elwood Gower's social security benefits for his own purposes when he know or should have known there were outstanding medical bills for his father, Defendant Elwood Gower. 18. That Defendant Craig Gower wrongfully converted the funds of his father's social security benefits, without authority or justification, into his own possession and for his own personal use to prevent said social security benefits from being applied to the necessary and medical needs of his father, Defendant Elwood Gower. 19. That the funds of said social security benefits rightfully belonged to Defendant Elwood Gower and Plaintiff for his necessary and appropriate medical services and treatment rendered by Plaintiff to 2 Defendant Elwood Gower. 20. That recovery for unjust enrichment is proper if one party is enriched by another, and injustice would result if recovery for the enrichment is denied. 21. That Defendant Craig Gower was enriched by the use of the social security benefits, which rightfully belonged to Defendant Elwood Gower, and injustice would result if recovery for enrichment was denied as said benefits were to be used to pay Plaintiff for the medical services it rendered to Defendant Elwood Gower. 5. Since Paragraphs 11 through 21, inclusive, are immaterial, inappropriate, scandalous, or impertinent to the proof of the cause of action, it is respectfully requested that these paragraphs be stricken from the complaint. WHEREFORE, it is respectfully requested that this Honorable Court grant the within Preliminary Objections and, consequently, strike paragraphs 11 through 21, inclusive, from Plaintiffs complaint. Respectfully submitted, .~~ MICHAEL D. RENTSCHLER, ESQUIRE 1300 Market Street, Suite 200 Lemoyne, PA 17043 (717) 975-9129 Attorney for Defendant Craig Gower 3 ~. . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, vs. Plaintiff ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Defendants NO. CIVIL ACTION -LAW CERTIFICATE OF SERVICE 1, MICHAEL D. RENTSCHLER, ESQUIRE, do hereby certify that on this date I served a copy of the within document via first-class mail, postage pre-paid to the following recipient(s): Daniel F. Wolfson, Esquire 267 East Market Street York, PA 17403-2000 Date: ~~ ~~~/ ~~- ~`~~.~ Mi ael D. Rentschler, squire .~.,. r., ~. c.~ - ~, rya , ~ , ri <~ .1 .. .__ ~ ~ } IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, Plaintiff vs. NO.O 1-4773 Civil CIVIL ACTION -LAW ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Individually and Jointly, Defendants NOTICE You have been sued in Court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice is served, by entering a written appearance, personally of by attorney, and filing in waiting with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so, the case may proceed without you and a judgment may be entered against you by the' Court without further notice for any money claimed in the Complaint, or document, or for any other claim or relief requested by he Plaintiff You may lose money or property or other right important to you. SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A fER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH TO FIND WHERE YOU CAN GET LEGAL HELP. NOTICIA Le han demandado a used en la torte. Si usted quaere defensas de eras demandas expuestas en las paginas, siguientes, usted tiene viente (20) dins de plazo al partir de la fecha de lademanda y la notifiadon. Usted debe presentar una apariencia escrita o en persona o por abogado y archivar en la torte en forma escrita sus defensas o sus olijeciones a last demandas en contra de su persona. Se avisado que si usted no se defienda, la torte tomara medidas y psedido entrar una Orden contra used sin previo aviso o notification y por eualquier queja o alivio que es pedido en Ia petition de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para used. LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATAMENTE. SI NO TIENE ABOGADO O SI NO TIENE EL DINERO SUFFICIENTE DE PAGAR TAL SERVICIO VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABA]O PARR AVERIGUAR DONDE SE PUEDE CONSEGUIR ASSITANCIA LEGAL. Lawyer Referral Service Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 (717)249-3166 a ~ P ' 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, NO. 01-4773 Civil Plaintiff vs. CIVIL ACTION -LAW ELWOOD GOWER, Individually, and ~RAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Individually and Jointly, Defendants AMENDED COMPLAINT AND NOW, this 27`h day of September, 2001, comes the Plaintiff, HCR Manor Care, by and through its attorney, Daniel F. Wolfson, Esquire, and the law firm of Wolfson ~ Associates, P.C., and files the within Complaint and in support avers as follows: 1. Plaintiff, HCR Manor Care is a health care provider qualified to conduct in the Commonwealth of Pennsylvania with offices and/or a place of business at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Defendant, Elwood Gower, is an adult individual with a current address of 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 1701 1. 3. Defendant, Craig Gower, is an adult individual with a last known address of Rollo Court, Lot 88, Mechanicsburg, Cumberland County, Pennsylvania 17055. 4. That Plaintiff filed itt original Complaint on or about August 13, 2001, and subsequently filed Preliminary Objections to said Complaint on or about September 6, 2001. 5. That Plaintiff is filing the within Complaint as an attempt to cure Defendants' Objections. r ~ s ' 6. That Defendant Craig Gower is the son of Defendant Elwood Gower. 7. That on or about April 11, 2000, Defendant Craig Gower executed an Admission Agreement on behalf of his father, Defendant Elwood Gower, which Agreement outlined various terms of residential health care services to be provided by Plaintiff and the Responsible Party therefor. A true and correct copy of the Admission Agreement is attached hereto, incorporated herein, and marked as Exhibit "A". 9. That Defendant Elwood Gower continues as a current resident of the Plaintiff in its facility in Cumberland County pursuant to the Admission Agreement between Defendant Craig Gower and Plaintiff. 10. That Defendant Craig Gower represented himself to be the Legal Representative of his father and signed the Admission Agreement accordingly. See Exhibit "A" at page nine (9). 11. That Defendant Graig Gower notified the Plaintiff that there was a duly executed Power of Attorney for Defendant Elwood Gower appointing him as the Attomey- in-Fact and thereby providing him with the authority to act on behalf of his father however, he failed to provide a copy to Plaintiff. 12. Defendant Craig Gower agreed to be the Responsible Party for the rights, obligations and duties of Defendant Elwood Gower under the aforementioned Admission See Exhibit "A", Section 11, Paragraphs 2.01, 2.02, previously identified and incorporated herein. 13. That on or about April 11, 2000, through the present, Defendant Elwood Gower was a health care resident of Plaintiff, where he did receive various necessary 2 . ' ~ r 'r residential health care services and health care treatment by Plaintiff. An itemization of said services is attached hereto, incorporated herein, and collectively marked as Exhibit ..B.. 14. That Defendant Craig Gower knew or should have known his father would incur expenses for health care services which the Plaintiff expected to be compensated. 15. That Defendant Craig Gower knew or should have known charges for health services incurred are not usually completely compensated by third party payor's or programs and therefore his father would incur health care expenses in excess any insurance and or Medical Assistance and that those expenses would be the personal of his father and or himself. 16. That at all times relevant thereto, Defendant Craig Gower, knew or should known of his responsibility and or duty to pursue and secure Defendant Elwood financial resources and any available benefits to pay for expenses incurred by his 17. That from the time Defendant Craig Gower executed the Admission with the Plaintiff, on behalf of his father, he undertook the handling of the rights and responsibilities related to the health care services received by his father, and at all times thereafter, he was under and remained under obligation to the Plaintiff. 18. That by executing the Admission Agreement, Defendant Craig Gower agreed in writing to assume and accept responsibility for the debt to be incurred by Defendant Elwood Gower for the services to be provided by the Plaintiff and to provide payment from Defendant Elwood Gower's income or resources for the fees and charges 3 .> ti identified in the Admission Agreement, and further, in the event of a breach of his duties obligations and or his failure to provide the information required to submit and an application for Medical Assistance, he agreed to be personally liable to the See Exhibit "B", Section I, Paragraphs 1.05, 1.06, 1.07, 1.10; Section 11, 2.01, 2.02, 2.04 and 2.05 previously identified and incorporated herein. 19. That Plaintiff submitted to Defendants a copy of the itemization of services showing all debits and credits for transactions with Plaintiff. 20. That Defendants have not objected to the above-mentioned Statement of submitted by Plaintiff to Defendants. 21. That Defendants have refused to pay the account balance identified in Exhibit „B ~~ 22. That Plaintiff has made numerous requests to Defendant Craig Gower, as the Legal Representative and/or Responsible Party for Defendant Elwood Gower, demanding the sums due and owing to Plaintiff be paid, and Defendant Craig Gower, as the Legal Representative and/or Responsible Party for Defendant Elwood Gower, has refused his obligation to pay necessary and appropriate bills on behalf of Defendant Elwood Gower, in direct violation of the Admission Agreement and his fiduciary duty as his father's legal representative. See Exhibit "A", Section I, Paragraphs 1.07, 1.10; Section 11, Paragraph 2.02 previously identified and incorporated herein. 23. That Defendant Craig Gower submitted an application for Medical Assistance behalf of his father, Defendant Elwood Gower, on or about November 27, 2000 as he 4 ~ ~ t ~ ~Y was required to do under the Admission Agreement. See Exhibit "A", Section I, Paragraph 1.05 previously identified and incorporated herein. 24. That pursuant to the above mentioned application, Defendant Craig Gower was notified his father's benefits were discontinued due to his father's excess resources in amount of Twenty Three Thousand Eight Hundred One and 12/Dollars ($23, 1801.12). A true and correct copy of the notice of discontinued benefits is attached incorporated herein, and marked as Exhibit "C". 25. That pursuant to said discontinuation of benefits, Defendant Craig Gower an appeal on behalf of his father, Defendant Elwood Gower, with the Department of Public Welfare. See Exhibit "C", previously identified and incorporated herein. 26. That Defendants did not appear at the appeal hearing, which occurred on or June 27, 2001, resulting in the dismissal of the appeal for failing to pursue it and the prior decision of the Department of Public Welfare that benefits were to be was upheld. See Exhibit "C" previously identified and incorporated herein. 27. That Defendant Craig Gower's failure to appear was a direct violation of II, Paragraph 2.05 of the Admission Agreement he signed with the Plaintiff in he agreed to cooperate in the process of applying for and obtaining Medical benefits. 28. That Defendant Craig Gower knowing failure to cooperate with the Department of Welfare to obtain Medical Assistance benefits for his father constitutes a breach of the Admission Agreement and the fiduciary obligations owed to the Plaintiff. 5 . ~ 1 'T 29. Defendant Craig Gower has not pursued Medical Assistance benefits on of his father who continues to reside with Plaintiff and incur debt for health care provided by Plaintiff. 30. That Defendant Craig Gower knew or should have known pursuant to the Agreement he was personally responsible for cooperating with the Medicaid representative in attempting to qualify his father for benefits. 31. That Defendant Craig Gower knew or should have known his father was personally responsible for charges incurred while a resident with Plaintiff if benefiu were denied and that any breach of his duty to provide payment to Plaintiff would result in his incurring personal liability on behalf of his father. See Exhibit "A" Section I, Paragraphs 1.07, 1.09,1.01, 1.02, 1.05, 1.10 and Section 11, 2.02, 2.04 and 2.05. 32. That pursuant to the appeal decision and in direct violation of the Section 11, 2.01 and 2.02 of the Admission Agreement he signed with the Plaintiff, Craig Gower willfully failed to appropriately utilize the assets of Defendant Gower, to pay for the residential health care services which were being provided to father. 33. That Defendant Craig Gower unequivocally and wilifiully violated his with the Plaintiff when he failed to follow through with the requirements of the Assistance process. 34. That at all times relevant thereto, Defendant Craig Gower willfully, ~, and unequivocally violated his agreement with the Plaintiff when he failed to remit payment on behalf of his father. 6 ~~ ~r 35. That Plaintiff alleges, and therefore avers, that Defendant Craig Gower is receiving Defendant Elwood Gower's finances and expending said funds for his own use instead of using his father resources and funds to pay Plaintiff as he agreed for the amount due and owing on Defendant Elwood Gower's account balance with Plaintiff. 36. That Defendant Craig Gower violated his fiduciary duty and responsibilities as the Legal Representative and/or Responsible Party for Defendant Elwood Gower by utilizing Elwood Gower's resources and finances for his own purposes when he knew or have known there were outstanding medical bills for his father, Defendant Elwood Gower, which are cunently due and owing to Plaintiff. 37. That the finances of Defendant Elwood Gower rightfully belonged to Defendant Elwood Gower and Plaintiff for the necessary and appropriate medical services and treatment rendered by Plaintiff to Defendant Elwood Gower. 38. As of the date of filing of the within Amended Complaint, the balance due, owing, and unpaid on Defendant Elwood Gower's account as a result of said charges is the sum of Forty-:Eight Thousand Two and 18/100. Dollars ($48,002.18). See Exhibit "A" as previously identified and incorporated herein. 39. Despite Plaintiff's reasonable and repeated demands for payment, Defendants have failed, refused and continue to refuse to pay all sums due and owing on Defendant Elwood Gower's account balance, all to the damage and detriment of the Plaintiff. 40. The damage to Plaintiff is the direct result of the failure to pay the' Plaintiff for health care services provided to Defendant Elwood Gower, as a resident of Plaintiff, by both Defendant Elwood Gower and or his Responsible Party, Defendant Craig Gower. 7 ~, 41. Pursuant to Section 1; Paragraph 1.03, of the Admission Agreement, Plaintiff is entitled to receive and Defendants have agreed to pay interest at a rate of eighteen percent (18%) per year on past due balances. See Exhibit "B" as previously and incorporated herein. 42. As of the date of the within Amended Complaint, the amount of interest has accrued on the past due balance is the sum of Three Thousand Seven Hundred and 62/100 Dollars ($3,761.62). 43. Plaintiff has retained the services of the law firm of Wolfson 8t Associates, .C., in the collection of the amounts due from Defendants. 44. Pursuant to Section 1, Paragraph 1.03, of the Admission Agreement, is entitled to receive and Defendants have agreed to pay reasonable attorney fees and all court costs if the account is refened to an attorney for collection. See Exhibit "B" as previously identified and incorporated herein. 45. As of the filing of this Complaint, Plaintiff has incurred reasonable attorney's fees from the law office of Wolfson 8i Associates, P.C., in the collection of the amounts due and owing by Defendants incident to the within action, and Plaintiff shall continue to incur such attorney's fees throughout the conclusion of the proceedings in the amount of percent (30%) of the principal balance which is due and owing. 46. That the amount of attorney's fees which represents thrity percent (30%) of principal amount due and owing is the sun of Fourteen Thousand Four Hundred and 100 Dollars ($14,400.65). 8 ., ,. .. _~ 47. Any and all conditions precedent to the bringing of this action have been performed by Plaintiff. 48. The amount in controversy exceeds the jurisdictional amount requiring compulsory arbitration. WHEREFORE, Plaintiff, HCR Manor Care, respectfully requests this Honorable enter judgment in favor of Plaintiff and against Defendants, Elwood Gower, Individually, and Craig Gower, Individually, and on Behalf of Elwood Gower, in the of Forty-Eight Thousand Two and 18/100 Dollars ($48,002.18), contractual in the amount of Three Thousand Seven Hundred Sixty-One and 62/100 Dollars ($3,761.62), reasonable attorney's fees in the amount of Twelve Thousand Four Hundred Seventy-Four and 351100 Dollars ($12,474.35), the costs of this action, and such other relief as the Court deems proper and just. Respectfully submitted, G~~> ~~a~~'~cc~ U Daniel F. Wolfson, quire WOLFSON et ASSOCIATES, P.C. 267 East Market Street York, PA 17403 (717) 846-1252 ID No. 20617 Attorney for Plaintiff 9 f ' i ~ ,., ~« ,~a~.u:.~gh.&~r s~~ r R w s~ea~yusrgu xx .. _ ... .. ~~ VERIFICATION ~~ r Daniel F. Wolfson, Esquire, hereby states that he is the attorney for the Plaintiff, HCR Manor Care, and he is authorized to take this verification on behalf of said Plaintiff in within action and verifies that the statements made in the foregoing Amended Complaint are true and correct to the best of his knowledge, information, and belief, based upon information provided by the Plaintiff. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. September 27, 2001 ~7~ yGl/ Daniel F.1~olfso~ ire WOLFSON si ASSOCIATES, P.C. 267 East Market Street York, PA 17403 (717) 846-1252 ID No. 20617 Attorney for Plaintiff ~, ,, EXHIBIT "A" HCR Manor Care ADMISSION AGREEMENT This Agreement is entered into by and among HCR Manor Caze, the Resident, and the Legal Representative, for the purpose of providing for the rights and responsibilities of the parties with respect to the Resident's stay at this HCR Manor Care's Health Caze Center ("Center"). Center: ~ 1. R ~G(1L'( l,Ql~ r Resident: ~'.~u3Cc}C'1 C. vy~teR. Legal Representative: G4~~-r ~ G~ Admission Date: ~ r(1 i ~ Deposit: S Term: This Agreement shall begin on the day the Resident enters the Center and end on the day the Resident is dischazged. I. RIGHTS AND RESPONSIBILITIES OF THE RESIDENT 1.01 Room and Boazd Rate. For the basic services provided for in Section 3.01, the Resident agrees to pay the applicable Room and Boazd Rate set forth on Attachment A hereto. The Room and Board Rate is subject to change upon thirty (30) days written notice. The Room and Board Rate set fdrth in Attachment A is payable in advance and is due by the tenth (10`") day of each month. The Resident shall be responsible for the Room, and Board Rate for the day of admission as well as the day of discharge. This Section shall not apply if the Resident is covered under a Governmental Program (see Section 1.05) or by a Third Party Payor or Managed Care Organization (see Section 1.06). 1.02 Ancillary Chazges. The Resident further agrees to pay to the Center all charges far additional medical, therapeutic, or personal care services or supplies that may be requested by the Resident, ordered by the attending physician, or provided in the Resident's Plan of Caze. The Center reserves the right to change for personal caze items of the Resident if necessary for the well-being of the Resident. Such "Ancillary Chazges" are descn'bed on Attachment B hereto, and a current ancillary charge list is maintained at the Center's business office for review during regulaz business hours. Ancillary Chazges shall be included in the Resident's statement for the succeeding month, and are payable in full, along with the Room and Board Rate by the tenth (10`") day of the month. 1 1.03 Late Pa~tnents. Accounts not paid in full within thirty (30} days of billing shall be subject to a service charge equal to the highest legal rate of interest permitted by State law as set forth in Attachment A on the past due balance each month until such time as the balance due is paid in full. Should the Resident's account for any reason be turned over for collection, the Resident agrees to pay the Center's collection costs, including attorney's fees. 1.04 Independent Providers. The Resident shall be directly responsible to independent providers, including but not limited to, the Resident's attending physician for any health or personal program in accordance with the terms of the program. 1.05 Governmental Programs. If the Resident is eligtble for coverage under any governmental program, such as Medicare, Medicaid, or through the Veterans Administration, and the Center participates in such program, the Center shall accept payments under such program in accordance with the terms of the program on the contract the Center has with the program. The Resident shall be responsible for any co-insurance, deductibles or non-covered charges, according to the same terms and conditions applicable to private pay residents. The Resident must comply with all program requirements. In the event the Resident's coverage under the governmental program(s) cease for any reason, the Resident will be chazged at the Center's rate for private pay residents in accordance with Sections 1.01 and 1.02. The Center participates in the following programs: / Medicare, Medicaid and/or _VA Medicare may pay for some or all of the Resident's care. If Medicaze agrees to pay for the Resident's Gaze, there is a required co-payment, which Medicare updates yearly. If the Resident also participates in Medicare Part B, for physical, occupational, or speech therapy or other billable charges (which are not covered by Medicaze Part A), the Resident and/or Legal Representative agree to pay any required deductible, any required co-insurance, and any non-covered services according to the same terms and conditions applicable to private pay residents. For Medicaid, see Attachment L for additional information. The Resident and/or Legal Representative aze responsible for applying for Medicaid. If the Resident receives Medicaid, most of the Center chazges such as Room and Boazd and nursing services are covered, although Medicaid may require the Resident to pay a portion of the Room and Boazd Rate from their monthly income. The Resident and/or Legal Representative agree to pay on a timely basis, as set forth in this Agreement, the contribution amount as determined and periodically adjusted by the State and/or local department(s) handling Medicaid. If the Resident and/or Legal Representative fail to pay the contribution amount, the Center may take such legal action as necessary, including requesting a court to order such payment. 1.06 Third Party Pavors and Managed Caze Organizations. If a Resident is a participant in a plan offered by a third party payor such as a Health Maintenance Organization ("HVii 0"), Preferred Provider Organization ("PPO"), Provider Sponsored Organization ("PSO"), or Physician Hospital Organization ("PHO"}, indemnity plan or another similar entity with which the Center has executed a provider agreement, the chazges aze governed by the applicable agreement. The Resident shall be responsible for any co-payments, deductibles or non-covered charges, according to the same terms and conditions applicable to private pay residents. If the Center has not executed a provider agreement with the Resident's third party payor, the Center ., will bill the Resident's third party payor as a service, but the Resident remains liable for charges not paid or covered by that third party payor including charges not paid within a reasonable period of time. 1.07 Private Pav Resident. The Resident and/or Legal Representative acknowledge that they are responsible for paying the Center for items and services provided during the stay at the Center and during which time the Resident has not been determined to be eligible for Medicaid. The Resident and/or Legal Representative agree to notify the Center promptly if there is insufficient income or assets to meet the financial obligations to the Center or to make prompt application to Medicaid for benefits. The Resident and/or Legal Representative agree to notify the Center in writing when application to Medicaid is made. The Resident and/or Legal Representative agree to cooperate fully in applying for Medicaid and in the eligibility determination process. If the Resident is no longer able to pay for care at the Center and the Resident is not eligible for Medicaid, the Resident will be notified of the Center's intention to dischazge the Resident for non-payment in accordance with the Agreement, Resident Handbook and State and federal laws. 1.08 Admission Information. It shall be the responsibility of the Resident and/or Legal Representative to notify the Center and to provide any needed information regazding all third party payors or governmental coverages on admission and throughout the stay including copies of insurance cards, identification or verification of eligibility and coveraee information. The Resident and/or Legal Representative agree to provide the Center with notice within five (51 days bf the Resident's disenrollment, enrollment, change in health care coverage, failure to pay premium(s) or renewal of insurance coverage and any cancellations in covezage as the Center relies on the information supplied regarding such coverage. The Resident and/or Legal Representative acknowledge that if they fail to provide such information, they may be responsible for any denied charges due to lack of authorization, ineligibility, non-coverage or other costs associated with the failure to provide such notice in accordance with the terms and conditions of this Agreement. 1.09 Application for Benefits. It shall be the responsibility of the Resident andlor Legal Representative to apply for coverage and to establish eligibility under any governmental, third party payor, managed Gaze or private insurance program The Center shall be under no obligation to bill any third party payor other than the Legal Representative and, when applicable, a governmental program third party payor or managed care organization with which the Center is under contract. 1.10 Prin~aty Responsibility for Payment. Except for payments for services covered under govenunentai programs or provider agreements, the Resident shall remain primarily liable for any and all charges for which the Center may agree to bill a thud party. The Resident and/or Legal Representative acknowledge that the insurance company, HMO, PPO, PSO, PHO or managed caze provider may not pay for non-covered services, supplies, equipment, medications, and other caze and services which may be delivered by the Center or its subcontractors. This 3 4 ~ ~ ~ •, Agreement serves as a written notice that the Center has notified the Resident and/or Legal Representative that services provided at the Center may not be covered by a governmental payor, third party payor or managed caze organization. The Resident and/or Legal Representative agrees to be responsible for non-covered services. A price list of services is always available at the business office upon request. 1.11 Personal Physician. The Resident has the right to choose a personal physician, provided that the physician selected is properly licensed and agrees to abide by applicable law and the rules and policies of the Center. At the time of admission, the Resident must supply the Center with the name of his/her personal physician. If the Resident changes physicians at any time after admission, the Resident and/or Legal Representative must immediately notify the Center of the new physician's name. If the physician chosen by the Resident fat7s to provide needed coverage and attendance or fails to abide by applicable laws and regulations, the Center shall have the right to call another physician to attend the Resident and the fees charged by such physician shall be borne by the Resident. 1.12 Pharmacy. The Resident and/or Legal Representative acknowledge the right to choose a pharmacy of choice, provided the pharmacy selected is properly licensed, packages and supplies pharmaceuticals in accordance with State law and agrees to abide by the Center's policies and procedures and the pharmacy has a medication distribution system similar to the Center's ancillary pharmacy's medication distribution system R. RIGHTS AND RESPONSIBILITY OF THE LEGAL REPRESENTATIVE 2.01 Legal Authority. The Legal Representative hereby represents that he/she has legal access to the Resident's income or resources and that the documents supporting such authority, if any, have been delivered to the Center. 2.02 Agreement to Make Payments on Behalf of Resident. The Legal Representative agrees to pay promptly from the Resident's income or resources all fees and charges for which the Resident is liable under this Agreement. The Legal Representative shall not incur personal liability on behalf of the Resident except for a breach of the duty to provide payment from the .Resident's income or resources for the fees and charges provided for in this Agreement. 2.03 Requested Items. The Legal Representative shall be personally liable for any services or products specifically requested by the Legal Representative to be supplied to the Resident, unless such services or products aze covered by a governmental program 2.04 Exhaustion of Resident's Funds. If the Resident's financial resources change such that the Resident may be eligible for Medicaid, the Resident and/or Legal Representative must notify the Center in writing when the application for Medicaid is made. If the Legal Representative fails to notify the Center in writing or fails to file for Medicaid in a timely and proper manner, the Legal Representative shall be personally liable for all charges and fees not covered by iVfedicaid which otherwise would have been covered had application been made in a timely and proper manner. a ,. ~ . 1 2.05 Cooperation for Financial Assistance. If the Resident is eligible for Medicaid, the Legal Representative shall provide such information about the Resident's finances as lvledicaid representative shall require for continued coverage of the Resident and be personally responsible for any chazges denied the Center due to any lack of cooperation. 2.06 Acceptance Upon Discharge. Upon termination of this Agreement as provided in the Resident Handbook, the Legal Representative agrees to arrange and pay for the departure of the Resident from the Center. If after notice the Resident is not removed as requested, then the Center is authorized and empowered to remove the Resident by reasonable means of transportation and to deliver the Resident to the residence address of the Legal Representative, if the Resident's condition permits, who shall unconditionally be obligated to accept the Resident and to pay promptly all charges. 2.07 Additional Responsibilities. The Legal Representative acknowledges the other duties and responsibilities for the Resident and to the Center as set forth in this Agreement and Attachments. III. RIGHTS AND RESPONSIBILITIES OF THE CENTER 3.01 Room and Standazd Services. As part of the Room and Board Rate, the Center shall furnish basic room board, common facilities, housekeeping, laundered bed linens and bedding, general nursing Gaze, personal assessment, social services, and such other personal services as may be required pursuant to the plan of caze prepared by the Resident's physician and the Center, with the Resident's consent, for the health, safety and general weA-being of the Resident. 3.02 Other Services. The Center shall act in accordance with the Resident Handbook, which is incorporated by reference in this Agreement. 3.03 Deposit. The Center hereby acknowledges receipt of the Deposit, if any, noted at the beginning of this Agreement. The Deposit shall be applied to the charges for the first month of the Resident's stay at the Center. 3.04 Refunds. Any refund owed to the Resident for advance payments shall be paid by the Center within thirty (30) days after discharge or transfer or within the time frame required by State law. In the case of Medicaid Residents, any such refund shall be paid within thirty (30) days of the Center's receipt of the final Medicaid payment for Gaze of the Resident. IV. GENERAL PROVISIONS 4.01 Consent to Release of Information. The Resident and/or Legal Representative hereby consents to the release of his/her medical records to the following persons: Center personnel, attending physicians and consultants; and person, firm, government entity, third party payor or managed .caze organization responsible for all or any party of the payment or re'unbursement of the Resident's charges, including any utilization review or quality assurance 5 reviews or payment audits performed by such; the personnel of any hospital or other health Gaze facility or provider to whom or which the Resident may be transferred; the Center's liability insurance carrier; and any person authorized by law to review the medical records. 4.02 Consent to Treat. The Resident and/or Legal Representative, by signing this Agreement, hereby authorizes the appropriate staff of the Center to perform such functions, care and ser~7ces (hereinafter "Treatment") as aze necessary to maintain the well-being of the Resident, including but not limited to, assistance with bathing, hygiene, dressing, toiletry, and daily activities; and general nursing care, the administration of medications and treatments, and the performance of therapies, as prescribed by the Resident's personal physician in the Resident's Tian of Caze, or as required from tune to time in the exercise of good nursing judgment, subject to any rights provided to the Resident by federal and/or state law. As applicable, the undersigned Legal Representative hereby represents that helshe has the legal authority to make health care decisions on behalf of the Resident, that documents supporting such authority have been delivered to the Center, and that such Legal Representative hereby consents on behalf of the Resident to the Treatment described above. 4.03 Consent to Photoeranh The Resident and/or Legal Representative agree to consent to the Center taking a photograph of Resident for use in identifying the Resident, for placement of the photograph in the Medication Administration Record or other records and for any other similaz uses of the photograph for Center and staff to identify the Resident. 4.04 Notice of Services. Policies and Additional Information. The Resident and/or Legal Representative; acknowledge that the items listed below have been explained and have received copies of the items or policies and procedures, if applicable. The Resident and/or Legal Representative acknowledge they have had the opportunity to ask questions and questions have been answered satisfactorily. a. Authorization for Release or Review of Yledical Information. See Attachment C. b. Authorization for Payment of Benefits. See Attachment D. c. Social Security Administration Appointment. See Attachment E. d. SNF Medicare Determination Notice. See Attachment F. e. Medicare Secondary Payor Questionnaire. See Attachment G. f. At the request of the Resident and/or Legal Representative, the Center shall maintain the Resident's personal funds in compliance with the laws and regulations relating to the Center's management of such funds. A description and/or policies and procedures of protection of resident funds and the Personal Trust Fund Agreement, Resident Personal Funds 6 1 Authorization and any other related documents. See Attachment H-1 and H-2. g. The Center's policy and procedure on bedholds, election of bedhoIds and readmission. See Attachment I (Center Supplement). h. Social Service Agencies and Advocacy Groups addresses and phone numbers. See Attachment I (Center Supplement). i. Name, address and phone number of Ombudsrnan. See Attachment I (Center Supplement). j. The location in the Center where the names, addresses and telephone numbers of state client advocacy groups, state survey and certification agency, the state licensure office, the state ombudsman program, the protection and advocacy network and the Medicaid fraud control unit. See Attachment I (Center Supplement). k. The name, specialty and way of contacting the attending physician, medical director and other physicians who serve the Center. See Attachment I (Center Supplement). 1 Procedures, name, address and phone number on how to file a complaint with the state survey and certification agency concerning resident abuse, neglect, mistreatment and misappropriation of property. See Attachment I (Center Supplement). m The Resident Handbook. See Attachment 7. n. Resident/Patient Rights. See Attachment K o. MedicarelMedicaid information and display of such information includng how to apply for and use Medicaze and Medicaid benefits, and how to receive refunds for previous payments. See Attachment L. p. Receipt of information on advance directives including a copy of "Refusal of Life Sustaining Treatment", which summarizes HCR Manor Caze's Limited Treatment Practices and "No Cardiopulmonary Resuscitation Orders" and a copy of the State summary of its laws governing the Resident's right to direct his/her medical treatment. See Attachment M-1 and M-2. q. Privacy Act Notification. See Attachment N. r. Inventory sheet and/or policy of personal items. See Attachment 0. 7 s. ASivf Form. See attachment P. t. See Attachment Q. u. See Attachment R. v. See Attachment S. w. See Attachment T. x. See Attachment U. y. See Attachment V. z. See Attachment W. 4.05 Assignment of Benefits. The Resident and/or Legal Representative hereby requests that payment of authorized government and/or third party payor benefits as described in Sections 1.05 and 1.06, if any, be made as set forth in Attachment D to this Agreement either to me or on my behalf for any service furnished by or in the Center. The Resident and/or Legal Representative hereby authorizes the Center and any holder of medical or other information to release such information to the Health Caze Financing Administration and its agents and to third party payors any information needed to determine these benefits or benefits for related services. 4.06 Termination. Discharge and Transfer: This Agreement may be terminated as set forth below and as set forth in the Resident Handbook under the Section Heading "Discharge". The Resident and/or Legal Representative may terminate this Agreement before 'the Resident's dischazge from the Center by providing the Center written notice of the Resident's desire to leave at least seven (7) days in advance of the Resident's departure. If the Resident IeaWes before the end of that time, the Resident must still pay for each day of the required notice unless the Center fills the bed before the end of the notice period. Except in the event of an emergency or death, the Resident shall be responsible for all charges for the Room and Boazd Rate and ~or all services performed up to the end of the day that the Admission ends. Dischazge from the specialized units such as the Transitional Care Unit or Subacute Unit may require less than seven (7) !days notice. If discharge or transfer becomes necessary because the Resident and/or Legal Representative or someone else abused the Resident's funds, the Center will request that local, state and federal authorities; as appropriate investigate, which may result in prosecution. 4.07 Indemnification. The Resident shall defend, indemnify and hold the Center harmless from any and all claims, demands, suit and actions made against the Center by any person resulting from,any damage or injury caused by the Resident to any person or the property s of any person or entity (including the Center), except in the case of negligence of the Center's employees and agents. 4.08 Changes in the Law. Any provision of the Agreement that is found to be invalid or unenforceable as a result of a change in State or Federal law will not invalidate the remaining provisions of this Agreement and, it is agreed that to the extent possible, the Resident and the Center will continue to fulfill their respective obligations under this Agreement consistent with the law. THE UNDERSIGNED HEREBY CERTIFY AND ACKNOWLEDGE THAT THEY HAVE EACH READ AND UNDERSTOOD THE FOREGOLVG AGREEMENT, AND THAT THEY HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS AND THAT ANY SUCH QUESTIONS HAVE BEEN ANSWERED TO THEIR SATISFACTION. Signature of Resident: Date: Signature of Legal Representative, if signing on behalf of Resident: Date: Q-~ 11 ~ ~ Signature of Legal Representative, signing on his/her own behalf • Date: r ~-l~'~ Center Representative: -- ~~ Date: ~'~ 1 ~ f ~ EXHIBIT "B" 1' .'„~r'~•1.'~n Statement MANORCARE CAMP HILL 583 1700 MARKET STREET CAMP HILL, PA 17011 (717}-737-8551 CRAIG GOWER FOR ELWOOD GOWER ROLLO CT LT 88 MECHANICSBURG, PA 17055 PRIVATE ROOM 224 -A Please Retum This Portion With Your Payment GOWER, ELWOOD C 45 04/11/00 02/26/01 DATE OP SERVICE CODE ~ SERVICE RENDERED CHARGES CREDITS 02/01/01 BALANCE FORWARD 41,581.18 02/28/01 51801 TOTAL INCONT-DLY FEE ( QTY 28 ) 84.00 02/28/01 99610 OXYGEN CONCENT RENTAL ( QTY 1 } 504.00 02/28/01 11600 CABLE RENTAL ( QTY 1 ) 5.00 03/01-03/31/01 ADV RGOM CHARGE a 5,828.00 PAYMENT DUE HY THE 10TH AMOUNT DUE 48, 002.7 5t 1: 83!29101 @8BID8NT LEDGER AS OF DATE OF FIRST ACTIVITY PAGE 6 (AR56( @BSTDENT RESIDENT R8SID6NT G1L -- ACCOUNTS RBC6IYABL6 -- NUNB6R TYPH NANB DATB QTY ACCOUNT C@ARG85 CREDITS BALANCE 45 PRIVATE GONER, ELWOOD C 04/11100 ADN CNTR RATE: 5828.80 ROOK 224 -A LBV6L 1 DIS PRIV PORE; 0.80 '*NBDICARE B - JAN 01 (CONY( "ENDING BALANC6 "PRIVATE - FBB 01 BAL FWD -LN- -30- -60- -90- -120+- 11599.61 29981.97 41581,18 51881 TOTAL INCONT-DLY FBE 02101/01 -- 02!28101 ZB 56151801120 04.00 99618 OXYGEN CONC6NT RENTAL 02101/81 -- 02128!01 1 59353601128 584.80 11680 CABLE RENTAL 02128181 1 59158401120 5.00 R8V LAST NO RC 82181101 13211880800 5828.88 ROOK CBARGS AT 828.00 02/01101 -- 82128101 28 51350001120 5628.08 ADV BOON CRARGE 03181/01 -- 03/31/01 13211000888 5828.08 '*BNDING BALANC6 *'INSURANC6 -FBB 01 BAL FWD -LW- -30- -60- -90- -120+- 191,49- .BB 190.69 *'ENDING BALANC6 *'NCR CO INS - F6B 01 BAL FWD -LN- -30- "ENDING BALANCD *'H6DICAR6 A - F8B 01 PAYNBNT NCR-9108 PAYNBNT "ENDING BALANCE *'NBDICA@E B -FBB 01 BAL FWD -LN- -30- PAYNBNT NCB-9100 **@NDING BALANC6 60- -96- -120+- 286.05 28B.0S 02/13/01 11210802000 522.00 82/13/81 11210082008 522.00 -60- -90- -120+- 1144,24 1144.24 02!13101 11218802000 522.00 1144.24 48882.18 190.69- 286.05 .80 622.24 03129101 IAfl56~ RBSIDBNT LBDGBR AS OR DATE OR FIRST ACTIVITY PAGR 1 RBSIDBNT RBSIDBNT RBSIDBNT G!L -- ACCOUNTS RECEIVABLE -- NUNBBR fYPB NANH DATE QTY RCCOUNT CHARGES CRBDIT6 BALANCE 45 PRIVATE GONER, BLW00D C 84111188 ADM CNTB RATE: 5828.08 ROOH 224 -A LBVEL 1 DIS PRIV PORT; 0.88 "PRIYATB - APR 88 11600 CABLE RBNTAL 04111100 -- 04/30100 11180 B$AUTY AND BARBER 84120180 "BNDING BALANCB "INSURANCE -APR 00 29001 PBARNACY LBGBND 04!11!00 -- 04/30180 1 51582 NOUND TRBATNBNT 04(11/80 -• 04115180 5 53202 NTRTNL/BNTRL SBRY GRP 2 04111100 -- 04!30100 20 14101 PHYSICAL THBflAPY VISIT 04112!88 -- 84/13100 4 14401 PHYSICAL TRBRAPY BVA1 04/12100 2 28102 SPEECH TRBRAPY VISIT 04115(08 -- 04138!00 14 28402 SPEECH TRBRAPY BVAL 04115100 1 51581 CATHBTSfl TRAY 84118100 1 ANCILLARY WRITE OFF 04!30100 BOON CBARGB AT 23fi.00 04111108 -- 84138100 20 "ENDING BALANCB ;'PRIYATB - NAY 00 BAL FWD -LN- -30- -68- -90- 15.80 PAYNBNT 05/22/00 11600 CABLE RBNTAL 05101!00 -- 05131!00 1 "ENDING BALANCB "INSURANCE -NAY 00 BAL FWD -LN- -30- -60- -98- 5421.59 29089 PBARNACY LBGBND 05/01100 -- 05/25108 1 53202 NTRTNL/ENTRL SBRY GRP 2 05181100 -- 05131108 112 99610 OXYGEN CONCBNT RBNTAL 05101100 -- 05/31/80 1 ROOK CBARGB AT 236.08 05181!08 -- 05131100 31 "ENDING BALANCB "PRIVATE - JUN 08 BAL FWD -LN- -30- -60- -90- 5.00 10.00- 11600 CABLE RENTAL 06/01100 1 "ENDING HALANCH "INSURANCE -JUN 00 BAL FWD -LN- -30- -60- -90- 8482,SS 5427.59 53202 NTRTNL(BNTRL SBNY GRP 2 06181188 -- 06!30100 180 99610 OXYGEN CONCENT RBNTAL 06101!80 -- 06138180 30 29801 PHARHACY LEGEND 06180100 -- 06128100 1 38807 PHARMACY NON LEGEND 06!08!00 -- 06109/88 1 ANCILLARY WRITE OFF. 06138100 ROOM CBARGB AT 236.80 06101100 -- 86130!08 30 1 59150401128 5.00 1 59158101120 18.00 15.00 54551207120 252.59 54151507120 48.00 56153207120 40.00 52150201120 100.00 52150201128 50.00 52950407120 358.00 52950407120 25.00 54151507120 10.00 57551501120 51350801120 4128.00 160.00 5427.59 -120+- 15.08 11210002000 25.00 59158401128 5.00 5.00- -120+- 5421.59 54551201120 304.55 56153201128 224.08 55353607120 550.00 51350881120 7316.08 13910.14 -120+- 5.00 59156401128 5.80 .80 -120+- 13918,14 56153267120 368.80 55353681120 540.80 54551281128 221.61 54951307120 29.04 57551581120 256.65 513SBB81120 1000.08 03129101 RBSIDBNT LBDGBR A6 OP DATE OF FIRST ACTIVITY PAGE 2 (RR561 R85IDBNT R8SID8NT R8SID8NT G/L -- ACCOUNT6 R8C8IVABL6 -- NUMBER TYPE NAME DATE QTY ACCOUNT CHA@G8S C@BOITS BALANCB 45 PRIVATB GOWER, BLW00- C 0§111100 ADM CNTR RATE: 5829.88 ROOM 224 -A LBVBL 1 DIS PRIV PORT; 8.80 *'INSURANCB -JUN 00 (CONTI '*BNDING BALANCB 11090.19 "PRIVATB • JUL 00 BAL FWD -LN- -38- -60- -90- -120+- 5,80 5.08 10.88• .0B 11100 BEAUTY AND BARBBR 01106!00 1 59158101128 10.00 "BNDING BALANCB 18,08 **INSURANCB -JUL 00 BAL FWD -LN- -30- •60- -98- -120+- 1908.00 8402.55 5421,59 2 1090.14 53202 NTRTN1IBNTRI SBRV GRP 2 07/01108 -- 01131180 106 56153207128 372.00 49610 OXYGEN CONCBNT RBNTAL 81!81180 -- 01/31180 1 55353681128 SSB.BB 29089 PHARMACY L8G8ND 01/05/08 -- 01111100 1 54551201128 61.59 11482 OCCUP THRRAPY BVAL 01107(80 1 52558681128 25.08 17102 OCCUP TBBRAPY VISIT 01/10!68 1 52550607120 25.00 38884 PBABNACY NONLBGBND 81111108 I 54951301128 21.21 20402 SPBBCH TBBRAPY BVAL 01/31100 1 52950401120 50.00 ROOM C8ARG8 AT 236.80 01/01188 -- 01731!88 31 513S0B01120 7316.80 "BNDING BALANCB 30324.94 *'FRIVATB • AUG 00 BA1 FWD -LN- -36- -60- •90- -128+- 10,88 5.08 5.00 18.80- 18,80 PAYNBNT 08/16100 11210002800 10.00 PAYMBNP 08/16180 11210802000 1525.80 ROLL CREDIT (BLIND( 61101/00 14411058000 10.00 ROLL CRBOIT (BLIND( 07101!08 14411850000 5.08 ROLL CRBDIT (BLINDI 01101106 14411050680 5.08 "8N-ING BA1ANC8 1525,08- **INSURANCB -AUG 00 BAL FWD -LM- -30• -68- -98- -128+- 8434,80 7980.00 8482.55 5421.59 30324.94 20102 SPBBCH TBBRAPY VISIT 08101100 -- 68/03100 3 52950401120 100.00 53202 NTRTNLIBNTRL SSRV GRP 2 08781180 -- 08131180 185 56153207128 312.08 99618 OXYGEN CONCBNT RBNTAL 08101/80 -- 08131106 1 55353601]28 550.00 11182 OCCUP TBBRAPY VISIT 08182100 -- BB/IS/8B 9 52550607120 308.88 29002 PBARMACY LBGBND 00103100 -- 08/20108 1 54SS1207120 59.18 28102 SP88CH TBBRAPY VISIT 88118!88 -- 88/31!88 10 529SB4B1120 525,08 20402 SPBBCH TBBRAPY BVAL 08/18100 1 52950401120 25.00 ROOM CHARGS AT 236.00 0010110@ -- 00(31/00 31 51358081120 1316.08 "BNDING BALANCB 39586.12 '"PRIVATB - S8P 00 BAL FWD -LM- -30- -60- -90- -120+- 1525,00- 152S.0B 11600 CABLE RBNTAL 69101/00 -- 09/36/00 1 59156401110 5.00 '*BNDING BALANCB 1520.80- 0312910] R86IDSNT LBDGBR AS OF DATE OF FIRST ACTIVITY PAGE 3 ~AR56) RBSIDBNT RB6ID8NT R66ID8NT GIL -- ACCOllNT6 RSCBIVRBLB -- NUN88R TYPB NANB DATE QTY ACCOUNT CBARG6S CR8DIT6 BALANCB 45 PRIVATB GOWBR, BLWOOD C 04/11/00 ADN ROON 224 -A LBVBL 1 DIS "INBURANCB - SBP 00 BAL FWD -LN- -30- -60- -90- 92SS.18 8434.00 1400.00 04B2.SS PAYMBNT CBC MAO N8D 09105100 20182 SP68CH TBBRAPY VISIT 09181108 -- 09121108 14 29802 PAARNACY LBGBND 09101!88 -- 09115/00 1 53202 NTRTNL/BNTRL 86RV GRP 2 09/01188 -- 89130100 100 94610 OXYGBN CONCBAT RBNTAL 69101!00 -- 09130100 1 ROOM CHRRGB AT 236.80 04101!00 -- 89130!00 30 "BNDING BALANCB "PRIVATB - OCT 00 BAL FND -LN- -30- -60- -90- 5.00 1525.80- 24002 PAARNACY LBGBND 09!30/00 -- 10/23/00 1 99610 OXYGBN CONCBNP RBNTAL 10161100 -- 10!31!00 31 30002 PAARNACY NON LBGBND 10/05100 1 11100 BBAUTY RNO BARBER 10!24!00 1 51501 SHALL OXYGBN TANR 10/ZS100 1 11608 CABLB RBNTAL 10131100 1 ROOK CHRRGB AT 820.00 10!01100 -- 10!31/00 31 ADV BOON CRARGB 11!01180 -- 11!30100 "BNDING BALANCB "INSURANCB - OCT 00 BAL FiID -LW- -30- -60- -90- 0198,10 4255.18 8434.80 8691.45- "BNDIHG BALANCB "PRIVATB - NDU 08 BAL FWD -LN- -30• -60- -90- 12340.61 5.80 1525,00- PAYMBNT 11121!00 PAYNBNT 11/21/00 38009 PAARNACY NONLBGSND 10/05/08 1 -30089 PAARNACY NONL8G8ND 18185!00 1 11600 CABLB RBNTAL 11!01100 1 99610 OXYGEN CONC6NT RBNTAL 11/01!80 -- 11!30!00 1 RBV LAST NO RC 11/01100 RODN CRARGB AT 020.@0 11(81!80 -- 11130(00 30 ADV BOON CRARGB 12/01100 -- 12131(00 "BNDING BALANCB "INSURANCB - NOV 00 BAL FWD -LM- -30- -60- -90- 0190,10 29009 PAARNACY LBGBND 38889 PAARNACY NONLBG6ND 9255,10 8434.00 09!01/00 10/BS/00 CNTR RATB: 5828.80 PRIU PORT: 8.80 -120+- 5421.59 39500.12 11210002000 16671.45 52450481120 775.00 54551201120 43.70 56153201120 368.80 55353601120 540.00 51350801128 7888.88 31107.31 -128+- 1520.08 54SS1201120 67.40 55353601120 550,00 54951301120 21.21 59158101128 10,88 541S1S01120 23.00 59158481128 5.08 51350001120 5828.00 13211880088 5828.00 -120+- 13910.14 31181.31 -120+- 10028.61 11210082800 11218002000 54951301120 54951381120 11.21 59150401128 5.08 55353601120 540.00 13211000000 51350001120 5828.00 13211000000 5820.00 -120+- 5218,69 31101,37 1 54551207120 1 54951387128 10020.61 31101.37 4992.61 6801.39 21.21 5828.00 6193.61 110.28 21.21 L 03129101 R86ID8NT LEDGER AS OF DATE OF FIRST ACTIVITY PAGE 4 (ARS6 ~ RBSIDHNT AESIDBNT R8SID8NT G!L -- ACCOUNTS RHCSIVABLB -- NUHBBR TYPE NAME DATB QTY ACCOUNT CHARGES CREDITS BALANCE 45 PRIVATB GOWER, RLWOOD C 04!11100 ADN CNTR RATE: 5028.00 BOON 224 -A LBVBL 1 DIS PRIV PORT; 0,08 "INSURANCE - NOV 00 (CONY) "ENDING BALANCE "PRIVATB - D8C 00 BAL FWD -LN- -30- -60- -90- -120+- 6193,61 1520.80 5.00 1525,00- fi193.61 PAYNBNT MAJOR MEDICAL CR 09105!00 11218802000 16671.45 PAYNBNT 12118108 11210002800 365.61 PAYMENT 12118108 11210882000 1134.39 11608 CABLE RENTAL 12101100 1 591SB481120 5.80 51801- TOTAL INCONT-DLY FHE 12101180 -- 12131180 31 56151801120 31.00 99610 OXYGEN CONCENT RENTAL 12!01!08 -- 12131(00 1 55353601120 558.08 R8V LAST HO RC 12(01(00 13211000000 5828.88 ROOH CAARGB AT 828.08 12/01!88 -- 12131!08 31 51350081120 5828.88 ADV AOON CAARGB 01101/01 -- 01131/01 13211AB0000 SBZ8.00 INS TO PRIVATB 0413@180 14411850880 5421.59 IN6 TO PRIVATE 05/31100 14411050080 8482.55 INS TO PRIVATB 86130(00 14411050808 1980.08 INS TO PRIVATE 01/31100 14411058800 8434.00 INS TO PRIVATB 08!31100 56153201128 372.08 REV OXGYEN 08131100 57557509100 558.00 R8V L8G8ND 08/31!80 57557589100 59,18 R8V RAB 08137100 51350001120 1316.00 ftBV L8G8ND 89!15100 54551207120 43,10 RBV NUTRI 09/30!06 56153201120 360.00 R8V OXYGEN 89138180 51557509100 540.00 RBV B 6 B 09138100 51350001120 7080.00 CREDIT ROLL (BLIND) 12181!88 14411858088 IS25.B0 CR60IT ROLL (BLIND) 12101/08 14411850000 5.00 CRBDIf ROLL (BLINDS 12101180 14411050000 1520.00 "ENDING BALANCE ':INSURANCE • D8C 00 BAL FWD -LM- -30- -6D- -90- -120+- 191.49- 8198,70 9255.18 13653.49 3 1515,88 PAYNBNT MAJOR HEDICAL CR 0910SI08 112100020801 6671,45 INS TO PRIVATB 04130fB0 14411050880 5427.54 INS TO PRIVATB 05/31/00 14411050000 840Z.5S INS TO PRIUATS 06!30100 14411850000 7980.80 INS TO PRIVATB 07131108 14411050800 8434.00 R8V OT BBIiSl00 52550681120 380.08 INS TO PRIVATE 08131100 56153207120 372.08 RBV OXGYEN 88131180 S1SS1S09180 S58.B0 REV LEGEND 08131/00 51557509108 59.18 R8V R6B 08(31100 51350001120 1316.00 RBV LEGEND 89/15100 54551201120 43,78 REV SP T4 HHD B 04121100 52950481120 715,80 RHV SP TO H8D B 09/21/08 52950407120 650.00 31515.88 35891.18 . 03!29101 . RESIDENT LBDGBR AS OF DATE OP FIR&T ACTIVITY PAGE S ~AR56) RSSIDBNT RBSIDBNT RSSIDBNT G/L -- ACCOUNTS RBCBIVABLB -- NUN88R TYPE NAME DRTE QTY ACCOUNT C8ARG8S CREDITS BALANCE 4S PRIVATE GOWBR, SLWOOD C 04/11!00 ADM CNTR RATE: 5028.00 ROOM 224 -A LBVBL 1 DIS PRIV PORT: 8.08 "INSURANCE -DBC 80 ~CONT~ R8V NUTRI 04(38!80 56153207120 360.00 RBV O8YG8N 89/38100 51551509180 548.08 REV B A B 09(30108 51350081120 1880.80 "ENDING BALANCE 190.69- "NCR CO INS -DBC 80 CO INS OT 00131100 52550611120 56.39 CO INS PART B SP 08131108 52958411128 94.16 SP PART B 09130100 52450411120 130.50 *'ENDING BALANCE 286.85 *'MBDICARB B - D8C 06 N8D B OT 08/31100 52550611120 225.50 88/31100 52550611120 18.03 CIA INS 88131100 52558611120 18.63 SP PART B 88/31100 52450411128 346,66 SP PART B 08/31/00 52950411120 154.16 CIA PART B 08!31!08 51551511128 154.18 SP PART B 09/30180 52450411120 522.00 MED B SP8BC8 09130100 52958411120 122.58 C/A SPBBCR 09/30/00 57551511120 122.50 "ENDING BALANCE 1144,24 "PRIVATE - JAN 01 BAL FWD -LM- -30- -60- -98- -120+- 5115.6] 29981,51 35@91,18 51881 TDTAL INCONT-DLY F8B 01/81!81 -- 01/31/81 31 56151801120 93.00 99618 OBYGBN CONCBNT RENTAL 81!01101 -- 01/31101 1 55353601128 558.00 11600 CABLB RENTAL 01/31101 1 59150401120 5.00 RBV LAST MO RC 01181181 13211088888 5828.08 ROOM CNARGB AT 828.80 01!01101 -- 01131/81 31 51350001120 5828.00 ADV ROOM CNARGB 82!01181 -- 02(28!01 13211000808 5828.80 CREDIT ROLL ~BLIND~ 01!01101 14411050000 112.39 CR80IT ROLL ~BLIND~ 01101181 14411850008 112.34 CREDIT ROLL (BLINDS 01/81/01 14411050080 8641.15 CREDIT ROLL ~BLIND~ 01101101 14411050080 8647,75 "ENDING BAlANCB 41581.18 *'INSURANC8 -JAN 01 BAL FWD -LM- -30- -60- -90- -120+- 191.49- 0748.18 Bi91,90- 190,64 "ENDING BALANCE 190.69- *'MCR CO INS -JAN 01 BAL FWD -LN- -30- -60- -90- -120+- 286,05 286,05 "BNDING BALANCE 286.05 '*MBDICARB B - JAN 01 BAL FWD -LM- -30- -60- -90- -120+- 1144,24 1144.24 EXHIBIT "C" PPn'~' -ASSISTANCE CHECK FG"; NL1. Jun, 21 201 04~40Hf~1 F_ Irv I II.G 1 U RYYLIUAN) ~ ttiE?e RTM1I~NT Z`F pUSL:C'NELFAAE ""MEET Li.tvC CvurITY ASSISTANCE OFFICc • _ • .• - J3 `NESTU1NSTcR DR • • FO s0%559 IEW~ Nar vercwc C-3pCt2 9-0731iI1'17a 214~27C0 eualaLa '- ~ ANar!ae rvv c-,ocrwnknmaY pe d bpncEi OmoYnt ypu'mll rucnrve L ._ ' ~ ~ T~x¢GL' ~; fXpPI- ~~ Cn<e A MDAth ^ in iho Mne G Ai Ih" Bank ~DICAL ~ I i ~] Yau no~e'~ s palxmc peY uapdry y 5 ASSISTANCE y 1 I ;ar :he per:x :a„-mnmq Ana enoins ~ -Mecpxe Cme h FOOU ~ i Y0y enli raeeiuo S br the ma9MS1 of men you will racarve loop 31amC- In me amoum m 3 -' STAMPS I I I a mpnfn t~cm _~..._ m J '"~a+e'uaa ©At the aanY ' GIBBING HOME CARE P I I LwNI p{ C?i4 8Va1CnT:tl you :uc axpeeteo ca :bv 5 n rtgnV. :owaa vow Bare. 17}JE FOLLOWING PER5QNS ARE INCLJOED . ,.--.:. ~... ~ ...' ...-. ..,. ... ... ._... _.• _ __ ._.-:.. ..... .~ :INE NAME b.. L NEO. SOC. :lCi. I ON C H7A.XPS A-'+ST. I SERVICE ' lPl ~ NAME id0. AS FO U CNE('.1C STAMPS ry!~ ~ rib u AV I I { I { ~ O ~ ~ ~1'GahOrs. c.~.e~,pcL "~7Jo0 ~umd. dU2 ~ 211'CA3S r.~pGtrlrrC~.S . ~l~?f,.8' CvrA•~ 8A- f~,l1t~~~1 J ~t~~ ~~eL'~.c30.~~3~ ~i~ ~,.~~f ~orcv~e. of° -~`rd'3iD.35 qua each vadu$ r~z yyyy~~,,,, F` 8~' f~c. cui~sc. r.~iD2teo ramie.. I2~Ll![lG°!3' • ~-•r+rX- OCJ`'TYLE. la~~' L ~A'dlrP.-~Jit ~S'}7~L'.75• _ .. y . i•d~D 3?AMPa . . ,... ~ ~ :..:. Numkfer aF PBnz:RS~ ~ i, ~- ,~.. -~ ... - _ _.. , ~] ~ , . - , _ :: ~. ~ ". , ., _ ' ' Eo~.P'er8oiis ~r Plame ~ ~RNEO INCCME a ~RORHS MI r ~r ;,.., ,. S MO HLT - NBmp 11NpR ~ INCAME Name GR t1NEgp N LY c / $ f~~~/.//. 5 . /J/. r`!/ i ~S l,i///, 1S ~iJ~/(~ ~' TOTAL GROSS MONTHLY (NCOME 3 TCTAL GROSS MONTHLY INCOME $ GRO55 MON i HLY DEPENDENT CARE COSTS 5 GROSS MONTHLY DEPENDENT CARE COSTS S I GROSS MEDICAL COSTS S TAwpl+nna Water/Sewage ' ME6IGAL A96I$TANCE Number of varanns- . Electric ~ GarOa¢eRrasn I Name ~ i•~~p~j°NN~'jf~ Gab U4lnty inat511afipn ~ ~5 r',''17 `j`rj` OR Omer ~~ I > ~~~Ji r ~ ' GROSS UTILITY COST§lUTILTY STANDARD' I S ---~ ~ ^ • t' ~;%/~'/;'. RENTtMORTGAGB S T~-,~~.' ~ t 1+. / ~~ Name , II dr+ y477ONTHl,Y 7 UNEARN~pMWME TAXES i$ Ali/;r/~' G ~ ~; 'Ir/'~ INSURANCE COST 4N HOME I g Y~;'; / ~ ; ~ / ~ ; ~ r /_~ ^, _ TOTAL SHELTER C-0S7 ~ g ~ g I~ % ` / / ' 'lhe hausehold may switM between the actual utiGtrv msts and [he TCTAL GROSS MbNTHLY INCOaaR ; H ' S(dRda[d Utility 840ar21icA 8f 1hB f!l71e Of respp(i-ca[idn 2nd ORe NE7 MOhITHLY INCOMF/NET SS~yli-ANNUAL INCOME I S ~I addiFlr»S! time during each iwefve•manth peficd. INCCME LIMIT ' S i co RECaaa NuPXaER aAT cTA IG clcT - i I ~ ~ ~ erkeis SfgnaIDrp Oat2 '. aleonpne NU(nUar I ~/ ~~ ~ry~'} ~~y ~ ~~ LSCwL HELP IS AVAILABLE AT L"~.v1L SEAViCES. !NG- ~~ArXI~ C.~iZ/'~v 81RVINc RDW 17D(} /y1Q~~ S•~• cRBLISL=_ PA ;Tel -axis Camp ~h'1/ ~.~ !7C/( :17-24.4.33Cd T1T•:ESas~s J you do nq[uhfYBfS78nd aurdeCision a/ have any gpB3bOns. c0.'VFCf your worker. ~~ FR:X NG. ~ Jun. 21 2001 04:41RM P3 , .< < <. i CONLMON'VPEAT..Tfi OR PENN$YI,'VANIA DL.PARTMENT Ok` PUBLIC WELP'A1ZE Buxesu of Hearings and Appeals 1401 North Seventh Street, First FIoor Harrisburg, Pennsylvania 17].Ob-2675 June 13, 2DD1 Case No_ 21DD89227-Oql NOT1C£ti OF SCIIEDiII.ED HEARING Elwood Gower fZe: PAJFS162 010116 1700 Market 5tr, Handwritten appea] 0?JOB/Ol Camp Hill, Pa 17011 Dear 114x. Gower: This notice acknowledges the receipt of your requost for a fair hearing. Because you have chosen a telephone hearing, your hearix~ will be conducted by a hearing officer, who acts as a judge. The °hearing oftTcer will call ,yau at the telephone number you provided as your appeal ratico at the date - and time specified below. Please notify the hearing aff'icer immediately if the nvmbez bas changed or is incorrect, ar if ynu would tike to change your hearing to aface-to-face hearing in liarris'rnag, Hearing Date: Wednesday, ,lone 27, 2001 Time= 09.00 s.m. Your>?honePlumber: (717)^x66-9255 Name and Phone of Weifaro Hearing Officer 2: Freeda M_ Prunty, (717) 7$3-3950 *I1~ORTANT:I#pou ar arepresentatiQefar yonis rnot available£or the hem„~, you will lose the case. Ifthe reason for your unavailability is deemed acceptable, yau may have the hearingpostpaaed_ 'ACk~NOWLEDCrEME~1•CARD1Bll.OCIIURE: Aselfaddressed,postage-paidpostcardhasbecn included with this notice. Please read the postcard carefully, check the appropriate box, and return the card to the Bureau of Hearinga and Appeals as soon as passible. A brochure has also been included with tlxis notice which provides a summary of the hearing process and information r. egarding optional hearing methods. if you have any questions regarding the cflntonts of this notice or the brochure, please contact the.hearing officer_ The Bureau n£]iearings and Appeals complies with the Americans with Disabilities Act. We will provide reasonable accommodations upon request. Please contact the hearing officer at the above address or telephone number upon receipt ofthis correspondence if you require special accommodations. Sincerely, A'reeda M. Prunty, Welfare Hearing Officer 2 cc: Cumberland CAO Craig 5. Gower lkn FROM FRX NO. Ty.l ., k14~ 2001 09: 57PM P2 ~~ i ~t®F Pueue COMMONWEALTH OF PENNSYLVANIA aa`~ ` DEPARTMENT zJF PUBLIC WELFARE BUREAU OF HEARINCi$ ANp APPEALS 1401 NORTH SEVENTH STREET, PO BOX 2675 ~r p ns p~F~ HARRISBURG, PENNSYLVANIA 17105 APPSAL OF: CASE NOI~SR¢ 210089227-001 SLAOOD QONSK - - - - -._- --~~ 1740 MERKET _~-- CAt+lQ B2TS., ~v ~v~~~~ ADJIIbiCA2ION OPSNSNCa STATF.L~IBNT This is a decision on the appeal of ELWOOD GOWER from an action taken by the CLttIDSALAND County Board Of Assistance. A hearing was scheduled fot June 27, 2001 at 4:00 a.m. Befare the hearing the Appellant orally advised the Bureau of seating and Appeals that he or she would withdraw the appeal. The Appellant was instructed to submit the withdrawal in writing to the W®Ifare Heating Officer 2. However, the written withdrawal has oat been received. Inasmuch as the appellant has failed to pursue the appeal, it is dismissed is accordance with PA Code 275.4(e)(5)(iii)(Ay. Zt is hereby ORDERED and DECR&ED that the appeal of the appellant is dismissed. Either party to this proceeding has fifteen (15y days from the date of this decision to request Reconsideration by the Secretary of the Department (In 8aod Stamp cases, only the Appellant may seek Reconsideration). To seek Reconsideration, you must fally complete the attached applicationfpetitioa for Reoonsidaration. The applicatioa/petition shall be addressed t0 the Secretary, but deliver ad to Direetgr, Bureau of Hearings and Appeals, P.O, sox 2fi75, Harristrurq, PA 17105-2675, and east be oos mark®d This action does not stop the time within which an appeal must be filed to Commonwealth Court. The appropriate pasty{ies), where permitted, may take issue with this Order and may appeal to the Commonwealth Court of peansylvania within thittp (30) days from the date of this order. This appeal stoat be filed with the Clerk of Commonwealth Court qt Pennsylvania, P.O. sox 11730, Harrisburg, PA 17108. FROM FqX NO. J~1.,F14. 2001 O9:57PM P3 ~ i If ypu file an appeal with the Gommondrealth ~ouzt, a copy pf the appeal musk be served on the government unit which made the determination in '"aceprdance with Pa A.A. 1514. In this case, service must be made tp. Department of Fublic Welfare, Bureau of Hearings and Appeals, P,O. Box 2675, 1401 N. 7th St., Gth Floor, Harrisburg, Pennsylvania 17105-2675, A1PD Department of Public Welfare, p~fice of Legal Counsel, Apom 309, wealth and Welfare 8uiidiag, Harrisburg, PA i73Z0. July 11, 2001 vwv~4d Final administrative Thomas E. Cheffins, Esquire Actipn & Mailing Date Dirg¢tar FROP1 FAX N0. J~.1., ,14, 2001 09:SSPM P4 +4 ~}PPllCAT1ON/pE7TTiON FOR RECONSiOERATiON {if you want ketonsiderati4n, you must complete this form) Case Name: Case Number. Data of Wearing and Appeals Fnal pecisianJFAA: If this application 3s granted, the Secretary of Public Welfare wilt review your complete case file and you will receive a decision from the Secretary. 7. Did the Bureau of Hearings and. Appeals' decision correctly apply state antl federal pollcypes), regulation{s}, and !avlf YES NQ if your answer ks 'NC.~' s. identify, to the bast of your ability, policy(ies), regulation{s), and law and explain how the Bureau of Wearinga and Appeals applied them incorrectly: b. To the hest of your abilities, give the specific policy(ies), regulation(s), and law that should be applied and explain why they should be applied: FRa FRX N0. ., ~,, .~'1~~~t71'~~17~' Su1.,~14 2601 09:56PM P1 Fax C©ver Sheet 17QG Marlca# Street £amp i-fifi, Petnnsylvania 17014 Phone; 717-737-8561 Fix: 717~'•7~~~ 8~ To: _.~ Frar7t, ComCanv: rd~ i Fax. ~~~,f y~ l~ C . 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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, NO. 01-4773 Civil Plaintiff vs. CIVIL ACTION -LAW ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Individually and Jointly, Defendants CERTIFICATE OF SERVICE AND NOW, this 27`h day of September, 2001, 1, Daniel F. Wolfson, Esquire, do hereby certify that I have served a copy of the foregoing Amended Complaint upon the of record by Regular Mail -Postage Pre-paid and addressed as follows: Michael D. Rentschler, Esquire 1300 Market Street, Suite200 Lemoyne, PA 17043 (Counsel for Defendants) ~~ ~~ Damel F. Wolfson, quire WOLFSON 8t ASSOCIATES, P.C. 267 East Market Street York, PA 17403 (717) 846-1252 ID No. 20617 Attorney for Plaintiff .a.,~ ,~ ,~ t-, ~ _i l + `""' -I I Lq _- _~,Y _ Y _ "'.7 - .% ~ _ y1.J - - -~i- Cj - '. ~1 :_ :... l i ,c- - i ., ~ .. _ rW~@"e0§~"i .. ~ :,a:.kim,n33u.,na~.xv;,~ ~. 1,'_ ~~EEFea~t ,A+k95~, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, Plaintiff NO. 01-4773 CIVIL vs. CIVIL ACTION -LAW ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, JURY TRIAL DEMANDED Defendants TO: HRC MANOR CARE NOTICE TO PLEAD YOU ARE HEREBY REQUIRED TO RESPOND TO THE WITHIN NEW MATTER WITHIN 20 DAYS OF SERVICE UPON YOU OR A JUDGMENT MAYBE ENTERED AGAINST YOU. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, vs. Plaintiff NO. 01-4773 CIVIL CIVIL ACTION -LAW ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, JURY TRIAL DEMANDED Defendants ANSWER AND NEW MATTER TO PLAINTIFF'S AMENDED COMPLAINT AND NOW, this .3a day of October, 2001, comes Defendant Craig Gower, by and through his attorney, Michael D. Rentschler, Esquire, who files the within Answer and New Matter to Plaintiffs Amended Complaint, as follows: 1. Admitted, upon information and belief. 2. This allegation is addressed to a defendant other than client, so the same is denied. 3. Admitted. 4. Admitted. 5. Admitted. 6. Admitted. 7. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 7 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 8. There is no paragraph 8 of plaintiffs amended complaint, so no response is 1 necessary. 9. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 9 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 10. Denied. After reasonable investigation defendaht is without knowledge as to the truth or falsity of the allegations contained in paragraph 10 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 11. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 11 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 12. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 12 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 13. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 13 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, it is denied that defendant Elwood Gower received necessary treatment and that the treatment was reasonable. 14. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 14 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 15. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 15 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 16. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 16 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 17. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 17 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 18. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 18 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, it is denied that defendant Craig Gower is personally liable for any purported debts of his father. 19. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 19 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 20. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 20 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 21. Admitted in part. Denied in part. It is admitted that defendant Craig Gower has not paid the amount requested by plaintiff. It is denied that the amounts requested are fair, accurate, and reasonable and that the amount alleged, is owed to plaintiff. 22. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 22 of the amended 3 complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 23. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 23 of the amended complaint, so the same is hereby denied and strict proofi thereof is hereby demanded. 24. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 24 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 25. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 25 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 26. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 26 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 27. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 27 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 28. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 28 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 29. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 29 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 30. Denied. After reasonable investigation defendant is without knowledge as to 4 the truth or falsity of the allegations contained in paragraph 30 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 31. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 31 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 32. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 32 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 33. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 33 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 34. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 34 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 35. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 35 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 36. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 36 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 37. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 37 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 5 38. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 38 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 39. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 39 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. Byway of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 40. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 40 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 41. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 41 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 42. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 42 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 6 Byway of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 43. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 43 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 44. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 44 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 45. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 45 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 46. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 46 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. By way of further answer, see defendant Craig Gower's New Matter which is incorporated herein by reference. 47. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 47 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. 7 48. Denied. After reasonable investigation defendant is without knowledge as to the truth or falsity of the allegations contained in paragraph 48 of the amended complaint, so the same is hereby denied and strict proof thereof is hereby demanded. NEW MATTER 49. Defendant Craig Gower incorporates by reference his responses to paragraphs 1-48 as if fully set forth herein. 50. Without admitting that defendant Craig Gower owes any money to plaintiff either individually or on behalf of his father defendant Elwood Gower, orjointly, plaintiff has failed to mitigate damages. 51. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, orjointly, he is not liable for any legal fees of Wolfson & Associates, P.C. 52. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, orjointly, defendant Craig Gower has not committed any acts which give rise to his liability for payment of legal fees. 53. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, orjointly, the legal fees alleged to be owed are not reasonable and not owed by defendant Craig Gower. 54. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, orjointly, defendant Craig Gower is not bound by any contract for legal representation by and 8 between plaintiff and Wolfson & Associates, P.C. 55. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, or jointly, Exhibit "A" to plaintiffs amended complaint does not owe any money to plaintiff. 56. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, or jointly, the plaintiff has filed to mitigate damages in that plaintiff permitted and continues to permit defendant Elwood Gower to reside at HRC Manor Care instead of discharging him from care at HRC Manor Care. 57. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, or jointly, defendant Craig Gower is not personally liable to plaintiff for any money allegedly owed to plaintiff. 58. Plaintiffs amended complaint fails to state a claim upon which relief can be granted against defendant Craig Gower, individually, or on behalf of defendant Elwood Gower. 59. Plaintiff has not provided reasonable and necessary treatment to defendant Elwood Gower. 60. Without admitting that defendant Craig Gower owes any money to plaintiff, either individually or on behalf of his father defendant Elwood Gower, or jointly, plaintiff has acted in bad faith. 61. Defendant Craig Gower is not responsible for any payments to plaintiff on behalf of his father defendant Elwood Gower. 9 62. Plaintiffs action is barred in whole or in part by the applicable statute of limitations. WHEREFORE, it is respectfully requested that this Honorable Court find in favor of defendant Craig Gower and against plaintiff. Respectfully submitted, MICHAEL D. RENTSCHLER, ESQUIRE 1300 Market Street, Suite 200 Lemoyne, PA 17043 (717) 975-9129 Attorney for Defendant Craig Gower 10 VERIFICATION I, Craig Gower, verify that the statements made in the foregoing Answer and New Matter are true and correct to the best of my information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. 4904, relating to unsworn falsification to authorities. Craig Gower, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, Plaintiff vs. ELWOOD GOWER, Individually, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Defendants NO. CIVIL ACTION -LAW JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, MICHAEL D. RENTSCHLER, ESQUIRE, do hereby certify that on this date I served a copy of the within document via first-class mail, postage pre-paid to the following recipient(s): Daniel F. Wolfson, Esquire 267 East Market Street York, PA 17403-2000 Date: ~~ ~ d oa / ~~ ~ ~ Michael D. Rentschler, Esquire c, i..~ ~ , `.l 1- :~ a lJ ' _ - ) _ ^ _ . ~ ' ~ t _- c .. -~! ap ~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, NO. 01-4773 Plaintiff vs. CIV-L ACTION -LAW 'OOD GOWER, Individually, CRAIG GOWER, Individually, on Behalf of ELWOOD GOWER, Defendanu PLAINTIFF'S REPLY TO DEFENDANT CRAIG GOWER'S NEW MATTER AND NOW, TO WIT, this 15t" day of November, 2001, comes the Plaintiff, HCR Care, by and through its attorney, Daniel F. Wolfson, Esquire, and the law firm of 8t Associates, P.C., and files the following Reply to New Matter and in support avers as follows: The allegations and averments contained within paragraphs One (1) through Forty- Eight (48) of the Plaintiff s Amended Complaint are incorporated herein by reference as if forth in full. 49. Paragraph 49 of Defendant's Answer and New Matter is an incorporation paragraph to which no response is required. To the extent that a response is necessary, is denied and the allegations contained in Plaintiff's Complaint are incorporated by reference as if set forth in full. 50. Denied. It is specifically denied that Plaintiff had failed to mitigate damages in this matter. To the contrary, Plaintiff has attempted to assist Defendant Craig Gower in obtaining Medical Assistance for his father, Defendant Elwood Gower, but Defendant Craig has refused and failed to cooperate with the proper procedures to obtain Medical on behalf of his father. Accordingly, Plaintiff's attempts to mitigate damages been thwarted by Defendant Craig Gower. 51. Denied. It is specifically denied that Defendant Craig Gower is not liable to for any attorney's fees as a result of this action. To the contrary, Defendant Craig Gower signed the Admission Agreement as Legal Representative on behalf of Defendant Elwood Gower, and in doing so, Defendant Craig Gower agreed to pay reasonable attorney fees and all court costs if the account is referred to an attorney for collection. Strict proof is demanded at trial. The herein referenced Admission Agreement was attached to Plaintiff's Amended Complaint as Exhibit "B" and is incorporated herein. 52. Denied. It is specifically denied that Defendant Craig Gower, has not committed any acts which give rise to his liability for payment of legal fees. To the contrary, Defendant Craig Gower violated the terms of the Admission Agreement by failing to follow through with the requirements of the Medical Assistance process and by utilizing Defendant Elwood Gower's resources and finances for his own purposes instead of utilizing said resources and finances to provide payment to Plaintiff. As a direct result of violation of the Admission Agreement by Defendant Craig Gower, the Plaintiff was (forced to refer the account of Defendant Elwood Gower to an attorney for collection due non-payment, which therefore makes Defendant Craig Gower liable for the payment of legal fees. Strict proof is demanded at trial. 2 53. Denied. It is specifically denied that the legal fees alleged to be due are not reasonable and not owed by Defendant Craig Gower. To the contrary, said legal fees are reasonable and due to Plaintiff as a result of the violation by Defendant Craig Gower, of the and conditions of the Admission Agreement. Strict proof is demanded at trial. 54. Denied. The allegations contained in paragraph 54 of Defendant Craig Answer and New Matter are conclusions of law to which no response is required. the extent that a response is necessary, same is denied and strict proof is demanded at By way of further response, Defendant Craig Gower is responsible for reasonable ~ legal fees as a result of his violation of the terms and conditions of the Admission 55. Denied. The allegations contained in paragraph 55 of Defendant Craig Gower's Answer and New Matter are unclear and confusing. Accordingly, after reasonable investigation, Plaintiff is without sufficient information or knowledge to form a belief as to truth or veracity of this allegation. Therefore, same is denied and strict proof is demanded at trial. 56. Denied. It is specifically denied that involuntarily discharging Defendant Elwood Gower would be an appropriate or responsible method of mitigation for Plaintiff to utilize in this matter. By way of further response, there are a number of specific criteria which must be met in order for a nursing home care facility to involuntarily discharge a resident and said criteria would not be met as said criteria pertains to Defendant Elwood Gower as Defendant Elwood Gower requires medical care and treatment that Plaintiff does not believe he would receive outride of Plaintiff's facility. Strict proof is demanded at trial. 3 57. Denied. It is specifically denied that Defendant Craig Gower is not personally liable to Plaintiff for money owed to Plaintiff as a result of the health care services provided to Defendant Elwood Gower. To the contrary, by executing the Admission Agreement, as Legal Representative on behalf of Defendant Elwood Gower, Defendant Craig Gower agreed that he would incur personal liability on behalf of Defendant Elwood Gower for a breach of the duty to provide payment to Plaintiff from Defendant Elwood Gower's income or resources for the medical services and treatment rendered to Defendant Elwood Gower and for failure to cooperate with Department of Public Welfare to obtain Medical Assistance benefits for Defendant Elwood Gower. By way of further response and as previously stated herein, Defendant Craig Gower has breached both of the aforementioned duties and is, therefore, personally liable for the amount currently due and owing to Plaintiff. Strict proof is demanded at trial. 58. Denied. The allegations contained in paragraph 58 of Defendant Craig Gower's Answer and New Matter are conclusions of law to which no response is required. To the extent that a response is necessary, same is denied and strict proof is demanded at trial. 59. Denied. It is specifically denied that Plaintiff failed in any way to provide reasonable and necessary treatment to Defendant Elwood Gower at any time during which Defendant Elwood Gower has been a resident of Plaintiff's facility. By way of further response, any and all allegations or inferences that Plaintiff acted in bad faith or was negligent in any manner whatsoever, is hereby specifically denied and strict proof is demanded at Trial. 4 60. Denied. It is specifically denied that Plaintiff has acted in bad faith in any of its relations with Defendant Craig Gower. By way of further response, any and all allegations or inferences that Plaintiff acted in bad faith or was negligent in any manner whatsoever, is hereby specifically denied and strict proof is demanded at Trial. 61. Denied. It is specifically denied that Defendant Craig Gower is not responsible for any payments on behalf of Defendant Elwood Gower. To the contrary, by executing the Admission Agreement, Defendant Craig Gower acknowledged and accepted liability, individually and on behalf of Defendant Elwood Gower, for the account balance is currently due and owing. By way of further response, Defendant Craig Gower violated his fiduciary duty and responsibilities as the Legal Representative and/or Responsible Party for Defendant Elwood Gower by not utilizing Defendant Elwood Gower's finances to pay Plaintiff when he knew or should have known there were outstanding medical care bills for Defendant Elwood Gower, in violation of the executed Admission Agreement. Further, the finances of Defendant Elwood Gower should have been utilized to pay Plaintiff for his necessary and appropriate medical services and treatment rendered by Plaintiff to Defendant Elwood Gower, but Defendant Craig Gower failed to use Defendant Elwood Gower's finances for that purpose, in violation of the executed Agreement. Strict proof is demanded at trial. 62. Denied. The allegations contained in paragraph 62 of Defendant Craig Gower's Answer and New Matter are conclusions of law to which no response is required. To the extent that a response is necessary, same is denied and strict proof is demanded at trial. 5 WHEREFORE, Plaintiff respectfully requests that this Honorable Court dismiss Defendant Craig Gower's Answer and New Matter and enter judgment in favor of Plaintiff and against Defendants, along with the allowable costs of this action, and such further relief as the Court deems appropriate. Respectfully submitted, ~~~~~ Daniel F. Wolfson, Esquire WOLFSON st ASSOCIATES, P.C. 267 East Market Street York, PA 17403 (717) 846-1252 I.D. No. 20617 Attorney for Plaintiff 6 VERIFICATION Daniel F. Wolfson, Esquire, hereby states that he is the attorney for the Plaintiff, HCR Manor Care, and he is authorized to take this verification on behalf of said Plaintiff in within action and verifies that the statements made in the foregoing Reply to New Matter are true and correct to the best of his knowledge, information, and belief, based upon information provided by the Plaintiff. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Date: ti1`S~ o~ Daniel F. Wolfson, Esquire WOLFSON st ASSOCIATES, P.C. 267 East Market Street York, PA 17403 (717)846-1252 ID No. 20617 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA HCR MANOR CARE, NO. 01-4773 Plaintiff vs. CIVIL ACTION -LAW ELWOOD GOWER, Individualy, and CRAIG GOWER, Individually, and on Behalf of ELWOOD GOWER, Defendants CERTIFICATE OF SERVICE AND NOW, this 15~' day of November, 2001, 1, Daniel F. Wolfson, Esquire, do hereby certify that 1 have served a copy of the foregoing Reply to New Matter upon counsel of record in the following manner and addressed as follows: REGULAR MAIL POSTAGE PRE-PAID Michael D. Rentschler, Esquire 1300 Market Street, Suite 200 Lemoyne, PA 17043 (Counsel for Defendant, Craig Gower) Darnel F. Wolfson, Esquire '~ WOLFSON 8i ASSOCIATES, P.C. 267 East Market Street York, PA 17403 {717) 846-1252 ID No. 20617 Attorney for Plaintiff ~} G lC` I K)CC~, "~ fug) _ -~T' ! ~ ~-:- ~ _ . i~ J ~ ;% G ~~ °f~ ~7 ~ ~~ a+. ~ i .urz . .. mi p*~3Td^~SrfC'{4}$3v