The URL can be used to link to this page

Home My WebLink About01-05810 ~:~f'''~'''-'~l' .< ... ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNlY, PENNSYLVANIA Lydia B. Durf, Administratrix of the Estate of Paul R. Durf and Lydia B. Durf, individually and as the spouse of Paul R. Durf Plaintiff vs. ~ No. 0/- 5b> 10 : Civil Action - Law United Church of Christ Homes, Inc. tja :Jury Trial Demanded Sarah A. Todd Memorial Home, Defendant . I aDO u.Je-,\. '&v- t \.. S-\; aJ CArI'51<.. FrI 1'10J3 TO THE PROTHONOTARY: PRAECIPE Please issue a Writ of Summons in the above caption matter. Respectfully submitted, ~~ ~~.~ H. Anthony Adams, Esquire --- Attorney for Plaintiff 128 E. King Street Shippensburg, PA 17257 (717)-532-3270 - '<_''7_'">___'_"""'."'''''-!'.c::'s''',,''.. ',:"_'<", 'I-__'~' -,'_^",'"",'^"O',_'cn"_,, ~--'" .""" ,,~," J' ", ,,, "~" ,,~~_"'''~'--''>' ,;.= """-.'\' -' <l "V'O"" , 'Y,""'" "', ,-F;,',,,-,_, ',-'-/!, " ,;,"'A':', ,;,~, ,,"-C"-," .~,~-: f.' _< ::'-:~ ~ .J uJ .,J Q "',-, ,,'.," """-'b~""' -,,,, ~1I'''II*~'i 'rd\Ff~~':':i'~ '" '"K,.'-&<''',- .c"""@'~,-j~-j'uijlfit,j';'ffi'>'~]xtN<~!T__~w, <: n if: 1';0" , , ,," ", <'" , \:J. ...f' V\ ~ v, \l ~ ~ -t:( b ~ Y ,,5;,~~'-'~' Vt ~ 0 D 0 V1 l.') C ~ ~ :x.. }:, "- :r- --....., ? ,<) , ;s \.-, )~,~~r.J..I~1P.~, r+;f:- ~~,~-- .::7;'_- j'-- , () c. c;:'- (:":1 .:11P- v) ,=0 '"') ". ~ ,'''r,~__.,;">.,-:,,..,,),_ ,,~.j..~_~mf"~ ,- -'!'J~<-: Jnltt'-~' '-''''o^~-~''-'' ~^ -c' ~'-- tYJ"""" ,'--','" - , .,.. Commonwealth of Pennsylvania County of Cumberland L'iDIA B. DURF, ALMINISTRATRIC OF' THE ESTATE OF PAUL R. DIJRF AND L'iDIA B. DURF, INDIVIDUALLY AND AS THE SPOUSE OF' PAUL R. DURF Court of Conunon Pleas YB. 01-5810 Civil No. _n_____n__nn______nn_____un__ xJKln__ UNITED CHURCH OF CHRIST HCl1ES, INC. T/A SARAH A. TODD MEIDRIAL HCME 1000 West South Street Carlisle PA 17013 Civil Law In _____________________________________________ UNITED CHURCH OF CHRIST HCMES, INC. T/A SARAH A. TODD MEMJRIAL HCME To _____________________________________________ You are hereby notified that ,J;,'iPJ}L!;l-'nQURf~.Admi.nisb:atilLO:L:tha..Estata.oLP1illL...R~_DlIRE_and_ r.VnT Il. B-.DURE.___ Individually and as the spouse of PAUL R. DURF the Plaintiff ha commenced an action in ___-GIVJ:L--LAWn____n______________n__________nn____ against you which you are required to defend or a default judgment may be entered against you. (SEAL) OCTOBER 8, 2001 Date ______________________________ 19____ /s/ Curtis R. Long -",--"'-r- -----T---------------" - - - --------- Prothonotary By ~Jrtljjzt/p-~_nn__ D:p~~-"::~/-'4J' ""';:,r,,~, " '", ""',~ _ ,nc~',,- ~ 'T~ ~31 I , >' ...' s: 81 ~: , I I , , I , , I , , , , I enf-'::r: :or ",. 1-" 00 ~:"~ ffi:><8' 0' !j' ::l ]~i ~rt~ ~ Ul 0> - rt f-' i:'l " Ul '" ..0 111 . " ~_ ," ~[,"Iil~).,,__ _~ ~~. I , :n ,I-" .< 'I-" if-' 'I:'" 'OJ I:;: , , , I , , I I , , , , , , I I , , I , , , , r .... = ~;-,,, '" < , '.',' .;.,"--~--lt"":'Ti"r;~ff\',',;_c~i'4'Frl'~-"i:"l~':F.':J'W''"~tt1{~'til'fiT~I-''fJ~I~kr,-'!h'1'f+:~ I , , I I I , I , , I I , , I I , , , , , , I I , , , , , I , , , , , , &>5::::!2 Ii 0 :l> H f-'O ::;\ ~':;; ~en CI f-'O> 0> Ul g ~: :l> ~ f-'~ ~ Q ":or 0 0 ;:i ~ en g"':l . w rt Q ~ ~ ~ 0> H rt en ~r-J H ;~ H ~ . ::;If<i:'ll:''' Et3o~t3 H:l>H en:l>t;j:l> ~?lo?l &la"':lo liJ~~~ 'd' 1:"'- ~~:o~ ~~8~ ~~;j f< ~ ~ ><: o liJ ~ ~ ....... ~ , , '", '0 '0 f-' I 111 00 f-' o n 1-" < ,I-" p-' 'r-J '0> i~ 1fi , , , i!$il:.~~f-'q!.\\I1'I<'WiI~~!l'~~~~~~I'(tlw';"",'Iif?1","'''"''' ""'"f''''''' ,- --'---j;'''''i-"I'7'''1'~;,~,'','''-,\n'~''?f''''~F;"-JFO[f'''';''l'i""!;'<'i'j'~7f'~;""""i~~ii~" "":1'tfC,"r ~"_ !,,'n"T".'n:il'!n 'I" 't LAW OFFICES OF RALPH F. TOUCH By: Edward 1. Cermanski, Esquire Attorney l.D. No. 56278 401 Penn Street, Suite 100 Reading, PA 19601 Tel. 610-320-4663 Fax 610-320-4767 Attorney for Defendant, United Church of Christ Homes t/a Sarah A. Todd memorial Home IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Lydia B. Durf, Administratric of the Estate of Paul R. Durf and Lydia B. Durf, Individually and as the spouse of Paul R. Durf, Plaintiff v. United Church of Christ Homes, Inc. t/a Sarah A. Todd Memorial Home, Defendants ;',1 ) ) ) ) ) ) ) ) ) ) ) CIVIL DIVISION NO.01-5810-Civil ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance in the above-entitled matter on behalf of the Defendant, United Church of Christ Homes, Inc. t/a Sarah A. Todd Memorial Home. Dated: October 24, 2001 JURY TRIAL DEMANDED PANEL OF TWELVE JURORS REQUESTED ;,1'~1'i' ,~ "~ " ," , ~,"-" /f-- Edward J. Cermanski, Esquire Attorney for Defendants ~, ~" ~ ~'I"',~r"lr'Ii',-J'O '-""~F", T'>~'~"~'''r'----- ''''' .~='''" ~ '" t-,j{ ~ CERTIFICATION OF SERVICE I hereby certify that I have served a copy of the ENTRY OF APPEARANCE upon all parties, their attorneys or representatives, and all other relevant organizations, in the manner(s) set forth below: By first-class. United States mail. postage prepaid: H. Anthony Adams, Esquire 128 East King Street, Suite A Shippensburg, P A 17257 Dated: October 24. 2001 {~ Edward J. Cermanski, Esquire Attorney for Defendants 1. __ JJ" T "'__, -f' ~"_',_',~__ ,_, ,~" ~>c-,',_nl_ ',," '" 1,.'1"-'-- &1 l!!I!II'"h''' '" _~~ ~__=,^"~~,~,,,~.;' ,e',- ... ,1Nl!'f!ll~!f);"'l'! -, . -r.'~-~A -,\,:--,-' '-"1i-~'n"" "r~' IiP'tr:/i -- r 'TNlirt' n~nHn'j-";Y;""r~':f~~":"ji'1t";r', ~~"tt"'~-~f,t~j~''ilt:'~'~~lf:;' Si';Y,:+J.!, ,,~_n,_,~, -~ ~ Q '" <:~ ~~E ~~(~ !> -"--."'l - C' ...-::hoc': ;,~ -< a [''j -.Of', r::> c"') -J r......) In :2; :;~ (n "--.; 'y '" =< !J. ~1W~",;\;~;'j;;\i";'''-':i;'''?''1'<l1Y'' "'if"~",-M"O\~-.:-i'~~~r'(1l,,;,W!~urJFV,~~J~~.lfl~~IWJ~~~,'t' ;" l:=C']~r~~" LAW OFFICES OF RALPH F. TOUCH By: Edward J. Cermanski, Esquire Attorney LD. No. 56278 401 Penn Street, Suite 100 Reading, PA 19601 Tel. 610-320-4663 Fax 610-320-4767 Attorney for Defendant, United Church of Christ Homes t/a Sarah A. Todd memorial Home , , IN THE COURT OF COMMON PLEAS OFCUMBERLANDCOUNTY,PENNSYLVANlA Lydia B. Durf, Administratric ofthe Estate of Paul R. Durf and Lydia B. Durf, Individually and as the spouse of Paul R. Durf, Plaintiff v. United Church of Christ Homes, Inc. t/a Sarah A. Todd Memorial Home, Defendants ) ) ) ) ) ) ) ) ) ) ) CNIL DNISION NO.01-5810-Civil PRAECIPE FOR RULE TO FILE COMPLAINT TO THE PROTHONOTARY: Kindly enter a Rule under Pennsylvania Rule of Civil Procedure 1037 upon Plaintiff in the above-captioned matter to file a Complaint within twenty (20) days from the service thereof or otherwise suffer a Judgment of Non Pros. , i ; '~,'i<['''' ,~ __ , ~~, . - .--=" , . c.~:--~? __ Edward J. Cermanski, Esquire Attorney for Defendants 'nO ,~~, - , ~W''',''~:nc:ri!r~'~ _c ,,',,-~'_.' '. '~~, LAW OFFICES OF RALPH F. TOUCH By: Edward J. Cermanski, Esquire Attorney LD. No. 56278 401 Penn Street, Suite 100 Reading, PA 19601 Tel. 610-320-4663 Fax 610-320-4767 Attorney for Defendant, United Church of Christ Homes t/a Sarah A. Todd memorial Home IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Lydia B. Durf, Administratric of the Estate of Paul R. Durf and Lydia B. Durf, Individually and as the spouse of Paul R. Durf, Plaintiff v. United Church of Christ Homes, Inc. t/a Sarah A. Todd Memorial Home, Defendants ) ) ) ) ) ) ) ) ) ) ) CIVIL DIVISION NO.01-5810-Civil RULE TO FILE COMPLAINT AND NOW, this,;)q-R day of Odob"'R_,.}OOl , a Rule is entered under Pennsylvania Rule of Civil Procedure 1037 upon the Plaintiff in the above-captioned matter to file a Complaint within twenty (20) days from the service of this Rule or otherwise suffer Judgment of Non Pros. [ ]/ 101300089 - ,., .--""_,1,. ."~, , (L~) ~ ~~ ~ ,,-); '"", CERTIFICATION OF SERVICE I hereby certifY that I have served a copy of the foregoing document(s) upon all listed parties or their attorneys in the following manner(s) and in accordance with all pertinent Rules of Civil Procedure: 1. By first-class, United States Mail, postage prepaid: H. Anthony Adams, Esquire 128 East King Street, Suite A Shippensburg, P A 17257 Dated: October 24, 2001 if ~ Edward J. Cermanski, Esquire Attorney for Defendants "f; "', _;. -".,'!t'~," r. .,., _ -" _ . _, ,_ _ _ -,,'I, ,_~ ~ _ _ ,~," ~ , ". ,-,. .' . ?, """', ~, .- ~^. ",,' ~ ~", _~ _>'~~ o,I'\l!!llIlf' .- ~ ~ ". "'<-_.'",".'-., u '[ ""lI'illiIiTllJ TU"l]jCTTnm'rnr~ ' IrcT'CIifI"iif s:.l ~:- i~e I:'~;':~ ~L. :t~\ =2 c' ';:J a COo) -l ,"-' '1:) j (.c;; ---:'11 _,,)':::J 2fJf Cirn :;::.."" e- ~::J -< =-0 .~~ ~~ (]') "f 1,_J!_l1Ii~~~-r~.;!"'\r.,-,,^,~;'lJ:-":~'!0T,*\pc"'Y'\~";!~~!&~'",~,"'~~~~;t!~!~~~'SM~,~~lM~- tl'ijr '-,'",,-"',,"." .,', " _, c, SHERIFF'S RETURN - REGULAR CASE NO: 2001-05810 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DURF LYDIA B ET AL VS UNITED CHURCH OF CHRIST HOMES DAVID MCKINNEY , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon UNITED CHURCH OF CHRIST HOMES INC T/A SARAH A TODD MEM HOME the DEFENDANT , at 1545:00 HOURS, on the 12th day of October 2001 at 1000 WEST SOUTH STREET CARLISLE, PA 17013 by handing to MARY JANE WALKER a true and attested copy of WRIT OF SUMMONS together with and at the Same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge So Answers: 18.00 3.25 .00 10.00 .00 31. 25 ?'"'~-,~~ R. Thomas Kline 10/15/2001 H ANTHONY ADAMS Sworn and Subscribed to before By: ?b~~~ Deputy Sheriff th' /t> 0. d me lS 7 - ay of O~, ~MI A.D. ~n&a~0/7 .'t"l.',_""F'" I' "~ - F_,~ ,,' IT ,l! I IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Lydia B. Durf, Administratrix of the Estate of Paul R. Durf and Lydia B. Durf, individually and as the spouse of Paul R. Durf Plaintiff : No. dO 0 I ,- 0 S; 8/ D : Civil Action - Law vs. United Church of Christ Homes, Inc. t/a :Jury Trial Demanded Sarah A. Todd Memorial Home, Defendant COMPLAINT Now comes the Plaintiff, Lydia B. Durf, as the administratrix of the Estate of Paul R. Durf and individually and as the spouse of Paul R. Durf and sets forth the following: 1. The Plaintiff is Lydia B. Durf who was granted Letters of Administration in the Estate of Paul R. Durf by the Register of Wills on October 9, 2001. Paul R. Durf died on December 11, 2000 and this action is brought on his behalf. 2. The Plaintiff, Lydia Durf, is an adult individual who resides at Walnut Bottom, Cumberland County, Pennsylvania. Lydia B. Durf was married to Paul R. Durf. Paul R. Durf and Lydia B. Durf had no children. 3. The Defendant is the United Church of Christ Homes, Inc. d/b/a Sarah A. Todd Memorial Home located at 1000 West South Street, Carlisle, Cumberland County, Pennsylvania. ,,- -I' ., " '"I"'" -~ '---r - '~-'I ""'., i)~-F~'>-l."if/'(;" ,'k;'~ ~i'C', " :' :I < _ _c' ,,," -, ~'~I 4. On September 29, 1999, Paul R. Durf became a resident of a nursing home owned by the Defendant. The nursing home was located at 1000 West South Street, Carlisle, Cumberland County, Pennsylvania. 5. Paul R. Durf remained a resident at the nursing home owned by the Defendant until the time of his death on December 11, 2000. 6. At the time of his admission to the nursing home he entered into a contract for admission as the "Resident" and Lydia B. Durf entered into the contract as the "Responsible Party". The Defendant as Sarah A. Todd Memorial Home entered into the contract as "Home". A copy of the agreement is attached hereto as Exhibit A. 7. As consideration for the contract, the Plaintiff paid the Defendant for room and board the amount of $4,350.00. Plaintiff has paid or has a balance to pay of $48,056.00. It is believed and therefore averred that various insurers have paid an additional $20,000.00. 8. Paul R. Durf was not able at any time during his stay at the Sarah A. Todd Memorial Home to walk or to move about in any fashion. 9. On or about October 15, 1999, the Defendant's employees andjagents allowed Paul R. Durf to fall during their attempt to move and or manipulate his position. '1'<1'1, ,"",",-", "-"", ,,, -'.,'1 . '1-- , ~ ~~ "TI~ ~"I " . ''lWi_ -,l.v '.', ~""' ^" 10. As a result of the fall, Paul R. Durf suffered numerous fractures to his back and injury to his head. 11. As a result of the fall and the injuries sustained there from Paul R. Durf experience severe pain and suffering. 12. Dr. Long who informed Mr. Durf and Lydia B. Durf that with therapy Paul R. Durf would regain some ability to walk and move without assistance had shortly prior to the fall seen Paul R. Durf at Johns Hopkins Hospital. 13. As a result of the fall and the injuries sustained there from Paul R. Durf was not able to receive adequate therapy and was from the time of the fall never able to walk. 14. The actions of the Defendant in allowing Paul R. Durf to fall did not meet the contractual obligation of basic services (Exhibit A 1.1) or supplemental services (Exhibit A 1.2) as set forth in the contract between the parties. 15. As a direct result of the breach of the contract the Plaintiff as an individual and on behalf of the Estate of Paul R. Durf has been required or obligated to pay the sum of $48,056.00 and has Estate has not been compensated for the personal injuries as set forth herein. "';;~,-1/."'llo,~ _,~'" ,,' .-,- I ~ ~- II ~I" ~ ~ ~ ~-o-.~'I;~,,_Q;';"" L:J'"- r.:' '~-.' ~ D'-, Wherefore, Plaintiff prays that all monies paid on the contract, together with damages for all injuries received as a result of the breach of the contract together with legal fees and costs of suit be awarded to Lydia B. Durf and! or the Estate of Paul R. Durf. COUNT II 16. Paragraphs 1 through 15 are incorporated herein by reference as fully as if set forth at length. 17. The acts of the Defendant were negligent and not performed with reasonable care to safeguard Paul R. Durf from harm in as much as the Defendant failed to use procedures and equipment to assure that he would not fall, failed to have adequate staff attend to the attempted movement of Paul R. Durf to assure that he would not fall; failed to properly train, control and supervise its employees to assure that a resident who could not move voluntarily would not fall and otherwise acted in a negligent manner. 18. The negligence of the Defendant was the direct and proximate cause of the injuries suffered by Plaintiffs as set forth herein. 19. The Defendant was further negligent in not advising anyone including Lydia Durf of the fall by Paul R. Durf. Only after Paul R. Durf complained of pain and told Lydia DUrf about the fall was any action taken. ["W<"l'".> C"!'<" , ~~~1 'r - ""~V=I~"'-~'i>';"'Y~-'j!fj:t~:".""'-- -flrer-- "f"'^ '~~, 20. The Plaintiffs have as a result of the negligence of the Defendant suffered injury in an amount in excess of $100,000.00. Wherefore, Plaintiff prays your Honorable Court enter judgment in her favor and against Defendant in an amount in excess of $100,000.00 Respectfully submitted, ~\~ f'~"""'" , ,~~ .,......, -" - 'f' e, _ "I :;!~-.1.iK!(r-"u'['~ - ':-""'" -",C,,',,' -,- I verify that the statements made in this complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date:# I ~P, &~ Lydia . Durf 'J_""'"Ji~~~~,,, 'I' ,,- ," ~ ~ .', ~j;:i'~;~':;i:ri':j'r ',-" _j: _,_:_~ . _ ':'" , _~':' ,,~, '~'."''- ~,'" Md~~1 SARAH A. TODD MEMORIAL HOME NURSING HOME ADMISSION AGREEMENT " 'J >. '1':' ,.', THIS AGREEMENT made this 8q . ~~y ,~fJ;;;;t;.,:~'v;; ," , . \ qqq . between Sarah A. Todd Memorial Home, located at 1000 West South Street, Carlisle, Pennsylvania, (hereinafter' called HOME). and v{)~ .~ , (hereinafter called 'RESIDENT) for the admlssl~ESIDENT to HOME, and '~' . ' ,of , ,.' ,'j'(RESI ENT's.legal 'representative or individual who has lawful access to RESIDENT's income or financial resources availablet6 pay for HOME's services; hereinafter called RESPONSIBLE PARTY) shall commence on ~ ;}\ IQltq,~: >; .' ,', RESIDENT, having applied for admission, andRESPC)NSIBLE PARTY, if any, affirm that the information provided in HOME's Application for Admission is. true and correct, and acknowledge that the submis~ion of any false information may constitute grounds for terminating this agreeril~nt. '.,' ", .'; :'.' . . Therefore, HOME, RESIDENT, and RESPONSIBLE PARTY, if any, agree to the following terms and conditions: . Ii 1. PROVISION OF SERVICES 1.1 Basic Services Provided by HOME. '. '"",' ,., " HOME agrees to provide basic services to RESIDENT which include room and board, routine nursing services, social services, dietary services, housekeeping and room/bed maintenance, activities, bedding, linen, and such personal serVices as may be determined by HOME to 'be legally and reasonably required for the health, safety, welfare, good grooming;'and well-tleingdf RESIDENT.; , " '~.:~, '>.:. "', " ';~, ',(, ,:') r 1.2 Supplemental Services and Supplies Prdvlded by Home ' Home agrees to provide supplemental services and 'suppllEis'as shown 'on the' HOME's Schedule of Charges as mayberequested by RESIDENT or 'as may be determined by HOME to be legally and reasonably required'foi,the health, safety, welfare, good grooming, and well-being of RESIDENT.., ,':: : "'''''__ !i, " II".' 1.3 Services of Physicians ."'. '. ":', ' .. Medications, treatments, therapy, diet and other servibesare provided\mder the direction of RESIDENT'S atlendingphysician.}HOME agreesto pennit RESIDENT to choose his or her own physician. HOME reserVes the tight to "appoint a physician for RESIDENT if RESIDENT or RESPONSIBLE PARTY fails to do so, or if physician selected by RESIDENT or RESPONSIBLE PARTY fails to comply with HOME's policies, procedures or regulations. !"">::;I" """_F,.,,_III\iImil~lt, - .'I'!I'!'!"""" !-, -. - ,~ ,r r;tLJ :'1~:l( J~~-' ""L""" ".~" . '." '? 1.4 Services of Other Providers " ;1 HOME agrees to permit resident to choose other providers of non-facility services conditioned by the provider's cOl11plie[l9!!t~itbHOME's policies and procedures. ~ I,'''', ,'... ." ' ,~ " '~i,: . ~, !", ,), .r,,:' ',';, " '.. ",'. ", . , .': ,~, ,. '.' :".:, , .' ,.'. :;:z . . '~", ' " 2. FEES AND CHAR.GES.. .;0 ;C." 2.1 Obligationof RESIDENT or,RESPONSIBLE PARTY . RESIDENT, ::or RESPPNS.lB~Ei. f;:ARTY solely, from RESIDENT's financial , resources, shall be responsibleforthe payment of all charges assessed by HOME for the'services and'supplies HOME provides to RESIDENT. Non-payment of charges may result in HOME's termination of this agreement after notification to RESIDENT or RESPONSIBLEPARl)'. j 0:' ,,", ,': 2.2 Schedule of Charges RESIDENT or RESPONSIBLE. PARTY acknowledges receipt of HOME's Schedule of Charges for basic and supplemental services, which are. considered part oUhis agreement. HOME retains the unilateral right to raise, lower, or modify the Schedule of Charges, and such change shall be effective no sooner than thirty (30) days after RESIDENT or RESPONSIBLE PARTY receives written notice thereof. If RESIDENT requests items or services not included on the schedule of charges, HOME will advise resident of the cost, if any, of such item or service. ' , , 2.3 Advance PClyment of Basic Service Charges RESIDENT, ,or RESPONSIBLE PARTY solely from RESIDENT's financial resources, agrees to pay basic service charges in advance. The first payment shall b~ in the aggregate amountof the basic service charges for each day starting V'Jithth~. date this Agreement commences to the end of the month. Thereafter, advance charges for basic seryicesshall be due on the twenty-fifth (25th) day of the month in which services are being provided. Advance payment of basic service charges is not required if RESIDENT or RESPONSIBLE PARTY has reasonable expectation that services will be covered by Medicare, or 'Medicaid.)f HOME does not concur with RESIDENT or RESPONSIBLE PARTY's . expectation , of ,Medicare coverage, RESIDENT or RESPONSIBLE PARTY must request in writing that a demand bill be submitted to the Medicare intermediary. When such written request is made, no advance , payment will be required While the Medicare intermediary reviews the request. If RESIDENT or RESPONSIBLE PARTY, believes that RESIDENT is eligible for Medicaid belJefjt~ payable to HOME and :;ubmits a completed application for , , 2 'f-'''';''l!l~'Wr"_ .. '0,_ " ~ _ 'I' ~~ -I "'.. :ii~':'<-:Gj'l~';;:-"'1-""-'~ .-"', '.-~ L (' ,'-- c~,.," . ~,,--, ~'=I 2.4 2.5 2.6 2.7 2.8 2.9 ''''''~"'.., Medicaid benefits, no advance payment will be required while the application is being reviewed. .;.~ _d," ',;,'. '. Payment of Medicare Deductible and Co-irisuranceiAmouhts;: .'" Except when RESIDENT is eligiblefor;tv1e~icfajd or when Medicare deductible and co-insurance amounts are covered:bY'!'ah\:insurance with \vhich HOME has a participating provider relationship, HESIb.ENT,or RESPONSIBLE PARTY solely from RESIDENT's financial resourc;e~,"agree~:to pay Medicare deductibles and co- insurance amounts. Payment of dedti~tiq!~1~ndco':'insuranceamounts is due on the twenty-fifth (25th) day of eachrno~th:f6116\ivingthe'month in which the services or slJ,Rplies were provided. ,J'F,~;;;,j!f;i " ' i.:i, " - ";:,:\;'~~:::';[J.'\;~f'~~;: :")'j: Payment of Medicaid Income Based Co(;payments RESIDENT, or RESPONSIBLE PARTY "solely:from RESIDENT's financial resources, agrees to pay Medicaid income',based co-payments in the amount determined by the Medicaid prograrfU:PaYment 6f Medicaid co-payment amounts is due on the twenty-fifth (25th) day'ofeachnionth following the month in which services were provided." ", .;," ,.;, i:' , ~'I c)~ " y Payment of Supplemental Services 'and Supplies' Charges' ., RESIDENT, or RESPONSIBLE: PARry. isolelyfrom RESIDENT's financial resources, agrees to pay supplemenfal 'ch::irges' for services 'and supplies not included in the basic service charge, " Payment for supplemental charges is due on the twenty-fifth (25th) day of each month following the month in which the services or supplies were provided. '11:: ;1{ '" ',' '.' " ",i,!;,:'.', ',.,iJ, }'}i",;' .", j , 'f". . , , ,,~ " :" " Payment of Services by Physicians' and 'Other Providers' i,' Payment of services provided byPhysieians!isthe responsibility of RESIDENT. Except where services of other providers'are:"payabIe to the home by Medicare or Medicaid under the terms of HOME'i;: provider' agreements, RESIDENT is responsible for payment of services'by'Other p'rovidersY " ' , '.' ' :.'?;,; ~r~~':j;:{'~' ;>;:,~; ,.;~1l! ,;-. ;'; ',~'! "\' Late Charges and Costs of Collection;;; ,~jf!r';: " ' " '", " RESIDENT, or RESPONSIBLE PARTY agrees to pay late charges calculated on the basis of one and one-quarter percent'(1.25%) per'month on charges for' services and supplies that are at leasethlrty(30rtlayspast due., RESIDENT, or RESPONSIBLE PARTY agrees top'aY' regsonable cOsts of collecting'past due accounts, including attorneys fees;': '~tj!r~W ,. 'c'. ,,', , '" ", . ~, '!"-'.' l~:i .,' ."_ _, . . ',.. ..,:' Refunds of Overpayments Overpayments will be refunded within thirty (30) days following the last day of the month in which RESIDENT is discharged., ':i 3" , ~ , "I! -; ~ , ' ,~ 1, ~~~~I n.., r }'<1'---<"--[ - ]. , 3. MEDICARE AND MEDICAID >,,'1 'J ,; ';, 3.1 Participation in Medicareand,M~djc;:a!?", .,' HOME participates in both the Medicare and Medicaid Programs. HOME agrees to provide services of the.samequ,?lity and type of care regardless of source of payment. RESIDENT and RESPONSIBLE PARTY, if any, acknowledge that no representation, statement, or clairrl' has been made by anyone connected with HOME that services to RESIDENT are or will be covered under Medicare or Medicaid. HOME makesno guarantee that services will be covered under either program. RESIDENT or RESPONSIBLE PARTY releases HOME, its agents and employees from any liability or responsibility in connection with RESIDENT's potential claim for coverage under~ the Medicare, Medicaid, or any other governmental assistance program., ' r" .~ . ", .. '.,' ,. ",' 3.2 "Acceptance of Medicare and Medicaid Rates In the event RESIDENT is determined eligible for benefits under the Medicare and/or Medicaid program and is entitled under one or both of these programs to have payment made for all of the items and services provided by HOME, HOME agrees to acceptthe.paymentfrom these programs, plus any related deductible, coinsurance andcopayment amounts owed by RESIDENT, as payment in full for the items and services covered thereunder. " 3.3 Application for Benefits ' ,I, RESIDENT shall apply promptly for eligibility and benefits under the Medicare and/or Medicaid program as soon as RESIDENT appears to meet said program's eligibility requirements. If RESIDENT fails to apply promptly, HOME is authorized in its sole discretion to prepare"all, necessary forms and documents from information provided by RESIDENT or RESPONSIBLE PARTY for RESIDENT or RESPQNSIBLE PARTY's signature, which RESIDENT or RESPONSIBLE PARTY shall not withhold unreasonably. ,HOME will submit such forms and documents to the appropriate state and/or federal agencies for a determination of RESIDENT's eligibility and benefits under the Medicare and/or Medicaid program. 3.4 Non-Covered Services RESIDENT, or .HESPONSIBlE PARTY solely from RESIDENT's financial , resources, agrees to pay charges for non-covered items and services. Payment for supplemental charges is' due on the twenty-fifth (25th) day of each month folloWing the month in which the services or supplies were provided. '4 ~t'__~...,~ ~~ " J " -'I ,~ e ""~r F - ~ Jt.>;;"'?~,.~J"t-:;nr "1 'He ',ire -'_-,V-"" C"L-,'"-'-i..-,t,, "'0< ,--, 4. 4.1 4.2 4.3 '''",-<",~,;'",,_., BED RESERVE PROVISIONS 'r" Private Pay Residents' " In the event RESIDENT, while not eligible for benefits payable to HOME under the Medicaid program, is dischargedfrorn'HOME,for the purpose of being admitted to I" ;._1 (,. - .,..~,.:,'" ~ . " ,- ," a hospital or for the purpose;: of,y,thetapeutlc.leave; HOME<shallreserve RESIDENT's bed until such time asRES!DENT;returns to HOME or RESIDENT or RESPONSIBLE PARTY notifies HOMEfr1'wrHing cif RESIDENT or RESPONSIBLE PARTY's intention to terminate tbis,'Ag~~ement.\.;HOME shall charge and RESIDENT shall pay HOME's curr~~fd~iIYiprivate rate for each day a bed is reserved for RESIDENT until RESID!=:~T,ejther returns to HOME or terminates this _-'-', . ,._ '. ,- ,'," 0(, ,,~',-;__t., \It. '_ I' Agreement "",,"{ ',n",\:'k"'" ".' ,., . . . .;J,~.;t"~ff!f~ ;'d. ,I,' ::: ',I , ". ',' Medicaid ReSidents ,,,1/, '?iiH)';;' ,',' ,0',' , ., -, "'>;l" "-.-', ,I. . '_ ,_ _ -,' ..~ ," 11 " In the event RESIDENT, while eligible fdfbenefitspayable,to:,HOME~under the Medicaid program, is discharged frol'r\'HOry,E:fdYth~ipufj:)ds'e6fDeing'adinitted to a hospital, HOME shall reserve a bec:lJor RESIDENTforup to fifteen (15) days per hospital stay. After such time, HOME'shallhotbe,dbligated to reserve a bed for RESIDENT, but will readmit RESIDE'NTto,the first available semi-private' bed upon discharge from the hospital.i';;rhtY,-:l" " '"f, 'i'I., .. ,. ',', , >-, ~:.~-;,...; 1~',I}ttJ.Hc .';(-\ i :(,( ~:l;~ ;, "i; " ::'"J;., In the event RESIDENT, while eligiblefof, benefits payable to HOME under~ the Medicaid program, is discharged from HOME for the purposebf therapeutic leave, HOME shall reserve RESIDENT's bed for) up to fifteen (15) days per year if RESIDENT is receiving skilled care or up td thirty (30) days per year if RESIDENT is receiving intermediate care. After such"time; HOMEshall continue'to reserve RESIDENT's bed if, before the expiration of said period, RESIDENT or RESPONSIBLE PARTY notifies HOMElniwritingofRESIDENT's intention to return to HOME and RESIDENT's agreement to pay HOME its then current rate for each additional day RESIDENT's bed is'reserVed.: ,,; ','." u:; ". :tp ,;:'",\, ,"- _ - "'~,,t ..' 'j Medicare Residents .f ,Bi;. \ .,' Medicare does not provide benefits payable to HOME for reserving a bed. In the event RESIDENT is eligible for benefits payable to HOME; under: the Medicaid program, bed reserve provisions will bel'inaccordance with those described above for Medicaid residents. In the event RESIDENT is not eligible for benefits payable to HOME under the Medicaid: program; bed ireserVe 'provisions :will be in accordance with those described aboVe' for P~ivate Pay residents.;' [t '. .,;;, " : ;,.,.->-;, .'-' , ,T, '. 1'.- ','. ~" ;;.:: :'!'"[ '.' l..-~. 5 ", "r ,~ - -I , ~ " ,[ 5. PERSONAL AND OTHER PROPERTY 'T~ - ,~. :,":'" 5.1 RESIDENT Responsibility . .' RESIDENT'or RESPONSIBLE Pt1f3T;Y",agree to provide such personal clothing and effects as neededor'desin3d',by 'RESIDENT, subject to space limitations in ". HOME. RESIDENTis permitteQ t(Hetain personal possessions that meet safety . . . criteria:' HOME'may; place restrictions on items that infringe upon the rights of -'.'{ othersor:are contraindicated by RESIDENT's physician as documented in the ( medical record by RESIDENTs'physician. . 'Y;j':::;:-'_' ,. o;~g:!_,' . ' , RESIDENT is responsible' for'maintaining insurance on any personal property or valuables kept at HOME. RESIDENT or RESPONSIBLE PARTY accept sole risk and liability for personal property orvaluables kept at home. 5.2 " I:IOME Responsibility.i ,,' HOME shall provide RESIDENT ":'{,i$h a locked space if requested by RESIDENT. Use of said locked' space, and thei placement or storage of any items therein, is recognized as being at the sole risk and liability of RESIDENT or RESPONSIBLE PARTY, and no liability or responsibility whatever with respect to any such items is assumed by HOME. . HOME accepts no liability to replace or be responsible for stolen, damaged, lost or misplaced personal property or valuables. HOME strongly recommends that no jewelry, or other valuables be brought to or ....... maintained at HOME.'" '.. , -, " '. , .' ~> '. ", r '~" ':', :;~ 6. RESIDENT'S PERSONAL FINANCES, 6.1 RESIDENT Funds Management' . . RESIDENT is encouraged to manage his or her own personal financial affairs. HOME will manage RESIDENT's personal financial affairs only when RESIDENT or RESPONSIBLE PARTY design'~tes the transfer of such responsibility in writing. RESIDENT funds managed by' HOME will not be commingled with HOME funds. ,--,', If funds managed for RESIDENT are in excess of $50.00, the amount in excess of $50.00, or, at HOME's option, all funds being held for RESIDENT, will be held in , an interest bearing account at a local financial institution insured by the Federal Deposit Insurance Corporation or the Federal Savings and Loan Insurance Corporation. 6.2 RESIDENTs Access to Funds .,. If assistance with financial manag&inent is provided, HOME agrees to issue up to $50.00 in cash to RESIDENT upon request during normal business hours, 6 F"'T~,k- ,_ .~'" . ' 'I' --'-"'~~' , ' . .- ;".~-;., ~-I ,'.c.i-~ it_,)' .""li"j1 "~'''" - " <", - - 'c__ 6.3 6.4 6.5 6.6 6.7 "~'~-' ,,- . , . . ~' . provided that RESIDENT's account'. balance ",'equals .. or exceeds the. amount requested. Withdrawal of amounts over $50.00 will require reasonable advance notice. , r;" :i\;\,{j~~~_ '-: :.'~r';' ~ . , . ' , ,....~ '" :. . ,<' J,_" . ,'< RESIDENT's Personal Needs Allowahde~\fii' ....:."., '. ,< .... '. . RESIDENT is permitted to retaina'pbrtioii~;orRESIDENT'sincome as a personal needs allowance, in an amount deterlllinedby the Medicaid Program. ,RESIDENT is not required to use any portion'ofRE$ipENT's persorial,needs allowance for basic or supplemental charges;"ndr;'wiI11iHbMEirfip6se a':icharge. against RESIDENT's personal funds for seiVicesp'aid:for by Medicare or Medicaid." HOME Accounting;~~;:;)lT~~tt'~ft ,; . ',;: ,'/;'''~, ' . If HOME provides assistance with financial 'management to RESIDENT, HOME shall maintain a separa~e, currentinCiividH~1 record,of;,financial,transactions for RESIDENT and shall gwe RESIDENT. or RESPONSIBLE PARTY a quarterly accounting of transactions made on RESIDENT's behalf. Upon request, RESIDENT or RESPONSIBLE PARn' shall be allowed 'to review RESIDENT's financial record during normal workirigh'ou:rs." .' "; .i.!" " -,.;,t~,tt, ,"H~,;"l,.f':: ;"'~' :1('''' .i' Deposits and expenditures shall,,'t:i~ iClocumented"with'writteni receipts. " Disbursement of funds to RESIDENT,.;'6rJiRESPONSIBLE' PARTY shall. be '.~ documented anct RESIDENT or RESp'ONSIBLE PARTY' shall acknowledge the . receipt of funds in writing. Accounts snalf'clearly refled deposits, receipt of funds, disbursal offunds and the current balance" .' . Medicaid and SSI Resource Limitati'6nsNotification ,', If RESIDENT is eligible for MedicaidnHOME 'will:notify', RESIDENT or RESPONSIBLE PARTY when the ac(#iunt'balance accuniulates,to a'point that is $200 less than the Medicaid and br SSI'~~$ourcelimitatidn that'RESIDENT may lose his or her Medicaid or SSI eligibili{ylf tf{~Miource limit is exceeded. i. ..' i~i1;(~~D:';i-~"fr;fn 1c'~ "~I ,( ~'.-,:, ,I,'. 'i~) " RESIDENT Funds Procedure Following termination of Service by HOME. In the event of termination of service by HOME after thirty (30)dayswritten notice, HOME will provide RESIDENT or RESPONSIBLE PARTY with an itemized written account of RESIDENi's funds and immediate payment ofariy balance remaining in RESIDENT's account with HOME. " l ' 1,,'.;';..'..:.'....'..i',';~'.,..';:~....., ':,' , 'h,:;," ,'."," _' d' '_1:-;"; '. ' ') RESIDENT Funds Procedure FcinowMg+~tinination of Service by RESIDENT If RESIDENT chooses to leave HOME:~fter..giving written notice, HOME shall, within thirty (30) days after R,ESIDEI'lTli"leaves; '!provide :,RESIDENT or RESPONSIBLE PARTY with an)temizedwritten amount of funds, including ';:T) ',';~/f~~{~, t . , }' c,',.-,' 7 ,;,~'; ; .;~ '. ----^,--,'.. -",'- -"- I' < , , ,~1"" ~, , :~'~~"~'~-F""';_Vfil " "i'!I' n ' f"" notification of funds still ,0wed,toHOME by RESIDENT or a refund owed to ~ESIDENT by 170NlE.', ';\;,;,:;,\~ii~ 6.8 RESIDENT Funds ProcedureFgllowing Discharge or Death of RESIDENT Upon discharge of RESIDENT, HOME shall return RESIDENT's funds being managed by,HOME to RESIDENt orRE;:SPONSIBLE PARTY. , ' , ..". -u_' ,_,,:',' ',' . ~..;, ". -'''f';.' '--- , , "'_le'" ',j 'L \ _', 1;: ':. \i ,>>,-f' ,,' "'0< " ,(.: ," i" ,n , ---.~,,' ',' "'--"1." 7.1 Term of Agreement ,,:,i The term of this Agreement shall commence on the date set forth above and will remain in effect until it is terminated by either party as described herein or until a different orsubsequentagreemen.t is' executed. Notification of adjustment in charges for basic qr supplemental services and supplies shall be considered an amendment to,this agreement, butatthetime of such adjustment, execution of a different or subsequent agreement shall not be necessary to effect such change of , rates. " , ',,,' ' , , 7.2 Termination, Discharge or Transfer Initiated by RESIDENT , RESIDENT orRESPONSIB,LE PARTY may terminate this Agreement by giving " ' ; advance 'written' notice to HOME ,of RESIDENT's discharge from HOME. , "Obligation' of RESIDENT-. or ..RESPONSIBLE PARTY solely from RESIDENT's , . , - - " ;~'" '. "' ~}.- ,,' , financial resources,.. to P?Y /iOME for services rendered through the date of discharge'shall continue until such financial obligations have been satisfied. . n ,,", ,:,;-, '," ; RESIDENT-or RESpONSIBLE PARTY may initiate RESIDENT's discharge at any time." RESIDENT will not beJorce,d to remain in HOME against RESIDENT's will for any period of time. ' : , o ',. Requests by RESIDENT or RESPONSIBLE PARTY to transfer to another room .. will be,' subject ~o' the ,availai:lility' of the room' requested and the needs of RESIDENT an.d otheuesiclents. HOME will advise RESIDENT or RESPONSIBLE PARTY of any aclditio~al,~harges for requested room if different than assigned room. " .' , "," ,; , 8 --..Hi0'_!!l'_ ^'~ ~ , .. , -~... ~. """l ';"'T';"'i'i'-i~({L~' co': ", "-nj'l'frr ._~o,,' _n.'~' '.~ "",..,~ 7.3 Termination, Discharge or Transfer Initiated by HOME HOME may terminate this Agreement by)ivin9 thirty (30) days advance written notice to RESIDENT or RESPONSIBLE pARTY. " 'H HOME may discharge or transfer RESIDENT only under the following conditions: . -, ' '.., ' -' ;' " ' .., , ' ~ ' a) b) c) d) ','; ", _' ':;' , .1. ,'" ," transfer or discharge is' necessary for RESIDENT's welfare and RESIDENT's needs cann,ot b~' met in HOME; , . ;. . ""- ::':'_.'-':' "". -'~", ,.ii::'~">'!' .-",\" :~~jJ;"<~ :'1' RESIDENT's health has improved sufficiently 'aha thei':services of HOME are no longer required, as documented by RESIDENT's physician; ,,' ' ',.;:,!, ", "t"";;;'~,~';"')' ,"_ . ,,-.; :_ _ 't' ,}~~_, ,."- the health or safety of 6thers'~t HOME is eridarigeirea; . '. RESIDENT has failed,after",reasomibl~riotice,to'1pay' for or have Medicare or Medicaid pay fof..HESIDENT's stayatHOME;, , ~ -', " ; '>." ; '- ,\ , . , , , ';, , .. e) HOME ceases to operate. ...., ," . .' ;. 0 ' ',,', \J~. ',_.', ;"; ''-.'' J.1 ", -'-,' ~ ,", . i..." ;_c .,,' \ ; -n:, "j:'_,;'{ "C- 'I ~ <,' ;..":i "J, ';f\;':' < . " :.:~ . ~ , :_, ~ ~::; , i t,:, , Notice of Transfer or Discharge by Home , " ," .,',., ,.. ',: In the event of transfer or discharge, HOMEwill'provicleadvance notice of thirty (30) days except when RESIDENT has urgent need for further medical attention, RESIDENT is absent from HOME for'thiHy'(30) days, RESIDENT's health' has improved to the extent that the services of HOME are no longer required, or RESIDENT's stay endangers the healt~ or safety of others at the facility. ,. ,- "!,,j '.." ,f .', 7.4 At minimum, the notice will contain the following information: ,~ :-\ ':A,) . '. ~"" ~~" ' ,'"' -- -, ", ~ a) "c , ,'fl : ,-, ,-' the reason for transferor'discharge;" ie. . ~>" 1 _ ,_ .. b) the effective date of the transfer or discharge; c) .-",,' ," -' -' the location to which RESIDENT is to betrarisferred; "'.1 (j-" d) , '~ ",<"" ^ '" ".!.: _\"" <f", ;, In If.. " ';;;-" ,; , a statement that the resident f/as' the right to, appeal the action to the Pennsylvania Departmerit ofFublicWelfare, Office of Hearing 'and Appeals, P.O. Box 2675, Harrisburg, PA17105-2675;';" . l : ;'l~ . ,"', ,:" _1 , e) the name, address, and telephone number of the state long term care ombudsman (the local Area Agency on Aging); 9 1-- ,-.. I' '~''"':~! ,n -n "f:^ _ ' ~~,- f) the name, : address, ."and"i~elephone number of the agency responsible fOr'prote'diCinancfadvocacy of developmentally disabled individuals; ',,' ' ...',: . g) ,,' .:i, ,I the name, address, and telephone number of the agency " responsible for the protection and advocacy of mentally ill persons. -, 1 ' , " . - '! , '- ~',' -..' 8. RESIDENT RECORDS 8.1 Record Maintenance . ., HOME shall maintain records in accordance with the requirements of federal and state govern~entalagenciesor other third party reimbursement sources. 8.2 Confidentiality and Authorization , HOME acknowledges th~f RESIDENT's personal and medical records are confidential. RESIDENT or RESPONSIBLE PARTY authorizes access and use of such records to HOME. In the event of RESIDENT's admission to a hospital or referral to other health care providers, RESIDENT or RESPONSIBLE PARTY authorizes the release of information to such institution or health care provider. In addition, RESIDENT or RESPONSIBLE PARTY authorizes the release of information on the medical. record, to tqird party payors or potential payors, government or regulatory agencies, the state ombudsmaA, and the HOME's liability carrier or HOME's legal counsel. ." 'I _' ' ,--,(1 9. MEDICAL TREATMENT AUTHORIZATION 9.1 Authorization by RESlDlENTor RESPONSIBLE PARTY RESIDENT or RESPONSIBLE PARTY authorizes HOME to provide care and treatment consistent with the terms of this agreement. 10. THIRD PARTY PAYJIIIENTS , 10.1 Authorization toBiU Third Party payors RESIDENT or ~ESPONSIBLE PARTY authorizes HOME to bill any third party payor directly for service rendered ,which may be covered' by any insurance or , government. assistance program,. including Medicare, Medicaid, and private insurers.' .. 10 1---,", ,",,, _ _?, -, ,~ - ~, c , =-~I"""""'~ f'~"" "'J~I:-~; ,;c'[:t': "-----".' .'~' ;"-" .~, ' ,-<"--~, 10.2 Assignment of Medicare Payments RESIDENT or RESPONSIBLE PARTY requests ,that payment of authorized Medicare benefits be made on RESIDENT's behalf to. HOME for any services furnished RESIDENT by HOME.', RESIDENT ',' or'/RESPONSIBLE PARTY authorizes any holder of medical informati~nabbut RESIDENT to release to the Health Care Financing Administration anClits agents any information needed to determine these benefIts or the benefits payable for related services. 11. MISCELLANEOUS PROVISIONS :~ " {; , 11.1 Governing Law '. .". ': pi ;1. This Agreement shall be governed by'and'construed ii-i;accordance with'the laws of the Commonwealth of Pennsylvania. '!. 11.2 Severability : , '" If any of the prOVIsions in this Agreement are declared to be invalid, such provisions shall be severed from the Agreemenfand the other provisions hereof shall remain in full force and effect. 11.3 Headings" .:i, ' Section headings- contained in this Agreement are for reference purposes orlly and do not constitute part of this agreement: .;, :",,' "," <,' 'w. 11.4 Entire Agreement . , :, " This Agreement together with HOME's 'Application for Admission,Schedule of Charges, Resident Handbook, Resident Rights, policies on Advance Directives and Financial Assistance constitute the entire understanding betWeen the parties with respect to the matter contained' herein;'superseding 'all prior and contemporaneous agreements and 'understandings; express or implied, oral or written. No addition or modification to this agreement may be made by RESIDENT or RESPONSIBLE PARTY without the consent of HOME, and such' addition or modification shall be in writing signed:j)YRESJ'DENT orRESPONSIBLE PARTY and a corporate officer of United Church of Christ Hom~s; Inc:. ' 11.5 Modifications " , " HOME may modify or amend this Agreement unilaterally to assure compliance with subsequent changes in governing law or regulation. ' Notice of any such changes will be provided to RESIDENT or R,ESPONSIBLE PARTY. 11, >r"~ < ~ ~"''''" _ _"" "" - " ",~." ,,- ~~"" ~ r"" - ~ ".,,~ ~'10.-':'::--T ".--''-,~'''': - ^<<-~' "~"-::_-''n ,-.-. , 11.6 Notices . All notices required or permitted, ,under thi,s Agreement shall be in writing and shall be deemed to have,been given;'ma,deand received when personally delivered or sent by regular U,S; Mail acldressed,tothe party(ies) as set forth above. Any party may change the'address to "Ytlic~,potices are,to be sent by giving notice of such change in the manner d~sc,ribl?d ,?b.9ve.'," ", ;" 12. ACKNOWLEDGEMENTS 12.1 Schedule of Charges RESIDENT and RESPONSIBLE, PARTY, if any, acknowledge receipt and understanding of HOME's Schedule of charges. 12.2 Resident Handbook RESIDENT and RESPONSIBLE PARTY, if any, acknowledge receipt and understanding of HOME's handbook on HOME's rules (Resident Handbook) and agrees to abide by HOME'sJules. 12.3 Resident Rights RESIDENT and RESPONSIBLE PARTY, if any, acknowledge receipt and " understan~ing of Resident Rights. 12.4 Advance Directives RESIDENT and RESPONSIBLE PARTY, if any, acknowledge receipt and understanding of HOME's policy on Advance Directives., 12.5 '. ,Financial Assistance. " " n' RESIDENT ,and RESPONSIBLE PARTY, ',if any, , understanping of HOMr::'s Fin~ncial Assistance policy. acknowledge receipt and ;'( " 12.6 Agreement, RESIDENT ',and RESPONSIBLE, PARTY, if any, by virtue of slgmng this Agreement, declare that this Ag~~ement has been fully explained and understood. ;,j;-' 'j,: I'. 12 '~Ir'f_, ',- "'1" ~." ",'~' 'r ' ~ "....-.. ~ ~ I ...,.,., " " II, ~~_~~r~' 0':,:'~$-nT'Q"~" . ,. IN WITNESS WHEREOF, the parties, intending to be legally bound, have signed this agreement on the date written below. WOW'I\ v{1i ~A~o-j~ HOME Represe ta ve & Title RESIDENT Witness Witness Q 'o.q ,Q,; Date Date ~~~ R SPONSIB~PPl TV ~ U)'JL;; Relatio hip to Resident Witness 1 /8--r / '1 r I . liSate ;:"k( ~'l _ ". " -- , """""', r ~" .~ ,- -""""" &5 ;JII ill\'! r","""""'_, ,~,~,. '-,' ,_~, ~,~jjf,--wl\I~'M!~I!lI~__~!W~~,I5_W,>,~',",fu'g~;"8"-;'".i'T-' ~--""-<O'ie.~' o ~;; [n!~~ ~- ",~, ~i~~: ~:; c::: "" ~E~ ~'c' z :;;! <"b"""",,~~. '" ~--:-:-:\ . -' <::.1 a.., " ::CJ- -, ':-.'11 :.:f-:: c:o ;;'.;;:,n , , ::2 iJ -< t:'" <:;) ,"" ",1H!:",,;~.;;"'""'%'~F'\-~-0P!tW?l;:iW)'"~l<'!!!':(-<~%l1!""-'f':''ii~~i'''''l!'H ,i.l"~~~lr" i:,;"''''''a'~''''w'~tt ..- - ~ ~ ,-,-~, ; ,M IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVA~ Lydia B. Durf, Administratric ofthe Estate of Paul R. Durf and Lydia B, Durf, Individually and as the spouse of Paul R. Durf, Plaintiff v, United Church of Christ Homes, Inc, tJa Sarah A. Todd Memorial Home, Defendants ) ) ) ) ) ) ) ) ) ) ) CIVIL DIVISION NO.Ol-58l0-Civil WITHDRAWAL OF APPEARANCE TO THE PROTHONOTARY: Kindly withdraw my appearance in the above-entitled matter on behalf of the Defendant, United Chnrch of Christ Homes, Inc, tJa Sarah A, Todd Memorial Home, Dated: June 26, 2002 if- _ > h" O".'='_ q"''''',~= ___~,_",__"_" ~'_",",,"'" _ "",,",".,__,~'",I "'~'_' U~>,~ ,_ ,._ _ _ ~ ,~, ~__'" =,< '...'_. ,., _ (/rJf- ~' Edward J. Cermanski, Esquire Attorney ID# 56278 - ", ~ 'TJ~ ' . ~ iL--' . , ,.. LYDIA B. DURF, Administratrix of the Estate of PAUL R DURF and LYDIA B, DURF, individually and as the spouse of Paul R Durf, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY Plaintiff CIVIL ACTION - LAW v. UNITED CHURCH OF CHRIST HOME t/a NO.: 2001-05810 SARAH A. TODD MEMORIAL HOME, Defendant JURY TRIAL DEMANDED ENTRY OF APPEARANCE ,',I , TO THE PROTHONOTARY: Please enter my appearance on behalf of Defendant, United Church of Christ "~-I Home t/a Sarah A. Todd Memorial Home, in the above-captioned action. McKissock & Hoffman, P.C. BY~~ Edwin A.D. Sch squire Attorney I.D, #: 75902 2040 Unglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 Date: June 27, 2002 \:,- ",~, '''i'",_~,""",,! '-'-"~','''_''''--_''''''_ "_,,,"":<~"~::e_.,.,-,O"- ";'-"",-': I'"f'\~" _- ~ ..,,, '-'. .,' :",-j'", ,_ "_"c;..' ., I ,'" <~ ,~' " & .' , ,~:__ r,"'_:~'__ ""~.'"'''''''''' __ "~',, . "--""~ ,. :'" ' "' .~--- ..... .' CERTIFICATE OF SERVICE i) " I hereby certify that I am this day serving a copy of the foregoing Entry of " i: Appearance and Withdrawal of Appearance upon the person(s) and in the manner ii' f:'i I t indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, first-class ~" i,~: i:; ~.. postage prepaid, addressed as follows: I , b'l ~' : Anthony Adams, Esquire 128 West King Street Shippensburg, PA 17257 (Counsel for Plaintiff) i I ~-, - [,C, r; " ;j !,'-j i' ,:} McKissock & Hoffman, P.C. I I /~ By:~J Edwin A.D. Schw ,squire Supreme Court I.D. #75902 2040 Linglestown Road Suite 302 Harrisburg, PA 17110 I" I I ", !'-, ! ': I' I Date:~", '?? <::.CO? (717) 540-3400 Attorneys for Defendant, United Church of Christ home Va Sarah A. Todd Memorial Home i;- ,_ .;_,_"",~_"~,,,,;w,,,~.~ >",~___' '''',~,,,, _ . "'o.,"",-:-I_'__,'_',^"YC'_"<""c_o_':T":_':',--_"::- - -_'_'_'_ , I " '> ~ ,"-', :v",n_'^'''~,'''\~_''_"",-",'_"" , ,,",,,",, ,_ 'C" ~ ,-"t. ' -,:-~" ~~- ':?:~'I-" '_''''-' . ,'->~\'" "';,V-'''',,-,!,_ ~':'l;__} J;"-~'.~ti;"\~^'~.,, ,,","~w'fJ.";;~""--"__- - - o'-'>r" ; '.. > ''''-,'' ',H,. _~ "_~"",,,'" F~"~__"" . .~-"- ,;''''';r.;'I[fllt''rri:~~':t1';'_-W-<$'K '[ "r'l~- --"~'rx:Hlff'frT JT'l~1j't,'Cf:r't"~~~'f~~*gi,;;.;t\'-;;:1~:1 ..', " <:) C) 0 C p.,) "1l S-~ c_ .--1 >:J tn ~.;~ ~r: :IJ QJ r -"-- Jl " "t,_ ;'-:-(1 f'~, en " C: '---I ,~ SJ " OJ I CJ r:: '."'1 -,- , , ,-';; I , -' f'ri :..~ I, " e,l 7, .:.~-=-- ,- .' '-' .' "- '1 :_-'1 :.q , 0 -, i: ", , " ~,> i; If~. I: fig 511 i'~ ' !'f ",,"' _",~" "Jl~~~~f~'~~'~~"i'_" ,!~~:~!r~_~.!M'Wt~iiJW~'j{~~~, -L_~~~~ , J .; "~ ~ t~ LYDIA B. DURF, Administratrix of the Estate of PAUL R DURF and LYDIA B. , DURF, individually and as the spouse of Paul R Durf, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY :~ Plaintiff CIVIL ACTION - LAW :~ v. 21: ,;; ,;: ',":1 UNITED CHURCH OF CHRIST HOME t/a NO.: 2001-05810 SARAH A. TODD MEMORIAL HOME, Defendant JURY TRIAL DEMANDED ;('j .< NOTICE TO PLEAD To: Lydia Durf c/o Anthony Adams, Esquire 128 West King Street Shippensburg, PA 17257 You are hereby notified to file a written response to the enclosed Answer and New Matter to Plaintiff's Complaint together with New Matter Counterclaim pursuant to Pa,RC.P. 2256 within twenty (20) days from service hereof or a default judgment may be entered against you. McKISSOCK & HOFFMAN, P.C. Date: ,,?~9 /0 -z BY:~ Edwin A.D. Schwa I.D. #: 75902 2040 Unglestown Road Suite 302 Harrisburg, PA 17110 (717)540-3400 Attorneys for Defendant, United Church of Christ Homes, Inc., t/a Sarah Todd Memorial Home '\'5f,-",_, ^~',^~~,-,~'c'__,'"__~;;I,,,.-"';'t~'~"_'"'_~'>T_''''7_''',_,,,,,,,,~_,"''''_I'''_,'_ ,',.___~'_" ,_'~'''_'''' ':;"'_:"" o"__,_,~'.-,-!'"r', r,-,'- ,V,,7.._.--,,---"'__',,"~_~",. ,',-,,-' ,'__'" ,". ^,,__ "',~", "','~,'".-_",~4"^''',,,,__,, ",~ .-1' - nr , .,. /0 LYDIA B. DURF, Administratrix of the Estate of PAUL R. DURF and LYDIA B. DURF, individually and as the spouse of Paul R. Durf, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY Plaintiff CIVIL ACTION - LAW ,,, f: v. i It f,i ~ , f"; f'<: UNITED CHURCH OF CHRIST HOME Va NO.: 2001-05810 SARAH A. TODD MEMORIAL HOME, Defendant JURY TRIAL DEMANDED c R! *:~ ~~! n E;; ANSWER AN,D NEW MATTER TO PLAINTIFF'S COMPLAINT TOGETHER WITH NEW MATTER COUNTERCLAIM PURSUANT TO PA.R.C.P. 2256 (: ['" ~" c' i I ('-- AND NOW COMES Defendant, United Church of Christ Homes, Inc., Va Sarah Todd Memorial Home, by and through its counsel, McKissock & Hoffman, and t:' respectfully files the foregoing Answer and New Matter to Plaintiff's Complaint together ls~-i with New Matter Counterclaim pursuant to Pa.R.C.P. 2256 and as such, provides as follows: 1. Defendant is without sufficient information to admit or deny the averments contained in paragraph 1 of Plaintiff's Complaint and as such, the averments contained in paragraph 1 of Plaintiff's Complaint are specifically denied and strict proof thereof is demanded at the time of trial. 2. Defendant is without sufficient information to admit or deny the averments contained in paragraph 2 of Plaintiff's Complaint and as such, the averments contained in paragraph 2 of Plaintiff's Complaint are specifically denied and strict proof thereof is demanded at the time of trial. :.~;. C",<"r ,~~_~ " , "_ r, '_' ",e".'~' " _~'"' '_'=_',,,. - y,_' $'-_. c ",^,."." _"~_,"_I~_",<_."",", <, >"0, .-'_', "_",_,<~""",,,,,,,_, "''',,'~ "" ," '" .'Y.__.. _ .._~Oc",',""^_"_,~ __ '___", _ " ~ <" .~ 'T:r.. -1' ,1("'-'._.';(";1'; J '.~- -- -m! "( .,. Jo i;:i , 0-' " >1' ~'i ",j ;~ j '};,~, ,~ -~ 3. Admitted. 4. To the extent the averments contained in paragraph 4 of Plaintiff's Complaint are consistent with the records and/or charts maintained in the regular course of business by Defendant, the averments contained in paragraph 4 are admitted. To the extent that such averments are inconsistent with the records and/or charts maintained in the regular course of business of Defendant, then such averments are specifically denied and strict proof thereof is demanded at the time of trial. 5. To the extent the averments contained in paragraph 5 of Plaintiff's Complaint are consistent with the records and/or charts maintained in the regular course of business by Defendant, the averments contained in paragraph 5 are admitted. To the extent that such averments are inconsistent with the records and/or charts maintained in the regular course of business of Defendant, then such averments are specifically denied and strict proof thereof is demanded at the time of trial. 6. Inasmuch as the averments contained in paragraph 6 of Plaintiff's Complaint refer to writing, such writing speaks for itself. d _, __ __'_~h~'=""'" =__ ,~'"_" ~ ~ _ " "',- 'j"",,..Y__-=,_ ~",~,", -,', ,I' ,-,"'~-",,>, ,-- -,--"' ,~. -^ ,,-~~_'""-_""-&','~" ",__-- ,,~,"-___ '~" C', "" ~""'C"'. " _""''' ','''''1',,'''>-, -'~' '- -" -'.' . --J l1n 1 . -~qh~ --~ ,:" <!: -",-::; - ~, ~ . ) 7, Inasmuch as paragraph 7 of Plaintiff's Complaint refers to specified amounts alleged to be set forth in Exhibit "AU to Plaintiff's Complaint and Exhibit "AU to Plaintiff's Complaint fails to include the schedule of charges as identified in paragraph 2.2 of Exhibit "A", Defendant is without sufficient information to admit or deny the averments contained in paragraph 7 of Plaintiff's Complaint. To the extent that the averments contained in paragraph 7 of Plaintiff's Complaint are consistent with records and/or charts maintained in the regular course of business of Defendant, such averments are admitted. To the extent that such averments contained in paragraph 7 of Plaintiff's Complaint are inconsistent with the records and/or charts maintained in the regular course of business of Defendant, such averments are specifically denied and strict proof thereof is demanded at the time of trial. 8. To the extent the averments contained in paragraph 8 of Plaintiff's Complaint are consistent with the records and/or charts maintained in the regular course of business by Defendant, the averments contained in paragraph 8 are admitted. To the extent that such averments are inconsistent with the records and/or charts maintained in the regular course of business of Defendant, then such averments are specifically denied and strict proof thereof is demanded at the time of trial. - ~" '.~,~.- "~. _" ~o,.,,_,,_,~ _>_,,~" __ _ ,",__0 ,,_~. ,," _'_ '!-"".' "_'_~'__'" ,," _,,"'~"' "''I''''''''+--<~ , ". __ ,^_ , ,_,_ 00.. ~_ ", ":~;i$!ir;. , J, '--'T '1::', ~^^ ~ , ) 9. To the extent the averments contained in paragraph 9 of Plaintiff's Complaint are consistent with the records and/or charts maintained in the regular course of business by Defendant, the averments contained in paragraph 9 are admitted. To the extent that such averments are inconsistent with the records and/or charts maintained in the regular course of business of Defendant, then such averments are specifically denied and strict proof thereof is demanded at the time of trial. 10. To the extent the averments contained in paragraph 10 of Plaintiffs Complaint are consistent with the records and/or charts maintained in the regular course of business by Defendant, the averments contained in paragraph 10 are admitted. To the extent that such averments are inconsistent with the records and/or charts maintained in the regular course of business of Defendant, then such averments are speCifically denied and strict proof thereof is demanded at the time of trial. 11. The averments contained in paragraph 11 of Plaintiffs Complaint are specifically denied and strict proof thereof is demanded at the time of trial. 12. Defendant is without sufficient information to admit of deny the averments contained in paragraph 12 of Plaintiff's Complaint and as such, the averments contained in paragraph 12 of Plaintiff's Complaint are -~'-'~'~-~~ ,_,<",~~ "",' ~'_'~_',,'n"', .~.-r_~,~, ,_"_,,~,,~,,.~,'o __~ ',-, ,',,',,"",,', -,",V ____,__ ,,0,_".-,", '? '"".' ,_,___,. ,I . =,~ ,,' 'l,F""-=. ---Yi"'--'" ~"-~--- , , specifically denied and strict proof thereof is demanded at the time of trial. By way of further response, Plaintiff's Complaint fails to specifically identify who "Dr. Long" is and in what capacity is alleged to have served relative to the averments contained in paragraph 12 of Plaintiff's Complaint. 13. The averments contained in paragraph 13 of Plaintiff's Complaint are :: specifically denied and strict proof is demanded at the time of trial. By way of further response, it is believed and therefore averred that decedent Paul R. Durf was non-ambulatory prior to his admission to the Defendant's facility. 14, The averments contained in paragraph 14 of Plaintiff's Complaint represent a conclusion of law to which no response is required. If it is later judicially determined that a response is so required, the averments contained in paragraph 14 of Plaintiff's Complaint are specifically denied and strict proof thereof is demanded at the time of trial. By way of further response, at all time relevant hereto, Defendant maintained a healthy and safe environment for decedent Paul R. Durf and any injuries alleged to have been sustained by Paul R. Durf are not a result of any actions and/or omissions of Defendant. :' ':<1i!:fiR)j!L__ "r=' ~_~~~_"" '''","-"r'"",_~ ",__,~,~_,__~_~,~_'I,~__~.,'~ __~~_",,","~ "..' _'_',,__" --.'T"" "'_~. ,- _., ~"''''T-",-,'S,___", _..7<,~,>"'"_' ',,.,,'~"~"'~,_,, , """, '" ""-"- ,.,"-~, - " ' ~~, ~ _ W_ -1,1"::-, - -. . > 15. The averments contained in paragraph 15 of Plaintiffs Complaint represent a conclusion of law to which no response is necessary. If it is later judicially determined that a response is so required, the averments contained in paragraph 15 of Plaintiff's Complaint are specifically denied and strict proof thereof is demanded at the time of trial. By way of further response, the averments contained in paragraph of Plaintiff's Complaint do not provide sufficient information as to who is alleged to have received any such payment and/or any information regarding the obligations of Plaintiff and/or the Estate of Paul R. Durf in submitting such payments. WHEREFORE, Defendant respectfully requests that this Honorable Court enter judgment in its favor and dismiss Plaintiffs Complaint with prejUdice and further award Defendant all such further relief as is proper and just. COUNT II 16. The responses contained in paragraphs 1 through 15, inclusive, are specifically incorporated herein by reference as if more fully set forth at length. 17, The averments contained in paragraph 17 of Plaintiff's Complaint represent conclusions of law to which no response is required, If it is later judicially determined that a response is so required, the averments ;--7T- ,.,,- --' ,-< ,""'" ~, "- ,--~ ___ ~'_'~, ,-_"__.~," __, , _' '''''', '1_"'_0-' _V"_,"'. ~"' . ~__, '1",.,",,' _" " _, _"" " "" ,"~, ""___ __ ~__,..' __'_;\'_'?"I," '_-_',"""",- ~ L__' , , contained in paragraph 17 of Plaintiff's Complaint are specifically denied and strict proof thereof is demanded at the time of trial. 18. The averments contained in paragraph 18 of Plaintiffs Complaint represent conclusions of law to which no response is required. If it is later judicially determined that a response is so required, the averments contained in paragraph 18 of Plaintiffs Complaint are specifically denied and strict proof thereof is demanded at the time of trial. 19, The averments contained in paragraph 19 of Plaintiff's Complaint ! ",I ;',i ,,-..,) represent conclusions of law to which no response is required. If it is later judicially determined that a response is so required, the averments contained in paragraph 19 of Plaintiff's Complaint are specifically denied and strict proof thereof is demanded at the time of trial. 20. The averments contained in paragraph 20 of Plaintiff's Complaint represent conclusions of law to which no response is required. If it is later judicially determined that a response is so required, the averments contained in paragraph 20 of Plaintiffs Complaint are specifically denied and strict proof thereof is demanded at the time of trial. (>,i;;~jlj. ^ _' ,~_",,"", ~c __ _ =.,_ ~_ _. ~~_ ___ ~,~,,__,~..I_...,..< <'VL,~, '" ' ',___~_"_o'_' _' ~,"__~ , 0- 'I' ~ "",~"''''' ,,-", ,,_' _ '. , '. "~~' . __ "~, _ _ - " _q'~__'-' '-, ~'" "71, ',,"--- , .." ' ,,,-,," n _ ~Jj - r:' ~'l' 'Cr~ ,- , , WHEREFORE, Defendant respectfully requests that this Honorable Court enter [I i ','! 0: judgment in its favor and dismiss Plaintiff's Complaint with prejudice and further award Defendant all such further relief as is proper and just. ~;! ~1 r: ," l'; NEW MATTER ~~ 21. Plaintiff's claims may be barred and/or limited because of the conduct of .,> iz, Plaintiff's decedent, under the doctrines of comparative negligent and/or f':: ~:: assumption of risk, to the extent that subsequent discovery may implicate. ',; "j 22. Plaintiffs claims may be barred and/or limited by virtue of any consent, release or agreement signed by Plaintiff under the doctrines of release and consent, to the extent that subsequent discovery may implicate, 23. Plaintiff's Complaint fails to set a cause of action for which relief may be granted. 24, Plaintiff's claims may be barred and/or limited because the injuries alleged to have been sustained by Plaintiff's decedent are the result of some person, party or entity to which Defendant exercised no legal right to control. ,~, ,~~,~ .. ,_~.~. ..~~, ,."~__",_ __,~ ~_~,'>o~__, _.'_.," .-",~__~ ... ,~ ,-,,~ - ..- ~~. '''IT , , 25, Nothing done or omitted by Defendant was the proximate cause of any injuries or damages alleged to have been sustained by Plaintiff and/or Ii :i " " " If ~ Plaintiff's decedent. " ;" ~) 'I ',I :~ ~ ji; 26. Plaintiff's decedent's failure to exercise due care was the proximate cause ;'; :Ii" tJ Ii of any and all injuries alleged to have been sustained by Plaintiff and/or ~' 1,: ~! ,'~' D Plaintiff's decedent. fi:: ",c' 27. To the extent that future discovery may implicate, Plaintiff's and/or " , '0, Plaintiff's decedent's injuries and/or losses, if any, were caused in whole ;,;,! \<-1 ,'~', or in part by persons not a party to the within action. ~ : '-:,; v; :(: ;U 28. To the extent that future discovery may implicate, Plaintiff and/or Plaintiff's decedent's injuries and/or losses, if any, were sustained as a result of natural and unknown causes and not related to any actions or omissions of Defendant. 29. At all relevant times hereto, Defendant rendered care and/or services in an appropriate manner, within the standard of care applicable thereto and in compliance with all statutes, rules, regulations, protocols and/or procedures applicable thereto. ,,~,"~'~,~IILr, ~, ~. .._ ."n,",,'_ _ __- < ,,~, '.' ,>.. '~?~_'" '___r.., " _,~. <', "" ,~ , ..>, - ,___~"._+_.,' "_,'0 .."~,__,~_"' _, _,_ '_"_I _?.' 1.1 T 30. All claims and causes of action plead against Defendant are barred by the .\ Plaintiff's knowing and volunta~ informed consent to the question in care. J;: :\ :.; ,,' ;, ;0' ~! \"; ri] '" <~- 'e;. ""1 /" p--j j", :,,,','1#,; ,~~,lJ , 31. In as much as the Pennsylvania Rules of Civil Procedure, specifically Rule 1032, provides that a party waives all defense if not presented by way of new matter, Defendant, upon advise of counsel, hereby asserts all affirmative defenses set forth in PaRC.P. 1030 with all such affirmative defenses being subject to demonstration during discove~ process and proof thereof, if relevant, at the time of trial. NEW MATTER COUNTERCLAIM PURSUANT TO PA.R.CP. 2256 32. Decedent Paul R. Durf became a resident of the Sarah A. Todd Memorial Home located at 1000 West South Street, Carlisle, Pennsylvania. See Exhibit A to Plaintiffs Complaint. 33, In return for the Sarah A. Todd Memorial Home providing residence to Paul R. Durf, Paul R. Durf (as the resident) and Lydia B. Durf (as the responsible party) agreed, in writing, to pay all charges assessed by the Sarah A. Todd Memorial Home for services and supplies provided to Paul R. Durf. See Exhibit A to Plaintiffs Complaint. ,- ,_ ~~,-. ,e~"~, ''''~''''',I~y" ,_~_ _ ,'"T__'c ~ _<~ _.~'." .__, ,>,",","'''' , _,,:.(. --" '~-----, ',"""-"'='--'-~'-' " "",=... " ~ ~-, --, --- ,,,,,----,(. i1ll'U i1. [" "_ ' i~f1-- < ^~ ;'~ -j);l1'M:IL , . , 34. Notwithstanding the fact that the Sarah A. Todd Memorial Home provided monthly billing statements to Lydia Durf, as the responsible person, for the charges assessed by the Sarah A. Todd Memorial Home for services and supplies provided to Paul R. Durf, Lydia Durf has refused, and continues in her refusal to pay the amounts which remain due and owing to the Sarah A. Todd Memorial Home by Paul R. Durf as the resident and/or Lydia B. Durf as the responsible party. A true and correct copy of the Monthly Statements from October 31, 1999 through June 10, 2002 are attached hereto and made a part hereof collectively as Exhibit "A". 35, The amounts charged by the Sarah A. Todd Memorial Home were reasonable and customary and were accurately reflected in the monthly statements as provided to Lydia Durf. 36. At no time during the residence of Paul Durf at the Sarah A. Todd Memorial Home did Paul DUrf or Lydia Durf complain that the charges were excessive or unreasonable. Furthermore, neither Paul Durf or Lydia Durf ever communicated any complaints to the staff at the Sarah A. Todd Memorial Home with respect to the conditions of Paul Durfs residence or the care and treatment of Paul Durf. ~~'_H~<~="~__~,~,.,.,,~, ,..= ,__~ ,",,,..t<_,,,, ,< .~_ _", _"""",__'_ ,_~,"'<'_ ___.;__"'_""~~'-:'_"_,"-,:,,,,_^,,,___ .,-~ -^, --" '- , ---. -<""-'~ - -- --~, _ U - 'T,:i , 1;-' '~',,>"-'. ~ fi ij t'~ ,-- ~ iJ' t~~ ';;' :l' '",' ,_1~ hi :'-:-i C'-'W[:JJi!f-:;.." C'(l",-- n--' 37. Defendant believes, and therefore avers, that Plaintiff's actions in commencing the instant matter was done as a pre-emptive effort to either avoid Plaintiff's obligation for payment to the Sarah A. Todd Memorial Home or for purposes of using this action as a negotiation tool for a possible offset or reduction in the amounts due and owing to the Sarah A. Todd Memorial Home. 38. The payment obligations of Paul Durf and/or Lydia Durf, as the responsible party, were independent from the obligations of the Sarah A. Todd Memorial Home. 39. Plaintiff's attempts to avoid payment obligations by creating baseless allegations of negligence against the Sarah A. Todd Memorial Home is improper. 40. Defendant Sarah A. Todd Memorial Home believes, and therefore avers that Plaintiff's action in commencing the instant matter was done for an improper purpose and in bad faith, and as such, Defendant reserves its right to pursue any action, including but not limited to an action for wrongful use of civil proceedings, against Plaintiff and counsel for Plaintiff, if and when such claims become ripe. >,-~ ." ,~ _J_~~, ~"_,_,~,,,_~.,," _". -m","~'" "'''''"_ ,,'_''''_',',",--,-- -'-'0'1"'_"_,"" '''__". '_', ',<rc' '" '" ,'_,' - " " ,,- q~T,-,",,""'~"O>: -1-' ';'-,," 'T "1- u',dC'" 1_ . , 41. The Estate of Paul Durf, and/or Lydia Durf, in her capacity as Executrix for 1-_1 the Estate of Paul Durf presently owe the Sarah A. Todd Memorial Home in excess of Twenty Eight Thousand Fifty Six and 73/100 Dollars ($28,056.73), together with interest at a rate of 1.25% per month on all "0 , ~ ,'< f~i ) .tl outstanding amounts. Furthermore, due to the default of the Plaintiff, Plaintiff is also obligated for the payment of all reasonable costs and attorney's fees. See 92,8 of Exhibit A to Plaintiff's Complaint. WHEREFORE, the United Church of Christ, Val the Sarah A. Todd Memorial ,_'0, Home respectfully requests this Honorable Court enter judgment in it favor and against Plaintiff/Counterclaim Defendant, the Estate of Paul Durf and/or Lydia Durf, as the executrix of the Estate of Paul Durf, and further award DefendanVCounterclaim Plaintiff all such further relief as is proper and just, including attorneys fees and costs. Respectfully submitted: Date: ~h,~~7 B~~C Edwin A.D. SchwC' uire I.D. #: 75902 2040 Unglestown Road, Suite 302 Harrisburg, PA 17110 (717)540-3400 Attorneys for Defendant United Church of Christ Homes, Inc., Va Sarah Todd Memorial Home ~ =~-"""'~",;!"'5'W'~-,",i-'-, ~ I ,~~"" , . .e"~',""'__'~_'_ .' EXHIBIT "A" , -., -~-"', ,,"; > '_ ,."-,. ''F ' ?,.,..",~ '_",0_ ~",. ^-:""':'="",:'-="",""'-"'-,,,._""-',~,~,",,:,' B t.::\ t(.:~men t Uni ted Church o'f Chh,st Home?;; Sarah A. Todd Memorial Home 1000 West South Stree~ Cal'l:i,j,l,,), PA 1701:', E)t.~.;\ "t.eme-~n t D.a tE~:: Ob/:tO/:;~OO~:: L yd :U\ Dl..wf' P..Cl.. Box 98 Walnut Bottom, PA 17266 Due Date= 06/25/2002 I'<fi!' P,~ul 1'< DUfuf Account Nr. 101041 .'~.._..~_..~ "M.._ ._.....n.'~.._._..M....._..M_....M._.'n..M_...~. _..~,,_..M.._.'M"~..M"M._. _ ".,.."..,._............M...."...'".......~_..._ ,.....".._~~_,.."__._,,.. .... ..~...."M.._..M.'"...a~~~...m___..._~a.__an.'._....... Dat<;, Dl::'~~~C:I~'i ption Dayr~ GlI..k'\nt f",\t(~ C h~.\ ('"<:J (0~;) F'~":'\ym€~n"t'E; Hi:\ 1 an c:€.; _woo_a'. "..._aM~.._..M'._. _..'_M" ...._"...._..M.' '"_~.............. Mw"~~__..~......_. _._...M.,.. "..wMMM.~' ,...a" ..,. ....~"'_. ........ ........~...... ._. ._."....,. _.__. MMM.._"......".._. _..... .M' .h....."...... ""~.. ~.. .... _..~......-.- BAL.AI'ICE ' FCl!',WAi'<D ~::a ,,-0 ~'\6 " T:, . ~~t1!1 O~jb.. '7::: ~1()Tr:::,: PJ.(f.~~\se 1~'(:~m:;.1: by ~JUr-1E ;;~~)!1 ~~OO;;;~, -th€~ Last amount pr:inte-~c1 on thf:.~ to;t,,\tfi!flwmt. Plfi!a'''fi! include Account l'Ii"" f'rom ,.tat.em€mt on 1>1EI'10 L.II~E cd Yc)UI~. c:l'lf:~c:k." Any paynH.:~nts 1'"€-)c(~:i.vf..~c1 aft(.?r 05/3:1./02 <.;\I"'(o."'?: not r.(.?fl(,:~c:t(.:.H:1 ()n ~~~ .t..<':l. 'l:.(?fIH.:-~n t;: P l(?<':\~::~f..~ df.~dtu::'l:. -i':\ny ~':l.dd i. t:i.(.')nal p.e:\YfIH'?1l t~::. Y()l...~ l'ni:\Y l',~:\"~.J(.? fIH:\(j f!..) ancl remit the balance remainingn Thank You.. "'-"''''''''l'''''''''''_Ifl!iI!'"_ ,,-< C-'k_'~I' " ~ ~, <-1- .t -i:" '" .. "",' '.', ,"<t:-j6'::I;:"f:'~:~d, 'ti~.l:(i;; ~~,h' 'tf'f ~: (~"h':,' 3. '~;:t. Hnl"H2'"" "'~:~~:~"i";~7( h f:~'",', :fddd' i~t;}i\l'll~;:i:i':'~ :l:j.:L. ht';:~i~~'~ ;;, ()6()'," ~1J.(o;~~rr. t- '~:::Cl\.'~:t h,:', S:; +. ii'~,:,{~:,~ t. ;i::~'l-:n,;,.l ,:'I. ~:;,:J.; Ii?' :.', F';::'~ :k70"L::;; St.;:~t":Hnf:,'Jt"i't n~,:\.t):;:.,:':: l~'~/lO/~'~,()O:t. i~;: ~~~ ~: '~'~I~ ;~,r,,!~':; ~;~:' ~l.,i~\ :i. h'u.:t. Bc}+~~om:\ PA :t ::J?'6<[~ !)....ll}:.~ -.:PEs: J;~::~:: :I.~:~:/~~(Nk.../20,O'1 /., ;,',,:. F;~E-~:: r'6l.ul Acc:r,:,ci:!"1,.t F~ '.oUY"f ;"'i!~':: ,:!~O tOr.l:l. ., . " ,," ". ' , """ ' , .' , , ' '. ' ,.' . ' .- on:.... '.,N..'- ".."....., "''''Hf'''~-''''''';.'.'_ .,.' "'"'........".;.....~:'"''''.'I...:-.''.',.:,,'!...,,..,',\,,~.,..,~..':"';;-;;':,,:\,.i~"N' h..".,..., _" ,...-_.... ......."......, '_' :;N ._. _, .... ._.',..;'n;'7,~ ,1.:::'.:.:;,.,........'",::. ":-"7~':'..","~~,'.'.,., ,:;."-'::"':.": .:;-.,..{:."..,. h. -;.: ."..,..:, "...;.-.:.."., "t'. - . ,'l?~Ot '\~~: X)~,~~i(~l~~.i. ,\:J.li'(;)!")" l~.::\ /~:; r:;':<!t"t(.:,'f Ch'aFg'(~~~:; - F' ~':\'i('~fl;:S;~'.t 'm nt,:I. <';~.ri t:~.::: ,..,'.;".."._,.,.._u,~, :..:_"_..,......',...~,;..", ,.::.: .~;, '.';, .:;.~' ;~<:..~ ~.i:~".:~,;'"i~::;:.::~~ ~:.'.;:'-"~:':'-"''-': ;;~.:~i ::;.,_ n.. ..;. ,... ._. .... ,," _~. "" .~.._ Gk,~':"~n t. u_ '-:..... ,... .;.. ',',.~ ,~. ..=- ,... ..., ~'.",," .'.- ;<~.,.;,,.'"0;,:.;'.,;:.., ;~" (".,.;;:.,,::,:; N:. .." '... ....,- ... ._._.._.''''._.'"'u_....,._..., . .., ," " , , ,. , , "):<<i::n...01)Q.f.:: ",' , ,", '. \::.qr-;~W[~_i:~ t~ ~'~B!I'O~~!).. :l:5 ~,:}B !! 0 ~::l (:l- .. ? ,~':3 ',' , , . "i...t(:th:~{ , ' ':: ,"'" ",' "', ': ',', ',: :;';~: ::~;~ =;;~ ,,,,,:,';' ~~\:: t;:, 7~:i,' ~,'~C:~:~' ;:.j~~~(lf"~(:~ggi~;; . '~i::h'~:::, ':',:,,!:.\~;;. {~:.t:::' 'f.\i11d~.i.ll t F':ll":i. n t,'~:~,~,! ~:Jr,) t;h~:.~ ',~ .,!-.h;'.::," 'fi'.'CH1} ',::~.~,2:X'~,I:.;{,fri(,::;ht ,on ';~E:?;C L,.J:!".,q:~ '().f :':/p t 1. 1'- 'C nt.::,: 'c: r l~ n '~/' 'I;:; ~!:C-:5>ii'l r::~f:~ <l':y;, f'.~:r,i~~I?-i !~: v-~~:{~' 'f';,i.:~-::!ii~.' ',' :i. ~;i:./ (),i:l/' ~:: O(j':L ~:\ t:'0;' n ~:~'t ,c. (,:;~.'r: 1 ii.~ G: .t r:~:.:d ~~: ~~ ~:! ~:~ ~: ::~ ~;:; '~\ ::~;: I:':~ ~~ ~~:: l~~ ' ,~:: ;~~ '~{'.:~~;~:;~ ~~.~ d i~;:'~':.~i::~~ ~~ J';i:~~ :;~,~ ,/1. d: ~.~r, ;\-::~~;.j,;, ~:;.~~t, ,~; '~~.)~. ~ ~~ '\:)' j P'l E'.n 'i: ~~, ,.~), 6 lJ. l'n .:;).' y 1"1 {i~ '.~ 1:/1 ,'r~ .:i~'d (,~, , ;-;,' ~ ~::; t,':'t 'L ~~:rnf..:n "to Ur';:I..t,"!.,:'~:i ChU,i"ch ().f Chlr:L'::;'~:. Hnm.-:;~~;~, ~3~r'ah A., 'i'odd l~eln()i~:La]. Heme 1000 Wes;t South Stlreet C:~jr].isle, ;='A :L70j.3 S.ta'ternen.t Da.te: J.:)./09/2001 L. ">,'cl :L .;:.. Du ("i:; p .. 0" E'iO x <?B !).j~':"lnut l-:H:~ttt:HI"l,1 F;'r:'l 1)'";'~(::.6 DUf?l: D.;;tt~;:]: 1:!./-:.?(:':./20():!. F~:,:';j P~:.l.U.J. F~ DUI,"'f" 1!:H::CDun t HI":: :LO:l.O.-:'}:L _.,--~. , .,.. ,_. _......... ,_..." ,..,.._, ".. ""_."_" .........m.... "'",_...... ._, _. __ ._. _n.... on' ....u..u.. ,,_ ,.., ,_, .._',,_,,_'no 'm._..... ..., ,on "".... h_ __ ,'.............. 'm.m.." D~:\ t~::,:. 1);a:~~C:\~'J, pt,ion D a ..../~; Guant F~,':\ "t(':.: Ch6'( !'.(JE:~';:; F'~:'~>-'mt'::'!n t:::, B-i:\], ,':\n C(~,~ ,... .'..'."..... ,.,~,..-, ,..--.--.-.-..--0.__" _....:. _._ ,... ,_. ........ _.. ,.,. ,... ,...-.'-. .'.' .... on....", ..,...~,' '""''''__~'_V;''~~'.",v'm ".. ......" '.0. ..,~u.-, ,,,' ,_. Bf:~JLt-li""~CE~ F'DF<~;j(.:IF?D ~':~ ~:~ ;1 0 ~5 6 " '7 ~::; ~:: ~:3 " () ~:;1 .::'~ " .? :'S \\!O"{'t:::ll ::;' 1 (':':'<:'t~:;if' !'.'(::;(r'd. -1:, by' ;'~lc),v'~:':'ITI t:H:-:: I~' :';':,6~. ::;::00:;',: t h\~'~ 1...,',,- ~;;, t ,":uJ'!ou.n t p v.:i. n 't.0:'c! on t. h,:.:,.' 1s.tatemei.}'t., F'].ease :LncJ.ude ACCOUI1.t ~Ir'n 1:y'orn ~;tateineI1.t an j~!~lvl(:) \_:[1~1~ Q't YCEtl.l~ c: h~;: c: 1<." (.':--In >'.. p.;:tymo:.;:..i"t t 1:~ j"f:'::' C'-i::':i. 'v,!:..,:.ci .:',~'f tf:'l'" :L 0./',] t /~':~OO:l. i.1.v't'::':' n n t 1"'-,;-/:'1; 1 G::' C t~:!,:i Dn 1;:, t.;":),'I:.(~,tnc'~nt, p:;.i;:.:'i!l,-:-:~(.:~, dE'du,c:t .,,:(l"l/ .;':\ciCl:ttiCj!"t,',l:L p~.:\;.dn,;'::;nt.':;~ '>'()U :'i'I,;':t,.."/ h.::.,'v'f:'2' m-:::'tde.' anc: rern:i.t tt12 t)a:LAflo::e remaining. l'I'\aflk YOlln ~'Sfi'~:'i/t~:;;'j" '~l -': ~r"r ~, "~,, ' ::::;t.;':i,tt,::'m(.;~n t. Un:i.ted Chllrch 01: Chrj.s;t 01c)fnes ~~,;i~j".~'i~h (.:~" 'fc)dd j'lJ0:fnoj''':i,.;?tl HOiTlif::' 1000 Wes.t Sou.tl1 S'treet Carlisle, PA 1.7013 Statement Date: 1(>/09/2001 L.':~/d :1.,:':\ DUi,"'f P"CJ" 3'-::10X 9B i)J-:,:'~ 1 nu t H{) t t(;)(B~! pp, :t ;'~':~6~) Dlle Da.te: 10/25/2001 F~:(,:~ :; P ~':\ U :I. !:~ Du I" '):: f.'ic:c:oun t Hf':: :l.OlO,q:1. nU n" '... ,..' '.....".... u.. _...... _..,._.., .."..., ..,...,...-. '..' ,,_ m. ,... _. .m.,_.._._."__' .,...._.._ __ .'n .... ,....,..m. _..,.... . ...._.. m, ,..,........__~, ,..'..__...m._....._.__ ___,....__.., ._ _"" __m......... m' '.-, D.::-~tE' nl;:,~'::; C!" i P t:i. on ll61,/,,,, Ch.k~n -1.', l:(~':\ tE' C::h.:.:\I"I:.:Jt.~,:::. I:> Et yrn€'~n t s B(;t 1.:,:\1": C(::'~ E~{:'iL.(;ii'~lCE FDi:;~!;J(:'iE~)) ::;;'~ ~:~ :1 0 ~:,:1 (;') " ./ :::; :?B:, ():.:,),(;;, ,,'?:::;; HUT!:::;: P:Lease remit by Oc:tober 25, 200]., the l.a~;t arnOuflt pr'ifltecl Ofl .the .:::.t.,:,:"t,i"!..~mt"!..:'nt." F'l(,::;,:':\-:.;;(,:,~ :i.nc::t.udl::'~ t'Jcc:ou,n'!:. 1'.11"'" .rt"'om .;;:.t~.:\tl:':'~fni::'~nt o'n j"lEI\.iCJ L.It".IE o'f ~:/c:r U t,., c: h f:' C k. " (.':j n ';./ p,::'~ }"'m{.:'~ n t ~::. 1" (::.:' c: f::'~ :i. vl,:::'d ,::1, .f t 1:'::' 1'" 09/ :,:; 0 /~;:: 0 0 :!. .i:i, f. f:'::' n 0 'i,", I" (.:.;'f 1 F! C t l~:':' c! (,',,",'..', ',','., +,.,',:;, "1,',1,',',"""""::"',", 'I,,', ',', ',',' ',i,. ',::''''','',',',','",','', ',,',', ,',',",',',,", I,', ,",', "", :;',''',','". ':.,' ',',",' "'".1, ]', 'l"',',',, ,',',',",", ,",'; ',',', .," ..,..,,' . , ." " . ~, " ""'," , ~ ,-" . ."., ,i:;b.':,/i:"l{';::;'~"::; >,:::",.1 In.;':.,')- ;.,:;;.......'1::... lii.;.;~..J(,:'.' ~rl(:i V'2n\J,.t t~)e ba:lance l~emalnj,l'g" Th.::'1.n k. You" "~""""li'.;",W-' _ ~~, ~ , ' - - ~ ,..""",,' 1'-, :T''''- -~", ~(\f;ii'it'J~~'..o,_ -~"lft)' 1"'" ""~" '-"U ~'. B 'U:'l te:.'ilH~-!n t Uni'ted Churctl o.t: Cl1V'is't Homes Sa~al, A" Todd l~efnorial ~iome 1000 West SOL{th S.tv'set Caj)'lisle, PA j,7013 Statement Da.te: 09/].4/2001 Lye! ;i,,:l. DUI"'f= P"C!" Box 9B WaJ,I1ut Bottom, PA' 17266 Dlle Date: 09/26/2001 i~(0:: Paul F< DUI~.'f; p,ccoun t HI"" 1,0:1.04:1. ---,_._._._.----_._.~._--_.._._,_..-._----_.,---------..--..--.--.-.--.-----.---,---.-.-------.----'---.---. D~:\ t.f:: nf::'~:i_Ci~.i ptiol"! Di:',Y~::, Ouan-l:. E:~:\ t f:~ C j.) (.:\ ". (~:J F:~ ~:; Pi:\;/iT,~:~n t,::; B~:\:I. ,:::~,n c~? -.--,--.--....-..---,-..-.-.-.--,-.-----'.....-'-'------------..--------.-.--,------.--------.. HAL.,:":)!"'lCE FOF~tJJ(':)F~D :::~B lJ () ::'l{:) " '.7:'::; ~~a l! ():,;,If::,,, ~, j',IO 'I' I::: " F~lease remj.t by Septe(nber' 26, 2001,~! the Last amount printe(j on ttle sta.ternel1tu Please inclLlde ACcollnt Nru .from statement Oil !~EI10 LI1~E ()f Y.D'.,I.!""' Ch0~c:k" (.=In'~/ pi:\'~/"m(,:,~nt~:i- l"f:~c:~:~:i.'v.f!.,d ~;\'f:t(':.~I~' OB/~.:.~l/:~.;:OO:l. ~':\I"f:::! not. 1"l:::'flf!::ct,f:"!..d on ~:~ 'j:.a t(~':m(~.:n"l:,;J p], (~':El.~:;f::~ d F!:du c:t .::\1') Y' .;:ic! ci :1, t :i, on~":~,l p.;",'::/fnE'n t. ~:; y'C)U m.:",y' h~';\v;:~.~ ;Tl~:I,(j (~~ ,':-I.nd 1"f'~fj"l:Lt thr::.:' b.;':\I{';\nC:l::'! i"F::m~':I,:i.nin(J" Th.::l.nk, '{nu." )'\,;,,,,,,,=- , I . ,~ , I" - .1l } 1]"" mi S t.~0, -J:.(0mG~n t I.JI"I :;, t,c!d Chun:h oi' Chr':i.st HCHIK"C; ~3-i:u~'C\h j':':-I.. TCidd iYI(-?mof':l.::i.l HCHIH'? 1000 .Wf::>~:;t South StF'EH-?-t Carlisle, l~A 17013 t)'l<rd,,~ment D<d,e~ NV:!.~,/~:~()()l Lyd L,\ D<'\I'i' I" . 0.. Bo x 9f:l Walnut Bottom, I"A 17266 Du,~ D,,\tG;" OB/2f:V200:1. F~~;; r. Paul R l)ul"f ."\c:c:ount i~F'r. :1.0:1.01.11 .,.. .",.... ri" ."......." ._..... .."........'u, .... .." ....._...".... ..............., "" ....._.._. .... .,.. ......"._......." .... .... ..".........'., .m.... .."....-...." .....-. ."..-. ".......- .." ........ ..".........,- ".."...." .... .... ,,- ........---.-.. .......'..""...... "".-..... .... l)-i:'l. t{~~\ l)E~~i; c: J'" i P t i on D.ct}"s~ ~lu<\I1 t F;'~6' te Chal"9<::-:-~:; P.c\ ym0:>n .t, ~:; H.::\.1.{:\nCE< .,,, ".. ,_, '.......,.., .'" m. .... ,_ .......'''.. ......,.._. ..,."...... ...' ".. .... ,,,.,,_,,...... ,.,. ...._.'" ........ ,...._. ...."..._, ........_,._.._ __ ".. ".. .... ........,............... ........ _...... _.._.. ....,....~.. .....,......-..-......" m.''',__'..., ...........' ,,_........ .... BAL,~i'ICE FGF,W{,>,I'<:l) ~:~B:I 05<:'h 7:':) ~:~B~, O~::16.. 7:':~ l'IOTEr. P10:O-:':\i:;~~ Irf.-:<m:i. t by ALl~JLt~i;t ~;~B;I :;::00:1. ~I thE:> L.~.:\~:;t {:\{IH:)\.\!Yl". pY':i.ntf?d c)n 'l:.h(.:~ statJ:,?fIH-?n1.:.. Pl(':-MI,'i:H0 :i.l1clud(~~ ACC::CH.U"lt. 1~.II".. .t=I"(Hn st.~tetn(0nt on lY1EI'1(J L.INE ()'f YCH.l f' c: I.H-:! c: k,,, An >' pa;/mr~:>n t~:; 1~.€'H:E:':i. v(::-:>d ~.:d:'h:-~ I" ()"7 /~:):t /~:~()():t 2\ Y'f:o) nc)t l~.~?t= 1 0H::t<-::>ci c)n .::i-t~.:\.b:?flH.:~ntJ: pl(.?~.:'t~:;E:: dE.duct ~':'d"!Y ~.:\dd:i.t:i.Dn~"l paym\"0nts you ff1-6\Y h6\'.,)1::.: m~':\d{.:o) and remit the balance remainj.ng" Thank,you. "<''F'''''''H!'Ff$ " '., "~'" "'" , L , II .. ~ " " _N ""1_ .~~ 'f~t-'-'-fJ--"~~" . "if " -- ~ .:::' !:.,::'t't('::'fn,::.,j , .;, :..1: Lhu,;..' " J' ..." , t~ n !":i. '::;.t. hCHnr:::",;;. 5dj'~I'\ ~" 'I'o(jd :~effiar'j.al ~c~!n= 1000 We!:;t SOLlth Stree.t C;a!~J.j,i;;j.e, ::)A 1.701~ ~:) t.<:\ t,i:"::'fn(.:::n t DEi. t(.:.:, :: 'J" .,/(}9 ./:~::OO:i. L. yu .1, d Du, v'"f P " D" E{D}( (.:)~:~ Wa:lrlLl't BO'ttclm, ~A 17266 Due I)ate: 07/2~/~~vv~ F:e::~ F',:':\U,]. F: DUlr'f ticCOu.n t ~..,jj'<':: :l.O:LOl'l:i. )).;",\ t.1:::; .\)(:, .;;; c ~.":i. p t :i, on v'.,.,.,... .V,;t ".""::~ j:;~.;:\ '\:.1::': Ci"i':;\l'"<l;j('::'-:::, PEi.ym'::.~n t.::;. :C';.<:\1 ::\n C:~:? Dtu:\n'l:. F' {'j ,( I'fl E ~"'l T -~ Pit-;;t4J f'"'11dL (1",-,\... ~." ?'DOb p~ ~b'\. Up-t.. ~ d'l;, :.:';;'/() "....'..:.. [':"',,-' ::::;(),/Ol :1.1 " ::::;~--::::;:': " ~:((,:':' ~':.:;';/:! ::::;".?':?" ',' ~:: S :i () ~:_:,,~.) " '7 :::';, B;:-:iLf:':)j.'.lCE FDF;~t'J{~F~D ~crrj , " i' ;:';"\';1.. j::;"'/ ,::ft.J\.. Y ..;::::."1,1 ~':':()Ol;: th,::<? L,.:";\st .:.;\fnuu.n-r:. pl'"':;.nt(,:,:/d un th~.:: ::;. t,.;';;. -l:.i.:":'{;'jc,;'n t." ".L+;,:'.;:l.'::.,;-" :\. n C::L uti !::~ (~l c: cc)un t \",j1'''" TI'''C)iTl ';;;, -t.,;:" t,(,:.~;nl:'::"( i t Di"j iYlEF1C ... -id ,," [').1'" '> i..'\,,\ i" cn+::~'c:1-';." i::'1n Y p{.;-Z,>"lTlf:::'n t.';::' ~'''i::.";CE:.:' :i. 'v'('::'(1 .:':l..r t.t::! ~-" O{:)/::::;O/:~;'~()()]. ,:',\ j'''E' n ,.', oj- 1"""1 :'T ,L ,'; .., '_.f;::i..1 Cjn , , ::,l;;:'!f:(-::"r'i T' P J ':::'.::'1_ '::~ (.:~, (:i (.::.,ej u. c t -::\n}'- ,:";'!.c!d:i. ti()n-;":\l ~ ml,\nt':::, }-'OU. i!;'::'_/ l"l.:':'.\/(.::' (;'j,;',i.C!(':: arlcl ~.ein:i..t 'the I}A:i.arlc:e r'emairling" 'f h,:'i.\'"\ k, .,,( ou. u ,-,-c'/""""""J"-'"l<. ~, ," , ,- 1 , ~,,~~ ~I"' ~ . ~"'1T -, '" "~'i-i~<- L"'," '-"'1 '~~'nc - ,-.. ~:~t.:.:\ t.(~.:'m(,:,:'n t l.Jrl:ited C~1l.ll"ch of Christ i'~ornes ~::;El.I".:':\h i:\" Todd F](.:~'{no!''':L.:":\l H()m(~':' ::.000 West SOlltrl S.treet Car'].j,s~],e~, !~A j.70j,3 S'tatement Date: 06/11/20~1 i,..yd :i,.::\ Du,v"f i'" "t.i" I::-:cj)-:: ~?B Wa:lnLl.t Bot'tom, F'A j7266 Dl12 Date~ 06/26/2001 i:~:€,~:: p ~';u,ll F( Du (""r (.':H::CDu.n t ("il'" ~ :LCi:i.Ol.}:i. D,::!.t,f,'~ D(.:~':::. c: I" :i. ):) t i on D,~y~::, DU.::\nt. ;:;~.::\ t.(':~ C h~':\ I'" ~J E' ~::' P ,,:\"'.lilH'::l"i t ~:; B,':l.l~':).n CI:: .--,...,-.----..-.-,---,--..-.----.-.--..---.---.-'-',._-_...~-,--,_. E{i:'::L(:)l',lC:E:: FCF;~tA,i{;i:~D ~':'::':? !l :.::;'7(,:;' ,,:":'~;':: :,:~(?!! :::';;7';,:J" :":'~;A. i",(DTi::::: ",i.i:..:-<:\':::.t::~, V.f:"::'m:L.t ,.'."fUj\jF '~:'(:;':! ":;'{\{\.i ,~.. ,,' '... ... !l the I_,ast amOllFlt pv'intecl orl 'll12 ';::. '!:.,';;. t.E'ii'tF::'n t" j:)],e~se j,rlc:].l.l(je AC:cC)I.lr)t i~r" 'fl"oln statement on ~IE:!~O I.,.INE ()f (.';'\ n ,>" ::) Ei.. }."m(.:.! n t ~::. {.... f:! c: (.:.:, :i. Vi:.:! d '::1. '1: t E' 1" () ~.:; /':..:~ 1./ ;'::0 () :L .;':1. v' (~:' ,", ,m, 'f' V' (,:::'f :L f:.':' c t E' d \"'{)U, V' C ;"i{-::: c: \,.:." !..il j ';:; t.,::!. '~.'.f-:'inl"::.~n \'!; p 1 (''::'.:':t ';:;.(,:.:' d (,::,cj u c t an}" .;':td c1 :i, t :i. Dn ~:i.:\ p~':"I,'y'[jH,:-:'n 'i:.~:; ')-/01.,\ fn.:';;. 'y' ~"i~;;,\"'(':':' t'l'lEtCj ('::' afl(:1 r'elnj.t .t~le I:)alan(:e vema:Lj'l:i.ng" Thank lOll" --'-5""''-'~lj, - ,~, ~ ~, e,".','_ 'r ~. ~~~ l!lii1r J'tli: ~ '," ",~"" '" _ B t ~':\ t. {::.~m(':~\ n t. Un:i.t(iN:i ChUl~'ch (yf Chr:i.~:.t HDmE-;.~:. Sarah Au .fo€jd Memorj,al Horne 1000 Wes.t Sout~l Street C-::l,/"'l:t '::;If:':~!1 Pi:! :t '?O:l. ~':;; statement I)ate: 05/10/200~ L;/c! :j.~:~ DUI"'f F'"O" nox ?E~ ltj~:\lnu.t nottDm, p{..\ 172bb Due Date: OS/25/2001 f~e:: Paul 1~ DUf'f ACCoLmt Nrl 101041 ...."..........'...h..._.._,""'..."....".._...'.."""......"........""''''.......''."_"..''.,.,.....,,,..,,.._.......-....,_....'''''_..._'".,....,..."q........,........~....,.,"'....'.,..."._.......,,'_.."."hU"'_....._n.._...,n........,,""..u...,u...._...._..un...,.'_.. D{:I.tf:~ 1)r:;.~~:~ C i":i, P t, i on 1) a y~::, Gkli:\r'lt 1":i,\t<2 C hf.\ l" €j E"!~:~ F'~:I.)/mE-:<n t~:~ Bi;\lan C(: ,...._____n......____...'_,...._'_._.____._.._.._____""'""_....____....__'n._'__._______uu..______,____n____'. nALf:II"'ICE FOI:~~tJJA!:~D 39 ~I :::;79.. :,:)~':: :~:; t} .',....7 q "{ ,I') ... ~ !I ',,) '" ~.,.f!\ i'-IOTE:~ Plf::~~.:\~::,(':'~ I'~€~'m:i,t. b}-'. !11;:-IY 2~')~1 ;;:~()()l!, th~:! I,ast -t:1.mount p(':i.n.I:,E:"!d on thF!.' .::~t.;':),t(>:.;.m~:.)nt." Pl(~,!.::t~::,(~. :Lncludl:,~' f~c:cou,nt i~,ll~'" 'ff'OITI .::;tatf!:.'m(.~'nt c)n 1."IEl1'10 L.Ii'~jE (:J'r \/DUI'" crH.:.:.ck,,, {lilY !)i.:'~>..frjl:::'nt,s:, l....f:~C(....;i\lE,:d .;':\'ftE!lr ()4/~:.}OI/~;:~OO:l. .r.1.1~'(.:! not !'"f::.,'flr.-:'!c:tE,d (,I') '::;t.~':'tt!:.~.(IH~.)n'i:,;; pli~.),::,..;::.i':: df.-:?clUC:'!:. ~'"n)" ~::~dd:i.t.icHI.::\l p':':'\}"fiH::,'nt~l:. ">,'OU. m,0.Y hi:'I.V(-:': m.;:l.d(.::. .;'::tnd l~'(::?m:i. t th€. b.;":'tl.::u',c(::? l"f:!m,:':'~:i.n :i.nr..J" Than I,';, You.. :-""'f"~~_\W ,,~- ~ ' ',1 -", ~~ ~r ~" "~I --~,,- ~< :::~ t .::1. t.l:.:;(n(.?! n t lJrl:i.ted Ct'lA~C:!'l of Ch~is.t Hornes ~::;~7ilr(:,'th li" Tode! 111(.:':-fn()1":!.i:~1 HDm(~':' :l. O()O i}.}{::,:.~:; t ~::;C)U "1.'. 1'1 S t 1'.P(:::' t C;aJ"].j,s].e, F'A j,701,3 Statemerlt Date: 04/09/200j L.~/d:La DU1".f p" 0" I{ox ~?:::~ Wa:lnlAt Bottom~ PA :l7266 Due Date: 04/25/2001 f;~E' ~ P<':\u:i. F\ Du.!'""f: Acco~jnt Nrc 101041 1 ;:1 I.~:! ""' ........ dh no....' ." .."'..........., m. u.. ...'.... u", ..,. .... ....m..m.'. '"" '""' u.. ._. ..,.....,.M. ._. n" n"" .'.' .,. ,_. ........ ".. ............, ',"" .....". 'H,.......' .... n.. ._. .... ,_. '..,.... ...' ."..... no..... ,." m. ._. ''"' d,. .... m'n""" ''"" .." ,_, m.no, m" B,::I.l'::i.nc(,: :OF:!';:.~<:: l''':i. !)"!:. :i,c)n :OEI.Y~:; (;~ui:\nt F~(':\ t~:.! Ch('ii.I"q(':.!~:; p(':I.'/ITI(~:'n t~:; ,.,.,......_._... .d..___'_.__._''""'m_...'_.__.___.........,_____....._....._.__....'__...._._.__...,.__"___d_.__."__...,............_.m_...__._......__...'-,----,-'. 0:.":':./0:1.,,/0:1. O:.::;/O:L,/():L o ~:) /:::') :!. .,,/ () 1 O:~:;/:::):i.,/Ol i'~lCJTE :l {~.:\. :1 0 ',/' ,f,) " l~ :,':~ Bf::)Lf;"lj"ICE FDF~bJi::'IPD 1'.'.......'1'1'"'"; [")' --Vhb I. ~-~,. ~ i=ar+~!i.( DN.....tS..u.c [;I.boD f"fnl"j 1::,)\, __ "W~ I"'A' '1''"'''''''''' n"ry' L\", ,L 1\ (', r" (/\0wlC(.L ,p,C ;<wO .' , r ! r::, h 1- U, VJ (Xl,::nL\.LJ,' IJUU.. '" '" ,...., 1"1' A",,:~ M \ i'-'(-I frfit: j\ -: 1..-Af1"'-""'-- Q PiO,'Yi'\E::I'IT - ~ ) I iwWJ fi,~ jyL '()1M,., ~'" ~.~ f\Jov ;),000 :';){;:.:'S",q:::. :\.f~J{,:,:')" ~.;!O ';;: ~:~ '7 " :I. (~) 9r5;')O"OO .'I'i ('t...,:. /1? ..... ,', ~l ,,' 1(.) " ""';d l.}O ~l 7:\.:2" ':,'6 {~fO ~l :,:"~b6" l.;.6 40 !l ~:)~:;;9" :::~.a :.':;;~P:l ~:'))":~" :::;;~ lease r"emit by APRIL 25, 2001, .the I_as.t amoun't pr:~r\'ted on ~i~tate(nent" I~]"ea$e j.llclucle ACC(JtAflt Nr. fl~om statemen"t (In ~lEj~O I...INE: C)'fl '>"0 U t,h c: ~'li::.! c: k, " j:-:ln y p (:1, }.'fnf::'';1'1 t ':::. 1"". f:.' C €:?:i. v f:: Cl .;:I,'f t (':''; I'" 0 ,q / ~) ."..,~~ () ():L El, I"(;,:! n C) t. I"(::.!"f ], (':': c t. i!!.' d en ';;; t,:':~. t,::!rn~::-:'n t;; plff.'.;:!.-::;.f!:~ d(-;'!du.C:t. ~":";,n}! .::e.dd i 1",:i.on(":\J P,::I,;.-'iTi(-:-:.n t':::. \-"O!..~ m.::l.\f \'l.::~\)(.::: iTi~).C~(-:-:' ~n(j v'enl:i.t ttle ba:lance remaining" 'l'hank YOlJ" i"~'""'''''''*';~!~ , ~"""- ,'~-, , ,. , ",'" t-< ,t - ~, " - !lr~ III IiIU st..::\ 1:.i::':il}(~n t, << . ' Un:i.ti::~c1 Chut"ch cd: Chr:i.st~ Hom(.:::s ~:;.;i\r'-i:\h A.. Todd l'I"h0iO()r:i.,al HOfIH':-:> 1000 West South Street Carlisle, PA 17013 81".(:1. tE-~mi::~n 1:. D<':\ t€.::: O~:)/:I. ~:)/~':~OO:l Lyd:i.<':'t. DUI.-.t= P.D" Box 9B W"d,nut Bottom" PA 17266 . DUf~ Datf~: O~V2B/~~001 I~.? Paul R D\.lI"f Account Nr. 101041 ._.... .".......~._.,_, _,_ ._'''H'''' .,_ '"...._._......_..___......_.....~.._, ,_......_. _._..M......_______,___.._ .M............._.......... ..__. ._______....___....__..___.. ...,.._.._......_........_.._.... ._.... ,_ "..__..__ ......M__......... 1) ~.:\ -t. if!! l)E-~SCI~':i. ptiC.W'1 D-i:\yt; Dual1 t F;:atf::' C ha rr..:j €':i:; P oi':1. ;/{,tl.€.:n t '!.=} Balal.ncti:: '"u.... ................ .... _...,...,......... ........ ."..... __.._.... ........_ '___.m............."'..., ....M....".._...._..........'O.. "" '"M__ __ _..M.M..........,.,....._.......,....,........."......"".... .__..__.._...__..._._....,,_..._ ....-........- ....."._-,_. B,;LAI'ICE Fc)l:,\~AI'm 14:1."07<',,,,1.,;:; 41. ,076" t~:,'l I'>IOTE:: Plt!:?('~sf;.? I".t!:~m:i.t by !TI(.ll;:CH ~~8~, ~.:~001, tht!:~ L~":I,~.;t amount. pr,:i.ntE,?d on ",tat,(;~mf.mt" Pl''!!<''''''0 j,nclud.o Account I~l"" 'f'l"Q(ll "t,,,tem.ont on 11EI'ICl L.II>~E (;)'1' yen.\!'" t: 1""1(-:)' c 1<.. Any P~':"i.Y(f)(o:.)r"tt~:; r.f..~c(-:.)'iV€'H:1 ~'d:t(-:.H~. O~:~/~~B/~~()O:t Eur(.:~ not f'E~'fl(.:.)'c:tE'H:l Dn ~~ t~.:\ .h~flH';~n '1:, II pl~~'~~':\~5\-? d(0duct .::\ny .i:'tdd i t:i.C)n~':\l p-i:tYfli(+~n t~:; you m<i:':\Y h~':\v(~,~ m.::H:h:~ arld r~mit the balance remaining~ Thank You.. \';'M-'f'-.<1!\'~~ ,-- " .' ~,- ,- " - ". 'IIi'Tr JI'.1 ~ - --1' . B t~:\ 'l".(,!'(IH.?n -t.. . Unit.d Church af Chri.t Hom.. Sarah A~ Todd Memorial Heme 1000 W..t South Str..t Carlisle, PA 17013 C' ,. " 't""ln"'I" t 1)"'" r,>,' 0':'/ 'I "'/"'00 \ ....) t.~~ >;;; ~:. i. <l\ 1..""-' II &.. ...e.. ,t;, Lyd i", Dur'f F""O" t.lC)X 9B Walnut Bottom, F"A 17266 DUEl 1),,\ tEl U ():;U:;;~6/~~001 I:~f~:: P-:i\ul Fi: Dlll~"f ACColmt Nru 101041 .... "'-_'.__"'_ "" _" ..n............-,_,_._....._ _. ....__..._....._........, ,,,..,,............. .... ....'... .... .".__..".................__.,........ ._._._ -, - ....--.. -.-----.--,....-....-....-.."--...."....~.....,, ...."....~ .,- ...- .... D-Et,-t.e D.t;CI"i pticll'l Dayi:; (au",nt F~it\tfi' C h.\I"~) f,lS F'f.\ymen tf:; B6\lanc: ......" "" ......" ..., __ .... ......,.,"" "'."',............ .... .... .... ,.,......... _. _n' ......".... ..., ,m .... 'm"" .... '''' '''" .... _.. __..........., m.'.,. ,.,,__ ................ .... ".. ..,...,.__.................._" .."..,_..,."" ___ ..,.......,.__......_R _......M _....._. BALAI'-lCE FOI'<:WAI'<:1) <H,,0'76.1.!:, 4:1.,0'76..43 "IDlEr. Pleas~:.~ 1"€'Hn:i.'t by FEBI:~UAf~Y ~::b, ;~OOl:1 .the L.~lS.t 6\(l)(JUnt pl"'int.E~d ('.)n mt""tt~"'.nt" Pho",,;. :i.nc:lud(~ ~)(:coun-t 1'-11'" 'fl'om ';;;t.,tem'~llt on I~EI'I() LINE (3'1' >"'OUY. cht::~c:k... FU1Y pi:'.ym(.:~nt~; 1..(-?c:f:.~iv€.~c1 C1:f;t.f:~r Oli~:):I./~::O():1. an::.? not l"'e'1:1f;;>c:t€,~d Dn si:.~":\"l:emE~nt,;: pl(0-0.--::~(<? 'Cl(o:-:-duc't -::\ny addi't.:i.(,)na.l p~:~ym€H'lt.s you may haV(0 m,::~df..~ (':\nd t"€~mi t the~ b(;....li:\nc:(.;:. 1".E:'Hn6.\:t.n:i.ng.. Th.::\nk You.. ~,,< ',;;1'"7,'W!11F0. ~,T~. ,~"~ " ~ , , ~,~, ",' " ,~ >'I'~~. ~ ,~- h"Tr"[ 1!:"j'<J,fIT ." ., F: t,.:":-!, t(':~'f1H,::'n -1:. [,Jr)j,.tecl ChUl"c:h 01: Chris.t Home~~ Sa~ah A" l'()dd ~Ienl()l"j.a]. 100(oe j,OO() Wes.t SCltltl') Str'ee't :;,1.' .L t.;;:, ;::'(~1 :[, '70 :\':.'::; Sta'telner)'t Date: 01/:l0/2()Ol ,Ld ,l)U.i,h"f F='"O" Box 9D WaJ.nLl't Bc).tto'n, I~A j.7266 Due Date: 01/26/2001 F;~l':::":: P~':l,u.l F.~ DUf"Y: (.~cC:(;junt. !",il";; :l.o:t(),.:',~:!. lJ,;';'( ":,1:::; D;::-~':::, C j'"' :i, p t i :J\""i 1),::\\1'::; F~.:;l. t(:::' Ch.;':\!"9E";;; P .::\ >'lTI \:~.:' n t '::; :UEl.l/:\n C(,:.;, ,- ' l)U.:~n t, :i,2/10/()O jVleejj,cal SUP~)].j.es :L ::;:'~ ,/ :L 0./ 0 () D }~ Y\:,l {:.':' n 1.2/1.0/00 InCOj'ltj,nerlce ~3uPIJ~.i j.2/31/00 RIJOm & Boalrc! Semj, :l2/31/()O F~(Jom & Boa~rd ~)emJ, :L"O() :1." 00 :1. "O() on ., ,~ ", ~) J. " 5~}'.) "/ " ~~:;,.,) 4li-:! O:::){:)" (:)i3 r:'1,Q ~i, 0";'.;,':;,, ,q€> ..:{,I.,~ ~! :L:L ~,':,,,:::::3 {li'}:1 :L::~()"E:3 )::-:(:'I(...(::'1)",\[:E FDF:tl,jf;~IPD :I,2/01/V~j Or'aJ. F~.ln€:'t:iDn 'l'~le!~a ,q.l~. ~I 0:::::<:";." {,n .;:').;y'" :::::::.:1 /,.... ".'"1:: >::~ 'l " "':' ".1 :1. ~.:,:I"OO 1:.::1 ,,()O :[',,00 :i.:L"hO :\':i.,,(::'() l+l+!. :t{t~?" {{.:3 ,,) l::)a" 00 (.i:l.!:.~ ,,00 "':'::'!ll{.;:::iO,,()O l'f,q!1- :,::1 :)6" l,t3 l!"l (\7,l-., /.t.t,1 1..!I..." ,.." \.;:) :?..:",} :L4~.::1" 00 (\DTE:i ;..' .Lf.~,;;\~::.E' \~';::':'fnl T. t.'.Ti-:':.;!.,.jL.lP1F:''( ;:::(::~;I :?()O:L ~l th!::~ L..';;l,~::.t .:':'1.rnDU.n"l:. p!"':i.nt.t:.'d Dn ,;:,.t,':':-'.t+:':::';"j)(.;,:.n'j:... \;':.>.::1':::,(::' . .. , - :I,I')cJ.ucle AC:(:(:)llrlt Nl~" 'fl"orn s.taternel'l.t Oll ;Til~I~() I_:!:NE~ o~' ';--h:::n,}.l" ChE";::!":,,, l~;'ln\..' D,-;;"i.'/fni:::.'nt.:::. j~'(':':'C:i.0:i.'v'(,~td .::(,'1:'1:.;;:,,1'" :L;?/~::':?,/'2000 ~':\r'f:! nc}t l'''(:.:.)'fIF!c:t,,:,:~d ,........ ..' t.::.. t.'::':"i!H''::'f"i t ~1 j,J.Li::.'':i,':;;.(,:.! ",''',,'' "..f '-"l,::.!jl"i:i. 'tj'H':':' !:)~;\,)".;";\n Ci.':':' d F.'ci U.c: t. ,:';',n .~/ El.d d i 't. :\. ()!"'I>::".1 p,':,-y'rn.;,: n '~:,':::. remainlf)9tF l"hank You,. \/DU, fn,:':\;/ h,;,;'<.'v'(':,' in,':l.,.-:! (<;.:, , Ex fW'Rd.. , , /::;.}II j ;1.oo{) ""'~',"""'~_r.. ,"'~, ".1 ," , 11 --'T''''-- "'1lcnr'..r '.~TI'- . . n t,;':\ t.~.:.:'nH':'~ n -1.', !..In:i.ti::~t:! Chu.l"'c:h CJ'-[ Chv':i.~;:,t HDmF::";~;, ~;)~"?l,I"(:~h (1" TCJdd l'I(':~flH:)I.d:L.:';\l HCJm(':~' 1,000 West SOlAth Street (:ar'llsJ.e, !~A 170j.3 L}.'-c\:L.::1. DUI~''f p" D" I.;:c)x 9:::s Walrlut Bc)ttom, F'A j.7266 Statement Date= 12/:l5/2000 Due Dateu 12/28/2000 F~F:;: Paul F: Duv"i= Account, Nr: 1()1041 :D'::'.t,E' Df.'!'::~ c: I-":L pt.:i. C:I\"\ .,.,_..,_________'__...d._'.._"_._____.____...'__.__.-------..--,.-,---.--..---.-.--'-.-.-.-'.--.--'.--.-.-,...-,-.--'--'.'-"-'-"'--' F~ ~':'~ t E"; Ch'::ll;'<Jf!.~;:; Pc\. '::-/in(,:.: n t ~:~ :F:,(:;,lEl.n C:f:::; l)ct'y"::; DU-F.~n t .,._.._..,.._____...._._..__,__..__'_._.._,_._,__.,_,_._.......__._.d..____,.___..__..__._...'_'__._._.._.'.---.---------....,.--.---.-,-,..---..-.-.-.--'-..-. H(:)L.(.~IHCE FCJF:lJJi:'~F~D j,j./()7/00 Beauty & Ba~ber 13./27/00 Oral I~uj'ction Thera :1.1/27/00 Or'al F'lnc'liofl Evalu j.1./28/00 O!~al F~llrlcti()11 'fller2 :1,]./29/00 Ora:L Fltnc'~ion 'fhera j,l/3()/OO I!1Coflti!1eI1Ce Sup!)li 1:l/30/00 Meclical Supplies :L :L/:':')O.,.lOO D!"'"~':\]' Fun c.l;,i()n .rh(.:'~!".;.:l, j.2/01/00 Rooin & Bo&rd .- Semi 12/01/()O Roo,n & BO&I~d Seml l:~::/()l,/O() i~.oom ,~:<: BD.:ftl'''c1 .-. ~::;;E'lTi:i. :!."OO :\,,,00 :l.c,OO :1.,,00 1,,00 :\.,,00 :1.,,00 :I ,,00 '7..()O ~.:.\:t ,,00 1:1.4..00 ~:,:l:l. ..00 :::::9 ~l i{.Ob" :I. 4, 7c,OO <:?"..BO ~':~ ':,;> :' l} 0 6:. .. :L i{- :l.?..Bfi' ::;9 :I,q:l.:::~" 1.:'.; :.:") (? , 4 ~~':~ /.':: .. ? ,~"{. :::; 9 !I l,~..q ~':~ " :::f':} :,:")\) ;1 l~ ~:,~/.;'~ " 6~':") :::)9 :1 ,q';~J? " ,q:':') :,')(7':1 :::I'~:::)" 6:.'::: :::~9:1 60:.3" no (/" BO ~:I:l."OO ~:3:t ,,:~;:O b () " ~:: ~::I <:?..ao B:i. " ~:':~() 60" :;:~~:I 9"BO :':;;':?!' =:,~,:l. :::~" 68 I..} :::~ ~I ()? ::~ " I.:. 'B 4:.3:1 ~:::::~O" (;':,g L\.:'-1, O~:':''::l'' c:.p 2~,q ~:.:l:t ,,00 J4~:!" 00 l/.{.::.:' " 00 ~:;:1 (.,\00.. 00 :l.1.-l-!,:.:'''OO '?9f::~.. 00 1 {::. 1::::;::::;,,00 le,.jUTE:; F'].ease refni't by D[(:EMBER 2811 2000~ tt~e l.,as't amount printec! C)fl st.;";!.t(,:,:'fl)(,:,:'n-r:... P:L('::~';'t~::.I:~~' inc:ludc-':.\ f0CCC)Un't. Hr'" 'fl"'ot'll ':?.t,-i:"t.t,(~~m(.:.:nt Dn !1'!E!\'\D L.Ii'.,iF 0'-;:: ,,:/c)u!.n c:hr::.'cf.-:." r::\n',:/ Pi:\;/fl"lF!!nt,';;:, j'"!:::!cE.i~,lE,~d .::\'ft,f:':'l" 1~';~/O'.7/~?OOO .::"1.!.'.:;:.: nc)t 1~.E:~"i::l1:':,;ct(-:~.d :~.: ~:: ct ':::. ji::., '~~: ;~~'~~ I~it~(':'! f~~. 'lj::!;~:, ~~: :~:~, j~~: ':~:;.~~~ l~,:,:, 1,1,1,' d (.:'! d l...1, c: t .t:\ n ),/ -t~,d ~Il. ~,~:, :,~:,: ~,~~,(,,~~,n '~::,'~ ;,:,." ',I, r.,.) El. ).."(1"1 (.:: n t ~;:. )"DU I'H ~':l. }.., h .::'1. 'v' (,:~, (n {';'!, d f::~ 1~'F:!m.;':\:!.n:i. fl<,:J ., _ , "1,,"""""_.~" ~ , r ," ,~ , T" .~, :.-~"' 0 "1mrr [,- .rr~'" _~ -> ~;;;t.::\ t.(':-:-ilH'N').1:, Un i t~:~d C hu [... C h G-"1: c:: h f' i ::E. t Hon"!f":'~~:; Sal~al, A~ 'f'odd Memoria], ~'I()me :tOOO WE'-:i;t Bnuth StV'{~')f:;'t Car'lisle, I~A 17013 S~ 'l:.::\ t(.:~mf!.,:'n t n.:':~ -J.',E' 11 t:i. /:1. :::~/~:~OO( L, >...d :i, ~3. DU,l'~'f P"D.. I':iox (.;-8 Walnllt Bottom, P'A 17266 n'le Date3 11/28/2000 F~(.:.~:~ P-:"ilul F: DUf"f l~~'lc:c:ount Nt":: lO:f.O,.:.t-:t _.____.______._,.,.._.__,..,_"___._,__._,____._.h....______._.___._,___..,__.______,__._._____,.._______.___,____.__.H_.'___ D~:\ tf::'~ D(.?~~ C I.... i P t i on D;:tY~::, UU.<7\l'it !:~.;:l, tf::~ C h (':~ 1'- (] €:! s; P.;7l.ymf.'~ni:.1:; Bal.::\ncf ___.,_._._,_,_____,___._,_,__._,._,,__,_.______._______.___,.___.,_________H__._'_".._.__.____,_,_.._______,___________,.___.. BM"AI'4CE Fm,WMm 10/31/00 InCofltinence Suppli J.O/31/0() Medj.cal. Supplies 11/01./00 i:~c)(:Jm g: BO{':H"d -.. S(.:~m:L 1..00 I.-!to " L!() bO"BO :\,t,i!'j" ()O :,:')l'f, 9'lfB.. ?!.t. 1.\(,,, 'iO 60"BO l.} ;1 ~:) ~,H) " 00 ~:)f..!. ~I (?l~B" 9J.; :::)l4 !I 9(j} ~.\ .. ~:.;~ '':' 1::') () l~:, ..:' .\ t< "')~' ~! " ~'''d)'' ,,' I ",",'" r 1'" '101 'u).y:1q,/d" ,. I :L ~ 00 :::10 HOTE:: F'l (.:~~:....~:~(,~) f'€~)m:j, t b'/ 1\IDv~::inbl~;.r ;::8, ~'::()O()!I ti'H':~' L1':).~S t amoun t pv':i.n ted on ~;:.t..E~t~-:..~'mE'nt" Plf!.'~:i.':::,(~'': :Lnclud(~,:, i~~Ic:c(:)unt !'-l!""" 'Y;!~'Dm st,a.j:.(.':;lilH-:~nt. on !ylE!l'!O L.INE C"(: your check.. Any payments receivec~ afte~' 10/31/2000 are not refJ.ectec! on -;:j, t~':\ 'i:,(.:'~ITJE-:'':n t.;: p 1 (~~'El,'::..:'(:!.' d F::d!), c: -1:. ~'itn y ~':'I.d d :i. 'i:. ion ~':\:\. p~'it ym(7,:n t-::~ ;/DU. ;TI2i_,/ h~:I,'V'(.":: m,:':,~d iE' .::~.nd f"i::-Jm:i. t th0~ b.::tlanc:e n::~m.;:~:i.n :i.n<.:,l" TI'l.;:'l.n k You" .t-~\'~ ",,'," '?I IT 'r '"-, St,. temen t . . Un:l'ted Chul"C:h of Chl":ls;'t Homes; S<1l,l"ah ,~. TIOdd l'lemol"j,.aJ. I-10m., :\.000 W~)S't SC)l,l,'th ~'l'tr~>E!''t Carlisle, PA 170:\.3 St.,.'tement Dateg 10/12/200i L.ydia .Durf P.O. F.IOX 98 WaJ.r-.u't Bottom, F'A 17266 Dl.,e l>a'te: 10/26/2000 Re: 1"auJ. I': DUFf Ac:c:ount NI'" 101041 -._._-_.__...~_.-.._.._._._--..~._.~..-._._--_.....,...-.-........-.--.--....,.....--....---.......--.--.---.....-----...-.-....--......--.....-......-.-..-.................,..----. I>ate D€.~~~Clription Days QU<3.nt R,.te Ch<iu"get~ r':'.aYft)G~n t.?J. B~\lm.n (:( ..-...,-...........--..-,--.--.--....------........---..--.............--...........-....,.......-.-...--.-.....-----..--------..-...'-........--......--....-,-.-............'.......---.--.-..... 23..20 30,359.69 "l.00 64.0~\ 2~:~ .. ~~O 4,49~)..00 ;30" ~;59 .. 6~ 30,:;)66..6~ :'50, 4:30 . 7~ ::10 II 4~\::1.. 9t 34,948.9' BALANCE FOI:;:WAl'm 09/;;;~0/00 Be,3.uty $: F.'<3.l"bel' 09/:30/00 M.~d:i.c.al S",ppliJ~?J 09/::30/00 Incon'tin~mce 81.\ppli ,,0/01/00 RI)Om I.}. Boal'd "" S.'lfii 1.00 :i..OO 1.00 3:1. 7.00 64..05 :t45,,00 NOTE: Ple<3.se r'ellli. 't by DCTOX3ER 26, 2000, the L.ast, <3.tllOl.m t pr"in tG~cI Cll1 !Statement. Pleaj5e include Account Nr. TI"Clm j5t.1tement on l'IE110 LINE ()'f YC1UI" check" <"my po\ym'2nts r'ec,..~ivecl <3.'f'tel" 9/30/2000 <3.l"e not l"e"j'l'flct.,)cI ()n statement., please d(?duct any ",dditi()nal pL~yments y~)U may h<3.ve lfi<3.de ome! I'emit the b<.,l<3.nce n;;m<3.inin9. Thank You" hl'?0'm.;!lf.!l,",-, , "~'^ , - ~ ~ ,-,~ "'~!l."",-,J[lV r n, ill B 1:.<':\ tefnen t Urd, te,c1 Church c)f Ch!":i,..,t l"lome,s; S~'ill'-<":\h All Todd tllf~m(:H":i..e:t.l HC:Hne 1000 We,,,; t Sou t h 13 t I"ec" t Cal--lisle, PA 17013 E)t~\tt-~mf.-:-nt, Dla.t~;)~ ()(y/:t~5/:;:~()O( Lydia \)\'<\"'f' P"D" BC)l( 98 Walnut Bottom, PA 17266 Due, Da t.e " O? /~~9 /~~OOO He" Palll F( Ill.,Y"I' Account NY': 101041 ......" m. .~..~..m '......,.......' ,."..~_, _. "..__ .....,.,...' __ ,_,...,.._.... ,..,...._. ....,.~....-,.... ~...,-_....._._. ..., -_....._._...~._~.. --.........- ........-, .....~......... ....._............._.~. ._...._.~._~ .-....-.... ..~.""'.... .... ..,. ... D.::\ .tf:,~ D€-;.s;.c:I"'j, ptit1t"1 ni:.\Y~; (~uant. j:"{c\te Ghal"ge~il F'.\ ymen 'r,f; J)<~ 1 ,;\n co;) ..'......... .._._ _~ ......., ........ .." __.........."..,. ,_.......~..,..... ........ _._......... _.......".~" '''' ".. .~._._....".. .... _, "...... "__._.......,.....,.....".."'~~..,,.,,. .... u.._...._......_. ........,_......,._.~..."._.~...........~......_.".,.,._._ Of.)/H~/OO Of.VO;UOO 08F51/00 o\Y::l:l/OO 09/01/00 !3{.\LANCE FDF<WAI'm F'AYI'fE~IT - f,.e ac., NOv, ~'- 11 ~q , , J..""""" oJ<. ;),5'')' Beo~u t.y & H,.I"bew Incontinence Sllppli l'led:i,cal tlL'pplies I:;':oom & B02.I'.tf .... S~~m:i. 45'1 (yO::> It 9f=t " If'''-! I'd), f4f..prl'lucILo1lio 1 "00 7,,00 '7,,00 1,,00 :54 ..80 ~,4.. 80 1. ..()O 6:5..95 <',::l,,?!,,\ 30 145..00 4,350.00 ~::o, ()()O . ()() (.,",' 90". '''~ '?~)!l ~)..,..., ',",' 9C'"" ,',01 ,r......,.. ...,.. 71 ,..,,,,' '''1.0 "'<I J.....) '17 .. 7.1 ",'",' ' "'t,m '7" iJ 4..~) II 7 l' ""I.. ;!.6 , o,o'i' " 6q :::')0 ~ :5~:1('Y It ~)9' "IOTE: 1::'1."a",,) n;,m:i,t. by S;EF'TE~IF.lEJ~ :<:'7',. ~,~OOO, the La~.t iMOO\.\I'1t p,":lnt",cI em th", ,;;t,.tEHoent" f"1(*iI\S'* inc:1.ude Account. 1'1"" 'f'n:lfll statement (J11 l'lEI"IO L.IHI'1 c)"f' 'jour' c:h€~ck.. f~n)" p~,yment~; r'e'!c:r:.-:-:i.v(~r.I i:\i'trar. t3/:,':):L/:;~OOO .e:\F'f::.) I"!C)'t, r'G)'flE,)c:.J:,l::.:od on ~:;t(:\ temt":.H1 t II p:Uf.'ase dedt\f.:t -i:\11Y ~.:'l.dd:i. tir.:Hii:\l l:J~~Y(IH~n'l:s you m~.tlY h<':\V(0 (l).;:\ch.;) .~tncl FEHn:i. t 'I:.h€.) b21.1an c:r::.) rem-:'il:i.ninc..j.. Th~\nk YOUn ,,,,,""In!',,,., , -, , .~ " ~'~I" - . . ~.,,; 'j' ;1, "i:.(:-:'!'fH,:::d"; 'I:, LJrllteo (:hUI~ci'l of Chrj.st ~!om8s B,:':\ 1" .;',\ n f;" 'r Dd ,j i'~(':o'mc) I":l. ,'iI, 1 ;"~C)n)(.:'~ J.OO() We~~.t so\~.th Street C:2y].J.sJ.e~ PA 17013 i_.';/Ci:1. ~':'\ Di..\l"'f: l::' " 0" Box 9~:3 W~:lrl~A't Bottom, F'A :l7266 :;>,,':~ 'l,:'=: D,:.~' ::~ c ~~ :L ;::' 'to:L Di"1 B{:I,,,.f;~'.ICi::: F:'DF:~~t..i(':)i:~D 07,'03/0() ~i!:)eech/iuleal":ing i~er ()7/05/00 Spee(:~'l/!"iear'j.l~g 'rj'el~ 07/07/00 ~3iJeectl/He~I~:~l')g "her 07/10/00 SiJeec:h/Heai~illg 'fl')er" 0.7/12/00 ~:::P<?;~':..~ch/H(''!!.:i~I'"'in\.:J Th':.~'f' 07/i4/00 S!}eecrl/keal"il'lg -Y';'\er' 0'7 ,/~:r."7 /00 b ~)~,:,!(,::.,c: h/Hc~.,'il V' i n;:J Ti"lf.:::" f' O'?/:L';.y-/OO bp;'Dech./HE'El.v':i.nl:.:) Ti.)'!::~'v' ()7/3~/OO Incbrl't:lrlsnc:e Sllppli 07/31/00 i~eci~.cal Supplie~~~ O:::~/OJ,,/()O i;~~ochn & I:;c'E~r'd .... ~3'::'Hn:i. [',;L,iTE::: D~i.'~/'::; G~u~'!(n t :;."O() :J.n()O :;',,00 :\.,,00 :;. ,,00 ::.,,00 :i,,,OO :1. ..00 :t ,,0:) 1,,00 31. S.t~temer,t I)a.te~ ()EI/:L:~/200( DU.0~ D,:!.. t,~;::: OB/~::B/~':~OOO i:;~(,:.~:: F','f\u:l. I:;~ Dtll,"f Accour\'t ~1":: 10].041, R.;";lt(,:,~ }~~':( :;, D.li C~ Ch.::.\.!"9''0S f' ~':\ ';/(1"1 o::.~n t s; 1.'}/.'1"OO f.tC~." 00 li,{.~" 00 (,'~:L :' ~::ltl.~" 41.{. E-:....70 ,." "> "'" ", 1: ,.J. " '" ,~~. J, <,... ,..,,,>--, ,,, , .q.l ;~ :;:: 5~:;" 1 :4" l~,:L :1 2~(::,:L " :3J{ I..~ 1 " ~':~'75)" ~;\4 /I,', '-:-"I-'~;) "."4 .,.,.",:" ".....:u f..~1'!~ 2D7" ~?1 (.,., ''';,C'-', ;' ,}.... 'I .~.. ". '" " (.) ",,,' ""("" "'4 '1' .J. ~",.;, "HI" ,,>' {l", n'-::.llJ (""lI-L ,.. !,'...,. 'in .'j f.~:L ~l :':~,;.~8" ~:~'f i(', ", ')/". ,:'\tf "" ...l "'., " ":1 "..,. , ,',- ''''(')'- '''''1 (,C" ... ., .... " "I:,,,, "~,,, B,,'?O 8,,'70 ,q,;+"OO ~:~" '?O ~:;.. '70 {.'?/.,i..OO' '~'+":t"OO f:~" }'Q 8..70 I..~I..; ,,00 l{.lf ,,()O 8..70 3t:'f,,80 b,O..:i.O :tl~~.)" ()() ~::,,-q "PO (;')0..10 ,q !,l.j.~?3.. O() ..'.:.ea~se j"8tn:L"t t)y ALlgUIS.t 28~ 2000, tne ~,ast ~fn()~~rlt ~)y'j.n'ted IJf\ 'tne ';;:. .t..;';l,''i:.C;.ti'(>'Dn 't.,,, ;::1 j, t::'~~.;l'::;;;:~' :i. n C;,:L ud (~':' {;, c c<::)u.n t ;"i ('.. 'f r'CHn ~; t.,',.. t.E'lTlf:::n .1:. Clf"l l~'lEhCi L. I r.jE: ()'j. '/DU1" Cr)(,::..C:l<... ,;'.)n"::," ~:),:?.ym0~nt~::. 1"i::':'Ci:':~:l.'../*:.:,d €,,'ft(:;:!,. )'/:::.:L/'~'~OO() i:\l"(~'~ not. r"'"i."~-l::LfI..:'c:'t(.;~cl (}n -::;.,~:.,.:\t('\Oi(.:-~n":';: P::":;':';~':;;.,;:.~ C';::,'Cil).':::'!:. -::\n>; <':\CI(I:L.~:.:f.c:,n<;t:L p.:r~>'m('::ii.'1.'.5:::._,'/"'OI..~ mH',Y' i'"~.;";'l",lf:.'~ fn,:'.Ct''::.:' arlci reinlt .the !:)alance rernaining.. 'r~ani~ YGl~u r I . . Statement United Church of Christ Homes Sarah A, Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 07/07/2000 ji Lydia Durf P.O. Box 98 Walnut Bottom, PA 17266 Due Date: 07/25/2000 Re: Paul R Durf Account Nr: 101041 -------------------------------------------------------------------------------- bate Description Days Quant Rate Charges Payments Balance I"~ ------------------------------------------------- BALANCE FORWARD 36,601.13 36,601.13 06/27/00 Speech & Hearing Ev 1. 00 66.00 12.16 36,613,29 06/27/00 Speech/Hearing Ther 1. 00 44.00 8,70 36,621. 99 06/28/00 Speech/Hearing Ther 1. 00 44.00 8.70 36,630.69 06/30/00 Incontinence Suppli 1. 00 58.00 58.00 36,688,69 06/30/00 Medical Supplies 1. 00 60.75 60.75 36,749,44 07/01/00 Room & Board - Semi 31 145.00 4,495.00 41,244.44 NOTE: Please remit by FEBRUARY 26, 2001, the Last amount printed on statement. please include Account Nr. from statement on MEMO LINE of your check. Any payments received after 01/31/2001 are not reflected on statement; please deduct any additional payments you may have made and remit the balance remaining. Thank You. ,..,."rQ1"o"""""?",,,,,," """...,.,1 .-,,.- " -",~'~ f - ,~ "I""~"' ="'" '" j 1 11 J 'I ~:~ -!:.-.':\ t~,:-:<j!H.:.:<n t Sarah A" 'l'odd Memorial ~Iome 1000 West SOl.lt!1 street CarJ,j,sle, F'A 17013 'f'elepllone: (717) 245-2187 Statement Date~ 06/13/200 Lye! i'.':\ ))ul,u'1: F' " 0 " Be) x 9B {.,J~:\lnu.t Bottom!! F'{;~ :t72:6b Du({-:' I).::l tE':; ()6,./~~B/~'~O()O I',:"~,, !"',,,-ul 1'< Ilul'''1' AC:C:CKU.) t ~.il~':: lOlOl.}:l. .m .... .... ,.., ,m.m..". . ".. '.HI..'.m ........ 'm.... ...' '." u.. '.,...".... '.,'.... ..'. ......um, ....n" .m"........'. ,'~ ".. ".......m .... ...'"., ..., .... m....'........ ......." ,.... .... '__"_., "...... ............ u......m..._..u~"'__........ ,...-...~._"-........_,, n{:\ti:":~ - DE:~::. c: 1'". :i. pt i on D.i:'I.V~:; UU.::\nt F~~':l. tE:'! C h~:l. I'" q ii:~'::; Pe~;/iTiE:':'n t.~i; I:,';~16\nc: ..',_'...'...,......'....__...._...._.____,...,...._._...,__.____.,,_____....___,___.,__._,___,___......m.___...______._.._____._____.______________,._.' (S~'::" 9:':':! ~':')~':~ ;'l :!. OD " 1- ~ ~:)~:~, :i. l~)" l~ :::)~:::\ :L'?G..:l.3 2') 2 !l :~:': ~':> (~} " 13 ~::, ~':~ ~! ~ ;:':t TO :1.; ,.,H-:;', c;.,J.l" 1... Bi~L. i:':j 1',iCE j::' DF~I;.J{1 !:;~ D ()5/::;::~:~/OO E~r::~El.uty' .7f:~ BEi.f'bi!::f' 05/31/00 Medj.ca], Suppl.ies 05/31/00 Irlcc)ntinence Suppli o ~S / ~':'~ :i. / () 0 D x Y'~:j (-":nl 06/01/00 Reo'A & Board -. Semi :1.,,00 '7..00 1" (to 6~::" <:)=:) J ,,00 ~::tB .. 00 :l. ,,00 :i.~) ,,00 ~:~O j, l1 ~:,:t " 00 :.:~~~, ~l :i. on " :L B "7,,00 ~5B " ()() 1 !,:\" 00 .:1 ~l ::) ~.10" 00 NUTE :~ Please re,nit by JlJ~IE 28, 2000, the L..ast amOuflt printed on 't~le statement.. I::'lease incllAde A~:(:OtAI1t NJ~" from statemel1t Ofl MEMO I_INE of )/C"..!.1'" C hE' C k,.. ~':ln ~/ p~':\>"mf!!n t':::. V'f;:'~ c;i:':~i v(,,::,d .::).'fl tE'I'" ~:,:!,,/~:):i. /~;:~OO() ~';'\ 1"'1::: fl()t I'-r:.~,'f 1 i::.:' c:-t.E-:d on S"tD,t.(-:')f!H'2nt;! pl(,::.-:";!,~:;(o":~ d(~:'duct ,;.:\ny' ,;':\dd:i. ticln.:":!.], pEj.Y.flH-:~nt~;:, }"ou, may h-i;\'v'(-':: m.::v:!(.::; and remit the balar)(:e remairlingn Ttlank YOll. ';f"1'-li!'I"'"-'!i!~,1l!. ~.",~ ~~,<<""",, , . ,,~ "'; , II!-,:] ll~~~~'~'-" r - '",'..11" ;:::;-l:,<':\i:,€-~m(-:t'n t ~ (. . E;.r.1.1~'.5l,.h I:':' Todd ivi~-:-mDI":i.~:\l H(;:!mf:~ j,QOO West Soutl1 Street Carlisle, PA 17013 Te],el:)t'one~ (717) 245-23.87 st~tement Datell 05/12/2000 Lycli;.'il DUJwf 1'" " 0 " Bo" 9El Walnut Botto(n, PA 17266 Due.Date: 05/30/2000 F~iit':: P at!.:!. i:;~ Dt\l~'"r: ACCffi!nt N~. 101041 _.....,__._.__.____.__.__,______'''._..__,__,...__._'....______,_'..._..M.______,....,....__.___.__'______..."..._____rt___.".M.,__.__',..".. l),:,:\.t.l!i' Dl::~-::; c I~' :i. p t i on l)~:,i,. y~:; DU~'i\n t I~E~ tf~' Ch(.:\!'-9ilifS P~;.ymi:":~n t~:; BE~ 1.::\1'1 C:f.:; .... ,..._.. '... .M.''''........ ._, ''', .m"" .... .,,, ....__ _,._., _M ,,,..... ...' "" "".... ,... ".. "....".._ .m.m ."...,. ",..... .... .',.'_..m .... ...'~m ,m.m .". '... _.. ,""'.... 'M. _., .'M __ __ m.'... .." _.. .._.... ........,._ ..'..m "., .... "'" ,... .._ -" ,... -. ....'.,. ,'" ,,- -. M'. ~:):i. :i.t4~:'" 00 60" '7~'j .q ~ll..i("y ~:i" 00 ~.~"l !I ::,\ ~~ 9 " ~':: ~:~ ~~ '.7 II ~:.i ~l 2: " ,-q ~:) ~':~ '.:? !l 6 :i. :.).. :I. ~:~ :::'r~:: II :t OE~ n :I. B Bi~ll...i~li\lCE FDF~Wl{i!:;~D 04/30/00 Incontinerlce Suppli 04/30/00 Medj,cal Supplies 05/01/00 Room & Boav'd - Serni :L " ()() :~:~:':> " ~~O :l. " 00 60 " '7!5 ~':~'? II !:)~:~;-1'.. 2~':) ~:~ ~:) n ~':~ 0 i'iOTE~ P1i!:)~':i,.~::~e l"'f!!mit b'y' l'ti(.':'tY ::10!! ~:':OOOll th{.,:) L~:l.st (':l.fllount pl~':i.nt(~.~d 01'1 thf':) ~i~t~.:\t.{'~'m(-:)I'!'I:,.. Pl(7.'Ett:~e :!.nf.::luc\(~,) f~~!eCf.)unt j\lr... 'f~v.om ~:~'i:..:,:\'b~t'f1H0nt on !l'iEiYj() L.:!:I\iE CJ'f }"QU V' c: h;?:~ c: I",'." (.11') Y p~':i";/flH::~n .t~::. I"f.'~ ci:,:):i, vE'd (':\ i;t,(.::: V' l.}/:~:,-O,/~20()() .:':.\ f't:.~ not. !'.E.d: 1 €':. c:t.€~.cl on 1::.1;,~'i\ t(':.~m;:':.:.<n 'I:.~; pl(':~'';;.t~;(,:~ d(,;-:'c!uct. ,::~ny ,i:~dd:t tion{':\l p~';!,ymF!n t1f:. yCiu fr!{':'I.Y h(T!.'v'e lTI('i!.(:!t.:~, arld remit the -balance remaining.. "hank You" "'"~N'~'l"~!I~..,_ , ~. " ~ r~~" ~~,,_ ,,,.' Iii ~v, "'" " " t(.~f-Jh{.:\'h 'J:. .'( d\'td l\:{~:.: (~)~~J-'" i '\:\ 1 H\':~t,(~,~, :L (){=!'O' ,'Wf,~"'j;,; 'to ~~?\:Yn,th ~:).t i~"{;:':'<<~ >1;. C;:,~\i':J. t !r":' \! !::f'A J. '70 \~:'S T{.:;f:L(;!.'l:~h(ij:"!(~ ;: ',;7) ~:t? ~:~.-t,il. t(.~;tn>:.::'!i'~ t 1,'.\\ tll:~~ l; (!4~/ 1 O,/~?O()() i." y'd :;, ,f,\ D,~:f. !~'f ;F'"O.. :t:~px <tB v.j~'!<.:;' n LL t E:'(:)"t, t()m '! F;'r" l'?~,::>~)I:~ ,.,......'.",.".'..,,-- l)f"J.l:'" n.:'!!. 'b:~~: 04/;;'i:':?/1.::000 f~t:...\.:: F' ;;11);]" ,t~~ D,!;~l !~'r .ti~,~:{:r~:)'h~n 'f~ t-!'1"" ,:: t,9-,:l94:t D(.~~~ii{::i'" :i.,p t:i. e,n P ,~\ '~:i'm,~~ 1"1 -.t, ~:-; l;~~'~;;, '-t:.~'!: C ha IJ~ ti i'~,~'~\!. ,Q::,:L/,:~';~:l. /' () 0 ';\~t~i;:~':L/()O -6::1. >:> ;::'1'1; )" .ob, ::,Ki~}!,~<\,;~ ':,LfC;.\) ::~t4t/-,q.:k(f"'9v )) 14 L.f~ i.',iGI~: i;:~ (ji'~~Wl~'f{l) :'!' i f;':, ,,~,:. '( " ';i~ ,"\,'/ it.. ',1'.{;',;'" 'lor,'" 1')""2,~ 'jj' . ", m'" " ..;t' ,~, "" ""-' ,~>:i. r~'bbif~ ~.: Hb,~", 1-'-;d ' ~:~'-$"J.1i 'Vh,;fi":~), "~;~:U f,t~~, J, ,i 'l!.-) ~~_ 7'rl' t"'''...; '.!..,,:,,!.,~i..',,\'''':;'''-'; ;:;"1 'I" I''-~'' .;. .1;", i" ,~,H~:,"<~}";~'\'.--',"':""~'~ ,~,~:,,; "Ji..JJ.. ." ,~: '. :t~k))i~ '(' d :~. .~:)'-~iH!' :i. 1,;,,00 tY t ..()O :t ;, ()<) 4:3,,, !:'l'() 20 :! :SB(.{. " ~3:.:J 'i'"OO ~!. ,l~ ~~, '1 (:to :;'~<~3 ;i i,y() ? "t)O ~::;1 46::\ ", ()() '.78,,90 4~'L;:.O :~~o ,q !' '::;; ~'Q " (1-{) 14t~l" OC!1 \""l::;:>fn:l. t, tr:;l' 1:~PI:;.:':rL.-" 27 11 ~'j~~)(/f~l'!1 tht'1, ;;>li~i:'t'~r:.ti:;, V"';'~";!...uJ"n '~\fi ti'i, ";(b'p;'!~' +;'~-'I:",-'q:,~"m" .~ .:l.: l'''f~'.:' c~:!,:j, L~$t a~~ur\t pr:Lr~ted Qn th~ p,(',\ t.Yff\ij\).f'i 1,"'!1 i:..l'f(~ ;!j~'(~~t~(Jn d :L l'i \/() :i. ~::':~:~'! ~~\$'4~" fl-c:d:. i~~::?'f (:'(1 tb':i.~i~ C:('1 t :j (:; :L \:'::.' ~:~, .:;; f~~ -I' ,::, :)l(~\l..t m'a }'" !'f,-..;'I\r:!o::;: ~,- " - "",,,<<,,.'...,,... "...'''''....m'"..~..!.._ E~,;~,1 q\O C:ik:! ~-;:'~() F 5fJf.+ ~' B~:':. ~5~;;:t .. 8:;:1 ~t ().~1~1~\" ~:~;,:~~ . 1~'~5" 7:::~ ~?::::. ; :L 7 ~?~ " '~':: :;> ;??~, ~;.~-:~t.y" ~;:'=::; ," - ~ 'r ~ , . ~:~~, ~\". 1'.' ,,\ t~ (.~~" ~::~ 'l:ti' t ~,;: '.n,:;:o-i'\ '::, " ' "Odii Mpln~r'~~~l L~om~ ::, ':}<>O f.1i(~.~s t :::3.::;,\.\'r ~"; ~::; t ;,..(:..~,:~.:, t, 1:,ar'l:Ls},&" ~'A ~7013 ~'.~D;~~n~= ('71~') 2aS-?187 i...yd i~;l Du.1....'f r:"'..Cj" :f:k:l"< ~.~'H ,~~lnl,~t Bo~tom~ PA 17266 :::~ 'i:"i"l. 'i..r:.!!n\7~1"1 t D~:l. t (':J:; O:\,/:\. <i:./~.::()()O DCi€': :o~~,t(,'!!:: O:::')/~::9'/~~'::OO<) l:~~~~ 1: F'.;:\fp~ '\, ::~ Du I.-.r: {.':lC:C:O~.r.n"t ('!:'-:; :i.O:!'Ol~l '.()!,,::,~;;, C: t''':l. pt '1 e'li ".M..'_....._..,.. '" 'm".. ""'_'..~,,.,...'.,_,...'._., ,....,.. .,...."........_".~...-,:...,',,'... ..".... ".. "..."...".......,.."". l:">:l~;,"'-flH;';'ll ,\", ti; ~ ~-('. t(.:,~ D,;1..~/~;; G;U,:7\nt X':~(:\!,.,J~h!Ci::: ~~.DI:;':t,,1AF~:O ~~./:1.5/()() C)r~:l F'LlnC.t1on f"~0~.LI ~.;::,,/': ~}/OO r:):'-i:~,l Fu'n..:;ttc:,n TI''\.:-;,Ht'....., .;::~'./:t6/{)(J f.:'~f'.f.,,1 ;::'u,n--::'t.ii,:)f'l " n0~r'';::\ :-;.'i:/'.l,B/OO Df"'~:i:i. F!,.'.nct,:i,Dn Tj"d?:'I.H,f.<, ~:~?/~;~~~':~./O;;) j~h",;:'l:.:L F;'\,~nct:J.r.)n "1'1",,::,;<;"(;1, ':.,:'/~';::':t/(.:O'- 0 :.- .[:'~ :;. F.:'ttn c: ".',:L C)n T n~,:.!}^'~), ~?/~:9/00 InC:Orltit~enc~ Sllo~li ~':?/:~~':;"),/OO 1"'1,:,:;.'(,1 j, \:-::\1 ~;;up;)l:i. f,:,~r; ..:':~/O:L,/()O i::":~:lo<rl t:!t. T-;{-f:~.-t\r'd .~. E;(-:.-~t;',j )~:~/()l/()(r F:;.:",-:;,m & E;o{r-.l" (:1 ",. ~;!'(.;1-m:i. t ..0() :1.,.00 1...()() :1,.. GO :l...OO :l. ..tJO i ,,00 1. "l)O "~'lOTi::::: F' ~':" 'tJ':-:' 'j:{ ,~" l.;~ n .:;: ::1.' C ;"lc'.1"~q[':1~t; :t ~::J, ((~O'?' " 04 :t. ~:~~: 6..0/ ,,(),q :1,8" 6~:~.1:-<" e;,:,:~ :L\'(.} ,,()<) ~):1. "CO ~~\:i. "Oi.') <:11,,00 ~li." O~) :J.9",fj<;;' :I. ~~ ~. c:..'.:;.l~ " )':.':~ 1H, 'I (",r::,I!..~.. !5~:; t;' "PO 9 ,'-'~3() ~;'"BO ?,,80 ';;>"GO :1, ~:~ :1 b :,:.>::':. ,. ~:r:;) :1. r:l-:\ ,'!.:,i;'~,6.. :I. ':,~; :L G ~l (,!~-;,,:) ,,':,;';':::') :tn~1 'j'6H" ';,';.::1 :: :3 ',I ~;~4q. .. H'~~ :L 9 :: :;~7~.Y .. ~:;:~} ~;~ () !' ~:\ ~:; (~ " C ~':! ~.;."1..00 t?~? " -H('.. ;'''2..l:;O ',J '.16,,::'0 :L(.~5,,<)O 4:::'::1..00 7:S" :\.0 ",'i :t,li,5..00 :L ,I 30~\., 00 ::;, 1.1~:".f:'S!:." v'/..:(,m:i. ';: bV !'f\r.:'::;[;:C:H 2~(":- :;':,~<~(..(;:." ''\,: ~"I~,:r L,;,!-;-:;'.t ~':Hrrt;)Un 't PI''':L i"l t~;.'!(:i {;)n '1,'. !-'1('Y' ::<';;,::,t,):-:-:'ir;~.:.:'ri'(:" F:')t.;:o~,~;:.P ,~,~,:,!'I:Ur"n \,\Il'f:,h "-,/Ol..\!'" Pl::,"/t1~~~:'nt" '~,',h;.;:: 'i;~l::':'C.-::H'Y('J il'jVo:i.;'::f;; ,-::01:)':;..'" 1"":1"'>' p.:Yl';./i1H..:;"~ ;:.~;~ i"'E,:~<::('':'':L'/'::':'{[ ,,~:'f'l;,<<-:-F' ::::/6/.:7:000- ~l"b' nQ'!:, !'''\;;,:,'1l11,.:~r(::t.\':'H:~ ':JI'~ thi~:~ ':!:" ':"";'" .,; ~:.:'t";l.::':\<.., .':;. i') :;, "'::"0.~::.:':';' ,:J;:::"Cil,.c r:: t. {!\(1 V ,;:,c:1 d:i i:. 'l. on ,0 I P~;\';/(fH.:-:-rl"l:. ::~ ~;/OU, m,:ry. h-:,:..\i(-? {:kitci \."!: ::'1',,;".; 1"~:..:'H,'i.t '~..h(,:,:. b\i1,::,-,":\l,tr::<!..~ f'rr..~tTI{:,'i.n:Ln\.:,l" Th,.~).n~". YC1U.. . -.' -.. ;:;} ';;, 8, 'l:,~:~;'n,::.\f'" -i.', ~~:;c'i>. y' ~.:' n ;.':;,.. f' ndd \"~<:',~~mi.:) 1".:i. ~(', :'i. !":'-::'fn(.~\ ';.o(}<> t,l'::?-':::, t:, HC)t! t, h- E~ t. t+..;:-:.~'0.' t C'~y],i~~lR.. F'ft ::7013 .... f"'~], I:,?: ~::,I",01'\':1'J:: ( ?:i ?', '?q ';:,.." ;1~:L H ';? 8t~~emen't Da't8n 02/16/20()O L.. '::-;,'d :L ~';'.. Du ;~' 'fl e " (}" I{,:) '):. ,?;,~ W~lnl~.t Bc).t.tom, ~'A :l7266 1)t;e l)~~e~ 02/28.~2000 r':':,.::<J: F'~i\ul i~ Dur"f' r:':'I<,:".;:-:c)u.nt !'.I!,'l: :1.0J.Ot.~:L :(;'i~ 'l:.(.:,:. D.T:'!~::.C\"NJ. t:)'l', i C.rn D.;I,.Y~;;' OU4l.n t C;h':li"'Ct,':i..m I::' aj'n\E)n 't ~i; F;~6\ 'l~ f::' Pio;'~L.t'\r.tC!:~ FOFi~l}J(::-:F~}) (1:\'/'1 ':.::-'/<y> "E~Ii:'~i.\U ty .i?: Hir<.l"j~\,~)i'" ,~:r:L/::';:i./OO Inc:()n'~:.inc.:,\nC€1 '2;:'J.po],:L ():I. /~:,~,; 1 /CiO ~"rC;!(:! :f. c~~..l SU,f)i:": 1. :Ll':j!:S O:~~~/O:i,./:)<'j: !~~t)C;iil' P.;~ F.~.~),,"Rj"d ,~, ~::.'::~mi 1. 4 ~ ~~,~-:.t.-\... Ol~ :l,,()O 7.,00 ,q,\S..tiO B,q,,60 :l.~;.;,..I)O '?"OO ll,f.\",:qO ~:~,q .. 60 1,,00 ~, ..00 2"7 1.1, ~( :~:: ()~) .~ () () ;,,;[I'!'E\; ~;:"f0!~':1,~::,::! i""'-':'~ffi1.'I,~ r."~/ ;;;'i:::BF~i,f01F"'( '\:~~:~.~ ~'~(JO<)" trtf.~ i,..~,:~';i;'t ~;\!llclc\n t ~'II''':i.n "tEY':'i on -1.:1111-:;' pt;\,"-/m(':':'ri'~:,:, '1:1.',0.' ::~;:.\)C~:)nC :;,nVC':LCI::~' cop>"',, i\,'::,.;;i.';'J:,\"fj;:;7'n'l:, " F;':l,t:::'-i:\':;'I":') l"'-::.:d:.ur""\ W:\' "':..:.'1 /':::'-U.!" {:iiUl'/ ':,;'~".'i':';.\~.:,'i-;t~:, )"'"i';":'C1f'lV(.:!d <).'~:l:,(.;:--r' ~;:/?/'~';~()()O :'!!,i"e not l~'\-~'''f,L'i;."~,:''u':-?d D1"'( tl'''':t.~--:~ i:: .\:, :.~ '1:,':.:~'iTl'::":": t:; P :i, ~:i'~:'~~:',I:':" (I i~'''l-:; U, .::; l.', ,.':~r", 'i.< l;',tj d 1. .t:L on 0. :1, p~'il. /f;j.~:,'n 'i,' -::; ,>"q(J. m,::\>/ i-,.:-;,V'(~ in~it,~,:l \,:.:. :,"1,1"'1(;: !-""7i.",:;\:L'::, '\:1"'i(:' btl,'i-.::',nf::(.;':' 1'.";'~';:"",i.~1,n:Ln9" ri"'\.~\n~'.', "{Ot..!... B~'i,:L f-.'l.1""! c:e ll~ [-l :::::..S~1- ,,04 1 ;',\ :1 ~'::7:t " 04 ),(~. ~l ;'3:L '7.. t{t.'~ l,:'~ '" 4()A':~" O!,ll :~ ~:~, 60',? .. 04 , '. r,;1,;;'. tl:':\'if!l,l\\(') t bf.l !r'.;;'~ }H, ;:;1 "'i c';d d j....\.:-?!lne'r ~;, (:I.:\' f'1,;)me~ :~, ':-,' (,<> :// f.',' ~:~ .t:, :-::;";') u "'__, i", :::~ 'i: C:~~"','iq;J,p, PA l70:~J 'r~1~1:)t~(:1~10: (71,7) ?45'-'2~,~~7 ~tt~'t~m~n't DA't8: 01/25;'200() L" 1"(~ 'i. ,;;\ uct~... "i~ ('"D.. X~{C1J:: 9f:~ Du,;,) l.).i,t 'tv..:' :~-- 02:/0n/:?(>oo ~!~'j.nt.l.t BC)ti~o(n~ PA 17266 l;>.:.:-!':-: f::',::?,l},]. Fi: ))~,f, ,.-'f (..'~ c;'; ~:: (:~ !"i, n t N yo :: :l.r)'l.Or.{ i. :D'if,ti~! D<<,~ ::~ ~:: V" i D t :i. ('.q"1 D~Yl~/':I; ChVBU'l"t. F;': ~'{{ +,(,:.~ C h '::1. r' q G~ ~!:, P ~!\.,/m~:;-;i"l t. .t;:_ E(~~".(.;lh;CE F();:::j,,l..J!::-l~:\i) :~.2/3~!99 Tr'lcclrr.tii'lenc2 SIAP[~lj. ';.,:::' ,';,3:1./99- !."~:t:~\d::,c<':\:;. S;upp:\ :i,>:,'J1's ~):L/!jJ,/OO RI~~Jln & Bo~rd .. !~8In3 9'~;64:':')" 19' j. .. 00 ~;'::~}.. :?O :~;':S" :,::':<> ., ,,00 1.():::~" 6!.5 3:L :L,('I~:,:;"OO :l. O~':~ " (;.~ ~,:.) ,q :ll,~<?~)" 00 hiOTC ~ , " , ~, ' .i, if::- ::', ~\:,r.':~,' \'~' F;.'HI:t. :1, f'i j. ':.:! 1) ::', ".":!~ '1 ;I",~;1- t ",.\mC:.l'l.:;:r'l -t, \:';\'" 'l.l'\ t~:~.,tl (".)on ~:~ ",~.,(~ 't,I:?.';n~:D'n 'f, .. '"' ". :,'.I.':~ .::~.:.~'!'\ .;:. t,;"l 'L 7.:"~ ':/('-"..1./" i:)-i:.\ y'm':~Jn t :L C;CJ ::i'/ c:J f i n",.IC: i ,:::.:-:-'f" '''',;'j':'/ ::'i,:,,",ym,~:.'.n-\'.':;l ~-q'~C';'::':1 'v'(.:,:.Ci ,,"'''I~.ti.::.'i'' t/.~:''L,/O') <;\I~';':'\ n4;)t t"~~'f~l~~'.'ct(.;:.d on 'l.'.h:i " ::'..~:...;..'i:,~~:.ir'..~f~pt:: fJ'~""':':;'''~:;I:':~ ['l(';:~:i'..{ct .::;,ny ;:$:~i:1'i t:i,cn.:.,l l:l,:';$"f1):2<nt.:t, ';lC.1.,\ m~','(:/ n,"\'v'f.' fl't;;\;(JC.? ',~pr:i t"~'~m-j,+. th(:,:. b.f.\J..;'?~~~!"::,~.:" i'"\~>::m,.:\:i.nil"Jq" T!'v:"{n;,:, Y'DU... F:.:tt1 <ilt'l r:.f:':: 9,643.1.'" "I ,,~I.b ,,:3'1' "t,7l.<f'"of.{ 1.4" cu,,,!. 0'1 "flifT!r' "r'"'.'!''"'. ~ '.. ~ ~-:1ta 'b~~NH~n t Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 (717) 245-2187 L.yd j,,-, DUI'''f f""O. Box 9B W.-.lnut Ht~th)m,. PA :1.7;~66 Bt<.d,010\ent 1)a't(,;): 01/0~,\/~~OOO 1)U(,;~ Da 'te r. ():I. /:1. 9/2:0()0 Re: 1"',,,-\.<1 R OUI'''!' Account Nrl :1.01041 1)", t,E'! l)€-~S;CF':i. p-t:i.c)n r(",te _...~..~,._...._. .__.__''''_''._NNN''N_''_ .... ."'NM ...,._.._ ........ .,., .............." ........_......._.__..., .m.__. ............_..__......_.... ...._._..... ...._....__ '_..___M'_....._....__ ........,_...'_.. ........_......m --..- ".. B.i:ll';il.n c:e-~ D.c\ys;, Quan t Ch('i\i"'gf:?'ii~ P'l!\ym,*:ont'l:;. no"........ .................... ........ __....,,_.._.......O' ,_ "...... ,... m.",' ....,." ____ m...............".... ".._............___..___""__ .._.... ........ "..".........._. _. _..... .... _'''.._.._......... _..._ ,." ....____._ __"00___" ...."..-.... BALANCE: FOHWAI":D 1 1./0:1./9<1' F~n()m & BOcl.t~.d "~ 8f:~mi U./IO/99 B~o<,,-uty 8< B,"-rbe.'" :1.:1./30/99 Inc,cmtin"""Clf1 f:>uppli :I.:LF30/99 l"l...dic:al f.-luPI31i(~s :t~::/Ol/9(7 Rc)om &; BO<:'\I'.<:I -. 8t:Nrd. ;';0 LO() :1.,,00 :I. "O() ~:):l. :L3~3.00 '7" ()() 34"BO 1.1~~..~::5 1 ;',3 " ()() 'j Pl(.:.;o.a~~r.':-:o l~.(.?mit P<:'\ytrH~nt in t~:.=. D.::'"l,y~~.. F'lf!!.a"E~t: p.cI.Y l~.;\-sj.t 6\trl(;)Unt pl...:t.ntG~d on -s;t6\'t.c.,;,mc.?nt.. I'f you fIl.::),dc= ~':\ p~'il,ym~:~nt :i.n I)f!~c.. :t999!1 ple~:\i:j.r0 deduct amoLmt paid from the last line i:ll'H:i l"'c~\i1li t the b-ib.l-.':\ncr.~ r'f~m.;:d.n:i.nq.. ^,q-""",'~-~,~;, - ',' "I 'I, 1, ::,'76,,:1.4 3"99(),,OO '7,,()O ::,4 " ElO :t.1.~~.. ~~5 4,. l ;:~:;, " ()() :L,,~P<'>.l4 5,,:~66,,:1.4 ~)!I :::r7~::;.. :tt.+ 5,40'7" 9't ~) 11 E\~:~O " :1. <;> 9,,<'>4;3.:1.9 ""~ ~ :1" I-'~~ ~-- , ,~.., L-2j.' . sAJiAH A. TODD MEMORIAL HOME ,.1000WE~tSQUTHSTREET . . . . ..CARLlSLE, PA 17013 pi-lQNE (717) 245"218'7.. AMOUNT OF 1$ ." dr:~ . . "" ,. ...' ' ,i , " :. ,. ....,. ,.,' "., .... PAYMENT . "..~ ,- "., '" RESIDENT NAME RESIDENT NUMBER SEX AGE ADMISSION DATE DISCHARGE DATE STATEMENT DATE DI..H:;':F' F'P,UL. F~ ()OO1.()1.04:L j\1 ~~~ !,:\ {?/:~~9'/':)9 10/:.':~:L/9('.? I L. YD]'{.', DI.JFW F' ,,0.. 'BDX ';~~::: E w. ~AIN Sl~E~r ~iJt-IL.-I'..jUT HlJTTOF\ PPI :!. ]~::,:::,6 }:<****j(~*~'{<******;:-:<******X<****)-k*}K* ******** HAI~I~Y ******** ***** TH(':-d".I!<~;~G}IVII..jE; ***** ***************>:<************** ,',' PL.l:::PISE i:;~EFIIT B.Y :l. :L/;;:~I..}/(?9 . .-, .',." . . . " , ' " ~ :::,".,':' ' ,', ',,' " . ' ..., ".kEf\~~bETf\6~;iN6RETURN THis PO~~i6i!~\J~rO(j'~!~~Y~:~0-{.':": PAEVIOUS BALANCE I $ , , " ~' ~ :,'. . ' "e'.'..:":,::',,-__ DATE TRANSACTION DESCRIPTION UNITS :L.OO REFERENCE # AMOUNT :L O/06/';y9 :to/~:~8/9~? 10/::;:1./99 Br-IF~BEJ\/BE~l~tJT Ie I f~l-...j SER\lTC!~: C[0PAYr~~r DUE FROM RESIDE~r. 3 U..:IJEL. 3 HC f:','~C:CI."ITY DAYS (~ 13:;:\. 00 MEDICAL SUF?L.IES F'E::i:~BC)Nf.)L_ L~'1~4UNIYF~Y- :t O/~::9....:1, 0/31 7'..00 ?60.,O() ::;'~9(.v..OO j,()/:3:L/.9? :1. 0/:3:1./':;/9 :L ,,()() B" .;;'~'4, :l." ~:y; :L I/O)]?? :'lO .i...I,.IJEL :i:\ O-lC' FACILITY DI~Y~:> (~! :1.:::1::5.. ()() ::)S'(?o..oo STATEMENTDATE :1.0/3:L/?':; PfiEVI9US ~Ai..ANC~,,' dURRF:NT 9.HARG,ES', .. 00 :1. ::r7 t~ " :l f.f CURRENT ACCT"BALANCE l :3 ',? ~:<;, " :L l~ .ADVANCE CHARGES,",~) :::?~:) ,:p 0 " 00 ,"'''' ... ;;;;~SARAnA.T(jDDl\1EMORiAtIi&~ ." ,<I:',~; :-:~;,:,: ,',',_,,'- :-\:" ;,,: ,,:.','. \,,'.tAf=i~.I,S,LF.',PA.j?,dl3"__'~:' ':~-:' :;::-,,::~.:~'->>,~~;,,'.,,:-,:;: ':, _".' PLEASE PAY Ill. THIS AMOUNT .. $ "T"; ::'1:':")66.. ~.4 ',,<. JUL-17-02 WED 07,49 AM MCKISSOCK HOFFMAN FAX: 7175403434 PAGE 17 . .' . . VERIFICATION I, Mary Jane Walker, hereby verifies that the statements in Answer and New Matter to Plaintiff's Complaint together with New Matter Counterclaim Pursuant to Pa.R.C.P. 2256, are true and correct to the best of my information, knowledge and belief. I understand that the statements are made subject to the penalties of PA.C.s. Section 4904, relating to the unsworn falsification to authorities. ~-!( ~,~ J).JJ{) Mary Jane Walker, Administrator for United Church of Christ Homes Va Sarah A. Todd Memorial Home Dated: /( , )'( . c{) 2c.. ,;~ ^' ~, ~--" '" r" ~,~ ~""~r t>--,~~ 'T r" .. III ,((~ ,. CERTIFICATE OF SERVICE I' i II !: "1 I,.....,' [: I'; I,: ~'< I';' " i> f' <;'J I hereby certify that on the date set forth below, I am serving a copy of the foregoing Answer and New Matter to Plaintiff's Complaint and New Matter Counterclaim pursuant to Pa.R.C.P. 2256 upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of the same in the United States Mail, first-class, postage prepaid, addressed as follows: I"~ ,>' I; " Anthony Adams, Esquire 128 West King Street Shippensburg, PA 17257 (Counsel for Plaintiff) L;~ rt~ II[ i;~': Ii r;: 1"- I I ,: i,," McKISSOCK & HOFFMAN, P.C. r::~, , ' r>:: j\;,; i Date: 7 ~9 /0 7 " ~, BY:~ Edwin A.D. Schwartz, I.D. #: 75902 2040 Linglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 Attorneys for Defendant, United Church of Christ Homes, Inc., Va Sarah Todd Memorial Home I,"~; li;-', i,~~ /'}c f ;'"::;~-~~,, ' "'" 'r"')' '>"">'-~',"" ,,",,-, ,_,---'-",~,'l' " ,~~'__"R)h "~'"","~ ,," >',1,', ,- ',;' , ,,,,~,r~!!' '~." ~ '-'\ ,7(,'"" 'c_' ",~,_", ,- ~ "T -" ",. '" . '''1- _ ,"" ,,,"',' ,:,<",~" '_"'~ ~ - "'-- ~",,'., "'~' ~,-," , ,..,....,. t, "'l" " ^'."-""" -J!l,":" ~ - - - - """-- ,~, < - ,. e" ",." "d,,"-- ,~- """~":c:'ft'IItfk'I@?-Y''':'''' ,;;:;, ""Y;f;"Yfr~f;'~jtil11t'~r[~;ij~~%':;Sf',~~~*i~ "~I ~ . . Cl , ~) ;~~ " "0 G, ,- ~ 'T '.. -':;'> , " 1 i",/ i , -< .. .. ~~~ " ) " , .. :;<; (~) '- .> c: :....) ( " I TI ~ , ::J >.t-:~ GO =< ~gJJ ~~~;f!!;j.l;Jlt~~~!I't$1n,~J R1-~,~~'I!J.w'Thlft"lfI;jJUI!!l!~~~~Rj:';' ';''r''-";;-_~_", " IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNlY - PENNSYLVANIA Lydia B. Durf, Administratrix of the Estate of Paul R. Durf and Lydia B. : Civil Action-Law Durf, individually and as the spouse of Paul R. Durf Plaintiffs vs : No. 2001-05810 United Church of Christ Home t/a Sarah A. Todd Memorial Home Defendant ANSWER Now comes the Plaintiff, Lydia Durf, by and through her attorney, H. Anthony Adams and sets forth the following: 21. Paragraph 21 is a conclusion of law to which no responsive pleading is required. 22. Denied, the Plaintiff has at no time signed any release or agreement wherein the stated cause was waived. 23. Denied, the pleading sets forth facts upon which relief could be granted. 24. Admitted that no cause exists against Defendant if the injury to Plaintiff was caused by a person, party or entity over which Defendant exercised no legal right to control. 25. Paragraph 25 is a conclusion of law to which no responsive pleading is required. '-'''' . ",,'",," ,'.-,;"j',,'I'~ 'I' ,,'- 1- , i r"''" '~~ll'-r-T'>J".'''~--- r'~n~' ,~ 26. Denied, Paul Durf at all times to the best of the Plaintiff's knowledge exercised due care and acted in a reasonable manner. 27. Admitted if true and proven 28. Admitted if true and proven :. 29. f" , i..; r i'c , Denied, as set forth in the Plaintiff's complaint the Defendant was negligent in allowing Paul Durf to fall. :' (~ 30. f ~ Denied, Plaintiff did not consent to the negligent acts of Defendant. I,'" , , r,'j ! 31. Paragraph 31 is a conclusion of law to which no responsive pleading is required. 32. Admitted 33. Denied, Lydia B. Durf never agreed to make payment of the charges assessed. f" 34. ! : Admitted, Lydia Durf has no personal responsibility for payment to Sarah A. Todd Memorial Home. j" !" 35. [". ":" Denied, Plaintiff is presently without sufficient information to form a belief as to the truth of the matter averred. ~, ~,., , [,l!!'" " . ' ~ "' 'r~' ,"",' 'I ," " .. , , 'i.i<!fiT,),~li1:Jiy,r--" c ~ '- . 'C '. ,"I~"~'.'Ul -- " . . ' 36. Denied, on numerous occasions Lydia Durf met with or conferred with the administration and staff at the Sarah A. Todd Memorial Home and complained of the costs and care given to her husband. 37. ~: Denied, Lydia Durf through counsel requested informal discovery of Sarah A. Todd Memorial Home records and related that the case would be dismissed if the records did not support the cause of action. This request made to Defendant's previous counsel has never been fulfilled. 38. ~,i Denied, paragraph 38 is a conclusion of law to which no responsive pleading is required. ,.< , k' 39. Denied, Lydia Durf was informed by her husband and an employee of the Defendant that her husband was "dropped" and suffered severe pain from the fall. 40. Denied, at all times Plaintiff has acted in good faith and in fact had offered to dismiss the caption if informal discovery proved that the incident did no occur. Defendant has never supplied the requested material. At no time even when Plaintiff offered to dismiss the action did she tie such dismissal to a reduction in the bill from the Sarah A. Todd Memorial Home. Wherefore Plaintiff prays the counter claim of Defendant be dismissed. Respectfully, '---,- ~~ H. ANTHONY ADAMS ATTORNEY AT LAW SUPREME COURT ID NO. 25502 49 WEST ORANGE STREET, SUITE 3 SHIPPENSBURG, PA 17257 'i<;''l'-<1'i'J,j'! ~ ',-' '1- - , ,~-.- 'f~f'"i.Yj''''['~-'-- ,", ~"'~1''' "~-""-J"~".--"'~-'" ~',"~'~<"' , . " VERIFICATION I verify that the statements made in this answer are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Date:'6'///;~O? ~r1A ~v 0-m;r , '''~'''~~~~ -~,~ ,,'- " 1- '," , . ~"~ " ~'"'~',"",- " ., ~'~< l,~lJL,j C5 #-1/ r ,~~im$ll!!~~Ul!!l';mr. '" -><~ "'~,. ..',i'; - '",u"~c':' :Tr~'i!L'~~"_ ~"" L'T' ",' r'4~~'i~r-~i]~j;"N:f~~u~--;t'^f'~n"';~i:W~,{P:~' o S; -0(; L1.;! -~', 7:,''-' 0> r' :;:.:::: i~8' :S -< " ~ co '-,7-0: 1'''-''.)- (- -" ':; --n \9 Ul -rn " :;' ?~;~ ,::::~ "'" :::a -< .1 I ! m~l'?k&;p,;{i-il!i!i'*,~m!;l\--'j\W~!.'4'Ny,~'-"~I"'.~i)\t"'~';,f-"q,'m-"",:l?4"l,*,"fj?';,,",~1l'1i-f.!:W%~,i8l1,i!'\!1~~lj!~!!!:N ;;i"""("-<'::T',' ,;; - tn" ~',"h" IN THE COURT OF COMMON PLEAS OF THE 39TH JUDICIAL DISTRICT" OF PENNSYLVANIA-FRANKLIN COUNTY BRANCH Lydia B. Durf Administratix of the Estate of Paul : Civil Action - Law R. Durf and Lydia B.Durf, individually As the spouse of Paul R. Durf Plaintiffs : No. 2001-05810 vs. United Church of Christ Home tja Sarah A. Todd Memorial Home Defendant PRAECIPE TO THE PROTHONOTARY: Please Dismiss the complaint filed by Plaintiffs in the above captioned matter. Respectfully submitted, i ~ \~~~ H. Anthony dams, Esquire Attorney for Plaintiffs 49 W. Orange Street, Suite 3 Shippensburg, PA 17257 (717)-532-3270 ~~ Edwin A. Schwa , squire McKissock & Hoffman. P.c. Attorney for Defendant 2040 Unglestown Road, Suite 302 Harrisburg, PA 17110 ;'! "~"'''',N'~,.. ,~" r > ,~', '~T ~ -" ., ~ _ ' ." ~~,'T, , ' \II!lIII ,0. ,,'~,,"~'~'1~",' ..,,,"'" 8' ~t "". '. " ....j"" ,,;;-x~lv'o'--'t"'--'~~~'-'.:t;"~"'ti'f'_':'f:":' 'tf"'~'a'-":'''i'~\ltii:'ffqt*'~'''4' ,cn:::i'f'r ''':;~'t'-~'0~thifti'] e a 0 W ~n s: '- -oCD J'" ~m z ..1.1 ZS;: N 2),.,;-" ,to- ,L_ kC7 -~-) :Po ~ Z " ""0 S--? 0 ?'"c ~ -I ,'.;) "> '::0 en -< _."l . ,"~!i'!!'!~iJt1$lW;W!!fl!~~l'!<ll,j~~>l~'li~(;f'W!'I'"-;;;-:V-'E{;":>o::")"i''- ,:,'~ ,,'~", ""~':;"""""'F!~'i"';;;""*'~"'~'~~"t~tiP;Y:-W''Y-;:)!!'1<I!!lIJ!fl\1_~J!i'' iJ":"lf1i"[]lir-m'-' t; l" r'~ f 11 Iii I I' r f:' I'" ~'" I'; f, u, 1<: f:~ ili.l I"~: I', Ii! I'..., . i"; , i': i'< i":'" ", I,:;:j .... i ~ i:;': ,';1 1 ' ~ I'" r,~ ' I':) 1'::- !,:" I'" "'J !,;;< iT! I':: I. j'/' I" " , i:'i ,'," I, f , , ":, , j"": i: n I "..". " .,' . \ LYDIA B, DURF, Administratrix of the Estate of PAUL R DURF and LYDIA B, DURF, individually and as the spouse of Paul R Durf, Plaintiff v, UNITED CHURCH OF CHRIST HOME tla SARAH A, TODD MEMORIAL HOME, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY CIVIL ACTION - LAW NO.: 2001-05810 JURY TRIAL DEMANDED PRAECIPE Please mark the above-referenced matter as settled, satisfied and discontinued with prejudice, Date: ~#~/<:\3 '. "Y""I~ ,,cO_ ,,,,, ,,"0 p ,~ ,'>'1'- ' Respectfully submitted, McKissock & Hoffman, P.C, By: Edwin A.D. chwa , Attorney I.D. No,: 5 2040 Linglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 Attorneys for Defendant, United Church of Christ Homes, Inc,. tla Sarah Todd Memorial Home '-.,1 ~'r~,o ^ "" ,_, ~ , i, , I I I l', j',: " ~, i [: !J ",' . '" ," ",~ , . ;. CERTIFICATE OF SERVICE I hereby certify that on the date set forth below, I am serving a copy of the foregoing Praecipe pursuant to Pa.R.C.P. 2256 upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of the same in the United States Mail, first-class, postage prepaid, addressed as follows: Anthony Adams, Esquire 128 West King Street Shippensburg, PA 17257 (Counsel for Plaintiff) Date: g-0-~~"" McKISSOCK & HOFFMAN, P.C. By: c#. Edwin A.D. Schwartz, E q 1.0. #: 75902 2040 Unglestown Road Suite 302 Harrisburg, PA 17110 (717) 540-3400 Attorneys for Defendant, United Church of Christ Homes, Inc., t1a Sarah Todd Memorial Home , ",< ^ ,r ^ - ,",,^ ~, ,~" -", _'I_'~"", c'----.,--, ". ',,' ,,___.--~'''' ' __ " ". --' , , !ll!!IIc"'-, ",_, ,,"',c, ,',."'""..'" .<<"..', " J~ , .~- '" , . ",~.,., _ o~ " "e;' ~ >"Ds~ltl'" ", T :;~' it'~tT"'T'vT."~'(111"I'ft' "?1<;~'4'\'Ofttt~r~';;!&'~' 'JttU:'it;}~~~ " 7g r.:J ~ Jl m .L1 l' \~ 8 ....... - ~ -. \ -..l::- -(l ~:::t..J ---..:1 ~ e; E ~ 1fJ (') f:;- -uG:;' Q)rp, ~~~~;: r-::.?--- <:;:----., -p.- zC", -p.c e z -j ~ c::' c,) o -Y" ~:: '-~) ;.'0 :.-, eJl " '?\;;: ----';-"! 7~1~i =:1 -~ :5:J -< "'" " ,,~~,,~~,~1jrn"~'-'<l!o""~'4;m-W~g1r"=-';1!l;R"',~i:%'~~i\\i<'-l!~~~~~~~~~~\~~'!i!IJ~~;'~;f~l,;"