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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
Inre:
No. 21-06-0177
PATRICIA A. EICHELBERGER,
an incapacitated person
ANNUAL REPORT OF GUARDIAN OF THE ESTATE UNDER
SECTION 5521(C) OF THE PROBATE, ESTATES AND FIDUCIARIES CODE
For the period: April 3, 2006 to April 3, 2007.]
1. I am the plenary guardian of the estate of the above-named incapacitate4.~erson. I ~B.s
appointed guardian by Order of the Court dated April 3, 2006, which has not be6n <rnodifie~y
subsequent Court Orders.' S
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2. The incapacitated person is living.
,
f'0
3. My initial inventory was filed on April 3, 2006 The inventory listed a totaIjstate ~ue . .
of $36430.63**. The inventory listed a total monthly income of$ O. comprising th~'fc>,llowini;
. "
**This value was mistakenly listed as assets of Patricia when in fact they are ass~ of
her mother Evelyn G. Eichelberger.
4. This report constitutes the filing of my first annual report.
5. At the beginning date of this reporting period, my initial balance on hand was $0..
6. During this reporting period, I received the following income for the incapacitated
person (add additional pages if needed):
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
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Date Received
April 3, 2006
April 10, 2006
May 3, 2006
May 6, 2006
June 2, 2006
June 10, 2006
July 3, 2006
July 10, 2006
August 3, 2006
August 7,2006
September 1, 2006
September 10, 2006
October 3, 2006
October 12, 2006
November 3, 2006
Source of Income
Social Security
Funds from EG Eichelberger(Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Amount
$910.00
$7,200.00
$910.00
$5,500.00
$910.00
$5,300.00
$910.00
$5,800.00
$910.00
$5,400.00
$910.00
$5,100.00
$910.00
$6,148.08
$910.00
"
16.
17.
18.
19.
20.
21.
22.
November 16, 2006
December 5,2006
December 5, 2006
January 3, 2007
January 10, 2007
Feburary 2, 2007
March 2, 2007
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Funds from EG Eichelberger (Mom)
Social Security
Social Security
TOTAL
$5,000.00
$910.00
$5,300.00
$910.00
$6,300.00
$938.00
$938.00
$68,024.08
7. During this reporting period, I made the following payments for the incapacitated
person (add additional pages if needed):
Date
1. 04/24/06
2. 04/24/06
3. 04/24/06
4. 04/22/06
5. 05/09/06
6. 05/09/06
7. 05/1 0/06
8. 05/18/06
9. 06/16/06
10. 06/16/06
11. 07/20/06
12. 07/20/06
13. 07/13/06
14. 08/23/06
15. 08/23/06
16. 08/23/06
17. 09/22/06
18. 09/22/06
19. 09/22/06
20. 10/20/06
21. 10/20/06
22. 10/20/06
23. 10/23/06
24. 11/06/06
25. 11/21/06
26. 11/21/06
27. 11/28/06
28. 12/22/06
29. 12/22/06
30. 12/22/06
31. 01/23/07
To Whom Paid
Highmark BS
Church God Home
Continuing RX
J. Bogar, Attorney
J. Bogar, Attorney
Dr. H. Burkett
Continuing RX
Church God Home
Church God Home
Continuing RX
Highmark BS
Church God Home
Continuing RX
Church God Home
Dr. H. Burkett
Continuing RX
Church God Home
Continuing RX
Highmark BS
Highmark BS
Church God Home
Continuing RS
Highmark BS
Dr. H. Burkett
Church God Home
Continuing RX
Highmark BS
Church God Home
Continuing RX
Highmark BS
Highmark BS
Reason for Payment Amount
Health Insurance $175.65
Nursing Care $5,985.90
Prescriptions $84.08
Guardianship $1,825.65
Filing of Guardianship $15.00
Foot Doctor $30.00
Prescriptions $80.11
Nursing Care $6,167.20
Nursing Care $6,024.00
Prescriptions $79.99
Health Insurance $418.65
Nursing Care $6,200.00
Prescriptions $74.79
Nursing Care $6,193.10
Foot Doctor $30.00
Prescriptions $44.79
Nursing Care $5,998.10
Prescriptions $74.79
Drug Coverage (IOmos) $265.50
Health Insurance $418.65
Nursing Care $6,143.90
Prescriptions $106.79
Drug Coverage (Imo) $26.55
Foot Doctor $30.00
Nursing Care $5,941.05
Prescriptions $74.79
Drug Coverage $26.55
Nursing Care $6,176.70
Prescriptions $80.05
Drug Coverage $23.20
Health Insurance $418.65
, 32. 01/23/07 Church God Home Nursing Care $6,568.40
33. 01/23/07 Flenniken Dentistry Dentist Appointment $122.00
34. 01/23/07 Continuing RX Prescriptions $192.11
35. 01/23/07 Highmark BS Drug Coverage $23.20
36. 02/16/07 Church God Home SS Amt. to Home $938.00
37. 02120/07 Guistwite Practice Doctor Appointment $48.19
38 03/13/07 Church God Home SS Amt. to Home $938.00
TOTALS $68,064.08
8. The present principal assets of the incapacitated person are:
Description of Asset Present Value
1. No Assets in Patricia's Name $0.00
9. The sources and amounts of income that I expect to receive for the incapacitated person
are:
Sources of Income
Amount of Income
(Indicate whether monthly,
quarterly or annually)
SS Check (Being Transferred to Church of God Home
$0.00
1.
10. The monthly expenses I expect to pay for the incapacitated person are:
To Whom Paid Amount
Patricia's Expenses Are Anticipated to be Paid by Medicaid
$0.00
1.
II. 10 have (8) have not (check one) requested and received permission from the Court to
invade principal to meet the needs of the incapacitated person. If you have requested and
received permission to invade principal, list the expenses that you have paid from principal
during the reporting period:
To Whom Paid Purpose
Not Applicable
Amount
1.
12. 10 have IX! have not (check one) paid myself compensation for services I rendered as
guardian. The amount I paid myself totaled $ [amount] and was calculated at the following rate:
[rate] per 0 week 0 month (check one).
13. If the incapacitated person is living, please check the correct response and complete, if
applicable:
(a) IX! There will not be a need for extraordinary expenditures on behalf of the
incapacitated person in the next 12 months.
(b) 0 There will be a need for extraordinary expenditures on behalf of the
incapacitated person in the next 12 months because
.' 14. If the incapacitated person is living, please check the correct response and
· complete, if appropriate:
(a) 0
directly.
The incapacitated person receIves monthly social security benefits
(b) 0 I am the designated payee to receive the incapacitated person's social
security benefits.
(c) IXl The designated payee of the incapacitated person's social security benefits
is Evelyn G. Eichelberger whose address is 801 N. Hanover Street, Church of God
Home, Carlisle, PA 17013. The payee IX) is 0 is not (check one) related to the
incapacitated person as Mother (NOTE: ARRANGEMENTS ARE BEING MADE
TO HAVE PATRICIA'S SOCIAL SECURITY CHECK SENT DIRECTLY TO THE
CHURHC OF GOD HOME)
15. Please note any concerns about the incapacitated person's physical or mental well-
being or the finances that the Court should know.
16. I am the guardian of the person of Patricia A Eichelberger. My annual report is
attached as well.
I certify that the information contained in this report is true and correct to the best of my
knowledge, information, and belief This statement is made subject to the penalties of 18 Pa.C.S.
~ 4904 (relating to unsworn falsification to authorities).
Date: April 11, 2007
.~
Robert D. Eichelberger,
Guardian of Patricia A Eichelberger
182 Chain Saw Road
Dillsburg, PA 17019
Telephone: 649-7074