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HomeMy WebLinkAbout07-5537IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, . V. No. S'*S3 C l v t l .?"'t FERNE A. MILLS, Defendant. CIVIL ACTION - EQUITY NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyer Referral Service Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. No. FERNE A. MILLS, Defendant. CIVIL ACTION - EQUITY AVISO USTED HA SIDO DEMANDADO/ A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra sttya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Service Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, . V. No. O7 - 90*Y C.: I U. ?FERNE A. MILLS, . Defendant. CIVIL ACTION - EQUITY COMPLAINT AND NOW, COMES, Plaintiff, Manor Healthcare Corp. d/b/a ManorCare Health Services - Carlisle, ("Plaintiff ManorCare"), by and through its attorneys, SCHU17ER BOGAR LLC, and files the within Complaint against Defendant, Ferne A. Mills ("Defendant Mills"), and in support thereof, provides as follows: 1. Plaintiff ManorCare, a corporation licensed to do business in the Commonwealth of Pennsylvania, is a residential and skilled nursing care provider with its principal offices located at 940 Walnut Bottom Road, Carlisle, Pennsylvania 17015. 2. Defendant Mills is an adult individual who currently resides at 263 Allen Road, Carlisle, Pennsylvania 17013. 3. On or about October 23, 2006, Defendant Mills made application for the admission of her spouse, Wesley Mills ("spouse"), to Plaintiff ManorCare's skilled nursing facility. 4. On or about October 23, 2006, Plaintiff ManorCare and Defendant Mills entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff ManorCare agreed to provide Defendant Mills' spouse with skilled nursing care and services in exchange for her promise to pay a specific monetary fee from her spouse's assets and, in the event that he were to become insolvent, to secure Medical Assistance benefits in a timely and proper manner. A true and correct copy of the Agreement is attached hereto as Exhibit "A." 5. After Defendant Mills' spouse became a resident of Plaintiff ManorCare's skilled nursing facility, he apparently became insolvent. As a result, pursuant to the Agreement, Plaintiff ManorCare notified Defendant Mills that she needed to apply for Medical Assistance benefits on behalf of her spouse, and an application for Medical Assistance benefits was subsequently filed. 6. If Defendant Mills fails to provide the documents requested by the Cumberland County Assistance Office to determine her spouse's eligibility for Medical Assistance benefits, the application for Medical Assistance benefits referenced herein will be denied. COUNTI BREACH OF CONTRACT/ SPECIFIC PERFORMANCE 7. The allegations contained in Paragraphs 1 through 6 are incorporated herein by reference as if fully set forth at length. 2 8. Defendant Mills breached her Agreement with Plaintiff ManorCare when she failed to secure Medical Assistance benefits for her spouse, and Defendant Mills continues to breach her Agreement with Plaintiff ManorCare by failing to provide those documents needed by the Cumberland County Assistance Office to determine her spouse's eligibility for Medical Assistance benefits. 9. Defendant Mills' breach of her Agreement with Plaintiff ManorCare has irreparably harmed and continues to cause Plaintiff ManorCare irreparable harm. 10. Only a decree of specific performance will adequately protect the interests of Plaintiff ManorCare and provide it with the benefits and/or protections promised under the Agreement. WHEREFORE, Plaintiff ManorCare seeks a decree from this Honorable Court which orders specific performance of the Agreement between the parties. Respectfully submitted, Dated. 0/0007 SCHUTJER BOGAR LLC By17?"ft1 Chadwick O. Bogar Attorney I.D. No. 83755 (717) 909-5920 Maria G. Macus-Bryan Attorney I.D. No. 90947 (717) 909-8640 305 North Front Street, Suite 401 Harrisburg, PA 17101 Attorneys for Plaintiff 3 VERnWATION the undersigned hereby verifies that the statements of fact in the foregoing Complaint are trine and cormet to the beet of my knowled8a, hd6rnution and belief. I understand that any false statemems therein we subject to the penahies contained in 18 Pa. C.S.A. § 4904, relating to unworn falsification to authorities. Dated: 4/?Y Amy Marsh, inew Office Mater Manor Healthcare Corp. d/b/a ManorCare Health Swviaas - Carlisle EXHIBIT "A" Y -r_ 1. PARTIES, ADbUSSION DATE, AND DEPOSIT The following are parties to this Agreement: A. Center (We, Us, Our): ManmCwe of Carhsle == B. Patient (You, Your): Wesley A Mills ` C. Responsible Party, if applicable (You, Your): Admission Date: 1x23/2006 Deposit Amount: $ 0 2. CENTER'S RESPONSOM17'IES - ' We will: Y. A. Provide You with a basic room, board, cow facilities, housekeeping, lawAcred bed linens, :. general musing case, personal wseasarent, abcial services, and other services. .# B. Apply Your deposit, if any, to Your first onj or two months of Yonr stay at om*r . C. RdUnd any www is owed to You within 301 days or within the time fame required by state law after Your discharge or transfer. 3. RESIDENT'S RIGMS AND RESPONSOMn liS 3.1 You have the right to: • r: A. Choose Your own personal physician ae lon? as the physician is properly licensed and caorpliea with Our policies and procedures. B. Choose Your own pharmacy as long as the #harmau complies with Our policies and procedures y and operates in compliance with state and laws. In order for You to rwav pamscron fi?deral drug coverage under Medicare Part D, the must have a contract with the Part D plan _ You select. 3.2 You will: A. Pay Us: ' 1. the roam and board rats for all days14 You reside at the Center including the day of admission. Unless you are covered w4er Medicaid or an i mmee plan that prohibits it, We may bill You for a late fee if You do leave tha Center before 12:00 pm. on the day of Your discharge. The ]ate The will re$ t any charges accrued by You while in the Center after ?^< 12:00 p.m. on the day of Your . If We change &a room and board rate, We will = { notify you in writing 30 days befim change. (Room and Board Rates are listed in Attachment A). 2. all additional ancillary charges accrued by You mobile in the Center. (Ancillary C huges are described on Attachment B) 3. any co-insurance, deductibles or reimb You receive for non-covered services if you are eligible for any insurance or gov mental program twlm ing Medicare, Medicaid, or Veteran's Administration. 4. Any additional or denied charges that a re not covered by Your ftenm nce cornpany's benefit or '.:.' third party payer : . S. within 30 days of the date on the bill. We hire a collection agency or attorney to collect .?, psyrrir.rit on Your account, You will pay for these collection costs. ' 1 .?3 ?7, B. Pay other providers, mcludmg Your uland" physician, directly 8or we they provide to You. C. Notify Us of Your coverings vmder any i»foranee plans or goverz anew progrms. D. NatW Us in writing within 5 days if Your coverage under any insurance plans or govcmnent programs changes while You an at the Center. E. Assign Us the right to bill and receive money directly Dam Your insurance or gove m od payor. ~ You authorize Center and any holder of medical or other information to release such informmbon to due Centers for Medicare-and Medicaid Services and its agents and to third party payon any information needed to determine Your beneft and Our right to receive payment F. Pay for any damage You cause to any person or property on Center grounds. G. Abide by our policies and procedures. 4. RESPONSMX PARTY'S RESPONSIBILITIES You will. A. Have legal access to the Patient's mcom or resources and deliver any documents supporting such anltority to the Center. B. Pay for all charger that Patient incurs while at the Center front the Patient's income or resources. C. Notify Us immediately and in writing if the Patient's financial resources are depleted. D. Secure Medicaid in a timely and proper manner. R Cooperate with Us by providing in&nwrtion about the Patient's lmaaces. F. T=ndar and accept the Patient when it is medically appropriate to discharge the Patient finer the Center. a. Abide by Our policies and procedures. H. Not n9uppropriatc the patient's income or resources or use them for the beoeSt of wrneone other than the Patient, I. Be personally liable for the payment of all charges if Yon fail to fulfill your other respon:?ibties under Ibis Agrearoent. 5. CONSENT You consent to allow Us to: A. Use and disclose your health information for purposes of trcammeat, payment, or health can B. Treat You to maintain Your well being. . C. Photograph you for identification purposes. 6. TERM AND TZRM1NATioN 6.1 Term This Agreernent begins on the day You are adrdned to the Center and ends on the day You are discharged - from the Center mleas you are ram within 15 days of Your &wJwge date. If You are readmitted within 15 days of being discharged from the Center, this Agreement we'll continue in effect as of the date of Your re-admission. 2 62 Termination A. By Yon: You may ternmoaate this Apvmmt: 1. immediately if you leave the Center because of eminency, or 2. by providing 7 days written notice of Your intent to leave the Ceder. B. By Us: We may ternamte this Agreed and discharge You from the Center by notifying You in writing. When legally mpued, We will notify you at lent 30 days prior to Yoor trmuft or discharge. In cases where the safety or bean of You or other individuals in the Center may be each age red, or if other legal ressoms exist, we will notify You as mom as practicable before traaefa or discharge. ' We can terminate the Agreement for any of the following reasons: 1. Yota needs cannot be met in the Center, 2. Your health has m9kimitly in;psoved so that You no longer need Our services; `f 3. The safety of other individuals in the Center is endangered, 4. The health of otter individuals in the Center is endangered, 5. After appropriate notim You have failed to pay for your stay at the Center; or 6. We cease to operate the Center. 7. ACKNOWLZDGMBNTS You aclmowledge that You have res roved the following ate: A. Room and Board Rate -AtteclmncutA B. AnoMary Charges - Attachimea B C. Notice of Informmtion Practioes and Receipt of Notice of Informtku Practices - Agachoients C-1 and C-2 D. Resident's Peraomai Trust Fond Agretsrme nt- Attachment D E. SNF Medicare Deternamation Form - Attachment E F. Medicare Secondary Payoar Questionnaire - Attaclmmeat F G. Sunmo mry of Limited Treatment Policy Attaclmoent G H. Medicare and Medicaid Informution I. Patient Information Handbook I. Center Supplement K Resident Rights By signing the Admission Agreemrmeat, You aclmowledge that you have ben given. and have read this Agremmt in its entirety, and all its attachmcm. You agree that all information subneitted as part of your adtn ission these Center is true and correct. You acknowledge that the Center relies an the accmracy of all information submitted by You or on Your behalf in determining whether to admit You to the Center. By signing below, the parties agree to the larnrs of this Admission Agreement: Patient Date Can* Reprase-nutive Date 3 i If applicable: a. !or 23.06 Reaponable Party Date Responsible Party's Telephone Number w d` Cl) `z3 Cdr f 3°i s` ? s 1 N ca c.7 to CTi Q 9m OT ?Y IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. FERNE A. MILLS, Defendant. No. 07-5537 CIVIL ACTION - EQUITY PETITION FOR PRELIMINARY INJUNCTION AGAINST RESPONDENT FERNE A. MILLS AND NOW COMES Petitioner, Manor Healthcare Corp. d/b/a ManorCare Carlisle ("Petitioner"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the within Petition against Respondent, Ferne A. Mills ("Respondent"), pursuant to Pa. R.C.P. § 1531, and, in support thereof, avers: 1. On or about September 20, 2007, Petitioner filed its Complaint against Respondent. 2. The Complaint sets forth a claim against Respondent relating to Respondent's breach of her contractual duties owed to Petitioner when she failed to secure Medical Assistance benefits on behalf of her spouse, Wesley Mills ("spouse"), per the Admission Agreement into which she entered on October 23, 2006. See Exhibit A to Complaint. ORIGINAL 3. The very nature of Respondent's breach of her contractual duty presents an issue of immediate and irreparable harm to Petitioner, as the application for Medical Assistance benefits filed with the Cumberland County Assistance Office will be denied due to the lack of necessary documentary evidence to qualify her spouse for Medical Assistance benefits. 4. The requested injunction would restore the parties to the status quo as it existed immediately prior to the breach of Respondent's contractual duty. 5. Greater injury would result from the denial of the requested injunction than from the granting of the same because absent the injunction, without the documentation necessary to qualify Respondent's spouse for Medical Assistance benefits, the application for Medical Assistance benefits filed on behalf of Respondent's spouse will be denied. 6. Petitioner's right to relief is clear. See Complaint attached hereto as Exhibit "A." 7. Petitioner lacks an adequate remedy at law, as upon information and belief, at all times material hereto, Respondent's spouse has been financially unable to fully compensate Petitioner for the care and services that it rendered to him. 8. A bond in the amount of $100.00 should be adequate in the event that it is later determined that the issuance of the instant petition was in error. 2 WHEREFORE, Petitioner respectfully requests that the Court schedule an immediate hearing on its request for injunctive relief and thereafter issue a decree ordering specific performance of the contractual duty of Respondent. Dated: Cf /?-o Z - ( 00-7 Respectfully submitted, SCHUUER BOGAR LLC Bradley A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Maria G. Macus-Bryan Attorney I.D. No. 90947 (717) 909-8640 305 North Front Street, Suite 401 Harrisburg, PA 17101 Attorneys for Plaintiff 3 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Petition for Preliminary injunction was sent to Shinkowsky Investigations to personally serve the following Defendant: Ferne A. Mills 263 Allen Road Carlisle, PA 17013 Dated: q I D-2 10 7 By: LIU& l'. ?--- Catherine Klobucar, Paralegal IN THE COURT OF COMMON PLEAS CUMBERLAND COUN'T'Y, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, V. Plaintiff, No. e)l -ss37 FERNE A. MILLS, NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Defendant. CIVIL ACTION - EQUITY Lawyer Referral Service Cumberland County Bar Association 32 South Bedford Street C- o Carlisle, PA 17013 0. . (717) 249-3166 o (800) 990-9108 `= 3 L -- I ?w . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. No. FERNE A. MILLS, Defendant. CIVIL ACTION - EQUITY AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Service Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990=9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a 1VIANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. No. FERNE A. MILLS, Defendant. CIVIL ACTION - EQUITY COMPLAINT AND NOW, COMES, Plaintiff, Manor Healthcare Corp. d/b/a ManorCare Health Services - Carlisle, ("Plaintiff ManorCare"), by and through its attorneys, ScxvTjF.R BOGAR LLC, and files the within Complaint against Defendant, Ferne A. Mills ("Defendant Mills"), and in support thereof, provides as follows: 1. Plaintiff ManorCare, a corporation licensed to do business in the Commonwealth of Pennsylvania, is a residential and skilled nursing care provider with its principal offices located at 940 Walnut Bottom Road, Carlisle, Pennsylvania 17015. 2. Defendant Mills is an adult individual who currently resides at 263 Allen Road, Carlisle, Pennsylvania 17013. 3. On or about October 23, 2006, Defendant Mills made application for the admission of her spouse, Wesley Mills ("spouse"), to Plaintiff ManorCare's skilled nursing facility. C?(Oplv 4. On or about October 23, 2006, Plaintiff ManorCare and Defendant Mills entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff ManorCare agreed to provide Defendant Mills' spouse with skilled nursing care and services in exchange for her promise to pay a specific monetary fee from her spouse's assets and, in the event that he were to become insolvent, to secure Medical Assistance benefits in a timely and proper manner. A true and correct copy of the Agreement is attached hereto as Exhibit "A." 5. After Defendant Mills' spouse became a resident of Plaintiff ManorCare's skilled nursing facility, he apparently became insolvent. As a result, pursuant to the Agreement, Plaintiff ManorCare notified Defendant Mills that she needed to apply for Medical Assistance benefits on behalf of her spouse, and an application for Medical Assistance benefits was subsequently filed. 6. If Defendant Mills fails to provide the documents requested by the Cumberland County Assistance Office to determine her spouse's eligibility for Medical Assistance benefits, the application for Medical Assistance benefits referenced herein will be denied. COUNTI BREACH OF CONTRACT/ SPECIFIC PERFORMANCE 7. The allegations contained in Paragraphs 1 through 6 are incorporated herein by reference as if fully set forth at length. 2 8. Defendant Mills breached her Agreement with Plaintiff ManorCare when she failed to secure Medical Assistance benefits for her spouse, and Defendant Mills continues to breach her Agreement with Plaintiff ManorCare by failing to provide those documents needed by the Cumberland County Assistance Office to determine her spouse's eligibility for Medical Assistance benefits. 9. Defendant Mills' breach of her Agreement with Plaintiff ManorCare has irreparably harmed and continues to cause Plaintiff ManorCare irreparable harm. 10. Only a decree of specific performance will adequately protect the interests of Plaintiff ManorCare and provide it with the benefits and/or protections promised under the Agreement. WHEREFORE, Plaintiff ManorCare seeks a decree from this Honorable Court which orders specific performance of the Agreement between the parties. Respectfully submitted, Dated.. SCHVTJER BOGAR LLC By Chadwick O. Bogar Attorney I.D. No. 83755 (717) 909-5920 Maria G. Macus-Bryan Attorney I.D. No. 90947 (717) 909-8640 305 North Front Street, Suite 401 Harrisburg, PA 17101 Attorneys for Plaintiff 3 VERIFICATION The undersigned hereby verifies that the statements of fact in the foregoing Complaint are true and correct to the best of my knowledge, information and belief 1 understand that any false statements therein are subject to the penalties contained in 18 Pa. C.S.A. § 4904, relating to unworn falsification to authorities. Dated: 41,1e1161--1, Amy Marsh, iness Office Manager Manor Healthcare Corp. d/b/a ManorCare Health Services - Carlisle Pmnsylvaala - ADMISSION AGREEMENT 1. PARTIES, ADMISSION DATE, AND DEPOSIT •r. TU following are parties to this Agreement: . i A. Center (We, Us, Our): ManorCare of Carlisle B. Patient (You, Your): Wesley A Mills r C. Responsible Party, if applicable (You, Your): Admission Date: 10/23/2006 Deposit Amount S 0 2. CENTER'S RESPONSIBILITIES We will: A. Provide You with a basic room, board, common facilities, housekeeping, laundered bed linens, general nursing Care, personal assessment, shoal servlce3, and otha aervrces. B. Apply Your deposit, if any, to Your first on* or two months of Your stay at Center. C. Refund any amounts owed to, You within A days or within the time frame required by state law after Your discharge or trawdbr. 3. RESIDENT'S RIGHTS AND RF.SPONSIBmirts ! 3.1 You have the right to: •-t ' A. Choose Your own personal physician as lon* as the physician is properly licensed and complies with Our policies and procedures. B. Choose Your own pharmacy as long as the jharmacy complies with Our policies and procedures - and operates in compliance with state and laws. In order for You to receive prescription ? =. drug coverage under Medicare Part D, the y must have a contract with the Part D plan You select. 3.2 You will: j A. Pay Us: , 1. the room and board rate for all days tb* You reside at the Center including the day of admission. Unless you are covered unc?r Medicaid or an msureace plan that prohibits it, We may bill You for a late fee if You do leave the Center before 12:00 p.m on the day of Your discharge. The late fee will refle t any charges accrued by You while in the Center after ` 12:00 pam on the day of Your discbar . If We change the room and board rate, We will notify you in writing 30 days before fbe: change. (Room and Board Rates are listed in ` Attachment A). - 2. all additional ancillary charges accrue by You while in the Canter. (Ancillary Charges are described on Attachment B) 3. any co-insurance, deductibles or reimbursement You receive for non-covered services if You - - are eligible for any insurance or goverr mental program inchtdiug Medicare, Medicaid, or Veteran's Adnvnistzation. - 4. Any additional or denied charges that are not covered by Your inairranm coaapany's benefit or ' - third party payer 5. within 30 days of the date on the bill. We hire a collection agency or attorney to collect payment on Your accoemt, You will pay for these collection costs. t o 4. 5. 7 °t B. Pay other providers, including Your attending physician, directly far care they provide to You. C. Notify Us of Your coverage under any msmmnce pleas or govermtent programs. D. Notify Us in writing within 5 days if Your coverage undo any insurance plans or govemsinent programs changes while You are at the Center. E. Assign Us the right to bill and receive money directly from Your insurance or government payor. You authorize Center and any holder of medical or other information to relea se such information to the Centers for Medicare-and Medicaid Services and its agents and to third patty payors any information needed to determine Your benefits and Our right to receive payment F. Pay for any damage You cause to any person or property on Center grounds. " . G. Abide by our policies and procedures. RESPONSIBLE PARTY'S RESPONSIBILITIES You wdl: A. Have legal access to the Patient's income or resources and deliver any documents supporting such °.. autbority 10 the Center. B. Pay for all charges that Patient incurs while at the Center from the Patient's income or resources. . ` ` C. Notify Us immediately and in writing if the Patient's financial resources an depleted D. Secure Medicaid in a timely and proper manner. fi Cooperate withUs by providing information about the PstierrVs finances. F. Transfer and accept the Patient when it is medieariy appropriate to discharge the Patient from the center. G. Abide by Our policies and procedures. H. Not misappropriate the Patient's income or resources or use them for the benefit of someone other ' than the Patient. I. Be personally liable for the payment of all charges if You fail to fulfill Your other responstibrMea under this Agreement. CONSENT You consent to allow Us to: A. Use and disclose your health information for purposes of treatment, payment, or health care operations. B. Treat You to maintain Your well-being C. Photograph you for identification purposes. 6. TERM AND TERMINATION 6.1 Term This Agreement begins on the day You are admmtted to the Center and ends on the day You are discharged from the Center unless you are readmitted within 15 days of Your discharge date. If You are re-admitted within 15 days of being discharged from the Center, this Agreement will continue m effect as of the date of Your re-admission. 2 l,r 62 Termination A. By You: You may terminate this Agreement: 1. immediately if you leave the Center because of emergency; or 2. by providing 7 days written notice of Your intent to leave the Center. B. By Us: We may tetrainate this Agreement and discharge You from the Center by notifying You in writing. Where legally required, We will notify you at least 30 days prior to Your transfer or discharge. In cases where the safety of health of You or other individuals in the Center may be endangered, or if other legal reasons exist, we will notify You as soon as practicable before transfer or discharge. We can tertrrinate the Agreement for any of the following reasons. 1. Your needs cannot be met in the Center; 2. Your health has sufficiently inrprovod so that You no longer need Our services; 3. The safety of other individuals in the Center is endangered; 4. The health of other individuals in the Center is endangered; 5. After appropriate notice, You have failed to pay for yore stay at the Center; or 6. We cease to operate the Center. 7. ACKNOWLEDGMENTS You acknowledge that You have received the following attachments: A. Room and Board Rate -Attachment A B. Ancillary Charges - Attachment B C. Notice of Information Practices and Receipt of Notice of lnfomnation Practices - Attachments C-1 and C-2 D. Resident's Personal Trust Fund Agreement- Attachment D E. SNF Medicare Determination Form - Attachment E F. Medicare Secondary Payor Questionnaire - Attachment F G, Summary of Lunited Treatment Policy - Attacbmoent G H. Medicare and Medicaid Information ' . I. Patient Information Handbook 1. Center Supplement K. Resident Rights By signing the Admission Agreement, You acknowledge that you have been given and have read this Agreement in - its entirety, and all its attachments. You agree that all information submitted as part of Your admission to the Center is true and correct. You acknowledge that the Center relies on the accuracy of all information submitted by You or on Your behalf in determining whether to admit You to the Center. By signing below, the parties agree to the term of this Admission Agreement: Patient Date ID.z3,O? &AIT Cen Representative Date 3 07z3 ? IS np'P??`b1e: ?' date g blc Pam ? Te1ePbO, gcspo? 4 {..? ? -? C] -? ??. _..? _ ?_ -l ?.?. s •• ?? C.:) `.v t..i ,? L OCT-03-2007(WE0) 08:25 P. 005/005 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. FERNS A. MILLS, Defendant. No. 07-5537 CIVIL ACTION - EQUITY ORDER d AND NOW, this day of , 2007, a bearing in the above-captioned matter on Petitioner's Petition for Preliminary injunction is scheduled .for 2007, at 1 o o'clock 8.n1. in Court Room No. . Cumberland County Courthouse. J. nj `; 7i j IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CASE NO.: 07-5537 Civil Term AFFIDAVIT OF SERVICE Manor Healthcare Corp. d/b/a ManorCare Health Services - Carlisle vs. Ferne A. Mills Commonwealth of Pennsylvania County of Dauphin sa. I, John Shinkowsky, a competent adult, being duly sworn according to law, depose and say that at 11:57 AM on 10/04/2007, I served Ferne A. Mills at 263 Allen Road , Carlisle, PA 17013 in the manner described below: ® Defendant(s) personally served. Adult family member with whom said Defendant(s) reside(s). Relationship is Adult in charge of Defendant(s) residence who refused to give name and/or relationship. Manager/Clerk of place of lodging in which Defendant(s) reside(s). Agent or person in charge of Defendant's office or usual place of business. ? Other: an officer of said Defendant's company. a true and correct copy of Notice, Complaint, Verification, Order, Petition for Preliminary Injunction Against Respondent Ferne A. Mills, Certificate of Service, Order, Brief in Support of Petition for Preliminary Injunction Against Respondent Ferne A. Mills, Certificate of Service issued in the above captioned matter. Description: t: 150 Sex: Female - Age: 50 - Skin: White - Hair: Blonde - Height: 5igh X Sworn to and sub$ crabed before me on this Jo S inkowsky day of it'd b?PR- 200 Sh' kowsky Investiga 316 Fawn Ridge Nort Harrisburg, PA 171 (800) 276-0202 N Y PUBLIC NOTARI SEAL Atty File#: 07-5537 - Our File# 2059 ELIZABETH A. 60W LEY, Notary Public Susquehanna Twp., Dauphin County My Commission Expires May 12, 2011 Law Firm: Schutjer Bogar LLC Address: 305 North Front Street, Suite 401, Harrisburg, PA, 17101 Telephone: (717) 909-5925 C ? -rt -r? c-?'? - c? c'? --? r ; ?, ; .? ' ? -?-? ? ? .. ? ' " N ?_ r?3? 3 . _ {? ::_ •. ? =. "-dry r F ? t? - ' C..? CC? -1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d /b / a MANORCARE HEALTH SERVICES - CARLISLE, FERNE A. MILLS, Plaintiff, V. No. 07-5537 Defendant. CIVIL ACTION - EQUITY AMENDMENT TO PETITION FOR PRELIMINARY INJUNCTION AGAINST RESPONDENT FERNE A. MILLS 1. Pursuant to Local Rule 208.3(a)(2), a judge has not ruled upon any other issue in the same or related matter. 2. Pursuant to Local Rule 208.3(a)(2)(9), to date, Petitioner has not received a Entry/Notice of Appearance of counsel of record for Respondent. However, Petitioner has been contacted by the Elder Law Clinic of the Dickinson School of Law of the Pennsylvania State University, and counsel has advised the undersigned's office that they will oppose the petition. Dated: Ilp Respectfully submitted, SCHUTJER BOGAR LLC By Bradley A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Maria G. Macus-Bryan Attorney I.D. No. 90947 (717) 909-8640 305 North Front Street, Suite 401 Harrisburg, PA 17101 Attorneys for Plaintiff C) C, r= -n rr, ID IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. FERNE A. MILLS, Defendant No. 07-5537 CIVIL ACTION- EQUITY ANSWER TO PETITION FOR PRELIMINARY INJUNCTION AGAINST RESPONDENT FERNE A. MILLS 1. Admitted. 2. Admitted in part and denied in part. It is admitted that Petitioner claims Respondent breached the Admission Agreement. It is specifically denied that Respondent breached the Admission Agreement. Petitioner filed a Medical Assistance application which was subsequently denied. Petitioner filed a timely appeal to the denial of the Medical Assistance benefits for Wesley Mills. At Petitioner's request, Respondent signed an authorization statement giving Petitioner the authority to pursue the appeal on Wesley Mills' behalf. The Cumberland County Assistance Office requested additional information regarding Respondent's income and resources, which Respondent has provided. Additionally, Wesley Mills and Respondent signed authorization statements with the Cumberland County Assistance Office allowing the County Assistance Office to seek financial information to determine Wesley Mills' Medical Assistance eligibility. 3. Denied. Petitioner will not suffer irreparable harm as Respondent has filed a timely Medical Assistance application. Although the Medical Assistance application was denied, Petitioner filed a timely appeal. Respondent has cooperated with Petitioner in pursuing that appeal in that Respondent has provided the Cumberland County Assistance Office and Petitioner's counsel with all requested documentation to qualify Wesley Mills for Medical Assistance. Respondent signed an authorization statement giving Petitioner the authority to pursue the appeal on Wesley Mills' behalf. Additionally, Wesley Mills and Respondent signed authorization statements with the Cumberland County Assistance Office allowing the County Assistance Office to seek financial information to determine Wesley Mills' Medical Assistance eligibility. 4. Denied. Respondent denies she breached the Admission Agreement. 5. Denied. Petitioner will not suffer injury as Respondent has filed a timely Medical Assistance application. Although the Medical Assistance application was denied, Petitioner filed a timely appeal. Respondent has cooperated with Petitioner in pursuing that appeal in that Respondent has provided the Cumberland County Assistance Office and Petitioner's counsel with all requested documentation to qualify Wesley Mills for Medical Assistance. Respondent signed an authorization statement giving Petitioner the authority to pursue the appeal on Wesley Mills' behalf. Additionally, Wesley Mills and Respondent signed authorization statements with the Cumberland County Assistance Office allowing the County Assistance Office to seek financial information to determine Wesley Mills' Medical Assistance eligibility. 6. Denied. Respondent denies she breached the Admission Agreement. Further, Respondent filed a timely Medical Assistance application and provided all requested documentation to the Cumberland County Assistance Office or the Petitioner's counsel. 7. Denied. It is denied that Petitioner lacks an adequate remedy at law. It is also denied that Respondent has any personal liability for Wesley Mills' nursing home care. Further, Respondent has not been able to ascertain whether Wesley Mills is liable for the amount Petitioner claims, as there is question whether the claims were properly submitted to Medicare and Petitioner's private insurance. 8. Denied. It is denied that an injunction is necessary or warranted as a matter of law. Therefore, Respondent denies any inference that a bond is necessary. Respectfully Submitted, Nichole M. Walters, Esq. Elder Law and Consumer Protection Clinic The Pennsylvania State University's Dickinson School of Law Attorney I.D. No. 84478 (717) 240-5152 Attorney for Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. FERNE A. MILLS, Defendant No. 07-5537 CIVIL ACTION- EQUITY CERTIFICATE OF SERVICE I hereby certify that on this 19"r., day of () LfD b <r , 2007, I served a true and correct copy of the foregoing Answer to Petitioner's Request for Preliminary Injunction Against Respondent via United States mail, first class, postage pre-paid on the following: Schutjer Bogar, LLC Maria Macus-Bryon, Esq. 305 N. Front Street, Suite 401 Harrisburg, PA 17101 By: -***n Elder Law and Consumer Protection Clinic Dickinson School of Law 45 N. Pitt Street Carlisle, PA 17013 n C= ° ` ? tv MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff V. FERNE A. MILLS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY NO. 07-5537 CIVIL TERM IN RE: CONTINUANCE ORDER OF COURT AND NOW, this 24th day of October, 2007, hearing in this matter is continued to January 4, 2008, at 9:15 a.m. By the Cqurt, Edward E. Guido, J. vM-a"riclare L. Hayes, Esquire For the Plaintiff ,,P"'r-ystal C. West, CLI Nichole M. Walters, Esquire For the Defendant :lfh r it { rv ???Al tt! 0 ! •O1 WV 9Z 100 LOOZ A `1UIy, a ?t d :] Hl ?o 4 A IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICE - CARLISLE, No. 07-5537 Plaintiff FERN A. MILLS, CIVIL ACTION - EQUITY Defendant MOTION FOR CONTINUANCE Defendant, Fern A. Mills, by and through her attorneys, the Elder Law and Consumer Protection Clinic of the Dickinson School of Law of Pennsylvania State University and Nichole M. Walters, states the following in support of this Motion: 1. Plaintiff is Manor HealthCare, a corporation located at 940 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17015. 2. Defendant is Fern A. Mills who resides at 263 Allen Road, Carlisle, Cumberland County, Pennsylvania 17013. 3. Plaintiff initiated this action by filing a complaint on September 20, 2007. On September 28, 2007, Plaintiff filed a Petition for Preliminary Injunction. 4. A hearing on Plaintiffs Petition was initially scheduled for October 24, 2007. At this hearing, this court continued the matter until January 4, 2007. 5. Defendant's counsel requests a continuance of the hearing until after January 14'', 2008 in order to collect the remaining documents requested by the plaintiff s attorney. 6. Plaintiff's counsel concurs in this Motion, and as such, the continuance is by agreement of all parties as required by Pa.R.C.P. 216(A)(1). WHEREFORE, Plaintiff requests that this Honorable Court grant this Motion and grant a continuance on the hearing that is scheduled for January 4, 2008. Respectfully Submitted: .Y.1???. ?A?GtQ?.4.c By: Nichole M. Walters, Esq. Supreme Court No. 84478 Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, Pennsylvania 17013 Date: December 21, 2007 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA x MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICE - CARLISLE, No. 07-5537 Plaintiff FERN A. MILLS, CIVIL ACTION - EQUITY Defendant x CERTIFICATE OF SERVICE I hereby certify that on December 21, 2007, I served the Defendant's Motion for a Continuance of Hearing and Proposed Order by placing true and correct copies of the same in the United States first class mail, postage prepaid, addressed as follows: Alison O'Horo, Esq. Schutjer Bogar LLC 305 North Front Street Harrisburg, PA 17101 By: Nichole M. Walters, Esq. Supreme Court No. 84478 Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, Pennsylvania 17013 r C O C:3 a? ' 4 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICE - CARLISLE, No. 07-5537 Plaintiff DEC E 6100" X 3 FERN A. MILLS, CIVIL ACTION - EQUITY Defendant t N ORDER AND NOW, this 3vr day of V"O" , 2007 upon consideration of Defendant, Fern Mills Motion for Continuance of Hearing, it is hereby ordered that the Motion is GRANTED. 4441 A hearing on Plaintiff's Petition for Preliminary Injunction is rescheduled to the 76 day of , 2008 at VC& M.-in Courtroom *3 of the Cumberland County Courthouse. Notice of the entry of this order shall be a to all p 'es by the Defendant. BY THE C J. Distribution: Nichole M. Walters, Esq. Alison O'Horo, Esq. Elder Law and Consumer Protection Clinic Schutjer Bogar LLC 45 North Pitt Street 305 North Front Street Carlisle Pa, 17013 Harrisburg, PA 17101 045F ?s mIU LL ?1i'v ?P 1. I ? Arl3 KLNn? ' 10 q Nd 2_ NYC- BUZ mvj- om,4' 40 MANOR HEALTHCARE CORP., d/b/a MANORCARE HEALTH SERVICE-CARLISLE, Plaintiff V. FERN A. MILLS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-5537 CIVIL TERM CIVIL ACTION - EQUITY ORDER OF COURT AND NOW, this 30th day of January, 2008, by agreement of the parties, this matter is continued generally. B Edward E. Guido, J. 4'iichole M. Walters, Esquire Elder Law and Consumer Protection Clinic 45 North Pitt Street Carlisle, PA 17013 X lison O'Horo, Esquire Schutjer Bogar LLC 305 North Front Street Harrisburg, PA 17101 t C_- srs + O ?-3 b Tj{ ,?jj?V, ow 3AL Nichole M. Walters Attorney I.D. No. 84478 The Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, PA 17013 (717) 240-5152 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff/Respondent No. 07-5537 V. FERNE A. MILLS, CIVIL ACTION - EQUITY Defendant/Petitioner EMERGENCY PETITION 1. Plaintiff is Manor Healthcare Corp. d/b/a ManorCare Health Services - Carlisle (hereafter "Respondent") and is a corporation licensed to do business in the Commonwealth of Pennsylvania, with its principal offices located at 940 Walnut Bottom Road, Carlisle, PA 17015. 2. Defendant is Ferne A. Mills (hereafter "Petitioner) and is an adult individual who currently resides at 263 Allen Road, Carlisle, Pennsylvania 17013. 3. Respondent filed a Complaint against Petitioner on September 18, 2007, requesting that this Court order Petitioner to cooperate with Respondent and the Cumberland County Assistance Office to provide the documentation necessary to qualify Petitioner's husband, Wesley Mills, for Medical Assistance. 4. A hearing was held before this Court on October 24, 2007 addressing Respondent's request for injunctive relief. At the conclusion of the hearing this Court continued the matter until January 4, 2008. A motion for continuance was filed by Petitioner and the matter was continued until January 30, 2008. 5. At the January 30, 2008 hearing, this Court continued the case generally. 6. The underlying facts of this case are as follows: A. On October 23, 2006, Wesley Mills, spouse of Petitioner, was admitted to Respondent's skilled nursing facility and returned home on April 21, 2007. B. Petitioner's husband fell at home on April 24, 2007 and was readmitted to ManorCare. C. Petitioner's husband was a resident of ManorCare from April 24, 2007 until he returned home on June 6, 2007. D. Respondent notified Petitioner that she needed to apply for Medical Assistance benefits on behalf of her husband, and an application for Medical Assistance was filed by Petitioner on August 20, 2007. E. Petitioner and her counsel continue to work with the Cumberland County Assistance Office to provide information, as requested, in order to determine the eligibility of Petitioner's husband for Medical Assistance. F. Petitioner's counsel and Respondent's counsel have worked together from September 2007 until present in an effort to get Medical Assistance coverage for the time Petitioner's husband was in Respondent's facility. 2 G. According to calculations by Petitioner's counsel, Petitioner's husband qualified for Medical Assistance following his purchase of an irrevocable burial trust in the amount of $2,000.00. H. At all times throughout Petitioner's counsel representation of Petitioner, Respondent and Respondent's counsel were aware that Petitioner was represented by the undersigned counsel. 7. On April 14, 2008 Respondent sent a notice to petitioner at her home address that states in part, "The admission agreement states that if an account is turned over for collection, the resident agrees to pay the facility's collection costs, including attorney fees. We have given you opportunities to pay this account, without success. Your payment, in full, must be received within the next five business days from the receipt of this notice. Please submit your payment and contact the Business Office to avoid collection fees." [Emphasis added]. A copy of this notice is attached as Exhibit A and incorporated by reference. 8. The notice sent by Respondent to Petitioner is in direct violation of the Fair Credit Extension Uniformity Act, 73 P.S. § 2270.4(b)(2), inter alia, which states: "With respect to debt collection activities of creditors in this Commonwealth, it shall constitute an unfair or deceptive debt collection act or practice under this act if a creditor violates any of the following provisions: (ii) if the creditor knows the consumer is represented by an attorney with respect to such debt and has knowledge of or can readily ascertain such attorney's name and address unless 3 the attorney fails to respond within a reasonable period of time to a communication from the creditor or unless the attorney consents to direct communication with the consumer." 9. Petitioner was diagnosed with dementia in 2007 and is currently taking medicine to treat this condition. Respondent's counsel is aware of this diagnosis, as this was brought to the Court's attention at the October 24, 2007 hearing. 10. On April 16, 2008, Petitioner, after being threatened by the notice, went to her bank and withdrew $19,925.95 from her savings account and obtained a cashier's check numbered 255428 payable to ManorCare in the same amount; this withdrawal has exhausted her savings account. 11. A stop payment was placed on cashier's check number 255428 by Petitioner on April 17, 2008. 12. A request for the return of the cashier's check was made by Petitioner's counsel on April 24, 2008 and May 15, 2008, however the cashier's check has yet to be returned. 13. Petitioner will be irreparably harmed if the cashier's check is not returned to her, as the amount of the check represents Petitioner's life savings. 14. There is no harm to Respondent in returning the check because Petitioner's outstanding bill with Respondent will be paid once Petitioner's husband is qualified for Medical Assistance. 4 15. Petitioner's counsel contacted Respondent"s counsel for her concurrence in this motion. Respondent's counsel did not respond to Petitioner's request for concurrence. WHEREFORE, Petitioner respectfully requests that this Court order Respondent to immediately return the cashier's check to Petitioner. Respectfully submitted, By'" i (-A 0&- `2W OJ Nichole M. Walters, Esq. Attorney I.D. No. 84478 The Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, PA 17013 Attorneys for Petitioner 5 E Xhlbit A We have notified you that this account balance is overdue on several previous occasions. The balance due includes all charges through the previous statement plus/minus any adjustments or payments. The admission agreement states that if an account is turned over for collection, the resident agrees to pay the facility's collection costs, including attorney fees. We have given you opportunities to pay this account, without success. Your payment, in full, must be received within the next five business days from the receipt of this notice. Please submit your payment and contact the Business Office to avoid collection fees Sincerely, MANOR CARE OF CARLISLE Patient Name WESLEY MILLS 26243 $19,925.95 FERNE MILLS 263 ALLEN RD CARLISLE, PA 17013 PLEASE MAKE CHECK PAYABLE AND REMIT TO: MANOR CARE OF CARLISLE 940 WALNUT BOTTOM ROAD CARLISLE, PA 17015 PLEASE DIRECT ALL QUESTIONS TO: MANOR CARE OF CARLISLE Business Office Manager (717)249-0085 PLEASE RETURN THIS SECTION WITH REMITTANCE I { i ? 01076 SEE REVIER'SE SIDE FOR s`:t , "tilNNG [N9 7F UC, 7 Nfryl'?:.MANOR CARE OF CARLISLE First-Class Mail 940 WALNUT BOTTOM ROAD U.S. Postage CARLISLE, PA 17015 ADDRESS SERVICE REQUESTED 1 PAIDe Toledo, Ohio Permit No. 612 IMPORTANT-BILLING INFORMATION ENCLOSED---OPEN IMMEDIATELY! FERNE MILLS 263 ALLEN RD CARLISLE, PA 17013 (717)249-0085 REMOVE THIS DOCUMENT ALONG THIS PERFORATION --?, Patient # Amount Due Legal Representative Name & Address .. ... .. ... ... ... ... ......... t:t: e:i. ...:tfi. i..: t:iit:iti :t ii:t: ii:i.. .: t. .. Verification I, Wesley A. Mills, verify that the statements in the foregoing document are true and correct based upon my personal knowledge. I am verifying the averment of facts because my wife, Feme A. Mills, lacks sufficient knowledge to properly verify all the facts as set forth in this petition due to confusion, caused by her dementia and increased stress from this litigation. I understand that false statements herein are made subject to penalties of 18 Pa. C.S.A. § 4904 relating to unsworn falsification fo authorities. Date: oil esley A. ills IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff/Respondent V. FERNE A. MILLS, Defendant/Petitioner No. 07-5537 CIVIL ACTION - EQUITY CERTIFICATE OF SERVICE I hereby certify that on May 19, 2008, I served the foregoing EMERGENCY PETITION by placing a true and correct copy of the same in the U.S. mail, First Class, postage prepaid, addressed as follows: Allison M. O'Horo, Esq. Schutjer Bogar LLC 417 Walnut Street, 4th Floor Harrisburg, PA 17101 By. , Lyndsey . Leatherman, Certified Legal Intern The Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, PA 17013 (717) 240-5152 ?..... TI. t ? K7 MANOR HEALTHCARE CORP. IN THE COURT OF COMMON PLEAS OF d/b/a MANORCARE HEALTH CUMBERLAND COUNTY, PENNSYLVANIA SERVICES, CARLISLE, Plaintiff V. FERNE A. MILLS, NO. 2007 - 5537 EQUITY Defendant CIVIL ACTION - EQUITY ORDER OF COURT AND NOW, this 23RD day of MAY, 2008, a Rule is issued upon Plaintiff to Show Cause why the Cashier's Check should not be returned to Petitioner. Rule returnable WEDNESDAY, MAY 28, 2008, at 3:30 p.m. in Courtroom # 3. By the Court, -00 Edward E. Guido, J. Nichole M. Walters, Esquire f_ __e Elder Law and Consumer Protection Clinic /Allison M. O'Horo, Esquire :sld J k .7,li "N " - } ! f FI'+at? a?...1 6,S :c d CE AN 860Z P\ Y ?? i °ilti.J ri 3Hi Jlr? MANOR HEALTHCARE CORP. d/b/a: IN THE COURT OF COMMON PLEAS OF MANORCARE HEALTH SERVICES, CUMBERLAND COUNTY, PENNSYLVANIA CARLISLE, Plaintiff VS NO. 2007-5537 EQUITY FERNE A. MILLS, : CIVIL ACTION - EQUITY Defendant ORDER OF COURT AND NOW, this 28th day of May, 2008, hearing in this matter is continued to July 9, 2008, at 1:30 p.m. At that time, ManorCare shall be prepared to testify as to the efforts it has made to determine the whereabouts of the check. The Defendant, Ms. Mills, shall be prepared to present evidence from the bank with regard to where the check was sent. It is further ordered and directed that Plaintiff, ManorCare, shall return the check to Ms. Mills if it is in ManorCare's possession. ByCourt, / Edwar E. Guido, J. -"Allison M. O'Horo, E Kirk S. Sohonage,Esquire e Schujter Bogar LLC 417 Walnut Street, 4th Floor Harrisburg, PA 17101 -Nichole M. Walters, Esquire The Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, PA 17013 :mlc l es rncZl s?24?o8 •"aj rr •? .?C''r ?/? t?ft1 1 $I ??VL j 2"q1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff/Respondent V. FERNE A. MILLS, Defendant/Petitioner No. 07-5537 CIVIL ACTION - EQUITY PRAECIPE TO WITHDRAW EMERGENCY PETITION To the Prothonotary: Kindly withdraw the Emergency Petition filed by Nichole M. Walters of the Elder Law and Consumer Protection Clinic on May 19, 2008. Respectfully submitted, By jEL".. Nichole M. Walters, Esq. Attorney I.D. No. 84478 The Elder Law and Consumer Protection Clinic The Dickinson School of Law The Pennsylvania State University 45 North Pitt Street Carlisle, PA 17013 Attorneys for Petitioner c;D It = n e at IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA MANOR HEALTHCARE CORP. d/b/a MANORCARE HEALTH SERVICES - CARLISLE, Plaintiff, V. No. 07-5537 FERNE A. MILLS, Defendant. CIVIL ACTION - EQUITY PRAECIPE TO WITHDRAW, DISCONTINUE AND END TO THE PROTHONOTARY: Kindly mark the above-captioned action as withdrawn, discontinued and ended with prejudice. Respectfully submitted, BOGAR LLC Dated: By: Braley A. Schutjer Attorney I.D. No. 75954 (717) 909-5291 Allison M. O'Horo Attorney I.D. No. 200568 (717) 909-5924 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff ORIGINAL r CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Praecipe to Withdraw, Discontinue and End was served via first-class, United States mail, postage prepaid, upon the following: Lindsey W. Leatherman The Elder Law and Consumer Protection Clinic 45 N. Pitt Street Carlisle, PA 17013 Dated: r7 I By: Catherine Klobucar, Paralegal A r.