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HomeMy WebLinkAbout07-5841IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Perini Services Southampton Manor, Ltd. d/b/a Shippensburg Health Care Center, V. Plaintiff CIVIL COURT DIVISION Docket No. ?`? - 'SRy (?iy? I Term Michael A. Lynch, Sr., Individually, Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., and Linda L. Lynch, Individually and as Civil Action-Law Successor Agent for Michael A. Lynch, Sr., Defendants NOTICE TO DEFEND 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 the 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 Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE Date: n Cumberland County Bar Association 32 S. Bedford Street Carlisle, PA 17013 (717) 249-3166 Respectfully submitted, CAPOZZI & ASSWOIATn. P.C. B Aadrew1C.- ise , Esquire Pa I.D. # 87 2933 North Front S eet Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Perini Services Southampton Manor, Ltd. d/b/a Shippensburg Health Care Center, V. Plaintiff : CIVIL COURT DIVISION Docket No. 07- S,Gy 1 e4lz rtl_ Michael A. Lynch, Sr., Individually, Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., and Linda L. Lynch, Individually and as Civil Action-Law Successor Agent for Michael A. Lynch, Sr., Defendants COMPLAINT NOW COMES, Perini Services Southampton Manor, Ltd. d/b/a Shippensburg Health Care Center ("Shippensburg Health Care Center"), by and through its attorneys, Capozzi & Associates, P.C., and makes the following Complaint for a money judgment against Defendants, and in support thereof, respectfully avers as follows: 1. Plaintiff is Shippensburg Health Care Center, a Pennsylvania corporation, which operates a long-term care nursing facility located at 121 Walnut Bottom Road, Shippensburg, Cumberland County, Pennsylvania, 17257. 2. Shippensburg Health Care Center is licensed to participate in the Medicaid and Medicare programs. 3. Defendant Michael A. Lynch, Sr. is an adult individual who resides at Shippensburg Health Care Center's facility (the "Resident"). 4. Defendant Michael A. Lynch, Jr. is an adult individual with a last known address at 211 N. Fourth Street, McConnellsburg, Fulton County, Pennsylvania 17233, and is the Power of Attorney and son of the Resident. 2 Defendant Linda L. Lynch f/k/a Linda Lane, is an adult individual residing at 211 N. Fourth Street, McConnellsburg, Fulton County, Pennsylvania 17233, and is the Successor Agent and daughter-in-law of the Resident. 6. On or about March 23, 2006, Resident and Defendant Lynch, Jr., as the Responsible Party and Power of Attorney, requested that Shippensburg Health Care Center admitted Resident to Shippensburg Health Care Center and executed an admissions agreement (the "Admissions Agreement") so that he could receive nursing care and services. A true and correct copy of the Admissions Agreement is attached hereto and incorporated herein as Exhibit "A." 7. Shippensburg Health Care Center provided Defendants with a copy of the PA Department of Public Welfare ("DPW") Admissions Notice Packet as required under 42 U.S.C. § 1396(r). A copy of the signed MAO 1 Certification page is attached hereto and incorporated herein as Exhibit "B." 8. During the period March 23, 2006 through the present, Shippensburg Health Care Center provided nursing care and service to the Resident pursuant to the terms of the Admissions Agreement. 9. At all times relevant to this action, the nursing care and services rendered met all applicable federal, state, and local standards of care. 10. Shippensburg Health Care Center is entitled to monetary compensation for the nursing care and services rendered to Resident. 11. To date, the Resident and Defendants Lynch, Jr. and Linda L. Lynch have failed and refused to remit payment in full each month from March 23, 2006 through the present. 12. The current invoice for Resident's account provides that this account is currently in arrears in the amount of $15,513.75 (the "Account Invoice"). A true and correct copy of the 3 Account Invoice is attached hereto and incorporated herein as Exhibit "C." COUNT I- BREACH OF CONTRACT Michael A. Lynch, Sr., Individually, and Michael A. Lynch, Jr., Individually, and as Power of Attorney and Responsible Party for Michael A. Lynch, Sr. 13. Shippensburg Health Care Center incorporates paragraphs 1 through 12 of this Complaint as if set forth herein. 14. Exhibit 2A of the Admissions Agreement provides that the rate for Resident's care at Shippensburg Health Care Center is $190.00 per day (the "Private Pay Rate"). 15. The Resident and his Representative were responsible to ensure Shippensburg Health Care Center receives payment for the Private Pay Rate, minus the amount of public Medical Assistance ("Patient Pay Liability"). 16. The first paragraph of the Admissions Agreement identifies Defendant Lynch, Jr. as the Resident's Representative. 17. The first paragraph of the Admissions Agreement also provides that "a checklist of the rights and responsibilities applicable to [the Resident's] representative is listed in Exhibit 1 and is incorporated into this Agreement." 18. The third paragraph of the Admissions Agreement provides that "We require the person responsible for making payments on your behalf to pay for your care under the terms of this contract in a timely manner." 19. The fourth paragraph of the Admissions Agreement provides that "If you are a beneficiary of ...Medicaid ...your representative agrees to make all necessary payments from your funds. Your representative could face a civil penalty for intentionally failing to pay required amounts from your funds...." 4 20. The first paragraph of page 2 of the Admissions Agreement provides that "If you or your representative do not pay the money you owe us and we hire a collection agency or attorney, you agree to be liable for their fees and court costs." 21. Exhibit 1 of the Admissions Agreement outlines the rights and obligations of Defendant Lynch, Jr. as Resident's Legal Representative. 22. To the extent that Defendants Lynch, Jr. and Linda L. Lynch have failed to remit payment in the amount of the Patient Pay Liability, they are personally liable for any misappropriation of funds. 23. Shippensburg Health Care Center has demanded payment from Defendant Lynch, Jr. (the "Demand Letter"). A true and correct of the Demand Letter, dated July 18, 2007, is attached hereto and incorporated herein as Exhibit "D." 24. Defendants' failure to remit payment and cure the default of the Admissions Agreement constitutes a breach of contract. 25. Shippensburg Health Care Center has been financially damaged by the failure of Defendant to pay for the nursing care and services that Shippensburg Health Care Center rendered to Resident. WHEREFORE, Shippensburg Health Care Center demands judgment against Defendants in the amount of $15,513.75, plus interest, attorney's fees, and costs of collection, which sum does not exceed the local limit for arbitration. COUNT II-QUANTUM MERUIT-UNJUST ENRICHMENT Michael A. Lynch, Sr., Individually, and Michael A. Lynch, Jr., Individually, and as Power of Attorney, Attorney in Fact, Responsible Party and/or Fiduciary for Michael A. Lynch, Sr. If this Honorable Court should find that an express contract did not exist between Plaintiff and Defendants, which is denied, then, in that event, Plaintiff pleads the following alternative cause of action in quantum meruit against the Defendants: 26. Shippensburg Health Care Center incorporates paragraphs 1 through 25 of this Complaint as if set forth herein. 27. Shippensburg Health Care Center's expectation of payment in exchange for rendering the nursing care and services to Resident was reasonable and just. 28. In rendering the nursing care and services to Resident, Shippensburg Health Care Center has conferred a substantial benefit upon him, and Resident has been unjustly enriched by accepting the nursing care and services. 29. The rates reflected in the Account Invoice are the just and reasonable charges for the nursing care and services. 30. Shippensburg Health Care Center is entitled to proper compensation for the nursing care and services rendered to Resident. 31. The total value by which Resident has become enriched on account of such nursing care and services in $15,513.75, as is specifically reflected in the Account Invoice. 32. Shippensburg Health Care Center has demanded payment from Defendants in that amount, but Defendants have refused to remit payment. WHEREFORE, Shippensburg Health Care Center demands judgment against Defendants in the amount of $15,513.75, plus interest at the legal rate of 6% per annum, attorney's fees, and costs of suit, which sum does not exceed the local limit for arbitration. 6 COUNT III - BREACH OF FIDUCIARY DUTY Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., and Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr. 33. Shippensburg Health Care Center incorporates paragraphs 1 through 32 of this Complaint as if set forth herein. 34. Defendant Lynch, Jr., personally and as Resident's Power of Attorney and Representative, and Defendant Linda L. Lynch, personally and as Resident's Successor Agent, accessed and controlled the income and assets, including Social Security income, of Resident. A true and correct copy of the General Durable Power of Attorney granted by Resident to Defendants Lynch, Jr. and Linda L. Lynch (the "Power of Attorney") is attached hereto, incorporated herein as Exhibit "E." 35. Shippensburg Health Care Center, by virtue of the Admissions Agreement and Power of Attorney, is an intended third-party beneficiary of the agency relationship that existed between Resident and Defendants Lynch, Jr. and Linda L. Lynch. 36. As Power of Attorney and Responsible Party for Resident, Defendant Lynch, Jr. had a fiduciary duty to ensure the basic and necessary care and maintenance of Resident. 37. Defendant Linda L. Lynch, as the Successor Agent and Resident's daughter-in-law, actively served as the point of contact for payment and Medical Assistance issues with Shippensburg Health Care Center, and made only one payment on or about April 3, 2007 in the amount of $6,000.00. 38. Defendants breached their fiduciary duty to Resident and to Shippensburg Health Care Center by refusing to transfer Resident's income and assets to pay for his nursing care and services. 7 39. Defendants' breach of their fiduciary duty is the actual and proximate cause of financial damage to Shippensburg Health Care Center in the amount of the $15,513.75, plus interest and costs of collection. WHEREFORE, Shippensburg Health Care Center demands judgment against Defendants in the amount of $15,513.75, plus interest, attorney's fees, and costs of collection, which sum does not exceed the local limit for arbitration. COUNT IV -CONVERSION OF MONEY Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., and Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr. 40. Shippensburg Health Care Center incorporates paragraphs 1 through 39 of this Complaint as if set forth herein. 41. Defendants Lynch, Jr. and Linda L. Lynch were aware that, pursuant to the Admissions Agreement and the DPW Admissions Notice Packet referenced at Exhibit B, a contractual relationship between Resident and Shippensburg Health Care Center, Resident's income properly belonged to Resident and Shippensburg Health Care Center. 42. Defendants Lynch, Jr. and Linda L. Lynch had a duty to safeguard and use Resident's income and assets to pay for his basic care and maintenance, including his nursing care and services. 43. Defendants Lynch, Jr. and Linda L. Lynch intentionally and permanently retained possession of the Resident's income and assets for their own use. 44. Defendants Lynch, Jr. and Linda L. Lynch's failure to transfer income and assets to Shippensburg Health Care Center despite repeated demands to pay the monthly Account Invoices constitutes conversion. 8 45. Shippensburg Health Care Center has been damaged by Defendants Lynch, Jr. and Linda L. Lynch's conversion of Resident's income and assets in the amount of at least $15,513.75. WHEREFORE, Shippensburg Health Care Center demands judgment against Defendant in the amount of $15,513.75, plus interest, attorney's fees, and costs of collection, which sum does not exceed the local limit for arbitration. COUNT V - PENNSYLVANIA "DUTY TO SUPPORT" LAW Michael A. Lynch, Jr., Individually and as the Son of Resident Michael A. Lynch, Sr. 46. Shippensburg Health Care Center incorporates paragraphs 1 through 45 of this Complaint as if set forth herein. 47. As the nursing facility that provided Resident with nursing care and services, Shippensburg Health Care Center had a legal and contractual duty to provide care, maintenance, and assistance to him. 48. The cost of Resident's nursing care and services, and other daily living expenses, at Shippensburg Health Care Center is the Patient Pay Liability plus Medical Assistance reimbursements. 49. Defendant Lynch, Jr. knew or should have known that Resident's monthly costs and expenses required payment of the Patient Pay Liability to remain current. 50. Defendant Lynch, Jr., at all relevant times, had sufficient financial ability and access to Resident's income to pay for Resident's maintenance and support. 51. Title 23 of the Pennsylvania Statutes section 4601 et. seq., 23 P.S. §4601 (the "Support Law"), requires children and spouses with sufficient financial ability to pay for the care 9 and maintenance of their indigent parents, and to provide their parents with financial assistance while they remain in a publicly supported nursing facility. 52. The Resident is "indigent" within the meaning of the Support Law because he is not able to pay his just debts. 53. As Resident's son, Defendant Lynch, Jr. is legally obligated to reimburse Shippensburg Health Care Center for nursing care and services rendered to Resident pursuant to the Support Law. 54. Defendant Lynch, Jr.'s failure to reimburse Shippensburg Health Care Center for the nursing care and services rendered to his father, Defendant Michael A. Lynch, Sr., constitutes a violation of the Support Law and resulted in financial damages to Shippensburg Health Care Center in the amount of $15,513.75, plus interest, attorney's fees, and costs of collection. WHEREFORE, Shippensburg Health Care Center demands judgment against Defendant Lynch, Jr. in the amount of $15,513.75, plus interest, attorney's fees, and costs of collection., which sum does not exceed the local limit for arbitration. COUNT VI- PETITION FOR ACCOUNTING Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., and Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr. 55. Shippensburg Health Care Center incorporates paragraphs 1 through 54 of this Complaint as if set forth herein. 56. Shippensburg Health Care Center is entitled to an accounting as a result of Defendants Lynch, Jr. and Linda L. Lynch's breach of their fiduciary duty as follows: a. All transactions and dealings with relation to their duties as Power of Attorney and Responsible Party over the assets and property of Resident; 10 b. All profits and losses gained or lost as a result of any investments or businesses run during their tenure as Power of Attorney and Responsible Party on behalf of Resident; c. A listing of all of Resident's assets and liabilities during the entire time they acted as Power of Attorney and Responsible Party for Resident and had control of Resident's assets and property, and any actions taken by Defendants Lynch, Jr. and Linda L. Lynch, as Power of Attorney and Responsible Party, with regard to the assets and property of Resident; d. Defendants Lynch, Jr. and Linda L. Lynch should account for any wrongful conversion, dissipation, and sale of Resident's property and return the items or their value to pay for Resident's obligations. 57. As a party to the Power of Attorney between Defendants Lynch, Jr. and Linda L. Lynch and Resident, Shippensburg Health Care Center is also entitled to a full and complete inspection of any books or records in the possession of Defendants Lynch, Jr. and Linda L. Lynch pertaining to their action as Power of Attorney. WHEREFORE, Shippensburg Health Care Center demands judgment in its favor and against Defendants Lynch, Jr. and Linda L. Lynch and for an Order directing Defendants Lynch, Jr. and Linda L. Lynch to produce all books and records for inspection relating to their actions as Power of Attorney and Responsible Party, account for all of the transactions, dealings, assets and liabilities of her transactions and such other relief that this Court may deem just and proper. Respectfully submitted, CAPOZZI & ASSOCIATES, P.C. Date: lD1 © ? - rew R. , Esquire Pa. I.D. # 874-4 2933 North Front treet Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff 11 VERIFICATION J? ov :2 D _ F 21 2001 I, Jeffrey Benevit, Business Manager of Shippensburg Health Care Center, do hereby verify that the facts made in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in Title 1S of the Pennsylvania Consolidated Statutes Section 4904, relating to unworn falsification to authorities. Jeffre nevi usiness Manager Shippensburg Health Care Center 12 HEALTH CARE CENTER 121 Walnut Bottom Road Shipyensburg, Pennsylvania 17257-9005 ADMISSION AGREEMENT EXHIBIT A (717) 530-8300 FAX (717) 530-8304 TrY 1-800-654-5984 This Agreement is between Shippensburg Health Care Center (the "Facility" or "we" and) Ava,-AL ldt? - ("the "Resident" or ` you") and; if you or the court have designated an individual to act on your behalf, or there is another individual to act on your behalf, or operation of law, . n? k?a\A rp_ fft-, ("your representative"). A checklist of the rights and responsibilities applicable to your representative is listed in Exhibit 1 and is incorporated into this Agreement. Paving for Your Care If you are applying to this facility as a private-pay resident, you must provide all financial information requested by us. If we later find; that the information you or your representative provided ' was incomplete or inaccurate, we will consider that as a breach of this Agreement which gives us the right to pursue all legal remedies against you or your representative. Who Can Be Required to Pay for Your Care Only you and your insurer can be required to pay for your care. No other person, (i. e. a family member, friend,- neighbor; legal representative or guardian) can be ? own. funds for your care, although he or she may knowingly required to pay from their payment for the cost of your care. We require the person responsible far making agree t a guarantee s on your behalf to pay for your care under the terms of this contract in a timely manner p If you -are a beneficiary of Medicare, Medicaid or any other third-party payment plan, your representative agrees to make all necessary payments from your funds. Your representative could face a civil penalty for intentionally failing to pay required amounts from your funds and could face a criminal penalty for abusing your funds. - Private Pav Residents The items and services included in our daily rate is basic room, board and general nursing care as required by your medical condition. Payment for items and services that are included in the daily rate and is payable one month in advance and due on the first of each month. Items and services included in your daily rate are listed in Exhibit 2.A. You will be charged separately for additional items-. and services not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges, medical transportation and additional services such as telephone expense, dry cleaning, beauty and barber services-and newspapers. Items and services for which you will be charged are listed in Exhibit 2.B. Payment for these additional items and services axe due after you have requested them, and, you have received and have been billed for them. Within 30 days of receiving an item or service, EXHIBIT A If you or your representative do not pay the money you owe us and we hire a collection agency or attorney, you agree to be liable for their fees and court costs. Private Duty Nurses Geriatric Aides If you want a private duty nurse or a private duty geriatric aide, you are responsible for selecting a person licensed and/or certified according to Pennsylvania laws and regulations. You are also responsible for paying him or her and for letting us know that you have hired one. The person you hire is not an employee or agent of the facility, but he or she must meet our standards and follow our policies and procedures. . Employees of the Facility may - not serve as private duty nurses or private duty geriatric aides. Holding Your Bed if You Leave the Facility If you are hospitalized or on leave from the Facility, we will hold your bed for you as follows: A. If you are private-pay resident, or are receiving inpatient care reimbursed under Medicare Program (and you are not covered under Medicaid), unless you notify us otherwise, we will hold your bed for as long as you pay for it at the daily rate you are currently being charged. B. If Medicaid pays for part or all of your nursing home care and you need to be hospitalized, we will hold your bed for up to the maximum number of days required by this state, currently 15 days. If you leave for any other reason, we will hold your bed for up to the maximum number of days required by this state, currently 18 days. You have a right to be readmitted to the facility to the first available appropriate bed. While we are holding your bed, you are still required to pay the Facility any amount for which you are liable as determined by the Medicaid Program. C. If you have applied for Medicaid, your bed will be reserved in accordance with Paragraph B. However, if you are found to be ineligible for Medicaid, then you are required to pay for the bed as a private pay resident as described in Paragraph A. D. Other third-party payers may or may not have a bed hold policy. We will discuss this if it applies to you. Your Right to Make Complaints and Suggest Changes in Policies and Services As a nursing home resident, you have many rights according to State and Federal law. These are described in detail in Exhibit 6, which is attached and is part of this Contract. You may make complaints about your care in the Facility and you may also suggest changes in the policies and services of the Facility. You will not be harassed or discriminated against for making a complaint or suggesting a change in a policy or service. You may present your complaints to facility, management company or to one of the following State agencies: Larry D. Cottle, LNHA Administrator Shippensburg Health Care Center 121 Walnut Bottom Road Shippensburg, PA 17257 717-530-8300 Ombudsman Office of Aging 16 West High Street Carlisle, PA - 17013 717-240-6110 717-532-7286 Ext. 6110 Peter E. Perini, Sr. President Magnolia Management, Inc. 1710 Underpass Way Hagerstown, MD 21740 301=745-8700 Department of Health 100 North Cameron Street 2nd Floor Harrisburg, PA 17101 717-783-3790 Your Right to Make Decisions You have the right to make your own medical decisions and to manage your personal- affairs. If you become disabled, it may be necessary for someone else to make decisions for you. For this reason, we recommend that you have a living will and/or advance directive for medical decisions and a financial Power of Attorney° but you are not required to do so. See Exhibit 7 for a description of your legal rights to decide about your future medical treatment. Transfer, Relocation and Discharge - You have the right to remain herey and you may not -be transferred, relocated or discharged against your will, except for the following reasons: (1) A medical reason (i.e. the facility cannot provide the kind of care that you need, your condition has improved so that you no longer need the care we provide, or a medical emergency arises; (2) Your welfare or the welfare of other residents or staff, (3) Nonpayment for a stay, or (4) the Facility ceases to operate. If we decide that you should be transferred or discharged, we will notify you, and an immediate family member or legal representative, by letter 30 days in advance. If you are transferred because of an emergency situation, we will provide the required notice as soon as practicable. The letter will contain the reasons for the transfer or discharge and its effective date. 'The letter will also tell you how you can appeal our decision to transfer or discharge you. If you are discharged involuntarily, we will attempt to make other appropriate arrangements for your care. However, if other arrangements are not available, your representative agrees to accept you into his or her custody if it is medically appropriate. Your Right to End This Contract If you decide to end this Contract and leave the Facility, you must pay your bill before you leave. You must give us five (5) days written notice to terminate this contract. If you leave before the end of that time, you must still pay for each day of the required notice. In the event you die while a resident of the facility, your representative is responsible for making the funeral arrangements. We will notify your representative immediately. If we are unable to reach your representative, we will contact the funeral home of your choice to facilitate arrangements. Additional Documents It is not possible to cover everything that is important to your stay in our Facility in the body of this Contract. Therefore, we have included additional important documents as Exhibits. These Exhibits are part of this Contract. Please verify that you received the Exhibits and that the contents of the Exhibits were explained to you by placing your initials on the line next to the description of each Exhibit. r4 Exhibit 1. Rights and Obligations of Representatives. Exhibit 2. For Private Pay Residents: (a) Items and services covered by daily rate. (b) Items and services not covered by daily rate. Exhibit 3. I-low to Apply For and Use Medicare and Medicaid Benefits. Exhibit 4. (a) Items and Services Covered by Medicaid. (c) Items and Services Not Covered by Medicaid. Exhibit 5. Physicians Who Practice at the Facility. Exhibit 6. Legal Rights of Pennsylvania to Decide Future Medical Treatment. Exhibit 7. Policies and Procedures Concerning Your Personal Funds and Your Personal Property. Exhibit 8. Services Provided by Outside Health Care Providers. Changes in Law Any provision of this Contract that is found to be invalid or unenforceable as a result of a change in State or Federal law will not invalidate the remaining provisions of this Contract. If there are services we have agreed to provide that are later found to be impossible to render as -a result of a change in State or Federal law, it is agreed that to the extent possible, the Resident and the Facility will continue to fulfill our respective obligations under this Contract consistent with the law. IN WITNES,?S? WHEREOF, the parties have executed this. Contract on this , day of . ?"1l+?1NIi? By: Witness Larry D. Cottle, Administrator Shippensburg.Health Care Center Witness Resident If the Resident has been -adjudicated disabled or the Resident's doctor determines that the Resident is incapable of understanding or exercising his or her rights and responsibilities, the Facility may require the signature of another person on this contract. The other person may be: (1) An appointed healthcare agent under an advance directive for medical care; (2) A. guardian or Power of Attorney of the person; (3) A surrogate or family member. Witness r= Responsible P e) Title: Indicate whether you are (1), (2) or (3) Sep,.21, 2007 4:01PM SHIPPENSBURG HEALTH CARE CTR No,5749 P. 2/4 EXMBIT 1 RIGHTS AND OBLIGATIONS OF REPRESENI'ATWE The Representative shall have the right to be notified by the Facility of any event or occurrence involving the Resident, which directly affects any obligation of the Representative under this Agreement. Representative agrees to assume independently, under this Agreement, the following obligations and is entitled to the following rights, as indicated by Representative's Initials accompanying any of the following provisions: • Representative agrees to be responsible for ensuring that any payment from the resident to which the Facility is entitled pursuant to this Agreement shall be paid to the Facility in a timely manner. In the event the Resident is a beneficiary of Medicare, Medicaid or any other third-party payment plan, Representative agrees to ensure that all co-payments, co-insurance or charges and fees for non-covered items and services, together with any late fees as described under this Agreement, shall be paid from the Resident's funds. Representative is subject to a civil penalty for willful violation of the agreement to distribute the Resident's funds to the facility. • (Unless the Representative voluntarily agrees to act as guarantor), Representative shall be responsible for any payments required under this Agreement only to the extent of the Resident's funds. Resident is applying for admission on private pay basis, and Representative agrees to assist the Resident in providing all financial information required by the Facility to determine the extent of the Resident's resources. If it is ever determined the Representative participated in the disclosure of incomplete or inaccurate information, the incomplete or inaccurate disclosure shall be deemed a material breach of this Agreement and the Facility reserves the right to pursue all available legal remedies against the Representative, including but not limited to an action for breach of contract. • Representative is signing this Agreement as a duly authorized agent such as an appointed healthcare agent under an advance directive or guardian appointed by a court. A copy of all supporting documentation for this representation is attached to this Agreement. • Representative is signing this Agreement on Resident's behalf, based upon a physician's certificate, a copy of which is attached to this Agreement, certifying that Resident does not possess the capability to understand his or her rights and responsibilities. • Representative agrees that in the event of the Resident's death, Representative shall take responsibility of all burial arrangements for the Resident and for removal of all personal property from the Facility. .Sep.2.1. 2007 4.01PM SHIPPENSBURG HEALTH CARE CTR No.5749 1'. 3/4 (Exhibit 1, Continued) • If it is the desire of the Resident or Representative to obtain the supplemental services of private duty nurses in accordance with the requirements described under this Agreement, Representative agrees to be responsible for arranging independently for those services, including ensuring any payment. Representative agrees that in the event the Resident's private funds are exhausted during the Resident's stay and the Resident is eligible to apply for benefits under the Medicaid Program, the Representative shall assist the Resident and the Facility with any application for Medicaid benefits. Representative further agrees to act, on behalf of the Resident, to facilitate any Medicare, Veterans Administration or other third-party benefits which may be available to cover the cost of Resident's care at the Facility. • In the event the resident seeks to terminate this Agreement, the Representative agrees to ensure that all notices required under this Agreement are provided to the Facility. • In the event of an involuntary termination of this Agreement, if other arrangements acceptable to the Resident cannot be made, the Representative agrees to accept the Resident into the Representative's custody, if medically appropriate. Representative has the right to copies of the following documents and any amendment to them. Representative further acknowledges receipt of the following documents, which may be amended from time-to-time. 1. A copy of this Admission Agreement. 2. A list of the Facility's rates, subject to amendment on thirty-(30) days notice, and a description of charges for services not included. 3. A list of health care providers offering services at the facility. • Representative acknowledges the Facility's right to any legal remedies available under law for Representative's breach of this Agreement. Sep-21. 2007 4:01PM SHIPPENSBURG HEALTH CARE CTR No.5749 P. 4/4 EXIMIT 2.A, Private Pay Residents DAE,Y ROOM RATES Total Daily Room Rates Effective January 1, 2007 Special Care Program Private Rooms ......... ......... :..... $200.00 $204.00 Semi-Private Rooms ................. $190.00 $199.00 Triple/Quad Rooms .................. $1$5.00 $1$9.00 A. The daily rate includes the following services: • Room • Board • Social Services • Nursing Care, including: o The administration of prescribed medications, treatments and diets o The provision of care to prevent skin breakdown, bedsores, and deformities.. o The provision of care necessary to encourage the resident from accident, injury and infection. o The provisions of care necessary to encourage, assist and train the resident in self care and group activities. The daily crate does NOT include the following items/services: • Physician Services • Medications • Specialized and/or specially ordered medical supplies/services/equipment • Prescribed dietary supplements • Cable ($7.00 per month) • Telephone and telephone services • Beauty/Barber Shop Services • Disposable Diapers • Items listed on Ancillary Charge Sheet • Personal Laundry Payment: Payment is due in full and on the first day of each month. Bill is done on a monthly basis. Each monthly payment shall also include any additional fees and charges incurred in the proceeding month. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE ADMISSIONS NOTICE PACKET IMPORTANT INFORMATION FOR _ 'ACILITY RESIDENTS AND THEIR SPOUSES imp, .. at information for nursing facility residents and their spouses. If you need this information in another language or someone to interpret it, please notify the nursing facility or contact your local County Assistance Office. Language assistance will be provided free of charge. Infornacidn importante para los residentes en hogares de ancianos y sus esposos Si usted necesita esta informaci6n en otro idioma o alguien que se Is traduzea favor de notifcar a) personal de la residencia o comunicarse con Is oficina local de Asistencia del Condado (CAO) Asistencia lingilistica sera provefda gratis Ba"We CaeAexas oraoCm Wbxo pax "CR aoMGA npecrapenytx x ttx cynpyr (cynpyroa). ECLx UM xyxtex Aaaxua AoxyMear as ApyroM sauce anu CM ycraus; rtepesoA, 06punarrrect. a Aoat npecrapeawx nx6o s Mecrnoe 610po no.Noure (County Assistance Office) rloMotub nepesoa raga npeaoerasnseres 6ecnmrxo. FART 1 - Pages 1-8 Notice of Rights of Nursing Facility Residents Applies to Everyone PART 2 - Pages 9-12 Medicaid Payment for, Nursing Facility Care Eligibility Requirements and Procedures Everyone should read this part - Even if you do not need Medicaid now. 3 - Pages 15-18 Protecting Resources and Income for the Spouse Living at Home Applies if you have a spouse who is living in the community, i e., is not in a nursing facility or medical institution PART 4 - Pages 19-22 Resource Assessment Form (PA 1572) To be used by a couple when one of them is in a nursing facility or other medical institution, and the other lives in the community. I certify that the notices required by 42 US C .. § 13961 (c) (1) (B) and (e) (6) were provided to me at the time of my admission to: Note: A new 409 is needed for each admission. Wl ARM A Name of Resi nt ?'?-, • ?! ?d ? N e of Facility Resident's Social Security Number Signature of Resident or Signature of Patient or esiden epresentative 5?J"-L Relationship to Resident Date PLACE IN MA401 UNTIL STAMPED BY fil Depa)rftent of Public Welfare W Utiiizitlort Management Review 0 n 05? G (o --yr it. i .,i-vn! AR, 6ntf ietea Std ? a{@ n This information packet contains important information nursing facility, and information about Medi id about your rights as a resident of a ca (also which can help pay for nursing facility care for people themselves Federal law 42 U S known as Medical Assistance who cannot pay all of th a pro ram , . C § 1396r (c) (1) (B) give you this information and (e) (6), requires e cost ts the nursing of care by facility to Even if you are paying for your nursing facility insurance is paying, it is important for you to learn about Medicaid b care yourself, or if' f Medicare or another e ore you might need it There are four (4) parts to this Admissions Notice Packet.. ntitns rJal?ntttntil?nrnitat7;aenr?nlnnne)utn nfatlm «imt?iinltlnti?if L,nM9tt MIVI t tticnnn&M(nrmmrelsts:ulme»t jate?a gr+nnm?lriunwursi?ttrnw n;Bdnnunl?lu itttnsumlvQn?ltiimt yalrispcatmianNwiiNi[i5rtlrtitnnnyr7 ?s~wn?mrunitu?ll?ir 6tucxlwtmurnritaiG t ' ?l?i#h1E?4lti?#{+9k???if?#?Utltili# i?i?9ERfi ?l?r3dt?? ??' gypp,, ry?g 1?{9.`?"thWJJ V2t(County Assistance Office) 7R OrJLq sp F-l Vl9J., rhdng tin quan trgng vE col sa duOng 1So dinh Cho thndng tni nbAn v3 vi phei nglu Neu qui vi do Wag tin nay bing mot the tie'ng We hay mot phien dick vien, xin thdng No Cho cd sa dutrng lio hay lien lac vdi Vin Phdng Trq C$p Qugn Hat Tro gidp vA ngdn ngif se duoc cung cfp miln phi EXHIBIT Affix UMR stamp here 11 UMR REPRES SHIPPENSBURG HEALTH CARE CTR Resident Aging Summary Aging From September 2007 0911812007 11:52:57 Compressed Zeno Balances Removed LYNCH, MICHAEL A Sep 07 Aug 07 Jul 07 Jun 07 May 07 Apr 07 Pre Apr 07 COMM CO A 0.00 0.00 0.00 0.00 0.00 0.00 -180..00 COMM CO B 0.00 0.00 0.00 68..58 87.15 191.00 1,154,45 Medicaid 0.00 3,486.66 -18.50 -23„50 -23.50 -23.50 -23..50 Medicare B 0.00 0.00 0.00 0.00 0.00 0.00 49 47 Resident Family 2,174.25 2.181.25 2.181.25 2 170 9g 13 14 7c awn - . ....,....- Total $-180.00 $1,501.18 $3,374.,16 EXHIBIT C Sep 07 Aug 07 Jul 07 Jun 07 May 07 Apr 07 Pre Apr 07 Total 2,174.25 5,667.91 2,162.75 2,224.33 2,249.90 2,346,75 3,432.67 $ 20,258..56 Louis J. Capozzi, Jr., Esquire' Daniel K. Natirboff, Esquire Donald R. Reavev. Esauire C v a r7rl Brian K. Zellner, Esquire Bruce G. Baron, Esquire Andrew R. Eisemann, Esquire Douglas A. Snyder, Esquire Timothy Ziegler, Reimb. Analyst -4- Karen L. Fisher, Paralegal Jennifer Kain, Paralegal • (lian d i PA NJ d M) u n , an ) t tf ' -i et ris?_ q_ 3 2' _ , .. sTf_ July 18, 2007 Michael A. Lynch, Jr. 211 North 4th Street McConnellsburg, PA 17233 2933 North Front Street Harrisburg, PA 17110 Telephone: (717) 233-4101 Fax: (717) 233-4103 www.capozziassociates.com Craig I. Adler, Esq. Of Counsel Re: Account with Shippensburg Health Care Center Account Name: Michael A. Lynch, Sr. Account Balance: $14,883.00, plus late charges, as of July 6, 2007 Our Matter No.: 891-07 Dear Mr. Lynch: Please be advised that our law firm represents Shippensburg Nursing Center regarding its accounts receivable. I am writing to notify you that we have been instructed by our client to prepare a lawsuit against you, if necessary, as the Power Attorney and Legal Representative of your father, to collect upon the above-referenced account. As you are aware, your father was found eligible for long term care medical assistance starting July 1, 2006, however, as his Legal Representative, you had a fiduciary duty to ensure that his private pay liability was paid on a monthly basis. This action is being taken because, despite previous notices requesting payment, you have failed to remit payment or agree to a settlement arrangement. When suit is filed it may give rise to the following consequences: 1. To defend this suit, it may be necessary for you to appear in court. 2. If a judgment is obtained against you, you may be required to pay court costs, attorney's fees, and interest in addition to the money you now owe. 3. If a judgment is obtained against you, a writ of execution may be issued ordering the seizure and sale of your personal or real property. 4. A judgment is a matter of public record, and it will negatively affect your credit rating. EXHIBIT If you notify this office in writing within 30 days after receiving this Notice that the debt, or any portion thereof, is disputed, we will obtain verification of the debt or a copy of any judgment against you and we will mail a copy to you. Unless you dispute the validity of the debt, or any portion thereof, within 30 days after receiving this Notice, the debt will be assumed to be valid. Please make arrangements to pay this debt in one or more installment payments, or you may call me if you have any other questions. This letter and all other communications from us are attempts to collect a debt. Any information obtained will be used for that purpose. I trust that you will give this your immediate attention. cc: Jeffery Benevit 2 GENEERAL DURABLE POWER OFATT'ORNEY NOTICE THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWER TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. HIS Aril , 2006 Date MICHAEL A. LYNCH ARK TNESSE r d AAs Principal EXHIBIT 6 WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 An agent shall have no authority to act as agent under this power of attorney unless the agent has first executed and affixed to this power of attorney an acknowledgment. ACKNOWLEDGMENT BY AGENT I, Michael A. Lynch, have read the attached power of attorney and am the person identified as the agent for the principal; I hereby acknowledge that in the absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. - ai-a Date Michael A. Lynch Agent COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS On this, the oZ day of , 2006, before me, a Notary Public in and for said County and State, the unders gned officer, personally appeared Michael A. Lynch, known to me (or satisfactorily proven) to be the person whose name is subscribed to the above- referenced Acknowledgment by Agent, and affirmed that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ??c, ? SEAL) NOTARIAL SEAL FA ' Yf gg? . RIGA L TOME Notary Public , StiiPPJYS BOR0uGH,CL&WRLANDC Ornf OUMY MY COrnrnission Expires Jun 7, 2008 yh J' WEIGLE be ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 An agent shall have no authority to act as agent under this power of attorney unless the agent has first executed and affixed to this power of attorney an acknowledgment. ACKNOWLEDGMENT BY SUCCESSOR AGENT I, Linda L. Lynch, have read the attached power of attorney and am the person identified as the Successor Agent for the principal; I hereby acknowledge that in the absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. Date Al. Linda L. Lynch Successor Agent COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS -rh On this, the o? `r day of , 2006, before me, a Notary Public in and for said County and State, the un ersigned officer, personally appeared Linda L. Lynch, known to me (or satisfactorily proven) to be the person whose name is subscribed to the above- referenced Acknowledgment by Successor Agent, and affirmed that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ? r c r? fi(SEAL) NOTARIAL SEAL P/ TRICIA L TOME Natory Public S"PPENSF3URGSORpURC ANDCCUNTY ..1 MY Comm(sslon ExPIles Jun 7.2008 WEIGLE & ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG; PA ,17ZS7-1'397 GENERAL DURABLE PO wER OFATTORNEY ARTICLE L DECLARATIONS I, Michael A. Lynch, presently residing at 82 West King Street, Shippensburg, Cumberland County, Pennsylvania 17257-1212, appoint my son, Michael A. Lynch, presently residing at 211 North Fourth Street, McConnellsburg, Pennsylvania 17233, to be my true and lawful agent with full power to carry out those acts specified in accordance with any limitations imposed herein. In the event that he is unwilling or unable to act as my said agent, I appoint my daughter- in-law, Linda L. Lynch, presently residing at 211 North Fourth Street, McConnellsburg, Pennsylvania 17233, as my Successor Agent. This Power-of-Attorney shall take effect upon its execution and shall remain in effect until my death, unless revoked by notice to my agent. This power of attorney shall remain in effect in the event of my subsequent disability or incapacity. In the event I revoke this instrument, any third party acting on the authority of the instrument, and without knowledge of the revocation, shall not be held accountable for any loss to me, my estate, heirs, successors or assigns. In the event an action is brought by any party in a court of competent jurisdiction for appointment of a guardian of my estate, and such action is not dismissed by the court due to my execution of this instrument, I nominate my agent to serve as guardian of my estate, unless such action was brought as a result of allegation that my agent has acted contrary to the instructions herein, or my best interests and such allegation is found to be warranted by the court. My agent shall serve without compensation. In the event that my agent, or a successor, is unable or unwilling to continue in that capacity, the agent shall be empowered to appoint a successor. ARTICLE II. POWERS GRANTED RELATED TO FINANCIAL MATTERS The following powers are granted to my agent to be used for my benefit and on my behalf in accordance with the directions specified herein. As to any assets, real or personal, standing in my name, held for my benefit or acquired for my benefit, I confer the following powers upon my agent: WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 1. As to any commercial, checking, savings, savings and loan, money market, Treasury bills, mutual fund account, safe deposit boxes, in my name or opened for my benefit - to open, enter, withdraw, deposit into, close and to negotiate, endorse or transfer any instrument affecting those accounts. 2. As to any promissory note receivable, secured or unsecured, or any accounts receivable - to collect on, compromise, endorse, borrow against, hypothecate, release and reconvey that note and any related deed of trust. 3. As to any shares of stock, bonds, or any documents or instruments defined as securities under law - to open accounts with stock brokers (on cash or margin), buy, sell, endorse, transfer, hypothecate and borrow against. 4. As to any real property, now or hereafter owned by me, specifically including, but not limited to, my real estate known as 82 West King Street, Shippensburg, Cumberland County, Pennsylvania 17257 - to collect rents, disburse funds, renegotiate leases, borrow against, renew any loan, buy or sell, and to sign any documents required for any such transaction, including deeds, without need for prior approval. 5. To hire and pay from my funds for counsel and services of professional advisors, physicians, dentists, accountants, attorneys and investment counselors. 6. As to my income taxes and other taxes - to pursue tax matters on my behalf including to: a. Prepare, sign, verify and file any tax return on behalf of the principal, including, but not limited to, joint returns and declarations of estimated tax; examine and copy all the principal's tax returns and tax records. b. Sign an Internal Revenue Service power of attorney form appointing any person including the agent herein to execute IRS documents and to otherwise represent the principal with respect to any and all matters before the IRS. C. Represent the principal before any taxing authority; protest and litigate tax assessments; claim, sue for and collect tax refunds; waive rights and sign all documents required to settle, pay and determine tax liabilities; sign waivers extending the period of time for the assessment of taxes or tax deficiencies. d. Hire preparers and advisors and pay for their services from my funds, and to do whatever is necessary to protect my assets from assessments as though I did those acts myself. e. In general, exercise all powers with respect to tax matters that the principal could if present. WEIGLE & ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA '17257-1397 7. To apply for benefits from any pension or insurance plan or policy, public or private, including but not limited to Medicaid and Medicaid benefits, to which I might be entitled, and in connection with any such plan or policy, to execute options thereunder, borrow against, cancel, surrender for cash value, or change beneficiaries. 8. To pursue claims and litigations. 9. To arrange for transportation and travel. 10. To partition property to create separate property for me. 11. To disclaim or release any powers or interests which I may have in any property. 12. To manage tangible personal property, including but not limited to, moving, storing, selling, donating, or otherwise disposing of said property. 13. To borrow money for me if that appears to be prudent, and in connection with any such transaction, to pledge any personal property for security as may be necessary. 14. To create one or more trusts for my benefit and to contribute to such trusts and receive income and/or principal from trusts in accordance with their terms. 15. To represent me in any and all matters requiring my approval and consent in connection with or arising out of my interest in any trust of which I am the settlor or beneficiary, and to exercise at any time and from time to time any power which I am now or may hereafter have with respect to any such trust, including any power to make withdrawals therefrom and any power to alter, amend or revoke, in whole or part, the same. 16. To renounce or resign any fiduciary position to which I have been appointed or in which I am serving, including, but without limitation, any position as an executor, administrator, trustee, guardian, agent or officer or director of a corporation, and in connection with such resignation, to file an accounting with a court of competent jurisdiction or agree to settlement by way of receipt and release or such other information method as my agent shall deem advisable. 17. To make any and all gifts of real property, personal property (including but not necessarily limited to liquid assets, cash, accounts, certificates of deposit, stocks, bonds, and other forms of securities both negotiable and non-negotiable) and/or mixed property, whatsoever and wheresoever situate for and on my behalf either outright or in trust to my family, including any agent, and in such amounts as my agent may decide, in accordance with the provisions of Pennsylvania Law [20 Pa. C.S. §5601.2(c)]. It is my specific intent and direction that any donee to which gifts can be made pursuant to this general Power of Attorney shall have the complete and unfettered right to reject any and all gifts made to him/her hereunder. WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 18. To claim or waive, wholly or partially, an elective share of the estate of my deceased spouse. 19. General Authority. To enter into any contract and/or to do all other things which my agent shall deem necessary and proper in order to transact any business for me or carry out the foregoing powers, which shall be construed as broadly as possible. ARTICLE III. POWERS GRANTED RELATED TO HEALTHCARE DECISIONS As to decisions related to my health care, I hereby grant the following power to my agent within the limitations specified. 1. To have full access to all of my medical records and to authorize or withhold authorization for medical and surgical procedures which my agent judges to be in my best interest, after medical consultation. 2. To authorize my admission to a medical, nursing, residential or similar facility and to enter into agreements for my care, whether at home or in such facility, with appropriate medical providers. 3. To arrange for my discharge, transfer from, or change in type of care provided. 4. To arrange and pay for consultation, diagnosis or assessment as may be required for my proper care and treatment. S'1" IN WITNESS WHEREOF, I hereby sign my name to this Power-of-Attorney this ,e day of April, 2006. HIS MICHAEL A. LYNCH MARK On the day of April, 2006, Michael A. Lynch, in our presence declared the preceding Power of Attorney to be his act and deed and being unable to sign his name because of health reasons Michael A. Lynch in our presence unassisted made his mark or cross in the space provided between his names, and we, in the presence of Michael A. Lynch, and in the presence of each other, havp silbscribed our name as witnesses. WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257_1397 r COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND : SS On this, the me) day of 6 Dn." 1 -1 2006, before me, a Notary Public in and for said County and State, the under igned officer, personally appeared Michael A. Lynch, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Power-of-Attorney, and acknowledged that he executed the same for the purposes therein contained and being unable to sign his name hereto because of health reasons Michael A. Lynch in my presence unassisted made his mark or cross in the space provided between his names. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SEAL Jerry A. Weigle, Notary Public Shippensburg, PA Cumberland County My Commission ires October 7, 2006 (SEAL) x :.? xk i?YI? _! 1. 'f :M1 ?L r ? r y , J ?c`• 1 .:'Z f Z •f 1 WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA '17257-1397 00 a W ? ? SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2007-05841 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND PERINI SERVICES SOUTHAMPTON VS LYNCH MICHAEL A SR R. Thomas Kline Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: LYNCH MICHAEL A JR but was unable to locate Him deputized the sheriff of FULTON serve the within COMPLAINT & NOTICE On October 16th , 2007 , this office was in receipt of the attached return from FULTON Sheriff's Costs: So answel:z-c 7 -- Docketing 18.00 Out of County 9.00 -?J Surcharge 10.00 R. Thomas Kline Dep Fulton Co 55.97 Sheriff of Cumberland County Postage 2.91 95.88 ? /,lb1?p? C 10/16/2007 CAPOZZI & ASSOCIATES Sworn and subscribe to before me this day of County, Pennsylvania, to in his bailiwick. He therefore A. D. SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2007-05841 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND PERINI SERVICES SOUTHAMPTON VS LYNCH MICHAEL A SR R. Thomas Kline Sheriff or Deputy Sheriff who being duly sworn according to law, says, that he made a diligent search and and inquiry for the within named DEFENDANT to wit: LYNCH LINDA L but was unable to locate Her deputized the sheriff of FULTON in his bailiwick. He therefore serve the within COMPLAINT & NOTICE County, Pennsylvania, to On October 16th , 2007 , this office was in receipt of the attached return from FULTON Sheriff's Costs: Docketing Out of County Surcharge ? - So answers- 6 . 00 .00 10.00 R. Thomas Kline .00 Sheriff of Cumberland County .00 / 16.00 ? /(/D//67 10/16/2007 CAPOZZI & ASSOCISTES Sworn and subscribe to before me this day of A. D. In The Court of Common Pleas of Cumberland County, Pennsylvania Perini Services Southampton Manor etc vs. Michael A. Lynch Sr. et al SERVE: Michael A. Lynch Jr. No. 07-5841 civil Now, October 8, 2007 , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Fulton County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Please mail return of service to Cumberland County Sheriff. Thank you. Affidavit of Service Now, , 20 , at o'clock M. served the within upon at by handing to a and made known to So answers, the contents thereof. Sheriff of Sworn and subscribed before me this day of , 20 copy of the original COSTS SERVICE _ MILEAGE _ AFFIDAVIT County, PA In The Court of Common Pleas of Cumberland County, Pennsylvania Perini Services Southampton Manor etc vs. Michael A. Lynch Sr. et al SERVE: Linda L. Lynch f/k/a Linda Lane No. 07-5841 civil Now, October 8, 2007 hereby deputize the Sheriff of Fulton deputation being made at the request and risk of the Plaintiff. //. Sheriff of Cumberland County, PA Please mail return of service to Cumberland County Sheriff. Thank you. Affidavit of Service Now, within upon at by handing to a and made known to copy of the original So answers, the contents thereof. Sheriff of Sworn and subscribed before me this day of , 20 I, SHERIFF OF CUMBERLAND COUNTY, PA, do County to execute this Writ, this 20 , at o'clock M. served the COSTS SERVICE $ MILEAGE AFFIDAVIT County, PA • FULTON COUNTY SHERIFF'S OFFICE 207 NORTH SECOND STREET, McCONNELLSBURG, PA 17233 (717) 485-4221 SHERIFF SERVICE PROCESS RECEIPT AND AFFIDAVIT OF RETURN 1. PLAINTIFF/S/ Perini Services Manor, Ltd. d/b/a Shippensburg Health Care Center 2. COURT NUMBER 07-5841 Cumberland County 3. DEFENDANT/S/Michael A. Lynch, Sr., Individually, Michael A. Lynch, Jr., Individually and as Power o 4. TYPE OF WRIT OR COMPLAINT: Attorney for Michael A. Lynch Sr., and Linda L. Lynch, Individually and as Successor for Michael A. Lurch Sr. Notice To Defend/ Civil Action SERVE 0 AT 5. NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC., TO SERVICE OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED OR SOLD Michael A. Lvnch Jr. 6. ADDRESS (Street, or RFD, Apartment No., Boro., Twp., State and Zip Code) 211 N. Fourth St. McConnellsburg, Pa. 17233 7. INDICATE UNUSUAL SERVICE: I-I COMMON. OF PA ? DEPUTIZE ? OTHER Now, I, SHERIFF OF FULTON COUNTY, PA, do hereby deputize the Sheriff of County to execute this Writ and make return thereof according to law. This deputation being made at the request and risk of the plantiff. SHERIFF OF FULTON COUNTY 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE: Notice To Defend/ Civil Action Complaint Verification Exhibit A,(1-8), B,C,D, and E 32 pages in all 9. SIGNATURE of ATTORNEY or other ORIGINATOR Cumberland Count 12. SEND NOTICE OF October 08, 2007 TO NAME AND ADDRESS BELOW: (This area must me completed if notice is to be mailed) One Courthouse Square, Carlisle, Pa. 17013 SPACE BELOW FOR USE OF SHERIFF ONLY - DO NOT WRITE BELOW THIS LINE 13. 1 acknowledge receipt of the writ NAME of authorized FCSD Deputy of Clerk and Title 14. Date Received 15. Expiration/Hearing Date or complaint as indicated above. Keith B. Stains, Sheriff October 10, 2007 October 09, 2007 16. 1 hereby CERTIFY and RETURN that I [:] have personally served, ? have legal evidence of service as shown in "Remarks", ® have executed as shown in "Remarks", the writ or complaint that described on the individual, company, corporation, etc., at the address shown above or on the individual, company, corporation, etc., at the address inserted below by handling a TRUE and ATTESTED COPY thereof. 17. ? I hereby certify and return a NOT FOUND because I am unable to locate the individual, company, corporation, etc., named above. (See remarks below) 18. Name and title of individual served (if not shown above) 119. A person of suitable age and discretion then Linda L_ Lvnch_ wife of Michael A. Lvnch Jr. residing in the defendant's usual place of abode. 1:1 . 20. Address of where served (complete only if different than shown above) (Street or RFD, Apartment No., City, 21. Date or Service 22. Time F-1 AM Boro, Twp., State and Zip Code) 1 ? EST October 10, 2007 4:10 ® EDST 23. ATTEMPTS Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. 1 10/10/07 2 KBS Advance 25. Service Costs 26. Notary Cert. 27. Mileage 28. Postage 29. Surcharge 30. Total Costs 31. COST DUE OR REFUND $ 100.00 $ 6.00 $ 5.00 $ $1.00 $10.00 $55.97 $44.03 Refund 32. REMARKS Paperwork was served to Linda Lynch on her and Michael A. Lynch Jr. It was served standing outside her residence at the address above. The total costs on Linda's return was $33.97 and will be added to this service. Costs for this service is $22.00. The total costs for both are$SS.97. 33. AFFIRMED and subscribed to before me this 11TH. SO ANSWER. 34. da of October, 2007 ii 5. ty Sh triff 36. Date 37 38. Signature of Keith B. Stains 39. Date 10/11/2007 Sheriff rot onotary eputy SHERIFF OF FULTON COUNTY MY COMMISSION EXPI s January 1, 2010 40. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE 41. Date Received OF AUTHORIZED ISSUING AUTHORITY AND TITLE. 10. TELEPHONE NUMBER 717-240-6390. 11. DATE FULTON COUNTY SHERIFF'S OFFICE 207 NORTH SECOND STREET, McCONNELLSBURG, PA 17233 (717) 485-4221 SHERIFF SERVICE PROCESS RECEIPT AND AFFIDAVIT OF RETURN 1. PLAINTIFF/S/ 2. COURT NUMBER Perini Services Manor, Ltd. d/b/a Shi ensbur Health Care Center 07-5841 Cumberland County 3. DEFENDANT/S/Michael A. Lynch, Sr., Individually, Michael A. Lynch, Jr., Individually and as Power o 4. TYPE OF WRIT OR COMPLAINT: Attorney for Michael A. Lynch Sr., and Linda L. Lynch, Individually and as Successor for Michael A. Lynch Sr. Notice To Defend/ Civil Action SERVE 5. NAME OF INDIVIDUAL, COMPANY. CORPORATION ETC., TOSERVICE ' OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED OR SOLD Michael A. I.Nnch Jr. 6. ADDRESS (Street, or RFD, Apartment No., Boro., Twp., State and Zip Code) AT 211 N. Fourth St. McConnellsburg, Pa. 17233 7. INDICATE UNUSUAL SERVICE: ? COMMON. OF PA ? DEPUTIZE ? OTHER Now, I, SHERIFF OF FULTON COUNTY, PA, do hereby deputize the Sheriff of County to execute this Writ and make return thereof according to law. This deputation being made at the request and risk of the plantiff. SHERIFF OF FULTON COUNTY 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE: Notice To Defend/ Civil Action Complaint Verification Exhibit A,(1-8), B,C,D, and E 32 pages in all 9. SIGNATURE of ATTORNEY or other ORIGINATOR 10. TELEPHONE NUMBER 11. DATE Cumberland County Sheriffs Office 717-240-6390. October 08, 2007 12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area must me completed if notice is to be mailed) One Courthouse Square, Carlisle, Pa. 17013 SPACE BELOW FOR USE OF SHERIFF ONLY - DO NOT WRITE BELOW THIS LINE 13. 1 acknowledge receipt of the writ NAME of authorized FCSD Deputy of Clerk and Title 14. Date Received 15. Expiration/Hearing Date or complaint as indicated above. Keith B. Stains, Sheriff October 10, 2007 October 09, 2007 16. 1 hereby CERTIFY and RETURN that I ? have personally served, ? have legal evidence of service as shown in "Remarks", ® have executed as shown in "Remarks", the writ or complaint that described on the individual, company, corporation, etc., at the address shown above or on the individual, company, corporation, etc., at the address inserted below by handling a TRUE and ATTESTED COPY thereof. 17. ? I hereby certify and return a NOT FOUND because I am unable to locate the individual, company,corporation, etc., named above. (See remarks below) 18. Name and titre of individual served (if not shown above) 19. A person of suitable age and discretion then Linda L. Lynch, wife of Michael A. Lynch Jr. residing in the defendant's usual place of abode. 1:1 . 20. Address of where served (complete only if different than shown above) (Street or RFD, Apartment No., City, 21. Date or Service 22. Time ? AM Boro, Twp., State and Zip Code) 1 ® PM October 10, 2007 EST 4:10 ®E DST 23. ATTEMPTS Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. 1 10110107 2 KBS Advance 25. Service Costs 26.NotaryGert. 27. Mileage 28. Postage 29. Surcharge 30. Total Costs 31. COST DUE OR REFUND $ 100.00 1 $ 6.00 $ 5.00 $ $1.00 $10.00 $55.97 $44.03 Refund 3"Z. KLMAKKS Paperwork was served to Linda Lynch on her and Michael A. Lynch Jr. It was served standing outside her residence at the address above. The total costs on Linda's return was-$33.97 and will be added to this service. Costs for this service is $22.00. The total costs for both are$55.97. 33. AFFIRMED and subscribed to before me this 11TH. 34. day of October, 2)007 37. ??'1f?\i k ) I ?_ / l,, ? 35. Signature of 38. Signature of Sheriff Keith B. Stains SHERIFF OF SO ANSWER. 36. Date - 39. Date 10/11/2007 N COUNTY MY COMMISSION EXPIR1cS January 1, 2010 40. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE OF AUTHORIZED ISSUING AUTHORITY AND TITLE. 41. Date Received FULTON COUNTY SHERIFF'S OFFICE 207 NORTH SECOND STREET, McCONNELLSBURG, PA 17233 (717) 485-4221 SHERIFF SERVICE PROCESS RECEIPT AND AFFIDAVIT OF RETURN 1. PLAINTIFF/S/ 12. COURT NUMBER Perini Services Manor, Ltd. d/b/a Health Care Center 07-5841 Cumberland County 3. DEFENDANT/S/ Michael A Lynch, Sr., Individually, Michael A. Lynch Jr., Individually and as Power of 4. TYPE OF WRIT OR COMPLAINT: Attorney for Michael A. Lynch Sr., and Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr. Notice To Defend/ Civil Action SERVE 5. NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC., TO SERVICE OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED OR SOLD Linda L. Lynch _ 6. ADDRESS (Street, or RFD, Apartment No., Boro., Twp., State and Zip Code) AT 211 N. Fourth St. McConnellsburg, Pa. 17233 7. INDICATE UNUSUAL SERVICE: ? COMMON. OF PA ? DEPUTIZE ? OTHER Now, I, SHERIFF OF FULTON COUNTY, PA, do hereby deputize the Sheriff of County to execute this Writ and make return thereof according to law. This deputation being made at the request and risk of the plantiff. SHERIFF OF FULTON COUNTY 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE: Notice To Defend Complaint Verification Exhibit A,(1-8),B, C, D, and E 32 pages in all 9. SIGNATURE of ATTORNEY or other ORIGINATOR Cumberland Couni 12. SEND NOTICE 10. TELEPHONE NUMBER 111. DATE 1 717-240-6390 October 08, 2007 TO NAME AND ADDRESS BELOW: (This area must me completed if notice is to be mailed) One Courthouse Square, Carlisle, Pa. 17013 SPACE BELOW FOR USE OF SHERIFF ONLY - DO NOT WRITE BELOW THIS LINE 13. 1 acknowledge receipt of the writ NAME of authorized FCSD Deputy of Clerk and Title or complaint as indicated above 14. Date Received 115. Expiration/Hearing Date Keith B. Stains, Sheriff October 10, 2007 ( October 09, 2007 16. 1 hereby CERTIFY and RETURN that I ® have personally served, ? have legal evidence of service as shown in "Remarks", ? have executed as shown in "Remarks", the writ or complaint that described on the individual, company, corporation, etc., at the address shown above or on the individual, company, corporation, etc., at the address inserted below by handling a TRUE and ATTESTED COPY thereof. 17. ? I hereby certify and return a NOT FOUND because I am unable to locate the individual, company,corporation, etc., named above. (See remarks below) 18. Name and title of individual served (if not shown above) I 19. A person of suitable age and discretion then residing in the defendant's usual place of abode. ? 20. Address of where served (complete only if different than shown above) (Street or RFD, Apartment No., City, 21. Date or Service 22. Time ? AM Boro, Twp., State and Zip Code) ® PM October 10, 2007 EST 4:10 ® E DST 23. ATTEMPTS Date Miles es Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. 1 10/10/07 2 Advance 25. Service Costs 26.NotaryCert. 27. Mileage 28. Postage 29. Surcharge 30. Total Costs 31. COST DUE OR REFUND $ 1 $ 18.00 $ 5.00 $ ,97 $10.00 33.97 JL. I`CCMAMI<J Advanced cost was put on Michael A. Lynch Jr. return. The cost of this service will be added to his service. Linda was served the paperwork for her and Michael Lynch outside her residence at the address above. 33. AFFIRMED and subscribed to before me this 11TH. 34. day of October, 37 MY COMMISSION EXPIRES January 1, 2010 40. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE OF AUTHORIZED ISSUING AUTHORITY AND TITLE. SO ANSWER. 35. Signature of 36. Date >e u Sheriff 38. Signature of Keith B. Stains 39. Date iheriff 10/11/2007 SHERIFF OF FULTON COUNTY 41. Date Received FULTON COUNTY SHERIFF'S OFFICE 207 NORTH SECOND STREET, McCONNELLSBURG, PA 17233 (717) 485-4221 SHERIFF SERVICE PROCESS RECEIPT AND AFFIDAVIT OF RETURN 1. PLAINTIFF/S/ 1 2. COURT NUMBER Perini Services Manor, Ltd. d/b/a Health Care Center 07-5841 Cumberland County 3. DEFENDANT/S/ Michael A Lynch, Sr., Individually, Michael A. Lynch Jr., Individually and as Power of 4. TYPE OF WRIT OR COMPLAINT: Attorney for Michael A. Lynch Sr., and Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr. Notice To Defend/ Civil Action SERVE 5. NAME OF INDIVIDUAL, COMPANY, CORPORATION, ETC., TO SERVICE OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED OR SOLD Linda L. LNnch 6. ADDRESS (Street, or RFD, Apartment No., Boro., Twp., State and Zip Code) AT 211 N. Fourth St. McConnellsburg, Pa. 17233 7. INDICATE UNUSUAL SERVICE: ? COMMON. OF PA ? DEPUTIZE ? OTHER Now, I, SHERIFF OF FULTON COUNTY, PA, do hereby deputize the Sheriff of County to execute this Writ and make return thereof according to law. This deputation being made at the request and risk of the plantiff. SHERIFF OF FULTON COUNTY 8. SPECIAL INSTRUCTIONS OR OTHER INFORMATION THAT WILL ASSIST IN EXPEDITING SERVICE: Notice To Defend Complaint Verification Exhibit A,(1-8),B, C, D, and E 32 pages in all 9. SIGNATURE of ATTORNEY or other ORIGINATOR Cumberland County 12. SEND NOTICE OF COPY TO NAME AND ADDRESS One Courthouse Square, Carlisle, Pa. 17013 10. TELEPHONE NUMBER 111. DATE 717-240-6390 October 08, 2007 area must me completed if notice is to be mailed) SPACE BELOW FOR USE OF SHERIFF ONLY - DO NOT WRITE BELOW THIS LINE 13. 1 acknowledge receipt of the writ NAME of authorized FCSD Deputy of Clerk and Title 14. Date Received 15. Expiration/Hearing Date or complaint as indicated above. Keith B. Stains, Sheriff October 10, 2007 October 09, 2007 16. 1 hereby CERTIFY and RETURN that 10 have personally served, ? have legal evidence of service as shown in "Remarks", ? have executed as shown in "Remarks", the writ or complaint that described on the individual, company, corporation, etc., at the address shown above or on the individual, company, corporation, etc., at the address inserted below by handling a TRUE and ATTESTED COPY thereof. 17. ? I hereby certify and return a NOT FOUND because I am unable to locate the individual, company,corporabon, etc., named above. (See remarks below) 18. Name and title of individual served (if not shown above) 19. A person of suitable age and discretion then residing in the defendant's usual place of abode. ? 20. Address of where served (complete only if different than shown above) (Street or RFD, Apartment No., City, 21. Date or Service 22. Time ED AM Boro, Twp., State and Zip Code) ®PM EST October 10, 2007 4:10 ® E DST 23. ATTEMPTS Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. Date Miles Dep. Int. 1 10/10/072 KBS Advance 25. Service Costs 26. Notary Cert. 27. Mileage 28. Postage 29. Surcharge 30. Total Costs 31. COST DUE OR REFUND $ $ 18.00 $ 5.00 $ 97 $10.00 33.97 32. REMARKS Advanced cost was. put on Michael A. Lynch Jr. return. The cost of this service will be added to his service. Linda was served the paperwork for her and Michael Lynch outside her residence at the address above. 33. AFFIRMED and subscribed to before me this 11TH, SO ANSWER. 34. day of October T,2007 35. Signature of 36. Date Deputy Sheriff 37. 38. Signature of Keith B 39. Date Sheriff B. Stainsti x 10/11/2007 rot onotary epu o ry u is 4zz MY COMMISSION EXPIRES January 1, 2010 SHERIFF OF FULTON COUNTY 40. 1 ACKNOWLEDGE RECEIPT OF THE SHERIFF'S RETURN SIGNATURE 41. Date Received OF AUTHORIZED ISSUING AUTHORITY AND TITLE. w j IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Perini Services Southampton Manor, Ltd. d/b/a Civil Court Division Shippensburg Health Care Center, Plaintiff V. : Docket No.: 07-5841 Michael A. Lynch, Sr., Individually and Civil Action - Law Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., And Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr., Defendants PRAECIPE TO ENTER DEFAULT JUDGMENT AGAINST DEFENDANTS To the Cumberland County Prothonotary: Kindly enter judgment for Plaintiff and against Defendants and assess damages certified to be calculable as a sum certain from the Complaint. Current amount due: $11,876.25 Attorney Fees: $2,087.50 Costs of Court $408.50 TOTAL: $14,372.25* Plus post-judgment interest and additional costs of collection. I understand that any false statements therein are subject to the penalties contained in Title 18 of the Pennsylvania Consolidated Statutes §4904, relating to unswom falsification to authorities. I verify that: 1. The last known address for Defendants are: Michael A. Lynch, Sr. c/o Michael Lynch, Jr. 211 N. Fourth Street McConnellsburg, PA 17233 • Michael A. Lynch, Jr. 211 N. Fourth Street McConnellsburg, PA 17233 Linda L. Lynch 211 N. Fourth Street McConnellsburg, PA 17233 2. It is certified that a written Notice of Intention to Enter Judgment by Default was mailed to Defendants, against whom this judgment is to be entered, after the default occurred and at least 10 days prior to the date of the filing of this Praecipe. A copy of the Notice of Intent to Enter Default Judgment is attached as Exhibit "A." Date: By: THIS DAY OF , 2007, JUDGMENT IS ENTERED IN FAVOR OF PLAINTIFF AND AGAINST DEFENDANT RICHARD RICHARDS, AND DAMAGES ASSESSED AT THE SUM $14,372.25, PLUS POST-JUDGMENT INTEREST AND ADDITIONAL COSTS OF COLLECTION. PROTHONOTARY Capozzi and AssoSiates, P.C. r. Amtrf-ew . Ei ann, Esquire Attorney o. 441 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 2 S IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Perini Services Southampton Manor, Ltd. d/b/a Civil Court Division Shippensburg Health Care Center, Plaintiff V. Michael A. Lynch, Sr., Individually and Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., And Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr., Defendants Docket No.: 07-5841 Civil Action -Law NOTICE OF INTENTION TO ENTER JUDGMENT BY DEFAULT TO: Michael A. Lynch, Sr. c/o Shippensburg Health Care Center 121 Walnut Bottom Road Shippensburg, PA 17257 Michael A. Lynch, Jr. Linda L. Lynch 211 N. Fourth Street 211 N. Fourth Street McConnellsburg, PA 17233 McConnellsburg, PA 17233 DATED: November 9, 2007 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: LAWYER REFERRAL SERVICE Lancaster Bar Association 28 E. Orange Street Lancaster, PA 17602 EEXH1131T (717) 393-0737 NOTICIA IMPORTANTE TO: Michael A. Lynch, Sr. c/o Shippensburg Health Care Center 121 Walnut Bottom Road Shippensburg, PA 17257 Michael A. Lynch, Jr. Linda L. Lynch 211 N. Fourth Street 211 N. Fourth Street McConnellsburg, PA 17233 McConnellsburg, PA 17233 DATED: November 9, 2007 USTED HA NO COMPLIDO CON EL AVISO ANTERIOR PORQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI USTED NO ACTUA DENTRO DE DIEZ (10) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA USTED SIN UNA AUDIENCIA Y USTED PODRIA PERDER SU PROPIEDAD O OSTROS DERECHOS IMPORTANTES. USTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEGUIDA. SI USTED NO TIENE ABOGADO O NO TIENE CON QUE PAGAR LOS SERVICIOS DE UN ABOGADO, VAYA O LLAME A LA OFICINA ESCRITA ABAJO PARA AVERIGUAR A DONDE USTED PUEDE OBTENER LA AYUDA LEGAL. LAWYER REFERRAL SERVICE Lancaster Bar Association 28 E. Orange Street Lancaster, PA 17602 (717) 393-0737 CAPOZZI AND ASSOCIATES, P.C. By: 2 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101 _ r CERTIFICATE OF SERVICE I hereby certify that I have caused the foregoing Notice of Intention to Enter Judgment by Default to be served by mailing the same on this date by regular first class United States mail, postage prepaid as follows: Michael A. Lynch, Sr. c/o Shippensburg Health Care Center 121 Walnut Bottom Road Shippensburg, PA 17257 Michael A. Lynch, Jr. 211 N. Fourth Street McConnellsburg, PA 17233 . Linda L. Lynch 211 N. Fourth Street McConnellsburg, PA 17233 Date: November 9, 2007 By: CAPOZZI AND ASSOCIATES, P.C. 4 Andr6y .. iseniann, Esquire Attorney I. D. "7441 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff 3 D• 3, p c? D D ? --) , _ -r-'i...? •-t 1- r•-, JFri " " s7 w IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Perini Services Southampton Manor, Ltd. d/b/a Civil Court Division Shippensburg Health Care Center, Plaintiff V. Michael A. Lynch, Sr., Individually and Michael A. Lynch, Jr., Individually and as Power of Attorney for Michael A. Lynch, Sr., And Linda L. Lynch, Individually and as Successor Agent for Michael A. Lynch, Sr., Defendants Docket No.: 07-5841 : Civil Action -Law RULE 236 NOTICE OF THE ENTRY OF DEFAULT JUDGMENT AGAINST DEFENDANTS TO: Michael A. Lynch, Jr. Michael A. Lynch, Sr. 211 N. Fourth Street c/o Michael Lynch, Jr. McConnellsburg, PA 17233 211 N. Fourth Street McConnellsburg, PA 17233 Linda L. Lynch 211 N. Fourth Street McConnellsburg, PA 17233 Pursuant to Pa. R.C.P. No. 236, you are hereby notified that a Judgment has been entered against you in the above proceeding as indicated below: X JUDGMENT BY DEFAULT - in the amount of $14,372.25, plus post-judgment interest and additional reasonable costs of collection. Money Judgment; Amount on Award of Arbitrators; Judgment on Verdict; Money Judgment Transferred from Other Jurisdiction; Other. IF YOU HAVE ANY QUESTIONS CONCERNING THIS NOTICE PLEASE CALL ATTORNEY ANDREW R. EISEMANN AT THIS TELEPHONE NUMBER: (717) 233-4101. By: AiO_THONOTARY U/30/07 3 # y PERINI SERVICES SOUTHAMPTON MANOR, LTD. d/b/a SHIPPENSBURG HEALTH CARE CENTER, Plaintiff V. MICHAEL A. LYNCH, SR., Individually and MICHAEL A. LYNCH, JR., Individually and as Power of Attorney for MICHAEL A. LYNCH, SR., and LINDA L. LYNCH, Individually and as Successor Agent for MICHAEL A. LYNCH, SR., Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Docket No.: 07-5841 : Civil Action -Law PRAECIPE TO SATISFY JUDGMENT TO: THE PROTHONOTARY OF CUMBERLAND COUNTY Kindly mark the judgment in the above-referenced action entered on November 30, 2007 in the amount of $14,372.25 as SATISFIED. Date: By: Respectfully submitted, CAPOZZI & ASSKIATES, P.C. -Amtrr-ew R. WehV n, Esquire Attorney ID 4 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff CERTIFICATE OF SERVICE I do hereby certify that I caused a true and correct copy of the foregoing document to be served via first class U.S. mail, postage prepaid, addressed as follows: Jerry A. Weigle, Esquire Weigle & Associates, P.C. 126 E. King Street Shippensburg, PA 17257 Date: f old qz i , Esquire Attorney I.D. No. 87441 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 2 70 rr r c n ? d rc r - -4- t V