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HomeMy WebLinkAbout03-52831N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION BEVERLY ENTERPRISES -PENNSYLVANIA, 1NC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG 741 Chambersburg Road Gettysburg, PA 17325 Plaintiff, No. -3".2g3 VS. COMPLAINT IN CIVIL ACTION AUDREY H. ADAMS 254 Stuart Road Carlisle, PA 17103 Defendant. FILED ON BEHALF OF Plaintiff COUNSEL OF RECORD OF THIS PARTY: John S. Pucin, Esquire PA I.D. #90401 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 Chestnut Street, Suite 1120 Philadelphia, PA 19106 (215) 599-1500 WWR#03206636 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION BEVERLY ENTERPRISES - PENNSYLVANIA, INC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG Plaintiff, VS. AUDREY H. ADAMS Defendant. Civil Action No. COMPLAINT IN CIVIL ACTION AND 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 this complaint and notice are served, by entering a written appearance personally or by an 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 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 Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 COMPLAINT 1. Plaintiff, Beverly Enterprises - Pennsylvania, Inc., is a Pennsylvania Corporation doing business as Beverly Healthcare - Gettysburg. 2. On or about February 14, 2003, Defendant entered into a written agreement with Plaintiff whereby Plaintiff agreed to provide, and Defendant agreed to pay for, nursing care services provided by the Plaintiff to herself. A copy of the Short-Term Admission Agreement is attached hereto as Exhibit "1" and is incorporated herein by reference, 3. Periodically from April, 2001 through August, 2003, Defendant received nursing care services from Plaintiff. 4. As of October 1, 2003, there is a principal balance due and owing for the services rendered in the amount of $9,899.10. COUNT ONE - ACCOUNT STATED 5. Plaintiff hereby incorporates by this reference each and every allegation contained in Paragraphs 1 through 4 above, as if the same were fully rewritten herein. Plaintiff delivered, and Defendant agreed to pay, for services rendered on her account. Plaintiff made due demand for payment, but Defendant has failed and refused to satisfy the 7. debt due. 8. $9,899.10. As of October I, 2003, Defendant owes Plaintiff upon an account the principal sum of A copy of the Itemized Resident Statement is attached hereto as Exhibit "2" and is incorporated herein by reference. COUNT TWO - BREACH OF CONTRACT 9. Plaintiff hereby incorporates by this reference each and every allegation contained in Paragraphs 1 through 8 above, as if the same were fully rewritten herein. 10. Defendant breached the terms of the Agreement by failing to pay Plaintiff for the services provided to her. 11. Plaintiff has performed all conditions precedent to demand performance fi.om Defendant. 12. Plaintiff has been dan~aged by Defendant's breach in the principal sum of $9,899.10 COUNT THREE -UNJUST ENRICHMENT 13. Plaintiff incorporates each and every allegation contained in Paragraphs 1 through 12 as if fully rewritten herein. 14. Plaintiff has provided services to and for the benefits of Defendant Audrey H. Adams. 15. Defendant has been un.justly enriched at the expense of Plaintiff as a result of her receipt of said services without payment for the same. 16. Plaintiff has been damaged in the amount of $9,899.10, which represents the reasonable value of services rendered by Plaintiff for which Defendant has not paid. WHEREFORE, Plaintiff Beverly Enterprises - Pennsylvania, Inc. d.b.a. Beverly Healthcare - Gettysburg, prays for the following relief: (1) On Counts One, Two and Three: For a Judgment against Defendant Audrey Adams in the principal sum of $9,899.10, plus interest at the rate of 6% per annum from the date of.judgment and costs. Respectfully submitted, WELTMAN, WEINBERG & REIS, CO., L.P.A. J~o, hn~j~.'~u~,~i~,~ ,Eqie~3~.Eijr~p~,L,_TMAVi~uX~r SEiUNrB ERG & REIS CO.,L .P.A. 325 Chestnut Street, Suite 1120 Philadelphia, PA 19106 (215) 599-1500 WWR#:03206636 THIS LAW FIRM IS A DEBT COLLECTOR ATTEMPTING TO COLLECT A DEBT AND ANY INFORMATION OBTAINED SHALL BE USED FOR THAT PURPOSE. FROM:MICHAEL MANOR ID:7I?33725S~ PACE 2/9 SHORT-TERM ADMISSION AGREEMENT !. CONSENT FOR ~EA~N~: ~e undemi~ed co~enB to ~e romine nursing and orh~ h~kh ~e se~ces whch my be ue~med ~ this ?a~St~as dixe~e~Cby the a~end~g phyhd~'s i~tm~iens: ~e:Patiem ~so co~ent~ to:=ea~t by ke~ c~e ~a~s ~nd~ sup~ion ~ requked by law.' ~e Pmi~t,~ ~e ri~t to re,%se ~eatm~ ~d to r~oke co~t for ~e~ent at ~y time· , ; .... ' ,; 2. CONSENW TO PH~H~ The Pa~ent a~ees to ~ow tho Facfli~ to photO,apb or vi~ota~ ~e Pati~t as a m~s "of id~fiffcafion in ca~ of emerg~cy or for he~-relazed,gu~s~. :~e photo'D~h,0r video~ wilt be kept co~d~aI., arid advice wff~en pc,albion mu~ be ob~ned ~om ~e Pa6~t if used for p~ses other ~an those smt~ ~ve. 3- ~L~ OF ~O~ON: To ~e ~t~t neces~ to dot,ne liability for payffieat ~d to obta~ r~mbur~mem; ~e Facility my disclose ~ions of ~e Pa~t's retard, ~ncluding hisser medi~ r~or~, to ~y person or ~ration-w~ch ~ or may be liable, for all or any ~ion of the Faciliu's c~rg¢, including bur nor limited to i~ur~.ce companies, health ~re pim~ Medi~¢e, M¢~ or workers compensation ~. 4. PERSONAL,FUNDS: The Patient has a right to manage his&er own personal funds., At, the Patient's written request, ~he Facility shall hold, safeguard, manage and account for these funds, At the Patient's request, information about how to open a Patient Trust Fund Accourrr, and how the funds will be handled, will be provided, 5. PER~SONAL VALUABLES: The Facility strongly discourages the keeping of valuable jewelry, papers, large sums of money, or other items considered of value in the Fac/liB,. The Facility will make reasonable efforts to safeguard the t?atienfs property/ valuables wh/ch the Patient chooses ro keep in h/s/her possession, The Patient agrees to inform the Facility of all vaIuable property upon admission, and at any time new iiems of~alue are added to the Patient's possessions. 6. FINANCIAL AGREEMENT: The Facility make~ mY,g-oCC~oee that:USe Patient~,s'care~ W~ll be covered.by Mediqare-~ NlO:ticaid_. or any th.j.O.~m'ance or other reimbursement sorrrce. By stgnlng th/s agreement, the Patient, i.It. dividually obligates to d~e Patient. The ~.genE-d~,~ot:assume ,responsibii.ky for paymen~:o:~'fh~¥eoif2'~f'the :Pati~'~,~a~:ouz of, the Agent's personal funds..:~e Pati'en~/A~ent is'egpeeted'to'settle:the account inffull:6r:make an--angemenr* for payment prior: tO'discharge. ~ All delinquent a~counts shall bear interest at a legal rate not m e-xceed the maximum allowable by state law. FEDERAL AND STATE LAWS PROIr~glT TlqE F'ACIi, IT¥ FRON! 1LEQUtRING- A TH]~RD' PA:R/fY GUARANTEE'OF PAYMENT AS A CONDITION OF ADMISSION'OR CONi'I, NU'ED STAY IN THE FACILITY. A list o~ supplies and services that are included in the Facility's private daily rate or that will ve ?a/d for by the Medicaid or Medicare programs and a list of supplies and services for which the Patient will be separately charged wilI be provided tc the Patient upon admission. A detailed list of and clxa~es for all supplies and services is mainta/ned in the Business Of Sce and is available for review during normal business hours. 7. INDEPENDF, aNW CONTR.ACTORS: Physicians are i:$dependenr contractors, nor agents of the Faciliw. Patient understands. and agrees that each of the erofessional groups or individual practitioners wh/ch render professional services to Patient will bill and colIect for these professional services, separate and apart from the Facility's billing and collections, but ~bject to thc autho- rizations granted by Patient in accordance with the agreement. 8. FACILITY. POLICY REGARDING IMPLEMENTATION OF PATIENT SELF DE£~F, MINATION AC-12 This Facility recognizes the fight of each Patient to utilize advance directives recognized under state law and will honor advance diremives d~veloped in accordance with state law and consistent with the level of care the Facility is licensed to provide, An advance directive is a written document that states choices for health care and/or names someone to make those choices. These choices may include the refusal of certain types of care. A LMng V611 and a Durable Power of Attorney for Health Care are examples of ]~E202B advance directives The tmd~rsig~ed acXnowledges that a copy of the Facility policy regarding implementation of the Patient Self Deierrnination Act has been provided to the Patient upon admission. The PaUent [ ] does D<] does not have an advance directive. 9. CONTRACT TERMINATION AFTER 60 DAYS: The undersigned agrees that the Sho~t-TermAdmission A~eement Shall be in effect for the first 60 days that the Pati~t resides in the Facility. On the 61st day, the Patient willbe:subject to the terms and conditions of and required to execute the Resident Admission Agreement which meets additional requirements for long-term care, The Resident Admission Agreement will be explained in detail on or before the expiration of the Short-Term Admission Agreement. Al/financial obligations r, hat arise during the first 60 days that the Short-Term Admission Agreement is in effect shall, be subject to the terms set forth ia the Short-Term Admission Agreement until the financial obligations are satisfied, 10. BED HOLDS: The Patient may need to be absent from the Facility temporarily for hospitalization or therapeutic leave. The Patient may request that the Facility hold open the Patient's bed during this time Coed hold). The Patient'shall be given notice of the bed hold option at the time of hospitalization or therapeutic leave. 11. INSURANCE BENe.e I 1 S: If the Facility agrees to file an insurance ulalm on behalf of the Patient. the undersigned authorizes direct payment to the Facility of any insurance benefits otherwise payable to or on behalf of the unde'rsigned for this Patient's stay. It is the Facility's policy to verify insurance benefits and review this information with the Patient; however, final determination coverage is made by the insurance company. 12. NONDISCRIMINATION STATEMENT: The Facility welcomes ali persons in need of its services and does not discrimi- nate on the baqlq of age, disability, race. color, national origin, ancestry~ religion, or sex. The Facitity does not discrim/nate among persons b~ed on their source of payment. 13. GRIEVANCES: Patients ar~ urged to bring any grievances concerning the Facility to the attention of the Facility Admiais- urator, State I_icenhng Agency, or Omburtqman. The Facility also offers a toll-free 'Hotliae" through which grievances can be registered directly with the corporate offices. This number is.1,800-572~9981. - 14~ ..~N'CE B~.~D. PL~ NO,.~C~5" I~_your .ceradi~rs, ¥~r:ma.v-.l~ ~Medmare:;..., Ce~ifaed D~nct: Pazt UniI., .At .som~curwh / c'~lSmk~r esfding ~ u.~t.-~n~.o,~ ~?propri~ta ' for you. In ~- ou. Under ~a~annoObe.d/~c~gg,~from thi~ facility The undemigned certifies that he/she has read the foregoing, received a' copy thereof,'and is duly authorized to execute the above and accept its terms. The Patient acknowledges that he/she has been informed of, has received a copy of. and has been encour- aged to review and ask quest/ons about all applicable Resident R~ghts and roles and regulations governing Patient conduct under ~ Federal and State Law. Mail and notices will be g~en directly to the patient unless spec/fically directed other,vise by Patient/ ~,_' Legal Representative/Agent. Z Patient Signature q/ Date Legal Representative/Agent (Circle appropriate one) Sigaamre Facility N~'ne and Number ~ ~ Date BE 20215 Whim - Business Office Yellow - Patient Pink - Med/cal Records lQ<Private RESIDENT-SPECIFIC INFORMATION This Facility accepts the following types of payments: (Check ail that apply_) [.]"Medicare [i.]~etedicaid [ ~,~%'terans Administration PARTIES The parties to rlxis Agreement are: (Name of I~jident) (Name of Resident s A=ent) (Name of Res/dent's Legal Representative) If a Legal Representative signs, check the Type of Legal Representative (below): [ ] COnservator of Person [ ] Conservator of Estate [ ] Other, specify [ ] Guardian [ ] Durable Power of Attorney for Health Care (DPAHC) [ ] Agent Acting Under General PtA If you are signing this Agreement on behalf of the Res/dent, note your relationship ro the resident: Relationship to Resktenr _ is /r'Jcv./ , ,_0 the above avee on the 02/*' of ;7~/~/c~ ,20~_~, the Re(~"ent shall be admitted to this Facility. As of that day, the Facility shall ~pro- vide th~/serv/ces described in ~his Agreement to the Resident until the date of the Resident's d/scharge or transfer. The Resident shall pay for the services provided by the Facility according to the terms of this Admission Agreement. ACKNOWLEDGEM]ENTS By si*~Jng the Admission Agreement Si*~nature Page, the Resident/Agent/Legal Representative acknowl- edges that he or she has been ~ven and has read this A~eement in its entirety, and all addendums. The Resident also acknowledges that the following information was provided upon or before admission by the Facility. Initial the lines below (if not applicable, write N/A): Q~_. !~ ~1~1~ A list of supplies and services that are included in the Facility's private daily rare or that will be paid for by the Medicaid or Medicare progra.ms and a list o£ supplies and services not included in the Facility'$ private da/fy rare or paid for by the Medicaid or Medicare programs for which the Resident will be separately Charged. 15 ~-h~rr, _ Business Office Pink - Medical Records Yellow - Resident ,3~.~.__ 2~ Information about the Facility's bed hold procedures. ~/~ (~,-3. A written explanation of how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous paymen~ covered by these benefits. (2~ ~ ...(~.. A statement explaining that the Resident may file a grievance with the appropriate State Agency about resident abuse, neglect, and/or misuse/theft of resident personal property in the Facility. (~,-J]/-~5. Copies of the State Resident Rig~hts. If your condition warrants, you may be placed in the facility's Medicare-Cet'fified Distinct Fart Unit. 'At some point, circumstances may occur which will make residing in another unit more appropriate for you. In that case, the facility will discuss such a transfer with you. Under law, you cannot be discharged from this facility unless you agree or unless, following an appeal, it is 1 have been informed, both orally and in writing, in a language I understand, of my rio~hts and the rules and regular/OhS governing my conduct and responsibilities during my stay at the Facility. determined that you may be involuntarily discharged or transferred. ~ A copy of the facility policy regarding implementation of the Patient Self Determination Acr~ and of the applicable State law. I do do not have an advance directive. NOTICES Notices shall be maiied to the address(es) indicated below. The Agent and/or Legal Represemative'is responsible for notifying the Facility in writing of any change of address. The Resident designates the following person(s) to be nodfied when any legally required notices are provid- ed to the Resident, Agent, and/or Legal Representative. LEGAL REPRESENTATIVE AND/OR AGENT Name '~'"~,~(h'~.~ ~704-~t['(~ Home Phone Work Phone Name Street OTHER PERSON TO BE NOTIFIED Home Phone Work Phone City State Zip White - Business Office Pink -Medical Records Yellow -Resident MAII, The Facility is authorized to handle the Resident'$ mail as follows: (Check one box only.) All mail given directly to ~e Resident Forward all of the Resident's mail to: [ ] Ail mail read to the Resident [ ] ~ve personal mail to the Resident; forw~d business mail to: SPECL4~LTY: ADDRESS: TELEPHONE: RESIDENT'S PI-.IYSICIAN 17 White - Business Office Pink - Medical Records Yellow - Res/dent ADMISSION AGREEMENT SIGNATURE PAGE Resident Date Witness if Resident Signed with a Mark Witness if Resident Signed with a Mark Legal Representative _( Leoal Represenranve s Telephone Number Date Date Date Le~=al RepresentaUve s Social Security No. Agent Date _( ~) A=ent s Telephone Number Facility Administrator or Desigffe/~ A=ent s Socml Security No. Note: The signatures above refer to the information contained on pages J through 18 of the Beverly Enterprises Admission Agreement. 19 %Zxite - Buziness Office Pink - MedicaJ Records Yellow - Res/dent On this of day of READMISSION AGREEMENT /t~r?e , ~I~C° ~, the parties below a~ee that on the. ~ ,-r~ BEVERLY · ~24~, the Resident shall be .readmitted to this facility. Continuation of the previous Admission Am'cement: The Resident Specific Information sect/on of the ori~nal Resident Admission Agreement dated ,~/'/~ I / a c_~>~ , has been reviewed and there is no significant change. The terms of the o~igin~ a agr'eement are in effect for this readmission and.the Resident Specific InformatiOn section of that agreement is on file in the Business Office available for review. Ail terms of the original Resident Admission Agreement ~re incorporated by reference as though set forth herein. Acknox,:ledgements: The Resident acknowledges that the follOwing information was provided upon or before readmission to the facility. The Resident must initial the lines below t© indicate acknowledgement: 4 tA, The option to open a Resident Trust Fund Account. : If the payor source has changed since the last discharge, a list of supplies and services included in the daily rate paid by the new payor and those items or services for which the Res/dent can be separately charged. A copy of the facility policy regarding implementation of the Patient Self Determination Act and of the apphcable state law. t do do not ~ have' an advance directive. If your condition warrants~ you may be placed in the facility's Medicare-Certified Distinct Part Unit. At some point, circumstances may occur which will make residing in another unit more approlSriate'To~ you. Ih that case~ the facilit? will discuss sudh a tran~f~r-'with you. Under law. you cannot be discharged from this faciliD unless you agree or unless, following an appeal, it is determined that you may be involuntarily discharged or transferred. Wimess if Resident Signed with a Mark Date Wimess if Resident Signed with a Mark Date Legal Representative ( ) Legal Representative s Telephone Number Date Legal Representative s Social Security No. Agent Aa~nt's Telephone Number Facility Administrator o~e~ignee BE zo2.~ 'Dale Agent's Social Security No. Date Pink -- Medical Rccorox Yellow - Resident READMISSION AGREEMENT Criteria for Use CRI~i fi~LIA FOR USE Tiffs Readmission Agreement (instead of a n~ R~id~t Ad--ion A~ltn:) C~ ~ ~ O~Y if both ~e following ch~ m in p~: 1. No more ~ ~ (~) days ~ve d~ hnce ~e I~t d~ch~e. ~cfion Cage~ 15 - t9) ~ ~* ~n~ Resident A~hon A~ent (B~ 202). p,_~.O.~g._D., IIIIIIIIIIIIIIIIIII~RE for '"WHEN & HOW TO COMPLETE'_' A detailed procedure on WHEN and HOW to use the Rcadmission A~eement (BE 20gA~ is found in the "Admission Process" section of the CrMit & Collections 3,lanuxxl. NOTE: When a Readmission Agreement (BE 202A) is used. the £acflity must comply with any State-specific requirements/'or opening a new medic, al record. Contact your Region Office for de~iled medicai record reqn~rements and instructions. BE 202A (5/95) Date: Facitit7: Resident Name: DATES OF SERVICE 4/01-08/03 5/01- 31/03 6/01 - 18/03 ITEMIZED STATEMENT Beverly Healthcare/Gettysburg Audrey Adams DESCRIPTION Room & f~ard Pharmacy Haircut Room & Board Pharmacy Room & Board Medical Supplies DAYS 8 31 18 Fac. #: Acct. ,~, CHARGES $ 1,399.20 $ 54.74 $ 9.00 $ 5,247.00 $ 39,96 $ 3,148.20 $ 1.00 3926 91310 CREDITS .$ 9,899.10 $ Credits $ 9,899.10 SHERIFF'S RETURN - NOT FOUND CASE NO: 2003-05283 P COMMONTWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND BEVERLY ENTERPRISES VS ADAMS AUDREY H PA DBA Thomas Kline Ro duly sworn according to law, says, that he made a diligent inquiry for the within named DEFENDANT ADAMS AUDREY H unable to locate Her in his bailiwick. ,Sheriff or Deputy Sheriff, who being search and but was He therefore returns the COMPLAINT & NOTICE the within named DEFENDANT 254 STUART ROAD CARLISLE, PA 17013 DEFENDANT · ADAMS AUDREY H · NOT FOIIND , as to IS IN A NURSING~SYCHIATRIC FACILITY IN MARYLAND. Sheriff's Costs: Docketing Service Not Found Surcharge 18,00 3.45 5.00 10.00 .00 36.45 / ' R. Thomas Kline Sheriff of Cumberland County WELTMAN WEINBERG REIS 10/14/2003 Sworn and subscribed to before me this day of Prothonotary SHERIFF'S RETURN - REGULAR CASE NO: 2003-05285 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND FAIRLANE CREDIT LLC VS LAUGHMAN GERALD JASON VIORAL , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to says, the within COMPLAINT & NOTICE was served upon LAUGHMAN GEP~ALD DEFENDANT , at 1641 00 HOURS, at 443 WHISKEY RUN ROAD NEWVILLE, PA 17241 GERALD LAUGHMAN a true and attested copy of COMPLAINT & NOTICE the on the 22nd day of October by handing to together with 2003 and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing Service Affidavit Surcharge 18 00 9 66 00 10 00 00 37 66 Sworn and Subscribed to before me this ~ day of A.D. · , ~/,.~ ~ Prdthonotary ! ~ So Answers: R. Thomas Kline 10/23/2003 DONALD MAZZOTTA By:  eputy Sheriff 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CiVIL DIVISION BEVERLY ENTERPRISES -PENNSYLVANIA, INC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG 741 Chambersburg Road Gettysburg, PA 17325 Plaimiff, VS. AUDREY H. ADAMS 254 Stuart Road Carlisle, PA 17103 No. 2003-5283 PETITION FOR CHANGE OF VENUE Defendant. FILED ON BEHALF OF Plaintiff COUNSEL OF RECORD OF THIS PARTY: John S. Pucin, Esquire PA I.D. #90401 WELTM.~dq, WEINBERG & REIS CO., L.P.A. 325 Chestnut Street, Suite 1120 Philadelphia, PA 19106 (215) 599-1500 WWR#03206636 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CWIL DWISION BEVERLY ENTERPRISES - PENNSYLVANIA, INC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG Plaintiff, VS. AUDREY H. ADAMS Defendant. Civil Action No. ,..~005 PETITION FOR CHANGE OF VENUE Now comes Plaintiff by and through counsel and moves this Court for an Order allowing for the change ofvanue from Court of Common Pleas Cumberland County, Pennsylvania to the Court of Common Pleas of Adams County, Pennsylvania. The reason for said request is that proper subject matter jurisdiction lies in Adams County, the location of the nm'sing home where the services were rendered to Defendant. Additionally, Defendant no longer resides at the address listed in the original complaint of 254 Stuart Road, Carlisle, Pennsylvania. Respectfully Submitted, Weltman, Weinberg & Reis Co., L.P.A. ~ Ii .' ~estnut Street, Suite 1120 Philadelphia, PA 19106 (215) 599-1500 WWR # 03206636 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CWIL DWISION BEVERLY ENTERPRISES - PENNSYLVANIA, INC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG Plaintiff, VS. AUDREY H. ADAMS Defendant. Civil Action No. ~  ORDER AND Now, this El__._ day of~__, 2003, upon review of Plaintiff's Petition For Change of Venue, the Court hereby orders that this matter be transferred from the Court of Common Pleas of Cumberland County, Pennsylvania to the Court of Common Pleas of Adams County, Pennsylvania. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION BEVERLY ENTERPRISES -PENNSYLVANIA, INC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG 741 Chambersburg Road Gettysburg, PA 17325 Plaintiff, VS. AUDREY H. ADAMS 254 Stuart Road Carlisle, PA 17103 No. 2003-5283 PETITION FOR CHANGE OF VENUE Defendant. FILED ON BEHALF OF Plaintiff COUNSEL OF RECORD OF THIS PARTY: John S. Pucin, Esquire PA I.D. #90401 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 Chesmut Street, Suite 1120 Philadelphia, PA 19106 (215) 599-1500 WWR#03206636 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CWIL DIVISION BEVERLY ENTERPRISES - PENNSYLVANIA, 1NC. d.b.a. BEVERLY HEALTHCARE - GETTYSBURG Plaintiff, VS. AUDREY H. ADAMS Defendant. Civil Action No. PETITION FOR CHANGE OF VENUE Now comes Plaintiffby and through counsel and moves this Court for an Order allowing for the change of venue from Court of Common Pleas Cumberland County, Pennsylvania to the Court of Common Pleas of Adams County, Pennsylvania. The reason for said request is that proper subject matter jurisdiction lies in Adams County, the location of the nursing home where the services were rendered to Defendant. Additionally, Defendant no longer resides at the address listed in the original complaint of 254 Stuart Road, Carlisle, Pennsylvania. Respectfully Submitted, Weltman, Weinberg & Reis Co., L.P.A. J ~'~h'Z0u4t 0slt r e e t, SuiS'~~ te Philadelphia, PA 19106 (215) 599-1500 WWR # 03206636 1120