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HomeMy WebLinkAbout01-6381BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V, FRANCIS J. TOTH and PAULA. TOTH, husband and wife, Defendants : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA :NO. OI - : CIVIL ACTION - LAW NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. r~v~- A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 (717) 249-3166 BEVERLY HEALTH & REHABILITATION SERVICES, INC., Plaintiff V, FRANCIS J. TOTH and PAULA. TOTH, husband and wife, Defendants · IN THE COURT OF COMMON PLEAS OF · CUMBERLAND COUNTY, PENNSYLVANIA 'NO. : CIVIL ACTION - LAW Beverly. 4. COMPLAINT AND NOW comes the Plaintiff, by and through its attorneys, the Offices of Fenstermacher and Associates, P.C., and files this Complaint, as follows: 1. Plaintiff Beverly Health & Rehabilitation Services, Inc. ("Beverly") is a Pennsylvania corporation trading and doing business as West Shore Health & Rehabilitation Center, with an address for conducting business at 770 Poplar Church Road, Camp Hill, PA '1701 '1. 2. Defendants Francis J. Toth and Paula Toth are adult individuals with a current residence of 112 Bunker Hill Road, New Cumberland, PA 17070. At afl times relevant hereto, Francis J. Toth was a patient and resident of Beverly is a nursing home facility licensed as such by the Commonwealth of Pennsylvania. 5. On or about January 29, 2001, Francis and Paula Toth voluntarily admitted Francis Toth to Beverly, and entered into an Admission Agreement with Beverly. A copy of such Agreement is attached and incorporated fully herein as Exhibit 6. The Toths applied for medical assistance and were approved, but were required to make private payment of $2,048.33 per moth. 7. The Toths agreed to make such monthly payment, and Beverly relied upon such representation in providing services and care. 8. At the time of admittance, the Toths were provided a detailed list of all charges, including room, board and medical care, for which the Toths would personally be responsible. 9. Beverly continued to provide all necessary services and care to Francis Toth, and Francis Toth accepted such services and care. COUNTI Breach of Contract 10. Paragraphs 1 through 9 are incorporated fully herein by reference. 11. The Toths agreed to pay for all services and care provided by Beverly. 12. As of this date, the Toths have failed and refused to pay for services totaling $43,096.60. 13. Despite repeated requests, the Toths have failed and refused to make payment of the amounts due. 2 WHEREFORE, Plaintiff respectfully requests this Honorable Court enter judgment for it and against Defendants for all monies due, plus interest and costs of suit. Said amount is greater than that requiring compulsory arbitration. COUNTII Quantum Meriut 14. Paragraphs 1 through 13 are incorporated fully herein by reference. 15. Beverly has provided services and care, and the Toths have accepted such services and care, with a current value of $43,096.60. 16. The costs charged by Beverly are reasonable and customary in the industry. 17. It would be unjust for the Toths to accept the benefit of such services and care without remuneration to Beverly. 3 WHEREFORE, Plaintiff respectfully requests this Honorable Court enter judgment for it and against Defendants for all monies due, plus interest and costs of suit. Said amount is greater than that requiring compulsory arbitration. Respectfully submitted, FENSTERMACHER AND ASSOCIATES, P.C. DATED: //- 9- ~,'~ By:. Mark K. E~ery Supreme Court I.D. #72787 5115 East Trindle Road Mechanicsburg, PA 17055 (717) 691-5400 Attorney for Plaintiff 4 EXHIBIT 'A' [~vate This Facility accepts the following types of payments: (Check all that apply.) [~edi'¢are [ ~g~caid ~Cc~ans Adndnistration The parties to this Agreement are: (Name of FacRi~y~ PARTIES (NarCO of Resident)--/ (Name of Rcsident's Agcn0 (Name of Resident'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) ~gcnt Acting Under General POA If you are signing this Agreement on behalf of the Resident, note your relationship to the resident: Rela~tionship to Resident ~ ~ a?/a:~t nan ee admitted to this Facility. As of that day, thc Facility shall pro- vide ~the~._ervi_ces .d.escnbed in this Agreement to the Resident until the date of the Resident's discharge or transter. The Resident shall pay for the services provided by thc Facility according to the terms of this Admission Agreement. ACKNOWLI/DGEM~NTS By signing the Admission Agreement Signature Page, the Resident/Agent/Legal Representative acknowl- edges that he or she has been given and has read this Agreement in its entii~, and all addendums. The Resident also acknowledges that the following information was provided upon or before admission by thc Facility. Initial the lines below (if not applicable, write N/A): 1. A list of supplies and servicc~ that are included in the Facility's private daily rate or that will be paid for by the Medicaid or Medicare programs and a list of supplies and services not included in the Facility's private daily rate or paid for by the Medicaid or Medicare progrm~s for which the Resident will be separately charged. White - Business Office 15 Pink - Medical Records Yellow - Relident Resident Date Wimess if Resident Signed with a Mark Witness if Resident Signed with a Mark Date Date Legal Representative Date -( )_ L~gal Representative's Telephone Numb~ Agent Legal Representative's Social Security No. Agent's Telephone Number Facility Adminislxator or D~si~nee Agent's Social Security No. Date Note: The signatures above refer to the information contained on pages 1 through 18 of the B~verly £nterprises Adtni~$ion Agr~menL White - Business Office 19 Pink - Medical Records Yellow - Resident VERIFICATION On behalf of Bevedy Health & Rehabilitation Services, Inc., f, Judy Skoda, hereby certify and verify that the facts set forth in the foregoing Complaint are true and correct to the be~t ofrny knowledge, ~nformatJofl and belie[ I understand that any fhlse statements herein are subject to tile penalties of 18 Pa. C. S. §4904 relating to unsworn falsification to authorities. DATE: Judy Skoda SHERIFF'S CASE NO: 2001-06381 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND BEVERLY HEALTH & REHABILITATIO VS TOTH FR3kNCIS J ET AL RETURN - OUT OF COUNTY 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: TOTH FRANCIS J but was unable to locate Him in his bailiwick. deputized the sheriff of YORK County, serve the within COMPLAINT & NOTICE He therefore Pennsylvania, to On December 6th , 2001 , attached return from YORK Sheriff's Costs: Docketing Out of County Surcharge Dep York County this office was in receipt of the 18.00 ~ 9.00 10.00 z$ R. ~TbxS~as Kline 52.84 r~e~f of Cumberland County .00 89.84 · 12/06/2001 FENSTERMACHER & ASSOC Sworn and subscribed to before me this /3~ day of ~ ~! A.D. ' ' Prothonotary SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2001-06381 p COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND BEVERLY HEALTH & REHABILITATI© VS TOTH FPJ~NCIS J ET AL 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: TOTH PAULA but was unable to locate Him in his bailiwick. deputized the sheriff of YORK County, serve the within COMPLAINT & NOTICE He therefore Pennsylvania, to On December 6th , 2001 this office was in receipt of the attached return from YORK Sheriff,s Costs: Docketing Out of County Surcharge 6.00 .00 10.00 .00 .00 16.00 12/06/2001  ' · Count? FENSTERMACHER & ASSOC Sworn and subscribed to before me this /3~ day of ~ A.D. Prothonot a fy