HomeMy WebLinkAbout08-2183IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL
SENIOR CARE, LLC d/b/a
d/b/a WEST SHORE HEALTH AND
REHABILITATION CENTER
770 Poplar Church Road
Camp Hill, PA 17011
Plaintiff,
CIVIL DIVISION
NO. OR - aIA3 01 .-t L l ?
VS. PETITION FOR CONFIRMATION
OF ARBITRATION AWARD
PURSUANT TO PA RCP 1328
ALMA FERGUSON
66 Asburg Drive
Mechanicsburg, PA 17050
CAROLYN KIRK
770 Poplar Church Road
Camp Hill, PA 17011
Defendants.
Filed on behalf of Plaintiff
West Shore Health & Rehab
Counsel of Record for this Party:
NATHAN T. CHASE, ESQUIRE
Pa. I.D. # 200295
DODSON, MCCAFFREY & ASSOCIATES
Suite 332 Building A
9800 McKnight Road
Pittsburgh, Pa. 15237
(412) 635-9314
Nathan-Chase@dodsomnccaffrey.com
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL
SENIOR CARE, LLC d/b/a
WEST SHORE HEALTH AND
REHABILIATION CENTER
Plaintiff,
CIVIL DIVISION
NO.
vs.
ALMA FERGUSON
CAROLYN KIRK
Defendants.
NOTICE TO FILE ANSWER
A party to these proceedings has filed a motion to confirm an arbitration award. If you
oppose the motion, you are required to file an answer to the motion within thirty (30)
days from the date below setting forth your objections to the motion. If you fail to file an
answer, a money judgment based on the arbitration award may be entered against you
without further notice. You may lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH
BELOW THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT
HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE
TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY
OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO
FEE.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA, 17103
717-249-3166
Toll Free (in PA) 1-800-990-9108
Date of
q lvy 4?
I
Nathan T. Chase, Esq.
Attorney for Petitioner
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN VENTURES NATIONAL CIVIL DIVISION
SENIOR CARE, LLC d/b/a
WEST SHORE HEALTH AND NO. 1,P.3
C (T??,.,
REHABILIATION CENTER
Plaintiff,
VS.
ALMA FERGUSON
CAROLYN KIRK
Defendants.
PETITION FOR CONFIRMATION OF ARBITRATION AWARD PURSUANT
TO PA RCP 1328
1. Plaintiff, Golden National Senior Care, LLC d/b/a West Shore Health and
Rehabilitation Center, is a Pennsylvania registered business in good standing, being
engaged in the business of providing nursing home care and medical assistance and
having an address of 770 Poplar Church Road, Camp Hill, County of Cumberland,
Commonwealth of Pennsylvania.
2. Defendant, Alma Ferguson, is an individual and a Pennsylvania Resident having her
current address at 66 Ashburg Drive, Mechanicsburg, PA 17050.
3. Defendant Carolyn Kirk, is an individual and a Pennsylvania Resident having her
address at Plaintiff's nursing home facility located at 770 Poplar Church Road, Camp
Hill, County of Cumberland, Commonwealth of Pennsylvania.
3. Defendant Kirk was admitted into Plaintiff's nursing home and healthcare facility on
or about June 15th of 2007 and she has remained at Claimant's facility until the present
date.
4. Defendant Ferguson has been Defendant Kirk's power of attorney and agent at all
times relevant to his petition. A true and correct copy of the power of attorney document
is attached hereto, made a part hereof and is labeled as Exhibit A.
5. On or about the date of admission, June 15th of 2007, by and through her then existing
agent and power of attorney, Defendant Ferguson, Defendant Kirk agreed to and signed
an Arbitration Agreement, which bound both Plaintiff and Defendants to resolve any
disputes through an independent private arbitration. A true and correct copy of the
Arbitration Agreement is attached hereto, made a part hereof and is labeled as Exhibit B.
6. During Defendant's stay at Plaintiff's facility, Defendants had accrued an unpaid
balance due to Plaintiff for services and items received of $28,729.00.
7. Defendants failed to pay the above stated amount following numerous attempts to
collect the same; Plaintiff subsequently filed a claim with the National Arbitration Forum
pursuant to the Arbitration Agreement.
8. Following proper service and notice via certified mail, signed return receipt, through
the United States Postal Service, hearings were held before the arbitrators on or about
February 21" of 2008 and the parties were given a full opportunity to present all
testimony and evidence they desired in support of their positions.
9. After the hearing and review of the claim, the National Arbitration Forum issued an
Award for Plaintiff and against Defendants, individually and jointly and severably liable,
for the amount of Twenty Eight Thousand Seven Hundred and Twenty Nine Dollars and
zero cents ($28,729.00). A true and correct copy of the Arbitration Award is attached
hereto, made a part hereof and is labeled as Exhibit C.
10. Since the award has been issued, Defendant Kirk subsequently approved for Medical
Assistance, resulting in a reduction of the back balance due.
11. Following the issuance of Medical Assistance toward the Arbitration Award Amount,
the private portion due now remains Nine Thousand Three Hundred Eighty Dollars and
Zero Cents ($9,380.00).
12. This now current balance of $9,380.00 remains unpaid contrary to the arbitrator's
award and demand.
- REST OF PAGE INTENTIONALLY LEFT BLANK -
WHEREFORE, Plaintiff respectfully requests that this Honorable Court enter an
order in the form attached hereto confirming the award of the arbitrators and entering
judgment in favor of Plaintiff, West Shore Health and Rehabilitation Center and against
Defendant, Betty Johnson, in the amount of Nine Thousand Three Hundred Eighty
Dollars and Zero Cents ($9,380.00), being the amount of the Arbitration Award less
Medical Assistance received.
submitted,
Nathan T. Chase, Esq.
Dodson, McCaffrey & Associates
Attorneys for Plaintiff
West Shore Health and Rehab Center
TVE FICATION
I, l sue, the undersigned, being an attorney for West
Shore Health and Rehabilitation Center, verify that the statements and averments made in
the foregoing Petition for Confirmation of Arbitration Award are true and correct to the
best of my knowledge, information and belief. I understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4907, relating to unsworn
falsification to authorities.
Date: ?- dv?e
Nathan T. Chase, Esq.
Dodson, McCaffrey & Associates
Attorneys for Plaintiff
West Shore Health and Rehab Center
EXHIBIT A
POWER OF ATTORNEY
12 fl 6
JUN-20-2007 09:22 FROM: ln?BEI
_ ...._ . _ _. _ .._.___. .? j lm.. .__ - P.31 ,41 a
ATfORMAILAN
19 S. OANOM S'['RW- R M 101
CAR JKA FENNonvA IA ma
cnn us-?. • F,I?r?s-as?,? -
......._v.__r ... .. ? _?..?.r•'r.. .? ti ... rr_r.M?.?Mr?+•?.-r•1Iti.+.?r?.•T.???.Y.... Y.?•.Y.r....??Y?.r..
NOTICE
I AIM CPR= OF .
3TUMN J. H06G
19 S. HANOM SUM
SUITE 101
CARLISLE. PA 17013
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
POWERS 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 13ECOME
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. 66.
IF THERE IS ANYTHING ASOUT 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 EX11"NEO TO ME THIS NOTICE
AND 1 UNDERSTAND ITS CONTENTS.
CAROL N H. KIRK D-AT/VU
i
JUN-20-2007 09.22 FROM:
LAWOWAMOr
?PH6111 J. ¦OGG
r S. MANO U S7VjW
SME 101
CARL MLL PA 17!113
T -13EI P.32/41
POWER OF ATTORNEY
1. Carolyn H, Kirk, of Cumberland County, Lemoyne,
Pennsylvania, do hereby nominate. constftt to and appoint Alma J.
Ferguson, as my true and lawhd Attorney-In-Fact, to act In my name,
place and stead to do and perform any act that I myseff might perform
if I were personally present In reprd to the following:
To endorse checks, notes, drags and any other aommerCiai
papers In my name and to withdraw money from any bank accounts
that I may have for my benefit, and to sign orders or receipts therefore
In my name;
To enter into any safe deposit box I may have in my own name
or jointly with another parson to inventory the contents of Nxh box or
to do or perform anX act with respect to the contents that I might legally
perform If I were per,tonally present.
To $ON and enter into a contract or contracts for the sale of all or
any part of rrry personal pnOperty, gf ctB and belongings of every kind
and nature whenever sIt<rated for my benefit with fire power to delver
possession of said peAu" property and to execute In my name any
documents necessary to transfer We to said personal property.
Including bills of sale or other documents of ttge, and fo take any
security interest for any unpaid balance which my Attorney-In.Fact In
her discretion may deem necessary and PmW, orb
assign or transfer shocks. bonds or a may. sell,
any other personal property.
To borrow money from such sources and on such terms as my
Attorney may deem fit and proper, and to A WOM In M*ncbon with
any loan of money a seamy amement coVGAV any of my real or
personal property and to execute, sign, adatowied0e and deliver in
any form that instrument that may be required In onnjunotion with the
transaction;
To autlUIZO my admusslon to medical, numft residenaltl or
similar facliy and to enter into agreerrma for my care. This pow is
to
be Mu toted and kVbnmrftd In aooordanca wigs the pmvlsions of
ChWW 50 of Me , Consolidated MWvar e%
on the date of executition ot this P of y. Stakiles. in ot
To StMofte medieW and suigkem pnooedures. This power is to
be construed and irnpie nw* d in aooordanca with the
Chapter t0 of Tile 20, Consoldstlsd pea P1°??s
iB StotLrtes. In effect
on the date of execution of this Poww of Attomey.
14 11 b
JUN-20-2007 09:22 FROM:
TO'BEI P.33141
I direct that this Power of Att?omey Shall be a durable Power of
Attorney and shall become effective immediately.
Card . Kirk
fitness
Q
UW Or"= or
l?PAB11T J. HOGG
19 S HANOM JymW
SUM 101
CAW %M PA i m 3
-- / MO
Date
15/16
JUN-20-2007 09:22 FROM:
Commonwealth of Pennsylvania
County of Cumberland ss
M:13EI
On this day of 2007. before
me, the underN? officeJ??
C
arolyn H. Kirk,
known to me or cagy proven to be 11110won whose name is
subscribed to the attached Power of AUorney, and acknowledged that
she executed the same for the purposes therein oontained.
IN WITNESS WHEREOF, i hereunto set my hand and official
seal.
A
My Commhwori expires:
t .
Notary Public
LAwp"%MpR
rEPEERN I HOGG
! S. HANOVER MVJMT
suers 101
CAKUSLL PA 17013
P- M-141
16116
JUN-26-2007 09:22 FROM:
TO:BEI
ACKNOWLEDGEMENT
1, Alma J. Ferguson, have read the attached P
and am the parson idetWW as the agent the der of y
ac4xWedge that in the a nce of aspa principal. I hereby
in the Power of Attomey or in yp Pa. O.S when n I act ? act as as athe cunt ry
?
I shah exercise the powers fax the benefrt of the principal.
assets. I shell keep the assets of the principal separate from my
1 shall exsraclse reasonable Caution and prudence.
I shall keep a fun and accurate recard Of By actions,
receipts and disburser ere on behalf of the principal.
Vma J. Fe 1.a
bete ----
LA* 4*txMi (W
TEMN J. NOGG
19 S. HANOVER SMIMT
Mm rot
CARLTSLFF. PA 17013
P. 35141
EXHIBIT B
ARBITRATION AGREEMENT
Jtarr-20-2887 89:21 FROM:
T0:BEI P. 28,41
RESIDENT AND FACIL,ITV ARBITRATION ACRC ENIEN7'
(NOT A CONDITION OFADMISSIOIV- READ Cj1acK1,14LY)
This Arbitration Agrivne:nt is a r,ceuu%j y
by
and C?GtrLis/ s? (the "Facility.')
("Re ident" ?r "ResidiMt's Authorized Rvm•n-matire
herta ter calhxtively re fam-d to a$ "ResidCnt'") in co*nction with an
this provision of nursing facility services (the .`tint for st and for
parties to this Arbitration Agrament ack won A O1'n'`'nt•?) by Facility to Residesident. . The
Agrcerrrr,-nt rn? gt and agrtse that part of the r'ldmp on c(cCution• this A titration
aaion 11g and up diet the Admission .1
transaction invoking intagae cam govern ed by the Federal A g?0o""nt `es a
ag ed by Facility and Resident that any and a4 claims, d' rbttration Act. It is understood and
referred to as a "claim" or coleetp. touts, and eontrove.•rspes (h b h. co11e*ctive 1y
way to the Admission Agtont or "chums") arising out of, or in connw:tpon •tiit or relating in any
.,hall be tee Adm sio A Any service or hwft care pr4wided by the Facility to the Rcsidrnt
or in the a olved % such an by binding arbptration to be oottdvded at -M. agreed
Code he s ?' at dre IradW in ?ondanee a ith t,, N upo ' by the Panics,
rocedum which is hereby incorporated into this tonal Arbitration Forum
COW PTOMs. This Wets shall be 8o?ad by and i Agre ad 0 %l' and not by a 1a•omit or resort to
U S.C_ Sections 1-16. ad under the Federal Arbitration Act, 9
This agreement to arbitrate includes, but is not limited to, any claim For
fir servroes rwWulcd to the Resident by the t°'acil' - Pay . nO"PaYm t, or r .61
tio?
or by the Admission 4grgcmw , breech of ?'
"f ?` ^? granted to the R vlk Or
de-w by law
ncWtgenoa, nql fit, fraud ex m?tatitaa, i
standards, as wc•It, or dainra 6attud an Mft
any departure &M ;;toss
way 'try and ail eiapms for rq relreF WxW ae medical or health care or safety
rnY. any Alleged breach. dcfaub based on cow tort, statutes. O
nMfigwxw. or in*wument. H% v . t* ngr? na o* baud. mi"ItPrtsen . suppfeesion of v
cornplaint with the Facility any approprWe the Resident's ria* to (
trncvancts or
such as agatcy, or fran txxldtag ,"ow under 42 C,F.R 3 r ? an -
ion Prom
or discharge the R Adertat, a seq. ,,fa decis6s to tratasfer
The Fatties atgree that
damages awardt* ifany, in an ofl
a gr sbai in ammdaw whh the p °d p ant to the Arbitration
Any CO award of the M Including any W to , atue or fadwW law gWt4ble to
a
a court ar ' mss) May be entwed as a judge pg io or ? aart lathe ev
juriad O'D fards MW Portion oft* We,=, unbua? any court hrnag ju xioa. irr fire Cvont
ective.
ctlbcdve and the rgrrtatder of the agmoen M s1ar11 remain
that portion shag riot be
It is the intention of the parties w this ,
the Jmft"2' their WCOMM s, and Maps. in ativA AW"Menj that it shall inure to the he
of and bind
of the Facility, MW aN Persons altosa `d lirnpta M the ads, steht
claim is derived an
th1w d sew s>
Pa?rt?nt, atpous,,,pe ties d?dher pavdlnj? aDOCUtor. 5t'r°° btdalfof the Rc?ident, inciudpn g y
any
Resident. The »t .
-nd that thin ? ?m adarinrstrata. or heir of the
hereto. t is to setah'* the a ns or. tmiacnce of the psrt
' ; J.:fia-tult,r;, ^.I:o.? ;? Nul?crut A
rl-itratlcal p,?: 1
r.a -vr+R .. i?.t i 1, b!, zt r:51.4Xj. r.
HtiYft xra. '/ Ti i?l1•IrX!:,x ill .?UF- r,l3.t , ,1!'r •I4rC, C1U11'G 1:1'1.•;
"R l R M' 'Yr :ICII IL1
N ?: - K:,;rm-xs CfF.ce P*,tk - +.:Wicel R+x:ra.
JUN-20-200T 09:21 FRt]M:
TU: BEI
P.29/41
,
;U .1:11174k elfin •r, ;,:; .•,;t ,n rh
r :•p?liC ?:1Li?l( ?'L, I, a':aGtl! ` 1•
p. %wii.v0 by ,iii; F f t ;!t • nos tic • i?iutt : hsil Le ;iTbit ' CL_tLd :r.:,, r:.1 Sara c;r
attd forc'vcr L:rrt ii at , tic Ir:Y•r,;w_Ir`S . t 'Si;t;m .,tktll I:c ;?divrd
e tnd ::huuld reasonably h1,:c N? cn lisccn,.r.
nctice cf Lbitrati•sn i; to the Facility i.)r r?,•eu?•t.?j I,,, the R... pri!?r t!; 1x •'?.c 1,0'•n %hich
she ;irvarmion procvedirtg. "tidert .,nd :aich 11ahn is n t prc
serittrd in
THE P.1R ms. UttiMRSTAND AND :AGREE THAT THIS CON r'b
i' ON 'TRAGT CA>`T 11NS .1 B??iDING
E TIER C, IN R ''H If' IOM'"Y BE ENFORCED RY Tile i'.1RTtM .kN THAT BY
AI INC INTO THIS IS A.4BtTR?TTIh .1GREEh1C!tiT, TILE AAR7'1t;S.iRE GI1NG 1
WAIVING THI?IRCONSM-UTiOVAL RIGHT TO HA1.•F.k. iV ('I.'4! D>I:Ct C-'ItiIry A THI)
"c
OF 1,1W BEFORE A .IUDG E AND A •JI:RY, AS WELL. %S ANY APPEAL FROM ,% DEC10 .4tON
OR AW.%RD OF DAMAGES.
r nngnt. (understands that (1) hr+ahe has the right to scxk Irgal counsel CunCxrnj this ,1rbi
Agrc'erraent (Z) that execution on oo of this ?Ubitratiiar q ng tratian
furnishing ofaerviees to the RoOdent ant is snot : precondition to admission or to the
by the Facility, turd (3) thi.'lrbitration Aby wtntgt notice to the Focibry from the »r n tt y be ncscinde?d
thirty drys, this Arbitration Residag xithm thirty days of Signature. if not rest;
t
if the hirty
Resident is Arbitration Agre shat! rcmarn in effect for all sub "? v`v n
?q+?rtt stays At the Facility, oveen
rged from and readmitted to the Fadliry.
'T'he 1 d4w1;i8"'d cutiPtcs that hwshe has read this Arbitration
.;xplained to him/her. that helshe uttdars<wWS its contunts *rd and thstt it has been ;iilty
:hat he/she is the Resident, or a person dul atrth has rcc?tcd a ropy art"the
j6r?ctnent %utd accept its tanng y ` od by the Ke sidI ?i31on tnd
Resident or otlx?ise to cx?ute this
Date:
Signature:
t.R"de")
Witness:
If the residm is unable tp Consent or sign this PrDvWon
it>?tnpetence or is a mirtor,utd an authori bocatse Of ahYsisat disability or tnenttd
is signing this MVeiatt,
following; complexe the
Date J5E 0 7
h Relationship to Residua: - j
(Authotited 1"MA t..rtt ttn
:r
V
.TUN-20-2007 04:222 FROM. TO:6EI
Date: Ile
Authorized Rgwmnwivt Signeure.
Print Nam wW 'Citie:
K p
P. 30,4t
0
Z
ik
r
Vy
I
Rcv. o3v13ro3
Whig - Ekvmmm p frwe pink - ModkO Rcor,b Ydbw - Rewdw
EXHIBIT C
ARBITRATION AWARD
NATIONAL ARBITRATION
- FORUM
Golden Gate National Senior Care, LLC d/b/a Golden Living
Center - West Shore
770 Poplar Church Rd
Camp Hill, PA 17011
CLAIMANT(s). AWARD
RE: Golden Gate National Senior Care, LLC d/b/a Golden Living Center - West Shore v
Alma Ferguson & Carolyn Kirk
File Number: MX0712002030936
Alma Ferguson Carolyn Kirk
66 Ashburg Dr 770 Poplar Church Rd
Mechanicsburg, PA 17050 Camp Hill, PA 17011
RESPONDENT(s).
The undersigned Arbitrator in this case FINDS and CONCLUDES:
Case Summary
1. The Claimant has filed a Claim with the National Arbitration Forum.
2. After Proof of Service of the Claim was filed with the Forum, where no Response has been filed, the Forum mailed to Respondent
a Second Notice of Arbitration.
3. The Respondent filed a Response with the Forum that was deficient pursuant to Rule 6 of the Code of Procedure.
4. An arbitration hearing notice was duly delivered to the Parties as required by the Forum Rules.
5. The Parties have had the opportunity to present all evidence and information to the Arbitrator.
6. The Arbitrator has reviewed all evidence submitted in this case.
Decision
1. The Arbitrator knows of no conflict of interests that exist.
2. This matter involves interstate commerce and the Federal Arbitration Act governs this arbitration.
3. The Claim was properly served on the Respondent by Claimant in accord with Rule 6, including a Notice of Arbitration.
4. On or before December 20, 2007 the Parties entered into a written agreement to arbitrate their dispute.
5. The Parties' Arbitration Agreement is valid and enforceable and governs all the issues in dispute.
6. This matter is arbitrable under the terns of the Parties' Arbitration Agreement and the law.
7. This matter has proceeded in accord with the applicable Code of Procedure Rules.
8. The evidence submitted supports the issuance of this Award.
9. The applicable substantive law supports the issuance of the Award.
Therefore, the Arbitrator ISSUES:
An Award in favor of the Claimant, for a total amount of $28,729.00.
Entered and Affirmed in the State of Pennsylvania
Jared D. Simm , Esq.
-- )
C
Arbitrator
Date: February 20, 2008
ACKNOWLEDGEMENT AND CERTIFICATE
OF SERVICE
This Award was duly entered and the Forum hereby certifies that
pursuant to the Parties Arbitration Agreement, a, copy of this Award
was sent by first class mail postage prepaid to the Parties at the above
referenced 'addiesses_. or their Rcpresewatives, on this date.
Honorable Harold-Kalina, Ret.
Director
February '21, 2008
6?
&It
2
c
OC/)
SHERIFF'S RETURN - REGULAR
CASE NO: 2008-02183 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
GOLDEN VENTURES NATIONAL
VS
FERGUSON ALMA ET AL
KENNETH GOSSERT
Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within PETITION was served upon
KIRK CAROLYN
the
RESPONDANT
at 1055:00 HOURS, on the 10th day of April , 2008
at 770 POPLAR CHURCH ROAD ROOM 910
CAMP HILL, PA 17011
CAROLYN KIRK
by handing to
a true and attested copy of PETITION
together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing
Service
Affidavit
Surcharge
ti?19?6F
6.00
15.00
.00
10.00
.00
V' 31.00
Sworn and Subscibed to
before me this
day
of ,
So Answers:
F
R. Thomas Kline
04/15/2008
DODSON & CHASE
By: '
" ?w -
e uty S V f
/Al
A.D.
SHERIFF'S RETURN - NOT FOUND
CASE NO: 2008-02183 P
COMMONTWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
GOLDEN VENTURES NATIONAL
VS
FERGUSON ALMA ET AL
R. Thomas Kline Sheriff or Deputy Sheriff, who being
duly sworn according to law, says, that he made a diligent search and
inquiry for the within named RESPONDANT
FERGUSON ALMA but was
unable to locate Her in his bailiwick. He therefore returns the
PETITION
NOT FOUND , as to
the within named RESPONDANT FERGUSON ALMA
66 ASHBURG DRIVE
MECHANICSBURG, PA 17050
DEFENDANT DOES NOT LIVE AT GIVEN ADDRESS.
Sheriff's Costs:
Docketing 18.00
Service 10.00
Not Found 5.00
Surcharge 10.00
`???P?aF .00
? 43.00
So a
R. Thomas Kline
Sh 1 f of Cumberland County
ODSON N & CHASE
04/15/2008
Sworn and Subscribed to before
me this day of
A. D.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN GATE NATIONAL CIVIL DIVISION
SENIOR CARE, LLC d/b/a
GOLDEN LIVING CENTER -
WEST SHORE No. 08 - 2183 - Civil Term
Plaintiff,
vs.
ALMA FERGUSON
CAROLYN KIRK;
Defendants.
PRAECIPE TO REINSTATE
PETITION FOR
CONFIRMATION
Filed on Behalf of Plaintiff
Golden Living Center - West Shore
Counsel of Record for this Party:
NATHAN T. CHASE, ESQUIRE
Pa. I.D. # 200295
DODSON & CHASE
Suite 332 Building A
9800 McKnight Road
Pittsburgh, Pa. 15237
(412) 635-9314
nchase@dodsonchase.com
Z
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN GATE NATIONAL
SENIOR CARE, LLC d/b/a
GOLDEN LIVING CENTER -
WEST SHORE
Plaintiff,
vs.
ALMA FERGUSON
CAROLYN KIRK
Defendants.
CIVIL DIVISION
No. 08 - 2183 - Civil Term
PRAECIPE TO REINSTATE PETITION FOR CONFIRMATION
To The Prothonotary:
Pursuant to Pa.R.C.P. No. 401(b)(1), please reinstate the Petition for Confirmation,
originally filed on April 74' of 2008, so that service may be issued in the above-captioned
Civil Action so the Writ Aiay be reissued to the Sheriff for service.
Natfian T. Chase, Esq.
Attorney for Plaintiff
Dodson & Chase
9800A McKnight Road, Suite 332
Pittsburgh, PA 15237
14
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
Filed on Behalf of Plaintiff
Golden Living Center - West Shore
Counsel of Record for this Party:
NATHAN T. CHASE, ESQUIRE
Pa. I.D. # 200295
DODSON & CHASE
Suite 332 Building A
9800 McKnight Road
Pittsburgh, Pa. 15237
(412) 635-9314
GOLDEN GATE NATIONAL CIVIL DIVISION
SENIOR CARE, LLC d/b/a
GOLDEN LIVING CENTER -
WEST SHORE No. 08 - 2183 - Civil Term
Plaintiff,
vs.
PRAECIPE TO REINSTATE
PETITION FOR
CONFIRMATION
ALMA FERGUSON
CAROLYN KIRK;
Defendants.
nchase@dodsonchase.com
Y
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
GOLDEN GATE NATIONAL
SENIOR CARE, LLC d/b/a
GOLDEN LIVING CENTER -
WEST SHORE
Plaintiff,
vs.
ALMA FERGUSON
CAROLYN KIRK
Defendants.
CIVlJ, DIVISION
No. 08 - 2183 - Civil Term
PRAECIPE TO REINSTATE PETITION FOR CONFIRMATION
To The Prothonotary:
Pursuant to Pa.R.C.P. No. 401(b)(1), please reinstate the Petition for Confirmation,
originally filed on April 7th of 2008 and reinstated for the first time on July 16th, 2008, so
that service may be issued in the above-captioned Civil Action so the Writ may be
reissued to the Sheriff for service.
Nathan .Chase, Esq.
Attorney for Plaintiff
Dodson & Chase
9800A McKnight Road, Suite 332
Pittsburgh, PA 15237
0004
-? d : `;
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2008-02183 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
GOLDEN VENTURES NATIONAL
VS
FERGUSON ALMA 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 na med RESPONDANT to wit:
FERGUSON ALMA
but was unable to locate Her in his bailiwick. He therefore
deputized the sheriff of YORK County, Pennsylvania, to
serve the within PETITION
On August 22nd , 2008 this office was in receipt of the
attached return from YORK
Sheriff's Costs: So answers-
Docketing 18.00
Out of County 9.00 -=
Surcharge 10.00 R. Thomas Kline
Dep York County 45.33 Sheriff of Cumber land County
Postage 2.68
85.01 f gjna Gov O
08/22/2008 v
DODSON & CHASE
Sworn and subscribe to before me
this day of ,
A. D.
A / YORKTOWNE BUSINESS FORMS, INC. Ptp (717) 8451-5955 Fax (717) 848-8936 email: ybf@blazenet.net
V
COUNTY OF YORK
OFFICE OF THE SHERIFF SER)IC7EI 9ACO1
45 N. GEORGE ST., YORK, PA 17401
SHERIFF SERVICE
PROCESS RECEIPT and AFFIDAVIT OF RETURN 1 114M 12
no Carus
110 WS& 1 PLAINTIFF/S/ 2 COURT NUMBE? GN v LV-4
GO e a er-- k/es Sd, 0 Ca,
3. DEFENDANT/S/ 4. TYPE OF WRIT OR COMPLAINTNOT ICE
1? r-k ?`" ?t 1>•er PET fC9NFIZPAT;Mr?
SERVE 5 AME OF INDIVIDUAL, COMPANY. CORPORATION, ETC TO SERVE OR DESCRIPTION OF PROPERTY TO BE LEVIED, ATTACHED. OR SOLD
Ma 'er?uSorl
6. ADDRESS (STREET OR RFOYNITH BOX NUMBER, APT NO., CITY BORO, TWP, STATE AND IP CODE)
AT 44
7. INDICATE SERVICE' U PERSONAL KPERSON IN CHARGE U DEPUTIZE U CERT MAIL U 1ST CLASS MAIL U POSTED U OTHER
28 Uts
NOW July
20 I, SHERIFF 80 QiQ UM I T, PA, do hereby deputize the sheriff of
York COUNTY to execute thi r ke return th r cording
to law. This deputization being made at the request and risk of the plaintiff., f
SHERIFF OF
6. SPECIAL INSTRUCTIONSOROTHER ((INFORMATION THAT WILLASSIST IN EXPEDITING SERVICgUT O/FCO Cumberland
V..•t?Mie?laq? ?. SN,t- - Y?CT?I??i:,w? ?1f>sK `u„M.?l?/tr?
Please mail return of service to Cumberland County Sheriff. Thank you.
AbV FEE PAID BY ATTY
NOTE: ONLY APPLICABLE ON WRIT OF EXECUTION: N.B. WAIVER OF WATCHMAN - Any deputy sheriff levy upon or attaching any property under within writ may leave same
without a watchman, in custody of whomever is found in possession, after notifying person of le attachment, t liability on the part of such deputy or the sheriff to any plaintiff
herein for any loss, desUudion, or removal of any property before sheriff's sale thereof. 17P --1011 1;?
9. TYPE NAME and ADDRESS of ATTORNEY / ORIGINATOR and SIGNATURE A444 7. V, 10. TELEPHONE NUMBER 1i1 DATE FILED
V,,q*.A CL.10, 52G)O 4 $3 :4s? r t4 I 3 91l - &3S -
12. SEND NOTICE OF SERVICE COPY TO NAME AND ADDRESS BELOW: (This area must be completed if notice is to be mailed)
/VA ??•ti &1e, 4 oa,,4 A Lx. 'Al- ? J A -, % i 11?- 1.4k L.,,I- ) .- l I S,1_N'z
13. 1 acknowledge receipt of the writ 14. DATE RECEIVED 15 Expiratlon/Heanng Date
or complaint as indicoled above. M JMC G I LL YC S O 18-08-08 18-15-2008
16. HOW SERVED: PERSONAL ( ) RESIDENCE ( ) POSTED( ) POE( j SHERIFF'S OFFICE ( ) OTHER( ) SEE REMARKS BELOW
17. '*,.1 heretry oertiy and return a NOT FOUND because 1 am unable to locate the individual, company, etc. named above. (See remarks below.)
10. NAME AND TITLE OF INDIVIDUAL SERVED / LIST ADDRESS HERE IF NOT SHOWN ABOVE (Relationship to Detendant) 19. Date of Service 120 Time of Service
21. ATTEMPTS Date I Tary,I I Miles I Int. ' Date I Time I Mlles T Int. Dale Time Miles Int. Date Time Miles Int. I Date Time Miles Int. Date Time Miles Int.
22.
THIS IS A BAD ADDRESS, J -NET GIVES AN ADDRESS OF 52N 8th STREET,
LEMOYNE,PA 17043
23. Advance Costs 24 Service Costs 125, N/F 26. Mileage
$100.0-0 .Co
34. F~ County Costa 35. Advance Costs 36 Service Cc
41. AFFIRMED and subscribed to befor me this - to
42. day of
ppMW- 5)
-A L
L" ',FAY PUBLIC
K COUNTY
.' ,AUG. 12, 2009
27. Postage 26. Sub Total 29. Pound 30 Notary 31. Surchg. 32. Tot. Costs 33 Costs Due R&d Check No.
?
rV/??
/ r ?#) 1
306
As 37 Notary Cent 36 MdeagwPostage/Not Found 39 . total Costs 40 Costs Due or Refund
SO ANSWERS
44 ?9nSheriff /5. DATE
46. eYork I 47 DATE
County Shw*
4 le
00
&?
RICHARD P. B ER, 8-19-2008
46. S ti lures of Foreign 49 DATE
C Shaaft
I SHERIFF'S RETURN - NOT FOUND
CASE NO: 2008-02183 P
COMMONTWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
GOLDEN VENTURES NATIONAL
VS
FERGUSON ALMA ET AL
R. Thomas Kline
,Sheriff or Deputy Sheriff, who being
duly sworn according to law, says, that he made a diligent search and
inquiry for the within named RESPONDANT
FERGUSON ALMA but was
unable to locate Her in his bailiwick. He therefore returns the
PETITION
PETITION FOR CONFIRMATION OF ARBITRATION AWARD
the within named RESPONDANT , FERGUSON ALMA
52 N 8TH STREET
, NOT FOUND , as to
LEMOYNE, PA 17043
SUPPOSED TO HAVE MOVED TO ETTERS (YORK COUNTY) 2 MONTHS AGO: PER
POST OFFICE, MAIL IS STILL DELIVERED AT THIS ADDRESS.
Sheriff's Costs:
Docketing 18.00
Service 17.00
Affidavit .00
Surcharge 10.00
Not Found 5.00
ql ? 4jof (?,,, 5 0. 0 0
So answers:
R. Thomas- `ZCl ine
Sheriff of Cumberland County
DODSON & CHASE
09/24/2008
Sworn and Subscribed to before
me this day of
A. D.