Loading...
HomeMy WebLinkAbout08-3002IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. 08 - 300. bv?t Te-w% J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone: (717) 249-3166 (800) 990-9108 ORIGINAL IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY AVISO PARA DEFENDER Conforme a PA RCP Nfim.1018.1 USTED HA SIDO DEMANDADO/ A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telefono: (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., : Plaintiff, V. No. dF- 3660-. !?Zn J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY COMPLAINT AND NOW COMES, Plaintiff, Church of God Home, Inc. ("Plaintiff Church of God"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the within Complaint against Defendant, J. Marc Bauerle ("Defendant Bauerle"), and in support thereof, provides as follows: 1. Plaintiff Church of God is a Pennsylvania corporation with its principal offices located at 801 North Hanover Street, Carlisle, Pennsylvania, 17103. 2. Defendant Bauerle is an adult individual who resides at P.O. Box 711, Mechanicsburg, Pennsylvania, 17055. 3. On or about November 29, 2007, Defendant Bauerle made application on behalf of his mother, Margaret Bauerle ("Ms. Bauerle"), for admission to Plaintiff Church of God's skilled nursing facility located at 801 North Hanover Street, Carlisle, Pennsylvania, 17103. 4. On or about November 29, 2007, Plaintiff Church of God and Defendant Bauerle entered into a written Admission and Care Agreement ("Agreement"). Pursuant to the Agreement, Plaintiff Church of God agreed to provide Ms. Bauerle with skilled nursing care and services in exchange for Defendant Bauerle's promise to pay a specific monetary fee from Ms. Bauerle's resources and to cooperate fully with Plaintiff Church of God upon becoming eligible for the receipt of Medical Assistance benefits, such "'[c]ooperation includes, when requested, providing information, [and] signing and delivering documents ...." A true and correct copy of the Agreement is attached hereto as Exhibit "A." 5. Subsequent to Ms. Bauerle's admission to Plaintiff Church of God's skilled nursing facility, she allegedly became insolvent. 6. On or about April 24, 2008, an application for the receipt of Medical Assistance benefits was filed with the Cumberland County Assistance Office. 7. The Cumberland County Assistance Office will deny the application for Medical Assistance benefits absent the receipt of the requisite documentation from Defendant Bauerle to the Cumberland County Assistance Office to determine Ms. Bauerle's eligibility for the receipt of Medical Assistance benefits. COUNTI BREACH OF CONTRACT/SPECIFIC PERFORMANCE 8. Paragraphs 1 through 7 are incorporated herein by reference as if fully set forth. 2 9. Plaintiff Church of God has provided skilled nursing care and services to Ms. Bauerle in accordance with the terms and conditions of the Agreement. 10. Defendant Bauerle breached the Agreement with Plaintiff Church of God when he failed to make timely and proper application for Medical Assistance benefits for Ms. Bauerle, and Defendant Bauerle continues to breach the Agreement with Plaintiff Church of God by failing to cooperate and provide all documentation needed by the Cumberland County Assistance Office to determine Ms. Bauerle's eligibility for Medical Assistance benefits. 11. Defendant Bauerle's breach of the Agreement with Plaintiff Church of God has irreparably harmed and continues to irreparably harm Plaintiff Church of God. 12. Upon information and belief, at all times material hereto, Ms. Bauerle has been financially unable to fully compensate Plaintiff Church of God for the care and services that it has rendered to her in accordance with the terms and conditions of the Agreement. 13. Accordingly, only a decree of specific performance will adequately protect the interests of Plaintiff Church of God and provide it with the benefits and/or protections promised under the Agreement. 3 WHEREFORE, Plaintiff Church of God seeks a decree from this Honorable Court which orders specific performance of the Agreement between the parties. Respectfully submitted, SCHUTJER BOGAR LLC Dated: 5 g 6 $ D By: Bradley A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Allison M. O'Horo Attorney I.D. No. 200568 (717) 909-5924 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff 4 EXHIBIT "A" Cq RCH OF GOD HOME, INC. - ADMISSION AND CARE AGREEMENT THIS AGREEMENT is made on this G day of 7 by /I i and between The Church of God Home, Inc., called the "Fac lity," a Pennsylvania non-profit corporation located at 801 North Hanover Street, Carlisle, Cumberl and County, Pennsylvania, and 'AltylOw?p i called "Resident" and Ab?') &?/ c? called "Responsible Party". The Resident and the Responsible Party reaffirm that the information provided in the Pre-Admission Questionnaire is true and correct and understand that the submission of false information may constitute grounds to terminate this Agreement.' The Resident has applied for admission to the Facility and the Facility has approved the. Application for Admission. Therefore, the Facility, The Resident. and Responsible Party agree to the following terms', 1. PROVISION OF SERVICES. The Facility will provide Resident with: (a) Skilled nursing care, i.e. professionally supervised nursing care and related health services under a plan of services regularly provided under a plan of care supervised by licensed personnel and, as required by the Resident's medical condition, assistance with activities of daily living. (b) Accommodations consistent with the level of care provided to the Resident including heat, air conditioning,.electricity and hot and cold water. (c) Bed, bedding, blankets and laundered bed linens, towels .and wash cloths. (d) Three meals each day, except as-otherwise medically indicated. (e) Activity programs and social services. 2. REC==G CHARGES. In exchange for the above services, the Resident shall pay the following recurring charges: (a) For skilled nursing care: $ 0-101 :ddollars •per day. Admission and Care Agreement - continued -3-. NON-RECURRING CHARGES. The Resident shall pay the following non-recurring charges: (a) P_ security deposit in the amount of thirty-one (31) .times the current daily rate for the level of care required by the resident, will be billed after admission day. The amount of the security deposit is $ rGt?. No interest will be paid on the security deposit. A security deposit will not be charged to residents who are receiving benefits for room and board provided by Medicare, until the Medicare benefit concludes. An applicant who is covered by Medicaid is not required to pay a security deposit. (b) The cost for enrollment in the community a ance and ALS (Advance Life Support) Unit is $ This fee must be paid prior to admission and w?lli] be billed annually to the.Resident. a. MISCELLANEOUS CHARGES AND OTTTSIDE SERVICES. Resident is responsible to pay for other services provided by the Facility which are not covered by the daily rate/charge. - A list of such services /charges. is attached to this Agreement nn the "'Chart of Costs. 1' The services of a licensed physician and dentist, a registered pharmacist and licensed pharmacy for the provision of pharmaceutical supplies, a licensed hospital, and. diagnostic services, will be made available at the Resident's expense. THE RESIDENT HAS THE RIGHT TO SELECT HIS/HER OWN PHYSICIAN OR ANY OTHER SERVICE PROVIDER SO LONG AS THE PHYSICIAN OR OTHER SERVICE PROVIDER IS PROPERLY LICENSED OR REGISTERED UNDER THE LAW, AND THAT ALL APPLICABLE GOVERNMENT RULES AND POLICIES OF THE FACILITY ARE MET. In addition to the Facility's charges, the Resident is responsible to pay -all fees and costs -for goods or services furnished to or for the Resident by anyone other than the Facility under this Agreement. The responsibility of the Resident to pay applies to all fees for costs of services provided for the Resident by any physician, dentist, optometrist,'. therapist, diagnostic or testing laboratory, pharmacist, pharmacy, hospital., or any other person,' facility or entity providing services or goods to or for the Resident, and for all drugs, medicines, medications, pharmaceutical supplies, corrective eye lenses, hearing aids, dentures, hair care, and other personal items or services for the Resident. SUCH FEES AND COSTS ARE NOT INCLUDED IN THE HOME'S DAILY RATE/CHARGE. Admission and Care Agreement - continued 5. ADMISSION. The Resident will be.admi5ted, or a bed will he reserved -for Resident, beginning on 2,9 All pre-admission charges will be billed after admission, and recurring charges will begin to accrue as of the above -date. The Resident may reserve an available bed by paying the daily rate for the bed reserved. The daily rate for the reserved bed will continue to accrue and be payable until the reservation is terminated, even if the Resident does not enter the Home for whatever reason, including illness, injury, incapacity or death. 6. PERIODIC BILLINGS AND PAYMENT DUE DATE. (a) on the first of,each month, Resident will be billed the current daily rate for Resident's current level of care times the number of days in the month. The bill is due and payable upon receipt. (b) Miscellaneous charges (refer to "Chart of Costs" attached to this Agreement) such as hair care, personal laundry, incontinency, supplies, etc., are.additional charges above the, daily rate. These miscellaneous charges*will. be added to, and included with,. your monthly bill. (c) Pha=acy charges will be billed as a separate part of the Facility's monthly bill, and will require a separate check... (d) Outside providers.will bill directly and separately..' 7. CHANGES IN CHARGES. From time to time,the Facility may change the amount of its charges. In addition, from time to time, the Facility may change how and when its charges are computed, billed or become due. The Facility reserves the right to make airy such changes at any time. Written notice of any such changes will be given to the Resident thirty (30) days in advance of implementation, unless' the change is required earlier under any, federal or state law or assistance program. 8. PARTICIPATION IN 11 MEDICARE/MEDICAID" PROGRAMS. The Facility participates in the Medicare program administered pursuant to Title XVIII of the Federal Social Security Act and the Pennsylvania Medical Assistance Program ("Medicaid") administered pursuant to the Pennsylvania state plan and Title XIX of the Federal Social Security. Act. However, the Facility reserves the right to withdraw from the Medicare/Medicaid. programs at any time in accordance with the law. Admission and Case Agreemeat - continued -9-. OBLIGATIONS OF RESPONSTELE PARTY. The Responsible Party is responsible for services and supplies that are billed through the Facility or billed directly to the Resident or Responsible party by any other provider. The Responsible Party is responsible' to pay all zees and costs from Resident's resources. 10. READMISSION - BED HOLD POLICY. If the Resident leaves the Facility for a period of hospitalization, therapeutic leave, or any other reason, other than the Resident's death, and if the Resident is not eligible for, or receiving medical assistance, the Resident's bed will be reserved and charges for the reserved bed will continue to accrue, unless the Resident or Responsible Party -otherwise directs in writing. If the Resident or Responsible Party elects not to reserve a bed, then the Resident will be eligible for readmission upon the availability of the first bed suitable for the Resident's level of care. If the Resident As receiving medical assistance benefits and - the Resident • leaves the Facility for -a period of hospitalization or therapeutic leave, the Resiclenf'1-•s- bed will be reserved for the applicable maximum number of days paid for the reserved bed under the Pennsylvania . Medical Ass '?s?an e`•. roggram. The current ' bed reservation period is fifteen (Is)"- ays for hospitalization, regardless of level of care, fifte n_ .(is) ?dAys for therapeutic leave for residents receiving skilled nursing--care,: and thirty (30) days for therapeutic leave for residents receiving intermediate care. The bed reservation period may be subject to change in accordance with any changes in the-Medical Assistance Program. if the period of hospitalization or therapeutic leave ends within 'the reservation period under the Medical Assistance Program, the Resident may return to the Facility. If the period of hospitalization or therapeutic leave exceeds the maximum time for reservation of a bed under the Pennsylvania. Medical Assistance Program, the Resident must wait until a suitable bed becomes available for readmission. The Resident is entitled to the first available bed suitable for the Resident's level of care if, at the time of readmission, the Resident rectuires the services provided by the Home. 11. REFUNDS. The security deposit for private pay residents, after deductions for the payment of any outstanding bills owed to the Facility, will be refunded within thirty (30) days after the Resident's -discharge from the Facility or death. Those Nursing Residents on Medical Assistance will receive their refund, if any due,' within ninety (90) days. There will.be no other refunds, in the absence of an overpayment, under this Agreement.. 12.. PERSONAL FINANCES. The Resident has the right to manage his/her personal funds. The Resident is and will be responsible to provide his/her personal funds. If the Resident elects, the Resident may designate, in writing, that the Facility hold and manage the Resident's personal funds. If the-Resident Admission and Care Agreement - continued desig=ates someone other than the Facility to manage his/her personal funds, the Resident or Responsible Party shall notify the Facility promptly.. The Resident is not required to make any designation, and 'is responsible for his/her own personal funds unless such designation is made. The Resident may revoke, at any time, the designation of the Facility as the manager of his/her personal funds by providing the Facility a written notice signed and dated by the Resident or Responsible Party. If.the Resident transfers to the Home, responsibility to -manage the Resident's personal funds, the Facility will do so in accordance with the "Rights of Nursing Facility Residents'", a copy of which 'is. provided - at the time of your admission, and the Facility's personal funds management policy. The Facility may deduct, at any time, charges due to the Facility under this agreement from. the Resident's personal funds managed by the Facility. 13. TERMINATION, TR=SFEI2 OR DISCHARGE. (a) 13v the Resident: The Resident may terminate this Agreement upon thirty (30) days written notice to the' Facility. If the Resident leaves the-Facility for any reason other than a medical emergency or his/her death, the Resident must give written notice to the Facility at least thirty (3o)-days in advance of the departure/ transfer/discharge or termination of the Agreement. If advance written notice is -not given to the Facility, 'there will be due to the Facility its daily and other charges then in effect for the Resident's current level of care for the required thirty (30) day notice period. The charge applies whether or not the Resident remains at the Facility during the thirty (30) day period. (b) By the Facility: The'Facility may terminate the Resident's stay and transfer or discharge the Resident if., (I) the transfer or discharge is necessary, to meet the Resident's welfare which cannot ..be-met by the Facility; (II) the Resident's health or condition has improved sufficiently that'the Resident no longer needs the services provided by the Facility; (III) the safety or health of individuals in the Facility is or otherwise would be endangered; Admission and Care AUeemenl- continued IV. The charges or other amounts due to the Facility under this Agreement have not been paid to the Facility or treated as paid to the Facility on the Resident's behalf by Medical Assistance under the Medical Assistance Program or by Federal Medicare benefits under Title XVIII of the Federal Social Security Act; or V. The Facility ceases to operate. The Facility generally will notify the Resident and Responsible Party or if none, a family member or legal representative of the Resident, if known to the Facility, at least thirty (30) days in advance of such a transfer or discharge. However, in any case, describe in subparagraph (I), (I1) and (111) above, or if the Resident has not resided at the Facility for at least thirty (30) days, the Facility will give such notice before transfer or discharge as is practicable under the circumstances. 14. THIRD PARTY PAYMENTS- The Resident may be or may become eligible to receive financial assistance, reimbursement or other benefits from third- parties, such as through private insurance, employee benefit plans. Medical assistance tinder the Pennsylvania Medical Assistance Program, Medicare benefits, supplementary medical or other health insurance, supplemental security income insurance. or old-age survivors' or disability insurance under or pursuant to the Federal Social Security Act or Program. If the Resident becomes eligible to receive payments from any third-parties for the stay and care of the Resident. the Resident/Responsible Party shall, at all times; cooperate fully with the Facility and each third-party payments. Cooperation includes, when requested, providing information, signing and delivering documents, and having the Facility designated by the Social Security Administration as the Resident's representative payee for receipt of Federal Social Security benefits or any other governmental assistance. reimbursement or benefits to the extent of all charges due the Facility. The Resident irrevocably authorizes the Facility to make claims and to take such other actions as maybe necessary for the Facility's receipt of third-party payments. To the fullest extent permitted by law. the Resident hereby assigns now or hereafter payable to the extent of all charges due to the endorse and turn over to the Facility any payments received from third-parties to the extent necessary to satisfy the charges under this Agreement. Admission and Care Agreement- continued 15. PERSONAL PROPERTY- The Resident/ Responsible Party is and will be responsible to furnish and maintain clothing, jewelry, personal possessions', and other items of property. The facility may limit the amount or type of property that the Resident may keep at the facility if there is insufficient space, or if medically indicated or necessary to protect the rights or welfare of others. All non-clothing items of value must be recorded on the resident's personal inventory located with their medical record on the day of admission or any day thereafter. The same is true if removing an item of value from the resident's room. You are requested to see the charge nurse regarding resident's personal property. If nametag labels are needed for clothing items, please leave them at the nursing station. 16. RESPONSIBILITIES OF RESIDENT- The Resident shall comply fully with all governmental laws and regulations, the provisions of this Agreement and the facility's existing policies, rules and regulations which may, from time to time, be altered or amended. 17. MISCELLANEOUS PROVISIONS a. The Resident and Responsible Party acknowledge that they are adult individuals and have read and understand the terms of this Agreement. b. The provisions of this Agreement shall be governed by the laws of the Commonwealth of Pennsylvania and shall be binding upon and inure to the benefit of each of the undersigned parties and their respective heirs, personal representatives, successors and assigned. c. The various provisions of this Agreement shall be severable one from another. If any provision of this Agreement is found by competent legal authority to be invalid, the other provisions shall remain in full force and effect as if the invalid provision had not been part of this Agreement. d. The Facility reserves the right to modify unilaterally the terms of this Agreement to conform to subsequent changes in the law or regulation and changes in charges. Resident will be provided thirty (30) days notice of changes in charges and, if practicable, reasonable notice of any modifications required by law. )Woo Resident/Responsible Party Resident Name /t_ C _G 7 Faci ity Repr Itative Date VERIFICATION The undersigned hereby verifies that the statements of fact in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. I Understand that any false statements therein are subject to the penalties contained in 18 Pa. C.S.A. § 4904, relating to unswOrA falsification to authorities. Dated 5-cs Sharon Cramer, SR Billing/AR Specialist Church of God Home, Inc. -6q. r.a 00 LTJ F' rv ra 0 00 00 r 4 t t e -10 0 CF 17 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, : V. No. b8 - 3bd Civit (erg J. MARC BAUERLE, Czr j7 : Defendant. CIVIL ACTION - EQUI u':, `- -4; 2> -'0 r CJ t -5 W`j rn PETITION FOR PRELIMINARY INTUNCTION AND NOW, COMES, Petitioner, Church of God Home, Inc. ("Petitioner'), by and through its attorneys, SCHUTJER BOGAR LLC, and files the following Petition against Respondent, J. Marc Bauerle ("Respondent"), pursuant to Pa. R.C.P. § 1531, and, in support thereof, avers: 1. Petitioner filed its Complaint against Respondent. 2. The Complaint sets forth a claim against Respondent relating to Respondent's breach of his contractual duties owed to Petitioner by failing to cooperate in the Medical Assistance application process for Margaret Bauerle, his mother ("mother"), by providing the necessary financial documentation to the Cumberland County Assistance Office to determine his mother's eligibility for benefits. See Exhibit "A" to Complaint. ORIGINAL 3. The very nature of Respondent's breach of his contractual duties presents an issue of immediate and irreparable harm to Petitioner, as the application for Medical Assistance benefits filed on behalf of Margaret Bauerle with the Cumberland County Assistance Office will be denied due to the lack of necessary evidence to qualify Respondent's mother for Medical Assistance benefits. 4. The requested injunction would restore the parties to the status quo as it existed immediately prior to the breach of Respondent's contractual duty. 5. Greater injury would result from the denial of the requested injunction than from the granting of the same because absent the injunction, without the information necessary to qualify Respondent's mother for Medical Assistance benefits, the Medical Assistance application will be denied. 6. Petitioner's right to relief is clear. See Complaint attached hereto as Exhibit "A." 7. Petitioner lacks an adequate remedy at law, as upon information and belief, at all times material hereto, Respondent's mother has been financially unable to fully compensate Petitioner for the care and services that it rendered to her and continues to render to her in accordance with the Agreement. 8. A bond in the amount of $100.00 should be adequate in the event that it is later determined that the issuance of the instant petition was in error. 2 WHEREFORE, Petitioner respectfully requests that the Court schedule an immediate hearing on its request for injunctive relief and thereafter issue a decree ordering specific performance of the contractual duty of Respondent. Respectfully submitted, SCHUTJER BOGAR LLC Dated: s g r By: Bradley A. Schu er ' Attorney I.D. No. 75954 (717) 909-5921 Allison M. O'Horo Attorney I.D. No. 200568 (717) 909-5924 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Fax No. (717) 909-5925 Attorneys for Plaintiff 3 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Petitioner's Petition for Preliminary Injunction was sent via regular, United States mail, postage pre-paid, upon the following: J. Marc Bauerle P.O. Box 711 Mechanicsburg, PA 17055 Dated: 5 By: 0AUUAA- Catherine Klobucar, Paralegal EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone: (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY AVISO PARA DEFENDER Conforme a PA RCP Num. 1018.1 USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telefono: (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. JK- 3oo )- GNf? J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY COMPLAINT AND NOW COMES, Plaintiff, Church of God Home, Inc. ("Plaintiff Church of God"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the within Complaint against Defendant, J. Marc Bauerle ("Defendant Bauerle"), and in support thereof, provides as follows: 1. Plaintiff Church of God is a Pennsylvania corporation with its principal offices located at 801 North Hanover Street, Carlisle, Pennsylvania, 17103. 2. Defendant Bauerle is an adult individual who resides at P.O. Box 711, Mechanicsburg, Pennsylvania, 17055. 3. On or about November 29, 2007, Defendant Bauerle made application on behalf of his mother, Margaret Bauerle ("Ms. Bauerle"), for admission to Plaintiff Church of God's skilled nursing facility located at 801 North Hanover Street, Carlisle, Pennsylvania, 17103. 4. On or about November 29, 2007, Plaintiff Church of God and Defendant Bauerle entered into a written Admission and Care Agreement ("Agreement"). Pursuant to the Agreement, Plaintiff Church of God agreed to provide Ms. Bauerle with skilled nursing care and services in exchange for Defendant Bauerle's promise to pay a specific monetary fee from Ms. Bauerle's resources and to cooperate fully with Plaintiff Church of God upon becoming eligible for the receipt of Medical Assistance benefits, such "[c]ooperation includes, when requested, providing information, [and] signing and delivering documents ...." A true and correct copy of the Agreement is attached hereto as Exhibit "A." 5. Subsequent to Ms. Bauerle's admission to Plaintiff Church of God's skilled nursing facility, she allegedly became insolvent. 6. On or about April 24, 2008, an application for the receipt of Medical Assistance benefits was filed with the Cumberland County Assistance Office. 7. The Cumberland County Assistance Office will deny the application for Medical Assistance benefits absent the receipt of the requisite documentation from Defendant Bauerle to the Cumberland County Assistance Office to determine Ms. Bauerle's eligibility for the receipt of Medical Assistance benefits. COUNTI BREACH OF CONTRACT/SPECIFIC PERFORMANCE 8. Paragraphs 1 through 7 are incorporated herein by reference as if fully set forth. 2 9. Plaintiff Church of God has provided skilled nursing care and services to Ms. Bauerle in accordance with the terms and conditions of the Agreement. 10. Defendant Bauerle breached the Agreement with Plaintiff Church of God when he failed to make timely and proper application for Medical Assistance benefits for Ms. Bauerle, and Defendant Bauerle continues to breach the Agreement with Plaintiff Church of God by failing to cooperate and provide all documentation needed by the Cumberland County Assistance Office to determine Ms. Bauerle's eligibility for Medical Assistance benefits. 11. Defendant Bauerle's breach of the Agreement with Plaintiff Church of God has irreparably harmed and continues to irreparably harm Plaintiff Church of God. 12. Upon information and belief, at all times material hereto, Ms. Bauerle has been financially unable to fully compensate Plaintiff Church of God for the care and services that it has rendered to her in accordance with the terms and conditions of the Agreement. 13. Accordingly, only a decree of specific performance will adequately protect the interests of Plaintiff Church of God and provide it with the benefits and/or protections promised under the Agreement. 3 WHEREFORE, Plaintiff Church of God seeks a decree from this Honorable Court which orders specific performance of the Agreement between the parties. Respectfully submitted, Dated: Agl6y By: SCHUTJER BOGAR LLC -7 Bradley A. Schutjer Attorney I.D. No. 75954 (717) 909-5921 Allison M. O'Horo Attorney I.D. No. 200568 (717) 909-5924 417 Walnut Street, 4th Floor Harrisburg, PA 17101 4 Attorneys for Plaintiff EXHIBIT "A" rgTJRCH OF GOD HOME, INC. - ADMISSION AND CARE AGREEMENT THIS AGREEMENT is made on this, day of A[,,xnA,, by and between The Church of God Home, Inc., called the "Facility" a Pennsylvania non-profit corporation located at 801 North Hanover Street, Carlisle, Cumberl d County, Pennsylvania, and called "Resident" and c? called "Responsible Party". The Resident and the Responsible Party reaffirm that the information provided in the Pre-Admission Questionnaire is true and correct and understand that the submission of false information may constitute grounds to terminate this Agreement. The Resident has applied for admission to the Facility and the Facility has approved the. Application for Admission. Therefore, the Facility, The Resident and Responsible Party agree to the following terms'. 1. PROVISION OF SERVICES- The Facility will provide Resident with: (a) Skilled nursing care, i.e. professionally supervised nursing care and related health services under a plan of services regularly provided under a plan of care supervised by licensed personnel and, as required by the Resident'e.medical condition, assistance with activities of daily living. (b) Accommodations consistent with the level of care provided to the Resident including heat, air conditioning,_electricity and hot and cold water. (c) Bed, bedding, blankets and laundered bed linens, towels .and wash cloths. (d) Three meals each day, except as-otherwise medically indicated. (e). Activity programs and social services. 2. RECURRING CHARGES. In exchange for the above services, the Resident shall pay the following recurring charges: (a) For skilled nursing care: $ C2 1 1 00dollars per day. Admission and Care Agreement - continued -3-. NON-REC=ING CHARGES. The Resident shall pay the f oll owing non-recurring charges: (a) P_ security deposit in the amount of thirty-one (31) times the current daily rate for the level of care required by the resident, will be billed after admission day. The amount of the security deposit is $6.??0r 60• No interest will be paid on the security deposit. A security deposit will not be charged to residents who are receiving benefits for room and board provided by Medicare, until the Medicare benefit concludes. An applicant who is covered by Medicaid is not required to pay a security deposit. (b) The cost for enrollment in the community a r a nd ALS (Advance Life Support) Unit is $ This fee must be paid prior to admission and w311?1 be billed annually to the.Resident. a. MISCELLANEOUS CHARGES AND OUTSIDE SERVICES. Resident is responsible to pay for other services provided by the Facility which are not covered by the daily rate/charge. A list of such Services /charges.is attached to this Agreement on the '"Chart of Costs . " The services of a licensed physician and dentist, a registered pharmacist and licensed pharmacy for the provision of pharmaceutical supplies, a licensed hospital, and diagnostic services, will be made available at the Resident's expense. THE RESIDENT HAS THE RIGHT TO SELECT HIS/HER OWN PHYSICIAN OR ANY OTHER SERVICE PROVIDER SO LONG AS THE PHYSICIAN OR OTHER SERVICE PROVIDER IS PROPERLY LICENSED OR REGISTERED UNDER THE LAW, AND THAT ALL APPLICABLE GOVERNMENT RULES AND POLICIES OF THE FACILITY ARE MET. In addition to the Facility's charges, the Resident is responsible to pay -all fees and costs 'for goods or services furnished to or for the Resident by anyone other than the Facility under this Agreement. The responsibility of the Resident to pay applies to all fees for costs of services provided for the Resident by any physician, dentist, optometrist,'. therapist, diagnostic or test ing:laboratory; pharmacist, pharmacy, hospital, or any other person,' facility or entity providing services or goods to or for the Resident, and for all drugs, medicines, medications, pharmaceutical supplies, corrective eye lenses, hearing aids, dentures, hair care, and other personal items or services for the Resident. SUCH FEES AND COSTS ARE NOT INCLUDED IN THE HOME'S DAILY RATE/CHARGE. Admission and Care Agreement - continued 5. ADMISSION. The Resident will be.admi5ted, or a bed will be reserved for Resident, beginning on //-, 21-L 7 All pre-admission charges will be billed after admission, and recurring charges will begin to accrue as of the above-date. The Resident may reserve an available bed by paying the daily rate for the bed reserved. The daily rate for the reserved bed will continue to accrue and be payable until the reservation is terminated, even if the Resident does not enter the - Home for whatever reason, including illness, injury, incapacity or death. 6. PERIODIC BILLINGS AND PAYMENT DUE DATE_ (a) On the first of'each month, Resident will be billed the current daily rate for Resident's current level of care times the number of days in the month. The bill is due and payable upon receipt. (b) Miscellaneous charges (refer to "Chart of Costs" attached to this Agreement) such as hair care, personal laundry, incontinency, supplies, etc., are. additional charges above the daily rate. These miscellaneous charges will be added to, and included with,. your monthly bill . - . _ . 7 . (c) Pharmacy charges will be billed as a separate part of the Facility's monthly bill, and will require a separate check... (d) Outside providers.will bill directly and separately.. 7. ' CHANGES IN CHARGES. From time to time, the Facility may change the amount of its charges. In addition, from time to time, the Facility may change how and when its charges are computed, billed or become due. The Facility reserves the right to make'aily such changes at any time. - Written notice of any such changes will be given to the - Resident thirty (30) days in advance of implementation, unless' the change is required earlier under any. federal or state law or assistance program. . 8. PARTICIPATION IN "MEDIC-ARE/MEDICAID" PROGRAMS. The Facility participates in the Medicare program administered pursuant to Title XVIII of the Federal Social Security Act and the Pennsylvania Medical Assistance Program ("Medicaid") administered pursuant to the Pennsylvania state plan and Title XIX of the Federal Social Security. Act. However, the Facility reserves the right: to withdraw from the Medicare/Medicaid.programs at any time in accordance with the law_ : Admission and Care Agreement - continued -9. OBLIGATIONS CP RESPONSIBLE PARTY. The Responsible Party is responsible for services and supplies that are billed through the Facility or billed directly to the Resident or Responsible Party by any other provider. The Responsible Party is responsible' to pay all fees and costs from Resident's resources- 10. READMISSION - BED HOLD POLICY. 'If the Resident leaves the Facility for a period of hospitalization, therapeutic leave, or any other reason, other than the Resident's death, and if the Resident is not eligible for, or receiving medical assistance, the Resident's bed will be reserved and charges for the reserved bed will continue to accrue, unless the Resident or Responsible Party _otheswise directs in writing. If the Resident or Responsible Party elects not to reserve a bed, then the Resident will be eligible for readmission upon the availability of the first bed suitable for .the Resident's level of care. If the Resident is receiving medical assistance benefits and - the Resident leaves. the Facility for a period of hospitalization or therapeutic leave, the Res bed will be reserved for the applicable maximum number of days paid for the resexved bed under the Pennsylvania Medical Ass'?Y ce"'-program. The current bed reservation period is fifteen (15)_,.ddys for hospitalization, regardless of level of care, fifte, (15} clays for therapeutic leave for residents receiving skilled nursing--care,_. and thirty (30) days for therapeutic leave for residents receiving intermediate care. The bed reservation period may be subject to change in accordance with any changes in the Medical Assistance Program. If the period of hospitalization or therapeutic leave ends within 'the 'reservation period under the Medical Assistance Program, the Resident may return to the Facility. If the period of hospitalization or therapeutic leave exceeds the maximum time for reservation of a bed under the Pennsylvania, Medical Assistance Program, the Resident must wait until a suitable bed becomes available for readmission. The Resident is entitled to the first available bed suitable for the Resident's level of care if, at the time of readmission, ;the Resident requires the services provided by the Rome. 11. REFUNDS. The security deposit for private pay residents, after deductions for the payment of any outstanding bills owed to the Facility, will be refunded within thirty (30) days after the Resident' s. discharge from the Facility or death. Those Nursing Residents on Medical Assistance will receive their refund, if any due,' within ninety (90) days. There 'Will .be no other refunds, in the absence of an overpayment, under this Agreement.. 12.. PERSONAL FINANCES. The Resident has the right to manage his/her personal funds. The Resident is and will be responsible to provide his/her personal funds. If the Resident elects, the Resident may designate, in writing, that the Facility hold and manage the Resident's personal funds. if the'Resident Admission and Care Agreement - continued deli gyrates someone other than the Facility to manage his/her personal funds, the Resident or Responsible Party shall notify the Facility promptly. The Resident is not required to make any designation, and -is responsible for his/her own personal funds unless such designation is made. The Resident may revoke, at any time, the designation of the Facility as the manager of his/her personal funds by providing the Facility a written notice signed and dated by the Resident or Responsible Party. if the Resident transfers to the Home, responsibility to -manage the Resident's personal funds, the Facility will do so in accordance with the "Rights of Nursing Facility Residents", a copy of which is. provided- at the time of your admission, and the Facility's personal funds management policy. The Facility may deduct, at any time, charges due to the Facility under this agreement from, the Resident's personal funds managed by the Facility. 13. TERMINATION, TRANSFER OR DISCHARGE. (a) By the Resident: The. Resident may terminate this Agreement upon thirty (30) days written notice to the Facility. If the Resident leaves the Facility for any reason other than a medical emergency or his/her death, the Resident must give written notice to the. Facility at least thirty (30)-days in advance of the departure/ transfer/discharge or termination of the Agreement. If advance written notice is not given to the Facility, there will be due to the Facility its daily and other charges then in effect for the Resident's current level of care for the required-thirty (30) day notice period. The charge applies whether or not the Resident remains at the•Facility during the thirty.(30) day period. (b) By the Facility: The-Facility may terminate the Resident's stay and transfer or discharge the Resident if. (I) the transfer or discharge is necessary.to meet the Resident's welfare which cannot be met by the Facility; (II) the Resident's health or condition has improved sufficiently that'the Resident no longer needs the services provided by the Facility, (III) the safety or health of individuals in the Facility is or otherwise would be endangered; Admission and Care Agreement- continued IV. The charges or other amounts due to the Facility under this Agreement have not been paid to the Facility or treated as paid to the Facility on the Resident's behalf by Medical Assistance under the Medical Assistance Program or by Federal Medicare benefits under Title XVIII of the Federal Social Security Act; or V. The Facility ceases to operate. The Facility generally will notify the Resident and Responsible Party or if none- a family member or legal representative of the Resident, if known to the Facility, at least thirty (30) days in advance of such a transfer or discharge, However, in any case, describe in subparagraph (I), (I1) and (Ill) above; or if the Resident has not resided at the Facility for at least thirty (30) days, the Facility will give such notice before transfer or discharge as is practicable under the circumstances. 14. THIRD PARTY PAYMENTS- The Resident may be or may become eligible to receive financial assistance, reimbursement or other benefits from third- parties, such as through private insurance, employee benefit plans. Medical assistance under the Pennsylvania Medical Assistance Program, Medicare benefits, supplementary medical or other health insurance, supplemental security income insurance, or old-age survivors' or disability insurance under or pursuant to the Federal Social Security Act or Program. If the Resident becomes eligible to receive payments from any third-parties for the stay and care of the Resident. the Resident/Responsible Party shall, at all times; cooperate fully with the Facility and each third-party payments. Cooperation includes. when requested, providing information, signing and delivering documents, and having the Facility designated by the Social Security Administration as the Resident's representative payee for receipt of Federal Social Security benefits or any other governmental assistance, reimbursement or benefits to the extent of all charges due the Facility. The Resident irrevocably authorizes the Facility to make claims and to take such other actions as maybe necessary for the Facility's receipt of third-party payments. To the fullest extent permitted by law. the Resident hereby assigns now or hereafter payable to the extent of all charges due to the endorse and turn over to the Facility any payments received from third-parties to the extent necessary to satisfy the charges under this Agreement. Admission and Care Agreement- continued 15. PERSONAL PROPERTY- The Resident/ Responsible Party is and will be responsible to furnish and maintain clothing, jewelry, personal possessions. and other items of property. The facility may limit the amount or type of property that the Resident may keep at the facility if there is insufficient space, or if medically indicated or necessary to protect the rights or welfare of others. All non-clothing items of value must be recorded on the resident's personal inventory located with their medical record on the day of admission or any day thereafter. The same is true if removing an item of value from the resident's room. You are requested to see the charge nurse regarding resident's personal property. If nametag labels are needed for clothing items. please leave them at the nursing station. 16. RESPONSIBILITIES OF RESIDENT- The Resident shall comply fully with all governmental laws and regulations, the provisions of this Agreement and the facility's existing policies, rules and regulations which may, from time to time, be altered or amended. 17. MISCELLANEOUS PROVISIONS a. The Resident and Responsible Party acknowledge that they are adult individuals and have read and understand the tea' rnis of this Agreement. b. The provisions of this Agreement shall be governed by the laws of the Commonwealth of Pennsylvania and shall be binding upon and inure to the benefit of each of the undersigned parties and their respective heirs, personal representatives, successors and assigned. c. The various provisions of this Agreement shall be severable one from. another. If any provision of this Agreement is found by competent legal authority to be invalid, the other provisions shall remain in full force and effect as if the invalid provision had not been part of this Agreement. d. The Facility reserves the right to modify unilaterally the terms of this Agreement to conform to subsequent changes in the law or regulation and changes in charges. Resident will be provided thirty (;0) days notice of changes in charges and, if practicable, reasonable notice of any modifications required by law. >,- . ? )Wf Resident/Responsible Party ?i Resident N" Facility,---R epr ltatI Date VERIFICATION The undersigned hereby verifies that the statements of fact in the foregoing Complaint are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C.S.A. § 4904, relating to unworn falsification to authorities. Dated '?" Sharon Cramer, SR Billing/ AR Specialist Church of God Home, Inc. MAY 1 4 2008 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. l?$ - 3ppa 0,; vt1 TAM J. MARC BAUERLE, Defendant. ORDER CIVIL ACTION - EQUITY AND NOW, this day of 2008, a hearing in the above-captioned matter on Petitioner's Petition for Preliminary Injunction is scheduled for 2008, at /,' _ U o'clock 00.m. in Court Room No. Cumberland County Courthouse. BY THE COURT: I tb3o uta_- ^v??1 ? • i7 ?fid -Yo IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. 08-3002 J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY CERTIFICATION Pursuant to Local Rule 208.3(a)(2), upon the information and belief of Petitioner, a Judge has not ruled upon any other issue in the same or related matter. 2. In accordance with Cumberland County Local Rule 208.3(a)(9), Petitioner is unaware of whether Respondent has retained counsel of record, and to date, Petitioner has not received a Entry/Notice of Appearance of counsel of record for Respondent. Dated: ?,t Respectfully submitted, SCHUTJER BOGAR LLC By: rl Bradley A. Sc utjer Attorney I.D. No. 75954 (717) 909-5921 Allison M. O'Horo Attorney I.D. No. 200568 (717) 909-5924 417 Walnut Street, 4thFloor Harrisburg, PA 17101 Attorneys for Petitioner rv ?? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CASE NO.: 08-3002 Civil Term AFFIDAVIT OF SERVICE Church of God Home, Inc. VS. J. Marc Bauerle Co®monvealth of Pennsylvania County of Dauphin so. I, John Shinkowsky, a competent adult, being duly sworn according to law, depose and say that at 7:10 PM on 05/22/2008, I served J. Marc Bauerle at 330 Stumpstown Road, Post Office Bog 711, Mechanicsburg, PA 17055 in the manner described below: ® Defendant(s) personally served. ? Adult family member with whom said Defendant(s) reside(s). Relationship is ? Adult in charge of Defendant(s) residence who refused to give name and/or relationship. ? Manager/Clerk of place of lodging in which Defendant(s) reside(s). ? Agent or person in charge of Defendant's office or usual place of business. ? an officer of said Defendant's company. ? Other: a true and correct copy of Notice to Defend, Complaint issued in the above captioned matter. Description: Sex: Male - Age: 60 - Skin: White - Hair: Bald - Height: 5' 11" - Weight: 170 to and subscribed before me on th} _ day of , 200 ?s 'k tvyl?-k ?I.IJC.Gt , X SnAnkowsky Invest 316 Fawn Ridge No Harrisburg, PA 1 (800) 276-0202 PAULA K. SMITH, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Feb. 3, 2012 Atty File#: - Our File# 3973 Law Firm: Schutjer Bogar LLC Address: 417 Walnut Street, 4th Floor, Harrisburg, PA, 17102 Telephone: (717) 909-5925 ORIGINAL ??r t ON to IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CASE NO.: 08-3002 Civil Term AFFIDAVIT OF SERVICE Church of God Home, Inc. VS. J. Marc Bauerle Commonwealth of Pennsylvania County of Dauphin as. I, John Shinkowsky, a competent adult, being duly swom according to law, depose and say that at 7:10 PM on 05/22/2008, I served J. Marc Bauerle at 330 Stumpstown Road, Post Office Box 711, Mechanicsburg, PA 17055 in the manner described below: ® Defendant(s) personally served. ? Adult family member with whom said Defendant(s) reside(s). Relationship is ? Adult in charge of Defendant(s) residence who refused to give name and/or relationship. ? Manager/Clerk of place of lodging in which Defendant(s) reside(s). ? Agent or person in charge of Defendant's office or usual place of business. an officer of said Defendant's company. ? Other: a true and correct copy of Order, Petition for Preliminary Injunction issued in the above captioned matter. Description: Sex: Male - Age: 60 - Skin: White - Hair: Bald - Height: 5' 11" - Weight: 170 JP - Sworn to and subs ribed efore me on th' fqhn Shinkowsky 0 day of f K) fq 20ov, inkowsky Inv s gations 316 Fawn Ridge orth l Harrisburg, PA 17110 (800) 276-0202 NOTARIAL SEAL Atty File#: - our File# 3974 PAULA K. SMITH, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Feb. 3, 2012 Law Firm: Schutjer Bogar LLC Address: 417 Walnut Street, 4th Floor, Harrisburg, PA, 17102 Telephone: (717) 909-5925 ORIGINAL +r? _' . ? :._ f 4A --pp ?: C , ?r e? 4J -01. .i IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. No. 08-3002 J. MARC BAUERLE, Defendant. CIVIL ACTION - EQUITY PRAECIPE TO WITHDRAW PETITION FOR PRELIMINARY INJUNCTION TO THE PROTHONOTARY: Kindly mark the Petition for Preliminary Injunction, filed in the above- captioned matter on May 12, 2008, as withdrawn without prejudice. Dated: l Respectfully submitted, By: Attorney I.D. 75954 (717) 909-5921 Allison M. O'Horo Attorney I.D. 200568 (717) 909-5924 417 Walnut Street, 41h Floor Harrisburg, PA 17101 Attorneys for Plaintiff ORIGNAL CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Praecipe to Withdraw Petition for Preliminary Injunction was served via regular, United States mail, postage prepaid upon the following: J. Marc Bauerle 330 Stumpstown Road P.O. Box 711 Mechanicsburg, PA 17055 Dated: By: Catherine Klobucar, Paralegal h+] C=:> t co r? SO3 1 ?y r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-3002 J. MARC BAUERLE, Respondent. CIVIL ACTION - EQUITY STIPULATED AGREEMENT Church of God Home, Inc. ("Petitioner') and J. Marc Bauerle ("Respondent") stipulate and agree to the following: 1. On or about May 12, 2008, Petitioner filed a Complaint against Respondent, the son of one of Petitioner's residents, Margaret Bauerle ("mother"). 2. The Complaint sets forth a single claim against Respondent based on his failure to specifically perform the terms of the written Admission and Care Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed to assist his mother in the application for Medical Assistance by failing to provide documentation needed by the Cumberland County Assistance Office. 3. An application for Medical Assistance benefits was filed on behalf of Respondent's mother on or about April 24, 2008, and was denied by the Cumberland County Assistance Office on May 27, 2008. 4. An appeal of the aforementioned denial is currently pending before the Cumberland County Assistance Office of the Department of Public Welfare. ORIGINAL 5. The parties agree to the entry of an Order directing Respondent to provide any and all records within his possession as rewired by the Cumberland County Assistance Office to determine the eligibility of Respondent's mother for Medical Assistance benefits within fifteen (15) days of the date of the Order and to diligently work to secure any and all other documents necessary to obtain benefits on Respondent's mother's behalf and to take any and all necessary actions to secure Medical Assistance benefits for his mother. That Order is attached as Exhibit "A." 6. Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction. Respectfully submitted, Dated: By: Allison M. allom Attorney for Petitioner Dated: By: -gill Ing J. M c Bauerle ExHlBrr °aaln IN THE COURT OF COMMON FLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-3002 J. MARC BAUERLE, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this day of , 2008, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that: 1. Within fifteen (15) days of the date of this Order, J. Marc Bauerle shall provide any and all records within his possession that are required by the Cumberland County Assistance Office to determine Margaret Bauerle's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits for Margaret Bauerle and take any and all necessary actions to secure Medical Assistance benefits for his mother. BY THE COURT J• C ? .a JUL z 3 2008 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-3002 J. MARC BAUERLE, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this 41 ' day of ?l 2008, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that: 1. Within fifteen (15) days of the date of this Order, J. Marc Bauerle shall provide any and all records within his possession that are required by the Cumberland County Assistance Office to determine Margaret Bauerle's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits for Margaret Bauerle and take any and all necessary actions to secure Medical Assistance benefits for his mother. 4 BY THE COURT ?'+ F ? n? / ? ,?1. ?' '?.????a ? ??;,a IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. J. MARC BAUERLE, Respondent. RETURN OF SERVICE I HEREBY CERTIFY THAT: No. 08-3002 CIVIL ACTION - EQUITY I, Catherine Klobucar, served the annexed Stipulated Order upon the following: J. Marc Bauerle 330 Stumpstown Road P.O. Box 711 Mechanicsburg, PA 17055 Service was made via first-class, United States mail, certified, return receipt requested, on August 4, 2008. A copy of the receipt evidencing service is attached hereto. I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained in the Return of Service is true and correct. Dated: I By: ?A?4,1? ??t,&Aj Catherine Klobucar SCHUTJER BOGAR LLC 417 Walnut Street, 4th Floor Harrisburg, PA 17101 JUL 2 3 2008 IN TBE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-3002 J. MARC BAUERLE, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this. day ofU 2008, in consideration of the parties' Stipulated Agreement, it is hereby ORDIZED AND DECREED that 1. Within fifteen (15) days of the date of this Order, J. Marc Bauerle shall provide any and all records within his possession that are required by the Cumberland County Assistance Office to determine Margaret Bauerle's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits for Margaret Bauerle and take any and all necessary actions to secure Medical Assistance benefits for his mother. BY THE COURT J- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. J. MARC BAUERLE, Respondent ? N b o - E., No. 08-3002 - - xw CIVIL ACTION - EQUI a. '- 'r- STIPULATED AGREEMENT Church of God Home, Inc. ("Petitioner') and J. Marc Bauerle ("Respondent") stipulate and agree to the following-. 1_ On or about May 22, 2008, Petitioner filed a Complaint against Respondent, the son of one of Petitioner's residents, Margaret Bauerle ("mother") 2_ The Complaint sets forth a single claim against Respondent based on his failure to specifically perform the terms of the written Admission and Care Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed to assist his mother in the application for Medical Assistance by failing to provide documentation needed by the Cumberland County Assistance Office. 3. An application for Medical Assistance benefits was filed on behalf of Respondent's mother on or about April 24, 2008, and was denied by the Cumberland County Assistance Office on May 27, 2008. 4. An appeal of the aforementioned denial is currently pending before the Cumberland County Assistance Office of the Department of Public Welfare_ COO p17 5_ The parties agree to the entry of an Order directing Respondent to provide any and all records within his possession as required by the Cumberland County Assistance Office to determine the eligibility of Respondent's mother for Medical Assistance benefits within fifteen (I5) days of the date of the Order and to diligently work to secure any and oll other documents neces.?--iry to obtain benefits on RespondenCs mother's behalf and to take any and all necessary actions to secure Medical Assistance benefits for his mother. That Order is attached as Exhibit "A-- 6. Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction- Respectfully submitted, Dated: By: r Allison M. O'Horo Attorney for Petitioner Dated: log By: - h22:Z?' 11? J. M/ c Bauerle EXHIBIT "A" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC_, Petitioner, V. : No_ 08-3002 J_ MARC BAUERLE, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this day of 2008, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that: I _ Within fifteen (15) days of the date of this Order, J. Marc BauerIe shall provide any and all records within his possession that are required by the Cumberland County Assistance Office to determine Margaret Bauerle's eligibility for Medical Assistance benefits and diligently work to secure any and all other documents necessary to obtain benefits for Margaret Bauerle and take any and all necessary actions to secure Medical Assistance benefits for his mother. BY THE COURT a r a M Lrl m 0 C 0 a O E O CC) U -0 N ? E ti B c 0 LTcl T cl? Lt U) CL +?a :r, --F s IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, V. J. MARC BAUERLE, Defendant. No. 08-3002 n p j E3 Urn CIVIL ACTION - EQUITY PRAECIPE TO SETTLE AND DISCONTINUE WITHOUT PREJUDICE TO THE PROTHONOTARY: Kindly mark the above-captioned matter as settled and discontinued without prejudice. Respectfully submitted, Dated: 6)0 SCHUTJER BOGAR LLC By: ?? ITradley A. Sch tjer Attorney I.D. 75954 (717) 909-5921 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Praecipe to Settle and Discontinue Without Prejudice was served via regular, United States mail, postage prepaid upon the following: Peter J. Russo, Esquire 3800 Market Street Camp Hill, PA 17011 Dated: J3 35 / O By: Linda L. Scisciani Senior Paralegal