HomeMy WebLinkAbout08-3707r
MAJOR CASE/NON-JURY
ASSESSMENT OF DAMAGES HEARING NOT REQUIRED
TABAS & ROSEN, P.C.
BY: LEWIS C. TRAUFFER, ESQUIRE
Attorney I.D. #60267
1601 Market Street, Suite 2300
Philadelphia, PA 19103
(215) 569-5050
MILTON S. HERSHEY
P.O. Box 853
Hershey, PA 17033
VS
ROBERT HUMMEL
591 Silver Spring
Mechanicsburg, PA
MEDICAL CENTER
Road
17050
Attorney for Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. OB - 37007 eivi l ler*t
CIVIL ACTION
COMPLAINT - CIVIL ACTION
NOTICE
You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within
twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in
writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case
may proceed without you and a judgment maybe entered against you by the court without further notice for any money claimed in the
complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT
AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL
HELP.
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
2 Liberty Avenue
Carlisle, Pennsylvania 17013
(717)249-3166 or(800)990-9108
COMPLAINT - CIVIL ACTION
THE MILTON S. HERSHEY MEDICAL CENTER
VS. ROBERT HUMMEL
1. Plaintiff is a non-profit corporation located at the
address indicated in the caption hereof.
2. Defendant is an individual who resides at the address
indicated in the caption hereof.
3. As the result of a certain medical condition, defendant
was treated by the plaintiff on May 28, 2007 thru Aug. 31, 2007.
4. The amounts, quantities and nature of said medical care,
the dates on which said medical care was rendered, and the
charges therefore are set forth in Exhibit "A" which is incor--
porated herein as if set forth at length.
5. Said medical care was commensurate with the condition of
defendant and was necessary for the health and welfare of
defendant.
6. At or about the time of defendant's treatment by plain-
tiff, implied, constructive and oral contracts arose between
defendant and plaintiff by the terms of which defendant became
obligated to pay plaintiff the charges for the medical care
rendered by plaintiff to defendant.
7. Defendant refuses to pay the balance due although
plaintiff has made demand that defendant do so.
8. As a result of the foregoing, there is due and owing
from defendant to plaintiff the sum indicated in Exhibit "A"
WHEREFORE, plaintiff demands judgment against defendant for
the sum of $72,298.07 plus six percent (60) interest per annum
from the date of discharge to the date of judgment, record costs
and non-record costs.
TABAS & ROSEN, P.C.
LEW S C. T UFFER, ESQUIRE
Attorney for Plaintiff
MS HERSHEY MEDICAL CENTER PAGE:
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 11/08/07 at 01:03 PM
Guarantor: HUMMEL ROBERT H
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050-0000
Patient: HUMMEL ROBERT H
Visit ##: 10500975
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Dat---
e Svc Code --- relit -
Description --- I - Units --- Debits --- I c'redits
--------------------------------------------------------
165 ---""-'--
02
05/28/07 42120 ADULT LEVEL II TRAUMA
81 ADULT IMC 1 -::'2945,. 00
-
05/28/07 46122
HEMOCCULT
STOOL 1
1 15
80.00
'
05/28/07 46472
05/28/07 46 ,
EMERGENCY VISIT, LEVE
1 7
.00
587.00
620
05/28/07 46 ROUTINE VENIPUNCTURE 1 1.7.00
699
05/28/07 4 THERA/DIAG INJECTION 1 56.00
6717
05/28/07 4 NONINVAS PULSE OX, MU 1 95.00
6736
05/28/07 10 TUBE THORACOSTOMY 1 393.00
1003
05/28/07 101004 ABO BLOOD GROUP
ANTIBODY SCREEN 1 21.00
05/28/07 101005
RH TYPE 1
1 47.00
05/28/07 104002
05/28/07
ALCOHOL (ETON), BLOOD
1 20.00
51.00
104009
05/28/07 104042 AMYLASE, BLOOD
CREATININE
BLOOD 1 44.00
05/28/07 104060 ,
GLUCOSE, BLOOD 1
1 14.00
05/28/07 104131
POTASSIUM (K), BLOOD
1 13.00
14
00
05/28/07 104145
05/28/07 1 SODIUM (NA), BLOOD 1 .
14.00
05052
05/28/07 PARTIAL THROMBOPLAS T 1 38.00
105059
05/28/07 1 PROTHROMBIN TIME 1 23.00
05657
05/28/07 1 CBC W/PLT/DIFF AUTO 1 48.00
11001
05/28/07 2 GLUCOSE BEDSIDE MONIT 1 28.00
45206
05/28/07 2 LIDOCAINE 10MG/ML 2 3.00
46057
05/28/07 2 CEFAZOLIN 1 GM/5 ML 2 4.25
46162
05/28/07 2 FENTANYL CITRATE 5 ML 3 9.55
46764
05/28/07 2 DIPHTHERIA TETANUS 0. 1 64.70
47786
05/28/07 2 MORPHINE SULFATE 10 M 1 3.00
49241
05/28/07 3 MIDAZOLAM 10MG/2ML 10 3.00
05606
05/28/07 305609 HUMERUS; RT 2 VIEW MI
FOREARM AP&LAT VIEWS 1 110.00
05/28/07 305612
05/28/07 30
WRIST 3+ VIEWS RIGHT 2
1 220.00
130.00
7101
05/28/07 307220 CHEST 1 VIEW
PELVIS 1-2 VIEWS 2 240.00
)5/28/07 310501
)5/28/07 3
CT HEAD UNENHANCED 1
1 158.00
755.00
1051.6
)5/28/07 310519 CT THORAX ENHANCED 1 1565.00
)5/28/07 310560 CT ABDOMEN ENHANCED
CT C-SPINE UNENHANCED 1
1 1080.00
)5/28/07 310562
)5/28/07
CT T-SPINE UNENHANCED
1 837.00
780.00
310564
)5/28/07 310567 CT L-SPINE UNENHANCED 1 788.00
)5/28/07 310704 CT PELVIS ENHANCED
OMNIPAQUE 300M(3/ML 15 1
1 1227.00
15/28/07 621044
5/28/07
I V SODIUM CHLORIDE 0
1 82.00
6.00
626080 IV DILUENT NML SALINE 1 8 00
-----------------------------------
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A-I
MS HERSHEY MEDICAL CENTER PAGE: 2
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 11/08/07 at 01:03 PM
Guarantor: HUMMEL ROBERT H
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050-0000
Patient: HUMMEL ROBERT H
Visit #: 10500975
-----------------------------------------------
--------------------
-
-Date Svc Code Description Units) ;Debits Credits
----------------------------------------------------------------
05/2,8/07
05/29/07 670334 IV INFUSION SET, UNIV
1 1 8.00
05/29/07 1672 81 ADULT IMC
104028 IONIZED CALCIUM 1 '1580.00
05/29/07
104042 CREATININE, BLOOD 1
1 99.00
14
00
05/29/07.-. 104060 GLUCOSE, BLOOD 1 .
13
00
05/29/.07..:
05/29/07 104065 UREA NITROGEN (BUN),
10 1 .
13.00.
05/29/07 4106 MAGNESIUM
104111 BLOOD GAS PANEL W/02 1
1 16.00
05/29/07
104131 POTASSIUM (K), BLOOD
1 152.00
14
00
05/29/07
05/29/07 104145 SODIUM (NA), BLOOD
1 1 .
14.00
05/29/07 04398 ELECTROLYTES
10 1 30.00
05/29/07 5656 CBC W/PLT AUTO
111 1 30.00
05/29/07 001 GLUCOSE BEDSIDE MONIT
245 4 112.00
05/29/07 289 DEXTROSE 5 % IN WATER
24 1 3.00
05/29/07 5554 LIDOCAINE 1 ML
246 3 23.50
05/29/07 057 CEFAZOLIN 1 GM/5 ML
246 2 4.25
05/29/07 162 FENTANYL CITRATE 5 ML
246 9 28.65
05/29/07 169 FOLIC ACID 5 MG/ML
246 1 10.20
05/29/07 401 THIAMINE HCL 100 MG/M
2 1 14.90
05/29/07 46558 MULTIVITAMIN (MVI-12)
2 1 9.95
05/29/07 46705 MORPHINE SULFATE 4 MG
2 2 6.00
05/29/07 46706 MORPHINE SULFATE 2 MG
2 5 15.00
05/29/07 46707 HYDROMORPHONE 2 MG/ML
2 2 6.00
05/29/07 46708 MEPERIDINE HCL 25 MG
247786 MORPHINE SULFATE 10 M 1 3.00
05/29/07
248225 SENNA SYRUP 1ML 1
1 3.00
5
95
05/29/07
05/29/07 248547 SUFENTANIL CITRATE 5M
25 1 .
44.40
05/29/07 0577 PROPOFOL 20ML
250899 HYDROMORPHONE 30MG/60 1
5 8.40
05/29/07
272129 ROCURONIUM BROMIDE 5M
3 47.50
103
35
05/29/07 272425 MIDAZOLAM 1MG/ML 2ML 2 .
3
00
05/29/07
05/29/07 272979 FAMOTIDINE 20MG PRE-M
2 2 .
20.70
)5/29/07 72987 CEFAZOLIN 1 GM PRE-MI
27 12 71.70
)5/29/07 3935 PANTOPRAZOLE 40 MG VI
27 1 13.05
)5/29/07 4324 HUMULIN R
305609 FOREARM AP&LAT VIEWS 200
2 38.20
)5/29/07
307551 FLUORO MORE THAN ONE
1 220.00
301
00
)5/29/07
)5/29/07 390248 GUIDEWIRE, 1.GMM X 15
39 2 .
20.00
)5/29/07 1101 OR TIME<=1HR EACH 15M
39 4 2284.00
)5/29/07 1102 OR TIME>1HR EACH 15MI
39
2 10 2610.00
)5/29/07 8
30 SUTURE, SINGLE ARM
3 7 63.00
98410 DURA PREP SOLUTION 1 10 00
--------------------------------- I
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MS HERSHEY MEDICAL CENTER PAGE
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 11/08/07 at 01:03 PM
Guarantor: HUMMEL ROBERT H
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050-0000
Patient: HUMMEL ROBERT H
Visit ##: 10500975
---------------------------
Date _.I Svc Code Description I Units-
05/29/07
398666
PBDS MINOR ORTHO PACK
--- -- -----
1
05/29/07 422014 5-1/2 TO 6 HOURS-RECO 1
05/29/07 464146 CORTEX SCREWS -AO 12
05/29/07 464148 DCP PLATE -AO 1
05/29/07 ' 464593 SURGILAV SET MULTI-OR 1
05/29./07 464627 TOURINQUET HOSE DUAL 1
05/29/07 464856 DISPOSABLE BLADE 1
05/29/07 502000 ANESTHESIA TIME-HOSP 14
05/29/07 503127 BAIR HUGGER FULL BODY 1
05/29/07 600520 SPIRO INCENTIVE ADULT 1
05/29/07 621054 IV LACTATED RINGERS 1 4
05/29/07 622024 IRRIGATION SOD CHL 0 1
05/29/07 627070 .
IV EXT SET 90" W/FLAS 1
05/29/07 630828 FOLEY OATH 16 FR W/ME 1
05/29/07 667765 SCD SLEEVES, KNEE LEN 1
05/29/07 669209 CANISTER FOR VAC UNIT 1
05/29/07 670334 IV INFUSION SET
UNIV 2
05/29/07 670727 ,
PCA ST INTEGRAL NOSIP 1
05/30/07 11672 81 ADULT IMC 1
05/30/07 104106 MAGNESIUM 1
05/30/07 104438 RENAL FUNCTION PANEL 1
05/30/07 105657 CBC W/PLT/DIFF AUTO 1
05/30/07 111001 GLUCOSE BEDSIDE MONIT 4
05/30/07 246127 DIPHENHYDRAMINE 25 MG 2
05/30/07 246130 DIPHENHYDRAMINE 50 MG 1
05/30/07 246170 FOLIC ACID 1 MG 1
05/30/07 246703 LORAZEPAM 2 MG 1
05/30/07 246706 MORPHINE SULFATE 2 MG 1
05/30/07 246707 HYDROMORPHONE 2 MG/ML 2
05/30/07 250022 THIAMINE 100MG 1
05/30/07 250899 HYDROMORPHONE 30MG/60 5
05/30/07 272811 DALTEPARIN 2500U/0.2M 2
05/30/07 272987 CEFAZOLIN 1 GM PRE-MI 6
05/30/07 273935 PANTOPRAZOLE 40 MG VI 1
05/30/07 307101 CHEST 1 VIEW 1
05/30/07 307310 KNEE 1-2 VIEWS LEFT' 1
05/30/07 347039 MRI T SPINE UNENHANCE 1
05/30/07 621054 IV LACTATED RINGERS 1 2
05/30/07 669209 CANISTER FOR VAC UNIT 3
05/31/07 11672 81 ADULT IMC 1
05/31/07 16681 INITIAL EVALUATION-PT 1
05/31/07 104438 RENAL FUNCTION PANEL 1
Debits
.86.00
1834.00
588.00
278.00
10-0 . 0 0
41.00
24.00
1060.00
25.00
7.00
24.00
6.00
22.00
34.00
75.00
60.00
18.00
24.00
1580.00
16.00
44.00
48.00
112.00
6.00
3.00
3.00
3.90
3.00
6.00
3.00
47.50
64.80
35.85
13.05
120.00
140.00
1650.00
12.00
180.00
1580.00
159.00
44.00
--------------------------------------
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3
Credits
-------------
A -3
MS HERSHEY MEDICAL CENTER PAGE: 4
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 11/08/07 at 01:03 PM
Guarantor: HUMMEL ROBERT H
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050-0000
Patient: HUMMEL ROBERT H
Visit #: 10500975
--------------------------------------------
Date Svc - Code - Description -- - -Units Debits I Credits l
-----------------------------------
05/31/07 111001
05/31/07 " 2 GLUCOSE BEDSIDE MONIT 4 " 112.00
45431
05/31/07 METOCLOPRAMIDE 5 MG/M 1 3.00
245554
05/31/07 2 LIDOCAINE 1 ML 3 23.50
46057
05/31/07 2 CEFAZOLIN 1 GM/5 ML 4 8.45
46162
05/31/07
2 FENTANYL CITRATE 5 ML 3 9.55
_
46170
05/31/07 246493 FOLIC ACID 1 MG
DEXAMETHASONE 4 MG/ML 1
4 3.00
05/31/07 246707
HYDROMORPHONE 2 MG/ML
2 3.05
6
00
05/31/07 250022 THIAMINE 100MG 1 .
3
00
05/31/07 250577
05/31/07 2 PROPOFOL 20ML 2 .
16.75
72425
05/31/07 27 MIDAZOLAM 1MG/ML 2ML 2 3.00
2811
05/31/07 2 DALTEPARIN 2500U/0.2M 1 32.40
73935
05/31/07 27 PANTOPRAZOLE 40 MG VI 1 13.05
5035
05/31/07 307 KPHOS 30MMOL/500ML D5 1 19.05
101
05/31/07 310 CHEST 1 VIEW 2 240.00
507
05/31/07 39 CT LOW EXT UNENHANCED 1 755.00
1101
05/31/07 39 OR TIME<=lHR EACH 15M 4 2284.00
8652
05/31/07 422004 PBDS BASIC PACK
1/2 TO 1 HOUR-RECOVER 1 94.00
05/31/07 464593
SURGILAV SET MULTI-OR 1
1 727.00
100
00
05/31/07 464615 TOURNIQUET HOSE DUAL 1 .
43
00
05/31/07 502000
05/31/07 5 ANESTHESIA TIME-HOSP 4 .
370.00
03141
05/31/07 600 LARYNGEAL MASKS 1 48.00
510
05/31/07 6 PULSE OXIMETER SNSR A 1 11.00
21044
05/31/07 62 I V SODIUM CHLORIDE 0 1 6.00
1054
05/31/07 6 IV LACTATED RINGERS 1 1 6.00
22023
05/31/07 6 IRRIGATION SOD CHL 0. 1 6.00
67422
05/31/07 66 IMMOBILIZER KNEE FOAM 1 25.00
7765
05/31/07 66 SCD SLEEVES, KNEE LEN 1 75.00
9208
05/31/07 66 VAC DRESSING SML FOR 1 49.00
9209
06/01/07 103 CANISTER FOR VAC UNIT 1 60.00
77
)6/01/07 1 S SEMI PRIV MED/SURG 1 1240.00
6700
36/01/07 56 THERAPEUTIC ACTIV 15 1 53.00
609
)6/01/07 10 INITIAL EVALUATION-OT 1 159.00
4438
)6/01/07 105 RENAL FUNCTION PANEL 1 44.00
656
)6/01/07 1110 CBC W/PLT AUTO 1 30.00
01
)6/01/07 2 GLUCOSE BEDSIDE MONIT 4 112.00
46037
)6/01/07 246170 21SACODYL 10 MG
FOLIC ACID 1 MG 1 3.00
)6/01/07 246707
HYDROMORPHONE 2 MG/ML 1
4 3.00
12
00
16/01/07 246734 MULTIVITAMIN/MINERALS 1 .
3
00
)6/01/07 250022 THIAMINE 100MG 1 .
3.00
---------------------------------------- I
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MS HERSHEY MEDICAL CENTER PAGE: 5
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 11/08/07 at 01:03 PM
Guarantor: HUMMEL ROBERT H
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050-0000
Patient: HUMMEL ROBERT H
Visit #k: 10500975
--------------------------- ------------ ------ ------------
Date Svc Code I Description --- - - Units)- - -Debits I _ _ Credits--I
----------------------------------------------------------------------
06/01/07
06/01/07 250899
2 HYDROMORPHONE 30MG/60 5 47.50
06/01/07 72811
27 DALTEPARIN 2500U/0.2M 2 64.80
06/01/07 2987
2 CEFAZOLIN 1 GM PRE-MI 8 47.80
06/01/07 73935
62 PANTOPRAZOLE 40 MG VI 1 13.05
06/01/07 1044
670334 I V SODIUM CHLORIDE 0
IV INFUSION SET
UNIV 2
1 12.00
06/02/07
10377 .,
S SEMI PRIV MED/SURG
1 9.00
1240
00
06/02/07
06/02/07 111001
246 GLUCOSE BEDSIDE MONIT 4 .
112.00
06/02/07 170
24 FOLIC ACID 1 MG 1 3.00
06/02/07 6707
2 HYDROMORPHONE 2 MG/ML 3 9.00
06/02/07 46734
25 MULTIVITAMIN/MINERALS 1 3.00
06/02/07 0022
2 THIAMINE 100MG 1 3.00
06/02/07 50092
2 OXYCODONE APAP 1TAB 6 9.00
06/02/07 72811
27 DALTEPARIN 2500U/0.2M 1 32.40
06/02/07 3935
3 PANTOPRAZOLE 40 MG VI 1 13.05
06/02/07 07101
621044 CHEST 1 VIEW
I V SODIUM CHLORIDE 0 2
1 240.00
06/03/07
10223
P PRIVATE MED/SURG RM
1 6.00
1240
00
06/03/07
06/03/07 111001
246 GLUCOSE BEDSIDE MONIT 4 .
112.00
06/03/07 170
2 FOLIC ACID 1 MG 1 3.00
06/03/07 46734
2 MULTIVITAMIN/MINERALS 1 3.00
06/03/07 46907
250 LORAZEPAM 0.5 MG 2 6.00
06/03/07 022
25 THIAMINE 100MG 1 3.00
06/03/07 0092
272 OXYCODONE APAP 1TAB 10 15.00
06/03/07 811
27 DALTEPARIN 2500U/0.2M 3 97.20
06/03/07 3737
6 PANTOPRAZOLE 40 MG TA 1 3.00
06/04/07 69208
10 VAC DRESSING SML FOR 1 49.00
06/04/07 223
16 P PRIVATE MED/SURG RM 1 1240.00
06/04/07 694
1 GAIT TRAINING 15 MIN 2 106.00
06/04/07 11001 GLUCOSE BEDSIDE MONIT 3 84.00
06/04/07 246170 FOLIC ACID 1 MG 1 3.00
06
/04/07 246705
2 MORPHINE SULFATE 4 MG 4 12.00
.
06/04/07 46734
246 MULTIVITAMIN/MINERALS 1 3.00
06/04/07 907
250 LORAZEPAM 0.5 MG 2 6.00
06/04/07 022
25 THIAMINE 100MG 1 3.00
)6/04/07 0092
27 OXYCODONE APAP 1TAB 10 15.00
)6/04/07 2811
2 DALTEPARIN 2500U/0.2M 2 64.80
)6/04/07 72987
27 CEFAZOLIN 1 GM PRE-MI 2 11.95
)6/04/07 3737
62 PANTOPRAZOLE 40 MG TA 1 3.00
)6/04/07 1054
62 IV LACTATED RINGERS 1 2 12.00
)6/04/07 7070
670 IV EXT SET 90" W/FLAS 1 22.00
334 IV INFUSION SET, UNIV 1 9 00
---------------------------------
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?s
MS HERSHEY MEDICAL CENTER PAGE:
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 11/08/07 at 01:03 PM
Guarantor: HUMMEL ROBERT H
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050-0000
Patient: HUMMEL ROBERT H
Visit #: 10500975
-----------------------------------
Date -- - - Svc - Code Description --- -Units Debits Credits
--------------------------
06/05/07
06/05/07 10223
11 P PRIVATE MED/SURG RM 1 1240.00
06/05/07 1001
2 GLUCOSE BEDSIDE MONIT 4 112.00
06/05/07 45546
246162 LIDOCAINE 1 ML
FENTANYL CITRATE 5 ML 5
3 7.10
06/05/07
246170
FOLIC ACID 1 MG
1 9.55
3
00
06/05/07
06/05/07 246705
2 MORPHINE SULFATE 4 MG 5 .
15.00
06/05/07 46708
24 MEPERIDINE HCL 25 MG 1 3.00
6734 MULTIVITAMIN/MINERALS 1 3
00
06/05/07 246784 HYDROMORPHONE 2 MG 1 .
3
00
06/05/07 246788 HYDROMORPHONE 4 MG 4 .
12
00
06/05/07 246907 LORAZEPAM 0.5 MG 1 .
3
00
06/05/07 250022 THIAMINE 100MG 1 .
3
00
06/05/07 250577 PROPOFOL 20ML 2 .
16
75
06/05/07 272425 MIDAZOLAM 1MG/ML 2ML 2 .
3
00
06/05/07
06/05/07 272811
27 DALTEPARIN 2500U/0.2M 1 .
32.40
06/05/07 3737
39 PANTOPRAZOLE 40 MG TA 1 3.00
06/05/07 1101
39 OR TIME<=lHR EACH 15M 4 2284.00
06/05/07 1102
39 OR TIME>1HR EACH 15MI 1 261.00
06/05/07 8230
422004 SUTURE, SINGLE ARM
1/2 TO 1 HOUR-RECOVER 4
1 36.00
06/05/07
464987
STRUT, HYBRID
1 727.00
90
00
06/05/07
06/05/07 502000
50 ANESTHESIA TIME-HOSP 5 .
439.00
06/05/07 3141
60 LARYNGEAL MASKS 1 48.00
06/05/07 0004
621054 RTL VAC WOUND CLOSURE
IV LACTATED RINGERS 1 8
2 824.00
06/05/07
621110
STAPLER SKIN DISP SS
1 12.00
82
00
06/05/07 622023 IRRIGATION SOD CHL 0. 1 .
6
00
06/06/07 56610 RE-EVALUATION-OT 1 .
105
00
06/06/07 246705 MORPHINE SULFATE 4 MG 2 .
6
00
06/06/07 246784 I-IYDROMORPHONE 2 MG 4 .
12
00
06/06/07 246907 LORAZEPAM 0.5 MG 1 .
3
00
06/06/07 250092 OXYCODONE APAP 1TAB 4 .
6
00
06/06/07 272811 DALTEPARIN 2500U/0.2M 2 .
64
80
06/06/07
06/06/07 272968
6 ENTERIC COATED ASPIRI 1 .
3.00
21054 IV LACTATED RINGERS 1 1 6.00
------------------------
----------------
- -------------------------
Not posted -
Balance: 50686.25
--------------------------
Iq _?
PENNsTATE 1 st Statement
M?Os Milton S Here]--
Medical Center
MSHMC PHYSICIANS GROUP
BILLING SERVICES
PO Box 643313, Pittsburgh, PA 15264-3313
ROBERT H HUMMEL POOD05
591 SILVER SPRING RD
MECHANICSBURG PA 17050-2871
rrrlllrrilllrrrrlrlrllir?rrlrllrrlrlriilrrilllrlrrrrilllrlrr
Patient Name ROBERT H HUMMEL
Statement Date 01129/08
Account Number 399006
Total Charges $ 1,172.00
Insurance Payments/Adjustments $ 0.00
Patient Payments $ 0.00
Pending with Insurance $ 0.00
Amount You Owe $ 21,612.00
Page 1 of 4
Thank you for allowing Penn State University Physicians Group to
provide you with services. Please send your payment for the full
amount. If you have any questions concerning how your insurance
company processed your claim, please call them. If no insurance is
listed on the back of this statement and one is available please
contact our office with your information.
Please note: To keep your account current, our policy is to apply
your payment to the oldest outstanding balance.
To make payments. billing questions or insurance changes:
Para preguntas acerca de su factura o cambios de segurocontamos con
representantes disponibles para asistir a Is comunidad hispana.
Phone: (717) 531-5069 or (800) 254-2619
In Person: Financial counselors are available in the Academic Support
Building (on campus just east of the main hospital and University
Physicians Center).
Available hours: Monday, Tuesday & Wednesday 8.00 am to 5:30 pm
Thursday & Friday 8:00 am to 4:30 pm
Written Correspondence:
Penn State Milton S. Hershey Medical Center
Patient Financial Services Department
PO Box 854, Mail Code A410
Hershey, PA 17033-0854
mmHg
This new statement has been specially designed with . Department of Public Welfare 1-800-692-7462
you in mind. Let us know what other improvements . Children's Health Insurance Program (CHIP) 1-800-543-7101
we should make. (Uninsured children and adolescents under age 19)
. AdultBasic Program 1-800-543-7101 i
Please e-mail your ideas to: (Uninsured adults between the ages of 19 and 64)
Statementideasahmc.osu edu
or write to us at: RNM3
Penn State Milton S. Hershey Medical Center
Statement Ideas, PO Box 854, MC A410
Hershey, PA 17033
Tlriv strrteiuretil is for yorrr physicfrot services aril]. The hospital nqv bill separately fur their services.
HERSHPHYSTI-01
PENNSTATE Statement Date: 01/29/08
Milton S. Hershey
Medical Center
MSHMC PHYSICIANS GROUP
BILLING SERVICES
PO Box 643313
Pittsburgh, PA 15264-3313
CHECKS SHOULD BE MADE PAYABLE AND
SENT TO:
MSHMC PHYSICIANS GROUP
PO BOX 643313
PITTSBURGH, PA 15264-3313
1 11111111111111111111 I n 111111 n 11111111111111111111111111111
Patient Name Account Number, Date Due
ROBERT H HUMMEL 399006 Upon Receipt
Amount You Owe Amount Paid
$ 21,612.00 Is
Check here if your address or insurance information has changed.
Ij Please indicate changes on the back of this page.
To pay by credit card: For your convenience, you may pay by Visa,
MasterCard or Discover Card. Please indicate your credit card
preference, provide the account information, and sign below.
I-j 3=7 U " u®
Account No.
Expiration Date
Signature X
CVV Code
00000399006 UP 0000000002161200012908
lT _ ?
Page 2 of 4
CPT
Date Code Diagnosis Description
06/11/07 99024 894.0 POST-OP FOL-UP VISIT
Payments/
Charges Adiustments
Pending Patient
Insurance Balance
TOTAL: $ 0.00 $ 0.00
$ 0.00 $ 0.00
PATIENT NAME ROBERT H HUMMEL VISIT NUMBER 8506253 `
DOCTOR(S) , ROGER1O 1 NEVES IVIb,DIV PLASTIC RECONST SURG LOCATION OP,'RHYSIC.LAN
CPT Payments/ Pending Patient
Date Code Diagnosis Description Charges Adiustments Insurance Balance
06/19/07 99024 881.10 POST-OP FOL-UP VISIT
TOTAL: $ 0.00 $ 0.00 $ 0.00 $ 0.00
rA t rGIV 1 n?amt KU5F=RT"H HUMMEL VISLT!NUM ''. " 150626.1' . "'
DOCTOR(S) ,`.DONALD R MACKAY',MD.DIV PLASTICG RECONST:,SURG LOCATION Op PHYSICIAN
CPT Payments/ Pending Patient
Date Code Diagnosis Description Charges Adiustments Insurance Balance
06/13/07 99024 813.90 POST-OP FOL-UP VISIT
TOTAL: $ 0.00 $ 0.00 $ 0.00 $ 0.00
PATIENT NAME ROBERT H HUMMEL VISIT NUMBER, 8512904
'`DOCTOR(S) LUCILLE:`ANDERSEN MD ORTHOPAEDICS DIV1SiQN LOCATION SATELLITE CLINIC, 7777
CPT
Date Code Diagnosis Description
06/15/07 99024 V54.89 POST-OP FOL-UP VISIT
Payments/
Charges Adiustments
Pending Patient
Insurance Balance
TOTAL:
$ 0.00 $ 0.00 $ 0.00 $ 0.00
(preceding the date) INDICATES NEW FINANCIAL ACTIVITY SINCE THE LAST BILL
.....................
HERSHPHYSTt-02
......................................................... _ ..
PLEASE COMPLETE IF YOUR ADDRESS OR INSURANCE HAS CHANGED
NAME RELATIONSHIP TO PATIENT HOME TELEPHONE WORK TELEPHONE
ADDRESS CITY STATE ZIP
POLICYHOLDER'S NAME INSURANCE COMPANY NAME GROUP POLICY/PLAN NUMBER
POLICYHOLDER'S IDENTIFICATION NUMBER CLAIM MAILING ADDRESS
POLICYHOLDER'S DATE OF BIRTH RELATIONSHIP TO PATIENT CITY STATE ZIP
POLICYHOLDER'S EMPLOYER NAME INSURANCE COMPANY TELEPHONE
(Workers Cornpensatk)n & Auto Insurance Claims Only) DATES OF COVERAGE
Adjuster's Name: Claim #: EFFECTIVE FROM: EFFECTIVE TO:
Page 3 of 4
YA I ItN I NAME: ROBERT H HUMMEL
DOCTOR(S): TAIVIRA L HEIMERT MD DIV OF DIAG RADIOLOGY VISIT NUMBER:' 8412904,
A
LOC
TION SATELLITE CLINIC
CPT
Dater Code Diagnosis Description
06/15/07 73560 V54.16 KNEE LIMITED Payments/ Pending
Charge Adjustments Insurance Patient
Balance
06/15/07 73090 V54.89 FOREARM ANTEROPOS LATERAL $ 180.00
$ 176
00 $ 180.00
. $ 176.00
TOTAL
: $ 356.00 $ 0.00 $ 0.00 $ 356.00
PATIENT NAME: ROBERT H HUMMEL VISIT NUMBER: 8525645
DOCTOR(S): DAN A GALVAN MD TRAUMA SURGERY DIV .
LOCATION: OP PHYSICIAN
CPT
Date Code Diagnosis Description
06/25/07 99211 959.8 OUTPATIENT VISIT EST Payments/ Pending
Charges Adiustments Insurance Patient
Balance
$ 60.00 $ 60.00
TOTAL
: $ 60.00 $ 0.00
$ 0.00
$ 60.00
PATIENT NAME: ROBERT H HUMMEL VISIT NUMBER: 8528177
DOCTOR(S): ERICA WALKER MD DIV OF DIAG RADIOLOGY LOCATION: SATELLITE CLINIC
CPT
Date Code Diagnosis Description
07/20/07 73560 823
02 KNEE LIMITED Payments/ Pending
Charges Adjustments Insurance Patient
Balance
.
07/20/07 73090 V54.89 FOREARM ANTEROPOS LATERAL $ 191.00
$ 187
00 $ 191.00
. $ 187.00
TOTAL -
: $ 378.00 $ 0.00 $ 0.00 $ 378.00
PATIENT NAME: ROBERT H HUMMEL VISIT NUMBER: 8528177
DOCTOR(S): LUCILLE ANDERSEN MD ORTHOPAEDICS DIVISION ,
LOCATION: SATELLITE CLINIC.,
CPT
Date Code Diagnosis Description Payments/ Pending
Charges Adiustments Insurance Patient
Bala
07/20/07 00999 V54.89 NO CHARGE VISIT nce
TOTAL
: $ 0.00 $ 0.00 $ 0.00
$ 0.00 i.
PATIENT NAME: ROBERT H HUMMEL' VISIT NUMBER: 8542709
DOCTOR(S): ROGERIO I NEVES MD DIV PLASTIC RECONST SURG LOCATION. OP PHYSICIAN
CPT
Date Code Diagnosis Description Payments/ Pending
Charges Adiustments Insurance Patient
Balan
07/24/07 99024 884.0 POST-OP FOL-UP VISIT ce
TOTAL
: $ 0.00 $ 0.00 $ 0.00 $ 0.00
PATIENT NAME: ROBERT H HUMMEL VISIT NUMBER. 8643461
DOCTOR(S): DONALD J FLEMMING MD DIV OF DIAG RADIOLOGY LOCATION: SATELLITE CLINIC
CPT
Date Code Diagnosis Description Payments/ Pending
Charges Adiustments Insurance Patient
Balan
08131/07 73560 V54.16 KNEE LIMITED
$ 191
00 ce
08/31/07 73090 733.03 FOREARM ANTEROPOS LATERAL .
$ 187.00 $ 191.00
$ 187.00
TOTAL
: $ 378.00 $ 0.00 $ 0.00 $ 378.00
" (preceding the date) INDICATES NEW FINANCIAL ACTIVITY SINCE THE LAST BILL
0 - / HERSHPHYSTI-03
Page 4 of 4
CPT
Date Code Diagnosis DeSCflDtlgn
08/31/07 99024 V54.89 POST-OP FOL-UP VISIT
TOTAL:
GRAND TOTAL:
Payments/
Charges Adjustments Pending
Insurance Patient
Balance
$0.00 $0.00 $0.00 $0.00
$ 1,172.00 $ 0.00 $ 0.00 $1,172.00
* (preceding the date) INDICATES NEW FINANCIAL ACTIVITY SINCE THE LAST BILL
A-10
HERSHPHYSTI-03
I RUMMEL,"ROBERT #399006 $50,686.07 (Hosp)
$21,612.00 (Phys)
VERIFICATION
LINDA SCHLADER hereby states that she is the
Team Manager, Customer Service of the Milton S. Hershey
Medical Center and verifies that the statements made in the
foregoing pleading are true and correct to the best of her
knowledge, information and belief. The undersigned understands
that the statements therein are made subject to the penalties of
18 Pa. C.S. §4904 relating to unsworn falsification to
authorities.
LINDA SCHLADER
DATE : bsl"?blby
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Uli D
t r..,
ID
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0
SHERIFF'S RETURN - REGULAR
CASE NO: 2008-03707 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
MILTON S HERSHEY MEDICAL CENTE
Vs
HUMMEL ROBERT
ROBERT BITNER , Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
HUMMEL ROBERT the
DEFENDANT at 0018:49 HOURS, on the 14th day of July 2008
at 591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050 by handing to
ROBERT HUMMEL DEFENDANT
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing His attention to the contents thereof.
Sheriff's Costs: So Answers:
Docketing 18.00
Service 13.00
Affidavit .00
Surcharge 10.00 R. Thomas K in
IDY
-1h 00
41.00
07/15/2008
TABAS & ROSEN
Sworn and Subscibed to
1.,
before me this day Deputy eriff
of A.D.
TABAS & ROSEN, P.C.
BY: LEWIS C. TRAUFFER, ESQUIRE ID NO.: 60267
1601 Market Street, Suite 2300
PHILADELPHIA, PA 19103
215-569-5050
The Milton S. Hershey Medical Center
P.O. Box 853
Hershey, PA 17011
VS.
Robert Hummel
591 Silver Spring Road
Mechanicsburg, PA 17050
000KI' UY UUMMUIN PLEAS
CUMBERLAND COUNTY
NO.: 08-3707
ORDER FOR JUDGMENT FOR WANT OF AN ANSWER AND ASSESSMENT OF DAMAGES
TO THE PROTHONOTARY:
Kindly enter judgment in the sum of $76,668.62 in favor of the Plaintiff(s) in the
above entitled matter for failure of the Defendant(s) to file an Answer to Plaintiff(s) Complaint in
Civil Action and assess Plaintiff(s) damages as follows:
Amount of Claim:
Interest at 6% per
annum from date of
discharge 8/31/07
$ 72,298.07
$ 4,370.55
Total:
I assess damages as above
Pro Prothonotary
I ..................... ................ ereby certify that the
10 day letter under R.C.P.R. 237.1 was forwarded to
Defendant Robert Hummel
Address 591 Silver Spring Road
Mechanicsburg, PA 17050
Date August 4, 2008
$ 76,668.62
Attorney for Plaintiff(s)
L . .................. ..........- .........certify
that the above names are correct and
the Precise Residence Address of the
Judgment creditor is
Address: Same
Address of
Defendants: Same
MILTON S. HERSHEY MEDICAL CENTER
VS.
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
ROBERT HUMMEL No.: 08-3707
COMMONWEALTH OF PA
COUNTY OF CUMBERLAND
LEWIS C. TRAUFFER being legally sworn, deposes and says:
(a) that the defendant (s) is/are not in the Military or Naval Service of the United States or
or of its allies, or otherwise within the provisions of the Soldiers' and Sailors' Civil
relief action of Congress of 1940 as amended;
(b) that defendant Robert Hummel is over 21 years of age and resides at:
591 Silver Spring Road, Mechanicsburg, PA 17050 and is employed in Private
Business.
(c) that defendant is over 21 years of age and resides at:
and is employed in Private Business.
Affidavit has ascertained the foregoing information by inquiry and belief and makes this Affidavit
with due authority.
Sworn to and subscribed before me
on this 3rd day of September, 2008.
LEWIS C. TRAUFFER, ESQUIRE
Attorney for the Plaintiff
ARIAL SEAL
HF SLOVITSKY, Notary Pu4kc
:I?'iA1illetphia Phita. Coualy
I'
NOTARY PUBLIC
I4>Yti Y.< ;'?.??`." _ti: ah` lA1.?tWrlK7Mh`41;d
. ,????a??;,?4;;,,+.;`.
TABAS & ROSEN, P.C.
BY: LEWIS C. TRAUFFER, ESQUIRE ID No.: 60267
1601 Market Street, Suite 2300
Philadelphia, PA 19103
(215)569-5050
Milton S. Hershey Medical Center
P.O. Box 853
Hershey, PA 17033
VS.
Robert Hummel
591 Silver Spring Road
Mechanicsburg, PA 17050
: COURT OF COMMON PLEAS
CUMBERLAND COUNTY
: No.: 08-3707
NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT
TO: Robert Hummel
591 Silver Spring Road
Mechanicsburg, PA 17050
DATE OF NOTICE/FECHA DEL AVISO: August 04, 2008
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY
AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU.
UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGEMENT MAY BE ENTERED AGAINST YOU
WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS.
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 T0, 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
2 Liberty Avenue
Carlisle, PA 17013 Phone Nos: (717) 249-3166 or (800) 990-9108
AVISO IMPORTANTE
USTED SE ENCUENTRA EN ESTADO DE REBELDIA POR NO HABER PRESENTADO UNA COMPARECBNIA ESCRITO CON ESTE
TRIBUNAL SUS DEFENSAS U OBJECTIONES A LOS RECLAMOS FORMULADOS EN CONTRA SUYO. AL NO TOMAR LA
ACCION DEBIDA DENTRO DE DIEZ DIAS DE LA FECHA DE ESTA NOTIFICATION, EL TRIBUNAL PODRA, SIN
NECESIDAD DE COMPARECER LISTED EN CORRE U OIR PREUBA ALGUNA, DICTAR SENTENCIA EN SU CONTRA Y USTED
PODRIA PERDER BIENES U OTROS DERECHOS IMPORTANTES.
USED DEBE LLEVAR ESTE AVISO A UN ABOGADO ENSEGUIDA. SI USTED NO TIENE ABOGADO, VAYA PERSONALMENTE
0 LLAME POR TELEFONO A LA OFICINA MENCIONADA A CONTINUACTION. ESTA OFICINA LE PUEDE PROVEER LA
INFORMATION NECESARIA PARA CONTRATAR A UN ABOGADO.
SI USTED CARECE DE LOS MEDIOS NECESARIOS PARA CONTRATAR A UN ABOGADO, DICHA OFICINA LE PUEDE
SUMINISTRAR LA INFORMACION NECESSARIA ACERCA DE AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS LEGALES A
LAS PERSONAS QUE TIENEN DERECHO A RECIBIR TAL AYUDA GRATIS O A UNA CUOTA REDUCIDA.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013 Phone Nos: (717) 249-3166 or (800) 990-9108
LEWIS C. TRA FER, ESQUIRE
ATTORNEY FOR THE PLAINTIFF
THIS CORRESPONDENCE IS BEING USED TO COLLECT A DEBT AND
THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
-73
OFFICE OF THE PROTHONOTARY
CUMBERLAND COUNTY COURT HOUSE
ONE COURTHOUSE SQUARE
CARLISLE, PA 17013
TO: Robert Hummel
591 Silver Spring Road
Mechanicsburg, PA 17050
C
The Milton S. Hershey Medical Center
P.O. Box 853
Hershey, PA 17011
VS.
Robert Hummel
CUMBERLAND COUNTY
No.: 08-3707
NOTICE
Pursuant to Rule 236 of the Supreme Court of Pennsylvania, you are hereby notified that
a Judgment has been entered against you in the above proceeding as indicated below.
/c/ axki e. r
CURT LONG 01 ard
PROTHONOTARY
X JUDGMENT BY DEFAULT
MONEY JUDGMENT
JUDGMENT IN REPLEVIN
JUDGMENT FOR POSSESSION
JUDGMENT ON AWARD OF ARBITRATION
TRANSFER OF JUDGMENT
IF YOU HAVE ANY QUESTIONS CONCERNING THIS NOTICE, PLEASE CALL:
ATTORNEY LEWIS C. TRAUFFER, ESQUIRE
AT THIS TELEPHONE NUMBER: 215-569-5050
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
THE MILTON S. HERSHEY MEDICAL CENTER
P.O. BOX 853
HERSHEY, PA 17011
V.
ROBERT HUMMEL
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
NO.: 08-3707
PRAECIPE FOR WRIT OF EXECUTION
TO THE PROTHONOTARY:
Issue writ of execution in the above matter,
directed to the Sheriff of Cumberland County;
(1) against
ROBERT HUMMEL
(2) against
PNC BANK
105 NOBLE BOULEVARD
CARLISLE, PA 17013
ACCT#: 50-0411-6521
(3) AMOUNT DUE
INTEREST FROM 8/31/07
AT 6% PER ANNUM
(COSTS TO BE ADDED)
O,(' P?t ,? ?L nj5?1!'
a0c d oP Lg (J
sa
deP°5`
e
d? '" ?
$72,298.07
$ 4,370.55
TABAS & ROSEN, P.C.
defendant(s) and
garnishee(s).
E'9-IS C. TRA FER, I.D. No. 60267
1601 Market Street, 2300
Philadelphia, PA 19103
(215) 569-5050
Attorney for Plaintiff
t
O
ro
a
d
I
"O
to ° LA O
G
,
y
WRIT OF EXECUTION and/or ATTACHMENT
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND)
NO 08-3707 Civil
CIVIL ACTION - LAW
TO THE SHERIFF OF CUMBERLAND COUNTY:
To satisfy the debt, interest and costs due THE MILTON S. HERSHEY MEDICAL CENTER,
Plaintiff (s)
From ROBERT HUMMEL, 591 Silver Spring Road, Mechanicsburg, PA 17050
(1) You are directed to levy upon the property of the defendant (s)and to sell
(2) You are also directed to attach the property of the defendant(s) not levied upon in the possession
of
GARNISHEE(S) as follows:
PNC BANK, 105 Noble Blvd, Carlisle, PA 17013
Any and all assets, including, without limitations, checking accounts, savings accounts, certificates of
deposit and safe deposit boxes of the defendant in the posession of the garnishee. Acct #50-0411-6521
and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined from
paying any debt to or for the account of the defendant (s) and from delivering any property of the defendant
(s) or otherwise disposing thereof;
(3) If property of the defendant(s) not levied upon an subject to attachment is found in the possession
of anyone other than a named garnishee, you are directed to notify him/her that he/she has been added as a
garnishee and is enjoined as above stated.
Amount Due $72,298.07
L.L. $.50
Interest FROM 8/31/07 AT 6% PER ANNUM - $4,370.55
Atty's Comm % Due Prothy $2.00
Atty Paid $160.50
Plaintiff Paid
Other Costs
Date: 9/24/08
(Seal)
REQUESTING PARTY:
Name LEWIS C. TRAUFFER, ESQUIRE
Address: TABAS & ROSEN, PC
1601 MARKET STREET, 2300
PHILADELPHIA, PA 19103
Attorney for: PLAINTIFF
Telephone: 215-569-5050
Supreme Court ID No. 60267
5
b4 - R. Long, Prothonotary
By: K.
Deputy
SHERIFF'S RETURN - GARNISHEE
CASE NO: 2008-03707 P
COMMONWEALTH OF PENNSLYVANIA
COUNTY OF CUMBERLAND
MILTON S HERSHEY MEDICAL CENTE
VS
HUMMEL ROBERT
And now WILLIAM CLINE
,Sheriff or Deputy Sheriff of
Cumberland County of Pennsylvania, who being duly sworn according
to law, at 0012:30 Hours, on the 29th day of September, 2008, attached
as herein commanded all goods, chattels, rights, debts, credits, and
moneys of the within named DEFENDANT
HUMMEL ROBERT
hands, possession, or control of the within named Garnishee
PNC 105 NOBLE BLVD
CARLISLE, PA 17013
Cumberland County, Pennsylvania, by handing to
WENDY WHISTLER (CSR)
personally three copies of interogatories together with 3
and attested copies of the within WRIT OF EXECUTION
, in the
true
and made
the contents there of known to Her .
Sheriff's Costs: So answE
Docketing .00
Service .00
Affidavit .00 R. Thomas Kline
Surcharge .00 Sheriff of Cumberland County
.0000 ??oloR/D8.
09/30/2008
Sworn and Subscribed to
before me this day of By V
Deputy Sheriff
A.D
R. Thomas Kline, Sheriff, who being duly sworn according to law, states
this writ is returned STAYED, DUE TO BANKRUPTCY.-
Sheriff s Costs: Advance Costs: 150.00
Sheriff's Costs: 86.19
Docketing $ 18.00 63.81
Poundage 1.69
Advertising
Law Library .50
Prothonotary 2.00 Refunded to Atty on 10/08/08
Milage 5.00
Surcharge 30.00
Levy 20.00
Post Pone Sale
Garnishee 9.00
Postage
TOTAL $
86.19 ? /o?/p f
So Ans rs•
R. Thomas Kline, Sheriff
By i c
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TABAS & ROSEN, P.C.
BY: LEWIS C. TRAUFFER
I.D. #60267
1601 Market Street, Suite 2300
Philadelphia, PA 19103
(215)569-5050
Attorney for Plaintiff
THE MILTON S. HERSHEY MEDICAL CENTER : COURT OF COMMON PLEAS
VS.
ROBERT HUMMEL
AND
PNC BANK
Garnishee
TO THE PROTHONOTARY:
: CUMBERLAND COUNTY
: NO.: 08-3707
PRAECIPE
Kindly dissolve PNC Bank as Garnishee regarding the above captioned case.
C EMS C. T UFFER, ESQUIRE
Attorney for Plaintiff
y..
LEWIS C. TRAUFFER
ATTORNEY I.D. 60267
1601 MARKET STREET, SUITE 2300
PHILADELPHIA, PA 19103
(215) 569-5050
THE MILTON S. HERSHEY MEDICAL CENTER
P.O. BOX 853
HERSHEY, PA 17011
VS.
ROBERT H. HUMMEL
591 SILVER SPRING ROAD
MECHANICSBURG, PA 17050
Attorney for Plaintiff
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
NO.: 08-3707
PRAECIPE TO VOID JUDICIAL LIEN
TO THE PROTHONOTARY:
Pursuant to Bankruptcy Court Rules and the discharge of the above claim by the attached
Order, kindly void the judicial lien and judgment entered in the above matter.
LEWIS . TRA ER, ESQUIRE
ATTORNEY FOR PLAINTIFF
B1 Official Fonn 1 UNITED STATES BANKRUPTCY COURT
(1/08) MIDDLE DISTRICT OF PENNSYLVANIA Voluntary Petition
Name of debtor (if individual, enter Last, First, Middle): Name of Joint Debtor (Spotlse)(Last, First, Middle)
Hummel, Robert H. I
All Other Names used by the Debtor in the last 8 years All Other Names used by the Joint Debtor in the last 8 years
(include married, maiden, and trade names): (include married, maiden, and trade names):
Last four digits of Soc. Sec or Individual Taxpayer I.D (ITIN) Last four digits of Soc. Sec. or Individual Taxpayer I.D (ITIN)
No./Complete EIN (if more than one, state all 4408 No./Complete EIN. (if more than one, state all:
Street Address of Debtor (No. & Street, City, State, & Zip Code) Street Address of Joint Debtor (No. & St., City, State & Zip Code)
591 Silver Spring Road
Mechanicsburg, PA 17050
County of Residence or of the County of Residence or of the
Principal Place of Business: Cumberland Principal Place of Business:
Mailing Address of Debtor (if different from street address above): Mailing Address of Joint Debtor (if different from street address):
Location of Principal Assets of Business Debtor (if different from street address above):
Type of Debtor Nature of Business Chapter of Bankruptcy Code Under Which
(Form of Organization) (Check one box) the Petition is filed (Check one box)
(Check one box) ? Health Care Business ® Chapter 7 ? Chapter 15 Petition for Recognition of a
® Individual (Inc. joint debtors ? Single Asset Real Estate as ? Chapter 9 Foreign Main Proceeding
See Exhibit D on pg 2 of form. defined in 1 l U.S.C. 101 (51 B) ? Chapter 11 ? Chapter 15 Petition for Recognition of a
? Corporation (Inc. LLC, LLP) ? Railroad ? Chapter 12 Foreign Nonmain Proceeding
? Partnership ? Stockbroker
? Chapter 13
? Other: (If the debtor is not one ? Commodity Broker
of the above entities, check this
? Clearing Bank Nature of Debts (Check one box)
box and state type of entity below) El Other ® Debts are primarily Consumer debts, defined in 11 U.S.C. 101(8) as
"
Tax Exempt Entity: incurred by an individual primarily for a personal, family or household
"
? Debtor is a tax exempt org. per purpose
? Debts are primarily Business debts
26 U.S.C. (Int. Revenue Code
Filing Fee (Check one box) Chapter 11 Debtors
? Full Filing Fee attached Check one box:
® Filing Fee to be paid in installments (Applicable to individuals ? Debtor is a small business as defined in 11 U.S.C. 101
only) Must attach signed application for the court's consideration ? Debtor is Not a small business as defined in 11 U.S.C. 101
certifying that the debtor is unable to pay fee except in installments. Rule Check if applicable:
1006(e). See Official Form No. 3A. ? Debtor's aggregate noncontingent liquidated debts owed to
? Filing Fee waiver requested (Applicable to Chapter 7 noninsiders or affiliates are less than $2,190,000.
individuals only). Must attach signed application for the court's ? A plan is being filed with this petition.
consideration. See Official Form 3B. ? Acceptances of the plan were solicited prepetition from one
or more classes of creditors, in accordance with 11 U.S.C. 1126(b).
Statistical/Administrative Information (estimates only)
? Debtor estimates that funds will be available for distribution to unsecured creditors. THIS SPACE IS FOR
COURT usE ONLY.
? Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds
available for distribution to unsecured creditors.
Estimated Number of Creditors
® ? ? ? ? ? ? ? ? ?
1-49 50-99 100-199 200-999 1000.5000 5001.10000 10001-25000 25001-50000 50001-10000 0- 100000
Estimated Assets
® ? ? ? ? ? ? ? ? ?
$0- $50001- $100001- $500001- $1,000,001- $10,000,001- $50,000,001- $100,000,001 $500,000,001 Mom than $1
$50,000 $100000 $500000 $I million $10 million $50million $100 million -$500,000,000 -$I billion billion
Estimated Liabilities
n 1:1 Z 1:1 E]
$0- $50001- 5100001- $500001- $1,000,001- $10,000,001- $50,000,001- $100,000,001 $500,000,001 MomthmS1
$50,000 $100000 $500000 $lmillion $10million $50 million $100 million -$500,000,000 -$l billion billion
r Pbl'h
orm u is ed by. Law Disks, 734 Franklin Avenue, Garden City, NY 11530 www.lawdisks.com
Case 1:08-bk-03680-RNO Doc 1 Filed 10/07/08 Entered 10/07/08 18:56:17 Desc
Main Document Page 1 of 8
fnkbcnd (11/08)
UNITED STATES BANKRUPTCY COURT
MIDDLE DISTRICT OF PENNSYLVANIA
In re: Debtor(s) (name(s) used by the debtor(s) in the last 8 years, including married, maiden, and trade):
Robert H. Hummel
591 Silver Spring Road
Mechanicsburg, PA 17050
Last four digits of Social-Security, Individual
Taxpayer-Identification, Employer Tax-Identification No(sxif
any):
xxx-xx-4408
Chapter 7
Case No. 1:08-bk-03680-RNO
FINAL DECREE
The estate of the above named debtor(s) has been fully administered
IT IS ORDERED THAT:
Leon P. Haller (Trustee)
is discharged as trustee of the estate of the above-named debtor(s); and the chapter 7 case of the above named
debtor(s) is closed without a Discharge of Debtor having been issued in accordance with Interim Bankruptcy Rule
4004(c)(1)(H).
Dated: Jan r9 .-
BY THE COURT
Honorable Robert N. Opel
United States Bankruptcy Judge
This docwnent is electronically signed and filed on the same date.
_?_?, 12604009776014 """
USBC PAM - LIVE - VERSION 3.2L Page 1 of 2
1:08-bk-03680-RNO Robert H. Hummel
Case type: bk Chapter: 7 Asset: No Vol: v Honorable: Robert N Opel II
Date filed: 10/07/2008
Date terminated: 01/23/2009 Date of last filing: 01/27/2009
Creditors
Alan Waters
595 Silver Spring Road (3106288)
Mechanicsburg, PA 17050 (cr)
Holy Spirit Hospital
503 N. 21st St. (3106289)
Camp Hill, PA 17011-2288 (cr)
Milton S. Hershey Medical Center
P.O. Box 853 (3106290)
Hershey, PA 17033 (cr)
Milton S. Hershey Medical Center, c/o Tabas & Rose
(3106291)
1601 Market St., Suite 2300 (cr)
Philadelphia, PA 19103-2306
NCO Financial Systems Inc. for Harry J. Lawall & S
(3106292)
P.O. Box 4936 (cr)
Trenton, NJ 08650-4936
PA Department of Revenue
Strawberry Square, Fourth and Walnut Str (3106293)
Harrisburg, PA 17128-0101 (cr)
PNC Bank
USX Tower, 600 Grant St. (3106294)
Pittsburgh, PA 15219-2702 (cr)
U.S. Internal Revenue Service
228 Walnut St. (3106295)
Harrisburg, PA 17108 (cr)
West Shore EMS
205 Grandview Ave., Suite 211 (3106296)
Camp Hill, PA 17011-1708 (cr)
West Shore Tax Bureau
3607 Rosemont Ave., P.O. Box 656 (3106297)
Camp Hill PA 17001 (cr)
https://ecf.pamb.uscourts.gov/cgi-bin/CreditorQry.pl?978471535804312-L 662 0-1 1/30/09
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