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08-6456
,• NOTICE OF APPEAL COMMONWEALTH OF PENNSYLVANIA 1 COURT OF CO MO PLEAS FROM Gumbe?ld un JUDICIAL DISTRI DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. /fg NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case mentioned below. NAM! OF APPELLANT nn II MAG. DIST. NO. OR NAM! OP D.J. Rru(c 4- runt, kp nh,,)d ADDRESS OF APPELLANT 0),dbesex &hk ST 0 .Al. OF JU MEN 11. THE CAS! OF IPI;11111 . IN D'I'in.i.r.l D 08 EfJN15 MITT DDS ?.. ?B? E L A! E OPLb CLAIM NO. ,?q L ^G ISIGNATURE F APPELLANT OR IS ATTORNEY OR AGENT c f CV 19 LT 19 1?elme / /1 r LJ.'?!/IS i ?9r This block will be signed ONLY when this notation is required un er Pa. R.C.P.J.P. No. 10088. This Notice of Appeal, when received by the District Justice, will operate as a SUPERSEDEAS to the judgment for possession in this case. Signature of Prothonotary or Deputy If appellant was Claimant (see Pa. R.C.P.J.P. No. 1001(6) in action before District Justice, he MUST FILE A COMPLAINT within twenty (20) days after filing his NOTICE of APPEAL. PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see Pa. R.C.P.J.P. No. 1001(7) in action before District Justice. IF NOT USED, detach from copy of notice of appeal to be served upon appellee). PRAECIPE: To Prothonotary Enter rule u on bEm) p appellee(s), to file a complaint in this appeal /???? Nameof ppellee(s) (Common Pleas No.-Dg- within twenty (20) days after service of le o su?fe entry of judgment of non pros. j? v Y n C Siqnatu of appellant or his attorney or agent RULE: To DEON)S ??^?? ?+?? , appellee(s) Name of appel! e(s) (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS WILL BE ENTERED AGAINST YOU UPON PRAECIPE. (3) The date of service of :his rule if service was by mail is the date of mailing. Date: D 3 , Signa of ono 17 r Deputy White---- Prothonotary Copy Green ---- Court File Copy Yellow--- Appellant's Copy Pink ------ Appellee Copy Gold ------ D. J. Copy PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE C LAWT (This proof of service` MUST BE FILED WITHIN TEN (10) DAYS AFTER filing the notice of appeal. Chack applicable boxes) COMMONWEALTH OF PENNSYLVANIA COUNTY OF ; ss AFFIDAVIT: I hereby swear or affirm that I served Fla copy of the Notice of Appeal, Common Pleas No. , upon the District Justice designated therein on (date of service) 119Q 1by-personal-servi& ? tby (certified{-*egistered) mail, sender's receipt attached hereto, and upon the appellee, (name) on 19 -El by personal service ? by (certified) (registered) mail, sender't receipt attached hereto. EJ and further that I served the Rule to File a Complaint accompanying the above Notice of Appeal upon the appellee(s) to whom; the Rule was addressed on 19---1 [ by personal servicg [] by (certified) (registered) mail, sender's receipt attached hereto. SWORN (AFFIRMED) AND SUBSCRIBED BEFORE ME THIS ? OAYGF 19 . Signature of affiant Signature of official before whom affidavit was made Title of official My commission expires on 19, % .... "w ?? Q D 0 C= era PA ??r` C ', C7 ? rn COMMONWEALTH OF PENNSYLVANIA I COUNTY OF• CUMBERLAND **.A Mag. Dist. No.: 09-3-03 MDJ Name: Hon. SUSAN X. DAY Address: 229 KILL ST, BOX 167 NT. HOLLY SPRINGS, PA Telephone: (717 ) 486-7672 17065 LYNN RNHOLD, DEF. 1 ETAL 112 N lL DLESEX RD CARLISLE, PA 17013 NOTICE OF JUDGMENT/TRANSCRIPT CIVIL CASE PLAINTIFF: NAME. and ADDRESS ' %ENNIS BURKETT, DDS ? 13 BROOKWOOD AVE APT/STS 1 CARLISLE, PA 17013 VS. DEFENDANT: NAME and ADDRESS rREINHOLD LYN , N & BRUCE, ET AL. 112 N MIDDLESEX RD CARLISLE, PA 17013 L J Docket No.: CV-0000176-08 Date Filed: 5/28/08 THIS IS TO NOTIFY YOUTHAT: Judgment: FOR PLAINTIFF (Date of. Judgment) ® Judgment was entered for: (Name) DENNIS BURKETT, DDS, ® Judgment was entered against: (Name) REINHOLD, LYNN A BRUCE in the amount of $ 31918.1 F Defendants are jointly and severally liable. Damages will be assessed on Date & Time This case dismissed without prejudice. M Amount of Judgment Subject to Attachment/42 Pa.C.S. § 8127, Portion of Judgment for physical damages arising out of residential lease $ 10/16/08 Amount of Judgment $ 3,776.40 Judgment Costs $ 141.76 Interest on Judgment $ .00 Attorney Fees $ .00 Total $ 3,918.16 Post Judgment Credits $ Post Judgment Costs $ Certified Judgment Total $ ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE OF APPEAL WITH THE PROTHONOTARY/CLERK OF THE COURT OF COMMON PLEAS, CIVIL DIVISION. YOU MUST INCLUDE A COPY OF THIS NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH YOUR NOTICE OF APPEAL. EXCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES, IF THE JUDGMENT HOLDER ELECTS T ENTER THE JUDGMENT IN THE COURT OF COMMON PLEAS ALL FURTHER PROCESS MUST COW,FROUTHE COURT-OF COMMOUPLEAt AND NJ5 PURTHER PROCESS`MAY BE 1 SUE BY E'MAG TERIAL UNL THE JUDGMENT IS ENTERED IN THE COURT'OF COMMON PLEAS, ANYONE INTERESTED IN THE JUDGMENT MAY FILE ' A REQUEST*DR ENTRY OF SATISFACTION. WITH THE MAGISTERIAL DISTRICT JUDGE IF THE JUDGMENT DEBTOR PAYS IN FULL, SETTLES, OR OTHERWISE COMPLIES WITH THE JUDGMENT. Date R"" efia{ pi I certify that this is a true d correc copy of the reco d of th proceedings containing t ie judimen. ,Date Magisterial District Jiglge w? Y 2010 My commission expires first Monday of January, SEAL AOPC 315-07 DATE PRINTED: 10/17/08 7$#1:00 AN U.S. Postal Service CERTIFIED i U.S. MAIL,ri RECEIPT .0 Er : Er (Domestic Mail Only; No Insurance Coverage Provided) cc (Domestic Mail Only; No Insurance Coverage Provided) t? For delivery information visit our website at www.usps.com For delivery information visit our website at www.usps.como M ru C3 Postage $ $0.42 0011 ru $0.42 0011 M Postage $ Certified Fee $2.711 1' O #2.70 13 r9 ? ? Certified Fee ... C3 Return Receipt Fee Postmark r1 ostma& O (Endorsement Required) $2.20 ' O R (Endorsemsement Receipt Required) Fee $2.51,, c Here p Rest rk W Delivery Fee ?, O C3 (Endorsement Required) • W7 Restricted Delivery Fee r O (Endorsement Required) r11J Total Postage & Fees $ $5.32 1012 2010 f,.- Ln Total Postage & Fees $ #" .32 10M /20118 r, ni r_ Sent To A , Sent To z,) t I-& kifst or AD S. No. C O Street, Ap . No.; m . e< ?C or PO teBox, zNo. Ctty [ti ???. 1_). 1 ----------- ............... °° ztP+ DI gate ----------- State, 27P+4 Srtns 7D PROOF OF SERVICE OF NOT11114 EAL AND RULE- O Ok£=b _"AJ?` . 'tis*eof eff service "J&'r'' 8E Flt L?"f?4WHHV " F#E AFTER filing- ths-notiag-OrAP CVWk 1W4bk boo 09) !. ra f I COMA iA1-Tt*Q///yyy?*????N¢($V0q 11A t. COUNIV Gg%,:, ss AFFIDAVIT: I hereby swear or affirm that I served - a copy of the-) Mcstic of p eaf Common Pfeas No. Mate 0 D upon tare t iiirict Justice d-esi-9nated therein on of se X ' ?f r - #) 1ltsr it:i ; by pe vM; q 051 ' `iistered) mail, sender's rc'cil ' acfim fiereio, and updtt i)* eln 114'ry?3?i??i?? -_? by personal sliwe by ( i sfcr d rtaiY seikdf*s'receipt"attached here a foqq.' And further that I served the Rule to File a Complaint accompanying ha above Notice of Appeal upon the appellee(s) to yrihpr)q,1Rrriefwas addaessel:on® - = "?yelspai .uica b Eie .(registered) miil, sender's receipt attached hereto. SWORN AF.lGIRMED) AND RISED BEFORE ME THIS _. Signature of alfi/nr Signal offpq - beIte whom a/i vit wrs r* Title oYoffftial ?iq C01 My corrmtlssion expires on A IIML MK ? I i .09SW ,?PJMAL COMMONWEALTH OF PENNSYLVANIA NOTICE OF COURT OF CO MO LEAS W N b?,? ld a DICIAL oISTRI DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case mentioned below. ruCp_ ? Lunn FDISqT.=: OR NAME MO! P D.J. ADDRESS OP APPELLANT CITY /U`* ST E3 3 ZIP COD! L 1h1dJ1rsfZ1 - Jis le IL 7 DATE OF JUD MGN 1I1T"1C^S! OF /Vi,-„rre 111 ID. lr.. rl © 08 CONK E7 ohs ageUC ??U???}hL? CLAIM NO. ]SIGNATURE F APPELLANT OR HIS ATTORNEY OR AGENT Cv 19. 09 1 LT 19 /Y 1?61weth r, (I"?(/1S f ?.r9r This block will be signed ONLY when this notation is required under Pa. R.C.P.J.P. No. 1008B if appellant was Claimant (see Pa. R.C.P.J.P. . This Notice of Appeal, when received by the District Justice, will operate as No. 1001(6) in action before District Justice, he a SUPERSEDEAS to the judgment for possession in this case. MUST FILE A COMPLAINT within twenty (20) _ days after filing his NOTICE ofe%PEft, Signature of Prothonotary or Depu?j --- g g PRAECIPE TO EfYTER. RULE, TO FILE COMPLAINT AND flUt-E TO-4 (This section of form to be used ©NL Y when ap/° 1tAnt. Wtj DEFENDANT (sea, Pa. R.C.P.J.P. No. 1001(7) inAct(pn bAWe t Justice. IF NOT USED, detach from copy of notice of apgeaf to be served /upon appellee). t ., „- PRAECIPE: To Prothonotary Qm` Enter rule upon--- j ppellee(s) IMS to file a-sompit in this appeal Name of ppellee(s) 7 (Common Pleas No. within twenty (20) days after service of r le o . s ffe entry of judgment of non pros. s Signatu of appellant or his attorney or agent FN K I RULE: To , appellee(s) Name bf appel! e(si (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT YOU UPON PRAECIPE: (3) 11 date of service of- .his rule if service was by mail is the d Date: , White---- Prothonotary Copy Green ---- Court File Copy Yellow --- Appellant's Copy Pink - --- Appellee Copy Gold ------ D. J. Copy )S WILL BE ENTERED AGAINST An im MIJ k trot .tt igna DENNIS BURKETT, DDS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2008-6456 CIVIL TERM BRUCE J. REINHOLD and J. LYNN REINHOLD, CIVIL ACTION-LAW husband and wife, Defendants 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 an attorney and filing in writing with the court, your defenses or objections to the claims set forth against you. You are warned that if you fail to do so, the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 (717) 249-3166 DENNIS BURKETT, DDS Plaintiff V. BRUCE J. REINHOLD and J. LYNN REINHOLD, husband and wife, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-6456 CIVIL TERM CIVIL ACTION-LAW COMPLAINT NOW, comes Plaintiff, Dennis Burkett, D.D.S., by and through his attorneys, O'BRIEN, BARIC & SCHERER, and files the within Complaint and, in support thereof, sets forth the following: 1. Plaintiff operates a dental practice located at 13 Brookwood Avenue, Suite 1, Carlisle, Cumberland County, Pennsylvania 17015. 2. Defendant, Bruce J. Reinhold, is an adult individual with a residence address of 112 North Middlesex Road, Carlisle, Cumberland County, Pennsylvania 17013. 3. Defendant, J. Lynn Reinhold, is an adult individual with a residence address of 112 North Middlesex Road, Carlisle, Cumberland County, Pennsylvania and is the spouse of Bruce J. Reinhold. 4. Defendants and their minor daughter, Madison Reinhold, have been long-term patients of Plaintiff s dental practice. 5. In connection with becoming patients at Plaintiffs dental practice, the Defendants have reviewed, completed and signed Patient Medical History forms, true and correct copies of these forms, with patient medical history redacted for privacy purposes, are attached hereto, collectively, as Exhibit "A" and are incorporated by reference. 6. The Patient Medical History forms bound Defendants to pay for the dental services provided by Plaintiff if the services were not paid for by a third party. 7. The Patient Medical History form executed by Defendant, Bruce Reinhold, also provided for the recovery of reasonable fees in the event collection action was necessary to recover for services rendered. 8. An Account History Report for services rendered by Plaintiff to Defendants and their daughter, Madison, since April, 2001 is attached hereto as Exhibit "B" and is incorporated by reference. Exhibit "B" has been redacted to maintain privacy of the patients. 9. Throughout the course of the parties' relationship, the Plaintiff has permitted Defendant, Bruce Reinhold, to pay for services provided through work in kind or purchases of goods at a reduced sales price. 10. At present, the principal sum of $3,776.40 is due to Plaintiff for dental services he has provided to Defendants and their daughter, Madison. 11. Defendants have failed and refused to provide any in kind services or other forms of remuneration to Plaintiff to pay the debt due and owing. COUNT 1- BREACH OF CONTRACT DENNIS BURKETT D.D.S. v. BRUCE REINHOLD and J. LYNN REINHOLD 12. Plaintiff incorporates by reference paragraphs one (1) through eleven (11) as though set forth at length. 13. Defendants have breached the obligations of the Patient Medical History forms appended as Exhibit "A" by failing and refusing to pay for dental services provided by Plaintiff. 14. As a direct and proximate result of this breach, Plaintiff has not been paid the $3,776.40 owed to him by Defendants. 15. All conditions precedent to recover under the contracts have been fulfilled. 16. As a consequence of the breach by Defendants, Plaintiff has been required to pursue collection of the debt due. IT The amount sought is not in excess of the limits requiring compulsory arbitration. WHEREFORE, Plaintiff requests that judgment be entered in his favor and against Defendants, Bruce Reinhold and J. Lynn Reinhold for the sum of $3,776.40 plus costs, expenses and reasonable attorney fees. Respectfully submitted, I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 David A. Baric, Esquire 11,x_712908 =2:07 7172495755 OBS PAGE 4c. Y-=ICA.TJON The statements in th.e foregoing Complaint are based upon information which has been assembled by my attorney in this litigation. The language of the statements is not my own., I have read the statements; and. to the extent that they ate based upon information which I have given to my counsel, they are true and correct to the best of my knowledge, information and belief l understand that false statements herein are made subject to the penalties of 13 Pa,C.S. § 4904 relating to unsworn falsifications to authorities. DATE; 2A4S?w? f?Lr' --W Dennis Burkett, DDS . SL:i.L::11 ~ DENNIS BURKETT, D.D.S., Family Dentistry- ,K )I'ti<nts i'atne .? How o yoa.preter to},e a else '. ,. , id artta All tatus ocr et it u or _ or P one F,ts1 A , r-esJJs/h? / t tty, tale / LrpJ Code /? o ome ?one? / (? . arent o Guardian r anent under ess tty fate tp oc e ??ne In Case of Enrtergenc.y please Call Phone Answers to the following questions are for our records only and will be considered confidential. tJ 1. Date of last physical exam Physician's name and phone number _ 2. Date of tast dental exam.-_-- Dentist's name and phone number 3, Date of last dental x-rays-- Are you having pain or discomfort: at this time? ....... ...................... ................. -.................................... ....... ............................ YES ,. 5. DO you feel very nervous about having dental treatment? ............................ ................................ .................... .... .....................Y1 S ? b. Have you ever had a bad experience in the dental office?-.. .......................................................................... .........................YES 7. Is there anything that. you dislike about your Smile- ..................................................................................... .........................YES 8. Have you been a patient in the hospital in the past two years?- ...................................................................... .........................YES 9. Have you been under the care of a medical doctor during the last two years? .............. .....YES 10. Is the patient taking any medications now? Please list medications and dosage below it. Have you ever had any excessive bleeding requiring special treatment`? ............... ................... ..................................... ............ YES tyro 12. Circle any of the foiloNving which you have had or have at present: Heart failure Mental Retardation Glaucoma Heat Disease or Attack Emphysema Pain in jaw joints Angina pectoris Tuberculosis (TB) Birth Defects High Blood pressure Asthma HIV Positive, AIDS Heart Murmur Hay Fever Hepatitis A (infectious) Rheumatic Fever Sinus Problems Hepatitis B (serum) Congential Heart Lesions Allergies or Hives Liver Disease Use of Tobacco Products Diabetes Jaundice Thyroid Disease Sexually Transmuted Diseases Blood Transfusion Heart Pacemaker Radiation Therapy Drug Addiction Heart Surgery Chemotherapy (cancer, leukemia) Hemophilia Cancer (type:. ) Arthritis Any type of transplant Anemia Alcoholism Cold Sores Stroke Rheumatism Epilepsy or Seizures Kidney Problems Cortison Medicine Fainting or Dizzy Spetls Ulcers Cough Phychiatric Treatment Sickle Cell Disease Bruise easily Any type of implant (heart valve, etc.) Artificial Hip, Knee or / j r l t other joint Personal History of allergic reation to. (i.e. itching, rash, swelling of hands, feet, tips or eyes, or made sick by:) n rst C- L. l1C Penicillin Latex Medications Aspirin ?- Codeine ;Sedatives) Local Anesthetic Other -- 13- Have you ever had any instruction in oral Irygei¢:e?.................................................................................................................y'ES ,- r' O..? t-N1 14. Are there, nor' any growths or sores in or around your mouth? ................................................................................................. YES 15. Do you have any trouble chewing'?........... ..................YES 15. Do you have pain i ' n or near your ears? ............... -................................................ ,......................... .............................. .......... YES 17. Do you habitually clench or grind your teeth during the day or night? ............ ............................... ........... ............................ ..... .YE:S O i8. Have you ever been evaluated or treated by a peridontist. (gum specialist)?.,.......... ...........YES '. 19. Have you ever been told yc,u have guar problems? ...................... ......................YES , '_0. Do you now have bleeding gums or any other gum condition?......,. ..................................................................................:......YES 21. A'0Nrt-N: Are you Pregnant now? .............................................................................................................................YES O 22. Is there anything related to your medical or dental history not indicated above? ........ .....:...................................... ................... YES NO if yes, please expl?ain:_ 23. Purpose of this dental visit?-.. ? d?_ ?° ??- -------- I acknowledge that I am responsible for informing my care givers about any changes to my health history prior to any treatment. I understand that my health histor information w. di e used a f ne s for diagnosis or treatment by the doctor. SfGNA UR Zy, i Date, EXHIBIT "A" u{ DENNIS BURKETT, D.D.S., Family Dentistry_..., Pa' nt Name '/1` SirDater` "" Sax F Marital Status Si M D W S cial Sec ri Num?? Lai I t r , Home Phone Home Address s ?? qtr. City/ State i Zip 2 . f ' Work-Phane . Person Financially Responsible for this Account Address Cit !St t Z y a e F Pl7ce of Employment Personal History Of: Personal History Of Allergic Reaction To: YES NO YES NO YES NO Heart Murmur Diabetes _ Penicillin Rheumatic Fever -- High Blood Pressure _ Aspirin Hepatitis Heart Disease Codeine Asthma Anemia (Barbiturates/Sedatives} Epilepsy/Convulsions i-_ Bleeding Disorders Local Anesthetic (Novocaine) Pregnancy (women) w/o Anti-coagulant therapy current Other (AIDS, V.D.) PLEASE HAND YOUR INSURANCE CARDS TO OUR RECEPTIONIST Whom may we thank for your referral? Patient Pharmacy name & phone no. Patient's Physicf Address CityState f Phone No. Vz"t Briefly describe reason for e i D t f s e ng oc or Please List Is Patient taking any ' medications now? YES % NO t, 2. 3. OFFICE PROCEDURE: Services you receive may be paid by cash, check, or Visa/Mastercard. If you have insurance will be happy to su mit your bill to your it uranc"ontpa?ly; n however, we ask that you take care of your portion of the bill at the time of each visit. (Dedu le and/or co-pay! insur ce). In the ev t coil rtion a on should become necessary to collect an unpaid balahce due for dental services rendered t or, my fa I ily, Ilw agrejf to pa 1 reasoabie tE+ g a; INSURANCE ACCOUNT INFORMATION: r?? f PR_ IMARY INSURANCE Employee Name Date of Birth Group #: ?i Employer Name/Address: Name of Dental Insurance: $??OaNDARY iNaUSANCE Employee Name Date of Birth Group Employer Name/Address I - Name of Dental Insurance. I SignatureK_L Date J- Jy' JIwa f TIME 1:35 PM Dennis Burkett, D.D.S. DATE 07/21/2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End 4m, Current $70.00 MIDI A &*yh&Ajkk ,01 &z? Z&ZL Jjm_ 404 / 4th ate Name P ovid r Tv°e - Description 11,>'tl d6r__ b&h iu_ 1Mc,- ?13D U/ ytw1 t 30 Day $35.00 60 Day $35.00 90 Day $3,706.40 Contract $0.00 Balance Due $3,846.40 j Estimated Ins $0.00 Balance Due Now $3,846.40 Debit Credit Balance 04106/2001 BRUCE REINHO D 2 Deleted OF-LEI ED--Mis IlaneousAdjustment: Adj. $2,104.80 $2,104.80 to balance history with Acct Bal. 04/1712001 BRUCE REINHOLD Acct Pmt Insurance Check: DOS-Name TYCO INT. $64.00 $2,040.80 LTD/ 3/8 05!22/2001 BRUCE REINHOLD Deleted DELETED-- Professional Courtesy: $2,040.80 $0.00 07130!2001 LYNN REINHOLD 2 Service 00150 INITIAL EXAMINATION $36.00 $36.00 Est Insurance $36.00 0713012001 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $50.00 $86.00 Est Insurance $50.00 07/30/2001 LYNN REINHOLD 5 Service 00274 BITEWiNG X-RAYS/FOUR FILMS $36.00 $122.00 Est Insurance $36.00 07/30/2001 LYNN REINHOLD 5 Service 00330 PANORAMIC FILM $64.00 $186.00 Est Insurance $64.00 07/30/2001 LYNN REINHOLD 2 Service 09910 APPL DESENSITIZING $8.00 $194.00 MEDICAMENTS 07130/2001 LYNN REINHOLD RB PM Note Pre-Authorization From Jul 30, 2001 was $194.00 Submitted to Prim. 08/01/2001 LYNN REINHOLD RB PM Note Insurance Claim From 07/30/01 was Submitted $194.00 to Prim. 08/09/2001 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name tycoAynn/7130 $186.00 $8.00 for claim from 07130101 0810912001 LYNN REINHOLD RB PM Note Prim Insurance Claim From Jul 30, 2001 was $8.00 closed. 08/2312001 BRUCE REINHOLD RB PM Note Statement Processed With No Message $8.00 Included. 0812912001 LYNN REINHOLD RB PM Note Pre-Authorization From Jul 30, 2001 was $8.00 Closed. 09/2512001 BRUCE REINHOLD RB PM Note Statement Processed With No Message $8.00 Included. 10/25/2001 BRUCE REINHOLD RB PM Note Statement Processed With No Message $8.00 Included.' 11/15/2001 BRUCE REINHOLD 2 PM Note Statement Processed With No Message $8.00 Included. 11121/2001 LYNN REINHOLD Deleted DELETED-- Professional Courtesy: $8.00 $0.00 11/27/2001 LYNN REINHOLD 2 Deleted DELETED- Miscellaneous Adjustment: $8.00 $8.00 11/27/2001 LYNN REINHOLD Acct Pmt Check: Number $8.00 $0.00 01/17/2002 LYNN REINHOLD 2 PM Note Insurance Claim From 01/17/02 was Submitted $0.00 to Prim. 01/17/2002 LYNN REINHOLD 2 Service 02750 CROWN-PORC/HIGH NOBLE METAL $725.00 $725.00 Tooth 31 Est Insurance $362.50 0112412002 BRUCE REINHOLD 2 PM Note Statement Processed With No Message $725.00 Included. 02111/2002 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name tycoAynn for $262.50 $462.50 claim from 01117/02 02111/2002 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Jan 17, 2002 was $462.50 closed. 03/74/2002 BRUCE REINHOLD 2 PM Note Statement Processed With No Message $462.50 Included. 03/06/2002 LYNN REINHOLD Deleted DELETED- Professional Courtesy: $462.50 $0.00 07/16/2002 MADISON REINHOLD 2 PM Note Recall Processed on Laser Postcard $0.00 current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 1 of 14 EXHIBIT "B" TIME 1:350M, Dennis Burkett, D.D.S. DATE 07/21/2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name Provider Type Description Debit Credit Balance 08/19/2002 MADISON REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $26.00 $26.00 Est Insurance $26.00 08/19/2002 MADISON REINHOLD 5 Service 01120 CHILD PROPHYLAXIS $38.00 $64.00 Est Insurance $38.00 08/19/2002 MADISON REINHOLD 5 Service 00272 BITEWING X-RAYS/TWO FILMS $20.00 $84.00 Est Insurance $20.00 08/19/2002 MADISON REINHOLD 5 Service 01203 TOP APPL FL EXCL PX-CHILD $21.00 $105.00 Est Insurance $21.00 08/21!2002 MADISON REINHOLD 2 PM Note Insurance Claim From 08/19/02 was Submitted $105.00 to Prim. 09/03/2002 MADISON REINHOLD Prim Ins Pmt Insurance Check: DOS-Name tyro-madison $105.00 $0.00 for claim from 08/19/02 09/03/2002 MADISON REINHOLD 2 PM Note Prim Insurance Claim From Aug 19, 2002 was $0.00 closed. 09/12/2002 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $54.00 $54.00 Est Insurance $54.00 09/12/2002 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $26.00 $80.00 Est Insurance $26.00 0911212002 BRUCE REINHOLD 2 Service 09910 home care fluoride gel-desensitizing $8.00 $88.00 med Tooth 2 09/16/2002 BRUCE REINHOLD 2 PM Note Insurance Claim From 09112/02 was Submitted $88.00 to Prim. 09/19/2002 LYNN REINHOLD 2 PM Note Recall Processed on Laser Postcard $88.00 09/24/2002 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $88.00 PAY PROMPTLY Included. 10102/2002 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name AETNA for $77.00 $11.00 claim from 09/12102 10/0212002 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Sep 12, 2002 was $11.00 closed. 1011512002 LYNN REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $26.00 $37.00 Est Insurance $26.00 1011512002 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $54.00 $91.00 Est Insurance $54.00 10115/2002 LYNN REINHOLD 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $36.00 $127.00 Est Insurance $36.00 10/1612002 LYNN REINHOLD 2 PM Note Insurance Claim From 10/15/02 was Submitted $127.00 to Prim. 1012912002 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $127.00 PAY PROMPTLY Included. 11/01/2002 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetnal"n for $113.00 $14.00 claim from 10/15102 11/01/2002 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Oct 15, 2002 was $14.00 closed. 11121/2002 BRUCE REINHOLD 2 PM Note Statement Processed With Message 'PLEASE $14.00 PAY PROMPTLY Included. 01/22/2003 BRUCE REINHOLD RB PM Note Statement Processed With Message'PLEASE $14.00 PAY PROMPTLY Included. 0212012003 BRUCE REINHOLD RB PM Note Statement Processed With Message'PLEASE $14.00 PAY PROMPTLY Included. 02/21/2003 Entire Account Deleted DELETED-- Professional Courtesy: per $14.00 $0.00 dennis 07/17/2003 MADISON REINHOLD RS PM Note Recall Processed on Laser Postcard $0.00 Current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 2 of 14 TIME 1:35 PM Dennis Burkett, D.D.S. DATE 07/21/2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name Provide r Tvoe Description Debit Credit Balance 08/04/2003 MADISON REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $26.00 $26.00 Est Insurance $26.00 08/04/2003 MADISON REINHOLD 5 Service 01120 CHILD PROPHYLAXIS $40.00 $66.00 Est Insurance $40.00 08/0412003 MADISON REINHOLD 5 Service 01203 TOP APPL FL EXCL PX-CHILD $21.00 $87.00 Est Insurance $21.00 08105/2003 MADISON REINHOLD RB PM Note Insurance Claim From 08/04103 was Submitted $87,00 to Prim. 08/2512003 MADISON REINHOLD Acct Pmt Insurance Check: DOS-Name aetna-madison $87.00 $0.00 08/25/2003 MADISON REINHOLD Prim Ins Pmt Check: Number for claim from 08/04/03 $0.00 $0.00 08125/2003 MADISON REINHOLD RS PM Note Prim Insurance Claim From Aug 04, 2003 was $0.00 closed. 08/25/2003 MADISON REINHOLD 2 Service 02392 2 SURF. POSTERIOR RESIN $120.00 $120.00 COMPOSITE Tooth 14 Surface OIL Est Insurance $96.00 08/25/2003 MADISON REINHOLD 2 Service 02391 1 SURF. POSTERIOR RESIN $92.00 $212.00 COMPOSITE Tooth 14 Surface O Est Insurance $73.60 08/26/2003 MADISON REINHOLD RB PM Note Insurance Claim From 08125/03 was Submitted $212.00 to Prim. 08/26/2003 BRUCE REINHOLD RS PM Note Statement Processed With Message'PLEASE $212.00 PAY PROMPTLY Included. 09/15/2003 MADISON REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-madison $92.00 $120.00 for claim from 08/25/03 09/15/2003 MADISON REINHOLD RB PM Note Prim Insurance Claim From Aug 25, 2003 was $120.00 closed. 0912212003 BRUCE REINHOLD R8 PM Note Statement Processed With Message'PLEASE $120.00 PAY PROMPTLY' Included. 1 010 1 /2003 MADISON REINHOLD Deleted DELETED- Professional Courtesy: $120.00 $0.00 12/0212003 LYNN REINHOLD 2 Service 02393 3 SURF. POSTERIOR RESIN $136.00 $136.00 COMPOSITE Tooth 5 Surface MFD Est Insurance $106.80 12/02/2003 LYNN REINHOLD 2 Service 02332 3 SURF ANTER RESIN-A.E.TECH $136.00 $272.00 Tooth 6 Surface MFD Est Insurance $108.80 12!02/2003 LYNN REINHOLD 2 Service 02332 3 SURF ANTER RESIN-A.E.TECH $136.00 $408.00 Tooth 11 Surface MFD Est Insurance $106.80 12/0212003 LYNN REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $40.00 $448.00 Est Insurance $40.00 12102/2003 LYNN REINHOLD 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $36.00 $484.00 Est Insurance $36.00 12/0212003 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $26.00 $510.00 Est Insurance $26.00 12/02/2003 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $566.00 Est Insurance $56.00 12102/2003 BRUCE REINHOLD 5 Service 00272 BITEWING X-RAYS1TW0 FILMS $20.00 $586.00 Est insurance $20.00 12/03/2003 LYNN REINHOLD 2 PM Note Insurance Claim From 12/02/03 was Submitted $586.00 to Prim. 12/0412003 BRUCE REINHOLD 2 PM Note Insurance Claim From 12/02/03 was Submitted $586.00 to Prim. Current Dental Terminology (CDT) 0 American Dental Association (ADA). AN rights reserved. Page 3 of 14 ' Y TIME 1:35`PM . Dennis Burkett, D.D.S. ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End DATE 07/21/2008 Date Name Provide r Tvae Descrlotion Debit Credit Balance 12/11/2003 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $586.00 PAY PROMPTLY included. 12/15/2003 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for $352.80 $233.20 claim from 12102/03 12/15/2003 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Dec 02, 2003 was $233.20 closed. 12/23/2003 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $289.20 Est Insurance $56.00 01/05/2004 LYNN REINHOLD 2 PM Note Insurance Claim From 12/23/03 was Submitted $289.20 to Prim. 01/06/2004 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Dec 02, 2003 was $289.20 closed. 01/1412004 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Dec 23, 2003 was $289.20 closed. 0112112004 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $289.20 PAY PROMPTLY Included. 01/22t2004 Entire Account Deleted DELETED-- Professional Courtesy: per $289.20 $0.00 dennis-exchange of services 0112612004 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT— per $289.20 $289.20 dennis-exchange of services 01/28/2004 BRUCE REINHOLD 2 PM Note Insurance Claim From 12102103 was Submitted $289.20 to Prim. 02/03/2004 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Dec 02, 2003 was $289.20 closed. 02/44/2004 BRUCE REINHOLD 2 PM Note Insurance Claim From 12/02103 was Submitted $289.20 to Prim. 02104/2004 LYNN REINHOLD 2 PM Note Insurance Claim From 12/23/03 was Submitted $289.20 to Prim. 02/1712004 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-brace for $101.00 $18820 claim from 12/02/03 02/1712004 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Dec 02, 2003 was $188.20 closed. 02/17/2004 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for $55.00 $133.20 claim from 12/23103 02/17/2004 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Dec 23, 2003 was $133.20 closed. 02/17/2004 BRUCE REINHOLD 2 PM Note Statement Processed With Message 'PLEASE $133.20 PAY PROMPTLY Included. 02/17/2004 Entire Account Deleted DELETED- Professional Courtesy: per $133.20 $0.00 dennis-exchange of services 03/09/2004 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $44.00 $44.00 Est insurance $44.00 03/09/2004 BRUCE REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM $17.00 $61.00 Tooth 12 Est Insurance $17.00 03/09/2004 BRUCE REINHOLD 2 Service 023944OR MORE POSTERIOR RESIN $196.00 $257.00 COMPOSITE Tooth 12 Surface MOBL Est Insurance $156.80 03/09/2004 BRUCE REINHOLD 2 Service 023944OR MORE POSTERIOR RESIN $196.00 $453.00 COMPOSITE Tooth 14 Surface MOBL Est Insurance $156.80 Current Dental Tenninoloav (CDT) 0 American Dental Association (ADA). All rights reserved. Page 4 of 14 TIME 1:35 PM. Dennis Burkett, D.D.S. ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name Provider Tyne Description 0310912004 BRUCE REINHOLD 2 Service 03120 PULP CAP-INDIRECT (EXCL REST) Tooth 14 Est Insurance $38.40 03/10/2004 BRUCE REINHOLD 2 PM Note Insurance Claim From 03/09/04 was Submitted to Prim. 03/10/2004 BRUCE REINHOLD 2 PM Note Pre-Authorization From 03/09104 was Submitted to Prim. 03116/2004 MADISON REINHOLD 2 PM Note Recall Processed on Laser Postcard 0311612004 BRUCE REINHOLD 2 PM Note Pre-Authorization From Mar 09, 2004 was Closed. 03/2212004 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-bruce for claim from 03/79/04 03/2212004 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Mar 09, 2004 was closed. 03/3012004 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 05/12/2004 BRUCE REINHOLD 2 PM Note Recall Processed on Laser Postcard 05/13/2004 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS Est Insurance $44.00 05/13/2004 BRUCE REINHOLD 2 Service 06930 RECEMENT BRIDGE Tooth 29 Est Insurance $51.00 05/1812004 BRUCE REINHOLD 2 PM Note Insurance Claim From 05/13/04 was Submitted to Prim. 05/2012004 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 06/01/2004 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-brace for claim from 05/13/04 06/01/2004 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From May 13, 2004 was closed. 06/09/2004 LYNN REINHOLD 2 PM Note Recall Processed on Laser Postcard 06109/2004 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS Est insurance $56.00 06/09/2004 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION Est Insurance $28.00 06/09/2004 BRUCE REINHOLD 2 PM Note Pre-Authorization From Jun 09, 2004was Submitted to Prim. 06/10/2004 BRUCE REINHOLD 2 PM Note Insurance Claim From 06/09/04 was Submitted to Prim. 06/10/2004 BRUCE REINHOLD 2 PM Note Pre-Authorization From Jun 09, 2004 was Closed. 06/21/2004 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-brace for claim from 06/09104 06/21/2004 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Jun 09, 2004 was closed. 06/22/2004 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 07/0712004 MADISON REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION Est Insurance $28.00 07/0712004 MADISON REINHOLD 5 Service 01110 ADULT PROPHYLAXIS Est Insurance $56.00 0710712004 MADISON REINHOLD 5 Service 00272 BITEWING X-RAYS/1WO FILMS Est Insurance $26.00 Current Dental Terminology (CDT) a American Dental Association (ADA). All rights reserved. Page 5 of 14 DATE 07121/2008 Debit Credit Balance $48.00 $501.00 $281.00 $44.00 $102.00 $111.20 $56.00 $28.00 $84.00 $28.00 $56.00 $26.00 $501.00 $501.00 $501.00 $501.00 $220.00 $220.00 $220.00 $220.00 $264.00 $366.00 $366.00 $386.00 $254.80 $254.80 $254.80 $310.80 $338.80 $338.80 $338.80 $338.80 $254.80 $254.80 $254.80 $282.80 $338.80 $364.80 I TIME 1:35'PM• Dennis Burkett, D.D.S. DATE 07121/2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name 07/07/2004 MADISON REINHOLD 07/08/2004 MADISON REINHOLD 07/1912004 MADISON REINHOLD 07/19/2004 MADISON REINHOLD 07/2712004 BRUCE REINHOLD 07/28/2004 BRUCE REINHOLD 08/10/2004 MADISON REINHOLD 08/1112004 MADISON REINHOLD 08/18/2004 MADISON REINHOLD 08118/2004 MADISON REINHOLD 08118/2004 MADISON REINHOLD 08/1812004 MADISON REINHOLD 08/1912004 MADISON REINHOLD 08/23/2004 BRUCE REINHOLD 08123/2004 MADISON REINHOLD 08123/2004 MADISON REINHOLD 08/30/2004 MADISON REINHOLD 08130/2004 MADISON REINHOLD 09/23/2004 BRUCE REINHOLD 10/2612004 BRUCE REINHOLD 11/03/2004 LYNN REINHOLD 11103/2004 LYNN REINHOLD 11103/2004 LYNN REINHOLD 11 10 412004 LYNN REINHOLD 11/09/2004 BRUCE REINHOLD Provider Type DescriMn 5 Service 01204 TOP APPL FLUOR-EXCL PX-ADULT Est Insurance $22.00 2 PM Note Insurance Claim From 07/07104 was Submitted to Prim. Prim Ins Pmt Insurance Check: DOS-Name aetna-madison for claim from 07/07/04 2 PM Note Prim Insurance Claim From Jul 07, 2004 was closed. 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. Deleted DELETED- Miscellaneous Adjustment: per dennis-exchange of services 2 Service 02392 2 SURF. POSTERIOR RESIN COMPOSITE Tooth 3 Surface OL Est Insurance $114.40 2 PM Note Insurance Claim From 08110/04 was Submitted to Prim. 5 Service 01351 SEALANT - PER TOOTH Tooth 2 Est Insurance $33.00 5 Service 01351 SEALANT - PER TOOTH Tooth 15 Est Insurance $33.00 5 Service 01351 SEALANT - PER TOOTH Tooth 18 Est Insurance $33.00 5 Service 01351 SEALANT - PER TOOTH Tooth 31 Est Insurance $33.00 2 PM Note Insurance Claim From 08/18/04 was Submitted to Prim. 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. Prim Ins Pmt Insurance Check: DOS-Name aetna-madison for claim from 08/10/04 2 PM Note Prim Insurance Claim From Aug 10, 2004 was closed. Prim Ins Pmt Insurance Check: DOS-Name aetna-madison for claim from 08/18/04 2 PM Note Prim Insurance Claim From Aug 18, 2004 was closed. 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS Est Insurance $44.00 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM Tooth 4 Est Insurance $17.00 2 Service 02393 3 SURF. POSTERIOR RESIN COMPOSITE Tooth 4 Surface MFD Est Insurance $142.40 2 PM Note Insurance Claim From 11 /03/04 was Submitted to Prim. 2 PM Note Recall Processed on Laser Postcard Debit Credit Balance $22.00 $386.80 $386.80 $132.00 $254.80 $254.80 $254.80 $254.80 $0.00 $143.00 $143.00 $33.00 $33.00 $33.00 $33.00 $37.60 $132.00 $44.00 $17.00 $143.00 $176.00 $209.00 $242.00 $275.00 $275.00 $275.00 $237.40 $237.40 $105.40 $105.40 $105.40 $105.40 $149.40 $166.40 $178.00 $344.40 $344.40 $344.40 Current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 6 of 14 TIME 1:351'M Dennis Burkett, D.D.S. ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End DATE 07/21/2008 Date Name Provider Twe Description Debit Credit Balance 1 1 /1 512004 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name AETNA-LYNN $143.40 $201.00 for claim from 11103104 11/15/2004 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Nov 03, 2004 was $201.00 closed. 11/30/2004 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $201.00 PAY PROMPTLY Included. 12/0212004 Entire Account Deleted DELETED-- Professional Courtesy: $201.00 $0.00 12/14/2004 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $28.00 $28.00 Est Insurance $28.00 12114/2004 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $84.00 Est Insurance $56.00 12/1412004 BRUCE REINHOLD 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $38.00 $122.00 Est Insurance $38.00 12114/2004 BRUCE REINHOLD 2 Service 09999 PREVIDENT HOME CARE GEL $10.00 $132.00 1211512004 BRUCE REINHOLD 2 PM Note Insurance Claim From 12114104 was Submitted $132.00 to Prim. 01/0312005 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name $122.00 $10.00 AETNA BRUCE for claim from 12/14104 01/0312005 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Dec 14, 2004 was $10.00 closed. 01/12/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $10.00 PAY PROMPTLY' Included. 01113/2005 BRUCE REINHOLD Deleted DELETED- Professional Courtesy: $10.00 $0.00 01/2712005 BRUCE REINHOLD 2 Service 02150 AMALGAM-2 $102.00 $102.00 SURFACE-PERMANENT OR PRIMARY Tooth 15 Surface MB Est Insurance $81.60 01/27/2005 BRUCE REINHOLD 2 Service D2160 AMALGAM-3 SURFACE-PERM OR $124.00 $226.00 PRIMARY Tooth 4 Surface MFD Est Insurance $99.20 01/31/2005 BRUCE REINHOLD 2 PM Note Insurance Claim From 01/27/05 was Submitted $226.00 to Prim. 02/08/2005 LYNN REINHOLD 2 PM Note Recall Processed on Laser Postcard $226.00 02/00/2005 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-bruce for $129.60 $96.40 claim from 01/27/05 02/09/2005 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Jan 27, 2005 was $96.40 closed. 02121/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $96.40 PAY PROMPTLY Included. 03/07/2005 LYNN REINHOLD 5 Service 00274 BITEWING X RAYSIFOUR FILMS $38.00 $134.40 Est Insurance $38.00 03/07/2005 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $190.40 Est Insurance $56.00 03/07/2005 LYNN REINHOLD 2 Service 09999 PREVIDENT HOME CARE GEL $10.00 $200.40 03/1512005 LYNN REINHOLD 2 PM Note Insurance Claim From 03/07/05 was Submitted $200.40 to Prim. 03124/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE $200.40 PAY PROMPTLY Included. 03/28/2005 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name AETNA-LYNN $94.00 $106.40 for claim from 03107/05 03/28/2005 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Mar 07, 2005 was $106.40 closed. Current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 7 of 14 TIME 1:35 PM, Dennis Burkett, D.D.S. ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name Provider Type Description 04/20/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 0412012005 Entire Account Deleted DELETED- Professional Courtesy: 06/23/2005 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS Est Insurance $44.00 06/23/2005 BRUCE REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM Tooth 12 Est Insurance $17.00 06/23/2005 BRUCE REINHOLD 2 Service 029W CORE BUILDUP-INCL. ANY PINS Tooth 12 Est Insurance $139.20 0612312005 BRUCE REINHOLD 2 Service 02750 CROWN-PORC/HIGH NOBLE METAL Tooth 12 Est Insurance $417.50 06/23/2005 BRUCE REINHOLD 2 PM Note Insurance Claim From Jun 23, 2005 was Submitted to Prim. 06/23/2005 BRUCE REINHOLD 2 PM Note Pre-Authorization From Jun 23, 2005 was Submitted to Prim. 06/2812005 BRUCE REINHOLD 2 PM Note Pre-Authorization From Jun 23, 2005 was Closed. 07/18/2005 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-bruce for claim from 06/23/05 07/18/2005 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Jun 23, 2005 was dosed. 07/27/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 08/11/2005 LYNN REINHOLD 2 PM Note Recall Processed on Laser Postcard 08/31/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 09113/2005 BRUCE REINHOLD Deleted DELETED- Professional Courtesy: 09/19/2005 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS Est Insurance $56.00 0911912005 LYNN REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION Est Insurance $28.00 09/19/2005 LYNN REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM Tooth 18 Est Insurance $17.00 09/19/2005 LYNN REINHOLD 2 PM Note Pre Authorization From Sep 19, 2005 was Submitted to Prim. 0912012005 LYNN REINHOLD 2 PM Note Insurance Claim From 09119/05 was Submitted to Prim. 09/27/2005 LYNN REINHOLD 2 PM Note Pre-Authorization From Sep 19, 2005 was Closed. 1010312005 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for claim from 09119/05 10/03/2005 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Sep 19, 2005 was closed. 11/1012005 LYNN REINHOLD 2 PM Note Insurance Claim From 11/10/05 was Submitted to Prim. 11/10/2005 LYNN REINHOLD 2 Service 02750 CROWN-PORC/HIGH NOBLE METAL Tooth 18 Est Insurance $417.50 DATE 07/21/2008 Debit Credit Balance $106.40 $106.40 $0.00 $44.00 $44.00 $17.00 $61.00 $174.00 $835.00 $56.00 $28.00 $17.00 $835.00 $503.20 $566.80 $101.00 $235.00 $1,070.00 $1,070.00 $1,070.00 $1,070.00 $566.80 $566.80 $566.80 $566.80 $566.80 $0.00 $56.00 $84.00 $101.00 $101.00 $101.00 $101.00 $0.00 $0.00 $0.00 $835.00 Current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 8 of 14 TIME 1:35 PW Dennis Burkett, Q.D.S. ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name Provider Tvue Description 11/30/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. 11/3012005 LYNN REINHOLD 2 PM Note Prim Insurance Claim From Nov 10, 2005 was closed. 11/3012005 LYNN REINHOLD Acct Pmt Insurance Check: DOS-Name aetna-lynn 12113/2005 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS Est Insurance $51.00 12/13/2005 BRUCE REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM Tooth 3 Est Insurance $19.00 12/13/2005 BRUCE REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM Tooth 30 Est Insurance $19.00 12/13/2005 BRUCE REINHOLD 2 Service 09951 OCCLUSAL ADJUSTMENT/LIMITED 12/14/2005 BRUCE REINHOLD 2 PM Note Insurance Claim From 12/13/05 was Submitted to Prim. 12/14/2005 BRUCE REINHOLD 2 PM Note Pre-Authorization From 12/13/05 was Submitted to Prim. 12/20/2005 BRUCE REINHOLD 2 PM Note Statement Processed With Message'PLEASE PAY PROMPTLY Included. 12/20/2005 BRUCE REINHOLD 2 PM Note Pre-Authorization From Dec 13, 2005 was Closed. 12/2012005 LYNN REINHOLD Deleted DELETED- Professional Courtesy: 01/02/2006 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-brute for claim from 12/13/05 01/02/2006 BRUCE REINHOLD 2 PM Note Prim Insurance Claim From Dec 13, 2005 was closed. 01/04/2006 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS Est Insurance $51.00 01/04/2006 BRUCE REINHOLD 2 Service 00220 PERIAPICAL X-RAWFIRST FILM Tooth 2 Est Insurance $19.00 01/04/2006 BRUCE REINHOLD 2 Service 07140 EXT OF TOOTH OR EXPOSED ROOT Tooth 2 Est Insurance $51.00 01/04/2006 BRUCE REINHOLD 2 Service 09940 OCCLUSAL GUARDS BY REPORT 01/09/2006 BRUCE REINHOLD 2 PM Note Insurance Claim From 01/04/06 was Submitted to Prim. 01/17/2006 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-brute for claim from 01 /04106 01117/2006 BRUCE REINHOLD RB PM Note Prim Insurance Claim From Jan 04, 2006 was closed. 01/2512006 BRUCE REINHOLD RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. 02/09/2006 BRUCE REINHOLD RB PM Note Recall Processed on Laser Postcard 02/23/2006 BRUCE REINHOLD RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. 02/23/2006 BRUCE REINHOLD Deleted DELETED-- Professional Courtesy. 03/22/2006 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION Est Insurance $30.00 03/22/2006 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS Est Insurance $60.00 Current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 9 of 14 DATE 07/21/2008 Debit Credit Balance $835.00 $835.00 $312.50 $522.50 $51.00 $573.50 $19.00 $592.50 $19.00 $98.00 $522.50 $155.20 $51.00 $19.00 $102.00 $475.00 $375.00 $30.00 $60.00 $303.80 $611.50 $709.50 $709.50 $709.50 $709.50 $709.50 $187.00 $31.80 $31.80 $82.80 $101.80 $203.80 $678.80 $678.80 $303.80 $303.80 $303.80 $303.80 $303.80 $0.00 $30.00 $90.00 TIME 1:35 ,PM, Dennis Burkett, D.D.S. DATE 07/21/2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name 03/22/2006 BRUCE REINHOLD 03/2212006 BRUCE REINHOLD 03/2312006 BRUCE REINHOLD 03/29/2006 BRUCE REINHOLD 04103/2006 BRUCE REINHOLD 04103/2006 BRUCE REINHOLD 04/19/2006 LYNN REINHOLD 04!19/2006 LYNN REINHOLD 04/1912006 LYNN REINHOLD 04/20/2006 LYNN REINHOLD 04/25/2006 BRUCE REINHOLD 05/0112006 LYNN REINHOLD 05/01/2006 LYNN REINHOLD 05/10/2006 LYNN REINHOLD 05/10/2006 LYNN REINHOLD 05/24/2006 BRUCE REINHOLD 05/24/2006 BRUCE REINHOLD 05/24/2006 BRUCE REINHOLD 05/25/2006 BRUCE REINHOLD 05/30/2006 LYNN REINHOLD 05/30/2006 LYNN REINHOLD 06105/2006 BRUCE REINHOLD 06/05/2006 BRUCE REINHOLD 06/13/2006 BRUCE REINHOLD 06/22/2006 BRUCE REINHOLD 07/25/2006 BRUCE REINHOLD Provider Type Description 5 Service 00274 BITEWING X-RAYS/FOUR FILMS Est Insurance $42.00 2 Service 06930 RECEMENT BRIDGE Tooth 28 Est Insurance $51.00 RB PM Note Insurance Claim From 03/22/06 was Submitted to Prim. RB PM Note Statement Processed With Message 'PLEASE PAY PROMPTLY' Included. Prim Ins Pmt Insurance Check: DOS-Name AETNA-BRUCE for claim from 03/22106 RB PM Note Prim Insurance Claim From Mar 22, 2006 was closed. 2 Service 00120 PERIODIC ORAL EXAMINATION Est Insurance $30.00 5 Service 01110 ADULT PROPHYLAXIS Est Insurance $60.00 5 Service 00272 BITEWING X-RAYS/TWO FILMS Est Insurance $30.00 RB PM Note Insurance Claim From 04119106 was Submitted to Prim. RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for claim from 04/19!06 RB PM Note Prim Insurance Claim From Apr 19, 2006 was closed. RS PM Note Insurance Claim From 05/10/06 was Submitted to Prim. 2 Service 02750 CROWN-PORC/HIGH NOBLE METAL Tooth 19 Est Insurance $417.50 RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. 2 Service 06930 RECEMENT BRIDGE Tooth 29 Est Insurance $51.00 RB PM Note Pre-Authorization From May 24, 2006 was Submitted to Prim. RB PM Note Insurance Claim From 05/24/06 was Submitted to Prim. Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for claim from 05/10/06 RB PM Note Prim Insurance Claim From May 10, 2006 was closed. Prim Ins Pmt Insurance Check: DOS-Name aetna-bruce for claim from 05/24/06 RB PM Note Prim Insurance Claim From May 24, 2006 was closed. RB PM Note Pre-Authorization From May 24, 2006 was Closed. RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. Debit Credit Balance $42.00 $102.00 $212.00 $30.00 $60.00 $30.00 $120.00 $835.00 $102.00 $365.00 $80.00 Current Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 10 of 14 • TIME 1:35=PM Dennis Burkett, D.D.S. ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Name Provider Type Description 11 /29/2006 BRUCE REINHOLD RB PM Note Statement Processed With Message -PLEASE PAY PROMPTLY' Included. 11/29/2006 BRUCE REINHOLD Deleted DELETED- Professional Courtesy: exchange of services 1210612006 LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURF/INC ANGLE Tooth 7 Surface MIL Est Insurance $153.60 12!0612006 LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURF/INC ANGLE Tooth 8 Surface DILF Est insurance $153.60 12/06/2006 LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURF/INC ANGLE Tooth 9 Surface DILF Est Insurance $65.30 12/06/2006 LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURF/INC ANGLE Tooth 10 Surface MIL 12106/2006 MADISON REINHOLD 2 Service CD BLEACHING MATERIAL 12/06/2006 MADISON REINHOLD Acct Pmt Check: Number 12/07/2006 LYNN REINHOLD RB PM Note Insurance Claim From 12106/06 was Submitted to Prim. 12112/2006 MADISON REINHOLD 2 Service 02150 AMALGAM-2 SURFACE-PERMANENT OR PRIMARY Tooth 2 Surface DL Est Insurance $89.60 12112/2006 MADISON REINHOLD 2 Service 02335 ANTER RESIN 4+SURF/1NC ANGLE Tooth 9 Surface DIF Est Insurance $153.60 12/14/2006 MADISON REINHOLD RB PM Note Insurance Claim From 12/12106 was Submitted to Prim. 12/18/2006 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for claim from 12/06/06 12/18/2006 LYNN REINHOLD RB PM Note Prim Insurance Claim From Dec 06, 2006 was closed. 12/2012006 BRUCE REINHOLD RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. 01/02/2007 MADISON REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-madison for claim from 12112106 01/02/2007 MADISON REINHOLD RB PM Note Prim Insurance Claim From Dec 12, 2006 was closed. 01/23/2007 BRUCE REINHOLD RB PM Note Statement Processed With Message'PLEASE PAY PROMPTLY' Included. 01/24/2007 Entire Account Deleted DELETED- Professional Courtesy: 03/2112007 BRUCE REINHOLD RB PM Note Recall Processed on Laser Postcard 04/18/2007 MADISON REINHOLD RB PM Note Recall Processed on Laser Postcard 04118/2007 LYNN REINHOLD RB PM Note Recall Processed on Laser Postcard 05101/2007 MADISON REINHOLD 5 Service 01110 ADULT PROPHYLAXIS Est Insurance $60.00 05/01/2007 MADISON REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION Est Insurance $30.00 05/0112007 MADISON REINHOLD 5 Service 01204 TOP APPL FLUOR-EXCL PX-ADULT Est Insurance $24.00 D5/0112007 MADISON REINHOLD 5 Service 00330 PANORAMIC FILM Est Insurance $78.00 DATE 07/21 /2008 Debit Credit Balance $105.40 $105.40 $0.00 $192.00 $192.00 $192.00 $192.00 $192.00 $45.00 $45.00 $112.00 $192.00 $566.40 $189.60 $316.00 $60.00 $30.00 $24.00 $78.00 $384.00 $576.00 $768.00 $813.00 $768.00 $768.00 $880.00 $1,072.00 $1,072.00 $505.60 $505.60 $505.60 $316.00 $316.00 $316.00 $0.00 $0.00 $0.00 $0.00 $60.00 $90.00 $114.00 $192.00 Current Dental Terminology (CDTI 0 American Dental Association (ADA). All rights reserved. Page 12 of 14 ? f l TIME 1:35 PM Dennis Burkett, D.D.S. DATE 07121/2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Dame Provider Type eAwilotion Debit redit Balance 05/02/2007 MADISON REINHOLD RB PM Note insurance Claim From 05/01/07 was Submitted $192.00 to Prim. 05/16/2007 MADISON REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-madison $192.00 $0.00 for claim from 05101/07 05/23/2007 MADISON REINHOLD RB PM Note Prim Insurance Claim From May 01, 2007 was $0.00 closed. 05/3112007 LYNN REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $30.00 $30.00 Est Insurance $30.00 05/31/2007 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $60.00 $90.00 Est Insurance $60.00 05131/2007 LYNN REINHOLD 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $42.00 $132.00 Est Insurance $42.00 05/31/2007 LYNN REINHOLD RB PM Note Pre-Authorization From May 31, 2007 was $132.00 Submitted to Prim. 06/0412007 LYNN REINHOLD RB PM Note Insurance Claim From 05/31/07 was Submitted $132.00 to Prim. 06/11/2007 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-lynn for $132.00 $0.00 claim from 05/31107 06/1112007 LYNN REINHOLD RS PM Note Prim Insurance Claim From May 31, 2007 was $0.00 closed. 06/13/2007 LYNN REINHOLD RB PM Nate Pre-Authorization From May 31, 2007 was $0.00 Closed. 08/23/2007 BRUCE REINHOLD RB PM Note Recall Processed on Laser Postcard $0.00 10/1612007 MADISON REINHOLD RB PM Note Recall Processed on Laser Postcard $0.00 10/3012007 MADISON REINHOLD 2 Del Adj DELETION ADJUSTMENT- $316.00 $316.00 10/30/2007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- exchange of $105.40 $421.40 services 10130/2007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- exchange of $514.00 $935.40 services 10/30/2007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- Professional $303.80 $1,239.20 Courtesy 10/3012007 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT-- Professional $522.50 $1,761.70 Courtesy 10/30/2007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- Professional $566.80 $2,328.50 Courtesy 10/30/2007 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT- $106.40 $2,434.90 10/30/2007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- Professional $10.00 $2,444.90 Courtesy 10/3012007 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT- $201.00 $2,645.90 10/30/2007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- per $254.80 $2,900.70 dennis-exchange of services 1013012007 BRUCE REINHOLD 2 Del Adj DELETION ADJUSTMENT- per $133.20 $3,033.90 dennis-exchange of services 10/3012007 MADISON REINHOLD 2 Del Adj DELETION ADJUSTMENT- Professional $120.00 $3,153.90 Courtesy 10130/2007 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT- per dennis $14.00 $3,167.90 10130/2007 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT- Professional $462.50 $3,630.40 Courtesy 10/30/2007 LYNN REINHOLD Del Adj DELETION ADJUSTMENT- Miscellaneous $8.00 $3,622.40 Adjustment 10/30/2007 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT- Professional $8.00 $3,630.40 Courtesy Currant Dental Terminology (CDT) 0 American Dental Association (ADA). All rights reserved. Page 13 of 14 TIME 1:35° PM. Dennis Burkett, D.D.S. DATE 07/21 /2008 ACCOUNT HISTORY REPORT FOR 2142: BRUCE REINHOLD Beginning - End Date Dame 10/30/2007 BRUCE REINHOLD 10/30/2007 BRUCE REINHOLD 10/31/2007 BRUCE REINHOLD 10/31/2007 BRUCE REINHOLD 1112712007 BRUCE REINHOLD 11/2712007 BRUCE REINHOLD 12/12/2007 BRUCE REINHOLD 01122/2008 BRUCE REINHOLD 01122/2008 BRUCE REINHOLD 02/2112008 BRUCE REINHOLD 03/1212008 BRUCE REINHOLD 03/12/2006 BRUCE REINHOLD 04/24/2008 BRUCE REINHOLD 04/24/2008 BRUCE REINHOLD 05/22/2006 BRUCE REINHOLD 05/22/2008 BRUCE REINHOLD 07/21/2008 BRUCE REINHOLD 07/2112008 BRUCE REINHOLD Provider Type Description Debut Credit Balance 2 Del Adj DELETION ADJUSTMENT- Professional $2,040.80 $5,671.20 Courtesy Del Adj DELETION ADJUSTMENT-- Adj. to $2,104.80 $3,566.40 balance history with Acct Bal. 2 BiIIChg Billing Charge $35.00 $3,601.40 RB PM Note Statement Processed With Message'PLEASE $3,601.40 PAY PROMPTLY' Included. 2 BiIIChg Billing Charge $35.00 $3,636.40 RB PM Note Statement Processed With Message $3,636.40 ' 11 /30/07- account to collections Included. RB PM Note Statement Processed With Message'PLEASE $3,636.40 PAY PROMPTLY' Included. 2 BiIIChg Billing Charge $35.00 $3,671.40 RB PM Note Statement Processed With Message 'billing $3,671.40 charge added to account' Included. RB PM Note Statement Processed With Message'PLEASE $3,671.40 PAY PROMPTLY' Included. 2 BiIIChg Billing Charge $35.00 $3,706.40 RB PM Note Statement Processed With Message'PLEASE $3,706.40 PAY PROMPTLY' Included. 2 BillChg Billing Charge $35.00 $3,741.40 RB PM Note Statement Processed With Message'PLEASE $3,741.40 PAY PROMPTLY' Included. 2 BiIIChg Billing Charge $35.00 $3,776.40 RB PM Note Statement Processed With Message 'PLEASE $3,776.40 PAY PROMPTLY' Included. 2 BillChg ji.tasz....,0% $35.00 $3,811.40 2 BiIIChg rG y $35.00 $3,846.40 $18,678.20 $14,831.80 $3,846.40 Current Dental Terminology {CDT) ® American Dental Association (ADA). All rights reserved. Page 14 of 14 CERTIFICATE OF SERVICE I hereby certify that on November 18, 2008, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy of a Complaint, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Kenneth F. Lewis, Esquire 1101 North Front Street Harrisburg, Pe lvania 17110 F David A. Baric, Esquire !"'? r„ ('_ -, + << -? ;A ,. P....,,? -d_ "'?:: ! } ?..._ W ,..J +..?.x ?F y .19 4?? _y W, '? a DENNIS BURKETT, DDS, Plaintiff V. BRUCE J. REINHOLD and J. LYNN REINHOLD, husband and wife, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-6456 CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED NOTICE TO PLEAD TO THE ABOVE-NAMED PLAINTIFF: You are hereby notified you must file a written response to the enclosed Answer with New Matter and Counterclaim within twenty (20) days from service hereof or a judgment may be entered against you. DATED :'L ? /Dg 14 KEN ET F. LEWIS, ESQUIRE I. . # 69383 Attorney for Defendant 1101 N. Front St. Harrisburg, PA 17102 (717) 234-3136 YOU SHOULD TARE 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. DAUPHIN COUNTY LAWYER REFERRAL SERVICE 213 North Front Street Harrisburg, PA 17101 (717) 232-7536 DENNIS BURKETT, DDS, Plaintiff V. : BRUCE J. REINHOLD and J. LYNN REINHOLD, husband and wife, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-6456 CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED ANSWER WITH NEW MATTER & COUNTERCLAIM Defendants, by their undersigned attorney, file this Answer and Counterclaim, averring as follows: ANSWER 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Denied. Exhibit "A" to the Complaint only contains two forms signed by Mr. Reinhold. 6. Denied. See response to paragraph #5 above. Further, while the forms indicate Mr. Reinhold would be responsible for payment, Plaintiff assured Mr. Reinhold he would accept monies received by their insurance company as payments in full. 7. Denied as stated. See Exhibit "A" attached to Plaintiff's Complaint, which document speaks for itself. 8. Denied. Exhibit "B" has been re-done by Plaintiff for purposes of filing suit against Defendants. The original account history shows that no money is owed by the Defendants. 9. Denied. As close friends, Plaintiff assured Mr. Reinhold he would accept monies received by their insurance company as payments in full. Mr. Reinhold returned this friendship, in part, by selling goods to Plaintiff at a reduced rate and by providing services (unloading tractor trailers, providing verbal appraisals; providing information regarding photography, etc.) at no charge, but as favors for a friend. 10. Denied. The original account history very clearly indicates that Defendants owe Plaintiff no money whatsoever. 11. It is denied that Defendants have any obligation whatsoever to Plaintiff. COUNT 1 - BREACH OF CONTRACT 12. Defendants incorporate paragraphs 1 through it of their Answer as if fully set forth herein. 13. Denied. Defendants have not breached the parties' agreement. No money is owed to Plaintiff. Plaintiff assured Mr. Reinhold he would accept monies received by their insurance company as payments in full. The original accounting history prepared by Plaintiff showed that he had, in fact, accepted the insurance company payments in full. 14. Denied for the reasons given above. 15. This is a conclusion of law to which no response is required. 16. Denied. As no money is owed Plaintiff, he has not been required to pursue any collection. 17. Admitted. WHEREFORE, Defendant requests the Court to dismiss Plaintiff's Complaint. NEW MATTER 18. Defendants hereby incorporate paragraphs 1 through 17 above as if fully set forth herein. AFFIRMATIVE DEFENSES 19. Plaintiff's Complaint fails to state a claim upon which relief can be granted. 20. Plaintiff's claims are barred by the doctrines of waiver, estoppel and/or laches. 21. Plaintiff's claims are barred by the statute of limitations. WHEREFORE, Defendants respectfully request that Plaintiff's Complaint be dismissed with prejudice. COUNTERCLAIM DEFENDANTS' COUNT I VIOLATION OF THE CONSUMER PROTECTION LAW 22. Defendants incorporates paragraphs 1 through 21 of their Answer and New Matter as if fully set forth herein. 23. The services for which Defendants went to Plaintiff were for personal and family purposes. 24. At all times relevant hereto, the Plaintiff was engaged in "trade" or "commerce" as defined by §201-2(3) of the Consumer Protection Law. 25. Plaintiff and Defendant Bruce Reinhold were long- time friends, their friendship beginning approximately one year prior to Mr. Reinhold becoming a patient at Plaintiff's dental practice. 26. Given their friendship, Plaintiff assured Mr. Reinholds he would accept monies received by their insurance company as payments in full for his dental services. 27. For many years, Plaintiff fulfilled his promise and the Defendants' expectations by accepting Defendants' insurer's payments as payment in full. 28. On or about the beginning of August, 2007, Plaintiff asked Mr. Reinhold to come see the progress on new home which was under construction. 29. Mr. Reinhold did not respond for three days, at which time Plaintiff again telephoned Mr. Reinhold extremely upset, saying Bruce was a horrible friend; that he had allowed him to make a living, etc. Mr. Reinhold advised Plaintiff he had been unavailable as he was caring for his mother who had broken her hip. 30. Within a day or two, Plaintiff left a rude message on Defendants' home answering machine, stating the same kinds of things as listed in paragraph #28 above. 31. Plaintiff then fraudulently changed the Defendants' account history -- now charging for all amounts that he had promised to forego. 32. Attached as Defendants' Exhibit "A" is the account history prepared by Plaintiff showing that he is not due any money whatsoever as of October 16, 2007. The attachment then shows Plaintiff made numerous "adjustments" to indicate Defendants owed him thousands of dollars. Concurrently, Plaintiff began adding $35.00 monthly "billing charges." 33. Plaintiff's above-stated actions violate the Consumer Protection Act, 73 P.S. §201-1, et. seq., by (xi) "Making false or misleading statements of fact concerning the reasons for, existence of, or amounts of price reductions"; and (xxi) Engaging in... fraudulent or deceptive conduct which creates a likelihood of confusion or of misunderstanding. 34. Defendants reasonably relied on Plaintiff's representations that they would not be billed any sums above what was paid by their insurance. WHEREFORE, Defendants demand judgment as follows: a. an award of three times the Plaintiff's claimed damages, which equals $11,329.20; b. reasonable attorney's fees; and c. costs of Court and any other fees, costs and further relief as the Court may deem appropriate. d. The total damages claimed by Defendant are within the limit requiring the case to be subjected to compulsory arbitration. Q 16 h 144' DATED: )451H KEN ET F. LEWIS, ESQ. Attorney for Defendants Attorney I.D. #69383 1101 North Front Street Harrisburg, PA 17102 (717) 234-3136 CERTIFICATE OF SERVICE I certify I have served a true and correct copy of the within document upon attorney for Plaintiff by mailing same, postage prepaid at Harrisburg, PA, on the filing date, at the following address: David A. Baric, Esq. 19 West South St. Carlisle, PA 17013 DATED: ?z 5 og KENNE H F. LEWIS, ESQUIRE Attor ey for Defendants y VERIFICATION I hereby verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. o.tea:JtG y /-0e J. Verification I verify the statements made in this document are true and correct to the best of my knowledge and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S section 4904 relating to unsworn falsification to authorities. / 2,1q- /W TIME "1.:39 ?M a go 04MMI BRUCE REINHOLD D4/17/01 BRUCE REINHOLD 0522101 BRUCE REINHOLD 07/30/01 LYNN REINHOLD 0730101 LYNN REINHOLD 07/30!01 LYNN REINHOLD 0730/01 LYNN REINHOLD 07/30/01 LYNN REINHOLD 0811)9101 LYNN REINHOLD 11/21101 LYNN REINHOLD 1127101 LYNN REINHOLD 11/27/01 LYNN REINHOLD 01/17!02 LYNN REINHOLD Dennis Burkett, D.D.S. o-: OIJN T HISTORY REPORT ?,f? CDR BRU:.E REINH.--D Seq,rr;n.q - End 02)11)02 LYNN REINHOLD 03106/02 LYNN REINHOLD 08/19102 MADISON REINHOLD 08/19/02 MADISON REINHOLD 08/19102 MADISON REINHOLD 08119102 MADISON REINHOLD 09/03102 MADISON REINHOLD 09/12102 BRUCE REINHOLD 09/12/02 BRUCE REINHOLD 09/12/02 BRUCE REINHOLD 10/0202 BRUCE REINHOLD 10/15/02 LYNN REINHOLD 10/15102 LYNN REINHOLD 10/15(02 LYNN REINHOLD 11/01/02 LYNN REINHOLD DATE 08116/07 Current $0.00 30 Day $0.00 60 Day Woo 90 Day $0.00 Conlract $0.00 Balance Due $0.00 Eked Ina $0.00 1 Balance Due Now $0.00 $ovid K 1M peacdodw QM QMS 2 Debit Adj Miscellaneous Adju*nent Adj. to balance $2,104.80 $2,104.80 Nd wy wth Acct Bal. Acct Pmt Insurance Check DOS-Name TYCO INT. $64.00 $2,040.80 LTD/ 318 Credit Adj Proftesionat Courtesy: $2;0s1mlw 90.00 2 Service 00150 INITIAL EXAMINATION $36.00 $36.00 Est Insurance $36.00 5 Service 01110 ADULT PROPHYLAXIS $50.00 $86.00 Est Insurance $50.00 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $36.00 $122.00 Est Insurance $36.00 5 Service 00330 PANORAMIC FILM $64.00 $186.00 Est Insurance $64.00 2 Service 09910 APPL DESENSITIZING $8.00 $194.00 MEDICAMENTS Prim Ins Pmt Insurance Check: DOS-Nwwtycoltynn/7/30 $186.00 $8.00 for claim from 07!30!01 Credit Adj Pnoftesional Courtesy: $Sao $0.00 2 Debi Adj Menus Adjustment: $8.00 $8.0D Acct Pmt Check: Number $8.00 $0.00 2 Service WM CROWN-PORC/HIGH NOBLE METAL $725.00 $725.00 Tooth 31 Est Insurance $362.50 Prim Ins Pmt Insurance Check DOS-Name tycolfy?xr for $262.50 $462.50 claim from 01117/02 Credit Adj Prwfessidnel CorftW. $0.00 2 Service 90120 PERIODIC ORAL EXAMINATION $26.00 $26.00 Est insurance $26.00 5 Service 01120 CHILD PROPHYLAXIS $38.00 $64.00 Est Insurance $38.00 5 Service 00272 BITEWING X-RAYSAWO FILMS $20.00 $84.00 Est Insurance $20.00 5 Service 01203 TOP APPL FL EXCL PX-CHILD $21.00 $105.00 Est Insurance $21.0 Prim Ins Pmt Insurance Check: DOS-Name tyco-madson $105.0 $0.00 for cldm from 08/19/02 5 Service 01110 ADULT PROPHYLAXIS $54.00 $54.00 Est Insurance $54.00 2 Service 00120 PERIODIC ORAL EXAMINATION $26.00 $80.00 Est Insurance $26.00 2 Service 09910 home cars fluoride gsi-dedww*izkV $8.00 $86.00 reed Tooth 2 Prim Ins Prat Insurance Check: DOS-Name AETNA for $77.00 $11.00 claim from 09/12102 2 Service 00120 PERIODIC ORAL EXAMINATION $25.00 $37.00 Est Insurance $26.00 5 Service 01110 ADULT PROPHYLAXIS $54.00 $91.00 Est Insurance $54.00 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $36.00 $127.00 Est insurance $36.00 Prim Ins Pmt Insurance Check: DOS-Nam aetna/lynn for $113.00 $14.00 claim from 10/15/02 Page 11 of 7 TIME 2:59-PM Dennis Burkett. D G.S. DATE 08/16107 ACCOUNT HISTORY REFOR`" Im am EINWI M IM peacdpdon 22M Cry 8dowe 02121 /03 Entire Account Crag Adj Professional Courtesy: Per dennis $14OD $0.00 08104103 MADISON REINHOLD 2 service 00120 PERIODIC ORAL EXAMINATION $26.00 $25.00 Est Insurance $25.00 08104103 MADISON REINHOLD 5 Service 01120 CHILD PROPHYLAXIS $40.00 $66.00 Est Insurance $10.00 080403 MADISON REINHOLD 5 Service 012003 TOP APPL FL EXCL PX-CHILD $21.00 $87.00 Est Insurance $21.00 09255103 MADISON REINHOLD Acct Pmt Insurance Check: DOS-Name aotrta-medison $87.00 $0.00 O WSW MADISON REINHOLD Prim Inns Pmt Check: Number for claim from 08104103 $0.00 $0.W 0825103 MADISON REINHOLD 2 Service 02392 2 SURF. POSTERIOR RESIN $120.00 $120.00 COMPOSITE Tooth 14 Surface OL Est Insurance $56.00 0825!03 MADISON REINHOLD 2 Service 02391 1 SURF. POSTERIOR RESIN $92.00 $212.0 COMPOSITE Tooth 14 Surface O Est Insurance $73.60 OW15W MADISON REINHOLD Prim Ins Prrd Ir surarce Check: DOS-Name aetra-madison $$2.00 $120.00 for claim from 06/25103 10101103 MADISON REINHOLD Credit Adj Pra$eesional Cotaissy. V=V0 $000 12/02!03 LYNN REINHOLD 2 Service 02393 3 SURF. POSTERIOR RESIN $136.00 $136.0 COMPOSITE Tooth 5 Surface MFD Est Insurance $106.80 12AM LYNN REINHOLD 2 Service 02332 3 SURF ANTER RESIN-A.E.TECH $136.00 $272.0D Tooth 6 Surfooe MFD Est kwxance $106.80 12102103 LYNN REINHOLD 2 Service 02332 3 SURF ANTER RESIN,A.E.TECH $136.00 $408.00 Tooth 11 Surfew MFD Est Insurance $108.80 12!02103 LYNN REINHOLD 2 Service 00110 LTD ORAL EVAL-PROBLEM FOCUS $40.00 $448.00 Est Insurance $40.OD 12102103 LYNN REINHOLD 5 Service 00274 BITEW ING X-RAYSIFOUR FILMS $36.0 $484.00 Est Intsdrartce $36.00 12.2(3 BRUCE REINHOLD 2 service 00120 PERIODIC ORAL EXAMINATION $26.00 WO.00 Est Insurance $2600 12.2103 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $566.0 Est Insurance $96.00 121022 BRUCE REINHOLD 5 Service OOM BiTEWING X-RAYS/TWO FILMS $20.00 $596.0 Est i euraince $20.00 12115103 LYNN REINHOLD Prim Ins Pmt Insurance Check DOS-Name abbw lynn for $352,80 $233.20 cairn from 12102.3 12!23/03 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.OD $289.20 Est Insurance $56.00 0122104 Entire Account Deleted DELETED-- PtotessiorW Courtesy: Per $2120 $0.00 dennis-exo hw" of services /d 0126104 LYNN REINHOLD 2 Del Adj DELETION ADJUSTMENT- per $210 $29920 denrnia4wetmVe of services 02117/14 BRUCE REINHOLD Prim Ins Pmt Insurance Check DOS-Name aefrt 4xw* for $101.00 $188.20 catm from 12102103 02A7104 LYNN REINHOLD Prim In Pmt Irtsnrarice Check DOS-Name aetrw4ynn for $55.00 $133.20 cairn from 1223.3 02117/04 Entire Account Credit Adj Couulesy: per dwwds-eKchaW of SPfulleVArtal ervices s $133.20 $0.00 03A9A4 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $44.00 $44.OD Est Insurance $44.00 P"* 2 of 7 TIME 2:59 PM Dennis SurAett. ';.`. DATE 08116107 Qft Pm t im UNWIN" Dd* ;Bwk Balance 03/09/04 BRUCE REINHOLD 2 Service 00220 PERINPICAL X-RAYIFiRST FILM $17.00 $61.00 Tooth 12 Est Insurance $17.00 03/®/04 BRUCE REINHOLD 2 Service 02394 4 OR MORE POSTERIOR RESIN $196.00 $257.00 COMPOSITE Tooth 12 Surface MOBL Est Insurance $156.80 0301104 BRUCE REINHOLD 2 Service 023944OR MORE POSTERIOR RESIN $196.00 $453.00 COMPOSITE Tooth 14 Surface MOBL Eat Insurance $156.80 0399/4 BRUCE REINHOLD 2 Service 03120 PULP CAP-INDIRECT (EXCL REST) $48.00 $501.00 Tooth 14 Est Insurance $38.40 0322104 BRUCE REINHOLD Prim Ins Pmt Insurance ChsGc: DOS-Name aabvH uw for $281,00 $220,00 claim from 03/09/04 05113/04 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $44.00 3264.00 Est Insurance $".00 05113/04 BRUCE REINHOLD 2 Service 060 RECEMENT BRIDGE Tooth 29 $102.00 $366.00 Est Insurance 551.OD 06/1104 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name astna-bnrce for $111.20 $254.80 Gain from 06/13/04 O&OW04 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $310.80 Est Insurance $56.00 06/09/04 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $28.00 $338.80 Eat Insurance $28.00 0621)04 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-bnjce for $64.00 $254.80 claim from 06/09104 07/07104 MADISON REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $28.00 $282.80 Eat Insurance $28.00 07107/04 MADISON REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $338,80 Est insurance $56.00 07107/04 MADISON REINHOLD 5 Service 00272 BITEWING X-RAYS/l wO FILMS $26.00 $364.80 Est Insurance 526.00 07/07104 MADISON REINHOLD 5 Service 01204 TOP APPL FLUOR-EXCL PX-ADULT $22.00 $366.60 Est Insurance $22.00 07119/04 MADISON REINHOLD Prim Ina Pmt Insurance Check: DOS-Name astna-madison $132.00 3254.80 for claim from 07107/04 0728104 BRUCE REINHOLD Cr*WA4 iMAiaoaimsmAd#,wbnent: per $254.80 $0.00 dw- swra --woof services 08110104 MADISON REINHOLD 2 Service 02382 2 SURF. POSTERIOR RESIN $143.00 $14100 COMPOSITE Tooth 3 Surface OL Eat Insurance $114.40 08/18/04 MADISON REINHOLD 5 Service 01351 SEALANT - PER TOOTH Tooth 2 $33.00 $175.00 Est Insurance $33.00 08M804 MADISON REINHOLD 5 Service 01351 SEALANT - PER TOOTH Tooth 15 $33.00 $209.00 Est Insurance $33.00 08/18/104 MADISON REINHOLD 5 Service 01351 SEALANT - PER TOOTH Tooth 18 $33.00 $242.00 Est Insurance $33.00 06/18104 MADISON REINHOLD 5 Service 01351 SEALANT -PER TOOTH Tooth 31 $33.00 $275.00 Est Insurance $33.00 0823104 MADISON REINHOLD Prim Ins Pmt Irusuxance Check DOS-Name aetna-maotson $37.60 $237.40 for claim from 08/10104 08130/04 MADISON REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetrra-madison $132.00 $105.40 for claim from 08/18/04 Page 3 of 7 TIME 2:59 PM Dennis Bu. e,'. ?.C-. 5 DATE 08/16/07 ACCOUNT His T QR"RFP-)Q, - am man Proymeir T m DOW 11103104 LYNN REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $44.00 $148.40 Est insurance $44.00 11/03/04 LYNN REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM $17.00 $155.40 Tooth 4 Est Insurance $17.00 1103+04 LYNN REINHOLD 2 Service Oi2.13 3 SURF. POSTERIOR RESIN $176.00 $344.40 COMPOSITE Tooth 4 Surface MFD Est insurance $142.40 11115!04 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name AETNA-LYNN $143.40 $201.00 for claim from 11!03/04 1202104 Entire Account Credit Adj PMkssWW Cour6esy: $201.00 $O.OD 120404 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $28.00 $28.00 Est Insurance $28.00 12/1404 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $84.00 Eat Insurance $56.00 12!14104 BRUCE REINHOLD 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $38.00 $122.00 Eat insurance $36.00 1211404 BRUCE REINHOLD 2 Service 09999 PREVIDENT HOME CARE GEL $10.00 $132.00 0IM3105 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name $122.00 $10.00 AETNA-BRUCE for claim from 1211404 01113105 BRUCE REINHOLD Credit Adj Protesaionsi Cwftey. $40.00 $0.00 0112705 BRUCE REINHOLD 2 Service 02150 AMALGAM-2 $102.00 $102.00 SURFACE-PERMANENT OR PRIMARY Tooth 15 Surface MS Eat Insurance $81.60 012705 BRUCE REINHOLD 2 Service 0218D AMALGAM-3 SURFACE-PERM OR $124.00 $225.00 PRIMARY Tooth 4 Surface MFD Est Insurance 599.2D 0210905 BRUCE REINHOLD Prim Ins Pr(d Insurance Check: DOS-Name aetna br oe for $128.150 $96.40 claim from 012705 030705 LYNN REINHOLD 5 Service W274 BITEWING X-RAYSIFOUR FILMS $38.00 $134.40 Est Insurance $38.00 0310705 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $190.40 Est Insurance 558.00 030706 LYNN REINHOLD 2 Service 09999 PREVIDENT HOME CARE GEL $10.00 $200.40 03AAM LYNN REINHOLD Prim Ins Pmt Insurance Check DOS-Name AETNA-LYNN $94.00 $106.40 for claim from 0310705 04P2005 Entire Account Credit AuSj Pmbos " Coufey. $106.40 $0.00 0623105 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $44.00 $44.00 Est Insurance $44.00 0642305 BRUCE REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM $17.00 $61.00 Tooth 12 Eat Insurance $17.00 062305 BRUCE REINHOLD 2 Service 02960 CORE BUILDUP-INCL ANY PINS $174.00 $235.00 Tooth 12 Eat Insurance $13920 0!32305 BRUCE REINHOLD 2 Service 02750 CROWN-PORC/HIGH NOBLE METAL $835.00 $1,070.00 Tooth 12 Est Insurance $417.50 07118/05 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetna-brute for $503.20 $586.80 claim from 062305 09/1305 BRUCE REINHOLD Credit Adj Professional Courtesy: $S -80 $O.OO Page 4 of 7 TIME 2:59 PM Dennis B?;Fr etc. DATE 08/16/07 ACCOUNT HIS T OR R.EPOR- III Im BMA W TM 0MCdDitiOn bit gne 0911905 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $56.00 $56.00 Eat Insurance $56.00 09119/05 LYNN REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $28.00 $84.00 Est Insurance $28.00 09/19105 LYNN REINHOLD 2 Service 00220 PERIAPICAL X-RAY/FIRST FILM $17.00 $101.00 Tooth 18 Est Insurance $17.00 10103105 LYNN REINHOLD Prim Ins Pmt Insurance Check: DOS-Name astna-tynn for $101.00 $0.00 clahn from 09119105 11/10105 LYNN REINHOLD 2 Service 02750 CROWN-PORCMIGH NOBLE METAL $835.00 $835,00 Tooth 18 Est Insurance $417.50 11MD)0 i LYNN REINHOLD Acct Pmt Insurance Check: DOS-Nam aeo*4ynn $312.50 $522.50 1211315 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $51.00 $573.50 Est Insurance $51 DO 12/1305 BRUCE REINHOLD 2 Service 00220 PERIHPICAL X-RAY/FIRST FILM $19.00 $592.50 Tooth 3 Est Insurance $19.00 1211315 BRUCE REINHOLD 2 Service 00220 PERMPICAL X-RAY/FIRST FILM $19.00 $611.50 Tooth 30 Est Insurance $19.00 1211315 BRUCE REINHOLD 2 Service 09961 OCCLUSAL ADJUSTMENT/LIMITED $98.OD $709.50 122016 LYNN REINHOLD Credit Adj Prdsceional Courtesy: $52250 $18700 01/0206 BRUCE REINHOLD Prim Ins Pmt Insurance Chet: DOS-Name astna-brace for $155.20 $31.80 cairn from 1211315 DlM4M6 BRUCE REINHOLD 2 Service 00140 LTD ORAL EVAL-PROBLEM FOCUS $51.00 $82.80 Eat Insurance $51.00 01XWM BRUCE REINHOLD 2 Service OOM PERIAPICAL X RAYIFIRST FILM $19.00 $101.80 Tooth 2 Est Insurance $19.00 0110416 BRUCE REINHOLD 2 Service 07140 EXT OF TOOTH OR EXPOSED $102.00 $203.80 ROOT Tooth 2 Est Instmar a $51.00 D1104106 BRUCE REINHOLD 2 Service 09940 OCCLUSAL GUARDS BY REPORT $475.00 $678.80 01/1706 BRUCE REINHOLD Prim Ins Pmt Inswance Check: DOS Name aetns-truce for $375.00 $303.80 claim from 01 /04106 022906 BRUCE REINHOLD Craft Adj Prafaas w CouftW. $30380 $000 032216 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $30.OD $30.00 Eat Insurance $30.00 032216 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $60.00 $90.00 Est Insurance $60.00 0322106 BRUCE REINHOLD 5 Service 00274 BnrMNG X-RAYSIFOUR FILMS $42.00 $13210 Est Insurance $42.00 032206 BRUCE REINHOLD 2 Service 06900 RECEMENT BRIDGE Tooth 28 $102.00 $234.OD Eat kw uranoe $51.00 041306 BRUCE REINHOLD Prim Ins Part Insurance Check. DOS-Name $212.00 $2200 AETNA-BRUCE for calm from 0322!06 04/1906 LYNN REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $30.00 $52.00 Eat Insurance $30.00 04119106 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $60.00 $112.00 Est Insurance $60.00 04/1906 LYNN REINHOLD 5 Service 00272 SITEWING X-RAYS/TWO FILMS $30.00 $14200 Est Insurance $30.00 page 5 of 7 TIME 2:59 Rk Dennis Burkev. .D.c.. DATE 06116107 C"COj. .4 C E. am NW& Pnwid w Im QuallAw 22M Qrsellt Balance 05/01/06 LYNN REINHOLD Prim Ins Pmt InsUreWe Check DOS-Name aetr"n for $120.00 $2200 ohim from 04119/06 O511OMS LYNN REINHOLD 2 Service 02750 CROWN-PORC/HIGH NOBLE METAL $835.00 $857.00 Tooth 19 Est Inarrance $417.50 05"W BRUCE REINHOLD 2 Service OOA30 RECEMENT BRIDGE Tooth 29 $102.00 $969.00 Est Inwmrice $51.00 05r3DM LYNN REINHOLD Prim Ins Pmt insurance Check: DOS-Name aetna4 mn for $365.00 $594.00 claim from 05110/06 06/06/06 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aetnfl-b um for $80.00 $514,00 cairn from 0524/06 0725106 Erdire Account Credit P4 Praiee wvd Courb : aeot sW of services 9614.00 $100 09/27/06 BRUCE REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $6D,00 $W.00 Eat Irierrarrce 560.00 0927/06 BRUCE REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION 530.00 $90.00 Eat 1rosarce, $30.00 0927/06 BRUCE REINHOLD 5 Service 00330 PANORAMIC FILM $78.00 $166.00 Est Insurance $78.00 0927/06 BRUCE REINHOLD 2 Service 02335 ANTER RESIN 4+SURFANC ANGLE $192.00 $360.00 Tooth 24 Surface DIF Est Wo ranee 08.80 0927106 BRUCE REINHOLD 2 Service 02362 2 SURF. POSTERIOR RESIN $143.00 $503.00 COMPOSITE Tooth 31 Surface OL 10/10106 BRUCE REINHOLD Prim Ins Pmt Insurance Check: DOS-Name aabw,4 rJOe for $397.60 $105.40 claim from 0927106 10119/06 MADISON REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $30.00 $135.40 Est Insurance $30.00 10/19106 MADISON REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $60.00 $195.40 Est Irwatce $60.00 tOM9/06 MADISON REINHOLD 5 Service 00272 BiTEWING X-RAYSlTWO FILMS $30.00 $225.40 Est Irwrrance $30.00 10/19106 MADISON REINHOLD 5 Service 01204 TOP APPL FLUOR-EXCL PX-ADULT $24.00 $249.40 Est Insurance $24.00 tOWM MADISON REINHOLD Prim Ins Prrt Irie ran4e Cheep: DOS-Name for claim from $144.00 $105.40 50119106 11/07106 LYNN REINHOLD 5 Service 01110 ADULT PROPHYLAXIS $60.00 $165.40 Est kwma "$80.00 11/07106 LYNN REINHOLD 2 Service 00120 PERIODIC ORAL EXAMINATION $30.00 $195.40 Est Ineurarwee $30.00 11120+06 LYNN REINHOLD Prim Ins Pmt Insurance Check DOS-Name adria-lyrirt for $90.00 $106.40 claim from 11107106 1129106 BRUCE REINHOLD Credit Adj Profsesionai Courtesy exchange of services V06.40 $0,00 12106/06 LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURFANC ANGLE $192.00 $192.00 Tooth 7 Surface MIL Est Insurance $153.60 12/06M LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURFANC ANGLE $192.00 $384.00 Tooth 8 Surface DiLF Est Insurance $153.60 12106106 LYNN REINHOLD 2 Service 02335 ANTER RESIN 4+SURF/INC ANGLE $192.00 $576.00 Tooth 9 Surface DILF Est insurance $65.30 12/06rEIB LYNN REINHOLD 2 Service 023W ANTER RESIN 4+SURF/INC ANGLE $192.00 $768.00 Tooth 10 Surface MIL Page 6 of 7 TIME 2:53 PM Dennis Bwr -u. AD DATE 0816/07 ACCOUNT HISTORY REPORT Qft I 121)6106 MADISON REINHOLD 12106106 MADISON REINHOLD 12/12/06 MADISON REINHOLD 12/12/)8 MADISON REINHOLD 12118106 LYNN REINHOLD 01102f07 MADISON REINHOLD 01124107 Entire Account 05101107 MADISON REINHOLD 05MV07 MADISON REINHOLD 05101/07 MADISON REINHOLD 05101107 MADISON REINHOLD 05/16107 MADISON REINHOLD 05131107 LYNN REINHOLD 05131107 LYNN REINHOLD 0=1107 LYNN REINHOLD 06/11/07 LYNN REINHOLD R9M Srlns adim 2 Service CD BLEACHING MATERIAL $45.00 $ 813.00 Acd Pmt Check Num1w 545.00 $768.00 2 Service 02150 AMALGAM-2 $112.00 $880.00 SURFACE-PERMANENT OR PRIMARY Tooth 2 Surface DL Est Irtaurarroe $98.60 2 Service 02335 ANTER RESIN 4+SURFRNC ANGLE $192.00 $1,07200 Tooth 9 Surface DIF Eat Insurance $153.60 Prim Ins Pmt Iris aince Check: DOS-Name aeu*4ynn tor x,40 $505,60 claim from 12/06/08 Prim Ins Pmt Insurance Check DOS-Name aehtaanadison $189.60 $316.00 for claim from 12/12108 Credit Adj Probasional Coudwy., $376.00 $0.00 5 Service 01110 ADULT PROPHYLAXIS $60.00 $50.00 Est insurance $60.00 2 Service 00120 PERIODIC ORAL EXAMINATION $3000 $90,00 Est Insurance $30.00 5 Service 01204 TOP APPL FLUOR-EXCL PX-ADULT $24.00 $114.00 Eat Insurance $24.00 5 Service 00330 PANORAMIC FILM $78.00 $19200 Est Insurance $78.00 Prim Ins Pmt Insurance Check: DOS-Name aebwnm d w $192.0D $0.00 for claim from 051011)7 2 Service 00120 PERIODIC ORAL EXAMINATION $30.00 $30,00 Est insurance $30.00 5 Service 01110 ADULT PROPHYLAXIS $60.00 $90,00 Est Ir4wance, $80.00 5 Service 00274 BITEWING X-RAYS/FOUR FILMS $42.00 $13200 Est Insurance $42.00 Prim Ins Pmt Insurance Check: DOS-Name aetne4ynn for $132.00 $0.00 claim from 05/31/07 $12,719.00 $12,719.00 $0.00 Page 7 of 7 r? f"? R e CK) r 3 rs DENNIS BURKETT, DDS IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2008-6456 CIVIL TERM BRUCE J. REINHOLD and J. LYNN REINHOLD, CIVIL ACTION-LAW husband and wife, Defendants NOTICE TO PLEAD You are hereby notified that you have twenty (20) days in which to plead to the enclosed Reply To New Matter, Answer and New Matter To Counterclaim or a Default Judgment may be entered against you. *114EAE , B CHERER Date: David A. Baric, Esquire I.D. # 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 DENNIS BURKETT, DDS Plaintiff V. BRUCE J. REINHOLD and J. LYNN REINHOLD, husband and wife, Defendants CIVIL ACTION-LAW REPLY TO NEW MATTER, ANSWER AND NEW MATTER TO COUNTERCLAIM AND NOW, comes Plaintiff, Counter-Defendant, Dennis Burkett, DDS, by and through his attorneys, O'BRIEN, BARIC & SCHERER, and files the within Reply to New Matter, Answer and New Matter to Counterclaim and, in support thereof, sets forth the following: REPLY TO NEW MATTER 18. Plaintiff hereby incorporates by reference paragraphs one through seventeen of his Complaint as though set forth at length. 19. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. 20. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. 21. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. WHEREFORE, Plaintiff requests that judgment be entered in his favor and against IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-,6456 CIVIL TERM Defendants in accordance with the relief prayed for by Plaintiff in his Complaint. ANSWER TO COUNTERCLAIM 22. Plaintiff incorporates by reference paragraphs one through seventeen of his Complaint and eighteen through twenty-one of his Reply to New Matter as though set forth at length. 23. To the extent these averments constitute conclusions of law they are denied and strict proof thereof is demanded. 24. Admitted. 25. Denied as stated. To the contrary, Plaintiff and Bruce Reinhold have been acquaintances during the period of time Bruce Reinhold has been a patient of Plaintiff's practice. 26. Denied. To the contrary, Plaintiff informed Bruce Reinhold that Plaintiff would accept insurance payments against his charges provided Reinhold provided and continued to provide in kind services and goods to offset the balance due after application of insurance payments. At no time did Plaintiff agree to accept the insurance payments in full if Bruce Reinhold failed and/or refused to provide in kind services or goods to offset the remaining balance owed. 27. Admitted in part and denied in part. It is admitted only that Plaintiff accepted insurance payments as full payment during the period of time Bruce Reinhold provided and continued to provide in kind services and goods to offset the remaining balance. 28. Admitted. 29. Admitted in part and denied in part. It is admitted only that Bruce Reinhold failed to respond to Plaintiff. The remaining averments are denied and strict proof thereof is demanded. 30. Denied. To the contrary, Plaintiff did not leave a "rude" message for Defendants. 31. Denied. To the contrary, Plaintiff charged Defendants for the actual amount owed for the services provided since Defendants had breached their agreement with Plaintiff to provide in kind goods and services to offset the debt remaining after application of insurance payments. 32. Denied. The document is a writing which speaks for itself. Moreover, Defendants' Exhibit A presumed that Defendant, Bruce Reinhold, would continue to provide in kind goods and services to offset the actual cost of the services provided by Plaintiff. 33. To the extent these averments are legal conclusions, no response is required. To the extent a response may be required the averments are denied. To the contrary, Plaintiff s actions did not violate the referenced Act. 34. Denied. To the contrary, Plaintiff made no representations to Defendants and there was no reasonable reliance by Defendants. WHEREFORE, Plaintiff requests that judgment be entered in his favor and against Defendants on the counterclaim of Defendants and judgment be entered in favor of Plaintiff in accord with the demand set forth in Plaintiff's Complaint. NEW MATTER TO COUNTERCLAIM 35. Plaintiff incorporates by reference paragraphs one through seventeen of his Complaint, paragraphs eighteen through twenty-one of his Reply to New Matter, paragraphs twenty-two through thirty-four of his Answer to Counterclaim as though set forth at length. 36. Defendants' counterclaim fails to state a claim upon which relief may be granted. 37. Defendants's counterclaim is barred by applicable statutes of limitation. 38. Defendants' counterclaim is barred by the doctrines of laches, waiver and/or estoppel. 39. Plaintiff was at all times justified in his actions. 40. Defendants have failed to plead all elements of fraud. 41. There was no justifiable reliance by Defendants on any representation of Plaintiff. WHEREFORE, Plaintiff requests that the counterclaim of Defendants be dismissed and judgment be entered in favor of Plaintiff in accordance with the prayer for relief set forth in Plaintiff s Complaint. Respectfully submitted, ' EN, BA Sc David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 da b.dir/litigation/bu rkett/reinhold/newmatter. rep 4 VERIFICATION I verify that the statements made in the foregoing Reply To New Matter, Answer and New Matter To Counterclaim are true and correct to the best of my knowledge, information and belief. This verification is signed by David A. Baric, Esquire, Attorney for Plaintiff and is based upon the statements provided by Plaintiff, as well as documents reviewed by the undersigned as attorney for Plaintiff. This verification will be substituted and ratified by a verification signed by the Plaintiff who is presently unavailable to sign said verification. I undersigned that false statements herein are made subject to penalties of 18 Pa.C.S. §4904, relating to unsworn falsifications to authorities. ?y David A. Baric, Esquire Dated: December 23, 2008 CERTIFICATE OF SERVICE I hereby certify that on December 23, 2008, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy of the Reply To New Matter, Answer and New Matter To Counterclaim, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Kenneth F. Lewis, Esquire 1101 North Front Street Harrisburg, Pennsylvania 17102 David A. Baric, Esquire '-? __t ?...r, ,a }_.y .°3 T'`.3 C?.+ ^^+'7 ,.. ? ::? Ij i 1 .1. DENNIS BURKETT, DDS Plaintiff V. BRUCE J. REINHOLD and J. LYNN REINHOLD, husband and wife, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-6456 CIVIL TERM CIVIL ACTION-LAW PRAECIPE TO ATTACH SUBSTITUTE VERIFICATION Please attach the following Substitute Verification to the Reply To New Matter, Answer and New Matter To Counterclaim filed in this matter on December 23, 2008. Respectfully submitted, Date: December 30, 2008 O EN, BARIC & SC RER L i David A. Baric, Esquire I.D. #44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 VERIFICATION I, Dennis Burkett, verify that the statements made in the foregoing Reply To New Matter, Answer and New Matter To Counterclaim are true and correct to the best of my knowledge, information and belief. I hereby ratify the verification previously supplied by my attorney, David A. Baric, Esquire and execute this verification as a substituted verification. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn falsifications to authorities. Date: _1%lllln?2 2b0 GJ.'fni? - Dennis Burkett CERTIFICATE OF SERVICE I hereby certify that on December 30, 2008, I, David A. Baric, Esquire of O'Brien, Baric & Scherer, did serve a copy of the Praecipe To Attach Substitute Verification, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Kenneth F. Lewis, Esquire 1101 North Front Street Harrisburg, Peawylvania 17102 David A. Baric, Esquire ?'} ;+J c? C.? :-" C., ? ??l t"il C"7 { _ =?. ?, ., G;J <?. 't7 ._? ? -. `.? DENNIS BURKETT, DDS, Plaintiff V. BRUCE J. REINHOLD and J. LYNN REINHOLD, husband and wife, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2008-6456 CIVIL TERM CIVIL ACTION - LAW JURY TRIAL DEMANDED REPLY TO PLAINTIFF'S NEW MATTER TO COUNTERCLAIM Defendants, by their undersigned attorney, file this Reply, averring as follows: 35. Defendants incorporate their Answer With New Matter and Counterclaim as if fully set forth herein. 36. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. 37. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. 38. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. 39. Denied for the reasons set forth in Defendants' initial pleading, which is incorporated by reference herein. 40. This is a legal conclusion to which no response is required. To the extent a response may be required, the averment is denied. WHEREFORE, Defendants demand judgment as follows: a. an award of three times the Plaintiff's claimed damages, which equals $11,329.20; b. reasonable attorney's fees; and c. costs of Court and any other fees, costs and further relief as the Court may deem appropriate. d. The total damages claimed by Defendants are within the limit requiring the case to be subjected to compulsory arbitration. DATED : } J ` KE ET F. LEWIS, ESQ. At rn y for Defendants Attorney I.D. #69383 1101 North Front Street Harrisburg, PA 17102 (717) 234-3136 VERIFICATION I hereby verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904, relating to unsworn falsification to authorities. Dated : i 4'?" ? W /- /- e r BR EINHOLD Dated: J. L REINH3 D CERTIFICATE OF SERVICE I certify I have served a true and correct copy of the within document upon attorney for Plaintiff by mailing same, postage prepaid at Harrisburg, PA, on the day of January, 200P9, at the following address: David A. Baric, Esq. 19 West South St. Carlisle, PA 17013 DATED : 1/s/6 / /,? /,JO KENN F. LEWIS, ESQUIRE Att TH ey for Defendants (??n ??? ?, ? ??? , ??` ?.M ? <? ..? at?