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HomeMy WebLinkAbout08-7099IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, V. DOROTHY MUSGRAVE, Defendant No. 08-11C99 Civil -FarW CIVIL ACTION - LAW NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone: (717) 249-3166 (800) 990-9108 ORIGINAL IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. V. DOROTHY MUSGRAVE, Defendant. CIVIL ACTION - LAW AVISO PARA DEFENDER Conforme a PA RCP Num. 1018.1 USTED HA SIDO DEMANDADO/A EN COUTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO, LLAME O VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES POSIBLE QUE ESTA OFICINA LE PUEDA PROVEER INFORMACION SOBRE AGENCIAS QUE OFREZCAN SERVICIOS LEGALES SIN CARGO O BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telffono: (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. U 8 - ?0 4 9? ??-.- v. DOROTHY MUSGRAVE, Defendant. CIVIL ACTION - LAW COMPLAINT AND NOW COMES, Church of God Home, Inc. ("Plaintiff"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the following complaint against Dorothy Musgrave ("Defendant"), and in support thereof, states: 1. Plaintiff is a foreign corporation licensed to do business in the Commonwealth of Pennsylvania, with its principal offices located at 801 North Hanover Street, Carlisle, Pennsylvania 17013. 2. Defendant is an adult individual who currently is a resident at Plaintiffs facility, located at 801 North Hanover Street, Carlisle, Pennsylvania 17013. 3. On or about July 12, 2007, Plaintiff and the Defendant entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff agreed to provide Dorothy Musgrave with skilled nursing services in exchange for Defendant's promise to pay, inter alia, a specific monetary fee. A true and correct copy of the Agreement is attached hereto as Exhibit "A." 4. Defendant currently owes the Plaintiff $86,144.87 for the skilled nursing services provided to her, and that amount will continue to accrue on a daily basis as long as she remains in Plaintiff's facility. COUNT I - BREACH OF CONTRACT 5. Paragraphs 1 through 4 above are incorporated by reference as though restated in full. 6. At all times material hereto, Plaintiff has been entitled to compensation for the care and services rendered to Defendant, purusant the terms of the Agreement entered into with Plaintiff. 7. Defendant has breached her contractual obligations by failing to pay Plaintiff for services rendered. WHEREFORE, Plaintiff demands judgment in its favor and against Defendant in the amount of $86,144.87. Dated: ll y 0*'? By Respectfully submitted, SCHUTJER BBOGAR LLC (f~ 4_`? Chadwick O. Bogar Attorney I.D. No. 83755 (717) 909-5920 Anthony T. Lucido Attorney I.D. No. 76583 (717) 909-0353 417 Walnut Street. 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff IN Cate/Time NOV-25-2008(TUE) 14:04 2541125 P.C04 11/25/2008 14:24 2541125 CHURCH OF GOD HO PAGE 04/07 cn-CUUv%Iut! IG:JI P. 004/007 VkZiII'ICAITON The undersigned hereby verifics that the statements of fact in the foregoing document are true and correct to the beat of any knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C. S. § 4.904, relatttg to unsworn fakfii,catio,n to authorities. Dated: li-o7, G? L24m a4a-n2c?? S haron Cramer, Business Office manager Church of God Home, Inc. EXHIBIT "A" CHURCH OF GOD HOME, INC. ADMISSION AND CARE AGREEMENT THIS AGREEMENT is made on this day of ^-. by y," a cilit and between The Church of God Home, Inc., ca4eat Pennsylvania non-profit corporation located rh Hanover Street arlisle, Cumberland Cc Pennsylvania, 1/1 A A L1;? and called "Resident" and 1-1 A I\' called "Responsible Party". The Resident and the Responsible Party reaffirm that the information provided in the Pre-Admission Questionnaire is true and correct and understand that the submission of false information may constitute grounds to terminate this Agreement.* The Resident has applied for admission to the Facility and the Facility has approved the. Application for Admission. Therefore, the Facility, The Resident and Responsible Party agree to the following terms: 1. PROVISION OF SERVICES. The Facility will provide Resident with: (a) Skilled nursing care, i.e. professionally supervised nursing care and related health services under a plan of services regularly provided under a plan of care supervised by licensed personnel and, as required by the Resident's medical condition, assistance with activities of daily living. (b) Accommodations consistent with the level of care provided to the Resident including heat, air conditioning,..electricity and hot and cold water. (c) Bed, bedding, blankets and laundered bed linens, towels .and wash cloths.- (d) Three meals each day, except as-otherwise medically indicated. (e) Activity programs and social services. 2. RECURRING CHARGES. In exchange for the above services, the Resident shall pay the following recurring charges: (a) For skilled nursing care: $ C9 IQ. 620_? -dollars.per day. Admission and Care Agreement - continued }. NON-RECURRING CHARGES. The Resident shall pay the following non-recurring charges: (a) A security deposit in the amount of thirty-one (31) .times the current daily rate for the level of care required by the resident, will be billed after a 's ion day. The amount of the security deposit is C. ? ?. No interest will be paid on the security deposit. A security deposit will not be charged to residents who are receiving benefits for room and board provided by Medicare, until the Medicare benefit concludes. An applicant who is covered by Medicaid is not required to pay a security deposit. (b) The cost for enrollment in the community a e and ALS (Advance Life Support) Unit is $ This fee must be paid prior to admission and w' 1 be?billed annually to the.-Resident. 4. MISCELLANEOUS CHARGES AND OUTSIDE SERVICES. Resident is responsible to pay for other services provided by the Facility which are not covered by the daily rate/charge. , A list of such services/charges . is attached to this Agreement on the "'Chart of Costs." The services of a licensed physician and dentist, a registered pharmacist and licensed pharmacy for the provision of pharmaceutical supplies, a licensed hospital, and- diagnostic services, will be made available at the Resident's expense. THE RESIDENT HAS THE RIGHT TO SELECT HIS/HER OWN PHYSICIAN OR ANY OTHER SERVICE PROVIDER SO LONG AS THE PHYSICIAN OR OTHER SERVICE PROVIDER IS PROPERLY LICENSED OR REGISTERED UNDER THE LAW, AND THAT ALL APPLICABLE GOVERNMENT RULES AND POLICIES OF THE-FACILITY ARE MET. In addition to the Facility.' s . charges, the Resident is responsible to pay -all fees and costs *for goods or services furnished to or for the Resident by anyone other than the Facility under this Agreement. The responsibility of the Resident to pay applies to all fees for costs of services provided for the Resident by any physician, dentist, optometrist,*. therapist, diagnostic or test ing:laboratory; pharmacist, pharmacy, hospital, or any other person, facility or entity providing services or goods to or for the Resident, and for all drugs, medicines, medications, pharmaceutical supplies, corrective eye lenses, hearing aids, dentures, hair care, and other personal items or services for the Resident. SUCH FEES AND COSTS ARE NOT INCLUDED IN THE HOME'S DAILY RATE/CHARGE. Admission and Care Agreement - continued 5. ADMISSION. The Resident will be witted, or a bed will be reserved-for Resident, beginning on - All pre-admission charges will be billed after admission, and recurring charges will begin to accrue as of the above-date. The Resident may reserve an available bed by paying the daily rate for the bed reserved. The daily rate for the reserved bed will continue to accrue and be payable until the reservation is terminated, even if the Resident does not enter the-Rome for whatever reason, including illness, injury, incapacity or death. 6. PERIODIC BILLINGS AND PAYMENT DUE DATE.. (a) On the first of.each month, Resident will be billed the current daily rate for Resident's current level of care times the number of days in the month. The bill is due and payable upon receipt. (b) Miscellaneous charges (refer to "Chart of Costs" attached to this Agreement) such as hair care personal laundry, incontinency, supplies, etc., are.additional charges above the, daily rate. These miscellaneous charges will be added to, and included with,. your monthly bill (c) Pharmacy charges will be billed as a separate part of the Facility's monthly bill, and will require a separate check. (d) Outside providers.will bill directly and separately. 7. CHANGES IN CHARGES. From time to time,the Facility may change the amount of its charges. In addition, from time to time, the Facility may change how and when its'charges are -computed, billed or become due. The Facility reserves the right to make any such changes at any time. Written notice of any such changes will be given to the Resident thirty (30) days in advance of implementation, unless- the change is required earlier under any federal or state law or assistance program. B. PARTICIPATION IN "MEDICARE/MEDICAID" PROGRAMS. The Facility participates in the Medicare program administered pursuant to Title XVIII of the Federal Social Security Act and the Pennsylvania Medical Assistance Program ("Medicaid") administered pursuant to the Pennsylvania state plan and Title XIX of the Federal Social Security. Act. However, the Facility reserves the right to withdraw from the Medicare/Medicaid programs at any time in accordance with the law. Admission and Care Agreement - continued -9-. OBLIGATIONS OF RESPONSIBLE PARTY. The Responsible Party is responsible for services and supplies that are billed through the Facility or billed directly to the Resident or Responsible Party by any other provider. The Responsible Party is responsible' to pay all fees and costs from Resident's resources. 10. READMISSION - BED HOLD POLICY. 'If the Resident leaves the Facility for a period of hospitalization, therapeutic leave, or any other reason, other than the Resident's death, and if the Resident is not eligible for, or receiving medical assistance, the Resident's bed will be reserved and charges for the reserved bed will continue to accrue, unless the Resident or Responsible Party -otherwise directs in writing. If the Resident or Responsible Party elects not to reserve a bed, then the Resident will be eligible for readmission upon the availability of the first bed suitable for the Resident's level of care.' If the Resident is receiving medical assistance benefits and - the Resident - leaves . the Facility for. -a period of hospitalization or therapeutic leave, the Resident's bed will be reserved for the applicable maximum number of days paid for the reserved bed under the Pennsylvania Medical Assistance- Program. The current :bed reservation period is fifteen (15) days for hospitalization, regardless of level of care, fifteen (15) days for therapeutic leave for residents receiving skilled nursing care,.. and thirty (30) days for therapeutic leave for residents receiving intermediate care. The bed reservation, period may be subject to change in accordance with any changes in the-Medical Assistance Program. If the period of hospitalization or therapeutic leave ends within *the 'reservation period under the Medical Assistance Program, the Resident may return to the Facility. If the period of hospitalization or therapeutic leave exceeds the maximum time for reservation of a bed under the Pennsylvania. Medical Assistance Program, the Resident- must wait until a suitable bed becomes available for readmission. The Resident is entitled to the first available bed suitable for the Resident's level of care if, at the time of readmission, the Resident requires the services provided by the Home. 11. REFUNDS. The security deposit for private pay residents, after deductions for the payment of any outstanding bills owed to the Facility, will be refunded within thirty (30) days after the Resident's. discharge from the Facility or death. Those Nursing Residents on Medical Assistance will receive their refund, if any due,* within ninety (90) days. There will.be no other refunds, in the absence of an overpayment, under this Agreement.. 12.. PERSONAL FINANCES. The Resident has the right to manage his/her personal funds. The Resident is and will be responsible to provide his/her personal funds. If the Resident elects, the Resident may designate, in writing, that the Facility hold and manage the Resident's personal funds If the Resident Admission and Care Agreement - continued designates someone other than the Facility to manage his/her personal funds, the Resident or Responsible Party shall notify the Facility promptly.. The Resident is not required to make any designation, and 'is responsible for his/her own personal funds unless such designation is made. The Resident may revoke, at any time, the designation of the Facility as the manager of his/her personal funds by providing the Facility a written notice signed and dated by the Resident or Responsible Party. If.the Resident transfers to the Home, responsibility to -manage the Resident's personal funds, the Facility will do so in accordance with the "Rights of Nursing Facility Residents", a copy of which 'is- provided at the time of your admission, and the Facility's personal funds management policy. The Facility may deduct, at any time, charges due to the Facility under..this agreement from. the Resident's personal funds managed by the Facility. 13. TERMINATION. TRANSFEROR DISCHARGE. (a) By the Resident: The. Resident may terminate this Agreement upon thirty (30) days written notice to the Facility. If the Resident leaves the Facility for any reason other than a medical emergency or his/her death, the Resident must give written notice to the. Facility at least thirty (30)-days in advance of the departure/ transfer/discharge or termination of the Agreement. If advance written notice is.not given to the Facility, .there will be due to the Facility its daily and other charges then in effect for the Resident's current level of care for the required.thirty (30) day notice period. The charge applies whether or not the Resident remains at the Facility during the thirty. (30) day period. (b) By the Facility: The-Facility may terminate the Resident's stay and transfer or discharge the Resident if: (I) the transfer or discharge is necessary.to meet the Resident's welfare which cannot be.met by the Facility; (II) the Resident's health or condition has improved sufficiently that'the Resident no longer needs the services provided by the Facility; (III) the safety or health of individuals in the Facility is or otherwise would be endangered; Admission and Care Agreement- continued IV. The charges or other amounts due to the Facility under this Agreement have not been paid to the Facility or treated as paid to the Facility on the Resident's behalf by Medical Assistance under the Medical Assistance Program or by Federal Medicare benefits under Title XVIII of the Federal Social Security Act; or V. The Facility ceases to operate. The Facility generally will notify the Resident and Responsible Party or if none, a family member or legal representative of the Resident, if known to the Facility, at least thirty (30) days in advance of such a transfer or discharge. However, in any case, describe in subparagraph (I), (II) and (III) above, or if the Resident has not resided at the Facility for at least thirty (30) days, the Facility will give such notice before transfer or discharge as is practicable under the circumstances. 14. THIRD PARTY PAYMENTS- The Resident may be or may become eligible to receive financial assistance, reimbursement or other benefits from third- parties, such as through private insurance, employee benefit plans. Medical assistance under the Pennsylvania Medical Assistance Program, Medicare benefits, supplementary medical or other health insurance, supplemental security income insurance, or old-age survivors' or disability insurance under or pursuant to the Federal Social Security Act or Program. If the Resident becomes eligible to receive payments from any third-parties for the stay and care of the Resident, the Resident/Responsible Party shall, at all times, cooperate fully with the Facility and each third-party payments. Cooperation includes, when requested, providing information, signing and delivering documents, and having the Facility designated by the Social Security Administration as the Resident's representative payee for receipt of Federal Social Security benefits or any other governmental assistance, reimbursement or benefits to the extent of all charges due the Facility. The Resident irrevocably authorizes the Facility to make claims and to take such other actions as maybe necessary for the Facility's receipt of third-party payments. To the fullest extent permitted by law, the Resident hereby assigns now or hereafter payable to the extent of all charges due to the endorse and turn over to the Facility any payments received from third-parties to the extent necessary to satisfy the charges under this Agreement. Admission and Care Agreement- continued 15. PERSONAL PROPERTY- The Resident/ Responsible Party is and will be responsible to furnish and maintain clothing, jewelry, personal possessions, and other items of.property. The facility may limit the amount or type of property that the Resident may keep at the facility if there is insufficient space, or if medically indicated or necessary to protect the rights or welfare of others. All non-clothing items of value must be recorded on the resident's personal inventory located with their medical record on the day of admission or any day thereafter. The same is true if removing an item of value from the resident's room. You are requested to see the charge nurse regarding resident's personal property. If nametag labels are needed for clothing items, please leave them at the nursing station. 16. RESPONSIBILITIES OF RESIDENT- The Resident shall comply fully with all governmental laws and regulations, the provisions of this Agreement and the facility's existing policies, rules and regulations which may, from time to time, be altered or amended. 17. MISCELLANEOUS PROVISIONS a. The Resident and Responsible Party acknowledge that they are adult individuals and have read and understand the terms of this Agreement. b. The provisions of this Agreement shall be governed by the laws of the Commonwealth of Pennsylvania and shall be binding upon and inure to the benefit of each of the undersigned parties and their respective heirs, personal representatives, successors and assigned. c. The various provisions of this Agreement shall be severable one from another. If any provision of this Agreement is found by competent legal authority to be invalid, the other provisions shall remain in full force and effect as if the invalid provision had not been part of this Agreement. d. The Facility reserves the right to modify unilaterally the terms of this Agreement to conform to subsequent changes in the law or regulation and changes in charges. Resident will be provided thirty (30) days notice of changes in charges and, if practicable, reasonable notice of any modifications required by law. ble Party 16 R o` 4 ? t m? T -0 ? W D ? 1 SHERIFF'S RETURN - REGULAR CASE NO: 2008-07099 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND CHURCH OF GOD HOME INC VS MUSGRAVE DOROTHY KENNETH E GOSSERT , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE was served upon MUSGRAVE DOROTHY the DEFENDANT , at 0015:15 HOURS, on the 17th day of December-, 2008 at 801 NORTH HANOVER STREET CARLISLE, PA 17013 by handing to DOROTHY MUSGRAVE DEFENDANT a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 4.50 Affidavit .00 Surcharge 10.00 Q .00 / z l2 ?r/0 8 /, ? 32.50 Sworn and Subscibed to before me this day of , So Answers: atl R. Thomas Kline 12/18/2008 SCHUTJER BOGAR LLC By: A. D. (David 1D. Bueff Prothonotary XirkS. Sohonage, Soficitor Ppwe X Simpson 1" (Deputy ftothonotary Irene E. 9dorrow 2"d Deputy Prothonotary office of the 1tothonotary umberfand County, Pennsylvania LL - 7699 CIVIL TERM AND NOW INTENTION ORDER OF TERMINATION OF COURT CASES IS 25TH DAY OF OCTOBER, 2011, AFTER MAILING NOTICE OF PROCEED AND RECEIVING NO RESPONSE -THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA R.C.P 230.2 BY THE COURT, DAVID D. BUELL PROTHONOTARY One Courthouse Square 9 Sure 100 • Carfsfe, P-A 17013 9 (717 240-6195 9 Fax (717 240-6573