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HomeMy WebLinkAbout08-7125IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. pg - 711 Civil -Frm V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION - EQUITY NOTICE TO DEFEND Pursuant to PA RCP No. 1018.1 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone: (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION - EQUITY "ISO PARA DEFENDER Conforme a PA RCP Num. 1018.1 LISTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veiente (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objeccionee a, las demandas presentadas aqui en contra suya. Se le advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted pued perder dinero o propiedad u otros derechos importantes para usted. LISTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI LISTED NO TIENE UN ABOGADO, LLAME 0 VAYA A LA SIGUIENTE OFICINA. ESTA OFICINA PUEDE PROVEERLE INFORMACION A CERCA DE COMO CONSEGUIR UN ABOGADO. SI LISTED 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 0 BAJO COSTO A PERSONAS QUE CUALIFICAN. Lawyer Referral Services Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Tel6fono: (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION - EQUITY COMPLAINT AND NOW COMES Plaintiff, Church of God Home, Inc. ("Plaintiff"), by and through its attorneys, Schutjer Bogar LLC, and files the within complaint against Louise Hoffheins ("Defendant"), and in support thereof, provides as follows: 1. Plaintiff is a non-profit, domestic corporation and skilled nursing facility licensed to do business in the Commonwealth of Pennsylvania, with its principal offices located at 801 Harrisburg, Carlisle, Pennsylvania 17013. 2. Defendant is an adult individual who currently resides at 23 Valley Street, Carlisle, Pennsylvania 17013. 3. On or about March 13, 2007, Defendant made application for the admission of her father, Lewis Ney, to Plaintiff's skilled nursing facility. 4. On or about March 15, 2007, Plaintiff and the Defendant entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff agreed to provide Lewis Ney with skilled nursing services in exchange for Defendant's promise to pay, inter alia, a specific monetary fee from Lewis Ney's assets and, in the event that Lewis Ney became insolvent, to secure Medical Assistance benefits on his behalf in a timely and proper manner, and to cooperate with Plaintiff in providing information about Lewis Ney's finances. A true and correct copy of the Agreement is attached hereto as Exhibit "A." 5. After his admission to Plaintiff's skilled nursing care facility, Lewis Ney allegedly became insolvent. 6. Subsequently, pursuant to the Agreement, Plaintiff filed an application for Medical Assistance benefits on behalf of Lewis Ney. Plaintiff was compelled to file the application because the Defendant failed to do so. 7. The above-referenced application for Medical Assistance benefits remains pending. However, if Defendant fails to provide the Cumberland County Assistance Office with the information necessary to qualify Lewis Ney for Medical Assistance benefits, the application will be denied, and any appeal of that denial will be unavailing. COUNTI BREACH OF CONTRACT/ SPECIFIC PERFORMANCE 8. The allegations contained in Paragraphs 1 through 7 above are incorporated by reference as though fully set forth herein. 9. Plaintiff has provided and continues to provide skilled nursing services to Lewis Ney in accordance with the terms and conditions of the Agreement. 10. The Defendant breached the Agreement with Plaintiff when she failed to secure Medical Assistance benefits on behalf of Lewis Ney, and the Defendant continues to breach the Agreement with Plaintiff by failing to provide the Cumberland County Assistance Office with the documents required to qualify Lewis Ney for Medical Assistance benefits. 13. The Defendant's breach of the Agreement has irreparably harmed and continues to irreparably harm Plaintiff. 14. Upon information and belief, at all times material hereto, Lewis Ney has been financially unable to fully compensate Plaintiff for the care and services that it has rendered and will continue to render to him in accordance with the terms and conditions of the Agreement. 15. Accordingly, only a decree of specific performance will adequately protect the interests of Plaintiff and provide it with the benefits and/or protections promised under the Agreement. WHEREFORE, Plaintiff seeks a decree from this Honorable Court which orders specific performance of the Agreement between the parties. Dated: tO-a-Mg By: Respectfully submitted, SCHUTHR BOGAR LLC Anthony T. Lucido Attorney I.D. No. 76583 417 Walnut Street, 4th Floor Harrisburg, PA 17101 (717) 909-0353 Fax (717) 909-5925 alucido@schutierbogar.com kx Uate/ ime 11/17/2008 NUV-If-dUU8(MUN) 13;55 14:17 _ 2541,125 2541125 CHURCH OF GOD HO Mon P. 004 PAGE 04/04 The undersigned hereby verifies that the statements of fact in the foregoing document are true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained In 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. iho-to-7 ? Dated- 'L Sharon Cramer, 5R ing/AR Specialist Church of God Home, Inc. r] EXHIBIT "A" CHURCH OF GOD HOME, INC. ADMISSION AND CARE AGREEMENT THIS AGREEMENT is made on this 15 44 day of V ?C u ' 7 , by and between The Church of God Home, Inc., calle the "Facility," a Pennsylvania non-profit corporation located at 841 North Hanover Street, Carlisle, Cumb 1 d county, Pennsylvania, and called "Resident" and 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: $_,P/a/00 J dollars per day. Admission and Care Agreement - continued -3-. NON-RECURRIIJG 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 dmission day. The amount of the security deposit is d $' t4 nd. No interest will be paid on the security deposit. A security deposit will not be charged to residents who are receiving benefits for room and board provided by Medicare, until the Medicare benefit concludes. An applicant who is covered by Medicaid is not required to pay a security deposit. (b) The cost for enrollment in the community a ance and ALS (Advance Life Support) Unit is $ This fee must be paid prior to admission and w ?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 servi ces /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 testing laboratory, pharmacist, pharmacy, hospital, or any other person, facility or entity providing services or goods to or for the Resident, and for all drugs, medicines, medications, pharmaceutical supplies, corrective eye lenses, hearing aids, dentures, hair care, and other personal items or services for the Resident. SUCH FEES AND COSTS ARE NOT INCLUDED IN =1 - HOME'S DAILY RATE/CHARGE. Admission and Care Agreement - continued 5. ADMISSION. The Resident will be admitted, or,a bed will be reserved for Resident, beginning on _?3-/_S"07 All pre-admission charges will be billed after admission, and recurring charges will begin to accrue as of the above-date. The Resident may reserve an available bed by paying the daily rate for the bed reserved. The daily rate for the reserved bed will continue to accrue and be payable until the reservation is terminated, even if the Resident does not enter the Home for whatever reason, including illness, injury, incapacity or death. 6. PERIODIC BILLINGS AND PAYNM 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. 8. 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 -g. 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. lo. 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. TERB= 3:ON, TRANSFER OR DISCHARGE. (a) By the Resident: The Resident may terminate this Agreement upon thirty (30) days written notice to the Facility. If the Resident leaves the-Facility for any reason other than a medical emergency or his/her death, the Resident must give written notice to the Facility at least thirty (30)-days in advance of the departure/ transfer/discharge or termination of the Agreement. If advance written notice is not given to the Facility, there will be due to the Facility its daily and other charges then in effect for the Resident's current level of care for the required thirty (30) day notice period. The charge applies whether or not the Resident remains at the Facility during the thirty (30) day period. (b) By the Facility: The Facility may terminate the Resident's stay and transfer or discharge the Resident if: (I) the transfer or discharge is necessary to meet the Resident's welfare which cannot be met by the Facility; (II) the Resident's health or condition has improved sufficiently that the Resident no longer needs the services provided by the Facility; (III) the safety or health of individuals in the Facility is or otherwise would be endangered; Admission and Care Agreement- continued IV. The charges or other amounts due to the Facility under this Agreement have not been paid to the Facility or treated as paid to the Facility on the Resident's behalf by Medical Assistance under the Medical Assistance Program or by Federal Medicare benefits under Title XVIII of the Federal Social Security Act; or V. The facility ceases to operate. The Facility generally will notify the Resident and Responsible Party or if none. a family member or legal representative of the Resident. if known to the Facility, at least thirty (30) days in advance of such a transfer or discharge. However. in any case. describe in subparagraph (1), (I1) and (11I) 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-parries 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. Resident/Responsible Party Resident Name Facility Date tative ? -b?. .o'Jo ?' O b ? ti v ?, a r=?: ? ,. .. -??? r IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Petitioner, No. V. ^!: r e1LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY '-1 PETITION FOR PRELIMINARY INJUNCTION AND NOW COMES Petitioner, Church of God Home, Inc. ("Petitioner"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the within Petition against Respondent, Louise Hoffheins ("Respondent"), pursuant to Pa. R.C.P. § 1531, and, in support thereof, avers: 1. Petitioner filed a Complaint against Respondent. 2. The Complaint sets forth a claim against Respondent relating to Respondent's breach of her contractual duty owed to Petitioner when she failed to cooperate with Petitioner to obtain Medical Assistance benefits on behalf of her father, Lewis Ney ("Mr. Ney"), pursuant to the Admission Agreement into which she entered on March 15, 2007. See Exhibit "A" to Complaint. 3. The very nature of Respondent's breach of her contractual duty presents an issue of immediate and irreparable harm to Petitioner, as the Medical Assistance application filed by Petitioner on behalf of Mr. Ney will inevitably be denied by the Cumberland County Assistance Office for failure to provide the necessary documentary evidence to qualify him for Medical Assistance benefits. Without this documentation, any subsequent appeals of a denial of benefits would be without merit. 4. The requested injunction would restore the parties to the status quo as it existed immediately prior to the breach of Respondent's contractual duty. 5. Greater injury would result from the denial of the requested injunction than from the granting of the same because absent the injunction, the documentation necessary to qualify Mr. Ney for Medical Assistance benefits will not be provided and his application will be denied and any appeal of that denial will fail. 6. Petitioner's right to relief is clear. See Complaint attached as Exhibit "A." 7. Petitioner lacks an adequate remedy at law, as upon information and belief, at all times material hereto, Mr. Ney has been financially unable to fully compensate Petitioner for the care and services that it has rendered, and continues to render, to him. 8. A bond in the amount of $100.00 should be adequate in the event that it is later determined that the issuance of the instant petition was in error. (Remainder of page intentionally left blank.) WHEREFORE, Petitioner respectfully requests that the Court schedule an immediate hearing on its request for injunctive relief and thereafter issue a decree ordering specific performance of the contractual duty of Respondent. Respectfully submitted, SCHUTJER BOGAR LLC Dated: ' 0 -025 By: • Anthony T. Lucido Attorney I.D. No. 76583 417 Walnut Street, 4th Floor Harrisburg, PA 17101 (717) 909-0353 Fax (717) 909-5925 alucido@schutierbogar.com Attorneys for Plaintiff EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. V. LOUISE HOFFHEINS, Defendant. : CIVIL ACTION -EQUITY COMPLAINT AND NOW COMES Plaintiff, Church of God Home, Inc. ("Plaintiff'), by and through its attorneys, Schutjer Bogar LLC, and files the within complaint against Louise Hoffheins ("Defendant"), and in support thereof, provides as follows: 1. Plaintiff is a non-profit, domestic corporation and skilled nursing facility licensed to do business in the Commonwealth of Pennsylvania, with its principal offices located at 801 Harrisburg, Carlisle, Pennsylvania 17013. 2. Defendant is an adult individual who currently resides at 23 Valley Street, Carlisle, Pennsylvania 17013. 3. On or about March 13, 2007, Defendant made application for the admission of her father, Lewis Ney, to Plaintiffs skilled nursing facility. 4. On or about March 15, 2007, Plaintiff and the Defendant entered into a written Admission Agreement ("Agreement"), pursuant to which Plaintiff agreed to provide Lewis Ney with skilled nursing services in exchange for Defendant's promise to pay, inter alia, a specific monetary fee from Lewis Ney's assets and, in the event that Lewis Ney became insolvent, to secure Medical Assistance benefits on his behalf in a timely and proper manner, and to cooperate with Plaintiff in providing information about Lewis Ney's finances. A true and correct copy of the Agreement is attached hereto as Exhibit "A." 5. After his admission to Plaintiffs skilled nursing care facility, Lewis Ney allegedly became insolvent. 6. Subsequently, pursuant to the Agreement, Plaintiff filed an application for Medical Assistance benefits on behalf of Lewis Ney. Plaintiff was compelled to file the application because the Defendant failed to do so. 7. The above-referenced application for Medical Assistance benefits remains pending. However, if Defendant fails to provide the Cumberland County Assistance Office with the information necessary to qualify Lewis Ney for Medical Assistance benefits, the application will be denied, and any appeal of that denial will be unavailing. COUNT I BREACH OF CONTRACT/ SPECIFIC PERFORMANCE 8. The allegations contained in Paragraphs 1 through 7 above are incorporated by reference as though fully set forth herein. 9. Plaintiff has provided and continues to provide skilled nursing services to Lewis Ney in accordance with the terms and conditions of the Agreement. 10. The Defendant breached the Agreement with Plaintiff when she failed to secure Medical Assistance benefits on behalf of Lewis Ney, and the Defendant continues to breach the Agreement with Plaintiff by failing to provide the Cumberland County Assistance Office with the documents required to qualify Lewis Ney for Medical Assistance benefits. 13. The Defendant's breach of the Agreement has irreparably harmed and continues to irreparably harm Plaintiff. 14. Upon information and belief, at all times material hereto, Lewis Ney has been financially unable to fully compensate Plaintiff for the care and services that it has rendered and will continue to render to him in accordance with the terms and conditions of the Agreement. 15. Accordingly, only a decree of specific performance will adequately protect the interests of Plaintiff and provide it with the benefits and/or protections promised under the Agreement. WHEREFORE, Plaintiff seeks a decree from this Honorable Court which orders specific performance of the Agreement between the parties. Dated: t9-0-0W By Respectfully submitted, SCHMER BOGAR LLC Anthony T. Lucido Attorney I.D. No. 76583 417 Walnut Street, 4th Floor Harrisburg, PA 17101 (717) 909-0353 Fax (717) 909-5925 alucido@schutierbogar.com RR U(3 Ie! I line 11/17/2008 NUV-I I-000Olmull) I3:70 14:17 _ 2541125 C7a 1 1 C5 CHURCH OF GOD HO Rlyf ISCAT r. truu PAGE 04/04 The undersigned hereby verifies that the statements of fact in the foregoing document are true and correct to the best of my knowledge, information and belief I understand that any false statements therein are subject to the penalties contained in 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. V. /I )Q.10/7 l.. ?;. 2 - 05 Dated: I Sharon Cramer, SR ing/AR Specialist Church of God Home, Inc. 11 EXHIBIT "A" CHURCH OF GOD HOME, INC. ADMISSION AND CARE AGREEMENT THIS AGREEMENT is made on this IS 44 day of /! w- o - by and between The Church of God Home, Inc., calle the "Facility," a Pennsylvania non-profit corporation located at 801 North Hanover Street, Carlisle, Cumb 1 d county, Pennsylvania, r and A called "Resident" and j/A k gda64;??D_ 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: vQ (a) For skilled nursing care: $_,R16100 dollars.per day. Admission and Care Agreement - continued -3-. NON-RECURRIN3 MACES. The Resident shall pay the following non-recurring charges: (a) P_ security deposit in the amount of thirty-one (31) times the current daily rate for the level of care required by the resident, will be billed after dmission day. The amount of the security deposit is d $ od. 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 retz+'?ti red to pay a security deposit- (b) The cost for enrollment in the community a ance and ALS (Advance Life Support) Unit is $ This fee must be paid prior to admission and w 11 be billed annually to the.-Resident. 4. MISCSLLANBOTS 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 APPLICARLE GOVERNMENT RULES AND POLICIES OF THE FACILITY ARE MET. In addition to the Facility's charges, the Resident is responsible to pay -all fees and costs for goods or services furnished to or for the Resident by anyone other than the Facility under this Agreement. The responsibility of the Resident to pay applies to all fees for costs of services provided for the Resident by any physician, dentist, optometrist,. therapist, diagnostic or testing laboratory, pharmacist, pharmacy, hospital, or any other person, facility or entity providing services or goods to or for the Resident, and for all drugs, medicines, medications, pharmaceutical supplies, corrective eye lenses, hearing aids, dentures, hair care, and other personal items or services for the Resident. SUCH FEES AND COSTS ARE NOT INCLUDED IN T= HOME'S DAILY RATE/CHARGE. Admission and care Agreem=t - continued 5. ADMIISSION. The Resident will be admitted or,a bed will be reserved-for Resident, beginning on _13-117-6 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 paya.ble-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 RESPONSIBLB 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 - c=timied 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. TM MINATION. TRANSFER OR DISCHARGE. (a) By the Resident: The Resident may terminate this Agreement upon thirty (30) days written notice to the Facility. If the Resident leaves the-Facility for any reason other than a medical emergency or his/her death, the Resident must give written notice to the- Facility at -least thirty (30), days in advance of the departure/ transfer/discharge or termination of the Agreement. If advance written notice is not given to the Facility, -there will be due to the Facility its daily and other charges then in effect for the Resident's current level of care for the required thirty (30) day notice period. The charge applies whether or not the Resident remains at the'Facility during the thirty (30) day period. (b) By the Facility: The Facility may terminate the Resident's stay and transfer or discharge the Resident if: (I) the transfer or discharge is necessary.to meet the Resident's welfare which cannot be met by the Facility; (II) the Resident's health or condition has improved sufficiently that'the Resident no longer needs the services _provided by the Facility; (III) the safety or health of individuals in the Facility is or otherwise would be endangered; Admission and Care Agreement- continued IV. The charges or other amounts due to the Facility under this Agreement have not been paid to the Facility or treated as paid to the Facility on the Resident's behalf by Medical Assistance under the Medical Assistance Program or by Federal Medicare benefits under Title XVIII of the Federal Social Security Act; or V. The Facility ceases to operate. The Facility generally will notify the Resident and Responsible Party or if none. a family member or legal representative of the Resident. if known to the Facility, at least thirty (30) days in advance of such a transfer or discharge. However- in any case. describe in subparagraph (1), (11) and (I11) 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-parry 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-parries 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 00) days notice of changes in charges and. if practicable, reasonable notice of any modifications required by law. Resident/Responsible Party r 7 Resident Name &__-) / _yL Y Facility R sentative Date IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, No. 08-07125 Civil Term V. LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY AMENDMENT TO PETITION FOR PRELIMINARY INJUNCTION AND NOW COMES Petitioner, Church of God Home, Inc. ("Petitioner"), by and through its attorneys, SCHUTJER BOGAR LLC, and files the within Petition against Respondent, Louise Hoffheins ("Respondent"), pursuant to Pa. R.C.P. § 1531, and, in support thereof, avers: 1. In accordance with Cumberland County Local Rule 208.3(a)(2), a judge has not ruled on any other issue in the same or related matter. 2. In accordance with Cumberland County Local Rules 208.3(a)(9), Petitioner is unaware of whether Respondent has retained counsel of record, and to date, Petitioner has not received an Entry / Notice of Appearance of counsel of record for Respondent, therefore, it is assumed that this petition is contested. 3. Petitioner filed a Complaint against Respondent. 4. The Complaint sets forth a claim against Respondent relating to Respondent's breach of her contractual duty owed to Petitioner when she failed to cooperate with Petitioner to obtain Medical Assistance benefits on behalf of her father, Lewis Ney ("Mr. Ney"), pursuant to the Admission Agreement into which she entered on March 15, 2007. See Exhibit "A" to Complaint. 5. The very nature of Respondent's breach of her contractual duty presents an issue of immediate and irreparable harm to Petitioner, as the Medical Assistance application filed by Petitioner on behalf of Mr. Ney will inevitably be denied by the Cumberland County Assistance Office for failure to provide the necessary documentary evidence to qualify him for Medical Assistance benefits. Without this documentation, any subsequent appeals of a denial of benefits would be without merit. 6. The requested injunction would restore the parties to the status quo as it existed immediately prior to the breach of Respondent's contractual duty. 7. Greater injury would result from the denial of the requested injunction than from the granting of the same because absent the injunction, the documentation necessary to qualify Mr. Ney for Medical Assistance benefits will not be provided and his application will be denied and any appeal of that denial will fail. 8. Petitioner's right to relief is clear. See Complaint attached as Exhibit "A." 9. Petitioner lacks an adequate remedy at law, as upon information and belief, at all times material hereto, Mr. Ney has been financially unable to fully compensate Petitioner for the care and services that it has rendered, and continues to render, to him. 10. A bond in the amount of $100.00 should be adequate in the event that it is later determined that the issuance of the instant petition was in error. 2 WHEREFORE, Petitioner respectfully requests that the Court schedule an immediate hearing on its request for injunctive relief and thereafter issue a decree ordering specific performance of the contractual duty of Respondent. Dated: 10, /1 Lot Respectfully submitted, SCHUTJER BOGAR LLC By. Anthony T. Lucido Attorney I.D. No. 76583 417 Walnut Street, 4th Floor Harrisburg, PA 17101 (717) 909-0353 Fax (717) 909-5925 alucido@schutierboRar.com Attorneys for Plaintiff 3 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Amendment to Petition for Preliminary Injunction was served via first-class, United States mail, postage prepaid, upon the following: Louise B. Hoffheins 23 Valley Street Carlisle, Pennsylvania 17013 Date: I D 0 By: (14A'wo?? -5, Cerissa A. Sutherland, Paralegal IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CASE NO.: 08-07125 AFFIDAVIT OF SERVICE Church of God Home, Inc. VS. Louise Hoffheins Commonwealth of Pennsylvania County of Dauphin ss. I, John Shinkowsky, a competent adult, being duly sworn according to law, depose and say that at 11:59 AM on 12/15/2008,1 served Louise Hoffheins at Child Time, Inc., 50 Alexander Spring Road, Carlisle, PA 17015 in the manner described below: ? Defendant(s) personally served. ? Adult family member with whom said Defendant(s) reside(s). Relationship is ? Adult in charge of Defendant(s) residence who refused to give name and/or relationship. ? Manager/Clerk of place of lodging in which Defendant(s) reside(s). ? Agent or person in charge of Defendant's office or usual place of business. an officer of said Defendant's company. ® Other: Served Stanley Sellers. Lead Teacher. who was in charge of the premises at the time of service. a true and correct copy of Notice to Defend, Complaint, Verification, Petition for Preliminary Injunction, Order issued in the above captioned matter. Description: Sex: Male - Age: 30 - Skin: Black - Hair: Black - Height: 5' 11" - Weight: 165 X / Sw rn to and subscribed before me on this Jo Shinkowsky ations day of .e?mlc? 206. Sh kowsky Inve #,th 316 Fawn Ridge AMA" lt6? Harrisburg, PA 17110 (800) 276-0202 N ARY PU IC COMMONWW (it OENNSYLVANIA NOTARIAL SEAL ty File#: - Our File# 5918 Jennifer L. Di Sylvester, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Feb. 26, 2009 Law Firm: Schutjer Bogar LLC Address: 417 Walnut Street, 4th Floor, Harrisburg, PA, 17102 Telephone: (717) 909-5925 t I?Ma V4i n. DEC 06L. , G IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, No. a$ - 7r AS V. LOUISE HOFFHEINS, Respondent CIVIL ACTION - EQUITY Ci vi l le m ORDER AND NOW, this day of 2008, a hearing in the above-captioned matter on Petitioner's Petition for the issuance of a Preliminary Injunction is scheduled for S 200#, at 3 ; 4Z o'clock /°.m. in Court 922. Room No. Cumberland County Courthouse, One Courthouse Square, Carlisle, Pennsylvania. w`; "cam i L4 , ON l 10/' - STIPULATION FOR ENTRY OF INJUNCTION Church of God Homes, Inc. ("Petitioner") and Louise Hoffheins ("Respondent") stipulate and agree IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY to the following: On or about December 4, 2008, Petitioner filed a Complaint against Respondent. 2. The Complaint sets forth a single claim against Respondent based on her failure to specifically perform the terms of the Admission Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed secure the Medical Assistance benefits on behalf of her father, Lewis Ney ("Mr. Ney"), pursuant to the Agreement. 3. An application for Medical Assistance benefits was filed on behalf of Mr. Ney and that application currently is pending before the Cumberland County Assistance Office of the Department of Public Welfare. 4. The parties agree to the entry of an Order directing Respondent to provide any and all records within her possession or control as required by the Cumberland County Assistance Office to determine the eligibility of Respondent for Medical Assistance benefits within fifteen (15) days of the date of the Order adopting this Stipulated Injunction. The parties also agree that Respondent will work diligently to secure any and all other documents or verifications required by the Cumberland County Assistance Office 1 to obtain Medical Assistance benefits, and will obtain those documents within thirty (30) days of the date of the Order adopting this Stipulated Injunction. The Order is attached as Exhibit "A." Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction. 6. The parties agree that failure to abide by the terms of this Stipulation and the Order adopting the same constitutes contempt of Court and may result in sanctions imposed by the Court. Respectfully submitted, Dated: / - S' 0 Dated: 0 z By:- Anthony T. Lucido, Attorney for Petitioner By: C &e* Louise Hoffheins EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. LOUISE HOFFHEINS, Respondent. ORDER No. 08-07125 Civil Term CIVIL ACTION - EQUITY AND NOW, this day of , 2009, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that within fifteen (15) days of the date of this Order, Louise Hoffheins shall provide any and all records in her possession that are required by the Cumberland County Assistance Office for the pending application to determine the eligibility of Lewis Ney for Medical Assistance benefits. Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days. BY THE COURT A 14- - , Kevin . Hess, J. L? ? go? e??D13 A? oa,.I i.4e , P a? ? ?} Ca 11.4101 10 -IJ °--e f IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, No. 08-07125 Civil Term V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION -EQUITY PLAINTIFF'S MOTION FOR CIVIL CONTEMPT AND NOW COMES Plaintiff, Church of God Home, Inc. ("Plaintiff"), by and through its attorneys, Schutjer Bogar LLC, and files the within Motion for Civil Contempt against Louise Hoffheins ("Defendant"), and in support thereof, provides as follows: 1. On January 5, 2009, Plaintiff and Defendant entered into a Stipulation for Entry of Injunction ("Stipulation"). A true and correct copy of the Stipulation is attached hereto as Exhibit "A". 2. Defendant agreed to obtain any and all documents or verifications required by the Cumberland County Assistance Office to obtain Medical Assistance benefits for Lewis Ney within thirty (30) days of the date of the Stipulation. 3. The Court signed an Order on January 5, 2009 requiring the parties to abide by the terms of the Stipulation signed on January 5, 2009. A true and correct copy of the Court's Order is attached hereto as Exhibit "B". 4. In return, Plaintiff agreed to withdraw its Petition for Preliminary Injunction. ORIGINAL 5. The parties also agreed that failure to abide by the terms of the Stipulation would constitute contempt of Court, punishable by sanctions. 6. Plaintiff has abided by the terms of the Stipulation. 7. Defendant, however, has failed to provide the agreed upon documentation, and has further failed to obtain the documentation required by the Cumberland County Assistance Office in order to qualify Lewis Ney for Medical Assistance Benefits. 8. In addition, Defendant has repeatedly refused and/or failed to sign an Authorization Statement which would allow Plaintiff to request the required records. 9. Defendant has failed to abide by the terms of the Stipulation and Order, and in doing so, has violated the parties' Stipulation and the Court's Order of January 5, 2009. 10. Pursuant to Local Rule 208.2(d) the Plaintiff's Motion for Civil Contempt is a Contested Motion. WHEREFORE, Plaintiff respectfully requests this Court hold a Hearing on this matter to find the Defendant in Contempt and issue an Order requiring: 1) Defendant to immediately comply with the January 5, 2009 Stipulation, and provide to Plaintiff the documents required to qualify Lewis Ney for Medical Assistance; 2) Defendant to sign an Authorization Statement, in her capacity as Responsible Party for Lewis Ney, allowing Plaintiff to request any additional records requested by the Cumberland County Assistance Office; 3) Defendant to suffer the sanction of immediate incarceration of three (3) days and the imposition of a monetary sanction in the amount of Fifty ($50.00) Dollars per day, beginning on February 5, 2009, until Defendant has purged herself of her contemptuous action; and 4) Defendant to be incarcerated for a period of ten (10) days. Respectfully submitted, Dated: -?I ` 23"6) g SCHUTJER BOGAR LLC By: Anthony T. ucid Attorney I.D. . 6583 (717) 909-0353 Kelly L. Bonanno Attorney I.D. No. 200811 (717) 909-8641 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff CERTIFICATE OF SERVICE I hereby certify that, on this day, a true and correct copy of the foregoing Motion for Civil Contempt was served via first-class, United States mail, postage prepaid upon the following: Louise Hoffheins 1027 Northfield Drive Carlisle, PA 17013 Dated: L4 0?3 [M By: 6464?? Catherine Klobucar, Paralegal EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Tenn LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY STIPULATION FOR ENTRY OF INJUNCTION Church of God Homes, Inc. ("Petitioner") and Louise Hoffheins ("Respondent") stipulate and agree to the following: 1. On or about December 4, 2008, Petitioner filed a Complaint against Respondent. 2. The Complaint sets forth a single claim against Respondent based on her failure to specifically perform the terms of the Admission Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed secure the Medical Assistance benefits on behalf of her father, Lewis Ney ("Mr. Ney"), pursuant to the Agreement. 3. An application for Medical Assistance benefits was filed on behalf of Mr. Ney and that application currently is pending before the Cumberland County Assistance Office of the Department of Public Welfare. 4. The parties agree to the entry of an Order directing Respondent to provide any and all records within her possession or control as required by the Cumberland County Assistance Office to determine the eligibility of Respondent for Medical Assistance benefits within fifteen (15) days of the date of the Order adopting this Stipulated Injunction. The parties also agree that Respondent will work diligently to secure any and all other documents or verifications required by the Cumberland County Assistance Office to obtain Medical Assistance benefits, and will obtain those documents within thirty (30) days of the date of the Order adopting this Stipulated Injunction. The Order is attached as Exhibit "A." 5. Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction. 6. The parties agree that failure to abide by the terms of this Stipulation and the Order adopting the same constitutes contempt of Court and may result in sanctions imposed by the Court. Respectfully submitted, Dated: /-S D f Dated: _S By: ?`z2 J Anthony T. Lucido, Attorney for Petitioner By: n/ Louise Hoffheins EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. : No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this 1-6 day of., 2009, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that within fifteen (15) days of the date of this Order, Louise Hoffheins shall provide any and all records in her possession that are required by the Cumberland County Assistance Office for the pending application to determine the eligibility of Lewis Ney for Medical Assistance benefits. Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days. BY THE COURT --Xz' 'q- , Kevin ,K. Hess, J. TRUE COPY rrr'7.4 p7,?D In Testimony v.h: r - ; h:: r'- ?...: hand and the seal of said Court at Carlisle, Pa. T ... ?day o Win....../?(\? w.. ..x_...e. _•..?7s+.:....x ......... ....?7K[[[[[ _ r EXHIBIT "B" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this day of. tlo , 2009, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that within fifteen (15) days of the date of this Order, Louise Hoffheins shall provide any and all records in her possession that are required by the Cumberland County Assistance Office for the pending application to determine the eligibility of Lewis Ney for Medical Assistance benefits. Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days. BY THE COURT 14101- Kevin Hess, J. TRUE COPY D In Testimony I:enu and the seal of said Court at Cari s7o, Pa. T ...... ....... ?day o ........ .?.. R 0r TN'- P R01 f jTAPy 2099 APR 27 P11(?* 1, 3 CHURCH OF GOD HOME, INC., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - EQUITY NO. 08-7125 CIVIL LOUISE HOFFHEINS, Defendant IN RE: CONTEMPT CITATION ORDER AND NOW, this /Z ' day of February, 2009, a rule is issued on the defendant to show cause why she should not be adjudged in contempt. This rule returnable and to be heard on Friday, May 22, 2009, at 3:15 p.m., in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. BY THE COURT, Kevin,A. Hess, J. CIQ _ r _£ .. = cv V M C. . A IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, V. LOUISE HOFFHEINS, Defendant. : No. 08-07125 : CIVIL ACTION - EQUITY STIPULATED AGREEMENT IN LIEU OF CONTEMPT HEARING AND NOW, this 22nd day of May, 2009, after discussion, Church of God Home, Inc. and Louise Hoffheins hereby enter into this Stipulated Agreement in Lieu of the Scheduled Contempt hearing, which Stipulated Agreement shall be incorporated into an Order of Court, and hereby agree as follows: 1. Within seven days (7) days, but no later than Friday, May 29, 2009, the Defendant Louise Hoffheins, as Agent for Lewis E. Ney, specifically Agrees to deliver to counsel for the Plaintiff the Wachovia Consolidated Bank Statements of December 2007 and January 2008 for the following accounts of Lewis E. Ney: a. CROWN CLASSIC BANKING - #1010141692337; b. ACCESS FIFTY CK - #1000693121366; C. PREMIUM SAVINGS - #3000081598842. ORIGINAL F;om:Schutjer Bogar LLC 717 909 5925 05/22/2009 11:40 #142 P.003/004 2. Next, within seven days (7) days, but no later than Friday, May 29, 2009, Louise Hoffheins, as Agent for Lewis E. Ney, specifically agrees to deliver to counsel an executed form necessary to obtain Lewis E. Ney's 2006 tax return, which 2006 tax return is currently not in Louise Hoffheins possession. 3. Further, within fourteen (14 ) days, but no later than June 5, 2009, Louise Hoffheins shall file an inventory and accounting of any and all assets of Lewis E. Nye, including monthly income of social security, annuity, pension and the like, over which she had control as his fiduciary, from August 2006 up to the date of the filing of the Inventory and Account. 4. Finally, failure to abide by the terms of this Stipulated Agreement and the Court's Order adopting the same shall constitute Contempt of Court and may result in sanctions. Dated: ?- -2 2 - S 9 Dated: e'2? OD Respectfully su 'tte Kirk S. Sohonage Attorney for Petitioner, Church of God Home, Inc. Mark Thomas Attorney for Louise Hoffheins CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Stipulated Agreement in Lieu of Contempt Hearing was served via first-class, United States mail, postage prepaid, upon the following: Mark Thomas, Esquire THOMAS, LONG, NIESEN & KENNARD 212 Locust #500, PO Box 9500 Harrisburg, PA 17108 Attorney for Louise Hofjheins 5' 41 -" 1 Date: By: William Keslar, Paralegal FILED . I? TH rAF?Y ?t?139 JUN -3 AN ! 1: S 0 [A FIE,' 2 ? 9 JO' y P111 !2: JUN O q 2009a IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, V. No. 08-07125 LOUISE HOFFHEINS, Defendant. ORDER CIVIL ACTION - EQUITY AND NOW, this S ` day of June 2009, Church of God Home, Inc. and Louise Hoffheins having resolved the outstanding contempt issues in the above-noted matter by entry into a Stipulated Agreement in Lieu of the Contempt Hearing, such attached Stipulated Agreement and the terms contained therein are hereby incorporated into and made a part of this Order and shall be enforceable as an Order of this Court. r, Jr., Judge /lw" A • A. irk V5 CIO tE'? 41 in i ?i W Q IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, V. LOUISE HOFFHEINS, Defendant. No. 08-07125 CIVIL ACTION - EQUITY AFFIDAVIT OF SERVICE I, William Keslar, being duly sworn according to law, depose and say that I served R. Mark Thomas, Esquire, with the attached Order dated June 5, 2009, in the above-captioned matter, via First-Class Regular Mail, to his business address at 101 South Market Street, Mechanicsburg, PA 17055 on the 8th day of June, 2009. Dated: (0 I Z 0 9 V___ Keslar, Paralegal Sworn to and Subscribed before me this I Z day of June, 2009. Notary P lic My Commission Expires: ap ypi,(yyg/LL1H pp p*#4$YLVA11w 140-TANAL BBAL BMTANY A. CNF'ARM NOTARY M IC SWATaK:. r,)%%%i1i1P,DAUPKNCOUNTY W C066bg S10P1 M 23.2011 ORIGINAL R ??AR ELLC Email: wkeslar@schugerbogar.com Direct Dial: (717) 909-8985 June 8, 2009 Via Regular Mail R. Mark Thomas, Esquire 101 South Market Street Mechanicsburg, PA 17055 In Re: Church of God Home, Inc. v. Louise Hoffheins Docket No. 08-07125 Dear Attorney Thomas: Schutjer Bogar LLC 417 Walnut Street 4th Floor Harrisburg, PA 17101 Fax (717) 909-5925 www.schutjerbogar.com Enclosed please find an Order issued June 5, 2009, by The Honorable Kevin A. Hess in the above-captioned matter. If you should have any questions, please do not hesitate to contact Kirk Sohonage at (717) 909-8160. Thank you. Sincerely, William Keslar Paralegal Enclosure HARRISBURG, PA PHILADELPHIA, PA PITTSBURGH, PA COLUMBUS. OH PRINCETON, NJ BALTIMORE, MD ARLINGTON, VA JUN 0 4 2009 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. 08-07125 V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION - EQUITY ORDER AND NOW, this S4L_-,-_ day of June 2009, Church of God Home, Inc. and Louise Hoffheins having resolved the outstanding contempt issues in the above-noted matter by entry into a Stipulated Agreement in Lieu of the Contempt Hearing, such attached Stipulated Agreement and the terms contained therein are hereby incorporated into and made a part of this Order and shall be enforceable as an Order of this Court. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ,? r„ ,__ G"J CHURCH OF GOD HOME, INC. Plaintiff, No. 08-07125 V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION- EQU STIPULATED AGREEMENT IN LIEU OF CONTEMPT HEARING ..v i-i1-- AND NOW, this 22nd day of May, 2009, after discussion, Churchof-God,= Home, Inc. and Louise Hoffheins hereby enter into this Stipulated Agreement r Lieu of the Scheduled Contempt hearing, which Stipulated Agreement shall bees incorporated into an Order of Court, and hereby agree as follows: 1. Within seven days (7) days, but no later than Friday, May 29, 2009, the Defendant Louise Hoffheins, as Agent for Lewis E. Ney, specifically Agrees to deliver to counsel for the Plaintiff the Wachovia Consolidated Bank Statements of December 2007 and January 2008 for the following accounts of Lewis E. Ney: a. CROWN CLASSIC BANKING - #1010141692337; b. ACCESS FIFTY CK - #1000693121366; C. PREMIUM SAVINGS - #3000081598842. COPY eFrom:Schutjer Bogar LLC 717 909 5925 0512212009 11:40 #142 P.0031004 2. Next, within seven days (7) days, but no later than Friday, May 29, 2009, Louise Hoffheins, as Agent for Lewis E. Ney, specifically agrees to deliver to counsel an executed form necessary to obtain Lewis E. Ney's 2006 tax return, which 2006 tax return is currently not in Louise Hoffheins possession. 3. Further, within fourteen (14 ) days, but no later than June 5, 2009, Louise Hoffheins shall file an inventory and accounting of any and alt assets of Lewis E. Nye, including monthly income of social security, annuity, pension and the like, over which she had control as his fiduciary, from August 2006 up to the date of the filing of the Inventory and Account. 4. Finally, failure to abide by the terms of this Stipulated Agreement and the Court's Order adopting the same shall constitute Contempt of Court and may result in sanctions. Dated: ?- 2 2 - J 9 Dated: o?? Respectfully submitte - , lljvlle?? Kirk S. Sohonage Attorney for Petitioner, Church of God Home, Inc. Mark Thomas Attorney for Louise Hoffheins CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing Stipulated Agreement in Lieu of Contempt Hearing was served via first-class, United States mail, postage prepaid, upon the following: Mark Thomas, Esquire THOMAS, LONG, NIESEN & KENNARD 212 Locust #500, PO Box 9500 Harrisburg, PA 17108 Attorney for Louise Hoffheins Date: By: William Keslar, Paralegal FILED- OF THE F-' J 1-1 .1 2009 Jul 15 F 3 CUM 'Y 'P - 1. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, V. LOUISE HOFFHEINS, Defendant. CIVIL ACTION - EQUITY No. 08-07125 PLAINTIFF'S SECOND MOTION FOR CIVIL CONTEMPT AND NOW COMES Church of God Home, Inc. ("Plaintiff'), by and through its attorneys, Schutjer Bogar LLC, and files the within Second Motion for Civil Contempt against Louise Hoffheins ("Defendant"), and in support thereof, provides as follows: 1. On January 5, 2009, Plaintiff and Defendant entered into a Stipulation for Entry of Injunction ("Stipulation"). A true and correct copy of the Stipulation is attached hereto as Exhibit "A". 2. The Defendant agreed to obtain any and all documents or verifications required by the Cumberland County Assistance Office to obtain Medical Assistance benefits for Lewis Ney within thirty (30) days of the date of the Stipulation, a violation of the same constituting contempt of Court. (Emphasis added.) 3. The Court signed an Order on January 5, 2009 requiring the parties to abide by the terms of the Stipulation. A true and correct copy of the Court's Order, dated January 5, 2009, is attached hereto as Exhibit "B". 4. The Plaintiff has abided by the terms of the Stipulation. 5. The Defendant, however, has violated the terms of the Stipulation by failing to provide and/or obtain the documentation and verifications required by the Cumberland County Assistance Office necessary to qualify Lewis Ney for Medical Assistance Benefits. 6. On February 12, 2009, based on Defendant's aforementioned failure, the Court signed an Order requiring the Defendant to show cause why she should not be found in contempt of Court. A true and correct copy of the Court's Order, dated February 12, 2009, is attached hereto as Exhibit "C". 7. On or about April 27, 2009, Plaintiff filed a Motion for Civil Contempt, citing Defendant's failure to comply with the January 5, 2009 Stipulation and Order. A true and correct copy of the Motion is attached hereto as Exhibit "D." 8. On or about May 22, 2009, the date set for the Civil Contempt hearing, Plaintiff and Defendant again entered into a Stipulation - this time, a Stipulated Agreement in Lieu of Contempt Hearing ("Stipulated Agreement") A true and correct copy of the Stipulated Agreement is attached hereto as Exhibit "E". 9. As required by the May 22, 2009 Stipulated Agreement, Defendant provided access to the bank account information, tax returns and a cursory accounting of Mr. Ney's assets. 10. However, the Defendant is still in contempt of the original January 5, 2009 Order, requiring that "Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days." See Exhibit "B." 11. Despite Plaintiff's requests to Defendant on June 24, 2009 and again on August 3, 2009, which are attached hereto as Exhibits "F" and "G" respectively, the Defendant continues her refusal and/or failure to: a. Execute the proposed Verified Statement regarding gifting of resources; b. Execute the PA-600; and C. Provide the required documents as outlined by the Cumberland County Assistance Office in their pending list of June 23, 2009, which includes the provision of documentation and verification evidencing an application for Veterans' Aid and Attendance benefits for Mr. Ney; proof of Mr. Ney's gross monthly income and any deductions therefrom; and a copy of Mr. Ney's Power of Attorney document. 12. Defendant has failed to abide by the terms of the Stipulation and Order, and in doing so, has violated the parties' Stipulation and the Court's Order of January 5, 2009. 13. The parties agreed, at paragraph 6 of the Stipulation, that "failure to abide by the terms of this Stipulation and the Order adopting the same constitutes contempt of Court and may result in sanctions imposed by the Court." 14. Pursuant to Local Rule 208.2(d), the necessity of filing Plaintiffs Second Motion for Civil Contempt was submitted to counsel for Defendant, without response, and is, therefore, presumed to be a Contested Motion. See Exhibit "F." WHEREFORE, Plaintiff respectfully requests this Court hold a Hearing on this matter to find the Defendant in contempt of Court and issue an Order requiring: 1. Defendant to immediately comply with the January 5, 2009 Stipulation, and provide to Plaintiff the documents required to qualify Lewis Ney for Medical Assistance; including, but not limited to: a. Defendant's signing the proposed Verified Statement regarding Lewis Ney's gifting of resources; b. Defendant's signing the PA-600, in her capacity as Responsible Party for Lewis Ney; C. Defendant's providing a copy of Lewis Ney's application for Veterans Aid and Attendance benefits; proof of Mr. Ney's gross monthly income and any deductions therefrom; and a copy of Lewis Ney's Power of Attorney document. 2. Defendant to suffer the sanction of immediate incarceration and the imposition of a monetary sanction in the amount of one hundred eighty ($180.00) Dollars per day, the applicable daily Medicaid rate, until Defendant has purged herself of her contemptuous action. Dated: 4, 17 goo Respectfully submitted, SCHUTJER BOGAR LLC By:? Livia F. L gton Attorney I.D. No. 91548 (412) 281-3710 Marijane E. Treacy Attorney I.D. No. 84070 (412) 281-3535 600 Grant Street, Suite 3290 U.S. Steel Tower Pittsburgh, PA 15219 (Fax) 412-281-0530 Chadwick O. Bogar Attorney I.D. No. 83755 (717) 909-5920 417 Walnut Street, 4th Floor Harrisburg, PA 17101 Attorneys for Plaintiff EMIT A IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY STIPULATION FOR ENTRY OF INJUNCTION Church of God Homes, Inc. ("Petitioner") and Louise Hoffheins ("Respondent") stipulate and agree to the following: 1. On or about December 4, 2008, Petitioner filed a Complaint against Respondent. 2. The Complaint sets forth a single claim against Respondent based on her failure to specifically perform the terms of the Admission Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed secure the Medical Assistance benefits on behalf of her father, Lewis Ney ("Mr. Ney"), pursuant to the Agreement. 3. An application for Medical Assistance benefits was filed on behalf of Mr. Ney and that application currently is pending before the Cumberland County Assistance Office of the Department of Public Welfare. 4. The parties agree to the entry of an Order directing Respondent to provide any and all records within her possession or control as required by the Cumberland County Assistance Office to determine the eligibility of Respondent for Medical Assistance benefits within fifteen (15) days of the date of the Order adopting this Stipulated Injunction. The parties also agree that Respondent will work diligently to secure any and all other documents or verifications required by the Cumberland County Assistance Office to obtain Medical Assistance benefits, and will obtain those documents within thirty (30) days of the date of the Order adopting this Stipulated Injunction. The Order is attached as Exhibit "A." 5. Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction. The parties agree that failure to abide by the terms of this Stipulation and the Order adopting the same constitutes contempt of Court and may result in sanctions imposed by the Court. Respectfully submitted, Dated: / _ S_ D Dated: C v? By:-, Anthony T. Lucido, Attorney for Petitioner .V r Louise Hoffheins EXHIBIT B ?ft IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY AND NOW, this day of 2009, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that within fifteen (15) days of the date of this Order, Louise Hoffheins shall provide any and all records in her possession that are required by the Cumberland County Assistance Office for the pending application to determine the eligibility of Lewis Ney for Medical Assistance benefits. Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days. BY THE COURT o ?r Kevin . Hess, J. ,? fed o r3 A D? } -- erll?le, PA 4 l j? Jloj 00 EXHIBIT C CHURCH OF GOD HOME, INC., Plaintiff vs. LOUISE HOFFHEINS, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - EQUITY NO. 08-7125 CIVIL IN RE: CONTEMPT CITATION ORDER AND NOW, this /Z ' day of February, 2009, a rule is issued on the defendant to show cause why she should not be adjudged in contempt. This rule returnable and to be heard on Friday, May 22, 2009, at 3:15 p.m., in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. BY THE COURT, Kevin'K. Hess, J. EXHIBIT D IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Plaintiff, No. 08-07125 Civil Term V. LOUISE HOFFHEINS, Defendant. : CIVIL ACTION - EQUITY PLAINTIFF'S MOTION FOR CIVIL CONTEMPT AND NOW COMES Plaintiff, Church of God Home, Inc. ("Plaintiff'), by and through its attorneys, Schutjer Bogar LLC, and files the within Motion for Civil Contempt against Louise Hoffheins ("Defendant"), and in support thereof, provides as follows: 1. On January 5, 2009, Plaintiff and Defendant entered into a Stipulation for Entry of Injunction ("Stipulation"). A true and correct copy of the Stipulation is attached hereto as Exhibit "A". 2. Defendant agreed to obtain any and all documents or verifications required by the Cumberland County Assistance Office to obtain Medical Assistance benefits for Lewis Ney within thirty (30) days of the date of the Stipulation. 3. The Court signed an Order on January 5, 2009 requiring the parties to abide by the terms of the Stipulation signed on January 5, 2009. A true and correct copy of the Court's Order is attached hereto as Exhibit "B". 4. In return, Plaintiff agreed to withdraw its Petition for Preliminary Injunction. 5. The parties also agreed that failure to abide by the terms of the Stipulation would constitute contempt of Court, punishable by sanctions. 6. Plaintiff has abided by the terms of the Stipulation. 7. Defendant, however, has failed to provide the agreed upon documentation, and has further failed to obtain the documentation required by the Cumberland County Assistance Office in order to qualify Lewis Ney for Medical Assistance Benefits. 8. In addition, Defendant has repeatedly refused and/or failed to sign an Authorization Statement which would allow Plaintiff to request the required records. 9. Defendant has failed to abide by the terms of the Stipulation and Order, and in doing so, has violated the parties' Stipulation and the Court's Order of January 5, 2009. 10. Pursuant to Local Rule 208.2(d) the Plaintiff's Motion for Civil Contempt is a Contested Motion. WHEREFORE, Plaintiff respectfully requests this Court hold a Hearing on this matter to find the Defendant in Contempt and issue an Order requiring: 1) Defendant to immediately comply with the January 5, 2009 Stipulation, and provide to Plaintiff the documents required to qualify Lewis Ney for Medical Assistance; 2) Defendant to sign an Authorization Statement, in her capacity as Responsible Party for Lewis Ney, allowing Plaintiff to request any additional records requested by the Cumberland County Assistance Office; 3) Defendant to suffer the sanction of immediate incarceration of three (3) days and the imposition of a monetary sanction in the amount of Fifty ($50.00) Dollars per day, beginning on February 5, 2009, until Defendant has purged herself of her contemptuous action; and 4) Defendant to be incarcerated for a period of ten (10) days. Respectfully submitted, Dated: +23-0q SCHUTJER BOGAR LLC By: Anthony T. ucid Attorney I.D. 6583 (717) 909-0353 Kelly L. Bonanno Attorney I.D. No. 200811 (717) 909-8641 417 Walnut Street, 4ch Floor Harrisburg, PA 17101 Attorneys for Plaintiff CERTIFICATE OF SERVICE I hereby certify that, on this day, a true and correct copy of the foregoing Motion for Civil Contempt was served via first-class, United States mail, postage prepaid upon the following: Louise Hoffheins 1027 Northfield Drive Carlisle, PA 17013 Dated: a3 By: 64'k;e?? &Lgt?-) Catherine Klobucar, Paralegal EXHIBIT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY STIPULATION FOR ENTRY OF INJUNCTION Church of God Homes, Inc. ("Petitioner") and Louise Hoffheins ("Respondent") stipulate and agree to the following: 1. On or about December 4, 2008, Petitioner filed a Complaint against Respondent. 2. The Complaint sets forth a single claim against Respondent based on her failure to specifically perform the terms of the Admission Agreement ("Agreement") entered into with Petitioner. See Complaint Exhibit "A." Specifically, the Complaint alleges that Respondent failed secure the Medical Assistance benefits on behalf of her father, Lewis Ney ("Mr. Ney"), pursuant to the Agreement. 3. An application for Medical Assistance benefits was filed on behalf of Mr. Ney and that application currently is pending before the Cumberland County Assistance Office of the Department of Public Welfare. 4. The parties agree to the entry of an Order directing Respondent to provide any and all records within her possession or control as required by the Cumberland County Assistance Office to determine the eligibility of Respondent for Medical Assistance benefits within fifteen (15) days of the date of the Order adopting this Stipulated Injunction. The parties also agree that Respondent will work diligently to secure any and all other documents or verifications required by the Cumberland County Assistance Office to obtain Medical Assistance benefits, and will obtain those documents within thirty (30) days of the date of the Order adopting this Stipulated Injunction. The Order is attached as Exhibit °A.° 5. Petitioner agrees to withdraw, without prejudice, its Petition for a Preliminary Injunction. The parties agree that failure to abide by the terms of this Stipulation and the Order adopting the same constitutes contempt of Court and may result in sanctions imposed by the Court. Respectfully submitted, Dated: ?'- By: Anthony T. Lucido, Attorney for Petitioner Dated: By: , Louise Hoffheins E IT "A" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this tr-? day of. 2009, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that within fifteen (15) days of the date of this Order, Louise Hoffheins shall provide any and all records in her possession that are required by the Cumberland County Assistance Office for the pending application to determine the eligibility of Lewis Ney for Medical Assistance benefits. Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days. TRUE Co rf r- r- RD In Testimony vvhcr cf, ; h- r : t ,;;y hang and the seal of said Court at Carlisle, Pa. T ..... 5 .?... day oG?U1...... ;0200` .......... ...1, BY THE COURT EXHIBIT "B" IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC., Petitioner, V. No. 08-07125 Civil Term LOUISE HOFFHEINS, Respondent. CIVIL ACTION - EQUITY ORDER AND NOW, this day of. 2009, in consideration of the parties' Stipulated Agreement, it is hereby ORDERED AND DECREED that within fifteen (15) days of the date of this Order, Louise Hoffheins shall provide any and all records in her possession that are required by the Cumberland County Assistance Office for the pending application to determine the eligibility of Lewis Ney for Medical Assistance benefits. Louise Hoffheins shall also diligently work to secure any and all other documents or verifications required by the Cumberland County Assistance Office in order to obtain benefits on behalf of her father, Lewis Ney, within thirty (30) days. BY THE COURT Kevin X Hess, J. jpy In Testimony cf, o my hand and the seal of said Court _attCarli.-le, Pa. T ...... ?`... day o ..VGA!!...... ?... .......t-w . ........ .. EXHIBIT E Unt ZY/ Ln1?7 11'. 7' (1 ( (70JbU0 ri-i•i"? LJ?xUll\ . --- - „-, From:Schutjer Bogar LLC 717 909 5925 0512212009 11:40 #142 P,0021004 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CHURCH OF GOD HOME, INC. Plaintiff, No. 08-07125 v. LOUISE HC FFHBITiS, Defendant CIVIL, A.CIION - EQUITY ST'IP'ULATED AGREEMENT IN LIEU_ OF CONTEMPT HEARING AND NOW, this 22nd day of May, 2009, after discussior4 Church of God Home, Inc. and Louise Hoffheins hereby enter iztto this Stipulated Agreeuwnt in Lieu of the Sched.uled Contempt hearing, wl&b. Stipulated Agreement shall be incorporated into an Order of Court; and hereby agree as follows: 7 . Within seven days (7) days, but no later than Friday, May 29, 2009, the Defendant Louise Hoffheins, as Agent for Lewis E. Ney, specifically Agrees to deliver to couzisel for the Plaintiff the Wachovia Consolidated Bank Statements of Der-ember 2007 and January 2008 for the following accounts of Lewis E_ Ney: a. CROWN CLASSIC BANKING - #1010141692337, b. ACCESS FIFTY CK -- #1000693121366; C. FUMIUM SAVINGS - #3000081598842. Lj7I 'ZZI ZUID'J r 1 r r Jul- Frvm,Schutjer Ragar LLC 2. 717 909 5925 0512212009 11:40 0142 P.003/004 Next, within seven days (7) days, but no later those Friday, May 29, 2009, Louise Hoffheins, as Agent for Lewis F. Ney, specifically agrees to deliver to counsel an executed form necessary to obtain Lewis E. Ney's 2006 tax return, which 2006 tax return. is currently not in Louise Hoffheins possession. 3. Further, wvidhin fourteen. (14 ) days, but no later than June 5, 2009, Louise HofB.ieins shall file an inventory and accounting of any, aand all assets of Lewis E. Nye, including monthly incorxte of social security, annuity, pension and the like, over which she had control as his fiduciary, from August 2006 up to the date of the filing of the T.nventory and Account 4. Finally, failure W abide by the terms of this Stipulated Agreement and the Court's Order adopting the same shall constitute Contempt of Court and may result in sanctions, Dated: Dated: a? O© Respectfully bu-ritbed, Kirk S. Sohonage Attorney for Petitioner, Church of God Home, Tzte. Mark Thomas Aftmey for Louise Hoffheins EDIT F BOGAR L911..Cft Email: bwilliams@schutjerbogar.com Direct Dial: (717) 909-5922 IF ° MD Via Facsimile. (717) 796-3600 R. Mark Thomas, Esquire 101 South Market Street Mechanicsburg, PA 17055 In Re: Church of God Home, Inc. v. Louise Hoffheins Docket No. 08-07125 Dear Attorney Thomas: Enclosed please find a pending list issued by the Cumberland County Assistance Office in regard to the Medicaid qualification of Mr. Ney. Our office will be able to obtain much of the requested information with the authorization statement that your client has provided, however Ms. Hoffheins' signature is required on the application, and she needs to complete the enclosed PA-4. Furthermore, the CAO has also indicated that they require a verified statement from your client indicating that no assets have been transferred in the past five years. I have taken the liberty to draft a proposed verified statement regarding the ownership and disposition of Mr. Ney's assets based on prior correspondences with your office. If my summary is accurate, please have Ms. Hoffheins sign and return to my attention along with the other documents. If I have mischaracterized any of Mr. Ney's holdings or past dispositions, please feel free to modify the verified statement accordingly. Please note that the CAO requires these documents by July 8, 2009. If you should have any questions, please do not hesitate to contact me at the number above. Sincerely, Brandon S. Williams Enclosure 417 Walnut Street, 4t Floor, Harrisburg, PA 17101 Fax (717) 909-5925 www.schutjerbogar.com Commonwealth of Pennsylvania Department of Public Welfare ' CUMBERLAND COUNTY BOARD OF ASSISTANCE 33 Westminster Drive aT V?~r P.O. Box 599 Carlisle, PA 17013-0599 6/23/2009 Information Due By: 7/8/2009 We have received an application requesting Nursing Home Care/Waiver Services under our Medicaid program. In order to determine eligibility, we will need the following verification as indicated below. Photo copies are acceptable. Name: Lewis Ney Case# 120811 Nursing Home: Church of God Home Pending Item Pending Items Needed: MA51-form provided by nursing home, dated 3-1-09 to include the options determination report X MA103- form provided by nursing home X Please note the application was received in our office on 6-16-09, therefore we are only able to honor a requested effective date of 3-1-09. X Social Security card Birth Certificate Medical insurance cards Medical insurance premiums to include rate and frequency Long Term Care Policies, including monies received and terms, if applicable Power of Attorney to include the Medical Power of Attorney X Signed'Authorization for Release of Information' form enclosed ( PA4)-signed by Lewis or POA X Read HIPAA disclosure information and complete the HIPAA disclosure request (PW1815) Verification of Gross Veterans Aid & Attendance benefits is needed. If you are not receiving benefits, you will need to apply for potential benefits in order to be eligible for Medicaid. (See the enclosed letter) X Current Verification of All GROSS monthly income, including interest. Verification includes award letters. X Statements for all bank accounts, CDs, IRAs, Annuities, Keoghs, stocks, bonds, and Annuities. Must include verification of all resources as of 3-1-09. X Personal Care Account balance as 3-1-09, including interest earned. X Current value of all life insurance policies as of the requested effective date. The policy type, current face value, current cash surrender value, policy number, date issued, and owner is needed. The verification must be from the insurance company. Title, vehicle registration, and insurance for all vehicles owned, including boats, motorcycles, and trailers. Deed to all property and current market values. If any property was transferred or sold within the lookback period (back to 02/08/2006 or 5 years if in a Trust), also provide a copy of the new deed, settlement papers, and verification of the fair market value. Title to mobile home and current tax assessment or market value. If any property was transferred or sold within the lookback period (back to 02/08/2006 or 5 years if in a Trust), also provide a copy of the new title, transfer papers, and verification of the fair market value. 1 of 2 Pending Item Pending Items Needed: Verification of all Resources sold, transferred, or given away during the lookback period (back to 02/08/2006 or 5 years if in a Trust). This Verification is to include the resource, the date, amount, and the disposition. If a vehicle or real estate was disposed of then the fair market value is also required. X Copy of burial agreement to include date purchased, value, and statement of irrevocability Deed to burial plots Provide a copy of lease/mortgage, homeowner's insurance, property taxes, utility bills. Federal income tax returns for the past three years, including all 1099s and schedules. Complete the enclosed'Medicaid Financial Review' form (PA 600 RL). Complete the enclosed application pages where highlighted (POA or Client needs to sign Application Affidavit) X Provide copies of all unpaid medical bills for which you would like Medicaid to pay Verification of all withdrawals/checks that exceeded $500 to include the disposition of the funds are needed for all Wachovia accounts during the lookback period (2/8/06 to current). X *By waiving the interview, you are certifying to this office, under penalty of fraud, that all information you have provided is true, correct, and complete to the best of your knowledge. You agree to report all changes or circumstances to this office within 10 days. *If determined eligible an ACCESS card will be issued to the Nursing home which will cover hospital, doctor and prescription drug expenses. If you receive any medical bills for the period after the authorization date, submit them to the Business office at the Nursing Home as they will have possession of the ACCESS card. *You will receive a PA 162 (Notice to Applicant) form when the case has either been authorized or denied. The notice will inform you of the amount that you will pay monthly out of the resident's income, to the nursing home, or if they are not eligible, the reason. This material is due by: 7/8/2009 *If information is not received by the date listed, the application could be discontinued and reapplication would be necessary. Per 55 PA Code 125.84, the County Assistance Office is to make an eligibility decision within 30 days of the date a client files his/her application. *If income is $2022 or under, the resource limit is $2000, with a $6000 disregard. If income is over $2022, the resource limit is $2400. 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J Y r. t fo v T, n v I I y J r n J r I r :n i _ r, I P i J i J I ? ?y rD r I z l = j ? ? VERIFIED STATEMENT CUMBERLAND COUNTY BOARD OF ASSISTANCE IN THE MATTER OF: Lewis Ney Case No.: 120811 VERIFIED STATEMENT I, Louise Hoffheins, am the Agent through Power-of-Attorney for my father, Lewis Ney. I hereby state that, upon information and belief, my father, Lewis Ney, has not owned, sold, transferred, or given away resources, including vehicles, real estate, life insurance policies, CDs, IRAs, Annuities, Keoghs, stocks, bonds, or annuities in the past five years. The undersigned hereby verifies that the foregoing statement of fact is true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C.S.A. § 4904, relating to unworn falsification to authorities. Dated: By: Louise Hoffheins, Agent for Lewis Ney EXHIBIT G ?SVAR ER Email: Ilangton@schutjerbogar.com Direct Dial: (412) 281.3710 F&M VIA FACSIMILE: (717) 796-3600 R. Mark Thomas, Esquire 101 South Market Street Mechanicsburg, PA 17055 Re: Church of God Home, Inc. v. Louise Hoffheins Docket No. 08-07125 Dear Mr. Thomas: On June 24, 2009, you received from Brandon Williams, of this firm, a faxed letter with several attachments, including the Cumberland County Assistance Office's ("CAO") current pending list for Mr. Ney's Medicaid application, the items identified therein all needing to be provided to the CAO. Additionally, attached were the PA-4 and PA-600L forms, which we requested that your client complete and return, as well as the draft Verified Statement required by the CAO. All of the prior attached documents are attached hereto for your reference. Since June 24, 2009, we have not heard from you, nor have we received the above identified documents. Given the passage of time and the recent denial of Mr. Ney's Medicaid application, time is of the essence. The denial notice, which also provides a list of missing documents, is provided here for your reference as well. Given the foregoing, please forward the completed documents to me immediately. If I do not hear from you and receive the completed documentation by close of business on August 7, 2009, I will be forced to once again to pursue litigation against your client. Thank you, SCHUTJER BOGAR LLC ?ivia F. Lan on Attachments U.S. Steel Tower, 600 Grant Street, 32n" Floor, Suite 3290, Pittsburgh, PA 15219 Fax: (412) 281-0530 www.schutjerbogar.com Commonwealth of Pennsylvania as PasL? r Department of Public Welfare CUMBERLAND COUNTY BOARD OF ASSISTANCE 33 Westminster Drive '•t,? aT P.O. Boa 599 Carlisle, PA 17013-0599 6/23/2009 Information Due By: 718/2009 We have received an application requesting Nursing Home CareNVaiver Services under our Medicaid program. In order to determine eligibility, we will need the following verification as indicated below. Photo copies are acceptable. Name: Lewis Noy Case# 120811 Nursing Home: Church of God Home Pending Item Pending Items Needed: MA51-form provided by nursing home, dated 3-1-09 to include the options deterniination report X MA103- form provided by nursing home X Please note the application was received in our office on 6-16-09, therefore we are only able to honor a requested effective date of 3-1-09. X Social Security card Birth Certificate Medical insurance cards Medical insurance premiums to include rate and frequency Long Term Care Policies, including monies received and terms, if applicable Power of Attorney to include the Medical Power of Attorney X Signed'Authorization for Release of Information' form enclosed ( PA4)-signed by Lewis or POA X Read HIPAA disclosure information and complete the HIPAA disclosure request (PW1815) Verification of Gross Veterans Aid & Attendance benefits is needed. If you are not receiving benefits, you will need to apply for potential benefits in order to be eligible for Medicaid. (See the enclosed letter) X Current Verification of All GROSS monthly income, including interest. Verification includes award letters. X Statements for all bank accounts, CDs, IRAs, Annuities, Keoghs, stocks, bonds, and Annuities. Must include verification of all resources as of 3-1-09. X Personal Care Account balance as 3-1-09, including interest earned. X Current value of all life insurance policies as of the requested effective date. The policy type, current face value, current cash surrender value, policy number, date issued, and owner is needed. The verification must be from the insurance company. Title, vehicle registration, and insurance for all vehicles owned, including boats, motorcycles, and trailers. Deed to all property and current market values. If any property was transferred or sold within the lookback period (back to 02/08/2006 or 5 years if in a Trust), also provide a copy of the new deed, settlement papers, and verification of the fair market value. Title to mobile home and current tax assessment or market value. If any property was transferred or sold within the lookback period (back to 02/08/2006 or 5 years if in a Trust), also provide a copy of the new title, transfer papers, and verification of the fair market value. 1 of 2 Pending Item Pending Items Needed: Verification of all Resources sold, transferred, or given away during the lookback period (back to 02/08/2006 or 5 years if in a Trust). This Verification is to include the resource, the date, amount, and the disposition. If a vehicle or real estate was disposed of then the fair market value is also required. X Copy of burial agreement to include date purchased, value, and statement of irrevocability Deed to burial plots Provide a copy of lease/mortgage, homeowner's insurance, property taxes, utility bills. Federal income tax returns for the past three years, including all 1099s and schedules. Complete the enclosed'Medicaid Financial Review' form (PA 600 RL). Complete the enclosed application pages where highlighted (POA or Client needs to sign Application Affidavit) X Provide copies of all unpaid medical bills for which you would like Medicaid to pay Verification of all withdrawals/checks that exceeded $500 to include the disposition of the funds are needed for all Wachovia accounts during the lookback period (2/8/06 to current). X *By waiving the interview, you are certifying to this office, under penalty of fraud, that all information you have provided is true, correct, and complete to the best of your knowledge. You agree to report all changes or circumstances to this office within 10 days. *If determined eligible an ACCESS card will be issued to the Nursing home which will cover hospital, doctor and prescription drug expenses. If you receive any medical bills for the period after the authorization date, submit them to the Business office at the Nursing Home as they will have possession of the ACCESS card. *You will receive a PA 162 (Notice to Applicant) form when the case has either been authorized or denied. The notice will inform you of the amount that you will pay monthly out of the resident's income, to the nursing home, or if they are not eligible, the reason. This material is due by: 7/812009 *If information is not received by the date listed, the application could be discontinued and reapplication would be necessary. Per 55 PA Code 125.84, the County Assistance Office is to make an eligibility decision within 30 days of the date a client files his/her application. *If income is $2022 or under, the resource limit is $2000, with a $6000 disregard. If income is over $2022, the resource limit is $2400. If your resources exceed the limit, then you must spend down your excess resources on unpaid medical expenses and/or an irrevocable burial reserve, in order to be eligible for retro-active nursing home medical assistance. Verification must be provided. *If you have any questions, need help in obtaining the required information or would like to request a face-to-face interview, please call. Case worker: Kim Nagle (2003) Phone: 1-800-269-0173 (ext.2728) or 717-240-2728 (direct line) Pax: 717-249-8141 CC: Louise Hoffheins, Church of God Home, Schutjer Bogar 2of2 A m A O S ° m m m O m y Cl) O 3 A m z -4 O z m m A O 4 Aa A m m om AA as 41 M mm .A mrn a z z C A z mr (nm TEL 00 E ;a 3 z Co Sn z m D? rj) m A 0 N C m m O Z a r A Ch m m A O v T F m ?O -c 0m Zm m0 T am n V Y7 Om n y m r z m 3,?' zz ?m 0 m 0 mm D A O N cn 0 m m O .ID •- Q: O O O O S? cm O O N = a- = 3 O -_ o N "' ° O A N ? ? <• A O O cCD c?°'3.as t7 0 (D tp a rt?D to D) ? N O y a Q m a S? vi ? C 0 O O O O O O 3 M-0 to y. 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VERIFIED STATEMENT CUMBERLAND COUNTY BOARD OF ASSISTANCE IN THE MATTER OF: Lewis Ney Case No.: 120811 VERIFIED STATEMENT I, Louise Hoffheins, am the Agent through Power-of-Attorney for my father, Lewis Ney. I hereby state that, upon information and belief, my father, Lewis Ney, has not owned, sold, transferred, or given away resources, including vehicles, real estate, life insurance policies, CDs, IRAs, Annuities, Keoghs, stocks, bonds, or annuities in the past five years. The undersigned hereby verifies that the foregoing statement of fact is true and correct to the best of my knowledge, information and belief. I understand that any false statements therein are subject to the penalties contained in 18 Pa. C.S.A. § 4904, relating to unsworn falsification to authorities. Dated: By: Louise Hoffheins, Agent for Lewis Ney 2069 AUG 20 AH: i i : 5U CHURCH OF GOD HOME, INC., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS. CIVIL ACTION - EQUITY NO. 08-7125 CIVIL LOUISE HOFFHEINS, Defendant IN RE: PLAINTIFF'S SECOND MOTION FOR CIVIL CONTEMPT ORDER AND NOW, this Z S~ day of August, 2009, hearing in the above-captioned matter is set for Thursday, September 17, 2009, at 11:00 a.m. in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. BY THE COURT, , x I ?li Kevin .Hess, J. Livia F. Langton, Esquire Chadwick O. Bogar, Esquire For the Plaintiff /R. Mark Thomas, Esquire For the Defendant ouise Hoffheins Defendant :rlm Corts LL OF THE ;• z ;rl, RY 2GO9 AUG 25 A 11: 20 CMS vTY r'c CHURCH OF GOD HOME, INC., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA vs. CIVIL ACTION - EQUITY NO. 08-7125 CIVIL LOUISE HOFFHEINS, Defendant IN RE: PLAINTIFF'S SECOND MOTION FOR CIVIL CONTEMPT ORDER AND NOW, this day of September, 2009, on agreement of the parties, hearing herein is continued in order to give the defendant an opportunity to bring herself into compliance. Further hearing herein is set for Friday, September 25, 2009, at 9:00 a.m. in Courtroom Number 4, Cumberland County Courthouse, Carlisle, PA. Livia F. Langton, Esquire For the Plaintiff q- /P-09 R. Mark Thomas, Esquire For the Defendant L?- BY THE COURT, Kevin A ess, J. Kevin A ss. rlm Cdr" THE Pf' " 2009 SEP 18 A1-??11 : c 6 T1I CUM