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HomeMy WebLinkAbout04-1872POST & SCHELL, P.C. BY: PAULA J. MCDERMOTT I.D. #:46664 240 GRANDVIEW AVENUE CAMP HILL, PA 17011 (717) 731-1970 PRESBYTERIAN HOMES, INC., t/d/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover, Delaware, Plaintiff, WILLIAM SHEWBROOKS and HELEN SHEWBROOKS Defendants. ATTORNEYS FOR PLAINTIFF PRESBYTERIAN HOMES, INC., t/d/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover, Delaware IN THE COURT OF COMMON PLEAS CUMBER/LAND COUNTY, PENNA. CIVIL ACTION - LAW NOTICE TO DEFEND 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 LA'WYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AF-FORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Associalion 2 Liberty Avenue Carlisle, PA 17013 800-990-9108 AVISO Le han demandado a usted en la corte. Si usted quiere defen-derse de estas demandas expuestas en las paginas siguien-tes, usted tiene veinte dias de plazo al partir de la fecha de la demanda y la notifica-cion. Hace falta ascentar una comparencia escrita o en persona o con un abogado y entregar a la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede continuar la demanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor del deman-dante y requiere que usted cumpla con todas las provisio-nes de esta deman-da. Usted puede perder dinero o sus propieda-des u otros derechos importan-tes para usted. LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATA-MENTE, SI NO TIENE ABOGADO O SI NO TIENE EL D1NERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Associalion 2 Liberty Avenue Carlisle, PA 17013 800-990-9108 POST & SCHELL, P.C. BY: PAULA J. MCDERMOTT I.D. #:46664 240 GRANDVIEW AVENUE CAMP HILL, PA 17011 (717) 731-1970 PRESBYTERIAN HOMES, 1NC., t/cl/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover, Delaware, Plaintiff, WILLIAM SHEWBROOKS and HELEN SHEWBROOKS Defendants. ATTORNEYS FOR PLAINTIFF PRESBYTEILIAN HOMES, INC., t/d/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover, Delaware 1N THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. CIVIL ACTION - LAW COMPLAINT AND NOW, comes Plaintiff, Presbyterian Homes, Inc., t/d/b/a Westminster Village Health Center, Dover, Delaware (hereinafter "PHI"), by and through its attorneys, Post & Schell, P.C., and in support of this Complaint avers the following: 1. Plaintiff, Presbyterian Homes, Inc. is a Pennsylvania non-profit corporation with an address of 1217 Slate Hill Road, Camp Hill, Cumberland County, PA 17011. 2. Defendant Helen Shewbrooks is an adult individual with an address of P. O. Box 11724, Wilmington, Delaware 19850, and is the wife of Raymond Shewbrooks. 3. Defendant William Shewbrooks is the son of Raymond Shewbrooks and Defendant Helen Shewbrooks, and is an adult individual with an address of 840 K Independence Drive, Homestead, Florida 33034. 4. Raymond Shewbrooks, Defendant William Shewbrooks' father and Defendant Helen Shewbrooks' husband, was a resident at Plaintiff's facility at Westminster Village Health Center, Dover, Delaware. 5. Raymond Shewbrooks was a private-pay patient. 6. The Admission Agreement at the facility was signed by Defendant Helen Shewbrooks on her husband's behalf. 7. A tree and correct copy of that Admission Agreement is incorporated hereby and attached hereto as Exhibit "A." 8. Pursuant to the Agreement attached hereto as Exhibit "A," Defendant Helen Shewbrooks undertook the contractual obligation to pay her husband's bills for the services provided. 9. Services were provided to Raymond Shewbrooks from June 24, 2002 through October 5, 2002. 10. Some of Raymond Shewbrooks' charges were paid by Medicare. 11. Some of Raymond Shewbrooks' charges were also paid by Blue Cross, the co- insurer. 12. At the present time, a balance is due and owing of $8,811.00 on Raymond Shewbrooks' account. 13. Blue Cross of Delaware has indicated that Blue: Cross payments representing co- insurance were paid to some member of the Shewbrooks' household on April 28, 2003. 14. Defendant William Shewbrooks claims he returned the check to Blue Cross. 15. Defendant Helen Shewbrooks contends that Defendant William Shewbrooks was handling all of his father's bills at Plaintiff's facility. -2- 16. at length. 17. COUNT I - BREACH OF CONTRACT (HELEN SHEWBROOKS) The averments of Paragraphs 1-15 are incorporated hereby as if set forth fully and Defendant Helen Shewbrooks undertook a contractual obligation to pay her husband's charges at Plaintiff's facility. Defendant Helen Shewbrooks has declined to dc, so. Defendant Helen Shewbrooks, accordingly, has breached the 18. 19. undertook with Plaintiff. WHEREFORE, contract she Plaintiff PHI respectfully requests this Honorable Court to grant judgment in its favor and against Defendants in the amount of' $8,811.00, together with interest, costs, attorneys' fees, and whatever other relief the Court may consider just and equitable, which amount is above the jurisdictional limit for compulsory arbitration. COUNT II - PHI v. HELEN SHEWBROOKS/DOCTRINE OF NECESSARIES 20. at length. 21. 22. The averments of Paragraphs 1-19 are incorporated hereby as if set forth fully and Plaintiff provided medical necessaries to Defendant's husband. Defendant has a legal obligation pursuant to the: doctrine of necessaries to pay for those services. WHEREFORE, Plaintiff respectfully requests this Honorable Court to grant judgment in its favor and against Defendant in the amount of $8,811.00, with interest, costs, attorneys' fees, and whatever other relief the Court may consider just and equitable, which amount is below the jurisdictional limit for compulsory arbitration. -3- 23. at length. 24. COUNT III - PLAINTIFF v. WILLIA3~I SHEWBROOKS The averments of Paragraphs 1-22 are incorporated hereby as if set forth fully and Upon information and beliefi William Shewbrooks has been controlling his parents' funds and paying bills. Defendant William Shewbrooks has refused to pay the bill for services provided 25. to his father. 26. Defendant William Shewbrooks has a legal obligation to apply his father's funds to his father's care at Plaintiff's facility. WHEREFORE, Plaintiff respectfully requests this Honorable Court to grant judgment in its favor and against Defendant in the amount of $8,811.00, with interest, costs, attorneys' fees, punitive damages, and whatever other relief the Court may consider just and equitable, which amount is below the jurisdictional limit for compulsory arbitration. Respectfully submitted, POST & SCHELL, P.C. Date: PAOLA J. MCDERMOTT, ESQUIRE Attorney I.D. # 46664 240 Grandview Avenue Camp Hill, PA 17011 (717) 731-1970 Attorneys t'or Plaintiff -4- VERIFICATION I, '~'~nC Da01'~ a duly authorized representative of Presbyterian Homes, Inc., t/d/b/a Westminster Village Health Center, Dover, Delaware, Plaintiff in the foregoing action, hereby affirm that the facts and matters set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. The undersigned understands that the statements made therein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworu falsification to authorities. Date: April ~, 2004 PRESBYTERIAN HOMES, INC. Title: ~e4: I:'ltlOJ~lo-I O('T(~C~F Nursing Care ^'~mi~sion Agreer~¢l~t Westminster Village Health Center Nursing Care Admission Agreement INTRODUCTION This A~-eemen: is a con.tract between the panieg listed below setting forth many rights and responsibilities of the nursing facility and the reiident. Long term care f~c/litlss and residents of long terrn care :Facilities have other rights and responsibilities under Delaware law. All of these rights are not listed below. However, to the extent that this or an)' other agreement, or nursing facility policy, attempts to waive or limit the legal rights of a resident, ~such an attempted w~iver or limitation is unenforceable and may ~ive rise to a legal action against ihe facility. Also, to the extent that this Agreement conflicts v~ith any current or future provision of law, the law is controlling. Residents of a facility that has been certified to participate in Medicare or Medica/d (i.e. the Delaware Medicaid Program) hax, e. additional rights u~der federal law. These right~ generally extend to all residents of certified facilities, whether or not Medicare or Medicaid is paying For this care. 2. PARTIES The parties to this Agreamant are: (a) lA) ~/~ (herein "thc facility"), and Co) .[~b lt.~ :~l,,.,)br,~/~. [~,~'1 (herein "the resident", if someone other thau thc resident is named, indicate' ~a~ indiVidual's relationship to the resident, for example, ~legal guardian" or "attomey-in~fac~.'9 The pa~cs to thi~ Agrce/nent recognize that ~¢ thctlity canno! require a leg~lly competent person to dedgnai~ an attorney-in-fact or other responsible parry ss a condition for admission ss a Resident. If a resident is not a party to this Agreement, the responsible party is entitled to enforce all rights perlaining to residency on behalf of the resident and resident is entitled to the same lighi$ and privileges as accorded to fully respomible residents who sign the Adm/ssion Agreement. 3. MEDICARE / MEDICAID CERTIFICATION The facility is ca~ficd to participate in the Medicare and Medicaid program. Provider participation in the Medicare and/er Medica/d pro~rarn is subject to termination by the facility or by the responsible governmental emily. N~rsing C,~e Admi~lo~ ^~eme~t 4. CHARGES Covered Services ..~.,~,~oa~] ~$J~o~rz,e5 the ~sident, h~ei. Unless ~d until te asident is eligime to have ~s or h~ ~e p~d ~r by Medicare or Medicad, ~e ~ciliW will ch~ge ~c p~ di~ ~te in ~iliW's S~edul~ o~ C]~es for ~e pro,s/on of l°ng t~ c~e s~ces. This cMrge ~vers ~1 room ~td bo~, items, equipm~t ~d s~ic~ r~on~ly zelated to ~e ~e ~d ~ent of ~e resider. Pabst.is due upon rc~ipt (no later ~ 30 days). Ch~s ~ ~tion ~ room ~d ~d are included in faciliW's Scheme of C~g~. ~e ~11 be no c~rge for ~y ~/ce, equipment or item w~ is not ac~ly ~,~ded to ~e ~sid~t. ~have r~eived a copy oflhe facili~'s S~edule of~a~es. Amended Charges The facility may amend the charges set forth in the preceding section (4al upon thirty (30) days written and/or an oral notice to the; ms/dent, legal representative (ii' one exists) and responsible party (ii'om exists). Rebate on Discharge If the resident is discharged prior to the end of the month, thc facility will provide a pro-rata re. fund of any prepayment for covered s~'vic~s within 30 days of the date of discharge. Billing Medicare Payment for residenls who are Medicare enxollees is not due unless and until Medicare has determined that there is no coverage. The facility hereby acknowledges its legal responsibility to submit any claim for payment to the Medicare program if required to do so by or on. behalf of the resident. I hate received a copy of the "Medicare Coverage Information" packet Billing Medicaid Residents Payment amounts for residents who arc entitled to Medicaid are determined by *abe Delaware Department of Health and Social Services,' Any payment made to a Medicaid certified f~ility for the cost of care for a private pay resident who is later found to be eligible for Medicaid will be refunded within five (5) days of notification of resident eligibility. The perties hereto recognize that it is illegal for a Medicaid certified facility to charge, soliciI, accept or receive additional monies beyond what the Medicaid program determines is due, as a condition for admitting, expediting the admission of, or retaining a re~derrt under Medicaid. Nm~ing Care Admission ^§reemc~t Page :3 The p~ie~ ~co~ze ~ a Mc~caid c~ fa~ m~y c~ge for items, equipment or s~c~ not ~imbw~ble ~d~ ~e MedieVal pw~, if ~e pro~sion of such i~, equipm~t or s~ce ~d the ch~ge ~fo~ is ~sclosed ~d a~eed to ~ advance, p~t to law. I have received a copy of the Delaware Health 8~' Social Services "Policy on Billing For Incidentals in Nursing Hemes." Obtaining Private Payment and Public Benefits The facility x~ill assist the resident and others acting on behalf of thc resident in applying for ~nd obtaining tn'irate insurance and public benefits to cover the cost of the resident's care. Tim resident agrees to cooperate to the be~t of hi~ or her ability with any such application. Interference The part/es acknowledge that a Medicaid certified fac/lity may not require, /n writing or orally, a promise thai a r~sident w/Il '~ema/n in private pay statt~ or refrain £rom apply/ng for Medicaid for a spocilfed period oft/me. Financial Guarantor The parties acknowledge that this Agreement ~'amding alone is insu/'ficient to legally bind any individual 'as financial guarantor for charges owed hereunder. Any other person signing this agreement is only obligated to make payment from the resident's funds and only to Re extent that those funds are available to such signing person, 5. PROTECTION OF RESIDENT'$ PROPERTY The thcility will take reasonable steps to prevent the theft or loss of the resident's property. The resident is not required to dcpodt personal funds (inclvding, but not limited to Social Security and pension ch~ks) with the faoil/ty. If the resident w/shes, however, the facility will hold, safeguard' and accoun0t for any personai ftmds deposited with the facility, in accordance with state and federal law. The parties acknowledge that any res/dent funds held by the facility are subject to v~rious provisions of state end/or federal law governing access to the funds, man,'latory post/ag of interest and repoxting on the statics of said funds. Thc procedure for filing claims/'or property of the resident which is lost or stolen is set forth in the facility's "Policy on the H~mdling of Alleged and/or Suspected Resident Abuse, Neglect, Mistreatment, Injuries of Unknown Origin, Theft, & Inappropriate Employee Conduct." Pn§e 4 I have received a copy of the fndlJty's "PolJey on the Handling of Alleged and/or Suspected Resident Abuse, Neglect, Mlslreatment, Injuries of Unknown Origin, Theft, & Inappropriate Empioye~ Conduct." 6, DISCHARE OR TRANSFER OF THE RESIDENT FROM THE FACILITY a~ Reasons for Transfer or Discharge The fazility will not discharge or transfer the resident from the facility except for medical reasons, for his or hex welfare or that of o{ter residents for nonpayment for his or her stay edter the facility has made reasonable efforts to collect the debt, or if the facility ceases to operate. Notice of Transfer or Discharge In the event that a discharge or transfer is necessary' and, except ~ ers emergency, the facility will give 30 days advance written notice to thc resident, to any legal representative, to the responsible party (if one exi,,~) and to ethers required by law to receive this notice. The written notice will set forth the reason for the transfer or dischm'ge, the effective date of the u~anffer or discharge and the location to which the resident will b~ tranfferred or dlacharged. The notice will also set forth any appeal fighis that the resident has trader law and additional information required by state and/or federal law. In the event of' all emerger~cy, ~ facility will giv~ the resident as mu,eh notice as. is possible under the ciwumstances. Ce Facility Responsibility for Transfer er Discharge In the event that a discharge or transfer is necessary, the fadli~' will provide stffficient preparation to assure that the transfex or discharge is safe and orderly. The facility is responsible for mmsforring the resident to an appropriate level of Holding the Re~idcnt's Bed Upon Trans[ar 1. Hospitalization In thc evcnt that thc restdent is transferxed ~ a hospital, the facility will hold the resident's bed for up to fourteen days, if the resident is Medicaid eligible and the facility is Medicaid certified. If tl~ resident is eutitled to Medicaid benefits for the period, and the /hcility is e, extifled under the Medicaid Program~ the facility will ace~t Medicaid bed hold payments as payment in flail. If the resident is not Medicaid eligible, the facility will accept the normal per diem listed in facility's Igch~tule of Charges. 2. Therapeu~c Leave In thc event ~e resident is absent from the facility on thcr~eutie leave, the facility wi]! hold the bcd upon paymen! of the £acility's Medicaid per diem rate. If the resident is enti'ded to Medicaid benefi(s during therapeutic leave, the facility will a¢c~t Medicaid bed hold payments Nursing C~re Admission Agreement (limited to 18 days per calendar y~r for skililed care residents and 30 days per calendar year for int~,~ucdiate care m~idents) as payment in lq. tll. The res/dent's calendar year begins on the da}, of' 1" therapeutic leave. Next Available Bed In the event the resident and othet~ acting on behalf of the resident choose not to pay to reserve a bed as set forth in paragraphs (d. 1) and (d.2), the resident is nevertheless entitled to the next available bed when he/she is ready to return to the facility. I have reed, ired a copy of the facility's "Reserved ]lied & Therapeutic Leave Policy? 7. TRANSFERS WITHIN THE FACILITY The resident will not be tnm~ferred within the facility except for medical reasons, for his or her welfare or that of other residents, or vdth the voluntary consent of the resident or his or her legal representer/ye. In the svent of a tram;for hexeuuder, except in an emergency, the facility will give prompt advance notice to the resident, to the responsib!o party.. (if one exists), to any' legal representative and to any filmily member who is known to the facility. The' notice will state the mason for the transfer, the effective date and the loca:ion to which the resident will be moved. In the event that a transfer within the facility is neces'~u-y, the facility will provide sufficient preparation to assure that the troffer is sffe and orderly. ' $, RE$IDENT'S'RIGHT$ The parties recognize that federal and state law guaranlee the resident other rights which are not set forth fully in this agreement. The facility agrees to uphold all of the rights of the resident und~ federal and state law. I have received a copy of "Notification of ResidenlI's Rights" and "Your Rights to Decide About Your Haal~h Care." 9. VISITING HOURS Visiting hours are open, howeve~ the facility requests that late arrivals (after 9:00 p.m.) be cleared with the £aeility administration in advance. 10. RESOLVING RESIDENT AND FAMILY CONCERNS The parties recognize the i~.ght of the residen~ to recomrnend changes in the facility and the responsibility of the facility to reSPOnd to the sugges,lions of thc residents. The Resident Handbook hereto sets forth the mannex by which a resident or others acting on behalf of the resident can suggest changes to ~he facility and the steps which the facility Nursing ~ ^drains/on Agrecm~t Pt~e 6 will take to encourage and assist residents in voicing their concerns, aud the method by which the facility will review and respond to the suggestions of residents and ethos acting on their behalf. The parties recognize that the Delaw~e Division of Aging has assigned an Ombudsman to each nursing facility in the state. The Ombudsman may a~sist the resident or others acting on behalf of the resident in resolving disputes with the facility. I have received a copy of the "Resident Handbook." 11. REGULATORY AGENCIES The parties recognize that the facility is licensed by the Department of I-Iealth and Social Services and rcguhted by the Health Care Financing AdmSnfstration of the U,S. Department of Health and Hu~nan Services. Both pau:ies recognize that regulatory changes rnzy alter the conditions of this agreement 12. CIVIL RIGHTS COMPLIANCE Presbyterian Homes' facilities am open to ~1.1 in need of our services, and axe not restricted to Presbyterians. Also, in accordance with the Federal Civil Rights Act: This facility has ag~.eed to ~omply with the provisions of the Federal Civil Rights Act of 1964 and all requirements proposed pursue~ thereto, to the end that no persons shall on the grounds of race, color, reliigiou~ crtwal, national origin, ancestry, age, sex, handicap, or disability should be excluded from participating in, be denied benefits or, or otherwise be subject to tiiscrimination in the provision of any care or service. The non-discriminatory policy of the institution applies to residents, physicians, end all employees. Under no circumstances will the application of this policy result in the ~egreg~on of build/rigs, wings, floors, and rooms for reasons of race, color, religious exeed, national origin, ancestry, age, sex, handicap, or disability. 13. SIGNATURES Resident or Ax~orized Representative Date Witness (If the resident signs by a mark or directs another) PRESBYTERIAN HOMES, INC., t/d/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover, Delaware, Plaintiff, WILLIAM SHEWBROOKS and HELEN SHEWBROOKS Defendants. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 04-1872 C1VIL ACTION - LAW PRAECIPE TO ENTER DEFAULT JUDGMENT TO THE PROTHONOTARY: Kindly enter judgment in favor of Plaintiff and against Defendant William Shewbrooks in the above-referenced matter in the mount of $8,811.00. Defendant William Shewbrooks was served via Certified Mail with a copy of the Complaint on May 3, 2004. A copy of cover letter dated April 28, 2004 and signed Certified Mail Return Receipt Card is attached hereto as Exhibit "A." Defendant William Shewbrooks failed to respond to the Complaint within twenty (20) days, and by letter dated June 28, 2004, Defendant William Shewbrooks was served via Certified Mail with a Notice of Intent to Enter Default Judgment, which he failed to respond to. A copy of cover letter dated June 28, 2004, Notice of Intent to Enter Default Judgment and signed Certified Mail Return Receipt Card is attached hereto as Exhibit "B." POST & SCHELL, P.C. PAULA~. ESQUIRE MCDERMOTT, Attorney I.D. # 46664 240 Grandview Avenue Camp Hill, PA 17011 (717) 731-1970 Dated: October 7, 2004 Attorneys for Plaintiff April28,2004 Paula J. McDermott Oirect Dial: 717-612-6012 Fex Number: 717-731-1985 pmcdermott@postschell.com File #: 1485/119726 Certified Mail- Return Receipt Requested William Shewbrooks 840 K Independence Drive Homestead, FL 33034 RE: Westminster Village Itealth Center v. William Shewbrooks Dear Mr. Shewbrooks: Enclosed for service upon you please find the Complaint which was filed against you in the Court of Common Pleas of Cumberland County, Pennsylvania with regard to the above- referenced matter. Kindly respond in accordance with the Notice to Defend. Thank you for your attention to this matter. Very truly yours, Paula J. McDermott PYlvl:djs Enclosure 240 (~RANDVIEW AVENUE CAMP HILL, PA 17011 717.731.1970 WWW. POSTSCHELL.COM A PENNSYLVANIA PROFESSIONAL CORPORATION June 28, 2004 Paula J. McDermott Direct Dial: 717-612-6012 Fax Number: 717-731-t985 pmcdetmott@postschell.com File#: 1485/119726 Certified Mail - Return Receipt Requested William Shewbmoks 840 K Independence Drive Homestead, FL 33034 RE: Westminster Village Itealth Center v. William Shewbrooks Dear Mr. Shewbrooks: Enclosed please lind a Notice of Intent to Enter Default Judgment for the above-captioned matter. I look forward to hearing from you regarding this action. Very truly yours, Paula J. McDermott PJM:djs Enclosure Cc: Valerie Fishel, PHI 240 GRANDVIEW AVENUE CAMp HILL, PA 17011 717.731.1970 A PENNSYLVANIA PROFESSIONAL CORPORATION WWW. POSTSCHELL.COM PRESBYTERIAN HOMES, INC., t/d/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover,, Delaware, Plaintiff, WILLIAM SHEW'BROOKS and HELEN SHEWBROOKS Defendants. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 04-1872 CIVIL ACTION - LAW NOTICE OF INTENT TO ENTER DEFAULT JUDGMENT TO: William Shewbrooks 840 K Independence Drive Homestead, FL 33034 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFglCE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 Liberty Avenue Carlisle, PA 17013 800-990-9108 Date: June 28, 2004 POST & SCHELL, P.C. PAULA~J. MCDERMOTY, ESQUIRE Attorney I.D. # 46664 240 Grandview Avenue Camp Hill, PA 17011 (717) 731-1970 Attorney for Plaintiff CERTIFICATE OF SERVICE I, Dena J. Stump, an employee of the law finn of Post & Schell, P.C., do hereby certify that on the date set forth below, I did serve a tree and correct copy of the foregoing document upon the following persons at the following addresses indicated below by sending same in the United States mail, first-class, postage prepaid: William Shewbrooks 840 K Independence Drive Homestead, FL 33034 Date: October 7, 2004 POST & SCHELL, P.C. PRESBYTERIAN HOMES, INC., t/d/b/a WESTMINSTER VILLAGE HEALTH CENTER, Dover, Delaware, Plaintiff, WILLIAM SHEWBROOKS and HELEN SHEWBROOKS Defendants. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 04-1872 CIVIL ACTION - LAW NOTICE OF ENTRY OF JUDGMENT TO: William Shewbrooks 840 K Independence Drive Homestead, FL 33034 Pursuant to Rule 236 of the Pennsylvania Rules of Civil Procedure, you are hereby notified that a judgment has been entered against you in the above-captioned proceedings in the amount of$8,811.00. Copies of the Praecipe for Entry of Judgment, together with a copy of the certified Notice of Judgment are attached hereto. The name and post office of the creditor is Presbyterian Homes, Inc., 1217 Slate Hill Road, Camp Hill, PA 17011. The name and post office address of counsel to the Judgment/Creditor is: Paula J. McDermott, Esquire, Post & Schell, P.C., 240 Grandview Avenue, Camp Hill, PA t7011, (717) 612-6012. Date: ~0-~' / 5~, 2004 Prothonotary