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Home My WebLink About11-05-09IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION lin Re: Estate of Bertha Stone, Register of Willa Deceased O.C. No.: 2009-00404 CLAIM AGAINST DECEDEI*T'I''S ESTATE Filed on Behalf of: Church of God Home, Inc. Counsel of Record for this Party: SCHUTJER BOGAR LLC Livia F. Langton Attorney I.D. No.: 91548 (412) 281-3710 Marijane E. Treacy Attorney I.D. No.: 84070 (412) 281-3535 600 Grant Street, Suite 3290 Pittsburgh, PA 15219 Fax (412) 281-0530 Bradley A. Schutjer Attorney I.D. No.: 75954 (717) 909-5921 417 Walnut Street, 4`~' Floor Harrisburg, PA 17101 Attorneys for Claimant N C7 0~ ~"? V.'1 ~'T ,.-t =r. ~ J `''74 r~ , <,~ J ~ ...~ ~ < ~,> -t~..r l,, ~ ~ f ? ~t i ~"1 G CJ3 ~ U1 :7 ? t'...1 t~ (. ~' ~ T ~~ 3 c~5 ~,,,~ GJ '""" r rz G' ') "'~ ~+ ~ ... i ~y,.4 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: Estate of Bertha Stone, Register of Willa Deceased O.C. No.: 2009-00904 CLAIM AGAINST DECEDENT'S ESTATE The Claimant, Church of God Home, Inc., certifies that there is due and owing by Bertha Stone, deceased, in accordance with the attached invoice, the sum of $68,357.61, plus attorneys' fees and costs, accruing interest at the highest rate permissible at law, and accruing late fees for goods and services. The sum of $b8,357.61 is a priority claim under 20 Pa. C.S.A. § 3392(3) for the value of nursing services rendered to the Decedent within (6) months of her death. The decedent, who resided at Church of God Home, Inc., a skilled nursing facility located at 801 N. Hanover Street, Carlisle, Pennsylvania 17013, died on or about March 7, 2009. On behalf of the Claimant, I do solemnly declare and affirm under the penalties of perjury that the information and representations made herein are true and correct to the best of my knowledge, information and belief. Written notice of said Claim has been given to Tina Hess of Good News Consulting, Inc., Administrator of the Estate of Bertha Stone, 140 Roosevelt Ave., Suite 206, York, PA. 17401, as well as the attorney for the estate, Mr. Shaw, on Novemlber 2, 2009. Respectfully submitted, Claimant Information Church of God Home, Inc. 801 N. Hanover Street Carlisle, Pennsylvania 17013 Schutjer ar LLC v) By Livia F. La on Attorney I. . No.: 91548 (412) 281-3710 Marijane E. Treacy Attorney I.D. No.: 84070 (412) 281-3535 600 Grant Street, Suite 3290 Pittsburgh, PA 15219 Fax (412) 281-0530 Attorneys for Claimant RESIDENT STATEMENT FROM CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 717-249-5322 AMOUNT PAID $ BERTHA E STONE c/o EDITH ECKART 527D SOUTH WEST STREET CARLISLE, PA 17013 Statement Date Due Date 06/30/2009 Upon Receipt ACCOUNT NUMBER .61 802320 Please make check payable to CHURCH OF GOD HOME, INC Remit To: CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 Please detach and return this portion with your remittance to the address above. Comments $0.00 $ 91,922.16 ~ $0.00 ~ $0.00 ~ $160,279.77 ~ $68,357.fi1 :::Date.::`:::;`:: .:..::....:..::::. :::..:.:::.. ` `;:;.:::;:.`: °.':;:.:Descd~ tion:~:~;::::;~;:' ~~':::Da si.' ; ~.::. ~ _: _ : ~._:..::: ; :.::::; : ~:::. P:::::.:.::.~:: ~ ::.::~ :~.::.:, , .::..:Y .>.:..:.: _ _ ~.~;:: ,.: Units.';: ; : .... ... __-_.~_~~`~ -~ .._...___---r-------~-- ~~;--:.; .. Rote.::.:.::::. Charges/ ., :., }. , ., Paymi:rlts ':: ':.=: `;:` `.:.::(Credit) `:_ ` ---- --- --~ ---- --.-.- _. .:.: : ; :.:: Balance..::'. Balance Forward $160,279.77 -_-_~_ • -$160,279.77 06/05/07 - 06/05/07 set (1) $11.25 $(11.25) $t60,268.52 06/D5/07 - 06/05/07 Wash & Set i $11.25 $11.25 $160,279.77 06/12/07-06/12/07 set {1) $11.25 $(11.25) $i 60,268.52 06/12/07 - 06/12/07 Wash & Set 1 $i 1.25 $11.25 $160,279.77 06/1 9107 - 06/19/D7 set (1) $11.25 $(i 1.25) $16D,268.52 06/19/07 - 06/19/07 Wash & Set 1 $11.25 $11.25 $160,279.77 D6/26/07 - 06/26/07 set (1) $11.25 ${11.25) $160,268.52 D6/26/07 - 06!26/07 Wash & Set 1 $11.25 $11.25 $160,279.77 07/D3/07 - 07/03/07 set (1) $11.25 $(11.25) $160,268.52 07/03/07 - 07/03/07 Wash & Set 1 $11.25 $i 1.25 $160,279.77 07/10/07 - 07/10!07 set (1) $11.25 $(11.25) $160,268.52 07/10/07 - 07/10/07 Wash 8~ Set 1 $i 1.25 $11.25 $160,279.77 07/1 7107 - 07/1 7/07 set (1 } $11.25 $(11.25) $160,268.52 0711 7/07 - 07/1 7/D7 Wash & Set t $12.25 $11.25 $160,279.77 07/24/07 - D7/24/D7 set (1} $11.25 ${11.25) $160,268.52 07/24/07 - 07/24/07 Wash & Set 1 $11.25 $11.25 $160,279.77 OB/i4/D7 - D8/14/07 set (1) $11.25 $(11.25) $160,268.52 08/14/07 - 08/14/07 Wash & Set 1 $11.25 $11.25 $160,279.77 D8/21/07 - 08/21/07 set (1) $11.25 $(11.25) $160,268.52 08/21/07 - 08/21/07 Wash $ Set 1 $11.25 $11.25 $160,279.77 08/28/07 - 08/26/07 set (1) $11.25 $(i 1.25) $i 60,268.52 08/28/07 -08/28/07 Wash & Set 1 $11.25 $11.25 $160,279.77 09/04/07 - 09/04/87 set (i) $11.25 $(11.25) $160,268.52 09/04/07 - 09/04/07 Wash & Set 1 $11.25 $11.25 $168,279.77 09/1 i/d7 - 09/11/07 set (1) $11.25 $(11.25} $i 60,268.52 09/11/07 - 09/11/07 Wash & Set 1 $11.25 $11.25 $160,279.77 FACILITY NAME RESIDENT NAME ACCOUNT NUMBER CHURCH OF GOD HOME, INC BERTHA E STONE 802320 fESIDENT STATEMENT FROM CHURCH OF GOD HOME, )NC 801 N HANOVER STREET CARLISLE, PA 17013 717-249-5322 Statement Date Due Date ACCOUNT NUMBER 06/30/2009 Upon Receipt 802320 57.61 AMOUNT PAID $ BERTHA E STONE c% EDITH ECKART 527D SOUTH WEST STREET CARLISLE, PA 17013 Please make check payable to CHURCH OF GOD HOME, INC Remit To: CHURCH OF GOD NOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 Please detach and return this portion with your remittance to the address above. .. :.:Date,.:.:.`,>_.. L ;'; ;. _, `:. ;. '.: Description °' .:.':..~. ;':.;; ..'q Daysl.. . U its ' .: Rate''.'..: : ~ :.Charges/.:.::~^:Payments : " C edit ~ 'Balance ... _~_._:__.._.-~- ---___._.--~ ------------=- --_---_.__ n .__-'_._~- '.-..___ r .._~ __ )-=-=s-'----_-: :_ .W_ ; :_: _°:~__. ---:-- :_: 09/18/07 - 09/18/07 set {1) $11.25 $(1125) $160,268.52 0911 8107 - 09/1 8/07 Wash & Set 1 $11.25 $11.25 $160,279.7? 09/21/07 - 09/21/07 set (1) $11.25 $(11,25} $160,268.52 09/21/07 - 09/21/07 Wash 8 Set 1 $11.25 $11.25 $160,279.77 09/25/07 - 09/25/07 set (1) $11.25 $(11.25) $160,266.52 09/25/07 - D9/25/07 Wash & Set 1 $11.25 $11.25 $160,279.77 10/02/07 -10/02/07 set (1) $11.25 $(11.25) $160,268.52 10/02107 - 10/02/07 Wash & Set 1 $11.25 $11.25 $160,279.77 1 0/09/07 - 1 0109107 set {1) $11.25 $(11.25) $160,268.52 10/09/07 -10/09/07 Wash & Set 1 $t 1.25 $11.25 $160,279.77 10/16/07 - i0/16107 set (i) $11.25 $(11.25) $160,268.52 10/16/07 - 10/16/07 Wash & Set 1 $11.25 $11.25 $160,279.77 10/30/07 - 10/30/07 set (1) $11.25 $(11.25) $160,268.52 10/30/07 - 10/30/07 Wash & Set 1 $i 1.25 $11.25 $160,279.77 11/06/07-11/06/07 set (1} $11.25 $(11.25} $160,268.52 11/06/07 -1 i/06107 Wash & Set 1 $11.25 $11.25 $160,279.77 11/13/07 - 11/13/07 set (1) $11.25 ${11.25} $16D,268.52 11/13/07 -11/13107 Wash & Set 1 $11.25 $11.25 $160,279.77 11/20/07 -11/20/07 set (1) $11.25 $(11.25) $160,268.52 11/20/07 -11/20/D7 Wash 3 Set 1 $11.25 $11.25 $160,279.77 1 1127107 -1 t/27/07 set (t) $11.25 $(11.25} $160,268.52 11/27/07 - 11/27/07 Wash & Set 1 $i 1.25 $i 1.25 $160,279.77 1 2101/07 - 12(06/07 Patient Liability $920.64 $161,200.41 12/01/07 - 12/31/07 Room & Board (31) $(210.00) $(6,510.00) $154,fi90.41 12/04/07 - 12/04/07 set (1) $11.25 $(11.25) $154,679.16 12/04/07 - 12/04/07 Wash & Set 1 $11.25 $11.25 $154,690.41 12/11/07 - 12/11/07 set (1} $11.25 $(11.25) $154,679.16 1 2/1 1107 -1 2/1 1/07 Wash & Set 12/18/07 - 12/18/07 set 12/18/07 - 12/18/07 Wash & Set 1 $11.25 $i 1.25 $154,690.41 (1) $11.25 $(11.25) $154,679,16 1 $11.25 $11.25 $154,690.41 FACILITY NAME RESIDENT NAME ACCOUNT NUMBER CHURCH OF GOD HOME, tNC BERTHA E STONE 602320 RESIDENT STATEMENT FROM CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 717-249-5322 BERTHA E STONE c% EDITH ECKART 5270 50UTH WEST STREET CARLISLE, PA 17073 Statement Date Due Date ACCOUNT NUMBER 06/30!2009 Upon Receipt 802320 ~ ~ : ~ ~ ~ $68,357.61 AMOUNT PAID $ Please make check payab{e to CHURCH OF GOD HOME, INC Remit To: CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 Please detach and return this portion with ya~r remittance to the address above. -::Date ::.::: ~ .: .. .: . _Descripfson :..::°>::: ::..,.:' _ : ; : : ;:: Days! .; . , aZaite_.;? `: ~ .Chargest:': ~_ •: Payments .. +. -Balance :. ~__.~._._;.------.-...___ . --.°_:_..:_.:-_. __..._.--=--=-- ~---_...~.~_~~~__ !Ir-its ~:~.__. -- _ ---.: __(Creditj..._..._~_..---_~.-.__._... ---.-.. - ~~ _:- ~...:.:~ 12/21W7 -12/21107 Puilups -Large (1) $14.82 $(14.82} $154,675.59 12/24/07 -12/24/07 set (i) $11.25 $(11.25] $154,664.34 12/24/07 -12/24/07 Wash & Set i $11.25 $11.25 $154,fi75.59 12/31!07 - 12/31/07 set {1) $11.25 ${11.25) $154,664.34 12/31107 -12/31/07 Laundry (i) $25.00 ${25.00) $154,639.34 12/31/07 -12/31/07 Wash & Set i $11.25 $11.25 $154,fi50.59 01/01/08 - 01106!08 Patient Liability $933.86 $155,564.45 01/01/08 - 01/31/08 Room & Board (31) $(227.00) $(7,037.00} $146,547.45 01!31/08-01/31108 Laundry {1) $27.50 ${27.50) $148,519.95 02/01/08 - 02/06/08 Patient Liability $933.86 $149,453.81 02/01/08 - 02/29/08 Room ~ Board (29) $(227.00) $(6,583.00) $142,870.81 02/26/08 - 02!26/08 Pullups -Large (i) $14.82 ${14.82) $142,855.99 02/29/08-02/29/08 Laundry (1) $27.50 $(27.50) $142,828.49 03/01/08 - 03/06/08 Patient Liability $933.86 $143,762.35 03/01/08 - 03/31/08 Room & Board (31) $(227.00} $(7,037.00) $136,725.35 03/16/08 - 03/16/08 Pullups -Large (1) $14.82 $(14.82) $136,710.53 03/31/08 - 03/31/08 Laundry (i) $27.50 $(27.50) $136,683A3 04/01/08 - 04/06/08 Patient Liability $933.86 $137,616.89 04/01/08 - 04/30/08 Room & Board (30} $(227.00) $(6,810.00) $130,806.89 04/02/08 - 04/02/08 Pullups -Large (1) $14.82 $(14.82} $130,792.07 04/29/08 - 04/29/08 Pullups -Large (1} $14.82 $(14.82} $130,777.25 04!30/08 - 04/30/08 Laundry (1) $27.50 $(27.50) $130,749.75 05/01/06 - 05/06/08 Patient Liability $933.86 $131,663.61 05/01/08 - 05/31/08 Room & Board (31) ${227.00) $(7,037.00} $124,646.61 05/31/08 - 05/31/08 Laundry (1) $27.50 $(27.50) $i24,fii9.ii 06/01/08 - 06/05/08 Patient Liability $833.8fi $125,452.87 06/01/08 - 06/30/08 Room & Board (30) ${227.00) ${6,610.00) $i 18,642.97 06/02/08 - 06/03/08 Puilups -Large (2) $14.82 $(29.64} $i i 8,61 3.33 06/28/08 - 06!28/08 Pullups -Large (i) $14.82 $(i 4.82} $118,598.51 06/30/08 - 06/30/08 Laundry (t) $27.50 $(27.50) $118,571.01 FACILITY NAME RESIDENT NAME ACCOUNT DUMBER CHURCH OF GOD HOME, INC BERTHA E STONE 802320 RESIDENT STATEMENT FROM CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARUSLE, PA 17013 717-249-5322 Statement Date Due Date ACCOUNT NUMBER 06130!2009 Upon Receipt 802320 .61 AMOUNT PAID $ BERTHA E STONE c/o EDITH ECKART 527D SOUTH WEST STREET CARUSLE, PA 17013 Piease make check payable to CHURCH OF GOD HOME, INC Remit To: CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 Piease detach and return this portion with your remittance to the address above. :Date.:.::.:; ; : : ..;;::~::..,`.: ; :'Description,: :. ~ ;:;::` -~.:;`::_.;.:.:..flaysl::`:: aZate'`~: Ctiargesl:... C dit U its ~ PaynieQts'; ; .Batance .. . . :. . n I { re ) 07/01/08 - 07/05/08 Patient Liability $833.86 $119,404.87 07/01!08 - 07P3i/08 Room & Board (31) $(227.00) $(7,037.00) $112,367.87 07/07/08 - 07/07/08 Pullups -Large (1} $14.82 $(14.82) $112,353.05 07/22/08 - 07/22/08 Aduft Wipes {i) $3.25 $(3.25} $112,349.80 07/30/08 - 07/30/08 Pullups -Large (1) $14.82 $(14.62) $112,334.98 07/31/08 - 07/31/08 Laundry (1) $27.50 $(27.50) $112,307.48 08/01/08 - 08/05/08 Patient LiabNity $833.86 $113,141.34 08/01/06 - 08/31/08 Room 8~ Board (31) $(227.00} $(7,037.00} $106,104.34 08/05/08 - 08/05/08 Wash Cream (1) $6.75 $(6.75} $106,097.59 08/16/08 - 08/16/08 Pullups -Large (1 } $14.82 $(14.82) $106,082.77 08/29/08 - 08/29/08 Puqups -Large (1) $14.82 $(14.82} $10$,067.95 08/31/08 - 08/31/08 Laundry (1 } $27.50 ${27.50} $106,040.45 09/01/08 -09/05/06 Patient Liability $833.86 $106,874.31 09101/OB - 09/30/08 Room & Board (30} $(227.00) $(6,810.00) $100,064.31 09/13/08 - 09/13/08 Pullups -Large (1) $14.82 $(14.82) $100,049.49 09/30/08 - 09/30/08 Laundry (1) $27.50 $(27.50) $100,021.99 09/30/08 - 09/30/08 Pullups -Large (i) $14.82 ${14.82} $100,007.17 10/01/08 - 10/05/06 Patent Liability $833.86 $100,841.03 1 0/01108 -1 0/31/08 Room & Board {31) $(227.00} $(7,037.00) $93,804.03 10/16/08 -10/16/08 Pullups -Large (1) $14.82 $(14.82) $93,789.21 10/31/08-10/31/08 Laundry (1} $27.50 $(27.50) $93,761.71 1 1/01/08 - 1 1105/08 Patient Liability $833.86 $94,595.57 i1/01/D8 -11/30/08 Room & Baani (30} $(227.00} $(6,810.00) $87,785.57 11/09/08 - 1 t/09/08 Pullups -Large (1} $14.82 $(14.82) $87,770.75 11/27/08 -11/27/08 Pullups -Large {1) $14.82 $(14.82) $87,755.93 11/30/08 -11/301 Laundry (1) $27.50 $(27.50) $87,728.43 12/01/08 -12!05/08 Patient Uability $833.86 $88,562.29 12/01/08 -12/31/08 Raom & Board (31) $(227.00) $(7,037.00) $81,525.29 12/13/08 -12/13108 Pullups -Large (i} $15.78 $(15.76) $81,509.53 1 2/22108 -1 2/22/08 Pharmacy (1} $89.49 $(69.49) $81,440.04 FACILITY NAME RESIDENT NAME ACCOUNT NUMBER CHURCH OF GOD HOME, INC BERTHA E STONE 80232D F~ESIDENT STATEMENT FROM CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 717-249-5322 Statement Date Due Date ACCOUNT NUMBER 06!30!2009 Upon Receipt 802320 .61 AMOUNT PAID $ __ BERTHA E STONE c% EDITH ECKART 527D SOUTH WEST STREET CARLISLE, PA 17013 Ptease make check payable to CHURCH OF GOD HOME, INC Remit To: CHURCH OF GOD HOME, INC 801 N HANOVER STREET CARLISLE, PA 17013 Please detach and return this portion with your remittance to the address above. ;.. . Date' ..-,':: ~:~::::~:. °..:::Descri tion..'.:>-:.~'>: P. . ~ ~ ':>;':.::~':.:'. :Da s/ `>:Rate::.:. .:'Char es/ Pa ments 9 Y. Y.. ~: I Balance.::.:.i . . :. ; .: .....~ ...:. ~.:~ ; . . ,:::: Units': ~ Cn~dlt 12/26/08 -12/26/08 Pufiups -Large (1) $15.76 $(15.76) $81,424.28 12/31/08 -12/31/08 Laundry (1) $27.50 $(27.50) $81,396.78 01/01/09 - 01/06/09 Patient Liability $894.8fi $82,291.64 01/01/09 - 01/31/09 Room ~ Board (31) $(236.00) $(7,316.00) $74,975.64 01/23/09 - D1/23/09 Pharmacy (1) $190.12 $(19D.12) $74,785.52 Di/23/09 - 01 J23/09 Pharmacy OTC (i} $5.04 $(5.04} $74,780.48 01/31/09-01/31/09 Laundry (1) $33.00 ${33.00} $74,747.48 02/01/09 - 02/06/09 Patent Liability $894.86 $75,642.34 02/01/05 - 02/28/09 Room & Board (28) $(236.00} $(6,608.00) $69,034.34 02/07/09 - 02/D7/09 Pullups -Large {i) $15.38 $(15.38) $69,018.96 02/14/09 - 02/14/09 Oxygen Concentrator (15) $3.00 $(45.00) $68,973.96 02/19/09 - 02/19/D9 Pullups -Large {1) $15.38 $(15.38} $68,958.58 02/25/09 - 02/25/09 Oxygen Cyclinders (1) $12.00 $(12.00) $68,946.58 02/27/09 - 02/27/09 Puilups -Large (1) $15.38 $(15.38) $68,931.20 02/28/09 - 02/28/09 Laundry (1) $33.00 $(33.00) $68,898.20 03/01/09 - 03/D6/09 Raom & Soard (6) $(236.00) $(1,416.00) $67,482.20 03/01/09 -03/06/09 Patient Lfabtlity $894.86 $68,377.06 03/02/09 - 03/02/09 Oxygen Cyclinders (1) $12.00 ${12.00) $68,365.06 03/07/09 - 03/07/09 Laundry (1) $7.45 $(7.45} $68,357.61 TOTAL BALANCE DUE: $68,357.61 FACILITY NAME RESIDENT NAME ACCOUNT NIUMBER CHURCH OF GOD HOME, INC BERTHA E STONE 802320 CERTIFICATE OF SERVICE I hereby certify that, on this date, a true and correct copy of the foregoing Claim Against Decedent's Estate, pursuant to 20 Pa. C.S.A. § 3384, was served via first-class, United States mail, postage pre-paid, upon the following: Tina Hess Administrator of the Estate of Bertha Stone Good News Consulting, Inc. 140 Roosevelt Ave., Suite 206 York, PA. 17401 Andrew Shaw Attorney for the Estate of Bertha Stone Law Office of Andrew H. Shaw, P.C. 200 S. Spring Garden St., Suite 11 Carlisle, PA 17013 `, Dated: ~~ BY~ Livia F. Lan n