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Home My WebLink About10-3307DIALYSIS CORPORATION OF AMERICA d/b/a DCA OF WARSAW, Plaintiff v. ANNA COLEMAN, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA c~ Docket No.. I b- 3 7 l ~`~' • ~ .ri; ~' Z'q. ~ . Gr. F"" -•e-. -~: R- ~ ~ c.~,? a r,;~ c~ 1 _~.y,; , Civil Action -Law -~ ~~ ~` COMPLAINT ~ ~~-, ~:- NOW COMES, Dialysis Corporation of America d/b/a DCA of Warsaw, by and through its attorney, Capozzi & Associates, P.C., and makes the following Complaint for a money judgment against Defendant, and in support thereof, respectfully avers as follows: Plaintiff, Dialysis Corporation of America d/b/a DCA of Warsaw ("DCA of Warsaw"), is a registered Pennsylvania corporation having its principal place of business at 27 Miller Avenue, Lemoyne, Cumberland County, Pennsylvania 17043. 2. DCA of Warsaw is an operating subsidiary of Dialysis Corporation of America ("DCA"). 3. Defendant Anna Coleman ("Patient" or "Defendant") is an adult individual with a last known address at 7389 River Road, Mollusk, Virginia 22517. 4. DCA of Warsaw provides dialysis treatments and services to its patients. 5. On or about March 10, 2006, Defendant executed a Consent for Hemodialysis Agreement ("Consent Agreement") to allow Defendant to receive regular dialysis treatments from DCA of Warsaw as scheduled by her physician and DCA of Warsaw. A true and correct copy of the Consent Agreement is attached hereto and incorporated herein as Exhibit "A.O a $qa. oo ~Pa Aml ~,`~ a~7ao ~~' a~2 a9 9 6. On or about March 10, 2006, Defendant executed a Patient Assignment and Authorization of Payment of Insurance Benefits Agreement ("Assignment and Authorization Agreement"), which required the Defendant to assign and forward insurance benefits that she received for the dialysis treatments from DCA of Warsaw. A true and correct copy of the Assignment and Authorization Agreement is attached hereto and incorporated herein as Exhibit «B „ 7. Paragraph 1 of the Assignment and Authorization Agreement provides that Defendant "hereby assigns, transfers and sets over to DCA of Warsaw monies and/or benefits to which the Patient is (or may be) entitled from any insurance ...provider ...as well as any others who maybe financially liable for the Patient's dialysis treatments and services and related medical care by andlor at DCA of Warsaw, including health insurance benefits ...for which the Patient is entitled, to cover the costs of dialysis treatment and services ...." Paragraph 2 of the Assignment and Authorization Agreement provides that Defendant "hereby authorizes and directs that payment of all insurance benefits...relating to any charges and costs incurred as a result of dialysis treatments and related services and medical care provided to the Patient by and/or at DCA of Warsaw, be paid and remitted directly to DCA of Warsaw...." 9. Paragraph 3 of the Assignment and Authorization Agreement provides that Defendant "hereby acknowledges that the monies or benefits to be paid by the Patient's insurance provider ...for the charges, costs and fees incurred by DCA of Warsaw in its provision of dialysis treatments and related services and medical care to the Patient is and shall at all times remain, the property of DCA of Warsaw...." 2 10. Paragraph 3 of the Assignment and Authorization Agreement further provides that Defendant "hereby covenants and agrees that in the event that any payment of insurance benefits ... is sent to the Patient...that the [Defendant] will promptly and unconditionally forward such payment directly to DCA of Warsaw." [emphasis added] 11. Paragraph 5 of the Assignment and Authorization Agreement further provides that Defendant "hereby acknowledges that, not withstanding the foregoing assignment and authorization of benefit payments to DCA of Warsaw, the Patient shall be responsible for any and all charges and costs billed by DCA of Warsaw for dialysis treatments and related services . . .and that DCA of Warsaw is authorized to bill the Patient directly for payment of such charges and costs." 12. DCA of Warsaw, at the special insistence and request of Defendant during the period March 10, 2006 through April 26, 2006 ("Dates of Service"), provided numerous separate dialysis treatments ("Dialysis") at the rates and on the dates set forth in DCA of Warsaw's business records ("Account Statement"). A true and correct copy of the Account Statement is attached hereto and incorporated herein as Exhibit "C." 13. To date, Defendant has failed and refused to pay as required pursuant to the Assignment and Authorization Agreement and the Account Statement in the amount of $18,534.20. 14. On October 29, 2009 and December 3, 2009, DCA of Warsaw's counsel mailed to Defendant demand letters, which provided information on how to pay the debt owed to DCA of Warsaw. A true and correct copy of the demand letters are attached hereto and incorporated herein as Exhibit "D." 3 COUNT I -BREACH OF CONTRACT 15. Paragraphs 1 through 14 are incorporated herein by reference. 16. The rates and total charges set forth in the Account Statement are just and reasonable and are the rates that Defendant agreed to pay for the Dialysis. 17. The total amount of principal that has become due and owing by Defendant to DCA of Warsaw as a result of her Dialysis treatment is $18,534.20. 18. To date, Defendant has failed and refused to pay the total amount due as provided under the Account Statement and the Assignment and Authorization Agreement. 19. DCA of Warsaw has been financially damaged in the amount of $18,534.20, plus interest and costs of collection. 20. Defendant's failure to cure her default with DCA of Warsaw pursuant to the Assignment and Authorization Agreement constitute a breach of contract. WHEREFORE, Plaintiff, Dialysis Corporation of America d/b/a DCA of Warsaw, demands judgment against Defendant in the sum of $18,534.20, plus interest at the legal rate of 6% per annum from the date of the judgment. COUNT II -QUANTUM MERUIT -UNJUST ENRICHMENT If this Honorable Court should find that an express contract did not exist between DCA of Warsaw and Defendant, which is denied, then, in that event, DCA of Warsaw pleads the following alternative cause of action in quantum meruit against the Defendant. 21. Plaintiff incorporates paragraphs 1 through 20 of this Complaint as if set forth at length herein. 4 22. Having requested DCA of Warsaw to provide the dialysis treatments and DCA of Warsaw having done so to the benefit of Defendant, Defendant became liable to DCA of Warsaw for the just and reasonable charges for the Dialysis. 23. The Defendant has been unjustly enriched by accepting the Dialysis. 24. The rates reflected in the Account Statement as Exhibit C are the just and reasonable rates for dialysis treatments and services. 25. The total value by which Defendant has become enriched on account of the Dialysis is $18,534.20, as is more specifically reflected in the Account Statement. 26. DCA of Warsaw has demanded Defendant pay this amount, but Defendant has failed to do so. 27. To date, the Defendant has not paid the total amount due. WHEREFORE, Plaintiff, Dialysis Corporation of America d/b/a DCA of Warsaw, demands judgment against Defendant in the sum of $18,534.20, plus interest at the legal rate of 6% per annum from the date of judgment. Respectfully submitted, Capozzi & Associates, P.C. Dated: S ~y ID B ~. , Y~ Michael M. Jerominski, Esquire Attorney I.D. No. 92977 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101 Attorneys for Plaintiff 83/15I2tiB6 89:38 13818813311 't DiAY~srs co>~roRa ~:. ~ ! Name of i?aticnr. ~~_ ~c~.1~lt~cr r-. lD I, Ehe undersigned pe~tiertt;. ( ) I, the undersigned par~att or t8 years of age or otht~r+vise hereby request old authse E>r. V • n ~x designate as bis yr her assvciatie ctr assis t to a~#fr~~ pmcedurt known as pentQtTCaI dialysis, ut-der such p~erctoneal progra~nrt m which I agree to abide, It has bean explained. to me that peritoneal dialysis, proccduro used ill the case of patiema with impalas certain cvmpoueatts of biood~; are separated by n;~ P passage of certain ~olccc~lea'ut~ hinders t3lstt of atf abdomen. I undett~tarld theca; as+c difFcreut ~xs of end together with tha PI> n '' 'm^s~e a''n+d physiciaai, I try cirrusastaacts anal rne. ~~ ~~ .t I~, ' ~. I xolenowiedgo tbaat the possi~le r~sks~and~eazaptscat litttited to) ctges i~ blood. ~' a d~ecide~ntet ov have been cxpla3tted ~ me ~''tl~a profrssional pers+ sash rislts and camplicatioz3s: I also u~statid tlia affects duriitg the lima first I'am receiving a p+erito~ related. tv this cottchtia~. I fv~thor ccnscat #a the sd blood or bland cC9anltarlpits, ar ally other tteatm~t accessary or desirable in the judgamcat of the ph~si+ I atrt aware that the dice of medicine is not an exa~ guarantrt, qr~r afreptian whatsoever has anyone ors my behalf. ooneetxliltg the results vfihis P~ ~atlGrn 7 ~~~ana F'ACI 11 / 11 OF Uste: ~r';~"7„' +df the above pztitnt wha is under e of consssrtjng; ar~d whomever hA ar she may er to me or the above p~atie~nt the ~ditidns has provided by the Centar's I~ ier CAPD, APb, or CCPD, is s yr faiiui~e of kid~i-ey fltnctiott by which meal rn'embrane which palrniits the r~-hen the blond ~ passing 'through my pment `~nplloyed for this treenneatt a help find rho sy~s#eor best suitable for aateal dialysis such as (but not sud malfiu:ctian ofo9vip~'att al7av~c center arld T accgrt all dr which afflicts ma can have t ar visit, but that that does isiratiaa af'sucil dCVgs, transfusions of lasting to inalttdt HITT testicag seemed. (s) in attendance. saicx~ce, and I ealcnowlcdge that as aen offerod yr made to nee ar to or EXHIBIT ., !. 05f04/280fi 10:31 13919613311 Pfsf~ 11f12 DULY~78 CaaroF~~7tO~t O~ AtMERIGA <~~4~, N ,F~ ~~~ ~A'xTENT ASS~GF \~1"~'' Ar~'~'ORJ.Z.A.TIO~ ~ r 5 fv ; 4/ , OF PA3~fi~NT Off' INSURANCE BENEFITSi ='~~~;~ ~~ ~.~.a~l~ Aar: ~~~~a.~ 1C~ieottF~sme- ~t'1f1r,~.. ~y~~/~c.~, Pa~mtID~: Dad ~•'7 (Plase?rincy -- 1~ 11~3~G1~N'x "~ ~ !' ~~- te'+a~8fer' sad rite vra to bCrl oiKiltdc mimes raedlor ~eHer on Leh dxe Pat'f+eos Ee (or ~ be) emided fi~ ~' ios~ce radlot haa~ came pravi~kr or te~c~assl. ~ or 1ocmT ~ovexe~aollel agiasrq, iealadit~ ~¢ ~ad&aue iaearawc ~ 1~5 wd] IIS any WFxxs who u4Y 1rc ~,entcta~r i#sbte. ~r ttie l~tiC+tt's d3e~ydis ~r~ents aad sorvJrxe rmd Ycl'amd radical are by wadlor et IiCA of KfflnRrnoclc, lr~olud%ng beabth inewluooa ls~ef~a, meijar modieai l~efitt end other ~tod3cal ~ oovaagc ax other polfcq far which the ~ettt Is e~tlsd, to cam iCte ousts of diadem 1t+aebrter~t aad servicd row3 atip ageer Aeod~esl tart re+td+a'~ed to the Pet&~! by endear es L~CA o!' Kt'feneresack. 2, Ai3'~Cl~1tTl.~.~'ION OF P~lX1~~9T +0-~' >INS>i3lRANCE BS~~RTI'S SIC ~' Od, +.w`•'rJ BQ~IQ~S i~ dfll~ir't8 ~t ~(C~E11t l~ ~7 ~7COC~. iYtCalFf~lpg ~11f~11~~1: i~aoeftm, If epp~cabl4 talatic~ to ~ and ataac iaceai~ed as a r+esu~t of d3a ~ sad. relsrod oetviceia aced medial oere pravid~cd to the Pat~end by ate aut DCA of Kt`lmeeaocic, be paLci ead ~amarsd derxfly to DCA o~>Ka6aeeon~adt hn Acoatde=eos vvEda hufroctiomis provided t-r to be p~videsd by eo agattt or rcpe~d'tve o~ETlC'A of ~clcfc. in dm o~DC~4 ofK~me-noadc, the mn~dcuxignedb4nbp #1at9~+at~ ranad blattit~cpr the e,~stneanee pns'~+ieidr ~' ab~!'rrapoat~rle 6or paq-~aeot of tba app~icebZc ~ beme9ts br imroor>~ tlm Patient's ttett~ ^cd to delfve+r sell piymeut >o - ~t ~ oz Sts adds as s~ $acde fn. ~c ittStEwat3on9 prm+l+iad ar~'be Pm*~ by en ~ or eve of DCA of ~oclc 3. Di1~VEI~Y OF i~'T P~t'k7~N'TS iI~CETV~D- ~'RdM P~RO'V1~R Tba ~ i~et~ aaarenrtedy~.t~upe Her hies m Ile ba p~ by t~ 1~t's M1ltoirasa~r pkul~.r o~ ~ovarireerat ~g1og for t1~e elast~q, e~i eel ba iscwe~d b7 l~A of Kllltt~ooelr ie ibt pra~#sEs>w of dlr~it, #t~atynaess eud t+eLbei seo~vKeep rued meilaat• estre sa she Yatiee! Se ~ ~g eit all'tlmes ~a~aia, ttis p~ropett~ of DCA o! I~fienarapti4 said M iartb4ra~rra tbexeoi Hie usdsrdgusd betaby cdveoa~ttta aAd eEreer ts3tt to toe eNaen Here stry pa~etei-# sf ies,eraare beau, b~d1a~ ~+edlaate iwtelfee. a!bklt Rlste df-ae71y tv '#'be dt'+r~c, eoete and ~eee iagerred b'A DC,d< M ~lmareoek a s ~te8 e+t f!s pror~los- d< ~Ir~~r ara/ reteted serYicer eead a~edtal me ~ !ba Faflezv! is scat w !ba Yc~tt or t~ ~OgiieaiNe sftp~ it~~ireter ttprn~meeh-e~ ae the osK may br, ls~ed~ertoelt~ or otlre~r*ris~, t~wt t>te ltndemfrbed pill l~ml~ rttd g4eotlt~iy lbrgard aaeb praptne!!t dtr~r to DCA, dl1Ki'teepaoelt, Page 1 of 2 EXHRRIBIT l> 65f 8A/26@6 18.31 13028813311 ~~ PA+~ 17/ ~ ~. 3~~tA5t3$ OF 3i~1'~'091tMATIOrQ ~ oader~nod Eby s as~l add0ems bct the n:i~e 1xy ~'.A ~' Kiimertxxc~ mr any wf its at Wives, of alI or part af8apr In!'anaax{an, t~oorda ar • eitb~ medial ar fi~acial is , tv ar wit11 ~ p mxpoeWiva or,aovr~artneat a4geeecY. iuelu~org ae~pr 'WrtY imso~ot: aadlor ht eere provi4t;r, who £a fob li~ible for tlxe Faaieao~t'a diatysis tr~aasmb and reislmd smrvf.+t~s ss- ate11 ss amed3eal arm, rvl,lcf~t inTctmsticcl is acoaw3r ~t the Via, vim sndlor of ~~ of ttnd t~ossa t4 DCA of Kih~oernook for tlae prov~am m rite ~Eiamt of ~h tlt~a3ya3s ~ eold leiamd Moat as w>•ii! as medial Care. S. R3E~PQP~t~I~.lt'I<'X FO~t IPAY3'~`3 9'hie mad 3xettby enknowledaaa tltst- noevvitbsanlcting ~ a~ asslgm<rmlt a~ ~-~lian oibeiime,$t payrna~am m Dt',Jl atKiiamm+a~ tse Paeicat stiali be ~e ~bt anq' oud ~ ~ and ogees 3~ by l of Kilsnotna+~ £or dislysia tredmmto aoA tell servlett pr+cwidied and trot d~vaViaE ocsacced ar paxd by stlcb tlat+d-potty psya~t ar EovECatnltl3rd ag~cy~ iticludit~, wltlltrot iimdta~ern a3.1 ~buce~rib3+; oo- amf bD-plty+yrcalt caamltt, ood tlxrrt INCA of Killtle~rtlotdc is autlYarized i4 3~ tS1ts Potiettc dixectiy iDr }1aytt~tet O'FSitcb a t+ad +caeta. t% 1~VOr~Y 'Ihc ~! !'' a1Ad~ tlta! tMs PatT~TT[' AS~~dT A1~1D At3THCl3~A:lTQQtiI O3;' AA'YD'I' bF 1NS't1~chNt~ ~ may not: be rmv~oiatd uulees~ tweh tievoea~sn ig aoo~p~pasl3od'Erl*'tht: wrlttrn c~od7ttt- sock nvooa~ort by DCA oflCih~lorrnulele. 7. p°iera~o+cor~s ~ ~ ~ a l~~y a~ mis ~n~,r Ass1C~tM~rrr All'17i.4~tL~A.TIOIrt OF Y~lYi~T' OF INS3LIRANCE 8t~'~F9<1'3 sburl'1 be ooxwidnmd as< vapid ad ati 9f~osatu-re: ~~'rn't,c~-- ~?.~.fir+~,rrr..:..j WiltDeas'~,~~ .~-~.,_;,~ ~'1'~---~ 3Print~ggrs; +'utim~. Co~~Ntu.,h Ua~e: 45 D' Ob i i ~~ ~ ~~ w you iQ! a8 & $~ ~~''111-~8Ck CT 1`fl~l+b~tl~3YC 0~ ~ Tt~ p)RISL' [lL~ILStO b}- IZ1E ~6If a~ COm~llplt 1~C l~ ~WV: a,i G~R~CA~t31V~ OF GUA>~YAN/~l'Y`~`O~i~'-Ili FAfv'~'I~~',~tI~AT~V~ TbC >Z;iilllSl~ ~ W7 CtTpfiC3 t11Bt 1it~9~ 36~ t~ 8plfOtlYf'Ed gtlpfd'!~]s ~Y ]D^~t ~0~ iutd< o~'ffiie a3wva~mRatlotied patird~t„ aad that Mh1te bas 8x31 au~roe3ty to ercetatts tkia faun an 111: ~~lt9i: Prloi I'~aume: pstp; Fags ~ of Z ~~ DI~+L.YSIS CORPORATiQN OF AMERICA Accounts Placed For Collection With Capozzi 8 Associates Date 2/3/2009 Representative KATIE A. J E Approval Facility: WARSAW Date Sent _~ .~ ~., DCA Account # Patient Name Patient Address Patient Phone # Patient SS# Patient Birth Date Primary Insurance (name & address) Subscriber Name Subscriber ID # Secondary Insurance (name 8~ address) Subscriber Name Subscriber ID # Date DCA Called Patient Date DCA Sent Letter to Pt Date of Service Amount Duero DCA Insurance Check # Date Ins Check Sent To Pt Insurance Name On Check Primary Payment? Secondary Payment? CoinsurancelDeductible Revised 03-26-07 123WA COLEMAN, ANNA PO BOX 104 7389 RIVER RD ' MOLLUSK, VA 22517 80462-7822 219-46-9611 2/7/1944 PATIENT BALANCE /SELF PAY COLEMAN, ANNA 219469611 12/8/2008 Effective Date 2/7/1944 Group # Effective Date Group # The following payments were sent to the subscriber: 03/10/06-03/31 /06 $7,000.00 NO INSURANCE N/A N/A Yes X No Yes: No Yes No Date of Service Amount Duero DCA Insurance Check # Date fns Check Sent To Pt Insurance Name On Check Primary Payment? Secondary Payment? Coinsurance/Deductible 04/03/06-04/26/06 $11,534.20 NO INSURANCE N/A WA Yes X No Yes No Yes No EXHIBIT Itemized UB04 Statement User KJOYCE Date: 2/3/09 Page 1 of 1 Facility: DCA-WARSAW 4709 RICHMOND RD WARSAW VILLAGE CTR WARSAW, VA 22572 (866) 390-0376 Provider Number: Insurer: PATIENT BALANCE/ SELF PAY Group Number: Policy Number219469612 Claim # 1st 2nd Rev. NDC Billing Description of Service Date ICD9 ICD9 HCPC Code Number Quantity Charges Patient: COLEMAN, ANNA PO BOX 104 MOLLUSK, VA 22517 128122-1 03N 0106-03131 /O6 CCPD; TRAINING 03/10/06 585.6 851 1 1,000.00 03/13/06 585.6 851 1 1,000.00 03!17/06 585.6 851 1 1,000.00 03/20/06 585.6 851 1 1,000.00 03/24/06 585.6 851 1 1,000.00 03/27/06 585.6 851 1 1,000.00 03!31 /06 585.6 851 1 1, 000.00 Treatment Item Subtotal: 7 $7,000.00 Claim Subtotal: 7 ;7,000.00 Grand Total: 7 $7,000.00 QMS Focus Release: 6.7.02 Itemized UB04 Statement User KJOYCE Date: 2/3/09 Page 1 of 1 Facility: DCA-WARSAW 4709 RICHMOND RD WARSAW VILLAGE CTR WARSAW, VA 22572 (866) 390-0376 Provider Number: Insurer: PATIENT BALANCE! SELF PAY Group Number: Policy Number219469612 Claim # 1st 2nd Description of Service Date ICD9 ICD9 PC v. NDC Code Number antity lling Charges Patient: COLEMAN, ANNA PO BOX 104 MOLLUSK, VA 22517 128123-1 04/03/06-04/26/06 ADMIN SUPPLIES 04/12/06 A4657 270 1 11.40 04/20/06 A4657 270 1 11.40 04/26/06 A4657 270 1 11.40 Treatment Item Subtotal: 3 $34.20 CCPD; TRAINING 04/03/06 585.6 851 1 1,000.00 04!07/06 585.6 851 1 1,000.00 04/12/06 585.6 851 1 1,000.00 04/19/06 585.6 851 1 1,000.00 04/20/06 585.6 851 1 1,000.00 04/24/06 585.6 851 1 1,000.00 04/26/06 585.6 851 1 1,000.00 Treatment Item Subtotal: 7 $7,000.00 EPOGEN 20000 IV 04/12/06 285.21 J0886 635 1 1,500.00 04/20/06 285.21 J0886 635 1 1,500.00 04!26/06 285.21 J0886 635 1 1,500.00 Treatment Item Subtotal: 3 $4,500.00 Claim Subtotal: 13 ;11,534.20 Grand Total: 13' $11,534.20 QMS Focus Release: 6.7.02 Louis ]. Capozzi, Jr., Esquire* Daniel K. Natirboff, Esquire Donald R. Reavey, Esauire Bruce. G. Baron, Esquire Andrew R. Eisemann, Esquire Michael M. Jerominski, Esquire Timothy Ziegler, Reimb. Analyst Karen L. Fisher, Paralegal Jennifer Kain, Paralegal Keyoung Gill, Paralegal • (liccns~d in PA, NJ and MD) •' Iliccnscd in PA and MD) Anna Coleman 7389 River Road Lancaster, PA 22503 Capon & Re: Account with Dialysis Corporation of America Account Balance: $18,534.20 plus costs of collection Our Matter No.: 1087-08 Dear Ms. Coleman: 2933 North Front Street Harrisburg, PA 17110 Telephone: (717) 233-4101 Fax: (717) 233-4103 www. c ap ozzi associates. co m Craig I. Adler, Esq. Of Counsel Please be advised that our law firm represents Dialysis Corporation of America. Dialysis Corporation of America is proud to provide compassionate and lifesaving services to individuals in need. However, in certain situations it becomes necessary for them to take stronger measures to enforce the agreements made by their patients to receive compensation for services rendered. Your account is now seriously overdue. Dialysis Corporation of America firmly believes that they are entitled to receive the above-referenced balance. They have instructed me to attempt to settle this account in an amicable manner, if possible. Although you have 30 days to contact me to dispute the amount, make payment, or make settlement arrangements, we will have no option but to prosecute a lawsuit against you if this issue is not resolved. NOTICE: UNLESS YOU DISPUTE THE VALIDITY OF THIS DEBT, OR ANY PORTION THEREOF, WITHIN 30 DAYS AFTER RECEIVING THIS NOTICE, THE DEBT WILL BE CONSIDERED TO BE VALID. IF YOU NOTIFY OUR OFFICE IN WRITING WITHIN 30 DAYS AFTER RECEIVING THIS NOTICE THAT THIS DEBT, OR ANY PORTION THEREOF, IS DISPUTED, WE WILL OBTAIN VERIFICATION OF THE DEBT AND WE WILL MAIL A COPY TO YOU. THE NAME OF THE ORIGINAL CREDITOR OF THIS DEBT IS IDENTIFIED ABOVE. THIS LETTER AND ALL OTHER COMMUNICATIONS FROM US ARE ATTEMPTS TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. Please make arrangements to settle this delinquent account or you may call me if you have any other questions. I trust that you will give this Notice your immediate attention. Yours truly, /kjg cc: Lisa A. Laudeman, DCA ,~ ~- Michael M. Jerominski EXHIBIT Louis J. Capozzi, Jr., Esquire• Daniel K. Natirboff, Esquire Donald R Reavey, Esquire Bruce G. Baron, Esquire Andrew R. Eisemann, Esquire Michael M. Jerominski, Esquire Dawn L. Richards, Esquire Timothy Ziegler, Reimb. Analyst Karen L. Fisher, Paralegal Jennifer Kain, Paralegal Keyoung Gill, Paralegal " (licensed in PA, Nl and 1ND) "• (licensed in PA and MD) Anna Coleman P. O. Box 104 Mollusk, VA 22517-0104 December 3, 2009 Re: Account with Dialysis Corporation of America Account Balance: $18,534.20 plus costs of collection Our Matter No.: 1087-08 Dear Ms. Coleman: 2933 North Front Street Harrisburg, PA 17110 Telephone: (717) 233-4101 Fax: (717) 233-4103 www. cayozziassociates. com Craig I. Adler, Esq. Of Counsel As you are aware, our law firm represents Dialysis Corporation of America regarding the above-referenced delinquent account. You have failed to respond to my letter, dated October 28, 2009, attempting to resolve this matter in an amicable manner. Accordingly, you have left me no choice but to advise our client to proceed with a civil Complaint to obtain a Money Judgment for the full amount owed, plus interest, attorney's fees, and costs of collection. Please call or write to me immediately if you would rather settle this matter and make flexible payment arrangements. Otherwise, this will be my final communication to you before we file the civil Complaint to obtain a money judgment for the full amount owed, plus costs of collection. Yours truly, ~jg cc: Lisa A. Laudeman, DCA i~~ Michael M. Jerominski THIS LETTER AND ANY FUTURE LETTERS FROM OUR FIRM ARE AN ATTEMPT TO COLLECT A DEBT, AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. DIALYSIS CORPORATION OF AMERICA IN THE COURT OF COMMON PLEAS OF d/b/a DCA OF WARSAW, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v Docket No.: ANNA COLEMAN, Defendant Civil Action -Law VERIFICATION I, Lisa Laudeman, Reimbursement Manager, do hereby verify under penalties of perjury and upon personal knowledge that the contents of the foregoing Complaint are true and correct. Date: ~~'~ ~~~~ Lisa Laudeman Reimbursement Manager Dialysis Corporation of America 214 Senate Avenue, Suite 300 Camp Hill, PA 17011 DIALYSIS CORPORATION OF AMERICA IN THE COURT OF COMMON PLEAS OF d/b/a DCA OF WARSAW, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff c ~ `~- • -v tx , , `-- ~ ' ~~ `' ~ v. Docket No.: 10-03307 :~> ~~ ~-. ~- re's _~,~, C! N "~' ~ ~ ~ ANNA COLEMAN, ~ = " '-' ~' c ~ `_~ ~-r`„ Defendant Civil Action -Law PRAECIPE TO ENTER DEFAULT JUDGMENT AGAINST DEFENDANT TO THE PROTHONOTARY/CLERK OF SAID COURT: Pursuant to Pa.R.Civ. P. No. 1037(b), enter judgment in favor of Plaintiff Dialysis Corporation of America d/b/a DCA of Royston and against Defendant Anna Coleman for failing to file an Answer to Plaintiff's Complaint within twenty (20) days from the date of service of said Complaint and assess Plaintiff s damages certified to be calculable as a sum certain from the Complaint, I hereby certify that: tr Current amount due: $18,534.20 ,~ Attorney Fees: $ 533.50 ~ ~~ ~y~o Cost of Court: $ b TOTAL: *$19, b(o~•7~ °~ * Plus post-judgment interest at the legal rate of 6% per annum, plus costs of collection. I understand that any false statements therein are subject to the penalties contained in Title 18 of the Pennsylvania Consolidated Statutes §4904, relating to unsworn falsification to authorities. I verify that: 1. The last known address for Defendant is as follows: ~I~.oO P~ ~Al'1~ 1 e~ a ~aea e~ a~rN3y9 ~o~tee ~Ou,~~ f• Anna Coleman 7389 River Road Mollusk, VA 22517 2. It is certified that a written Notice of Intention to Enter Judgment by Default was mailed to Defendant, against whom this judgment is to be entered, after the default occurred, and at least 10 days prior to the date of the filing of this Praecipe. A copy of the Affidavit of Service is attached as Exhibit "A." A copy of the Notice of Intent to Enter Default Judgment is attached as Exhibit "B." Date: June 25, 2010 Michael M. Jerominski, Esquire Attorney I.D. No. 92977 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff 2 DIALYSIS CORPORATION OF AMERICA dfbla DCA OF ROYSTON, Plaintiff v. ANNA COLEMAN, 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Docket No.: 10-03307 c5 ~' Defendant Civil Action -Law ,:.a `;; ---, AFFIDAVIT OF SERVICE ~ = ' ' ~"~ ~.~ - - , COMMONWEALTH OF PENNSYLVANIA ) ' `' ! P'~ COUNTY OF DAUPHIN ) t _ _ ~' ~_ Michael M. Jerominski, Esquire, being duly sworn, deposes and says: 1. I am over the age of 18 and not a party to this action, 2. On the 20`h day of May, 2010, I served a copy of the attached Complaint upon the Defendant by putting it in a postage prepaid envelope and mailing it to Defendant Anna Coleman, 7389 River Road, Mollusk, VA 22517 by first class certified U.S. mail. 3. On May 26, 2010, Defendant claimed the attached Complaint. A true and correct copy of the executed U.S. Postal Service Form 3811 is attached. Date: G~~y ~~~ Sworn to before me this %`~ day of June 2010. N Notarial Seal Keyoung J. Gill, Notary Public Susquehanna Twp., Dauphin County MY Commission fJCDires April 1, 2013 Michael M. Jerominski, Esquire Exhibit A ® Complete items 1, 2, and 3. Also complete item 4. it Restricted Delivery is desired. ~ Print your name and address on the reverse so that we can return the card to you. ~ Attach this card to the back of the mailpiece, or on the trout if space permits. 1. Article Addressed to: ~'~,C~JC- /i'_._. / _`~~ _r' J. ;'ice:" ~, _Ji A. Signature X r^ _ , _ ~ Agent B. Received by (Printed Name) C. bate of Delivery ,j~Yl'nGd~' ~Cftle~n.inr y~J'~1F~/D D. Is delivery address different from item 1? ^ Yes It YES, enter delivery address below: ^ No '..~~~~~~.~,r G:~+J`.._, i/ 7-'1 .: % cC `_~ ! f,r 3. Servi ype t Certitied Mail ^ Fx~ress Mail ^ Registered IL7-t~etum Receipt for Merchandise ~ Insured Mail ^ C.O 0. ~: 4. Aestrlcted DeliveryT (Extra Feel Yes 2~ Artic~eNumber 7008 1140 0001 6332 2266 (transfer from secv/ce labs)) ~-_-, ~~...~-~;r:~~,-- - - = - -'°,mm „~::,,~.,.~a,..~,~„~.rt~-~ .,~_;A.~-~-~ PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-7540 Exhibit A UNITED STATESPQsT~~.,.~Fr~V~c~~.._ ; • Sender: Please print your name, address, and ZIP+~"iri~tliis kio~,~~ .`~ Michael M. Jerominski, Esquire ~ ~.~-~ Capozzi & Associates, P.C. _ .. ~~' 2933 N. Front Street ',.t ::.. Harrisburg, PA 17110 ~ ``'' :_ r:~ N: 1/ v` ~ Exhibit A DIALYSIS CORPORATION OF AMERICA d/b/a DCA OF ROYSTON, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. Docket No.: 10-03307 ANNA COLEMAN, Defendant : Civil Action -Law NOTICE OF INTENTION TO ENTER JUDGMENT BY DEFAULT TO: Anna Coleman 7389 River Road Mollusk, VA 22517 DATED: June 15, 2010 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAYBE 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 TELEFHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-316b Exhibit B DIALYSIS CORPORATION OF AMERICA : IN THE COURT OF COMMON PLEAS OF d/b/a DCA OF ROYSTON, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v. Docket No.: 10-0330? ANNA COLEMAN, Defendant Civil Action -Law NOTICIA IMPORTANTE TO: Anna Coleman 7389 River Road Mollusk, VA 22517 DATED: June 15, 2010 USTED HA NO COMPLIDO CON EL AVISO ANTERIOR PORQUE HA FALTADO EN TOMAR MEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI USTED NO ACTUA~ DENTRO DE DIEZ (10) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA USTED SIN UNA AUDIENCIA Y USTED PODRIA PERDER SU PROPIEDAD O OSTROS DERECHOS IMPORTANTES. USTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEGUIDA. SI USTED NO TIENE ABOGADO O NO TIENE CON QUE PAGAR LOS SERVICIOS DE UN ABOGADO, VAYA O LLAME A LA OFICINA ESCRITA ABAJO PARA AVERIGUAR A DONDE USTED PUEDE OBTENER LA AYUDA LEGAL. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 ,moo;-. Michael M. Jerominski, Esquire I.D. No. 92977 2933 N. Front Street Harrisburg, PA 17110 (717) 233-4101 2 Exhibit B DIALYSIS CORPORATION OF AMERICA IN THE COURT OF COMMON PLEAS OF d/b/a DCA OF WARSAW, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff v' Docket No.: 10-03307 n °- ~ ~' ~ . ~, ~ T: C. ~-} ANNA COLEMAN, `~ Defendant Civil Action -Law ~~ ;~,- ~- ~ ; ;~ ~-: CERTIFICATE OF RESIDENCE ~ "~ v I hereby certify that the name and address of the proper person(s) to receive this Notice under Pa. R. Civ. 236 is: Anna Coleman 7389 River Road Mollusk, VA 22517 Date: June 25, 2010 /~`vI. , Michael M. Jerominski, Esquire Attorney I.D. No. 92977 Capozzi & Associates, P.C. 2933 North Front Street Harrisburg, PA 17110 (717) 233-4101 Attorney for Plaintiff