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HomeMy WebLinkAbout10-4671 i V •, PERINI SERVICES/ IN THE COURT OF COMMON PLEAS OF SOUTH HAMPTON M ANOR, L.P.: CUMBERLAND COUNTY, PENNSYLVANIA Pl 'ntiff v. NO. 2010- y 6?? CIVIL TERM MARY CAMPBELL and JESSICA E. SMIKLE, : AGENT FOR MARY C AMPBELL and INDIVIDUALLY, cn N D endants l nf'. ? ?+ NOTICE + i "D You have been su d in court. If you wish to defend against the claims set for" the following pages, you must take action within twenty (20) days after this complaint an6otiqe are served, by entering a writ ten appearance personally or by an attorney and filing in writing v*h ^Z the court, your defenses o r 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 furth er 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 OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, Pennsylvania 17013 (717) 249-3166 ? 9d Ob Pt ,(L? a.YS 3 a-I PERINI SERVICES/ SOUTH HAMPTON M )NOR, L.P. Plaintiff v. MARY CAMPBELL a JESSICA E. SMIKLE, AGENT FOR MARY and INDIVIDUALLY, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- CIVIL TERM COMPLAINT NOW, comes Perini Services/South Hampton Manor Limited Partnership d/b/a Shippensburg Health Care Center ("Shippensburg Health"), by and through its attorneys, BARIC SCHERER, and files the within Complaint and, in support thereof, sets forth the following: 1. Shippens urg Health is a Maryland limited partnership duly authorized to conduct business in the Commonwealth of Pennsylvania with a business address of 121 Walnut Bottom Road, Shippensburg, C berland County, Pennsylvania 17257. 2. Defend t, Mary Campbell, is an adult individual with a residence address of 121 Walnut Bottom Road, S ippensburg, Cumberland County, Pennsylvania 17257. 3. Defendant, Jessica E. Smikle, is an adult individual with a residence address of 306 Shepherd Lane, Ship 4. Shippens 121 Walnut Bottom RoE 5. On or ab4 Shippensburg Health fa( 6. On or abi Campbell, executed an , and correct copy of the , incorporated. sburg, Franklin County, Pennsylvania 17257. Health operates a resident skilled care nursing facility located at Shippensburg, Cumberland County, Pennsylvania. June 8, 2009, Mary Campbell sought to be admitted to the June 8, 2009, Jessica E. Smikle as attorney-in-fact for Mary Agreement on behalf of Mary Campbell at the facility. A true Agreement is attached hereto as Exhibit "A" and is 7. Pursuant the Admission Agreement, Mary Campbell would be responsible to pay any costs of care whi ch were not covered by a third party payer. 8. On or abol ut June 8, 2009, Mary Campbell became a resident of the Shippensburg Health facility and remai ns a resident to the date hereof. 9. Pursuant the Admission Agreement, Jessica E. Smikle agreed, as the responsible party for M Campbell, to pay the costs of care provided from the income of Mary Campbell. 10. As of Jun 8, 2010, Mary Campbell owed Shippensburg Health the sum of $8,532.07 for the costs o care provided by Shippensburg Health to her. A true and correct copy of the Statement reflecti g the balance due is attached hereto as Exhibit "B" and is incorporated. 11. Demand as been made upon Jessica E. Smikle to pay the amount due for the costs of care provided to Mary Campbell. COUNT I-BREACH OF CONTRACT 1URG HEALTH v. MARY CAMPBELL AND JESSICA E. SMIKLE 12. Plaintiff i#corporates by reference paragraphs one through eleven as though set forth at length. 13. Mary Campbell has breached her obligation to pay for the costs of care as provided by Shippensbwg Health. 14. Jessica E. Smikle has breached her obligation to pay for the costs of care provided to Mary Campbell from the income and assets of Mary Campbell. 15. As a cons $8,532.07 to June 8, 2011 16. The accru E. Smikle has failed to p? name of Mary Campbell. of that breach, Shippensburg Health is owed the sum of debt consists of the private pay obligation of Mary Campbell. Jessica the private pay obligation from the benefits she has received in the 17. The Admi sion Agreement bound Mary Campbell to pay for the costs of her care at the facility and bound Jessica E. Smikle to pay the costs of care from the assets and income of Mary Campbell. 18. The Admission Agreement provides for the recovery of a penalty for late payments in the amount f 1.5% per month. 19. The Admission Agreement provides for the recovery of reasonable attorney fees and costs incurred by Shi pensburg Health to collect a debt due and owing to Shippensburg Health. WHEREFORE, Plaintiff requests judgment in its favor and against Mary Campbell and Jessica E. Smikle for the um of $8,532.07 plus additional interest, costs and expenses and any additional amount comin due to the date of award and attorney fees and costs. II-MONEY HAD AND RECEIVED HEALTH v. JESSICA E. SMIKLE 20. Plaintiff incorporates by reference paragraphs one through nineteen as though set forth at length. 21. During the period of residence at the facility, Jessica E. Smikle has been receiving social security d pension benefits of Mary Campbell. 22. The prope use of those funds would have been to pay the costs of care accruing for the care of Mary Campbell at Shippensburg Health. 23. At the time of receipt of those funds, Jessica E. Smikle knew that these funds should be paid over to S 'ppensburg Health for the costs of Mary Campbell's care. 24. Jessica E. Smikle gave no consideration for the funds of Mary Campbell she has received. 25. Demand has been made upon Jessica E. Smikle to tender the funds of Mary Campbell to Shippensb4 Health and she has failed and refused to do so. WHEREFORE, requiring her to: a) return the b) pay over c) pay its v; d) award requests judgment in its favor and against Jessica E. Smikle matter in specie; value if Jessica E. Smikle has consumed the money in beneficial use; if Jessica E. Smikle has disposed of the funds received; and expenses and interest. Respectfully submitted, BARIC SCHERER p4w- 4?lzr- L. David A. Baric, Esquire I.D. # 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Attorney for Plaintiff 07/68/2010 16:35 7172495755 OBS PAGE 67 v?xr?rc TION The statements ' the foregoing Complaint are based upon information which has been assembled by my attorney in this litigation. The language of the statements is not my own. I have read the statements; and to the extent that they are based upon information which I have given to my course)., they are true and connect to the best of my knowledge, information and belief. I understand that false, statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 .relating to unsworn falsifications to authorities, i)ATF..: alL r4* Allison x?nniowicz 2 IPPENSB.I:j#.EALTH CARE CENTER ADMISSION AGREEMENT THIS AGREEMENT, made this day of oig n A.D., by and between SHIPPENSBURG HEALTH CARE CENTER (hereafter "SHIPPENSBU G") and _ I!AMpL116 (hereafter "Resident"), previously residing at (Street Address and Post Office Box) S r j and (hereafter "Legal Rep , residing at (Street Address and Post Office Box) The Legal The staff of S all relationship with the Resident is that of IPPENSBURG will take whatever time is necessary to answer f your questions. Please continue to ask questions until you are sure that you understand. 1. . PROVISION OF SERVICES A. NURSING routine nursing (except -as othi wash cloths, housekeeping established by Schedule is atta in full. The Rate SHIPPENSBUR covered by the SERVICES: SHIPPENSBURG will provide the *-Resident with services, semi-private accommodations, three meals each day rwise medically indicated), blankets, bed linens, towels and sundering of blankets, linens; towels, and wash cloths, services, and activity programs and social services as the facility, as identified on the. Rate Schedule, The Rate ;hed to this Agreement and is incorporated herein as if set forth Schedule sets forth the list of supplies and services included in ms's daily rates, those supplies and services which are not daily rates for which the Resident will be separately charged, 1 EXHIBIT "A" and those supplies and services covered by the Medicare and/or Medicaid programs for nrolled Residents. Feder, t and state laws and regulations change regularly and frequently require changes related to the care and services SHIPPENSBURG provides. Additionally, other financial factors may require SHIPPENSBURG to make changes vela ed to provision of its can: and services. On this basis, the Rate Schedule may be changed, upon notice to the resident. B. ANCILI provide anci private acco ancillary ser discretion of C. OU SHIPPENSB providers an SHIPPENSB expense unli payer. Shou providers mu and must coi but not limite legally requh approved in SHIPPENSBI SHIPPENSBI law, as well services to R The Re those designE Resident rece agents of SHI outside provid for payment of SHIPPENSBU Furthermore, approved out compensation insurance. Tc required worke and pay for sup lRY SERVICES AND SUPPLIES; SHIPPENSBURG will also iry services and supplies as set forth in the Rate Schedule, and modations upon the direction of the Resident's physician. The :es and supplies are subject to change from.time to time at the HIPPENSBURG. RG makes available, from time to time, the services of outside non-facility services. These services will be available under RG's policies and procedures, and at the Resident's sole 5s the charges for such services are covered by a third party f the Resident arrange for the services of outside providers, the t be properly licensed or registered under state and federal law, ply with all SHIPPENSBURG policies and procedures, including, to, providing SHIPPENSBURG with documented proof of their d liability insurance coverage. All outside providers must be friting by SHIPPENSBURG before providing any services. At RG's sole discretion, only providers deemed by RG to fulfill all of the requirements set forth in federal and state as SHIPPENSBURG's policies and procedures, may provide Went recognizes and agrees that all outside providers,. including ted by SHIPPENSBURG, are independent contractors. The gnizes and agrees that such providers are not associates or PPENSBURG, and that SHIPPENSBURG is not liable for any :r's acts or omissions. The Resident shall be solely responsible all charges of any provider who renders care to the Resident in RG, unless the charges are covered by a third party payer. ;he Resident agrees to confirm that any Resident initiated, ;ide provider (i.e, private duty nurse, etc.) has . worker's insurance coverage as required by law, as well as liability the extent that the outside provider does not have the legally is compensation insurance coverage, the Resident will provide .h coverage. II. RESIDENT'S RIGHTS SHIP ENSBURG welcomes all persons in need of its services and doe not discriminate on the basis of age, disability, race, color, national origin ancestry, religion, or sex. Furthermore, SHIPPENSBURG does not discr minate among persons based on their sources of payment. A. 1. SHIPPENSBURG SERVICES: By signing this Agreement, the Resident consents to SHIPPENSBURG providing routine nursing and other health care services and administering all medication as directed by the attending physician, or when the attending physician is unavailable, SHIPPENSBU G's Medical Director. SHIPPENSBURG is not obligated to provide the esident with any medications, treatments, special diets or equipment with ut specific orders or directions from the Resident's physician or SHIPPENSBU G's Medical Director. From time to time SHIPPENSBURG may participate in tr ining programs for persons seeking licensure or certification as health care wo ers. In the course of this participation, care may be rendered to the Reside it by such trainees under supervision as required by law. Consent to routine nursing care provided by SHIPPENSBURG shall include consent for car by such trainees. 2. PHYSICIAN SERVICES: The Resident acknowledges that he or she is under the medical care of a personal attending physician, and that SHIPPENSBU G provides services based on the general and specific instructions oft at physician, or when unavailable, SHIPPENSBURG's Medical Director. The esident has a right to select his or her own attending physician. If, however, the Resident does not select an attending physician, or is unable to select an atten ing physician, an attending physician may be designated by SHIPPENSBU G or in accordance with state law. All attending physicians must meet and conform with all of SHIPPENSBURG's policies and procedures, and are subjec to the terms set forth in the Outside Providers and Non-facility Services sectio of this Agreement. 3. right to refuse also has the ri or revocation c Where, in the law, the Reside regarding refu; a Legal Repre: federal law. RIGHT TO REFUSE TREATMENT: The Resident has the reatment and to revoke consent for treatment. The Resident it to be informed of the medical consequences of such refusal consent, and to be informed of alternate treatments available. pinion of the attending physician or by judgment of a court of it is determined to be mentally incompetent to make a decision I of treatment, the decision to refuse treatment may be made by :ntative or other surrogate decision-maker, subject to state and B. SHIPP NSBURG strongly discourages the keeping of valuable jewelry, papers, larg sums of money, or other items considered of value in SHIPPENSB RG. However, the Resident shall be permitted to retain and use personal clotting and possessions as space permits, unless to do so would infringe upon the right of other residents or unless determined medically inadvisable a documented by the Resident's physician in the Resident's medical record. SHIPPENSBURG shall make reasonable efforts to properly handle and s6 feguard the Resident's personal property in SHIPPENSBURG. The Resident agrees to inform SHIPPENSBURG of all valuable property upon admission. If, at any time during the Resident's stay, new items of value are added to the Resident's possessions in SHIPPENSBURG, the Resident agrees to so inform S IPPENSBURG's Administrator or designee. The RJa ident is responsible for obtaining at his or her own expense any insurance crage necessary to cover potential damage to or loss of any of Resident's ponal property. SHIPPENSBURG shall not be liable for damage to or loss of y of Residen t's personal property. Should the Resident lose his or her prope or believe that his or her property has been otherwise removed from his or possession, the Resident agrees to follow SHIPPENSBURG's procedure foing reports of lost or stolen property. In the SHIPPENSBU SHIPPENSBU Legal Represe estate. If the twenty-four (2d Resident auth storage until c Resident's prol Should days of the F SHIPPENSBUI arrangement, of the Residen consideration c the Resident's SHIPPENSBUI SHIPPENSBUI SHIPPENSBUI thereof. event that Resident is transferred or discharged from G, or if the Resident expires, the Resident hereby authorizes G to transfer the Resident's personal property to the Resident's itative, or to any duly authorized representative of Resident's tesident's personal property is not claimed or removed within hours of the Resident's transfer or discharge, or expiration, the rizes SHIPPENSBURG to place his personal property into aimed. Standard daily storage charges will continue while the ;rty remains in SHIPPENSBURG. he Resident's property fail to be claimed within fourteen (14) ;sident's transfer, discharge, or expiration, the Resident and .G hereby agree to a storage and sale arrangement. Under this HIPPENSBURG agrees to bear any and all costs of the storage is property, not including any insurance thereon. However, in ' SHIPPENSBURG's storage of the. Resident's property, should property fail to be claimed within thirty (30) days of placement by G, into storage, the Resident hereby agrees that G may dispose of the Resident's property with and at G's discretion, including retaining all proceeds from any sale C. 1. CONFIDENTIALITY: Information included in the Resident's medical records is confidential. Unauthorized persons shall not be allowed to review these records without the Resident's -written consent, except as required or permitted b law. 2. ONSENT TO RELEASE BY SHIPPENSBURG: The Resident authorizes SHI PENSBURG to release all or any part of the Resident's medical or financial re rds to any person or entity which has or may have a legal or contractual obl ation to provide the Resident with medical services, or to pay all or a portion of the costs of care provided to the Resident, including but not limited to hos ital or medical services companies, insurance companies, workers' comp nsation carriers,. welfare funds, and/or the Resident's employer. The Resident Iso authorizes release of information from medical or financial records to any edical professional or institution responsible for the Resident's medical or nun ing care when the Resident is transferred or discharged from SHIPPENSBU G. The Resident hereby releases SHIPPENSBURG from any liability for dam ges or other loss suffered in or incurred by the Resident and arising out of o directly or indirectly related to the reliance by the facility upon the foregoing a thorization. 3. P OTOGRAPHS: The Resident authorizes SHIPPENSBURG to photograph or v deotape the Resident as a means of identification or for health related purpose . The photographs or videotapes may also be used to help locate the Re Went in the event of. an unauthorized absence from SHIPPENSBUR , but shall otherwise be kept confidential. If SHIPPENSBURG intends to use It photograph or videotape for purposes other than those noted above, SHIPPE SBURG shall get written permission from the Resident in advance of such use (SHIPPENSBURG sometimes requests Resident to permit the use of their hotograph and written impressions about SHIPPENSBURG in marketing and ither public information materials). The Resident retains the right to refuse th taking of a photograph at any particular time. D. 1. RULES AND REGULATIONS: The Resident agrees that SHIPPENSB RG may, to maintain orderly and economical operations, adopt reasonable les and regulations to govern the conduct and responsibilities of the Resident. These rules and regulations include that SHIPPENSBURG is a SMOKE FR E CAMPUS, with no smoking or use of smokeless tobacco products pe itted in all its buildings, grounds and parking areas, for new residents, their visitors, staff, vendors, physicians, contractors, and volunteers. The Resident agrees to follow those rules and regulations. It is understood that these rules and regulations may be amended from time to time as SHIPPENSB RG may require. Any changes to the rules and regulations shall be given to the Resident in writing. NOTE: Some residents admitted prior to the effective date of the SMOKE FREE CAMPUS Policy will be allowed to continue smoking in special designated areas as required by Federal regulations. 2. IET The Resident understands that his or her diet is medically prescribed a d, therefore, must be monitored by SHIPPENSBURG. The Resident agrees to consult with Nursing . or Dietary staff when food or beverages are brought into SHIPPENSBURG. 3. SHIPPENSBU according to medications distribution s) SHIPPENSBU 4. value of SHIF agrees to use premises. TI replacement c Resident. Hov is to be expects 5. encourages the attempt to acs rooms. For si rearrangement activities. XCATIONS: No medications or drugs may be brought upon premises unless the medications or drugs are labeled requirements of state and federal law. Packaging of I be compatible with SHIPPENSBURG's medication m. No drugs or medications may be brought into unless they are delivered directly to the nurses' station. UAKt Ue bMIFFEN55URG'S PROPERTY: To preserve the 'ENSBURG's property for future residents' use, the Resident due care to avoid damaging SHIPPENSBURG's property and e Resident shall be responsible for the costs of repair or. SHIPPENSBURG's property damaged or destroyed by the ever, the Resident shall not be responsible for such damage as d from ordinary wear and tear. CARE OF THE RESIDENT'S ROOM: SHIPPENSBURG Resident to have a SHIPPENSBURG-like environment, and will ommodate all reasonable requests to individualize resident fety reasons, SHIPPENSBURG must approve any addition or of furniture, hanging of pictures, posters, or other similar ? 6 6. INDEMNIFICATION: The Resident hereby agrees to indemnify and hold harmless SHIPPENSBURG, its officers, directors, agents, and employees from and against any and all claims, demands or causes of action for injury or death to person or damage to property, including all costs and attorneys fees incurred in defending any claim, demand or cause of action which is caused by the Resident and which is not caused by any willful or negligent action of SHIPPENSBURG. This indemnification includes, but is not limited to, all claims, demands or causes of action stemming. from the acts or omissions of he Resident, including but not limited to Resident's refusal of any nursing care, medical or other treatment, or any other item or service deemed necessary by SHIPPENSBURG or any other treating health professional. 111. POLICY REGARDING THE IMPLEMENTATION OF THE PATIENT SELF-DETERMINATION ACT The fol owing information is being provided to the Resident as a result of a federal la which requires certain health care institutions, including SHIPPENSB RG, to disclose to the Resident his or her rights under federal and state law o make decisions regarding his or her health care. A. 1. SHI PENSBURG recognizes and appreciates the dignity and value of each Resld nt's life, and the right of each Resident to make decisions regarding his r her care. 2. SHI PENSBURG recognizes the Resident's right to have these decisions mad on his/her behalf by a substitute decision-maker in accordance with state law hen the Resident is no longer able to make them. 3. SHIT those health a such advance law and consk provide. A he, choices for he, Resident wisho of certain type: Health Care ar 'PENSBURG recognizes the right of each Resident to utilize ire advance directives recognized under state law, and will honor directives developed and implemented in accordance with state tent with the level of care SHIPPENSBURG is licensed to filth care advance directive is a written document that states filth care and/or names or precludes those Individuals who the is to make those choices. These choices may include the-refusal of care. A Living Will and a Durable Power of Attorney for .examples of such advance directives. 7 PENN YLVANIA LAW PERMITS SHIPPENSBURG TO REFUSE TO HONG DECISIONS BY THE INDIVIDUAL YOU APPOINT AS YOUR AGEN IN AN ADVANCE DIRECTIVE OR BY A "HEALTH CARE REPR SENTATIVE" WHO SEEKS TO MAKE SUCH DECISIONS FOR YOU NDER PENNSYLVANIA LAW IF SHIPPENSBURG HAS A GOOD FAITH BELIEF THAT THE INDIVIDUAL IS NOT REALLY AUTHORIZED TOMAKE DECISIONS FOR YOU UNDER THE LAW OR THAT THE DECISIONS BEING MADE ARE NOT CONSISTENT WITH THE RULES FORS CH INDIVIDUALS TO MAKE DECISIONS ON YOUR BEHALF ESTABLISHED BY PENNSYLVANIA LAW. B. HEALTH CARE ADVANCE DIRECTIVE. A health care advance n. RECE CHANGES IN PENNSYLVANIA LAW (discussed further below in Subs ction C) PROVIDE SOME ADDITIONAL REASONS TO CONSI ER HAVING AN ADVANCE DIRECTIVE. C. HEALTH ARE REPRESENTATIVE. PENNSYLVANIA LAW PERMITS AN INDIVIDU L QUALIFYING AS A "HEALTH CARE REPRESENTATIVE" UNDER 20 P . C.S. § 5461 TO MAKE HEALTH CARE DECISIONS FOR INCAPACITA ED PERSONS, WHO HAVE AN END-STAGE MEDICAL CONDITION R ARE PERMANENTLY UNCONSCIOUS, WITHOUT THAT WHILE HIPPENSBURG WILL REQUIRE A "HEALTH CARE REPRE ENATIVES" TO CERTIFY THAT THEY HAVE KNOWLEDGE OF THE INCAPACITATED PERSON'S PREFERENCES, VALUES, AND M RAL AND RELIGIOUS BELIEFS, THE LAW PERMITS THEM TO MA E SOME DECISIONS BASED ON THEIR OWN EVALUATION OF THE INFORMATION ABOUT THE INCAPACITATED PERSON'S CONDITION WHERE INSTRUCTIONS FROM THE INCAPACITATED PERSON IS LACKING. 8 ?' AN A VANCE DIRECTIVE CAN PROVIDE SPECIFIC INSTRUCTIONS FOR ND ALSO LIMIT WHO CAN QUALIFY AS A "HEALTH CARE REP SENTATIVE:' OR CAN PROVIDE THEM WITH ADDITIONAL AUTH RITY TO ACT ON ONE'S BEHALF. IF A RESIDENT WISHES TO P ACE SUCH LIMITS ON THE ABILITY OF OTHERS TO ACT AS THEI "HEALTH CARE REPRESENTATIVE" OR TO PROVIDE ADDI ZONAL INSTRUCTIONS FOR THEM, THE RESIDENT SHOULD CON ID ER HAVING A WRITTEN ADVANCE DIRECTIVE THAT STAT S THEIR WISHES; AND, THE RESIDENT MAY WISH TO CONS LT WITH THEIR FAMILY AND LEGAL COUNSEL ON THIS QUES ION. D. 1. Questions about SHIPPENSBURG's policies regarding health care decision-mak ng and/or advance directives may be presented to SHIPPENSB RG's Administrator. 2. 3. 4. attorney ant should consult with their family, physician, and using any Advance Directive Forms. ? 9 IV. CAPACITY OF RESIDENT AND GUARDIANSHIP If the R sident is or becomes unable to understand or communicate, -qnd is determined o be incapacitated by the Resident's physician, in the absence of the Resident's prior designation of an authorized Legal Representative, or upon the unwillingness or inability of the Legal Representative to act, SHIPPENSBU G shall have the right to commence a legal proceeding to adjudicate the Resident incapacitated. As a result of such a legal proceeding SHIPPENSBU G shall have a court appoint a legal guardian for the Resident. SHIPPENSBU G also shall have the right to commence a legal proceeding to have a court r lace an authorized Legal Representative with a new one or with a legal guardian when SHIPPENSBURG has a good faith belief that the Legal Representative is not acting in the best interests of the Resident. The cost of the legal proceedings, including attorney's fees and costs, if not covered by the Commonwealth, shall be paid promptly by the Resident or the Resident's estate. V. A. 1. STATUS decisions for hii make certain di Agreement, the Resident and de person, or as th make health ci Representative acting under a d next-of-kin, or o Legal Represen appointment by SHIPPENSBUR SHIPPENSBUR, original Power of FINANCIAL ASPECTS OF THE AGREEMENT . While not legally required, if the Resident is unable to make nself or herself, a Legal Representative should be available to ;cisions on behalf of the Resident. For the purposes of this Resident's Legal Representative is the person selected by the .fined under state and federal law as the Resident's responsible e person recognized under state law as having the authority to ire and/or financial decisions for the Resident. The Legal nay or may not be court appointed, may be an attorney-in-fact urable power of attorney for health care, guardian, conservator, :her person allowed to act for the Resident under state law. If tative status has been conferred by a court of law or through the Resident, verification of such status must be provided to 3 at the time of Admission. Such verification includes providing 3 with a certified copy of any court order, or a validly executed Attorney or other legal document. 10 2. REQUIREMENTS. For purposes of this Agreement, LEGAL REPRESEN ATIVES ARE REQUIRED TO SIGN THIS AGREEMENT FOR ADMISSION, AND AGREE TO DISTRIBUTE TO SHIPPENSBURG, FROM THE RESIDENT'S INCOME OR RESOURCES, PAYMENT WHEN DUE FOR ITEMS/SER ICES PROVIDED TO THE RESIDENT. Legal Representative is contractually ound by the terms of this Agreement and may become personally liable for fail re to perform their fiduciary duties under the Agreement. Legal Representatives are also required to produce financial documentation as proof of the Resi nt's ability to pay for charges when due. Wherever this Agreement efers to the Resident's financial obligations under this Agreement, the term "Resident" shall be construed to include the obligations any Legal Representative to act on behalf of Resident. B. 1. INC ME AND ASSETS/ CHANGES TO INCOME AND ASSETS: it is essential t at the Resident advise SHIPPENSBURG of the Resident's income and a sets, and to communicate changes in the Resident's income or assets to SH PPENSBURG as quickly as possible. The Resident hereby agrees to no-ti SHIPPENSBURG ninety (90) days prior to the time when the Resident has eason to believe that his income and assets will no longer be sufficient to ful ill his financial obligations under the terms of this Agreement. 2. MEDICAL ASSISTANCE. Generally, when private funds are depleted, resi ents apply for Medical Assistance benefits under Title XIX of the Social Securi Act and Article IV of the Pennsylvania Public Welfare Code. The Medical ssistance application process can be complicated, and the processing ti a can be lengthy. SHIPPENSBURG is experienced in the Medical Assist nce Application process, and can be of great assistance to the Resident in th' process. To be of assistance, SHIPPENSBURG must have accurate reco of the history and depletion of the Resident's income and significant ass ts. 3. DISCLOSURE FORM. On this basis, please set forth the Resident's inco a and assets below: 11 Income Number. Income: Pension: Accou t Numbe Monthly Income: Financial Institution: Payee: Trusts: Accoun Number(s): Monthly Income: 12 I Institution(s): Type Payee 13 Vehicle(s): ear, Moke and Model: State Account I?lukber(s): Financial Account Number(s): Financial I ostitution(s): 14 i Other Si nific nt sets lease de cribs Describe natur Liabilities e and ex nt: Has a Will been corn leted?: Yes No If yes, Ex Ex ecutor's Name: ecutor's Address: 15 5. R ei t of 1 me! Re resentative Payee. Many Residents find security in a pointing SHIPPENSBURG as the "Payee" or "Representative Payee" of t e Resident's income, including social security income. By appointing S IPPENSBURG as the "payee" or the "Representative Payee", the Resident dire s that his or her income be directed to SHIPPENSBURG for the purposes of paying for the Resident's care and services. Any excess funds accumulated are refunded to the Resident or the Resident's Legal Representative on or before the tenth (10) day of the month following the receipt of the! benefits. This is not required. However, if the. Resident is Administr tordesignee. SHIPPENSBURG will assist you in making these arrangements 6. PRIVATE RESIDENTS: A Resident is considered private (or private pay) when no state or federal program is paying for the Resident's room and board. A private-pay Resident may have private insurance or another third party, which pays all or some of his or her charges. a.) Daily Rate. The Resident agrees to pay SHIPPENSBURG's private pay per diem to as described in the Rate Schedule. The Resident agrees to pay SHIPPEN BURG in advance for one month's private daily rate. For each additional mo th's stay, the Resident agrees to pay SHIPPENSBURG in advance on or before the tenth (101h) day of the month. Any unused advance payment shall a refunded to the Resident ninety (90) days after the Resident's discharge If th Resident becomes covered by Medicaid or Medicare, or leaves SHIPPENSBU G before the end of the month. b.) Ra Adjustments. SHIPPENSBURG may occasionally need to increase the daily rate or optional service charges. If this happens, the Resident shall receive thirty (30) days advance written notice of the rate adjustment. HIPPENSBURG shall provide notice to the Resident, and if known, the R sident's Legal Representative. When a notice of a rate adjustment is eceived, the Resident can choose to end this Agreement by providing writt n notice to the Administrator. If the Resident falls-to leave SHIPPENSBU G prior to the effective date of the rate adjustment, the Resident shall be consid red to have consented to the increase. 16 c.) Insurance. Even when there is private insurance coverage, charges. Wh re the Resident's private insurer is a managed care plan with which SHIPPE SBURG has a contract, SHIPPENSBURG agrees to invoice the managed care Ian directly for the Resident's care and services. However, all charges that ar not covered by the managed care plan are the responsibility of the Resident. These non-covered charges include but are not limited to any coinsurance and/or deductible amounts which the managed care plan requires the Resident to pay, to the extent allowed under federal and state laws. Where the Resident's private insurer is not a managed care plan with which SHIPPENSBU G has a contract, SHIPPENSBURG will invoice the Resident, who is primarily responsible for payment of the invoice. 7. MEDICAL ASSISTANCE MEDICAID RESIDENTS: A Medicaid Resident is one who receiv s benefits from the state Medicaid program for all or a majority of his or her r om and board charges. The services currently covered by Medicaid are s t forth in the attached Rate Schedule, which is subject to change. SHI PENSBURG makes no guarantee of any kind that the Resident's car will be covered by Medicare, Medicaid, or any third party insurance or ther reimbursement source. SHIPPENSBURG, its agents and associates are hereby released from any liability for the Resident's potential claim f r any failure to obtain such coverage. With respect to applying for and receiving Medical Assistance through the Medicaid Program, SHIPPENSBURG will assist the Resident in the application process. The Resident agrees to the following: a.) Quaiifyir under the Medic to establish and but are not limit Resident's asset assets and incon ig for Medicaid Assistance. If the Resident elects coverage aid Program, the Resident agrees to act as quickly as possible maintain eligibility for Medicaid. These actions must include, ed to, taking any and all steps necessary to ensure that the ;s and income are within the required limits and that these ie remain within allowable limits for Medicaid: 17 b.) Provi financial i application ac agencies. Ac manner requo deadlines set attend any i Assistance el agencies. Fa completion an requested by for SHIPPENS ng Application Information. The Resident agrees to provide id other information required for completion of the Medicaid urately and truthfully, as requested by applicable state/county itionally, the Resident agrees to provide this information in the ted by the applicable agencies, and in compliance with any ? the applicable agencies. Furthermore, the Resident agrees to d all interviews necessary for completion- of the Medical ibility process, as requested by the applicable state/county ire to provide all financial and other information required for support of the Medicaid application accurately and truthfully, as )pllcable state/county agencies, may result in personal liability URG's charges, c.) Keepi g SHIPPENSBURG Informed. The Resident agrees to keep SHIPPENSBU G informed of the status and progress of the Medicaid application. Tie Resident agrees to provide SHIPPENSBURG with copies of any financial a d other information related to the Medicaid application; including a copy of the c mpleted application. d.) Transf rring Assets. If the Resident transfers assets, this transfer may disqualify the Resident for Medicaid and/or cause a discontinuance of the Resident's M icald benefits. The Resident acknowledges that this may result in discharge o the Resident due to non-payment, and personal liability for SHIPPENSBU G's charges. e.) Legal Representative Controlling Resident's Funds. If the Resident's Legal Representative has control of or access to the Resident's income and/or assets, the Legal Representative agrees to use these funds solely for the Resident's welfare. This includes, but is not limited to, making prompt payment for care and services provided to the Resident as specified and required by the terms of this Agreement. Failure to use these funds solely for the Resident's welfare may result in personal liability for SHIPPENSBURG's charges. f.) Providi g Financial Information. The Resident certifies that any financial inform tion regarding the Resident's income and assets required by SHIPPENSBUR and provided by the Resident is complete and accurate. g.) Daily ate Payment. The Resident agrees to pay the costs or SHIPPENSBUR 's per diem rate as described in the Rate Schedule. 18 h.) Tel SHiPPENS nation or Denial of Coverage. The Resident may remain in JRG for as long as he or she is certified eligible for Med' 'd coverage, orlfor as long as any share of cost owed by the Resident is paid as due. A Resident who remains in SHIPPENSBURG ft has been c SHiPPENSB pay based c service. Wh Resident agi earliest doss i.) Reside monthly incom Medicaid prop share of the cc of their care c the Medicaid p of their care b, share is the re: j.) Appeal Medical Assista limit benefits. ? her benefits, F making any ck Resident's bens appealing any Assistance bens information relai to, notices of d behalf of SHIPP liability for failure thereof, the Res REPRESENTAT a er Medicaid coverage snied and a final determination has been made must pay JRG charges as a private resident. In this event, the Resident will i the private rates, charges, and terms in effect at the time of are the Resident fails to pay the private rates and charges, the )es to seek immediate placement at an alternate facility at the ble time. Residents who have not already been determined 's Share of Cost. The Medicaid program reviews the available of all persons requesting Medicaid. Based on this review, the m requires most Medicaid residents to pay for a reasonable t of their care. The amount of the Resident's share of the cost change based upon the services the Resident chooses, and gram can adjust the amount of the Resident's. share of the cost ed upon changes in the Resident's Income. Payment of that onsibility of the Resident. of Finding of Ineligibility. Where the Resident. applies for nce benefits, the applicable state/county agency may deny or Vhile Resident retains all legal responsibility for obtaining his or lesident authorizes SHIPPENSBURG to assist Resident in aims and to take all other. actions necessary to secure the .fits, including, but not limited to, assisting the Resident in state/county agency determination and requesting Interim ifits. The Resident agrees to provide SHIPPENSBURG with all ed to obtaining benefits upon receipt, including, but not limited enial. This paragraph shall not create any responsibility on ENSBURG to obtain benefits or any portion of benefits, nor any i to obtain same. To facilitate this authorization, but not in lieu !dent agrees to properly execute the AUTHORIZATION FOR ION - MEDICAID statement attached to this Agreement. 19 8. EDICA E RE 1 ENT A Medicare Resident is one who receives benefits from the federal Medicare program for his or her SHIPPENSBURG care. The se ices currently covered by Medicaid are set forth in the attached Rate Schedul , which is subject to change. Some additional items and services may be also overed by Medicare. SHIPPENSBURG makes no guarantee of any kind that the Resident's care will be covered by Medicare, Medicaid, or any thi d party insurance or other reimbursement source. SHIPPENSB RG, its agents and associates are hereby released from any liability for the Resident's potential claim for any failure to obtain such coverage. a.) Contin ing Payment of SHIPPENSBURG Charges Pending Eligibll V. Where the Resident is not currently covered by Medicare, the Re 'dent agrees that while coverage Is being pursued the Resident shall p y the private pay rate as a private pay resident as described within t Is Agreement. If the Resident is unable to pay the private pay rate, th Resident agrees to pay SHIPPENSBURG an amount that is at least eq al to the Resident's monthly income from all of the Resident's income sources. This amount, minus any amount not covered by Medicare, shall be refunded to the Resident within thirty (30) days of payment by Medicare should the Resident be found eligible by Medicare. Once th Resident is determined to be eligible for Medicare, the amount of the Resi ent's share of cost not covered by Medicare shall be paid to SHIPPENS URG on or before the tenth (1(Yh) day of each month. Furthermor , the Resident shall immediately pay to SHIPPENSBURG any amount the Resident is in arrears. If payment of any outstanding amount cannot be ade immediately, the Resident shall immediately discuss same with SHIPP NSBURG's Administrator or the Administrator's designee, and shall make arrangements to bring his or her account into balance within the shortest pos ible time. b.) Daily ate Payment. The Resident agrees to pay the costs of SHIPPENSBUR 's per diem rate as described in the Rate Schedule for those supplies and se ices not paid for by the Medicare program. c.) Coinsurance and Deductibles. The Resident is responsible for payment of any Medicare coinsurance and/or deductibles that are not paid to SHIPPENSBUR1.3 by the Medicaid program or private insurance. d.) Limited is established k coverage is lirr specified numb Medicare cover, days in the currt average. The Resident understands that Medicare coverage federal guidelines and not by SHIPPENSBURG. Medicare ,d in that only a specified level of care is covered for a of days (benefit period). If the Resident no longer meets s criteria, coverage can be ended before the use of all allotted benefit period. 20 C e.) Expir to demonstra Medicaid) for coverage exr or other payn discharged fr she must so If the Residei the Resident the Resident from Medicare f.) Appe Medicare ber may deny the a denial occu benefits. Ho Resident in r secure his or subsequent a The Resident obtaining ben This paragrar determined the to have a Den on behalf of S for failure to of the Resident REPRESENTi 9. MANAGE switches the (hereafter "M( the Resident a.) The switching the R ition of Benefits. Prior to admission, the Resident must be able e the ability to pay SHIPPENSBURG (either privately or through services rendered after Medicare benefits expire. When Medicare res, the Resident may remain in SHIPPENSBURG if private pay ent arrangements have been made. If the Resident wishes to be m SHIPPENSBURG upon expiration of Medicare benefits, he or dvise SHIPPENSBURG at the time of the Resident's admission. t intends to become private pay when Medicare benefits expire, igrees to pay in advance for one month's private daily rate when ;hanges to private pay status. No advance payment is required Residents who are eligible for Medicaid coverage. Is of Denials of Coverage. Where the Resident applies for :fits, the applicable intermediary; carrier or government agency Resident these benefits or some portion of these benefits. Where s, the Resident retains all responsibility for obtaining his or her fever, the Resident authorizes SHIPPENSBURG to assist the aking all claims and to taking all other actions necessary to er benefits, including, but not limited to, appealing any initial or verse determinations, including requests for Reconsideration. grees to provide SHIPPENSBURG with all information related to its upon receipt, including, but not limited to, notices of denial. does riot apply to benefits for which SHIPPENSBURG has Resident is not eligible, and does not affect the Resident's right and Bill filed. This paragraph shall not create any responsibility IPPENSBURG to obtain any portion of benefits, nor any liability ain same. To facilitate this authorization, but not in lieu thereof, :reby agrees to properly execute the AUTHORIZATION FOR LION - MEDICARE statement attached to this Agreement. IkRE ORGANIZATIONS: Where the Resident enrolls in or 0dent's enrollment to any managed care organization including MCOs that provide Medicare or Medicaid benefits, s as follows: shall advise SHIPPENSBURG prior to enrolling in or enrollment to any MCO. b.) The esident acknowledges that SHIPPENSBURG is not responsible for and has made no representations regarding the actions or decisions of any MCO with whi h SHIPPENSBURG is a participating provider, including decisions relatin to a denial of coverage. 21 c.) SHI PENSBURG will accept payment from the MCO as payment in full only for those services and supplies covered by the MCO. The Resident is responsible for any co-payments or other costs assigned to the Resident under the managed are plan, or not covered by the MCO under the terms of the managed care lan. If the Resident utilizes services which the MCO refuses to pre-authorize, he Resident shall pay SHIPPENSBURG for those services. Further, the Resident shall pay SHIPPENSBURG for services for which the MCO has dens d payment because the Resident failed to supply information to the MCO, or for services which are denied subsequently by the MCO. d.) SHI PENSBURG reserves the right to withdraw -as a participating provider in an MCO at any time and for any reason. In the event that SHIPPENSBU G withdraws as a participating provider, the Resident may convert his or er coverage to a health plan in which SHIPPENSBURG is a participating pr vider. Effective the date of SHIPPENSBURG's withdrawal from the Resident's CO, the Resident is obligated to pay for services and supplies provided to t e Resident as a private pay resident. If possible, SHIPPENSBU G will provide the Resident with advance written notice of its withdrawal from the Resident's MCO thirty (30) days before SHIPPENSBURG's withdrawal. 10. ASSIGNME authorizes SHIF secure receipt c charges. To the SHIPPENSBUR all of the Resid payable to the e promptly endors, third parties to Agreement. To hereby agrees PAYMENTS stet 11. FINANCIAL admission the I executed and le individual chosei in-fact should th Resident agrees available, the R4 available. Judg NT OF THIRD PARTY PAYMENTS: The Resident irrevocably PENSBURG to make claims and to take all other actions to f third party payments to reimburse SHIPPENSBURG for its fullest extent permitted by law, and as security for payment of is charges, the Resident hereby assigns to SHIPPENSBURG nt's rights to any third party payments now or subsequently tent of all charges due under this Agreement. Resident shall and deliver to SHIPPENSBURG any payments received from the extent necessary to satisfy the charges under this acilitate this assignment, but not in lieu thereof, the Resident a properly execute the ASSIGNMENT OF THIRD PARTY -ment attached to this Agreement. POWER OF ATTORNEY: The Resident agrees. that upon ;esident, if able, will supply SHIPPENSBURG with a fully lolly valid original Financial Power of Attorney appointing an at the Resident's sole discretion to be his financial attorney- Resident become medically incompetent. If not able, the to work with SHIPPENSBURG to pursue guardianship. This t. If, in the judgment of the Resident, no such individual is it agrees to appoint such an individual when one becomes of the Resident's incompetence shall not require a court 22 adjudication, but shall require the written order of Resident's physician plus confirmation by a second examining physician. The Resident's financial attomey-In-fa t shall be granted the authority to make financial decisions for the Resident, including the unlimited power to pay SHiPPENSBURG's charges and invoices from the Resident's income, and from the proceeds of the attorney-in- fact's sale of a Resident's assets. The se ection of this attorney-in-fact serves at the complete discretion of the Resident. However, should the Resident revoke the power of his or her appointed attorney-In-fact, or should the Power of Attorney become inoperable for any reaso , the Resident hereby agrees to immediately appoint a successor attorney-in-fact for the financial purposes set forth herein, if such an individual is available. Up n receiving a duly executed copy or facsimile of this Agreement noting the R sidenfs appointed financial attorney-in-fact, SHIPPENSBURG may act hereu der. Revocation of the attorney-in-fact shall be ineffective as to SHIPPENSBU G unless and until written or actual notice or knowledge of such revocation is r ceived. The attorney-in-fact's power shall continue in full force and effect an may be relied upon by SHIPPENSBURG despite purported revocation unt I written notice of revocation is received by SHIPPENSBURG. M-_.--._I n--- -- -_ -•• - before s should first consult with his or her family and attorney g any Financial Power of Attorney form. VI. PAYMENT INFORMATION A. DUE Di SHIPPENSBUI basis to the Re day of each me month, the acc; add late charg assessed on the and one-half p, charge does nc this Agreement. The Resi accept installm? payment does r payment for the G's charges for services provided shall be billed on a monthly Ment. These charges are due and payable by the tenth (loth) th. If payment is not received by the fifteenth (15th) day of each ant balance is considered past due, and SHIPPENSBURG may s to the Resident's account. These late charges shall be monthly balance at the lesser of the monthly rate of 1.5% (one rcent) or the maximum amount permitted by law. This late alter any obligations of SHIPPENSBURG or Resident under nt recognizes that SHIPPENSBURG does not offer credit or t payments. SHIPPENSBURG's acceptance of a partial limit SHIPPENSBURG's rights under this Agreement to full re and services provided. 23 B. BILLING DDRESS: All of SHIPPENSBURG's invoices are to be mailed to the following ddress for prompt payment (either Resident's address or Legal Representati 's address, when applicable): C. FAILURE due date for Resident's fail the due date c may require advance notice failure to pay, Termination se under federal I security field c DEFAULT of ti with payments. IV rAT ANU MI-AULT OF AGREEMENT: SHIPPENSBURG's its payments falls on the fifteenth (15th) day of each month. ire to remit a required payment within twenty-one (21) days of :onstitutes DEFAULT of this Agreement, and SHIPPENSBURG the Resident to vacate SHIPPENSBURG after appropriate If the Resident is required to vacate SHIPPENSBURG for SHIPPENSBURG shall provide advance notice as set forth in ;ctlon of this Agreement. SHIPPENSBURG retains the right aw and social security regulations to request the regional social )ffice to change the name of Representative in the event of its Agreement or the Representative Payee is consistently late 24 D. VEND It is hereby agreed that this Admission Agreement is a transactlon a tsred into and accepted by the parties herein at the offices of SHIPPENS URG, in Cumberland County, Pennsylvania. Resident agrees that, I event of DEFAULT, SHIPPENSBURG may bring a civil action in the ourt of Common Pleas of Cumberland County, Pennsylvania to collect any amounts owed to SHIPPENSBURG under the terms of this greement. E. ATTOR EY'S F ES AND COSTS OF COLLECTION: In the event that SHIPPENSBU G institutes and is a prevailing party in litigation in court against any party to thi Agreement arising from DEFAULT or other non-payment under Agreement, S IPPENSBURG shall be entitled to receive from the losing party reasonable att rneys' fees and costs of collection. F. FEE FOR RETURNED CHECKS: A service fee of $25.00 (twenty-five dollars) or the actual fee charged by the bank, whichever is greater, will be charged for an returned check. G. conveyance to equal in value 1 and this assigns enforced agains and shall pay SI of the Resident not the Resider death. its Agreement shall operate as an assignment, transfer and )WIPPENSBURG of as much of the Resident's property as is the amount of any unpaid obligations under this Agreement, lent shall be an obligation of the Resident's estate and may be the Resident's estate. The Resident's estate shall be liable to IPPENSBURG an amount equivalent to any unpaid obligations order this Agreement. This assignment shall apply whether or is residing in SHIPPENSBURG at the time of the Resident's 25 VII. BED HOLDS A. NOTIC . The Resident may need to be absent from SHIPPENSBURG temporarily fo hospitalization or therapeutic leave. The Resident may request that SHIPPE SBURG hold open the Resident's bed during this time. This is known as a ' ed hold." The Resident, and if known, the Resident's Legal Representativ shall be given notice of the bed hold option at the time of hospitalization or therapeutic leave. A schedule of charges for bed holds is. located on the Rate Schedule attached to this Agreement. B. MEDIC ID RESIDENTS: If the Resident's care is paid under the Medicaid Prog m, Medicaid currently pays for up to 15 consecutive bed hold days for each hospitalization and for up to 30 bed hold days each year for therapeutic le ve. If the Medicaid Resident's hospitalization or therapeutic leave exceed the bed-hold period paid under the Medicaid program, the Resident may equest an additional bed hold period from SHIPPENSBURG by agreeing to pa the daily additional bed hold amount listed in 'the attache Rate Schedule. Oth rwise, the Resident shall be readmitted upon the first availability of a bed in a on-private room as long as the Resident requires the services provided by S IPPENSBURG and is eligible for Medicaid benefits. C. PRIVAT AND MEDICARE RESIDENTS: Any Private or Medicare Resident may request a bed hold from SHIPPENSBURG. The Resident's private insuran a may or may not pay for bed holds. The Medicare program does not pay for bed holds. However, if the Medicare Resident is also eligible for Medicaid, and if proven to the satisfaction of SHIPPENSBURG, Medicaid pays for 15 bed hold days. Otherwise, a Private or Medicare Resident requesting a bed hold must pay SHIPPENSBURG's bed hold rate set forth in the Rate Schedule for the bed being held during the bed hold period. 26 VIII. PERSONAL FUNDS A. RESIC manage his i management Fund Author! account for tl from SHIPPE B. a SHIPPEN 1. SHI an int( accounts. f or her accoi of less than account, or as to how h maintain all amount maii ;NT FUND AUTHORIZATION. The Resident has. a right to her own personal funds. If the Resident wants assistance with 1 personal funds, and requests so in writing through a Resident ition form, SHIPPENSBURG will hold, safeguard, manage, and use funds. A Resident Fund Authorization form can be obtained SBURG's Administrator or designee. RES. Resident personal funds deposited with shall be handled as follows: ISBURG shall deposit funds in excess of fifty dollars ($50.00) in bearing account insured by the Federal Deposit Insurance (FDIC) that is separate from any SHIPPENSBURG operating I interest earned on the Resident's funds shall be credited to his nt. SHIPPENSBURG shall have the option of depositing funds ifty dollars in a non-interest bearing account, an interest bearing i petty cash fund. SHIPPENSBURG shall inform the Resident s or her funds are being held. SHIPPENSBURG's policy is to resident funds in a separate account, except for a nominal tained in a petty cash fund for the Resident's convenience. 2. SHIPP NSBURG shall have a system that ensures a complete and separate ac ounting, based on generally accepted accounting principles, of the persona funds deposited with SHIPPENSBURG by each Resident or on his or herb half. This system shall also ensure that the Resident's funds are not com ingled with SHIPPENSBURG's funds or with any other funds besides tho se of other residents. In addition to the required quarterly accounting, HIPPENSBURG shall provide individual financial records at the written re quest of the Resident. 3. The pers onal fund balance a resident receiving Medicaid benefits must remain with! a certain dollar range for the Resident to continue to receive benefits. S IPPENSBURG shall notify a Medicaid resident if his or her account bala nce is within two hundred dollars ($200.00) of the federal Supplement I Security Income (hereafter "SSI") limit. SHIPPENSBURG shall also n tify the Resident if the account balance, in addition to the Resident's nown non-exempt assets, reaches the SSI resource limit. Furthermore, SHIPPENSBURG shall notify the Resident if the account balance, in ddition to the Resident's known non-exempt assets, reaches the resource limits for Medicaid eligibility. A balance in excess of this limit may cause t e Resident to lose eligibility for Medicaid or SSI. 4. If a Resl expires, SH ant who has personal funds deposited with SHIPPENSBURG 'PENSBURG shall refund the Resident's personal account 27 balance wi hin thirty (30) days, and provide a full accounting of these funds to the indi idual, probate jurisdiction administering the Resident's estate, or other enti y as required by state law or regulation. However, any outstandin balance owed to SHIPPENSBURG for the Resident's care and services s all first be deducted from the Resident's personal account as permitted b law. 5. SHIPP NSBURG shall ensure the security of all resident personal funds deposited ith SHIPPENSBURG, and shall not take money from a Medicare and/or Mer'caid resident's personal funds for any item or service for which payment is overed by Medicare and/or Medicaid. IX. FUNERAL SHIPP funeral rela SHIPPENSBI have on the time, SHIPPE concerning ar Funeral Funeral ,,jbuKU assumes no financial responsibility for the funeral or i expenses associated with a Resident's passing. G recognizes the emotional hardship that such an event may sident's family and loved-ones. To assist during this difficult 35BURG will convey the Resident's wishes, as expressed below, igements to a designated funeral director. rrangements: 2"?vc-'e r: Burial Fund: Cemetery Lot Location: Person As uming Responsi ility for Burial: 28 4 X. TERMINATION OF AGREEMENT A. RiGR concerning t4 Resident Rig B. it required for emergency notice two Agreement. u_`mINATE: An explanation of the Resident's rights nation, transfer, and discharge is contained in the Statement of which is attached to but separate from this Agreement. ;NT INITIATED: Notice of resident initiated termination is oper discharge planning. Other than in the case of a medical death, the Resident will provide SHIPPENSBURG with written ( business days before the Resident's termination of this C. REFU DS: If a Resident has personal funds deposited with SHIPPENSB RG upon termination of this Agreement, SHIPPENSBURG shall refund the R sident's personal account balance within thirty (30) days, and provide the sident or the Resident's estate with a full accounting of these funds. Howe er, any outstanding balance owed to SHIPPENSBURG for the Resident's care and services shall first be deducted from the Resident's personal account as permitted by law. Xl. RESIDENT GRIEVANCE/ COMPLAINT RESOLUTION A. RESID NT GRIFVeni(--_=c. 1.) All Residents, family members, and Resident representatives are urged t bring any grievances concerning SHIPPENSBURG to the attentio of the SHIPPENSBURG Administrator or the Administrator's desione i- 2.) ( addition to bringing grievances to. the attention of SHIPPE SBURG Administrator or designee, residents may also contact the outside representative of his or her choice. Outside representatives include the Governor's Action Line at (800) 932-0784, the Department of Health Hot Line at (800) 254-6154, the Long Term Care Ombudsman located ithin the Local Area Agency on Aging, and the Legal Services Program. The telephone number of the local Long Term Care Ombudsman and the Legal Services Program is located within the Resident' Bill of Rights accompanying this Agreement. 29 e. (a) UN ESS OTHERWISE MUTUALLY AGREED UPON IN WRITING, SHOO D GRIEVANCE PROCEDURES FAIL, THE RESIDENT AND SHIPP NSBURG AGREE THAT ALL DISPUTES ARISING UNDER THIS AGREEMENT, WITH THE EXCEPTION OF DISPUTES CONC RNING DEFAULT (AS DEFINED ABOVE IN SECTION VI-C) OR OT ER NON-PAYMENT FOR SERVICES RENDERED, SHALL BE RESO VED BY BINDING ARBITRATION BEFORE A NEUTRAL ARBIT TOR, ASSIGNED TO THE MATTER IN ACCORDANCE WITH THE MERICAN HEALTH LAWYERS ASSOCIATION (AHLA) ALTER ATIVE DISPUTE RESOLUTION SERVICE RULES OF PROC DURE FOR ARBITRATION. (b) SU H ARBITRATION SHALL TAKE PLACE AT SHIPPENSBURG AT A UTUALLY AGREED UPON TIME. ANY TIME A DISPUTE ARISE , ANY PARTY MAY REQUEST THE APPOINTMENT OF AN ARBIT ATOR TO RESOLVE THE DISPUTE. (c) THE REQUESTING PARTY SHALL NOTIFY THE OTHER PARTY IN WRITING A MINIMUM OF SEVEN (7) BUSINESS DAYS PRIOR TO REQUE TING THE APPOINTMENT OF THE ARBITRATOR. (d) FEES, PARTY. (e) THE BINDING HAVING COSTS OF THE ARBITRATOR AND ALL COSTS TED WITH THE ARBITRATION, INCLUDING ATTORNEY'S STS, AND EXPENSES SHALL BE BORNE BY THE LOSING DECISION OF THE ARBITRATOR WILL BE FINAL AND AND MAY BE ENTERED AS A JUDGMENT IN ANY COURT COMPETENT JURISDICTION. 30 k? XII. MISCELLANEOUS PROVISIONS A. CLINICAL/ FINANCIAL INFORMATION: With and at SHIPPENSB RG's discretion, the Resident hereby authorizes SHIPPENSB RG to obtain all of the necessary clinical and/or financial documentation from the Resident prior or transferring hospital or nursing facility. B. SOL AG EM ENT: This Agreement, along with any documents attached or included by reference, Is the only agreement between SHIPPENSB RG and parties. Changes to this Agreement are valid only if made in writs g and signed by all parties. If changes in state or federal law make any pa of this Agreement invalid, the remaining terms remain valid and enforceable. C. NOW, SSIGNABLE AGREEMENT: The Resident agrees that the right of the Reside t to reside at SHIPPENSBURG is personal and not assignable. The Resident may not transfer his or her rights under this Agreement to any other person. ILI D. GOVER ING LAW: This Agreement shall be governed by and construed by the laws of the Commonwealth of Pennsylvania, and shall be binding upon and shall be or the benefit of each of the undersigned parties and their respective he! , personal representatives, successors and assigns. E. SIEVE ABILITY: The Resident and SHIPPENSBURG agree that each separate oblig tion contained in this Agreement shall be deemed a separate and independe it agreement. If any term, condition, clause or provision of this Agreement shall be determined or declared to be void or invalid in law or otherwise, the only that term, condition, clause or provision shall be stricken from this Agree ent, and in all other respects this Agreement shall be valid and continue in full orce, effect and operation. F. CAPTi NS: The captions used in this Agreement are inserted only for the purpose of eference. Such captions shall not be deemed to govern, limit, modify or in an manner affect the scope, meaning or intent of the provisions of this Agreement. The captions shall be given no legal effect. G. WAIVEF conditions, or ci be deemed or t< term, condition performance the : A waiver by either party at any time of any of the terms, venants of this Agreement, or of any default or breach shall not ken as a waiver at any time thereafter of the same or any other or covenant herein contained, nor of the strict and prompt -IF 31 H. MODIFICATIONS: SHIPPENSBURG reserves the right to unilaterally modify this A reement to the extent necessary to conform the Agreement with subsequent c anges in law or regulation. SHIPPENSBURG will notify the Resident thirty days (30) before such modification, if possible. XIII. ACKNOWLEDGMENTS A. RATE SC EDU E: The Resident and the Resident's Legal Representative hereby ackno ledge the receipt of a copy of the Rate Schedule and sufficient opportunity to ask questions about the Rate Schedule to answer all of their questions abo it SHIPPENSBURG's charges. The Resident and the Legal Representative hereby acknowledge that SHIPPENSBURG can and will alter the Rate Sche ule from time to time, and that Resident will be subject to those changes. The Resident and the Resident's Legal Representative hereby agree to be subject t those changes as provided in this Agreement. B. STATEMEI Legal Reprew receiving a writ and as further Resident's Rig Representative questions abou The Resident i that the accorr from time to ti obligations on Resident. C. COMMONNI the Resident's I and of receivin Packet, accoml Resident's Lei opportunity to appropriate rest hereby acknowl subject to chanc contractual oblic to the Resident. IT OF RESIDENTS RIGHTS: The Resident and the Resident's ntative hereby acknowledge being informed orally and of en copy of the Resident's Rights, as set forth in this Agreement, ;et forth in the accompanying SHIPPENSBURG's Statement of its. Furthermore, the Resident and the Resident's Legal hereby acknowledge having sufficient opportunity to ask the Resident's rights and have received appropriate responses. nd the Resident's Legal Representative hereby acknowledge Danying Statement of Resident's Rights is subject to change ne, and shall not be construed as imposing any contractual SHIPPENSBURG or granting any contractual rights to the CAL I n'b AUM1551UN5 NOTICE PACKET: The Resident and egal Representative hereby acknowledge being informed orally it a written copy of the Commonwealth's Admissions Notice anying this Agreement. Furthermore, the Resident and the al Representative hereby acknowledge having sufficient sk questions about the Resident's rights and have received onses. The Resident and the Resident's Legal Representative .dge that the Commonwealth's Admissions Notice Packet is e from time to time, and shall not be construed as imposing any ations on SHIPPENSBURG or granting any contractual rights 32 D. PRIPRI,_Y and the Resk orally of and Care Records Resident and sufficient oppc have received E. about health Commonweal SHIPPENSBt medical treats Legal Repress questions ab Treatment Se and have rece F. STATEME? Legal Represei receiving a writs in compliance i 1996 (HIPAA). Representative questions about G. AGR_ hereby acknowle this Agreement, representative o Resident's Legz opportunity to a appropriate respc -- • ?- • =4 -????• I - ncAL i ri UAKE RECORDS: The Resident !nt's Legal Representative hereby acknowledge being informed -ceiving a written copy of the Privacy Act Statement -Health in compliance with the Privacy Act of 1974. Furthermore, the e Resident's Legal Representative hereby acknowledge having tunity to ask questions about the Privacy Act Statement and ppropriate responses. yRc mvvAnit:t DIRECTIVES: The Resident and the Resident's ttatvve hereby acknowledge being informed orally and in writing ,are advance directives, including receiving a copy of the 's Medical and Treatment Self-Directive Statement, and of G's policy concerning health care advance directives and ant decisions. Furthermore, the Resident and the Resident's tative hereby acknowledge having sufficient opportunity to ask it advance directives, the Commonwealth's Medical and Directive Statement, and SHIPPENSBURG's policy thereon, :d appropriate responses to all of their questions. i yr rKIVAGY PRACTICES: The Resident and the Resident's Wive hereby acknowledge having been Informed orally of and sn copy of SHIPPENSBURG's Statement of Privacy Practices, fth the Health Insurance Portability and Accountability Act of Furthermore, the Resident and the Resident's Legal hereby acknowledge having sufficient opportunity to ask he Statement and have received appropriate responses. T: The Resident and the Resident's Legal Representative Ige that they have carefully read and understand the terms of and that the terms have been explained to them by a SHIPPENSBURG. Furthermore, the Resident and the Representative hereby acknowledge having sufficient ak questions about the Agreement and have received 33 parties IN WI NESS WHEREOF, INTENDING TO BE LEGALLY BOUND, the heret have executed this Agreement the ;?-? day of _ _ 02 0 O `1 , and same shall be considered b1nding upon all parties, and shall remain in full force and effect unless' and ur?tll cancelled according to the terms of this Agreement. Resident Date 6??10g Date SHIPPENSBURG Witness Witness Date r--- Date Date 34 i Shippensburg Health Care Center 121WALNUT BOTTOM RO SHIPPENSBURG, PA 172S7 (717)530-8300 Mary Campbell 01528 Mary Campbel 3.06 Shephard Lane Shippensburg PA 17257 Balanc ll 04/01/10 Balance Porwa 04/01/10 Private Porti Mary Campbell e ue. 8,532.07 Payments/ Charges Credits 6,996.24 . 04/01/10-04/30/10 1,535.83 0 00 ---------- ---------- Please Remit: 8,532.07 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor ~~lttititr of ~uu~brrl,~~~ ~ ~~~~~ „~w{ ,,~:r~ ,~ r ,:~ ~,.. ~> cF -~~ sr~R}FR ,~,- ~I, - ;i_s: `- ~~ T' ~_ ~ ;'', aolo w~ ti p~~~ray ;_ Perini Services/ South Hampton Manor, LP vs. Jessica E. Smikle Case Number 2010-4671 SHERIFF'S RETURN OF SERVICE 08/02/2010 05:39 PM -Ronald Hoover, Deputy Sheriff, who being duly sworn according to law, states that on August 2, 2010 at 1739 hours, he served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Jessica E. Smikle, by making known unto herself personally, at 306 Shepherd Lane, Shippensburg, Cumberland County, Pennsylvania 17257 its contents and at the same time handing to her personally the said true and correct copy of the same. RONALD HOOVER, DE TY 08/02/2010 05:39 PM -Ronald Hoover, Deputy Sheriff, who being duly sworn according to law, states that on August 2, 2010 at 1739 hours, he served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Jessica E. Smikle as agent for Mary Campbell, by making known unto herself personally, at 306 Shepherd Lane, Shippensburg, Cumberland County, Pennsylvania 17257 its contents and at the same time handing to her personally the said true and correct copy of the same. RONALD HOOVER, EPUTY SHERIFF COST: $62.44 August 03, 2010 (c} CountySuite Sheriff. Teleosoff, Inc. SO ANSWERS, RON R ANDERSON, SHERIFF PERINI SERVICES/ IN THE COURT OF COMMON PLEAS SOUTH HAMPTON MANOR, L.P. CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. : No. 40--9'x- Civil Term lO --guy! MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL Defendants ANSWER TO COMPLAINT ran Answering Defendants, Mary Campbell and Jessica E. Smikle, (herei4l er "Answering Defendants"), by and through their attorney, John J. Mangan, her files_- this Answer to the Complaint and in support thereof avers as follows: 1. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. To the extent that a responsive pleading may be deemed required by the Court, Answering Defendants are without sufficient knowledge or information to form a belief as to the truth of the averments contained in the corresponding paragraph and strict proof thereof is demanded at the time of trial. 2. Admitted. 3. Denied in part, Admitted in part. Denied that Answering Defendant's current name is Jessica Smikle; Admitted as to the address. 4. Admitted. 5. Admitted. 6. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 7. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 8. Admitted. 9. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 10. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 11. Denied. After reasonable investigation, defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in the corresponding paragraph and strict proof thereof is demanded at the time of trial. COUNT I BREACH OF CONTRACT SHIPPENSBURG HEALTH v. MARY CAMPBELL AND JESSICA E. SMIKLE 12. No response is necessary to this averment. 13. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 14. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 15. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 16. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 17. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 18. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 19. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. COUNT II MONEY HAD AND RECEIVED SHIPPENSBURG HEALTH v. JESSICA E. SMIKLE 20. No response is necessary to this averment. 21. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 22. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 23. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 24. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. 25. Denied. The averments in this paragraph are conclusions of law to which no response is required under the Pennsylvania Rules of Civil Procedure; therefore, they are deemed denied. WHEREFORE, Answering Defendants demands that Plaintiff's Complaint be dismissed and that judgment be entered in their favor, together with reasonable counsel fees and costs. Respectfull submitted, John !/Ma6y6n Atto ey r Answering De ndants Date: Attorney I.D. #87040 17 West South Street r/ CI) Carlisle, PA. 17013 717-241-2446 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM VERIFICATION John J. Mangan, Esquire, states that he is the attorney in relation to the within matter; that he makes this affidavit as attorney because he has sufficient knowledge or information and belief, based upon his investigation of the matters averred or denied in the foregoing document; and that this statement is made subject to the penalties of 18 Pa. C.S. §4904, relating to unsworn falsification to authorities. Date: Johni. M gan, Esquire r 1/ 7 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. 10-671 Civil Term CERTIFICATE OF SERVICE 1, John J. Mangan, do hereby certify that on this P day of September 2010, I caused a true and correct copy of the foregoing Answer to Complaint on behalf of the Answering Defendant, to be served upon the following persons by via U.S. mail and/or hand delivery: David Baric, Esq. 19 West South Street Carlisle, PA 17013 // 3/// 6;1 A 9 BAYLEY & -MANGAN John J. Mangan, ]Esquire Attorney I.D. #: 87663 17 West South Street Carlisle, PA 17013 (717) 241-2446 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants c =i n -+ X IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Please enter my appearance on behalf of the Defendant, JESSICA E. SMIKLE, in the above-captioned matter. l Date: Zo?7 <7 John Bayle Man squire 17 West South Street Carlisle, PA 17013 (717) 241-2446 Supreme Court I.D. # 87663 PERINI SERVICES/ SOUTH HAMPTON MANOR., L.P Plaintiff v. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR. MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM CERTIFICATE OF SERVICE 1, John J. Mangan, Esquire, do hereby certify that I this day served a copy of the foregoing document upon the following by First Class U.S. Mail: Dated: David A. Baric, Esquire 19 West South Street Carlisle, PA 17013 John J: , Esquire BAYLEY & MANGAN John J. Mangan, Esquire Attorney I.D. #: 87663 17 West South Street Carlisle, PA 17013 (717) 241-2446 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff v. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants ;~ •~~ SAP '~ PM ~~'' S y ~UM~En~~ ~,~~~~ ~ ~~~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Please enter my appearance on behalf of the Defendants, MARY CAMPBELL and JESSICA E. SMIKLE, n/k/a JESSICA E. WHITE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, in the above-captioned matter. Date: ~~ John J M an, squire Bayl y & angan 17 est South Street Carlisle, PA 17013 (717)241-2446 Supreme Court I.D. # 87663 ,. PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff v. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM CERTIFICATE OF SERVICE I, John J. Mangan, Esquire, do hereby certify that I this day served a copy of the foregoing document upon the following by First Class U.S. Mail: David A. Baric, Esquire 19 West South Street Carlisle, PA 17013 Dated: ~ ~/~~~_ John J M gan, Esquire PERINI SERVICES/ IN THE COURT OF COMMON PLEF SOUTH HAMPTON MANOR, L.P.: CUMBERLAND COUNTY, PENNS Alm Plaintiff crsD i d V. w NO. 2010- 4671 CIVIL TERM :z --4c) c> -- MARY CAMPBELL and -r -- ?rn y JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants MOTION TO COMPEL NOW, comes Plaintiff, Perini Services/South Hampton Manor, L.P. d/b/a Shippensburg Health Care Center, by and through its attorney, David A. Baric, Esquire of BARIC SCHERER, and files within Motion to Compel and, in support thereof, sets forth the following: 1. On or about October 19, 2010, Plaintiff served a Request For Production Of Documents upon counsel for Mary Campbell and Jessica E. Smikle. A true and correct copy of Plaintiffs Request For Production Of Documents is attached hereto as Exhibit "A" and is incorporated. 2. By correspondence dated November 18, 2010, counsel for Plaintiff reminded the attorney for Mary Campbell and Jessica Smikle that responses were past due. A true and correct copy of this correspondence is attached as Exhibit "B." 3. To date, Plaintiff has received no response to the Request for Production of Documents. 4. No Judge of this Court has previously ruled on any motion in this case. WHEREFORE, Plaintiff requests that Mary Campbell and Jessica Smikle be ordered and directed to produce the documents requested to Plaintiff within thirty (30) days of said order. Respectfully submitted, BARIC SCHERER i David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certify that on December , 2010, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Motion To Compel, by first class U.S. mail, postage prepaid, to the party listed below, as follows: John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 David A. Baric, Esquire PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2010- 4671 CIVIL TERM MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants PLAINTIFFS REQUEST FOR PRODUCTION OF DOCUMENTS Pursuant to Pa.R.C.P. No. 4009, as amended, the Plaintiff, Perini Services/ South Hampton Manor, L.P., by their attorneys, Baric Scherer, request you to produce copies of the following documents, at its expense within thirty (30) days of service of this request. INSTRUCTIONS If you object to the production of any document on the grounds that the attorney-client, attorney work-product or any other privilege is applicable thereto, you shall with respect to that document: (a) State its date; (b) Identify its author; (c) Identify each person from whom the document was received; (d) Identify each person who received it; (e) Identify each person from whom the document was received; (f) State the present location of document and all copies thereof; (g) Identify each person who has ever had possession, custody or control of it or copy thereof, and Exhibit "A" (h) Provide sufficient information concerning the document and the circumstances thereof to explain the claim of privilege and to permit the adjudication of the propriety of that claim. As referred to herein, "document" includes written, printed, typed, recorded, or graphic matter, however produced or reproduced, including correspondence, telegrams, other written communications, data processing storage units, tapes, contracts, agreements, notes, memoranda, analyses, projections, indices, work papers, studies, reports, surveys, diaries, calendars, films, photographs, diagrams, drawings, minutes of meetings, or any other writing (including copies of any of the foregoing) regardless of whether you, your former or present counsel, agents, employees, officers, insurers, or any other person acting on your behalf, are now in possession, custody or control. DOCUMENTS REQUESTED 1. Any and all documents ever received by you from Shippensburg Health Care Center. 2. Any and all documents you ever sent to Shippensburg Health Care Center. Copies of any and all power(s) of attorney appointing you as an agent or given by you to another person as your agent. 4. Copies of any checks you forwarded to Shippensburg Health Care Center as payment for any services rendered by Shippensburg Health Care Center. Any and all documents you intend to rely upon at the trial of this matter. 6. Any and all documents which support your denial of paragraph 7 of the Complaint filed in this matter. 7. Any and all documents which support your denial of paragraph 9 of the Complaint filed in this matter. Respectfully submitted, B :AC SCHERER David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 dab.dirlshcc/campbelVdocument. req CERTIFICATE OF SERVICE I hereby certify that on October / 9 , 2010, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Plaintiffs Request For Production Of Documents, by first class U.S. mail, postage prepaid, to the party listed below, as follows: John J. Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 1 z?- k David A. Baric, Esquire BARK Attorneys-at-Law SCHERER David A. Baric Michael A. Scherer Tricia D. Naylor Bret P. Shaffer 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 (717) 249-5755 - Fax dbaric@baricscherer.com November 18, 2010 John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 RE: Perini v. Campbell Dear John: According to my calendar, the period for you to respond to my document production request in the above matter has now expired. Please advise me as to when I may expect to receive the documents. Absent a response, I will be filing a motion to compel production of the documents. Very truly yours, BARIC SCHE R David A. Baric, Esquire DAB/' cc: File dab.dir/shcc/campbell/mangan3.ltr Exhibit "B" UEU U 7 ZU1U PERINI SERVICES/ IN THE COURT OF COMMON PLEAS OF SOUTH HAMPTON MANOR, L.P.: CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants NO. 2010- 4671 CIVIL TERM RUL AND NOW, this Aday of , 2010, upon consideration of the foregoing Motion To Compel, it is hereby ordered that (1) a rule is issued upon the Defendants to show cause why Plaintiff is not entitled to the relief requested; 0710 (2) the Defendants shall file en answer to the petition within days of this date; (3) the motion shall be decided under Pa.R.C.P. No. 206.7; i d- (5) argument shall be held on kJ P-,WA ZS?A the /47 day of 20 , at a: 6 aW/p.m., in Courtroom of the Cumberland County Courthouse; and (6) notice of the entry of this order shall be provided to all parties by the Plai*f. °? B OURT ,- rn "-I 0 corr r-) va??cl l? 13ctr?[' ?5?. J.° ' --F cn c., ti?'-ry C";l ? BAYLEY & MANGAN John J. Mangan, Esquire Attorney I.D. #: 87663 17 West South Street Carlisle, PA 17013 (717) 241-2446 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants FILED-OFFICE OF THE PP0TH0N0TP+ \ `E` 7916 DEC 30 PM 4: 00 CUMBERLAND PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM PRAECIPE TO WITHDRAW APPEARANCE TO THE PROTHONOTARY: I, Jessica White, hereby authorize John Mangan, Esquire to withdraw his appearance with the regard to the above captioned matter. Date: ZZ' / / t45 Date: 1 1 J 'pssica White, Defendant John Ingan, Esquire Bay ey Mangan 17 est South Street Carlisle, PA 17013 (717) 241-2446 Supreme Court I.D. # 87663 y PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 2010-4671 CIVIL TERM CERTIFICATE OF SERVICE I, John J. Mangan, Esquire, do hereby certify that I this day served a copy of the foregoing document upon the following by First Class U.S. Mail: David A. Baric, Esquire 19 West South Street Carlisle, PA 17013 Dated: l z l ? e? XC Jo gan, Esquire 3 JAN 0 6 2011 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM ORDER OF COURT AND NOW, this day o , 2011, upon review of the attached Motion To Make Rule Absolute, it is hereby ordered that the Defendants be ordered to produce complete responses to the Request For Production Of Documents within fifteen (15) days of the date of this Order John J. Manga.n,Jr,Fzl '?Jessaca. E . SrniK.l? ? b uld A. Banc, &st BY T T, Edward E. Guido, J. L -> p n PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA . 2010- 4671 CIVIL TERM NO .a -sy i ? . r :;:o CD PLAINTIFFS MOTION FOR SANCTIONS 1. Plaintiff, Perini Services/South Hampton Manor, L.P., moves for sanctions against Defendants, Jessica E. Smikle, Individually and as agent for Mary Campbell for failing to obey an Order of this Court compelling discovery. 2. On October 19, 2010, Plaintiff served its request for production of documents on Defendants pursuant to Rule 4009 of the Pennsylvania Rules of Civil Procedure. A copy of which is attached hereto as Exhibit "A" and incorporated herein by reference. 4. On or about December 3, 2010, Plaintiff filed a Motion To Compel, a copy of which is attached hereto as Exhibit "B" and incorporated herein by reference. 5. On December 10, 2010 , the Court entered an Order a copy of which is attached hereto as Exhibit "C" and is incorporated herein by reference. 6. On or about January 5, 2011, Plaintiff filed a Motion To Make Rule Absolute, a copy of which is attached hereto as Exhibit "D" and is incorporated herein by reference. 7. On January 7, 2011, the Court entered an Order on the Motion To Make Rule Absolute, a copy of which is attached hereto as Exhibit "E" and is incorporated herein by reference. 8. Defendants failure to adhere to this Court's Order of January 7, 2011, is in direct violation of Rule 4019(a)(1)(viii) of the Pennsylvania Rules of Civil Procedure. 9. Pursuant to Rule 4019 (c) and (g)(1) of the Pennsylvania Rules of Civil Procedure, the Court may grant a Motion For Sanctions when a parry fails to comply with its Order compelling compliance. 10. Plaintiff requests an Order be issued prohibiting Defendants from introducing any written evidence in support of any defense in the instant matter as provided for at Pa.R.C.P. 4019 (c)(2). 11. Plaintiff requests an Order be issued directing entry of a default judgment against Defendants as provided for at Pa.R.C.P. 4019 (c)(3). 12. The Honorable Edward E. Guido has previously ruled in this matter. WHEREFORE, Plaintiff requests that this Court enter an Order granting its motion and the relief requested therein, as well as attorney's fees, costs and such other relief as the Court deems appropriate. Date: Respectfully submitted, 5CSCHERER David A. Baric, Esquire I.D. #44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 PE,RINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM PLAINTIFFS REQUEST FOR PRODUCTION OF DOCUMENTS Pursuant to Pa.R.C.P. No. 4009, as amended, the Plaintiff, Perini Services/ South Hampton Manor, L.P., by their attorneys, Baric Scherer, request you to produce copies of the following documents, at its expense within thirty (30) days of service of this request. INSTRUCTIONS If you object to the production of any document on the grounds that the attorney-client, attorney work-product or any other privilege is applicable thereto, you shall with respect to that document: (a) State its date; (b) Identify its author; (c) Identify each person from whom the document was received; (d) Identify each person who received it; (e) Identify each person from whom the document was received; (f) State the present location of document and all copies thereof, (g) Identify each person who has ever had possession, custody or control of it or copy thereof, and EXHIBIT "A" (h) Provide sufficient information concerning the document and the circumstances thereof to explain the claim of privilege and to permit the adjudication of the propriety of that claim. As referred to herein, "document" includes written, printed, typed, recorded, or graphic matter, however produced or reproduced, including correspondence, telegrams, other written communications, data processing storage units, tapes, contracts, agreements, notes, memoranda, analyses, projections, indices, work papers, studies, reports, surveys, diaries, calendars, films, photographs, diagrams, drawings, minutes of meetings, or any other writing (including copies of any of the foregoing) regardless of whether you, your former or present counsel, agents, employees, officers, insurers, or any other person acting on your behalf, are now in possession, custody or control. DOCUMENTS REQUESTED Any and all documents ever received by you from Shippensburg Health Care Center. 2. Any and all documents you ever sent to Shippensburg Health Care Center. 3. Copies of any and all power(s) of attorney appointing you as an agent or given by you to another person as your agent. 4. Copies of any checks you forwarded to Shippensburg Health Care Center as payment for any services rendered by Shippensburg Health Care Center. 5. Any and all documents you intend to rely upon at the trial of this matter. 6. Any and all documents which support your denial of paragraph 7 of the Complaint filed in this matter. 7. Any and all documents which support your denial of paragraph 9 of the Complaint filed in this matter. Respectfully submitted, B RIC SCHERER David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 dab.dir/shcc/campbell/document. req CERTIFICATE OF SERVICE I hereby certify that on October / 9 , 2010, 1, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Plaintiffs Request For Production Of Documents, by first class U.S. mail, postage prepaid, to the parry listed below, as follows: John J. Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 < 1 David A. Baric, Esquire PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM ..? c cs = r - r r-17 C. n MOTION TO COMPEL NOW, comes Plaintiff, Perini Services/South Hampton Manor, L.P. d/b/a Shippensburg Health Care Center, by and through its attorney, David A. Baric, Esquire of BARIC SCHERER, and files within Motion to Compel and, in support thereof, sets forth the following: 1. On or about October 19, 2010, Plaintiff served a Request For Production Of Documents upon counsel for Mary Campbell and Jessica E. Smikle. A true and correct copy of Plaintiffs Request For Production Of Documents is attached hereto as Exhibit "A" and is incorporated. 2. By correspondence dated November 18, 2010, counsel for Plaintiff reminded the attorney for Mary Campbell and Jessica Smikle that responses were past due. A true and correct copy of this correspondence is attached as Exhibit "B." 3. To date, Plaintiff has received no response to the Request for Production of Documents. 4. No Judge of this Court has previously ruled on any motion in this case. EXHIBIT"B" WHEREFORE, Plaintiff requests that Mary Campbell and Jessica Smikle be ordered and directed to produce the documents requested to Plaintiff within thirty (30) days of said order. Respectfully submitted, BARIC SCHERER David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certify that on December , 2010, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Motion To Compel, by first class U.S. mail, postage prepaid, to the party listed below, as follows: John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 David A. Baric, Esquire PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM PLAINTIFFS REQUEST FOR PRODUCTION OF DOCUMENTS Pursuant to Pa.R.C.P. No. 4009, as amended, the Plaintiff, Perini Services/ South Hampton Manor, L.P., by their attorneys, Baric Scherer, request you to produce copies of the following documents, at its expense within thirty (30) days of service of this request. INSTRUCTIONS If you object to the production of any document on the grounds that the attorney-client, attorney work-product or any other privilege is applicable thereto, you shall with respect to that document: (a) State its date; (b) Identify its author; (c) Identify each person from whom the document was received; (d) Identify each person who received it; (e) Identify each person from whom the document was received; (f) State the present location of document and all copies thereof, (g) Identify each person who has ever had possession, custody or control of it or copy thereof, and Exhibit "A" (h) Provide sufficient information concerning the document and the circumstances thereof to explain the claim of privilege and to permit the adjudication of the propriety of that claim. As referred to herein, "document" includes written, printed, typed, recorded, or graphic matter, however produced or reproduced, including correspondence, telegrams, other written communications, data processing storage units, tapes, contracts, agreements, notes, memoranda, analyses, projections, indices, work papers, studies, reports, surveys, diaries, calendars, films, photographs, diagrams, drawings, minutes of meetings, or any other writing (including copies of any of the foregoing) regardless of whether you, your former or present counsel, agents, employees, officers, insurers, or any other person acting on your behalf, are now in possession, custody or control. DOCUMENTS REQUESTED Any and all documents ever received by you from Shippensburg Health Care Center. 2. Any and all documents you ever sent to Shippensburg Health Care Center. Copies of any and all power(s) of attorney appointing you as an agent or given by you to another person as your agent. 4. Copies of any checks you forwarded to Shippensburg Health Care Center as payment for any services rendered by Shippensburg Health Care Center. 5. Any and all documents you intend to rely upon at the trial of this matter. Any and all documents which support your denial of paragraph 7 of the Complaint filed in this matter. Any and all documents which support your denial of paragraph 9 of the Complaint filed in this matter. Respectfully submitted, B RIC SCHERER David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 dab.dir/shcc/campbelUdocument. req CERTIFICATE OF SERVICE I hereby certify that on October 19 , 2010, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Plaintiffs Request For Production Of Documents, by first class U.S. mail, postage prepaid, to the parry listed below, as follows: John J. Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 < 1 David A. Baric, Esquire BARIC Attorneys-at-Law SCHERER David A. Baric Michael A. Scherer Tricia D, Naylor Bret P. Shaffer 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 (717) 249-5755 - Fax dbaric@baricscherer.com November 18, 2010 John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 RE: Perini v. Campbell Dear John: According to my calendar, the period for you to respond to my document production request in the above matter has now expired. Please advise me as to when I may expect to receive the documents. Absent a response, I will be filing a motion to compel production of the documents. Very truly yours, BARIC SCHE R 0 David A. Baric, Esquire DAB/' cc: File dab.dir/shcc/campbell/mangan3.ltr Exhibit "B" PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM RUL AND NOW this A ? Yof , 2010, upon consideration of the foregoing Motion To Compel, it is hereby ordered that (1) a rule is issued upon the Defendants to show cause why Plaintiff is not entitled to the relief requested; 026 (2) the Defendants shall file an answer to the petition within days of this date; (3) the motion shall be decided under Pa.R.C.P. No. 206.7; (5) argument shall be held on 4119-a /yz I/A , the day of 20 (1, at 4 6 aWo/p.m., in Courtroom 30 of the Cumberland County Courthouse; and (6) notice of the entry of this order shall be provided to all parties by the Plaintiff. B?..??OURT, J. EXHIBIT "C" PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM MOTION TO MAKE RULE ABSOLUTE v' - ...tea r"• AND NOW, comes Plaintiff, Perini Services / South Hampton Manor, L.P. by and through its attorneys, BARIC SCHERER, and files the within Motion to Make Rule Absolute and, in support thereof, sets forth the following: 1. Plaintiffs filed a Motion To Compel Production, a true and correct copy of said Motion is attached hereto as Exhibit "A" and is incorporated. 2. By Order of Court dated December 10, 2010, the Honorable Edward E. Guido, directed the Defendants to show cause why the Motion should not be granted within twenty (20) days of service. A true and correct copy of the Order is attached hereto as Exhibit "B" and is incorporated. 3. To January 4, 2011, no answer has been filed by the Defendants. EXHIBIT "D" WHEREFORE, Plaintiff requests that the rule be made absolute and that the Defendants be ordered to produce complete responses to the Request For Production Of Documents within fifteen (15) days of the date of this Order Respectfully submitted, ar?A'N SCHE R J David A. Baric, Esquire I.D. # 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and : JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA C-1 NO. 2010- 4671 CIVIL TERM= a 9 co 3 zz r' r .. MOTION TO COMPEL NOW, comes Plaintiff, Perini Services/South Hampton Manor, L.P. d/b/a Shippensburg Health Care Center, by and through its attorney, David A. Baric, Esquire of BARIC SCHERER, and files within Motion to Compel and, in support thereof, sets forth the following: 1. On or about October 19, 2010, Plaintiff served a Request For Production Of Documents upon counsel for Mary Campbell and Jessica E. Smikle. A true and correct copy of Plaintiffs Request For Production Of Documents is attached hereto as Exhibit "A" and is incorporated. 2. By correspondence dated November 18, 2010, counsel for Plaintiff reminded the attorney for Mary Campbell and Jessica Smikle that responses were past due. A true and correct copy of this correspondence is attached as Exhibit "B." 3. To date, Plaintiff has received no response to the Request for Production of Documents. 4. No Judge of this Court has previously ruled on any motion in this case. EXHIBIT "A" WHEREFORE, Plaintiff requests that Mary Campbell and Jessica Smikle be ordered and directed to produce the documents requested to Plaintiff within thirty (30) days of said order. Respectfully submitted, BARIC SCHERER Lt David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 CERTIFICATE OF SERVICE I hereby certify that on December , 2010, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Motion To Compel, by first class U.S. mail, postage prepaid, to the party listed below, as follows: John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 David A. Baric, Esquire PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM PLAINTIFFS RE VEST F®R PR®DiTCTI®N ®F D®CUMENTS Pursuant to Pa.R.C.P. No. 4009, as amended, the Plaintiff, Perini Services/ South Hampton Manor, L.P., by their attorneys, Baric Scherer, request you to produce copies of the following documents, at its expense within thirty (30) days of service of this request. INSTRUCTIONS If you object to the production of any document on the grounds that the attorney-client, attorney work-product or any other privilege is applicable thereto, you shall with respect to that document: (a) State its date; (b) Identify its author; (c) Identify each person from whom the document was received; (d) Identify each person who received it; (e) Identify each person from whom the document was received; (f) State the present location of document and all copies thereof; (g) Identify each person who has ever had possession, custody or control of it or copy thereof; and Exhibit "A" (h) Provide sufficient information concerning the document and the circumstances thereof to explain the claim of privilege and to permit the adjudication of the propriety of that claim. As referred to herein, "document" includes written, printed, typed, recorded, or graphic matter, however produced or reproduced, including correspondence, telegrams, other written communications, data processing storage units, tapes, contracts, agreements, notes, memoranda, analyses, projections, indices, work papers, studies, reports, surveys, diaries, calendars, films, photographs, diagrams, drawings, minutes of meetings, or any other writing (including copies of any of the foregoing) regardless of whether you, your former or present counsel, agents, employees, officers, insurers, or any other person acting on your behalf, are now in possession, custody or control. DOCUMENTS REQUESTED Any and all documents ever received by you from Shippensburg Health Care Center Any and all documents you ever sent to Shippensburg Health Care Center. 3. Copies of any and all power(s) of attorney appointing you as an agent or given by you to another person as your agent. 4. Copies of any checks you forwarded to Shippensburg Health Care Center as payment for any services rendered by Shippensburg Health Care Center. 5. Any and all documents you intend to rely upon at the trial of this matter. 6. Any and all documents which support your denial of paragraph 7 of the Complaint filed in this matter. Any and all documents which support your denial of paragraph 9 of the Complaint filed in this matter. Respectfully submitted, B RIC SCHERER David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 dab.dir/shcc/campbeil/document.req CERTIFICATE OF SERVICE I hereby certify that on October / 9 , 2010, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Plaintiffs Request For Production Of Documents, by first class U.S. mail, postage prepaid, to the party listed below, as follows: John J. Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 David A. Baric, Esquire 19 West South Street BARIC Carlisle, Pennsylvania 17013 (717) 249-6873 Attorneys-at-Law (717) 249-5755 - Fax dbaric@baricscherer.com SCHERER David A. Baric Michael A. Scherer Tricia D, Naylor Bret P. Shaffer November 18, 2010 John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Pennsylvania 17013 RE: Perini v. Campbell Dear John: According to my calendar, the period for you to respond to my document production request in the above matter has now expired. Please advise me as to when I may expect to receive the documents. Absent a response, I will be filing a motion to compel production of the documents. Very truly yours, BARIC SCHE R It David A. Baric, Esquire DAB/' cc: File dab.dir/shcc/camp b elVmangan3.ltr Exhibit "B" CERTIFICATE OF SERVICE I hereby certify that on January 4' , 2011, 1, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Motion To Make Rule Absolute, by first class U.S. mail, postage prepaid, to the parties listed below, as follows: John Mangan, Esquire Jessica E. Smikle Bayley & Mangan 306 Shepherd Lane 17 West South Street Shippensburg, Pennsylvania 17257 Carlisle, Pennsylvania 17013 Jessica E. Smikle as agent for Mary Campbell 306 Shepherd Lane Shippensburg, Pennsylvania 1257 u David A. Baric, Esquire PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants ORDER OF COURT AND NOW, this day o 2011, upon review of the attached Motion To Make Rule Absolute, it is hereby ordered that the Defendants be ordered to produce complete responses to the Request For Production Of Documents within fifteen (15) days of the date of this Order BY THE.:COUR , ?A Edward E. Guido, J EXHIBIT "E" CERTIFICATE OF SERVICE I hereby certify that on February 16 , 2011, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of Plaintiffs Motion For Sanctions, by first class U.S. mail, postage prepaid, to the party listed below, as follows: John Mangan, Esquire Bayley & Mangan 17 West South Street Carlisle, Penn is 17013 David. A. Baric, Esquire 3 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2010- 4671 CIVIL TERM `' r.a MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants 4h- RULE _. -= AND NOW, this it day of , 2011, upon consideration of the foregoing Motion For Sanctions, it is hereby ordered that (1) a rule is issued upon the Defendants to show cause why the Plaintiff is not entitled to the relief requested; (2) the Defendants shall file an answer to the Motion within 420 days of this date; (3) the Motion shall be decided under Pa.R.C.P. No. 206.7; (4) depositions shall be completed within. days of this date; (5) argument shall be held on _ 1770A141A the day of 2011, at 3d a.m./^., in Courtroom 3of the Cumberland County Courthouse; and (6) notice of the entry of this order shall be provida-1Q, all parties by the Plaintiff. BY T COURT, J. J06 J. ` "bavid A. Ewric , Mai ! a/g/I s IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants NO. 2010- 4671 CIVIL TERM AFFIDAVIT OF SERVICE TO THE PROTHONOTARY: c ° ° Zm -4 ?rn v't z 4C:1 ° r o me ` za ° w ac ") °rn x C:1 I certify that the attached correspondence dated March 15, 2011 was mailed to each Defendant via United States First Class mail along with a copy of the Rule dated February 18, 2011 and was not returned to me as undeliverable. David A. Baric, Esquire DATE: March 22, 2011 1 J BARIC Attorneys-at-Law SCHERER David A. Baric Michael A. Scherer Tricia D. Naylor Bret P. Shaffer 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 (717) 249-5755 - Fax dbaric®baricscherer.com March 15, 2011 Mary Campbell 121 Walnut Bottom Road Shippensburg, Pennsylvania 17257 Jessica Smikle 306 Shepherd Lane Shippensburg, Pennsylvania 17257 RE: Perini Services/South Hampton Manor, L.P. v. Campbell, et al. Dear Ms. Campbell and Ms. Smikle: Enclosed for service upon you find a copy of the Rule to Show Cause issued regarding our motion for sanctions in this matter. I note a copy was provided to attorney Mangan who has withdrawn from representing the two of you in this matter. I have no objection to extending the time period for you to answer the motion. Please note a hearing has been scheduled for this matter for Monday, April 18, 2011 at 9:30 a.m. in Courtroom #3. Very truly yours, DAB/j1 Enc. cc: File dab. d it/shcc/ca mpbell/campbell&sm ikle.ltr BARIC SCHERER /A? - n David A. Baric, Esquire 3 PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2010- 4671 CIVIL TERM MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants r_ i RU -- AND NOW, this It day of , 2011, upon consideration of the foregoing Motion For Sanctions, it is hereby ordered that (1) a rule is issued upon the Defendants to show cause why the Plaintiff is not entitled to the relief requested; (2) the Defendants shall file an answer to the Motion within 010 days of this date; (3) the Motion shall be decided under Pa.R.C.P. No. 206.7; (4) depositions shall be completed within days of this date; (5) argument shall be held on - 17741AI41A the day of 2011, at 47: 30 a.m./^., in Courtroom 3of the Cumberland County Courthouse; and (6) notice of the entry of this order shall be provi.SQ all parties by the Plaintiff. BY TAE COURT, J. `John J. Mar?M, Jr, F, ?bamid A. Bou-ie , &q- &?O' M'Ii?d alalI f PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO, 4671 Civil 2010 0 VS. C MARY CAMPBELL AND JESSICA E. Zm SMIKLE, AGENT FOR MARY CAMPBELL AND INDIVIDUALLY cn - RULE 1312-1 Defendant s' rte- ?: • ? C3 The Petition for Appointment of Arbitrators shall be substantial) i Following form: y r --t PETITION FOR APPOINTMENT OF ARBITRATORS TO THE HONORABLE, THE JUDGES OF SAID COURT: _F141 ate. "L9 N .a w .x- David A. Baric, Esquire , counsel for the plaintifft in the above action (or actions), respectfully represents that: 1. The above-captioned action (or actions) is (are) at issue. 2. The claim of plaintiff in the action is $ $,532.07 The counterclaim of the defendant in the action is 0.00 The following attorneys are interested in the case(s) as counsel or are otherwise disqualified to sit as arbitrators: r?+ X_n ? m oa -t ? ?C O CD M John J. Mangan, Esquire WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitrators to whom the case shall be submitted. 0'* 06 Rk 0"t spec full bmitted L'It,tA177a7 (2 (t 0.7 ayo David A. Baric, Esquire ORDER OF COURT AND NOW, petition, Esq., and captioned action (or actions) as prayed for. 200 , in consideration of the foregoing Esq., and Esq., are appointed arbitrators in the above By the Court, Kevin A. Hess, P.J. PERINI SERVICES/ IN THE COURT OF COMMON PLEAS OF SOUTH HAMPTON MANOR, L.P.: CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. NO. 2010- 4671 CIVIL TERM MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL -' ?' and INDIVIDUALLY, . Defendants ', cn. Cr C:3 G -7.1 ' ° c' ORDER OF COURT -, c? AND NOW, this / , ay of April, 2011, upon consideration of the argument presented on the Motion For Sanctions and the matters of record, the Court hereby authorizes entry of a default judgment against the Defendants in the amount of $21,631.07, together with interest in the amount of $1,622.35 from November 16, 2010 with a per diem of $10.67, attorney fees of $2,960.00 and costs of $292.00 for a total of $26,505.42. BY THE Edward E. Guido, J. ,/ avid A. &ric, . mo?? orb PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2010- 4671 CIVIL TERM C= MARY CAMPBELL and -C IM M = --? JESSICA E. SMIKLE, n AGENT FOR MARY CAMPBELL o o and INDIVIDUALLY, ® Defendants ? C.) - xr C r, J ? C) ? PRAECIPE TO ENTER JUDGMENT ON ORDER TO THE PROTHONOTARY: Please enter judgment in the above-captioned matter pursuant to the Order Of Court signed by the Honorable Edward E. Guido on April 18, 2011, entering judgment in favor of the Plaintiff in the amount of $26,505.42. Respectfully submitted, B C SCHE R J Y David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 C* ?Iy.ot>?d dt4L1 ,?? a sga 3g PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants ORDER OF COURT AND NOW, this Jd , aay of April, 2011, upon consideration of the argument presented on the Motion For Sanctions and the matters of record, the Court hereby authorizes entry of a default judgment against the Defendants in the amount of $21,631.07, together with interest in the amount of $1,622.35 from November 16, 2010 with a per diem of $10.67, attorney fees of $2,960.00 and costs of $292.00 for a total of $26,505.42. BY THE COURT,- Edward E. Guido, J. CERTIFICATE OF SERVICE I hereby certify that on April 20, 2011, I, David A. Baric, Esquire of Baric Scherer, did serve a copy of the Praecipe Enter Judgment On Order, by first class U.S. mail, postage prepaid, to the parties listed below, as follows: Jessica E. Smikle Jessica E. Smikle 306 Shepherd Lane as agent for Mary Campbell Shippensburg, Pennsylvania 17257 306 Shepherd Lane Shippensburg, Pennsylvania 1257 L I David A. Baric, Esquire PERINI SERVICES/ SOUTH HAMPTON MANOR, L.P. Plaintiff V. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, Defendants TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 2010- 4671 CIVIL TERM PRAECIPE TO WITHDRAW ma) ?. =-n M z r -< M > C Ma C 71 -a N Please withdraw the Petition For Appointment Of Arbitrators filed in this matter on April 12, 2011. Date: April 19, 2011 Respectfully submitted, B C YSCHE David A. Baric, Esquire I.D. 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 WRIT OF EXECUTION and/or ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) NO 10-4671 Civil CIVIL ACTION - LAW TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, interest and costs due PERINI SERVICES/SOUTH HAMPTON MANOR L.P. Plaintiff (s) From MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL and INDIVIDUALLY, 306 Shepherd Lane, Shippensburg, PA 17257 (1) You are directed to levy upon the property of the defendant (s)and to sell LEVY ON ANY AND ALL PERSONALTY LOCATED AT 306 SHEPHERD LANE, SHIPPENSBURG, PA. (2) You are also directed to attach the property of the defendant(s) not levied upon in the possession of GARNISHEE(S) as follows: and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined from paying any debt to or for the account of the defendant (s) and from delivering any property of the defendant (s) or otherwise disposing thereof; (3) If property of the defendant(s) not levied upon an subject to attachment is found in the possession of anyone other than a named garnishee, you are directed to notify him/her that he/she has been added as a garnishee and is enjoined as above stated. Amount Due $26,505.42 Interest Atty's Comm % Atty Paid $218.94 L.L..50 Due Prothy $2.00 Other Costs Plaintiff Paid Date: 4/21/11 (Seal) REQUESTING PARTY: Name DAVID A. BARIC, ESQUIRE Address: BARIC SCHERER 19 WEST SOUTH STREET CARLISLE, PA 17013 David D. Buell, Pro onnotary By,,, Deputy Attorney for: PLAINTIFF Telephone: 717-249-6873 Supreme Court ID No. 44853 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PRAECIPE FOR WRIT OF EXECUTION PERINI SERVICES/ SOUTH ? Confessed Judgment HAMPTON MANOR, L.P., Plaintiff VS. MARY CAMPBELL and JESSICA E. SMIKLE, AGENT FOR MARY CAMPBELL AND INDI VIDUTRPb ldant ® Other File No. 2010-4671 Civil Term Amount Due $26,505.42 Interest Address: Atty's Comm == 306 SHEPHERD LANE Costs rrt° ZG SHIPPENSBURG, PA 17257 • Wit"- N C7 -L? TO THE PROTHONOTARY OF THE SAID COURT: Jr 3 ?© W The undersigned hereby certifies that the below does not arise out of a retail installmeo- , contract, or account based on a confession of judgment, but if it does, it is based on the appropriate origl proceeding filed pursuant to act 7 of 1966 as amended; and for real property pursuant to Act 6 of 1974as amended. Issue writ of execution in the above matter to the Sheriff of Cumberland County, for debt, interest and costs, upon the following described property of the defendant (s) please levy on any and all personalty located at 306 Shepherd Lane, Shippensburg, Cumberland County, PA PRAECIPE FOR ATTACHMENT EXECUTION Issue writ of attachment to the Sheriff of County, for debt, interest and costs, as above, directing attachment against the above-named garnishee(s) for the following property (if real estate, supply six copies of the description; supply four copies of lengthy personalty list) and all other property of the defendant(s) in the possession, custody or control of the said garnishee(s). ? (Indicate) Index this writ against the garnishee (s) as a lis pe agains ea e fje ant(s) described in the attached exhibit. Date 11 Signature: ::.mow. '°:LLy C: D Print Name: David A. Baric, Esquire sa4.00 rerA RKl?' s V a. yq CQ?' ga•AU a 4. u) u « 14.00OA a 50 %A Address: 19 West South Street Carlisle, PA 17013 Attorney for: Plaintiff Telephone: (717) 249-6873 Supreme Court ID No: 44853 00 1?? (U 9-4 01 5s s ao ?+?? aE ?T?v?e?1 WRIT OF EXECUTION and/or ATTACHMENT COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) N010-4671 Civil CIVIL ACTION - LAW TO THE SHERIFF OF CUMBERLAND COUNTY: To satisfy the debt, interest and costs due PERINI SERVICES/SOUTH HAMPTON MANOR, L.P. Plaintiff (s) From MARY CAMPBELL and JESSICA E. SMIKLE AGENT FOR MARY CAMPBELL & INDIVIDUALLY (1) You are directed to levy upon the property of the defendant (s)and to sell (2) You are also directed to attach the property of the defendant(s) not levied upon in the possession of GARNISHEE(S) as follows: SHEIBLEY PROPERTIES, L.P., 67 WEST NORTH STREET, CARLISLE, PA 17013 and to notify the garnishee(s) that: (a) an attachment has been issued; (b) the garnishee(s) is enjoined from paying any debt to or for the account of the defendant (s) and from delivering any property of the defendant (s) or otherwise disposing thereof; (3) If property of the defendant(s) not levied upon an subject to attachment is found in the possession of anyone other than a named garnishee, you are directed to notify him/her that he/she has been added as a garnishee and is enjoined as above stated. Amount Due$26,505.42 Interest Atty's Comm % Atty Paid $2110.94 Other Costs Plaintiff Paid Date: 6/23/11 L.L. Due Prothy $2.00 David D. Buell, rothonotary (Seal) REQUESTING PARTY By: Name DAVID A. BARIC, ESQ. Address: BARIC SCHERER ATTORNEYS AT LAW 19 WEST SOUTH STREET CARLISLE, PA 17013 Attorney for: PLAINTIFF Telephone: 717-249-6873 Supreme Court ID No. 44853 Deputy o r. ? --t rn? IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENN c_ ??a , ?VAIA 1-1 CIVIL DIVISION _<T PRAECIPE FOR WRIT OF EXECUTION °? -?•= -r2 PERINI SERVICES/SOUTH ? Confessed Judgment '' C-' wF,° HAMPTON MANOR, L.P., P aintiff ®Other vs. File No. 2010-4671 Civii T'errr ", ' MARY CAMPBELL and JESSICA E. Amount Due $26,505.42 SMI KL AGENT FO Defendant Interest &MPBELL & INDIVIDUALLY 306 SHEPHERD LANE Atty's Comm S SHIPPENSBURG, PA 17257 Costs GARNISHEE : SHEIBLEY PROPERTIES, L.P., 67 WEST NORTH STREET, CARLISLE, PA 17013 TO THE, PROTHONOTARY OF THE SAID COURT: The undersigned hereby certifies that the below does not arise out of a retail installment sale, contract, or account based on a confession of judgment, but if it does, it is based on the appropriate original proceeding filed pursuant to act 7 of 1966 as amended; and for real property pursuant to Act 6 of 1974 as amended. Issue writ of execution in the above matter to the Sheriff of County, for debt, interest and costs, upon the following described property of the defendant (s) PRAECIPE FOR ATTACHMENT EXECUTION Issue writ of attachment to the Sheriff of Cumberland County, for debt, interest and costs, as above, directing attachment against the above-named garnishee(s) for the following property (if real estate, supply six copies of the description; supply four copies of lengthy personalty list) Sheibley Properties, L.P., 67 West North Street, Carlisle, PA 17013 and all other property of the defendant(s) in the possession, custody or control of the said garnishee(s). ? (Indicate) Index this writ against the garnishee (s) as a lis pe against re st o eAd s) described in the attached exhibit. L Date (o d' Signature: y S (' Print Name: David A. Baric, Esquire (?iM.k o?"1, ? '? to Address: 19 West South Street ?t a. 44 CSF 9a,O0 l?tl Carlisle, PA 17013 a 1, 0 0" I Attorney for: Plaintiff 14. 0 0 Telephone: (717) 249-6873 Supreme Court ID No: 4 4 8 5 3 % P. Co tPua 0 ,z a tot) ? to 3 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy 001'r ui C4t,fa)"I"11141 F ILEU-Dfi FICA. C I THE PR0TH0N,0 AR," 2011 JUL 20 AM S: 92 Richard W Stewart Solicitor OFF E 1.. I-F EF;,.?_ CUMBERLAND COUNTY PENNSYLVANIA Perini Services/ South Hampton Manor, LP vs. Case Number Mary Campbell (et al.) 2010-4671 SHERIFF'S RETURN OF SERVICE 07/19/2011 11:07 AM - William Cline, Deputy, who being duly sworn according to law, attached as herein commanded all goods, chattels, rights, debts, credits, and monies of the Defendant, in the hands, possession, or control of the within named garnishee, Sheibley Poperties, L.P. at 127 Lincoln Street, Carlisle, PA 17013, Cumberland County, by handing to Dave Sheibley, Owner, personally three copies of interrogatories together with three true and attested copies of the Writ of Execution and made the contents there of known to him. The writ of execution and notice to defendant was mailed on July 19, 2011 to Mary Campbell and Jessica Smikle, Agent for Mary Campbell at 306 Shepherd Lane, Shippensburg, PA 17257. SO ANSWERS, July 19, 2011 RON NDERSON, SHERIFF n i liam Cline, Corporal c GouniySuite Sheriff. Telao,oft, In,; SHERIFF'S OFFICE OF CUMBERLAND COUNTY I R Anderson ED-ratj-? iff .sdy S Smith chief Deputy 20!? FEB 22 PM 2: 5 ,99 Richard W Stewart CUMBERLAQ COIN D" Solicitor _ PENNSYLVANIA Perini Services/ South Hampton Manor, LP Case Number vs. Mary Campbell (et al.) 2010-4671 SHERIFF'S RETURN OF SERVICE 05/10/2011 08:40 PM - Gerald Worthington, Deputy Sheriff, who being duly sworn according to law, states that on May 9, 2011 at 2005 hours, he served a true copy of the within writ of execution, upon the defendant, to wit: Jessica E. Smickle (individually), by making known unto Jessica E. Smikle, at 306 Shepherd Lane, Shippensburg, Cumberland County, Pennsylvania 1727 its contents and at the same time handing to her personally the said true and correct copy of the same. Upon serving the writ of execution, a levy was completed. Postcard and copy of levy mailed to attorney and letter mailed to defendant on 05-12-11. 05/10/2011 08:40 PM - Gerald Worthington, Deputy Sheriff, who being duly sworn according to law, states that on May 9, 2011 at 2005 hours, he served a true copy of the within writ of execution, upon the defendant, to wit: Jessica E. Smickle (as Agent for Mary Campbell), by making known unto Jessica E. Smikle, at 306 Shepherd Lane, Shippensburg, Cumberland County, Pennsylvania 17257 its contents and at the same time handing to her personally the said true and correct copy of the same. Upon serving the writ of execution, a levy was completed. Postcard and copy of levy mailed to attorney and letter mailed to defendant on 05-12-11. 05/13/2011 Property claim filed this date by Clarence White. All parties notified by mail. 05/23/2011 Reference is made to property claim dated May 13, 2011, entered by Clarence H. White, Writ of Executior No. 2010-4671 Civil Term, Perini Services / South Hampton Manor vs Mary Campbell and Jessica Smikle. Ronny R. Anderson, Sheriff, has determined that the claimant, Clarence H. White, in the above mentioned property claim, is the owner of the property set forth in the claim. 06/03/2011 No objections were filed in this case. Refunding $ 25.00 to claimant Clarence H. White. Writ to stay open as property remains. 02/21/2012 Ronny R. Anderson, Sheriff, who being duly sworn according to law, states this writ of execution is returned as ABANDONED. No action on writ in over 6 months. SHERIFF COST: $137.68 SO ANSWERS, February 21, 2012 RON R ANDERSON, SHERIFF . S? C R Anderson if ,dy S Smith chief Deputy Richard W Stewart Solicitor SHERIFF'S OFFICE OF CUMBERLAND COUNTY # _Lj PRO T H 0F i ?t.? y 4111 a9 4tI?1lt?rr(Tp? ufi ?'Ei:J 00 ? 1f 1'.` Perini Services/ South Hampton Manor, LP vs. Mary Campbell (et al.) SHERIFF'S RETURN OF SERVICE 4112 FEB 22 PM 2:59 MMBEP,LAa 40 00fJNT'. PENNSYLVANIA Case Number 2010-4671 07/19/2011 11:07 AM - William Cline, Deputy, who being duly sworn according to law, attached as herein commanded all goods, chattels, rights, debts, credits, and monies of the Defendant, in the hands, possession, or control of the within named garnishee, Sheibley Poperties, L.P. at 127 Lincoln Street, Carlisle, PA 17013, Cumberland County, by handing to Dave Sheibley, Owner, personally three copies of interrogatories together with three true and attested copies of the Writ of Execution and made the contents there of known to him. The writ of execution and notice to defendant was mailed on July 19, 2011 to Mary Campbell and Jessica Smikle, Agent for Mary Campbell at 306 Shepherd Lane, Shippensburg, PA 17257. 02/21/2012 Ronny R. Anderson, Sheriff, who being duly sworn according to law, states this writ of execution is returned as ABANDONED. No action on writ in over 6 months. SHERIFF COST: $93.72 February 21, 2012 SO ANSWERS, RONK'Y R ANDERSON, SHERIFF ?. C7G f,?t ?ia . ?! 3' 7