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Home My WebLink About11-13141 THIS IS AN ARBITRATION MATTER ASSESSMENT OF DAMAGES HEARING NOT REQUIRED TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE Attorney I.D. #60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 11-13i14 C (vi l Ter At VS CIVIL ACTION CHARLES B. EWING -,, 137 Blacksmith Road_ Camp Hill, PA 17011 1 , :- M ,-a C) COMPLAINT - CIVIL ACTION _< -. s NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 (717)249-3166 or(800)990-9108 b OJK+ $qa, 00 N aid 0-k Ry$?s 0as11bgz/ COMPLAINT - CIVIL ACTION THE MILTON S. HERSHEY MEDICAL CENTER VS. CHARLES B. EWING 1. Plaintiff is a non-profit corporation located at the address indicated in the caption hereof. 2. Defendant is an individual who resides at the address indicated in the caption hereof. 3. As the result of a certain medical condition, defendant was treated by the plaintiff on May 1, 2010 thru Aug. 3, 2010. 4. The amounts, quantities and nature of said medical care, the dates on which said medical care was rendered, and the charges therefore are set forth in Exhibit "A" which is incor- porated herein as if set forth at length. 5. Said medical care was commensurate with the condition of defendant and was necessary for the health and welfare of defendant. 6. At or about the time of defendant's treatment by plain- tiff, implied, constructive and oral contracts arose between defendant and plaintiff by the terms of which defendant became obligated to pay plaintiff the charges for the medical care rendered by plaintiff to defendant. 7. Defendant refuses to pay the balance due although plaintiff has made demand that defendant do so. 8. As a result of the foregoing, there is due and owing from defendant to plaintiff the sum indicated in Exhibit "A" WHEREFORE, plaintiff demands judgment against defendant for the sum of $48,932.20 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. TABAS & ROSEN, P.C. LEWIS C. TRA FER, ESQUIRE Attorney for Plaintiff MS HERSHEY MEDICAL CENTER PAGE: 1 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/04/10 at 03::09 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14421095 -------------------------------------------------------------------------------- I Date I Svc Code I Description I units Debits I Credits --------------------------------------------------------------------------------- 05/01/10 11674 81 ADULT IMC 1 2055.00 05/01/10 46472 EMERGENCY VISIT, LEVE 1 860.00 05/01/10 46620 ROUTINE VENIPUNCTURE 1 22.00 05/01/10 46712 12 LEAD EKG-TRACING O 1 152.00 05/01/10 46717 NONINVAS PULSE OX, MU 1 124.00 05/01/10 46794 IV PUMP, SINGLE LINE 1 3.00 05/01/10 46933 IV INF,THER,PROPH,DX, 1 269.00 05/01/10 46935 IV INF,ADD SEQ INFUS, 2 332.00 05/01/10 46937 THER IV PUSH,EA ADDL 4 288.00 05/01/10 46945 EA ADDT SEQ IVP OF SA 1 72.00 05/01/10 46972 LACTIC ACID 1 80.00 05/01/10 100031 MRSA BY PCR 1 216.00 05/01/10 100071 ANCA 1 90.00 05/01/10 100076 FLUORESCENT ANTIBODY 1 62.00 05/01/10 100080 ANA SCREEN 1 110.00 05/01/10 102003 SENSI, DISK METHOD/PL 1 53.00 05/01/10 102019 GRAM STAIN 3 102.00 05/01/10 102100 CULTURE, BACTERIAL 3 258.00 05/01/10 102105 CULTURE, BLOOD 2 226.00 05/01/10 102115 CULTURE, AFB 1 128.00 05/01/10 102118 SMEAR, FLUOR/ACID FAS 3 144.00 05/01/10 102147 HOMOGENIZATION, TISSU 1 48.00 05/01/10 102214 CULTURE, URINE QUANT 1 52.00 05/01/10 102215 CULTURE TYPE IMM/ANTI 10 350.00 05/01/10 102303 CULTURE, FUNGUS OTHER 2 1'04.00 05/01/10 102312 CONCENTRA FOR INF AGE 1 21.00 05/01/10 104020 C REACTIVE PROTEIN QU 1 63.00 05/01/10 104040 CPK 2 42.00 05/01/10 104048 MYOGLOBIN 1 87.00 05/01/10 104096 LDH 1 21.00 05/01/10 104106 MAGNESIUM 1 21.00 05/01/10 104438 RENAL FUNCTION PANEL 1 57.00 05/01/10 105029 FIBRINOGEN 1 44.00 05/01/10 105033 FIBRIN SPLIT PRODUCTS 1 72.00 05/01/10 105052 PARTIAL THROMBOPLAS T 1 50.00 05/01/10 105059 PROTHROMBIN TIME 1 30.00 05/01/10 105067 SEDIMENTATION RATE (E 1 28.00 05/01/10 105657 CBC W/PLT/DIF F AUTO 1 62.00 05/01/10 106010 URINALYSIS-BASIC/REFL 1 23.00 05/01/10 107574 HAPTOGLOBIN 1 90.00 05/01/10 191023 LVL4 SURGICAL PATHOLO 1 112.00 05/01/10 246493 DEXAMETHASONE 4 MG/ML 12 5.05 -------------------------------------------------------------------------------- - Continue - 4-1 MS HERSHEY MEDICAL CENTER PAGE: 2 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/04/10 at 03:09 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14421095 --------------------------------------------------- ----------------------------- I Svc Code Description Units Debits Credits ---------------------------------------------------=---------------------------- 05/01/10 246705 MORPHINE SULFATE 4 MG 2 6.30 05/01/10 248356 METOPROLOL 5MG/5ML 1 3.00 05/01/10 248716 LABETALOL 100MG/ML 1 4.70 05/01/10 251127 CLINDAMYCIN 900MG 6 106.30 05/01/10 251129 POTASSIUM CHLORIDE 10 30 35.10 05/01/10 251908 TYLENOL EXTRA STRENGT 2 3.00 05/01/10 272205 CLINDAMYCIN 600MG IV 4 86.95 05/01/10 272811 DALTEPARIN 2500U/0.2M 1 37.90 05/01/10 272988 CEFTRIAXONE 1 GM PRE- 4 30.20 05/01/10 273401 ZOSYN 3.75GM BAG 3 61.85 05/01/10 274274 VANCOMYCIN HCL INJ 2 30.20 0.5/01/10 307102 CHEST 2 VIEW A/P LAT 1 188.00 05/01/10 310501 CT HEAD UNENHANCED 1 981.00 05/01/10 347062 MRI BRAIN UNENH & ENH 1 2649.00 05/01/10 347270 GADOLINIUM PER ML 17 272.00 05/01/10 600504 AMBUBAG ADULT W/MASK 1 31.00 05/01/10 600510 PULSE OXIMETER SNSR A 2 68.00 05/01/10 621044 I V SODIUM CHLORIDE 0 1 2.00 05/01/10 621054 IV LACTATED RINGERS 1 4 12.00 05/01/10 621055 KIT ER IV START 1 19.00 05/01/10 621105 YANKAUER SUCT TB W/0 1 1.00 05/01/10 627070 IV EXT SET 90" W/FLAS 2 28.00 05/01/10 670334 IV INFUSION SET, UNIV 3 9.00 05/02/10 11677 P PRIVATE ROOM 1. 1614.00 05/02/10 104106 MAGNESIUM 1. 21.00 05/02/10 104129 PHOSPHORUS, BLOOD 1. 19.00 05/02/10 104433 BASIC METABOLIC PANEL 1. 55.00 05/02/10 105059 PROTHROMBIN TIME 1. 30.00 05/02/10 105657 CBC W/PLT/DIFF AUTO 1. 62.00 05/02/10 245847 CEPHALEXIN 500 MG 31 9.00 05/02/10 246201 HYDRALAZINE 20 MG/ML 1. 14.55 05/02/10 246271 METHYLPREDNISOLONE 40 2 12.10 05/02/10 246705 MORPHINE SULFATE 4 MG 4 12.60 05/02/10 251099 FLUCONAZOLE 200MG TAB 2 3.00 05/02/10 272811 DALTEPARIN 2500U/0.2M 2 75.80 05/02/10 273401 ZOSYN 3.75GM BAG 3 61.85 05/02/10 273935 PANTOPRAZOLE 40 MG VI 1 12.30 05/02/10 274274 VANCOMYCIN HCL INJ 2 30.20 05/02/10 600510 PULSE OXIMETER SNSR A 1 34.00 05/02/10 621054 IV LACTATED RINGERS 1 1 3.00 05/02/10 669194 TAPE SURG SOFCLOTH RO 2 28.00 05/03/10 11677 P PRIVATE ROOM 1 1614.00 -------------------------------------- ------------------------------------------- - Continue - MS HERSHEY MEDICAL CENTER PAGE: 3 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/04/10 at 03:09 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14421095 -------------------------------------------------------------------------------- Date I Svc Code I Description I Units Debits I Credits -------------------------------------------------------------------------------- 05/03/10 104014 ALKALINE PHOSPHATASE 1 19.00 05/03/10 104016 BILIRUBIN TOTAL 1 19.00 05/03/10 104106 MAGNESIUM 1 21.00 05/03/10 104129 PHOSPHORUS, BLOOD 1 19.00 05/03/10 104156 SGPT (ALT) 1 20.00 05/03/10 104433 BASIC METABOLIC PANEL 1 55.00 05/03/10 104591 VANCOMYCIN LEVEL 1 48.00 05/03/10 105657 CBC W/PLT/DIFF AUTO 1 62.00 05/03/10 245527 NIFEDIPINE 10 MG 3 7.50 05/03/10 245847 CEPHALEXIN 500 MG 4 12.00 05/03/10 246201 HYDRALAZINE 20 MG/ML 1 14.55 05/03/10 246271 METHYLPREDNISOLONE 40 2 12.10 05/03/10 246705 MORPHINE SULFATE 4 MG 1 3.15 05/03/10 246706 MORPHINE SULFATE 2 MG 4 12.20 05/03/10 248356 METOPROLOL 5MG/5ML 1 3.00 05/03/10 251099 FLUCONAZOLE 200MG TAB 1 3.00 05/03/10 272811 DALTEPARIN 2500U/0.2M 2 75.80 05/03/10 273741 METOPROLOL 25 MG TAB 3 9.00 05/03/10 273935 PANTOPRAZOLE 40 MG VI 1 12.30 05/03/10 275166 OSCAL D 500 1 TAB 1 3.00 05/03/10 621054 IV LACTATED RINGERS 1 2 6.00 05/04/10 62367 P PRIVATE ROOM 1 1614.00 05/04/10 79591 MYELOPEROXIDASE AB 1 222.00 05/04/10 79654 PROTEINASE 3 AB 1 259.00 05/04/10 100025 CLOSTRIDIUM DIFFICILE 1 114.00 05/04/10 104055 IGA IMMUNOGLOBULIN 1 79.00 05/04/10 104056 IGG IMMUNOGLOBULIN 1 79.00 05/04/10 104057 IGM IMMUNOGLOBULIN 1 79.00 05/04/10 104167 C3 COMPLEMENT 1 115.00 05/04/10 104170 C4 COMPLEMENT 1 115.00 05/04/10 104323 CREATININE, URINE OR 1 50.00 05/04/10 104379 PROTEIN, URINE QUANT 1 30.00 05/04/10 104433 BASIC METABOLIC PANEL 2 110.00 05/04/10 104500 RHEUMATOID FACTOR, QU 1 57.00 05/04/10 104536 PROTEIN ELECTROPH MIC 1 154.00 05/04/10 104562 IMMUNOFIXATION, SERUM 1 163.00 05/04/10 104563 IMMUNOFIXATION, URINE 1 136.00 05/04/10 105657 CBC W/PLT/DIFF AUTO 1 62.00 05/04/10 109468 CCP ANTIBODY 1 236.00 05/04/10 109733 ANA AB BY IFA 1 37.00 05/04/10 245527 NIFEDIPINE 10 MG 9 22.50 05/04/10 245840 CEPHALEXIN 250 MG 6 9.00 -------------------------------------------------------------------------------- - Continue - f3 MS HERSHEY MEDICAL CENTER PAGE: 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/04/10 at 03:09 PM Guarantor: EWING CHARLES B 137 BLAQkSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit $#: 14421095 -------------------------------------------------------------------------------- Date I Svc Code I Description I Unitsl Debits I Credits -------------------------------------------------------------------------------- 05/04/10 245847 CEPHALEXIN 500 MG 4 12.00 05/04/10 246271 METHYLPREDNISOLONE 40 1 6.05 05/04/10 246706 MORPHINE SULFATE 2 MG 4 12.20 05/04/10 247061 PREDNISONE 10 MG 12 6.00 05/04/10 251099 FLUCONAZOLE 200MG TAB 1 3.00 05/04/10 251109 MORPHINE 15 MG TAB 1 3.00 05/04/10 272811 DALTEPARIN 2500U/0.2M 2 75.80 05/04/10 273741 METOPROLOL 25 MG TAB 2 6.00 05/04/10 273935 PANTOPRAZOLE 40 MG VI 1 12.30 05/04/10 275166 OSCAL D 500 1 TAB 3 9.00 05/04/10 600510 PULSE OXIMETER SNSR A 1 34.00 05/04/10 621054 IV LACTATED RINGERS 1 4 12.00 05/04/10 622024 IRRIGATION SOD CHL 0. 1 3.00 05/04/10 627068 IV EXT ST 421N W/2 SI 1 9.00 05/04/10 627070 IV EXT SET 90" W/FLAS 1 14.00 05/04/10 669194 TAPE SURG SOFCLOTH RO 1 14.00 05/04/10 670334 IV INFUSION SET, UNIV 1 3.00 05/05/10 104106 MAGNESIUM 1 21.00 05/05/10 104129 PHOSPHORUS, BLOOD 1 19.00 05/05/10 104433 BASIC METABOLIC PANEL 1 55.00 05/05/10 104550 HEPATITIS B CORE ANTI 1. 98.00 05/05/10 104551 HEPATITIS B SURF ANTI 1 90.00 05/05/10 104553 HEPATITIS B SURF ANTI 1 86.00 05/05/10 104556 HIV TYPES 1&2 1. 103.00 05/05/10 104557 HEPATITIS C ANTIBODY 1. 124.00 05/05/10 105657 CBC W/PLT/DIFF AUTO 1. 62.00 05/05/10 245527 NIFEDIPINE 10 MG E; 15.00 05/05/10 245840 CEPHALEXIN 250 MG 6. 9.00 05/05/10 246124 DOCUSATE-SENNA 50MG-8 1. 3.00 05/05/10 246706 MORPHINE SULFATE 2 MG 1. 3.05 05/05/10 246707 HYDROMORPHONE 2MG/1ML 2. 18.45 05/05/10 247061 PREDNISONE 10 MG 12 6.00 05/05/10 247786 MORPHINE SULFATE 10 M 3 10.25 05/05/10 251099 FLUCONAZOLE 2 00MG TAB 1. 3.00 05/05/10 251109 MORPHINE 15 MG TAB 1 3.00 05/05/10 251110 MORPHINE 30MG TAB 2 6.00 05/05/10 272811 DALTEPARIN 2500U/0.2M 1 37.90 05/05/10 273737 PANTOPRAZOLE EC 40 MG 1 3.00 05/05/10 273741 METOPROLOL 25 MG TAB 2 6.00 05/05/10 273777 LINEZOLID 600 MG TAB 1 244.40 05/05/10 275166 OS CAL D 500 1 TAB 2 6.00 05/05/10 621054 IV LACTATED R=NGERS 1 2 6.00 ---------------------------------------------------•----------------------------- - Continue - h- MS HERSHEY MEDICAL CENTER PAGE: 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/04/10 at 03:09 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14421095 ---------------------------------------------------•----------------------------- I Date I Svc Code I Description i Unitsl Debits I Credits -------------------------------------------------------------------------------- 05/05/10 9990771 CRYOFIBRINOGEN 05/05/10 I 9990772 CRYOGLOBULIN 1 24.00 1 23.00 -------------------------------------------------------------------------------- * - Not posted I Balance: I 20903.45 I -------------------------- Q i MS HERSHEY MEDICAL CENTER PAGE: 1 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/30/10 at 04:05 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14760149 -------------------------------------------------------------------------------- Date Svc Code Description I Unitsl Debits ( Credits -------------------------------------------------------------------------------- 07/30/10 .10232 P PRIV MED/SURG RM 1 1775.00 07/30/10 46472 EMERGENCY VISIT, LEVE 1 946.00 07/30/10 46620 ROUTINE VENIPUNCTURE 1 23.00 07/30/10 46698 THERA/DIAG INJ, SUBCU 1 39.00 07/30/10 46699 THERA/DIAG INJECTION 1 79.00 07/30/10 46717 NONINVAS PULSE OX, MU 1 136.00 07/30/10 46937 THER IV PUSH,EA ADDL 2 158.00 07/30/10 100031 MRSA BY PCR 1 238.00 07/30/10 102005 SENSI MIC PER PLATE 1 59.00 07/30/10 102019 GRAM STAIN 1 37.00 07/30/10 102100 CULTURE, BACTERIAL 1 95.00 07/30/10 102104 CULTURE, ANAEROBES ON 1 86.00 07/30/10 102105 CULTURE, BLOOD 2 248.00 07/30/10 102118 SMEAR, FLUOR/ACID FAS 1 53.00 07/30/10 102147 HOMOGENIZATION, TISSU 1 53.00 07/30/10 102189 ID DEFIN AEROB ISOL E 1 58.00 07/30/10 102214 CULTURE, URINE QUANT 1 57.00 07/30/10 102303 CULTURE, FUNGUS OTHER 1 57.00 07/30/10 104020 C REACTIVE PROTEIN QU 1 69.00 07/30/10 104068 GLYCOHEMOGLOBIN 1 89.00 07/30/10 104167 C3 COMPLEMENT 1 127.00 07/30/10 104170 C4 COMPLEMENT 1 127.00 07/30/10 104323 CREATININE, URINE OR 1 55.00 07/30/10 104379 PROTEIN, URINE QUANT 1 33.00 07/30/10 104433 BASIC METABOLIC PANEL 2 122.00 07/30/10 105067 SEDIMENTATION RATE {E 1 31.00 07/30/10 105197 DRVVT 3 438.00 07/30/10 105199 STA-LA 20 1 197.00 07/30/10 105657 CBC W/PLT/DIFF AUTO 1 68.00 07/30/10 106011 URINALYSIS-BASIC & MI 1 55.00 07/30/10 109830 BETA 2 GLYCOPROT IGG 1 174.00 07/30/10 109831 BETA 2 GLYCOPROT IGA 1 174.00 07/30/10 109832 BETA 2 GLYCOPROT IGM 1 174.00 07/30/10 111001 GLUCOSE BEDSIDE MONIT 2 80.00 07/30/10 191023 LVL4 SURGICAL PATHOLO 1 123.00 07/30/10 245482 DEXTROSE 59.- IN WATER 1 3.00 07/30/10 246273 METHYLPRED. SOD. SUCC 1 9.80 07/30/10 246582 METOPROLOL 50 MG 1 3.00 07/30/10 246614 PREDNISONE 20 MG 8 3.00 07/30/10 247061 PREDNISONE 10 MG 2 3.00 07/30/10 250855 NIFEDIPINE 30MG 3 5.35 07/30/10 251251 IDUR 20MEG UD 3 3.00 - Continue - / ? -(0 MS HERSHEY MEDICAL CENTER PAGE: 500 UNIVERSITY DRIVE HERSHEY,'PA 17033 Statement on: 08/30/10 at 04:05 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14760149 --------------------------------------------------------------------------------- Date Svc Code Description Units Debits Credits --------------------------------------------------------------------------------- 07/30/10 273437 ZOSYN 4.5GM PREMIX BA 8 153.80 07/30/10 273737 PANTOPRAZOLE EC 40 MG 1 3.00 07/30/10 273776 DALTEPARIN 5000U SYR 2 63.95 07/30/10 275228 VANCOMYCIN 5G VIAL 3 31.65 07/30/10 275308 HYDROMORPHONE 1MG/ML 1 3.00 07/30/10 621044 I V SODIUM CHLORIDE 0 1 2.00 07/30/10 621055 KIT ER IV START 1 21.00 07/30/10 627070 IV EXT SET 90" W/FLAS 1 15.00 07/30/10 670334 IV INFUSION SET, UNIV 1 3.00 07/31/10 10232 P PRIV MED/SURG RM 1 1775.00 07/31/10 48229 DUPLEX SCAN EV-COMPLE 1 663.00 07/31/10 102105 CULTURE, BLOOD 1 124.00 07/31/10 104013 ALBUMIN 1 21.00 07/31/10 104014 ALKALINE PHOSPHATASE 1 21.00 07/31/10 104016 BILIRUBIN TOTAL 1 21.00 07/31/10 104106 MAGNESIUM 1 23.00 07/31/10 104129 PHOSPHORUS, BLOOD 1 21.00 07/31/10 104136 PROTEIN, SERUM 1 20.00 07/31/10 104156 SGPT (ALT) 1 22.00 07/31/10 104433 BASIC METABOLIC PANEL 1 61.00 07/31/10 105657 CBC W/PLT/DIFF AUTO 1 68.00 07/31/10 111001 GLUCOSE BEDSIDE MONIT 4 160.00 07/31/10 246271 METHYLPREDNISOLONE 40 1 6.30 07/31/10 246614 PREDNISONE 20 MG 4 3.00 07/31/10 246707 HYDROMORPHONE 2MG/1ML 1 3.85 07/31/10 250756 NIFEDIPINE 90MG 1 7.10 07/31/10 273107 HUMALOG 5 UNITS 20 48.35 07/31/10 273437 ZOSYN 4.5GM PREMIX BA 16 307.60 07/31/10 273737 PANTOPRAZOLE EC 40 MG 1 3.00 07/31/10 273741 METOPROLOL 25 MG TAB 2 6.00 07/31/10 273776 DALTEPARIN'5000U SYR 2 63.95 07/31/10 274274 VANCOMYCIN HCL INJ 4 62.40 07/31/10 275308 HYDROMORPHONE 1MG/ML 2 6.00 07/31/10 621042 I V SODIUM CHLORIDE 0 1 2.00 07/31/10 627068 IV EXT ST 421N W/2 SI 1. 10.00 07/31/10 627070 IV EXT SET 90" W/FLAS 1. 15.00 07/31/10 670334 IV INFUSION SET, UNIV 1. 3.00 08/01/10 10232 P PRIV MED/SURG RM 1. 1775.00 08/01/10 16681 INITIAL EVALUATION-PT 1. 228.00 08/01/10 102105 CULTURE, BLOOD 1. 124.00 08/01/10 104129 PHOSPHORUS, BLOOD 1. 21.00 08/01/10 104433 BASIC METABOLIC PANEL 1. 61.00 -------------------------------------------------------------------------------- - Continue - f7 MS HERSHEY MEDICAL CENTER PAGE: 3 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/30/10 at 04:05 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit ##: 14760149 -------------------------------------------------------------------------- Date I Svc Code I Description Units Debits Credits 08/01/10 104591 VANCOMYCIN LEVEL 1 53.00 08/01/10 105657 CBC W/PLT/DIFF AUTO 1 68.00 08/01/10 111001 GLUCOSE BEDSIDE MONIT 4 160.00 08/01/10 245482 DEXTROSE 5% IN WATER 2 6.00 08/01/10 246614 PREDNISONE 20 MG 4 3.00 08/01/10 247061 PREDNISONE 10 MG 6 3.00 08/01/10 250562 NAPROXEN 250MG 2 6.00 08/01/10 250756 NIFEDIPINE 90MG 1 7.10 08/01/10 251251 KDUR 20MEG UD 4 6.00 08/01/10 251908 TYLENOL EXTRA STRENGT 2 3.00 08/01/10 273437 ZOSYN 4.5GM PREMIX BA 16 307.60 08/01/10 273737 PANTOPRAZOLE EC 40 MG 2 6.00 08/01/10 273741 METOPROLOL 25 MG TAB 2 6.00 08/01/10 273776 DALTEPARIN 5000U SYR 2 63.95 08/01/10 274274 VANCOMYCIN HCL INJ 2 31.20 08/01/10 275228 VANCOMYCIN 5G VIAL 6 63.30 08/01/10 275308 HYDROMORPHONE 1MG/ML 2 6.00 08/01/10 305608 ELBOW 3+ VIEWS RIGHT 1 183.00 08/01/10 305622 KNEE 4 OR MORE VIEWS 1 325.00 08/01/10 307276 ELBOW 3+ VIEWS LEFT X 1 183.00 08/01/10 307311 KNEE 4 OR MORE VIEWS 1 325.00 08/01/10 621043 I V SODIUM CHLORIDE 0 1 3.00 08/01/10 670334 IV INFUSION SET, UNIV 1 3.00 08/02/10 10232 P PRIV MED/SURG RM 1. 1775.00 08/02/10 16694 GAIT TRAINING 15 MIN 1. 76.00 08/02/10 56609 INITIAL EVALUATION-OT 1. 228.00 08/02/10 100047 LYME AB IGG & IGM 1. 128.00 08/02/10 104129 PHOSPHORUS, BLOOD 1. 21.00 08/02/10 104433 BASIC METABOLIC PANEL 1. 61.00 08/02/10 105657 CBC W/PLT/DIFF AUTO 1. 68.00 08/02/10 111001 GLUCOSE BEDSIDE MONIT 4 160.00 08/02/10 245482 DEXTROSE 501 IN WATER 2 6.00 08/02/10 247061 PREDNISONE 10 MG 12 6.00 08/02/10 250562 NAPROXEN 250MG 2 6.00 08/02/10 250756 NIFEDIPINE 90MG 1 7.10 08/02/10 273437 ZOSYN 4.5GM PREMIX BA 16 307.60 08/02/10 273737 PANTOPRAZOLE EC 40 MG 2 6.00 08/02/10 273741 METOPROLOL 25 MG TAB 2 6.00 08/02/10 273776 DALTEPARIN 5000U SYR 2 63.95 08/02/10 275228 VANCOMYCIN 5G VIAL 6) 63.30 08/02/10 621043 I V SODIUM CHLORIDE 0 1 3.00 08/03/10 104433 BASIC METABOLIC PANEL 1 61.00 Continue MS HERSHEY MEDICAL CENTER PAGE: 4 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 08/30/10 at 04:05 PM Guarantor: EWING CHARLES B 137 BLACKSMITH RD CAMP HILL, PA 17011-0000 Patient: EWING CHARLES B Visit #: 14760149 ------------------------------------------------------------------------- Date I Svc Code I Description Unitsl Debits Credits 08/03/10 104591 VANCOMYCIN LEVEL 1 53.00 08/03/10 111001 GLUCOSE BEDSIDE MONIT 2 80.00 08/03/10 245482 DEXTROSE 516 IN WATER 1 3.00 08/03/10 247061 PREDNISONE 10 MG 6 3.00 08/03/10 250562 NAPROXEN 250MG 1 3.00 08/03/10 273437 ZOSYN 4.5GM PREMIX BA 4 76.90 08/03/10 273737 PANTOPRAZOLE EC 40 MG 1 3.00 08/03/10 273741 METOPROLOL 25 MG TAB 1 3.00 08/03/10 275228 VANCOMYCIN 5G VIAL 3 31.65 08/03/10 621044 I V SODIUM CHLORIDE 0 1 2.00 * - Not posted Balance: 17548.75 ------------------------ STATEMENT OF PHYSICIAN SERVICES PENNSTATE CHARLES B EWING 137 BLACKSMITH RD The Milton S. Hershex Medical Center CAMP HILL PA 17011-8417 The College of Medidine IF ANY QUESTIONS PLEASE CONTACT MSHMC ACCOUNT # 847045 ENT FINANCIAL SERVICES 1of4 STATEMENT DATE: 08130110 LAST STATEMENT DATE: 08121110 FED TAX ID # 251857035 >>> PAIILNI : LMAKLM 0 tPUM MIL149 14421095 PERFORMED BY: TAO OUYANG NO DIV OF DIAG RADIOLOGY PLACE OF SVC: OP HOSPITAL 05101410 7045026 348.9 CT HEAD UNENNANCED 352.00 352.00 05/01/10 7055326 793.0 MRI BRAIN WEN ENH 973.00 973.00 PERFORMED BY: JANET A NEUTZE MD DIV OF DIAL RADIOLOGY 05/01/10 7102026 V72.83 CHEST 2 VIEWS FRONTILAT 90.00 90.00 PERFORMED BY: KLAUS F HELM NO DIV OF ANATOMIC PATHOLOGY PLACE OF SVC: INPATIENT D5/01/10 BBUS26 446.29 TISSUE EXAM LEVEL 4 214.00 214.00 PERFORMED BY: LAWRENCE H JONES NO HERSHEY INT NED ASSOC 05/01/10 99223 401.9 INITIAL HOSPITAL CARE 583.00 583.00 PERFORMED BY: MICHAEL D IOFFREDA NO DIVISION OF DERMATOLOG 05/01/10 99253. Z5 702.8 INITIAL INPT CONSULTATION 331.00 331.00 05/01/10 11100 702.8 BIOP SKIN SIM 1 LES 148.00 148.00 PERFORMED BY: LAWRENCE E KASS NO DIV OF EMERG ROOM PLACE OF SVC: EMERGENCY ROOM D5/01110 99285.25 686.9 EMERGENCY VISIT 470.00 470.00 05/01/10 9301D 729.5 ECG ELECTROCARDIOGRAM 88.00 88.00 n n PERFORMED BY: LAWRENCE H JONES NO HERSHEY INT NED ASSOC PLACE OF SVC: INPATIENT 05102110 99233 401.9 DAILY HOSPITAL CARE 300.00 300.00 PERFORMED BY: SHIRLEY A ALBANO NO DIVISION OF RHEUMATOLOGY 05/02110 992-% 446.29 INITIAL INPT CONSULTATION 439.00 439.00 PERFORMED BY: ZACHARY S HUSTON MD HERSHEY INT NED ASSOC 05/03/10 99232 401.9 DAILY HOSPITAL CARE 208.00 208.00 PERFORMED BY: JOSEPH L ENAMA MD DIVISION OF RHHEUMATOLOGY 05/03/10 99233 446.29 DAILY HOSPITAL CARE 300.00 300.00 PERFORMED BY: ZACHARY S HUSTON NO HERSHEY INT NED ASSOC 05/D4/10 99232 401.9 DAILY HOSPITAL CARE 208.00 208.00 PERFORMED BY: SHARON E BANGS DO DIVISION OF RHEUMATOLOOY D5/D4/10 99232 446.29 DAILY HOSPITAL CARE 208.00 208.00 PERFORMED BY: HLIROKO SHIKE MD DIV CLINICAL PATHOLOGY 05/D4/10 8416526 446.29 PROTEIN ELECTOPHOR SERUM 98.01) 98.00 ? CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK /4 -ID . _ ........ ........ -- ............. .... .. ........ . STATEMENT OF PHYSICIAN SERVICES PENNSTATE CHARLES B EWING 137 BLACKSMITH RD Wormw The Milton S. Hershey Medical Center. CAMP HILL PA 17011-8417 The College of Medicine ACCOUNT ## 647045 2 of 4 STATEMENT DATE: 08130110 LAST STATEMENT DATE: 08121110 FED TAX ID # 251857035 05/04/10 8633526 446.29 IMMUNDFIXATION OTHR FLOS 1DD.00 10D.00 PERFORMED BY: ZACHARY S HUSTON MD HERSHEY INT MED ASSOC 05/05/10 99238 401.9 HOSP DISC DAY LESS 3D MIN 191.00 191.00 PERFORMED BY: JOSEPH L ENAMA MD DIVISION OF RHEUMATOLOGY D5/D5/10 99232 446.29 DAILY HOSPITAL CARE 208.00 208.00 14760149 PERFORMED BY: KLAUS F HELM MD DIV OF ANATOMIC PATHOLOGY PLACE OF SVC: INPATIENT 07/30/10 8830526 709.8 TISSUE EXAM LEVEL 4 227.00 227.00 PERFORMED BY: MICHAEL BONGIOVANNI MD DIV CLINICAL PATHOLOG 07/30/10 8539026 446.29 FIBRINOLYSIN SCREENING 104.00 104.00 LUPUS PERFORMED BY, JAMES G MARKS MD DIVISION OF DERMATOLOGY 07/30/10 99253.25 702.8 INITIAL INPT CONSULTATION 351.00 351AD PLACE OF SVC: OP HOSPITAL 07/3D/10 1110D 702.8 BIOP SKIN SIM 1 LES 157.00 157.00 PERFORMED BY: MICHAEL J BECK MD HERSHEY INT MED ASSOC PLACE OF SVC: INPATIENT 07/30/1D 99223 446.29 INITIAL HOSPITAL CARE 618.00 618.00 n PERFORMED BY: NANCY J OLSEN MD DIVISION OF RHEUMATOLOGY 07/30/10 99254 446.29 INITIAL INPT CONSULTATION 465.00 465.00 PERFORMED BY: LAWRENCE E KASS MD DIV OF EMERG ROOM PLACE OF SVC: EMERGENCY R00J4 * 07/30110 992M 447.6 EMERGENCY VISIT 498.00 498.00 PERFORMED BY: DAVID C HAN MD VASCULAR SURGERY PLACE OF SVC: INPATIENT 07/31110 9397026 729.81 DUPLEX SCAN EV - COMPLETE 334.00 334.00 PERFORMED BY: LISA L SHERWOOD MD HERSHEY INT MED ASSOC 07/31/10 99232 446.29 DAILY HOSPITAL CARE 220.00 22D.00 PERFORMED BY: STEPHANIE A BERNARD MD DIV OF DIAS RADIOLOGY 08/01/10 7356426.LT 729.81 RAD EXAM KNEE COMP INTERP 95.00 95.00 D8/0111D 7308026.LT 726.91 ELDON COMPLETE >3 VIEWS 77.00 77.00 DIV01110 7356426.RT 719.06 RAD EXAM KNEE COMP INTERP 95.00 95.00 D8/D1/1D 7308026.11T 729.81 ELBOW COMPLETE >3 VIEWS 77.D0 - - - - - - - - ---------- 77.00 ? CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK ?I I STATEMENT OF PHYSICIAN SERVICES PENNSTATE H BLACKSMITH LEES B RD 3 of 4 mnmm The Milton S. Hershey Medical Center CAMP HILL PA 170114417 STATEMENT 10 The College of Medicine DATE: 08130110 LAST STATEMENT ACCOUNT A 647045 DATE: 08121110 IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES ,.grFE :y(71pp .q1f D AX I D 5 5 .................................. ..:... . __ . WIR?. , . r 7H " lm 11,1..,. v6n,.,r ,'fYx,, .kcc?iA} i? ?r It f "6' i? .`?+vP' r N .t +.:i ° k'gyp! +??! ? ?; ?,al t, ?l ?e?r.;S.;?„,.Ai? a r>?...+F .SA.'i-:iiK•.ID?A 1n.1?;x'.,,r?'k.: PERFORMED BY: LISA L SHERWOOD MO HERSHEY INT MED 1LSSDC 08/01/10 99232 446.29 DAILY HOSPITAL CARE 220.00 22D.00 PERFORMED BY: NANCY J OLSEN MD DIVISION OF RHEUMATOLOGY D8/01/10 99232 446.29 DAILY HOSPITAL CARE 220.00 220.00 PERFORMED BY: PHILIP A MASTERS MD HERSHEY INT MED ASSOC 08/02/10 99232 446.29 DAILY HOSPITAL CARE 220.00 22D.00 PERFORMED BY: NANCY J OLSEN MD DIVISION OF RHEUMATOLOGY 08/02/10 99231 446.29 DAILY HOSPITAL CARE 120.00 120.00 PERFORMED BY: PHILIP A MASTERS MO HERSHEY INT MED ASSOC 08/03110 99238 446.29 HOSP DISC DAY LESS 30 MIN 202.00 202.00 PERFORMED BY: SHARON E BALKS DO DIVISION OF RHEUMATOLOGY 08/03/10 99232 446.29 DAILY HOSPITAL CARE 220.00 220.00 BALANCE: CHARLES B EWING 010129.00 INDICATES NEW FINANCIAL ACTIVITY SINCE LAST BILL. IF YOU HAVE ANY QUESTIONS ABOUT THE AMOUNT YOUR INSURANCE COMPANY PAID, CONTACT THEM DIRECTLY. FOR ANY OTHER QUESTIONS REGARDING YOUR BALANCE, PLEASE CONTACT OUR OFFICE. IF PAYMENT HAS BEEN MADE, THAW YOU AND DISREGARD THIS BILL. RNM3 n THANK YOU FOR USING MSHMC PHYSICIANS GROUP FOR YOUR PHYSICIAN o SERVICES. IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL, PLEASE CONTACT US AT 717-5314069 OR 800-254-2619, BETWEEN 8:00AM AND 5:30PM MONDAY THROUGH WEDNESDAY OR BETWEEN 8:00AM AND 4:3DPM THURSDAY AND FRIDAY. 6.1)-- STATEMENT OF PHYSICIAN SERVICES PIENNSTATE CHARLES B EWING 4 of 4 137 BLACKSMITH RD The Milton S. Hershey Medical Center CAMP HILL PA 17011-8417 STATEMENT The College of Medicine DATE. 08/30/10 FAST STATEMENT ACCOUNT # 647045 DATE. 08121110 _. ,,. FD TAX ID 251857035 IF ANY QUESTIONS, PLEASE CONTACT. MSHMC PATIENT FINANCIAL SERVICES .: .. ... ......In 01,., kcal 4 °? '1. $ y a rF7:i ,TYiuST EN'. rJ }??d??l `lry rt L)W 1 tl( ??I4(44 '4 i4?' V Yt r ?l(. 7 .. .i n. ?4.':.. rite ,,:..?... ...,•?:...,.,,,., .. .. tk.?,t.?y ni ,...?..,r u.:.„. .. . ? .,.,:7?.4,,., ,.. ..;a .. .?7c. i!,^ Tt;'?^',;?...+7.,._ r ,w:r ?,?Y:T _8t. ::d ,.r .9 BALANCE SMARY RESPONSIBLE PARTY POLICY # TOTAL I ;rte GUARANTOR RESPONSIBILITY 10124.00 ? ----_-^???---1M_?21TLg1tTe P?f.?S€ D?`TA&tL14 F_R€Z I7_ gaMQN1.Po2T12N!O STATEMENT DATE: GUARANTOR RESPONSIBILITYi MINIMUM PAYMENT: BF6 08130110 $ 10129.00 $10129.00 MSHMC PHYSICIANS GROUP BILLING SERVICES P O BOX 654 HERSHEY PA 17033-0854 [30000647045 UP 0000000001012900083010 1111 III III I I III I I III I I[11111 IIII I III I I IIit 1 111114111111 1111111 Mai( MSHMC PHYSICIANS GROUP CHARLES B EWING TO: 137 BLACKSMITH RD PO BOX 643313 CAMP HILL PA 17011-8417 PITTSBURGH PA 15264-3313 . DFFlCE USE ONLY CHECK ONE FOR CREDIT CARD PAYMENT, PLEASE FILL IN INFORMATION BELOW _m/C l i l l l l l l l l l 1 I I I I I 647045 Win, NE : [il1EB! -VISA CARD NUMBER IXP DATE $ 10129.00 091201, -DISC CARDHOLDER NAME {PRINT} HC: F6B0,..... CREDIT CARD SIGNATURE MSHMC PHYSICIANS GROUP CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK STATEMENT OF PHYSICIAN SERVICES PENNSTATE CHARLES B EWING 1 or 1 137 BLACKSMITH RD The Milton S. Hershey Medical Center CAMP HILL PA 17011-8417 STATEMENT The College of Medicine DATE: 09102110 LAST STATEMENT ACCOUNT ## 647045 DATE: 08121110 - IF ANY QUESTIONS, PLEASE CONTACT MSHMC PATIENT FINANCIAL SERVICES _. -. FED TAX ID # 251857035 _.. .. . . . . r,' , ;:':??r?„?i,*.?:,,. ,. .. '.. (. ... .,Vd,3, rr ?. ti7:'?-F" ?c,5;1'"`,Pl>r' ?hy,i+cr'A 4 7?'' h,5d •Ur ar(1 ?_.L })A ?',/'4 V }yl 7ygr t >j? ?N?jf jy !r#h?.. fir' > l +? F l ? ?? ? l't N? d? I ' ? k? ? ?? ?S 'l' '?r ??? k ? ? ? ; r xf ,? F*3 ,?y!l Wk NMI r7 ip rI )..rw. tiH ?C., yy?7b ,}??jCryr? l1i? u?a A ? N?E ? ?,? _ y T'?M1•'t "'!"i ? ?. IY f f4 Yi 1 'V (. J li 4 I ? yy ? 55 % . i'('1Ff?l. {, 1, ,P> lAW; ,?' k 'g'??1Ki ? t ? 5??f l!? S f t4 rx Vl d >tn ^!'1rS'FN : r l , r T Tk .4i?4 } T T I.,GI ?}{ r? . r? lJ4 - !:i N':??1 .L 4FM1p. .. Y,r ?.V - .. . ? •? .. .. . ..? .v. ,,. . :. , ....... .. .. t. . ..+ . ? r i t »> PATIENT: CHARLES• B EWING ? ,6447045 ... 14760149 PERFORMED BY: NANCY J OLSEN MD DIVISION OF RHEUMATOLOGY PLACE OF SVC: INPATIENT 07/31/10 99253 446.29 INITIAL INPT CONSULTATION 351.00 351.00 BALANCE: CHARLES B EWING 5351.00 * INDICATES NEW FINANCIAL ACTIVITY SINCE LAST BILL. IF YOU HAVE ANY QUESTIONS ABOUT THE AMOUNT YOUR INSURANCE COMPANY PAID, CONTACT THEM DIRECTLY. FOR ANY OTHER QUESTIONS REGARDING YOUR BALANCE, PLEASE CONTACT OUR OFFICE. IF PAYMENT HAS BEEN MADE, THANK YOU AND DISREGARD THIS BILL. RNM3 THANK YOU FOR USING MSHMC PHYSICIANS GROUP FOR YOUR PHYSICIAN SERVICES. IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL, PLEASE CONTACT US AT 717-531-5069 OR 800-254-2619, BETWEEN 8:0011M AND 5:30PH MONDAY THROUGH WEDNESDAY OR BETWEEN 8:00AM AND 4:30PM THURSDAY AND FRIDAY. w BALANCE SUMMARY RESPONSIBLE PARTY POLICY 9 TOTAL Ln IBC3E GUARANTOR RESPONSIBILITY $ 351.00 r rn IMPORTANT: PLEASE DETACH AND RETURN BOTTOM PORTION OF STATEMENT STATEMENT DATE GUARANTOR RESPONSIBILITY: MINIMUM PAYMENT: 13176 09102/10 $ 351.00 $ 351.00 MSHMC PHYSICIANS GROUP BILLING SERVICES P O BOX 854 HERSHEY PA 17033.0854 ODDDD647045 UP GOODOODOODD3510009021O I??JIJ.I??dd?lt?..L.1??16??I1??1:1611h1??1t»II?Ld?t Mall MSHMC PHYSICIANS GROUP CHARLES B EWING TO. 137 BLACKSMITH RD PO BOX 643313 CAMP HILL PA 17011-8417 PITTSBURGH PA 15264-3313 OFFICE USE ONLY FOR CREDIT CARD PAYMENT, PLEASE FILL IN INFORMATION BELOW """-?'===??'?`=°'•R- u =NIS'7tR ''+MN,`'E{ CHECKONE I I I I I I I I I I I I I I I 1 I 647045 M/C CARD NUMBER XP DATE __ . =;P _A ttir "f=a=: -VISA $ 351.00 09123110 -DISC III0906 HC: FSBO CARDHOLDER NAME (PRINT) E TYP: DMND --mpp CREDIT CARD SIGNATURE MSHMC PHYSICIANS GROUP ? CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS C BACK - /y EWING,*CHARLES B. 4647045 $38,452.20 (Hosp) 10,480.00 (Phys) VERIFICATION LINDA SCHLADER hereby states that she is the Team Manager, Customer Service of the Milton S. Hershey Medical Center and verifies that the statements made in the foregoing pleading are true and correct to the best of her knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. 1 LINDA SCHLADER DATE : 1 c? _ ( 5 -1D SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff y?ttlt'h Ot ?111t!(?i'J?7 Jody S Smith \•?N cw _ ?7) Chief Deputy a, Richard W Stewart -.?. ° r,-) - F,1 fm.? Solicitor , . _ r, -) c r, r ?.r ..D The Milton S. Hershey Medical Center , C N e vs. ase umb r - Charles B. Ewing 2011-1314 SHERIFF'S RETURN OF SERVICE 02/22/2011 Ronny R. Anderson, Sheriff, who being duly sworn according to law, states that he made a diligent search and inquiry for the within named defendant to wit: Charles B. Ewing, but was unable to locate him in his bailiwick. He therefore returns the within Complaint and Notice as not found as to the defendant Charles B. Ewing. Request for service at 137 Blacksmith Road, Camp Hill, Pennsylvania 17011 the defendant was not found. The Camp Hill Postmaster has confirmed, Charles B. Ewing's new address is 823 S. Cameron Street, Harrisburg, Pennsylvania 17104. SHERIFF COST: $46.50 February 22, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF uchaSit a ?-ir7E e sort. In; ii_ED-OFEIGE : - "HE PROTHONOTARY TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE I.D. #60267 1601 Market Street, Suite 2300 Philadelphia, PA 1910- (215)569-5050 Attorney for Plaintiff ICAL : COURT OF COMMON PLEAS THE MILTON S. HERSHEY CENTER VS CHARLES B. EWING TO THE PROTHONOTARY: Please reinstate 823 S. Cameron Street, LEWIS C. Tf?AtFFER, ESQUIRE Attorney for Plaintiff ayvc} s ID.oo IFd 04hl a? g4qq 1 lZ4? 2s6 392. 2011 MAR 10 AM 10. 51 CUMBERLAND COUNTY PENNSYLVANIA : CUMBERLAND COUNTY : NO. 11-1314 Civil Term P R A E C I P E he attached Complaint to be served at Harrisburg, PA 17104, Dauphin County. SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy FILED C3FE 'i HE r'r;v a t :,Fi ^, 20' I ,.'R 12 P'1 2: ? 3 Richard W Stewart Solicitor CUMBERLAND eY PEPcNS)'L%I'A" 1;A The Milton S. Hershey Medical Center Case Number vs. Charles B. Ewing 2011-1314 SHERIFF'S RETURN OF SERVICE 03/11/2011 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Charles B. Ewing, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Dauphin County, Pennsylvania to serve the within Complaint and Notice according to law. 04/04/2011 Dauphin County Return: And now, April 4, 2011 I, Jack Lotwick, Sheriff of Dauphin County, Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Charles B. Ewing the defendant named in the within Complaint and Notice and that I am unable to find him in the County of Dauphin and therefore return same NOT FOUND. Several attempts were made to 823 S. Cameron Street, Harrisburg, Pennsylvania 17104 with no response, this docket has since then expired. SHERIFF COST: $37.00 April 12, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF (c) GountySuite Shenff. ieieosoft. fix tf i a of t h e ? I?vrrfff William T. Tully Solicitor Dauphin County 101 Market Street Harrisburg, Pennsylvania 17101-2079 ph: (717) 780-6590 fax: (717) 255-2889 Jack Duignan Chief Deputy Michael W. Rinehart Assistant Chief Deputy Jack Lotwick Sheriff Commonwealth of Pennsylvania County of Dauphin CHARLES B EWING Sheriff s Return No. 2011-T-1383 OTHER COUNTY NO. 20111314 I, Jack Lotwick, Sheriff of the County of Dauphin, State of Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for CHARLES B EWING the DEFENDANT named in the within COMPLAINT and that I am unable to find him/her in the County of Dauphin, and therefore return same NOT FOUND, APRIL 4, 2011. SEVERAL ATTEMPTS WERE MADE AT 823 S CAMERON ST HARRISBURG, PA 17104 WITH NO RESPONSE, PAPERS EXPIRED Sworn and subscribed to before me this 11 TH day of April, 2011 -)P*2 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Karen M. Hoffman, Notary Public City of Harrisburg, Dauphin County M Commission Expires August 17, 2014 THE MILTON S HERSHEY MEDICAL CENTER VS So Answers, Sheriff of Dauphin County, Pa. By Deputy Sheriff Deputy: G MILLER Sheriffs Costs: $41.25 3/16/2011 wr PROTHONOTAR'i TABASJ& ROSEN, P.C. BY: L WIS C. TRAUFFER, ESQUIRE I.D. 60267 1601 arket Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 Attor ey for Plaintiff THE MIILTON S. HERSHEY MEDICAL CENTER VS B. EWING TO THEIPROTHONOTARY: 2011 APP 25 PM 3: O1PENNSYLVANIA T : COURT OF COMMON PLEAS : CUMBERLAND COUNTY NO. 11-1314 Civil Term P R A E C I P E P ease reinstate the attached Complaint to be served at 823 S.ICameron Street, Harrisburg, PA 17104, Dauphin County. LE IS C. TRA R, ESQUIRE Attorney for Plaintiff ??z \O.w ?d a?1 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor OFFICE OF THE S-ERIFF w 10r $7 '1 I'll THE PRO ? HCKO T RY G, I L I t? `? Ir34 f~. C ti 1 .:'t V CUMBERLA'KC'. CC'1!? y 1)ERt'SYL''A,NIA The Milton S. Hershey Medical Center I vs. Charles B. Ewing Case Number 2011-1314 SHERIFF'S RETURN OF SERVICE 04/26/2011 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Charles B. Ewing, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Dauphin County, Pennsylvania to serve the within Complaint and Notice according to law. 05/20/2011 Dauphin County Return: And now, May 20, 2011 I, Jack Lotwick, Sheriff of Dauphin County, Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Charles B. Ewing the defendant named in the within Complaint and Notice and that I am unable to find him in the County of Dauphin and therefore return same NOT FOUND. Several attempts were made to 823 S. Cameron Street, Harrisburg, Pennsylvania 17104 with no response before the Complaint and Notice expired. SHERIFF COST: $37.00 May 25, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF (c; GoonfySUIte Sheriff. Ieieosoft Inc cptlitift Of the 'Sit"wrfff William T. Tully Solicitor Dauphin County 101 Market Street Harrisburg, Pennsylvania 17101-2079 ph: (717) 780-6590 fax: (717) 255-2889 Jack Lotwick Sheriff Jack Duignan Chief Deputy Michael W. Rinehart Assistant Chief Deputy Commonwealth of Pennsylvania THE MILTON S. HERSHEY MEDICAL CENTER VS County of Dauphin CHARLES B EWING Sheriff s Return No. 2011-T-2072 OTHER COUNTY NO. 111314 I, Jack Lotwick, Sheriff of the County of Dauphin, State of Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for CHARLES B EWING the DEFENDANT named in the within REINSTATED COMPLAINT and that I am unable to find him/her in the County of Dauphin, and therefore return same NOT FOUND, MAY 20, 2011. 7 ATTEMPTS WERE MADE AT 823 S CAMERON STREET, HARRISBURG, PA WITH NO RESPONSE; PAPERS EXPIRED Sworn and subscribed to before me this 23RD day of May, 2011 -)P*2 So Answers, ell Sheriff of Dauphin County, Pa. C? e? COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Karen M. Hoffman, Notary Public City of Harrisburg, Dauphin County M Commission Expires August 17, 2014 Deputy Sheriff Deputy: T STRUBHAR Sheriffs Costs: $41.25 4/28/2011 • , TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER I.D. No. 60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER vs CHARLES B. EWING Lug 1 ??t' 27 Fi I r r ?_ Ak t?! ?r ?l ?t?/ It 3 E' : COURT OF COMMON PLEAS : CUMBERLAND COUNTY : No. 11-1314 Civil Term PLAINTIFF'S MOTION TO SERVE DEFENDANT, CHARLES B. EWING, PURSUANT TO SPECIAL ORDER OF THE COURT IN ACCORDANCE WITH PENNSYLVANIA RULE OF CIVIL PROCEDURE 430 Plaintiff, by its attorney, Lewis C. Trauffer, Esquire, respect- fully requests this Honorable Court to enter an Order permitting and authorizing service of the Civil Action Complaint in the above-captioned case upon defendant, Charles B. Ewing (here- inafter defendant) by regular and certified mail and by posting at his last known mailing address of 823 S. Cameron Street, Harrisburg, PA 17104. In support of this Petition, plaintiff avers as follows: 1. Suit was instituted and service of process requested against the defendant Charles B. Ewing on or about Feb. 4, 2011 at 137 Blacksmith Road, Camp Hill, PA 17011 as is evidenced by the attached Return of Non-Service. (Exhibit "A") 2. Thereafter, the Sheriff reported the inability to accomplish service of process because defendant's new address is 823 S. Cameron Street, Harrisburg, PA 17104 which was confirmed by the post office. (Exhibit "A") 3. Plaintiff thereafter reinstated complaint to be served at the new address of 823 S. Cameron Street, Harrisburg, PA 17104 4. Plaintiff received an affidavit of non-service from the Sheriff of Dauphin County stating that several attempts were made at 823 S. Cameron Street, Harrisburg, PA 17104 with no response, papers expired. (Exhibit "B") 5. Plaintiff reinstated complaint again to be served at 823 S. Cameron Street, Harrisburg, PA 17104. 6. Plaintiff again received an affidavit of non-service stating that 7 attempts were made at 823 S. Cameron Street, Harrisburg, PA with no response; papers expired. (Exhibit "C") 5. Plaintiff has made a good faith effort to serve the defendant. 6. Plaintiff has complied with the legal requirements and provisions set forth in Pennsylvania Rule of Civil Procedure 430, and therefore requests that service be permitted by regular and certified mail and by posting. WHEREFORE, Plaintiff requests this Honorable Court to permit service of process in accordance with the attached Order. L WIS C. T UFFER, ESQUIRE Attorney for Plaintiff TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE I.D. No, 60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER : COURT OF COMMON PLEAS vs : CUMBERLAND COUNTY CHARLES B. EWING : No. 11-1314 Civil Term PLAINTIFF'S MEMORANDUM OF LAW IN SUPPORT OF MOTION TO SERVE DEFENDANT, CHARLES B. EWING, PURSUANT TO SPECIAL ORDER OF THE COURT IN ACCORDANCE WITH PENNSYLVANIA RULE OF CIVIL PROCEDURE 430 Pennsylvania Rule of Civil Procedure 430 provides as follows: "(a) If service cannot be made under the applicable rule, the plaintiff may move the Court for a special order directing the method of service. The Motion shall be accompanied by an Affidavit stating the nature and extent of the investigation, which has been made to determine the whereabouts of the defendant, and the reasons why service cannot be made." The Advisory Committee's Note, concerning the above-cited rule, provides that "a good faith effort" to locate the defendant must be made. An illustration of a good faith effort, as described in the Note, includes inquiries of postal authorities, inquiries of relatives, neighbors, friends, and employers of the defendant, and examination of local telephone directories, voter registration records, and motor vehicle records. Plaintiff has made a comprehensive good faith effort to lo- cate the whereabouts of said defendant(s), as is more fully set forth in the attached Motion and Affidavit. Said defendant has obstructed and/or prevented service of process under the ordinary channels of service. WHEREFORE, plaintiff requests that the attached Order be entered so that service of process may be effectuated on said defendant(s) by posting a copy of the Civil Action Complaint at their last known address and by regular and certified mail. Respectfully submitted, LEWIS C. TRA ER, ESQUIRE Attorney for Plaintiff TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE I.D. No. 60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER : COURT OF COMMON PLEAS vs CHARLES B. EWING : CUMBERLAND COUNTY : No. 11-1314 Civil Term AFFIDAVIT OF INVESTIGATION INTO THE WHEREABOUTS OF DEFENDANT, CHARLES B. EWING, IN ACCORDANCE WITH PENNSYLVANIA RULE OF CIVIL PROCEDURE 430 I, Maureen Smith, being duly sworn according to law, depose and say that I am a secretary employed by the law firm of Tabas and Rosen, P.C., and. I was instructed by Lewis C. Trauffer, Esquire to send out the following letters to confirm the address of Charles B. Ewing (hereinafter defendant), the defendant in the above-captioned matter. I wrote to the United States Post Office to obtain a current address, copy of which is attached as Exhibit "D". A copy of a person search is attached as Exhibit "E" A copy of a white pages search is attached as Exhibit "F". No other address has surfaced as a result of the above inquiries other than the last known address. The aforementioned information is true and correct to the best of my knowledge, information, and belief. Maureen Smith Sworn to and subscribed before me this 23rd day of June , 2011. (2 4 hy-& - Notary Publi COMMNVMALTN OF PENNSYLVANIA NOTARIAL SEAL CHLOETTE D. SAVAGE, Notary Public City of phj his, Phila. County Commission Expires A ust 17.2014 TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE I.D. No. 60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215)569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER : COURT OF COMMON PLEAS vs : CUMBERLAND COUNTY CHARLES B. EWING : No. 11-1314 Civil Term VERIFICATION I, Lewis C. Trauffer, verify that I am the attorney for Milton S. Hershey Medical Center and I did file Civil Action Complaint with the office of the Prothonotary in Cumberland County on Feb. 4, 2011. Thereafter, the Complaint was forwarded to the Sheriff to be served on Charles B. Ewing. I received a Return of Non-Service stating defendant has moved to 823 S. Cameron St., Harrisburg, PA 17104 which was confirmed by the post office. The complaint was reinstated and forwarded to the Sheriff for deputized service to Dauphin County. I received a Return of Non-Service stating several attempts were made with no response. The complaint was again reinstated and forwarded to the Sheriff for deputized service to Dauphin County. I received a Return of Non-Service stating several attempts were made with no response. LEWIS C. T FER, ESQUIRE oG-23-?r Date TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER I.D. NO. 60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff MILTON S. HERSHEY MEDICAL CENTER : COURT OF COMMON PLEAS vs : CUMBERLAND COUNTY CHARLES B. EWING : No. 11-1314 Civil Term AFFIDAVIT OF SERVICE I, Maureen Smith, being duly sworn according to law depose and say that I am secretary to Lewis C. Trauffer, Esquire and I did mail Plaintiff's Petition to Serve Defendant, Charles B. Ewing, pursuant to Special Order of the Court in Accordance with Pennsylvania Rule of Civil Procedure 430 in the above matter to Charles B. Ewing at 823 S. Cameron Street, Harrisburg, PA 17104 by certified mail and regular mail. Date Sworn to and subscribed before me this 23rd day of?l June' 2011. (-),Abr- . X, L rte NOTARY PUBLI COMMONWEALTH OF PENNSYLVANIA Maureen Smith NOTARIAL SEAL CHLOETTE D. SAVAGE, Notary Public City of Philadelphia, Phila. County My Commission E ires August 17, 2014 SHERIFFS OFFICE OF CUMBERLANU COUNTY Ronny R Anderson Sheriff nSp ofuurbrr Jody S Smith Q? Chief Deputy A Richard W Stewart - Solicitor OFFICE OF TKF S4£RIFF The Milton S. Hershey Medical Center Case Number vs. Charles B. Ewing 2011-1314 SHERIFF'S RETURN OF SERVICE 02/22/2011 Ronny R. Anderson, Sheriff, who being duly swom according to law, states that he made a diligent search and inquiry for the within named defendant to wit: Charles B. Ewing, but was unable to locate him in his bailiwick. He therefore returns the within Complaint and Notice as not found as to the defendant Charles B. Ewing. Request for service at 137 Blacksmith Road, Camp Hill, Pennsylvania 17011 the defendant was not found. The Camp Hill Postmaster has confirmed, Charles B. Ewing's new address is 823 S. Cameron Street, Harrisburg, Pennsylvania 17104. SHERIFF COST: $46.50 February 22, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF .64 c) County Suite Shenff, TeleosoR, litc. SHERIFF'S OFFICE OF CUMBERLANU`COUNTY Ronny R Anderson Sheriff Qa?tp of CRMh'P4t441+ Jody S Smith Chief Deputy Richard W Stewart Solicitor OFFICE OF THE SHERIFF The Milton S. Hershey Medical Center Case Number vs. 2011-1314 Charles B. Ewing SHERIFF'S RETURN OF SERVICE 03/11/2011 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Charles B. Ewing, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Dauphin County, Pennsylvania to serve the within Complaint and Notice according to law. 04/04/2011 Dauphin County Return: And now, April 4, 2011 I, Jack Lotwick, Sheriff of Dauphin County, Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Charles B. Ewing the defendant named in the within Complaint and Notice and that I am unable to find him in the County of Dauphin and therefore return same NOT FOUND. Several attempts were made to 823 S. Cameron Street, Harrisburg, Pennsylvania 17104 with no response, this docket has since then expired. SHERIFF COST: $37.00 April 12, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF (c) countySufte ShenR, TeleoSoft, Inc. ice t I 0shermt William T. Tully Solicitor Dauphin County 101 Market Street Harrisburg, Pennsylvania 17101-2079 ph: (717) 780-6590 fax: (717) 255-2889 Jack Duignan Chief Deputy Michael W. Rinehart Assistant Chief Deputy Jack Lotwick Sheriff Commonwealth of Pennsylvania County of Dauphin THE MILTON S HERSHEY MEDICAL CENTER VS CHARLES B EWING Sheriff s Return No. 2011-T-1383 OTHER COUNTY NO. 20111314 I, Jack Lotwick, Sheriff of the County of Dauphin, State of Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for CHARLES B EWING the DEFENDANT named in the within COMPLAINT and that I am unable to find him/her in the County of Dauphin, and therefore return same NOT FOUND, APRIL 4, 2011. SEVERAL ATTEMPTS WERE MADE AT 823 S CAMERON ST HARRISBURG, PA 17104 WITH NO RESPONSE, PAPERS EXPIRED Sworn and subscribed to before me this 11TH day of April, 2011 -)P? Z COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Karen M. Hoffman, Notary Public City of Harrisburg, Dauphin County M Commission Expires August 17. 2014 So Answers, 4'(- Sheriff of Dauphin County, Pa. By Deputy Sheriff Deputy: G MILLER Sheriffs Costs: $41.25 3/16/2011 if SHERIFF`o OFFICE OF CUMBERLANV COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor ?aaaxr ct Gutnbar? OFIRCE OF THE SHERIFF The Milton S. Hershey Medical Center Case Number vs. Charles B. Ewing 2011-1314 S-HE- FPS -RET-URN-Of SERMCE 04/26/2011 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Charles B. Ewing, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Dauphin County, Pennsylvania to serve the within Complaint and Notice according to law. 05/20/2011 Dauphin County Return: And now, May 20, 2011 I, Jack Lotwick, Sheriff of Dauphin County, Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for Charles B. Ewing the defendant named in the within Complaint and Notice and that I am unable to find him in the County of Dauphin and therefore return same NOT FOUND. Several attempts were made to 823 S. Cameron Street, Harrisburg, Pennsylvania 17104 with no response before the Complaint and Notice expired. SHERIFF COST: $37.00 May 25, 2011 SO ANSWERS, RON R ANDERSON, SHERIFF "c- I b (c) County&nte Sheriff. Teleosoft, Inc. of v 'S,?rty William T. Tully Solicitor Dauphin County 101 Market Street Harrisburg, Pennsylvania 17101-2079 ph: (717) 780-6590 fax: (717) 255-2889 Jack Duignan Chief Deputy Michael W. Rinehart Assistant Chief Deputy Jack Lotwick Sheriff Commonwealth of Pennsylvania County of Dauphin THE MILTON S. HERSHEY MEDICAL CENTER VS CHARLES B EWING Sheriff s Return No. 2011-T-2072 OTHER COUNTY NO. 111314 I, Jack Lotwick, Sheriff of the County of Dauphin, State of Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for CHARLES B EWING the DEFENDANT named in the within REINSTATED COMPLAINT and that I am unable to find him/her in the County of Dauphin, and therefore return same NOT FOUND, MAY 20, 2011. 7 ATTEMPTS WERE MADE AT 823 S CAMERON STREET, HARRISBURG, PA WITH NO RESPONSE; PAPERS EXPIRED Sworn and subscribed to before me this 23RD day of May, 2011 -?Ll Z COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Karen M. Hoffman, Notary Public City of Harrisburg, Dauphin County M Commission Expires A 17, 2014 So Answers, Sheriff of Dauphin County, Pa. 'qn ,%4 I'0 ?A?;yf By Deputy Sheriff Deputy: T STRUBHAR Sheriffs Costs: $41.25 4/28/2011 Tabas Rosen,P.c. ATTORNEYS AT LAW ALLAN M. TABAS* (1953-1999) RONALD I. ROSEN*• RICHARD D. WCEN I E HOWARD R. MANILOFF** LEWIS C. TRAUFFER*** T. WESLEY BREWER** CAROL H. JOHNSON, Paralegal JACK ZASOWSKI, Legal Asslotant * MEMBER OF PA BAR * MEMBER OF NJ BAR • MEMBER OF NY BAR • NJ MANAGING ATTORNEY Postmaster Harrisburg, PA 17104 June 14, 2011 Request for Change of Address or Boxholder Information Needed for Service of Legal Process Please furnish the new address or the name and street address (if a boxholder) for the following: 1601 MARKET STREET SUITE 2300 PHILADELPHIA, PA 19103 215 569-5050 FAX: 215 569-0809 34 TANNER STREET HADDONFIELD, NJ 08033 856 429-8123 FAX: 856 429-2038 HARRISBURG AREA 717 232-0606 Reply to Philadelphia Charles B. Ewing (File No. 242099) 823 S. Cameron St., Harrisburg, PA 17104 The following information is provided in accordance with 39 C.F.R. § 265.6(d)(6)(ii). There is no fee for providing boxholder information. The fee for providing change of address information is waived in accordance with 39 C.F.R. § 265(d)1) and (2) and corresponding Administrative Support Manual § 352.44a and b. I . Capacity of requester: Attorney 2. Statute or regulation that empowers me to serve process: Not required. 3. The names of all known parties to the litigation: The Milton S. Hershey Medical Center v Charles B. Ewing 4. The court in which the case has been or will be heard: Court of Common Pleas, Cumberland County 5. The docket or other identifying number if one has been issued: No. 11-1314-Civil Term 6. The capacity in which the individual is to be served: Defendant WARNING The submission of false information either (I) to obtain and use boxholder information for anypurpose other than the service of legal process in connection with actual or prospective litigation or (2) to avoid payment of the fee for change of address information could result in criminal penalties including a fine of up to $10,000 or imprisonment of not more than 5 years or both (Title 18 U.S.C. § 1001). I certify that the above information is true and that the address information is needed and will be used solely for service of legal process in connection with actual or prospective litigation. LEWIS C. TRAUFFE ,, SEItSQQUIRE FOR POST OFFICE USE ONLY I$(, No change of address order on file. ? Not known at address given. ? Moved, left no forwarding address. ? No such address. NEW ADDRESS or BOXHOLDER'S NAME and STREET ADDRESS POSTMARK JUN 18 `I D 1 C7ARLES B EV71NG » ZzbaSearcb. People Search Engine Wage of 16 0 AF Reverse Phone Search Search b SS# Ba(,k ound_ ChE MW ZABAA t11Wr&wJM R? CHARLES B EWING All States Zak Public Informationi `Results Summary: 2 C EWING / 12 EWING / 21 CHARLES B EWING / 30 C B SWING / 8: CHARLES B EWING - Detailed Background Report Premium ListinG Comprehensive Report. Criminal Records. Latest Contact Information. Find CHARLES B EWING Premium Listing Get Current Phone and Address. Premium Services: Search _by Phone Number Reverse Phone Search Run a Background Check C EWING - 2 Free Listings Check _messages for: EWING -CHARLES - CHARLES B EWING Leave a message for C_HARLES_ B_EWING_ E-mail This Page Know When You're Being Searched on the Internet Create a Public Record CHARLES EWING.... More Info on.._CHARLESB.__EWING Check for Email Address Google More-Info on CHARLES_B EWING Check for Email Address Gooqle EWING -12 Free Listings Check messages for: - - CHARLES B EWING Leave a message for CHARLES B EWING E-mail This Page Know When You're Being Searched on the Internet Create a Public Record Check for Email Address Google Confirm Current Phone & Address CHAR_LES.._E. WING. More Info on CHARLES BEWING. Check for Email Address Google 823 CAMERON Neighborhood & Property Resort Record Created: Unknown HARRISBURG, PA 17104 (717) 635-9659 Confirm Current Phone & Address Background Check on C-HARLE-S-EWING Check for Email Address Gooqle More ...Info ..on CHARLES _B EWING Check for Email Address Gooqle rpn ZoaftoRthhone & Address j/ http://www.zabasearch.com/query1_zaba.php?sname=CHARLES%20B%20EWING&state=PA&ref=... 6/20/11 823 CAMERON Neighborhood & Property Report Record Created: Unknown HARRISBURG, PA 17104 (717)635-9659 Confirm Current Phone & Address Background Check on CHARLES.EWING C?Hes Ew r - r_ Ham.sb•, -Cr, PA. I WhitePa.ges WhitePages Advertisement: View Charles Ewinci's Profile b Senior Business Aoaplication A..._ Universal Health Services, Inc:. ( ... UHS of Delawar... I KING OF PRUSSIA, PA D Faculty University of Phoenix Phoenix, AZ... University of ... I MultiLocation A CUSTOMER SERVICE. ADMINISTRATOR. This position will be responsible... Crown Cork and... I PHILADELPHIA, PA P PHYSICAL THERAPIST St. Marys Home Care is currently ... Mercy Health S... I Langhorne, PA View More Opportunities! Interest Based Ad Cf'%W0t'f tCwlefS WEIGHT WATCHERS WINS AT LOSING. IMLIST Rated # I hest plan l for weight loss bY U_S. News and'Worfd Report Aavertlsement:Cllck.. Now_to Get_Your 3 FREE Credit Scores from Equifax+. 40 Results for Charles Ewing in Harrisburg, PA See_i_n _..a.p Or search: . Last name only 1. You? Claim & edit 2. Charles ..... Ew.i.n.g. 3. S Cameron St Harrisburg, PA Prior: Camp Hill, PA Click to see more 4. Associated people: unknown ,F http://www.whitepages.com/dir/harrisburg-pa-17104/ewing/charles Page 1 )r4 6/20/11 MILTON S. HERSHEY MEDICAL IN THE COURT OF COMMON PLEAS OF CENTER, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff V. CHARLES B. EWING, : Defendant 11-1314 CIVIL ORDER OF COURT AND NOW, this 30th day of June, 2011, upon consideration of the Plaintiff's Motion for Alternate Service under Pa.R.C.P. 430(a) and it appearing to the Court that Plaintiff's good faith efforts to ascertain the present whereabouts of Defendant, Charles B. Ewing has been unsuccessful, Plaintiff's Motion is GRANTED. IT IS ORDERED AND DIRECTED: 1. That the Plaintiff is directed to serve the Complaint upon Defendant by posting a copy of the Complaint upon the premises at 823 S. Cameron Street, Harrisburg, PA 17104. 2. That the Plaintiff serve the Complaint by certified and regular mail to the Defendant's last known address at 823 S. Cameron Street, Harrisburg, PA 17104 3. That the Plaintiff effect service by publication to include the notice prescribed in Pa.R.C.P. 430, in a legal journal and newspaper of general circulation in Cumberland County, Pennsylvania; Lewis C. Trauffer, Esquire Attorney for Plaintiff (C)Oy MaJed 00111 By the Court, M. L. E ert, Jr., C? Z Or " 7 Z r" V,y or" ? C:3 A ?"x O c? p = r C2 bas i o? o C-- Pa rn NJ 0,6 t :t T?3DNOTA , TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER I.D. No. 60267 1601 Market Street, Suite 2300 Philadelphia, PA 19103 (215) 569-5050 Attorney for Plaintiff Z0, I I OCT -6 PH Z: 4D rUMBERLAND COUNT` PENNSYLVANIA MILTON S. HERSHEY MEDICAL CENTER Plaintiff VS CHARLES B. EWING Defendant : COURT OF COMMON PLEAS : CUMBERLAND COUNTY : NO. 11-1314 CIVIL P R A E C I P E TO THE PROTHONOTARY: Please discontinue the above matter as to CHARLES B. EWING without prejudice. LEWIS C. T UFFER, ESQUIRE Attorney for Plaintiff