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HomeMy WebLinkAbout12-1207WELTMAN, WEINBERG & REIS CO.. L.P.A. Attorney for Plaintiff(s) BY: Sarah E. Ehasz, Esquire I.D. No.86469 436 Seventh Avenue, Suite 1400 Pittsburgh, PA 15219 Phone: 412.434.7955 Fax: 412.434.7959 File # 9321813 ?7 `" `11. 69 CUMBERLAND COUKY P' PNNS YLVANIA IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GGNSC CAMP HILL WEST SHORE LP Plaintiff vs. Civil Action No. O` bid` -1 ,9? &l JOANN SHATTO Defendant(s) COMPLAINT AND NOTICE TO DEFEND YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by an 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. 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 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 GM?? ?b3.75p01 C' 04- cW 2A-M-u Ao- 7i53< COMPLAINT 1. Plaintiff is a corporation with offices at PO Box 180970, Fort Smith, AR 72918. 2. Defendant is an adult individual residing at 166 Lee Ann Ct, Enola, PA 17025. 3. At the specific instance and request of Defendant, Plaintiff provided certain medical services to Defendant. A true and correct copy of the pertinent part of the Admissions Agreement is attached hereto and marked as Exhibit "I". 4. Defendant received and accepted the aforementioned medical services which were provided by Plaintiff. 5. The prices charged by Plaintiff were the prices that Defendant agreed to pay. 6. Plaintiff avers that there is a balance due and owing from Defendant in the amount of $10,341.10 as of July 20, 2011. A true and correct copy of Plaintiff s Statement of account is attached hereto, marked as Exhibit "2", and made a part hereof. 7. Plaintiff claims interest at the rate of 6.00% per annum from July 20, 2011. 8. Plaintiff avers that interest calculated at the aforesaid rate from July 20, 2011 to January 27, 2012 amounts to $742.86. 9. Although repeatedly requested to do so by Plaintiff, Defendant has willfully failed and/or refused to pay the aforementioned balance, or any part thereof to Plaintiff. WHEREFORE, Plaintiff demands Judgment in its favor and against Defendant, Joann Shatto, in the amount of $11,083.96 (principal plus interest) with interest at the rate of 6.00% per annum from January 27, 2012 and costs. THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED SHALL BE USED FOR THAT PURPOSE. WELTMAN, WEINBERG & REI%, CO., L.P.A. Sarah E. Ehasz, Esquire I.D. No.86469 436 Seventh Avenue, Suite 1400 Pittsburgh, PA 15219 Phone: 412.434.7955 Fax: 412.434.7959 File # 9321813 4128711045 GOLDEN LIVING 1. Preamble 05:08:50 p.m. 02-02-2012 2 16 This Admission Agreement is a legally binding contract that defines the rights and obligations of each person (or party) who signs it. Please read this Agreement carefully before you sign it. If you have any questions, please discuss them with LivingCenter staff before you sign the Agreement. You are encouraged to have this Agreement reviewed by your attorney, or by any other advisor of your choice, before you sign it. If you are able to do so, you must sign this Agreement in order to be admitted to this LivingCenter. If you are not able to sign this Agreement, your Legal Representative, who has been given authority by you to admit you to the LivingCenter, must sign it on your behalf. This Agreement will become effective on the day you are admitted to the LivingCenter regardless of the date you and/or your Legal Representative signs it. You are not required to sign any other document as a condition of admission to the LivingCenter. 11. Parties to This Agreement DEFINMONS To make this Agreement easier to understand, references to "we," "our," "us," "the LivingCenter" or "our LivingCenter" mean: (Type or print the name of the LivingCenter as it appears on its license) References to "you," "your," "Patient" or "Resident" mean the person who will be receiving care in this LivingCenter. This person is: (Type or print the Resident/Patient's name here) The Necessary Parties to this Agreement are the Resident, the LivingCenter and, if applicable, the Resident's Legal Representative, including anyonc%who bas legal access to the Resident's income and/or resources to pay for the Resident's care. NOTE: Any person who has legal access to your funds or your other assets is your Legal Representative, and your Legal Representative must sign this Agreement as a Necessary Party to this Agreement. By signing this Agreement, your Legal Representative agrees to use your income and/or other resources to pay for your care. Your Legal Representative also agrees (a) to provide complete and accurate disclosure of all relevant information to the LivingCenter, (b) to cooperate fully in applying for all applicable private or governmental benefits to pay for your care, and (c) to fulfill all other fiduciary duties owed to you. By signing this Agreement, the Legal Representative confirms that he or she has legal access to your income or resources to pay for your care. Your Legal Representative also agrees to inform the LivingCenter's Executive Director immediately if he or she no longer has legal access to your income and/or resources. Any Legal Representative who signs this Agreement on your behalf assumes no PERSONAL financial liability for your care provided by the LivingCenter. Our LivingCenter does not require you to have anyone sponsor you or guarantee payment for your care by signing or co-signing this Agreement as a condition of admission, expedited admission or continued stay in the LivingCenter. However, as a Necessary Party to this Agreement, your Legal Representative agrees to be contractually bound by the terms of this Agreement and may be personally liable for failure to perform duties required by it. EXRB1T Golden LivinaCcatpS: Admirnin+ •?....e...?-•'--- '^^^^^' r 4128711045 GOLDEN LIVING 111. Consent to Treatment 05:09:08 P.M. 02-02-2012 3 /6 You consent to receive routine nursing care and other care and services provided directly, or under arrangement, by this LivingCenter. You also consent to receive other healthcare services directed by your attending physician as well as necessary emergency care. If you are, or become, incapable of making your own medical decisions, we will follow the direction of a person with legal authority under state law to make medical treatment decisions on your behalf, such as a guardian, conservator, a person you designate in an advance healthcare directive or power of attorney for healthcare, or next of kin. IV. Financial Arrangements Beginning on (date), we will provide routine nursing and emergency care and other services to you in exchange for payment. Your attending physician or other practitioners who provide services to you during your stay in our LivingCenter are independent contractors and not the LivingCenter's agents or employees. They may bill and collect for their services separate and apart from the LivingCenter's billing and collections. Our LivingCenter participates in the following government insurance programs: Medicare Medicaid Veterans Affairs Other We cannot guarantee that your care will be covered by Medicare, Medicaid, third-party insurance or other reimbursement source. By signing this Agreement, you agree to pay your account with the LivingCenter for the items and services provided to you. ' At the time of admission, you and your Legal Representative promise to provide us with all information necessary to submit claims and obtain payment for your care. We may disclose portions of your medical records to insurance companies, healthcare service plans, Medicare, Medicaid, TRICARE or other entities that may be liable for all or any portion of the LivingCentet's charges for your care in order to determine liability for payment or to obtain reimbursement. If, for any period of time during which you receive care and services from us, your primary or secondary source , of payment changes, you and your Legal Representative promise to give us the updated information necessary to submit claims and obtain payment, including but not limited to all information required by the State Medicaid Agency to apply for Medicaid benefits. Your Share afthe Colt of Your Care Medicaid, Medicare or a private insurance plan may require that you pay a co-payment, coinsurance, deductible or other amount, all of which the LivingCenter considers to be your share of the cost of the care and services provided to you. Nonpayment, including failure to pay your share of the cost of your care, is grounds for involuntary discharge from our LivingCenter. If you do not know whether your care in our LivingCenter can be covered by Medicaid or Medicare, we will help you get the information you need. A. Charges for Self-Pay Residents The basic monthly rate for self-pay and privately insured residents is $ and includes payment for the services and supplies described in the Notices given to you upon admission. We will give you written notice in compliance with applicable state law before increasing the basic monthly rate. The prorated basic monthly rate will be charged for the day of admission, and we may charge for the day of discharge if you depart the LivingCenter after 11 a.m. A r:nlr4n 1 ivinarenre - Artmicainn Avteement free ID/29/09) 4128711045 GOLDEN LIVING 05:09:28 p.m. 02-02-2012 416 Charges for optional supplies and services that are not included in our basic monthly rate are also listed in the Notices given to you upon admission. We will only charge you for optional supplies and services that you specifically request, unless the supply or service is required in an emergency. We will give you written notice in compliance with applicable state law before implementing any increase in charges for optional supplies and services. If you become eligible for Medicaid at any time after your admission, the services and supplies included in the basic rate and the optional supplies and services may change. At the time Medicaid confirms it will pay for your stay in this LivingCenter, we will review and explain any changes in coverage to you. B. Charges for Medicaid, Medicare and Insured Residents If you are approved for Medicaid benefits after you are admitted to our LivingCenter as a self-pay or privately insured resident, you may be entitled to a refund. We will refund any payments made for services and supplies that are later paid for by Medicaid (less any co-payment, coinsurance, deductible or other amount that is your share of the cost of your care) when our LivingCenter receives payment from the Medicaid program. If you are entitled to benefits under Medicare, Medicaid or private insurance, and if we are a participating provider in that program or with that insurer, we agree to accept payment from them for your routine care. However, you are still responsible for paying all applicable deductibles, copayments and coinsurance amounts, as well as any charges not covered by Medicare, Medicaid or your insurance plan. The Notices given to you upon admission describe the services covered by the Medicaid daily rate, services that are covered by Medicaid but are not included in the daily rate, and services that are not covered by Medicaid but are available if you request them and wish to pay for them. The Notices given to you upon admission also describe the services covered by Medicare, and services that are not covered by Medicare but are available if you request them and wish to pay for them. Medicaid and Medicare will pay for covered supplies and services only if they are considered medically necessary by the Medicare or Medicaid program. If Medicare or Medicaid determines that a supply or service is not medically necessary, or if we believe it is not covered by the rules of the program, we will ask whether you still want that supply or service and if you are willing to pay for it yourself. We will only charge you for optional supplies and services that you specifically request, unless that supply or service is required in an emergency. A detailed list of the charges for all supplies and services is maintained in the Business Office and is available upon request during normal business hours. C. Bitting and Payment We will give you an itemized statement of charges that you must pay every month. You agree to pay the account monthly on the fifteenth (I 5th) day of each month in which the statement is received. We accept payments in cash, by check or by credit card. You also acknowledge that the charges for services provided under this Agreement remain due and payable until fully satisfied. If you are discharged for any reason, including death, this Agreement shall operate as an assignment, transfer and conveyance to the LivingCenter of the amount of your assets of sufficient value to satisfy all unpaid obligations under this Agreement. This assignment shall be an obligation of your estate and may be enforced against it to pay the LivingCenter an amount equivalent to your unpaid obligations under this Agreement. Golden Liv;ngccatas: Admission ASrecmes,t (mv 10/29109) 41 287 1 1045 GOLDEN LIVING 05:09:49 p.m. 02-02-2012 5 /6 D. Payment of Refunds Due to You At the time of your discharge, you may be due a refund, such as unused advance payments you may have made for optional services not covered by the basic rate. Upon actual notice of final settlement of all third-party claims, we will refund promptly any money due to you, after deducting any amounts owed by you to us. V. Transfers and Discharges You may leave our LivingCenter at any time without prior notice to us. We will cooperate as necessary with your discharge or transfer to another facility. ; Except in an emergency, we will give reasonable notice to you before transferring you to another room within our LivingCenter. We will not discharge you from our LivingCenter against your wishes without prior written notice, as required by law. Our written notice of transfer or discharge against your wishes will be provided 30 days in advance. However, we may provide less than 30 days notice: (a) if the reason for the transfer or discharge is to protect your health and safety or the health and safety of other, individuals, or (b) if your improved health allows for a shorter notice, or (c) if you have been in our LivingCenter for less than 30 days. Our written notice will include the effective date of discharge, the location to which you will be transferred or discharged, and the reason the discharge is necessary. VI. "Bed Holds" and Readmissions If you will be temporarily absent from the LivingCenter for hospitalization or therapeutic leave, you may { request the LivingCenter to hold your bed during this time (called a "bed hold"). The Medicare program and most private insurance companies do not cover costs related to holding your bed in these situations. We will notify you and/or your Legal Representative of the option to pay the applicable daily rate for each day we hold your bed open. You and your representative have 24 hours after receiving this notice to let us know whether you want us to hold your bed for you. If Medicaid is paying for your care, the state Medicaid program may pay us to hold the bed for you for a limited time. If you are away from our LivingCgtter due to hospitalization for a longer period of time, we will readmit you to the first available bed in a semi-private room if you wish to be readmitted and if the LivingCenter is able to provide the level of care you need and is otherwise able to meet your needs. VII. Personal Property and Funds We strongly discourage keeping valuable jewelry, papers, cash or other items of value with you in the LivingCenter. You agree to inform us of all valuable property you bring with you upon admission and at any time new items of value are added to (or removed from) your possession. We will make reasonable efforts to safeguard your belongings that you keep in your possession. If our LivingCenter participates in Medicaid or Medicare and you give us your written authorization, we will agree to hold personal funds for you in a manner consistent with al I federal and state laws and regulations. You are not required to allow us to hold your personal funds for you as a condition of admission or continued stay in e our LivingCenter. Upon request, we will give you our policies, procedures and authorization forms related to our ; holding your personal fiords for you. V111. Photographs You agree that we may take photographs of you for identification, security and other purposes related to your care. We will not photograph you for any other purpose, unless you give us your prior written permission to do so. 6 Golden LivingCeW"s: Admission A`reemeot (rev 10/29/09) 4 1 2871 1045 GOLDEN LIVING IX. Confidentiality of Your Medical Information 05:10:11 P.M. 02-02-2012 6!6 I i You have a right to confidential treatment of your medical information. Your confidentiality rights are described in our Notice of Privacy Practices, which is given to you upon admission. You may authorize us to disclose medical information about you to a family member or other person by completing an Authorization for Disclosure of Medical Information form that will be provided to you upon request. X. LivingCenter Rules and Grievance Procedure You agree to comply with our LivingCenter rules, policies and procedures. When you are admitted to the LivingCenter, we will give you a copy of our rules, policies and procedures. The LivingCenter grievance procedure for resolution of resident complaints is included in Notices given to you upon admission and also is available upon request. XI. Entire Agreement This Agreement and the Notices given to you upon admission constitute the entire Agreement between you and us for the purposes of your admission to our LivingCenter. There are no other agreements, understandings, restrictions, warranties or representations between you and us as a condition of your admission to our LivingCenter. This Agreement supersedes any prior admission contracts regarding your admission to our LivingCenter. However, if you execute, or have executed, an Alternative Dispute Resolution Agreement with us in connection with any admission to our LivingCenters, then that Agreement shall be, and remain, binding upon you, and upon us, in accordance with the terms that are set forth in that Agreement. If any provision of this Agreement becomes invalid, the remaining provisions shall remain in full force and effect. The LivingCenter's acceptance of a partial payment on any occasion does not constitute a continuing waiver of the payment requirements of this Agreement, or otherwise limit the LivingCenter's rights under this Agreement. This Agreement shall be construed according to the laws of the State of Other than as noted for a duly authorized Resoent's Legal Representative, the Resident may not assign or otherwise transfer his or her interests in this Agreement. Golden LivingCenten: Admission Agreemetn (mv 10/29109) 4128711045 GOLDEN LIVING 08:29:09 a.m. 07-12-2011 415 Resident's Name: ' Admission Date: Record Number: By signing below, you, your Legal Representative and this LivingCenter agree to the terms of this Admission Agreement: Repres?Rtta vc i the t.ivingt'enter ( Date By my signature, I acknowledge that I hu a read this Admission Agreement or had it read to me, that I understand what I am signing, and that I accept its terms. Signature of lloident Date By my signature, I represent that 1 am a person duly authorized by Resident or by law to execute this Admission Agreement and that I accept its terms. of Resident's Legal Representative (if applicable) Date Address Phone NOTE: Copies of all documents verifying the status of the Legal Representative must be obtained at the time of admission. Examples of the required documents include but are not limited to the following: Power of Attorney, Durable Power of Attorney, Healthcare Proxy, Guardianship Appointment, Conservator Appointment and others conveying legal authority. A LEGAL REPRESENTATIVE, INCLUDING ANY PERSON OTHER THAN THE RESIDENT OR FINANCIALLY RESPONSIBLE SPOUSE, MAY NOT BE REQUIRED BY THE FACILITY TO ASSUME PERSONAL FINANCIAL LIABILITY FOR THE RESIDENTS CARE. By signing this Agreement and providing current credit card information, you authorize us to charge all charges under this Agreement to your credit card. If you plan to pay using a credit card, please provide the card information below. Discove' Account # Exp. MastcrCard's Account # Exp. Visa" Account # Exp. K (nildcn Lmngt'entcrs Adml-ton agreement Ircv nl 10j 41 2871 1 04 5 GOLDEN LIVING 08:29:21 a.m. 07-12-2011 515 THIS AGREEMENT GOVERNS IMPORTANT LEGAL RIGHTS. PLEASE READ IT CAREFULLY AND IN ITS ENTIRETY BEFORE SIGNING. ?- iyj Pnnt Name of Resident Print Name and NumFx,,r of Living Signature of Resident Date By my signature, t acknowledge that 1 have read this Agreement or had it read to me, that I understand what I am signing, and that I accept its terms. Signature on behalf of LivingCenter: 1, ?? ; (name of J LivingCenter witness), sign this Agreemen eha f of LivingCenter. B signature, I attest that (I) before Resident and/or Resident's representative signed this document I offe ed the signer(s) the opportunity to read it in full, or to have it read to him/her in full; (2) 1 saw _ t e signature of the resident, or of the person signing on behalf of the Resident, written on this document. S nature of Resident's Legal Represcrttativc Print Name of Legal Representative By my signature, 1 represent that I am a person duly authorized by Resident or by law to execute this Agreement and that I accept its terms. Specify Capacity of Legal Rcpr#..wnwtive (e.g., Power of Attorney, Agent, Next of Kin) Address Other acknowledgments: Printed Name and Signature of Other Representative or Next of Kin Date Printed Name and Signature of Other Representative or Next of Kin Date ^~ Printed Name and Signature of Other Representative or Next of Kin Date Gulden LrvfngCow,:m .Alternative Dkputc Resolution Ayrecment (rev.OLIO) 13 ."a WIT GGNSC CAMP HILL WEST SHORE LP EM4 ?:. 770 POPLAR CHURCH RD CAMP HILL PA 17011 living Itemized Resident Statement Resident Name: Mailing Address: Joann Shatto RESIDENT ACCOUNT 1, 102974-00285-43147 Joann Shatto 828 Llmckiln Rd New Cumberland PA 17070 DATE PREPARED, 07120111 DATE / PERIOD COVERS DESCRIPTION DAYS / QTY CHARGES CREDITS Jul 12-26 2010 Barber & Beautician Fee 2 $48.50 Au 21-31 2010 Room Charges 11 $2,345.48 Au 2-30 2010 Barber & Beautician Fee 4 $89.50 Au 14-28 2010 Accillaries $22.46 Au 21-23 2010 Physical Thera Charges 4 $28.71 Au 23 2010 Ocu ational Thearpy Cha es 2 $25.45 Sept 1-2 2010 Room Charges 2 $440.67 Sept 3-21 2010 Medicaid Private Portion 19 $2,386.99 Sept 7-27 2010 Barber & Beautician Fee 3 $70.50 Oct 15-31 2010 Medicaid Private Portion 17 $2,386.99 Oct 4-25 2010 Barber & Beautician Fee 4 $58.00 Oct 4 2010 Facial Tissue 1 $1.36 Nov 1-15 2010 Medicaid Private Portion 15 $2,386.99 Nov 1-15 2010 Barber & Beautician 3 49.50 Dischar a Date 11/16110 CHARGES CREDITS AMOUNT DUE $10,341.10 $0.00 $10,341.10 Page 1 of 1 VERIFICATION The undersigned does hereby verify subject to the penalties of 18 PA. C.S. 4904 relating r to unsworn falsifications to authorities, that he/she is G" I ?iC?? ???? r (NAME) N n l of 41k]'Pt\ / 1 V 0 plaintiff ,/:d .?. , (TITLE) (COMPANY) herein, that he/she is duly authorized to make this verification, and that the facts set forth in the foregoing Complaint in Civil Action are true and correct to the best of his/her knowledge, information and belief. (SIGNATURE) WWR# 9321813 SHERIFF'S OFFICE OF CUMBERLAND COUNTY .._,,-.y 7? ra;anrflS?Rffs'( Ronny R Anderson Sheriff ,,,,tuaur,r??rt Jody S Smith fl? KAR -b AM 8' 2 Chief Deputy k"' W ISEP A14D COUNil '-r' Richard W Stewart PENN YLVANIA Solicitor GGNSC Camp Hill West Shore, LP Case Number vs. 2012-1207 Joann Shatto SHERIFF'S RETURN OF SERVICE 02/29/2012 12:22 PM - Shawn Gutshall, Deputy Sheriff, who being duly sworn according to law, states that on February 29, 2012 at 1222 hours, he served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Joann Shatto, by making known unto herself personally, at 166 Lee Ann Court, Enola, Cumberland County, Pennsylvania 17025 its contents and at the same time handing to her personally the said true and correct copy of the same. ) 1 __ J r'. H GUTSHALL, DEPUTY SHERIFF COST: $43.00 March 02, 2012 SO ANSWERS, RON R ANDERSON, SHERIFF Li PENNSYL N1 Dennis J. Shatto Attorney Id. 25675 Cleckner and Fearen 119 Locust Street Harrisburg, PA 17101 717-238-1731 Attorneys for Defendant GGNSC Camp Hill West Shore LP, Plaintiff V. JOANN SHATTO, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA CIVIL ACTION - LAW No. 2012-1207 Civil ANSWER TO COMPLAINT 1. Denied. Plaintiff is believed to be a limited partnership. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth of the averment that Plaintiff has an office in Fort Smith, AR, and proof is demanded. 2. Admitted. 3. Denied as stated. Defendant was recommended to have certain medical services, and was advised that those services could be provided at a facility known as Golden Living on Poplar Church Road in Camp Hill, PA. She agreed to be admitted there for that purpose. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth of the second sentence, and proof is demanded. 4. It is admitted that Defendant received and accepted the medical services which were offered to her. S. Denied. Defendant does not believe she was given any information about Plaintiff's prices. Defendant expected that any charges for services would be paid by her automobile insurance or by medicare. 6. Denied. A portion of the alleged balance is for services rendered after Plaintiff received notification from Medicare that Defendant would no longer be covered, and Defendant was not notified of the termination of coverage in a timely manner. Defendant believes that all services should have been paid by Medicare or Medicaid. 7. It is admitted that Plaintiff claims interest. It is denied that Plaintiff is entitled to interest. 8. The calculation is admitted, but Defendant denies that she is obligated to pay interest. 9. Admitted, for the reasons set forth in no. 6 above. WHEREFORE, Defendant demands judgment in her favor and against Plaintiff. CLECKNER AND FEAREN Dennis J. Shatto V E R I F I C A T I O N I, JOANN SHATTO, hereby verify and state that to the extent the foregoing ANSWER contains facts supplied by me, such facts are true and correct to the best of my knowledge, information and belief; however, to the extent that the foregoing document and/or its language is that of counsel, I have relied upon counsel in making this Verification. I understand that false statements made herein are subject to the penalties of 18 Pa.C.S.A. §4904, relating to unsworn falsification to authorities. Date /,f -y-1z J N SHAT CERTIFICATE OF SERVICE I, DENNIS J. SHATTO, hereby certify that on this day, I served a true and correct copy of the foregoing document upon the person(s) indicated below, by depositing same in the United States mail, first class postage prepaid, addressed as follows: Sarah E. Ehasz, Esquire Weltman, Weinberg & Reis 436 7t' Ave. , Suite 1400 Pittsburgh, PA 15219 CLECKNER AND FEAREN 01 Dennis J. Shatto, Esquire PA Attorney ID 25675 L 119 Locust Street Date: P. 0. Box 11847 Harrisburg, PA 17108-1847 ('717)238-1731 PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in triplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: (List the within matter for the next Argument Court.) ~ o CAPTION OF CASE (entire caption must be stated in full) GC~NSCCaknp~I1 W~s-1 Shv r~ ~ ~ vs. Toav~ r~ ~ha-~o C ~~ N -~Z Q ~~ ~ ~a ~, G x ~,, No. o~O I p~ - ~ dy~ , vi Te m 1. State matter to be argued (i.e., plaintiffs motion for new trial, defendant's demurrer to complaint, etc.):~Ia1 i'1~ S ~p-~-IOi(1 ~j;( sUlVY1Yi'1LiYU ~U~J~~j 'Qt~YCf 2. Identify all counsel who will argue cases: (a) for plaintiffs: ~~ar aL,h ~hQS2 , ~S4 . ~ 11~'Q I~~ ~ V1~1?~InlnPr~ ~ R2 ~S Ca . (Name and Address) ~I`~(~ ~'~" i°~v~u~ ~e '~D ~ 1521 (b) for defendants: ~~v,~~~ s ~. Shams, ~sq ~ , Cler ~ncr ~ ~e are. (Name and Address) (I Q Lo cu s k ~~e ~-~, 4-~tr ri ~our~ , `~1~-- I~-I a 1 3. I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: ~-. a~ ~ ~, Sara} ~ . ~hasz Print your name ~ l a.~~-f~-~ I Attorney for Date: INSTRUCTIONS: 1. Original and two copies of all briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) before argument. 2. The moving party shall file and serve their brief 14 days prior to argument. 3. The responding party shall file their brief 7 days prior to argument. QNA~ 4. ff argument is continued new briefs must be filed with the COURT ADMINISTRATOR (not the Prothonotary) after the case is relisted. , vvvv a~ G~2 I +c~`f- ~r _~ ~-r rat r~ "~ ~ ~~ ~-~, ~~ °~~ -q. ~Y~' a ~'1 O(114'~S, ~ a~9s~ CERTIFICATE OF SERVICE The undersigned hereby certifies that a true and correct copy of PRAECIPE FOR ARGUMENT was on the following on this 1rJ day of o ~ a by first class, U.S. Mail, postage pre-paid: Dennis J. Shatto, Esq. Clerkner & Fearen 119 Locust St. Harrisburg, Pa 17101 WELTMAN, WEINBERG & REIS CO., L.P.A. By: Sarah E. Ehasz, Esquire PA ID# 86469 Weltman,Weinberg & Reis 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 WWR No. 9321813 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION c-~ C~ ~t ~ ~- -t t°~ ~ cmi rn t" ~ GGNSC CAMP HILL WEST SHORE LP, A ~ s'''- ~ ~r ti ~ ts3 '. ~ Ir ~ C3 G7 ~ --~ C1 Plaintiff, Case No.: 2012-1207 Civil -~ ~ ~'~"1 °~ „m c~ ~-- ~ ~ 0 ~ r~+ ~~ ~ -~: `~ ~ vs. MOTION FOR SUMMARY JUDGMENT JOANN SHATTO, Defendant. FILED ON BEHALF OF: Plaintiff COUNSEL OF RECORD OF THIS PARTY: Sarah E. Ehasz, Esquire PA ID# 86469 Weltman,Weinberg & Reis CO L.P.A. 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 WWR# 9321813 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GGNSC CAMP HILL WEST SHORE LP, Plaintiff, Case No.: 2012-1207 Civil vs. MOTION FOR SUMMARY JUDGMENT JOANN SHATTO, Defendant. MOTION FOR SUMMARY JUDGMENT AND NOW COMES, Plaintiff, by and through its counsel, Weltman, Weinberg & Reis, C ., L.P.A., and hereby files this Motion for Summary Judgment against the Defendant. In support there f, Plaintiff avers as follows: 1. Plaintiff filed a Complaint against Defendant seeking judgment in the amount $11,083.96 (principal plus interest) with interest at the interest rate of 6.0% per annum from January 2~7, 2012, and costs. A true and correct copy of the Complaint is attached hereto as Exhibit "A" and made a part hereof. 2. Attached to the Complaint was Verification from an authorized representative of Plai verifying the accuracy of the amount sought. See Exhibit "A". 3. Defendant ftled an Answer to Plaintiff's Complaint. A true and correct copy of Answer is attached hereto as Exhibit "B" and made a part hereof. 4. On or around May 18, 2012, Plaintiff served upon Defendant a set of requests admissions and requests for production of documents. A true and correct copy of the same is hereto as Exhibit "C" and made a part hereof. 5. No response to the discovery demands has been received from the Defendant. 6. The requests for admissions are now deemed admitted under Pennsylvania Rule of Procedure 4014(b). Thus Defendant has admitted that there was an admissions agreement WWR# 9321813 Plaintiff and Defendant; that she received medical services from the Plaintiff; that she accepted t medical services from the Plaintiff; that section IV of the admissions agreement states that Defend agreed to pay for the items and services provided by Plaintiff; that the items and services provided Defendant by Plaintiff were correctly identified to Defendant in the statement of account; that the balan due and owing to Plaintiff for the items and services provided to the Defendant is $10,341.10 as of Jt 20, 2011; that the healthcare bill which is the subject of this suit accrues interest at the statutory rate 6.0% per annum; that interest calculated from July 20, 2011 to January 27, 2012 amounts to $742.86; tl Defendant has not submitted any written dispute as to billing inaccuracy concerning the healthcare bill question; and that the amount due and owing to Plaintiff is $11,083.96 (principal plus interest) w interest at the rate of 6.0% per annum from January 27, 2012 and costs. 7. By way of her Answer, the documents attached to this Motion, and the Requests ; Admissions, deemed admitted under Pa.R.C.P. 4014(b), the Defendant has admitted all facts material this matter and verified the amount owed. 8. There are no meritorious defenses against this action and Plaintiff is entitled to summa judgment as a matter of law against Defendant. WHEREFORE, Plaintiff respectfully requests that this Honorable Court grant summary judgm~ in favor of Plaintiff and against Defendant for $11,083.96 (principal plus interest) with interest at the le interest rate of 6.0% per annum from January 27, 2012, and costs. Respectfully Submitted: By: Sarah E. Ehasz, Esquire PA ID# 86469 Weltman,Weinberg & Reis 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 WWR# 9321813 Supreme ~~i' E' C -~ `!:~,', ~~ I-u~, _~~~; ~ '` A: County F ~ _i.... ,F`or,Fh'atlrorrotary ITse Only ' r ~ t _ l ~ i~ Docket N'o ~ - ! •~l: ~f Fj~ The information collected on this form is used solely for court administration purposes. This • form does no supplement or replace the fling and service of pdeadfngs or other papers as required by law or rules of court. CoauneACemeat of Action: ® Complaint ©Writ of Summons ©Transfer from Another Jurisdiction ~ Petition ~j Declaration of Taking Lead Plaintiff s Name: GGNSC CAMP HILL, WEST SHORE LP Lead Defendant's Name: JOANN SHATTO Are money damages retiaested? ~ Yes ©No Dollar Amount Requested: ®witltin arbitration check one ( ) ~ out9ide arbitration imita limits Is this a Class Action Suit? Q Yes ®No Is this an MDJAppeal? ~J Yes ~ o Name ofPlaintiff/Appellant's Attorney: SARAH E EHASZ Check here if you have no attorney (are aSelf-Represented [Pro Se] Litigant) Natare of the Case: Place an "X" to the left of the NE case category .that most accurately describes your PRX1rDlRY CASE. l;f you are. making more than one type of claim, check the one that you consider most important. ' S %~. ~' ; C T' 1 ~. 0 N ".: ~'_:, TORT (do not include Mass Tort) © Intentional ~ Malicious Prosecution Q Motor Vehicle © Nuisance [~ Premises Liability ©Produet Liability (does not include mass tort) ® Slander/Libel/Defamation ~ Other: MASS TORT Asbestos Q Tobacco © Toxic Tort -DES Toxic Tort -Implant Toxic Waste Q Other: CONTRACT (do not include Judgments) ~ Buyer Plaintiff Q Debt Collection: Credit Card © Debt Collection: Other ® Employment Dispute: Discrimination Q Employment Dispute: Other ®Other: REAL PROPERTY © Ejectment Eminent Domain/Condemnation Q Ground Rent © Landtord/TenantDtspute ® Mortgage Foreclosure: Residential ~ Mortgage Foreclosure: Commercial Partition ~ Quiet Title Q Other; CIVIL APPEALS Administrative Agencies Board of Assessment Board of Elections Dept. of Transportation Statutory Appeal: Other Zoning Board Other: MISCELLANEOUS Q Common Law/Statutory Q Declaratory Judgment Mandamus Non-Domestic Relations ® Restraining Order Quo Wairanto Replevin Other: Updated WELTMAN. WEiINBERG & iItEIS CO.. L.P.A. Attorney for P1Aintiff(s) BY: Sarah E. Ehasz, Esquire I.D. No.86469 436 Seventh Avenue, Suite 1400 Pittsburgh, PA 15219 Phone: 412,434.7955 Fax: 412.434.7959 File # 9321813 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GGNSC CAMP HILL WEST SHORE LP Plaintiff vs. Civil Action No. JOANN SHATTO Defendants} COMALAINT AND NOTICE TO DEFEND YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth i the following pages, you must take action within twenty (20) days after this complaint and notice are se ed, by entering a written appearance personally or by an attorney and filing in writing with the court our defenses or objections to the claims set forth against you. Yau are warned that if you fail to dos the case may proceed without you and a judgment may be entered against you by the court without fu her notice for any money claimed in the complaint ar for any other claim or relief requested by the plai tiff. 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 HA E A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PRO IDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PRO1 YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO EL1Gi PERSONS AT A REDUCED FEE OR NO FEE. IDE 3LE CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET _ CARLISLE, PA 17013 (717) 249-3166 COMPLAINT 1. Plaintiff is a corporation with offices at PO Box 180970, Fort Smith, AR 72918. 2. Defendant is an adult individual residing at 166 Lee Ann Ct, Enola, PA 17025. 3. At the specific instance and request of Defendant, Plaintiff provided certain medical services to Defendant. A true and correct copy of the pertinent part of the Admissions Agreement is attached hereto and marked as L;xhibit "1 ". 4. Defendant received and accepted the aforementioned medical services which were provided by Plaintiff. 5. The prices charged by Plaintiff were the prices that Defendant agreed to pay. 6. Plaintiff avers that there is a balance due and owing from Defendant in the amount of $10,341.10 as of July 20, 2011. A true and correct copy of Plaintiffs Statement of account is attached hereto, marked as Exhibit "Z", and made a part hereof 7. Plaintiff claims interest at the rate of 6.00/u per annum fiom ,iuly 20, 2011. 8. Plaintiff avers that interest calculated at the aforesaid rate fiom July 20, 2011 to J 27, 2012 amounts to $742.86. 9. Although repeatedly requested to do so by Plaintiff, Defendant has willfully failed and refused to .pay the aforementioned balance, or any part thereof to Plainti~If WHEREFORE, Plaintiff demands Judgment in its favor and against Defendant, Joann Shatto, ~n the amount of $11,083.96 (principal plus interest) with interest at the rate of 6.00% per annum from January 27, 2012 and costs. THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBT SHALL BE USED FOR THAT PURPOSE. WELTMAN, WEINBERG & REIy9~, CO., L.P.A. ~'~- Sarah E. Ehasz, Lsquire ~.~- I.D. No.86469 436 Seventh Avenue, Suite 1400 Pittsburgh, PA 15219 Pl~one: 412.434.7955 Fax: 412.434.7959 File # 9321813 4128711045 GOLDEN LIVING 05, 08; 5o p,m, 02-02-1012 !. Preamble This Acirtia:ion gg~sment is a lrgally binding contract that ckfiaes the ri is ~m'Pariy) who signs it. Please read this Agnxment ~ful gh and obligations ofrach discuss them wish LivingCenier stall'' before ~' before You sign it. If you have an person reviewed by your attom You sign the Agreement, You arc encouraged to have this Asp please cy, or by any other advisor ofyourchoicc, before you sign it greement If you are able to do so, You mwt sign this Agreement in order to be adrni able to sign this Agreerntpt tted to this Livin LiviogCenter, moat sign it oa yotu behalff. 'T'his gtativc, who ~ bren gives autbori t~Center, If you err not the Liv' greement will baeome effective oa the daou to admit yew to the aay otherm~~kr ~Ieas of the date you and/or your Legal R Y You are admitted to dnoumeat as a condition of admission to the LivingCent~er, eataGve signs it, Yau are rear required to sign (l. Parties to This Agreement D'RP'INiTIONS Livti~g ~ ~~ ctrl easier to understand, referrraces to "wr," "o~•~~~ ~~s~.+ "the LivingConter" or "our or tM'tnt the tome of the LivinBCentar is k A tars on Refet+cncea to'you,'• "your," "patient" or "Resident" mean the ~` LivingCetttar. This person is; Person who wilt be rccciving care in this (Type tome The Necessary Parties to this A Letpil RGPreaentative, iincludjII ~ y~~ ~ bas cga~access to the Rasidcnrt~s Inaomeplanable, the Resident's for the Resident's carp. tiler resources to pay NOTE: Any person who has legal access to your funds or your olhrr assets is our Le y°ur Legal ~Pna~tative must alga :this A Y gal Representative, and Agreement, your Legal greemcnt as a Necessary Party to ibis A EEeprsaontativr egrets to use your income and/or greemrnt. HY signing this Yom Lcga[ R°Pleaentauive also agrees (a to other resources to to the LivingCenter, (b) to ) Provide complete and accurate diselosur+e of all~r levant infarmatioo for your cat+e, and c to cooperate lwiy in applying for all applicable private or govemmrntal () lulfili alt other fiduciary ,tics owed to you. H beaetita to pay Repr~seatattvr confirms that.be or she has legal access to Y signing this Agreement, the Legal Legal Representative also agrees to inform thr Liviu Yow income or t,caourcea to pay for your cart. Your bngcr has legal acres: to your income and/or rrsouneti.~tcr's Executive Director in'-mcdiately if he or she na ~y Legal RoPresen+tative who signs this A for your cart provided by the Livin grerment on your behalf assumes no P$RSpN t3Center. Ottr LivingCenter does not require you to have anyonel sponsorty or S~rantce Payment for your cart by sittrting or co-si expedited adrniaaioa or continued stay in the Livin$Center.~ owever, as a Nece your Legal R ti~ment ~ a condition of admission, liable for fail entative agrees to be contractually bound by the terms of this A~ Pariy to this A perform duties required by it, 8r~ment, gr+eement and may be personalty ao~~t~ynR~~te,s:,~~~~.~..~...,_...~.,~,~~. EXHIBIT 4 1 2671 1 045 GOLDEN LIVING 05:09;08 p.m, 02-02-2012 {!I. Consent to Treatment You consent to receive routine nwsing care and other care and services provided directly, or under acrartgoment, by this LivingCenter, You also consent to receive other healthcare services dinctcd by your attending physician as well as necessary emergency care. If you are, ar become, incapable of making your own medical decisions, we will follow the direction of a person with legal authority under state law to make medics! tmatrrteai decisions on your bebalf, such as a guardian, conservator, a person you designate in an advance healthcare directive or power of attorney for healthcare, or next of kin. IV. Flnanciaf Arrangements Beginning on (date), we will provide routine nursing and emergency care and other services to you in exchange for payment. Your attending physician or other practitioners who provide services to you during yow stay in our LivingCenter are independent coatraetonr and not the Livin$Center's agents or employees, They may bit! and collect for their services separate and apart from the LivingCenter's billing and collections. Our LivingCenter participates in the following government insurance programs; Medicare Medicaid Veterans Affairs Other ,. We cannot guarantee that your care will be covered by Medicare, Medicaid, third•party insurance ar other reimbursement source. By signing this Agreement, you agree to pay yow account with the LivingCenter for the items and services provided to you, " At the time of admission, you and yow Lcgai Representative promise to provide us with all information necessary to submit claims sad obtain payment for your care, We may disclose portions of your medical records to insurance companies, healthcare service plans, Medicare, Medicaid, TRICARE or other entities that may be liable for sll or any portion of the LivingCente='s charges far your care in order to determine liability for payment or to obtain reimbursement. If, for any period of limo during which you receive care and services from us, your primary or secondary source of payment changes, you sad your Legal Representative promise to give us the updated infonnatioa necessary to submit claims sad obtain payment, including but not• limited to all information required by the State Medicaid Agency to apply far Medicaid benefits. Your Si4are ofdfre Coal of Year Cara Medicaid, Medicare or a private insurance plan may require that you pay a co-payment, coinsurance, deductible or other amount, all of which the LivingCenter considers to be yow share of fhe cost of the care and services provided to you. Nonpayment, including failure to pay your share of the cost of your care, is grounds for involuntary discharge from our LivingCenter, If you do not know whether your care in our LivingCenter can be covered by Medicaid or Medicare, we will help you got the information you need. A. Chars for Salt-Pay Rssldants The basic monthly rate for self-pay and privately insured residents is S end includes payment for the sarvicat sad supplies described in the Notices given to you upon admission. We will give you written notice in compliance with applicable state law before incr't:asing the basic rnonthly talc. The prorated basic monthly rate will be charged for the day of admission, and we may charge fot the day of discharge if you depart the LivingCenter slier i I a. m. (inlrtnn f ivinof'mhax• Arlmi~iinnAvreemmtlrev If1I29N14) 4f 28711045 GOLDFNLIVING 05:09:28 p.m. 02-02-2012 Charges for optional supplies and services that are not included in our basic monthly rate are also listed in the Notices gives to you upon admission, Wa will only charge you for optional supplies sad services that you specifically request, unless the supply or service is required in an emergency, We will give you written notice in compliance with applicable state law before implementing any increase in charges for optional :applies and scrvices. Ifyou become eligible for Medicaid st any time after your admission, the services and supplies included in the basic rate and the optional supplies and services may change. At the time Medicaid confirms it will pay for your spry in this LivingCentar, we will review and explain any changes in coverage to you. B. Char~ea for Medicaid, Medicare and Insured Residents Ifyou are approved for Medicaid bene$ts after you arc admitted to our LivingCentcr as a self-pay or privately insured rrsident, you may be entitled to a refund. We will refund any payments made for services and supplies that arc late' paid for by Medicaid (Ices any co-payttunt, coinsurance, deductible or other amount that is your share of the cost of your care) when our LivingCeater receives payment from the Medicaid program, If Yov are entitled to bcaefets wader Medicare, Medicaid or private iasutslnnce, aad if we arc a participating provider is that program or with that insurer, we agree to accept payment from them for your routine care, However, You arc still regsoasibfe fbr paying at! applicable deductibles, repayments and coinsurance amounts, as well as any charges not covered by Medicare, Medicaid or your insurance plan, The Notices gives to you upon admission describe the services covered by the Medicaid daily rate, services that era covered by Medicaid bui aro not included in the deity rate, and ,scrvices that are sot coveraf by Medicaid but are aJtiilable if you roquast them and wish to pay for them, ,~ ,. T~ Nobces gIvan to You upon admission also describe the services covered by Medicare, and services that are not covarecl by Medicare but are available Ifyou request them and wish to pay for them, Medicaid sad Medicare will pay for covarad supplies and services only if they are considered m~{rally necessary by the Medicare ar Medicaid program, If Medicare or Medicaid determines that a supply or service Is not medically necessary, or if we believe it is not covered by the rules of the program, we will ask whether you shill want tha `supply or sarvioe and if you are willing tc pay far it yourself. We will only charge you for optional supplies asld services that you specifically request, unless that supply or service is required in an emergency, A detatted list of the charges for all supplies and scrvices is maintained in the Business Oftlce and is available upon request during normal business hours, C. Blllir-~ and Payment We will give you an itemized statement of charges that you must pay every munch, you agree io pay the account tnontbly on the fifteenth•(I Sth~ day of each month in which the statement is recaivad. We accept payments in cash, by check or by credit card. You also acknowledge that the charges far services provided under this Agreement remain due and payable unfit fully satisfied. Ifyou are discharged for aay reason, including death, this Agreement shalt operate as an assi traoafer and conveyance to the LivingCentcr of the amount of your assets of sufficient value to~sah'stfy al! unpaid obligations under this Agrecntent. This asaigtunent shat! be an obligation of your estate and may ba enforced against it to pay the LiviagCenter an amount equivalent to your unpaid obligations under this Agreement Golden LivinaCente-~; Adruiutoa MRament (rev !0/29/04) 4128771045 GOLOEN LIVING 05:09:49 p.m. 02-02-2of 2 D. Payment at Refunds Due to You At thr tuna of your dischargo, you maybe due a refund, such u unused advance payments you may have mt+da for optional setvicea not covered by the basic rate. Upon actual notice of final settlement of all third-party claims, we will refund promptly any money due to you, aRer deducting any amounts owed by you to us. V. Trsnehrs snd Dbchatges You tray leave our Liv[tsgGenter at any lima without prior notice to us. We wip cooperak as necessary with your discharge or transfer to another facility. Except in an emergency, we will give reasortsble notice to you before transferring you to another room within our LiviagCenter. We wilt not discharge you from our LivingCenter against your wishes without prior written notice, as required by law. Our writtea notice of transfer or discharge against your wishes will be provided 3t} days in advance. [~mvever, we may provide less than 30 Jaya notice; {a) if the reason for the transfer ar discharge is to protect your health and safety or the health and safety of other,iadividuals, or (b) ifyow improved health allows for a shorter notiea, or (c) if you have bran [n our LivingCoater for lass than 34 days. Otu written notice will include the effective data of discharge, the location to which you will be traasferred or discharged, and tht reason the discharge is necessary. Vf. "Bed Hofdts" and Readmissions if you will be temporarily absent from the LivingCenur for hospitalization or therapeutic leave, you may .request the Liv~gCcnter to hold your bed during this tune (called a "bed hold"), The Medicare program and most private in:uraacc companies do not saver costs related to holding your bad in these situations. We will n~Y Y~ ertd/orY~ Legal Representative of the option to pay the applicable daily rate for each day we hold yaw bad open. You sad yourr reprasantadve have 24 hours aticr receiving this notice to let us know whetber you waM us to hold your bed for you. If Msdicaid is paying for your care, the state Medicaid program may pay us to hold the bed for you for a limited time. If you are away From ow LivingCgpter due to hospitatizat(on for a longer period of time, we will readmit you to the first avsii~le bed in a~emi-private room if you wish to be readmitted and if the LivingCcnter is able to provide the level of cart you need and is oWerwise able to meet your seeds. Vtl. Petsottal ProJperty and Funds Wa strongly discourage keeping valuable jewelry, papers, cash or other items of value with you in the LivingCenter. You agree w inform us of a!I valuable property you bring with you upan admission end at any time new items of value are added to (or removed from) your possession. We will make reasonable efforts to safeguard your bclongiags that you keep in your possession. if our LivingCenter participates in Medicaid or Medicare and you give us your written authorization, we will agree to hold personal funds for you in a manner consistent with aU federal and state laws and regulations. You arc net rrquinod to allow us to hold your personal funds for you as a condition of admission or continued stay in ow LivingCentar. Upon regtust, we will give you ow policies, procedtu,es and authorization farms rotated to our holding your petsoaal tLads for you. Vfff. PhatayraJphs You agree that we may take photographs of you for identification, security and other purposes related to your care. We will not photograph you for any other purpose, unless you givo us your prior written permission to do so. ~~ •~,,' Golden Uvinat:talors; Admiuion A~eemen~ (rev 10139!09) 4128711045 GaLDEN LIVING 05;10: i 1 p.m, 02-02-2012 tX. ConfldentiaHty of Your Medical lnforntatian You have a right to confidential treatment of your medical information. Your confidentiality rights are drscribed in our Notice of Privacy practices, which is given to you upon admission. You may authorize us to disclose medical information about you to a family member or other ptrson by completing an Authorization for Disclosure of Medical Information form that wil! be provided to you upon request. K. LivingCenter Rules and Grievance Procedure You agree to comply with our LivingCenter rules, policies and procedures, When you are admitted to the LivingCenter, we will give you a copy of ow rules, policies and procedures. The LivingCenter grievance procedure for resoluticm of resident complaints is included in Notices given to you upon admission and also is available upon request. XI, Entire Agroement This Agr+xrnant sad the Notices given to you upon admission constitute the entire Agreement between you and ua for tho purposes of your admission to our LivingCenter, There are no other agroaments, understandings, restrictions, warranties or representations between you and us as a condition of your admission to our LivingCenter. 'This Agmement supersedes any prior admission contracts regarding your admission to our LivingCenter. However, if you execute, or have executed, an Alternative Dispute Resolution Agraerrwnt with us in connection with any adrrilssion to our LlvingCenten, then that Agrooment shall be, and remain, binding upon you, and upon us, in accordance with the terms that aro set forth in that Agreement, df any provision of this Agreement becomes invalid, the remaining provisions shall remain in full force and ef)cect. The LivingCcnter's acceptance of a partial payment on any occasion dace net constitute a continuing waiver of the payment requirements of this Agreement, or otherwise limit the LivingCenter's rights under this Agreement. This Agreement shall be cansWed according to the laws of the State of Other than as noted for a duly authorized Resident's Legal Representative, the Reaidcnt may nut assign or otherwise transfer his or her interests in this Agreement. Golden LivinaCrnterf; Admuaion Aamment (rev IOJ24/D9) 4128711045 GOLDEN LIVING Resident's Name: ~~ {' ('~ ~•~ --~~ Admission Date; ____~~~ ,~ ., (.(,,! 08; 29;09 a,m. 07-12-2011 Record Number: ~•1 ~J ~ oy signing below, you, your t,rgoi t2apresentativesnd this LivinkCrntcr agree to the terms orthis Admisalon Agreement: ~-- ~ % l t ; ngCrntcr '.~ ~ f)vlr By my signature, l acknowledge that 1 h e read this Admission Agreement or had it read to me, that l understand what ! am signing, and that 1 accept its terms. Signature of Rcvidcnt Date By my signature, t represent that t air>' a person duly authorised by Resident ter by law to execute this Admission Agreement and that 1 accept its terms. I,r '1 `{ G/zy/~o DaW AJ~csy Phunr NUTS: Copies of all ctocuments verifying the status of the Legal Represenlativc must be ubluined a1 the lima of admission, Examples of the requires! ckx:uments include but are not lintitrd to the following; Power of Attomay, Durable Power of Attorney, Healthcare Proxy, Guardianship Appointment, Conservator Appointment and others conveying legal authority. A LEGAL REPRESENTATIVE, INCLUDING ANY PERlSON OTHER THAN THI; RESIDENT OR FINANCIALLY RESPONSIBLE SPOUSE, MAY NOT BE REQUIRED BY THE FACILITY TO ASSUME PERSONAL R[NANCIAL LIABILITY FOR THE RESIDENT'S CARE., By signing this Agreement and providing current credit card information, you authorize us to charge all charges under this Agreement to your, credit card. tf you plan to pay using a credit card, please provide the card information below. Discover' Account ~ Exp. - MasterCard't Account t,r . Exp. Visa" ACCUUnC # _ Exp. >< rulJcnl,ivin}1{:Cn1Crs .4dmr.~xian:lgruamcntlrev.tll 1U1 I i 4 1 2871 1 045 GOLDEN LIVING 08:19:11 a.m, 07-72-1011 ~~g TN18 AQREEMENT QOYERNS IMPORTANT 4E6Af. Rf6HT3. PR,EASE READ fT CARfEPULLY ANO IN ITS E11tTtRETY f~EleORfE SIGNING. Print` 'umr of Roxrdem ' ~'C. ' ~,' , ___ ~~ Print Namc and Num 'r of LivingC'un r ~ ~ ~ '~.r;i~;t Sigrtaturc of Resident Date sy my signature, !acknowledge that !have re this Agreement or had ii read to me, that !understand what ! am signing, and that !accept its terms. . Signature nn behalf of ~ ivingCenter: !, 1• J~ ' ~ LivingCcnter witness), sign this Agreemtn e a f of Livin Center. B ) r (name of before Resident and/or Resident's represent five signed this document i off ed theast'gner(s)tthethet (1) opportunity to read it in full, or to have it.read to him/her in full; (Z) ! saw t e signature of the resident, or of the person signing on behalf of the Resident, written on this document. ~` ~ , . elute of Resident's cgat Rcpresrntati vc Print Namr of Legal Rcprcscntattve 13y my signature, l represent that t am a person duly authorized by Resident or by Jaw to execute this Agreement and that I accept its terms. Specify Capacity of Legal Represcrttative (r.g„ power ul;Attorncy, Agent, Next of Kin} Other acknowledgments; ,.. Printed Name ^nd Signature of t7thcr Represcntative or Ncxt of Kin Date Prinlcd Name and Sigrtalurr of Other R~prcxcntativc ur Ncxt of Kin ~'' bate "-"~ Printed Namr and Signature of C)ther R~presentative or Ncxt of Kin Datr ""-"- Ciuldcn LivingC'cnwnr: Alr¢magvu Diaput< Rwwludon ANrc:omunt trcv, tll~ In) I) GGNSC CAMP HILL WEST SHORE LP ~~~~~ .,~,w.e .. 9, .. y yniN ,~~ ; ~ 770 POPLAR CHURCH RD ~~°~. ~~ ~ ~~~.~':.15.::.,<>~ ~ r CAMP HILL PA 17011 "a,.,..w~ . - ~~~~~~ itemized Resident Statement Rscfd~ni Nsms: Mr+ginp Addnsa: AEB~p~~T ACCOUNT aK: Joann Shatto 102874-0028___ ~5~3147 Joann Shatto 8T8 Llmckllrt Rd DATE PREPARED, Nsw Cumbttr'land PA 17070 07!20111 ATE f PtMtmn rtnuena ___ __.__ 1 2010 Room Cha es 11 2 345,48 ~ 2010 Barber & Beautician Fee 4 3 2010 Acclilarles 89.50 3 2010 Plnrafral Trion.,, r^ws.»~., 22.46 t 3-212010 Medicaid Private Portion ~ 19 440.67 e 7-27 2010 Barber & Beautician Fee 3 S2 386.89 70,50 cx 15.312010 Medicaid Private Portion 17 ?Ct 4-25 2010 Barber 6 Beautician Fee $2 386.99 Oct 4 2010 Faaal Tissue 4 558.00 i 1.36 ov 1-15 2010 Medicaid Private Portion 15 Dv 1-15 2010 Barber & Beautician 3 32 386.99 49.50 Dlschar a Date 11/16/10 CHAROE9 CREDITS AMOUNT OUE 310, 341.10 50 00 . $10,341.10 Page 1 of 1 VER~~j AC TION The undersigned does hereby verify subject to the penalties of 181'A. C.S. 4904 relating to unsworn falsifications to authorities that he/she is ;'`~~ I Che ~.~ ~lU~~~ ~ / (NAME) of ~ Y f~ ,plaintiff (Ti1"LE) (CQMPANY) herein, that he/she is duly authorized to make this verification, and that the facts set forth in the foregoing Complaint in Civil Action are true and correct to the best of his/her knowledge, information and belief. r .1 ~~ (SI NA.TURE) WWR# 9321513 rl J ._;, F . . ..ii". i,ll~'.,~ lh. ., ~ ~~. , ~~-~r~r~s~~~~y~r:~,~, Dennis J. Shatto Attorney Id. 25675 Cleckner and Fearen 119 Locust Street Harrisburg, PA 17101 717-238-1731 Attorneys for Defendant ~~',~ GGNSC Camp Hill West Shore LP, Plaintiff v. JOANN SHATTO, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA CIVIL ACTION - LAW No. 2012-1207 Civil ANSWER TO COMPLAINT 1. Denied. Plaintiff is believed to be a limited partnership. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth of the averment that Plaintiff has an office in Fo Smith, AR, and proof is demanded. 2. Admitted. 3. Denied as stated. Defendant was recommended to have certain medical services, and was advised that those services could be provided at a facility known as Golden Living on Poplar Church Road in Camp Hill, PA. She agreed to be admitted there for that purpose. After reasonable investigation, Defendant is without knowledge or information sufficient to form a belief as to the truth of the second sentence, and proof is demanded. 4. It is admitted that Defendant received and accepted the medical services which were offered to her. Q ~z i~ X13 .. ~, 5. Denied. Defendant does not believe she was given any information about Plaintiff's prices. Defendant expected that any charges for services would be paid by her automobile insurance or by medicare. 6. Denied. A portion of the alleged balance is for services rendered after Plaintiff received notification from Medicare that Defendant would no longer be covered, and Defendant was not notified of the termination of coverage in a timely manner. Defendant believes that all services should have been paid by Medicare or Medicaid. 7. It is admitted that Plaintiff claims interest. It is denied that Plaintiff is entitled to interest. 8. The calculation is admitted, but Defendant denies that she is obligated to pay interest. 9. Admitted, for the reasons set forth in no. 6 above. WHEREFORE, Defendant demands judgment in her favor and against Plaintiff. CLECKNER ND FEAREN Dennis J. Shatto V E R I F I CAT I O N I, JOANN SHATTO, hereby verify and state that to the exten the foregoing ANSWER contains facts supplied by me, such facts ar true and correct to the best of my knowledge, information an belief; however, to the extent that the foregoing document and/o its language is that of counsel, I have relied upon counsel i making this Verification. I understand that false statements made herein are subject t the penalties of 18 Pa.C.S.A. X4904, relating to unsworn falsification to authorities. Date• JOA ~, r CERTIFICATE OF SERVICE I, DENNIS J. SHATTO, hereby certify that on this day, I servec a true and correct copy of the foregoing document upon the person(s) indicated below, by depositing same in the United State: mail, first class postage prepaid, addressed as follows: Sarah E. Ehasz, Esquire Weltman, Weinberg & Reis 436 7t'' Ave. , Suite 1400 Pittsburgh, PA 15219 Date : ` S (L CLECKNER AND FEAREN Dennis J. Shatto, Esquire PA Attorney ID 25675 119 Locust Street P. 0. Box 11847 Harrisburg, PA 17108-1647 (717)238-1731 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION GGNSC CAMP HILL WEST SHORE LP, Plaintiff, v. JOANN SHATTO, Defendant. NO.: 2012-1207 PLAINTIFF'S FIRST REQUEST FOR ADl~ISSI©NS AND REQUEST FOR PRODUCTION OF DOCUNI)li;NTS Plaintiff demands that the Defendant answer and respond to the following Request for Production of Documents under oath pursuant to the Pennsylvania Rules of Civil Procedure within 30 days from the date of service hereof. Plaintiff also demands that Defendant answer and respond to the following Request for Admissions pursuant to Pa. Rules of Civil Procedure 4014. You are requested to admit the truth of each of the statements of fact hereinafter stated. You are instructed that: 1. These requests are made under Pennsylvania Rules of Civil Procedure 4001, et seq., and each of these matters of which an admission is requested shall be deemed admitted unless your sworn statement in compliance with such Rules is timely made. 2. If you do not admit each of such statements, you must specifically deny each one not admitted or set forth in detail the reasons why you cannot truthfully either admit or deny each such matter. 3. Your answer, signed and properly verified, must be delivered to the undersigned attorney of record for the Plaintiff within thirty (30) days after delivery hereof. 4. If you fail or refuse to admit the truth of any such statement of fact acid the Plaintiff thereafter proves the truth thereof, you may be required to pay the reasonable expenses incurred in making such proof, including attorneys' fees, witness expenses, etc. 5. If, in response to any of the following statements of fact, it is your position that the statement is true in part or as to soma items, but not true in full or as to all items, then answer separately as to each part or item, 6. if you have been sued in more than one capacity or if your answers would be different if answered in any different capacity, such as partner, agent, corporate officer or director or the like, then you are requested to answer separately in each such capacity. Failure to do so constitutes an admission in any such capacity. ?. In these Requests for Admissions: A, The word " ere n "means all entities, and, without limiting the generality of the foregoing, includes natural persons, joint owners, associations, companies, partnerships, joint ventures, trusts, and estates; B. The word "document(s)" means all written, printed, recorded, graphic, or photographic matter, or, sound reproductions, however produced or reproduced, pertaining to any manner to the subject matter indicated; C. The words "identity". "identify", "identification", when used with respect to a personts) means to state the full name and present or last known address and business address of such erson s and, if an actual person, his present or last known job title, and the name and address of his present or [ast known employers; D. The words "ident}ty", "identify" "identification", when used with respect to a date, subject matter, name(s) or person(s) that wrote, signed initialed, dictated or otherwise participated in the creation of the same, the name(s) of the addressee or addressees if any and the name(s) and addresses} of each r on who have possession, custody, and control of said document{s). If any such document was, but is no longer in your possession, custody, or control, or in existence, state the date and manner of its disposition; and E. The word "identi ", when used with respect to an act (including an alleged offense), occurrence, statement, or conduct {hereinafter collectively called "act"), means to { 1) describe the substance of the event or events constituting such an act, and to state the date when such act occurred; (2} identi each and every erson s participating in such an act; (3) identi all other erson s (if any) present when such act occurred; (4) state whether any minutes, notes, memoranda, or other record of such act was made; (5) state whether such record now exists; and (6) identi the rson s presently having possession, custody or control of such record. 8. Unless otherwise indicated, all Requests herein relate to those certain events, persons, and period of time more fully described in the pleading in this case. 9. These requests are of a continuous nature. These Requests for Production of Documents shall be deemed continuing so as to require supplemental answers and documents if any information of documents are acquired subsequent to the filing of responses hereto, which information or documents would have been included in the answers and documents produced had it been known or available at the time the answers and the documents provided pursuant hereto were produced. Defendants shall supply such information and documents by supplemental answers and production of documents as soon as such information becomes known or available and in all events, prior to trial of this action. If objection is made to any requests for production of documents, it is demanded that the requests for which there is no objection be answered and furnished within the aforesaid period. All documents identified in response hereto shall be organized and labeled to correspond with the request to which it pertains. For all documents produced, list the individual and his or her job title and department from whose files it was produced and the current custodian of said document. If a document called for is believed to exist or is known to exist, but is in tha possession, custody or control of another person or party, the existence of the document, the identity of the possessor, custodian and one in control of such documents shall be provided along with any applicable common description or citation utilized by the publisher, possessor, custodian or disseminator of such document. If any document called for by this request is withheld on the basis of any claim of privilege or any similar claim, identify that document as follows: author; addressee; indicated or blind copies, date, subject matter; number of pages; attachments or appendices; ail persons to whom distributed, shown or explained; present custodian; and nature of the privilege or similar claim asserted. REQUEST FOR PRODUCTION OF DOCUMENTS 1: Produce any and all documents evidencing proof of payments, including, but not limited to, cancelled checks, receipts, coupons, statements, accountings, memoranda, invoices, financial statements, accounting entries, diaries, charts, lists, phone records, data compilations etc. REQUEST FOR PRODUCTION OF DOCUMENTS 2: Produce any and all documents you intend to introduce and/or provide testimony on as evidence at the time of trial. REQUEST FOR PRODUCTION OF DOCUMENTS 3: Produce all documentary evidence or information substantiating the defenses asserted in your Answer. REQUEST FOR ADMISSION NO. l ; A true and correct copy of the Admissions Agreement between Plaintiff and Defendant is attached to these requests as Exhibit "1." Admitted Denied If the answer to Request for Admissions No. 1 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. REQUEST FOR ADMISSION N0.2: Defendant received medical services from the Plaintiff. Admitted Denied If the answer to Request for Admissions No. 2 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied, Please attach any documentation in your possession that supports your response to this request. REQUEST FOR ADMISSION N0.3: Defendant accepted the medical services from Plaintiff. Admitted Denied If the answer to Request for Admissions No.3 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request and identify the Defendant's addresses and the dates that Defendant resided at the said address. REOUEST FOR ADMISSION N0.4 Section IV of the Admissions Agreement states that Defendant agreed to pay for the items and services provided by Plaintiff See Exhibit "1." Admitted Denied If the answer to Request for Admissions No. 4 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. Specifically identify each and every service and/or expense that is in dispute, by citing the date of said service/expense, the nature of said service/expense, the employee associated with said service/expense and the amount of said servicelexpense. REQUEST FOR ADMISSION NO. S: The items and services provided to Defendant by Plaintiff are correctly identified in the Statement of Account which is attached hereto as Exhibit " 2." Admitted Denied If the answer to Request for Admissions No. 5 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. REQUEST FOR ADMISSION N0.6: The balance due and owing to Plaintiff for the items and services provided to the Defendant is $10,341. l 0 as of July 20, 2011. Admitted Denied If the answer to Request for Admissions No. 6 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. REQUEST FOR ADMISSION N0.7; The healthcare bill which is the subject of this suit accrues interest at a statutory rate of six (6.0%) percent per annum from July 20, 2011. Admitted Denied If the answer to Request for Admissions No. 7 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. REOUEST FOR ADMISSION N0.8: Interest calculated at the aforesaid rate from July 20, 2011 to January 27, 2012 amounts to $742.86. Admitted Denied If the answer to Request for Admissions No. 8 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. Please specify the dates, times and manner (letter, email, etc) by which the Defendant disputed any of the professional services, at home services or expenses listed. Identify which specil-ic services were disputed the nature of said service/expense, the date of said services, the employee associated with said service/expense and the amount of said service/expense. REQUEST FOR AD~yIISSION N0.9: Defendant has not submitted any written dispute as to billing inaccuracy concerning the healthcare bill in question. Admitted Denied If the answer to Request for Admissions No. 9 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. R_QUEST FOR ADMISSION NO. 10: The amount due and owing to Plaintiffis $11,083.96 (principal plus interest) with interest at the rate of 6.0% per annum from January 27, 2012 and costs. Admitted Denied If the answer to Request for Admissions No. 10 is anything other than an unqualified admission, please qualify your response by setting forth which parts of the request are admitted and which parts are denied, or set forth in detail the reasons why the answer cannot be admitted or denied. Please attach any documentation in your possession that supports your response to this request. Please specify the exact amount you believe to be the correct balance, along with a detailed description of which professional services, at home services and expenses are attributable to the amount you acknowledge. THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED SHALL BE USED FOR THAT PURPOSE. .•~ / Sarah E. Ehasz, Esquire /'1 Pa. I.D. #86469 (~' Weltman, Weinberg & Reis Co., L.P.A. 1400 Koppers Bldg. 436 Seventh Avenue Pittsburgh, AA ] 5219 (412) 434-7955 W WR; 8747694 DEFENDANT'S VERIFICATION (please print) under penalty of perjury and subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities verify that the foregoing Responses are true and correct to the best of my knowledge, information and belief. Date Signature CERTIFICATE OF SERVICE A true and correct copy of Plaintiff's First Request for Production of Documents and Request for Admissions has been served by U.S. Mail, on the ~ day of , 2012, upon the following: Dennis J. Shatto, Esquire 119 Locust St. Harrisburg, PA 17101 By: At28711045 GptDSNLIVINO oS:oB;sop.m, p1-pz-xot2 !. Ptealunblo ~ Adatitafon Agreement fs a Iogaliy bindlttg eottitt<et fatal defines the rights end obit a d° ) wbo aigtu !t. Fleece road this Agroomaat oarefltl'ly betbre ou si person hem with Livia g dons of eeoh reviewed byyourattomt~ontor atafr"before you sign the Aaarpesment You era encoura cdvto ha euthieASreeeesc ey, or by any other advaaor ofyour choice, before you alga tt, g !f you arc ebk to do ao 8 moat able to sign fhk A 'you moat sign tbts Agroetnent in order to bo adml Llvingt~~~ ~~la~Orttegt? your Leg+tl Itcauyst~ntative, wha bas ~ to this LivingCenter, If ou the Ltvin~enter ~° it on your behalf, This A been given autharlty by Yoa to a Y arc sot an o mgardtesa of the date you end/orgyo a+taRQOaome atl`'atlve ort the da dtttit You to the y then dooumeht as a condition of adntasaion to the LivingCent~~~dV4 signs it, Yau ere nat~requ~lredU~ Sign II, Parties to This Agreement b~~ITiONS LiV gC ~AW~oomont easier to understand refbnnc~ to "tNO," i~a~, rr , it n ~ rrleBtl: ~ `us, the LlvingConfer" or "cur • -..- ~~ ~~ ~ me name or8wi LivingCentor of a bra on itt llronse) ~ ~BCotttor. ,TMs ,pers~ris,"patient" or "Resident" mean the person who w{(1 be rocalvin g caro is this - --- • -.,,,~...~„o,~-, name hero)- Tha Necessaq, Perms ifl this A I.cgaa R-ttUvo, ipcluding anYone,whO has legalaecess to th ~aa dent's income a for the R~sidettt's caro, ~ Aplacable, the RCatdcat's nd/or resources to pay NOTL: Aoy Ix+'eat who has legal access to your funds or our olber Yatr Legal Rop:ecoptarivc must sign .this A Y assote fs your a.,cgal R A~e~t. Your Lags! It ~'eemcnt es a Nscea opresentadve, and 'apmeseatative a ~' patty to Chia ABl'eemont. $Y s~ing this Your Lagsl Soros to use your income and/or other resources to a for ~Pr~oahtave aaso agrees !a _ to the I.ivitsg~pp., (b) to ) to provide eo<nplcte and acctu:to dfsclostuc of aipretevant~ln ortnation foryour cerc, ~ a ~ COpperatc twty !n aPpIY~B for all () fuliala ell other tiduof appllceblc private ar govcrttmcn Represe»tatfi'e thet.be or she has l ~ dodos owed to you, By aig~nit~ this A tai atcnetlrs to pay Legaa ROP~setttetiv~o aaso ageetos to inform the L~l esa to your lncornQ or troao greetnent, the Legal longer has ae~at accetis to nBCentcr s Bxccullve biroctorajrntnediatety ha or she na You' tnoome and/or resources, ~Y I.agal Rpproetn~iYe who signs this A e ibr Your `~'° rovidod b the Livia ~ ament on your behalf asautncs no a'$RSQN a'guarantaeixymant for out, ~tW' (htrLivingCentardoea not re uir~ ~ financial liability Y care by signing or co-signing this A ~ q you to have anyone sponsor you axpadttod adtraieeion or continued stay in the Livia ~ mpnt as a condition of adrnt:stop, tiablerf~ fail ~~ttve agues to be eantractua>ay bonund by ~e ~~e o has q°r3' p Pe~'orm duties requtrod by lt, arty to this ABremnont, greernent and may be personalty oelden l.ivihRCcYtbrb: Admtnkw ~~......,...r,,,.. ,n,~mm~, ~~~~Bl e 2 /t1 41287'1 t 045 GOt,pEN UYlNG 111. Ctmt;<ent M Troatment G5;09;08p,nr, 02-02-2012 3!6 Yau coaeent oo rea}vo routine nursing care and other care and sorvicea provided d}rectly, or under etrangoment, by thla LivitrgCatter, you also consent to rocoive other heaftlscara ecru}cos dlreatcd by your attond}ng phyalcian as wolf as rscocesary emergency care, if you are, or become, iacapablt of making your own m~ical decis}ores, wo will tbtlow the direction of a person With legs! authority under etato law to make medical troatment decldons on your behalf, such as a guardian, conscrv:tor, a petpoti you designate in an advance heatWcare throat{ve or power of attorney for healthcare, or aext of kio. iY, i:fnancla! Arratt~ments Beginning on (date), we will provide routine nursing and emergency care end atfrer services to you in exchange far payment. Your attendigg physician or other practitlonars who provido servfees ro you during your stay in our LivingGenter are itxbpendent contractors and not the LivingCentor's agents or employeoa, They may bail and Collect far their services serparata and apart t}om the L1vlagCenter's biking and collections. Our LivIngCenter participates td the following government Insurance pcogtatns: Medicare Medicaid Veterans Affairs Other ,. We tsaaaot guatlsntae that your care will be eoveredlyy Medicare, Medicaid, third-party insurance or other reimbtasement source. By dgrr}ng this Agreement, you agree to pay your account with tho C.ivingCenter far the itcrna and services providod to you, At tho time of admission, you and your Legal Represontative promise to provide us with al! informadan necessary to submit aiaima and obtain peymcnt for your care. Wa may d}sctose portions of your medical records to wsuraace eompantes, healthcare service plans, Medicare, Medicaid, TRIGARE or other t+ntitics that may be liable far~all or any portion of the LivingCante~'s charges far your care In order to determine iiablllty far payment or to obtain reimbursement. If, for any period of time durlag which you receive care and ecru}cos from us, your primary yr secondary source ; of payment changes, you sad your Logel Repreaeruative prom}sa to give us the updated 9nformadan necessary to ' subrttlt claltns and obtain payment, }neluding but not• Iicnited to a!1 Information required by the State Medicaid Agegey to apply for Medicaid benefits. '. q Year Spars ofr`hs Coal o,J'Yaar Cara Medicaid, Medicare or a private insurance plan may roqu}re that you pay a co-payment, coinsurance, deductible or other amount, all of which the LivingGenter considers to be your share of the cost of the care and services provided to you, Nonpayment, including failure to pay your share of the cost of your care, is groturds for involuntary discharge from our LivingGcnter, if you do not know whether your care in our LivingCenter can be covered by Medicaid or Mediaarc, we wilt help you gat the information you need, A. ChatRss far S~Ii-Pay ResJdtrttet This basic moMhfy rate for selfpay and privately insured roaidents is $ far the services and supplios described in the Noticos g}van to you upon admissionaWe will glvC youcrrt wrYtten notice in cotnpl}once with applicable state law before increasing the basic monthly rate. The prorated basic moathly rate will be charged far the day ofndmisslon, and we may charge for the day of discharge if you depart the Liu}ngGenterafter [ I n.m. ,: lrnbinn i iv{no(`nntrxe~ Arlntitit{n„ Avreemm[!rm 1i11291d41 . . at2S7ttOgS OOLDENLIVIMG o5;os;2sp,m, o2-OZ-20t2 41b Charges far optional supplies and services that are net included in our basin monthly rate are also listed in the Notices given to you upon admission. We will only charge you for optional supplies and services that You spaeifically ttiquast, unless the rtuppiy or service is required in an emergency, Wa will give you wrfttan notice in compliance with applicebio state law before implemnnting any increase in charges for optional aupp!(as and sorvices. Ifyou bacomo eligible for Medicaid at any dme after your admission, We services and supplies included in the basic rata and the optional suppJiee and sorvices may change. At the Limo tVlodicaid confirms it will pay ~rYow'stay in this LivingCantor, we will review and explain any changes in coverage to you. B. Charraest for Medicaid, Madlaare and Ensured Residents if You aro approved for Medicaid benatits after you am admitted to our LivingCantcr as n self-pay or privately itunttCd resident, you may be entitled to a refund, We wilt reiWtd any payments made for scrvicos and supplies that arc later paid far by Medicaid (less any co-payment, coinsutance, daduotible or other amount that is your share of the cost of your carp) avhon oar LlvingCwter rceoives payment from the Medicaid program, If you aro ontitlad to benefits ardor Medicare, Medicaid at p~tivate iuSUranca, and if Wa era a. pattlCipating provider fa that program or wfth that insurer, wo agree to:ccapt payment from sham far your routine care, Howover, you aw still roaponafBCe for payizwg ail applicable deduoHbloa, copaymanta and coinsurance amauatta, a: well as any charger not edvared by Medicare, Madiaaid or your insurance plan, Tha Notices given to you upon ndmiesion describo tits services covered by the Medicaid daily rate, sccvices f>Zat ate covered by fNodieaid buk aro not Gncludcd in the daily rate, aAd services that arc not coveraci by Medkafd but aro aJtiilable if you requaat them apd wish to pay for their, ~~ ,. 1'ha Noifoes given to you upon atlrrtisaion also describe the servlcos covered by Medicare, end servicos that era not covered by Modlcan but are availebto If you request kham and wish to pay for them. Medicaid and Asedteare wfll pa3 for ooven+od t+upplfes and aetvicalt onty if they era cortafderod matifcaily necessary by die Medieara ar Medieaid program, IPModicaro or Medicaid dataruatna~ that a supply or wrvko Is net madicafly neoraaary, ar !f we balievn ft !snot eovared by the rules of the ask whether you atilt want that` apply ar sarvioe and If you are willing to pay for it yn s~elJ f'a~ wa wi ll Wa will only cbacge you for optional supplies and a~trvlocs that au a supply ar servcae is required in an omargency, A detailed list of the charges for all~supplios 1aes~s orviccs is maintained In the }3uaineas Oftioc and is available upon request during normal huntress hours. C, 811!!nq and Payment We will give you an itemized statement of charges that you must pay ovary month, Xou agree to pay the accoum taonthty on the fifteenth•(1 Sth) day gfoaeh month in wltlch tho statement is roceived, We aocapt paY~s in cash, by check of by eradit card, Yau else acknowledge that the charges far services provided under this Agreement remain due and payable until fully satisfied, If you era discharged for arty rcaaan, including doath, this A traasfcr and corrve Sreemont shalt operate as an assignment, ranee to We ~LtvingCenter of the amount of your aasota of sufilcicnt value W aatisi~ ail uttpald obligations under this Agreement. This aesigntrtont shall bn en oblfgation afyour estate and may bo oaforced against it to pay the LivingCenter an amount equivalent to your unpaid obiigatione artier this Agreement. OoMan t.iri~nten, Admtulor ~amoat (rov 1 fU29rty41 4t2s'Ytt0~15 tiULQENUYINO 05; 09;49p,m, 02-02-2012 1~. PaYmant of Refunds Due to You At the flute of your discharge, you Wray ba dua a refund, such as unused advtutee payments you tray have nude ilttr optional services net covered by the basic rata. Upon Actual notice of tins! aettietnent ofall third-patty chtittu, we wilt rafurni promptly any money due to you, after deducting any amouats owed by you td us. V, Transhrs and Disct~arpes You tt>aty kava otu Livingt~enter at any time without prior notice to ue. We wilt cooperate as necessary with your disoharge or transfer to another facility, 1;xcept in an arnergency, we will give rcasoaablt notice to you before transferring you to another room within our LiviagCanter. We will not discharge yea fmm our LivingCenter againei your wishes without prior written notice, ag required by law. Our writseq ntatice oftransfer or discharge against your wishes will be provided 30 days ht advance. However, we ttuy pmviik less than 30 days notice: (a) !f the reaaaa Per fire transfer or disc health ttnd aaf~r or the health and safety 4f other,iadividuala, or (b) ifyour improved haalthaltowstfop~ hart r r notltx, or (c) if you have beta is our LivinaCartter for leas than 30 days,- Our ~vrftten natke will (sciatic the ctPectlva ds-ta of dischtrrga, the loaadon to which you will be traoaferred or disehargtxl, and tits reason the discharge is nacxasary, V!. "Bad Moth" and Readrrelsslons if you will ba tentptxarily Abacni from she LiviugCaater for haspitaiization or therapeutic leave, you may .regttest the LiviatgCaattar to hold your bed doting this tuna (called a "bad hold") The Mediaara program and moat private inaunusco companiae do not cover costs rt;hued to holding your bad in these si tuatiana, Wa will ~i'y Y~ a-dlor' Y'om' Legal Idepnasdntadva of the option to pay the applicable daily rata for each day we hold Yom' bad Wxm. You and your representative have 24 hours after receiving this notice tp let us know whether you v+tmt us to hold your bat fbr you, If Medicaid is paying for your care, the state Madioaid program ttuty pay us to hold the bad for you for a limited time If you areaway from our LivingC ter dua to hoapitalizatloa for a Eonger period of time, wo will readmit you to the first availabks bed in a semi-privets room if you wish to ba raadmittzd and if the LivingCorttcr is shtc to provide the lave! of care you need and 1s oWerwiae able to meet your uaeda. Vll. Aersonal proputy and Bandar Wo strongly diacoutaYe keeping valuable Jowalry, papers. cash ar nthar items of value with you in the LivingCentar. You agree w iutbrnt us of all valuable property you br(ng with you upon admission aad at spy time new items of value are Added so (or removed from) your possession, We wilt make reaannabla eiTarca to satbgarard your belongings that you keep i» your possessioa, If our LivingCenter participates in Medicaid or Medicare and you give us your written authorization, wa will agree to hold personal finds fveyou in a trterrtter consiatcnt with alt federal and state laws and regulations, Ynu are not required. to allow ua to hold your par»onal funds for you as a condition of admission or continued swy iu our LivingCentar. Upon request, we will glue you our policies, procedures and suthorizatien forms related to our ' holding your personal ti~ada for you, 'a Vtlt. photographs , You agree that we may take photographs of you for identification, security and other purposes related to your cars, We wip not photo~aph you far any other purpose, unless you give us your prior written permission to do so, ti Oaldrn t.Ivln4Ce»taai Admiuion A greemoat(rov lan9rm) 4128771046 GOLDEN LIVING __.~ . 05tt0111 p.m, D2~02-2012 t7t. CanfldantiafiEy of Your Medlcel tnfarmatfan You have a rigln Io confidtntial treatment ofyour tnedJcal Information. Your confidentiality rights are dtsoribtd in our Notice of Privacy Practices, whJch is given to you upon admission. You may authoN2ro us to disclose modiral infbmlation about you to a family member or other person by compkting as Authorixatlan for Disclosure of Modica! information form that will be provided to you upon request, X. LlvingCenbrr Rcttes and Grfevanre procedure You agree to comply with our LfvingCentar n1les, policies and procedures, vVhcn you art admitted to the LivingCenter, we will give you a copy of our rotes, pal ides and procedures. The LivingCentar grievance ptooedure for resolution of resldcnl cumpiainta is included in .Notices given to you upon admission and also is available upon requtst. XI. E`tttlre Agreement This Agreement sad the Notices given W you upon admission constitute the entire Agreamant between ycu ~~~~; ~P~sts ff~ ur admission to our LivingCenttr, There aro no other agreements, undtrstandings, Livin enter. 'T`his A preaentatians behveen you and us as a condition of your admission to our SC gr~mtnt:upcrscdes any prior admission contracts regarding your admission to our L.IvingCenter, However, if you execute, or have executed, an Alteroativo Dispute Acso}utian Agreement with us in cont>bction with any ndmlaston tv ow LEvingCenters, thin chef Agreement shall be, and remain, binding upon yon, and upon us, In accoedanot with the terms that an sat fozth in that Agreement. !f any provisloa of this Agreement bacotnes invalid, the remaining provisions shad remain in Iltll farce end effect, The i.ivir-gCtnttr's aocaptance of a partial' payment on any occasion does vat constitute a cantinuiflg waiver of fife paymen! rtquirentonts of this Agretment, ar otherwise limit the LiringCanter's rights under This Agrtemaat. This Agreement shall be construed according to the Iowa of the State of Other than as noted for a duly euthorJzed Resi~leat's Legal Reprasentativc, the ReeIdent may nut assign or otherwise trartafa his ar her interests in this Agreement. 616 Golden LlvleaCentent AdntsNan Aaraomairt (rev 10rZ9HW) 4[28711045 GOCDpNt1VIMG ~~ oe;ze;ot+a.m. o7-tz-zott an Resident's Name; Admission t)ste; _ ~~ ,~ y.. ~_ ~I Record Number; ~•l ~1 ~/ `. I3y signing bclow~ you, your l.rgut Rcprcaentattivesnd this EvlvlnKCentcr u6rec tc- the terms of th si Admission Agrcemr:nt: "v t3y my sigriature, l uc[caawledge that ! h~~e read this Admission Agreement ar had it read to me, that 1 understand what 1 um signing, and that t accept its terms, 9ig-trlturo of Rrsidcm t)IIrC --~-"" sy my signature, I represent thus I ati~ a person duly authorized by Resident or by law to exectttc [Iris Admission Agreement and that i accept its terms. r}l •n n+ vats A~Wresr s '~-'~"~" Nhone NU't'~: Copirs afeN ttocetttiorttr veriYytns thasflutus uPtho t.eyal Aepresantetive rnusr be Obtuintsd tct the time ot'r,dmisslon, Exarnpks of the required Jocutnentg intaudo but ere not limilvc! to the following; Powor Of Attorney, Durable Power of Attantey, Healt}reetr proxy, Guardinnship Appai-ttment, ConscrveWr Appaint>ncnt and others Cphvcyin~ It:gttl aulhbNly. A LEQ+AI. Rt~PRR8ENTATIV~, IMC~,UDINGi ANY PERSON 07Hrl:i# THAN 'r'H1~ RI~IDENT CIR ~[NANCIA>LLY RE$PtaNS~B~.@ gpOUSL, MAY Nt~Y 8B RBQU1Rrt:D BY THIf3 FACILITY TO ASSUME PER80NAL RtF1/lNC1AL LIAB[t,tYTY POR THE RESiIDBNT'S CARItc., . fay signing this Agreerent tend providing current credit card information, you authorize us to charge all charges under this Agreement to youttcredit caYrd. 1f you plan ro pay using tt c;redit card, please provide the card inPorrnation below. Discaver'~ Account I!- 1/xp. MasterCarcik Account 11 ~~ Exp. _ Visax AcCUUnt # .____ ~~ ------~-----~__._.~-.- ~ Exp. fiulden LlvinyCvnt~n• .~dm~,niun ngruumunl ircv. 01~ tb) A128it 1 WS GOI.DEM UVIN6 08;78;21 a.m, 07-17-2011 THIS AGRETMENT ©QyE~~g IMRORTpNT LEC3AL R16HTS. ~'LFJ~E RE/lD IT CAREFULLY AND !N !T8 ENTIRETY 8L°~OR1E 8r13NgIM4. .,~, ~_1 rrcm tvtun0 ~u Rttatdenl - q[~~ , Y\ ~ l,t S't.F., Print Nume and Nurn er ar LivfnyC'un r Signature of Rerident Date sY rnY signature, t acknowledge that !have re t this Agreement ter hud it read to me, that t understand whet t am signing, and that !accept its terms. Signature on behalf of LivingCcnter; {, J~ "` ' LivingCcnterwitness), sign this Agreemen e a f of L{vin Center, 13 (namo of before Reaidant and/or Resident's represent tivo signed thin document ~ off yd the signer(s)tthe that (1) opportunity to read it in full, or to have lt.cead to him/her in tl(!1; (2} 1 saw"tie signature of the resident, ar of the person signing on bcha(f af.the (tcsidcnt, written ran this document. ~` lure of RcaidetN'x r . r ~ it Repttsyontarive Prlnt Names of l.ugul Rupnaenauve By my signature, t represent that l am a person duly authorized by Resident or by law to oxecute this Agreement and that t accept its terms. SPacil~ Capaofly of Legal kaprescatativo (e,g„ Yower of Attorney, Agent, Next of KinJ AdcMasa Phune Other acknawtedgments; ~. ;, ~. Printed Name and Sistuturo of gtlnr Represcnta-ive or Next of Kin Data Primed Name and Signrture nrOther Reprcxcntarivc ur Next of Kin "- Printed Name and Signature of p fthe Rupn~~nta~ f`~ ryt.xt of Kin pate `~"~' (lulden LivlnrtC'cn0.m~ Alicntarlvc D}ypwc Ruoludon Agrcumun rrav. (11~ 111) ~„~, . .. ~~•~ ~..~ ++~ 1~~~~ GGN3C CAMP HILL WEST SHORE LP 770 POP~.AR CHURCH Rp CAMP HfU. PA 17011 ltemlzed Reddens Statement Page 1 nC 1 ~C~~Bi1C CERTIFICATE OF SERVICE A true and correct copy of the within Plaintiff s Motion for Summary Judgment and Brief Support has been served by U.S. Mail, Postage Pre-Paid, on ~~day of ~'~ , 2012 upon t: following: Dennis J. Shatto, Esq. Cleckner & Fearen 119 Locust St. Harrisburg, Pa 17101 By: Sarah E. Ehasz, Esquire PA ID# 86469 Weltman,Weinberg & Reis C .P.A. 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 WWR# 9321813 GGNSC Camp Hill West Shore LP In the Court of Common Pleas of Cumberland Plaintiff Joann Shatto County,Pennsylvania No. 12 -1207 Defendant Civil Action—Law. Oath We do solemnly swear(or affirm)that we will support,obey and defend the Constitution of the United States and the Constitution of this Commonwealth and that we will discharge the duties of ou office with fidelity. Signa a Si ature Signature Kathleen K. Shaulis Linda Clotfelt R. H. Hawn ,fir. Name(Chairman) Name Name Shaulis Law Office Law Office of Linda Clotfelter Law Office of R.H.Hawn,Jr.,LLC Law Firm Law Firm Law Firm P.O. Box 1229 5021 E. Trindle Rd Suite 100 39 Old Coach Lane Address Address Address Carlisle 17013 Mechanicsburg 17050 carlisle 17013 City, Zip City, Zip City, Zip Award We,the undersigned arbitrators,having been duly appointed and sworn(or affirmed), make the following award: (Note: If damages for delay are awarded,they shall be separately stated.) To (n G 1 I�11�e�` <-t I'b 34 4 1 . f O �1 Us 1 1j, �►M .Arbitrator, dissents. (Insert name if applicable.) e Date of Hearing: 4/26/13 Date of Award: 4/26/13 (Chairman) Notice of EnPnf y war d Now,the �Ci ` day of 20 13 ,at M.,the above award was entered upon the docket and notice thereof given by mail to the parties or their attorneys. Arbitrators' compensation to be paid upon appeal: $ y16 S Z Prothonotary Deputy PILED�o JHEP OIFFlcr R I flotio TIJ .rl , 7613APR,26 Pm CtIN'RER 4 Nr L PENCS cou,4ip ef 5--z-, T!LEO-0FF10E: (JF THE PRO TH0N0 l'A i' Dennis J. Shatto 20 113 ��, �� � �. � � Attorney Id. 25675 Cleckner and Fearen CUMBERLAND COUNTY 119 Locust Street PENNSYLVANIA Harrisburg, PA 17101 717=238-1731 Attorneys for Defendant GGNSC CAMP HILL WEST SHORE LP, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS . CIVIL ACTION - LAW JOANN SHATTO, NO. 2012-1207 Civil Defendant NOTICE OF APPEAL FROM AWARD OF BOARD OF ARBITRATORS TO THE PROTHONOTARY: Notice is given that JoAnn Shatto, Defendant, appeals from the award of the board of arbitrators entered in this case on April 26, 2013 . A jury trial is demanded. I hereby certify that the compensation of the arbitrators has been paid. Respect lly submitted: Denni4sJ4Seh a t t Attorney for Appellant CERTIFICATE OF SERVICE I, DENNIS J. SHATTO, hereby certify that on this day, I served a true and correct copy of the foregoing Notice of Appeal upon the persons indicated below, by depositing same in the United States mail, first class postage prepaid, addressed as follows: Ashley L. Sweeney, Esquire Weltman, Weinberg & Reis 436 Seventh Ave Suite 1400 Pittsburgh, PA 15219 Deryck Henry, Esquire 5621 N. Front St . Harrisburg, PA 17110 Date: Z�� Z0�3 CLECKNER AND FEAREN Dennis J. Shatto, Esquire PA Attorney ID 25675 119 Locust Street P. 0. Box 11847 Harrisburg, PA 17108-1847 (717) 238-1731 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GGNSC CAMP HILL WEST SHORE, Plaintiff, No. 2012-1207 TYPE OF PLEADING: vs. PLAINTIFF'S MOTION TO DISQUALIFY OPPOSING COUNSEL JOANN SHATTO, FILED ON BEHALF OF: Defendant. Plaintiff COUNSEL OF RECORD OF THIS PARTY: Ashley Sweeney, Esquire PA I.D. # 313667 WELTMAN, WEINBERG & REIS CO., L.P.A. 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 (412) 434-7955 WWR# 9321813 rrl C) '"P ri -- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GGNSC CAMP HILL WEST SHORE, Plaintiff, No. 2012-1207 vs. JOANN SHATTO, Defendant. PLAINTIFF'S MOTION TO DISQUALIFY OPPOSING COUNSEL AND NOW, comes the Plaintiff, by and through its counsel, Weltman, Weinberg& Reis Co., L.P.A., and in support of its Motion respectfully represents as follows: 1. On February 27, 2012, Plaintiff filed a complaint against Defendant for the amount of$11,083.96, which is the amount owed to Plaintiff by Defendant for services rendered at a long term care facility. 2. Attached to that complaint was an admissions agreement executed on behalf of Defendant by her son, Dennis Shatto. 3. Dennis Shatto is an attorney who is representing his mother in the instant case. 4. On April 26, 2013, an arbitration was held. 5. During the arbitration, Dennis Shatto was questioned, under oath, and he admitted to executing the admissions agreement so that his mother could enter the facility and begin receiving care. 6. An arbitration award was granted in favor of Plaintiff. 7. Defendant has appealed the arbitration award. 8. Plaintiff intends on calling Dennis Shatto as a witness at the impending trial. 9. According to Pennsylvania Code Rule 3.7, "[a] lawyer shall not act as advocate at a trial in which the lawyer is likely to be a necessary witness..." 10. Plaintiff avers that allowing Dennis Shatto to remain Defendant's attorney and also be called as a witness by Plaintiff would be confusing, misleading, and a conflict of interest. 11. As a trial date has not yet been set, this disqualification would not cause Defendant substantial hardship because she will still have ample time to hire a different attorney. WHEREFORE, Plaintiff humbly requests that this Honorable Court enter an order stating that Dennis Shatto is not permitted to serve as counsel for Defendant because he will be called as a witness for Plaintiff at trial. Respectfully Submitted: A ley S -ene , Esquire PA I.D. # 313667 WELTMAN, WEINBERG &REIS CO., L.P.A. 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 (412) 434-7955 WWR# 9321813 CERTIFICATE OF SERVICE A true and correct copy of the within Plaintiff's Motion to Disqualify Opposing Counsel has been served by U.S. Mail, Postage Pre-Paid, on 22 J of No tie/AC,' , 2013 upon the following: Dennis Shatto, Esq. 119 Locust St. Harrisburg, PA 17101 BY: AA _ AK: _ .. _. -ylSwe- ey, Esqu' 04n i �) 3 PRAECIPE FOR LIS G C SE OR ARGUMENT (Must be typewritten and submitted in triplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: (List the within matter fo ,.the=[a1>rxt Argument Court.) Plaintiffs Motion to Disqualify Opposing Counsel CAPTION OF CASE r (entire caption must be stated in full) (.1),7 W _ GGNSC CAMP HILL WEST SHORE C) vs. - s ,:' JOANN SHATTO No. 1207 2012 Term 1. State matter to be argued (i.e., plaintiff's motion for new trial, defendant's demurrer to complaint, etc.): Plaintiffs Motion to Disqualify Opposing Counsel 2. Identify all counsel who will argue cases: (a) for plaintiffs: Ashley Sweeney, Esquire (Name and Address) 1400 Koppers Bldg., 436 Seventh Avenue, Pittsburgh, PA 15219 (b) for defendants: Dennis Shatto, Esquire (Name and Address) 119 Locust Street, Harrisburg, PA 17101 3. I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: e b LA j r rr �7, 2 01 q Ashley Sweeney, Esquire Signature AK mint y•ur Plaintiff Date: / ( a(R 201 ? Attorney for INSTRUCTIONS: 1. Original and two copies of all briefs must be filed with the COURT ADMINISTRATOR(not the Prothonotary) before argument. 2.The moving party shall file and serve their brief 14 days prior to argument. 3.The responding party shall file their brief 7 days prior to argument. 4. If argument is continued new briefs must be filed with the COURT ADMINISTRATOR(not the Prothonotary)after the case is relisted. aAk kq CtJ II 39 ySq, 4-.99 s4s • CERTIFICATE OF SERVICE A true and correct copy of the within Praecipe for Listing Case for Argument, on Plaintiff's Motion to Disqualify Opposing Counsel, has been served by U.S. Mail, Postage Pre-Paid, on__ of n px , 20 / upon the following: Dennis Shatto, Esquire 119 Locust Street, Harrisburg, PA 17101 By: an t ' ,/ GGNSC CAMP HILL WEST IN THE COURT OF COMMON PLEAS OF SHORE, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff CIVIL ACTION—LAW vs. NO. 2012-1207 JOANN SHATTO, Defendant IN RE: PLAINTIFF'S MOTION TO DISQUALIFY OPPOSING COUNSEL RULE TO SHOW CAUSE AND NOW, this y day of December, 2013, in consideration of the Plaintiff's Motion to Disqualify Opposing Counsel: 1. A rule is issued upon the defendant to show cause why the relief requested ought not to be granted; 2. the defendant shall file an answer to the petition within twenty (20) days of service; 3. the petition shall be decided under Pa. R.C.P. No. 206.7; 4. argument is set for January 8, 2014, at 9:15 a.m. in Courtroom Number 4; and 5. notice of the entry of this order shall be provided to all parties by the plaintiff. BY THE COURT, Kevi . Hess, P. J. c M a C i;3 `. r FILED-OFFICE OF THE PROTHONOTARY MI 3 DEC 16 Pfl 2: 143 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION GGNSC CAMP HILL WEST SHORE Plaintiff No. 2012-1207 vs. AFFIDAVIT OF SERVICE OF THE RULE TO SHOW CAUSE ORDER OF COURT JOANN SHATTO Defendant FILED ON BEHALF OF Plaintiff COUNSEL OF RECORD OF THIS PARTY: Ashley Sweeney,Esquire PA. I.D.#31.3667 WELTMAN, WEINBERG&REIS CO., L.P.A. 1400 Koppers Building 436 Seventh Avenue Pittsburgh,PA 15219 (41.2)434-7955 WWR#09321813 • IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CIVIL DIVISION GGNSC'CAMP HILL WEST SHORE Plaintiff No. 2012-1207 vs. JOANN SHATTO Defendant AFFIDAVIT OF SERVICE OF THE RULE TO SHOW CAUSE ORDER OF COURT BEFORE ME, the undersigned authority, personally appeared Ashley Sweeney, Esquire, who according to law deposes and says that a copy of the Rule to Show Cause Order of Court has been served on the following Defendant's Attorney, Dennis Shatto,Esquire. 1. On or about December 10, 2013, Plaintiff received a Rule to Show Cause Order of Court dated December 04, 2013, issuing a Rule upon Defendant to file an answer to Plaintiff's Motion to Disqualify Opposing Counsel and the argument scheduled for January 08, 2014. Said Rule to Show Cause Order of Court is attached as Exhibit"1". 2. On or about December 11, 2013, Plaintiff mailed the Rule to Show Cause Order of Court to 119 Locust Street, Harrisburg, PA 17101. WELTMAN, WEINBEERG&REIS,CO.,L.P.A. - ne , squire PA I.D. # 136. WELTMAN, WEINBERG& REIS CO., L.P.A. 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 (412)434-7955 WWR#09321813 Sworn to and subscribed before me this le' day of ›vc..err.1 ,20 13 . ,dryfes_t_ _ OTY PUB COMMONWEALTH OF PER ■ A Notarial Seal Wayne A.Jones,Notary Public City of Pittsburgh,Allegheny County _My Comadcsksn Tres M ae 2014 ���,,:fs ada m• otailas GGNSC CAMP HILL WEST : IN THE COURT OF COMMON PLEAS OF SHORE, : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff : CIVIL ACTION—LAW vs. : NO. 2012-1207 JOANN SHATTO, . Defendant . IN RE: PLAINTIFF'S MOTION TO DISQUALIFY OPPOSING COUNSEL RULE TO SHOW CAUSE AND NOW, this 1- day of December, 2013, in consideration of the Plaintiff's Motion to Disqualify Opposing Counsel: ,l. A rule is issued upon the defendant to show cause why the relief requested ought not • to be granted; 2. the defendant shall file an answer to the petition within twenty(20)days of service; 3. the petition shall be decided under Pa. R.C.P. No. 206.7; 4. argument is set for January 8, 2014, at 9:15 a.m. in Courtroom Number 4; and 5. notice of the entry of this order shall be provided to all parties by the plaintiff. BY THE COURT, ' AL Kevi A . Hess, P. J. C) ,"..a C. -,. L I EXHIBIT ....... 7,7.3 ZrD 5.--:, 0 q 7Z / ti Dennis J. Shatto tti C Attorney Id. 25675 1113 DEC 27 p Cleckner and Fearen 411ID: 23 119 Locust Street CUMBERLAND Harris urg, PA 17101 PENNSYLVANIA Attorneys for Defendant GGNSC CAMP HILL WEST SHORE LP, IN THE COURT OF COMMON PLEAS Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA VS . CIVIL ACTION - LAW JOANN SHATTO, NO. 2012-1207 Civil Defendant DEFENDANT' S ANSWER TO MOTION TO DISQUALIFY COUNSEL 1 . It is admitted that Plaintiff filed a complaint. The characterization of the content of the complaint is denied because the complaint speaks for itself. 2 . Denied. It is denied that there was an agreement between Plaintiff and Defendant . The document attached to the complaint was not completed, lacks material terms, including price, and does not constitute a binding contract . The statement that the document was executed on behalf of Defendant by her son, Dennis Shatto, is a conclusion of law. An agency relationship cannot be established by acts or conduct of the purported agent . 3 . Admitted. 4 . Admitted, but irrelevant. The decision of the arbitrators was appealed. 5 . Denied as stated. During the arbitration, Dennis Shatto, despite his objection, was called as a witness at the request of one of the panel members . There is no record of his testimony, and Mr. Shatto does not recall the exact questions he was asked, or his verbatim responses . Among other testimony and explanations, he stated that his signature appears on the document attached to the complaint. 6. Admitted, but irrelevant. The decision of the arbitrators was appealed. 7 . Admitted, but irrelevant . This is a de novo proceeding. 8 . Denied, on the basis that Defendant has no way of knowing whom Plaintiff will call as witnesses at trial . 9. It is admitted that the quoted language appears in Rule 3 . 7 of the Disciplinary Code. The Code speaks for itself. In any event, the rule does not purport to prohibit an attorney from representing the client other than as an advocate at trial. 10 . Denied. Prior to the arbitration, Mr. Shatto was not asked, through discovery or otherwise, whether or not his signature appears on the document attached to the complaint as exhibit "A". It is a fact which has never been in dispute, and will not be in dispute at trial . Mr. Shatto' s continuing representation of his mother is not confusing, misleading or a conflict of interest. If it becomes necessary for Plaintiff to call Mr. Shatto as a witness at trial on a disputed fact, the Court can determine at that time, whether (or the extent to which) Mr. Shatto can continue to act as advocate . The rule does not prohibit his representation in pre-trial proceedings . 11 . Denied. Defendant has a right to be represented by the attorney of her choice. Moreover, the rule does not provide a basis for disqualification in representation in pre-trial proceedings . WHEREFORE, Defendant respectfully requests that the Motion be denied as premature. Respectfu ly submitt d, De Shatto Pa. Attorney Id. 25675 CLECKNER AND FEAREN 119 Locust Street Harrisburg, PA 17101 717-238-1731 Dated: 1-11-16-13 Attorneys for Defendant CERTIFICATE OF SERVICE I, DENNIS J. SHATTO, hereby certify that on this day, I served a true and correct copy of the foregoing document upon the person (s) indicated below, by depositing same in the United States mail, first class postage prepaid, addressed as follows : Ashley Sweeney, Esquire Weltman, Weinberg and Reis 1400 Koppers Building 436 Seventh Avenue Pittsburgh, PA 15219 CLECKNER AND FEAREN By Dennis J. Shatto, Esquire PA Attorney ID 25675 / 119 Locust Street Date: ��J��J�3 P. 0. Box 11847 Harrisburg, PA 17108-1847 (717 ) 238-1731 GGNSC CAMP HILL IN THE COURT OF COMMON PLEAS OF WEST SHORE LP, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff . • • V. JOANN SHATTO, CIVIL ACTION - LAW Defendant NO. 2012-1207 CIVIL TERM IN RE: MOTION TO DISQUALIFY COUNSEL ORDER OF COURT AND NOW, this 8th day of January, 2014, upon suggestion that the motion is premature, ruling on the request for disqualification of opposing counsel is deferred. By the Court, WAIL Kevi A. Hess, P. J. , <_;eryck Henry, Esquire For the Plaintiff Dennis J. Shatto, Esquire For the Defendant : lfh . Cap IE.S rnZ.1 if.ri. r-,--),UD c___ 7_- `/9//641 r- `