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Home My WebLink About06-13-12NOTICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF FLORENCE Z. YAWGER, DECEASED No. 21-12-401 To the Clerk of the Orphans' Court Division: Kindly enter the claim of Sarah A. Todd Memorial Home in the amount of $15,473.69 against the above-captioned Estate. The claim is a priority claim under 20 Pa.C.S.A. §3392(3) for nursing facility services within six (6) months of the date of death. The Decedent,, who resided at Sarah A. Todd Memorial Home, died on January 25, 2012. Written notice of said claim was given to Andrew C. Sheely, Esq., counsel for the estate of Florence Z. Yawger, at 127 South Market Street, Mechanicsburg, PA 17055 on June 12, 2012. Claimant: Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Respectfully Submitted, Date: ~J ~ ~ ~ `~ ~~ :.~ ~- - . N O ' ' a _~~ ca 4n ~ 3 r i L ~ ~ Q~ .. .. a -` N 0 . c--> ~`.~+ Latsha Davis & McKenna, P.C. __ ~_ ~ ~,A _ Steven M' Montresor Attorney No. 74244 1700 Bent Creek Boulevard, Suite 140 Mechanicsburg, PA 17050 Phone: (717) 620-2424 Fax: (717) 620-2444 smontresor@ldylaw. com 149694v1 v~h SARAH A. TODD MEMORIAL HOME 1000 West South Street, Carlisle, PA 17013 (717) 245-2187 • (717) 245-9733 FAX www.ucc-homes.or~; 6/11/12 Billing & Payment Inquiry Florence Z Yawger Res#: 102335 Ending Balance: 15,473.69 PP Billed: 36,717.56 Payments from Responsible party: 20,798.52. Payments from Grane Hospice 445.35 Total PP Payments: 21,243.87 Net Due: 15,473.69 Sarah A Todd Memorial Name 1000 West South Street Carlisle, PA 17013-2798 l-elephone: (717} 245-2187 Atty Andrew Sheely 127 S. Market Street Apt S Mechanicsburg, PA 17055-0095 STATEMENT Statement Date: 05/10J2012 Due Date: 05/25/2012 Amount Enclosed $ Amount Due: $ 15,473.69 Account #: 102335 RE: Florence Z Yawger Current 31-50 Days 61-90 Days Over 90 Days Amount Due V .00 AO .00 15,473.69 ~~n IYV 1 [. ' '-'-`-' Yf1T PlCiv I iJ vu[ UrVIV KLZ.Clrl ""' RU1 PSV WI [K THE 25TH OF THE MOMH ***** Please remit the LAST AMOUNT your statement. Include the ACCf# from the statement on the MEMO of your check. Payments after 5/7/12 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECTTOA 1.25% LATE CHARGE PER A $14.0 FEE WILL BE CHARGED for RETURNED CHECKS *' Florence ZYawger -Account #: 102335 Sarah ATodd Memorial Nome 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717} 245-2187 Statement Date: 05/1OJ2012 Due Date: 05,/2S/2012 STATEMENT Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17D13-2798 Telephone: (717) 245-2187 Statement Date: 04/12/2012 Due Date: 04/25/Z012 Amount Enclosed $ Amount Due: $ 15,473.69 Account#: 102335 RE: Florence Z Yawger Atty Andrew Sheely 127 S. Market Street Apt B Mechanicsburg, PA 17055-0095 ~d S., :~' _ t _ ~ ` x __,.:'~... ~ »_.._. - _ _....._ .-. ....,. ,.. t , ... . 4 .:. R~ie ~.~.~..' ~ . Ckiar ss -„ '~' _., _i~ `SAL .,~ f _~'°;; ~ ~'-A 1aJtii_ Balance B/F 15,473.b9 i _ . 15,473.69 ~, i li I Current 31-60 Days 61-90 Days ~ Over 90 Days Amount Due .00 .00 6,762.66 8,711.03 15,~73.6~ wv i C. ~ ~ ~ ~ I'M l l•I CiV i 1J UV C UYVIV ttCl..C1Y l '°"'T C5U 1 IVV W I GK THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT your statement. Include the ACCT# from the statement on the MEMO of your check. Payments after 4/11/12 do not ref]ect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.2596 LATE CHARGE PER A X10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Florence Z YaNrger - Acco;.~nt #: 102335 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Teie~hone: (717) Z45-2187 Statement Date: 04/12/2012 Due Date: 04/25/2012 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Atty Andrew Sheely 127 S. Market Street Apt B Mechaniaburg, PA 17055-0095 STATEMENT Statement Date: 03/i2/2012 Due pate: 03/25/2012 Amount Enclosed $ Amount Due: $ 15,473.69 Account #~: 102335 RE: Florence Z Yawger Current 31-60 Days 61-90 Days Over 90 Days Amount Due .00 6,762.66 319.17 8 391.86 ~'~• '~=t ivvi~. ~ ~ ~ ~-- rri n-i ov i t~ UUC Ut'VIV KCLCIYI T°°T' tSVI IVV Vil tK THE 25TH pF THE MONTH ***** Please remit the LAST AMOUNT your statement. Include the ACCT# from the statement on the MEMO of your check. Payments after 3/9/12 do nat reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.Z5% LATE CHARGE PER A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Florence ZYawger -Account #.:102335 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: {717} 295-2187 Statement Date: 03/12/2012 Due Date: 03J25/2012 STATEMENT Sarah A Todd Memorial Hame 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 02/13J20i2 Due Date: 02/25/2012 Amount Enclosed $ Amount Due: $ 15,473.69 Account #: 102335 RE: Florence Z Yawger Kim Parent 804 Lancelot Avenue Mechanicsburg, PA 17055 Current 31-60 Days 61-90 Days C+ver 90 Days Amount Due 6,762.66 319.17 8,391.86 .00 ..- ~ _- ,y.~-~3_;-_ ~ NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NU LAI kR THE 25TH OF THE MONTH ***** Please remit the tASf AMOUNT your statement. Include the ACCT# from the statement on the MEMO of your check. Payments after 2,9/12 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUB)ECr TO A 1.25% LATE CHARGE PER A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Florence ZYawger -Account #: 102335 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 02/13/2012 Due Date: 02/25/2012 STATEMENT Sarah ATodd Memor"saE Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 01/12/2012 Due Date: 01,125/2012 Amount Enclosed $ Amount Due: $ 17,267.03 Account #: 1OZ335 RE: Florence Z Yawger Kim Parent 804 Lancelot Avenue Mechanicsburg, PA 17055 ._ ... Balance B/F 8,837.21 - 8,837.21 12/07/II GRAVE HOSPICE 445.35 8,391.86 12/01/11 Medical Supplies 165 .68 200.84 8,592.70 12/14/11 Incontinence Supplies 6 10.40 62.40 8,655.10 12/21/11 Personal Supplies 1 1.18 1.18 8,656.28 12/31/11 Personal Laundry Services 1 30.00 30.00 8,686.28 12/31/11 Cable Television 1 24.75 24.75 8,711.03 01/01/12 - 01/31/1 Room & Board -Semi-Private 31 276.00 8,556.00 17,267.03 I Current 1-30 Days 31-60 Days 61-90 Days Over 90 Days Amount Due .00 8,875.17 6,391.86 .00 .00 ~¢~... .,T ~;' NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BU[ NU LAI tK THE 25TH OF THE MONTH ***** Ptease remit the LAST AMOUNT your statement. Include the ACCr# from the statement on the MEMO of your check. Payments after 1/IO/12 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER A $1D.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Florence ZYawger -Account #: 102335 Sarah A Todd Memorial Horne 1000 West South Street Carlisle, PA 17013-2798 Telephone: {717) 245-2187 Statement Date: Ol/I2/2012 Due Date: 01/25/2012 STO~TEM EIVT Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-218 7 Statement Date: 12f 13/2011 Due Date: 12J26/2011 Amount Enclosed $ Amount Due: $ 8,837.21 Account #: 102335 RE: Florence Z Yawger Kim Parent 804 Lancelot Avenue Mechanicsburg, PA 17055 ~, ~ ~ . ' . -. _. - k .. _~t.._,_ _. .. .~. , ,. . .. Balance B/F 8,652.54 8,652.54 11/18/11 PARENT, K1M 8,207.19 445.35 11/01/11 Medical Supplies 120 .68 41.11 536.46 11/30/11 Personal Laundry Services 1 30.00 30.00 566.46 11/30/11 Cable Television 1 24.75 24.75 591.21 12/01/11 - 12/31/11 i I Room & Board -Semi-Private 31 266.00 8,246.00 8,837.21 ~ f Current 1-30 Days 31-6Q Days fit-90 Days Over 9D Days Amount Due ~ .00 8,391.86 445.35 .00 r ~`` t .00 ~ ' 8;-8 ~.2~, ~,.~ NOTE: ***** PAYMENT IS DU[ UPON RECEIPT ***** BUT NO 1111 ER THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT your statement. Include the ACCT# from the statement on the MEMO of your check. Payments after 12/8111 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUB]ECT TO A 1.25% LATE CHARGE PER A $10.00 F'cE WILL BE CHARGED for RETURNED CHECKS ** Florence ZYawger -Account #: 102335 Sarah A Todd Memorial Nome 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 12/13/2011 Due Date: 12/26/2011 STATEMENT Sarah ATodd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Cate: 11/11/2011 Due Date: 11/25/2011 Amount Enclosed $ Amount Due: $ 8,207.19 Account #; 102335 RE: Florence z Yawger Kim Parent 804 Lancelot Avenue Mechanicsburg, PA 17055 °~ '' . ` t - Date, ~ _ ~ ~ l ~'.:_''ta~F"'H+, ~'~.~.~ ~ ~_ ~ 7}a ~i ~Y~' .. ~:--~~r,Res'crs .oJl~~~rr-~ .~., ,,~ . Aav ~: ualL ~°' ~-~~$i ~` ~^~~~ ..lw.Rate ~'''I-~vr ~~arfa:>.:_ .,+~~ChaC es 7k~'~~;s~~- , Ra:: a is ~~.~ 'x` r~..; .: Ba~anees ^ 10/19/11 Balance 8/>= PARENT, KIM 1Z,591.33 12,59L33 12,591.33 .00 10/01/il Medical Supplies 122 .68 124.84 124.84 10/10/11 Guest Meals -Supper SNF 1 6.13 6.50 131.34 1Oj23/11 Medical Equipment Rental 2 19.54 39.08 170.42 10/31/11 Personal Laundry Services 1 30.00 30.00 200.42 10/31/11 Cable Television 1 24.75 24.75 225.17 10/31/11 Personal Supplies 1 2.02 2.02 227.19 11/Ol/11 - 11/30/11 Room & Board -Semi-Private 30 266.00 7,980.00 8,207.19 Current 1-30 Days 31-b0 Days 61-90 Days Over 90 Days Amount Due ~ .o0 8,207.19 .oo .oo .oo .s,,?oT ~9 NOTE: ***** PAYMENT IS DUE UPON RECEIPT **"`"`* t3U i NU uai ttt THE 25TH OF THE MONTF- ***** P{ease remit the LA.S f AMOUNT your statement. Include the ACCI•# from the statement on the MEMO of your check. Paymen*s after 11/10/11 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.25% LATE CHARGE PER A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Florence ZYawger -Account #: 102335 Sarah A Todd Memorial Hon-,e 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717} 245-2187 Statement Date: 11/11/2011 Due Date: 11/25/2011 STATEMENT Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 Statement Date: 10/11J2011 Due Date: 10/25/2011 Amount Enclosed $ Amount Due: $ 12,591.33 Account #: 102335 RE: Florence Z Yawger Kim Parent 804 Lancelot Avenue Mechanicsburg, PA 17055 09/25/11 _-- p _ , Personal Su plies 1 2.70 2.70 _ _._ 2 70 09/27/11 09/30/11 Medical Supplies Cable Television 44 1 .68 31.88 . 34.58 09/15/11 - 09/30/1 Room & Board -Semi-Private 16 24.75 266.00 24.75 4,256.00 59.33 4 315 33 09/30/11 10/O1/il - 10/31/11 Personal Laundry Services Room & Board -Semi-Private 1 31 30.00 266 00 30.00 246 8 00 , . 4,345.33 12 . , . ,591.33 1 Current 1-30 Days 51-60 Days 61-90 Days Over 90 Days ~ Amount Due ~ .00 ~ 12,591.33 I .00 00 I 00 ~ `~ NOTE. ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT your statement. Tndude the ACCT# from the statement on the MEMO Statement Date: 10/11/2011 of your check. Payments after 10/11/11 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECTTO A 1.25% LATE CHARGE PER Due Date: 10/25/2011 A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** Florence ZYawger -Account #: 102335 Sarah A Todd Memorial Home 1000 West South Street Carlisle, PA 17013-2798 Telephone: (717) 245-2187 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF FLORENCE Z. YAWGER, DECEASED No. 21-12-401 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United States mail, postage prepaid, upon the following: Andrew C. Sheely, Esq. 127 South Market Street Mechanicsburg, PA 17055 Dated: ~' ~' ,,~' - ~. D ~2 ,--- - -~ i ~> Steven M. Montresor 149694v1