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Home My WebLink About12-6095IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ~~ CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTIONn~ -t?' r-- -~- KAY L. HAND, Individually and as LORI L. WALLOWER, D.O. ~ Co-Executor of the Estate of 204 Mumper Lane, Suite 1 ~ °~ MARGARET R. ALBERT, Deceased Dillsburg, PA 17019 ~ d 169 Yorktowne Road York, PA 17408 BONNIE S. PEPO, Individually and as Co-Administrator of the Estate of MARGARET R. ALBERT, Deceased 1659 Lisburn Road Wellsville, PA 17365 Plaintiffs DILLSBURG FAMILY HEALTH CENTER 204 Mumper Lane, Suite 1 Dillsburg, PA 17019 HOLY SPIRIT HEALTH SYSTEM 503 North 21St Street Camp Hill, PA 17011 ,..., cn rr- -v N -a ca 0 tsa SPIRIT PHYSICIAN SERVICES, INC. 205 Grandview Avenue, Suite 210 Camp Hill, PA 17011 A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a ELMCROFT OF DILLSBURG 153 Logan Road Dillsburg, PA 17019 Tom.,. r ~--. ~;~ ° ~', ~ ..,.; ~-: -~; ~~_~ r> ALERT PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY 219 North Baltimore Avenue Mt. Holly Springs, PA 17065 JURY TRIAL DEMANDED Defendants versus ~ l~~ ~~ S ~~ ~, PRAECIPE FOR WRIT OF SUMMONS 0 Q~~ ~tia~ ~ ~~.asi3~3 TO THE PROTHONOTARY OF SAID COURT: Please issue a Writ of Summons in the above-captioned action. X Writ of Summons shall be issued and forwarded to ()Attorney and (X) Sheriff Michal J. Navitsky, Esquire I.D. No. 58803 Navitsky, Olson & Wisneski LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 (717)541-9205 „~ 9- ab- is IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -MEDICAL PROFESSIONAL LIABILITY ACTION KAY L. HAND, Individually and as Co-Executor of the Estate of MARGARET R. ALBERT, Deceased 169 Yorktowne Road York, PA 17408 BONNIE S. PEPO, Individually and as Co-Administrator of the Estate of MARGARET R. ALBERT, Deceased 1659 Lisburn Road Wellsville, PA 17365 LORI L. WALLOWER, D.O. 204 Mumper Lane, Suite 1 Dillsburg, PA 17019 DILLSBURG FAMILY HEALTH CENTER 204 Mumper Lane, Suite 1 Dillsburg, PA 17019 HOLY SPIRIT HEALTH SYSTEM 503 North 21S` Street Camp Hill, PA 17011 SPIRIT PHYSICIAN SERVICES, INC. 205 Grandview Avenue, Suite 210 Camp Hill, PA 17011 A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a ELMCROFT OF DILLSBURG 153 Logan Road Dillsburg, PA 17019 ALERT PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY 219 North Baltimore Avenue Mt. Holly Springs, PA 17065 JURY TRIAL DEMANDED Plaintiffs versus Defendants ~. l ~.- ~DO9 5 ~'~t't WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANTS: YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFFS HAVE COMMENCED AN ACTION AGAINST YOU. -~~ :~~~ Prothonotary Dated: a p ~~ b Deputy Craig A. Stone, Esquire I.D. No. 15907 Marshall, Dennehey, Warner Coleman & Goggm ' 1. E, €1r' I .? l 4200 Crums Mill Road, Suite B Harrisburg, PA 17112 COUNTY (717) 651-3500 Phone s}EN SYLVr NIA (717) 651-9630 Facsimile Attorneys for Defendant, A.L. Dillsburg Operations, LLC t/d/b/a Elmcroft of Dillsburg KAY L. HAND, Individually and as the Co- Executor of the Estate of MARGARET R. ALBERT, Deceased and BONNIE S. PEPO, Individually and as Co-Administrator of the Estate of MARGARET R. ALBERT, deceased, Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO. 2012-6095 V. LORI L. WALLOWER, DO.; DILLSBURG FAMILY HEALTH CENTER; HOLY SPIRIT HEALTH SYSTEM; SPIRIT PHYSICIAN SERVICES, INC.; A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a/ ELMCROFT OF DILLSBURG; and ALERT PHARMACY SERVIES, INC., JURY TRIAL DEMANDED ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance on behalf of Defendant, A.L. Dillsburg Operations, LLC t/d/b/a Elmcroft of Dillsburg in the above-captioned matter. , WARNER I0-IS-Ia Craig A.Sfone?-EsZruire " Attorney ID # 15907 4200 Crums Mill Road, Suite B Harrisburg, PA 17112 Phone: (717) 651-3502 Facsimile (717) 651-9630 Email: castone@mdwcg.com CERTIFICATE OF SERVICE I hereby certify that I am this -]`J?day of 2012, serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pa. Rules of Civil Procedure and by depositing a copy of same in the United States Mail, first-class postage prepaid, addressed as follows: Michael J. Navitsky, Esquire Thomas M. Chairs, Esquire Navitsky, Olson & Wisneski, LLP Dickie, McCamey & Chilcote, P.C. 2040 Linglestown Road 425 N. 21" Street, Suite 302 Suite 303 Camp Hill, PA 17011 Harrisburg, PA 17110 Represents, Lori L. Wallower, D. 0., Dillsburg Represents Plaintiffs Family Health Center, Holy Spirit Health System, Spirit Physician Services, Inc. Charles J. Daly, Esquire 1155 Business Center Drive Suite 160 Horsham, PA 19044 Represents Alert Pharmacy COLEMAN Craig A. Ston?'Esquire Attorney ID # 15907 , WARNER 4200 Crums Mill Road, Suite B Harrisburg, PA 17112 Phone: (717) 651-3502 Facsimile (717) 651-9630 Email: castone(i?mdwcg com 05/953165.v1 THE LAW OFFICE OF CHARLES J. DALY, ESQ. By: Charles J. Daly, Esquire Attorney ID: 28200 1 155 Business Center Drive, Suite 160 Horsham, PA 19044 Phone: (215) 443-8901 Fax: (215 443-8903 E-Mail: C'huck.Daly(a~,SA-Trial.com KAY L. HAND, INDIVIDUALLY AND AS THE CO-EXECUTOR OF THE ESTATE OF MARGARET R. ALBERT, DECEASED AND BONNIE S. PEPO, INDIVIDUALLY AND AS CO-ADMINISTRATOR OF THE ESTATE OF MARGARET R. ALBERT, DECEASED. Plaintiffs, v. LORI L. WALLOWER, D.O.; DILLSBURG FAMILY :HEALTH CENTER; HOLY SPIRIT HEALTH SYSTEM; SPIRIT PHYSICIAN SERVICES. INC.; A. L. DILLSBURG OPERATIONS, LLC, T/D/B/A ELMCROFT OF DILLSBURG; AND ALERT PHARMACY SERVICES, INC., T/D/B/A ALERT PHARMACY' Defendants. Attof-ncw.;F~r Defendant, Alert Pharmr.rci ,Service II COURT OF COMMON PLEAS ~.:: =;~ e:~ CUMBERLAND COUNTY PA .,~~ ~ ~ `, ~==' . . , , - _._; NO. 12-6095 CIVIL, ~_~. ` JURY TRIAL DEMANDED c ~ ~„ y~~ ~~~: :~w,_ _._ ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance on behalf of Defendant, Alert Pharmacy Service lI, in the above-captioned matter. Respectfully submitted: THE LAW OFFICE OF CHARLES J. DALY, ESQ. ~: J Charles J. Daly, Esquire -~----~ - Attorney for Defendant, Alert Pharmacy Service II Dated: October l7, 2012 THE LAV4' OFFICE OF CHARLES J. DALY, ESQ. By; Charles J. Daly. Esquire Attorney ID: 28200 1 155 Business Center Drive, Suite 160 Horsham, PA 19044 Phone: (215) 443-8901 Fax: (215) 443-8903 KAY L. HAND, INDIVIDUALLY AND AS THE CO-EXECt1TOR OF THE ESTATE OF MARGARET R. ALBERT, DECEASED AND BONNIE S. PEPO, INDIVIDUALLY AND AS CO-ADMINISTRATOR OF THE ESTATE, OF MARGARET R. ALBERT, DECEASFD. Plaintiff, v. LORI L. WALLOWER, D.O.; DILLSBURG FAMILY HEALTH CENTER; HOLY SPIRIT HEALTI-i SYSTEMg SPIRIT PHYSICIAN SERVICES, INC.; A. L. DILLSBURG OPERATIONS, LLC', T/D/B/A ELMCROFT OF DILLSBURG; AND ALERT PHARMACY SERV"ICES, INC., T/D/B/A ALERT PHARMACY Defendants. Attorneti°,for Defendant, Alert Phur~nzac~v Service II COURT OF COMMON PLEAS CUMBERLAND COUNTY. PA NO. 12-6095 CIVIL JURY' TRIAL DEI`/1ANDED CERTIFICATE OF SERVICE I, Charles J. Daly, Esquire, counsel for Defendant Alert Pharmacy Service II. do hereby certify that on the l 7`h day of October, 2012, I filed wi1:h the Court am Entry of Appearance, and served a true and correct copy of the same via first class mail, postage prepaid upon the parties as follows: Michael Navitsky, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestawn Road, Suite 303 Harrisburg, PA 171 l0 Thomas M. Chairs, Esquire Dickie, McCarney & Chilcote, PC Plaza 21, Suite 303 425 North 21st Street Camp Hi]l, PA 17011 Craig Stone, Esquire Marshall, Dennehey, Warner, (~oleman & Goggin 4200 Gums Mills Road Suite B Harrisburg, PA 171 12 r ~////// /~ Charles J. Daly, Esquire 1 ~1 13 2 ~) :'~ DICKIE, MCCAME.Y & CHILCOTE, P.C. BY: Thomas hl. Chairs, Esquire ATTORNEI' I.D. NO. 78565 BY: Aaron S. Jayman, Esquire ATTORNEI' LD. NO. 85651 Plaza 21, Suite 302 425 North 21st Street Camp Hill, PA 17011 717-731-4800 ('I'elc) 888-811-7144 (h"ax KAY L. HAND, individually and as Co- Executur of the Estate of MARGARET R. ALBF.R7', Deceased and BONNIE S. PEPO, individually and as Co-Executor of the Estate of MARGARET R. ALBERT, Deceased. Plaintiffs -_ A~f"I'ORNEI' FOR: DF:FENUAN"1'S LORI L. WALLOR'ER, D.O., DILLSBURC FAMILI' '~ HEAL'CH CENTER, HOLY SPIRIT HEAL"1'H SYS"TEM, j AND SPIRIT PHYSICIAN SERVICES, INC. ~-- --- -- I IN "THE COURT OF COMMON PLEAS OF Ci_!MBF.RLAND COON"Tl', ~~ PENISSYI,~'ANI;t NO. 12-6095 CIVIL ACTION -MEDICAL ~~. LORI L. WALLOWER, ll.0., UILLSBIJRG FAMILY HEALTH CEN"TER, HOLY SPIRIT HEALTH SYS'I'F,M, SPIRIT PHYSICIAN SERVICES, INC., A.L. DILLSBURC OPERATIONS, LLC, t/d/b/a ELMCROFT OF DILLSBURC and ALERT PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY, Defendants JURY TRIAL llEMANllF,U , ., --, _ ,, - .. a ~::: --- - ~.... -.. ~, :_-: c~.. ~ __ k'._~ ENTRY OF APPEARANCE TO'l'HF; PROTHONOTARY: Please enter the appearance of Thomas M. Chairs, Esduire and ,baron S. Jai man. l ,quire, as counsel for Defendants, Lori L. Wallower, D.O., Dillsburg Family Health Center, Holy Spirit f Icahh S~~stem. and Spirit Physician Services, Inc., in the above-captioned rnarier. Respectfully submitted. DICKIE, MC('~1MEY & CIJILCO"1'1~:, P.('. -.- ~ J ~ l -- -- Date: C)ctober 17. 2012 f3y'- ~ Nq. Cl~ ~ ~~~~ "Thom airs,`Isquirc Supreme Court I.D. #78565 Aaron S. Jayman, Esquire Supreme Court I. D. #85651 425 N. 2I~` Street, Suite 302 Camp 14;11. P-1 ? 701 1. -37ri(! (71 "7) 731-4800 (888) 811-7144 ,t111oene~~ J~~r Uc'1c~r~dui~t~, l.r~rr ~.. 6!',~/lu~rc~~~ U.U., l~illsbur~ l~~u~rrili~ llcul~h Cej'rlc~r. Il~~/~, :~j>ir~rl Ilr~~/lh S'yslem, and .S~~iri~ Ph1-~siciar7 Sc~rrrcc~s /~u~. 2 CERTIFICATE OF SERVICN: \Nl~ NOVA'. ~Jctober 17, 2012, 1, Thomas M. Chairs, l:syuir•c, herch~ ccrtif~, that I did ser~~e a true and correct copy of the foregoing ENTRY OF APPEAIZANCE u}~on all counsel of record by depositing, or causing to be deposited, same in the U.S. mail, postage prepaid, at Camp Hill. !'enns~~~lvania, addressed as follows: By N first-Class Mail: >\~Ii;:ha_! .I. Na~it~k. I:scluire NAVII~SKY~. OI.SO"J c~c VVISN>~,SKI. LLN 2040 I_inglestown Road. Suite 303 Han-isburg. PA 17110 (Counsel i-or Plaintiffs) Charles J. llaly, Inquire LAVA OI'I~ICLS Oh CHARLES J. DAL~Y 1 1 >~ Business Center Drive, Suite 160 Horsham.I'A 19044 (Counsel t~~r Alert Pharmacy Services, Inc., t; d/b/a Alert Pharmacy ) Craig ~. '~~one, l~aquire Mf1RS1IALL„ DENNEI-iF,Y, WARNER, COLh:MAN & GOGGIN 4200 Crams Mill Road, Suite B Harrisburg, PA 17110 (Counsel for A.L. Dillsburg Operations, LLC t/d/b/a Elmcrott of Dillsburg) i ~' ,' ,~ ,~ l~homas ~. (hh ~r~. I~:squirc SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy ., ;:ri ~ rarr ~? ~+~, ~- ~;~j-aJFrf~~. ~`;.lt` ptC^ ~~~~f~ ~rt~; i Richard W Stewart Solicitor ~~ i ~ ~~r 3 i P~ ~: ~ taI~M~3Et~~.,~~U 1;~1~~'t~Y ~~:Nf~SYLVAMl1~ Kay L. Hand (et al j Case Number vs. Holy Spirit Hospital (et al.) 2012-6095 SHERIFF'S RETURN OF SERVICE 10/02/2012 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Lori L. Wallower, DO, but was unable to locate her in his kailiwick. He therefore deputized the Sheriff of York County, Pennsylvania to serve the within Writ of Surrimons according to law. 10!02/2012 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Dillsburg Family Health Center, but was unable to locate them in his bailiwick. He therefore deputized the Sheriff of York County, Pennsylvania to serve the within Writ of Summons according to law. 10/02/2012 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: A.L. Dillsburg Operations, LLC t/d/b/a Elmcroft of Dillsburg, but was unable to locate them in his bailiwick. He therefore deputized the Sheriff of York County, Pennsylvania to serve the within Writ of Summons according to law. 10/0312.012 09:25 AM -Noah Cline, Deputy Sheriff, who being duly sworn according to law, states that on October 3, 2012 at 0925 hours, he served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Alert Pharmacy Services, Inc. t/d/b/a Alert Pharmacy, by making known unto Eric Donley, Vice President for Alert Pharmacy Services, Inc. at 219 N. Baltimore Avenue, Mount Holly Springs, Cumberland County, Pennsylvania 17065 its contents and at the same time handing to him personally the said true and correct copy of the same. -~.. , ,_ ~~_ A ._... G ~ ~- _. NOAH CLINE. DEPUTY 10/03/2012 01 15 PM -Noah Cline, Deputy Sheriff, who being duly sworn according to law, states that on October 3, 2012 at 1315 hours, he served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Holy Spirit Hospital, by making known unto Kay Tipton, Legal Coordinator for Holy Spirit Hospital at 503 N. 21st Street, Camp Hill, Cumberland County, Pennsylvania 17011 its contents and at the same time handing to her personally the said true and correct copy of the same. --, -____~ ."i G. NOAH CLINE, DEPUTY 10/03/2012 01:15 PM -Noah Cline, Deputy Sheriff, who being duly sworn according to law, states that on October 3, 2012 at 1315 hours, he served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Spirit Physician Services, Inc., by making known unto Kay Tipton, Legal Coordinator for Spirit Physician Services, Inc. at 503 N. 21st Street, Camp Hill, Cumberland County, Pennsylvania 17011 its contents and at the same time handing to her personally the said true and correct copy of the same. .-~ ~.._._ ._ NOAH CLINE, DEPUTY 10!10/2012 11:2.0 AM -York County Return: And now October 10, 2012 at 1120 hours I, Richard P Keuerleber, Sheriff of York County, Pennsylvania, do hereby certify and return that I served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Lori L. Wallower, DO by making known unto Bonnie Horanic, Office Manager for Lori L. Wallower, DO at 204 Mumper Lane, Suite 1, Dillsburg, Pennsylvania 17019 its contents and at the same time handing to her personally the said true and correct copy of the same. 10/10/2012 11.20 AM -York County Return: Ancl now October 10, 2012 at 1120 hours I, Richard P. Keuerleber, Sheriff of York County, Pennsylvania, do hereby certify and return that I served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Dillsburg Family Health Center by making known unto Bonnie Horanic, Office Manager for Dillsburg Family Health Center at 204 Mumper Lane, Suite 1, Dillsburg, Pennsylvania 17019 its contents and at the same time handing to her personally the said true and correct copy of the same. 10/10/2012 1 1 31 AM -York County Return: Ancl now October 10, 2012 at 1131 hours I, Richard P. Keuerleber, Sheriff of York County, Pennsylvania, do hereby certify and return that I served a true copy of the within V`Jrit of Summons, upon the within named defendant, to wit: A.L. Dillsburg Operations, LLC by making k~io~vn unto David Kloster, Executive Director for A.L. Dillsburg Operations, LLC at 153 Logan Road, Dillsburg, Pennsylvania 17019 its contents and at the same time handing to him personally the said true and correct copy of the same. SHERIFF COST: $123.45 October 22, 2012 SO ANSWERS, .,, ~' RON R ANDERSON, SHERIFF SHERIFF'S OFFICE OF YORK COUNTY Richard P Keuerleber Sheriff Reuben B Zeager Chief Deputy, Operations ~ ' , KAY L. HAND ET AL Case Number vs. LORI L. WALLOWER, D.O. (et al.) 12-6095 CIVIL SHERIFF'S RETURN OF SERVICE 10/10/2012 11:20 AM -DEPUTY COREY STRINE, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED WRIT OF SUMMONS (WOSM) BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE BONNIE HORANIC, OFFICE MANAGER, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR LORI L. WALLOWER, D.O. AT 204 MUMPER LANE, SUITE 1, DILLSBURG, PA 17019. r .-' {,' REY STRINE, DEPUTY 10/10/2012 1120 AM -DEPUTY COREY STRINE, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED WRIT OF SUMMONS (WOSM) BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE BONNIE HORANIC, OFFICE MANAGER, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR DILLSBURG FAMILY HEALTH CENTER AT 204 MUMPER LANE. SUITE 1, DILLSBURG, PA 17019. . ~.._. ~p REY STRINE. DEPUTY 10/10/2012 11:31 AM -DEPUTY COREY STRINE, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED WRIT OF SUMMONS (WOSM) BY HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE DAVID KLOSTER, EXECUTIVE DIRECTOR, WHO ACCEPTED AS "ADULT PERSON IN CHARGE" FOR A.L. DILLSBURG OPERATIONS, LLC AT 153 LOGAN ROAD, DILLSBURG, PA 17019. ~'`~` REY STRINE. DEPUTY SHERIFF COST: $85.07 October 16, 2012 ;r ~~~v;€.!:'-~4!~/~~ ~ ~ 4 c r'r`wa~;°•,A;~'YIL.VANlA __ '+itatara N~ ._.__~___s.__~ ~?~~ a ~.. ,~t~~tin. ~[~tarp ~ubi~c c; f:ri~:~~ts".sbur~ i'wp., lr'uii: %ounfy i i'~^y E;cmrr,k~~;irn ~xpir~s Fib. 1, 2013 ~. x~4n ,'v~ria o s~.,c:ia~+c;n of Notaries NOTARY SO S, RICHARD P KEU LEBER, SHERIFF PETER J. MANGAN, ESQ. Solicitor Richard E Rice, II Chief Deputy, Administration Affirmed and subscribed to before me this 16TH day of OCTOBER 2012 ~~, ~~ ~~~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA KAY L. HAND and BONNIE S. PEPO, Individually and as Co-Executors of the NO. 2012-6095 Estate of MARGARET R. ALBERT, Deceased, CIVIL ACTION - MEDICAL Plaintiffs PROFESSIONAL LIABILITY V. LORI L. WALLOWER, D.O., DILLSBURG FAMILY HEALTH CENTER, HOLY SPIRIT HEALTH SYSTEM, SPIRIT PHYSICIAN SERVICES, INC., A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a ELMCROFT OF DILLSBURG, and ALERT PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY JURY TRIAL DEMANDED A( '1021 W y N ) :: . . `tip PETITION FOR APPROVAL OF DECEDENT'S COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS PURSUANT TO PA. R.C.P. 2206 AND SEALING OF THE RECORD Petitioners, Kay L. Hand and Bonnie S. Pepo, Individually and as Co-Executors of the Estate of Margaret R. Albert, deceased, by and through their attorneys, Navitsky, Olson & Wisneski LLP, hereby aver as follows: Margaret R. Albert died on November 14, 2010 from complications of a medication error which began on October 21, 2010, and continued until November 1'), 2010. She was erroneously prescribed Coumadin which, because she did not require a blood thinner, caused internal bleeding which led to her death on November 14, 2010. A copy of Margaret Albert's death certificate is attached hereto as Exhibit A. 2. Petitioners are the adult children of the decedent. Petitioners are the Co-Executors of the Estate of Margaret R. Albert, by virtue of a Certificate of Grant of Letters Testamentary duly granted by the Register of Wills of York 1 4 County, Pennsylvania on or about January 31, 2011. A copy of the Certificate of Grant of Letters Testamentary is attached hereto as Exhibit B. 4. Margaret R. Albert died Testate. A copy of her Will is attached hereto as Exhibit C. 5. Decedent is survived by her children, your Petitioners, Kay L. Hand and Bonnie S. Pepo. 6. Your Petitioners initiated suit by Writ of Summons against all Defendants listed in this litigation seeking damages for the injuries their mother sustained and for the loss of their mother. The suit was docketed under this case number. This action will be dismissed with this settlement. ?. After extensive discussions and negotiations, the parties have agreed to a full and final settlement of all claims. Defendants, although disputing liability for the death of the decedent, medical causation, and the damages incurred, nonetheless have agreed to compromise and settle all claims for the total amount of $180,000.00. A copy of the proposed Release is attached hereto as Exhibit D. 8. In view of the disputed nature of the claim, Your Petitioners consider the offer to be fair, just and equitable and to be in the best interest of the Estate and the persons entitled by law to recover damages for the death of the decedent. 9. Your Petitioners retained the firm of Navitsky, Olson & Wisneski LLP and entered into a Contingent Fee Agreement with said attorneys for their professional services, plus expenses. A copy of the Power of Attorney and Fee Agreement is attached hereto as Exhibit E. 10. Pursuant to the Power of Attorney and Fee Agreement, Navitsky, Olson & Wisneski LLP is entitled to a fee of 35% of the settlement, but has voluntarily reduced the fee to 2 11. Navitsky, Olson & Wisneski LLP has also incurred expenses for investigation, medical records, expert reports, mediation expenses, and miscellaneous items totaling; $744.00. An itemization of the expenses is attached hereto as Exhibit F. 12. No federal or state liens have been asserted against the proceeds of this case and the Estate has no other debts or liens that are owed out of the proceeds of this case or otherwise from the Estate. 13. By reason of the death of the decedent, Margaret R. Albert, two causes of action arose against the Defendants: one under the Wrongful Death Act for the benefit of your Petitioners, and one under the Survival Act for the benefit of decedent's Estate to recover damages for her death. 14. Petitioner's counsel has received approval from the Department of Revenue to allocate 75% pet-cent of the settlement proceeds to the Wrongful Death Action and 25% of the settlement proceeds to the Survival Action. See, letter from the Pennsylvania Department of Revenue attached hereto as Exhibit G. 15. There are sufficient assets in decedent's Estate to satisfy any outstanding debts, of which there are none. 16. Your Petitioners believe that, in accordance with the terms of the Power of Attorney and Fee Agreement and the Department of Revenue's acknowledgement letter, a fair, just and equitable distribution of all settlement proceeds would be as follows: a) Wrongful Death Allocation $ 93,942.00 (75 % of net settlement proceeds of $125,256.00) b) Survival Action Allocation $ 31,314.00 (25 % of net settlement proceeds of $125,256.00) C) Navitsky, Olson & Wisneski LLP legal fees $ 54,000.00 3 d) Navitsky, Olson & Wisneski LLP $ 744.00 reimbursement of expenses TOTAL $180,000.00 17. Pursuant to paragraph of the Release, Petitioners request that the Court immediately seal this Petition, the Release, and any documents identifying the terms and/or conditions of the settlement so that such documents are not accessible or disclosed to anyone. All parties understand that sealing of the record is discretionary with the Court. Petitioners are providing the Court with two proposed Orders approving the settlement - - one with a provision sealing the record and one with no such provision. 18. An Affidavit signed by the Petitioners requesting court approval in accordance with the terms of this Petition is attached hereto as Exhibit H. WHEREFORE, Your Petitioners pray that your Honorable Court enter an Order approving said compromise settlement, directing distribution of proceeds in accordance with the terms of this Petition and authorizing the Petitioners to sign a Release and to mark the above- captioned action settled and discontinued and issue an Order approving same. Respectfully submitted, Date: 23,6;2)13 1 NAVITSKY, OLSON & ,,A • 4A./ Michael J(Fr8itsky, Esq t?) I.D. No. 03 2040 Linglestown Road, Suite Harrisburg, PA 17110 717/541-9205 Counsel for Petitioners 4 ESKI UP 3 ?_ ?r+-?- ?? M w k W 4 yW R 0 N O y N I r _ a ,Np. w? Q LL ffi Wa a ? UA l`. x m a? ?c 0 Uc c J L Zc 041 A a ~ Y ? Y Ale ? a e ;a ?u N 8 ? ?s d ? m h t r i I I ? e @1 ?_ a l ? 6J ? " ? ? v' y i ? " fi O •" , 3 i ) r1 ? 5 1+ .j 4 , = y 3 ? ? N ? .p N 3 3 'f ? d _ q ,- •. i ? ? F - i ® ?? ? ? j m s' ? dl l E 6" G w z q Z • p o 6 ? ! 0-3 0 q ,.1 C?1 e ° -a v o a i s co Obi $ 0! $ b N ld 4 1w r+ v N a ?, a z . ° _ C w ,y ? GG ? Z S. 0.a a S ri A '4 44 (a E a E p E 6 b 0? uU 0 ? 3 ? _ F U 3 €? ? 8? A d O < ? u y? a v ,4 ?. a K 2 C Ln 0 d R ? L y! J i ?S O CN ° b 5 E as p s CA w y a 8 ?p a ? a E g oo n cu0 - s v a cn 41 -4 M -,4 g o ^-? u ?y a cl e ;c? ? =m a zz ? IS ?? ? CD o n a c 3 a 0 5 a gt 90 c •- $6 T. A !I ? E V ? DO o ? g l' $ 8 ? 2 5 s L N ? v =z f 4 i : o o ? a L ¢ 55=-0 j 8- C 2i J S ? e b ? m 0 Vr W e 07 0 1123 s a N 3 0 ?Q A. ?. 4 v Q ? G a ? U ? s R, ? v d ? ? p ? a ? ? B A A ? ? e V ? _b C ?yAo ? a ? b o d tg8g a ?? a s a ?? S9 s ?z e s s e??s ?m L? Y 2 t7i o n-o gs = U r ... t O i e? ?I a. r _ E s ? s ? c I z ? r c? c A IP D e ??_o s a ? ?JR ? D Ja o A ti A ?yw ? s- 3J v3 a eeW?- Fi ?e O sa ? a e' ? A p# L ? n ??? ,rn aw0H ?x.?aun? ui??oo? W:iOM:c -0!OZ 9l'A ,, ? , ? ? ? ?11? _.? -- c'S >I N LE ?. ]).:eas11 IA01'. 1 i 41.1E:' tc1 '11.11 H I",: ILK 41 N 11' ?ir , 1 Tai. I (; -26 !;, WHEREA.S,on January31,201J. thef.-lic iE;instnuaer:ls): Will Dated: April 10, 2007 was admitted to probate as the last will of M E : G i' . t 11, IR.,%] J 17, F .T' 1; f ;t? County, who died on November 14, 2010 JA WHEREAS, a true copy of the v r l a s pi s ai ?rl x e] l er(t THEREFORE, I, Bradley C. J ii cc la, I t; i; es, of W: 0 s u 1 any t h !' ' r Commonwealth of Pennsylvania, hereby c rdf, , th.r 1 tNa t] ins h, , g :'ar t J'11 I . ' KAY L. HAND and BONNIE S. PEW rv) c kur 111-1 cli ral f. e , s)E: S 'C : ; administer the estate according to law, aril d', v 1 i, a i ; l : a ppi :ar s o i i ecc r n Center in York, Pennsylvania. EV 7 S77MOIVY WHEREOF, I Lai, e h i r to se t a y: s L IA, i fi :e : se. January 31, 2011. 'x .6;? f1 ui , C: 1. G ?.isti:r l1? er - - h y Col n ro E:a ; ra Bradley C. Jacobs REGISTER OF WILLS York County, Pennsylvania LAST WILL AND TESTAMENT of MARGARET R. ALBERT I! I, MARGARET R. ALBERT, a resident of Warrington Township, York County, 'i Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby I make, publish and declare this as and for my Last Will and Testament, hereby revoking, annulling and making void any and all Wills by me at any time heretofore made. ITEM 1: I direct that the payment of the expenses of my last illness and funeral from i my estate as soon after my death as conveniently may be done. I further direct that my remains be interred at Suburban Memorial Gardens. ITEM 2: 1 give, devise and bequeath all the rest, residue and remainder of my estate, i real, personal and mixed, of whatever kind and wheresoever situate, which I may own or have i the right to dispose of at the time of my death unto my beloved husband, LE STER E. i ALBERT, to be his absolutely. i ITEM 3: In the event that my beloved husband LESTER E. ALBERT should i i predecease me, or if he should fail to survive me by thirty (30) days, or in the event that we I should die as a result of a common disaster or accident as to render it impossible to determine i which of us died first, then in such event, I give, devise and bequeath all the rest, residue and Rim, HuwM HeRROLD, ? remainder of my estate, real, personal and mixed of whatever kind and wheresoever situate CRAUMANN, FERRO LLP > f Ar7oxxers nY Law 129 E.. M-x Sixerr f-.. Pe MYLV-u 17401 ro it (7171,8468856 MARG T R. ALBERT i 1 which I may own or have the right to dispose of at the time of my death unto the following individuals in the following manner: A. I hereby give and bequeath One-Third (1/3) of this my residuary estate unto my beloved grandsons JASON E. RODGERS and TODD A. RODGERS, or the survivor of theirs, in equal shares. B. I hereby give and bequeath One-Third (113) of this my residuary estate unto my beloved daughter KAY L. HAND, per stirpes. C. I hereby give and bequeath One-Third (1/3) of this my residuary estate unto my beloved daughter BONNIE S. PEPO, per stirpes. ITEM 4: I empower my Executor, without prior authorization or approval of any Gitim, HIMPS. HCRROLD, SCHMIMANN, FKRRO LLP ATIOR s AT LAM 129 E cr MAZCrr STrttrT YORK. PFNNS- 17401 T'UIPMW- (717) 846886 Court, to do everything it deems advisable, even though it would not be authorized or appropriate for fiduciaries (but for this power) under any statute or rule of law; including this grant (without impairing its plenary nature) power to acquire by purchase or otherwise, and retain temporarily or permanently, all kinds of realty and personalty, even common stocks, unsecured obligations, and interest in investment trusts and discretionary common trust funds-all without diversification as to kind or amount; to sell, mortgage, lease or otherwise dispose of any such property, making sales publicly or privately, wholly or partly on credit; to delegate discretionary powers to agents, remunerate them and pay their expenses; and to distribute in kind or in money, or partly in each, even if shares be composed differently. All powers granted by this Will shall be exercisable by the Executor for the time being acting, including any substitutes. MARL T R. ALBERT 2 ITEM 5: I direct that no Trustee, Executor or other fiduciary named, nominated or appointed in this, my Last Will and Testament, shall be required to post bond or give any security of any type for any purpose whatsoever, any law or rule of Court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary not withstanding. ITEM 6:. L direct that any and all inheritance, estate and transfer taxes imposed upon my estate, passing under my Will or otherwise, shall be paid out of the principal of my residuary estate. ITEM 7: I hereby nominate, constitute and appoint my daughters KAY L. HAND and BONNIE S. PEPO as Co- Executrices of this my Last Will and 'Testament. IN WITNESS WHEREOF, I, MARGARET R. ALBERT, the above-named, have to this, my Last Will and Testament, signed my name at the bottom of page one through three for the purpose of identification and at the end hereof, on page four, have set my hand and seal this /y?L day of 2007. MARGA T R. ALBERT Signed, sealed, published and declared by MARGARET R: ALBERT' heiabove-named GR1RS4, HRAes, HeRROLR, SCHAUMANN, FpstRO LLP AIIDRNRYS AT LAR 129 EAST MARKU STRP YORK. PRr.'nsMMIA 17401 71:t MOW,, (717) 846-8856 Testatrix, as and for her Last Will and Testament, in the presence; of us who, in her presence and in the presenceVf each other, have at her request subscribed our names as witnesses hereto. of ?r of 3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS: We, MARGARET R. ALBERT T '4"' the Testatrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, that she signed willingly or willingly directed another to sign for her, that she executed it as her free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses, and that, to the best of their knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. MAR( T R. AL ERT, Testatrix Wit s Witness GRIESf HIMFS, HERROLD, SCHAUMA.NH, FERRO I.LF AnoRREYS AT LAw 129 EAST MAR- STReer Yo- FF?+rsri - 17401 'Ri.rrl+o (717) 9468956 Subscribed, sworn to, and acknowledged before me by MARGARET R. ALBERT, the Testatrix, and subscribed and sworn to before me by the aforenamed witnesses, this (c)- day of -Apr', 1 5 2007. NOTARIAL SEAL BARBARA L SULLIVAN Notory PuW Cr OF YORK. YORK COMM My Commw", Expires Jun 1, 2006 4 mm r - m v x O z v v 0) rn ao ro Ul rn kL-- m 0 N > x m N t?f z m m m W y 3 { D r" D m z 1 r n a m 7?d Z Z r F i xk; bJ KAY L. HAND, Individually and as the Co- Executor of the Estate of MARGARET R. ALBERT, Deceased and BONNIE S. PEPO, Individually and as Co-Administrator of the Estate of MARGARET R. ALBERT, deceased, Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA DOCKET NO. 2012-6095 V. LORI L. WALLOWER, DO.; DILLSBURG FAMILY HEALTH CENTER; HOLY SPIRIT HEALTH SYSTEM; SPIRIT PHYSICIAN SERVICES, INC.; A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a/ ELMCROFT OF DILLSBURG; and ALERT PHARMACY SERVIES, INC., JURY TRIAL DEMANDED FULL AND FINAL RELEASE 1. FOR AND IN CONSIDERATION of the sum of one hundred eighty thousand ($180,000.00) dollars paid to Kay L. Hand and Bonnie S. Pepo, individually and as co- administrators of the estate of Margaret R. Albert, deceased, hereinafter referred to as "the undersigned", receipt of which is hereby acknowledged, the undersigned do for themselves, and as the co-personal representatives of the Estate of Margaret R. Albert, fully release and discharge Lori L. Wallower, D.O.; Dillsburg Family Health Center; Holy Spirit Health System; Spirit Physician Services, Inc.; A.L. Dillsburg Operations, LLC, t/d/b/a Elmcroft of Dillsburg; Senior Care, Inc.; Beazley p1c; Alert Pharmacy Services, Inc., t/d/b/a Alert Pharmacy Service II; State Auto Property and Casualty Insurance Company; PACE Insurance Program and all other persons, governmental entities, associates and corporations whether or not named herein, their heirs, executors, administrators, attorneys, successors, assigns and insurers, and their respective agents, servants and employees (herein after collectively referred to as "Releasees") from any and all causes of action, claims and demands of whatsoever kind on account of all known and unknown injuries, losses, damages and/or death, allegedly sustained by the undersigned, or said Estate, and, specifically, from any claims or joinders for sole liability, contribution, indemnity or otherwise as a result of, arising from, or in any way connected with Margret R. Albert's admission and residency at Elmcroft of Dillsburg and any and all healthcare services, skilled nursing services, pharmacology services and residential services provided to her from October 7, 2009 through November 14, 2010, at Elmcroft or at Dillsburg Family Health Center, and especially events arising following the alleged ordering and provision of Coumadin commencing on or about October 20, 2010. All sums set forth herein constitute damages on account of physical injuries and sickness within the meaning of Section 104 (a)(2) of the Internal Revenue Code of 1986, as amended. The undersigned do understand and agree that the acceptance of said sum is in full accord and satisfaction of a disputed claim and that the payment of said sum is not an admission of liability by any party, whether or not named herein. 2. It is expressly understood and agreed that this release and settlement is intended to cover, and does cover, not only all now known injuries, death, losses and damages, but any further losses and/or damages which arise from, or are related to, the occurrences described above. 3. The undersigned hereby agree, on behalf of themselves, the Estate of Margret R. Albert and on behalf of her heirs, executors, successors and/or assigns, except as set out below, to satisfy any and all valid liens that have been asserted and/or which could be or may be asserted for reimbursement of any medical benefits or other benefits provided to the undersigned by a third party as a result of injuries or death allegedly resulting from the occurrences described above. Additionally, the undersigned hereby agree, on behalf of themselves, the Estate of Margaret R. Albert and on behalf of her heirs, executors, successors and/or assigns, to indemnify and save forever harmless the Releasees named in this document from and against any, and all claims, demands or actions, including for litigation costs, expenses and attorneys fees, known or unknown, made against the Releasees by any person or entity on account of, or in any manner related to or arising from the Legal Action noted above. 4. The undersigned represent the neither Margret R. Albert nor the Estate of Margret R. Albert was the recipient of conditional payments by or from Medicare resulting from or arising out of the occurences described above or the Legal Action noted above, including, but not limited to, the alleged ordering and provision of Coumadin commencing on or about October 20, 2010. However, if it should be determined by Medicare that such conditional payment were made by it, the Undersigned understand and agree that as the personal representatives of the Estate of Margret R. Albert, the Estate of Margret R. Albert has an obligation to reimburse Medicare, pursuant to the Medicare Secondary Payer statute for any conditional payments made by Medicare on behalf of Margret R. Albert relating to the subject incident. The undersigned agree that, in the event Medicare claims reimbursement for conditional payment amounts relating to the subject incident, that the Undersigned, solely in their capacity as personal representatives of the Estate of Margret R. Albert, shall fully satisfy any and all reimbursement claims or demands from Medicare and agree to defend, hold harmless, and indemnify all parties release in Paragraph 1 of this Full and Final Release from any and all such claims or demands made by Medicare. 5. It is further understood and agreed that this is the complete Release and that there are no written or oral understandings or agreements, directly or indirectly, connected with this Release, that are not incorporated herein. This Release shall be binding upon and inure to the successors, assigns, heirs, executors, administrators, and legal representatives of the respective parties hereto. 6. In the event that court approval is required for the settlement, compromise or resolution of this matter, the settlement is conditioned upon the undersigned undertaking any and all necessary action to obtain same. Court approval, if necessary, will be sought by the undersigned in generic fashion without revealing any term or condition of settlement, along with a concurrent motion to seal record, the form of which will be approved by Releasees prior to filing. The undersigned, her family, representatives and/or attorney(s) will take whatever reasonable steps are necessary to seek to assure that the terms and conditions of this settlement are not accessible or disclosed to anyone other than the parties hereto, their respective attorneys and the court, as necessary. It is further understood and agreed that if court approval is required for any aspect of the settlement of this matter, that notwithstanding the provisions of Pa. R.C.P. No. 229.1, Releasees shall not be obligated to pay the settlement funds for a period of twenty (20) business days from receipt of this executed Release or court order approving settlement, whichever is later. 7. If this settlement is ever determined by any court to be without effect because some necessary court approval was not obtained, or if Releasees are subjected to further legal action or claim which could not have been instituted or presented had proper court approval been obtained by the undersigned, the undersigned will indemnify the released parties for any future loss, cost or expense, including but not limited to, reasonable attorney's fees for defending, litigating and settling any such claims or action, and for any judgment resulting from any such claim or action. 8. It is further understood and agreed and made part hereof, that the undersigned, their family and representatives and her attorney(s) as well as the Releasees and their attorneys shall not comment, either directly or indirectly, on any aspect of this case or settlement to any member of the news media, or in any way publicize or cause to be publicized in any news or communications media, including but not limited to newspapers, magazines, journals, radio, television on-line computer systems and law-related publications, the facts of this case, the existence of this settlement and the terms and conditions of this settlement. Moreover, the parties to this Release, nor any person or entity acting on their respective behalf or for their respective benefit, shall not, directly or indirectly, make, or publish, or cause to be made, or published, any statements, oral or written, of a derogatory, demeaning and/or disparaging nature regarding any other party to this Release for the purposes of generating business or injuring the reputation and/or professional or personal standing of any other party to this Release. The parties agree that the consideration for each party's agreement to the confidentiality of this settlement and as to non-disparagement is the consent and agreement of the other(s) and it is acknowledged by all the parties that it is believed to be in the best interest of all parties to mutually abide by the terms of this confidentiality/non-disparagement provision. The parties paid no monies or compensation to the other(s) as compensation for, or in consideration of, the inclusion of this confidentiality/non-disparagement provision as a term of this settlement. 9. Following Execution of this Release, the undersigned will file a Praecipe voluntarily discontinuing the case, filed in the Court of Common Pleas of Cumberland County, Docket No: 2012-6095, with prejudice, and without mention of any settlement. 10. This Release is to be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. THE UNDERSIGNED HEREBY DECLARE that the terms of this settlement have been completely read; and that they have discussed the terms of this settlement with legal counsel of their choice; and said terms are fully understood and voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims on account of the injuries and damages above-mentioned, and for the express purpose of precluding forever any further or additional suits arising out of the aforesaid claims. IN WITNESS WHEREOF, we have hereunto set our hand and seal this day of 2013. SEAL KAY L. HAND, Co-Administrator of the Estate of Margaret R. Albert, deceased. SWORN to and subscribed before me this Day of , 2012 Notary Public (SEAL) BONNIE S. PEPO, Co-Administrator of the Estate of Margaret R. Albert, deceased. SWORN to and subscribed before me this Day of 92012 Notary Public 05/982327.v1 POWER OF ATTORNEY AND FEE AGREEMENT BY SIGNING THIS AGREEMENT, I (WE) ACKNOWLEDGE THAT I (WE) HAVE ENGAGED "THE LAW FIRM OF NAVITSKY, OLSON & WISNESKI LLP (HEREINAFTER NOW LLP), TO REPRESENT ME (US) UNDER THE FOLLOWING TERMS AND CONDITIONS: NOW 1-1-11 may on my (our) behalf secure medical, work and other similar records, conduct an investigtiongotiate, an if ne essary start it ainst anyone responsible for my (our) injuries and losses with respect to Al d /mf 0 with full power and authority to appear on behalf of the undersigned in any Court of record or in a Aiini trative or other proceeding, to do and perform all and every act and thing whatsoever that may be requisite and necessar to be ne in connection with the above claim as fully as the undersigned might or could do if personally present, hereby ratifying and confirming all that said attorney shall lawfully do or cause to be done therein by virtue of this power of attorney. 2. I (we) understand that so long as the case is handled by a NOW LLP attorney, I (we) will not be responsible for any fees and/or expenses unless a recovery or benefit is obtained. 3. In the event that the client has been referred by another attorney or law firm, the client understands that NOW LLP may pay the forwarding attorney or law firm a fee. Any such fee would be paid out of NOW LLP's attorney fee, not out of the client's net proceeds. 4. If my (our) case is handled to a successful completion by a NOW LLP attorney, I (we) agree to pay NOW LLP all reasonable out-of- pocket expenses without the payment of interest, plus a fee for time expended as follows: ME NOW LLP a. SETTLEMENT PRIOR TO STARTING SUIT AND 70% 30% NO MEDIATION OR ARBITRATION b. SETTLEMENT FOLLOWING SUIT BUT PRIOR TO 65% 35% MEDIATION, TRIAL OR ARBITRATION c:. SETTLEMENT OR VERDICT AT MEDIATION, TRIAL OR ARBITRATION, AFTER MEDIATION, 60% 40% TRIAL, ARBITRATION, OR APPEALS OR SHORTLY BEFORE MEDIATION, TRIAL OR ARBITRATION IF THE CASE HAS BEEN TOTALLY PREPARED d. OTHER CASES 5. If for any reason I (we) take (our) case to another attorney or law firm or handle it myself (ourselves), I (we) recognize that NOW LLP has, in good faith, expended money and time for my (our) benefit and I (we) therefore agree to pay, or have my (our) new attorney pay, immediately, upon severing the NOW LLP attorney/client relationship, all the out-of-pocket expenses incurred on my (our) case. In addition, when the case is successfully concluded, I (we) agree to pay or to direct my (our) new attorney to pay as a fee 20% of the gross recovery to NOW LLP. 6. In the event that any settlement is made on a structured or deferred payment basis, NOW LLP shall be entitled to receive their fee based on the present value of the structured settlement, as if paid as a lump sum at the time of settlement. NOW LLP does not structure or defer payment of their attorney fee or expenses. 7. Attorneys shall have power of attorney to endorse client and 'P 'use's signature on settlement checks for deposit in attorney's escrow account and to sign medical and wage authorizations on be lfj f client. Ika BY SIGNING THIS AGREEMENT, THISr;' DAY OF f , 20_1(, I (WE) ACKNOWLEDGE THAT I (WE) HAVE READ, UNDERSAIOOD,AN RECEIVED A COPY F ME AND AGREE WITH ITS TERMS AND CONDITIONS. WITNES E ): CLIE S): 1 ?e Dn (SEAL) (SEAL) POWER OF ATTORNEY AND FEE AGREEMENT DY SIGNING THIS AGREEMENT, 1 (WE) ACKNOWLEDGE THAT I (WE) HAVE ENGAGED THE LAW FIRM OF NAVITSKY. OI.SON & WISNESKI LLP (HEREINAFTER NOW LLP), TO REPRESENT ME (US) UNDER THE FOLLOWING TERMS AND CONDITIONS: 1. NOW LLP may on my (our) behalf secure medical, work and other similar records, conduct an i vesti ti n tiate, and if ii necessary start suit ainst anyone responsible for my (our) injuries and losses with respect to IWITMAPD with full power and authority to appear on behalf of the undersigned in any Court o record or in any i ative or o er proceeding, to do and perform all and every act and thing whatsoever that may be requisite and necessary to be One i connection with the above claim as fully as the undersigned might or could do if personally present; hereby ratifying and onfirming all that said attorney shall lawfully do or cause to be done therein by virtue of this power of attoniey. 2. I (we) understand that so long as the case is handled by a NOW LLP attorney, I (we) will not be responsible for any fees and/or expenses unless a recovery or benefit is obtained. 3. In the event that the client has been referred by another attorney or law firm, the client understands that NOW LLP may pay the forwarding attorney or law firm a fee. Any such fee would be paid out of NOW LLP's attorney fee, not out of the client's net proceeds. 4. If my (our) case is handled to a successful completion by a NOW LLP attorney, I (we) agree to pay NOW LIT all reasonable out-of- pocket expenses without the payment of interest, plus a fee for time expended as follows: - ME NOW LLP a. SETTLEMENT PRIOR TO STARTING SUIT AND 70% 30% NO MEDIATION OR ARBITRATION b. SETTLEMENT FOLLOWING SUIT BUT PRIOR TO 65% 35% _ MEDIATION, TRIAL OR ARBITRATION c. SETTLEMENT OR VERDICT AT MEDIATION, TRIAL OR ARBITRATION, AFTER MEDIATION, 60% 40% TRIAL, ARBITRATION, OR APPEALS OR SHORTLY BEFORE MEDIATION, TRIAL OR ARBITRATION IF THE CASE HAS BEEN TOTALLY PREPARED c" OTHER CASES `i. If for any reason I (we) take (our) case to another attorney or law firm or handle it myself (ourselves), I (we) recognize that NOW LLP has, in good faith, expended money and time for my (our) benefit and I (we) therefore agree to pay, or have my (our) new attorney pay, immediately, upon severing the NOW LLP attorney/client relationship, all the out-of-pocket expenses incurred on my (our) case. In addition, when the case is successfully concluded, I (we) agree to pay or to direct my (our) new attorney to pay as a fee 20% of the gross recovery to NOW LLP. 6. In the event that any settlement is made on a structured or deferred payment basis, NOW LLP shall be entitled to receive their fee based on the present value of the structured settlement, as if paid as a lump sum at the time of settlement. NOW LLP does not structure or defer payment of their attorney fee or expenses. 7. Attorneys shall have power of attorney to endorse client and s Ouse's signature on settlement checks for deposit in attorney's escrow account and to sign medical and wage authori 'ons on be of cli nt. BY SIGNING THIS AGREEMENT, THIS W DAY OF J , 20X, I (WE) ACKNOWLEDGE THAT I (WE) HAVV READ, UNDERSTOOD, AND RECEIVED A COPY OF SAME AND AGREE WITH ITS TERMS AND CONDITIONS. (SEAL) (SEAL) ?X l?, I? I? d 0 N 1? 1 N . S' cs? t ? ,y ^?,_ J .'s c CA C? -i D O w ° m0 ° ° -OVmmmo O ? ° °LA. y ?xz°? 0 n W W C, n O T w IK O O (D co p W K N m to n 3 T n M (°A y !? o ° a to D i n y O?i < N'O y a -' (O (O cn n fu Z 7 m (`7? y NN (NT CN"Ln Iv (°D ON 00? jO Id j N N N N N N c N ? CD z N co - W c C) O fn 3 D DDDDI> V or or LTUQ ?M (D A A. -?? (A CO) ai W W tmn, Z Si Ei fir Si E a 0) N 99999 33 o O o o O y I 0> Obi m w Obi m I 0 c c o ? 33;R- m or m o o > > > o ? n a? c ? nnV.i n C C C m (D 2 DO o ° S b 05 ?n?C/) cr) ;c3 ^'2 N O(D -2 ' cf) 3 C N C O O o 3 co o o c (p Cn 3i m o Q Cl) c C CL i D 3 ° c ? j " ' A ' i O O N N O N O AC J 0 0 N N O O N (n G7 -J 00 V -1 a O V W(T CT OO I I W Of d 7 O ?N A N W s -+ O ( Jf 0 7 0 N N O O N N V W O O 0 C) N) -4 C) 0 4 V 0 0 V -40(1700 N W 77Wf N D 3 Z n rt (D7C' Dm0 -if x N 7 0 (D 0 N O (D y N ? (D (D co) X- O f r Fx(,6;1 ?r fr. pennsylvana DEPARTMENT OF REVENUE January 8, 2013 Michael Navitsky, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road Harrisburg, PA 17110 Re: Estate of Margaret Ruth Albert File Number 6711-0186 Court of Common Pleas Cumberland County Dear Mr. Navitsky: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition, the 79 year old decedent died as a result of medical negligence. Decedent is survived by her two daughters. Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the net proceeds of this action, $93,942.00 to the wrongful death claim and $31,314.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302; 72 P.S. §9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Sinc ely, on E. Baker Trust Valuation Specialist Inheritance Tax Division Bureau of Individual Taxes I PO Box 280601 1 Harrisburg, PA 17128 1 717.783.5824 1 shabaker@pa.gov T µ,._- ?x?lbif AFFIDAVIT I, Kay L. Hand, do hereby affirm, certify and warrant that I approve of the settlement and distribution of proceeds proposed in the Petition for Approval of Settlement and Distribution of Proceeds Pursuant to Pa. R.C.P. 2039, and I request that the Court approve such settlement and distribution. Date: (? aO 13 Sworn to and subscribed before me this <?.3r & day of E 2013 4l? Kay L. Hand Notarv Public -COMMONWEAI OF PENNY NI Notarial Seal Lois E. Stauffer, Notary Public Susquehanna Twp., Dauphin County My Commission Expires March 28, 2013 Member, Pe Sylvudo Auociotion of Notm .. A . r. AFFIDAVIT I, Bonnie S. Pepo, do hereby affirm, certify and warrant that I approve of the settlement and distribution of proceeds proposed in the Petition for Approval of Settlement and Distribution of Proceeds Pursuant to Pa. R.C.P. 2039, and I request that the Court approve such settlement and distribution. Date: 1-4.13 Bonnie S. Pepo Sworn to and subscribed before me this J?-s & day of )Co' -(-,.,?j , 2013 Notary Public COMMONWEALTH FPENNSYLVANIA Notarial Seal Lois E. Stauffer, Notary Public Susquehanna Twp., Dauphin County My Commission Expires March 28, 2013 Member, Plermylvania Association of Notaries 1535780.doc DICKIE, MCCAMEY & CHILCOTE, P.C. BY: Thomas M. Chairs, Esquire ATTORNEY I.D. NO. 78565 Plaza 21, Suite 302 425 North 21st Street Camp Hill, PA 17011 717-731-4800 (Tele) 888-811-7144(Fax) KAY L. HAND, individually and as Co- Executor of the Estate of MARGARET R. ALBERT, Deceased and BONNIE S. PEPO, individually and as Co-Executor of the Estate of MARGARET R. ALBERT, Deceased, Plaintiffs V. LORI L. WALLOWER, D.O., DILLSBURG FAMILY HEALTH CENTER, HOLY SPIRIT HEALTH SYSTEM, SPIRIT PHYSICIAN SERVICES, INC., A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a ELMCROFT OF DILLSBURG and ALERT PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY, Defendants ATTORNEY FOR: DEFENDANTS LORI L. WALLOWER, D.O., DILLSBURG FAMILY HEALTH CENTER, HOLY SPIRIT HEALTH SYSTEM, AND SPIRIT PHYSICIAN SERVICES, INC. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 12-6095 CIVIL ACTION - MEDICAL CJ7 [?) - --- xG JURY TRIAL DEMANDED p.k.? MOTION TO DISMISS LORI L. WALLOWER, D.O., ONLY AND NOW, comes Defendant, Lori L. Wallower, D.O., by and through her attorneys Dickie, McCamey & Chilcote, P.C. and files the within Motion to Dismiss and in support thereof avers as follows: The Plaintiffs initiated this civil action with the filing of a Complaint. The Plaintiffs have named a number of physicians and institutional Defendants in this medical malpractice action. 2. In the course of discovery, the parties have reached an agreement that provides for the voluntary dismissal of Lori L. Wallower, D.O. from this case. The Stipulation providing for the dismissal of Lori L. Wallower, D.O. is attached hereto as Exhibit "A". 3. Pursuant to the Stipulation of Counsel, Dr. Wallower respectfully requests the Court enter an Order approving her voluntary dismissal from this case. WHEREFORE, Lori L. Wallower, D.O. respectfully requests this Court enter an Order approving of the dismissal of Lori L. Wallower, D.O. from this case and directing the Prothonotary to remove Lori L. Wallower, D.O. from the caption of this case. Respectfully submitted, DICKIE, MCCAMEY & CHILCOTE, P.C. Date: February 20, 2013 Thom". Chairs, Esquire Supreme Court I.D. #78565 425 N. 21" Street, Suite 302 Camp Hill, PA 17011-3700 (717) 731-4800 (888) 811-7144 Counsel for Lori L. Wallower, D. 0., Dillsburg Family Health Center, Holy Spirit Health System, and Spirit Physician Services, Inc. 2 EXHIBIT A 1524152.doc DICKIE, MCCA,MEV & CHILCOTE, P.C. BY: Thomas M. Chairs, Esquire A'1-i'ORNEV I.D. NO. 78565 BY: Aaron S. Jai man, Esquire ATI'OR.NEV I.D. NO. 85651 Place 21, Suite 302 425 North 21st Street Camp Hill, PA 17011 717-7314800 (Tele) 888-811-7144(Fax) A7 rURNEY F'OR: DEFENDANTS ' LORI L. WALLOWER, D.O., Dll.t SBURC FAVIIIA HEALTH CENTER, HOLY SPIRIT HEAuni 11 iTFNI. AND SPIRIT PHYSICIA% SEEN ICI i. IM. KAY L. HAND, individually and as Co- Executor of the Estate of MARGARET R. ALBERT, Deceased and BONNIE S. PEPO, individually and as Co-Executor of the Estate of MARGARET R. ALBERT, Deceased, Plaintiffs V. LORI L. WALLOWER, D.Q., DILLSBURG FAMILY HEALTH CENTER, HOLY SPIRIT HEALTH SYSTEM, SPIRIT PHYSICIAN SERVICES, INC., A.L. DILLSBURG OPERATIONS, LLC, t/d/b/a ELMCROFT OF 01I.I,SBURG and ALERT PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY, Defendants CIVIL ACTION - MEDICAL JURY TRIAL DEMANDED STIPULATION TO DISMISS It is hereby stipulated and agreed by and between counsel for all parties of record that 1,o i I.. Wallower. D.O. is voluntarily dismissed from this ease with prejudice. NAVITSKY, OLSON Datc: a ' $- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 12-6095 Michael J. Navi y, Esqu Counsel (orlf' inti/Ts , LLP LAW OFFICES OF CHARLES J. DALY Date: Charles J. Daly, Esqu rc C'ounselpr.Verl Pharmac,?- Services. Inc., 1, i lb? a Alert Pharmacy MARSHALL, DENNEHEY, WARNER, COLEMAN & GOGGIN, P.C. Date: Craig A. Stone, Esquire Counsel for A. L. Dillsburg Operatioas, LL( t!d/b/a Elmeroft of Dillsburg Date: DICKIE, MCCAMEY & C COTE, P.C. Thom 'hairs. Esquire Counsel for Lori L. Wallower, D. U„ DillsburL Family Health Center, Holy Spiri! Heahh.Vjwvm. and Spirit Physician Services, Inc. 2 LAW OFFICES OF CHARLES J. DALY Datc: Date Date: Charles J. Dale, k'squire Counsel for. lert Phurmuc't Scrric'e.s 117( I d b, a Alert Phurmuc-Y MARS L DENN II .Y, WARNER, COLE MIN GOW141 P.C. 2I1?-?13 Craig A. Stone, 1---'squire Counsel Jor ,4. L. Dillsburg Operations, 11C t/d/bla Flmcroft of Dillsburg DICKIE, MCCAMEY & C ",COTE, P.C. Thoma Chairs, Fsquirc Counsel for Lori L Wallower, 1).0 . l)ills-h1n,O Family Health Center, flolV Spirit /leulih Sv.stcmi and Spirit Physician Services, Inc 2 CERTIFICATE OF SERVICE AND NOW, February 20, 2013, I, Thomas M. Chairs, Esquire, hereby certify that I did serve a true and correct copy of the foregoing Motion to Dismiss Lori L. Wallower, D.O., Only upon all counsel of record by depositing, or causing to be deposited, same in the U.S. mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as follows: By First-Class Mail: Michael J. Navitsky, Esquire NAVITSKY, OLSON & WISNESKI, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 (Counsel for Plaintiffs) Charles J. Daly, Esquire LAW OFFICES OF CHARLES J. DALY 1155 Business Center Drive, Suite 160 Horsham, PA 19044 (Counsel for Alert Pharmacy Services, Inc., t/d/b/a Alert Pharmacy) Craig A. Stone, Esquire MARSHALL, DENNEHEY, WARNER, COLEMAN & GOGGIN, P.C. 4200 Crums Mill Road, Suite B Harrisburg, PA 17110 (Counsel for A.L. Dillsburg Operations, LLC t/d/b/a Elmcroft of Dillsburg) Chairs, Esquire IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA KAY L. HAND and BONNIE S. PEPO, Individually and as Co-Executors of the NO. 2012-6095 Estate of MARGARET R. ALBERT, : Deceased, CIVIL ACTION–MEDICAL Plaintiffs PROFESSIONAL LIABILITY ACTION V. c DILLSBURG FAMILY HEALTH rn� rzn CENTER, HOLY SPIRIT HEALTH �c �o 'O rn SYSTEM, SPIRIT PHYSICIAN ; _6 SERVICES, INC., A.L. DILLSBURG <o a o n OPERATIONS, LLC, t/d/b/a ELMCROFT x—F OF DILLSBURG, and ALERT : = _4 PHARMACY SERVICES, INC., t/d/b/a ALERT PHARMACY JURY TRIAL DEMANDED PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please mark the above-captioned action ended and discontinued. Respectfully submitted, NAVITSKY, OLSON & WI SKI LLP Mic ael J. a itsky, Esqui I.D. No. 03 2040 Linglestown Road, Suit 3 3 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: April 8, 2013 r CERTIFICATE OF SERVICE I, Lois Stauffer, an employee of the law firm of Navitsky, Olson & Wisneski LLP hereby certify that a true and correct copy of the foregoing Praecipe to Discontinue was served upon the following person by first-class United States mail,postage prepaid on April 8, 2013, as follows: Craig A. Stone, Esquire Marshall, Dennehey 4200 Crums Mill Road, Suite B Harrisburg, PA 17112 Counsel for Defendant A.L. Dillsburg Operations, LLC, t/d/b/a Elmcroft of Dillsburg Thomas M. Chairs, Esquire Aaron S. Jayman, Esquire Dickie, McCamey& Chilcote, P.C. Plaza 21, Suite 302 425 North 21" Street Camp Hill, PA 17011 Counsel for Defendants Dillsburg Family Health Center, Holy Spirit Health Systems, and Spirit Physician Services, Inc. Charles J. Daly, Esquire The Law Office of Charles J. Daly, Esq. 1155 Business Center Drive, Suite 160 Horsham, PA 19044 Counsel for Defendant Alert Pharmacy Services, Inc., t/d/b/a Alert Pharmacy Lois Stauffer