HomeMy WebLinkAbout12-26-12ANNUAL REPORT OF GUARDIAN
OF THE ESTATE
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of Sven O. Jensen an Incapacitated Person
No. 21-09-0807
I. INTRODUCTION
Keystone Guardianship Service ,was appointed
®Plenary ^ Limited Guardian of the Estate by Decree of M.L. Ebert J,,
dated 9/29/109
® A. This is the Annual Report for the period from September 30 2011
to September 29 20 ] 2 (the "Report Period"); or
^ B. This is the Final Report for the period from
to _ (the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death:
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of
1~_ r~-, J., dated
~b ~, ...
~,_, .: ; r
~t"_" E 3.,. d,
+•
(~ t~7
~ ~ c~
c.._. ~ V ~ L3J
~ OCi
V
W ~' `~
O
~ _
CC `"'"
w:~ V
cv
Page 1 of 5
Estate of Sven O. Jensen an Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $504,534.10
B. State the value(s) of income and principal assets at the
beginning of the Report Period. (Same as Inventory if first
otherwise, ending balance from last Report.)
Principal $351,407.07
Income $18,154.13
C. What is the total amount of income earned during the
Report Period? $37,971.21
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $(79,183.82)
E. What are the balances remaining at the end of the Report
Period?
1. Principal $307,638.06
2. Income $20,710.53
3. Total of Principal and Income $328,348.59
III. ADDITIONAL INFORMATION
(If more space is needed, please attach additional pages)
A. Principal
1. How is the principal balance listed above currently invested?
(Please specify, e.g., real estate, certificates of deposit,
restricted bank accounts, etc.):
HNB Checking #100110983 $2,726.11
HNB Savings #200112953 $6,785.00
Jackson National IRA #1005683323 $249,911.95
Halifax Bank CD#300114354 $15,000.00
Mid Penn CD #301084438 $10,000.00
Mid Penn CD #301084437 $15,000.00
Burial Reserve: Hollinger Funeral Home $8,215.00
Total Principal Balance: $307,638.06
Page 2 of 5
Estate of Sven O. Jensen an Incapacitated Person
2. Have there been any expenditures from the principal
during the Report Period? .............................................................. ®Yes ^ No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? .............. ®Yes ^ No
b. List purpose and amount of expenditures:
All principal used is transferred to Income.
c. Was Court approval received prior to
expending the principal? ...................................................... ®Yes ^ No
3. Were additional principal assets received during the
Report Period which were not included in the
Inventory or a prior Report filed for the Estate? .......................... ^Yes ®No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? ............................... ^Yes ^ No
b. State the sources and amounts of the
additional principal received:
B. Income
1. State sources and amounts of income received during
the Report Period (e.g., Social Security, pension, rents,
etc.):
Interest income
US Treasury -Social Security
Presbyterian Homes -spouse refund
Total income received during Report Period:
$583.31
$23,427.00
$13,960.90
$37,971.21
Page 3 of 5
Estate of Sven O. Jensen an Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
Halifax Bank Checking #100110983 $2,060.26
Halifax Bank Savings #200112953 $1,008.92
Mid Penn Bank CD #301084438 $373.62
Jackson National IRA #1005683323 $17,267.73
Total Income Balance: $20,710.53
C. Expenses for Care and Maintenance
Specify what expenditures were made from the principal and
income for the care and maintenance of the Incapacitated
Person (e.g., clothing, nursing home, medicine, support, etc.):
Advanced Podiatry Services $121.93
Alpha Diagnostics $199.27
Arden Courts $65,051.62
Comm. Of PA Mobile Dentistry $65.00
Family Practice Center $35.00
Freedom Blue PPO $3.00
Heartland Healthcare Services $2,445.51
On Sight Healthcare $416.98
Pinnacle Health Hospitals $274.65
See Right Pharmacy $687.79
Smith Radiology $g,68
Total Expenses for Care and Maintenance: $69,309.43
D. Other Expenditures
Specify what other expenditures were made during the Report
Period. (Do not include any items stated in response to
question C above.)
Comcast $744.94
Hazen Elder Law $4,399.27
Keystone Guardianship -costs $265.78
Leona Shaffer -tax preparation $80.00
Register of Wills $15.00
Stephen J Hogg, Esq. $674.25
The Patriot News $101.40
Total for Other Expenditures: $ 6,280.64
Page 4 of 5
Estate of Sven O. Jensen an Incapacitated Person
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Court
Amount Method of Determination Approval Obtained
3 593.75 ($75.00 per hour) ^ Yes ~ No
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Court
Amount Approval Obtained
N
~ Yes !~~ No
^ Yes ~ No
I verify that the foregoing information is correct to the best of my knowledge,
information and belief, and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities.
Date
. ,. _ n
Signature of Guardian of the Estate
Melanie Peters for Keystone Guardianship Services
Name of Guardian of the Estate (type or print)
PO Box 804
Address
Elizabethville Pa 17023
Ciry, State, Zip
71.7-265-4056
Telephone
Page 5 of 5
Sven ]ensen
INCOME STATEMENT
for Period
September 30 2011 To September 29 2012
INCOME
Interest Income
US Treasury -Social Security
refund of payment
TOTAL INCOME
EXPENSES
Nursing Home Expenses
Medical
Keystone Services Cost
Keystone Services Fees
Household Expenses
TOTAL EXPENSES
INCOME / (LOSS)
Sep 30 2011
Sep 29 2012
583.31
23,427.00
13,960.90
37,971.21
65,051.62
4,257.81
265.78
3,593.75
6,014.86
79,183.82
(41,212.61)
Account 4010 -Interest Income / Sven ]ensen
September 30 2011 -September 29 2012
Description Date Reference
interest -HNB checking 09-30-2011 Auto Deposit
interest -HNB checking i1-30-2011 Auto Deposit
interest -HNB checking 12-31-2011 Auto Deposit
interest -HNB checking 01-31-2012 Auto Deposit
interest -HNB checking 02-29-2012 Auto Deposit
interest -HNB checking 03-31-2012 Auto Deposit
interest -HNB checking 04-30-2012 Auto Deposit
interest -HNB checking 05-31-2012 Auto Deposit
interest -HNB checking 06-30-2012 Auto Deposit
interest -HNB checking 07-31-2012 Auto Deposit
interest -HNB checking 08-31-2012 Auto Deposit
interest -HNB savings 10-13-2011 Auto deposit
interest -HNB savings 11-15-2011 Auto deposit
interest -HNB savings 12-13-2011 Auto deposit
interest -HNB savings 01-12-2012 Auto deposit
interest -HNB savings 02-14-2012 Auto deposit
interest -HNB savings 03-13-2012 Auto deposit
interest -HNB savings 04-13-2012 Auto deposit
interest -HNB savings 05-11-2012 Auto deposit
interest -HNB savings 06-13-2012 Auto deposit
interest -HNB savings 07-13-2012 Auto deposit
interest -HNB savings 08-14-2012 Auto deposit
interest -HNB savings 09-13-2012 Auto deposit
Interest -Mid Penn CD #301084438 06-29-2012 Auto Deposit
Debit Credit Balance
997.63
8.43 1,006.06
9.27 1,015.33
5.17 1,020.50
5.19 1,025.69
8.12 1,033.81
13.22 1,047.03
6.50 1,053.53
12.29 1,065.82
9.07 1,074.89
4.88 1,079.77
5.03 1,084.80
87.17
19.59 1,104.39
20.74 1,125.13
14.47 1,139.60
15.51 1,155.11
12.54 1,167.65
10.65 1,178.30
8.29 1,186.59
6.15 1,192.74
4.82 1,197.56
4.39 1,201.95
3.45 1,205.40
1.92 1,207.32
122.52
373.62 1,580.94
373.62
583.31 1,580.94
Account 4018 -refund of payment / Sven Jensen
September 30 2011 -September 29 2012
Date Reference Description Debit Credit Balance
6,869.45
02-28-2012 Deposit Presbyterian Homes Spouse Refund 13,960.90 20,830.35
13,960.90
13,960.90 20,830.35
AP Transactions / Sven Jensen
From September 30 2011
To September 29 2012
Open
Closed
Vendor Date Invoice Description Total Paid
Advanced Podiatry Services 04-02-2012 Check #368 121.93 121.93
121.93 121.93 /
Alpha Diagnosics LLC 06-20-2012 Check #389 199.27 199.27
199.27 199.27
Arden Courts 10-10-2011 Check #332 5,278.00 5,278.00
Arden Courts 11-09-2011 Check #340 5,265.50 5,265.50
Arden Courts 11-30-2011 Check #342 5,271.00 5,271.00
Arden Courts 01-13-2012 Check #349 5,454.50 5,454.50
Arden Courts 02-07-2012 Check #355 5,464.00 5,464.00
Arden Courts 02-28-2012 Check #361 5,468.50 5,468.50
Arden Courts 04-02-2012 Check #370 5,473.00 5,473.00
Arden Courts 05-09-2012 Check #381 5,468.50 5,468.50
Arden Courts 06-06-2012 Check #385 5,459.00 5,459.00
Arden Courts 07-06-2012 Check #392 5,489.73 5,489.73
Arden Courts 07-31-2012 Check #397 5,464.39 5,464.39
Arden Courts 09-05-2012 Check #402 5,495.50 5,495.50
65,051.62 65,051.62 /
Comcast 11-09-2011 Check #337 66.14 66.14
Comcast 11-30-2011 Check #341 66.14 66.14
Comcast 01-13-2012 Check #348 66.14 66.14
Comcast 02-07-2012 Check #354 66.15 66.15
Comcast 02-28-2012 Check #362 66.15 66.15
Comcast 04-02-2012 Check #369 66.15 66.15
Comcast 04-23-2012 Check #374 66.15 66.15
Comcast 05-23-2012 Check #383 70.48 70.48
Comcast 06-27-2012 Check #390 70.48 70.48
Comcast 07-31-2012 Check #395 70.48 70.48
Comcast 08-22-2012 Check #401 70.48 70.48
744.94 744.94
Comm. of PA Mobile Dentistry 05-09-2012 Check #376 65.00 65.00
65.00 65.00 /
Family Practice Center 01-13-2012 Check #350 30.00 30.00
Family Practice Center 05-23-2012 Check #382 5.00 5.00
35.00 35.00 /
Freedome Blue PPO 01-13-2012 Check #347 3.00 3.00
3.00 3.00 /
Hazen Elder Law 02-28-2012 Check #359 4,399.27 4,399.27
4,399.27 4,399.27 /
Heartland Healthcare Services 10-10-2011 Check #334 332.17 332.17
Heartland Healthcare Services 1i-09-2011 Check #339 325.47 325.47
Heartland Healthcare Services 12-13-2011 Check #345 354.17 354.17
Heartland Healthcare Services 01-13-2012 Check #351 296.31 296.31
Heartland Healthcare Services 02-07-2012 Check #357 204.50 204.50
Heartland Healthcare Services 03-19-2012 Check #365 183.35 183.35
Heartland Healthcare Services 04-13-2012 Check #373 202.24 202.24
Heartland Healthcare Services 05-09-2012 Check #379 162.97 162.97
Heartland Healthcare Services 06-15-2012 Check #387 235.51 235.51
Heartland Healthcare Services 07-31-2012 Check #394 148.82 148.82
2,445.51 2,445.51 /
Keystone Guardianship- costs 10-05-2011 Check #331 20.99 20.99
Keystone Guardianship- costs i1-09-2011 Check #336 21.65 21.65
Keystone Guardianship- costs 12-09-2011 Check #343 24.08 24.08
Keystone Guardianship- costs 01-05-2012 Check #346 24.34 24.34
Keystone Guardianship- costs 02-02-2012 Check #353 13.63 13.63
Keystone Guardianship- costs 03-06-2012 Check #364 23.42 23.42
Keystone Guardianship- costs 04-06-2012 Check #371 12.00 12.00
Keystone Guardianship- costs 05-04-2012 Check #375 20.36 20.36
Keystone Guardianship- costs 06-07-2012 Check #386 20.00 20.00
Keystone Guardianship- costs 07-10-2012 Check #393 38.22 38.22
Keystone Guardianship- costs 08-08-2012 Check #398 29.09 29.09
Keystone Guardianship- costs 09-10-2012 Check #403 18.00 18.00
265.78 265.78
Keystone Guardianship -fees 10-05-2011 Check #331 393.75 393.75
Keystone Guardianship -fees i1-09-2011 Check #336 431.25 431.25
Keystone Guardianship -fees 12-09-2011 Check #343 318.75 318.75
Keystone Guardianship -fees 01-05-2012 Check #346 243.75 243.75
Keystone Guardianship -fees 02-02-2012 Check #353 225.00 225.00
Keystone Guardianship -fees 03-06-2012 Check #364 356.25 356.25
Keystone Guardianship -fees 04-06-2012 Check #371 262.50 262.50
Keystone Guardianship -fees 05-04-2012 Check #375 300.00 300.00
Keystone Guardianship -fees 06-07-2012 Check #386 281.25 281.25
Keystone Guardianship -fees 07-10-2012 Check #393 337.50 337.50
Keystone Guardianship -fees 08-08-2012 Check #398 200.00 200.00
Keystone Guardianship -fees 09-10-2012 Check #403 243.75 243.75
3,593.75 3,593.75 '~
Leona Shaffer 03-22-2012 Check #366 2011 Tax Preparation 80.00 80.00
80.00 80.00.E
On Sight Healthcare 02-07-2012 Check #358 235.17 235.17
On Sight Healthcare 06-15-2012 Check #388 181.81 181.81
416.98 416.98
Pinnacle Health Hospitals i1-09-2011 Check #338 56.79 56.79
Pinnacle Health Hospitals 02-28-2012 Check #363 132.07 132.07
Pinnacle Health Hospitals 04-13-2012 Check #372 56.75 56.75
Pinnacle Health Hospitals 05-09-2012 Check #377 14.52 14
52
Pinnacle Health Hospitals 08-14-2012 Check #400 14.52 .
14.52
274.65 274.65 /
Register of Wills 11-02-2011 Check #335 15.00 15.00
15.00 15.00 /
See Right Pharmacy 10-10-2011 Check #333 11.98 11
98
See Right Pharmacy 12-13-2011 Check #344 8
54 .
See Right Pharmacy
01-13-2012
Check #352 . 8.54
See Right Pharmacy
02-07-2012
Check #356 17.05 17.05
See Right Pharmacy
05-09-2012
Check #380 10.78 10.78
See Right Pharmacy
06-06-2012
Check #384 16.73 16.73
See Right Pharmacy
07-06-2012
Check #391 10.07 10.07
See Right Pharmacy
08-14-2012
Check #399 24.84 24.84
See Right Pharmacy
09-19-2012
Check #404 278 22 278 22
309.58 309.58
687.79 687.79 /
Smith Radiology, Inc. 07-31-2012 Check #396 8.68 8.68
Stephen ). Hogg, Esquire
The Patriot News
02-28-2012 Check #360
04-02-2012 Check #367
8.68 8.68
674.25 674.25
674.25 674.25 ,/
101.40 101.40
101.40 101.40
79,183.82 79,183.82
AP Transaction Vendor Invoice.
Sven Jensen
BALANCE SHEET
as at Sep 29 2012
ASSETS
Sep 29 2012
Income- HNB Checking #100110983 2,060.26
Income- HNB Savings #200112953 1,008.92
Income- Mid Penn CD #301084438 (matures 8/14/2014) 373.62
Income- Jackson National Insurance- IRA #1005683323 17,267.73
Principal- HNB Checking #100110983 2,726.11
Principal- HNB Savings #200112953 6,785.00
Jackson National Insurance- IRA #1005683323 249,911.95
Halifax Bank CD #300114354 (matures 9/14/2013) 15,000.00
Mid Penn CD #301084438 (matures 8/14/2014) 10,000.00
Mid Penn CD #301084437 (matures 12/14/2013) 15,000.00
Burial Reserve: Hollinger Funeral Home & Crossroads Cemetary Asso. 8,215.00
TOTAL ASSETS ................. _
328,348.59
LIABILITIES
TOTAL LIABILITIES
SHAREHOLDER'S EQUITY
Assets at time of Appointment
Assets discovered after Appointment
Current Earnings
TOTAL EQUITY
TOTAL LIABILITIES & EQUITY
504,534.10
2,693.67
(178,879.18)
_._. __
328,348.59
Z7o 'ono rn