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HomeMy WebLinkAbout13-3736 Supreme Court OAT,ennsylvania Court of- Common, Pleas For Prothonotary Use Only: ( � C>vil Cover S Docket No: _ l�UM" P' i"'�Q1x1 County (3'° � Civil (erm The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service ofpleadings or other papers as required bylaw or rules of court. Commencement of Action: S El Complaint El Writ of Summons El Petition 0 Transfer from Another Jurisdiction Declaration of Taking E C Lead Plaintiff's Name: Lead Defendant's Name: T Ka- Korb A I ice �i l ips Dollar Amount Requested: ithin arbitration limits I Are money damages requested? Yes No (check one) outside arbitration limits O N Is this a Class Action Suit? Yes No Is this an MDJAppeal? 'OYes 0 No A Name of Plaintiff /Appellant's Attorney: d b J ' Check here if you have no attorney (are a Self- Represented [Pro Se[ Litigant) Nature of the Case Place an "X" to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS M Intentional El Buyer Plaintiff Administrative Agencies 0 Malicious Prosecution 0 Debt Collection: Credit Card El Board of Assessment 0 Motor Vehicle Debt Collection: Other F1 Board of Elections 0 Nuisance 0 Dept. of Transportation Fj Premises Liability 0 Statutory Appeal: Other S M Product Liability (does not include E mass tort) El Employment Dispute: Slander/Libel/ Defamation Discrimination C n Other: © Employment Dispute: Other El Zoning Board , Other: M Da 1 Q Other: O MASS TORT 0 Asbestos N M Tobacco Toxic Tort - DES 0 Toxic Tort - Implant REAL PROPERTY MISCELLANEOUS 0 Toxic Waste Other: 1:1 Ejectment E] Common Law /Statutory Arbitration B 0 Eminent Domain /Condemnation 0 Declaratory Judgment Ground Rent M Mandamus Landlord /Tenant Dispute 0 Non- Domestic Relations Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABLITY Mortgage Foreclosure: Commercial Quo Warranto Dental 0 Partition El Replevin M Legal 0 Quiet Title © Other: Medical 0 Other: Other Professional: Updated 1/1/2011 COMMONWEALTH OF PENNSYLVANIA NOTICE OF APPEAL COURT OF COMMON PLEAS FROM Judicial District, County Of Cumberland MAGISTERIAL DISTRICT JUDGE JUDGMENT COMMON PLEAS No 15 -3 r% 0'1'4 Teft NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the Magisterial District Judge on the date and in the case referenced below. NAME OF APPELLANT MAG. �DIST.NO. NAME OF MDJ Alice Phillips MD-04 Hon. Paula �Carreal ZIP CODE ADDRESS OF APPELLANT CITY STATE 9 Tall Oak Dr. Mechanicsburg PA 17050 DATE OF JUDGMENT IN THE CASE OF (Plaintiff) (Defendant)' 5 -30 -13 Kay Kurt �5 Alice Phillips SIGNATURE OF AP NT OR ATTORNEY OR AGENT DOCKET No. MJ- 9304 -CV -91 -2013 This block will be signed ONLY when this notation is required under Pa. I ap nt was Claimant (see Pa. R.C.P.D.J. No. 1001(6) in action R.C.P.D.J. No. 1008B. This Notice of Appeal, when received by the Magisterial District Judge, will before a Magisterial District Judge, A COMPLAINT MUST BE FILED operate as a SUPERSEDEAS to the judgment for possession in this case. within (20) days after filing the NOTICE of APPEAL. Signature of Prothonotary or Deputy PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see Pa.R.C.P.D.J. No. 1001(7) in action before Magisterial District Judge. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon Kay Kurt appellee(s), to file a complaint in this appeal Name of appellees) (Common Pleas No. �3 _ ��Jto �'IY� ( rrd ) within twenty (20) days after service ule or suffer entry of judgment of non pros. lgnature of appellant or attorney or agent RULE: To Kay Kurt appellee(s) Name of appellee(s) (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty (20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS MAYBE ENTERED AGAINST YOU. (3) The date of service of this rule if service was by mail is the date of the mailing. . Date: iy I d�hJ 20 ignature of Prothonotary or Deputy YOU MUST INCLUDE A COPY OF THE NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH THIS NOTICE OF APPEAL. AOPC 312 -05 IY7 - M t d) wso £h L • t L ho t L! dd GN (bb! # hot X OPI-OUOS S r hl,-d ad tl1N`dh �� lb3 8Wpp A�.- f!�pOp t3 J:?f 'a4 ° {1 1 J COMMONWEALTH OF PENNSYLVANIA Notice Of Judgment/Transcript CIVII COUNTY OF CUMBERLAND Case Mag. Dist. No: MDJ- 09 -3 -04 Kay - Kurt MDJ Name: Honorable Paula P. Correal V. Address: 5275 East Trindle Road Alice Phillips Suite 110 Mechanicsburg, PA 17050 Telephone: 717 -697 -2201 Alice Phillips Docket No: MJ- 09304 -CV- 0000091 =2013 9 Tall Oak Drive Case Filed 3/21/2013 Mechanicsburg, PA 17050 Disposition Summary Docket No Plaintiff Defendant Disposition Disposition Date MJ- 09304 -CV -0000091 -2013 Kay Kurt Alice Phillips Default Judgment for Plaintiff 05/30/2013 Judgment Summary Participant Joint/Several Liability . Individual Liability Amount Alice Phillips $0.00 $9,403.08 $9,403.08 Kay Kurt $0.00 $0.00 $0.00 Judgment Detail ("PostJudgment) In the matter of Kay Kurt vs. Alice Phillips on 5/30/2013 the judgment was awarded as follows: Judgment Component Joint/Several Liability Individual Liabiiity Deposit Applied Amount Civil Judgment $0.00 $9,219.41 $9,219.41 Filing Fees $0.00 $146.50 $146.50 Server Fees $0.00 $32.17 $32.17 Costs $0.00 $5.00 $5.00 Grand Total: $9,403.08 ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY- FILING A NOTICE OF APPEAL WITH THE PROTHONOTARY /CLERK OF COURT OF COMMON PLEAS, CIVIL DIVISION. YOU MUST INCLUDE A COPY OF THIS NOTICE OF JUDGMENTITRANSCRIPT FORM WITH YOUR NOTICE OF APPEAL. EXCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES, IF THE JUDGMENT HOLDER ELECTS TO ENTER THE JUDGMENT IN THE COURT OF COMMON PLEAS, ALL FURTHER PROCESS MUST COME FROM THE COURT OF COMMON PLEAS AND NO FURTHER PROCESS MAY B.E ISSUED BY THE MAGISTERIAL DISTRICT JUDGE UNLESS THE JUDGMENT IS ENTERED IN THE COURT OF COMMON PLEAS, ANYONE INTERESTED IN THE JUDGMENT MAY FILE A REQUEST FOR ENTRY OF SATISFACTION WITH THE MAGISTERIAL DISTRICT JUDGE IF THE JUDGMENT DEBTOR PAYS IN FULL, SETTLES, OR OTHERWISE COMPLIES WITH THE JUDGMENT. Date Magist6dai District Judge -_ 5---,-,.• certify that this is a true and correct copy of the record of the proceedings containing the judgment • Date Magisterial District Judge NADJS 315 Pagel of 2 Printed: 05130/2013 12:19:23PM Kay Kurt Docket No.: MJ -09304 -CV- 0000091 -201 V. Alice Phillips Participant! List Plaintiff(s) Kay Kurt ' c/o .Kay LLC 5002 Lenker Street Mechanicsburg, PA 17050 Defendant(s) Alice Philtips a 9 Tall Oak Drive Mechanicsburg,'PA 17050 , MDJS 315 Page 2 of 2 Printed: 05/30/2013 1219:23PM L✓ .J L � t3 Jl1. -3 Phi : I t Cu MB 4 NSYL\A � PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service MUST BE FILED WITHIN TEN(10)DAYS AFTER filing of the notice of appeal. Check applicable boxes.) COMMONWEALTH OF PENNSYLVANIA COUNTY OF1vt ; ss AFFIDAVIT: I hereby(swear)(affirm)that I served 13-313e NIITer61 a copy of the Notice of Appeal,Common Pleas No. , upon the Magisterial District Judge designated therein on (date of service) J ,20 1 3 , ❑ by personal service by(certified)(registered)mail, sender's receipt attached hereto, and upon the appellee, (name) , on 31.0(11 I ,20 13 ❑by personal service by(certified)(registered)mail, sender's receipt attached hereto. (SWORN)(AFFIRMED)AND SUBSCRIBED BEFORE ME THIS r DAY OF S ',20 ,3 40141.. Signature of official before whom affidavit was made FE- of. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Title of official LOYD P. SCHROEDER,NOTARY PUBLIC SUSQUEHANNA TWP., DAUPHIN COUNTY My commission expires on S IL ,20 1-) MY COMMISSION MAY 02,2017 AOPC 312A-05 Karl E. Rominger, Esquire Rominger&Associates j , .� :., PA Attorney License No. 81924 JUL 15 155 South Hannover Street CUMBERLAND CClU, l y Carlisle, PA 17013 PENNSYL'V'ANIA (717) 241-6070 Attorney for Plaintiffs IN THE COURT OF COMMON PLEAS OF KAY LLC D/B/A/ :CUMBERLAND COUNTY, PENNSYLVANIA HOME INSTEAD SENIOR CARE Plaintiffs DOCKET NO.: 13-3736 V. CIVIL ACTION—LAW ALICE PHILLIPS AND HAROLD C. MIRABITO, SR Defendants 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 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. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORAMTION 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 Phone: (717) 249-3166 (800) 990-91.08 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court,please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the Court. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference Karl E. Rominger, Esquire Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiffs IN THE COURT OF COMMON PLEAS OF KAY LLC D/B/A/ .CUMBERLAND COUNTY, PENNSYLVANIA , HOME INSTEAD SENIOR CARE Plaintiffs DOCKET NO.: 13-3736 V. CIVIL ACTION—LAW ry ALICE PHILLIPS AND HAROLD C. MIRABITO, SR Defendants COMPLAINT AND NOW, comes Plaintiff, Kay LLC d/b/a Home Instead Senior Care, by and through their counsel, Karl E. Rominger, Esquire, and submits the following: 1. Kay LLC d/b/a Home Instead Senior Car (hereinafter Plaintiff) is a limited liability company located at 5002 Lenker Street Mechanicsburg, PA 17050 in Cumberland County. 2. Alice Phillips (hereinafter Defendant Phillips) is an adult residing at 9 Tall'Oak Drive, Mechanicsburg, PA 17050 in Cumberland County. 3. Harold C. Mirabito, Sr. (hereinafter Defendant Mirabito) is an adult individual believed to be residing at 585 Yocumtown Road Etters, PA 17319-9704 in York County. 4. Plaintiff is a commercial business providing care services to senior citizens through individual contractual transactions that require payment upon services rendered. 5. Defendant Phillips assigned all health care decisions to her son Harold C. Miradito (Defendant Mirabito) in December, 2012. A true and correct.-copy of handwritten letter is a attached herein and marked as EXHIBT A. 6. Defendant Mirabito has been representing himself as Power of Attorney and De- Facto Agent for his mother Defendant Phillips. 7. The Plaintiff and Defendants Phillips and Miradito did enter into a signed contractual obligation whereas the Plaintiff would provide care services to Defendant Phillips in exchange for prompt payment for the services. A true and correct copy of the Service Agreement is attached herein and marked as EXHIBIT B. 8. Plaintiff performed care services to Defendant Phillips at her Tall Oak Drive residence in accordance with the Service Agreement. A true copy of invoices are collectively attached and marked as EXHIBIT C. 9. Defendants Phillips and Miradito have refused to pay for care services provided by Plaintiff resulting in Plaintiff amounting to damages in excess of$9403.08 COUNT I—BREACH OF CONTRACT DEFENDANT PHILLIPS 10. The previous paragraphs are incorporated herein as if fully set at length. 11. Defendant Phillips did enter into a contractual agreement with the Plaintiff via through a signed and executed Service Agreement. The Service Agreement specifically states that the "responsible party agrees to pay for all services within seven (7) days from receiving the Company invoices and is responsible for all collection and attorney's fees incurred by the Company in the collection of any delinquent amounts owing Company. Interest on unpaid invoices will accrue at the rate of one-half percent (1,5%) per month. 12. Plaintiff provided senior care services in accordance with the signed Service Agreement, but Defendant Phillips has breached the contract by refusing to pay for said services. WHEREFORE, Plaintiff requests the Honorable Court find that Defendant Phillips has . breached the Contract with Plaintiff and award damages for$9403.08 including monthly accrued 1.5%interest from December 1, 2012 and ongoing to the present as well as attorney fees, and all related costs of prosecution of this claim as such relief the Court deems appropriate. COUNT II-BREACH OF CONTRACT DEFENDANT MIRABITO 13. The previous paragraphs are incorporated herein as if fully set at length.. 14. Defendant Mirabito has been representing himself as the Power of Attorney and/or De-Facto Agent for Defendant Phillips, and is the responsible party for payment of the outstanding invoices generated from Plaintiff's services provided to Defendant Phillips. 15. Defendant Mirabito, as De-Facto Agent Defendant Phillips entered into a contractual agreement with Plaintiff through a signed and executed Service Agreement. The Service Agreement specifically states that the "responsible party agrees to pay for all services within seven (7) days from receiving the Company invoices and is responsible for all collection and attorney's fees incurred by the Company in the collection of any delinquent amounts owing Company. Interest on unpaid invoices will accrue at the rate of one-half percent (1.5%) per month. 16. Plaintiff provided senior care services in accordance with the signed Service Agreement,but Defendant Mirabito has breached the contract by refusing to pay for said services. COUNT III- UNJUST ENRICHMENT DEFENDANT PHILLIPS 17. The previous paragraphs are incorporated herein as if fully set at length. 18. Plaintiff provided senior care services to Plaintiff Phillips and has fulfilled all aspects of the Contract Service Agreement and has incurred $9,403.08 in fees. 19. Defendant Phillips has benefited from such services through the enrichment of safe, and dependable senior care. Defendant Phillips has been unjustly enriched by the Plaintiff's services through refusing to pay Plaintiff accordingly. WHEREFORE, Plaintiff requests the Honorable Court find that Defendant Phillips was unjustly enriched and award damages to Plaintiff for$9403.08 including monthly accrued 1.5% interest from December 1, 2012 and ongoing to the present as well as attorney fees, and all related costs of prosecution of this claim as such relief the Court deems appropriate. Respectfully Submitted, ROMINGER & ASSOCIATES Date: '`-- Karl E. Rominger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff Karl E. Rominger, Esquire Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiffs IN THE COURT OF COMMON PLEAS OF KAY LLC D/B/A/ :CUMBERLAND COUNTY, PENNSYLVANIA HOME INSTEAD SENIOR CARE Plaintiffs DOCKET NO.: 13-3736 V. CIVIL ACTION—LAW ALICE PHILLIPS AND HAROLD C. MIRABITO, SR Defendants ATTOREY VERIFICATION Karl E. Rominger, Esquire states that he is the attorney for Plaintiff in this action; that he makes this affidavit as attorney because he has sufficient knowledge or information and belief,based upon his investigation of the matters averred or denied in 'the foregoing document, and the Plaintiff was unavailable to sign the verification within the time allowed for filing the pleading; and that this statement is made subject to the penalties of 18 Pa. C.S. Pa.C.S. §4904, relating to to authorities. Date: (64 3 7!!: V Karl E. Rominger, Esquire 155 South Hanover Street Carlisle,Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff � f From:Home instead Senior Care 717 731 9965 07/12/2013 12:41 #113 P.002/006 a z, Home"brnstead vi/ Afi ✓�f . �+rl.�/G+GG.I�SM SERVICE AGREEMENT Retired ONO! This Non-Medical Companionship and Homecare Services Agreement (the "Agreement") is entered into on (date), by and between Kay, LLC ("Company"), d/b/a Home Instead Senior Care (HISQ, 3 and ("Client") with an address of c l C " f Kay, LLC d/b/a/RISC performs non-medical companionship,homecare,and ersonal care services and Client desires to enter into this Agreement with the Company for the services listed below. The Client is allowed, by law, a three (3) day period following the day the Agreement is signed by both parties, to further consider the terms of this Agreement, during which the Client can cancel the Agreement without financial or other penalty,and without explanation. Now,therefore,in consideration of the mutual promises contained herein,the parties,intending to be legally bound,agree as follows: Begin Date:Dea 7. Continuing Care -Offers a reduced rate for clients with long-term needs and requires week notice to reduce or cancel services. Temporary Care-Designed for clients with short-term,or decreasing needs such as recuperating from an illness,injury or surgery; adjusting to new environment or change; and requires only 3 business days advanced notice to reduce or cancel service. Minimum of 25 hours service required. Occasional Care - Designed as back-up care when primary caregiver needs a break; has an appointment; is sick, hospitalized or out of town;attending a wedding,graduation,etc,;or when client only needs care on `bad days'. Must enroll in advance and maintain service deposit with provider. Day and Evening Rate S /hour Sleepover 10 hour Shift $ /Shift �4 With Personal Care $_2_,9S_/hour Q With Personal Care $ocis,/Shift Rise and Shine/Tuck In $ /shift F Service Schedule: 5 i CAREGivers are employees of Kay,LLC d/b/a/HISC and are insured and bonded through our agency. All payroll and f tax responsibilities are processed through Kay,LLC d/b/a/HISC and are not the responsibility of the client. Weekend Rates - Shifts which begin between 7pm on Friday until lam on Monday are computed at 10%above the Regular Rates. The Following Holidays will be charged at one and one-half(1.5)times the service fee charged. New years Eve after 12:00pm, New Years Day,Easter/Passover, Memorial Day,Independence Day, Labor Day,Thanksgiving, Christmas Eve after 12:00pm and Christmas Day. You will be provided Holiday Service on these days unless you call to cancel. Automobile mileage is'charged at the rate of 58.5 cents/mile, and paid out to the CAREG*Yff m full, for all errands and incidental transportation involving use of the CAREGiver's own vehicle. Client's car: Yes The service fees and mileage rate are subject to change with thirty(30)days notice. Each visit requires a minimum of three(3)hours("Minimum Visit"). Scheduled service visits that are not canceled twenty-four (24)hours in advance of the appointment will be assessed the charge for a Minimum Visit under this Agreement,except in those cases involving medical emergencies. Sleepover Service is a discounted 10 hour shift from 9pm to Tarn. CAREGiver assists client in the evening,to get ready for bed, during the night as needed, and in the morning to get ready for the day. CAREGivers are not permitted to do any housework during this shift.CAREGivers are permitted to sleep when client is sleeping,up to 8 hours. If CAREGivers are unable to sleep at least 5 hours per night on a regular basis,due to client needs,the assignment will be converted to an hourly rate. They must be provided with a reasonable place to sleep(bed,couch,recliner),pillow,and blanket. Rise and Shine/Tuck-In Services are 90 minute shifts designed to assist the client in getting ready for the day or getting ready for bed. Normally includes meal preparation, bathing & dressing assistance and medication reminders. CAREGivers are not permitted to do any housework during this shift. Service must be used at least 5 days each week(Mon-Fri). Shift times are not guaranteed. Availability of this service may be limited. 1 of 2 From:Home Instead Senior Care 717 731 9985 07/12/2013 12:41 0113 P.003/008 9 In the event that a client requires all service to be provided by certain caregivers, and RISC can only accommodate that request by paying overtime wages to CARE-Givers,the client will be billed at one and one-half times the Regular Rate, 3 Kay,LLC d/b/a/RISC conducts personal face to face interviews and documents all pertinent information of each employee. 4 Entry into Client's home will be handled in the following manner: CX)t' Billin ompany will invoice the responsible party two(2)times a month. There is a required fully refundable deposit of $ ,amounting to approximately one(1)week scheduled service,which is due upon(a)entering into this Agreement and ( initially accepting a proposed CAREGiver. The deposit fairly funds the costs incurred by the Company while providing services for one week prior to first invoicing. This deposit will be refunded in full within seven(7)days of payment of the final invoice under this Agreement. Further, the responsible party expressly grants to Company a right of setoff, against unpaid invoices,with regard to the deposit. The responsible party agrees to pay for all services within seven(7}days frown tite.date of receiving(vompapy's invoice,and is , s responsible for all:collection,and,attorney's.fees incurred by Company in the collection of any delinquent amounts owing to Company 'Interest on unpaid invoices will accrue at the late.bf otte,imd 666-half percent(I:510)per ntoitth. We will only accept checks made payable to Home Instead Senior Care. No individual as a result of the individuals' affiliation with Home Instead Senior Care may assume power of authority or guardianship over a client using our services. . . Home Instead Senior Care may not require a client to endorse checks over to our agency. Termination: We will provide 10 days written notice of the intent to terminate service. Less than 10 days notice will be given if the client has failed to pay for services and despite notice is more than 14 days in arrears, or if the health and welfare of the CAREGiver is at risk. f. Restriction on Hiring Company Employees: During the tern of this Agreement and for a period of one(1)year following the discontinuance of services with Company and the termination of this Agreement, Client agrees not to hire, employ, or independently contract for the services of any Company employee who is/was employed by Company at any time during the term of this Agreement, unless such person is placed through Company. If Company permits placement a fee equal to four e months of scheduled service or$3,600,whichever is greater,is payable to Company within 10 days of such employment. Governing Law: This Agreement has been made and entered in the Commonwealth of Pennsylvania and shall be governed by, 3 and construed in accordance with,the laws of the Commonwealth of Pennsylvania, without giving effect to its conflicts of law provisions. Client acknowledges that the Provider is not a registry or employment service. Client agrees not to solicit or induce,nor allow any person or entity acting on Client's behalf to solicit or induce, any caregiver of Kay, LLC, to terminate the caregiver's relationship with Kay, LLC and/or work for Client or others directly,bypassing Kay,LLC. Caregiver's relationship with Kay, LLC extends,by separate employment agreement with the caregiver,for one year after ending employment with Kay, LLC. If i Client breaks the agreement outlined in this paragraph,Client agrees to pay Provider a fee equal to four(4)months(sixteen(16) weeks) of the caregiver's scheduled monthly number of billable hours during the past twelve (12) months, at the caregiver's highest hourly rate of pay. Disclaimer/Waiver: f CLIENT UNDERSTANDS THAT COMPANY PROVIDES ONLY NON-MEDICAL COMPANIONSHIP AND HOMECARE SERVICES AND IS NOT LICENSED OR INSURED TO PROVIDE MEDICAL SERVICES OF ANY KIND. THIS AGREEMENT IN NO MANNER OBLIGATES, REQUIRES OR CONTEMPLATES THE PROVISION OF EMERGENCY OR NON-EMERGENCY MEDICAL SERVICES BY COMPANY, ITS EMPLOYEES, OR AGENTS. CLIENT AGREES f THAT COMPANY, ITS EMPLOYEES, OR AGENTS WILL NOT BE HELD LIABLE FOR NOT PROVIDING EMERGENCY OR NON-EMERGENCY MEDICAL SERVICES. CLIENT FURTHER WAIVES ANY RIGHT, FOR THEMSELVES, THEIR ESTATE AND/OR THEIR HEIRS, TO BRING SUIT ON THE BASIS THAT COMPANY, ITS EMPLOYEES OR AGENTS DID NOT PROVIDE EMERGENCY OR NON-EMERGENCY MEDICAL SERVICES FOR CLIENT. 3 The parties have executed this Non-Medical Companionship,Homecare,and Personal Care Services Agreement: The.name,address,,and..telephone numbe.r.of the.resporisible.party:for.receiying and.paying invoices for services rendered by ` Ho a Iris Senior Care to h`"C'ent. (Name of persona reefing Pay Company invoices) (Kay,LLC representative) a TjaAA 06K Or. n irsh ma Y-0, 1 (Billing address and tel phone number) Horne Instead Senior Care,5002 Lenker Street,Suite 141 Mechanicsburg,PA 17050 ph:717-731-9984 f'.731-9985 2of2 r Frbm:Home Instead Senior Care 717 7319985 07/12/2013 12:41 #113 P.004/008 z 4g 7 x *Home k Instead SENIOR CARED Client Confidentiality Statement I Home Instead Senior Care maintains a practice of confidentiality and protection of personal and s medical information of the clients in our service.In order to provide for the highest quality of ; service, there may be instances in which Home Instead Senior Care discloses information about you. . s 3 Use and disclosure may occur when: 4f a A referral is made on your behalf, or to coordinate other appropriate in-home services. These may include a consultation with doctors, nurses,health care personnel,facilities and providers who specialize in health related products. For the purpose of billing for services. Home Instead Senior Care may be required to release medical information to an insurance company or to third party payer. a Maintaining quality assurance for your service. Home Instead Senior Care may discuss your service needs with office staff and CAREGivers who provide service to you. a Releasing information to family members and other individuals involved in the coordination of services. Information may be released to the following: Designated s Agent,Power of Attorney, Conservator,Guardian, family members,relatives,and/or friends who have your well-being in their interest and also have the need for relevant service information. Is there anyone to whom Home Instead Senior Care should not release information? If so,please name: i f i a In the event of medical emergency when the release of confidential information will benefit professionals providing service or care. a Situations of abuse, neglect and domestic violence are identified, or required by law. (I".//& 'L^---- f/� C Home Instead Senior Care Representative Client/Designated Agent Date I Date Each Home Instead Senior Care office is independently owned and operated. Fr•om:Home Instead Senior Care 717 731 9985 07/12/2013 12:42 #113 P.005/008 tt • k 1 Homelwnsste ad OD MEN t 3 Consumer Notice of Direct Care Worker Status This form is to be completed by every consumer utilizing the services of a Home Care Agency. i. l C AA (' b J fG Sr. understand that: PRINT NAME 4 t Initial Below l The direct care worker who will be providing services in my home is an employee of Kay, LLC, d/b/a Home Instead Senior Care. Home Instead Senior Care is responsible for withholding State and Federal +; Income tax, Federal Unemployment tax, Social Security taxes and Medicare taxes on behalf of the direct care worker. Home Instead Senior Care is also responsible for paying workers' compensation insurance to cover the direct care worker in the event of accident or injury on the job. iyM 1 have been informed that Home Instead Senior Care maintains general and professional liability insurance covering the direct care worker. If Home Instead Senior Care does not maintain general and professional liability insurance, and the direct care worker is not covered under workers' compensation, I have been advised to check my homeowner's or renter's insurance to determine if it covers any injury or accident involving the direct care worker while working in my home. Signature of Consumer or Consumer's Representative Date is A Signature of Representative of Home Instead Senior Care 15ate Frdm:Home instead Senior Care 717 731 9985 07/12/2013 12:42 #113 P.006/005 f t DETAILED INVOICE Service For :Alice Phillips(2) Billed To : Mrs. Alice Phillips(2) Invoice#: 1780-1212-1 5002 Lenker Street Mechanicsburg,PA 17050 Invoice Date :5/15/2013 (717)731-9984 Service Period:Dec 01,2012-Dec 15,2012 www.Homelnstead.com I t 12/7 3:00pm 10:30pm Normal Stoffels,Carol Hourly Service,Level 2 7.50 $20.95 7$207A5 10:30pm 7:00am Weekend Scott,Cheryl Sleepover,Level 0.85 $186.95 12/8 7:00am 4:00pm Weekend Ross,Juliette(Jill) Hourly Service,Level 2 9.00 $23.05 4:00pm 10:15pm Hartzell,Marna Hourly Service,Level 2 6.25 $23.05 $144.06 1 10:15pm 7:00am Drasher,Marlene Sleepover,Level 2 0.88 $186.95 $164.52 12/9 7:00am 10:00am Weekend Kapp,Christina Hourly Service,Level 2 3.00 $23.05 $69.15 3:00pm 9:00pm Daniels,Charlotte Hourly Service,Level 2 6.00 $23.05 $138.30 12/10 1:00pm 6:00pm Normal Koons,Marguerite(P Hourly Service,Level 2 5.00 $20.95 $104.75 4 12/11 3:00pm 9:00pm Normal Daniels,Charlotte Hourly Service,Level 2 6.00 $20.95 $125.70 9:00pm 7:00am Scott,Cheryl Sleepover,Level 1 1.00 $169.95 $169.95 12/12 7:00am 10:00arn Normal Ross,Juliette(Jill) Hourly Service,Level 2 3.00 $20.95 $62.85 12/13 3:00pm 9:00pm Normal Myers,Jody Hourly Service,Level 2 6.00 $20.95 $125.70 9:00pm 9:15am Scott,Cheryl Hourly Service,Level 2 2.25 $20.95 $47.14 Sleepover,Level 2 1.00 $169.95 $169.95 r 12/15 7:00am 1:30pm Weekend Ross,Juliette(Jill) Hourly Service,Level 2 6.50 $23.05 $149.83 1:30pm 9:00pm Daniels,Charlotte Hourly Service,Level 2 7.50 $23.05 $172.88 . 9:00pm 7:00am Clouse,Lori Sleepover,Level 2 1.00 $186.95 $186.95 f E { f I t i l i Miles: 0.00 @ $0.59 = $0.00 Miscellaneous Charges: = $0.00 Additional Charges/Credits: m $0.00 Service Deposit Applied: _ $0,00 Current Invoice Total: _ $2,355.20 Total Amount Due: $2,355.20 Due Date: June 09,2013 "All Overdue Invoices are Subject to an 18%Annual Service Charge Please Retain For Your Records __ --. �._._ __......__ •----- --- .'Please Detach And Return This PortionWilb Your Payment Payable to Home Instead Senior Care Each Home Instead Senior Care Franchise 0lrice is independently owned and operated. Invoice#: 1780-1212-1 Service For: Alice Phillips(2) Service Period. Dec 01,2012-Dec 15,2012 Mrs.Alice Phillips(2) Current Invoice Total: $2,355.20 9 Tall Oak Dr. Mechanicsburg,PA 17050 Total Amount Due: $2,355.20 Due Date: June 09,2013 Fram:dome Instead Senior CAre 717 731 995b U// 14/evlo 1G;4e Pilo r.vVllVVo DETAILED INVOICE Service For: Alice Phillips(2) Billed To: Mrs.Alice Phillips(2) 5002 Lenker Street Invoice#: 1780-1212-2 Mechanicsburg,PA 17050 Invoice Date: 5/15/2013 (717)731-9984 R Service Period:Dec 16,2012-Dec 31,2012 www.Homeinstead.com : 12/16 7:00am 10:00am Weekend Dougherty,Ashley 7Hourly ervice,Level 2 3.00 $23.05 $69.15 12/18 3:00pm 9:00pm Normal Daniels,Charlotte ervice,Level 2 6.00 $20.95 $125.70 9:00pm 7:00am Dougherty,Ashley r,Level 2 1.00 $169.95 $169,95 12/19 7:00am 10:1 Sam Normal Dougherty,Ashley Hourly Service,Level 2 3:25 $20.95 $68.09 ' 3:00pm 9:00pm Stoffels,Carol Hourly Service,Level 2 6.00 $20.95 $12530 12/22 1:30pm 10:00am Weekend Myers,Amanda Hourly Service,Level 2 10.50 $23.05 $242.03 r Sleepover,Level 2 1.00 $186.95 $186.95 i 12/24 4:00pm 8:45pm Holiday Green,:sill Hourly Service,Level 2 4.75 $31.43 $149.29 8:45pm 10:00am Myers,Amanda Hourly Service,Level 2 3.25 $31.43 $102.15 Sleepover,Level 2 1.00 $254.93 $254.93 12/25 4:00pm 10:00am Holiday Myers,Amanda Hourly Service,Level 2 8.00 $31.43 $251.44 Sleepover,Level 2 1.00 $254.93 $254.93 12/26 10:00am 3:00pm Normal Myers,Amanda Hourly Service,Level 2 5.00 $20.95 $104.75 12/28 10:00am 5:00pm Normal Koons,Marguerite(P 12.00 Hourly Service,Level 2 7.00 $20.95 $146.65 12/29 9:00am 2:00pm Weekend Doelp,Laura Hourly Service,Level 2 5.00 $23.05 $115.25 2:00pm 9:30pm Daniels,Charlotte Hourly Service,Level 2 7.50 $23.05 $172.88 12/30 10:00am 2:00pm Weekend Myers,Amanda 1100 Hourly Service,Level 2 4.00 $23.05 $92.20 } 2:00pm 9:15pm Genet,Deborah Hourly Service,Level 2 7.25 $23.05 $167.11 12/31 5:00pm 9:00pm Holiday Myers,Amanda Hourly Service,Level 2 4.00 $31.43 $125.72 9:00pm 10:00am Hourly Service,Level 2 3.00 $31.43 $9419 Sleepover,Level 2 1.00 $254.93 $254.93 w"101=1 j v .. .. _ 0-6 him . Miles: 24.00 G $0.59 = $14.04 x Miscellaneous Charges: _ $0.00 Additional Charges/Credits: _ $0.00 Service Deposit Applied: _ $0.00 f Current Invoice Total: _ $3,288.12 Total Amount Due: $V88.12 Due Date: June 09,2013 "All Overdue Invoices are Subject to an 19%Annual Service Charge Please Retain For Your Records Please Detach And Return This PortionWitb Your Payment Payable to Home Instead Senior Cam Each dome Instead Senior Care Franchise Office is independently owned and operated Invoice#: 1780-1212-2 Service For: Alice Phillips(2) Service Period: Dec 16,2012-Dec 31,2012 Mrs.Alice Phillips(2) Current Invoice Total: $3,288,12 9 Tall Oak Dr. Mechanicsburg,PA 17050 Total Amount Due: $3,288.12 Due Date, June 09,2013 From:Home Instead Senior Care . 717 731 998b Uii1efeUIJ le:4L IFI IJ r.�tio{��o DETAILED INVOICE f Service For :Alice Phillips(2) Billed-To : Mrs. Alice Phillips(2) Invoice#: 1780-0113-1 5002 Lenker Street s Invoice Date•5/15/2013 Mechanicsburg,PA 17050 F (717)731-9984 Service Period:Jan 01,2013-Jan 15,2013 www.Homeln§tead.com 1. 1 1/2 10:00am 6:00pm Normal Scott,Cheryl Hourly Service,Level 2 8.00 $20.95 $167.60 it 6:00pm 9:00pm Myers,Amanda Hourly Service,Level 2 3.00 $20.95 $62.85 F 1/3 10:00am 9:00pm Normal Scott,Cheryl Hourly Service,Level 2 11.00 $20.95 $230.45 i 1/4 3:00pm 6:00pm Normal French,Jaime Hourly Service,Level 2 3.00 $20.95 $62.85 ' 6:00pm 3:00pm Weekend Myers,Amanda Hourly Service,Level 2 11.00 $23.05 $253.55 Sleepover,Level 2 1.00 $186.95 $186.95 115 3:00pm 9:15pm Weekend Scott,Cheryl Hourly Service,Level 2 6.25 $23.05 $144.06 1/6 10:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 11.00 $23.05 $253.55 1/9 2:00pm 6:00pm Normal Scott,Cheryl Hourly Service,Level 2 4.00 $20.95 $83.80 1/10 9:15am 4:15pm Normal Scott,Cheryl Hourly Service,Level 2 7.00 $20.95 $146.65 1/12 10:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 11.00 $23.05 $253.55 9:00pm 7:00am Sleepover,Level 2 1.00 $186.95 $186.95 1/13 7:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 14.00 $23.05 $322.70 t l 4 Ff 4 { F I i I Miles: 0.00 « $0.59 a $0.00 Miscellaneous Charges: _ $0.00 Additional Charges/Credits: $0.00 Service Deposit Applied: _ $0.00 Current Invoice Total: _ $2,355.51 Total Amount Due: $29355.51 Due Date: June 09,2013 *All Overdue Invoices are Subject to an 16%Annual Service Charge Please Retain For Your Records Please Detach And Petura This PortionWith Your Payment Payable to Home Instead Senior Care V^ ' Each Home Instead Senior Care Franchise Once is independently owned and operated. Invoice#: 1780-0113-1 Service For: Alice Phillips(2) 2 Mrs.Alice Philli s Service Period' Jan 01,2013-Jan 15,2013 P ( ) Current Invoice Total: $2,355.51 9 Tall Oak Dr. Mechanicsburg,PA 17050 Total Amount Due: $2,355.51 Due Date: June 09,2013 1 Karl E. Rominger, Esquire Rominger& Associates PA Attorney License No. 81924 = 'Z P P1 i i t �' a `4 155 South Hannover Street Carlisle, PA 17013 ' 'j(°�'- 15 i (' (717) 241-6070 CUMBERLANIJ COUNT ,Y P E N N 5 Y LVA N l A Attorney for Plaintiff KAY KURT (k/a KURT KAY) IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. : DOCKET NO.: 13-3736 ALICE PHILLIPS Defendants : CIVIL ACTION—LAW 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 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. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORAMTION 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 Phone: (717) 249-3166 (800) 990-9108 AMERICANS WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the Americans with Disabilities Act of 1990. For information about accessible facilities and reasonable accommodations available to disabled individuals having business before the Court,please contact our office. All arrangements must be made at least 72 hours prior to any hearing or business before the Court. All arrangements must be made at least 72 hours prior to any hearing or business before the court. You must attend the scheduled conference Karl E. Rominger, Esquire Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiff KAY KURT (k/a KURT KAY) : IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. DOCKET NO.: 13-3736 ALICE PHILLIPS Defendants : CIVIL ACTION—LAW COMPLAINT AND NOW, comes Plaintiffs, Kay Kurt (k/a Kurt Kay)by and through counsel, Karl E. Rominger, Esquire, and submits the following: 1. Kay Kurt (k/a Kurt Kay hereinafter Plaintiff) is an adult individual and owner of Kay LLC d/b/a Home Instead Senior Care located at 5002 Lenker Street Mechanicsburg, PA 17050 in Cumberland County. 2. Alice Phillips (hereinafter Defendant Phillips) is an adult residing at 9 Tall Oak Drive, Mechanicsburg, PA 17050 in Cumberland County. 3. Plaintiff provides care services to senior citizens through individual contractual transactions that require payment upon services rendered. 4. Defendant Phillips assigned all health care decisions to her son Harold C. Miradito (Defendant Mirabito) in December 2012. A true and correct copy of handwritten letter is a attached herein and marked as EXHIBT A. 5. The Plaintiff and Defendant Phillips did enter into a signed contractual obligation whereas the Plaintiff would provide care services to Defendant Phillips in exchange for prompt payment for the services. A true and correct copy of the Service Agreement is attached herein and marked as EXHIBIT B. 6. Plaintiff performed care services to Defendant Phillips at her Tall Oak Drive residence in accordance with the Service Agreement. A true copy of invoices are collectively attached and marked as EXHIBIT C. 7. Defendant Phillips has refused to pay for care services provided by Plaintiff resulting in Plaintiff obtaining a Judgment for damages in the amounting to $9403.08 from Magisterial District Court 09-3-04 by Honorable Paula P. Correal on May 30, 2013 with docket number MJ-09304-CV-91-2013. A true and correct copy of the Judgment is attached herein and marked as EXHIBIT D. 8. Defendant Phillips filed an Appeal to the Judgment on June 25, 2013 and has brought this proceeding to this Honorable Court. A true and correct copy of the Notice of Appeal is attached herein and marked as EXHIBIT E. COUNT I—BREACH OF CONTRACT 9. The previous paragraphs are incorporated herein as if fully set at length. 1.0. Defendant Phillips did enter into a contractual agreement with the Plaintiff via through a signed and executed Service Agreement. The Service Agreement specifically states that the "responsible party agrees to pay for all services within seven (7) days from receiving the Company invoices and is responsible for all collection and attorney's fees incurred by the Company in the collection of any delinquent amounts owing Company. Interest on unpaid invoices will accrue at the rate of one-half percent (1.5%) per month. 11. Plaintiff provided senior care services in accordance with the signed Service Agreement,but Defendant Phillips as the responsible party has breached the contract by refusing to pay for said services. WHEREFORE, Plaintiff requests the Honorable Court find that Defendant has breached the Contract with Plaintiff and award damages to Plaintiff for $9403.08 including monthly accrued 1.5% interest from December 1, 2012 and ongoing to the present as well as attorney fees, and all related costs of prosecution of this claim as such relief the Court deems appropriate. COUNT II -UNJUST ENRICHMENT 12. The previous paragraphs are incorporated herein as if fully set at length. 13. Plaintiff provided senior care services to Plaintiff Phillips in fulfillment of all aspects,of the Contract Service Agreement and has incurred damages in excess of $9,403.08 in fees. 14. Defendant Phillips has benefited from such services through the enrichment of safe, and dependable senior care. Defendant Phillips has been unjustly enriched by the Plaintiff's services through refusing to pay Plaintiff accordingly. WHEREFORE, Plaintiff requests the Honorable Court find that Defendant Phillips was unjustly enriched and award damages to Plaintiff for$9403.08 including monthly accrued 1.5% interest from December 1, 2012 and ongoing to the present as well as attorney fees, and all related costs of prosecution of this claim as such relief the Court deems appropriate. Respectfully Submitted, ROMINGER & ASSOCIATES Date: Karl E. Rominger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff Karl E. Rominger, Esquire Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiff KAY KURT (k/a KURT KAY) : IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. DOCKET NO.: 13-3736 ALICE PHILLIPS Defendants : CIVIL ACTION—LAW ATTOREY VERIFICATION Karl E. Rominger, Esquire states that he is the attorney for Plaintiff in this action; that he makes this affidavit as attorney because he has sufficient knowledge or information and belief,based upon his investigation of the matters averred or denied'in the foregoing document, and the Plaintiff was unavailable to sign the verification within the time allowed for filing the pleading; and that this statement is made subject to the penalties of 18 Pa. C.S. Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: U Karl E. lZbminger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff Y J T Z - , From:Home Instead Senior Care 717 731 9985 07/1212013 12:41 #113 P.002/008 } ' s HomeTnstead f Zo wr, �f�aei-LOrra.G�M SERVICE AGREEMENT Revised 09A6111 This Non-Medical Companionship and Homecare Services Agreement (the "Agreement") is entered into on (date), by and between Kay, LLC ("Company"), d/b/a Home Instead Senior Care (HISC), and l ("Client") with an address of ` Kay, LLC d/b/a/RISC performs non-medical companionship,homecare, and ersonal care services and Client desires to enter into this Agreement with the Company for the services listed below. The Client is allowed, by law, a three (3) day period following the day the Agreement is signed by both parties, to further consider the terns of this Agreement, during which the Client can cancel the Agreement without financial or other penalty,and without explanation. Now,therefore,in consideration of the mutual promises contained herein,the parties,intending to be legally bound,agree as follows: Begin Date: ea ~7, 01 _ Continuing Care- Offers a reduced rate for clients with long-term needs and requires week notice to reduce or cancel s services. Temporary Care-Designed for clients with short-term,or decreasing needs such as recuperating from an illness,injury or surgery; adjusting to new environment or change; and requires only 3 business days advanced notice to reduce or cancel service. Minimum of 25 hours service required. Occasional Care - Designed as back-up care when primary caregiver needs a break; has an appointment; is sick, hospitalized or out of town; attending a wedding,graduation,etc.;or when client only needs care on `bad days'. Must enroll in advance and maintain service deposit with provider. Day and Evening Rate $ /hour Sleepover 10 hour Shift S /Shift 1 With Personal Care $_2p, .42S`/hour _)With Personal Care $ 1&61 qS-/Shift Rise and Shine/Tuck In $ /shift Service Schedule: CAREGivers are employees of Kay,LLC d/b/a/HISC and are insured and bonded through our agency. All payroll and tax responsibilities are processed through Kay,LLC d/b/a/HISC and are not the responsibility of the client. Weekend Rates - Shifts which begin between 7pm on Friday until lam on Monday are computed at 10%above the Regular Rates. The Following Holidays will be charged at one and one-half(1.5)times the service fee charged. New years Eve after 12:00pm, New Years Day,Easter/Passover, Memorial Day, Independence Day, Labor Day,Thanksgiving,Christmas Eve after 12:00pm and Christmas Day. You will be provided Holiday Service on these days unless you call to cancel. Automobile mileage is charged at the rate of 58.5 cents/mile, and paid out to the CAREGi r in full, for all errands and incidental transportation involving use of the CAREGiver's own vehicle. Client's car: Yes The service fees and mileage rate are subject to change with thirty(30)days notice. Each visit requires a minimum of three(3)hours("Minimum Visit"). Scheduled service visits that are not canceled twenty-four (24)hours in advance of the appointment will be assessed the charge for a Minimum Visit under this Agreement,except in those cases involving medical emergencies. Sleepover Service is a discounted 10 hour shift from 9pm to lam. CAREGiver assists client in the evening,to get ready for bed, during the night as needed, and in the morning to get ready for the day. CAREGivers are not permitted to do any housework during this shift.CAREGivers are permitted to sleep when client is sleeping,up to 8 hours. If CAREGivers are unable to sleep at least 5 hours per night on a regular basis,due to client needs,the assignment will be converted to an hourly rate. They must be provided with a reasonable place to sleep(bed,couch,recliner),pillow,and blanket. Rise and Shine/Tuck-In Services are 90 minute shifts designed to assist the client in getting ready for the day or getting ready for bed. Normally includes meal preparation, bathing & dressing assistance and medication reminders. CAREGivers are not permitted to do any housework during this shift. Service must be used at least 5 days each week(Mon-Fri). Shift times are not guaranteed. Availability of this service may be limited. 1 of 2 From:Home Instead Senior Care 717 731 9985 07/12/2013 12:41 #113 P.0031008 " E In the event that a client requires all service to be provided by certain caregivers, and HISC can only accornmodate that request by paying overtime wages to CARE-Givers,the client will be billed at one and one-half times the Regular Rate. Kay,LLC d/b/a/HISC conducts personal face to face interviews and documents all pertinent information of each employee. Entry into Client's home will be handled in the following manner: oor' t Billin • ompany will invoice the responsible party two(2)times ea month. There is a required fully refundable deposit of $ ,amounting to approximately one(1)week scheduled service,which is due upon(a)entering into this Agreement f and( initially accepting a proposed CAREGiver. The deposit fairly funds the costs incurred by the Company while providing services for one week prior to first invoicing. This deposit will be refunded in full within seven(7)days of payment of the final t invoice under this Agreement. Further, the responsible party expressly grants to Company a right of setoff, against unpaid = invoices,with regard to the deposit. ` The responsible patty agrees to pay for all services.within,seven(7)days froth the.date of receiving tromisany's invoice,and is responsible for all collection and,attorney's .fees incurred by_Company m the.collection of.any.delintiuent amounts owing to ,.., ect . company.,'.Interest on unpaid invoices will accrue at the rate of one.anti one-halfpercent(i:5 a per month. We will only accept checks made payable to Home Instead Senior Care. No individual as a result of the individuals' affiliation with Home Instead Senior Care may assume power of authority or guardianship over a client using our services. Home Instead Senior Care may not require a client to endorse checks over to our agency, s Termination: We will provide 10 days written notice of the intent to terminate service. Less than 10 days notice will be given if the client has failed to pay for services and despite notice is more than 14 days in arrears, or if the health and welfare of the CAREGiver is at risk. € Restriction on Hiring Company Employees: During the term of this Agreement and for a period of one(1)year following the 3 discontinuance of services with Company and the termination of this Agreement, Client agrees not to hire, employ, or independently contract for the services of any Company employee who is/was employed by Company at any time during the term of this Agreement, unless such person is placed through Company. If Company permits placement a fee equal to four months of scheduled service or$3,600,whichever is greater,is payable to Company within 10 days of such employment. Governing Law: This Agreement has been made and entered in the Commonwealth of Pennsylvania and shall be governed by, and construed in accordance with,the laws of the Commonwealth of Pennsylvania,without giving effect to its conflicts of law provisions. 3 Client acknowledges that the Provider is not a registry or employment service. Client agrees not to solicit or induce,nor allow any person or entity acting on Client's behalf to solicit or induce, any caregiver of Kay, LLC, to terminate the caregiver's relationship with Kay, LLC and/or work for Client or others directly,bypassing Kay,LLC. Caregiver's relationship with Kay, i LLC extends,by separate employment agreement with the caregiver,for one year after ending employment with Kay, LLC. If Client breaks the agreement outlined in this paragraph,Client agrees to pay Provider a fee equal to four(4)months(sixteen(16) weeks) of the caregiver's scheduled monthly number of billable hours during the past twelve(12) months, at the caregiver's highest hourly rate of pay. Disclaimer/Waiver: CLIENT UNDERSTANDS THAT COMPANY PROVIDES ONLY NON-MEDICAL COMPANIONSHIP AND HOMECARE SERVICES AND IS NOT LICENSED OR INSURED TO PROVIDE MEDICAL SERVICES OF ANY KIND. THIS AGREEMENT IN NO MANNER OBLIGATES, REQUIRES OR CONTEMPLATES THE PROVISION OF EMERGENCY i OR NON-EMERGENCY MEDICAL SERVICES BY COMPANY, ITS EMPLOYEES, OR AGENTS. CLIENT AGREES THAT COMPANY, ITS EMPLOYEES, OR AGENTS WILL NOT BE HELD LIABLE FOR NOT PROVIDING EMERGENCY OR NON-EMERGENCY MEDICAL SERVICES. CLIENT FURTHER WAIVES ANY RIGHT, FOR THEMSELVES, THEIR ESTATE AND/OR THEIR HEIRS, TO BRING SUIT ON THE BASIS THAT COMPANY, ITS EMPLOYEES OR AGENTS DID NOT PROVIDE EMERGENCY OR NON-EMERGENCY MEDICAL SERVICES FOR CLIENT. j The parties have executed this Non-Medical Companionship,Homecare,and Personal Care Services Agreement: I The name, address, and.telephone number of the responsible.party,foureceiying and paying invoices for services rendered by H Care to C 171A "s (Name of person a reefing Pay Company invoices) (Kay,LLC representative) 0 06 r. n` t (Billing address and tel phone number) Home Instead Senior Care,5002 Lenker Street,Suite 101 Mechanicsburg,PA 17050 ph:717-731-9984 f. 731-9985 2 of 2 From:Home Instead Senior Care 717 731 9985 07/12/2013 12:41 #113 P.004/006 F *Home Il istead SENIOR CARE° Client Confidentiality Statement r Home Instead Senior Care maintains a practice of confidentiality and protection of personal and medical information of the clients in our service.In order to provide for the highest quality of service, there may be instances in which Home Instead Senior Care discloses information about f you. 4 i 3 Use and disclosure may occur when: i • A referral is made on your behalf,or to coordinate other appropriate in-home services. These may include a consultation with doctors,nurses,health care personnel, facilities and providers who specialize in health related products. a • For the purpose of billing for services. Home Instead Senior Care may be required to . release medical information to an insurance company or to third party payer. l • Maintaining quality assurance for your service. Home Instead Senior Care may discuss your service needs with office staff and CAREGivers who provide service to you. • Releasing information to family members and other individuals involved in the coordination of services. Information may be released to the following: Designated s Agent,Power of Attorney, Conservator, Guardian,family members,relatives, and/or friends who have your well-being in their interest and also have the need for relevant service information. Is there anyone to whom Home Instead Senior Care should not release information? If so,please name: f s i • In the event of medical emergency when the release of confidential information will benefit professionals providing service or care. • Situations of abuse,neglect and domestic violence are identified, or required by law. Home Instead Senior Care Representative Client/Designated Agent Date Date Each Home Instead Senior Care office is independently owned and operated. From:Home Instead Senior Care 717 731 9965 07/12/2013 12:42 #113 P.005/008 i Homeln' s-wead t z Zv w.f �r' �ersveu��M Consumer Notice of Direct Care Worker Status This form is to be completed by every consumer utilizing the services of a Home Care Agency. i f I, f4 ,r A C M r a b f O Sr. understand that: PRINT NAME i Initial Below The direct care worker who will be providing services in my home is an employee of Kay, LLC, d/b/a Home Instead Senior Care. Home Instead Senior Care is responsible for withholding State and Federal Income tax, Federal Unemployment tax, Social Security taxes and Medicare taxes on behalf of the direct care worker. Home Instead Senior Care is also responsible for paying workers' compensation insurance to cover the direct care worker in the event of accident or injury on the job. 1 have been informed that Home Instead Senior Care maintains general and professional liability insurance covering the direct care worker. If Home Instead Senior Care does not maintain general and professional liability insurance, and the direct care worker is not covered under workers' compensation,I have been advised to check my homeowner's or renter's insurance to determine if it covers any injury or accident involving the direct care worker while working in my home. Signature of Consumer or Consumer's Representative Date /Q/7 Z Q Signature of Representative of Home Instead Senior Care bate From:Home Instead Senior Care 717 731 9965 07/12/2013 12:42 #113 P.006/008 DETAILED INVOICE Service For :Alice Phillips(2) Billed To : Mrs.Alice Phillips(2) 5002 Lenker Street Invoice#: 1780-1212-1 Invoice Date: 5/15/2013 Mechanicsburg,PA ]7050 Service Period:Dec 01 2012-Dec 15 2012 www. omeln to i > www.HomeInstead.com { { l 12/7 3:00pm 10:30pm Normal Stoffels,Carol Hourly Service,Level 2 7.50 $20.95 $157.13 10:30pm 7:00am Weekend Scott,Cheryl Sleepover,Level 2 0.85 $186.95 $158.91 12/8 7:00am 4:00pm Weekend Ross,Juliette(Jill) Hourly Service,Level 2 9.00 $23.05 $207.45 { 4:00pm 10:15pm Hartzell,Marna Hourly Service,Level 2 6.25 $23.05 $144.06 10:15pm 7:00am Drasher,Marlene Sleepover,Level 2 0.88 $186.95 $164.52 12/9 7:00am 10:00am Weekend Kapp,Christina Hourly Service,Level 2 3.00 $23.05 $69.15 j 3:00pm 9:00pm Daniels,Charlotte Hourly Service,Level 2 6.00 $23.05 $138.30 12/10 1:00pm 6:00pm Normal Koons,Marguerite(P Hourly Service,Level 2 5.00 $20.95 $104.75 12/11 3:00pm 9:00pm Normal Daniels,Charlotte Hourly Service,Level 2 6.00 $20.95 $125.70 9:00pm 7:00am Scott,Cheryl Sleepover,Level 1 1.00 $169.95 $169.95 12/12 7:00am 10:00am Normal Ross,Juliette(Jill) Hourly Service,Level 2 3.00 $20.95 $62.85 F 12/13 3:00pm 9:00pm Normal Myers,Jody Hourly Service,Level 2 6.00 $20.95 $125.70 9:00pm 9:15am Scott,Cheryl Hourly Service,Level 2 2.25 $20.95 $47.14 Sleepover,Level 2 1.00 $169.95 $169.95 12/15 7:00am 1:30pm Weekend Ross,Juliette(Jill) Hourly Service,Level 2 6.50 $23.05 $149.83 1:30pm 9:00pm Daniels,Charlotte Hourly Service,Level 2 7.50 $23.05 $172.88 1. 9:00pm 7:00am Clouse,Lori Sleepover,Level 1.00 $186.95 $186.95 } i 1 i {r I Miles: 0.00 @. $0.59 = $0.00 Miscellaneous Charges: _ $0.00 Additional Charges/Credits: _ $0.00 Service Deposit Applied: _ $0.00 Current Invoice Total: _ $2,355.20 Total Amount Due: $29,355.20 Due Date: June 09,2013 "All Overdue Invoices are Subject to an 18%Annual Service Charge Please Retain For Your Records Please Detach And Return This PortionWitb Your Payment Payable to Home Instead Senior Care Each Home Instead Senior Care Franchise Office is independently owned and operated. Invoice#: 1780-1212-1 Service For: Alice Phillips(2) Service Period: Dec 01,2012-Dec 15,2012 Mrs. Alice Phillips(2) Current Invoice Total: $2,355.20 9 Tall Oak Dr. Mechanicsburg,PA 17050 Total Amount Due: $2,355.20 Due Date: June 09,2013 From:Home Instead Senior Care 717 731 9965 07/12/2013 12:42 #113 P.007/008 DETAILED INVOICE Service For : Alice Phillips(2) Billed To : Mrs.Alice Phillips(2) 5002 Lenker Street Invoice#: 1780-1212-2 Mechanicsburg,PA 17050 i Invoice Date: 5/15/2013 (717)731-9984 Service Period:Dec 16,2012-Dec 31,2012 www.Homelnstead.com 5 F 12/16 7:00am 10:00am Weekend Dougherty,Ashley Hourly Service,Level 2 3.00 $23.05 $69.15 12/18 3:00pm 9:00pm Normal Daniels,Charlotte Hourly Service,Level 2 6.00 $20.95 $125.70 9:00pm 7:00arn Dougherty,Ashley Sleepover,Level 2 1.00 $169.95 $169.95 12/19 7:00am 10:15am Normal Dougherty,Ashley Hourly Service,Level 2 3.25 $20.95 $68.09 3:00pm 9:00pm Stoffels,Carol Hourly Service,Level 2 6.00 $20.95 $125.70 12/22 1:30pm 10:00am Weekend Myers,Amanda Hourly Service,Level 2 10.50 $23.05 $242.03 Sleepover,Level 1.00 $186.95 $186.95 12/24 4:00pm 8:45pm Holiday Green,Jill Hourly Service,Level 2 4.75 $31.43 $149.29 8:45pm 10:00am Myers,Amanda Hourly Service,Level 2 3.25 $31.43 $102.15 Sleepover,Level 2 1.00 $254.93 $254.93 12/25 4:00pm 10:00am Holiday Myers,Amanda Hourly Service,Level 2 8.00 $31.43 $251,44 Sleepover,Level 2 1.00 $254.93 $254,93 12/26 10:00am 3:00pm Normal Myers,Amanda Hourly Service,Level 2 5.00 $20.95 $104.75 12/28 10:00atn 5:00pm Normal Koons,Marguerite(P 12.00 Hourly Service,Level 2 7.00 $20.95 $146.65 12/29 9:00am 2:00pm Weekend Doelp,Laura Hourly Service,Level 2 5.00 $23.05 $115.25 2:00pm 9:30pm Daniels,Charlotte Hourly Service,Level 2 7.50 $23.05 $172.88 12/30 10:00am 2:00pm Weekend Myers,Amanda 12.00 Hourly Service,Level 2 4.00 $23.05 $92.20 1 2:00pm 9:15pm Genet,Deborah Hourly Service,Level 2 7.25 $23.05 $167.11 r 12/31 5:00pm 9:00pm Holiday Myers,Amanda Hourly Service,Level 2 4.00 $31.43 $125.72 9:00pm 10:00am Hourly Service,Level 2 3.00 $31.43 $94.29 a Sleepover,Level 2 1.00 $254.93 $254.93 3 pf I, Miles: 24.00 @ $0.59 = $14.04 Miscellaneous Charges: _ $0.00 Additional Charges/Credits: a t $0.00 1 Service Deposit Applied: _ $0,00 Current Invoice Total: $3,288.12 Total Amount Due: $3,288.12 Due Date: June 09,2013 'All Overdue Invoices are Subject to an 18%Annual Service Charge Please Retain For Your Records Please Detach And Return This PonioaWith Your Payment Payable to Home Instead Senior Care N .� Each Home Instead Senior Care Franchise Office is independently owned and operated. Invoice#: 1780-1212-2 Service For: Alice Phillips(2) Service Period: Dec 16,2012-Dec 31,2012 Mrs.Alice Phillips(2) Current Invoice Total: $3,288.12 9 Tall Oak Dr. Mechanicsburg,PA 17050 Total Amount Due: $3,288.12 Due Date: June 09,2013 From:Home Instead Senior Care . 717 731 9985 07/12/2013 12:42 #113 P.008/008 r DETAILED INVOICE Service For :Alice Phillips(2) s Billed To : Mrs. Alice Phillips(2) 5002 Lenker Street fi Invoice#: 1780-0113-I Invoice Date : 5/15/2013 Mechanicsburg,PA 17050 i (717)731-9984 Service Period:Jan 01,2013-Jan 15,2013 www.Homelnstead.com 1 i 1/2 IO:O n 6:00pm Normal Scott,Cheryl Hourly Service,Level 2 8.00 rS2 0.95 $167.60 6:00pm 9:OOpm Myers,Amanda Hourly Service,Level 2 3.00 20.95 $62.85 1/3 10:00am 9:00pm Normal Scott,Cheryl Hourly Service,Level 2 11.00 20.95 $230.45 1/4 3:00pm 6:00pm Normal French,Jaime Hourly Service,Level 2 3.00 $20.95 $62.85 i 6:00pm 3:00pm Weekend Myers,Amanda Hourly Service,Level 2 1 1.00 $23.05 $253.55 Sleepover,Level 2 1.00 $186.95 $186.95 115 3:00pm 9:15pm Weekend Scott,Cheryl Hourly Service,Level 2 6.25 $23.05 $144.06 1/6 10:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 11.00 $23.05 $253.55 1/9 2:00pm 6:00pm Normal Scott,Cheryl Hourly Service,Level 2 4.00 $20.95 $83.80 1]10 9:1Sam 4:15pm Normal Scott,Cheryl Hourly Service,Level 2 7.00 $20.95 $146.65 1/12 10:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 11.00 $23.05 $253.55 _. 9:00pm 7:00am Sleepover,Level 2 1.00 $186.95 $186.95 t 1/13 7:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 14.00 $23.05 $322.70 1 i 1 4 ._ _ ... .,_ .,n .i1is,,.�. ..F2iC.. ,� .,Ma.._ :ems-.+•' .._. _ �,a F I Mlles: 0.00 @ $0.59 $0.00 Miscellaneous Charges: _ $0.00 Additional Charges/Credits: - $0.00 Service Deposit Applied: m $0.00 Current Invoice Total: _ $2,355.51 Total Amount Due: $2,355.51 Due Date: June 09,2013 *All Overdue Invoices are Subject to an 18%Annual Service Charge Please Retain For Your Records Please Detach And Return this PortionWith Your Payment Payable to Home Instead Senior Care Each Home Instead Senior Care Franchise office is independently owned and operated. Invoice#: 1780-0113-1 Service For: Alice Phillips(2) Mrs.Alice Phillips(2) Service Period: Jan 01,2013-Jan 15,2013 Current Invoice Total: $2,355.51 9 Tall Oak Dr. Mechanicsburg,PA 17050 Total Amount Due: $2,355.51 Due Date: June 09,2013 From:Home Instead Senior Care 717 731 9985 07/12/2013 12:15 #112 P.003/003 COMMONWEALTH OF PENNSYLVANIA ..Notice of JudgmenVTranscript Civil COUNTY OF CUMBERLAND Case Mag.Dist.No: MDJ-09-3-04 Kay Kurt MDJ Name: Honorable Paula P.Correal Address: 5275 East Trindle Road Alice Phillips Suite 110 Mechanicsburg,PA 17050 Telephone: 717-697-2201 Kay Kurt Docket No: MJ-09304-CV-0000091-2013 clo Kay LLC Case Filed: 3/2112013 5002 Lenker Street Mechanicsburg, PA 17050 Disposition Summary Docket No Plaintiff Defendant Disposition Disposition Date MJ-09304-CV-0000091-2013 Kay Kurt Alice Phillips Default Judgment for Plaintiff .05/30/2013 Judgment Summary Participant Joint/Several Liability. Individual Liabilfty Amount Alice Phillips $0.00 $9,403.08 $9,403.08 Kay Kurt $0.00 $0.00 $0.00 Judgment Detail (*PostJudgment) In the matter of Kay Kurt vs.Alice Phillips on 6/30/2013 the judgment was awarded as follows: Judament Component JoInUteveral Liability Individual Liability Deposit Apolled Amount Civil Judgment $0.00 $9,219.41 $9,219.41 Filing Fees $0.00 $146.50 $146.50 Server Fees $0.00 $32.17 $32.17 Costs $0.00 $5,00 $5.00 Grand Total: $9,403.08 ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30 DAYS AFTER THE ENTRY OF JUDGMENT BY FILING A NOTICE OF APPEAL WITH THE PROTHONOTARY/CLERK OF COURT OF COMMON PLEAS, CIVIL DIVISION. YOU MUST INCLUDE A COPY OF THIS NOTICE OF JUDGMENTITRANSCRIPT FORM WITH YOUR NOTICE OF APPEAL. EXCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR MAGISTERIAL DISTRICT JUDGES,IF THE JUDGMENT HOLDER ELECTS TO ENTER THE JUDGMENT IN THE COURT OF COMMON PLEAS, ALL FURTHER PROCESS MUST COME FROM 74E COURT OF COMMON PLEAS AND NO FURTHER PROCESS MAY BE ISSUED BY THE MAGISTERIAL DISTRICT JUDGE. UNLESS THE JUDGMENT IS ENTERED IN THE COURT OF COMMON PLEAS,ANYONE INTERESTED IN THE JUDGMENT MAY FILE A REQUEST FOR ENTRY OF SATISFACTION WITH THE MAGISTERIAL DISTRICT JUDGE IF THE JUDGMENT DEBTOR PAYS IN FULL,SETTLES, OR OTHERWISE COMPLIES WITH THE JUDGMENT. Date is rial District is a true an correct copy of the recur d-o7ltFe proceedings pontalong the tug ei Da tb )eogiste-r-ial District Judge MDJS 315 age 1 of 2 Printed 05130/2013 12:19-.23PM f. From:Home Instead Senior Care 717 731 9985 07/12/2013 12:14 #112 P.002/003 COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS NOTICE OF APPEAL Judicial District,County Of FROM Cumberland MAGISTERIAL DISTRICT JUDGE JUDGMEN�T COMMON PLEAS No. NOTICE OF APPEAL f f Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the Magisterial District Judge on the date and in the case referenced below. NAME OF APPELLANT MAG.DIST.NO. NAME OF MDJ Alice Phillips MDJ 09-3-04 Hon. Paula P. Correal I ADDRESS OF APPELLANT CITY STATE ZIP CODE I 9 Tall Oak Dr. Mechanicsburg PA 17050 DATE OF JUDGMENT IN THE CASE OF(Plaintiff) (Defendant)' 5-30-13 Kay Kurt Alice Phillips DOCKET No. SIGNATURE OF AP NT OR ATTORNEY OR AGENT MJ-9304-CV-91 -2013 QlLb— k This block will be signed ONLY when this notation is required under Pa. I ap nt was Claimant (see Pa. R.CP.D,J. No. 1001(6) in action R.C.P.D.J.No.1008B. u This Notice of Appeal, when received by the Magisterial District Judge,will before a Magisterial District Judge, A COMPLAINT MUST BE FILED j operate as a SUPERSEDEAS to the judgment for possession in this case. within twenty (20)days after filing the NOTICE of APPEAL x 3 signatum of Prothonotary or Deputy 6 PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT(see Pa.R.C.P.D.J. No. 1001(7)in action before Magisterial District Judge. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. f PRAECIPE: To Prothonotary Enter rule upon Kay Kurt appellee(s),to file a complaint in this appeal Name of appellee(s) (Common Pleas No, i?�_ 37 .IVY I'rpll )within twenty(20)days after service oLn ule or suffer entry of judgment of non pros. 3 � 5 lgnature of appellant or attorney or agent ) r RULE: To Kay Kurt appellee(s) Name of appellee(s) (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty(20)days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time,a JUDGMENT OF NON PROS MAYBE ENTERED AGAINST YOU. ,/��� j (3) The date of service of this rule if service was by mail is the date of the mailing. jLJ!%IaC�tdJ I Date: � a 20 ��, Signature ofProthonotary orDeputy YOU MUST INCLUDE A COPY OF THE NOTICE OF JUDGMENTITRANSCRIPT FORM WITH THIS NOTICE OF APPEAL. f AOPC 312-05 j z I t KAY KURT(k/a KURT KAY), IN THE COURT OF COMMON PLEAS Plaintiff, OF CUMBERLAND COUNTY, PA NO.: 13-3736 ALICE PHILLIPS, Defendant CIVIL ACTION -LAW NOTICE TO PLEAD CD CD �. C TO: Plaintiff, KAY KURT g� 3 You are hereby notified to file a written response to the enclosed New Matter and Counterclaim within twenty(20)days from service hereof or a judgment may be entered against you. J. rou Le a Esq. A for Defendant, Alice Phillips J. Ronaldo Legaspi, Esquire I.D.No. 200240 Law Offices of J. Ronaldo Legaspi 2023 N. Second Street, Ste. 104 Harrisburg, PA 17102 717.743.0586 Attorney for Defendant, Alice Phillips KAY KURT(k/a KURT KAY), IN THE COURT OF COMMON PLEAS Plaintiff, OF CUMBERLAND COUNTY, PA NO.: 13-3736 ALICE PHILLIPS, Defendant CIVIL ACTION -LAW ANSWER AND NOW comes the Defendant,Alice Phillips, by and through her counsel,J. Ronaldo Legaspi,who files this Answer and New Matter, and in support thereof aver as follows: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted in part and denied in part. It is admitted that Defendant did execute the attached handwritten letter. By way of further answer,the letter speaks for itself. Any characterizations of said letter are denied. Further,the allegations contained in paragraph 4 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the same is denied. 2 5. Denied. This allegation is specifically denied. At no time did Ms. Phillips enter any contract for services with Plaintiff. 6. Admitted in part and denied in part. It is admitted that Plaintiff performed some care services for Ms. Phillips. It is specifically denied that the services performed by Plaintiff fulfilled the terms of the alleged Agreement. 7. Admitted. 8. Admitted. COUNT 9. Defendant incorporates by reference Paragraphs 1 through 8 as if fully set forth herein. 10. Denied. This allegation is specifically denied. At no time did Ms. Phillips enter any contract for services with Plaintiff. 11. Denied. This allegation is specifically denied. At no time did Ms. Phillips enter any contract for services with Plaintiff. COUNT II 12. Defendant incorporates by reference Paragraphs 1 through 11 as if fully set forth herein. 13. Admitted in part and denied in part. It is admitted that Plaintiff performed some care services for Ms. Phillips. It is specifically denied that the services performed by Plaintiff fulfilled the terms of the alleged Agreement. 14. Denied. The allegations contained in paragraph 14 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the same is denied. 3 WHEREFORE, Defendant seeks dismissal of the lawsuit filed against her by the Plaintiff herein. NEW MATTER 15. Defendant incorporates by reference Paragraphs 1 through 14. 16. The Plaintiff fails to state a claim upon which 'relief can be granted. 17. The alleged contract is invalid due to incapacity of Defendant. 18. The alleged contract is invalid, as it was made pursuant to an invalid power-of-attorney. 19. The Plaintiff's claims are barred by the doctrine of fraud. 20. The Plaintiff's claims are barred by the doctrine of set-off. 21. The Defendant's failure to comply with any alleged obligations under the Contract Service Agreement is excused by Plaintiff's own breaches of the putative Agreement. 22. Plaintiff has failed to mitigate damages, if any. 23. Defendant reserves the right to assert any additional defenses which may arise in the course of discovery or trial in this matter. WHEREFORE,Defendant seeks dismissal of the lawsuit filed against her by the Plaintiff herein. COUNTERCLAIM 24. Defendant incorporates by reference Paragraphs 1 through 23 as if fully set forth herein. 4 25. Prior to December 2012, Ms. Phillips had received skilled nursing and personal care from Celtic Healthcare,based in Mars,Pennsylvania, in connection with treatment and hospitalization for prior ailments. 26. On or about November 30, 2012, Ms. Phillips was admitted to Penn State Hershey Medical Center for spinal surgery. 27. During her rehabilitation and recovery after surgery, Ms. Phillips was notified by staff members of Penn State Hershey Medical Center that arrangements were made for Celtic Healthcare,with whom she was familiar,having had previously received treatment from them,to provide services for her personal care in her home upon discharge from the hospital. 28. On or about December 7, 2012, Ms. Phillips was discharged from Penn State Hershey Rehabilitation Hospital to her residence with a prescription for round-the- clock skilled nursing care and personal care. A true and correct copy of the Prescription is attached hereto and marked as Exhibit"A." 29. On or about December 7, 2012, a representative from Home Instead, believed to be known as "Danielle," appeared at Ms. Phillips' residence, requesting information pertaining to her medical condition,health insurance,hospital discharge and offering personal care services to Ms. Phillips. 30. Due to Ms. Phillips' frail condition,having been recently discharged from the hospital after her spinal surgery, Original Plaintiff's representative solicited Ms. Phillips' son,Harold Mirabito, for the aforesaid information and to accept care services, while Ms. Phillips was also present but somewhat indisposed and still in the process of recovering from her spinal surgery. 5 31. Because Ms. Phillips,nor any person on her behalf, contacted the Original Plaintiff to request the aforesaid care services,Ms. Phillips and Mr. Mirabito believed the representative to be a care provider from Celtic Healthcare, and thus acceded to her request for information. 32. When asked about her health coverage,Ms. Phillips stated that she had Medicare coverage and that"everything was covered by Medicare,"indicating her belief that the services offered by Original Plaintiff would be paid for by her medical insurance. 33. Original Plaintiffs representative acknowledged the statement made by Ms. Phillips and denoted the fact of her Medicare coverage on a health questionnaire form, despite the fact that Original Plaintiff's representative knew that the offered services did not qualify for Medicare coverage. 34. Original Plaintiff's representative did not disabuse Ms. Phillips or Mr. Mirabito of their clear misapprehension that the services contemplated in the alleged Agreement were covered by Medicare and/or additional supplemental long-term-care insurance. 35. Original Plaintiff's agent gave assurances to Ms. Phillips and Mr. Mirabito that no payment was required and that"everything would be taken care of,"giving the false impression that her insurance would cover the cost of care services. 36. Mr. Mirabito provided Original Plaintiff's representative with copies of Ms. Phillips Medicare and supplemental insurance information and the prescription from Ms. Phillips' physician for comprehensive skilled and personal care. 6 37. In connection with her prescribed treatment,Ms. Phillips required an array of services,which included skilled nursing,physical therapy, and occupational therapy, in addition to home health aide services. 38. During the relevant period,Ms. Phillips was receiving skilled nursing care services from Celtic Healthcare on a periodic basis of three days per week, for one hour per day, as well as physical and occupational therapy three times per week. 39. Ms. Phillips also supplemented the aforesaid personal care with the assistance of family members. 40. Original Plaintiff sent care providers to Ms. Phillips residence during the relevant period from December 7,2012,through December 31, 2012, although Ms. Phillips was unaware that she was receiving care from two separate and distinct agencies, due to the deceptive actions of the Original Plaintiff. 41. On numerous occasions during the relevant period, Original Plaintiff's care providers rendered poor and inadequate care, including failing to report for shifts, necessitating calls to the agency from Mr. Mirabito,requesting prompt and adequate service. 42. On several occasions during the relevant period, Original Plaintiff's care providers failed to render adequate care services, endangering and placing at great risk of harm the Original Defendant,to wit: sleeping during the shift; failing to assist Original Plaintiff in activities of daily activities; failing to give medication reminders; and failing to monitor the medical condition and status of Ms. Phillips. COUNT Fraud in the Inducement 7 43. Original Defendant incorporates by reference Paragraphs 1 through 42 as if fully set forth herein. 44. On December 7, 2012, Original Plaintiff s agent made representations and omissions of material fact regarding Medicare coverage for the services provided by the Defendant, leading Original Defendant to believe that the Original Plaintiffs care services would be paid for by Medicare and/or her supplemental long-term-care insurance. 45. Original Plaintiff's agent knew that Ms. Phillips believed, due to her explicit statements regarding the same,that the care services offered by Original Plaintiff would be paid for by Medicare and/or her supplemental long-term care insurance. 46. Original Plaintiff's agent made the misrepresentations and omissions to induce Original Defendant and Mr. Mirabito to agree to hire Original Plaintiff to provide care services. 47. Original Defendant and Mr. Mirabito reasonably relied upon Original Plaintiff s misrepresentations and omissions. 48. Original Defendant was damaged by Original Plaintiffs misrepresentations and omissions. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest, attorneys' fees and costs,together with such other relief as this Court deems proper. COUNT H Fraudulent Misrepresentation 49. Defendant incorporates by reference Paragraphs 1 through 48 as if fully set forth herein. 8 50. On December 7, 2012, Original Plaintiff's agent made representations and omissions of material fact regarding Medicare coverage for the services provided by the Defendant, leading Original Defendant to believe that the Original Plaintiff's care services would be paid for by Medicare and/or her supplemental long-term care insurance. 51. Original Plaintiff's agent knew that Original Defendant and Mr. Mirabito believed, due to her and Mr. Mirabito's explicit statements,that the care services offered by OP would be paid for by Medicare and/or her supplemental insurance. 52. Original Plaintiff's agent made the misrepresentations and omissions to induce Original Defendant and Mr. Mirabito to agree to hire Original Plainitff to provide care services. 53. Original Defendant reasonably relied upon Original Plaintiff's misrepresentations and omissions. 54. Original Defendant was damaged by Original Plaintiff's misrepresentations and omissions. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest, attorneys' fees and costs,together with such other relief as this Court deems proper. COUNT III Negligent Misrepresentation 55. Defendant incorporates by reference Paragraphs 1 through 54 as if fully set forth herein. 9 56. Under the circumstances alleged, Original Plaintiff owed a duty to Ms. Phillips to provide her with accurate information about the Company's ineligibility for Medicare coverage for the offered services. 57. Original Plaintiff represented to, or otherwise misled,Ms. Phillips and Mr. Mirabito that its offered services would be paid for Medicare and/or her supplemental long-term care insurance. 58. Original Plaintiff failed to correct Ms. Phillips' and Mr. Mirabito's clearly stated belief that the offered services would be paid for by Medicare or her supplemental insurance. 59. Original Plaintiff's representations were false,negligent and material. 60. Original Defendant justifiably relied on Original Plaintiff s misrepresentations and material omissions and acted as instructed to by Original Plaintiff s representative. 61. As a proximate result of Original Plaintiffs negligent conduct, Original Defendant has suffered, and will continue to suffer general and special damages in an amount according to proof at trial. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest, attorneys' fees and costs,together with such other relief as this Court deems proper. COUNT IV Breach of Contract 62. Defendant incorporates by reference Paragraphs 1 through 61 as if fully set forth herein. 10 63. Even assuming that the alleged contract is enforceable against Original Defendant, which is vehemently denied,the services provided did not substantially comply with the proferred Service Agreement. 64. As set forth fully hereinabove, Original Plaintiff care providers failed to render the services enumerated in the Service Agreement,but instead provided deficient services,to wit: care providers slept during the day shift or at times when Ms. Phillips was not sleeping; regularly failed to report for shifts; failed to assist in her activities of daily living, such as bathing and dressing assistance; and failed to give medication reminders,placing Ms. Phillips at great risk of harm in her fragile state of recovery. 65. Ms. Phillips has been damaged by Original Plaintiff s breaches, including the compromise of her care and rehabilitation during her tenuous recovery period. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest,attorneys' fees and costs,together with such other relief as this Court deems proper. Respectfully submitted, Date: August 13, 2013 (?� J. pi,Esq. PAWAR ID#200240 Law Offices of J. Ronaldo Legaspi 2023 N. Second Street Harrisburg, PA 17104 (717) 743-0586 jleg=i&aol.com 11 ATTORNEY AFFIDAVIT I, J. Ronaldo Legaspi,Esquire,being duly sworn according to law, depose and state that I am counsel for the Defendant,that I am authorized to make this Affidavit on behalf of said Defendant, and that the facts set forth in the foregoing are true and correct to the best of my knowledge, information, and belief. J. R D G pI DATE: August 13, 2013 12 EXHIBIT "A" PENNSTATE HERSHEY Physican l Medicine and Rehabilitation Pen State Milton S.Hershey Medical Center Wton S.Hershey 1135 Old Nest Chocolate Avenue.Suite 101' Medical Center Hummelstown.PA 17036 Tel.717-5314010 ram.717-531-7102 NAME R,r DOB H7 ADDRESS DATE PATIENT NO ALLERGIES INDICATION Label All Prescriptions ® Refill Times 7W See the nlerse sick of this rimscriminn for section•vmvr Lmures iminted in thermal ink. 6lerni®D AID440148 1�w2707111 Adn.•matlabueni,ALD. AID444101 1664702259 Shmgmint:Ztuvg.M.D. N10419248 -ICNIK 75716 m.,h),Ha&m,11.D. SID44..3037 1407877484 Sm,Stark.D t) 05011789 I II&X8196R Ymbvn•Zadov,D.O. 05016180 1356570212 Ewe' t C Hdls,NI D MD04509412 t0n147641316 SL BSTITL?ION PCRMISSIBLC:IN ORDER rOR A BRANDNA.HE PRODLICTTD BC DISPENSED,THE PRCSCRI DER NI UST HA'ZDN•R17E"BRAND NCCCSSART" OR-BRAND MEDICALLY NECESSARY"IN THE SPACE BELOIV, A3.D. .L�. RA-C. C.R.N.P. D C.A Reg Nn. PENNSTATE HERSHEY Physical Medicine and Rehabilitations Penn State Milton S.Hershey Medical Center Milton S.Hershey >• Medical Center y 1135 Old Nest Chocolate Avenue.Suite 101 Hummeistown,PA 17036 Tel:717-531-7010 1 Fav 717-331-7102 d NAME p-.—DOB HT ,,VT ADDRESS BATE RATIENT NO AUERGI S INDICATION ® ` Label All Prescriptions tijt.i, Refill Times See the reverse side Of this roes ANK)n for section,ItTKr features printed In thermal ink Ort•ralt Atalw'n:aI.D 11ID44014y IW2707111 Adnana L'IaMtem,\I.D NID444101 1(69 702254 SK-9mmng 7.ha.g.?110 RID41424H 100107571( Y'C4 ,h)Huila.,.%LD NID441017 14975 74..44 Suit Surk,DO ([90117[[) Io0WH= 5ce;*V'ny Zntm.D U 0416180 1156570212 Gvntt C HdIS.M D. mw4w tr I00347MOP SLBSTrTLTIO%PER1tISSIBLC-.IN ORDER WR A BRAND NA%IC PRODUCT n) BE DISPENSED.THE PRESCRIBER MUST HAND WRITE-BRANDNECESSARI' OR-BRAND AICDICALLYNC CESSARY-IN TISCSP4CL BCLOL\: h7�p. D.U. PA-C CRN.E D E.A.Reg No CERTIFICATE OF SERVICE I hereby certify that I have this day served the foregoing document upon the following persons by United States Mail,First Class Mail: Karl Rominger, Esquire Rominger&Associaates 155 S. Hanover Street Carlisle, PA 17013 Dated: August 13, 2013 V ma o qespi ey foendant, Alice Phillips 13 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson T `--(`� Sheriff ce ,r°A t �ktsctr nt Ltr�u��,*y� Jody S Smith i 2013 AUG 15 Pl 3; 4 0 Chief Deputy Richard W Stewart CtJr1BERLl fiD I OWIT t Solicitor OFF CE OF THE SHEPrr: H N N-S Y LVA M A Kay LLC d/b/a Home Instead Case Number vs. Alice R. Phillips(et al.) 2013-3736 SHERIFF'S RETURN OF SERVICE 07/23/2013 08:53 PM- Deputy Jamie DiMartle, being duly sworn according to law, served the requested Complaint & Notice by"personally" handing a true copy to a person representing themselves to be the Defendant, to wit: Alice R. Phillips at 9 Tall Oak Drive, Silver Spring Township, Mechanicsburg, PA 17050. "Note caption for this service was Kay Kurt (k/a Kurt Kay)vs.Alice Phillips* PIE DI RT , DEPUTY 07/23/2013 08:53 PM- Deputy Jamie DiMartle, being duly sworn according to law, served the requested Complaint& Notice by"personally" handing a true copy to a person representing themselves to be the Defendant, to wit:Alice R. Phillips at 9 Tall Oak Drive, Silver Spring Township, Mechanicsburg, PA 17050. U17� A PI E DIM TL PUTY 07/24/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Harold C Mirabito, Sr., but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of York, Pennsylvania to serve the within Complaint& Notice according to law. 07/31/2013 08:55 AM -The requested Complaint& Notice served by the Sheriff of York County upon Harold C Mirabito, Sr., personally, at 585 Yocumtown Road, Etters, PA 17319. Richard P. Keuerleber, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $80.76 SO ANSWERS, August 13, 2013 RONW R ANDERSON, SHERIFF :,G)Cou^tYSuite Sheriff,Teleosoft SHERIFF'S OFFICE OF YORK COUNTY Richard P Keuerleber PETER J.MANGAN, ESQ. Sheriff Solicitor Reuben B Zeager ^ Richard E Rice, II Chief Deputy, Operations Chief Deputy,Administration KAY LLC D/B/A HOME INSTEAD SENIOR CARE vs. Case Number ALICE PHILLIPS (et al.) 13-3736 SHERIFF'S RETURN OF SERVICE 07/31/2013 08:55 AM-DEPUTY COREY STRINE, BEING DULY SWORN ACCORDING TO LAW, SERVED THE REQUESTED COMPLAINT& NOTICE BY"PERSONALLY" HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE THE DEFENDANT, TO WIT: HAROLD C. MIRABITO, SR.AT 585 YOCUMTOWN ROAD, ETTERS, PA 17319. 661REY STRINE, DEPUTY SHERIFF COST. $45.60 S ERS, August 07,2013 RICHARD P KEUERLEBER, SHERIFF COMMONWEALTH OF PENNSYLVANIA al Seal Cook Public York Coup Ires Feb,1,2017 IR,PENNSYLVANIA AS SOCIATION OF NOTARIES ---------------------- ------------------------------------------------------------------------------------------------------------------- Affirmed and subscribed to before me this NOTARY 7TH day of AUGUST 2013 (c)CountySuite Sheriff,Teleosoft,Inc. Karl E. Rominger, Esquire ORIGINAL Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiff KAY KURT (k/a KURT KAY) : IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. DOCKET NO.: 13-3736 , - rn CO C/) ALICE PHILLIPS ,.:, rr, Defendants : CIVIL ACTION-LAWS:.`! Znr- -< L a NOTICE TO PLEAD TO: Defendant Alice Phillips C/O J. Ronaldo Legaspi, Esquire , 2023 N Second Street Ste. 104 Harrisburg, PA 17104 You are hereby notified to file a written response to the enclosed within twenty(20) days from service hereof or a judgment may be entered against you. Respectfully Submitted, 9 1 ROMINGER& ASSOCIATES Date: Karl ominger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff a Karl E. Rominger, Esquire Rominger& Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiff KAY KURT (k/a KURT KAY) : IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. DOCKET NO.: 13-3736 ALICE PHILLIPS Defendants : CIVIL ACTION—LAW ANSWER TO NEW MATTER& COUNTER CLAIM AND NEW MATTER TO COUNTER CLAIM AND NOW, comes Plaintiffs, Kay Kurt (k/a Kurt Kay)by and through counsel, Karl E. Rominger, Esquire, and submits the following: 15. No Allegation contained in paragraph—No answer required. 16. CONCLUSION OF LAW-No Answer required. Otherwise Denied. Strict Proof Demanded. 17. CONCLUSION OF LAW—No Answer required. Otherwise Denied. Strict Proof Demanded. 18. CONCLUSION OF LAW-No Answer required. Otherwise Denied. Strict Proof Demanded. 19. CONCLUSION OF LAW-No Answer required. Otherwise Denied. Strict Proof Demanded. 20. CONCLUSION OF LAW-No Answer required. Otherwise Denied. Strict Proof Demanded. 21. CONCLUSION OF LAW-No Answer required. Otherwise Denied. Strict Proof Demanded. 22. CONCLUSION OF LAW-No Answer required. Otherwise Denied. Strict Proof Demanded. 23. No allegation contained in paragraph—No answer required. 24. No allegation contained in paragraph—No answer required 25. DENIED—Upon reasonable investigation of the allegation(s) Plaintiff is unable to confirm same. As such all is DENIED and Strict proof is demanded. 26. DENIED—Upon reasonable investigation of the allegation(s) Plaintiff is unable to confirm same. As such all is DENIED and Strict proof is demanded. 27. DENIED—Upon reasonable investigation of the allegation(s) Plaintiff is unable to confirm same. As such all is DENIED and Strict proof is demanded. 28. ADMITTED: It is admitted only that Defendant Phillips was prescribed nursing and personal care. 29. ADMITTED/DENIED IN PART—It is admitted only that a Home Instead representative came to Ms. Phillip's residence to discuss nursing care services only after Ms. Phillips called Home Instead on or about December 5, 2012 and initiated the contact and inquiry. It is denied that Home Instead representatives initiated the contact with Ms. Phillips to offer any health care services. 30. DENIED: It is denied that Home Instead Representatives "solicited"Harold Mirabito for any reason. Strict Proof Demanded. 31. DENIED. It is denied Ms. Philips and Mr. Mirabito did not contact Home Instead and request health care services and that Plaintiff lead Defendant Phillips to believe the Home Instead Representative was from Celtic Healthcare. Strict Proof is Demanded. 32. DENIED— Statement of Fact and no allegation contained therein. No Answer is required. Plaintiff denies any culpability in what the Defendant allegedly believed. Strict Proof is Demanded. 33. DENIED- It is denied that any Home Instead Representative acknowledged any alleged statements made by the Defendant concerning her Medicare coverage 34. DENIED— Strict Proof Demanded. 35. DENIED—It is denied that any Home Instead Representative gave any assurances to Defendant Phillips and/or her son/Power of Attorney Mr. Mirabito that no payment was required for the services rendered to Ms. Phillips. Strict Proof Demanded. 36. DENIED —It is denied that Defendant Phillip's son/Power of Attorney gave any Home Instead Representative any documents pertaining to Mr. Phillips Medicare Coverage and supplemental insurance information. 37. No allegations contained within this paragraph. No answer required. 38. No allegations contained within this paragraph. No answer required 39. No allegations contained within this paragraph. No answer required 40. DENIED—It is denied that Plaintiff was engaged in any deceptive practices when dealing with the Plaintiff and/or any her representatives. Strict Proof Demanded 41. DENIED- It is denied that Plaintiffs services were of a poor quality. If anything Plaintiff's services were of an excellent standard as the Defendant Phillips often called Plaintiff for additional hours even to travel to Atlantic City with Defendant and provide care services for Defendant Phillips during the time. Strict Proof Demanded 42. DENIED —It is denied that Plaintiff failed to render adequate services to Defendant and/or endangered Ms. Phillips in any manner. Strict Proof Demanded. 43. No allegations contained in this paragraph. No answer required. 44. DENIED —It is denied that Plaintiff made any representations and/or omissions of material fact regarding Defendant Phillips' Medicare coverage that would lead Defendant Phillips and/or her Power of Attorney to believe Plaintiff's services would be paid for by Medicare and/or her supplemental long-term care insurance. Strict Proof Demanded. 45. DENIED—It is denied that Plaintiff made any representations and/or omissions of material fact regarding Defendant Phillips' Medicare coverage that would lead Defendant Phillips and/or her Power of Attorney to believe Plaintiff's services would be paid for by Medicare and/or her supplemental long-term care insurance. Strict Proof Demanded. 46. DENIED—It is denied that Plaintiff made mis-representations and omissions to induce Defendant and/or her Power of Attorney Mr. Mirabito to hire Plaintiff to provide care services. Strict Proof Demanded. 47. DENIED—It is denied that Plaintiff made mis-representations and omissions to induce Defendant and/or her Power of Attorney Mr. Mirabito to hire Plaintiff to provide care services. Strict Proof Demanded. 48. DENIED - It is denied that Plaintiff caused any damages for the Defendant. Strict Proof Demanded. 49. No allegation contained in this paragraph. No answer required. 50. DENIED—It is denied that Plaintiff made any representations and/or omissions of material fact regarding Defendant Phillips' Medicare coverage that would lead Defendant Phillips and/or her Power of Attorney to believe Plaintiff's services would be paid for by Medicare and/or her supplemental long-term care insurance. Strict Proof Demanded. 51. DENIED—It is denied that Plaintiff made any representations and/or omissions of material fact regarding Defendant Phillips' Medicare coverage that would lead Defendant Phillips and/or her Power of Attorney to believe Plaintiff's services would be paid for by Medicare and/or her supplemental long-term care insurance. Strict Proof Demanded. 52. DENIED—It is denied that Plaintiff made mis-representations and omissions to induce Defendant and/or her Power of Attorney Mr. Mirabito to hire Plaintiff to provide care services. Strict Proof Demanded 53. DENIED—It is denied that Plaintiff made mis-representations and omissions to induce Defendant and/or her Power of Attorney Mr. Mirabito to hire Plaintiff to provide care services. Strict Proof Demanded. 54. DENIED - It is denied that Plaintiff caused any damages for the Defendant. Strict Proof Demanded. 55. Paragraph contains no allegations. No answer required. 56. DENIED—It is denied that Plaintiff had any duty to Defendant to provide information regarding the Medicare coverage eligibility of the Plaintiff's services. It is further denied that Plaintiff provided any inaccurate information to Defendant regarding the Medicare coverage eligibility. Strict Proof Demanded. 57. DENIED—It is denied that Plaintiff made any representations and/or omissions of material fact regarding Defendant Phillips' Medicare coverage that would lead Defendant Phillips and/or her Power of Attorney to believe Plaintiff's services would be paid for by Medicare and/or her supplemental long-term care insurance. Strict Proof Demanded. 58. DENIED —It is denied that Plaintiff made any representations and/or omissions of material fact regarding Defendant Phillips' Medicare coverage that would lead Defendant Phillips and/or her Power of Attorney to believe Plaintiff's services would be paid for by Medicare and/or her supplemental long-term care insurance. Strict Proof Demanded. 59. DENIED —It is denied that Plaintiff's representations to Defendant Phillips were false, and/or negligent and material. Strict Proof Denied. 60. DENIED —It is denied that Plaintiff committed any misrepresentations and/or omissions. Strict Proof Demanded. 61. DENIED—It is denied that Plaintiff was negligent in any manner when dealing with the Defendant Phillips, and that any damages to Defendant were causally related any conduct from the Plaintiff. 62. No allegation contained in this paragraph. No answer required. 63. DENIED-It is denied that Plaintiff's services did not comply with the Service Agreement. Strict Proof Demanded. 64. DENIED —All allegations contained therein are collectively denied. Strict Proof Demanded. 65. DENIED—It is denied that Defendant Phillips was damaged in any manner resulting from any actions of the Plaintiff. NEW MATTER 66. Plaintiff incorporates by reference the above paragraphs as if fully set forth herein. 67. On or about December 5, 2012 Defendant Phillip contacted the Plaintiff to inquire about obtaining health care services offered by the Plaintiff. See Attached Service Inquiry Form marked as Exhibit F. 69. On December 6, 2012 Defendant's Power of Attorney Harold Mirabito spoke with Plaintiff's representative in preparation for the care being rendered to Defendant Phillips. Defendant Phillips and her son/Power of Attorney Harold Mirabito knowingly engaged Plaintiff to render health care services to Defendant Phillips. 70. Prior to being discharged from Penn State Hershey Medical Center, Defendant Phillips was received Interdisciplinary Patient Discharge Instructions. Whereas, Plaintiff Home Instead Senior Care is listed as the "Agency"that will provide Defendant Phillips with "private duty" nursing care. Defendant Phillips knowingly entered into a contractual agreement with Plaintiff for private duty health care services. See Attached Marked as Exhibit G. 71. Defendant Phillips sent Plaintiff a copy of the December 5, 2013 letter addressed to Ms. Philips from Bankers Life and Casualty Company along with an Authorization for Claims Processing Purposes that was signed by Harold C. Mirabito, Sr., as well as a completed Claims Form. See Attached marked as Exhibit H. 72. On or about January 18, 2013 through and including January 20, 2013 Defendant Phillips requested that Plaintiff provide a caretaker to accompany Defendant Phillips on a trip to Atlantic City. Plaintiff provided a Care Taker for this occasion. Defendant Phillips knowingly and intentionally contracted with Plaintiff for the health care services provided to her. See Attached Client log marked as Exhibit I invoice marked as Exhibit J. Respectfully Submitted, ROMINGER & ASSOCIATES Date: Karl E. ominger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff Karl E. Rominger, Esquire Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiff KAY KURT (k/a KURT KAY) : IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. DOCKET NO.: 13-3736 ALICE PHILLIPS Defendants : CIVIL ACTION—LAW ATTOREY VERIFICATION Karl E. Rominger, Esquire states that he is the attorney for Plaintiff in this action; that he makes this affidavit as attorney because he has sufficient knowledge or information and belief, based upon his investigation of the matters averred or denied in the foregoing document, and the Plaintiff was unavailable to sign the verification within the time allowed for filing the pleading; and that this statement is made subject to the penalties of 18 Pa. C.S. Pa.C.S. §4904, relating to-unsworn falsification to authorities. Date: / � 3 Karl- ominger, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff Karl E. Rominger, Esquire Rominger&Associates PA Attorney License No. 81924 155 South Hannover Street Carlisle, PA 17013 (717) 241-6070 Attorney for Plaintiff KAY KURT (k/a KURT KAY) : IN THE COURT OF COMMON PLEAS OF Plaintiff :CUMBERLAND COUNTY, PENNSYLVANIA V. DOCKET NO.: 13-3736 ALICE PHILLIPS Defendants : CIVIL ACTION—LAW CERTIFICATION OF SERVICE I hereby certify that on September 5, 2013, I mailed a true copy of the Plaintiff's Answer to Defendant's Counter Claim to the following person at the following address by U.S. Mail, postage prepaid, and via Facsimile (717) 695-9520 delivered to addressee only: Mr. J. Ronaldo Legaspi Law Office of J Ronaldo Legaspi 2023 North Second Street Suite 104 Harrisburg, PA 17%arl Date: Q Zor 3 Roming er, Esquire 155 South Hanover Street Carlisle, Pennsylvania 17013 (717) 241-6070 Supreme Court ID#81924 Attorney for Plaintiff �®BIIE�Yf. ur.>��.ug�sasau:rv3r.auWuuu.�t s.�..ssuustasist�su�uao�taasirt��m to s� �t s ,�:. nssrr-it^.a:.. :i;u.�aiatiwara+r�t.at� rnn.,n l tyurry�3 € a`lEe f l E M iJ R I O . Date !{ s' Ua _ 4 ( irne;=`�;y 1 '1_ Inquiry 7aeny .. ., (2�R ationship to C(tent„ ( )tftt Work* COW FAX (4)flow laid you hear about i " I All," Agency" � '.' "! _ peeific� �rsn�(j } '. t ""}( )tvtr.MPS.MSal�4. Age__bOB�_. Address 1-1 city ,} , (N Amhulatory"V N t It Boor Own W69114 YN 4kt. s,rxi +rtt'Y, --�Meat Prep - rttc Shop,......,Mod,R00mdws .:.,. __AN- i WAlkir r Ls�utidry _ ,A stet Tftcs�iia y"Taal du+ g _ L1t Ftcusskrytn Icuzidtitairsrn* �arttic+n iTUATIQ;�T '. �.Lt zt' k `- A � Y�, T511 i + i BROCHURE; Name: Address _ `it Ste ( " SERVICE CALL -. 7a . Date: Tigre. Address � Zip City —State 1 FOLLOW-UP CALL: r 1`': Date 12AC -X)1By ► "�� 2n°: Date 12 l,�t � �+r�' B 3"': Date By t E Client: YES/NO Closed Lead: YESI O; Additional info: L�// i bad limas,c MIS 9, (au r ',*ions Canv C k0s ca,t� ca cj&_ mop l ht t1 I HaNU}b (%01)), �,AA f 105.0 ��'1 . '� f PENNSTATE HERSHEY Page 3 of 3 Rehabilitation INTERDISCIPLINARY PATIENT Philips,Alice R 12/11/39 F Hospital DISCHARGE INSTRUCTIONS 12/3/12 PT# 13834 MR#3366 In Psr6krsldp wMSelect Medial INSTRUCTIONS FOR PATIENT AND FAMILY Dr.Zhang HMR# 1649517 Patient Name: Date: OOS# 18529505 RESPIRATORY THE TREATMENT/MEDICATIONS: VENT 10 2 SETTINGS: OTHER: EDUCATIONAL PROVIDED: EEMPLOYEE SIGNATURE&TITLE: DATE/TIME: NOTIFICATION l ARRANGEMENTS MADE BEFORE DISCHARGE (HOME HEALTH,HOSPICE,MEALS ON WHEELS,ETC. AGENCY: I `t z yA j? PHONE: AGENCY: ' ? ' ;4 '- l. - f PHONE: AGENCY: " f' PHONE: EMPLOYEE SIGNATURE&TITLE: ` t i I DATE/TIME: 't HOME MODIFICATIOI If RQUIPME T ARRANGEMENTS {., r .� ,,�— EMPLOYEE SIGNATURE&TITLE: ( ;,I DATE/TIME: - 'r� . _ + ?L. _.' FOLLOW-UP APPOINTMENTS WHEN: i.. WHO: t IN`s.. C.. ` t' 1 WHERE: PHONE: t ....L. WHEN: WHO: WHERE: PHONE: WHEN: WHO: WHERE: PHONE: WHEN: WHO: WHERE: PHONE: EMPLOYEE SIGNATURE&TITLE: DATE/TIME: I HAVE RECEIVED ALL MY VALUABLES: ❑ HEARING AID ❑ DENTURES ❑'LEGAL PAPERS ❑ EYEGLASSES ❑ MEDICAL EQUIPMENT ❑ PROSTHETIC DEVICES THIS IS TO CERTIFY THAT THE ABOVE INSTRUCTIONS HAVE BEEN EXPLAINED TO ME AND I UNDERSTAND THEM AND 1 HAVE NO FURTHER QUESTIONS. SIGNATURE OF PATIENT: DATE/TIME: AND/OR rT,•. SIG DATE/TIME: /,*TURE OF SIGNIFICANT OTHER: IC PLANNING/PATIENT EDUCATION d0 i� yl D C(, ET D{- �A A �t I ( ' t � 1 , t ;: I -_ � l SIGNATURE OF CASE MANAGER_ 6 � .,,��. _- V y '� a DATE/TIME:,, _ a; t �` r— MISCELLANEOUS Signature �''�'' ice• " DATE/TIME: Form* PS-AD-664(Rev.411) /v— WHITE-CHART CANARY-PATIE PINK-PHYSICIAN s 'ALNXM LIFE kND CARIALn'COAMANF ro An 1938-Camt4 IN 46082-1938 'eatpkore: 8 0U-634-3072 SO 1 92 8 Alice R Phillips December 5, 2012 9 Tall Oak Dr Mechanicsburg PA 17050 Dear Mrs. Phillips: Thank you for taking the time to call us on 12/5/2012. This letter con- firms our conversation. Enclosed is the claim packet we discussed. In addition to the completed claim form we suggest you ask your care provider to send us the following: For Home Health Care: Your initial assessment/oasis assessment Plan of care Agency's license The daily visit notes Itemized billing statements and Explanation of Medicare Benefits (EOMB) , if applicable Upon receipt of the information and completion of our review, we will promptly send you a letter informing you of our decision. If you have any questions regarding this matter, please call Customer Service at 1-800-621-3724, 8:00 AM - 4:30 PM Central Standard Time. Sincerely, Policyholder Services J67TC 000930 Your servicing office is #1051 1215 Manor Dr Ste 300 Mechanicsburg PA 17055 Phone (717)791-2100 Agent: Patrick T Moran Exh � � � 1 `BANKERS 1 .t1EE AND CASUALTY COMPANY Filing a first time Long-Term Care (LTC) Claim with Bankers Life and Casualty Company The purpose of this instructional document is to assist you through the claim filing process. There is important information we must receive from multiple parties in order to appropriately evaluate each claim. Required claim material must be received in order for payment to be considered. Bankers provides resources to assist you throughout the process. LTC Claim Checklist Filing a claim can be done in 4 steps! Please refer to the detailed information below. CAF 1: Call the Intake Team Y3: Provide authorized representatives ??( 2: Fill out the claim form IX 4: Submit documentation During the initial claim filing process, we may ask for additional information from you and/or your provider(s) to learn more about your condition and care needs. Step 1: Call the Intake Team before you file a claim Before you file a claim, please contact one of our Intake Specialists. They will work with you one-on-one to answer your questions, walk you through your polic, benefits and assist you with the claim filing process. You can reach an Intake Specialist a Woo) 621-372 etween the hours -- -of 8:00 AM - 4:30 PM Central Time, Monday through Friday. Intake peciaiists can assist with such questions as: • Who are the qualified Providers in my area? • What types of services and expenses does my specific policy actually cover? What are my dollar limits? • What factors are considered to determine if I duality to receive policy benefits? • What is an Elimination Period? Must I satisfy an Elimination Period before I file a long-term care claim? • What information may be requested during the claim process? • How quickly can I expect a decision on my claim? • What do I need to submit to receive reimbursement? Step 2: Fill out the claim form Once your care begins, you will need to complete a claim form. Please keep the following items in mind when filing an LTC claim: • Provide as much detail as possible to each of the questions, including you and your providers' current addresses and telephone numbers. Providing incomplete information may lengthen the claim processing time. • Feel free to attach additional pages if you need more room to respond to any question. • Sign the enclosed Authorization for Claims Processing Purposes form included with the claim packet. Initial Provider Assessment: A written summary that provides a general description of tf►e Policyholder (physical assessment, height, weight, age, etc.) and a description of their primary medical history. t_1 Provider qualifications including licensing for Agency, Aide, Caregiver, etc., as well as certification, and/or individual training or experience, if applicable per your policy. From an Assisted Living Facility t..j Facility's Service Plan: A set of actions the care Provider will implement in order to resolve and/or support the diagnoses and/or care needs of the Policyholder. JL— Medication List: A list of all the medications the Policyholder is taking and information on how they are to be administered. Itemized Bill(s): This document shows the charges (by reason) you have incurred during care. The charges need to be itemized in order for us to verify which expenses are covered by your policy. Facility License: A document showing that the Facility is licensed or certified. From an Adult Day Care Provider Adult Day Care Plan of Care: A set of actions the care Provider will implement in order to resolve and/or support the diagnoses and/or care needs of the Policyholder. - Itemized Bill(s): This document shows the charges (by reason) you have incurred during care. The charges need to be itemized in order for us to verify which expenses are covered by your policy. Facility License: A document showing that the Facility is licensed or certified. Questions If you do not see your provider type listed or have additional questions, please contact our Intake Team Monday through Friday between 8:00 AM -4:30 PM Central Time at U800) 621-3724, or visit our website at www.bankers.com. Notes • If any testing such as Mini Mental State Exam (MMSE) or a neuropsychological evaluation has been completed, please include this information in your claim submission. • For non-facility claims; a Benefit Eligibility Assessment (BEA) may be requested during our eligibility review. This is a visit by a qualified licensed healthcare practitioner from an independent agency (not affiliated with Bankers) who conducts an assessment with the Claimant in their place of residence_ During the assessment, this individual will gather information about the functional abilities of the Insured. They will also administer a cognitive screening and discuss relevant medical history and current health conditions of the Insured. ./► BANKERS ,I S. 1 0 S S 1011 C) a LIFE AND CASUALTY COMPANY Authorization for Claims Processing Purposes Pursuant to the HIPAA Privacy Rule 164.508(c) I, the undersigned, authorize any licensed physician, medical practitioner, hospital, clinic, medical or medical related facility, the Veteran's Administration, insurance company, the Medical Information Bureau, Inc. (MIB), employer or Government agency to disclose personal information about me as described below. This authorization was prepared by Bankers Life and Casualty Company for purposes of obtaining personal information necessary to process a claim for benefits. The information subject to this authorization is any and all information, including health information, requested by Bankers Life and Casualty Company for the purpose stated above as well as any information provided to them or their affiliated insurance companies on any previous applications, The information covered by this authorization does not include psychotherapy notes but does include any information about drug abuse, alcoholism, and mental illness. In addition, the information covered by this authorization does include any such information that has been restricted by my request. Persons or entities employed by or authorized by Bankers Life and Casualty Company to perform tasks related to the claims process are hereby authorized to use the personal information covered by this authorization. I understand that if the person or entity that receives this information is not a health care provider or health plan covered by federal privacy regulations, the information will likely no longer be protected by the federal privacy regulations and may be subject to redisclosure. However, I further understand that all such persons or entities have signed agreements to protect said information. I understand that I may revoke this authorization in writing at any tirrre, except to the extent that action has been taken by Bankers Life arid Casualty Company, or, so long as Bankers Life and Casualty Company has a legal right to contest the coverage or a claim under the coverage. Revocation requests must be sent in writing to: Bankers Life and Casualty Company Privacy Office 11825 North Pennsylvania Street Carmel IN 46032 1 understand that Bankers Life arid Casualty Carnpany cannot condition the payment of a claim on my signing this authorization. This authorization will expire upon the final action related to the claim for which this authorization is signed. A copy of this authorization may be used in place of the original. If this authorization is for someone other than myself, that individual and my authority to act on his/her behalf are explained below. (Please Print)Name of Individual Whose Information is covered By (Please Print)Name of Representative with authority to act on behalf This Authorization of the Individual Whose Information K Covered By This Authorization % i Signature of Individual and Date Relationship of Representative to individual Signature of Representative and Date :j► BANKERS LONG-TERM CARE AND LIFE AND CASUALTY COMPANY 1 � Vii . www.bankers.com SHOT fT� `R1 CMitbL i6 FORM POLICY NUMBER: Please send completed claim form to: Bankers Life and Casualty Company .........._......_..___.._..__.. Date:1a .Z . 4lL PO Box 1902 If you would like assistance in completing this claim form, please call 1-800-621-3724. Carmel IN 46082-1902 1. Claimant Name: p h $ ._. r Date of Birth: 1J-111-1 Address: T�, 1( G gi� L._ _ -- City: h_e r �► c,.n _� f _: State: _ , _— Zip: To make an address change, please fill out the Address Change Request Form attached to this form. Phone: Ol ? (al 40 14 q _—. Sex: F` M i F 2. Contact Person (if unable to reach) Name: L"�g r c—L M►1`A , c Address:_. ?. _ yy cu!hew n 0"A - City: _ _++e5 State: i''.!4--- Zip: I *Z.3 Phone: (-21 ��'a - l� o� 4 Relationship: 50 A 3. Describe your limitations. indicate the first day the limitations were present, if applicable, or provide an approximate time frame: 2V vV ag '-;to (cal f 1'l A e f�i nt CT P 6 u_1 111�8�I a j N j /�I o L. -Z— 1 !1 i{"J:'.c 1 nit° �1 r fjk• i1� 1 1, . U 'n Ve ALI � l J l 4. Cause or Condition which requires you to need Long-Term Care: I 1 Sickness WInjury If limitations (caused by an injury, when, where, and how did it happen? 11kV ? .�U j a _ 5. Are you currentlly, o2 rn have you been, hospitalized within the last year? k. Yes No From: II I l L3 To: ! / Hospital Name: Address: / 5 S` i A I A-1 - c l c:%c.o k'i- /� ✓� `�tl / f}c,rsft4 f 7 s ' fw POLICY NUMBER: _., �. 4 _� .... -._.._.. - ..__...- .... CLAIMANT N Elf ... .c L_.. ` -...�..'4 ._._._........._- ..... b. List your medical history during the last two years below, starting with most recent treatment. (Please attach additional pages if necessary.) Name of Physician: Phone: ( ) — Address: _ City: _ State: Zip: Conditions) treated: Date(s): Name of Physician: Phone: (_ � _ Address: _ City: State: _ Zip: Conditions) treated: Date(s): Name of Physician: Phone: (_ ) Address: City: -- _ --- __--. - State: _ _ Zip: _ —.-- Condition(s) treated:^ Date(s): 7. Please complete the information in either Box A or Box B for services already provided. (Please attach additional pages if necessary.) A. NURSING HOME OR ASSISTED LIVING FACILITY CONFINEMENT: Name of Facility:.__— _. _. Tax ID: Contact Person, if known: Address: City: State: - Zip:-.----- Phone Number: (_ Fax Number: Admitted: __/ / Discharged:—_/_-/ Payer Source: B. HOME HEALTH CARE,- ADULT DAY CARE OR OTHER CARE SERVICFS: Name of Care Provider: C!�'+t, �i.�� ;; L C k Q� Tax ID: _ Contact Person, if known: N OIL 1-v-_'1SC 1� Address: City: 1 < 6_1`11:1 ,rc I-iLA. State:__'� Zip: Phone: gris cf Fax: ( ) Admitted:LD G 2 _�_Ji +j Discharged:C' f Payer Source: 8. Do you currently have coverage for medical care under Medicare"? (If yes, is coverage for Part A or Part B only,or for both?) ; Part A only Part B only ~Parts A&B No Medicare Coverage Has a claim been submitted? VYes No POLICY NUMBER: W oi,` 20 C, CLAIMANT NAME: 9. Do you have any other insurance that may provide coverage? Check all that apply: Coverage under a Medical Plan Company Policy Number: Phone Number: Has a claim been submitted? Yes No ;Medicare Supplemental Policy Company k 5 , Policy Number- Q s 1­ 2 0 L. Phone Number: !Ripo (,,J Has a claim been submitted? ;—)(Yes No Other Third Party Coverage (Auto Insurance, Injury/Accident, Property Insurance, etc.) Company Policy Number: Phone Number: Has a claim been submitted? Yes No Workers' Compensation Company Policy Number: Phone Number: ---! Yes F. No Has a claim been submitted? I Other Long-Term Care Insurance Company Policy Number: Phone Number: F No Has a claim been submitted? Yes No Insurance Unknown 10. Do you have a Power of Attorney, Conservator, or Guardian or other person who can legally represent you?* If Yes, who? Name: k)c"v- N C Phone Number: _ZL2J Cf Address: City: 1: � er State: zip: 9 *Please attach to this form a copy of the document giving this person legal authority. For your protection some states require us to inform you that any person who knowingly files a statement of claim containing false or misleading information is subject to criminal and civil penalties, depending upon the state. Such actions may be deemed a felony and substantial fines may be imposed. If we determine that benefits have been paid under this coverage as a result of your fraudulent action(s), we have the right to recover those benefit amounts. We may recover those benefit amounts directly from you or by reducing any subsequent benefit payments under this coverage. We will determine the manner in which we seek recovery of benefit payments made under fraudulent conditions. I declare that all of the above answers are complete and true to the best of my knowledge and belief. I understand that the company reserves the right to require further proof. x Signature of Policyholder(or Legal Representative) Date signed(Month/Day/Year) Policyholder(or Legal Representative)Name(Please Print) Signed at(City,County, State) If Legal Representative, give relationship to Policyholder (8112) AK residents:A person who knowingly and with intent to injure, MN residents: A person who files a claim with intent to defraud defraud, at deceive an insurance company files a claim containing or helps commit f 4 U Istan insurer is guilty of a(tirne. false, incomplete, or misleading information may be prosecuted under 15 .g J-' state law. NH residents:eny person-W�viho'With tf,6 �Mrfi( Ri injure, defraud or deceive any insurance company, files a statement of claim AZ residents: For your protection Arizona law containing any false, incomplete or misleading information is subject requires the following s=ent to appear on this to prosecution and pur-iishment for insurance fraud, as provided in 10 -20, form. Any person who ngly presents a false or N.H. Rev. Stat.Ann. 638. fraudulent claim for payment of a loss is subject to NJ residents:Any person who knowingly files a statement of clairn criminal and civil penalties. containing any false or misleading information is subject to criminal AR residents:Any person who knowingly presents a false at and civil penalties. fraudulent claim for payment of a loss or benefit or knowingly NM residents:Any person who knowingly present,,a false at presents false information in an application for insurance is guilty of a fraudulent claim for payment of a loss of benefit or knowingly crime and may be subject to fines and confinernent in prison. presents false information in an application for insurance is guilty of CA residents:For your protection California law requires the following crime and may be subject to civil fines and cris'ninal penalties. to appear on-if iis form. Any person who knowingly presents false or NY residents,Any person who knowingly and with intent to defraud fraudulent claim for the payment of a loss is guilty of a crime and may any insurance company or other person files an application for insuranc be subject to fines and confinement in state prison, or statement of claim containing any materially false information or CO residents:It is unlawful to knowingly provide false,incomplete, conceals,for the purpose of misleading, information concerning any far material thereto, commits a fraudulent insurance act,which is a crime of misleading facts or information to an insurance company for the and shall also be subject to a civil penalty not to exceed five. thousand purpose of defrauding or alterripting to defraud the company. dollars arid the stated value of the clairn for each such violation, Penalties may include imprisonment, fines, denial of insurance arid civil damages. Any insurance company or agent of an insurance OH residents:Any person who, with intent to defraud or knowing h that he is facilitating a fraud against an RISUIer, submits an applicatic; company who knowingly provides false, incomplete,01 Misleading facts or information to a policyholder or claimant for the purpose of or files a clairn containing a false or deceptive statement is guilty of defrauding of attempting to defraud the policyholder or claimant with insurance fraud. regard to a settlement or award payable front insurance proceeds shall OK residents:Viaining: Any person who V and with inteni be reported to the Colorado division of insurance within the to injure, defraud or deceive any insurer, makes anydain'l department of regulatory agencies. for the proceeds of an insurance policy containing any false, DC residents:Warning: It is a criine to provide false or misleading incomplete or misleading infoimation is guilty of a felony. information to an insurer for the purpose of clefiauding the insurer or OR residents: Any person who knowingly and with intent 10 defraLl any other person. Penalties include imprisonment and/or fines. In of solicit another to defraud an insurer: (1)by submitting an addition, the insurer may deny insurance benefits if false information application, or(2) by filing a claim containing a false statement as to materially related to a claim was provided by the applicar nt. any material fact, may be violating state law. DE residents:A person who knowingly and with intent to injure, PA residents:Any person who knowingly and with intent to defraud defraud, or deceive any insurer, files a statement of claim containing any any insurance company or other person files an application for insuraf ic false, incomplete,or misleading information is guilty of a felony, of statement of clairn containing any materially false information of FL residents:Any person who knowingly and with intent to injure, conceals for the purpose of misleading, information concerning any fac defraud, or deceive any insurer files a statement of clairn or an material;hereto con-irnits a fraudulent insurance act,which is a crime application containing false, incomplete, or misleading information is and subjects such person to criminal and civil penalties. guilty of a felony of the third degree. PR residents:Any person who, knowingly and with the intention of defrauding presents false information in an insurance application, or ID residents:Any person who knowingly and vvith intent to defraud or deceive any insurance company, files a statement of clairn containing arty presents, helps or causes the presentation of a fraudulent claim for false, incomplete,of misleading information is guilty of a felony. the payment of a loss or any other benefit, or presents more than or claim far the same damage or loss, shall incur a felony, and upon IN residents-.A person who knowingly and with intent to defraud an conviction shall be sanctioned for each violation with the penalty of insurpi files a statement of clairn containing false, incomplete, at fine of not less than five thousand (5,000)dollars and not more thar misleading information commits a felony. ten thousand(10,0001, dollars,of a fixed terrn of imprisonment for KY residents:Any person who knowingly and with intent to defraud three(3)years, or both penalties. Should aggravated circumstances t any inSL1i ance company or other person files a statement of clairn present,the penalty thus established may be increased to a r-naximur containing any materially false it or conceals, fat the of five(5)years; if attenuating circumstances are present, purpose of misleading, information concerning any fact material it may be reduced to a minimum of two(2)years. thereto commits a fraudulent insurance act, which is a crime. TX residents:Any person who knowingly presents a false or ILA and RI residents:Any person who knowingly presents a false or fraudulent claim for payfnent of a loss is guilty of a crime and may I fraudulent clairn for payment of a loss or beriefit or knowingly Subject to fines and confinement in state prision. presents false information in an application for insurance is guilty WV residents:Any person who knowingly presents a false or of a ctirne and may be subject to fines and confinement in prison. fraudulent claim for payment of a loss or benefit or kricivvingiy MD residents:Any person who knowingly and willfully presents a false presents false information in an application for inSUlance is guilty of or fraudulent claim for payment of a loss or benefit or who knowingly a ct Jr-ne and may be subject to fines and confinement in prison. and willfully presents false information in an application for insurance is All other states residents: Any person who knowingly and with guilty of a crime and may be subject to fines and confinement in prison.. intent to defraud any insurance company that submits an application ME I TN /VA and WA a ui-ffrie loknowingly provide for insurance or statement of claim containing any materially false false, incomplete or misleading information to an insurance con'ipany information,or conceals information concerning any fact material for the purpose of defrauding the company. Penalties may include thereto for the purpose of misleading, may be committing a crime, : I which is subject to criminal and civil penalties. imprisonment, fines or a denial of insurance benefits. A401b► BANKERS LIFE AND CASUALTY COMPANY 1 50 1,03 www.bankers.com ADDRESS CHANGE REQU All address change requests must be submitted in writing. Use this form to request a permanent c of address. Please allow 30 days for the address change to be processed. Policyholder's Name: Claimant's Name: Policy Number(s): PLEASE CHANGE MY ADDRESS TO: Address: City: State Zip code Effective Date of Change: (This address change will remain in effect until further written notification is received.) Name of person completing this form (please print)- Signature of Policyholder(or Legal Representative) Date Signed(month/Date/Year) Policyholder(or Legal Representative) Name(Please Print) Signed at(City/county/State) If Legal Representative, give relationship to Policyholder (Attach a copy of your legal authority, Power Of Attorney, guardianship, etc. if applicable) PLEASE NOTE: This address change will affect all correspondence being sent to the policyholder by Bankers, such as: PremiL Statement, Claim Checks, Explanation of Benefits (EOB). This form must be signed and dated by the policyholder or Legal Representative in order to be considered v, Without proper signature(s) or documentation, this document is null and void, if you have further questions please feet free to contact our Customer Service Department at 1-800-621-3724 between the hours of 8:00 AM —4-30 PM Central Time, Monday through Friday. Please mail Address Change Request Form to: Policy Benefits Department PO Box 1902 Carmel, IN 46082-1902 Or Fax to: 312-396-5952 18895 Clknt log Ho e'`st d Report Run Date 04/06/2013 Client:1780 Phillips(2),Alice AI III Date Category Staff Log 01/21/2013 dja Amanda Myers went on a weekend trip to Atlantic City with Alice and her son. She drove the client's car to Atlantic City.There were 2 rooms for them. one for alice and amanda.And one for her son.I called her on Monday 1/21 and checked in with her.Everything went well. 01/16/2013 mr Spoke to Alice 3:30pm yesterday she said she is home now and she asked to have either Amanda or Cheryl in the evening to help her get ready for bed,she also asked for Cheryl thursday 10-4p,and Amanda ALL WEEKEND.Both caregivers agreed to the hours. 01/14/2013 hospital DNH Spoke to dtr Paula who said her mom is in hershey med center with chest pains,possible heart attack but dont know yet. 01/07/2013 DNH Spoke to Sally&Harold at 1140am.They said that Alice is making her own schedule this week so I will just have to call her back again. 01/07/2013 DNH LM at I I30am for both Sally and Alice to call me back about the schedule. 12/27/2012 D Se 12/18/2012 DNH Son Harold emailed me the family schedule on 12/13.I forwarded it to scheduling.I emailed him again today to see if they needed service going forward. 12/07/2012 DNH Did CC,signed paperwork.Log book-yes. Each Home Instead Senior Care Franchise Office is independently owned and operated. page#1 DETAILED INVOICE Service For : Alice Phillips(2) Billed To : Mrs. Alice Phillips(2) 5002 Lenker Street Invoice#: 1780-0113-2 I Mechanicsburg,PA 17050 Invoice Date : (717)731-9984 Service Period :Jan 16,2013 -Jan 31,2013 www.HomeInstead.com Date From To Type CAREGiver Miles Service Qty. Rate SubTotal 1/17 10:00am 4:00pm Normal Scott,Cheryl Hourly Service,Level 2 6.00 $20.95 $125.70 1/18 6:00pm 7:00am Weekend Myers,Amanda Hourly Service,Level 2 13.00 . $23.05 $299.65 1/19 7:00am 9:00pm Weekend Myers,Amanda Hourly Service,Level 2 14.00 $23.05 $322.70 9:00pm 7:00am Hourly Service,Level 2 10.00 $23.05 $230.50 1/20 7:00am 5:30pm Weekend Myers,Amanda Hourly Service,Level 2 10.50 $23.05 $242.03 r C. , Total 53-9 S11=9 Miles: 0.00 @ $0.59 = $0.00 Miscellaneous Charges: _ $0.00 Additional Charges/Credits: _ $0.00 Service Deposit Applied: _ $0.00 Current Invoice Total: _ $1,220.58 Total Amount Due: $19220.58 Due Date: June 09,2013 'All Overdue Invoices are Subject to an 18%Annual Service Charge Please Retain For Your Records Please Detach And Return This Portionwith Your Payment Payable to Home Instead Senior Care Each Home Instead Senior Care Franchise Office is independently owned and operated. Invoice#: 1780-0113-2 Service For: Alice Phillips(2) Service Period: Jan 16,2013 -Jan 31,2013 Mrs.Alice Phillips(2) Current Invoice Total: 9 Tall Oak Dr. $1,220.58 Mechanicsburg,PA 17050 Total Amount Due: $1,220.58 r � \ Due Date: June 09,2013 KAY LLC DB/A HOME INSTEAD: IN THE COURT OF COMMON PLEAS SENIOR CARE Plaintiff, OF CUMBERLAND COUNTY, PA : -- c w, C' C7 NO.: 13-3736 ma c; ALICE PHILLIPS, ' Defendant CIVIL ACTION- LAW c Xr� "{ - X�c—) CD E3 C-3 1.C—. �W --€ .-3 NOTICE TO PLEAD TO: Plaintiff, KAY LLC DB/A HOME INSTEAD SENIOR CARE You are hereby notified to file a written response to the enclosed New Matter and Counterclaim within twenty(20)days from service hereof or a judgment may be entered against you. J. o o Legaspi, Esq. A rney for Defendant, Alice Phillips J. Ronaldo Legaspi, Esquire I.D.No. 200240 Law Offices of J. Ronaldo Legaspi 2023 N. Second Street, Ste. 104 Harrisburg, PA 17102 717.743.0586 Attorney for Defendant, Alice Phillips .KAY LLC D/B/A HOME INSTEAD: IN THE COURT OF COMMON PLEAS SENIOR CARE Plaintiff, OF CUMBERLAND COUNTY, PA NO.: 13-3736 ALICE PHILLIPS, Defendant CIVIL ACTION - LAW ANSWER AND NOW comes the Defendant,Alice Phillips,by and through her counsel,J. Ronaldo Legaspi,who files this Answer and New Matter, and in support thereof aver as follows: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Denied as stated. It is specifically denied that Answering Defendant assigned all healthcare decisions to Defendant Mirabito. By way of further,answer, the document speaks for itself. Any characterizations thereof are specifically denied. 2 6. To the extent the allegations in Paragraph 6 are directed to another defendant other than the Answering Defendant, Ms.Phillips is without knowledge or information sufficient to form a belief as to the truth of the allegations, and on that basis denies those allegations. To the extent the allegations in Paragraph 6 of the Complaint are directed at Answering Defendant,the.allegations are admitted in part and denied in part. It is admitted that Harold Mirabito was involved in some of the arrangements for Ms. Phillips':care. It is specifically denied that Ms.Phillips ever appointed Mirabito as her agent pursuant to a power-of-attorney. 7. To the extent the allegations in Paragraph 7 are directed to another defendant other than the Answering Defendant, Ms. Phillips is without knowledge or information sufficient to form a belief as to the truth of the allegations, and on that basis denies those allegations. To the extent the allegations in Paragraph 7 of the Complaint are directed at Answering Defendant,the allegations are specifically denied.At no time did Ms. Phillips enter any contract for services with Plaintiff. 8. Admitted in part and denied in part. It is admitted that Plaintiff performed some care services for Ms. Phillips. It is specifically denied that the services performed by Plaintiff fulfilled the terms of the.alleged Agreement. 9. Admitted in part and denied in part. It is admitted that Answering Defendant,did not pay for the referenced care services. The remainder of the allegations contained in paragraph 9 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the same is denied. COUNT 3 10. Defendant incorporates by reference Paragraphs 1 through 9 as if fully set forth herein. 1 L. Denied. This allegation is specifically denied. At no time did Ms. Phillips enter any contract for services with Plaintiff. By way of further answer,the document speaks for itself. 12. Admitted in part. Denied in part. It is admitted that Plaintiff performed some care services for Ms. Phillips. It is specifically denied that Ms. Phillips ever entered into a contract with the Plaintiff. COUNT II 13. Defendant incorporates by reference Paragraphs 1 through 12 as if fully set forth herein. 14. To the extent the allegations in Paragraph 14 are directed to another defendant other than the Answering Defendant,Ms. Phillips is without knowledge or information sufficient to form a belief as to the truth of the allegations, and on that basis denies those allegations. To the extent the allegations in Paragraph 14 of the Complaint are directed at Answering Defendant, the allegations are admitted in part and denied in part. It is admitted that Harold Mirabito was involved in some of the arrangements for Ms. Phillips' care. It is specifically denied that Ms. Phillips ever appointed Mirabito as her agent pursuant to a power-of-attorney. The remainder of the allegations contained in paragraph 14 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the,same is denied. 15. To the extent the allegations in Paragraph 15 are directed to another defendant other than the Answering Defendant, Ms. Phillips is without knowledge or 4 information sufficient to form a belief as to the truth of the allegations,and on that basis denies those allegations. To the extent the allegations in Paragraph 15 of the Complaint are directed at Answering Defendant,it is specifically denied that any contractual agreement was entered into with the Plaintiff that is binding on Ms. Phillips. The remaining allegations contained in paragraph 15 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the same is denied. By way of further answer.,the document speaks for itself 16. To the extent the allegations in Paragraph 16 are directed to another defendant other than the Answering Defendant, Ms..Phillips is without knowledge or information sufficient to form a belief as to the truth of the allegations,and on that basis denies those,allegations. To the extent the allegations in Paragraph 16 Hof the Complaint are directed at Answering Defendant,the allegations are admitted in part and denied in part. It is admitted that Plaintiff performed some care services for Ms. Phillips. It is specifically denied that the services performed by Plaintiff fulfilled the terms of the alleged Agreement. The remaining allegations contained in paragraph 16 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the same is denied. WHEREFORE,Defendant seeks dismissal of the lawsuit filed against her by the Plaintiff herein. COUNT III 17. Defendant incorporates by reference Paragraphs 1 through 16. 18. Admitted in part and denied in part. It is admitted that Plaintiff performed some care services for Ms. Phillips.It is specifically denied that the services performed 5 by Plaintiff fulfilled the terms of the alleged Agreement. The remaining allegations contained in paragraph 18 constitute mere conclusions of law to which no response is required. To the extent that a response may be required,the same is denied. 19. Denied. The allegations contained in paragraph 19 constitute mere conclusions of law to which no response is required. To the extent that a response may be required, the same is denied. WHEREFORE,Defendant seeks dismissal,of the lawsuit filed against her by the Plaintiff herein. NEW MATTER 20. Defendant incorporates by reference Paragraphs 1 through 19. 21. The Plaintiff fails to:state a claim upon which relief can be granted. 22. The alleged contract is invalid due to incapacity of Defendant. 23. The alleged contract is invalid, as it was made pursuant to an invalid power-of-attorney. 24. The Plaintiff's claims are barred by the doctrine of fraud. 25.. The Plaintiff's claims are barred by the doctrine of set-off. 26. The Defendant's failure to comply with any alleged obligations under the Contract Service Agreement is excused by Plaintiff's own breaches of the putative Agreement. 27. Plaintiff has failed to mitigate damages, if any. 28. Defendant reserves the right to assert any additional defenses which may arise in the course of discovery or trial in this matter. 6 WHEREFORE, Defendant seeks dismissal of the lawsuit filed against her by the Plaintiff herein. COUNTERCLAIM 29. Defendant incorporates by reference Paragraphs 1 through 28 as if fully set forth herein. 30. Prior to December 2012,Ms. Phillips had received skilled nursing and personal<care from Celtic Healthcare, based in Mars, Pennsylvania,in connection with treatment and hospitalization for prior ailments. 3L On or about November 30, 2012, Ms. Phillips was admitted to Penn State Hershey Medical Center for spinal surgery. .32. During her rehabilitation.and recovery after surgery, Ms. Phillips was notified by staff members of Penn State Hershey Medical Center that arrangements were made for Celtic Healthcare,with whom she was familiar,having had previously received treatment from them, to provide services for her personal care in her home upon ,discharge from the hospital. 33. On or about December 7, 2012,Ms. Phillips was discharged from Penn State Hershey Rehabilitation Hospital to her residence with a prescription for round-the- clock skilled nursing care and personal care. A true and correct copy of the Prescription is attach,hed hereto:and marked as Exhibit"A." 34. On or about December 7,2012, a representative from Home Instead, believed to be known as"Danielle,"-appeared at Ms. Phillips' residence, requesting information pertaining to her medical condition,health insurance,hospital discharge and offering personal care services to Ms. Phillips. 7 35. Due to Ms. Phillips' frail condition,having been recently discharged from the hospital after her spinal surgery, Original Plaintiff's representative solicited Ms. Phillips' son,Harold.Mirabito,for the:aforesaid information and to accept care services, while Ms. Phillips was also present but somewhat indisposed and still in the process of recovering from her spinal surgery. 36. Because Ms. Phillips,nor any person on her behalf, contacted the Original Plaintiff to request the:aforesaid care services,Ms. Phillips and Mr.Mirabito believed the representative to be a care provider from Celtic Healthcare, and thus acceded to her request for information. 37. When asked about her health coverage, Ms. Phillips stated that she had Medicare•coverage,and that":everything was covered by Medicare,"indicating her belief that the services offered by Original Plaintiff would be paid for by her medical insurance. 38. Original Plaintiffs representative acknowledged the statement made by Ms.Phillips and denoted the fact of her Medicare coverage on a health questionnaire form,despite the fact that Original Plaintiff's representative knew that the offered services did not qualify for Medicare coverage. 39. Original Plaintiff's representative did not disabuse Ms. Phillips or Mr. Mirabito of their clear misapprehension that the services contemplated in the alleged Agreement were covered by Medicare and/or additional supplemental lung-terra-care insurance. 40. Original Plaintiffs agent gave assurances to Ms. Phillips and Mr. Mirabito that no payment was required and that"everything would be taken care of," giving the false impression that her insurance would cover the cost of care services. 8 41. Mr. Mirabito provided Original Plaintiff's representative with copies-of Ms. Phillips Medicare and supplemental insurance information and the prescription from Ms. Phillips' physician for•comprehensive skilled and personal care. 42. In connection with her prescribed treatment,Ms. Phillips required an array of services, which included skilled nursing,physical therapy, and occupational therapy, in addition to home health aide services. 43. During the relevant period.,Ms. Phillips was receiving:skilled nursing care services from Celtic Healthcare on a periodic basis of three days per week, for one hour per day, as well as physical and occupational therapy three times Per week. 44. Ms. Phillips also supplemented the aforesaid personal care with the assistance of family:members. 45. Original Plaintiff sent care providers to Ms. Phillips residence during the relevant period from December 7, 2012,through December 31,2012,although Ms. Phillips was unaware that she was receiving care from two separate and distinct agencies, due to the deceptive actions of the'Original Plaintiff. 46. On numerous occasions during the relevant period, Original Plaintiff's care providers rendered poor and inadequate care, including failing to report for shifts, necessitating calls to the agency from Mr.Mirabito,requesting prompt and adequate service. 4T On several occasions during the relevant period, Original Plaintiff's care providers failed to render,adequate care services, endangering and placing at great risk of harm the Original Defendant, to wit: sleeping during the shift; failing to assist Original 9 Plaintiff in activities of daily activities; failing to give medication reminders; and failing to monitor the medical condition and status of Ms. Phillips. COUNT Fraud in the Inducement 48.. Original Defendant incorporates by reference Paragraphs 1 through 47 as if fully set forth herein. 49. On December 7,201.2, Original Plaintiff's agent made representations and omissions of material fact regarding Medicare coverage for the services provided by the Defendant, leading Original Defendant to believe that the Original Plaintiff.s care services would be paid for by Medicare and/or her supplemental long-term-care insurance. 50. Original Plaintiff's agent knew that Ms. Phillips believed, due to her explicit statements regarding the same,that the care services offered by Original Plaintiff would be paid for by Medicare and/or her supplemental long-term care insurance. 51.. Original Plaintiff-s agent made the misrepresentations and omissions to induce Original Defendant and Mr. Mirabito to agree to hire Original Plaintiff to provide ' care services. 52. Original Defendant and Mr. Mirabito reasonably relied upon Original Plaintiffs misrepresentations and omissions. 53. Original Defendant was damaged by Original Plaintiff's misrepresentations and omissions. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest,:attorneys' fees and costs,together with such other relief as this Court deems proper. 10 COUNT II Fraudulent Misrepresentation 54. Defendant incorporates by reference Paragraphs 1 through 53 as if fully set forth herein. 55. On December 7, 2012, Original Plaintiff's agent made representations and omissions of material fact regarding Medicare coverage for the services provided by the Defendant, leading Original Defendant to believe that the Original Plaintiff's care services would be paid for by Medicare and/or her supplemental long-term care insurance. 56. Original Plaintiffs agent knew that Original Defendant and Mr. Mirabito believed,-due to her.and Mr. Mirabito's explicit statements,that the care services offered by OP would be paid for by Medicare and/or her supplemental insurance. 57. Original Plaintiff s agent made the misrepresentations-and omissions to induce Original Defendant and Mr. Mirabito to agree to hire Original Plainttff to provide care services. 58. Original Defendant reasonably relied upon Original Plaintiff's misrepresentations and omissions. 59. Original Defendant was damaged by Original Plaintiff s misrepresentations and omissions.. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest,attorneys' fees and costs, together with such other relief as this Court deems proper. COUNT III Negligent Misrepresentation 11 60. Defendant incorporates by reference Paragraphs 1 through 59 as if fully set forth herein. 61_ Under the 6rcu m stances alleged, Original Plaintiff owed a duty to Ms. Phillips to provide her with accurate information about the Company's ineligibility for Medicare coverage for the offered:services. 62. Original Plaintiff represented to, or otherwise misled,Ms. Phillips and Mr. Mirabito that its offered services would be paid for Medicare.and/or her supplemental long-term care insurance. 63. Original Plaintiff failed to correct Ms. Phillips' and Mr. Mirabito's clearly stated belief that the offered services would be paid for by Medicare or her supplemental insurance. 64_ Original Plaintiff's representations were false,negligent and material. 65. Original Defendant justifiably relied on Original Plaintiffs misrepresentations and material omissions and acted as instructed to by Original Plaintiff, representative. 66. As a proximate result of Original Plaintiff's negligent conduct, Original Defendant has suffered,and will continue to suffer general and special-damages in an amount according to proof at trial. WHEREFORE,Original Defendant demands judgment for damages against Original Plaintiff, interest,attorneys' fees and costs,together with such other relief as this Court deems proper. COUNT IV Breach of Contract 12 67. Defendant incorporates by reference Paragraphs 1 through 66 as if fully set forth herein. 68. Even assuming that the alleged contract is enforceable against Original Defendant, which is vehemently denied,the services provided did not substantially comply with the proferred Service Agreement. 69. As set forth fully hereinabove, Original Plaintiff care providers failed to render the,services enumerated in the Service Agreement, but instead provided deficient services,to wit: care providers slept during the day shift or at times when Ms. Phillips was not sleeping; regularly failed to report for shifts; failed to assist in her activities of daily living, such as bathing and dressing assistance; and failed to give medication reminders,placing Ms. Phillips at great risk of harm in her fragile state of recovery. 70. Ms.Phillips has been damaged by Original Plaintiff's breaches, including the compromise of her care and rehabilitation iduring her tenuous recovery period. WHEREFORE, Original Defendant demands judgment for damages against Original Plaintiff, interest,attorneys' fees and'costs,together with such other relief as this Court deems proper. Respectfully submitted, Date: September 17, 20:13 J. 414 i, Esq. PA AA ID#200240 Law Offices of J. Ronaldo Legaspi 2023 N. Second Street Harrisburg, PA 17104 (717) 743-0586 jlegaspi@aol.com 13 ATTORNEY AFFIDAVIT I, J. Ronaldo Legaspi, Esquire, being duly sworn according to law, depose and state that I am counsel for the Defendant,that I am authorized to make this Affidavit on behalf of said Defendant, and that the facts set forth in the foregoing are true and correct to the best of my knowledge, information, and belief. G�2 '--�- _ J. R ,9�LEGASPI DATE: September 17, 2013 CERTIFICATE OF SERVICE I hereby certify that I have this day served the foregoing document upon the following persons by United States Mail,First Class Mail: Karl Rominger, Esquire Rominger&Associaates 155 S. Hanover Street Carlisle, PA 17013 Dated: September 17, 2013 J. eg pi A ey for Defendant, Alice Phillips 16