The URL can be used to link to this page

Home My WebLink About07-08-13 ANNUAL REPORT OF GUARDIAN RECORDED OFFICE OF OF THE ESTATE REGISTER OF WILLS ?Q13 JuL 8 PR 1 34 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CLERK OF ORPHANS' COURTDIVISION ORPHANS' COURT CUMBERLAND CO., PA Estate of Raymond Clark an Incapacitated Person No. 21-12-0040 I. INTRODUCTION Keystone Guardianship Service was appointed ®Plenary ❑ Limited Guardian of the Estate by Decree of Thomas A. Placev C.P.J., dated February 16,2012 ® A. This is the Annual Report for the period from February 17 2012 to February 16 1 2013 (the 'Report Period"); or ❑ B. This is the Final Report for the period from , to (the"Report Period"),and is filed for the following reason: 1. The death of the Incapacitated Person. Date of death: Name of Personal Representative: 2. The Guardianship was terminated by the Court by Decree of J.,dated Page 1 of 4 Estate of Raymond Clark an Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $0.00 B. State the value(s) of income and principal assets at the beginning of the Report Period. (Same as Inventory if first otherwise, ending balance from last Report.) Principal $0.00 Income $0.00 C. What is the total amount of income earned during the Report Period? $25,913.65 D. What is the total amount of income and principal spent for all purposes during the Report Period? $(23,460.82) E. What are the balances remaining at the end of the Report Period? 1. Principal $0.00 2. Income $ 2,452.83 3. Total of Principal and Income $2,452.83 III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages) A. Principal 1. How is the principal balance listed above currently invested? (Please specify, e.g., real estate, certificates of deposit, restricted bank accounts, etc.): Total Principal Balance: $0.00 2. Have there been any expenditures from the principal during the Report Period? .............................................................. ❑ Yes ® No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? .............. ❑ Yes ❑ No b. List purpose and amount of expenditures: c. Was Court approval received prior to expending the principal? ...................................................... ❑ Yes ❑ No Page 2 of 4 Estate of Raymond Clark an Incapacitated Person 3. Were additional principal assets received during the Report Period which were not included in the Inventory or a prior Report filed for the Estate? ........... ............... ❑ Yes ® No If yes: a. Was Court approval requested prior to receiving the additional principal? ....................................... ❑ Yes ❑ No b. State the sources and amounts of the additional principal received: B. Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): Interest Income $1.61 PBGC—Bethlehem Steel pension $9,018.46 US Treasury—Social Security $16,746.00 Refund —Argus/Humana $147.58 Total income received during Report Period: $25,913.65 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): Halifax Bank Checking#036297210 $2,452.83 Total Income Balance: $2,452.83 C. Expenses for Care and Maintenance Specify what expenditures were made from the principal and income for the care and maintenance of the Incapacitated Person (e.g., clothing, nursing home, medicine, support, etc.): Edward E. Lamarque,MD $584.39 Golden Living West Shore $20,945.69 Total Expenses for Care and Maintenance: $21,530.08 Page 3 of 4 Estate of Raymond Clark an Incapacitated Person D. Other Expenditures Specify what other expenditures were made during the Report Period. (Do not include any items stated in response to question C above.) Halifax Bank—checks $14.32 Keystone Guardianship—costs $280.64 Keystone Guardianship— reimburse $20.78 Register of Wills $15.00 Total for Other Expenditures: $330.74 E. Guardian's Commissions List amounts of compensation paid as Guardian's commission and state how amount was determined: Court Amount Method of Determination Approval Obtained $100.00 Fees ($100.00 per month + $500 start-up fee) ®Yes ❑ No F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount Approval Obtained _N/A ❑ Yes ❑ No ❑ Yes ❑ No I verify that the foregoing information is correct to the best of my knowledge, information and belief, and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904 relative to unsworn falsification to authorities. Date Si",f an of the Estate Melanie Peters Name of Guardian of the Estate(type or print) PO Box 804 Address Elizabethville Pa 17023 City,State,Zip 717-674-5757 Telephone IL— Page 4 of 4 Income Statement- SQL-Ledger Version 2.8.27-Raymond Clark-kg-c.. http://keyguard.anteil.com/rp.pl Raymond Clark INCOME STATEMENT for Period To February 16 2013 INCOME Feb 16 2013 Interest Income 1.61 PBGC - Bethlehem Steel pension 9,018.46 US Treasury - Social Security 16,746.00 Refund of Payment 147.58 TOTAL INCOME 25,913.65 EXPENSES Nursing Home Expenses 20,945.69 Medical 584.39 Bank Charge 14.32 Keystone Services Cost 280.64 Keystone Services Fees 1,600.00 Keystone Services Purchases 20.78 Household Expenses 15.00 TOTAL EXPENSES 23,460.82 INCOME / (LOSS) 2,452.83 1 of 1 6/20/2013 9:14 AM Account 4018-Refund of Payment/Raymond Clark- SQL-Ledger Ver... http://keyguard.anteil.cotr ca.pl?path=biti/mozilla&action=list transact... Account 4018 - Refund of Payment / Raymond Clark - February 16 2013 Date Reference Description Debit Credit Balance 08-13-2012 Deposit Argus/Humana Refund 147.58 147.58 147.58 147.58 147.58 1 of 1 6/20/2013 9:29 AM AP Transactions/Raymond Clark- SQL-Ledger Version 2.8,27-Ray.. http://keyguard.anteii-com!ap.pl?action-transactions&direction=ASC_.. AP Transactions/ Raymond Clark To February 16 2013 Open Closed Vendor bate Invoice Description Total Paid Edward E, Lamarque MD 07-25-2012 Check #110 469.91 469.91 Edward E. Lamarque MD 09-19-2012 Check #117 50.86 50.88 Edward E. Lamarque MD 11-05-2012 Check #121 38.16 38.16 Edward E, Lamarque MD 12-28-2012 Check #125 25.44 25.44 L/584.39 584.39 Golden Living West Shore 04-12-2012 Check #103 747.00 747.00 Golden Living West Shore 05-02-2012 Check #104 2,066.86 2,066.86 Golden Living West Shore 05-24-2012 Check #106 2,066.86 2,066.86 Golden Living West Shore 06-14-2012 Check #108 2,066.86 2,066.86 Golden Living West Shore 07-25-2012 Check #111 1,596.95 1,596.95 Golden Living West Shore 08-13-2012 Check #114 2,066.86 2,066.86 Golden Living West Shore 09-18-2012 Check #116 2,066.86 2,066.86 Golden Living West Shore 10-10-2012 Check #120 2,066.86 2,066.86 Golden Living West Shore 11-20-2012 Check #123 2,066.86 2,066.86 Golden Living West Shore 12-28-2012 Check #126 2,066,86 2,066.86 Golden Living West Shore 01-10-2013 Check #128 2,066.86 2,066.86 ✓ 20,945.69 20,945.69 Halifax Bank 04-10-2012 Auto Deduction Check Charge 14.32 14.32 L/1432 14.32 Keystone Guardianship - Costs 04-12-2012 Check #102 60.65 60.65 Keystone Guardianship - Costs 05-04-2012 Check #105 21.98 21.98 Keystone Guardianship - Costs 06-07-2012 Check #107 29.25 29.25 Keystone Guardianship - Costs 07-09-2012 Check #109 14.27 14.27 Keystone Guardianship - Costs 08-08-2012 Check #113 25.58 25.58 Keystone Guardianship - Costs 09-10-2012 Check #115 13.31 13.31 Keystone Guardianship - Costs 10-08-2012 Check #119 14.61 14.61 Keystone Guardianship - Costs 11-06-2012 Check #122 66.38 66,38 Keystone Guardianship - Costs 12-07-2012 Check #124 12.35 12.35 Keystone Guardianship - Costs 01-04-2013 Check #127 8.46 8.46 Keystone Guardianship - Costs 02-08-2013 Check #129 13.80 13.80 -/ 280.64 280.64 Keystone Guardianship - Fees 04-12-2012 Check #101 500.00 500.00 Keystone Guardianship - Fees 04-12-2012 Check #102 100.00 100.00 Keystone Guardianship - Fees 05-04-2012 Check #105 100.00 100.00 Keystone Guardianship - Fees 06-07-2012 Check #107 100.00 100.00 Keystone Guardianship - Fees 07-09-2012 Check #109 100.00 100.00 Keystone Guardianship - Fees 08-08-2012 Check #113 100M 100.00 Keystone Guardianship - Fees 09-10-2012 Check #115 100.00 100.00 Keystone Guardianship - Fees 10-08-2012 Check #119 100.00 100.00 Keystone Guardianship - Fees 11-06-2012 Check #122 100.00 100.00 Keystone Guardianship - Fees 12-07-2012 Check #124 100.00 100.00 Keystone Guardianship - Fees 01-04-2013 Check #127 100.00 100.00 Keystone Guardianship - Fees 02-08-2013 Check #129 100.00 100.00 1,600.00 1,600.00 Keystone Guardianship - Purchases 05-04-2012 Check #105 5.00 5.00 Keystone Guardianship - Purchases 11-06-2012 Check #122 15.78 1538 20.78 20.78 1 oft 6/20/20 Li 9:15 AM AP Transactions/Raymond Clark- SQL-Ledger Version 2.8.27- Ray.. h ttp://keyguard.anteil.com/ap.pl?action=transactions&direction=ASC... Register of Wills 07-26-2012 Check #112 15.00 15.00 V15.00 15.00 23,460.82 23,460.82 AP Transaction r Vendor Invoice_ 2 oft 6/20/2013 9:15 AM Balance Sheet- SQLLedger Version 2.8.27- Raymond Clark-kg-rclark http://keyguard.anteii.corWrp.pi Raymond Clark BALANCE SHEET as at Feb 16 2013 ASSETS Feb 16 2013 Income- HB Checking #036297210 2,452.83 TOTAL ASSETS 2,452.83 LIABILITIES TOTAL LIABILITIES SHAREHOLDER'S EQUITY Current Earnings 2,452.83 TOTAL EQUITY 2,452.83 TOTAL LIABILITIES & EQUITY 2,452.83 1 of 1 6/20/2013 9:14 AM