HomeMy WebLinkAbout13-6223 Supreme Co ;ennsylvania
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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 ofcourt.
iM Commencement of Action:
-`' " i L�
Complaint ❑ Writ of Summons ❑ Petition
5 t ❑ Transfer from Another Jurisdiction ❑ Declaration of Taking
Lead Plaintiff's Name: Lead Defendant's Name
r Diakon Lutheran Social Ministries Debra Grimm
a T: -
•.' Dollar Amount Requested: ❑ within arbitration limits
I Are money damages requested? b Yes ❑ No (check one) ❑outside arbitration limits
N:r Is this a Class Action Suit? ❑ Yes No Is this an MDJAppeal? ❑ Yes ! No
is
Name ofPlatntiff /Appellant'sAttorney: Brian K. Zellner, Esquire
❑ Check here if you have no attorney (are a Self- Represented [Pro Se] Litigant
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TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS
13 Intentional 11 Buyer Plaintiff Administrative Agencies
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❑ Malicious Prosecution ❑ Debt Collection: Credit Card ❑ Board of Assessment
❑ Motor Vehicle C Debt Collection: Other ❑ Board of Elections
' - ❑ Nuisance Nursing home ❑ Dept. of Transportation
❑ Premises Liability ❑ Statutory Appeal: Other
iS ' ❑ Product Liability (does not include
mass tort) 13 Employment Dispute:
+E' Discrimination
Zc ❑ Slander/Libel/ Defamation ❑ Employment Dispute: Other ❑ Zoning Board
G•'C=, ❑ Other:
T , 13 Other:
❑Other.
` MASS TORT
' ❑ Asbestos
N ❑ Tobacco
❑ Toxic Tort - DES
_ ❑Toxic Tort - Implant REA PROPERTY MISCELLANEOUS
❑ Toxic Waste ❑ Ejectment ❑ Common Law /Statutory Arbitration
z•'`'� ❑Other ❑ Eminent Domain /Condemnation ❑ Declaratory Judgment
(3 Ground Rent ❑ Mandamus
}{ ❑ Landlord/Tenant Dispute ❑ Non - Domestic Relations
❑ Mortgage Foreclosure: Residential Restraining Order
PROFESSIONAL LIABLITY ❑ Mortgage Foreclosure: Commercial ❑ Quo Warranto
❑Dental ❑Partition 13 Replevin
❑ Legal ❑ Quiet Title ❑ Other•
y, ❑ Medical ❑ Other:
❑ Other Professional:
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Updated 111/2011
I
FIL OFF/t'
Brian K. Zellner, Esquire ' t = ROT} ON-1� ! �"
Hynum Law r
Supreme Court ID #59262 2013 OCT 22 PH 1:
2608 North 3 Street C1
Harrisburg, PA 17110 MBE L CO
(717) 774 -1357 PENN$ YLV AN1
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
DIAKON LUTHERAN SOCIAL N O. 13- o a l
MINISTRIES d /b /a
CUMBERLAND CROSSINGS,
Plaintiff,
V.
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney and responsible
party for CHARLES HOWE
and
CHARLES HOWE,
Defendants. : CIVIL ACTION - LAW
NOTICE
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 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 OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA 17013
Phone: (717) 249 -3166 0
L- =C ` a
f
LISTED HA SIDO DEMANIDADO EN CORTE. Si usted desea defenderse de las
demandas que se presentan mas adelante en las siguientes paginas, debe tomar
accion dentro de is proximos viente (20) dias despues de la notification de esta
Demanda y aviso radicando personalmente o por rnedio de un abogado una
comparecencia escrita y radicando en la Corte por escritosus defenses de, y
objecciones a, las demandas presentadas aqui en contra suya. Se le advierte de que si
usted falla de tornar accion como se escribe anteriormente, el caso puede proceder sin
usted y un fallo por qualquier suma de dinero reclamada en la demandaa o cualquier
otra reclamacion o remedio solicitado por el demandanta puede ser dictado en contra
suya por la Corte sin mas aviso adicional. Usted puede perder dinero o propiedad y
otros direchos importantes para usted.
USTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO IMMEDIATAMENTE.
SI USTED NO TIENE UN ABOGADO, LLAME 0 VAYA A LA SIGUIENTE OFICINA.
ESTAOFICINA PUEDE PRO VEERLE INFORMACION A CERCA DE COMO
CONSEGLJTR UNABOGADO.
ST USTED NO PUEDE PAGAR POR LOS SERVICIOS DE UN ABOGADO, ES
POSSIBLE QUE ESTA OFICINA LE PUEDA PRO VEER INFORMACION SOBRE
AGENCIES QUE OFREZCAN SERVTCIOS LEGALES SIN CARGO O BAJO COSTO A
PERSONAS QUECUALIFICAN.
Cumberland County Bar Association
32 South Bedford Street
Carlisle, PA 17013
Phone: (717) 249 -3166
Brian K. Zellner, Esquire
Hynum Law
Supreme Court ID #59262
2608 North 3 I Street
Harrisburg, PA 17110
(717) 774 -1357
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
DIAKON LUTHERAN SOCIAL NO.
MINISTRIES d /b /a
CUMBERLAND CROSSINGS,
Plaintiff,
V.
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney and responsible
party for CHARLES HOWE
and :
CHARLES HOWE,
Defendants. : CIVIL ACTION - LAW
COMPLAINT
1. Plaintiff, Cumberland Crossings, is a Senior Living Community of Diakon Lutheran
Social Ministries located at 1 Longsdorf Way, Carlisle, PA 17015.
2. Defendant, Debra Grimm, is an adult individual who resides at 50 Green Park Road,
Elliottsburg, PA 17024.
3. Defendant, Charles Howe, is an adult individual who resides at 1 Longsdorf Way,
Carlisle, PA 17015.
4. The Defendant, Charles Howe, applied for admission to the Plaintiff and was
admitted on October 25, 2011.
5. The Defendant, Debra Grimm, was the Power of Attorney and Responsible Party
for the Defendant, Charles Howe, at the time of his admission on October 25, 2011.
A true and correct copy of the Power of Attorney is attached hereto as Exhibit "A ".
6. The Defendant, Debra Grimm, on or about October 25, 2011 signed a Nursing
Facility Admission Agreement. A true and correct copy of said Admission Agreement
is attached hereto as Exhibit "B."
7. The Defendant, Charles Howe, has been a resident at the Plaintiff's facility since
October 25, 2011.
8. The Plaintiff is owed $37,323.99 for skilled nursing services. Attached hereto as
Exhibit "C" is true and correct copy of the Account Statement.
COUNT I - BREACH OF CONTRACT
DIAKON LUTHERAN SOCIAL MINISTRIES d /b /a CUMBERLAND CROSSINGS
v. DEBRA GRIMM AND CHARLES HOWE
9. Paragraphs 1 through 8 are incorporated herein by reference as though set forth
at length.
10. On or about October 25, 2011, Plaintiff and Defendants, Charles Howe and
Debra Grimm as Power of Attorney and Responsible Party for the Defendant Charles
Howe, entered into an admission agreement pursuant to which Plaintiff agreed to
admit the Defendant Charles Howe into its facility in consideration for Defendants'
agreement to pay Plaintiff for the skilled nursing care and other services. A true and
correct copy of said Admission Agreement is attached hereto as Exhibit "B."
11. Plaintiff provided skilled nursing care and other services to the Defendant,
Charled Howe, since October 25, 2011. A true and correct copy of the account
statement evidencing charges for the services rendered is attached as Exhibit "C."
12. The Defendant, Debra Grimm as Power of Attorney for the Defendant Charles
Howe, had access to his financial resources.
13. The Defendants are $37,323.99 in arrears on payments to Plaintiff. Despite
repeated demands by Plaintiff for payment, Defendants have failed and refused and
continues to fail and refuse to pay this amount.
14. The failure to remit to Plaintiff the amount owed is a material breach of the
agreement between the parties.
15. The breach, as aforesaid, has caused Plaintiff injury in the amount of $37,323.99.
WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter an
Order as follows:
a. Granting judgment for the Plaintiff and against Defendants in the amount of
$37,323.99;
b. Granting Plaintiff its expenses, including reasonable attorney fees and costs incurred
in connection with this action and pursuant to the Agreement between the parties;
c. Granting Plaintiff interest at the statutory rate from October 25, 2011; and,
d. Granting such other relief as the Court deems equitable and just.
COUNT II — BREACH OF IMPLIED CONTRACT
DIAKON LUTHERAN SOCIAL MINISTRIES d /b /a CUMBERLAND CROSSINGS
v. DEBRA GRIMM AND CHARLES HOWE
In the event it is determined that no written contract between Plaintiff and Defendants as
alleged in Counts I, the Plaintiff alleges as follows:
16. Paragraphs 1 through 15 are incorporated herein by reference as though set forth
at length.
17. On or about October 25, 2011, the Defendants, Debra Grimm and Charles Howe,
agreed to pay Plaintiff for skilled nursing care and other services.
18. On or about October 25, 2011, Plaintiff admitted the Defendant Charles Howe.
19. The facts, as set forth herein, establish an implied in law and implied in fact
contract.
20. Due to the existence of the implied in law and implied in fact contracts, Plaintiff is
entitled to compensation for services rendered to Defendant Charles Howe.
21. Plaintiff has demanded payment under the terms of the implied in fact and implied in
law contracts by sending invoices, but Defendants, Debra Grimm and Charles Howe,
have refused to make payment.
22. Plaintiff has been damaged by the refusal of Defendants to pay for the skilled
nursing care and other services provided, in breach of the implied in law and implied in
fact contract.
WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter an
Order as follows:
a. Granting judgment for the Plaintiff and against Defendants in the amount of
$37,323.99;
b. Granting Plaintiff its expenses, including reasonable attorney fees and costs incurred
in connection with this action;
c. Granting Plaintiff interest at the statutory rate from October 25, 2011, and,
d. Granting such other relief as the Court deems equitable and just.
COUNT III — UNJUST ENRICHMENT - QUANTUM MERUIT
DIAKON LUTHERAN SOCIAL MINISTRIES d /b /a CUMBERLAND CROSSINGS
v. CHARLES HOWE
In the event it is determined that no written contract and no implied -in -fact contract
existed between Plaintiff and Defendants as alleged in Counts I and II, the Plaintiff
alleges as follows:
23. Plaintiff hereby incorporates paragraphs 1 through 22 of this Complaint as if set
forth at length herein.
24. As more fully described herein, Plaintiff's expectation of payment from the
Defendant Charles Howe was reasonable.
25. The Plaintiff has conferred a substantial benefit upon the Defendant Charles Howe.
26. The Defendant Charles Howe retained the benefit of the bargain with Plaintiff.
27. The Defendant Charles Howe has been unjustly enriched at the expense of the
Plaintiff.
28. Due to Defendant's unjust enrichment, the Plaintiff is entitled to proper
compensation.
29. Defendant's unjust enrichment at the Plaintiff's expense has damaged the Plaintiff.
30. The fair market value of said services at the time they were furnished is $37,323.99.
31. The Defendant has refused to pay Plaintiff the fair market value for the services
rendered to him.
WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter an
Order as follows:
a. Granting judgment for the Plaintiff and against Defendant Charles Howe in the
amount of $37,323.99;
b. Granting Plaintiff its expenses, including reasonable attorney fees and costs incurred
in connection with this action;
c. Granting Plaintiff interest at the statutory rate from October 25, 2011; and,
d. Granting such other relief as the Court deems equitable and just.
COUNT IV — FRAUD
DIAKON LUTHERAN SOCIAL MINISTRIES d /b /a CUMBERLAND CROSSINGS
v. DEBRA GRIMM AND CHARLES HOWE
32. Paragraphs 1 through 31 hereof are incorporated herein by reference as
though set forth at length.
33. In order to further induce Plaintiff to skilled nursing care and other services
to Defendant Charles Howe, the Defendants, Debra Grimm and Charles
Howe, represented to Plaintiff that they would pay for services rendered to the
Defendant Charles Howe.
34. Plaintiff believes, and therefore avers, that such representation was
materially false, in that Defendants, Debra Grimm and Charles Howe, have
not paid.
35. Such material misrepresentation was made by Defendants, Debra Grimm
and Charles Howe, with actual knowledge of its falsity, or in reckless disregard
of its truth or falsity, as to the actual intent of Defendants with respect to their
intent to pay for services.
36. In justifiable reliance upon the material misrepresentation of Defendants,
Debra Grimm and Charles Howe, Plaintiff provided the skilled nursing care
and other services to the Defendant Charles Howe.
37. As a result of the misrepresentations of Defendants, Debra Grimm and
Charles Howe, and their failure to pay as originally agreed, Plaintiff has been
damaged in the amount of $37,323.99.
WHEREFORE, Plaintiff respectfully requests this Honorable Court to enter an
Order as follows:
a. Granting judgment for the Plaintiff and against Defendants in the amount of
$37,323.99;
b. Granting Plaintiff its expenses, including reasonable attorney fees and costs incurred
in connection with this action;
c. Granting Plaintiff interest at the statutory rate from October 25, 2011; and,
d. Granting such other relief as the Court deems equitable and just.
Date: ! �� �/ 13 /&---
Brian K. Zellner
Attorney ID 59262
Hynum Law
2608 North 3rd Street
Harrisburg, PA 17110
[717] 774 -1357
Attorney for Plaintiff
VERIFtCATI oN
hereby state that l am the authorized representative of the
Plaintiff -" h this action and that the statements of fact made in the foregoing
Complaint are true and correct to the best of my information and belief. The
undersigned understands that the statements herein are made subject to the
penalties of 18 Pa. Cons. Stat. Ann, § 4904 relating to unsworn falsification to
authorities.
Date: /u / s/13 _.._..�..
Printed Namd.
Title: 7��.Y
i
*****NOTICE*****
THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON
YOU DESIGNATE (YOUR "AGENT ") BROAD POWERS TO HANDLE YOUR PROPERTY,
WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL.
OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL
BY YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT
TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR
AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT IN ACCORDANCE WITH
THIS POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT
YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU
EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE
POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S
AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S
FUNDS.
A COURT MAY TAKE AWAY POWERS OF YOUR AGENT IF IT FINDS YOUR
AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY
ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO
EXPLAIN IT TO YOU.
I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND
ITS CONTENTS.
�J' f
Charles L. Howe, Principal Date
EXHIBIT
a
8
Av
BEING mindful that my affairs be properly managed notwithstanding any future
disability, this Power of Attorney shall not be affected by my disability. In the event of
my disability, my said agent shall have all of the powers as set forth above
IN WITNESS WHEREOF, I, t , ab ve -n med principal have hereunto set my
hand and seal this'_ day of z �. , 2011.
WITNESS:
_(SEAL)
6hhAs L. o e,
Principal
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the `� day of X11 4 , 2011, before me, the
undersigned officer, personally appeared Charles L. Howe, known to. me to be the
person whose name is subscribed to the within instrument and acknowledged that he
signed same for the purposes therein stated.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public
CO MMONWEALTH OF PENNSYLVA
Nbtailal Semi
Patricia b Med; Notary Public
Carlisle Don; Qunberiand County
My Commission Expires Nov. 8, 2013
Member, Penn- tvanla Association of Notaries
AGENT ACKNOWLEDGMENT
I, Debra D. Grimm, have read the attached power of attorney and am the person
identified as the agent for the principal. I hereby acknowledge that in the absence of a
specific provision to the contrary in the Power of Attorney or in 20 Pa.C.S. when I act as
agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements
on behalf of the principal.
IN WITNESS WHEREOF, I t above-named, agent have hereunto set my hand
and seal this Y 6 day of _z , 2011.
WITNESS:
-1-- (SEAL)
�- Debra D. Grimm,
Agent
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the 7 - 6 9 - day of , 2011, before me, the
undersigned officer, personally appeared De ra D. Grimm, known to me to be the
person whose name is subscribed to the within instrument and acknowledged that she
signed same for the purposes therein stated.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
g-
Notary Public
COMMONWEALTH OF PENNSYLVANrA
Nota Seat
Pabicla A. Medc, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Nov. 8, 2013
Member, Permsvivania Association of Notaries
MAN1 ' HANDS..ONF HEART.
D 1AKV N
LUTHERAN sociA LM1VISTRUS
NURSING FACILITY ADMISSION AGREEMENT
This Nursing Facility Admission Agreement ( "Agreement") is made on this 9 day of
, 201. by and between . P_ r.nl�, a„ �p i_ ("Facility"),
a facility of Diakon Lutheran Social Ministries and Ci4 ARt - t • t -
(referred to below as "You ").
A. Facility is a licensed nursing facility located in ���1 Pennsylvania.
B. You are an individual in need of the nursing services that Facility provides and You agree to
be admitted to Facility for the provision of nursing services within the capability of Facility.
fJ I)M A [' &IH M has been appointed by You through a durable Power of
Attorney or Advance Directive to make admission and/or financial decisions on Your behalf
(copy of document attached).
OR
❑ p j has been appointed guardian by a court to make admission
and/or financial decisions on Your behalf (copy of document attached). .
The above =named individual shall be referred to below -as "Your legal representative ".
(If You have designated a "responsible party ", Your responsible party may execute this
Agreement on Your behalf: However, Your responsible party may not make health care and/or
financial decisions for You unless Your responsible party also has legal authority to make such
decisions as an agent under a properly executed power of attorney or as Your court appointed
guardian.]
NOW THEREFORE, in consideration of the terms and covenants contained in this Agreement,
the parties agree as follows:
1. Services Provided.
a. Facility shalt provide. You. with. the appropriate level of nursing. services. and_oth.er
specified items and services within the capacity and capability of the Facility. These
services shall be provided as part of the daily roomy rate ( "Daily Rate ") and include basic
room, meals, general nursing care, activity program, housekeeping services, bedding and
linens, personal hygiene supplies, and routine nursing supplies. Facility may also provide
additional services ( "Additional Services" 1 1 upon Your request or as otherwise required by
Your condition, within the capacity of Facility. You hereby acknowledge that You have
been advised verbally of the Daily Rate and charges for Additional Services and that a
written schedule of the Daily Rate and Additional Services has been provided to You
and/or Your legal representative.
b. Facility reserves the right to change the Daily Rate and the charges for Additional -
Services at any time. Facility shall notify You and /or Your legal representative in writing
PA SNr admission agreement- Rev. 1.07 EXHIBIT
c. not less than thirty (30) days prior to any change in the Daily Rate and/or the charges for
Additional Services.
d.. Physician services: You or Your legal representative shall. designate a physician,. who
must be properly licensed and must abide by applicable laws, regulations, and the
policies of Facility, to be responsible for the medical evaluation of You and to presen`be a
planned regimen of care. Your physician must be credentialed by Facility prior to
providing services to You at Facility. You understand that in the event Your attending
physician is not available or in an emergency, Facility may engage any licensed physician
to attend to You and to render medical treatment.
2. Consent. By entering into, this Agreement, You and/or Your legal representative consent to
the assessment, treatment, and care of You by Facility within the means, capacity and
capability of Facility.
3. 1'aymen i for Services.
a. Daily Rate You and/or Your legal representative shall be responsible to pay the Daily
Rate of the Facility. If You are eligible for coverage under a goverrmiental program or,
by a third party payor or managed care organization, Your Daily Rate may be fully or
partially covered. however, You and/or. Your legal representative shall be responsible
for any deductibles, required co- insurance, patient liability payments, or non - covered
charges.
b. Additional Services You and/or Your legal representative shall also be responsible for
payment of Additional Services provided to You. If You are eligible for coverage under
a governmental program or by a third party payor or managed care organization,
Additional Services may be fully or partially covered. However, You and/or Your legal
representative shall be responsible for any deductibles, required co- insurance, patient
liability payments, or non - covered charges.
c. Payment Dates Each month, You will receive a statement which includes two types of
charges: the monthly fee due for the current month's room and board (at the Daily Rate)
and any charges for Additional Services - from the previous month. The statement will
also reflect all payments deposited in the bank by the last day of the previous month. All
Bills by Facility You are due and payable upon receipt. Payirieag ibiy be rr'iade at
Facility or mailed to Facility's lock-box in Philadelphia using the return envelope
accompanying Your monthly statement.
d. Collections/Late Payments You and /or Your legal representative shall be responsible to
pay all actual attorney's fees and costs i_nourred by Facility relative to the collection of
any amounts ninety (90) days past due.
e. Change in Charges. Facility reserves the right to increase or decrease the Daily Rate and
charges for Additional Services provided to You. Facility shall provide You and/or Your
legal representative with not less than thirty (3 0) days' notice prior to the expected
increase or decrease.
PA SNF admission agreement - Itov.1.07
f. Failure to nay for services or apply for medical assistance In the event You and/or Your
legal representative do not pay for services provided by Facility or in the event You
and/or Your legal representative do not apply for medical assistance when Your resources
are exhausted pursuant to Paragraph 7, You shall be discharged for nonpayment of stay.
4. Legal representative's authority. An individual executing this Agreement as a legal
representative is representing that he /she has legal access to the resident's income and/or
.financial resources and that he/she will pay from the resident's income and/or financial
resources all fees and charges for which the resident is liable. under this Agreement. The. legal
representative assumes no financial responsibility beyond the resources of the resident.
However, in the event that such legal representative misappropriates the resident's income
and/or resources or otherwise illegally transfers assets, the legal representative may be liable
to the Pennsylvania Department of Public Welfare and /or the Facility for the cost of care that
should have been paid for by the resident. In addition, misappropriation of funds , may also
result in the imposition of civil or criminal penalties against the. legal representative.
5. Admission Information.
a. Responsibility to provide accurate and timely information Upon admission, and
throughout Your stay, You and/or Your legal representative will notify Facility and
provide all infonnation needed regarding Your eligibility for coverage by third party
payors, managed care organizations, or governmental programs, including copies of
insurance cards, coverage information, verification of eligibility, etc.
b. Change in eligibility You and /or Your legal representative must notify Facility in
writing within five (5) days of a change in. your coverage status, such as Your
disenrollment, enrollment, failure to pay premiums or cancellation of coverage. If You
and/or Your legal representative fail to provide such information, You and/or Your legal
representative may be responsible for any charges or costs incurred by Facility as a result.
6. Medicare.
a. Facility is a participating provider in the Medicare program. Medicare may pay for
limited skilled nursing days. Upon admission to Facility or during Your stay at Facility,
if Facility expects that Medicare will not pay for the services provided. to You under this
Agreement; Facility shall inform You and /or Your legal representative in writing why the
services may not be covered. I
b. Facility shall concurrently inform You and/or Your legal representative of Your right to
demand that Your bill be submitted to Medicare.
7. Medical Assistance.
n. Facility is a participating provider in the Pennsylvania Medical Assistance Program. You
and/or Your legal representative shall be responsible to apply for Medicaid on a timely
basis if You are eligible. You and/or Your legal representative are responsible for giving
Facility notice at least six (6) months in advance of the date Your resources will be
PA SNF admission agreement - Rev. 1.07
exhausted. If You and /or Your legal representative do not apply for Medicaid on a timely
basis or do not provide information required. by the Pennsylvania Department of Public
Welfare to determine Your eligibility for Medicaid, Facility may transfer or discharge
You for nonpayment of stay.
b. You and/or Your legal representative are responsible for payment of any amounts that the
Pennsylvania Department of Public Welfare or one of its local offices determines is Your
contribution, or patient liability. If You and/or Your legal representative do not pay such
amounts due, Facility may transfer or discharge You for nonpayment of stay.
c. Facility may charge for items and services not paid. by Medicaid if charges are disclosed
and agreed to by the parties in advance.
d. Consistent with the reimbursement regulations of the Commonwealth ofPennsylvania,
residents who are or who become beneficiaries of Medicaid will be accommodated in
semi- private rooms.
S. Transfers and Discharges.
a. Reasons for Transfer or Discharge Facility has the right to transfer or discharge You. for
medical reasons, for Your welfare or that of other residents, or for nonpayment of stay if
Facility has made reasonable efforts to collect Your outstanding amounts due.
b. Notice of Transfer or Discharge Except in emergency cases, Facility shall provide You
and Your legal representative with not less than thirty QO) days' written notice prior to
Your transfer or discharge, unless appropriate plans acceptable to You and/or Your legal
representative are implemented sooner.
c. Discharge Plan Facility shall provide a coordinated interdisciplinary discharge plats for
You to ensure that You have a program of continuing care after discharge from Facility
in accordance with Your needs.
d. Transfers between Facilities If Facility terininates this Agreement or otherwise
discharges or transfers You to another health care facility, Facility shall assure that
appropriate arrangements are made for Your safe and orderly transfer and that You are
transferred. to an appropriate. place capable of meeting Your ne -eds, Facility shall ptovidc
clinical records describing Your needs, including a list of orders and medications directed
by the attending physician, to the facility to which You are transferred. You may be
charged for the costs of copying Your clinical records.
e. Bed Hold Policy Prior to Your transfer for hospitalization or therapeutic leave, Facility
shall provide You with written notice of Your right to resume residence at Facility and
Facility's bed hold policy in accordance with state law.
f. Appeal and Fair Hearing for Medicare and Medicaid Beneficiaries You and/or. Your
legal representative shall have the right to an appeal and a fair hearing with respect to
Facility's decision to transfer or discharge You.
PA SPIIF admission agreement -Rev. 1.47
9. Termination by Facility.
a. Failure to Pay Facility may discharge You and terminate this Agreement upon Your
failure to pay for the services provided by Facility pursuant to the terms and conditions of
this Agreement, including for Your failure to apply for Medicaid when eligible. Facility
shall provide You and /or Your legal representative with not less than thirty (30) days'
notice of tcrinination of this Agreement and Your discharge or transfer.
b. Closure or Destruction of Facility Facility reserves the right to terminate this Agreement
upon closure or destruction of Facility. In the event that Facility intends to close, Facility
shall provide You and Your legal representative with thirty (30) days' written notice of
intent to close. You and/or Your legal representative shall be responsible to pay all fees
incurred prior to the date of termination.
10. Termination by You (Applicable only to private pay residents.) You and/or Your legal
representative may terminate this Agreement for any reason upon seven (7) days' written
notice to Facility. Except in the case of an emergency transfer or death, if You acid /or Your
legal representative do not give the required seven (7) days' written notice, You and /or Your
legal representative will be responsible for payment of the Daily Rate for each day of the
required notice, regardless of whether You still resided at Facility.
11. Effect of Termination Upon termination of this Agreement neither party shall have any
further obligations except obligations incurred prior to the date of termination and as
otherwise set forth in this Agreement.
12. Refunds In the event of Your death, Facility shall refilnd the following amount to Your
personal representative or guardian within sixty (60) days of the date Your room is cleared of
Your personal property:
a. the amount of the difference between any payment made by You for monthly charges for
"elder care services" (as defined below) and the cost of the "elder care services" actually
provided to You.
i. elder care services are services or treatment provided to meet a resident's need for
personal care or health care, including, but not limited to, assistance with
activities of daily living' physical; occupational or speech therapy, and: medical -
social services. Room and board is not included in elder care services.
13. Tnventory and storage of Your personal Property after death. Facility shall contact Your
representative or guardian Mthin twenty -four (24).hours of Your death to arrange for an
inventory of Your personal property.
a. If Your representative or guardian is unable to claim Your personal property within three
(3) business days after Your death, Facility may place Your personal property in storage
for up to thirty (30) days.
PA OT admission agreement - Rev. 1.07
r.
b. If Your property is unclaimed after the storage period of thirty (30) days, Facility shall
send notice by certified mail stating that Your personal property will be disposed of at the
end of an additional fourteen (14) day period.
e. If Your personal property is unclaimed following the additional fourteen (1 4) day period,
Facility shalt dispose of the property.
14. Advance Directives Facility has provided information to You about the Facility's policies
concerning implementation of Advance Directives, and a written description of Pennsylvania
law concerning Advance Directives. Facility shall comply with Your rights under state law
to make decisions concerning medical care, including the right to accept or refuse medical or
surgical treatment and the right to formulate advance directives and shall document in Your
clinical record whether or not You have executed an advance directive. Facility does not .
condition the provision of medical care to You based on whether or not You have executed
an advance directive.
15. Resident Funds
a. Written Authorization Facility shall not require You to deposit personal funds with
Facility. If You elect to deposit personal funds, upon Your and/or Your legal
representative's written authorization, Facility shall hold, manage, safeguard. and account
for such personal funds at no additional charge to You.
b. Deposit If You are a Medicare or Medicaid beneficiary, Facility shall deposit any
amount -of Your personal funds in excess of Fifty Dollars ($50) into an account that is
separate from any of Facility's operating accounts and shall credit all interest earned on
such separate account to such account. For amounts less than the amounts set forth
above, Facility shall maintain such personal funds in a non - interest bearing account or
petty cash fund.
c. .Accounting and Records Facility shall provide a complete and separate accounting of
each Facility resident's personal funds, maintain a written record of all financial
transactions involving Your personal funds deposited at Facility and afford You and/or
Your legal representative reasonable access to such record.
d. Disbur selnent Upon Death In the event of Your death Facility shall convey Your
persoral funds and aacb thig of*strcb funds to the individual administering Your estate,
within thirty (30) days of Your death.
16. Your Rights Facility has provided You and /or Your legal representative with a copy of
Facility's Resident Rights outlining Your legal rights during Your stay at Facility, and You
and/or Your legal representative acknowledge receiving information about Resident Rights.
17. Your Personal Property You shall be permitted to keep and use personal clothing and -
possessions as space in Facility permits unless to do so would infringe upon the rights of
other residents and unless medically contraindicated, as reasonably determined by Facility.
Facility shall make reasonable provisions for the handling and storage of Your personal
FA SNF admission areement- Rev. 1.07
clothing and possessions and provide You access to such clothing and possessions: You are
advised not to have valuables such as large amounts of money, jewelry, etc. in the Facility.
Facility will investigate all allegations of lost or misappropriated resident property at Facility,
but will be responsible for such lost or misappropriated property only in limited
circumstances.
18. Visitors You shall be permitted to have visitors at Facility in accordance with all applicable
policies and procedures of Facility. Facility reserves the right to limit visitors or access to
You if Facility has determined that such access may be detrimental to Your care and well-
being or in the event visitors. are disruptive to other residents or the operations of Facility.
Notwithstanding the foregoing, ]Facility shall not restrict access to Your legal counsel or
representatives of Pennsylvania's Department of Aging.
19. Indemnification You will defend, indemnify and hold Facility harmless from any and all
claims, liabilities, damages, costs or expenses (including reasonable attorneys' fees) arising
from or resulting in any manner from any of Your acts or omissions which damage or injure
any person or the property of any person or of Facility. This provision does not release the
Facility from any liabilities or duties otherwise imposed by law.
20. Miscellaneous.
a. Compliance with Laws Facility shall comply with all applicable federal and state laws,
as may be in effect from time to time.
b. Governing Law This Agreement shall be governed by and construed in accordance with
the laws of the Commonwealth of Pennsylvania, notwithstanding any conflict of laws
provisions to the contrary.
c. Seyerability If any term or provision this Agreement or the application thereof to any
person or circumstance shall to any extent be invalid or unenforceable, the remainder of
this. Agreement or the application of such term or provision to persons or circumstances
other than those to which it is held invalid or unenforceable shall not be affected, and
each term and provision of the Agreement shall be valid and enforceable to the fullest
extent permitted by law:
d. Assignment You may 'not assign this kgreement'.
e. Waiver The waiver by Facility of a breach of any provision of this Agreement by You
shall not operate or be construed as a waiver of any subsequent breach by You.
f. Notices Any notice required or permitted to be given under this Agreement shall be
deemed properly given if in writing and if mailed by regular mail in the case of Your
legal representative, delivered to Your room in the case of notices to You, or to the
principal office of Facility in the case of notice to Facility. The effective date of any such
notice shall be the date of inailing or the date of personal delivery, whichever is
applicable. The address to which notice shall be sent may be changed by a written notice
given pursuant to this Paragraph.
PA SNF admission agreement - Rev. 1.07
' s
g. Non - Discrimination Facility shall not discriminate against You on the basis of Your sex,
age, race, color, creed, national origin,, sexual orientation, handicap or any other class
protected by law.
h. Entire Asreement This Agreement contains the entire Agreement of the parties relating
to the subject matter hereof This Agreement supersedes and replaces in its entirety any
existing agreement behveen You, Your legal representative and Facility regarding Your
admission to Facility, and may not be waived, changed, modified, extended "or discharged
except by a writing executed by the Facility and by the party against whom enforcement
of any such waiver, change, modification, extension or discharge is sought-
i. Change in Law Facility reserves the right to amend this Agreement upon thirty (30)
days' written notice to You and /or Your legal representative if any change in federal, state
and local laws, regulations, policy and/or interpretation ofthe same, shall impair the
continuing validity and/or effectiveness of any material provisions of this Agreement.
j. Headinas The headings of the Paragraphs hereof are for convenience only and shall not
control or affect the meaning or construction or limit the scope or intent of any of the
provisions of this Agreement.
k. Acknowledgment of Receipt of Resident Handbook and Notice of Privacy Practices
You acknowledge receipt of Facility's Resident Handbook and HIPAA Notice of Privacy
Practices.
BY SIGNING BELOW, YOU ACKNOWLEDGE THAT YOU HAVE READ THE
FOREGOING AGREEMENT AND THAT YOU HAVE HAD AN OPPORTUNITY TO
ASK QUESTION'S ABOUT TIDE AGREEMENT.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first above
written.
FACILITY RESIDENT OR RESIDENT'S LEGAL
REP 'ENTATIVE OR RESIDENT'S
PO SME P f RTY 1
By. Bj7 c Fes' y
Name(t)rintcd) Name(printed)
PA SAT admission a_eleement- Rev. 1.07
Page: 1 of 1
T A STATEMENT
x- A D 1 A �� IN Invoice # Account # Date
LUTHERAN SOCIAL MINISTRIES 263202 1899CCNC 10/16/2013
Cumberland Crossings Retirement Community
1 Longsdorf Way
Carlisle, PA 17015 -7623 Due Date Amount Due Amount Paid
Facility # (717) 245 -9941 10/23/2013 $37,323.99
Business Office # (717) 240 -6040
Resident Name
Debra Grimm
50 Green Park Road Howe, Charles L
Elliottsburg, PA 17024
Please make check payable to Diakon Lutheran Social Ministries
Charles L Howe Cumberland Crossings Retirement Community 10/16/2013
Debra Grimm
Date Description Units Net Balance
—L MM - 4 — Throuah I Char es Credits
06/30/2012 Balance Forward $0.00
09/01/2012 09/30/2012 Resident Liability (Sep) .00 2,857.2
10/01/2012 10/31/2012 Resident Liability (Oct) .00 2,857.2
11/01/2012 11/30/2012 Resident Liability (Nov) .00 2,857.2
12/01/2012 12/31/2012 Resident Liability (Dec) .00 2,857.2
01/01/2013 01131/2013 Resident Liability (Jan) .00 2,877.2
02/01/2013 02/28/2013 Resident Liability (Feb) .00 2,877.2
03/01/2013 03/31/2013 Resident Liability (Mar) .00 2,877.2
04/01/2013 04/30/2013 Resident Liability (Apr) .00 2,877.2
05/01/2013 05/31/2013 Resident Liability (May) .00 2,877.2
06/01/2013 06/30/2013 Resident Liability (Jun) .00 2,877.2
07/01/2013 07/31/2013 Resident Liability (Jul) .00 2,877.2
08/01/2013 08/31/2013 Resident Liability (Aug) .00 2,877.2
09/01/2013 09/30/2013 Resident Liability (Sep) .00 2,877.2
TOTAL BALANCE DUE $37 ,323.99
EXHIBIT
SHERIFF'S OFFICE OF CUMBERLAND COUNTY
Ronny R Anderson
Sheriff
Jody S Smith
Chief Deputy jn ' I(' j, P, ,
Richard W Stewart
Solicitor 3 MCG or �"S�4R)a C`
�''E"ISY v'fa lf`,
Diakon Lutheran Social Ministries d/b/a Cumberland Crossings Case Number
vs.
Debra Grimm (et al.) 2013-6223
SHERIFF'S RETURN OF SERVICE
10/23/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry
for the within named Defendant to wit: Debra Grimm, but was unable to locate the Defendant in the
Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Perry, Pennsylvania to serve the within
Complaint& Notice according to law.
10/24/2013 The requested Complaint& Notice served by the Sheriff of Perry County upon Debra Grimm, personally,
at 50 Green Park Road, Elliotsburg, PA 17024. Carl Nace, Sheriff, Return of Service attached to and
made part of the within record.
10/24/2013 08:18 PM - Deputy Ronald Hoover, 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: Charles Howe at 1 Londsdorf Way, South Middleton, Carlisle, PA 17015.
RONALD HOOVER, DEPUTY
SHERIFF COST: $53.46 SO ANSWERS,
October 28, 2013 RONW R ANDERSON, SHERIFF
;!CcumySLj to Short.7e1eosoft nc
Diakon L utheran Social IN THE COURT OF COMMON PLEAS OF
THE 41st JUDICIAL DISTRICT OF PENNSYLVANIA,
Ministries PERRY COUNTY BRANCH
Versus
Debra Grimm
No. 2013-6223 Cumberland Co.
SHERIFF'S RETURN
And now October 24 , 2013 : Served the within name Debra Grimm
the defendant(s) named herin, personally at her place of residence in Tyrone Twp-50 Green
Park Road,
Elliottsburg,
Perry County, PA, on October 24, 2013 at 3:08 o'clock PM
by handing to Debra Grimm, defendant 1 true and attested
copy(ies) of the within Complaint
and made known to her the contents thereof
Sworn and subscribed to before me this
day of oc I D .20 3 So answers
Y
r
f
Prothonotary Deputy Sheriff of Perry County
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
MARGARET F.FLICKINGER,Notwy PuNle
Bloomfield Soro,Perry County
My Commission Expires February 16,2016
HYNUM LAW @rr THE PROTROROTAR+"
Brian K. Zellner, Esquire
Attorney ID#59262 M DEC —6 PM !: l 6
2608 North 3r6 Street
Harrisburg, PA 17110 C"'ERLAND COUNTY
717-774-1357 PENNSYLVANIA Attorneys for Plaintiff
DIAKON LUTHERAN SOCIAL IN THE COURT OF COMMON PLEAS
MINISTRIES d/b/a CUMBERLAND CO., PENNSYLVANIA
CUMBERLAND CROSSINGS,
Plaintiff NO. 2013-6223
V. CIVIL ACTION— LAW
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney, and responsible
party for CHARLES HOWE, and
CHARLES HOWE,
Defendants
PRAECIPE TO ENTER DEFAULT JUDGMENT
TO THE PROTHONOTARY:
Kindly enter judgment in favor of Plaintiff and against Defendants, Debra
Grimm, Charles Howe, and Charles Howe, in the amount of $37,323.99, plus costs.
A Ten-Day Notice of Taking Default Judgment was served on the Defendants on or
about November 26, 2013. Copies of the transmittal letters and Notices are
attached hereto as Exhibit A.
1C.,
Brian K. Zellner, Esquire
Attorney for Plaintiff
Date: December 5, 2013
�ia��
0
HYNUM LAW, POC *
2608 NORTH THIRD STREET
HARRISBURG, PA 17110
PHONE [717] 774-1357
FAX [717] 774-0788
November 26, 2013
Debra Grimm
50 Green Park Road
Elliotsburg, PA 17024
RE: Diakon Lutheran Social Ministries d/b/a Cumberland Crossings v.
Debra Grimm and Charles Howe
Dear Ms. Grimm:
Enclosed is a Ten-Day Notice of Intent to Take Default Judgment. Please be
advised accordingly.
Respectfully submitted,
AngelnA. Ke ly, Paralegal
A k
Enclosures
EXHIBIT
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
DIAKON LUTHERAN SOCIAL NO. 2013-6223
MINISTRIES d/b/a
CUMBERLAND CROSSINGS,
Plaintiff
V.
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney and responsible
party for CHARLES HOWE
and
CHARLES HOWE,
Defendant : CIVIL ACTION - LAW
TO: Debra Grimm Charles Howe
50 Green Park Road Cumberland Crossings
Elliotsburg, PA 17024 1 Londsdorf Way
Carlisle, PA 17015
Date of Notice: November 22, 2013
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST
YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A
JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU
MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS.
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.
THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE
TO PROVIDE YOU WITH INFORMATION 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
l
Brian K. Zellner,Esquire
HYNUM LAW
Supreme Court ID #59262
2608 N. Third Street
Harrisburg, PA 17110
(717) 774-1357
Attorney for the Plaintiff
HYNUM LAW, P . C .
2608 NORTH THIRD STREET
HARRISBURG, PA 17110
PHONE [717] 774-1357
FAX [717] 774-0788
November 26, 2013
Charles Howe
Cumberland Crossings
1 Lonsdorf Way
Carlisle,'PA 17015
RE: Diakon Lutheran Social Ministries d/b/a Cumberland Crossings v.
Debra Grimm and Charles Howe
Dear Mr. Howe:
Enclosed is a Ten-Day Notice of Intent to Take Default Judgment. Please be
advised accordingly.
Respectfully submitted,
Angela A. Ke ly, Paralega
ak .
Enclosures
IN THE COURT OF COMMON PLEAS
t
CUMBERLAND COUNTY, PENNSYLVANIA
DIAKON LUTHERAN SOCIAL NO. 2013-6223
MINISTRIES d/b/a
CUMBERLAND CROSSINGS,
Plaintiff
V.
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney and responsible
party for CHARLES HOWE
and
CHARLES HOWE,
Defendant : CIVIL ACTION - LAW
TO: Debra Grimm Charles Howe
50 Green Park Road Cumberland Crossings
Elliotsburg, PA 17024 1 Londsdorf Way
Carlisle, PA 17015
Date of Notice: November 22, 2013
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN
APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE
COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST
YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A
JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU
MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS.
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.
THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER,THIS OFFICE MAY BE ABLE
TO PROVIDE YOU WITH INFORMATION 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
Brian K. Zellner, Esquire
HYNUM LAW
Supreme Court ID#59262
2608 N. Third Street
Harrisburg, PA 17110
(717) 774-1357
Attorney for the Plaintiff
CERTIFICATE OF SERVICE
On this 5th day of December, 2013, I certify that a copy of the foregoing
document was served upon the following Defendant by placing the same in the
United States mail, first class, addressed as follows:
Debra Grimm Charles Howe
50 Green Park Road Cumberland Crossings
Elliotsburg, PA 17024 1 Lornsdorf Way
Carlisle, PA 17015
L
Brian K. Zellner, Esquire
Hynum Law
2608 North 3rd Street
Harrisburg, PA 17110
DIAKON LUTHERAN SOCIAL IN THE COURT OF COMMON PLEAS
MINISTRIES d/b/a CUMBERLAND CO., PENNSYLVANIA
CUMBERLAND CROSSINGS,
Plaintiff NO. 2013-6223
V. CIVIL ACTION— LAW
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney, and
responsible party for CHARLES
HOWE, and CHARLES HOWE,
Defendants
RULE 236 NOTICE
TO: Charles Howe
Notice is given that Judgment in the amount of $37,323 9I9A, lus costs, in the
above captioned matter has been entered against you on I �` �'3
silk
wy
Prothonotary
By:
Clerk or Deputy
If you have any questions concerning the above case, please contact:
Brian K. Zellner, Esquire
Attorney or Filing Party
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774-1357
DIAKON LUTHERAN SOCIAL IN THE COURT OF COMMON PLEAS
MINISTRIES d/b/a CUMBERLAND CO., PENNSYLVANIA
CUMBERLAND CROSSINGS,
Plaintiff NO. 2013-6223
V. CIVIL ACTION—LAW
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney, and
responsible party for CHARLES
HOWE, and CHARLES HOWE,
Defendants
RULE 236 NOTICE
TO: Debra Grimm
Notice is given that Judgment in the amount of $37,323.99 us yosts, in the
above captioned matter has been entered against you on
Prothonotary
By:
Clerk or Deputy
If you have any questions concerning the above case, please contact:
Brian K. Zellner, Esquire
Attorney or Filing Party
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774-1357
DIAKON LUTHERAN SOCIAL
MINISTRIES d /b /a
CUMBERLAND CROSSINGS,
Plaintiff
v.
DEBRA GRIMM, as legal
Representative, attorney in fact,
power of attorney, and responsible
Party for CHARLES HOWE, and
CHARLES HOWE,
Defendants
: IN THE COURT OF COMMON PLEAS c''''''..-.;`,-
: CUMBERLAND COUNTY ,.. ,
: PENNSYLVANIA tr ',.,a
•4 1 ''?2
�.Zp d',:. ,ter.
: NO.2013 -6223
: CIVIL ACTION - LAW
PLAINTIFF'S MOTION TO COMPEL DEFENDANTS TO ANSWER THE
INTERROGATORIES IN AID OF EXECUTION
AND NOW comes, Plaintiff, Diakon Lutheran Social Ministries d/b /a Cumberland
Crossings, by and through its Counsel, Brian K. Zellner, Esquire of Hynum Law and
avers the following:
1. On or about December 5, 2013, Plaintiff entered judgment against Defendants
Debra Grimm and Charles Howe.
2. On or about January 3, 2014, Plaintiff addressed Interrogatories to the
Defendants.
3. Plaintiff's Counsel had requested that the Defendants provide answers to its
Interrogatories within thirty (30) days of its letter dated January 3, 2014.
4. Plaintiff did not receive answers to its Interrogatories within thirty (30) days.
5. To date, the Defendant has not answered the Interrogatories.
6. Plaintiff respectfully requests Your Honorable Court to compel the Defendants to
Answer the Interrogatories.
WHEREFORE, Plaintiff respectfully requests this Court to grant Plaintiffs Motion to
Compel Defendants to Answer the Interrogatories.
Date: 3J�7Jl�'
61/&
Brian K. Zellner, Esquire
Attorney for Plaintiff
Hynum Law
Attorney Id. 59262
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774 -1357
DIAKON LUTHERAN SOCIAL : IN THE COURT OF COMMON PLEAS
MINISTRIES d/b/a CUMBERLAND : CUMBERLAND COUNTY,
CROSSINGS, : PENNSYLVANIA
Plaintiff
v.
: NO. 2013-6223
: CIVIL ACTION - LAW
DEBRA GRIMM, as legal representative, :
Attorney in fact, power of attorney, and :
Responsible party for CHARLES HOWE, :
and CHARLES HOWE,
Defendants
CERTIFICATE OF SERVICE
On this day of March,2t2014, I certify that a copy of the MOTION TO COMPEL
DEFENDANTS TO ANSWER INTERROGATORIES IN AID OF EXECUTION was served
upon the following Defendant by placing the same in the United States mail, first class, postage
paid, addressed as follows:
Debra Grimm
50 Green Park Road
Elliotsburg, PA 17024
Charles Howe
Cumberland Crossings
1 Longsdorf Way
Carlisle, PA 17015
rian Zellner, Esquire
Hynum Law
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774-1357
DIAKON LUTHERAN SOCIAL
MINISTRIES d/b/a CUMBERLAND
CROSSINGS,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY,
: PENNSYLVANIA
: NO. 2013-6223
DEBRA GRIMM, as legal representative, :
attorney in fact, power of attorney, and :
responsible party for CHARLES HOWE, :
and CHARLES HOWE,
Defendants
CIVIL ACTION - LAW
ORDER
AND NOW, this 3 day of A tr , 2014, upon consideration of the
Plaintiff s Motion to Compel Defendants to Answer the Interrogatories in Aid of Execution, it is
hereby ordered that said Motion is GRANTED.
Defendants have 30 days from service of this Order to Answer Plaintiff's
Interrogatories, or suffer sanctions pursuant to Pa.R.C.P. 4019.
BY THE COURT:
Dstribution:
,../Brian K. Zellner, Esquire
Grimm, Pro Se
..-Charles Howe, Pro Se
2-
r
1
Brian K. Zellner, Esquire
Hynum Law
Supreme Court ID #59262
2608 N. Third Street
Harrisburg, PA 17110
(717) 774-1357
DIAKON LUTHERAN SOCIAL
MINISTRIES d/b/a CUMBERLAND
Plaintiff,
v.
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney, and responsible
party for CHARLES HOWE,
and CHARLES HOWE,
' ,l'f=;0T CNO%i,
11114 JUL 24 PH 2: 4
CUMBER!n
PL NNrt ygc,GIUrq FY
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PA
: NO. 2013-6223
Defendant, : CIVIL ACTION - LAW
PLAINTIFF'S PETITION FOR CONTEMPT
AND NOW comes, Plaintiff, Diakon Lutheran Social Ministries d/b/a Cumberland
Crossings, by and through its Counsel, Brian K. Zellner, Esquire of Hynum Law and
avers the following:
1. On or about December 6, 2013, Plaintiff entered judgment against the
Defendant.
2. On or about March 28, 2014, Plaintiff addressed Interrogatories In Aid of
Execution to the Defendant.
3. To date, Plaintiff has not received Answers from the Defendant to the
Interrogatories sent on or about March 28, 2013.
4. An Order of Court was entered on April 3, 2014 which granted Plaintiff's
Motion to Compel and gave the Defendant 30 days to Answer Plaintiff's
I nterrogatories.
5. To date, Plaintiff's Counsel has not received Answers from the Defendant.
6. The Defendant has willfully failed to abide by the April 3, 2014 Order of
Court because the Plaintiff has not received Answers to the Interrogatories.
WHEREFORE, Plaintiff respectfully requests this Court find the Defendant in
Contempt.
Date: 7J23/11
Re pr II Submitted:
rian K. Zellner, Esquire
Hynum Law
Attorney ID. No. 59262
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774-1357
Attorney for the Plaintiff
CERTIFICATE OF SERVICE
I, Brian K. Zellner, Esquire, do hereby certify that on this, the day of July,
2014, I served a true and correct copy of the foregoing Petition for Contempt and
proposed Order of Court upon the following individual by way of First Class Mail,
Postage Prepaid:
Dated: ? 2,3 I
Debra Grimm
50 Green Park Rd.
Elliotsburg, PA 17024
Charles Howe
Cumberland Crossings
1 Lonsdorf Way
Carlisle, PA 17015
Brian K. Zellner, Esquire
Hynum Law
Attorney ID. No. 59262
2608 North 3rd Street
Harrisburg, PA 17110
(717) 774-1357
Attorney for the Plaintiff
DIAKON LUTHERAN SOCIAL
MINISTRIES d/b/a CUMBERLAND
CROSSINGS,
Plaintiff,
v.
DEBRA GRIMM, as legal
representative, attorney in fact,
power of attorney, and responsible
party for CHARLES HOWE,
and CHARLES HOWE,
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PA
: NO.2013-6223
Defendant, : CIVIL ACTION - LAW
AND NOW, this /344- day of
Plaintiff's Petition for Contem t against the D
Hearing is scheduled forail
" day of
ORDER
2014, upon consideration of the
ndant, it is hereby ordered that a
, 2014 ato223O /p.m.
in Courtroom .z75—at the Cumberland County Courthouse, Carlisle Pennsylvania.
BY THE COURT:
Distribution:
rian K. Zellner, Esquire, 2608 North 3rd Street, Harrisburg, PA 17110
,/Debra Grimm, Pro Se, 50 Green Park Rd. Elliotsburg, PA 17024
tXharles Howe, Pro Se, Cumberland Crossings, 1 Lonsdord Way, Carlisle, PA 17015
C'
W
rrn
;If
441
Brian K. Zellner, Esquire
Hynum Law
Atty. ID #59262
2608 N. Third Street
Harrisburg, PA 17110
(717) 774-1357
Ir eJi f fricF:
T HoNd _ '
29` 4 SEP _
Dry/{L Fr
IN THE COURT OF COMMON PLEAS s � �i�//l }�
CUMBERLAND COUNTY, PENNSYLVANIA
DIAKON LUTHERAN SOCIAL MINISTRIES : NO. 2013-6223
d/b/a CUMBERLAND CROSSINGS,
Plaintiff,
v.
DEBRA GRIMM, as legal representative,
Attorney in fact, power of attorney, and
Responsible party for CHARLES HOWE,
and CHARLES HOWE,
Defendant,
: CIVIL ACTION — LAW
PRAECIPE TO WITHDRAW CONTEMPT PETITION
TO THE PROTHONOTARY:
Please withdraw the Contempt Petition in regard to the above -matter.
Date: 7/511/
rian K. Zellner, Esquire
Attorney ID 59262
Hynum Law
2608 N. Third Street
Harrisburg, PA 17110
[717] 774-1357
Attorney for Plaintiff
CERTIFICATE OF SERVICE
On this Y day of SEPTEMBER, 2014, I certify that a copy of the
PRAECIPE TO WITHDRAW CONTEMPT PETITION was served upon Counsel
for the Defendant by placing the same in the United States mail, first class,
postage paid, addressed as follows:
Debra Grimm
50 Green Park Rd.
Elliotsburg, PA 17024
Charles Howe
Cumberland Crossings
1 Longsdorf Way
Carlisle, PA 17015
Brian K. Zellner, Esquire