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HomeMy WebLinkAbout13-6735 Supreme Col e l?ennsylvania Cour fComino Pleas For Prothonotary Use Only: Ctvilo' 1eSheet r `� 1 ` Docket No: Cu er� County ` f County 3 -- (� ( X11 ti f� The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as required by law or rules of court. T Commencement of Action: ® Complaint ® Writ of Summons J Petition S ® Transfer from Another Jurisdiction © Declaration of Taking e E' Lead Plaintiff's Name: Lead Defendant's Name: C' HCR ManorCare, Inc. Jerome Phoenix T a Dollar Amount Requested: Owithin arbitration limits C ;Y Are money damages requested? 0 Yes 0 No (check one) ©outside arbitration limits s this a Class Action Suit? © Yes G No Is this an MDJAppeal? ® Yes x N6 A,: Name of Plaintiff /Appellant's Attorney: David A. Baric, Esquire ' ® Check here if you have no attorney (are a Self- Represented [Pro Sel :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. I :I TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS T3 'Intentional 13 Buyer Plaintiff Administrative Agencies ® Malicious Prosecution [3 Debt Collection: Credit Card ® Board of Assessment — -- rl Motor Vehicle n Debt Collection: Other ® Board of Elections I Nuisance money owed for © Dept. of Transportation .0 Premises Liability skilled nursing care © Statutory Appeal: Other - , `,© Product Liability (does not include ®Employment Dispute: mass tort) � • . •' � -� { k F.: Discrimination .® Slander/Libel/ Defamation C );rl Other:' Q Employment Dispute: Other E3 Zoning Board f. T. E3 Other: Zti Q Other: MASS TORT Asbestos N, © Tobacco © Toxic Tort -DES © Toxic Tort - Implant � REAL PROPERTY MISCELLANEOUS © Toxic Waste t Other: ® Ejectment © Common Law /Statutory Arbitration © Eminent Domain /Condemnation © Declaratory Judgment B'7 Q Ground Rent © Mandamus ® Landlord/Tenant Dispute © Non - Domestic Relations .. Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABLITY ® Mortgage Foreclosure: Commercial © Quo Warranto ® Dental © Partition 0 Replevin .[3 Legal El Quiet Title 13 Other: :d Medical Other: C Other Professional: Updated 1/1/2011 HCR MANORCARE, INC., IN THE COURT OF COMMON PLEAS OF Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA V. N O. JEROME J. PHOENIX, CIVIL ACTION -LAW Respondent PETITION TO APPOINT ARBITRATOR NOW, comes HCR ManorCare, Inc., Petitioner, by and through its attorneys, BARIC SCHERER LLC, and files the within Petition to Appoint Arbitrator and, in support thereofo tsr ` forth the following: 1. The Petitioner is a HCR ManorCare, Inc., a Ohio corporation which owns ° operates a skilled care facility at 1700 Market Street, Camp Hill, Cumberland County, c , ) : 5r7 Pennsylvania 17011 ( the "Center "). 2. Respondent, Jerome J. Phoenix, is an adult individual with a residence address of 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011. Jerome J. Phoenix became a resident of the Center on June 12, 2012 and remains a resident to the date hereof. 3. Petitioner files this petition pursuant to 42 Pa.C.S.A. §7305 and 42 Pa.C.S.A. §7342(a). 4. On or about June 12, 2012, Petitioner and Respondent entered into an Admission Agreement for Respondent, Jerome J. Phoenix to enter the Center for nursing care, a true and correct copy of which is attached hereto as Exhibit "A" and is incorporated by reference. 5. On or about June 12, 2012, Petitioner and Respondent entered into a certain Voluntary Arbitration Agreement, a true and correct copy of which is attached hereto as Exhibit "B" and is incorporated by reference. � ,� 9Xlb 6. Under the terms of the Voluntary Arbitration Agreement, all disputes between the parties were to be resolved by arbitration. 7. During the course of Respondent, Jerome J. Phoenix's stay at the Center, the Petitioner provided skilled nursing care to Respondent, Jerome J. Phoenix. 8. Respondent has failed to pay for the costs of care he received after demand for payment has been made by Petitioner. 9. In an effort to resolve the dispute Petitioner demanded arbitration pursuant to the terms of the Voluntary Arbitration Agreement, which requires three arbitrators to conduct the :arbitration, one selected by each of the parties and the two selected arbitrators to select the third. 10. Petitioner appointed Bradley L. Griffie, Esquire as its arbitrator and requested that Respondent appoint an arbitrator so that the two arbitrators could jointly select the third as set forth in the Voluntary Arbitration Agreement. 11. To date Respondent has failed to appoint an arbitrator. 12. Unless an arbitrator is appointed for the Respondent, the third arbitrator may not be appointed, and Petitioner will be deprived of its right to have the dispute between the parties 'resolved through arbitration. 13. In light of Respondent's failure to select an arbitrator, Petitioner requests that this. Court appoint an arbitrator on behalf of the Respondent according to the terms of the Voluntary Arbitration Agreement. 14. The Voluntary Arbitration Agreement requires each arbitrator to be a retired State' or Federal Judge or a Member of the State Bar where the Facility is located with at least 10 years of experience as an attorney. WHEREFORE, Petitioner requests that this Court designate an arbitrator selected by the' Respondent and that the arbitrator designated by the Court be empowered to serve with the same force and effect as if he had been specifically named by the Respondent. Respectfully submitted, BARIC SCHERER LLC David A. Baric, Esquire I.D.# 44853 19 West South Street Carlisle, PA 17013 (717) 249 -6873 Attorney for HCR ManorCare, Inc. VERIFICATION I verify that the statements made in the foregoing Petition To Appoint Arbitrator are true and correct to the best of my knowledge, information and belief. This verification is signed by David A. Baric, Esquire, Attorney for Plaintiff and is based upon the statements provided by Plaintiff, as well as documents reviewed by the undersigned as attorney for Plaintiff. This verification will be substituted and ratified by a verification signed by the Plaintiff who is presently unavailable to sign said verification. I undersigned that false statements herein are made subject to penalties of 18 Pa.C.S. §4904, relating to unsworn falsifi tions to authorities. k J . David A. Baric, Esquire Dated: November 12, 2013 Pennsylvania ADMISSION AGREEMENT 1. PARTIES, ADMISSION DATE, AND DEPOSIT The following are parties to this Agreement: A. Center (We, Us, Our): ManorCare Camp Hill B. Patient (You, Your): Jerome Phoenix C. Responsible Party, if applicable (You, Your): Vincent House Admission Date: 06/12/12 Deposit Amount: $ 0 2. CENTER'S RESPONSIBILITIES We will: A. Provide You with a basic room, board, common facilities, housekeeping, laundered bed linens, general nursing care, personal assessment, social services, and other services. B. Apply Your deposit, if any, to Your first one or two months of Your stay at Center. C. Refund any amounts owed to You within 30 days or within the time frame required by state law after Your discharge or transfer. 3. RESIDENT'S RIGHTS AND RESPONSIBILITIES 3.1 You have the right to: A. Choose Your own personal physician as long as the physician is properly licensed and complies with Our policies and procedures. B. Choose Your own pharmacy as long as the pharmacy complies with Our policies and procedures and operates in compliance with state and federal laws. In order for You to receive prescription drug coverage under Medicare Part D, the pharmacy must have a contract with the Part D plan You select. 3.2 You will: A. Pay Us: 1. the room and board rate for all days that You reside at the Center including the day of admission. Unless you are covered under Medicaid or an insurance plan that prohibits it, We may bill You for a late fee if You do not leave the Center before 12:00 p.m. on the day of Your discharge. The late fee will reflect any charges accrued by You while in the Center after 12:00 p.m. on the day of Your discharge. If We change the room and board rate, We will notify you in writing 30 days before the change. (Room and Board Rates are listed in Attachment A). 2. all additional ancillary charges accrued by You while in the Center. (Ancillary Charges are described on Attachment B) 3. any co- insurance, deductibles or reimbursement You receive for non- covered services if You are eligible for any insurance or governmental program including Medicare, Medicaid, or Veteran's Administration. 4. Any additional or denied charges that are not covered by Your insurance company's benefit or third party payer 5. upon receipt of the bill. If We hire a collection agency or attorney to collect payment on Your account, You will pay for these collection costs including attorney fees and costs. 1 EXHIBIT "A" B. Pay other providers, including Your attending physician, directly for care they provide to You. C. Notify Us of Your coverage under any insurance plans or government programs. D. Notify Us in writing within 5 days if Your coverage under any insurance plans or government programs changes while You are at the Center. E. Assign Us the right to bill and receive money directly from Your insurance or government payor. You authorize Center and any holder of medical or other information to release such information to the Centers for Medicare and Medicaid Services and its agents and to third party payors any information needed to determine Your benefits and Our right to receive payment. F. Pay for any damage You cause to any person or property on Center grounds. G. Abide by our policies and procedures. t 4. RESPONSIBLE PARTY'S RESPONSIBILITIES You will: A. Have legal access to the Patient's income or resources and deliver any documents supporting such authority to the Center. B. Pay for all charges that Patient incurs while at the Center from the Patient's income or resources. C. Notify Us immediately and in writing if the Patient's financial resources are depleted. D. Secure Medicaid in a timely and proper manner. + E. Cooperate with Us by providing information about the Patient's finances. F. Transfer and accept the Patient when it is medically appropriate to discharge the Patient from the Center. G. Abide by Our policies and procedures. H. Not misappropriate the Patient's income or resources or use them for the benefit of someone other i than the Patient. I. Be personally liable for the payment of all charges if You fail to fulfill Your other responsibilities 3 under this Agreement. i 5. CONSENT You consent to allow Us to: A. Use and disclose your health information for purposes of treatment, payment, or health care operations. B. Treat You to maintain Your well- being. C. Photograph you for identification purposes. 6. TERM AND TERMINATION 6.1 Term This Agreement begins on the day You are admitted to the Center and ends on the day You are discharged from the Center unless you are readmitted within 15 days of Your discharge date. If You are re- admitted within 15 days of being discharged from the Center, this Agreement will continue in effect as of the date of Your re- admission. 6.2 Termination A. By You: 2 You may terminate this Agreement: 1. immediately if you leave the Center because of emergency; or 2. by providing 7 days written notice of Your intent to leave the Center. B. By Us: We may terminate this Agreement and discharge You from the Center by notifying You in writing. Where legally required, We will notify you at least 30 days prior to Your transfer or discharge. In cases where the safety or health of You or other individuals in the Center may be endangered, or if other legal reasons exist, we will notify You as soon as practicable before transfer or discharge. We can terminate the Agreement for any of the following reasons: 1. Your needs cannot be met in the Center; 2. Your health has sufficiently improved so that You no longer need Our services; 3. The safety of other individuals in the Center is endangered; 4. The health of other individuals in the Center is endangered; 5. After appropriate notice, You have failed to pay for your stay at the Center; or 6. We cease to operate the Center. 7. ACKNOWLEDGMENTS You acknowledge that You have received the following attachments: A. Room and Board Rate — Attachment A B. Ancillary Charges — Attachment B C. Notice of Information Practices and Receipt of Notice of Information Practices — Attachments C -I and C -2 D. Resident's Personal Trust Fund Agreement — Attachment D E. SNF Medicare Determination Form — Attachment E F. Medicare Secondary Payor Questionnaire — Attachment F G. Summary of Limited Treatment Policy — Attachment G H. Medicare and Medicaid Information I. Patient Information Handbook 3. Center Supplement K. Resident Rights By signing the Admission Agreement, You acknowledge that you have been given and have read this Agreement in its entirety, and all its attachments. You agree that all information submitted as part of Your admission to the Center is true and correct. You acknowledge that the Center relies on the accuracy of all information submitted by You or on Your behalf in determining whether to admit You to the Center. 3 By signing below, the parties agree to the terms of this Admission Agreement: Patient Date o n, ter Representative Date If ap icable: Responsible Party Date Responsible Party's Telephone Number 4 ATTACHMENT A ROOM AND BOARD RATE Second Floor Private $9,517 Semi - Private $8,835 Triple $7,626 Third Floor Private $9,207 Semi- Private $8,339 Arcadia $9,207 Assisted Living Private $3,472 Deluxe $4, 154 Shared $2,666 5 VOLUNTARY ARBITRATION AGREEMENT ( "AGREEMENT") THE PARTIES ARE WAIVING THEIR RIGHT TO A TRIAL BEFORE A JUDGE OR JURY OF ANY DISPUTE BETWEEN THEM. PLEASE READ CAREFULLY BEFORE SIGNING. THE PATIENT WILL RECEIVE SERVICES IN THIS CENTER WHETHER OR NOT THIS AGREEMENT IS SIGNED. ARBITRATION IS DESCRIBED IN THE VOLUNTARY ARBITRATION PROGRAM BROCHURE COPY, ATTACHED AND MADE PART OF THIS AGREEMENT. Made on . 2— !Z (date) by and between the Patient JilaZ3 F I 0 " m (X or Patient's Legal Representative V ' 'PP) i— �� � (collectively referred to as "Patient ") and the Center 1. Agreement to Arbitrate "Disputes ": All claims arising out of or relating to this Agreement, the Admission Agreement or any and all past or future admissions of the Patient at this Center, or any sister Center operated by any subsidiary of HCR ManorCare, Inc.( "Sister Center "), including claims for malpractice, shall be submitted to arbitration. Nothing in this Agreement prevents the Patient from filing a complaint with the Center or appropriate governmental agency or from seeking review under any applicable law of any decision to involuntarily discharge or transfer the Patient. 2. Demand for Arbitration: shall be written, sent to the other Party by certified mail, return receipt requested. 3. FAA: The Parties agree and intend that this Agreement, the Admission Agreement and the Patient's stays at the Center substantially involve interstate commerce, and stipulate that the Federal Arbitration Act ( "FAA ") and applicable federal case law apply to this Agreement, preempt any inconsistent State law and shall not be reverse preempted by the McCarran- Ferguson Act; United States Code Title 15, Chapter 20, or other law. Any amendment to such version of the FAA is hereby expressly waived. 4. Arbitration Panel: Three (3) arbitrators (the "Panel ") shall conduct the arbitration. Each Party will select one Arbitrator, the two selected Arbitrators will select a third. Each Arbitrator must be a retired State or Federal Judge or a Member of the State Bar where the Center is located with at least 10 years of experience as an attorney. The Panel will elect a Chief Arbitrator who will be responsible for establishing and resolving issues pertaining to procedure, discovery, admissibility of evidence, or any other issue. 5. Sole Decision Maker: Except as otherwise provided in 6 below, the Panel is empowered to, and shall, resolve all disputes, including without limitation, any disputes about the making, validity, enforceability, scope, interpretation, voidability, unconscionability, preemption, severability and /or waiver of this Agreement or the Admission Agreement, as well as resolve the Parties' underlying disputes, as it is the Parties' intent to avoid involving the court system. The Panel shall not have jurisdiction to certify any person as a representative of a class of persons and, by doing so, adjudicate claims of persons not directly taking part in Arbitration. 6. Procedural Rules and Substantive Law: The Panel shall apply the State Rules of Evidence and State Rules of Civil Procedure except where otherwise stated in this Agreement. Also, the Panel shall apply, and the arbitration award shall be consistent with, the State substantive law, including statutory damage caps, for the State in which the Center is located, except as otherwise stated in this Agreement or where preempted by the FAA. The Panel's award must be unanimous and shall be served no later than 7 working days after the arbitration hearing. The award must state the Panels' findings of fact and conclusions of law, shall be marked "confidential ", and must be signed by all three Arbitrators. If any damages are awarded, the award must delineate specific amounts for each type of damages awarded, i.e. economic, non - economic, etc. The failure of the Panel to issue a unanimous award creates an appealable issue, appealable to the appropriate court, in addition to those set forth in paragraph 7, below. In the event the appellate court finds a non - unanimous award invalid as against law or this Agreement, the award shall be vacated and the arbitration dismissed without prejudice. A subsequent arbitration, if any, of the same claim or claims shall remain subject to the terms of this Agreement. 7. Final with Limited Rights to Review (Appeal): The Panel's award binds the Parties. The Parties have a limited right of appeal for only the express reasons allowed by the FAA or as provided in 6, above. i EXHIBIT "B" 8. -Right to Change Your Mind: This Agreement may be cancelled by written notice sent by certified mail to the Center's Administrator within 30 calendar days of the Patient's date of admission. If alleged acts underlying the dispute occur before the cancellation date, this Agreement shall be binding with respect to those alleged acts. If not cancelled, this Agreement shall be binding on the Patient for this and all of the Patient's subsequent admissions to the Center or any Sister Center without any need for further renewal. 9. Binding on Parties & Others: The Parties intend that this Agreement shall benefit and bind the Center, its parent, affiliates, and subsidiary companies, and shall benefit and bind the Patient (as defined herein), his /her successors, spouses, children, next of kin, guardians, administrators, and legal representatives. 10. Fees and Costs: The Panels' fees and costs will be paid by the Center except in disputes over non - payment of Center charges wherein such fees and costs will be divided equally between the Parties. The Parties shall bear their own attorney fees and costs in relation to all preparation for and attendance at the arbitration hearing. 11. Confidentiality: The arbitration proceedings shall remain confidential in all respects, including all filings, deposition transcripts, discovery documents, or other materials exchanged between the Parties and the Panels' award. In addition, following receipt of the Panels' award, each Party agrees to return to the producing Party within 30 days the original and all copies of documents exchanged in discovery and at the arbitration Hearing. 12. Non - waiver of this Agreement: A waiver of the right to arbitrate a specific Dispute or series of Disputes, as described above, does not relieve any Party from the obligation to arbitrate other Disputes, whether asserted as independent claims or as permissive or mandatory counterclaims, unless each such claim is also individually waived. With multiple Patient admissions, the presentation of an arbitration agreement at a later admission to the Center or a Sister Center shall not constitute a waiver by the Center of a prior signed arbitration agreement. 13. Severability: Except as provided in 6, any provision contained in this Agreement is severable, and if a provision is found to be unenforceable under State or Federal law, the remaining provisions of this Agreement shall remain in force and effect. This Agreement represents the Parties' entire agreement regarding Disputes, supersedes any other agreement relating to disputes, and may only be changed in writing signed by all Parties. This Agreement shall remain in full force and effect notwithstanding the termination, cancellation or natural expiration of the Admission Agreement. 14. Health Care Decision: The Parties hereby stipulate that the decision to have the Patient move into this Center and the decision to agree to this Agreement are each a health care decision. The Parties stipulate that there are other health care facilities in this community currently available to meet the Patient's needs. THE PARTIES CONFIRM THAT EACH OF THEM UNDERSTANDS THAT EACH HAS WAIVED THE RIGHT TO TRIAL BEFORE A JUDGE OR JURY AND THAT EACH CONSENTS TO ALL OF THE TERMS OF THIS VOLUNTARY AGREEMENT. PATIENT ACKNOWLEDGES THE RIGHT TO REVIEW THIS AGREEMENT WITH AN ATTORNEY OR FAMILY BEFORE SIGNING. PATIENT: PATIENT'S LEGAL REPRESENTATIVE: Printed Name (Date) Printed am e (Date) Signature of Patient Signature of Patient's Legal Representative' in his /her Repre entative capacity CENTER REPRESENTATIVE t ignyature of Patidiei Legal Representative in his /her Individual capacity Signa re of ter Representative �/2�L4 Patien s Legal Representative should sign on both lines above containing the phrase "Patient's Legal Representative." 2 HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION—LAW JEROME J. PHOENIX, • Respondent : NO. 13-6735 CIVIL TERM IN RE: PETITION TO APPOINT ARBITRATION ORDER OF COURT AND NOW, this 19th day of November, 2013, upon consideration of Petitioner's Petition To Appoint Arbitration, a Rule is hereby issued upon Respondent to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. BY THE COURT, Christylee4. Peck, J. ✓David A. Baric, Es q. q 19 West South Street Carlisle, PA 17013 Attorney for Petitioner Jerome J. Phoenix 1700 Market Street Camp Hill, PA 17011 Respondent, pro Se CD h, :rc rY,_ Caf i•ES /97--C1 LECL, (T.) r..„) <C7 /1/ (--; ' 0 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Chief Deputy i 7 ' Richard W Stewart CUMBERLANU 4 .g. Solicitor , F C„ >, -HE T PENNSYLVANIA HCR ManorCare, Inc. vs. Case Number Jerome J Phoenix 2013-6735 • SHERIFF'S RETURN OF SERVICE 11/19/2013 Ronny R Anderson, Sheriff, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Jerome J Phoenix, but was unable to locate the Defendant in his bailiwick. The Sheriff therefore returns the within requested Petition as"Not Found"at 1700 Market Street, Camp Hill Borough, Camp Hill, PA 17011. Deputies were advised by the Business Manager at Manor Care that the defendant was discharged and now resides at 1205 S. 28th Street, Harrisburg, PA 17111. 11/22/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Jerome J Phoenix, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Dauphin, Pennsylvania to serve the within Petition according to law. 12/05/2013 10:31 AM-The requested Petition served by the Sheriff of Dauphin County upon Jerome J Phoenix, personally, at 1205 S. 28th Street, Harrisburg, PA 17111. Jack Lotwick, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, December 11, 2013 RONRANDERSON, SHERIFF ' . of tit $11criff 4„ Shelley Ruhl Jack Duignan Real Estate Deputy \�y \ • ' � * Chief Deputy Matthew L. Owens 104^ .•'∎�.�- Michael W. Rinehart Solicitor Assistant Chief Deputy Dauphin County 101 Market Street Harrisburg,Pennsylvania 17101-2079 ph:(717)780-6590 fax (717)255-2889 Jack Lotwick Sheriff Commonwealth of Pennsylvania HCR MANORCARE, INC. VS County of Dauphin JEROME J. PHOENIX Sheriffs Return No. 2013-T-3083 OTHER COUNTY NO. 2013-6735 And now: DECEMBER 5, 2013 at 10:31:00 AM served the within PETITION upon JEROME J. PHOENIX by personally handing to JEROME J. PHOENIX 1 true attested copy of the original PETITION and making known to him/her the contents thereof at 1205 SOUTH 28TH STREET, ROOM 219A HARRISBURG PA 17111 SERVED PETITION TO APPOINT ARBITRATOR So Answers, Sheriff of Dauphin County, Pa. j;104400.1;v By 11 Dep Sheriff Sworn to and subscribed De s+qty: J STRAINING before me t i's • ►- day of Sheriffs Costs: $47.25 11/29/2013 c,; iii LEM A:D. -40■MalilS) - PRO ONOTARY HSN COUNTY CO MISSION EX ik1S 1ST MONDAY JANUARY, 3011 HCR MANORCARE, INC., • N THE COURT OF COMMON PLEAS OF Petitioner CUMBERLAND COUNTY, PENNSYLVANIA • v. • NO. 2013-6735 CIVIL TERM • JEROME J. PHOENIX, : CIVIL ACTION-LAW Respondent r— MOTION TO MAKE RULE ABSOLUTE AND NOW, comes Petitioner, HCR ManorCare, Inc., by and through its attorneys,1Ba4tc Scherer LLC, and files the within Motion to Make Rule Absolute and, in support thereof, sets forth the following: 1. Plaintiff filed a Petition To Appoint Arbitrator in this matter on or about November 13, 2013 a true and correct copy of said Petition is attached hereto as Exhibit"A"and is incorporated. 2. By Order of Court dated November 19, 2013, the Respondent was to show cause why the court should not designate an arbitrator on behalf of the Respondent within twenty(20) days of service. A true and correct copy of the Rule is attached hereto as Exhibit"B" and is incorporated. 3. Service of the Petition was made upon the Defendant by the Sheriff of Dauphin County, Pennsylvania. A true and correct copy of said Service Return is attached hereto as Exhibit "C"and are incorporated. 4. To December 30, 2013, no response has been filed by the Respondent. WHEREFORE, Petitioner requests that the Court designate an arbitrator to serve on the Respondent behalf to resolve the dispute between the parties. Respectfully submitted, .BARIC SCHERER LLC / <v David A. Baric, Esquire I.D. #44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Petitioner • CUMBERLAND COUNTY, PENNSYLVANIA • v. NO. (3 — c 73 c " •JEROME J. PHOENIX, • CIVIL ACTION-LAW e/� Respondent : RULE AND NOW,this day of , 2013 upon consideration of the foregoing Petition To Appoint Arbitrator, it is hereby ordered that: (1) a rule is issued upon the Respondent to show cause why the Petitioner is not entitled to the relief requested; (2) the Respondent shall file an answer to the petition within days of this date; (3) the petition shall be decided under Pa.R.C.P. No. 206.7; (4) depositions shall be completed within days of this date; (5) argument shall be held on ,the day of , 2013, at a.m./p.m. in Courtroom of the Cumberland County Courthouse, Carlisle, Pennsylvania; and (6) notice of the entry of this order shall be provided to all parties by the petitioner. BY THE COURT, J. David A. Baric, Esquire Baric Scherer LLC 19 West South Street Carlisle, Pennsylvania 17013 Jerome J. Phoenix 1700 Market Street Camp Hill, Pennsylvania 17011 EXHIBIT "A" HCR MANORCARE, INC., IN THE COURT OF COMMON PLEAS OF Petitioner • CUMBERLAND COUNTY, PENNSYLVANIA • v. • NO. JEROME J. PHOENIX, • CIVIL ACTION-LAW Respondent • ORDER OF COURT APPOINTING ARBITRATOR AND NOW,this day of , 2013,upon consideration of Petitioner's Petition to Appoint an Arbitrator, any response thereto, and good cause appearing therefor, it is hereby ordered and decreed that , is hereby appointed to serve as arbitrator in the dispute between the parties and is empowered to serve with the same force and effect as if he had been specifically named by the Respondent. BY THE COURT, J. Parties to be notified: David A. Baric, Esquire Baric Scherer LLC 19 West South Street Carlisle, Pennsylvania 17013 Jerome J. Phoenix 1700 Market Street Camp Hill, Pennsylvania 17011 HCR MANORCARE, INC., • IN THE COURT OF COMMON PLEAS OFD., Petitioner • CUMBERLAND COUNTY, PENNSYLVA$IAµ, z 'o , v. • NO. aL' _43 ' a • JEROME J. PHOENIX, • CIVIL ACTION-LAW Respondent : o �' c. L. PETITION TO APPOINT ARBITRATOR NOW, comes HCR ManorCare, Inc., Petitioner, by and through its attorneys,BARIC SCHERER LLC, and files the within Petition to Appoint Arbitrator and, in support thereof, sets forth the following: 1. The Petitioner is a HCR ManorCare, Inc., a Ohio corporation which owns and operates a skilled care facility at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011 (the"Center"). 2. Respondent, Jerome J. Phoenix, is an adult individual with a residence address of 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania 17011. Jerome J. Phoenix became a resident of the Center on June 12, 2012 and remains a resident to the date hereof. 3. Petitioner files this petition pursuant to 42 Pa.C.S.A. §7305 and 42 Pa.C.S.A. §7342(a). 4. On or about June 12, 2012, Petitioner and Respondent entered into an Admission Agreement for Respondent, Jerome J. Phoenix to enter the Center for nursing care, a true and correct copy of which is attached hereto as Exhibit"A" and is incorporated by reference. 5. On or about June 12, 2012, Petitioner and Respondent entered into a certain Voluntary Arbitration Agreement, a true and correct copy of which is attached hereto as Exhibit "B" and is incorporated by reference. 6. Under the terms of the Voluntary Arbitration Agreement, all disputes between the parties were to be resolved by arbitration. 7. During the course of Respondent, Jerome J. Phoenix's stay at the Center, the Petitioner provided skilled nursing care to Respondent, Jerome J. Phoenix. 8. Respondent has failed to pay for the costs of care he received after demand for payment has been made by Petitioner. 9. In an effort to resolve the dispute Petitioner demanded arbitration pursuant to the terms of the Voluntary Arbitration Agreement, which requires three arbitrators to conduct the arbitration, one selected by each of the parties and the two selected arbitrators to select the third. 10. Petitioner appointed Bradley L. Griffie, Esquire as its arbitrator and requested that Respondent appoint an arbitrator so that the two arbitrators could jointly select the third as set forth in the Voluntary Arbitration Agreement. 11. To date Respondent has failed to appoint an arbitrator. 12. Unless an arbitrator is appointed for the Respondent,the third arbitrator may not be appointed, and Petitioner will be deprived of its right to have the dispute between the parties resolved through arbitration. 13. In light of Respondent's failure to select an arbitrator,Petitioner requests that this Court appoint an arbitrator on behalf of the Respondent according to the terms of the Voluntary Arbitration Agreement. 14. The Voluntary Arbitration Agreement requires each arbitrator to be a retired State or Federal Judge or a Member of the State Bar where the Facility is located with at least 10 years of experience as an attorney. WHEREFORE, Petitioner requests that this Court designate an arbitrator selected by the Respondent and that the arbitrator designated by the Court be empowered to serve with the same force and effect as if he had been specifically named by the Respondent. Respectfully submitted, BARIC SCHERER LLC David A. Baric, Esquire I.D.#44853 19 West South Street Carlisle, PA 17013 (717)249-6873 Attorney for HCR ManorCare, Inc. VERIFICATION I verify that the statements made in the foregoing Petition To Appoint Arbitrator are true and correct to the best of my knowledge, information and belief. This verification is signed by David A. Baric, Esquire, Attorney for Plaintiff and is based upon the statements provided by Plaintiff, as well as documents reviewed by the undersigned as attorney for Plaintiff. This verification will be substituted and ratified by a verification signed by the Plaintiff who is presently unavailable to sign said verification. I undersigned that false statements herein are made subject to penalties of 18 Pa.C.S. §4904,relating to unsworn falsifi tions to authorities. David A. Baric, Esquire Dated: November 12, 2013 Pennsylvania ADMISSION AGREEMENT PARTIES,ADMISSION DATE,AND DEPOSIT The following are parties to this Agreement: A. Center(We,Us,Our):ManorCare Camp Hill B. Patient(You,Your):Jerome Phoenix C. Responsible Party,if applicable(You,Your): Vincent House Admission Date: 06/12/12 Deposit Amount: $0 2. CENTER'S RESPONSIBILITIES We will: A. Provide You with a basic room,board,common facilities,housekeeping,laundered bed linens, general nursing care,personal assessment,social services,and other services. B. Apply Your deposit,if any,to Your first one or two months of Your stay at Center. C. Refund any amounts owed to You within 30 days or within the time frame required by state law after Your discharge or transfer. 3. RESIDENT'S RIGHTS AND RESPONSIBILITIES 3.1 You have the right to: A. Choose Your own personal physician as long as the physician is properly licensed and complies with Our policies and procedures. B. Choose Your own pharmacy as long as the pharmacy complies with Our policies and procedures and operates in compliance with state and federal laws. In order for You to receive prescription drug coverage under Medicare Part D,the pharmacy must have a contract with the Part D plan You select. 3.2 You will: A. Pay Us: 1. the room and board rate for all days that You reside at the Center including the day of admission. Unless you are covered under Medicaid or an insurance plan that prohibits it,We may bill You for a late fee if You do not leave the Center before 12:00 p.m.on the day of Your discharge. The late fee will reflect any charges accrued by You while in the Center after 12:00 p.m.on the day of Your discharge. If We change the room and board rate,We will notify you in writing 30 days before the change. (Room and Board Rates are listed in Attachment A). 2. all additional ancillary charges accrued by You while in the Center. (Ancillary Charges are described on Attachment B) 3. any co-insurance,deductibles or reimbursement You receive for non-covered services if You are eligible for any insurance or governmental program including Medicare,Medicaid,or Veteran's Administration. 4. Any additional or denied charges that are not covered by Your insurance company's benefit or third party payer 5. upon receipt of the bill.If We hire a collection agency or attorney to collect payment on Your account,You will pay for these collection costs including attorney fees and costs. 1 EXHIBIT "A" B. Pay other providers,including Your attending physician,directly for care they provide to You. C. Notify Us of Your coverage under any insurance plans or government programs. D. Notify Us in writing within 5 days if Your coverage under any insurance plans or government programs changes while You are at the Center. E. Assign Us the right to bill and receive money directly from Your insurance or government payor. You authorize Center and any holder of medical or other information to release such information to the Centers for Medicare and Medicaid Services and its agents and to third party payors any information needed to determine Your benefits and Our right to receive payment. F. Pay for any damage You cause to any person or property on Center grounds. G. Abide by our policies and procedures. 4. RESPONSIBLE PARTY'S RESPONSIBILITIES You will: A. Have legal access to the Patient's income or resources and deliver any documents supporting such authority to the Center. B. Pay for all charges that Patient incurs while at the Center from the Patient's income or resources. C. Notify Us immediately and in writing if the Patient's financial resources are depleted. D. Secure Medicaid in a timely and proper manner. E. Cooperate with Us by providing information about the Patient's finances. F. Transfer and accept the Patient when it is medically appropriate to discharge the Patient from the Center. G. Abide by Our policies and procedures. H. Not misappropriate the Patient's income or resources or use them for the benefit of someone other than the Patient. I. Be personally liable for the payment of all charges if You fail to fulfill Your other responsibilities under this Agreement. 5. CONSENT You consent to allow Us to: A. Use and disclose your health information for purposes of treatment,payment,or health care operations. B. Treat You to maintain Your well-being. C. Photograph you for identification purposes. 6. TERM AND TERMINATION 6.1 Term This Agreement begins on the day You are admitted to the Center and ends on the day You are discharged from the Center unless you are readmitted within 15 days of Your discharge date. If You are re-admitted within 15 days of being discharged from the Center,this Agreement will continue in effect as of the date of Your re-admission. 6.2 Termination A. By You: 2 You may terminate this Agreement: 1. immediately if you leave the Center because of emergency;or 2. by providing 7 days written notice of Your intent to leave the Center. B. By Us: We may terminate this Agreement and discharge You from the Center by notifying You in writing. Where legally required, We will notify you at least 30 days prior to Your transfer or discharge. In cases where the safety or health of You or other individuals in the Center may be endangered,or if other legal reasons exist,we will notify You as soon as practicable before transfer or discharge. We can terminate the Agreement for any of the following reasons: 1. Your needs cannot be met in the Center; 2. Your health has sufficiently improved so that You no longer need Our services; 3. The safety of other individuals in the Center is endangered; 4. The health of other individuals in the Center is endangered; 5. After appropriate notice,You have failed to pay for your stay at the Center;or 6. We cease to operate the Center. 7. ACKNOWLEDGMENTS You acknowledge that You have received the following attachments: A. Room and Board Rate—Attachment A B. Ancillary Charges—Attachment B C. Notice of Information Practices and Receipt of Notice of Information Practices—Attachments C-1 and C-2 D. Resident's Personal Trust Fund Agreement—Attachment D E. SNF Medicare Determination Form—Attachment E F. Medicare Secondary Payor Questionnaire—Attachment F G. Summary of Limited Treatment Policy—Attachment G H. Medicare and Medicaid Information I. Patient Information Handbook J. Center Supplement K. Resident Rights By signing the Admission Agreement,You acknowledge that you have been given and have read this Agreement in its entirety,and all its attachments. You agree that all information submitted as part of Your admission to the Center is true and correct. You acknowledge that the Center relies on the accuracy of all information submitted by You or on Your behalf in determining whether to admit You to the Center. 3 By signing below,the parties agree to the terms of this Admission Agreement: Patient Date //Z._ LC. nter Representative Date If ap icable: fi Z/7-10— r._ I . .. Responsible Party Date Responsible Party's Telephone Number 4 ATTACHMENT A ROOM AND BOARD RATE Second Floor Private $9,517 Semi-Private $8,835 Triple $7,626 Third Floor Private $9,207 Semi-Private $8,339 Arcadia $9,207 Assisted Living Private $3,472 Deluxe $4, 154 Shared $2,666 5 VOLUNTARY ARBITRATION AGREEMENT("AGREEMENT") THE PARTIES ARE WAIVING THEIR RIGHT TO A TRIAL BEFORE A JUDGE OR JURY OF ANY DISPUTE BETWEEN THEM. PLEASE READ CAREFULLY BEFORE SIGNING. THE PATIENT WILL RECEIVE SERVICES IN THIS CENTER WHETHER OR NOT THIS AGREEMENT IS SIGNED. ARBITRATION IS DESCRIBED IN THE VOLUNTARY ARBITRATION PROGRAM BROCHURE COPY,ATTACHED AND MADE PART OF THIS AGREEMENT. Made on p/jZ/12, (date) by and between the Patient jj 'JZ)J"rie., ph lL*r Patient's Legal Representative V ; eh f-/*)r ` , (collectively referred to as "Patient") and the Center 11 t a._,► it • 1. Agreement to Arbitrate "Disputes": All claims arising out of or relating to this Agreement, the Admission Agreement or any and all past or future admissions of the Patient at this Center, or any sister Center operated by any subsidiary of HCR ManorCare, Inc.("Sister Center"), including claims for malpractice, shall be submitted to arbitration. Nothing in this Agreement prevents the Patient from filing a complaint with the Center or appropriate governmental agency or from seeking review under any applicable law of any decision to involuntarily discharge or transfer the Patient. 2. Demand for Arbitration: shall be written, sent to the other Party by certified mail,return receipt requested. 3. FAA: The Parties agree and intend that this Agreement,the Admission Agreement and the Patient's stays at the Center substantially involve interstate commerce, and stipulate that the Federal Arbitration Act ("FAA") and applicable federal case law apply to this Agreement, preempt any inconsistent State law and shall not be reverse preempted by the McCarran-Ferguson Act; United States Code Title I5, Chapter 20, or other law. Any amendment to such version of the FAA is hereby expressly waived. 4. Arbitration Panel: Three (3) arbitrators (the "Panel") shall conduct the arbitration. Each Party will select one Arbitrator, the two selected Arbitrators will select a third. Each Arbitrator must be a retired State or Federal Judge or a Member of the State Bar where the Center is located with at least 10 years of experience as an attorney. The Panel will elect a Chief Arbitrator who will be responsible for establishing and resolving issues pertaining to procedure,discovery,admissibility of evidence, or any other issue. 5.Sole Decision Maker: Except as otherwise provided in 6 below,the Panel is empowered to,and shall,resolve all disputes, including without limitation, any disputes about the making, validity, enforceability, scope, interpretation, voidability, unconscionability, preemption, severability and/or waiver of this Agreement or the Admission Agreement, as well as resolve the Parties' underlying disputes,as it is the Parties' intent to avoid involving the court system. The Panel shall not have jurisdiction to certify any person as a representative of a class of persons and,by doing so, adjudicate claims of persons not directly taking part in Arbitration. 6. Procedural Rules and Substantive Law: The Panel shall apply the State Rules of Evidence and State Rules of Civil Procedure except where otherwise stated in this Agreement. Also, the Panel shall apply, and the arbitration award shall be consistent with,the State substantive law, including statutory damage caps, for the State in which the Center is located, except as otherwise stated in this Agreement or where preempted by the FAA. The Panel's award must be unanimous and shall be served no later than 7 working days after the arbitration hearing. The award must state the Panels' findings of fact and conclusions of law, shall be marked "confidential", and must be signed by all three Arbitrators. If any damages are awarded,the award must delineate specific amounts for each type of damages awarded, i.e. economic, non-economic, etc. The failure of the Panel to issue a unanimous award creates an appealable issue, appealable to the appropriate court, in addition to those set forth in paragraph 7, below. In the event the appellate court finds a non-unanimous award invalid as against law or this Agreement, the award shall be vacated and the arbitration dismissed without prejudice. A subsequent arbitration, if any, of the same claim or claims shall remain subject to the terms of this Agreement. 7. Final with Limited Rights to Review (Appeal): The Panel's award binds the Parties. The Parties have a limited right of appeal for only the express reasons allowed by the FAA or as provided in 6,above. 1 EXHIBIT "B" 8. Right to Change Your Mind: This Agreement may be cancelled by written notice sent by certified mail to the Center's Administrator within 30 calendar days of the Patient's date of admission. If alleged acts underlying the dispute occur before the cancellation date,this Agreement shall be binding with respect to those alleged acts. If not cancelled, this Agreement shall be binding on the Patient for this and all of the Patient's subsequent admissions to the Center or any Sister Center without any need for further renewal. 9. Binding on Parties & Others: The Parties intend that this Agreement shall benefit and bind the Center, its parent, affiliates, and subsidiary companies, and shall benefit and bind the Patient (as defined herein), his/her successors, spouses, children,next of kin,guardians,administrators,and legal representatives. 10. Fees and Costs: The Panels' fees and costs will be paid by the Center except in disputes over non-payment of Center charges wherein such fees and costs will be divided equally between the Parties. The Parties shall bear their own attorney fees and costs in relation to all preparation for and attendance at the arbitration hearing. 11. Confidentiality: The arbitration proceedings shall remain confidential in all respects, including all filings, deposition transcripts, discovery documents, or other materials exchanged between the Parties and the Panels' award. In addition, following receipt of the Panels' award, each Party agrees to return to the producing Party within 30 days the original and all copies of documents exchanged in discovery and at the arbitration Hearing. 12. Non-waiver of this Agreement: A waiver of the right to arbitrate a specific Dispute or series of Disputes, as described above, does not relieve any Party from the obligation to arbitrate other Disputes, whether asserted as independent claims or as permissive or mandatory counterclaims, unless each such claim is also individually waived. With multiple Patient admissions, the presentation of an arbitration agreement at a later admission to the Center or a Sister Center shall not constitute a waiver by the Center of a prior signed arbitration agreement. 13. Severability: Except as provided in 6, any provision contained in this Agreement is severable, and if a provision is found to be unenforceable under State or Federal law,the remaining provisions of this Agreement shall remain in force and effect. This Agreement represents the Parties' entire agreement regarding Disputes, supersedes any other agreement relating to disputes, and may only be changed in writing signed by all Parties. This Agreement shall remain in full force and effect notwithstanding the termination, cancellation or natural expiration of the Admission Agreement. 14. Health Care Decision: The Parties hereby stipulate that the decision to have the Patient move into this Center and the decision to agree to this Agreement are each a health care decision. The Parties stipulate that there are other health care facilities in this community currently available to meet the Patient's needs. THE PARTIES CONFIRM THAT EACH OF THEM UNDERSTANDS THAT EACH HAS WAIVED THE RIGHT TO TRIAL BEFORE A JUDGE OR JURY AND THAT EACH CONSENTS TO ALL OF THE TERMS OF THIS VOLUNTARY AGREEMENT. PATIENT ACKNOWLEDGES THE RIGHT TO REVIEW THIS AGREEMENT WITH AN ATTORNEY OR FAMILY BEFORE SIGNING. PATIENT: PATIENT'S LEGAL REPRESENTATIVE: Printed Name (Date) Printed ame f (Date) Signature of Patient Signature of Patient's Legal Representative' in his/her Representative capacity 1 CENTER REPRESENTATIVE Ii, '11'1 , •..i�.6-■ t' ::gn.ture of Patie t s Legal Representative in his/her Individual capacity Signa iter Representative Patien,'s Legal Representative should sign on both lines above containing the phrase"Patient's Legal Representative." 2 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff ,,A9 Di eilnibrr�r fd Jody S Smith Chief Deputy x .l� Richard W Stewart Solicitor oFFICE D'F ThE; =EF2iFF HCR ManorCare, Inc. Case Number vs. Jerome J Phoenix 2013-6735 SHERIFF'S RETURN OF SERVICE 11/19/2013 Ronny R Anderson, Sheriff, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Jerome J Phoenix, but was unable to locate the Defendant in his bailiwick. The Sheriff therefore returns the within requested Petition as"Not Found"at 1700 Market Street, Camp Hill Borough, Camp Hill, PA 17011. Deputies were advised by the Business Manager at Manor Care that the defendant was discharged and now resides at 1205 S. 28th Street, Harrisburg, PA 17111. 11/22/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Jerome J Phoenix, but was unable to locate the Defendant in the Sheriffs bailiwick. The Sheriff therefore deputizes the Sheriff of Dauphin, Pennsylvania to serve the within Petition according to law. 12/05/2013 10:31 AM-The requested Petition served by the Sheriff of Dauphin County upon Jerome J Phoenix, personally, at 1205 S. 28th Street, Harrisburg, PA 17111. Jack Lotwick, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, December 11, 2013 RONNK ANDERSON, SHERIFF RE C. L.0 v EXHIBIT "B" (c)CountySuilo Sheriff,Toleosoft Inc. IIllsi~"'' !u ' Shelley Ruhl ` ti Jack Duignan Real Estate Deputy NOV �1 • ' Chief Deputy r .•� t'�* Michael W. Rinehart Matthew L. Owens � �� �,..,.� �- Solicitor Assistant Chief Deputy Dauphin County 101 Market Street Harrisburg,Pennsylvania 17101-2079 ph:(717)780-6590 fax:(717)255-2889 Jack Lotwick Sheriff Commonwealth of Pennsylvania HCR MANORCARE, INC. VS County of Dauphin JEROME J. PHOENIX Sheriffs Return No. 2013-T-3083 OTHER COUNTY NO. 2013-6735 And now: DECEMBER 5, 2013 at 10:31:00 AM served the within PETITION upon JEROME J. PHOENIX by personally handing to JEROME J. PHOENIX 1 true attested copy of the original PETITION and making known to him/her the contents thereof at 1205 SOUTH 28TH STREET, ROOM 219A HARRISBURG PA 17111 SERVED PETITION TO APPOINT ARBITRATOR So Answers, (5:z Sheriff of Dauphin County, Pa. By �� Dep t Sheriff Sworn to and subscribed Des"ty: J STRAINING before me •s .' day of Sheriffs Costs: $47.25 11/29/2013 ,,,,. c.1 1_ A:D. •_:„191ffigi PRO ONOTARY irf!14tN COUNTY CO- MISSION WIRES Iii i 1S'T MONDAY JANUARY, 20 HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION—LAW JEROME J. PHOENIX, • Respondent : NO. 13-6735 CIVIL TERM IN RE: PETITION TO APPOINT ARBITRATION ORDER OF COURT AND NOW, this 19th day of November, 2013, upon consideration of Petitioner's Petition To Appoint Arbitration, a Rule is hereby issued upon Respondent to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. BY THE COURT, Christyleeft. Peck, J. D id A. Baric, Esq. 9 West South Street Carlisle, PA 17013 Attorney for Petitioner Jerome J. Phoenix 1700 Market Street Camp Hill, PA 17011 Respondent, pro Se w -� :rc rn y ZG „ 0- z. L)la' EXHIBIT I tcl I, \Lt CERTIFICATE OF SERVICE I hereby certify that on December 31,2013,I,David A.Baric,Esquire of Baric Scherer LLC, did serve a copy of Motion To Make Rule Absolute,by first class U.S. mail,postage prepaid,to the party listed below, as follows: Jerome Phoenix 1205 South 28th Street Harrisburg, Pennsylvania 17111 /11/ , David A. Baric, Esquire HCR MANORCARE, INC., IN THE COURT OF COMMON PLEAS OF Petitioner CUMBERLAND COUNTY, PENNSYLVANIA V. NO. 2013-6735 CIVIL TERM JEROME J. PHOENIX, CIVIL ACTION-LAW Respondent ORDER OF COURT AND NOW, this day of 204.3, upon review of the attached Motion To Make Rule Absolute, it is hereby ordered and decreed that the Court designates gL� - , Esquire, to serve as the arbitrator for the Respondent to resolve the dispute between the parties. BY THE COURT, J. I David A. Baric, Esquire Baric Scherer LLC 19 West South Street Carlisle, Pennsylvania 17013 ,/ Jerome Phoenix 1205 South 28th Street Harrisburg, Pennsylvania 17111 rn c ... alrY.i HCR MANORCARE, INC., IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2013-6735 CIVIL TERM JEROME J. PHOENIX, CIVIL ACTION -LAW Defendant r-) APPLICATION TO CONFIRM ARBITRATION AWARD NOW, comes HCR ManorCare, Inc., Plaintiff, by and through its attorneys, BA C -- SCHERER LLC, and files the within Application to Confirm Arbitration Award and, in sp rt ' thereof, sets forth the following: 1. The parties to this matter were bound by a certain Arbitration and Limitation of Liability Agreement, a true and correct copy of which is attached hereto as Exhibit "A" and is incorporated by reference. 2. A dispute arose amongst the parties and HCR ManorCare sought arbitration of the dispute under the terms of the Arbitration and Limitation of Liability Agreement. 3. Arbitration was held before Bradley L. Griffie, Esquire, Hubert X. Gilroy and Nathan C. Wolf, Esquire after their appointment as arbitrators. 4. Bradley L. Griffie, Esquire as arbitration administrator, served the Defendant with notice of the arbitration hearing. Proof of said service is attached hereto as Exhibit "B" and is incorporated by reference. 5. The arbitrators have rendered an Arbitrators' Decision and Award in this matter a true and correct copy of which is attached hereto as Exhibit "C" and is incorporated by reference. 6. Pursuant to 42 Pa.C.S.A. §7313, a party to an arbitration may make application to the Court of Common Pleas for confirmation of the award by the Court. 7. Pursuant to 42 Pa.C.S.A. §7316, upon confirmation of the award, a judgment or decree shall be entered in conformity with the order. 8. Copies of the Arbitrators' Award was mailed to all of the parties on May 21, 2014. 9. No request for modification or correction of the award has been filed by the Defendant to the date of this application. WHEREFORE, Applicant requests that the award of the arbitration administrator be confirmed and judgment be entered in conformance therewith. Respectfully submitted, BARIC SCHERER LLC David A. Baric, Esquire I.D.# 44853 19 West South Street Carlisle, PA 17013 (717) 249-6873 Attorney for HCR ManorCare, Inc. VOLUNTARY ARBITRATION AGREEMENT ("AGREEMENT") THE PARTIES ARE WAIVING THEIR RIGHT TO A TRIAL BEFORE A JUDGE OR JURY OF ANY DISPUTE BETWEEN THEM. PLEASE READ CAREFULLY BEFORE SIGNING. THE PATIENT WILL RECEIVE SERVICES IN THIS CENTER WHETHER OR NOT THIS AGREEMENT IS SIGNED. ARBITRATION IS DESCRIBED IN THE VOLUNTARY ARBITRATION PROGRAM BROCHURE COPY, ATTACHED AND MADE PART OF THIS AGREEMENT. Made on fp AZ /12 (date) by and between the Patient t me, phOgJ or Patient's Legal Representative V I: rr- /-) f "' f *) a (collectively referred to as "Patient") and the Center MC aiYy-� Nil/ • 1. Agreement to Arbitrate "Disputes": All claims arising out of or relating to this Agreement, the Admission Agreement or any and all past or future admissions of the Patient at this Center, or any sister Center operated by any subsidiary of HCR ManorCare, Inc.("Sister Center"), including claims for malpractice, shall be submitted to arbitration. Nothing in this Agreement prevents the Patient from filing a complaint with the Center or appropriate governmental agency or from seeking review under any applicable law of any decision to involuntarily discharge or transfer the Patient. 2. Demand for Arbitration: shall be written, sent to the other Party by certified mail, return receipt requested. 3. FAA: The Parties agree and intend that this Agreement, the Admission Agreement and the Patient's stays at the Center substantially involve interstate commerce, and stipulate that the Federal Arbitration Act ("FAA") and applicable federal case law apply to this Agreement, preempt any inconsistent State law and shall not be reverse preempted by the McCarran-Ferguson Act; United States Code Title 15, Chapter 20, or other law. Any amendment to such version of the FAA is hereby expressly waived. 4. Arbitration Panel: Three (3) arbitrators (the "Panel") shall conduct the arbitration. Each Party will select one Arbitrator, the two selected Arbitrators will select a third. Each Arbitrator must be a retired State or Federal Judge or a Member of the State Bar where the Center is located with at least 10 years of experience as an attorney. The Panel will elect a Chief Arbitrator who will be responsible for establishing and resolving issues pertaining to procedure, discovery, admissibility of evidence, or any other issue. 5. Sole Decision Maker: Except as otherwise provided in 6 below, the Panel is empowered to, and shall, resolve all disputes, including without limitation, any disputes about the making, validity, enforceability, scope, interpretation, voidability, unconscionability, preemption, severability and/or waiver of this Agreement or the Admission Agreement, as well as resolve the Parties' underlying disputes, as it is the Parties' intent to avoid involving the court system. The Panel shall not have jurisdiction to certify any person as a representative of a class of persons and, by doing so, adjudicate claims of persons not directly taking part in Arbitration. 6. Procedural Rules and Substantive Law: The Panel shall apply the State Rules of Evidence and State Rules of Civil Procedure except where otherwise stated in this Agreement. Also, the Panel shall apply, and the arbitration award shall be consistent with, the State substantive law, including statutory damage caps, for the State in which the Center is located, except as otherwise stated in this Agreement or where preempted by the FAA. The Panel's award must be unanimous and shall be served no later than 7 working days after the arbitration hearing. The award must state the Panels' findings of fact and conclusions of law, shall be marked "confidential", and must be signed by all three Arbitrators. If any damages are awarded, the award must delineate specific amounts for each type of damages awarded, i.e. economic, non -economic, etc. The failure of the Panel to issue a unanimous award creates an appealable issue, appealable to the appropriate court, in addition to those set forth in paragraph 7, below. In the event the appellate court finds a non -unanimous award invalid as against law or this Agreement, the award shall be vacated and the arbitration dismissed without prejudice. A subsequent arbitration, if any, of the same claim or claims shall remain subject to the terms of this Agreement. 7. Final with Limited Rights to Review (Appeal): The Panel's award binds the Parties. The Parties have a limited right of appeal for only the express reasons allowed by the FAA or as provided in 6, above. EXHIBIT "A" 1 8. Right to Change Your Mind: This Agreement may be cancelled by written notice sent by certified mail to the Center's Administrator within 30 calendar days of the Patient's date of admission. If alleged acts underlying the dispute occur before the cancellation date, this Agreement shall be binding with respect to those alleged acts. If not cancelled, this Agreement shall be binding on the Patient for this and all of the Patient's subsequent admissions to the Center or any Sister Center without any need for further renewal. 9. Binding on Parties & Others: The Parties intend that this Agreement shall benefit and bind the Center, its parent, affiliates, and subsidiary companies, and shall benefit and bind the Patient (as defined herein), his/her successors, spouses, children, next of kin, guardians, administrators, and legal representatives. 10. Fees and Costs: The Panels' fees and costs will be paid by the Center except in disputes over non-payment of Center charges wherein such fees and costs will be divided equally between the Parties. The Parties shall bear their own attorney fees and costs in relation to all preparation for and attendance at the arbitration hearing. 11. Confidentiality: The arbitration proceedings shall remain confidential in all respects, including all filings, deposition transcripts, discovery documents, or other materials exchanged between the Parties and the Panels' award. In addition, following receipt of the Panels' award, each Party agrees to return to the producing Party within 30 days the original and all copies of documents exchanged in discovery and at the arbitration Hearing. 12. Non -waiver of this Agreement: A waiver of the right to arbitrate a specific Dispute or series of Disputes, as described above, does not relieve any Party from the obligation to arbitrate other Disputes, whether asserted as independent claims or as permissive or mandatory counterclaims, unless each such claim is also individually waived. With multiple Patient admissions, the presentation of an arbitration agreement at a later admission to the Center or a Sister Center shall not constitute a waiver by the Center of a prior signed arbitration agreement. 13. Severability: Except as provided in 6, any provision contained in this Agreement is severable, and if a provision is found to be unenforceable under State or Federal law, the remaining provisions of this Agreement shall remain in force and effect. This Agreement represents the Parties' entire agreement regarding Disputes, supersedes any other agreement relating to disputes, and may only be changed in writing signed by all Parties. This Agreement shall remain in full force and effect notwithstanding the termination, cancellation or natural expiration of the Admission Agreement. 14. Health Care Decision: The Parties hereby stipulate that the decision to have the Patient move into this Center and the decision to agree to this Agreement are each a health care decision. The Parties stipulate that there are other health care facilities in this community currently available to meet the Patient's needs. THE PARTIES CONFIRM THAT EACH OF THEM UNDERSTANDS THAT EACH HAS WAIVED THE RIGHT TO TRIAL BEFORE A JUDGE OR JURY AND THAT EACH CONSENTS TO ALL OF THE TERMS OF THIS VOLUNTARY AGREEMENT. PATIENT ACKNOWLEDGES THE RIGHT TO REVIEW THIS AGREEMENT WITH AN ATTORNEY OR FAMILY BEFORE SIGNING. PATIENT: ,14 Printed Name (Date) Signature of Patient CENTER REPRESENTATIVE Signa f. ter Representative Patiet. PATIENT'S LEGAL REPRESENTATIVE: Printed ame / (Date) Signature of Patient's Legal Representative' in his/her Repre entative capacity i ft Ji : tgn.ture of Patie t s Legal Representative in his/her Individual capacity s Legal Representative should sign on both lines above containing the phrase "Patient's Legal Representative." 2 GR.UM' & ASSOCIATES, P. C. Bradley L. Griffie, Esquire Hannah Herman -Snyder, Esquire Robin J. Bassett Office Manager Kelly L. Perez Legal Assistant Reply to: Carlisle David A. Baric, Esquire Baric & Scherer 19 West South Street Carlisle, PA i 7 013 Jerome J. Phoenix 1205 South 28th Street Harrisburg, PA 17111 Attorneys and Counselors at Law April 2, 2014 RE: HCR Manorcare Inc. vs. Jerome J. Phoenix No. 2013-6735 — Civil Term Arbitration Proceedings Dear Mr. Baric and Mr. Phoenix: 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 100 Lincoln Way East, Suite D Chambersburg, PA 17201 (717) 267-1350 (800) 347-5552 Fax (717) 243-5063 Enclosed herein please find an Amended Notice of Hearing. Due to circumstances beyond our control, the hearing needed to be continued to a later date. It is now scheduled for Tuesday, April 29, 2014 to begin at 1:30 p.m. here at my office in Carlisle. As Mr. Baric has already provided information relative to witnesses and exhibits, I want to remind Mr. Phoenix of his obligation to attend to that matter pursuant to the terms of the Notice. Please see that all information is exchanged within the time frames provided. BLG/klp Enclosure Cc: ' Hubert X. Gilory, Esquire (with enclosure) Nathan C. Wolf, Esquire (with enclosure) EXHIBIT "B" • 4"•-• t: HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. : NO.2013-6735 CIVIL TERM JEROME J. PHOENIX, : CIVIL ACTION - LAW Defendant AMENDED NOTICE OF HEARING J AND NOW this day of April, 2014, it is hereby directed that the hearing in the above captioned action previously scheduled for Tuesday, April 22, 2014 to begin at 9:00 a.m. is hereby continued to Tuesday, April 29, 2014 at 1:30 p.m., said Arbitration Hearing to be held at the law offices of Griffie & Associates, P.C., 200 North Hanover Street, Carlisle, Pennsylvania, 17013. Each party shall provide the other party with the full name, title, address, and phone number, and an outline of intended testimony for all prospective witnesses who are intended to be called as witnesses at the time of the hearing. In addition, each party shall provide the other with a list of all documents to be relied upon at the hearing and intended to be used as evidence at the hearing, except documents to be used solely for impeachment purposes. In the event either party intends to use sworn recorded statements as evidence, or otherwise to be relied upon at the hearing, such sworn recorded statements shall be provided to the other party along with the full name, title, address and telephone number of the statements' Declarant. All such documentation and information shall be provided to the other party by no later than April 9, 2014. The hearing shall proceed pursuant to the terms of the Voluntary Arbitration Agreement executed by the parties or their representative on June 12, 2012. 4rl)')11 Date Distribution: David A. Baric, Esquire Counsel for Plaintiff Jerome J. Phoenix Defendant Hubert X. Gilroy, Esquire Arbitrator Nathan C. Wolf, Esquire Arbitrator 1171-1 riffi , Esquire 1ti"Qtor Supreme Cou ID No. 34349 GRIFFIE & ASSOCIATES, P.C. 200 North Hanover Street Carlisle, PA 17013 (717)243-5551 (800)347-5552 HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. JEROME J. PHOENIX, Defendant : NO. 2013-6735 CIVIL TERM : CIVIL ACTION - LAW ARBITRATION PANEL DECISION AND AWARD I. PROCEDURAL HISTORY: By correspondence of November 8, 2013, counsel for 1CR ManorCare, Inc. (hereinafter "the facility") requested the services of Bradley L. Griffie, Esquire, to serve as Arbitrator pursuant to the terms of an Arbitration Agreement executed by a representative of the facility and by Vincent L. House, II (hereinafter "Legal Representative") as Legal Representative and Power of Attorney for Jerome Phoenix (hereinafter "Patient"). Upon Petition filed by counsel for HCR Manorcare, Inc., the Court of Common Pleas of the 9th Judicial District, Cumberland County Branch, appointed Hubert X. Gilroy, Esquire to serve as Arbitrator for Patient by Order of Court dated February 28, 2014. Arbitrators Bradley L. Griffie, Esquire and Hubert X. Gilroy, Esquire selected Nathan C. Wolf, Esquire to serve as the third Arbitrator pursuant to the terms of the aforesaid Arbitration Agreement. By correspondence and Notice of Hearing dated February 17, 2014. from the Arbitrator, Bradley L. Griffie, Esquire, a hearing was scheduled in this matter to take place on Tuesday, April 22, 2014, to begin at 9:00 a.m. at 200 North Hanover Street, Carlisle, Cumberland County, Pennsylvania. No Notices were returned to the mailer, Arbitrator, Bradley L. Griffie, Esquire. A request for a change in the hearing date by facility resulted in a rescheduling of the hearing to Tuesday, April 29, 2014 at 1:30 p.m. EXHIBIT 'IC" By correspondence dated February 20, 2014, the facility gave notice to the Arbitrators and Patient of the facility's intended witnesses and exhibits, pursuant to the requirements of the Arbitration Agreement. Appearing at the hearing before the Arbitration Panel on Tuesday, April 29, 2014, were Steven Viganti, Business Office Manager for HCR ManorCare, Inc. and David A. Baric, Esquire for HCR ManorCare, Inc. II. FINDINGS OF FACT: 1. On June 12, 2012, Vincent L. House, II, (hereinafter "Legal Representative"), executed an Admissions Agreement and an Arbitration Agreement associated with the Patient's admission to the facility located at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania, on behalf of Patient, as Patient's Legal Representative. 2. Paragraph 3.2 of the referenced Admission Agreement provided confirmation from Patient, through his Legal Representative, that he would pay the room and board rates to the facility, exclusive of expenses covered by insurance, Medicaid, Medicare, Veteran's Administration payments, or related payments made on behalf of the Patient. 3. Pursuant to paragraph 3.2A of the said Admission Agreement, Patient agreed, through his Legal Representative, that he would pay all charges that he incurred while at the facility located at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania. 4. Patient, through his Legal Representative, agreed to room and board charges as described in the Attachment A to the Admission Agreement. 5. Facility assisted Patient in securing Medicaid coverage for Patient's expenses associated with his residency at the Facility. 6. Statements of charges were submitted to Patient and Legal Representative for the period from June 12, 2012 through and including the period covering October 4, 2013, for room and board services and related charges, which charges were billable on a private pay basis. 7. Patient exited the facility permanently on October 4, 2013 at which time all appropriate insurance payments or applicable payments from Medicare or Medicaid have been applied to the outstanding bill of the Patient by the facility. 8. The facility billed Patient directly and through his Legal Representative on a monthly basis for services provided to Patient. 9. The facility provided monthly past -due notices to the Patient directly and through his Legal Representative for fees due to the facility for services rendered which remained unpaid. 10. Neither Patient, his Legal Representative; nor anyone on his behalf, objected to the billings. 11. All payments made to the facility from all sources have been applied to Patient's billing for services provided by the facility. 12. While some private payments have been received, an outstanding balance remains due for services provided to Patient by the facility for which private payment is still due. 13. Patient failed to pay his obligated Private Pay Portion for services of the facility. 14. The total balance due for services provided to Patient from June 12, 2012 to October 4, 2013, which remained due and owing at the time of the hearing, is $5,786.76. 15. Pursuant to paragraph 10 of the Arbitration Agreement executed between the parties, in a dispute over non-payment of facility charges, the Arbitration panel's fees will be paid equally by the parties. 16. The dispute between the parties in this matter involved the non-payment of charges. 17. The facility made a formal Demand for Arbitration pursuant to the terms of the Arbitration Agreement upon Patient individually and through her Legal Representative. 18. Proper notice of the time and place of the hearing was provided to the facility and to Patient pursuant to the terms of the Arbitration Agreement. 19. No request for a continuance, or other contact, was made by Patient or by Legal Representative with any of the Arbitrators prior to the hearing. 20. The hearing began at 1:30 p.m. on Tuesday, April 29, 2014 at 200 North Hanover Street, Carlisle, Cumberland County, Pennsylvania. 21. The Arbitrators are not aware of any efforts made by Patient or his Legal Representative to contact any of the Arbitrators relative to Patient's inability to attend the hearing, but Legal Representative did contact Arbitrator, Bradley L. Griffie, Esquire, prior to the hearing to advise him that neither Legal Representative nor Patient would be attending the hearing. III. CONCLUSIONS OF LAW: Patient, Jerome J. Phoenix, (hereinafter "Patient") through his Legal Representative, Vincent L. House, II (hereinafter "Legal Representative"), entered into the terms and conditions of the Admission Agreement and the Arbitration Agreement executed by the Patient's Legal Representative, with the facility, HCR ManorCare, Inc., on June 12, 2012. The contracts are binding and provide all appropriate notices pursuant to Pennsylvania law. The binding Arbitration Agreement provides that all claims and controversies between the facility and Patient will be resolved through application of the terms of the Arbitration Agreement. Patient has failed to meet Patient's obligations under the terms of the Admission Agreement to compensate the facility for services provided to Patient. Legal Representative also serves as Patient's Power of Attorney. Proper notice of services rendered and fees incurred was provided by the facility to Patient pursuant to the terms of the Admission Agreement. The parties and legal counsel received proper notice of all proceedings under the Arbitration Agreement, including Notice of the hearing. ARBITRATORS' AWARD Pursuant to the findings set forth herein, Judgment is hereby entered against Jerome J. Phoenix, in favor of HCR ManorCare, Inc. in the amount of $5,786.76. Arbitrator's fees for the Arbitration Hearing are awarded in the amount of $600.00 ($150.00 each for Arbitrators Hubert S. Gilroy, Esquire and Nathan Wolf, Esquire, and $300.00 for Arbitrator Bradley L. Griffie) and shall be divided equally between the parties such that HCR ManorCare, Inc. shall compensate the Arbitrator for their fees in the sum of $300.00 and Jerome J. Phoenix shall likewise compensate the Arbitrators for their fees in the sum of $300.00. In the event that HCR ManorCare, Inc. compensates the Arbitration Administrator in the full amount of fees and costs due, HCR ManorCare's Judgment is adjusted from the $5,786.76 amount set forth above to include the share of Arbitrator's fees of Jerome J. Phoenix in the amount of $300.00 for a total Judgment of $6,086.76. Hubert X. Gilroy, Es tare Arbitrator Nath..- _ olf, Esquire ato iffie, Esquire HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. JEROME J. PHOENIX, Defendant : NO.2013-6735 CIVIL TERM : CIVIL ACTION - LAW CERTIFICATE OF SERVICE sr I, Bradley L. Griffie, Esquire hereby certify that I did, the di day of May, 2014, cause a copy of the Arbitration Panel Decision and Award to be served upon the Plaintiff and Defendant by serving them by first class mail, postage prepaid, and certified mail, at the following addresses: DATE: { y David A. Baric, Esquire 19 West South Street Carlisle, PA 17013 Jerome J. Phoenix 1205 South 28th Street Harrisburg, PA 17111 riff] • , Esquire or Supreme Court ID No. 34349 GRIFFIE & ASSOCIATES, P.C. 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 CERTIFICATE OF SERVICE I hereby certify that on May 27, 2014, I, David A. Baric, Esquire of Baric Scherer LLC, did serve a copy of the Application To Confirm Arbitration Award, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Jerome J. Phoenix 1205 South 28th Street Harrisburg, Pennsylvania 17111 David A. Baric, Esquire HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION — LAW JEROME J. PHOENIX, Respondent : NO. 13-6735 CIVIL TERM IN RE: APPLICATION TO CONFIRM ARBITRATION AWARD ORDER OF COURT AND NOW, this 10th day of June, 2014, upon consideration of Plaintiff's Application To Confirm Arbitration Award, a Rule is hereby issued upon Defendant to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. BY THE COURT, Chrislee L. Peck, J. Xavid A. Baric, Esq. 19 West South Street Carlisle, PA 17013 Attorney for Petitioner Jerome J. Phoenix 1205 South 28th Street Harrisburg, PA 17111 Defendant, pro Se :rc co? 'es ifla,'L HCR MANORCARE, INC., IN THE COURT OF COMMON PLEAS OF Petitioner CUMBERLAND COUNTY, PENNSYLLANI'A v. NO. 2013-6735 CIVIL TERM JEROME J. PHOENIX, CIVIL ACTION -LAW Respondent : MOTION TO MAKE RULE ABSOLUTE AND NOW, comes Petitioner, HCR ManorCare, Inc., by and through its attorneys, Baric Scherer LLC, and files the within Motion to Make Rule Absolute and, in support thereof, sets forth the following: 1. Plaintiff filed an Application To Confirm Arbitration Award in this matter on or about May 28, 2014 a true and correct copy of said Application is attached hereto as Exhibit "A" and is incorporated. 2. By Order of Court dated June 10, 2014, the Respondent was to show cause why the court should not confirm Petitioner's Application To Confirm Arbitration Award within twenty (20) days of service. A true and correct copy of the Rule is attached hereto as Exhibit "B" and is incorporated. 3. To July 3, 2014, no response has been filed by the Respondent. WHEREFORE, Plaintiff requests confirmation of the arbitration award in this matter in the amount of $6,086.76 and a judgment entered of record in this matter. Respectfully submitted, RIC SCHERER LL David A. Baric, Esquire I.D. # 44853 19 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 HCR MANORCARE, INC., Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLV/WIA, rn rt.% -;f4. rn r."1) '1712 IN? 0 - co -0 r-,:ts c.? 7 7.r.. i•-•3 v. NO. 2013-6735 CIVIL FERM JEROME J. PHOENIX, CIVIL ACTION -LAW Defendant APPLICATION TO CONFIRM ARBITRATION AWARD NOW, comes HCR ManorCare, Inc., Plaintiff, by and through its attorneys, BARIC SCHERER LLC, and files the within Application to Confirm Arbitration Award and, in support thereof, sets forth the following: 1. The parties to this matter were bound by a certain Arbitration and Limitation of Liability Agreement, a true and correct copy of which is attached hereto as Exhibit "A" and is incorporated by reference. 2. A dispute arose amongst the parties and HCR ManorCare sought arbitration of the dispute under the terms of the Arbitration and Limitation of Liability Agreement. 3. Arbitration was held before Bradley L. Griffie, Esquire, Hubert X. Gilroy and Nathan C. Wolf, Esquire after their appointment as arbitrators. 4. Bradley L. Griffie, Esquire as arbitration administrator, served the Defendant with notice of the arbitration hearing. Proof of said service is attached hereto as Exhibit "B" and is incorporated by reference. 5. The arbitrators have rendered an Arbitrators' Decision and Award in this matter a true and correct copy of which is attached hereto as Exhibit "C" and is incorporated by reference. EXHIBIT "A" 6. Pursuant to 42 Pa.C.S.A. §7313, a party to an arbitration may make application to the Court of Common Pleas for confirmation of the award by the Court. 7. Pursuant to 42 Pa.C.S.A. §7316, upon confirmation of the award, a judgment or decree shall be entered in conformity with the order. 8. Copies of the Arbitrators' Award was mailed to all of the parties on May 21, 2014. 9. No request for modification or correction of the award has been filed by the Defendant to the date of this application. WHEREFORE, Applicant requests that the award of the arbitration administrator be confirmed and judgment be entered in conformance therewith. Respectfully submitted, BARIC SCHERER LLC David A. Baric, Esquire I.D.# 44853 19 West South Street Carlisle, PA 17013 (717) 249-6873 Attorney for HCR ManorCare, Inc. VOLUNTARY ARBITRATION AGREEMENT ("AGREEMENT") THE PARTIES ARE WAIVING THEIR RIGHT TO A TRIAL BEFORE A JUDGE OR JURY OF ANY DISPUTE BETWEEN THEM. PLEASE READ CAREFULLY BEFORE SIGNING. THE PATIENT WILL RECEIVE SERVICES IN THIS CENTER WHETHER OR NOT THIS AGREEMENT IS SIGNED. ARBITRATION IS DESCRIBED IN THE VOLUNTARY ARBITRATION PROGRAM BROCHURE COPY, ATTACHED AND MADE PART OF THIS AGREEMENT. Made on Representative MC 2. (date) by and between the Patient s/�Cyye. Pho Patient's Legal / eh ]-/*)u ,, (collectively referred to as "Patient") and the Center (i . 1. Agreement to Arbitrate "Disputes": All claims arising out of or relating to this Agreement, the Admission Agreement or any and all past or future admissions of the Patient at this Center, or any sister Center operated by any subsidiary of HCR ManorCare, Inc.("Sister Center"), including claims for malpractice, shall be submitted to arbitration. Nothing in this Agreement prevents the Patient from filing a complaint with the Center or appropriate governmental agency or from seeking review under any applicable law of any decision to involuntarily discharge or • transfer the Patient. 2. Demand for Arbitration: shall be written, sent to the other Party by certified mail, return receipt requested. 3. FAA: The Parties agree and intend that this Agreement, the Admission Agreement and the Patient's stays at the Center substantially involve interstate commerce, and stipulate that the Federal Arbitration Act ("FAA") and applicable federal case law apply to this Agreement, preempt any inconsistent State law and shall not be reverse preempted by the McCarran-Ferguson Act; United States Code Title 15, Chapter 20, or other law. Any amendment to such version of the FAA is hereby expressly waived. 4. Arbitration Panel: Three (3) arbitrators (the "Panel") shall conduct the arbitration. Each Party will select one Arbitrator, the two selected Arbitrators will select a third. Each Arbitrator must be a retired State or Federal Judge or a Member of the State Bar where the Center is located with at least 10 years of experience as an attorney. The Panel will elect a Chief Arbitrator who will be responsible for establishing and resolving issues pertaining to procedure, discovery, admissibility of evidence, or any other issue. 5. Sole Decision Maker: Except as otherwise provided in 6 below, the Panel is empowered to, and shall, resolve all disputes, including without limitation, any disputes about the making, validity, enforceability, scope, interpretation, voidability, unconscionability, preemption, severability and/or waiver of this Agreement or the Admission Agreement, as well as resolve the Parties' underlying disputes, as it is the Parties' intent to avoid involving the court system. The Panel shall not have jurisdiction to certify any person as a representative of a class of persons and, by doing so, adjudicate claims of persons not directly taking part in Arbitration. 6. Procedural Rules and Substantive Law: The Panel shall apply the State Rules of Evidence and State Rules of Civil Procedure except where otherwise stated in this Agreement. Also, the Panel shall apply, and the arbitration award shall be consistent with, the State substantive law, including statutory damage caps, for the State in which the Center is located, except as otherwise stated in this Agreement or where preempted by the FAA. The Panel's award must be unanimous and shall be served no later than 7 working days after the arbitration hearing. The award must ;tate the Panels' findings of fact and conclusions of law, shall be marked "confidential", and must be signed by all three Arbitrators. If any damages are awarded, the award must delineate specific amounts for each type of damages awarded, i.e. economic, non -economic, etc. The failure of the Panel to issue a unanimous award creates an Lppealable issue, appealable to the appropriate court, in addition to those set forth in paragraph 7, below. In the ;vent the appellate court finds a non -unanimous award invalid as against law or this Agreement, the award shall be 'acated and the arbitration dismissed without prejudice. A subsequent arbitration, if any, of the same claim or ,laims shall remain subject to the terms of this Agreement. '. Final with Limited Rights to Review (Appeal): The Panel's award binds the Parties. The Parties have a imited right of appeal for only the express reasons allowed by the FAA or as provided in 6, above. EXHIBIT "A" 8. Right to Change Your Mind: This Agreement may be cancelled by written notice sent by certified mail to the Center's Administrator within 30 calendar days of the Patient's date of admission. If alleged acts underlying the dispute occur before the cancellation date, this Agreement shall be binding with respect to those alleged acts. if not cancelled, this Agreement shall be binding on the Patient for this and all of the Patient's subsequent admissions to the Center or any Sister Center without any need for further renewal. 9. Binding on Parties & Others: The Parties intend that this Agreement shall benefit and bind the Center, its parent, affiliates, and subsidiary companies, and shall benefit and bind the Patient (as defined herein), his/her successors, spouses, children, next of kin, guardians, administrators, and legal representatives. 10. Fees and Costs: The Panels' fees and costs will be paid by the Center except in disputes over non-payment of Center charges wherein such fees and costs will be divided equally between the Parties. The Parties shall bear their own attorney fees and costs in relation to all preparation for and attendance at the arbitration hearing. 11. Confidentiality: The arbitration proceedings shall remain confidential in all respects, including all filings, deposition transcripts, discovery documents, or other materials exchanged between the Parties and the Panels' award. In addition, following receipt of the Panels' award, each Party agrees to return to the producing Party within 30 days the original and all copies of documents exchanged in discovery and at the arbitration Hearing. 12. Non -waiver of this Agreement: A waiver of the right to arbitrate a specific Dispute or series of Disputes, as iescribed above, does not relieve any Party from the obligation to arbitrate other Disputes, whether asserted as Independent claims or as permissive or mandatory counterclaims, unless each such claim is also individually waived. With multiple Patient admissions, the presentation of an arbitration agreement at a later admission to the :enter or a Sister Center shall not constitute a waiver by the Center of a prior signed arbitration agreement. 3. Severability: Except as provided in 6, any provision contained in this Agreement is severable, and if a srovision is found to be unenforceable under State or Federal law, the remaining provisions of this Agreement shall amain in force and. effect. This Agreement represents the Parties' entire agreement regarding Disputes, supersedes ny other agreement relating to disputes, and may only be changed in writing signed by all Parties. This Agreement hall remain in full force and effect notwithstanding the termination, cancellation or natural expiration of the ,dmission Agreement. 4. Health Care Decision: The Parties hereby stipulate that the decision to have the Patient move into this Center id the decision to agree to this Agreement are each a health care decision. The Parties stipulate that there are other ,alth care facilities in this community currently available to meet the Patient's needs. HE PARTIES CONFIRM THAT EACH OF THEM UNDERSTANDS THAT EACH HAS WAIVED IBE IGHT TO TRIAL BEFORE A JUDGE OR JURY AND THAT EACH CONSENTS TO ALL OF THE ERMS OF THIS VOLUNTARY AGREEMENT. PA'T1 NT ACKNOWLEDGES THE RIGHT TO EVIEW THIS AGREEMENT WITH AN ATTORNEY OR FAMILY BEFORE SIGNING. kTIENT: 17;r6?A4 /6( e (Date) inted Name ;nature of Patient :NTER REPRESENTATIVE r PATIENT'S LEGAL REPRESENTATIVE: wee u 1. dere er Printed " ame / (Date) Signa re of Patient's Legal Representative' in his/her Repr- entative capacity ign ture of Patie t s Legal Representative in his/her Individual capacity Patie s Legal Representative should sign on both lines above containing the phrase "Patient's Legal Representative." GRrggrE &.2ssocIATEs, P.C. Attorneys and Counselors at Law 200 North Hanover Street Bradley L. Griffie, Carlisle, PA 17013 (717) 243-5551 Esquire iannah Herman -Snyder, 100 Lincoln Way East, Suite D Esquire Chambersburg, PA 17201 (717) 267-1350 Robin J. Bassett Office Manager Kelly L. Perez Legal Assistant Reply to: Carlisle April 2, 2014 David A. Baric, Esquire Baric & Scherer 19 West South Street Carlisle, PA i 7013 Jerome J. Phoenix 1205 South 28th Street Harrisburg, PA 17111 RE: HCR Manorcare Inc. vs. Jerome J. Phoenix No. 2013-6735 — Civil Term Arbitration Proceedings Dear Mr. Baric and Mr. Phoenix: (800) 347-5552 Fax (717) 243-5063 Enclosed herein please fmd an Amended Notice of Hearing. Due to circumstances beyond our control, the hearing needed to be continued to a later date. It is now scheduled for Tuesday, April 29, 2014 to begin at 1:30 p.m. here at my office in Carlisle. As Mr. Baric has already provided information relative to witnesses and exhibits, I want to remind Mr. Phoenix of his obligation to attend to that matter pursuant to the terms of the Notice. Please see that all information is exchanged within the time frames provided. BLG/klp Enclosure Cc: ' Hubert X. Gilory, Esquire (with enclosure) Nathan C. Wolf, Esquire (with enclosure) EXHIBIT "B" ritetived, HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA VS. JEROME J. PHOENIX, Defendant : NO. 2013-6735 CIVIL TERM : CIVIL ACTION - LAW AMENDED NOTICE OF HEARING „ AND NOW this .4 day of April, 2014, it is hereby directed that the hearing in the above captioned action previously scheduled for Tuesday, April 22, 2014 to begin at 9:00 a.m. is hereby continued to Tuesday, April 29, 2014 at 1:30 p.m., said Arbitration Hearing to be held at the law offices of Griffie & Associates, P.C., 200 North Hanover Street, Carlisle, Pennsylvania, 17013. Each party shall provide the other party with the full name, title, address, and phone number, and an outline of intended testimony for all prospective witnesses who are intended to be called as witnesses at the time of the hearing. In addition, each party shall provide the other with a list of all documents to be relied upon at the hearing and intended to be used as evidence at the hearing, except documents to be used solely for impeachment purposes. In the event either party intends to use sworn recorded statements as evidence, or otherwise to be relied upon at the hearing, such sworn recorded statements shall be provided to the other party along with the full name, title, address and telephone number of the statements' Declarant. All such documentation and information shall be provided to the other party by no later than April 9, 2014. The hearing shall proceed pursuant to the terms of the Voluntary Arbitration Agreement executed by the parties or their representative on June 12, 2012. Date Distribution: David A. Baric, Esquire Counsel for Plaintiff Jerome J. Phoenix Defendant Hubert X. Gilroy, Esquire Arbitrator Nathan C. Wolf, Esquire Arbitrator 1111.Griff Esquire • it for Supreme Cou ID No. 34349 GRIFFIE & ASSOCIATES, P.C. 200 North Hanover Street Carlisle, PA 17013 (717)243-5551 (800)347-5552 HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. JEROME J. PHOENIX, Defendant : NO. 2013-6735 CIVIL TERM : CIVIL ACTION - LAW ARBITRATION PANEL DECISION AND AWARD L PROCEDURAL HISTORY: By correspondence of November 8, 2013, counsel for 1-ICR ManorCare, Inc. (hereinafter "the facility") requested the services of Bradley L. Griffie, Esquire, to serve as Arbitrator pursuant to the terms of an Arbitration Agreement executed by a representative of the facility and by Vincent L. House, II (hereinafter "Legal Representative") as Legal Representative and Power of Attorney for Jerome Phoenix (hereinafter "Patient"). Upon Petition filed by counsel for HCR Manorcare, Inc., the Court of Common Pleas of the 9th Judicial District, Cumberland County Branch, appointed Hubert X. Gilroy, Esquire to serve as Arbitrator for Patient by Order of Court dated February 28, 2014. Arbitrators Bradley L. Griffie, Esquire and Hubert X. Gilroy, Esquire selected Nathan C. Wolf, Esquire to serve as the third Arbitrator pursuant to the terms of the aforesaid Arbitration Agreement. By correspondence and Notice of Hearing dated February 17, 2014. from the Arbitrator, Bradley L. Griffie, Esquire, a hearing was scheduled in this matter to take place on Tuesday, April 22, 2014, to begin at 9:00 a.m. at 200 North Hanover Street, Carlisle, Cumberland County, Pennsylvania. No Notices were returned to the mailer, Arbitrator, Bradley L. Griffie, Esquire. A request for a change in the hearing date by facility resulted in a rescheduling of the hearing to Tuesday, April 29, 2014 at 1:30 p.m. EXHIBIT "C" By correspondence dated February 20, 2014, the facility gave notice to the Arbitrators and Patient of the facility's intended witnesses and exhibits, pursuant to the requirements of the Arbitration Agreement. Appearing at the hearing before the Arbitration Panel on Tuesday, April 29, 2014, were Steven Viganti, Business Office Manager for HCR ManorCare, Inc. and David A. Baric, Esquire for HCR ManorCare, Inc. II. FINDINGS OF FACT: 1 On June 12, 2012, Vincent L. House, II, (hereinafter "Legal Representative"), executed an Admissions Agreement and an Arbitration Agreement associated with the Patient's admission to the facility located at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania, on behalf of Patient, as Patient's Legal Representative. 2. Paragraph 3.2 of the referenced Admission Agreement provided confirmation from Patient, through his Legal Representative, that he would pay the room and board rates to the facility, exclusive of expenses covered by insurance, Medicaid, Medicare, Veteran's Administration payments, or related payments made on behalf of the Patient. Pursuant to paragraph 3.2A of the said Admission Agreement, Patient agreed, through his Legal Representative, that he would pay all charges that he incurred while at the facility located at 1700 Market Street, Camp Hill, Cumberland County, Pennsylvania. 4. Patient, through his Legal Representative, agreed to room and board charges as described in the Attachment A to the Admission Agreement. 5. Facility assisted Patient in securing Medicaid coverage for Patient's expenses associated with his residency at the Facility. 6. Statements of charges were submitted to Patient and Legal Representative for the period from June 12, 2012 through and including the period covering October 4, 2013, for room and board services and related charges, which charges were billable on a private pay basis. 7. Patient exited the facility permanently on October 4, 2013 at which time all appropriate insurance payments or applicable payments from Medicare or Medicaid have been applied to the outstanding bill of the Patient by the facility. 8. The facility billed Patient directly and through his Legal Representative on a monthly basis for services provided to Patient. 9. The facility provided monthly past -due notices to the Patient directly and through his Legal Representative for fees due to the facility for services rendered which remained unpaid. 10. Neither Patient, his Legal Representative, nor anyone on his behalf, objected to the billings. 11. All payments made to the facility from all sources have been applied to Patient's billing for services provided by the facility. 12. While some private payments have been received, an outstanding balance remains due for services provided to Patient by the facility for which private payment is still due. 13. Patient failed to pay his obligated Private Pay Portion for services of the facility. 14. The total balance due for services provided to Patient from June 12, 2012 to October 4, 2013, which remained due and owing at the time of the hearing, is $5,786.76. 15. Pursuant to paragraph 10 of the Arbitration Agreement executed between the parties, in a dispute over non-payment of facility charges, the Arbitration panel's fees will be paid equally by the parties. 16. The dispute between the parties in this matter involved the non-payment of charges. 17. The facility made a formal Demand for Arbitration pursuant to the terms of the Arbitration Agreement upon Patient individually and through her Legal Representative. 18. Proper notice of the time and place of the hearing was provided to the facility and to Patient pursuant to the terms of the Arbitration Agreement. 19. No request for a continuance, or other contact, was made by Patient or by Legal Representative with any of the Arbitrators prior to the hearing. 20. The hearing began at 1:30 p.m. on Tuesday, April 29; 2014 at 200 North Hanover Street, Carlisle, Cumberland County, Pennsylvania. 21. The Arbitrators are not aware of any efforts made by Patient or his Legal Representative to contact any of the Arbitrators relative to Patient's inability to attend the hearing, but Legal Representative did contact Arbitrator, Bradley L. Griffie, Esquire, prior to the hearing to advise him that neither Legal Representative nor Patient would be attending the hearing. III. CONCLUSIONS OF LAW: Patient, Jerome J. Phoenix, (hereinafter "Patient") through his Legal Representative, Vincent L. House, II (hereinafter "Legal Representative"), entered into the terms and conditions of the Admission Agreement and the Arbitration Agreement executed by the Patient's Legal Representative, with the facility, HCR ManorCare, Inc., on June 12, 2012. The contracts are binding and provide all appropriate notices pursuant to Pennsylvania law. The binding Arbitration Agreement provides that all claims and controversies between the facility and Patient will be resolved through application of the terms of the Arbitration Agreement. Patient has failed to meet Patient's obligations under the terms of the Admission Agreement to compensate the facility for services provided to Patient. Legal Representative also serves as Patient's Power of Attorney. Proper notice of services rendered and fees incurred was provided by the facility to Patient pursuant to the terms of the Admission Agreement. The parties and legal counsel received proper notice of all proceedings under the Arbitration Agreement, including Notice of the hearing. ARBITRATORS' AWARD Pursuant to the findings set forth herein, Judgment is hereby entered against Jerome J. Phoenix, in favor of HCR ManorCare, Inc. in the amount of $5,786.76. Arbitrator's fees for the Arbitration Hearing are awarded in the amount of $600.00 ($150.00 each for Arbitrators Hubert S. Gilroy, Esquire and Nathan Wolf, Esquire, and $300.00 for Arbitrator Bradley L. Griffie) and shall be divided equally between the parties such that HCR ManorCare, Inc. shall compensate the Arbitrator for their fees in the sum of $300.00 and Jerome J. Phoenix shall likewise compensate the Arbitrators for their fees in the sum of $300.00. In the event that HCR ManorCare, Inc. compensates the Arbitration Administrator in the full amount of fees and costs due, HCR ManorCare's Judgment is adjusted from the $5,786.76 amount set forth above to include the share of Arbitrator's fees of Jerome J. Phoenix in the amount of $300.00 for a total Judgment of $6,086.76. Hubert X. Gilroy, Es uire Arbitrator r ,/1 /././ ,.// Nath olf, Esquire Arb ffie, Esquire HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA vs. JEROME J. PHOENIX, Defendant : NO. 2013-6735 CIVIL TERM : CIVIL ACTION - LAW CERTIFICATE OF SERVICE sr I, Bradley L. Griffie, Esquire hereby certify that I did, the di day of May, 2014, cause a copy of the Arbitration Panel Decision and Award to be served upon the Plaintiff and Defendant by serving them by first class mail, postage prepaid, and certified mail, at the following addresses: DAIE: 11/4i David A. Baric, Esquire 19 West South Street Carlisle, PA 17013 Jerome J. Phoenix 1205 South 28th Street Harrisburg, PA 17111 or Supreme Court ID No. 34349 GRIFFIE & ASSOCIATES, P.C. 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 iff , Esquire CERTIFICATE OF SERVICE I hereby certify that on May 27, 2014, I, David A. Baric, Esquire of Baric Scherer LLC, did serve a copy of the Application To Confirm Arbitration Award, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Jerome J. Phoenix 1205 South 28th Street Harrisburg, Pennsylvania 17111 David A. Baric, Esquire HCR MANORCARE, INC., : IN THE COURT OF COMMON PLEAS OF Petitioner : CUMBERLAND COUNTY, PENNSYLVANIA v. : CIVIL ACTION — LAW JEROME J. PHOENIX, Respondent : NO. 13-6735 CIVIL TERM IN RE: APPLICATION TO CONFIRM ARBITRATION AWARD ORDER OF COURT AND NOW, this 10th day of June, 2014, upon consideration of Plaintiff's Application To Confirm Arbitration Award, a Rule is hereby issued upon Defendant to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. 21vid A. Baric, Esq. 9 West South Street Carlisle, PA 17013 Attorney for Petitioner Jerome J. Phoenix 1205 South 28th Street Harrisburg, PA 17111 Defendant, pro Se :rc BY THE COURT, Chris lee L. Peck, J. EXHIBIT "B" CD -r1 C CERTIFICATE OF SERVICE I hereby certify that on July 8, 2014, I, David A. Baric, Esquire of Baric Scherer LLC, did serve a copy of Motion To Make Rule Absolute, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Jerome Phoenix 1205 South 28th Street Harrisburg, Penns lvania 17111 David A. Baric, Esquire HCR MANORCARE, INC., IN THE COURT OF COMMON PLEAS OF Petitioner CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 2013-6735 CIVIL TERM JEROME J. PHOENIX, CIVIL ACTION -LAW Respondent : ORDER OF COURT AND NOW, this / 1 ' day of , 2014, upon review of the attached Motion To Make Rule Absolute, it is hereby ordered and decreed that Rule previously issued relative to this matter is absolute and the arbitration award is confirmed and a judgment in the amount of $6,086.76 is entered of record in this matter BY THE COURT, CA/c-t- ZieCaC_ David A. Baric, Esquire Baric Scherer LLC 19 West South Street Carlisle, Pennsylvania 17013 Jerome Phoenix 1205 South 28th Street Harrisburg, Pennsylvania 17111 c: -ca •,rye pt E - 174 s LO CF) 17 D//� t r1 5