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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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IN RE: ) No. � of 2013 ,:,�� � � � �
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SAM C. HANIKSON, ) � � �'' � �''' �"
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An Alleged Incapacitated Person ) �a. � m o M +�
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PETITION FQR RULE TO SHOW CAUSE WHY AGENT UNQE , �'R � �
ATTORNEY SHOULD N4T BE ORDERED TO FILE AN ACCOUNT�,A►, ' REMO�VEL'� r�
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TO THE HONORABLE, THE JUDGES OF SAID C(�URT:
Petitioner, Golden Living Center-West Shore ("Golden Living Center"), files this Petition
for Rule to Show Cause Why Agent Under Power of Attorney Should Not Be Ordered to File an
Account and Removed (the "Petition") and states as follows:
1. Sam C. Hanikson ("Mr. Hanikson") is a ninety-five (95) year old male, having
been born an February 21, 1918.
2. Mr. Hanikson currently resides at Golden Living Center-West Shore, with an
address of 770 Poplar Church Road, Camp Hill, PA 17011, since his initial admission on or
about December 15, 2012.
3. Upon his admission to Golden Living Center, Mr. Hanikson had executed a
Power of Attorney dated as of February 17, 2011 (the "Power of Attorney") appointing Albert A.
Brooks as Agent. A true and correct copy of the Power of Attorney instrument is attached
hereto as Exhibit A. Upon information and belief, Albert A. Brooks is an adult individual with a
last-known address of 25 N. Linden Street, Harrisburg, PA 17103 who has served under the
Power of Attorney instrument since on or about February 17, 2011.
4. Upon admission to Golden Living Center and thereafter, Mr. Hanikson was
determined to be eligible for Medical Assistance Long-Term Care ("MA-LTC") benefits to cover
the costs of his long term care at Golden Living Center.
H BG D 6:140142-1 026135-161675
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5. On or about June 20, 2013, Mr. Hanikson's MA-LTC benefits were denied by the
Department of Public Welfare's Cumberland County Assistance Office as a result of Agent
Albert Brooks's failure to provide required information. A true and correct copy of
documentation relating to this denial is attached hereto as Exhibit B.
6. Petitioner filed a timely appeal and request for review on behalf of Mr. Hanikson
with the Department of Public Welfare regarding the denial of Mr. Hanikson's MA-LTC benefits.
A true and correct copy of the Notice of Pre-Hearing Conference from the Department of
Welfare's Bedford County Assistance Office is attached hereto as Exhibit C.
7. Golden Living Center has endeavored to remind Agent Albert Brooks repeatedly
of the duty to comply with the MA-LTC renewal and to submit the required verification necessary
to cause Mr. Hanikson to receive MA-LTC benefits. A true and correct copy of the
correspondence evidencing such efforts is attached hereto is attached hereto as Exhibit D.
8. Upon information and belief, Agent Albert Brooks has been noncompliant with
the MA-LTC application and verification process and has refused to cooperate with Golden
Living Centers' good-faith efforts.
9. Upon information and belief, Mr. Hanikson may be irreparably harmed if MA-LTC
benefits are not pursued on his behalf, which requires the submission of the requisite
verification. Upon confirmation and belief, because the requisite verification has not been
provided to date, Mr. Hanikson's estate may have been dissipated for the benefit of persons
other than himself.
10. Golden Living Center therefore files this Petition to Show Cause why an Ager�t
under Power of Attorney should not be ordered to file an Account and Removed for failure to
cooperate with the MA-LTC process.
H BG D 6:140142-1 026135-161675
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11. Pursuant to Pennsylvania law, this Court has mandatory jurisdictionai of all
matters pertaining to the exercise of powers by an agent acting under a power of attorney,
including a fiduciary's settlement of account and removal, 20 Pa.C.S §§ 711(12) and (22).
12. Pursuant to Pennsylvania law, an Agent is required to account for his or his
administration of principal's funds "whenever directed to do so by the Court." 20 Pa.C.S. §
5601.
13. Based on the apparent lack of cooperation of Mr. Hanikson's Agent to act on his
behalf and in his best interests, including but not limited to the failure to account for funds and to
pursue MA-LTC benefits, the Court to issue a Rule to Show Cause Why Agent Under Power of
Attorney Should Not Be Ordered to File an Account and Removed.
WHEREFORE, Golden Living-Cumberland files this Petition for Rule to Show Cause
Why Agent Under Power of Attorney Should Not Be Ordered to File an Account and Removed
and respectfully requesting that this Honorable Court issue a rule to show cause in the form
attached hereto to the interested parties directing them to appear before the Court as set forth
hecein, and grant such other relief as may be just and proper under the circumstances.
Date: NOVC�bGr' �q. Zd�3 Respectfully submitted,
TUCKER ARENSBERG, P.C.
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gy 1�e�c-
Kristen Lieb
Pa. I.D. #315373
Nora Gieg Chatha
Pa. I.D. #200446
Tucker Arensberg, P.C.
2 Lemoyne Drive, Suite 200
Lemoyne, PA 17043
Counsel for Golden Living Center-
West Shore
H BG DB:140142-1 026135-161675
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VERIFICATION (`��
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, , in my capacity as for Golden Livmg
Center-West Shore, hereby state that I am authorized to sign this Verification on behalf of Golden
Living Center-Reading and that the fa�ts contained in the foregoing Petition are true and coRect to
the best of my knowledge, information, and belief. This Verification is made subject to the
penalties of 18 Pa.C.S. §4904 relating to unswom falsification to authorities.
Dated: a ' , 2013
nnt Name: Clare Bennett
Print Title: Business Office Manager
Golden Living Center-West Shore
HBGDB:139050-1
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TMRaUGi-i'4U7' YOtJR LI��TfM�, - �N IIFR�:
. �f tNCAPAClT,q�'EI�, UN[,ESS YOU X RESS��R Y4U i3�C(�M�
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f ACTIT�G pIV YOUR BE�ALF T�RMtNAT S Y�URR$ ��A COUR f
AUTE�QR1TY. A�rENT S
Yfl�R A��'r MUST�',EEP YOUR �UT�tDS SEPARAT�FRQM
Y4UR AG�NT'S Fi,INDS,
A CQURT CAN TAK�AW�Y��E p4�WCRS 41� YQUR AG[NT fr•
� IT F1NDS Y0(1R AGEN"F tS NpT AC'1'[NG ���ppLR�Y.
# 7'f-(C PqWFRS AND DU7'!ES Or Ai�i ACiEN
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IF 't'{�tERE 1S A1r�Y7'1•tt1YG�a�U7"TI-I�S 1=QItM 'T'F-��T YUU
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� this Power of Attp�nty to my aforesaid Stcpson, I do so with thc k��pw� b ����� +
� intc�tion he they may exercis�a11 o�'the powers set forth in �his p�„�,�t�d���� I
�ltorney whethec or not t am under�ny d isability to art on my own behnit' �
third parcy deeling with rny afor�said Stcpson�s my Att�rr�ey shall not bc A�y �
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i entitl+�d to reasonable�omprnsatinn far scrvicrs rendered he eunder.�j shAlt!x �
; mY A�tvrtt�Y sh�ll be entitkd to reimbursement tor�ctuul expenscs sd ana��tion. �
bahalf of thc principat �nd to rcasoneble expcnses incurred in co�n��tion wit �n '
�� perfor�t�ance ot'the Atiornay's duties. h the �
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witho�t lin�itation thc c.�xercisc�f options,el�ctions undcr or A�eit�s� w'tlls nnd
� lrusts,re{eases,di�;laimers and renunciatians of interesc, prdperty nnd pow�rs.
Contracts,�nd r�vocable or irrevqcablc trusts !'or my benefit,and to Ctind such ,
�� trusts with property beion�in�to me. '
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an cxtcnt by me for whatevcr rol Icd in any fashion or to �
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� c�do�ny artd a�t thin�s my Attorrtcy dccros �ecess �r$ Aj� �hi�k proper and �
the power to inco 83'Y pPropris[e, including :
rporatc business, the pqwe�to borrow a»d to plcd��asscts,end �
the power to ctose aut, liqu;date,or sctt thc b�siness at such time or upon such '
�crrns as to my Altor��ey shatl dccm bcst, �
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r�habilitation,conv�tles�rnt,mcdica!or similar taci[i R �sidcntial, f
i ��reements for my carc; to cops�ni to sur6ical,thera�ucAiC or Q herr��to
pro�edi�res;and co rtmove anci pEec�me in such institutions or plac s us'mt
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rcbutacions and she�t! have tutl authority to rtview�l�y�nea��a) d�rat 1 tll �tA f
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ar�ther�hird paMy p�yors. �nsun;rs �
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either o�cri�ht ar in trust or, in the case of � YCar per pers�n or entity,
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my��cnts)as oribinaf o�successQ�trus ecs. �his owcr i ��ns,�incfudirtg
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rnake additions ca an existing trust�nd daes not require mn a,u���hc ri�ht io �
don�es equ�fiy or praponiar�atcty and may entirely exclude oht � tO traa�the �
permissible danees and the paE�ern foltowed on thC occas;o�o�aor rn�rc
b��s txed nat be foilowed on the occasion ofAny c�thcr ;1't � �y su���'����
B or b�fts. �
20' ���5�W�'�Y be acceptcd and cetied ttpon b an on �
is pres�nted unti!such p�rsa�cither rrceives written noti�e u Y y c�p��m �t �
� �t'�gunrdian or simtl�r r�u�;a�y'ofmy cstate or l�as uccuaf kn<w���ation by me i
dtath. A c�py shall h�ve chr st�rn�e�'�cct as thr oribinal. ����.my
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2 i. This pawer ot'Attornry sha11 noi t�e a f�' I
I disebifity or in�apacit , atl ccced by my tiubsr �n �
Y acts donc by my a�cnt p�rsu$nt ccr th,s y t i
anY t�"�od of my disabitity or incapgcity shat! have thc�m���- '
pc�wcr durinb �
� my benetit and bind me and my sucressars in intcrest as it' �C�e����ure t�
�i not disabltd, 1 wcre competcnt�nd
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` ���af r�presentativ Y �cnt shall bi�~d�re And m hti ' ' . �
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t�fanikson,who in duc forrn of tav„acknow�� p �����y App���d Sam �
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EXHIBIT "B"
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� Notice ID: 90166fi1035
�:IIM13E�fll/1N0 CAO
:t,i WF::STMINSTER DHIVE
° (:AltlJalE.PA 1701;�-'/�„1lfi . ' ` '
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U�F'�N 1'M�N I' UF PUHL[C MIELt=Al2E
M�l D�te: 06/21/2013
OFFICE OF INCOME MAINTENANCE
Record ID: 21/01T6958 Telephone: 1-800-269-0173
Ggnsc Camp Hitl West Shor NOti�e ID: 9016661035
770 Popiar Church Rd COMPASS: The fast and easy way to apply for benefits
Camp Hili.PA 17011-2302 r1�v.comQass.st�te ua�s
Pennsy/vania r+eceives information from other state and federa/agencies to verify the information you
give them. !f you mjsr�epresen�hlde, or withho/d facts whfch may aHect your eligtbt/fty for benefits,you
may be requfred to repay your benefits,and you may be prosecuted and dfsqualified from r+eceiving
certafn future benefits.
DEAR GGNSC CAMP HILL WEST SHOR,
You have been designated to receive a copy of this notice on behatf of Sam Hanikson
(500157234). Please read further for details.
Which benefit? This is a summary of your benefits. ,
You can find more information inside this letter.
r`�, Medical Assistance � Your eligiblity for benefits has been reviewed and you do not ,
� qualify for Medical Assistance because you did not give us the �
; ; ir�formatron we asked for. Read this letter for more t
� � information. ,,;
. ;
; � �
� ' ; If you do not agree with this decision.fill out the enclosed Fair �
3 4 �
; i Hearing form, then mai!it or give it to your caseworker by July �
� ; 21, 2013. �
. . ..._ .. .... ....... ....___.. _ __.. ., . ._.......... _. _.v_�...__...__.,_.w.._..._.._.._,�_...... ....� :
_��_.. .�.._.....�__......_..._._ ._._......e... .. .........._.._._......... ...,�
`�� � You do not qualiiy for paynte�t of services in a Lon Term ?
y Long Term Care # Care factlity because you did not glve us the information s �
� ; we asked for. Read this!e#ter for more information. � �
� � � �
� � if you do not agree with this decision,fill out the enclosed Fair j
;
: ;; Hearing form, then mail it or give it to your caseworker by July ;
i = _.
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21,2013. ;
___..r. ...._._._......... ....��.._..._.__�_._.._..��._., ........ .,_..__.,..�..,�.�. ...._ .. .____, .._...._. _.... .... ....._.............._�
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tlf you hav� a�disability and need this letter in large print or another format, �
°piease call our helpline at 1-800-692-7462. TDD Services are available at � �
�1-800-451-5886. ; �
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�
lf you do not agr�ee with our decision�you have the right to a Fair Hearing. To learn more about Fair ;.
'':Hearings, read Your Right to Appeal and to a Fair Hearing. � �
�
�
Do you need lega!help? You can get ftee legal help by visiting: �
MIDPENN LEGAL SERVICES at 401-405 LOUTHER STREET,CARLISLE, PA 17013 or by calling{717) ;�
243-9400. ----
Re�ord ID: 21/017fi958 Mail Date: 06/21/2013 PanR 1 nf R PA 1R9 *on�aaa�n���nnnn�n�+�
� � ♦
Notice ID: 9U 1 Ei661 Q:35
'� Your Medical Assistance Benefits
� Who does not qualify?
Who� When?
SAM June 20,2013
This is the law we used to make this
decision: 55 Pa.Code§§ 125.1(d), 155.2,
181.1(d),201.'!, 201.3,201.4, 257.24
SAM:(Starting 06/20/2013)You do not quatify fo�this benefit because you failed to provide information
needed to decide if you qualify.The following information was not received:
;
.
Name(s): Items(s}:
SAM JANIKSON-FORM M3
-MONTHLY PENSION-GROSS AMOUNT
-BANK STATEMENTS OF ANYIALL ACCTS
-APPLICATION Nt?T COMPLETE AS QUESTIONS
-9C,9D,9F NOT ANSWERED.
This information was due by 06/19/13.
�`� Long Term Care
(� Who does not qualify?
Who? When?
°S� June 20, 2013
�
y This is the law we used to make this decision:
55 Pa.Code§§ 125.1(d), 155.2, 181.1(d).
201.1,201.3, 201.4,257.24
}SAM: (Starting 06/20/2013)You do not qualify for payment of services in a Long Term Care facitiry
because you do r�ot qualify for Medical Assistance.
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Notice I D: 90 9 6661�35
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Your Right to Appeal and to a Fair Hearin
g Call the statewic
What does right to appeal mean? Customet Servic
Your right to appeal means that you have the right to ask us to review our decision, if you th�nk that Center at
we made a mistake.You can ask us to review our decision at a fair hearing. 1-877-395-8930.
What is a fair hearing? In Philadelphia,
A Fair hearing is a mee6ng where you, the county assistance office(CAO),and a judge can talk call
about your appeal. 1-215-560-7226.
When can you ask for a fair hearing?
You can ask for a fair hearing if: The call is free.
•you apply for benefits and you get a letter saying you do not qualify,or Call Monday to
•you get a letter saying that your benefits will stop or change, or Friday from 8 a.n
•you do not agree with the amount of your benefit. to 5 p.m.
How can you ask for a fair hearing?
Y�u can call the CAO to ask for a fair hearing if you get a letter telling you about a decision that you think
is wrong. If the decision is for Cash Assistance, Medica!Assistance. Low Income Home Energy
Assistance Program, LIHEAP,or State Supplementary Payment. SSP, you must also complete the
attached Fair Hearing Form. if the decision is for SNAP (Food Stamps)fil{out the form and send it to us.
You do not have to do this, but iYs easier for us to track your appeal if you do.
Do you need lega!help?
You can get free legal help by visiting
MIDPENN LEGAL SERVICES
at 401-405 LOUTHER STREET, CARLISLE, PA 17013 or by calling(717)243-9400.
: , . , .
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�. Choose the kind of fair hearing you want:
. A telephone hearing at a place you choose.Tell us which phone number to use, such as
your own�or a friend or relative's phone number. If you choose this kind of hearing, make sure
we can reach you at this phone number.
► The judge w'tll call you and everyone in your case, such as your witnesses, anyone helping
you,and the CAO.
•A telephone hearing at the CAO.You wiH go to the CAO for your hearing.
► The judge will call you there in the office,and cal!anyone helping you.
• A face-to-face hearing with everyone in the hearing room.
You can choose to have your hearing in Erie,Harrisburg, Philadetphia, Pittsburgh, Plymouth,or
Reading.
► The judge,you,CAO staff,witnesses and anyone helping you will be in the room.
• A face-to-face hearing with some people in the hearing room and some people on the phone.
You can choose to have your hearing in Erie, Harrisburg, Phitadelphia,Pittsburgh, Plymouth,
or Reading.
► You and anyone helping you wiil be in the hearing room with the judge. The CAO staff will be �
on the phone.
Z. Fill out and sign the Fair Hearing Form included in this packet �
3. Mail the form to: CUMBERLAND CAO.33 WESTMINSTER DRIVE
CARLISLE, PA 17013-997fi
or ive this foRn to the CAO. ---
g PAlFS t62 F 10H2
Record ID: 21/0'l76958 Mail Date: 06/21/2013 PanR�nf R *on,aa�,����...............
1 � a
Notice iD: 90t66fi1035
'•For Cash Assistance,Medical Assistance,or SSP, you must m�il�r give the form V .`�; � ' e �
to the CAO within 30 days of the rira�liric�cfate c»i your letter.
•If you are applying for SNAP and you clo not��c�ree with the decision, you must Catl the S#atewide
maii or give the forrn to the CAO w�thin�0 ciays of the mailinc�date�n your letter.
Customer Service
• If you already get SNAP and you do not agree with the decision,you must mail Center at
or give the form to the CAO within 90 days of the�rst day of the rnonth that your 1-877-395-8930.
benefits change.
• For LIHEAP you must mail or give the form to your CAO within 30 days of In Philadelphia,
the mailing date on your letter. ���
Reminder:You may continue to receive your benefits while you wait for your fair heari�g if: 1-215-560-7226.
�. This letter tells you that your benefits will stop or be reduced;and The call is free.
• This letter provides you a date to request an appeal and to continue your Call Monday to
bene�ts while you wait for the Fair Hearing Decision;and Friday from 8 a.m.
• We receive your request fcx appea!by that date;�R to 5 p.m.
• ,
2. This letter telis you that your benefits will stop or be reduced;and
• The reason for this chanqe is because of information you provided on a semiannuai reporting
form;and .
• Your request for appeal is received or postma�ked within 10 days of the mailing date on this
letter.
:x�x �`,��� ' v 'n�
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, �r�r �^:s�'f.'x,a���:- w s•�.,t;��k. ..:r,'*�IL. �
Can you talk with us before the fair hearing?
Yes.You will get a letter from the CAO asking if you want to meet before the fair hearing
takes place.A meeting before the hearing is cailed a pre-hearing conference. This
meeting will not delay or reptace your fair hearing.
You can use this meeting to teU us if you have information that you think might change
our decision.You can bring someone to speak for you if you want to.
Can you get a copy of any information we used to make our decisjon?
Yes, you can ask for a copy of ali the documents that will be used at the hearing.
Who can come to the hearing�
You can bring anyone to the hearing,such as witnesses who might have information.
You can speak for yourseff or bring someone to speak for you who knows more about the
rules of the program.
Whst zf you speak another language,are deaf or have another d�sability?
You can ask for an interpreter or other assistance to be at the fair hearing on the attached
Fair Hearing Form.This is a free service.You may bring a friend or relative to help you at the
hearing,but the department will provide the o�ficia!interpreter.
,*�^�+�a� ,.: t ��•��,.«A;-.4 yr�.�-�...a�..,�%^ rf �R�.
.t;�! , �s"�, ' � �F t r' r �.
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.:.✓�'�..'i�'-� �31i;'�+*��Ny �'.Z�wSwT^ }�"�/• 4� . .
What happens at a fair hearing?
1.The CAO w�l tell you and the judge how they made their decision.You may ask
quest�ons.
2.You will have time to tell the judge your side of the case. Someone can speak for you(if
you want),and your witnesses can speak.You may show documents to the judge.
3.The judge may ask questions.
When will you know what the judge decides?
The judge will send you the decision within 90 days(within 60 days fo� SNAP)of the day you asked
for the hearing.
i ' �
EXH I BIT "C"
i• � ' ►
,
p�nnsylvania
DEPARTMENT OF PUBLIC WEIFARE
NOTICE OF pRE-HEARING CONFERENCE
Bedford County Assistanoe Office
150 North Street
Bedford.PA 15522
{814)623-6127 or(800)542-8584
Fax: (814)623-7310
July 10, 2013
Sam C. Hanikson
Golden Living Center-WS
770 Poplar Church Rd
.
Camp Hiii, PA 17011-2302 �
Re: Sam C. Hanikson
Case Record Number 21 —017695&001
Notice Form PA/FS 162 F, Dtd. 06121/2013, I D#9016661035
PLEASE READ THIS tIYIPORTANT LETTER
YOU MlGHT BE ABLE TO GET BENEFITS SOONER
Mr. Hanikson:
The Caunty Assistance Office(CAO)received your appeal and your request to have a review(hearing) on the
decision on your Tvc�e of Benefits and/or Action.
The Bureau of Hearings and Appeals(BHA)will schedule a hearing on your appeal with an Administrative Law
Judge. You will receive a notice from BHA that teils.you the�me and date for the hearing.
You are encouraged to schedule a meeting with a supervisor or manager at the CAO before the hearing to
discuss the reasons why you disagree with the decision.
Mee�ng with the CAO supervisor or manager gives you the chance to:
• Provide the CAO with new information or copies of documer�ts that may change the decision
• Talk about the decisions with a CAO sta#f person other than your caseworker
• Explain why you think the decision is wrong
• Review the reasons the CAO used to make the decision.
If you present information that changes the CAO's decision, benefits may be authorized or retumed to you.
Even if you meet with the CAO supervisor or manager,you stilt have the right to have a hearing with the BHA.
If you wou�l like to meet with a CAO supervisar or manager before the hearing:
• Please c�mplete and retum the second p�e of this letter to the address listed above, or
>
• Call the telephone number listed at the top of this page.
�
�
��cc: Clare Bennett, Golden Living Center-WS
Bediad Counly Assistar�oe Of'Ifca
15p Npttlt Street�Bedford,PA 1552't�814.623.6127�F 814.613.7310.�www.dpw.state.pa.us
a,. '� '' *
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, P Y
OEPARTMENT OF PUBLIC WEIFARE
PRE HEARING CONFERENCE REQUEST FORM
Name of Appellant: Sam C. Hanikson
Case Record Number: 21/0176958
Appeal No.: 001
Name of Representa#ive if Applicable: Clare Bennett, Golden Living Center-WS
:.
Please chedc one of#he following:
I would like to discuss my appeal with the CAO supetvisor or manager before my hearing.
Please call me at: (telephone number).
I do not want to meet with the CAO manager or supervisor before my hearing.
I withdraw my appeal. The issue I appealed is resolved. I no longer need the hearing.
Signature , Date
You may also withdraw your app�al via cellular te�ct messaging or computer
emali.
Your text or email must include your fuil name, record number ton your notice),
phone number and statiement to withdraw the appeal i�the measage.
Text or ema�l your written withdrawal to: ra-bhawestemres�ion��aa.�ov
9edfond county Assiatanoe ot�Cx
150 North Stteet�Bedfond,PA 1552Z�814.623.6127(F 814.623.7310.�www.dpw.stete.pa.us
i: t ► �
EXHIBIT "D"
�: � � �
March 19, 2013
Sam Hanikson
25 North Linden St.
Harrisburg, PA 17103
Patient: Sam Hanikson
Facility Name: Golden Living Center West Shore
Account Number: 00285-45301-0001
Dear Sam Hanikson,
This letter is regarding the resident's stay at Golden Living Center- West Shore.
Based on the information I have been provided regarding your Medical Assistance
application,Medical Assistance is going to be denied due to failure to comply with the
Medical Assistance process. Failure to comply with the Medical Assistance process
will result in a balance due of$12,073.92.
Please remit a check payable to Golden Living Center-West Shore within 5 business
days for$12,073.92. Payment can be made online at www.goldenlivin .g com via
Mastercard,Visa, Discover, or American Express. Check, money order, or cashier's
check are also acceptable payment methods as well.
Enclosed is an itemized statement reflecting the private pay balance of$12,073.92 when
Medical Assistance is denied due to fa.ilure to comply with the Medical Assistance
process. Payment in full is expected within 5 business days of this letter.
In addition, enclosed is an itemized statement reflecting$4,500.00 balance due
immediately if you comply with the Medical Assistance process.
If you have any questions,please contact me at the Central Billing Office at 1-866-325-
5606.
Sincerely,
Sarah Beli
Private Collections and Customer Service Manager
866-325-5606 x 2340
1.. e r ,, . _ _ _
PROOF OF SERVICE
��
On this�day of �t�.��,(� , 2013, I hereb certif that I cau
Y Y s e d a t r u e a n d
correct copy of the foregoing Petition for Rule to Show Cause Why Agent Under Power of
Attorney Should Not and Be Ordered to File an Account and to Provide Documentation to be
served upon the following parties by via first- class U.S. Mail, postage prepaid, addressed as
follows:
Albert A. Brooks Sam C. Hanikson
25 N. Linden Street c/o Golden Living Center-West Shore
Harrisburg, PA 17103 770 Poplar Church Road
Camp Hill, PA 17011
TUCKER ARENSBERG, P.C.
.
By: �..�c_
Kristen Lieb
Pa. I.D. #315373
Nora Gieg Chatha
Pa. I.D. #200446
2 Lemoyne Drive, Suite 200
Lemoyne, PA 17043
(717) 234-4121
H BGDB:140142-1 026135-161675