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HomeMy WebLinkAbout05-0535COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS CUMBERLAND COUNTY JUDICIAL DISTRICT NOTICE OF APPEAL FROM DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. 05-535 CIVIL TERM NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case mentioned below. NAME OF APPELLANT MAD. DIST. NO. OR NAME OF D.J. Dorothy Rist CV-0000729-04 Thomas A. Pla( ADDRESS OF APPELLANT CITY STATE ZIP CODE 2100 Bent Creek Blvd Apt/ Ste 238 c/o Bridges at Bent Creek, Mechanicsburg, PA 17050 DATE OF JUDGMENT IN THE CASE OF (PLAINTIFF) (DEFENDANT) 1/20/2005 ROBC Limited Partnership vs Dorothy Rist . CLAIM NO. CV YEAR 0000729-04 LT YEAR SIGNATURE. OF APPELLANT 9R HIS TTORNEY ORA NT ' < Li lJN( G?al?c?r45°G?-_1 f-.Jl?/?-f CC /1 c, /??L.<a?lllt] Sttr?r?YZ Stet (l ?flvl /)L1/L;I F"q This block will be signed ONLY when this notation is required under PA. 11 appellant was Claimant (see PA R.C.P.J.P. R.C.P.J.P. No. 10088. No. 1001(6)) in action before district Justice, he This notice of Appeal, when received by the District Justice, will operate as A SUPERSEDEAS to the Judgment for possession in this case. MUST FILE A COMPLAINT within twenty (20) days after filing his NOTICE of APPEAL. PRAECIPE TO ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see PA R.C.P.J.P. No. 1001(7) in action before District Justice. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon ROBC Limited Partnership appellee(s) ile a complaint in this appeal Name of appellee(s) (Common Pleas No. 05-535 CIVIL )within twenty (20) days after service of rule or ere ?fpjpuud1gment of non pros. n` fb 1/ t1t or his attorney or agent p u Van, Esquires RULE: To ROBC Limited Partnership appellee(s) 549 Bridge Street Name of appeflee(s) New Cumberland, PA 17070 Supreme Court ID #32317 (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty(20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS WILL BE ENTERED AGAINST YOU UPON PRAECIPE. Date: - Prothonotary Copy Green - Court File Copy Yellow - Appelant's Copy Pink Appellee Copy Gold - D. J. Copy Froth. - 76 (3) The date of service of this rule if service was by mail is the date of the mailing. Jan 28, 2005 year Signature Prothonofa o Deputy PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service MUST BE FILED WITHIN TEN (10) DAYS AFTER filing the notice of appeal. Check applicable boxes) COMMONWEALTH OF PENNSYLVANIA COUNTY OF : ss AFFIDAVIT: I hereby swear or affirm that I served ? a copy of the Notice of Appeal, Common Pleas No. upon the District Justice designated therein on (date of service) _ year _ _, ? by personal service E] by (certified) (registered) mail, sender's receipt attached hereto, and upon the appellee, (name , or year ___ ? by personal service ? by (certified) (registered) mail, sender's receipt attached hereto. ? and further that I served the Rule to File a Complaint accompanying the above Notice of Appeal upon the appellee(s) to whom the Rule was addressed on _, year , ? by personal service E] by (certified) (registered) mail, sender's receipt attached hereto. SWORN (AFFIRMED) AND SUBSCRIBED BEFORE ME THIS DAY OF . YEAR @gnufure of Affianl signature of offeial before whom affidawt was made rifle of off'aaf Mil My commission expires on year TI __ , Co 7 C) _rn Q -< COMMONWEALTH OF PENNSYLVANIA COUNTY OF: CUMBERLAND Mag.Dist . No.: 09-3-04 DJ Name: Hon. THOMAS A. PLACEY Addmes:104 S SPORTING HILL RD MECHANICSBURG, PA Telephone. (717) 761-8230 17050 DOROTHY RIST 2100 BENT CREEK BLVD APT/STE 238 C/O BRIDGES AT BENT CREEK MECHANICSBURG,: PA 17050 ,.4 THIS IS TO NOTIFY YOU THAT: -' Judgment: NOTICE OF JUDGMENT/TRANSCRIPT PLAINTIFF: CIVIL CASE NAME and ADDRESS FROBC LIMITED PARTNERSHIP 202 BLACK MATT ROAD DOUGLASSVILLE, PA 19518 L J VS. DEFENDANT: NAME and ADDRESS r-RIST, DOROTHY 2100 BENT CREEK BLVD APT/ST3 238 C/O BRIDGES AT BENT CREEK LMECHANICSBURG, PA 17050 J t DocketNo.: CV-0000729-04 Date Filed: 11/24/04 Judgment was entered for: (Name) Rnnr T.TMTTPn PARTNRRRHTP F Judgment was entered against: (Name) RTRT nnRnTHv in the amount of $ 6, -AIR _ "32 on: (Date of Judgment) E Defendants are jointly and severally liable. (Date & Time) F Damages will be assessed on: ? This case dismissed without prejudice. ? Amount of Judgment Subject to Attachment/42 Pa.C.S. § 8127 $ F7 Portion of Judgment for physical damages arising out of residential lease $ Amount of Judgment $ 6,224.8 2 Judgment Costs $ 113.50 Interest on Judgment .00 Attorney Fees $ .00 Total $ 6,338.32 Post Judgment Credits $` Post Judgment Costs $_y Certified Judgment Total ANY PARTY HAS THE RIGHT TO APPEAL WITHIN 30. DAYS-AFTER THE ENTRY OF JUDGMENT. BY FILING A NOTICE OF APPEAL WITH THE PROTHONOTARY/CLERK OF THE COURT OF COMMON PLEAS, CIVIL DIVISION. YOU -- MUST INCLUDE A COPY OF THIS NOTICE OF JUDGMENT/TRANSCRIPT FORM WITH YOUR NOTICE OF APPEAL. EXCEPT AS OTHERWISE PROVIDED IN THE RULES OF CIVIL PROCEDURE FOR DISTRICT JUSTICES, IF THE JUDGMENT HOLDER ELECTS TO ENTER THE JUDGMENT IN THE COURT OF COMMON PLEAS, ALL FURTHER PROCESS MUST COME FROM THE COURT OF COMMON PLEAS AND NO FURTHER PROCESS MAYBE ISSUED BY THE DISTRICT JUSTICE UNLESS THE JUDGMENT IS ENTERED IN THE COURT OF COMMON PLEAS, ANYONE INTERESTED. IN THE JUDGMENT MAY FILE A REQUEST FOR ENTRY OF SATISFACTION WITH THE DISTRICT JUSTICE IF THE JUDGMENT DEBTOR PAYS IN FULL, SETTLES, OR OTHERWISE COMPLIES WITH THE JUDGMENT. Ad 1 2t) DateDistrictJustice , i I certify that this is a true arfd correct r e-reoor4.QU,.g proceedings containing.the judgment. 1 G Q Date`' District Justice ,, My commission expires first Monday of January, 2010. SEAL AOPC 315-03 DATE PRINTED: 1/20/05.. 9:30:24 AM U? n .LL t Y ? a r? cry N co ?O `ter` LI?J C (-S ..As C, c? Vl -Y1 t'Yt CJ f"nr 1 .JrJ -, rr, O "O PROOF OF SERVICE OF NOTICE OF APPEAL AND RULE TO FILE COMPLAINT (This proof of service MUST BE FILED WITHIN TEN (10) DAYS AFTER filing the notice of appeal. Check applicable boxes) COMMONWEALTH OF PENNSYLVANIA COUNTY OF , +s_t rt?kr ?C(1(i _ Ss AFFIDAVIT: I hereby swear or affirm that I served a copy of the Notice o? `Appel, Common Pleas No. upon the District Justice designated therein on (date of service) 1 f?y year _;Z by personal (ser lice M by (i.' rtdieo (registered) mail, sender's r ; pt attached hereto, and upon the appellee, (name'1f..)? '01 I t year ? by personal service i? byj( sa tifie (registered) mail, sender's receipt attached hereto, ® and further that I served the Rule to Fil a Complaint accompanying the above Notice of Appeal upon the appellee(s) to whom the Rule was addressed on f " 5 yea?C.t.' 5-_, by personal service ® by (certified) (registered) mail, sender's receipt attached hereto. SWORN (AFFIRMED) D SUBSCRIBED BEFORE ME ^? t THIS ? Y F :T}?:, YEA i'? ? gal L'CC rid.{. / Sgnotum. of Affiani t ; Signature ofOoatbelore whom alfda,&&w made / -- rine of oft"al r J v My commission expires on _ year G-? G NOWAK am UAW 11111111VU4111UPAIIIII14 MCA- rLdft 1 aIIIIIIIIIIIIIN /K1ROIIOH IbYIL 1 COMMONWEALTH OF PENNSYLVANIA COURT OF COMMON PLEAS NOTICE OF APPEAL FROM JUDICIAL DISTRICT DISTRICT JUSTICE JUDGMENT COMMON PLEAS No. OS-5--6 CIVIL TERM NOTICE OF APPEAL Notice is given that the appellant has filed in the above Court of Common Pleas an appeal from the judgment rendered by the District Justice on the date and in the case mentioned below. NAME OF A4P,PELLA?T MAG DIST NO. OR NAME OF DJ. A'Y 18S% PIPPELLB(JT i CITY STATE ZIPC D,Ti, VJ ((_,-cvyc 7, i,l DATE OF..??Iljj,,?,' h7 NT IN THE QAS {1F (QILA,(tNTIFF) (QEFENDANT) 1jG! 00 n!?!!G. LILt11.. IXa o?7,"f 77£2.1?. ' 'Or41G'y ? vs. CLAIM NO. CV YEAR 'Y"90 7 Gri--1)4 LT YEAR SIGNATjURF. OF AP, P yCAN96R Fys:A 1Op UOR MA ,ept J. f( j / . 3.. . This block will be signed ONLY when this notation is required under PA. If appellant was Claimant (see PA R.C.P.J.P. R.C.P.J.P. No. 10086. No. 700)(6)) in action before district Justice, he This notice of Appeal, when received by the District Justice, will operate as A SUPERSEDEAS to the Judgment for possession in this case. MUST FILE A COMPLAINT within twenty (20) days after filing his NOTICE of APPEAL. or PRAECIPE T6 ENTER RULE TO FILE COMPLAINT AND RULE TO FILE (This section of form to be used ONLY when appellant was DEFENDANT (see PA R.C.P.J.P. No. 1001(7) in action before District Justice. IF NOT USED, detach from copy of notice of appeal to be served upon appellee. PRAECIPE: To Prothonotary Enter rule upon appellee(s), toAile a complaint in this appeal Name of appellee(s) OS-5351 CIVIL (Common Pleas No. within twenty (20) days after service o6-rule o , tier entry;of judgment of non pros. Y > : -x sr' aYF??eiap7ou?iJtafivspadrereraaaoar+r RULE: To appellees) Name oiappe/lee(s) -rvi w- 2 c, (1) You are notified that a rule is hereby entered upon you to file a complaint in this appeal within twenty(20) days after the date of service of this rule upon you by personal service or by certified or registered mail. (2) If you do not file a complaint within this time, a JUDGMENT OF NON PROS WILL BE ENTERED AGAINST YOU UPON'PRAECIPE. MYYU+?FF ,MWV 4.rt'a }k 1 (3) The date of service of this rule if service was by mail is the date of r taf4(°tri? " 1t} A+»kMY,M If Jan 28, 2005 {cFay ? Date: , Year _ _?k.%I, ulF W "?fi+ ?4 Fonotat o deputy ilk JWA*'yr,' N' White - Prothonotary Copy Green - Court File Copy Yellow - Appelant's Copy Pink - Appellee Copy Gold - D. J. Copy Ploth_ - 76 art 001IGI.AS VIII` Pap 0 if Postage $ $0.37 ??M6tiR! D Certified Fee q 1y'. i V I C3 1 1 09 4 .1 C3 Return R Fee eq t $1.7. cslm ? Here J ? (Endorsement RR ired) C- j. ? r / RWd F t d D li 0 $3 e ? I I O e e c very ee (Endorsement Required) J . - J 1-3 $7 92 Total Postage & Fees . $ m C3 sad To p G n ; - ?- ` ? -- --------- $lieet, Apt. No.; ---------- --- er P08av Ne. a oa. ?t k 'mss ---- -- ---- --------------------- - i` s?? Z asv ¢ :r r .. . -- r t..5 ¦COMMeWe1,W.?a.wwwnww- 4L?"?by'(PrOliid Mm 4If ReetrMl #11y 6 dp*W -1 C?7 M • Mint yow ntamWd otfrllN on the revere to that we cartam" 1M fllfd to You. Nwha) D. Dots d Dom" • Aftch V 0" fs 80 NO Of the mdlpieoe. - - theiibnOXe/oaoP fe. or on t..?ltlcla ndaeae.a+s RoC3c ?,,R.;?, PGr4.lre?s?t ao a f?1?k ??o,-t??t, Qo??sv;?1e LPF? LACJ lg D;rddwwyadd,sadMfsmttfromtWn1? ?YM M YE% mgm doWery addrm WOW: 0 No 3. So" TOO 4,68~ me C3 ftnalf"ma t7 A gWMad t1FfMtluo ROCW for MerMrdM O wwrod htMl 4 C.o.D.__ _ 2. ANANCIS ? txf sw icelabaA 7003 0500 0001 6558 5948 olim Pti nm 3811. Fo wMay 2m 00111111111100 MUM PAGNO EXHIBIT "A" U.S . Post al Ser vice,., t CE RTIF IED MAIL R EC .,, EIF (Do mestic M ail Only ; No Insuran ce Covers! J to - - to NECNANIC58IRi @A 170597 ui n Postage $ 10.37 ^ f O C3 Certified Fee ;2.30 91 /J n.? O Retum Reciept Fee (Entlorsemenit Required) $1.75 t a ra f M Restricted (Endorsement Required) 53.50 n f. 9 7s m Totaf Postage & Fees $ 17.92 rtAs S F ) ' O Sent TO 10)-/ 51,a+b 5a„(+Pe, 14a it 1Mik year nergq wd add9dis snit a reverse e4 *at we can return the card to you. M Afeh iMa card to the beck of ShemeApktce, Olin Nre form Kspace pennft. t. Mee.Atldeaseed tim (`? J'- --?-• . Not. !a4 5o. sfbr K,ac ,,, as b?cc? Y ? X AUSM _ ? & -~?-++YYAimid`• by (RMm--d NmM) G Date of DWArp DD.1$"VetywftAPMlmeM'kcmeaml? Yee M YES, enter da#wf aftem below. ? No SOVIO•s Type ¦ Cotw Mal ? D weae Mea ? stared a Return Recoot for Mercho riere r mm e*mil rj Mo.o. 14. Restricted Detlvery 95(ft feel ¦ Yes 2. NIbkNyR?.r "-- 7003 0500 0001 6558 5955 (a rrrarIwie:ieiww"O rra ram 3811. February tom Demnseeo Relurn ReoMpt 102Mce44-160 ; EXHIBIT "A" Steven J. Proctor, Esquire Attorneys for Plaintiff Attorney I.D. #24428 Susan Quirits, Esquire Attorney I.D. 987001 Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown, PA 19464 610-323-6200 COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW ROBC LIMITED PARTNERSHIP CASE NO. 05-535 Civil Term Plaintiff V. DOROTHY RIST Defendant NOTICE TO PLEAD TO: DOROTHY RIST You are hereby notified to file a written response to the enclosed Complaint upon within twenty (20) days from service hereof or a judgement will be entered against you. You must have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and notice are served, by entering a written appearance personally or by an attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so, the case may proceed without you and ajudgment may be entered against you by the Court without further notice for any money claimed for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE, PA 17013 717-249-3166/800-990-9108 Steven . Proctor., Esquire Attorney for Plaintiff Steven J. Proctor, Esquire Attorney I.D. #24428 Susan Quirits, Esquire Attorney I.D. #87001 Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown, PA 19464 610-323-6200 Attorneys for Plaintiff COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW ROBC LIMITED PARTNERSHIP 202 Black Matt Road Douglassville, PA 19518 Plaintiff V. DOROTHY RIST 2100 Bent Creek Blvd. Apt. 138 Mechanicsburg, PA 17050 Defendant CASE NO. 05-535 Civil Term COMPLAINT AND NOW, Plaintiff, ROBC Limited Partnership, through the undersigned counsel, by way of Complaint against Defendant, Dorothy Rist, alleges the following: 1. Plaintiff, ROBC Limited Partnership, is a limited partnership duly organized in the Commonwealth of Pennsylvania, with a principal office located at 202 Black Matt Road, Douglassville, PA, 19518 (hereinafter referred to as "Plaintiff'). 2. Defendant, Dorothy Rist, is an adult individual with a mailing address of 2100 Bent Creek Blvd., Apt. 138, Mechanicsburg, PA, 17050 (hereinafter referred to as "Defendant"). FACTUAL BACKROUNI) 3. On or about February 20, 2005, the parties signed an "Assisted Living Admission Agreement" for accommodations in an assisted living unit and related services at Plaintiff's facility, The Bridges at Bent Creek, located at 2100 Bent Creek Boulevard, Mechanicsburg, Cumberland County, PA, 17050 ("the Facility"). A true and correct copy of said agreement is attached hereto, made a part hereof, and is marked as Exhibit "A". 4. The agreement stipulates that the Defendant was to receive the basic level of room, board and care at a rate of $1,330.00 per month. 5. Defendant was responsible for monthly charges associated with her care at the facility, including rental fees in the amount of $1,330.00 per month as well as monthly charges for incidental care items and pharmacy charges. 6. On August 23, 2004 Defendant was given notice from the Facility that her rental and care payments were delinquent. A true and correct copy of said notice is attached hereto, made a part hereof and is marked as Exhibit "B". 7. The notice provided Defendant with 30 days to correct the situation or she would have to vacate the premises. 8. Defendant failed to cure her account delinquency, and has refused to vacate the premises. 9. Defendant currently owes a total of $10,391.04 for rent, assistance, and supplies for the period from March 17, 2004 through February 11, 2005, as detailed on Plaintiff s tenant ledger, a true and correct copy of which is attached hereto, made a part hereof and marked as Exhibit "C". 10. Plaintiff also claims late fees in the amount of $25.00 per month which thru 02111105 amounts to $275.00. 11. In addition, Plaintiff claims entitlement to reimbursement of $113.50 in j udgment costs incurred by Plaintiff as the prevailing party in the civil action filed by Plaintiff against Defendant on the instant claim in Cumberland County Magisterial District No. 09-3-04 at Docket No. CV-0000729-04. COUNTI (BREACH OF CONTRACT) 12. Plaintiff incorporates paragraphs 1 through 11 as though, again, set forth in full and complete detail. 13. The conduct by Defendant as described above constitutes a breach of contract. 14. Defendant has failed to pay the rental and care and supplies charges as agreed, although the Facility provided all contracted services to Defendant. 15. As a direct and proximate result of said breach by Defendant of her contractual obligations to Plaintiff, Plaintiff has been damaged in the amount of $10,391.04. WHEREFORE, Plaintiff demands judgment against Defendant in the amount of $10,391.04, together with interest at the legal rate of 6% per annum from March 17, 2004; costs of suit; together with rent from 02/11/05 at $1330 per month through the date that Defendant actually vacates the unit together with late fees at ;$25 per month from March 1, 2005 through the date defendant actually vacates the unit and for such other relief as the Court shall deem just and proper. Respectfully submitted, Binder, alis & Proctor, P.C. By. Steven J. Proctor, Esquire Attorney for Plaintiff VERIFICATION I, Steven J. Proctor, hereby verify that I am the attorney for Eldercare Investments, LLC and General Partner of ROBC Limited Partnership, and am therefore authorized to execute to this Verification on the Plaintiff's behalf, and do hereby verify that the facts contained in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief and that the exhibits attached hereto are true and correct copies of the originals. I understand that false statements made herein are subject to the penalties of 18 Pa. C. S. §4904 relating to unworn falsification to authorities. Dated: February 16, 2005 J. Proctor, Esquire ASSISTED LIVING ADMISSION AGREEMENT Updahdt Ne"ober 21,1003 This Agreement is required by the Commonwealth of Pennsylvania's Regulations governing P,er?orml Care Homes (her after "PCH'). The agreement is made in duplicate this -P6 day of Resident's Name 1 Street Address, City, State, 1. Resident agrees to pay the Bridges at Bent Creek (hereafter "the Bridges") a: Daily rate of $ _(pQ ° for them, board and personal care services; or 4` Monthly rate of $ ` .J573 41 Seasons Security Deposit Pet Deposit Total Deposit $? Ce Assisted Level of Care Non-r efundable ?f 7573 Additional charges for services and items may be billed according to the Bridges' rate and charge schedule attached to this agreement. The amounts states[ reflect the actual amount charged. 2. The Bridges will provide the resident thirty (30) days notice in writing of any rent increases. 3. The Resident agrees to abide by the House rules as attached to this agreement. 4. The resident is provided with a copy of "Resident's Rights" as attached to this agreement. EXHIBIT "A" doZ:Eo SO ST QaB S•d Assisted Living Agreement -Page 2 5. Assurance of Confidentiality The Bridges acknowledges that the resident's personal and medical records are confidential. The resident acknowledges that such records are hereby released and may be used internally by the staff of the Bridges to determine appropriateness of care and to develop resident support plans and in case of the resident's admission to a hospital or health care institution, may be released to such institution 6. Required Medical Evaluation and Screening for Admission The resident agrees to have a medical evaluation by a physician prior to commencement of residency and annually thereafter. The resident also agrees to provide a copy of his/her annual medical evaluation on the form designated by the Department of Public Welfare to the Bridges. Prior to admission and annually thereafter, the resident agrees to participate in and share needed information for the Bridges to complete the Screening instrument and any other assessment tools developed by the Bridges to determine the appropriateness of care available in light of the residents present medical and social needs. 7. Activities Program The Bridges will have a program of social, physical, intellectual and recreational activities designed to promote the resident's active involvement with other residents and family and the community, S. Basic Services The community agrees to provide to the Resident the following basic services: (i) Room accommodations; (h) Weekly laundry services for linens and towels (does not include personal laundry); (iii) Weekly housekeeping; (iv) Dietary services including three well-balanced meals and snacks on a daily basis and regular diets or modified diets prescribed by physician order or supervised care; (v) Transportation to medical appointments on allotted days; (vi) Observation ofthe Resident's physical and mental condition; (vii) Basic utilities: including water, electricity, heating and cooling (does not include personal telephone services in the Resident's room or long distance telephone service). The monthly base rates for Basic Services are dependent upon the room accommodations provided to the Resident and are set forth on the Fee Schedule which is attached to and made a part ofthis Agreement. doz?eo sa st aa? s•d Assisted Living Agreement-Page 3 9. The Community will provide the Resident access to a telephone for use in calling the local service area The Resident may also make long distance calls and will be charges for such calls on the monthly bill as set forth in Patagnaph 3.1.5 of this Agreement and in accordance with the Fee Schedule. Additionally, the Resident should refer to the Fee Schedule for the cost of personal telephone services in the Resident's room For information concerning the availability and cost of basic and premium television cable services at the Community, the Resident should refer to the Fee Schedule. Personal Care Services The Community acknowledges that residents will require assistance with personal care services such as the following: (i) Medication; (u7 Dressing; (iii). Bathing; (iv) Hair Care; (v) Mouth Care; (vi) Toileting; (vii) Eating Habits; (viii) Walking/Moving; (ix) Orienting; (x) Redirecting; ()q) Cuing. The Community knows these needs will vary among residents and that a particular resident's need for assistance may periodically change or fluctuate. To address these concerns, the Community offers an Assisted Care program with additional levels of care: Assisted living Plus, Assisted Living Plus I, Assisted Living Plus II, and The Bridge. The difference between the programs is the number ofpersonal care services provided and the cost for the additional assistance. The Community will provide the level of care that Resident needs based upon the Level of Care Assessment. In addition to the charge for Basic Services, the Resident will pay a monthly charge for personal care services. The charge for the personal care services is dependent upon the level of care the Resident receives. If the needs of the Resident change, resulting in the need for a change in level of care the Resident is receiving, the Community will immediately notify the Resident and the Responsible Peaty and at the same time, will begin to provide the appropriate level of care and make the applicable adjustment to the monthly charge for the level of care that is being provided. The Resident, Responsible Party and Payor, if any, understand that the amended monthly charges will become effective on the date that the level of care changes, and will be prorated accordingly. 6.d dla:60 80 Sr 9aj Assisted Living Agreement-Page 6 If resident is unable to sign his/her name, resident should show his/her mark below: Resident's Mark Witness to Mark (Other than Administrator) Date Marked Date Witnessed A copy of the signed Admission Agreement shall be given to the resident and a copy shall be filed in the resident's record. Act. P.L. 744: This community has agreed to comply with the provisions of the Federal Civil Rights Act of 1964, and the PennsylvaniaHuman Relations Act, and all requirements proposed pursuant thereto, to the end that no persons shall on the grounds of race, color, religions creed, national origin, ancestry, age, sex, handicap or disability should be exclude from participating In, be denied benefits of, or otherwise be subject to discrimination in the provision of any care or service. The nondiscriminatory policy of the institution applies to residents, physicians and all employees. Under no circumstances will the application of this policy result in the segregation of buildings, wings, floors, and rooms for reasons of race, color, religions creed, national origin, ancestry, age, sex, handicap or disability. For More Information or to File a Compliant Contact: Pennsylvania Human Rights Commission Riverfrout Office Center 1101-1125 S. Front Street, 5th Floor Harrisburg, PA 17104-2515 Voice: (717) 787-9784 ar d J60:60 so SS qe? Assisted Living Agreement - Page 5 13. Refunds a. K after the Bridges gives notice of discharge or transfer, and the resident moves out of the Bridges before the 30 days are over, the Bridges shall give the resident a refund equal to the previously paid charges for rent and personal care services for the remainder of the 30 day time period. b. Refunds of unused portion of payments for room and board will be made upon the death of the resident, or the medical need for a resident to be permanently placed in another institution. 14. Notice of Intent to Leave After a resident gives notice of intent to leave in accordance with this Agreement, and if the resident moves out of the Bridges before expiration of the required thirty (30) days, the resident owes the Bridges the charges for rent and personal care services for the entire length of the thirty (30) daytime period for which payment has not been made. The Agreement has been reviewed by the resident and explained to the resident by the Administrator or his/her designee. The resident understands that the Administrator must give the resident and his/her designated person. If applicable, thirty (30) days advance written notice before changing the Agreement. It is required that the Administrator acquaint resident with the Regulations which are posted in the community. In signing this Agreement, the Resident acknowledges each of the conditions and the fact that the Regulations have been explained. 15. Late Fee The community will charge a $25 late fee for payments'. received after the l e calendar day. Charges not paid by the 200' day of the month will accrue interest on the unpaid charges at a rate of 1% per month ,'Y" Cg 'Resi at's Sig;nWt?re 01 ate Signed dw Adminis s o ignee's Signature Designated Person or Referral Agency (Signature is at the option of the resident) Payor it.d Date Signed Date Signed Date Signed d£2z£o so 91 98A Assisted Living Agreement- Page 4 10. Requirements for Discharge or Transfer a. If the Bridges initiates a discharge or transfer of the resident, or if the Bridges is closing, the Administrator shall give thirty (30) day prior written notice to the resident, the designated person, and the referral agent, citing the reasons for the discharge or transfer. b. If the resident chooses to leave the Bridges, the resident will provide to the bridges a thirty (30) day prior written notice. The resident may be charged for up to (30) days of rent and personal care services after the date of the notice whether or not the resident remains on the Bridges for the entire time period. c. if a delay in discharge or transfer would jeopardize the health or safety of the resident or others in the Bridges, as certified by a physician or the Department of Public Welfare, or both, the time periods required in Subsections a and b herein do not bave to be observed. d. The date and reason for the discharge or transfer, and the destination of the residcnt, if known, shall be recorded in the resident's record. 11. Discharge due to change in the resident's condition The administrator sliall notify both the resident and the designated person, if any, of the need to transfer the resident in the following situations: A. The resident's physician or a local appropriate assessment agency has determined that the resident needs a higher level of care. In this situation, a plan for other placement shall be made as soon as possible by the Administrator in conjunction with the resident or designated person, if any, or both. If assistance with relocation is needed, the Administrator shall contact appropriate local agencies, such as the Area Agency on Aging, county mental heahh/mentai retardation program or drug and alcohol program for assistance. The Administrator shall also contact the appropriate PCH licensing field office. b. The resident's condition is such that the resident is a danger to self or other residents and the resident must be removed from the Bridges. In this situation, the Administrator shall take appropriate interim immediate action to protect the health and safety of the resident, other residents of the Bridges and the staff. 12. Notice of Intent to Leave The resident shall give the Administrator written notice at least thirty (30) days in advance of hislher intent to leave. The refund and/or additional charges incurred by the Resident will be governed by the following Refund Section provisions. -- Jae:60 50 St 9a-J OT'd Assisted Living Agreement - Addendum I - Page I - Fee Schedule The Bridges at Bent Creels: (Authorization of Services/Ancillary Charges Acknowledgement) Resident: ?iA L rJ 1. Authorization of Services Would you prefer- 1. the community to do your personal laundry? (circle)?it:s?r no 2. to utilize the beautician/barber? (circle) yes or,42 3. to utilize the house podiatrist? (circle) yes or 8P Initial Deposit/Waiting List Fee Reservation fee of $ _ is required to place the resident"s name on the waiting list for admission. $ of the reservation fee is non-refundable. Ancillary Charges Acknowledgement Services available: Cost: Additional Level of Care (LOC determined at time of assessment or if a change in resident condition occurs) Seasons Assisted Living Plus Assisted Living Plus I Assisted Living Plus II The Bridge $295/month $300/month $500/month $900/month $1,450/month Pharmacy Beauty/barber/manicure service Catering per pharmacy's charges per salon's charges Available%harges per event request Guest Meals (can be added to bill or paid at time of meal) Breakfast $3.00 per guest Lunch $6.00 per guest Dinner $9.00 per guest Specials As posted Guest Accommodations Rollaway Bed Guest Room $10.00 daily rate $75.00 per night Lost Key replacement L -C, $5.00/key d12:60 SO ST aaJ Assisted Living Agreement- Addendum I - Page 2 - Fee Schedule Services availxble: Lost Emergency Bracelet Personal Housekeeping weekly Personal Laundry flat linen Cost: $200.00 $25.00 per hour (in addition to service) Also provided in '/z hour increments $5,00 per load (including personal service) Community Supplied Flat Linens included Personal Maintenance hour $50,00 per hour (also provided in'/- Increments) Podiatrist Per Doctor's Charges Transportation (Provided on Tuesday & Friday as stated below): (This is within a 15-mile radius of the community) Physician's Appointment (within a 15 mile radius) Included Physician's Appointment (outside a 15 male radius) $0.35 per mile Personal Errands (within a 15 mile radius) $20.00 per trip Driver Waiting Time (provided in h hour increments) $8.00 per hour Accompanied by Staff (provided in % hour increments) $15.00 per hour (Transportation on non-scheduled days at a rate of $0.35/mile) Tray Service $1.00 per tray Telephone Basic Local Service $15.00 per month Long Distance Charges (US, excl. AL and HI) $0.10 per minute Long Distance International Varies Installation $30.00 one-time fee Basic Supplies (ie, gloves, tissues, incontinent items, wound care dressings) will be billed at the current market rate Resident or nsible Party O O Date g•d dTZ:EO so ST 9aj Assisted Living Agreement -Addendum H -Page 1- Resident Rights The Bridges at Bent Creek Resident Rights The right to be informed of your rights in writing. The bridge's Administrator must tell you upon admission what your rights are and must post a copy of them for easy viewing by residents. Your rights must also be made a part of the admission agreement. The right to be informed in writing of the Bridge's policies, services and charges. The Bridges must have written policies about its rules abut your responsibilities as a resident. You must also be informed in writing by the Bridges of all services and the charges for those services. The right to leave and return to the Bridges at reasonable times. You are frce to leave and return to the Bridges during reasonable tunes consistent with the Bridge's rules. The right to use your own clothing and possessions. The amount and kind depends upon available space and whether other residents' rights would be violated. The right to receive visitors. You are free to receive visitors for a minimum of 8 hours per day, 7 days per week. The right to telephone access and privacy. The Bridges must provide you access in reasonable privacy to a phone. You are free to make local calls without charge, except where a standard pay phone is used. Arrangements for payment of long distance calls are to be included in the Admissions Agreement. The right to receive and send mail. You have access to the U.S. Matz. You are free to write and send mail at your own expense. Your mail should arrive to you unopened. The right to be free of retaliation from complaints. You are free to exercise your rights and voice grievances and recommend changes in policies and services of the Bridges. The personal care home may not take any action against you because you voiced a grievance. ET'd dbZ=EO SO ST 9aj Assisted Living Agreement - Addendum 11- Page 2 -Resident Rights The right to be free from mental, physical and sexual abuse, exploitation, neglect and involuntary seclusion. No one may mistreat, threaten or coerce you in anyway. The right to privacy and to be treated with dignity and respect. The right to privacy takes many forms. You are free to communicate and meet privately with anyone. You should be treated with courtesy and afforded privacy for personal needs like bathing and toileting. The right to be provided with thirty (30) days advance written notice of the community's intent to terminate your residency and the reason for termination. The right to be free from chemical (drug) and physical restraints. The right to keep at least $60.00 per month of your own funds for personal use. The right to request and receive assistance in relocating. The right to freed participate in any religious, social or community activity of your choosing. 41-d dsa:eo so ST 9a? Assisted Living Agreement- Addendum 11 -Page 3 -Resident Rights Personal Care Home Licensure Regulations give rights to Personal Care Home residents in Pennsylvania. For a more complete explanation of your rights and how they apply to your individual circumstances, contact your local long-term care ombudsman: Cumberland County Office of Aging & Community Services 16 West High Street Suite 100 Carlisle, PA 17013 Phone: 717-244-6110 An Ombudsman is: A resource • A problem solver ¦ One concerned with protecting the rights of older Pennsylvania's in long-term care facilities by answering questions, investigating complaints and resolving problems Who may contact the Ombudsman for assistance: • A resident • Family or friends • Staff • Community groups • Anyone All communications with the Ombudsman are CONFIDENTIAL The resident may voice grievances and recommend changes in ;policies and services of the Bridges through Town Council or the Owner (610) 326-9090 if'satisf tctiou is not obtained through the community staff A resident may contact the Governor's Action Line if grievances cannot be resolved through these means: Governor's Action Line 304 Financial Building Harrisburg, PA 17120 1-800-932-0784 (toll free) 'L ?v Data; D ST -d dsa:eo so 91 9a? Assisted Living Agreement - Addendum III- Page I -House Rules The Bridges at Bent Creek House Rules 1. Visiting: Visiting hours are not restricted. Please feel free to schedule visiting times with your loved ones at your convenience 2. security. Doors to the community will be secured at dusk for your safety and security. The front entrance is accessible by pressing the keypad in the vestibule when the doors are secured. 3. Meals: Meal times are as follows. Times are subject to change with appropriate resident notification: Breakfast 7:30am-8:30ant Lunch l 1:30am -12:30,pm Dinner 5:00pm - 6:00pm 4. Snacks- A variety of snacks are available in the Cafe. 5. Alcohol: Alcohol may be used in moderation in the resident's room, as well as in the dining room, if purchased by the resident and stored in the resident's room The community may provide both alcoholic and non-alcoholic beverages for scheduled events. 6. Tipping: Tipping staff is not allowed. Fire Drills: Residents are required to participate in every fire drill. Move to the nearest exit and safety and wait for fiuther instructions. DO NOT IGNORE THE FIRE ALARM. 8. Personal Items: Clothing and personal items should be labeled with the resident's name to assist in returning items to the resident if they become lost. Residents are encouraged to furnish their rooms with their own belongings or used fmnilure provided by the Bridges. 9. Mail: 91 'd U.S. Mail is delivered to an individualized locked mailbox near the dining room dSZ=EO So SS gad Assisted Living Agreement - Addendum III -Page 2 - House Rules 10. Team Members: Team Members should be treated with respect and dignity enabling them to perform their duties. 11. Smoking: The Bridges is strongly committed to maintaining and improving the health and well-being of all residents and staff-, therefore, smoking is prohibited inside the building. Smoking is allowed on the rear patio only. Residents who violate this rule or residents who are deemed by the Bridges in its sole discretion to be unable to safely stoke without supervision will be asked to give all cigarette and cigarette lighting devices to staff who will supervise smoking so as to provide for the safety and well-being of other residents and staff. 12. The Bridges Resident Handbook is incorporated herein and made a part hereof. ------- ds2tco so Si Gad Assisted Living Agreement - Addwdum r V- Page 1 Assisted Living was developed to provide an alternative to nursing homes, emphasizing quality of life, for our nation's elderly. With this choice each resident and their family must understand the rewards, the risks and the shared responsibilities inherent in this type of living environment. Assisted Living is often described with terms such as 'autonomy and independence', 'dignity and respect' and 'freedom of choice'. If you choose to reside in our community, each resident and their family members bave chosen our quality of life setting rather than a medical or institutional care setting. With your desire to remain as independent as possible there are potential risks. We do not provide 24-hour skilled nursing care. As part of this resident agreement, you and your family members acknowledge that some of these inherited risks to injury are beyond our control. Because residents are not monitored 24-hours a day, the risk of bodily injury from falls and accidents is a common reality. If you have sustained a previous fall prior to moving in our community there remains an even higher risk of falling again For the cognitively diminished resident, the risk of wandering into a non-secure area is also present. Any resident that sits in a wheelchair for extended periods of time, has a history of skin breakdown, or spends extended periods of time in bed has a high risk of skin breakdown caused by pressure. Although these are some of the more common inherited risks in the aging process there can be additional risks depending on each resident's needs, diagnosis, and medical conditions. Assisted Living is what its name implies "assistance in living". Twenty-four (24) hour skilled nursing care is not and will not be provided. In summary, we want you and your family members to be informed of the inherent risks we often cannot control, as we respect your decision to retain your independence and maintain your quality of life. 1 _ Res* degrURepre. a'veSignat re Datete dSZ:EO So Si qad 8i'd Assisted Living Agreement-Addendum V -Page I -Respite It is understood that Resident is coming to the Bridges under a respite stay. Such respite stay is expected to end on at which time Resident will be discharged from the CommunM(3d# d Resident leave prior to the end of this respite stay or decide to leave affsr the discba hove, Resident shall be. subject to paragraphs 9 and 12 above with respect to the inotice period and the right of the Bridges to bill the resident for thirty (30) days following Resident's written notice of his/her decision to leave. -- dL3:60 SO ST gad 61 'd Assisted Living Agreement -Addendum VI (3 Pages) Introduction: Assisted Living was developed to provide an alternative to nursing homes, emphasizing quality of-life, for our nation's elderly. With this choice each resident and their family must understand the rewards, the risks and the shared responsibilities inherent in. this type of living environment. Assisted Living is often described with terms such as'autonomy and independence', 'dignity and respect' and 'freedom of choice'. If you choose to reside in our community, each resident and their family members have chosen our quality of life setting rather than a medical or institutional care setting. With your desire to remain as independent as possible there are potential risks. We do not provide 24-hour skilled nursing care. As part of this resident agreement, you and your family members acknowledge that some of these inherited risks to injury are beyond our control. Because assisted living is specifically designed to offer residents more independence and autonomy, and that 24-hour care and supervision is not provided on an individual basis, the risk of bodily injury and severe consequences from fills and accidents is a common reality. If you or your family member have/has sustained a previous fall prior to moving in our community, there remains an even higher risk of falling again. Therefore, it is our ' policy that all new residents moving into our community obtain an order from their primary care physician for an Occupational and Physical Therapy evaluation. In addition, if you sustain a fall in our community, your physician will be notified and another order for therapy may be obtained from your primary care physician if appropriate. All residents receive an emergency call bracelet that works with the community's emergency call system in each resident suite (not in the common areas where additional Elcombe units and buttons are provided). We strongly suggest that you wear this bracelet at all times so that you can notify staff in case help is needed or you are not able to reach the Elcombe unit in the room or the button in your bathroom 1 understand that I or my family member am/is at risk for falling and I/we acknowledge that Uwe have been given the opportunity to discuss my or my family member's condition and any preventative interventions with the community's staff members. I fiuther understand that The Bridges at Bent Creek can matte no guarantee that I or my family member will not fall. The community has adopted a sbared-risk program to work together to minimize the risks that you or your family may fall in the future and be harmed as a result. Your participation in the shared risk program by providing any input or suggestions that you may have that would promote you or your family member's safety, by carefully evaluating all of the options to reduce the risk of falls, and by supporting those options that you believe to be in your or your family member's best interests is very important to us and essential to reducing the risk of falls. d9a:EO go ST qaA TZ'd Assisted Living Agreement -Addendum VI - Page 2 Elopement: For the cognitively diminished resilient, the risk of wondering into a non-secure area is also present. Many residents come to assisted living with some form of dementia, and that coupled with a resident being ambulatory will put them at risk for elopement. Because assisted living is specifically designed to offer residents more independence and autonomy, and that 24 hour care and supervision is not provided on an individual basis, the risk of elopenl ent is a reality. In addition, some medications that may alter mental status also may put a resident at risk for elopement. With a physician order and family consent, a resident: who has a history of elopement or who we feel is strongly at risk may be placod in our community's secured unit. I/We understand that I or my family member am/is at risk for elopement. We have been given the opportunity to discuss my or my family member's condition and ;preventative interventions with the community staff IlWe understand that the Bridges at Bent Creek can make no guarantee that I or my family member will not leave the community unattended. Self Administration of Medications: We believe that in order for a resident to self administer medications belshe should be able to list and identify each prescribed medication, describe the purpose of the medication, describe and demonstrate the correct dosage, and correctly take or apply the medication. If a resident or a resident family member requests that a resident self administer medication, we will assess the residents ability to do so. If a resident is unable to successfully complete the above task, we believe that it is not safe for the resident to self administer his/her own medications. I/We understand that "the Bridges at Bent Creek is not responsible for medications errors that result for the self administration of medications by a resident. mokin : The Bridges at Bent Creek is a smoke free building. However, we; do recognize that smoking is a resident right and therefore the Bridges has designated an outdoor area where residents may smoke. The location of this area may change from time to time. Residents may smoke only in this designated area and must extinguish all their eigarettelcigar brats in community-designated containers. If a resklent does not follow these guidelines, at the option of the community, that resident will not be allowed to smoke and all cigarettealcigars will be taken from them or that resident may be asked to leave the community. The Bridges at Beat Creek does not provide 24- hour supervision and takes no responsibility for a resident smoking. --`-- -- --' _ d62:60 SO SI 9ad 00 •d Assisted Living Agreement -Addendum VI - Page 3 In summary, we want you and your family members to be informed of the inherent risks we often cannot control, as we respect your decision to retain your independence and maintain your quality of life. X A Re ' ent Date Responsible Pary Date &kz ? Administrator r DeRipee E2'd Date d0E:CO So ST qaj -L THE BRIDGES AT BENT CREEK ADDENDUM TO RESIDENCYAGREEMENT This agreement made this a ,3 day of Residents Name:?!icL Effective Date of this Agreement: ?3G/I e-/ It is agreed that the rate is being changed to: 4 o t R .ident Date Date D Date - Payer Adminis for esignee F: rw4CwSmddmftw to TOWMW&Vwx t dOZ-EO SO SS Qaj PET POLICY The Bridges consents to the Resident keeping the following Pct in his/her unit: Kind and Breed Name Color Weight Age The Resident will be completely responsible for the health, welfare, and care of the Pat The Resident will ensure that the Pet does not disturb the rights of other residents to the peaceful enjoyment of their units and of the common areas. The Resident will walk and curb the Pet only In areas designated by'tbe Bridges and will be responsible for cleaning up after the Pet. When the Pet is not in the Resident's unit, the Resident will keep it oo a leasb no longer than five feet or in a cage or other appropriate closed and ventilated container; and in the control of the Resident. If the Pet is a bird, the Resident will keep it caged both in and on of the unit.' The Resident will comply with all vaccinations and licensing requirements applicable to the Pet, showing proof of this upon request, and will comply with appropriate standards of care, treatment, and grooming. The Resident will be liable for any personal injury or property damage caused by the Pet that is suffered by the Bridges, its employees or agents, othes.residents, guests, or iuvhees. The Resident will pay all costs and expense, including reasonable attorneys' fees and`r?oart costs, incurred by the Bridges in enforcing any liability of the Resident under this Addendum. The Resident agrees to pay a second security deposit of $250.00 to the Bridges that may be used by the Bridges to repair any damage caused by the Pet and/or to clean the unit and its carpeting due to Pet waste or odors. The Bridges will return any unused amounts to the Resident within thirty (30) days after the expiration oftheResidmtAgreement This Addendum will continue until the Resident Agreeniie0t between the Resident and Bridges is terminated unless either party terminates this Addendum for any reason giving. ourteen (14) days prior written notice to the other patty. The Bridges may terminate this Addendum upon 24 h notice in the even the Resident fails to comply with any ofthe Resident's obligations under this Addendum. \w If the Bridges determines that the Resident, for any reason, is unable to'ugre for the Pet, the Bridges reserves the right to arrange for the Pet to be delivered to a Sponsor whose name, address. and telephone number are listed below: Name: Address: Telephone; ' In the event th o Bridges is unable to contact the Sponsor or that the sponsor is unwilling to accept delivery of Una Pet the Br' es will arrange for the Pet to be delivered to a local entity that the Bridges determines to be appropriate a Resident will pay all costa of delivery, feeding, care, treatment and housing of the Pet. Resident admowledges that he/she bas no right to keep a Pet except to the extent expressly permitted by this Addendum, and that the Bridges reserves the right to withdraw its consent by terminating this Addendum as provided for above. Resident/Representative Date Administrator/Designee Date py6d dLE:60 go ST qad at BENT CREEK 9LatstCd1%4y ,abut lm'w Community Ms. Dorothy Mist 2100 Bent Creek Blvd. Apt 138 Mechanicsburg, PA 17050 August 23, 2004 Dear Dorothy: As per your verbal conversation with Christy DiCrilio and Karen Mackley, this letter is to inform you that we must give you a 30-day notice. Since you have been unable to pay the balance on your account, we feel it necessary to do so. This situation is unfortunate, but we feel it in the best interest. for all parties for you to look elsewhere for placement. If you creed assistance with placement, please do not hesitate to ask. Please notify us of your plans as soon as possible. Sincerely, Karen Maeeldey d ? General Manager 9/i ?/off EXHIBIT "B" 2109 Bent Creek Boulevard • Mechanicsburg, PA 17050 Phone: (717) 795-1100 • FAX: (717) 795-9152 E d , ~ doh--E0 g0 St gad Tenant Ledger Dorothy Rist c/o The Bridges at Bent Creek 2100 Bent Creek Blvd, Rm 138 Mechanicsburg, PA 17050 Date: Tenant Code: Property: Unit: Status: Rent: Deposit: Move In Date: Move Out Date: Due Day: Tel# (O): Tel# (,H): 02/15/05 horisdol horobc 0138 Current 1,330.00 250.00 03/01/04 Date Description Charges Payments Balance Balance Forward 0.00 03/01/04 Rent 1,330.00 1,330.00 03/01/04 Basic Local Telephone Service 15.00 1,345.00 03101/04 chk# 93 Chk allocated with Rm 252 1,063.00 282.00 03117104 Supplies-Liquid soap pump bottle 2120 1.30 283.30 03117/04 Long Distance-2/16/04-3115/04 2.20 285.50 04101104 Rent 1,330.00 1,615.50 04/01104 Basic Local Telephone Service 15.00 1,630.50 04/11/04 Late Fee 25.00 1,655.50 04116/04 Transport-Premier Eye 4113 10.50 1,666.00 04/19104 Long Distance-03116104-04/15/04 4.10 1,670.10 05101/04 Rent 1,330.00 3,000.10 05101/04 Basic Local Telephone Service 15.00 3,015.10 05/11104 Late Fee 25.00 3,040.10 05/18104 Transport-51 Lancaster Blvd. 5/11 10.50 3,050.60 05/18/04 Long Distance-4/16104-5115/04 1.30 3,051.90 05/20104 chk#303 1,000.00 2,051.90 06/01/04 Rent 1,330.00 3,381.90 06101104 Basic Local Telephone Service 15.00 3,396.90 06111104 Late Fee 25.00 3,421.90 06/18/04 Long Distance 5/16/04-6/15/04 2.00 3,423.90 07101104 Rent 1,330.00 4,753.90 07101104 Basic Local Telephone Service 15.00 4,768.90 07/11104 Late Fee 25.00 4,793.90 07116104 Long Distance 6/16/04-7115/04 3.60 4,797.50 07119104 Supplies-Soap, Bar 6/27 0.73 4,798.23 07/19104 Supplies-2 Soap, Bar 7/5 1.46 4,799.69 07119104 Supplies-Kieenex 7/7 1.63 4,801.32 07/19104 chk#313 1,351.00 3,450.32 08101104 Rent 1,330.00 4,780.32 08101104 Basic Local Telephone Service 15.00 4,795.32 08/09/04 chk#319 600.00 4,195.32 08109104 chk# cash 100.00 4,095.32 08/11104 Late Fee 25.00 4,120.32 08116104 Long Distance-7/16/04 to 8/15/04 1.00 4,121.32 09101104 Rent 1,330.00 5,451.32 CONTINUED EXHIBIT "C" Tenant Ledger Dorothy Rist c/o The Bridges at Bent Creek 2100 Bent Creek Blvd, Rm 138 Mechanicsburg, PA 17050 Date: Tenant Code: Property: Unit: Status: Rent: Deposit: Move In Date: Move Out Date: Due Day: Tel# (O): Tel# (H): 02/15/05 horisdol horobc 0138 Current 1,330.00 250.00 03/01104 Date Description Charges Payments Balance Balance Forward 5,451.32 09/01/04 Basic Local Telephone Service 15.00 5,466.32 09/11/04 Late Fee 25.00 5,491.32 09116/04 Long Distance-8116/04-9115/04 0.70 5,492.02 10/01/04 Rent 1,330.00 6,822.02 10101/04 Basic Local Telephone Service 1500 6,837.02 10105/04 chk#328 1,000.00 5,837.02 10111/04 Late Fee 25.00 5,862.02 10/18/04 long distance 9116-10116 9.50 5,871.52 11/01104 Rent 1,330.00 7,201.52 11/01/04 Basic Local Telephone Service 15.00 7,216.52 11/11104 Late Fee 25.00 7,241.52 11/16/04 Long Distance -10/16-11115 1.40 7,242.92 11/16/04 chk#333 1,200.00 6,042.92 11/22104 Apr'04-1%fee unpaid chgs over 30 days 13.49 6,056.41 11/2204 May'04-1 % fee unpaid chgs over 30 days 13.53 6,069.94 11/22104 Jun'04-1%fee unpaid chgs over 30 days 20.52 6,090.46 1112204 Jul '04-1 % fee unpaid chgs over 30 days 20.73 6,111.19 11/22104 Aug'04-i% fee unpaid chgs over 30 days 27.50 6,138.69 11122104 Sep '04-1 % fee unpaid chgs over 30 days 41.21 6,179.90 11122104 Oct'04-1%fee unpaid chgs over 30 days 44.92 6,224.82 11/30/04 Nov'04-1 % fee unpaid chgs over 30 days 46.72 6,271.54 12/01/04 Rent 1,330.00 7,601.54 12101/04 Basic Local Telephone Service 15.00 7,616.54 12/11104 Late Fee 25.00 7,641.54 12116104 Transport -Premier eye 11/16 4.20 7,645.74 12/16104 Long Distance 11/16-12115 0.60 7,646.34 01101/05 Rent 1,330.00 8,976.34 01/01/05 Basic Local Telephone Service 15.00 8,991.34 01/11105 Late Fee 25.00 9,016.34 01118/05 Long Distance 12/16-1115 4.70 9,021.04 02/01/05 Rent 1,330.00 10,351.04 02/01105 Basic Local Telephone Service 15.00 10,366.04 02111/05 Late Fee 25.00 10,391.04 Current 30 Days 60 Days 90 Days Amount Due 1,374.70 1,370.00 1,603.42 6,042.92 10,391.04 Steven J. Proctor, Esquire Attorney I.D. #24428 Susan Quirits, Esquire Attorney I.D.#87001 Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown, PA 19464 610-323-6200 Attorneys for Plaintiff COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION-LAW ROBC LIMITED PARTNERSHIP 202 Black Matt Road Douglassville, PA 19518 Plaintiff CASE NO. 05-535 Civil Term V. DOROTHY RIST 2100 Bent Creek Road Apt. 138 Mechanicsburg, PA 17050 Defendant CERTIFICATE OF SERVICE I, Steven J. Proctor, Esquire, hereby certify that a true and correct copy of Plaintiffs Complaint has been served upon the following person by U.S. Mail, first class, postage prepaid on: February 16, 2005: Barbara Sumple-Sullivan, Esquire Attorney for Defendant 549 Bridge Street New Cumberland, PA 17070-1931 Binder, Kalis & Proctor, P.C. By:? Steven J. Proctor, Esquire Attorney for Plaintiff 0 Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ROBC LIMITED PARTNERSHIP, Plaintiff V. DOROTHY RIST, Defendant To: ROBC Limited Partnership c/o Stephen J. Proctor, Esquire Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown, PA 19464 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Civil Action - Law NO. 05-535 In Divorce NOTICE TO PLEAD You are hereby notified to file a written response to the enclosed New Matter filed by Defendant to Plaintiff s Complaint within twenty (20) days from service hereof or a judgment may be entered against you. Dated: ?2) 05 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant Barbara Surnple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ROBC LIMITED PARTNERSHIP, Plaintiff V. DOROTHY RIST, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 05-535 CIVIL ACTION - LAW ANSWER AND NEW MATTER TO PLAINTIFF'S COMPLAINT Admitted. 2. Admitted. 3. Denied. It is denied that the parties signed an Assisted Living Admission Agreement on February 20, 2005. It is averred that Defendant signed only page 5 of the Assisted Living Agreement and this page was signed on February 20, 2004. It is denied that Defendant signed Addendum I-Page 2-Pee Schedule, Addendum H-Page 3-Resident Rights, Addendum IV-Page 1, Addendum VI-Page 3 or The Bridges at Bent Creek Addendum to Residency Agreement all as attached as Exhibit "A" of Plaintiffs Complaint. It is further averred that Defendant did not receive, and did not desire to receive, assisted living during her stay at the Bridges. Also, Defendant's stay was intended to be only temporary until she could find an alternate residence. 4. Admitted. 5. Admitted in part. Denied in part. It is admitted that Defendant was responsible for $1,330.00 per month. It is denied that Defendant ever utilized the pharmacy services through the Bridges. All of Defendant's prescription were filled personally by Defendant at a local Rite Aid Pharmacy. 6. Admitted with the clarification that Defendant did not accept the notice attached to Plaintiff's Complaint as Exhibit -B.- 7. Denied. Exhibit "B" is a writing which speaks for itself and the characterization of same is denied. 8. Admitted. It is admitted that Defendant failed to satisfy her delinquency and vacate the residence. However, it is averred that Defendant failed to satisfy the delinquency and vacate the premises as a result of the inappropriateness of the one room apartment she was provided at The Bridges at Bent Creek. In Defendant's room, Defendant had to endure constant loud noises eminating from the heating element located in her closet which effected her peaceful enjoyment of the room. Defendant endured other heating and ventilation problems. Nonnal repairs to Defendant's refrigerator and electric were needed, however, despite Defendant's complaints, the problems remain unattended to. 9. Admitted with the clarification that said sums are not due for reasons set forth in paragraph 8 above and are incorporated herein by reference. 10. Denied. Paragraph 10 is denied as a conclusion of law to which no responsive pleading is due. 11. Denied. Paragraph 11 is denied as a conclusion of law to which no responsive pleading is due. COUNT I BREACH OF CONTRACT 12. Paragraphs I through l l of Defendant's Answer are incorporated herein by reference. 13. Denied. Paragraph 13 is denied as a conclusion of law to which no responsive pleading is due. By way of further answer, it is averred that Plaintiff, not Defendant, breached the contract between the parties by failing to provide adequate and appropriate housing. 14. Admitted in part. Denied in part. It is admitted that Defendant has not paid the amounts charged to her account. However, it is denied that Plaintiff has performed the services as provided in paragraph 8 of Plaintiff's Exhibit "A," which includes Defendant receiving room accommodations, basic utilities and peaceful enjoyment. 15. Denied. Paragraph 15 is denied as a conclusion of law to which no responsive pleading is due. WHEREFORE, Defendant demands judgment in her favor. NEW MATTER 16. Defendant signed page 5 of the Assisted Living Agreement on February 20, 2004, with the expectation that she would receive appropriate and comfortable housing in her room at the Bridges at Bent Creek. 17. Since Defendant began her stay at the Bridges at Bent Creek, the noise level in Defendant's room, eminating from the heating element located in her closet, has been very disturbing and the facility has refused to correct the situation. 18. Defendant's room at the Bridges at Bent Creek is in need of repairs to the refrigerator and electricity which have not been attended to even after Defendant's complaints to the faculty. 19 20 Dated Plaintiff has ignored these problems and malfunctions since Defendant moved into her room. Plainti IT has denied Defendant peaceful enjoyment of her room. WHEREFORE, Defendant requests judgment in her favor. Respectfully bmitted, r ? 05 Barbara Sumple-Sullivan, Esquire 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 Supreme Court I.D. 32317 Attorney for Defendant (Barbara Sumple-Sullivan, Esquire Supreme Court 1132317 549 Bridge Street New Cumberland, PA 17070 (717)774-1445 ROBC LIMITED PARTNERSHIP, Plaintiff V. DOROTHY RIST, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO, 05-535 CIVIL ACTION - LAW VERIFICATION I, Dorothy Rist, hereby certify that the facts set forth in the foregoing Answer and New Matter to Plaintiffs Complaint are true and correct to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties of 18 Pa. C.S.A. 34904 relating to w>,sworn falsification to authorities. DATED: 3 J 3 2005 t I ( I r A D ROTH IST Barbara Sumple-Sullivan, Esquire Supreme Court #32317 549 Bridge Street New Cumberland, PA 17070 (717) 774-1445 ROBC LIMITED PARTNERSHIP Plaintiff V. DOROTHY RIST, Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 05-535 CIVIL ACTION - LAW CERTIFICATE OF SERVICE 1. BARBARA SUMPLE-SULLIVAN, ESQUIRE, do hereby certify that on this date, I served a copy of the foregoing DEFENDANT'S ANSWER TO PLAINTIFF'S COMPLAINT, in the above-captioned matter upon the following individual by first class mail, postage prepaid, addressed as follows: Steven .1. Proctor, Esquire Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown. PA 19464, DATED: Barbara Sumple-Sullivan, uire 549 Bridge Street New Cumberland, PA 17070-1931 (717) 774-1445 Supreme Court I.D. No. 32317 Attorney for Defendant ., - '' ?, _, ,, Steven J. Proctor, Esquire Attorney I.D. #24428 Susan Quints, Esquire Attorney I.D. #87001 Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown, PA 19464 610-323-6200 Attorneys for Plaintiff COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL CIVIL ACTION-LAW ROBC LIMITED PARTNERSHIP : CASE NO. 05-535 Civil Term Plaintiff V. DOROTHY RIST Defendant PLAINTIFF'S ANSWER TO NEW MATTER 16. Admitted. 17. Denied. Plaintiff responded to Defendant's multiple complaints about maintenance issues in a timely manner. 18. Denied. Plaintiff made multiple repairs to all electrical appliances in room only to have Defendant cause further damage to such items. 19. Denied. Plaintiff has maintenance records which shall establish a historylof each maintenance call to Defendant's room. 20. Denied. Defendant has prevented Plaintiff from properly maintaining he room by both causing damage to her room and by refusing to allow staff to enter her room to mak needed repairs. By way of further information, Plaintiff even allowed Defendant to change rooms in an effort to address her concerns. WHEREFORE, Plaintiff demands judgment against Defendant together with atto eys' fees, interest, costs of suit and expenses and for such other and further relief as the Court shall eem just and proper. Respectfully Submitted, Binder, Kalis & Proctor, P.C. By: - Steven J. Proctor, Esquire VERIFICATION I, Dale Kuhlman, hereby verify that I am the Vice-President of Eldercar Investments, LLC and General Partner of ROBC Limited Partnership, and am ther fore authorized to execute to this Verification on the Plaintiff s behalf, and do hereby v rify that the facts contained in the foregoing Complaint are true and correct to the best of in knowledge, information, and belief and that the exhibits attached hereto are true a correct copies of the originals. I understand that false statements made herein are subject t the penalties of 18 Pa. C. S. §4904 relating to unsworn falsification to authorities. Eldercare Investments, LLC Dated: March 24, 2005 BY: Kuhlman, ?, - ?_ .-y ? -J _ ±? - 't .; ? :_ i t_: .. `. F`J ??, .. _? _, 1 U. Steven J. Proctor, Esquire Attorney I.D. 424428 Susan Quirits, Esquire Attorney I.D.#87001 Binder, Kalis & Proctor, P.C. 1035 High Street Pottstown, PA 19464 610-323-6200 Attorneys for Plaintiff COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLV. CIVIL ACTION-LAW ROBC LIMITED PARTNERSHIP 202 Black Matt Road Douglassville, PA 19518 Plaintiff V. DOROTHY RIST 2100 Bent Creek Road Apt. 138 Mechanicsburg, PA 17050 Defendant CASE NO. 05-535 Civil Term CERTIFICATE OF SERVICE I, Steven J. Proctor, Esquire, hereby certify that a true and correct copy of I Answer to Defendant's New Matter has been served upon the following person by first class, postage prepaid on: March 24, 2005: Barbara Sumple-Sullivan, Esquire Attorney for Defendant 549 Bridge Street New Cumberland, PA 17070-1931 Binder, & Proctor, P.C. By: Steven'J. Proctor, Esquire Attorney for Plaintiff .S. Mail, ?? :; - m,. ?' - :.. -; ,,__ ": _ ?. ?` ??; Curtis R. Long Prothonotary office of the i9rotbonotarp Cumberlanb QCountp Renee K. Simpson Deputy Prothonotary John E. Slike Solicitor 05 - Z35 CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 29TH DAY OF OCTOBER 2008 AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE - THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA RCP230.2 BY THE COURT, CURTIS R. LONG PROTHONOTARY One Courthouse Square • Carlisle, Pennsylvania 17013 • (717) 240-6195 • Fax (7171 ')An <C7)