HomeMy WebLinkAbout03-05-14 (2) _ f �l
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ANNUAL REPORT OF
C(.rj->, ,.
GUARDIAN OF THE ESTATE ORPHM'S COURT
CWBMLMD CO."PA
COURT OF COMMON PLEAS OF
Cumberland COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
Estate of Inez Davis an Incapacitated Person
No. 21-07-0200
I. INTRODUCTION
Gloria J. Banks was appointed
RIPlenary F--1 Limited Guardian of the Estate by Decree of Oler J
dated April 4, 2007
A. This is the Annual Report for the period from July 12 2012
to July 11 , 2013 (the "Report Period"); or
rl B. This is the Final Report for the period from
to (the "Report Period"), and is filed
for the following reason:
1. The death of the Incapacitated Person. Date of death:
Name of Personal Representative:
2. The Guardianship was terminated by the Court by Decree of
J., dated
Form G-02 rev. /0./3.06 Page 1 of 5
rXl,
Estate of Inez Davis An Incapacitated Person
II. SUMMARY
A. State the value of the estate reported on the Inventory $ 75.00
B. State the value(s) of principal assets at the beginning of
the Report Period. (Same as Inventory if first Report,
otherwise, ending balance from last Report.) $ 301.72
C. What is the total amount of income earned during the
Report Period? $ 17,401.39
D. What is the total amount of income and principal
spent for all purposes during the Report Period? $ 257,761.42
E. What are the balances remaining at the end of the Report
Period?
1. Principal $ 7,024.72
2. Income $
3. Total of Principal and income $ 7,024.72
III. ADDITIONAL INFORMATION
(If more space is needed,please attach additional pages.)
A. Principal
1. How is the principal balance listed above currently
invested? (Please specify, e.g., real estate,
certificates of deposit, restricted bank accounts, etc.):
Principal is maintained in an interest bearing account at Metro Bank and in a
Resident Trust Account at the Jewish Home.
2. Have there been any expenditures from the principal
during the Report Period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . M Yes No
If yes:
a. Have all expenditures from the principal been for
the sole benefit of the Incapacitated Person? . . . . . . . . El Yes 0 No
Form c-02 rev. /0./3.06 Page 2 of 5
Estate of Inez Davis An Incapacitated Person
b. List purpose and amount of expenditures:
See attached ledger showing $ 247,836.80
expenditures and Court Order dated May 10,2013 $
approving expenditures. $
$
c. Was Court approval received prior to
expending the principal? . . . . . . . . . . . . . . . . . . . . . . . Yes 0 No
3. Were additional principal assets received during the
Report Period which were not included in the
Inventory or a prior Report filed for the Estate? . . . . . . . . . . . ® Yes ®No
If yes:
a. Was Court approval requested prior to
receiving the additional principal? . . . . . . . . . . . . . . . . Yes No
b. State the sources and amounts of the
additional principal received:
settlement proceeds from personal injury litigation $ 247,082.54
$
$
$
$
B. Income
1. State sources and amounts of income received
during the Report Period (e.g., Social Security,
pension, rents, etc.):
Social Security $ 4,006.80
Pension $ 12,640.30
Interest on settlement proceeds $ 754.26
$
$
$
Total income received during Report Period: $ 17,401.36
Farm G-02 rev. I0./3.06 Page 3 of 5
Estate of Inez Davis An Incapacitated Person
2. How is income currently invested? (Please
specify, e.g., restricted bank accounts, client
care account, etc.):
Income is maintained in an interest bearing account at Metro Bank and in a
Resident Trust Account at the Jewish Home,
C. Expenses for Care and Maintenance
Specify what expenditures were made from the principal and
income for the care and maintenance of the Incapacitated
Person (e.g., clothing, nursing home, medicine, support, etc.):
The Incapacitated Person is a Medical Assistance recipient at a long-term care
facility. Her income, with the exception of$45 per month personal needs
allowance, is applied to the cost of her nursing facility care. The personal needs
allowance is applied to the cost of personal care needs such as clothing and hair
care.
Litigation proceeds were spent for healthcare needs, medical equipment, personal
items, etc., as outlined in the attached ledger and Court Order.
D. Other Expenditures
Specify what other expenditures were made during the Report
Period. (Do not include any items stated in response to
question C above.)
See attached ledger and Court Order.
E. Guardian's Commissions
List amounts of compensation paid as Guardian's commission
and state how amount was determined:
Court
Amount Method of Determination Approval Obtained
0.00 n/a 0 Yes D No
M Yes M No
Form G-02 rev. 10.13.06 Page 4 of 5
Estate of Inez Davis
An Incapacitated Person
F. Counsel Fee
List amounts paid as counsel fee, and indicate whether Court approval was obtained.
Amount Court
Approval Obtained
28 787.18
Oyes []No
0 Yes El No
I verify that the foregoing information is correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties of 18 Pa.C.S. § 4904
relative to unsworn falsification to authorities.
Signature ofGvardian of Everl,
Gloria J. Banks
Name ofGmrdtan ofthe Fstate(type or print)
576 Catherine Street
Address
Harrisburg, PA 17112
City,State,zip
(717) 545-4816
Telephone
Form G-02 rev.10.13.06
Page 5 of 5
1
COURT OF COMMON PLEAS
ESTATE OF INEZ H. DAVIS, CUMBERLAND COUNTY,
An Incapacitated Person. PENNSYLVANIA
ORPHANS' COURT DIVISION
O.C.NO. 21-07-0200
DECREE
AND NOW, this /0 6/c day of / fle � 2013, upon consideration
of the Petition for Allowance of Distribution of Principal of an Incapacitated Person, it is hereby
ORDERED and DECREED that Gloria J. Banks, plenary guardian of the estate and person of
her mother, Inez H. Davis, is authorized to spend from the proceeds from settlement in the matter
of Gloria J. Banks, Guardian of Inez H. Davis v. GGNC Camp Hill West Shore, LP, et. al.,
docketed in the Cumberland County Court of Common Pleas at Civil Action No. 10-924,for the
benefit of the Incapacitated Person (to the extent medical insurance is not available and plus
taxes, warranties and shipping cost as necessary) as follows:
Hearing Aides $ 9,083.00
Dentures $ 2,816.00
Cataract Surgery (unless not medically advisable) $ 4,200.00
n
Wheelchair—InvacareSolara $ 6p�4�00 w
c = , m
ca
Wheelchair—for Petitioner's home
Lift chair—U1traLift(2) $ 9� A Q=
cn o ra
Active Passive PRO LowerBody Exerciser
�- Cz
Miscellaneous Support, Rehabilitative and Therapeutic $2,436.46
Items
Clothing and accessories $2,000.00
Sneakers (3 pair nonskid) $ 300.00
Shoes(3 pair Orthopedic) $ 435.00
Refrigerator/Freezer $ 800.64
Television $ 1,179.97
CD/Tape Player $ 186.00
Phone $ 121.20
Burial Plot $ 3,000.00
Irrevocable Burial $10,000.00
(or as approved
by Dauphin
County Office of
Assistance)
Golden Living Nursing Home $ 1,819.21
Jewish Home $ 55.00
Michael Davis—reimbursement for medical records $ 650.00
duplication
Care Manager fee—(Petitioner's Hearing Exhibit 2)
Janet Foreman, CRNP, SkarlatosZonarich LCC $ 900.00
It is hereby ORDERED and DECREED that Gloria J. Banks, plenary guardian of the
estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to
purchase a handicap accessible vehicle, for a purchase price, including tax and tags, not to
exceed$61,000.00, to be titled in the name of Inez Davis and Gloria Banks, the Incapacitated
Person's disabled daughter, as tenants in common (with no rights of survivorship). Petitioner is
authorized to purchase an extended warranty for$1,035.00 and pay the first year of insurance
coverage in an amount not to exceed$1,776.00. Gloria Banks will be otherwise responsible for
operating costs of the vehicle, including insurance, maintenance, and registration. Upon the
death of the Incapacitated Person,the Incapacitated Person's one-half interest in the vehicle will
be an asset of her estate available to satisfy the Pennsylvania Department of Public Welfare's
Estate Recovery Claim.
It is hereby ORDERED and DECREED that Gloria J. Banks, plenary guardian of the
estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to pay to
Gloria Banks,the Incapacitated Person's disabled daughter$18,135.00 for renovations to make
her home handicapped accessible; and$22,550.00 representing a portion of amounts Petitioner
spent for the care of the Incapacitated Person since her incapacity.
It is hereby Ordered and Decreed that term life insurance policies currently maintained
on the life of Inez Davis may be allowed to lapse, with the cash value less any taxes owed added
to her estate;provided, however, in the alternative, said policies may be sold or transferred to, or
maintained by, a third party upon payment to the estate of Inez Davis the cash value of the
policies.
IT IS FURTHER ORDERED and DECREED that Gloria J. Banks, plenary guardian of
the estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to pay
from principal the sum of$27,342.18.15 (inclusive of costs) to SkarlatosZonarich LLC for legal
services provided to the Incapacitated Person and $795.00 to Rhoads& Sinon, LLP.
IT IS FURTHER ORDERED and DECREED that Gloria J. Banks,plenary guardian of
the estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to
distribute the Incapacitated Person's principal remaining after the above distributions have been
made, less $8,000, to Special Needs Trusts for the sole benefit of her disabled children,'Elsie L.
Baker. Carolyn A. Henderson and Gloria J. Banks, said distribution to be divided twenty-five
(25%)percent in trust to Elsie L. Baker, twenty-five (25%)percent in trust to Carolyn A.
Henderson and fifty(50%) in trust to Gloria J. Banks.
IT IS FURTHER ORDERED and DECREED that Gloria J. Banks, plenary guardian of
the estate and person of her mother, Inez H. Davis, an Incapacitated Person, is authorized to
spend up to$125.00 per month from principal of the Incapacitated Person for miscellaneous
personal expenses of the Incapacitated Person.
BY THE COURT:
J
ORPHA S' COURT DIVISION
Distribution:
Elizabeth B.Place,Esq.,SkarlatosZonarich LLC, 17 South Second Street, 6"'Floor, Harrisburg,Pa 17101
Addie A.Abelson,Esq.,Office of Chief Counsel, Department of Public Welfare,3rd Floor West,Health &Welfare
Building,7"and Forster Streets, Harrisburg, PA 17120
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