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Home My WebLink About05-08-14 (2) REV-1500 Fx(02-11) 1505610143 PA Department of Revenue OFFICIAL USE ONLY Pennsylvania Bureau of Individual Taxes DEaARrMCer DD REVENUE County Code veer File oMNrmbe Ha Boxrg,PA INHERITANCE TAX RETURN 21 13 1051 Harrisburg, A 1 N BELOW RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08 15 2013 04 07 1924 Decedent's Last Name Suffix Decedent's First Name MI HENSEL RUTH L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return (] 2. Supplemental Return 3,Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate 0 4a_Feture rote e t Canpromi a (date of death after 12-12-82) $, Federal Estate lax Return Repaired g Decedent Died Testate E Dadent Maintained a Living Trust (AHach Copy of Will) ce(Attach Copy of Trust O S. Total Number of Safe Deposit Boxes ❑ 9. Litigation Proceeds Received 0 10.Spousal Poverty Credit(Date of Death ❑ 11,Elechon to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) ra CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORV4*10N SHOULD'IA DIRE= O: Name Daytime Tele olr&Number� � b GERALD J BRINSER 717 830 348, 2 ua � Fill zc c7 r r— rn r-" -• rn CO C:1 REGISTER OF VKLLS-,USE ONLY G -n First Line of Address cs n C) "x7 -ri c7 -n 6 E MAIN STREET m rQ Second Line of Address T PO BOX 323 City or Post Office State ZIP Coda DATE FILED PALMYRA PA 17078 Correspondent's e-mail address: gjbrin @aof.COm Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, It is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE _ Q, gi, Linda Byers ADDRESS a 1 1 [=! 1270 Second Avenue, Chambersburg,PA 17202 SIGNATURW PREPARER OTHER THA REPRESENTATIVE DATE Gerald J Brinser 2 5 ADD SS Brinser,Wagner&Timmerman 6 E. Main Street, Palmyra, PA 17073 Side 1 L 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name. HENSEL, RUTH L. RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B).. . . .... _.............. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. 51 , 653 . 84 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. g. Total Gross Assets(total Lines 1 through 7)................................. 8. 51 , 653 . 84 7 , 109 . 04 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 57 , 539 . 98 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. 11. Total Deductions(total lines 9 and 10).................................................................. 11. 64 , 649 . 02 12. Net Value of Estate(Line 8 minus Line 11).-......_....................._......................... 12. -12 , 995 . 18 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)......................... 14. -12 , 995 . 18 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 15 (a)(1.2)X .00 16. Amount of Line 14 taxable 16 at lineal rate X .045 17. Amount of Line'4 taxable 17 at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate_X .15 19. TAX DUE................................................................................................................... 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 13 - 1081 Decedent's Complete Address: ENTNAM h L. — - llage, 100 Mt. Allen Drive 57ATE ZIP urg PA 17855 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments — A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 0.00 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (q) Check box on Page 2,Line 20 to request a refund — —.- 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use or income of the property transferred;... ............ ......... ......... b. retain the right to designate who shall use the property transferred or its income;..... ......... C. retain a reversionary interest;or......._.._.......................---...................... ....................___..._...._............_.. x d. receive the promise for life of either payments,benefits or care?........_............................ -.................... x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receivingadequate consideration?..............-....................... ................._..................................................... ...... ❑ 1 Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?......... 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?....................................._..................................._......................................... ❑ ❑x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)). For dates of death on or after Januarryy 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(if)j. The statufe does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: •The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P S.§9116(a)(1x.2)1. •The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)1. •The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent 172 P.S.5g9116(a)(1.3). A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blots or adoption. Apennsylvania DEPARTMENT OF REVENUE SCHEDULE E INHERITANCE TAX RETURN CASH, BANK DEPOSITS AND MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF Hensel, Ruth L. FILE NUMBER 21 - 13 - 1051 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Brethren in Christ Foundation -Thrift Accumulation Plan (TAP)Account#2718 (Includes accrued interest of$8.12) 26,367.96 2 PNC Bank - Checking Account#5070071536 24,952.67 3 Insurance Refund 212.65 4 Miscellaneous 111.30 5 Orrstown Bank Check 9.26 TOTAL(Also enter on Line 5, Recapitulation) 51,653.84 REV-1511 EX.(10-09( pennsylvania SCHEDULE H DEPARTMENT OF REVENUE p'�tR�� /p��/�� INHERITANCE TAX RETURN FUNB` L Ea*PE 7 SAND RESIDENT DECEDENT Ar111111MSTpA�^_-Y ESTATE OF Hensel, Ruth L. /�A�Or�h7rrW ('(A'S FILE NUMBER Decedent's debts must be reported on Schedule I. 21 - 13 - 1051 ITEM _ NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Linda Byers- Reimburse Expenses of Funeral Luncheon 1,108.23 2 Cocklin Funeral Home 619.39 3 Rev. Ron Burgard 75.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Linda Byers 2,582.92 Street Address 1270 Second Avenue City Chambersburg State PA zi _ p 17202 Year(s)Commission Paid 2013/2014 z Attorneys Fees Brinser, Wagner&Zimmerman --Gerald J. Brinser 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) 2500.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills (Ltrs. Pd. $60.00 = $10,000-$25,000) 148.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs - 1 Register of Wills -Additional Cost of Letters 75.00 TOTAL(Also enter on line 9, Recapitulation) 7,109.04 peninsylvania SCHEDULE i DEPARTMENT TA REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN , MORTGAGE RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Hensel, Ruth L. 21 - 13- 1051 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Messiah Lifeways @ Messiah Village-January through March, 2013 19,200A9 2 Messiah Lifeways @ Messiah Village-April through August, 2013 20,660.11 3 Reserve for Commonwealth of PA, Dept. of Public Welfare Claim for the period June 4, 2013 17,679.78 through August 14, 2014. TOTAL(Also enter on Line 10, Recapitulation) 57,539.98 REVA513 EX+(01-10) -'Afjf�' pennsylvania DEPARTMENT OF REVENUE SCHEDULE J RESIDENT BENEFICIARIES RESIDENT DECEDENT _L ESTATE OF Hensel, Ruth L. I FILE NUMBER 21 - 13- 1051 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) r, TAXABLE DISTRI B UTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Linda Byers Daughter 1270 Second Avenue g MISC. Personalty, 1/2 0.00 Chambersburg, PA 17202 Residue 2 Jeffrey Byers Grandson 815 Woodland Circle $1,000 Specific 0.00 Waupaca, WI 54981-1066 Bequest 3 Judith (Byers) Benner Granddaughter $1,000 Specific 9320 Oak White Road 0.00 Nottingham, MD 21236-4725 Bequest T r amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. ABLE DISTRIBUTIONSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV.1513 E%+(01.10) Ea pennsylvania DEPARTMLOPREVENUE SCHEDULE J RESIDENT RN BENEFICIARIES continued RESIDENT ESTATE OF Hensel, Ruth L. FILE NUMBER 21 - 13- 1051 NUMBER NAME AND ADDRESS OF PERSON(S) RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE RECEIVING PROPERTY DECEDENT (Words) (ggg) Do Not List Trustee(s) I, TAXABLE DISTRIBUTIONS Iincludeoutrights ousal distributions,and transfers under Sec.9116(a)(1.2)I 4 Brian Frey Grandson $1,000 Specific 0.00 2808 Old Orchard Road Bequest; 1/4 Lancaster, PA 17601-5334 Residue 5 Gregg Frey Grandson $1;000 Specific 0.00 194 Springdale Lane Bequest; 1/4 Millersville, PA 17551 Residue Page 2 of Schedule J WILL OF RUTH L. HENSEL I, RUTH L. HENSEL, currently of Upper Allen Township, Cumberland County, Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose again to redeem me and give me eternal life, do hereby make,publish and declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. 1. 1 direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. 1 direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. I bequeath the sum of One Thousand Dollars ($1,000) unto each of my grandchildren,namely,Jeffrey Byers,Judith Byers,Brian Frey and Gregg Frey,or their issue per stirpes. IV. I •and Dollars ($1,000) unto my great granddaughter, Emma Jean Byers. V. Contingent upon the approval of Messiah Village,I grant unto my husband,John S. Hensel, the right to continue living at my residence at 521 Dogwood Drive, Messiah Village, Mechanicsburg, Pennsylvania, for one (1)year from the date of my death. At that time, he must either purchase my equity in the cottage or move from the premises. VI. I bequeath unto my husband, John, any of my items of household furnishings he may desire. I bequeath any items not chosen by him unto my daughters, Linda and Brenda, to be equally divided between them as they see best. VII. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment,I devise and bequeath equally unto my daughters, Linda and Brenda. VIII. I appoint my daughter, Brenda Frey, Executrix of this my Will. In the event that she fails to qualify or ceases to act as Executrix, I appoint my daughter, Linda Byers, Executrix of this my Will. IX. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, 1, RUTH L. HENSEL, herewith set my hand to this my - Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this ID4-day of 41A4 1999. V (SEAL) RUTH L. HENSEL Signed by RUTH L. HENSEL, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this /Dz(, day of 4uqu, + , 1999. / p �7 Ve- .- 77Il residingat kxe. ...a i ►�, GZL � residinga Y -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF WE, RUTH L. HENSEL, l w . VV- SRO-1 and Ovl � the testatrix and the witnesses, respectively, whose names are signed to the attar foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed,and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Cy RUTH L. HENSEL WITNESS SS Subscribed, sworn or affirmed and acknowledged before me by RUTH L.HENSEL,the testatrix, Gce r e and YIA74A' witnesses, this day of ,0 tcitco7f , 1999. s (SEAL) otat Public Notadat Seal buLi orca Sue Ctimenhaga,Notary Public per Allen Twp.,Cumberland County y C ommission Expires April 28,2001 Member.Pennsylvania Association at Notaries -3- BICF Brethren in Christ FOUNDATION Financial Services. or Faithful Stewards POST OFFICE BOX 290 431 GRANTHAM ROAD GRANTHAM, PA 17027 November 1, 2013 Mr. Gerald J. Brinser Brinser, Wagner&Zimmerman P.O. Box 323 Palmyra, PA 17078 RE: Ruth L. Hensel SS#: 193-14-8359 Dear Mr. Brinser: At the time of her death on August 15, 2013,Ruth L. Hensel had one account with the Brethren in Christ Foundation. Thrift Accumulation Plan(TAP)Account#2718 had a balance of$26,359.84 as of Mrs. Hensel's death. The accrued interest was $8.12 with a total date of death value of$26,367.96. There are no joint owners or beneficiaries on the account. Also, please be informed that our address has changed to 431 Grantham Road,Mechanicsburg,PA J 17055. If I can be of further assistance, please do not hesitate to contact me at 717-796-4788, Extension 45420;or at klehmang.bicfoundation org. Sincerely, Kimberly J. Le man Account Officer KJL/Ijl Phone: (717) 796-4788 Fax: (717) 697-7714 E-mail: info @bicfoundation.org Nov, 8, 2013 1 :47PM PNC Bank No 9354 P I U - -N P - .0 November 8,2013 Gerald J Brinser Esq. Brinser Wagner&Zimmerman 6 E Main St 2"'FI P 0 Box 323 Palmyra, PA 17078 RE: Ruth L Hensel DOD: 08-15-2013 Dear Mr. Brinser: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checking Account Account#5070071536 Established: 04-19-1993 RUTH L HENSEL DOD balance: S 24,952.67+0.00 accrued interest Interest paid 01-01-2013 thru 08-15-2013 S 052 YTD Please note that this office provides date of death balances for deposit accounts(IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law, .0'rhe reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 1 of I RECEIPT FOR PAYMENT Cumberland County - Regiister Of Wills Receipt Date : 10/01/2013 One Courthouse Square Receipt Time : 14 :32 : 35 Carlisle, PA 17613 Receipt No . : 1075753 i HENSEL RUTH L, Estate File No . : 2013-01051 - — Paid By Remarks : GERALD BRINSER CJ ------ -- - ------------ -- Receipt Distribution --------------- --------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 60 . 00 WILL CUMBERLAND COUNTY GENERAL FUN 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE JCS FEE 15 . 00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D 5 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15_00 CUMBERLAND COUNTY GENERAL FUN Check# 4287 $148 . 50 Total Received. . . . . . . . . $148 . 50 .4 3 Lsf MESSIAH ewa Form Pa-01 vs- at MESSIAH VILLAGE J 100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 RESIDENT# UNIT ST DATE 49308 STMT. LINDA BYERS 009 W 11/311/2013 1270 SECOND AVE Mrs.RUTH L. HENSEL CHAMBERSBURG, PA 17201 TOTAL AMOUNT DUE $19,200.09 DATE DUE 12/31/2013 DATE DESCRIPTION RATE Days/ Balance Forward Units CHARGES CREDITS BALANCE 19,200.09 15 [PDA THIS UA S U0 D'E PLEASE ESCAPED YOUR NC FiCC LEASE SEND PAYJ`V1ENTW;,IEDWE1-'fl CURRENT OVER JU 49308 OVER 60 OVER OVER 120 TOTAL AMOUNT DUE 0.00 0 0.00 0.00 19,200.09 $1,200.09 -NESIDENT NAME Mrs. RUTH L. HENSEL lease make check payable to Messiah LifeW2ys at Messiah Village. Farm Pao' 1%finance charge may be assessed On accounts for which payment has not been received by the due date. Thank you! NIA If You have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank You! MESSIAH ifeways 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 QUESTIONS: CALL: !(71 697 4666 RESIDENT# UNIT TMT. DATE 49308 009 W 8/31/2013 JNDA BYERS RESIDENT RUTH HENSEL 270 SECOND AVE ;HAMBERSBURG, PA 17201 TOTAL AMOUNT DUE $20,660.11 DUE DATE 11/30/2013 DATE DESCRIPTION RATE —VA—Y'91— CHARGES CREDITS BALANCE 4/1-4130/13 RM/BD NURSING 295.00 30.00 8850.00 8,850.00 511-5/31/13 RM/BD NURSING 295.00 31.00 9145.00 17,995.00 6/1-6/3/2013 RM/BD NURSING 295.00 3.00 885.00 18,880.00 06/30/13 PATIENT LIABILITY 1186.74 1186.74 20,066.74 07/31/13 PATIENT LIABILITY 1186.74 1186.74 21253.48 08/31/13 PATIENT LIABILITY 1186.74 1186.74 22440.22 50% DISCOUNT ON LIABILITY OWED 1780.11 20660.11 RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTALAMOUNTDUE 49308 $20,660.11 RESIDENT NAME �1%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Racal Services at 790-8220. Thank You! MESSIAH L f ewa sm at MESSIAH VILLAGE April 9, 2014 Linda Byers 1270 Second Ave Chambersburg, PA 17201 RE: Medicaid Application for Ruth Hensel Dear Mrs. Byers, Thank you so much for supplying the bank statements we needed to prove Medicaid ("MA")eligibility for Mrs. Hensel. With Jerry's help I also obtained the statements from the Brethren in Christ Foundation for 2013 yesterday, which helped give us the total picture. Initially with what we understood was available in assets,we planned to file for MA approval on April 1, 2013. The billing of$19,200 last December was to cover the unbilled charges for January through March 2013 at which point she would have spent down below the required$8,000(State asset limit because her income was under$2,130 per month). In a recent discussion with Jerry,we learned there was an additional bank account at April 1, 2013. The balance in the TAP account at the Brethren in Christ Foundation was$26,293.87 at March 31, 2013. Here is the analysis: Two PNC Accounts—April 2013 $23,418.49 BICF Account 3.31.13 $26,293.87 Total assets available April 2013 $49,712.36 Jan—Mar charges paid 12.9.13 ($19.200.09) New balance $30,512.27 Amount permitted to keep $8,000.O 0 Difference to be spent down $22,512.27 With the amount of$22,512.27 to be spent down we arrived at a new effective date. Instead of April 1, 2013 we asked for and received approval effective June 4, 2013 through the date of Mrs. Hensel's death on August 15, 2013. That means we must bill privately at the full rate of$295 per day for April,May and 3 days in June which is a total of$18,880. After the effective date of June 4,2013, we are allowed to bill for the resident's income less insurance premiums. We've estimated that to be$1,186.74 per month or$3,560.22 for June,July and August. We discounted that by 50%,$1,780.11 because of our lateness in getting the matter resolved for you. We had a significant change in personnel in our billing department which has caused delays in certain MA matters. We do apologize. So attached is the final bill for Ruth Hensel as follows: April 1, 2013 through June 3, 2013 Patient Liability for June—August $1 , 50%discount in Patient Liability $ 3,560.22 2 560. 1 780.11 $20,660.11 Given the balance in the M&T account for the estate at March 2014,we remained under the$8,000 allowed to be maintained by a Medicaid resident and allowed for additional expenses of the estate. My apologies again for the lateness of this letter and bill but we do appreciate your cooperation in getting the Medical Assistance approval retroactive to June 3, 2013 which will allow us to receive some payment for those final months. Since ly, i Julie Sto t Chief Ii ncial Officer /c/c. Gerald Brinser, Esq. RECEIPT FOR PAYMENT LISA M. N, ESQ. Receipt Date : 5/08/2014 Cumberland nd Cou County - Register Of Wills One Courthouse Square Receipt Time : 15 : 01 : 37 Carlisle, PA 17613 Receipt No. : 1077952 HENSEL RUTH L Estate File No. : 2013-01051 -- - Paid By Remarks : LINDA J BYERS DB1 - -------------- ----- Receipt Distribution ------ ------- ----------- Fee/Tax Description Payment Amount Payee Name ADD PROBATE FEE 75_00 CUMBERLAND COUNTY GENERAL FUN Check# 106 75 . 00 Total Received. . . . . . . . . 75 . 00 LAW OFFICES BRINSER, WAGNER& ZIMMERMAN A P rojessional Corporation 6 EAST MAIN STREET- SECOND FLOOR (EAST MAIN&SOUTH RAILROAD STREETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE: (717)838-6348 FAX: (717)838-6912 MECHANICSBURG OFFICE GERALD J. BRINSER MESSIAH VILLAGE KEITH D. WAGNER 100 MT. ALLEN DRIVE JOHN M.ZIMMERMAN MECHANICSBURG, PA 17055 CALEB J.ZIMMERMAN PHONE:(717)697-4666 May 7, 2014 O a c � � mm Glenda Famer Strasbaugh, Register of Wills m v o Cumberland Co. Courthouse 1 Courthouse Square CO rn o Carlisle PA 17013 oC� c� o oc _n_3 In Re: Ruth L. Hensel Estate v 1 N r'- m File No. 21-13-1051 w cn o Q Dear Register of Wills: Enclosed you will find an Inventory and two(2)copies of the Inheritance Tax Return for the Estate of Ruth L. Hensel. Also enclosed is a check in the amount of$75.00 in payment of the "additional cost of letters". If you have any questions, please feel free to contact me. Thank you. Very truly yours, BRINSER, WAGNER& ZIMMERMAN Gerald J. Brinser GJB/wlc Enclosures c: file �-. =�_ . . �, �. M, .. 4• �� v 1 �✓� _ /. !� V ♦1111111 w W N C) t� [` o o cv E uj CL U C OU W M CJ K ti O c. CL- C Q3 CJ J F— O `L " J Z O'rl K] G_ r_ .-i to W 4.1 W ''� 3 O ly U N Cl) a pU Q W O O O S..) E Q:, y. Z O cc K K to O V n W CD F-i ti O O J c : C7 � U C W � Q a