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Home My WebLink About03-26-15 (2) ANNUAL REPORT OF GUARDlAN OF THE ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA ORPHANS' COURT DIVISION Estate of Ravmond Clark ,an Incapacitated Person No. 21-12-0040 I. INTRODUCTION Kevstone Guardianship Service ,was appointed �Plenary Limited Guardian of the Estate by Decree of Thomas A. Placey , C.P.J., dated February 16, 2012 � A. This is the Annual Report far the period from February 17 , 2014 to February 16 , 2015 (the "Report Period"); or ❑ 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: � �? �.,, � �' � :��—�., �] t,'�f""7 ..� � ..s �"7 2. The Guardianship was terminated by the Court by Decree of , � , y ;�;, - , � ..,.� ,.,� .-�� `s r,� � —rj J.,dated � _ � -Y� c� i N � � ._# � G'� � W Page 1 of 4 � Estate of Ravmond Clark ,an Incapacitated Person II. SUMMARY A. State the value of the estate reported on the Inventory $0.00 B. State the value(s)of income and principal assets at the beginning of the Report Period. (Same as Inventory if tirst otherwise, ending balance from last Report.) Principal $0.00 Income $2,027.67 C. What is the total amount of income earned during the Report Period? $27,124.78 D. What is the total amount of income and principal spent for all purposes during the Report Period? $(25,372.81) E. What are the balances remaining at the end of the Report Period? 1. Principal $ 0.00 2. Income $3,779.64 3. Total of Principal and Income $3,779.64 III. ADDITIONAL INFORMATION (If more space is needed,please attach additional pages) A.Principal l. How is the principal balance listed above currently invested? (Please specify, e.g.,real estate, certificates of deposit, restricted bank accounts, etc.): Total Principal Balance: $0.00 2. Have there been any expenditures from the principal during the Report Period? .............................................................. ❑ Yes � No If yes: a. Have all expenditures from the principal been for the sole benefit of the Incapacitated Person? .............. ❑ Yes ❑ No b. List purpose and amount of expenditures: c. Was Court approval received prior to expending the principal? ................................. ❑ ..................... Yes No Page 2 of 4 Estate of Ravmond Clark ,an Incapacitated Person 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: B.Income 1. State sources and amounts of income received during the Report Period (e.g., Social Security, pension, rents, etc.): Interest Income $14.46 PBGC—Bethlehem Steel pension $9,838.32 US Treasury—Social Security $17,272.00 Total income received during Report Period: $27,124.78 2. How is income currently invested? (Please specify, e.g., restricted bank accounts, client care account, etc.): Halifax Bank Checking#036297210 $3,779.64 Total Income Balance: $3,779.64 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.): Edward E. Lamarque,MD $236.30 Golden Living West Shore $22,841.33 Harrisburg Dental Health Assoc. $766.00 Total Expenses for Care and Maintenance: $23,843.63 Page 3 of 4 Estate of Ravmond Clark ,an Incapacitated Person 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.) Halifax Bank—checics $20.19 Keystone Guardianship—costs $278.11 Keystone Guardianship—reimburse $15.88 Register of Wills $15.00 Total for Other Expenditures: $329.18 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 $1,200.00 Fees ($100.00 per month) �Yes ❑ No F. Counsel Fee List amounts paid as counsel fee, and indicate whether Court approval was obtained. Court Amount �lpproval Obtained N/A '.� Yes ❑ No ❑Yes ❑ 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 autharities. a`� � �S ,.�,��..� Date Signatu o Guardian af tlae Estate Melanie Peters Name of Guardian of the E'state(type or print) PO Box 804 Address Elizabethville.Pa 17023 City,State,Zip 717-674-5757 Telephone Page 4 of 4 Income Statement-SQL-L,edger Uersion 2.8.27-Raymond Clark-kg... http://keyguard.anteil.com/rp.pl Raymond Clark INCOME STATEMENT for Period February 17 2014 To February 16 2015 INCOME Feb 17 2014 Feb 16 2015 Interest Income 14.46 PBGC - Bethlehem Steel pension 9,838.32 US Treasury - Social Security 17,272.00 TOTAL INCOME 27,124.78 - EXPENSES Nursing Home Expenses 22,841.33 Med ical 1,002.30 Bank Charge 20.19 Keystone Services Cost 278.11 Keystone Services Fees 1,200.00 Keystone Services Purchases 15.88 Household Expenses 15.00 TOTAL EXPENSES 25,372.81 INCOME / (LOSS) 1,751.97 1 of 1 3/19/2015 4:15 PM Account 1011 -Income-HB Checking#036297210/Raymond Clark... http:Ukeyguard.anteil.com/ca.pl?action=list transactions&departmen... Account 1011 - Income- HB Checking #036297210 / Raymond Clark February 17 2014 - February 16 2015 Description Date Reference Source R Debit Credit Balance 2,027.67 Edward E. Lamarque MD 05-14-2014 Check #176 183.54 1,844.13 Edward E. Lamarque MD 06-19-2014 Check #181 52.76 1,791.37 ✓236.30 Golden Living West Shore 03-11-2014 Check #170 2,154.97 -363.60 Golden Living West Shore 04-08-2014 Check #172 2,110.97 -2,474.57 Golden Living West Shore 05-14-2014 Check #177 1,875.63 -4,350.20 Golden Living West Shore 06-19-2014 Check #182 1,292.21 -5,642.41 Golden Living West Shore 07-09-2014 Check #183 2,110.97 -7,753.38 Golden Living West Shore 08-08-2014 Check #185 2,110.97 -9,864.35 Golden Living West Shore 09-12-2014 Check #189 2,110.97 -11,975.32 Golden Living West Shore 10-27-2014 Check #191 580.98 -12,556.30 Golden Living West Shore 11-10-2014 Check #193 2,110.97 -14,667.27 Golden Living West Shore 12-09-2014 Check #194 2,110.97 -16,778.24 Golden Living West Shore 01-13-2015 Check #198 2,135.86 -18,914.10 Golden Living West Shore 02-12-2015 Check #200 2,135.86 -21,049.96 �22,841.33 Halifax Bank 11-04-2014 Auto Deduction 20.19 -21,070.15 �0.19 Harrisburg Dental Health Assoc. 06-19-2014 Check #180 766.00 -21,836.15 ✓`J66.00 Interest - HB Checking 02-28-2014 Auto Deposit 0.88 -21,835.27 Interest - HB Checking 03-31-2014 Auto Deposit 1.02 -21,834.25 Interest - HB Checking 04-30-2014 Auto Deposit 0.88 -21,833.37 Interest - HB Checking 05-31-2014 Auto Deposit 1.09 -21,832.28 Interest - HB Checking 06-30-2014 Auto Deposit 1.29 -21,830.99 Interest - HB Checking 07-31-2014 Auto Deposit 1.05 -21,829.94 Interest - HB Checking 08-31-2014 Auto Deposit 0.97 -21,828.97 Interest - HB Checking 09-30-2014 Auto Deposit 1.05 -21,827.92 Interest - HB Checking 10-31-2014 Auto Deposit 1.54 -21,826.38 Interest - HB Checking 11-30-2014 Auto Deposit 1.53 -21,824.85 Interest - HB Checking 12-31-2014 Auto Deposit 1.57 -21,823.28 Interest - HB Checking 01-31-2015 Auto Deposit 1.59 -21,821.69 14.46 Keystone Guardianship - Costs 03-17-2014 Check #171 16.66 -21,838.35 Keystone Guardianship - Costs 04-09-2014 Check #173 21.29 -21,859.64 Keystone Guardianship - Costs 05-14-2014 Check #175 13.93 -21,873.57 Keystone Guardianship - Costs 06-11-2014 Check #179 26.72 -21,900.29 Keystone Guardianship - Costs 07-10-2014 Check #184 29.46 -21,929.75 Keystone Guardianship - Costs 08-12-2014 Check #186 21.67 -21,951.42 Keystone Guardianship - Costs 09-08-2014 Check #188 20.24 -21,971.66 Keystone Guardianship - Costs 10-09-2014 Check #190 43.10 -22,014.76 Keystone Guardianship - Costs 11-05-2014 Check #192 31.52 -22,046.28 Keystone Guardianship - Costs 12-11-2014 Check #196 18.97 -22,065.25 Keystone Guardianship - Costs 01-12-2015 Check #197 21.77 -22,087.02 Keystone Guardianship - Costs 02-09-2015 Check #199 12.78 -22,099.80 �278.11 Keystone Guardianship - Fees 03-17-2014 Check #171 100.00 -22,199.80 Keystone Guardianship - Fees 04-09-2014 Check #173 100.00 -22,299.80 1 of 2 3/19/2015 4:16 PM Account 1011 - Income-HB Checking#036297210/Raymond Clark... http:Ukeyguard.anteil.com/ca.pl?action=list transactions&departmen... Keystone Guardianship - Fees 05-14-2014 Check #175 100.00 -22,399.80 Keystone Guardianship - Fees 06-i1-2014 Check #179 100.00 -22,499.80 Keystone Guardianship - Fees 07-10-2014 Check #184 100.00 -22,599.80 Keystone Guardianship - Fees 08-12-2014 Check #186 100.00 -22,699.80 Keystone Guardianship - Fees 09-08-2014 Check #188 100.00 -22,799.80 Keystone Guardianship - Fees 10-09-2014 Check #190 100.00 -22,899.80 Keystone Guardianship - Fees i1-05-2014 Check #192 100.00 -22,999.80 Keystone Guardianship - Fees 12-11-2014 Check #196 100.00 -23,099.80 Keystone Guardianship - Fees 01-12-2015 Check #197 100.00 -23,199.80 Keystone Guardianship - Fees 02-09-2015 Check #199 100.00 -23,299.80 1,200.00 Keystone Guardianship - Purchases 04-29-2014 Check #174 12.88 -23,312.68 Keystone Guardianship - Purchases 09-05-2014 Check #187 3.00 -23,315.68 �15.88 PBGC Pension 02-28-2014 Auto Deposit 819.86 -22,495.82 PBGC Pension 04-01-2014 Auto Deposit 819.86 -21,675.96 PBGC Pension 05-01-2014 Auto Deposit 819.86 -20,856.10 PBGC Pension 05-30-2014 Auto Deposit 819.86 -20,036.24 PBGC Pension 07-01-2014 Auto Deposit 819.86 -19,216.38 PBGC Pension 08-01-2014 Auto Deposit 819.86 -18,396.52 PBGC Pension 08-29-2014 Auto Deposit 819.86 -17,576.66 PBGC Pension 10-01-2014 Auto Deposit 819.86 -16,756.80 PBGC Pension 10-31-2014 Auto Deposit 819.86 -15,936.94 PBGC Pension 12-01-2014 Auto Deposit 819.86 -15,117.08 PBGC Pension 01-02-2015 Auto Deposit 819.86 -14,297.22 PBGC Pension 01-30-2015 Auto Deposit 819.86 -13,477.36 9,838.32 Register of Wills 06-09-2014 Check #178 15.00 -13,492.36 � 15.00 Social Security 03-12-2014 Auto Deposit 1,435.00 -12,057.36 Social Security 04-09-2014 Auto Deposit 1,435.00 -10,622.36 Social Security 05-14-2014 Auto Deposit 1,435.00 -9,187.36 Social Security 06-11-2014 Auto Deposit 1,435.00 -7,752.36 Social Security 07-09-2014 Auto Deposit 1,435.00 -6,317.36 Social Security 08-13-2014 Auto Deposit 1,435.00 -4,882.36 Social Security 09-10-2014 Auto Deposit 1,435,00 -3,447.36 Social Security 10-08-2014 Auto Deposit 1,435.00 -2,012.36 Social Security 11-12-2014 Auto Deposit 1,435.00 -577.36 Social Security 12-10-2014 Auto Deposit 1,435.00 857.64 Social Security 01-14-2015 Auto Deposit 1,461.00 2,318.64 Social Security 02-1i-2015 Auto Deposit 1,461.00 3,779.64 17,272.00 27,124.78 25,372.81 3,779.64 2 of2 3/19/2015 4:16 PM Balance Sheet- SQIrLedger Uersion 2.8.27-Raymond Clark-kg-rclark http://keyguard.anteil.com/rp.pl Raymond Clark BALANCE SHEET as at Feb 16 2015 ASSETS Feb 16 2015 Income- HB Checking #036297210 3,779.64 _.......... TOTAL ASSETS 3,779.64 LIABILITIES _._...___.._____...... ........__. TOTAL LIABILITIES ' SHAREHOLDER'S EQUITY Current Earnings 3,779.64 ____._._....._ _............ TOTAL EQUITY 3,779.64 TOTAL LIABILITIES & EQUITY 3,779.64 1 of 1 3/19/2015 4:14 PM PO Box 804 Keystone Elizabethville, PA 17023 G u a rd i a n s h i p connie@keystoneguardianship.com m e laniepkeystoneguardiansh i p.com Se rvi ces heather@keystoneguardianship.com gina@keystoneguardianship.com m issy@keystoneguardiansh i p.com March 23, 2015 Register of Wills � 4 � � �j . 1 Courthouse Square � .� � �� Carlisle, PA 17013 �,� ;; �? � ,�; �� ., �..,..a h� -r �� i F'r� . � E'J RE: Raymond Clark (21-12-0040) ��7 3 �� ,, -�� ,..,, :: � ` �' '�:.: �'' wr.,� c;� Dear Sir or Madame: � Enclosed are the following with regard to the Ray�nond Clark Guardianship: 1.) Annunl Report of Guardian of the Estate and 6uardian of the person for the period of February 17, 2014 to February 16, 2015; 1 - original nnd 1- copy to be stamped and return�d. 2.) A check in the amount of $15.00 for the filing fee. 3.) A prepaid envelope for the return of the time-stamped copy of the report. If you are in need of additional information for this filing; ple4se contact us. Sincerely, Gti��.,� �- � Melanie Peters ENCLOSURES Phone: (717) 674-5757 * Fax: (717) 362-3381 * www.keystone�uardianship.com