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HomeMy WebLinkAbout94-00130 '"i , , , " ,I I I ".j " . ! I, , , , ~ ;! ',' ", " , i ' I' " , ' \ ., , " r I , i(i ,I I, I' , , " !! ,,' I , , >1'1' " 11 I' . I , II '." " , , I~j 'V .~, J .~I II I, ;'1 'I , , "I , , " , 'i' .It !0 ~ . ,'1 \ , , - 1 " ,I i' , , " " , I , . 1,,1 I, " J , ' , , " I, " 'I II' '" " , , " il-," " " 1,1 , ' I\i " , I " " " , " " 1 '! ,~ 'I I, I' " ~ r 'II ~ , , I' ." , , Ii , , , I II; , Ji, , I 1,/ ,I ',I" , ,\ 'I ,II , 1,\, 'II 1\" , , HOL Y SPIRIT HOSPITAL, Pla;ntlff V. WILLIAM BROWN and DEBORAH K. BROWN, Defendants . . IN THE' COURT OF CC>>IMON PI.EAB CUMBERLAND COUNTY, PENNSYI. VANIA CIVIL ACTION - I.AI'I . . . . ; . . NO. 130 G 119 ~ . . : : r::n.Qf1.P.1. A. I.N T AND NOW comss Plllint;ff by and through its attorney, Arthllr A. Kus Ie, ESqLi! re, and respectt'llll y reprssents thB following: 1. Plaintit'f, HOLY SPIRIT HOSPITAL, is a hospital facility organized and existing under the laws of' the Commonwealth of Pennsylvania located at North 21st Street, Camp Hill, Cumberland COLmty, Pennsylvania. 2. ,Defondants, WILI.IAM BROWN tlnd DEBORAH K. BROWN, lfre adult married individuals residing lit 45 Creekside Drive, Enola, Cumberland County, Pennsylvania. cPUNT 1 3. Paragraphs I through 2 as set forth hereinabove are incorporated I!erein by reference thereto. 4. On or about December 26, 1991 and from t imB to time tllrough ApI'; I 26, 1993, Defendants' daughter, Tr;sha M. Brown, was admitted to HolY Spirit Hospital for trEJIltment. Plaintiff in good fa i tll prov ided tile necessary med i ca I serv ices to Defendants' dltugllter tlnd therea t'ter billed De fend,lnts t'or those serv i CBS and " expeflses 111t:llf'red. wh I eh lire ; ts LISUlll and cus tomary charges for I ~j these services, 6. A copy 0 f tha b iI/I ng for Berv 1 CIlB nmderfiQ to Defendnnts' daughter, Tris/lII M. 8rown, by Plaintiff i/1 lIttac/led hereto, made a part hereof' and mi/r/(ed E.xhiblt "A". 6. Defendllnts lire im7ebteQ to Pll'llnt Iff in the amOlll1t of Two ThollBnnd One Hlmdred and Sixty-Two ~lfId SO/IOO ('2,162.60) Dollars. 7. Demand ha!i betJn tmtde llpon Defendants for prompt payment amolmt rille, which demand has gone 11l1/1eedec7. WHEREFORE, Plaintiff prays YOllr Honorable COllrt to enter Judgment in Its favor and against Defsndnnts In the amount of '2,162.60 a long with interest at the rllte of 6* per annum find the costs of this proceeding. ,COUNT 2 8. Paragraphs 1 throllgh 7 all set forth here Inabove are incorporated herein by reference thereto. 9. On or abollt July 26, 1992, Defendant, WII/lam Brown was admitted to Holy Spirit Hospital for treatment. Plaintiff in good faith provided the necessary medical services to Defendant, Wi II iam Brown and thereafter billed Defendants for those serv ices and expenses incurred, wh I ch {/f'e its lIslla I and cus tomary charges for these Berv Ices, 10. A I though De fendan t, Deborah K. Brown, was not prOVided any medical sarvices she wOllld be unju,'Jtly enrlchRd aB tile services provided were necessary medical services for her husband's hea I eh and we I fare. t J ~" "-j " 'I , , , , , .. .... , I 1"- '\' 1\ 'I , ' " " I , " /.,- ;,1 " ,I " 'I " '. " " RIIHkt'l' WA" 1',1 PATIENT INFORMATION $$ *' IENQL.A IFA/170"Je PH * I 12 SEXI F MS. S RACEI 1 OCCUPATIONI STUDENT I I AMEli f"I III lli1~4n~. .' ~Ir( *' 11 li46>4 ' , . . ~. .) , I "'i;,1 ;,~ ' ,I itl, ~ , j.II,~ " r 1" J :'; ',' I..:..' ,,(I" ',I "F" ~'?11"O'7'" ,,"!;,' 717-'1:)2-'~4' ,'~. 0101 0410211I "'1,' ,;'i~ ~ ! ,\ 1111 'II), PH *1 . ~~I. . , HIJL. Y SP 1 F\ IT H(J'~~' 17 ~\\. CAMF' HIL.L.. Pi\NN$VL.V/\NIA 1 Nil OUTPATIENT FQRM . , AltO t'ATI:;I 1204nl 121~4 , , ,':II .1 "'\il~.I~,,,":,'. ,,"j;;" ~,\', ~ ' " NAMII "\'J: IRO~N ,TAIIHA 1'1 ADDRI8.' 4e CREIK.IDE DAIVE I'IRTHDAT.' 1~/Oe/l'7' AOE" : IMPL.OYIRI ' I ADDRESS' I , CHURCH' " 01HIRS , I NAME' ADD""I.,., , '1_," , IMIiI'lOENCV CONTACT INFORMATION 8ROWN ,WILLIAM H REL. TO PT. F WORK PH *1 717~'3e-1448 4e CRIIK'IDE DR~VE ./ENOL.A IPA/171);<15 PH *1 717-732-4344 ~ \ \ ',I' I . ',( I"" " )'" I . I I' ~' J " I REL TO 1"11 WORK PH *1 I I PH ..., '~ INFORMATION ' I ~:" /. ':, ,j~~ ADM SOURCE I R~ PATIENT TV,..,' pt :'i I'm HOSP iSERVI lolliF FINANCIAL CL.II' ~:w VISIT CUNIC CODEI OUTPT RIO ' tl~! ICD-9 OXI '~ , ,'" ;~ \) I," i ~ , " I" " . 'j'" ADMIT DR' ATTND DR' . i ptlFER DF" , ADMIT DX' COMPLAINT! I CASE 11133. 'HAI'lMA AAJANA MD 111336 '~RMA' RAJANA MD " ,.......',l_.,~.,,'..;.,;.. '.....,.... .__ i 7$cr: J.. , " . NAME' ,,'., " ADDRES'I IMPLQYI~' ADORns I WILLIAM,IROWN. 4~ CAIKK.IDE DAlVE IENOL.A LEON. WINTERMYEA INe , I OUARANTOR lNFORMATION PT R~L TO OUARI D IPA/1702e CONTACT NAMEI I I . ~ ,1" .~ ,':/, '/!~: ,,.!t'i ,,'1('.' '\; , f' I ~ ,'e" ). ' ''.:!.l 'I,' ',f,' L" -.71 , ..,".,' i,'<:I',li ". ,'.', , .' ,"/', -.'1 '''i''. . " 'I' '~(i ,t)l',/,,~\\t!: ~:','.' SS *I~ 1"-44.~~7,~~.,~~&1 PH * I 717~1,33t~,~),~{!~ PH *1 717-'31-14..'" :"i, L ':"}"I\' , t,. , , DATI/TlMEI DE$CRIPTlONI ACCIDENT INFORMATION ACC INDI JOB RELATEDI LOCATION' . . PLAN INSURANCE CO SUB8CAUIlR 11 ~09 CAPITAL BLUE CROSS 8ROWN .WILLIAM INSURANCE COB REL 1 1 D INFORMATION POL.ICY ... PC VFY 1694453 Y GROUP * MA CONTRACT NUMBER 77 0242e7000 112 U 114 ,,' I MEDICARE SECONDARV QUESTIONSI INITIALS' MEDICAl'll SIONATURE ON FILEI N COMMENT" ECHOCARDIOGRAM PRElI~ERT 11 PRECriRl 21 PERMANENT COMMENT' . PATIENT NAMEI BROWN .TRISHA M REOlsrERED BVI AOSLH PTIII la54728 MR*I 118466 END I)F DOCUMENT 12/26/91 FHOM LB40,OPREOSFl I f-MCU' -~- "~l (I' bAJI Uf JlIIl U^,lO' I II, "'1'1,1 DIlL '1, r----- -......-----.-- .-.---. I-OYl)I.1l ,.It'I'''' HOI.Y $I'IRI" HOef'ITAL , ' ~rM"'~J, $0:1 N 21S1' IT CAH" '"LI., f'A 11011 ~ ,,.., ""HHifl IlJRTH-DA . ,,~~ 00 . Ftl' ~3-1~1'747 11/0.,1. - , ute .J~;;~~~~.~---'.~_'I=~:'II"~';'~'jjlJ'~J .i'~.. _[.~'i)'j~'~~~~L"n~Y!~~~_t~,~~~=--- ----.-..--,-------..-~.-...--. .."---.,.-- ~"~ITI'_ ~~J"~_ii}Nj.r:.'..I:-_12~'.t~!J~!'!~.'_ .,._. .!.'I~'~I!j!!!.!!!.'!!!.~_ .....t!'ll.U;Y tUJ . n QI/.""'HOA ,UIfJ III LI.l AH DROllN 48 CRMmK610H ORIVH f.NOL^. f'A 1"fO~S I 361 11 t 1t441 N"MI "DO""1t - .----.---.-......----.......-..-... -~- SH^R"A RAJANA "D I,. 1- All ,8mIJ PLEASE RETURN nlls PORTION WITt! YOllR PAYMfNT. 7~ ~cUt r'~~\'iJ''',N' I s 'l =--=r3--- D'80'II'III)" nr flI!nVlcr 1IIIo\L tn)'\I'II....t'iEnVlf.ffi ('~_..__~~l:r~ PIP ('I)\,rll^lll" IIH fownj\t\F F/\I I ('.FIlMI!!: !1m (I) till I INl\ 1;,1 tln;o It'" f.11 tllll F"" G)Vf!flAOI IWi CO flQ4 PI\JlIrH ~MlJUNT .nAIL Of' CURRl,:Nr CIlAAGES. PA 7/]0 .~TA STREf' SCRE011.540120 7/10 OrF/O.. VISIT 011810003 "ENT,S ANI to,OO "".00 ADJUST" 10,00 H.OO NT$ ell rl'HIIARO 0,00 "y 0,. CUM"!!NT LABORATORY CLINIC CHARGU :400 '!l10 10,00 "'!l,00 10,00 ....,00 $UI)- or AI. c)F CU"R, CHARGU 1S'!l, 00 'Il'5,OO DI,. NoelSl ,,,p. 034.0 'Al"IINT 1$ "UI! "roN II tl! IPT 01' nlu STA EHENT, YOU "AY SU8"'T THiS ~ R" "0 YOUR IN6URANcm CAR I"R FOR ICE I "IIURSf.H.:N1' . fWWAI. IDE NT flU ~J-'I\'U.\! ~... _p.:nJYl.7~ "HEll ALL OIJf'~rION~ TO THE nWWH: S$ OFF'reF 1111l1li1.21.1R ,O.L PLEASE SEND PAYMENt TO HOLY SPIRIT HOSPITAL 503 NOf1TH 21ST STREET CAMP filII, PA 17011~~Jnn ~aL!HIS AHOU T 55.00., A\JtJlIII JI,II1 "/III~ r" BILlltl!) MA" llf- Nfl f ',1MI., ~'l)n NI'V OtAnl',r'\ nlll "I I'-"Ill WH", 011'1 filiI. '/,-'1 '-flfflMllfD I)ll H Itl' 1jIlM,f ~ f, 11111'1\'; 11') tlf)! rAy MI"f "Mil 0' 1,lr 1 '." I' 'II . I" ,'. r I I if If . f II ", I ~'.'.\ t tilt. e,1 ,"~'1'." 1""/111/.1,1 HOl.Y SPIRIT HOSrlTAL tAH" HIU.. "A · Rf.lI"UA Ill. u, I ,tU/'U . . ;1"I:l"" 11111. Y ~p IIH r Itl)~\P 1 I AI. CAMP 11111., flENN~IYI.VANIA Illlll OIHPArIENr Form pr It. 279U27 'M'~ It. .,8466 ". NAMe:, ADORf.fUI, ..RnIDAI!;. , IMPLOyui. '. AOllRt:65 . ClIllRCli. Ill/OWN ,JIll !'IliA M 4fi CRLr~~/n[ u~lvr 11/00/1979 AilE. IW' It':N1 I tlFOr~MA1' ION Au.j 0 7 1~9Z ontE R5 f\!'\ Il' /r. NOI. A /I'A/11Ui1!1,.II /# I 12 REX' F H91 ~ RACE. I OCClIPA r 1 tIN I ~; 11IUl'. N r / I I Pit /I. AHB. 9911-11-0819 n 7-1"-6346 CIF.O I 041 Uil!" [Mf,RGENCY CONTACT 1 NHJRHAr J ON NAME. orlOWN ,WI LLI AM I. In:L 10 PT.,.. WORK PII /I' 717-938- 1<168 Al)ORES~ 1 45 CrlEEKl'l1 DE UR I VE IEN()LA l"A/l1ll2'3 PI. /I .'17-132-6346 HAME. AODRE5~1 1 liE I. 'fO flT. 1 1 WORK Pit /# I 1'1\ /II CASE INFORHA'rJON AOM I T' DR, Illl'HI !lIIAJlHA IM.JANA HIl AllH !1nUIlCI': I RI' PA T I ENI TYPF.. C AnNO DR' 111331) SI\AfIHA HAJANA HIl f111tlfl ~,[lIVI 'clm fiNANCIAL eLS. B REfER OR. I)' I/' V,Ii'l1 r CLINIC COllE. Fife eTR AOMIl ox. ,'. 'J' I II. r?\ '~I:,-9L,lJXI COMPLAIN'. J/JIi(' - L1V '1 I Ace ItIF.Nl I fll~~~ON . DATEITIME. Ace INIlI ~"-ll Jon REI.ATm. LOCATION. DEFlCR I Pr/ ON, HAME. ADORE S5 I E"I-'LOYt:R. AtlDRUS, Witt I A" InWWN "!l CAUI<S/lIE URIVE IENOLA llON E WINIERHYER INe 1 llUMMN rOI~ I NI: OIlHA 1'1 ON PT I~EI. TO flUMl, II IPA/I'/025 CONTACT NMil: I 1 1 ~s /I' 169.....-~317 Pit /I' 717-132-630116 1'11/11 717-938-1"68 PL AN ~ I N5lJAANC[ CO 00 ,5UU~CR I ilEA "1 D' eM'1 TAL BUll( CAOSS IA N ,WILL IAI1 U "3 'oil INEIIInIlNCE COB IU.L I II I NH1RltA r ION POLICY H PC VFY 1694<1[13 Y or~ouP " "A CONTRIICT NUHaER 11 0242~7000 MEDICARE tlECONI>ARY QUE~H10N!i. INI1'IALSI ""OICA"E SIlIN^tllR[ ON PILEI N COHHlNT61 flRI~ C,;LRT I I PIlf.CfRT 2. PErIHMU:Nl l:tll1l1f:N r, PAT IfNI NA"' I fj!1l1WN ,,"lmIA " Ilnil''''flIIIlIIY, Fltn'll PT/l1 2'1~1,1'127 HA/lI IIn<1M' f 1m OF llOClJt1F:NT 12. 14 07130/92 FROH I.CO<l,OPAEG5F/ OAlI("1I1I1 lJMfl"] n-_.~_:"l~, HOLY .',RIT HO.'lrAL '" .. '''T n OA"r HILI,./ 'A 111 113....... "11' n'II..Yon J ';;"~~;~';~J~T ,L]t\';,'~,~~ I "'" IllnH"OA I t 1/'"'' r" I . ._, ...,--_._,'. .. "__6=:J "'1"1111 ' i~ [ ---- ~'I-;:0ii.;,7; "il; ,\ljDI~';' " 11:!~~~~_~~~1!.1 ..n II Il L I A" 1111I0"" ... C_I.M.IDI DltlVE INOLA,'A I',." 1 :III ., ......... NUl _I1Dn.., HYNICM "'llit PO PLEASE RETUmJ fHIS POFlflON WITH YOUR PAYMENI 7"H~ ~cJ~ I ":;;:>. r.~_ "15'1l'II"Of IIl)PII^1 111.."e" L' .~l,~~ -_. .---;:-;i;z-- -;'" ,7Jwi,^-;;-i - "r7j';.(-,~:,ilii"';' 'nl'-;;' 1';;",(' COlli 'HMIl\fR III', (:1,1 'III I IIl'i U) r~,'.' 1 j', 1 0 NUl -.-_. - --.-- -.------ ----- ._-.- ,_. I "o."'/l,\t I; "lllo. r^,IHU .AMOUHr Otr ClltlRI"' eM"...... / "" 1:1" A"n ""JUI11lt: 1'1 ,"., CUL'URE ".,,,,,,,, 1.... 1.... "0' Vlel' """"1' ...... ...... tALA" I 'OII11AItD '.'0 'VMRA , 0' CUIt_.", LA'ORATO"Y a.IMIC CHAItGeS Jot ItO ..... 4.." 1.. ot ...... CU"_. CIIA"81%8 11.00 !JI.OO itA' II'. .... 'AY"'''' I' IUI UPote Itl I'"~ 0' Itlll IrAT "'N'. YOU NAY flUI"t1 'Hill'" " TO YOUR '".UltAMCI CAIt" IR '01 Itll".UW'''"I"'. 'It (11M 111(rn NrJ ," 'r,,;' , 'Arlit" W\JM"" RUIR AU. olii ,.IiON'i"Iq THE BllS'NE~'.. OF 101 I 11l7)7f!1.'l1" '''';J S'-:-I!: ,~=--=.'j'-- ~,' PLEAS!. '!.NO f'A\Wtll TO I HOl V SPIRIT HOSPIT Al L!~! JHJ.!_ ^"OU'!L . 55 .lI9 follDllllllj."1 !l/l!lttn 1J'i ". 0'1' ',[ f "'."11, Fl'rl .,n 503 NOI\IH 21ST SrnEEr II/An',f"' ',Ill ,.,I"r(I' I,' 1'\1 ....\'1 "lll:r"r'lfV ('AMP I t!1 ! , F'A 1 itlll.22AJl "'1\1,.", :/,' ';'~.'l' t I' ,~I." , '; ,1.,:')', I'~'\' .1';I:'I~~f. "lvll,',!,1 MOLY .'IR" HO""A~ CA" HILL. 'A HOLY '''In HOI"'AL In .. .tlT " CIA"' HILL, ,. PI' '13-' 41 '11 . n.t""..., I"" '.lltnl.IA I t t Itll" J" ^,,:,I,.'iI'~'~JJ'1 i~~'.';17i~.'~1',' Il~~":" [o^] --=,,-----1 'Cl.~'- -;'.'!iI.!lI;\!J~!' 1-;}.~p~Lv.._tj",:,! -.. .,111)'. "OI.lC, tlU".DIA AIm UlLtlAN '.OllN ... CItIIM.IDI DII'Y! .NOL.A,'A 1"11 t 3ft ., ,.^I.l. "")1"'" .... 'UYUi bllttO' "p .-. --'---'--'" "LilAI'll! ~H'J/1N nlls POflflON WITH YOUR PAYMENJ, 7~ ~t.J" -~---- -.".-.--...".-'-[- '..----.- 'jllll'lrotj m 'I 'tVII I 101M ~!~~~l!~~'!..~.,_ .. __.~._.____ ..I:IIA't(Ufi ,AMI)U"l '~;,-'--J $ P^)~njl _ --.---. .-.----. 1',1 l'()vfll.Afll r ~lf r n"IiIl^Io~ IIlI 11)'..111"0' 'ii, ')\lll,t.ljf ,JI'i 1.:0 "0' INt; L:l flo'J Ill' ("I) I/O) I" r\ tll)4 +..- .-.... ...---- ----- '^"INI AMOlJN "'AI ..,,' tt'I? IIn "", II'I? '"n 0' CU'..NT CHA..,.., PAY ':"Tt AN" APJU""I 1'1 ~ADUA'" II., ,tt..ttl.,,, t." t"o 'M. 'NO ,ncwott"'.IIO. II." ..... .N& CULTUltI .1'14""1 ..... ..... .NAL U' .t'.t'4t.. "4." ""." ILVI( UI .IJI.'4.., J..... J..... '/Of VI.t, .,t""." 41." ..... IAUN I ''''WAltD .... 'UR"A Y 0' CUltltENT CHAIt."a N,. Iu'r~'I' .,. LANRAIORY ,It INAIIN' .IIIV 4.. CLINic I" t. .1 n." 114." ....... t. I' 17." ....... 41. .. TAL 0' CURRo CHARI.' ""T." T"". II 11', 'PI' . 4 TI..' 'A"I"', tI, BUr. UPON lit: .tu, 0'" Nil itA "INT. 'OU NAY IUlN" 'HI' '0 " TO YOUl '..UlANe. CA_-lllt ,.. Itll.."".....". rtr,.nAt 11J"0 tiC) r11"~ I , ---,n:1 '''Y.'"ti' -,.- 'AII"'rNlJ....." ---~';:;:n,"it3j-il ,il;~n'lj lllr.-----"L.AOI 'r'-N-o "A- "-'lll-r-()-'-~'_.~- '''-nl "llhIN"1'IOfl', I r. _IIiI'. ~.~!!!!! ,. ,,""8'J!lI' HOLV SPIRIT HOSPITAL 'At.'NII ,~ItOU'" 74 .,10 . A!lllllp r,^!I'Mlfr.rllul ,;".71l t.frP,IiAIl"llnrtj;'- fiO~1 N(\llrH 21ST ~,IIlEEr ItlAII' f', 11"1 rll'.IFI' IIO~ "'II (1""',I'llr"'A'IPf) 1~^Mf' 11111, PA 1/0112288 1,1,'.~!I,\;r!~;II;~;:~jC:~lllr.~~lj'" III l,",:,/,:,'r'~"'~j~~:,'l,,~~~ UJ'i11 '.~ ~--'J OM (Jf DAII 0' 1I111.. !.!...~'1Ul~.(, J.t -. HOLY t',R'l HOBPll~L IOJ N 111T"n- CA"P .IILL, 'A '''7 7U"1I4' _" 'EI . r.3-llle7~7 I'~:];t~~j;G[. I'~] '~~~~';'!.'~~,I ,.. '1'11"1'-1'111 I;;" [ -'--'l HAM. "ILL III" IIlO"N ..~ C~KEM.IOH OAIV& t:NOLA. "" noes 1 :Ill - CS.D ...._..~I.0i\lJ!~~'11 1-~-,~;,-"i0].;~lJ ,,,....1:1 ... ..""'1 r .. j:'1 ,:~:- ;-~ ,,:".I!.~-'~.- I' 1______, 7 KHADHiitiiliANt riD-- ADD.'" ------.----.. l PLEASE RETURN THIS PORTION WITH YOUR PAYMENr, 7~ ~"" '~1:ll\',;,' 1\- __' ,-.-.-----.".---- - ..-.".". ~_. 81J'-'f11Pi'IHlOF ,!fIlVICf IOl^L 1:,1 1:f)VIIIAlU Hit CllVHIj\,,1 fm ," tllflll! " _.lIlflll ~l 11 ~L t1f 1\IIIe18 COlli l'II1\1ll\!B UI'; (,U IIlll I~m Ul flr" I 1; 1.'1 flU.I " 'jlll --- --~-- 0.- CUkRliNl' CIlARGE ,S. PA A1.1.1UlI THE U t:FT ANI<Lt: 01J6I 017.. liS,OO .EFT roo., 011610116 68.00 D VISIl' l.EVEl. 0117103011 $4.00 .1101; $U~G ""-LGOII "6Oa93 21,aS 0,00 lIty OF CURR"NT CU~RGE:S "IS SUpr'LIES 270 21,eS 21,iS OX X-R~y Jl!O 136.00 116,00 E"EMG.:NCY ROOH 4S0 ''',00 84,00 .' ',' l'Al. 0' CURRo CHARGU Po..l 'ir l!4l.1B t Dill OSISr ., ' 'lS.n 'I , r~YHENT 18 OUK UPON RRCRIPT OF rUI8 BT^T "ENT, YOU HAY SU~HIT THIS f H TO YOUR INtUR~NCE CA~ lRR fOM REI"~UMS~".Nl . 'IOIMlIOINT. NO ~I 1111)' . _ e41.1 RUEn At.l Ql!I'STIONS TO THE BUf3lm ~;S Ort";E 171717" \)1111 i"'.lt~- PlEASI SEND PAYMEN' TO HOLY SPIRIT HOSPITAL e03 NOfHH 21sr STREEr CAMP Hill, PA '701' ,22AR 10101. Y t, lit( 'r HOSr 11 ~L eAHr- Hit L. "^ "^"'II' ",,lOWII PAY THII MOUNT ^OUllll.r.~l1'mmr,:' "::-;-i,j-;,I ,.r-,'j\ll, '1:" Mlf '~~~^,1I.,1 ; tjrlf n,''l'" , r>>': III r 1',.1:; ""P!Af1Itl oR II ", ;1111"1,1 I! '"Mil ' ': 'I 1,1, All. "\11' f" III! ,v' fll'\ ~,IU':' " ,,,,,,, ',' 11.',', r rO\tFltI _I l........t [L--- .._--,-,_....,-, ... ..c __"H,H~r"".m., . ,Olllt.,J.8.J 'H~..-" ____.._ .....I.--.;~;.II:r:;~lJ.M,~Ii'~ -.~Y;I!I _ __m UIl.t1iL, ;';J;;;~'~';~~ I''''' :~L:' ",'" ~ ~u nOI I .JlywTDA I ~ 11/00n' . .,..____-=-l . ._~,-_.__:=::J I ,,~" I UAU rlf nlll PAI( ('/ ttw'" "lll HOLY "I"IT HO.'ITAL .03 N .IIT IT CA"' HILL, 'A 111 1n~'UI '11' 'J"III'147 .-.__. -'T- ._- ~-~. u.t ( iI.I} '1".',1 . ,'t,l' ~ ~;I\ " "I OU_"AtlfO" MID IIILLIA" IROIIN 41 CRIIKIIDI DRIVI INOLA,'A non I CIC NT ., I N"~' ,1Dbl'llll -- Iii I cHUi HI U iL.liAH' D : 0 ."- f'LEAfJE RErum, THIS pom'ON WITH YOUlI PAYMEN r ~~ , ~ [__'n] ""'",'11,'1 all tU4 ,_.~:."'~__ S r :;~~I 0' H:::~t~~~:'; CHAR~~:~\l::~A'Y ~'I~:~~"~NO' ~,~~~~~:j~E ~~;'''::~I,:':::i- ,~4/'1 "'OP VI.IT Oll'IOOOJ 41,00 41.00 I j ULAN I 'ORIIAI" 0.00 r ,I 'n 111/11,1 t ',I t I)\I"',\(IF III 11111')' Ill' I') W'" ".All"" "MOUtH Y 0' CURRINT CHAR81. CLINIC 510 45.00 41.00 . ~ ! .01-1 J ~ ~ ,i " i 1 , "I I,' " ",i ), i" TAL 0' CURRo CHAR8E. 45.00 41.00 'U.3 , ' ',I ,:.,' PAY"INT I' DUE UPON R YOU "AY 'VI"IT THII f TO YOUR IN.URANCI CAR 'OR RII"IUR'I"ENT. CII" " IIR 0' TIIII ITA "INf. " ~, ~ "1 Ir 11M 'I)lttl,~jl) ill1',1 d, , . -'T- ,.---- -'41:'" :'-;OOi~- r FIE'f'l All';Ji'Jr~rl()tls In nil:. , --,........... nll51t'Ehri" "<:E , ...~.. (111) ,'111;' q " ' I, u~oo .-. ___Jo_ HOLY IPIRIT HOSPITAL CAM' HILL, PA PLlA';!: SF..NO 1'1\ ,~.lE.NT TO HOl V SPIRIT HOSPITAL 50:1 nORTH 21!i1 STREET CM,H' Hill, p., I tnl t.r~nn A"OUNT , , ". . 'i'l , " II; ,I " , , , " , 'I \.0 " " I:' " , , " , , , , " " . .' , , , , , , " " " " ,I i l'lXllInlT "nil lli' .. ,------, . '...... _... ....H. '~^.:'I II' "'~~_ _,... o.1I1L,JIlU J ~"JL.., 1 ,.l'dltJj.IIIW.....'.~~...-_l,' " .1'"'710911'1 ,,' ! ,\1 1,11, " /lll~ II II' I II \IH~I II" II 49 . QU.'6/CJ? , ~ . ~tsJ I 7 0' ,.--.,__ e IR IIH)A Ii ll~;;"'~'~~ 0'1114/51 lr. ..,--,] L"'L L__, J ' [1,\111', "'!,(~.~_ t, II lU. " HOlY arlMlr HQSflrAL 501 N itlS\' Sf CAMP tlILI., PA ""U- ill.., 'f.I. ~3-1~1~7~7 . ~11-i tT 'tl',IIIIM,1 I ,-,'li.'i';.Ji;;1ji;jj' ",," ' I' ....';;;tiToT;r- /1/4(\%41.\11.1:$ DUAIMHrO" Mm II 1 Ll.l A" .rHlWN ... CIU!11< .1 DE OA f.NOLA, PA 170e!l COMM INS 799 ""'-1' AODlln\ Al DOUe lillI/lAB Mil 1'1 ~A5E /H, IlInN IHIS flOfHlON WIfH YOUlI I'AYM~NI 7A4H~ *cJlt I-^G~;f',; '--"-', - .~-----I QU,' ............ 0;-;, ,i ;j;;;-'-' --J' N~'" II tUII,I,I^1 11I'V1J;f1'i ..._._..~- -- '--'-- 'tll',lll [11I.\l , 110)""11'\"1 lllllf. I tI,\IIIIHi Ii, 11\ /1111 ..._~.. _ . _,., '_. .m' ..__"."._., _, 1',[ 11)','1<'\'11 fill llt,IIU.lill I l'I!!(1l 11.1,) III', l" rlnl 11',',1 li"1 DITAI 'PI" 'PI" OF CUAAI';Nl' CIlARllES, PAY 0"" P^~ 0'449"8'4 D tAUC VUlT OltIlO~OtJ ENT,S ANII 10,00 1)3,00 AllJUa THE TS 10,00 OJ J 00 !'OAWAIIO 0,00 Y 01' CVRRIlNr CIIARG[8 EHEftGf.NCY AOOM 450 TAI<EHOM[ OAUOS is] 53,00 10,00 SJ,OO 10,00 IUt-T TAL 01' CURR, CIIARGCS 63,00 115,00 JI10 . 1 0 PAY"'CNT 18 DUll UI'ON ~I!Cl!IPr 01' OilS $ rA r M[NT, YOU MAY 8U~Mlt THis,.. tH TO YOU~ IN9U~ANC[ CA~AI~R FOft ftll"~UkS~"tNl , Ft '''1\1 1l)f1ttJ NIl ,I '~I.' . r-' It."nn ~1\JM'''1l -:!fTun I1FFFli",\i'l7ji'I'~~ III 'W----. - "P-.".--' IIlmltu ',011101 Jlll^';1 ';IUllj'^\r..unllll ''''1'''''''''' HOLY SPIRIf HOSPITAL ~IO:I tiff' '"' :'In I ~;rllU,1 CAMP 11111, J>^ I/OI12~flA --n-:oo ,- liJ,OO' HOLY 'PIRIT HOSPITAL CA"' HILI. "A -, '1 P~~JHI.!'~tHl~~' Ii>L)IIi<'I,'il'lldflll'll . It' . flAil. ,I i.'1 j',"lI ,'fill 1'1 IPI.'! ,,\I , IIIE i,I' ".'11)\','. II)'" II"'! 63.00 'I I I ~ 1 1 : \ I '\ '\ '" ,j" '1',1 ii, I, "1',1 " , , I,',' " Ii' 'f", ,I, Ii j ; , 'I I' " " ". 'H 1 . " 1/',' ':, I , " , .1 " . , I , I , , , " , " "i,1 , " , ), i . ,I , I , /1'" , , I, I. .i" I' MV1.lV AJNWJIIV JISfJ>I 'V illlfl LilV " 'I " , :,1 " , , IN'THI CQUJT'O' COMMON PLIA ~ 00UIm, "NNSYLVAN,I CIVIL ACTION ~ LAW " tfO. ' , . ~ -... -. - . . ..-~..- .- ~ . HOLY .'IaIT "O'P%~AL, PUIN~Ir' , , V. ~ILLIA" I~OWN .nd, I)I'OaAH 1(. IROW,N, DIP'NOANTS C, 0 M P L A I, N T , hereby certify thet ttte within dQcl!rrlGnt Is a tru8 and correct 0lIIIII 'of tllll ~Ifllnal Wild In this eet. ' Vou ar.'l1nreby notifl.'J to P'''1l1 II lh,~ wlthlll Qocl.lment wlthl~1 :20 q~yt of s(lrvic.c, or d~flllllt jud_ment /nlllI bll entered llBllln.t you. Jury )',Iul LJemunded. Allornoy I,D. No. C J l) CI ARTHUR A. KUSIC AnORtlEV AT LAW ~201 C~UM' MI~L llOAO M. 8c)~ e70'& HA~~IS'U'RG. PENNSYLVANIA f1tOHOt& --..,.- C?l7) &~()'!I" 0 ,," ~ {'~ ~ \ ~ g .J::. \1\ ~ t) '" ~, ~ " I "" I I, 'I; ", I " I, ':"1 ',i\ II " , ,I .-,' ~ , " " ','. ,-'j ';1",1 " i I ~ i.' I,' ',' , " )1" , " ".' " II,r, , n, i 'I' ',.~,~. ,,';!..>.' '~lll' ... '" ' " ...;,I , ~ - n a ~' " 1'\ ... ... "'" .;". ~. ., . ~ "y .~ ~ ~ \'~ ~. \.) '1-, ,l tJ. " ~ , ., , n , , ., ,. ','-I' i'., 'I " , "l 'll '> " q .. ~ h' , '.. ~ I; '~ I' ..l 3 ' .' I- t 011 III , . l/l ~, ~! ~i :i ~ " J .Q III cl ~i '... - ~ ~ I I II: ~ ~1 I . J~ ~, H C ";J J ..:l ~ i~ ..: ~r E-o ~! .... ~~ H ~ '... '... llo ., ~ 1~ :::1 I> I> :g :a '... ,., 0 u U tIl .,1 <>: ~ cJ ' '... a. "" ~I al ,:t: 0 0 ~~ E-o ~I " M H I : ~ ~i"- <>: '" H tIl' llo ~ ~ t2 III <(I P u <>:' 'T:! ~I 0 == :P. 15 N .. ~ . all ro1 , I, ~r: ;" '~ tll" -I r:J,O ,i-:":'I,..,..t LIo. r. . " ' " - - '. ., , ' I, 111:1'. . II :.:i ~fj . I. _ " t '1:.'- ~LJ , 'II' " M JI ;1'1 I''. ,. , \, WRIT 0' I!XECUTION .nd/or ATTACHMENT OOMMONWEAL m OF PENNSYL VANIA) OOUNTY OF CUMBERLAND) NO, ,,2,ol::130 CIVILltlum-t CIVIL ACTION. LAW TO TI-IE SI-IERIFF OF_CUDt>>.t1.anl1, '. "...,COUNTY: To ..U.ty 'h. d.bt, Int.."laOO coata due,. J!c>f.Y,JJIl!X.!!JtqgpJ..t1I...L......Nllr.th....2.lIit--6.tl'.Illlt, ...SlIIlP Hill.....j'.4.1....17.lU.L...........n'....'_ ",. ,.. ,_...,.____..." ,..._......_. "__.,...,...._...__........_.......____PLAINTIFF(S) lrom .,_,....mUJ..am.Ilm.m. and_Oe.bo.tallK. ,.lWlWn ,.,-_...45,creekaJ..da OrJ.~e.-Enol/l.,.1?l/.+-l7~_,__ _...__...._,.., "__'...n'..'.......,,_.....,_......_'......,._,... ...", n .....,.., .._ _....._'...m.... ..,..............,..._..._...____......____...___,____OEFENDANT(S) (I) You all directed 10 levy up()n Ihe p,operty 01 Ihe delendanl(s) and to sell_......_____ PlllaB'!,_J..!Yr_.9!1_1;J1.!...P-B!,BE[IIlJ I)!'?~~~ty" ~ClCl.!t~,.l.!L!,~.C;n1.!1!!.!l~9.!1_J?rt.YJl.I-En.olA......&. ~ 70~5 -------.--~----.------.__._._,.._._----------------------. -.-."--..--., .--..--.--.----.-----.".-.--.----- ..--.. ---_. --- -,.---.--..- -.-...--....---.-...-.-..- -------------_.....--.....--.--~- (2) You a,e also dl,ected 10 altach the p,operty 01 Ihe dslendant(s) not levied upon In the posaeealon 0' .- -..,.___. ._._.__..__..__..____.__._____._ m _____.____~_____.__._._ __~. ----...---.----.--, _.'.-.. . ....- .- -".' - ...--...,.._ ~-.. . _. _ ____M._____"_M__._..__'_~__..___.__._.___._,______.. -.,---...._~-~-.. .-.-......----.---- ... -~--_.~-------_._---_._------ '__..__,_._ ...,...._ __u _.._____ _" __ GARNISHEE(S) as follow.: ...-.-.~._.._...__M.________._".n_u.______._____~.____.___ and 10 nolKy Ihe garnlshee(s) thaI: (a) an aUnchmenl has been Issued; (b) the garnlshee(s) IlIIa,e enjoined "om paying any d.bt 10 or lor the account 0' the defendant(s) and Irom dellve,lng any propsrty 01 the delendant(s) or otherwise disposing Ihereo.; (3) II p'o~rty oflhe de'endant(8) not levied upon an subject to altachmenlls lound In the possession 01 anyone()lhtr than a named garnishee, you a,e dl,ecledlo notlly hlm/herthal he/she has been added as a garnishee and Is enjoined as above .IAlld, Armunt Due ,___,... &2~22.5..5_0 ,_. _. Int.rUI UllL9L....6.L..$, _133.....53. A"y..Comm,___......._,..........._, ,%., _, ,_.."" A"y Paid ----...----__$102.t)6 ....,...._ ........._,..., PlalntKI Paid... .___...... ____,__ _.._,_... ......., _.,.._ ,_..,_...___ LL ..U ~.o,~...Q _____....._, ...m...._'_______ Due P'OltlY . ,._.$1..00.._.___..._____ OIhe, COSIS..___, ,__.. .__...,____,___, .-'-"'--" -.----.---------- -- .-.....-....--.--.---.--.....-..-------... OAt.: MlII:l;l1....J tL_...1.'!9:~._, ...,_....._,......__._,_"......, ,,_, _.MM:en~J:.,.h'llllIeL, P,othDnolary, Civil Dlvlalon by: ...{:;J.d1"-JJ, ~utl,!>! D.puty REQUESTING PARTY: Namt -....Mthw:.A.__XUa.1.c....,E8Q).1 r.. ,..., __'_H_'_ Add,...: _ 4~Ol~...FQIIQ....",_,..__ HAn:j,~r.g.J'.Il.....11112_._..._____ A"orn.y 10,: Plllintiff ....__...___,...,_.....,_....__._".__ T.ltphon.: ........ll7~'O::.,'j610,__...__ " ___.._ Supreme Court 10 No, ._,... 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