By:��
`
`YOU ARE HEREBY SUMMONED to answer the complaint in this action and to serve
`a copy of your answer, or, if the complaint is not served with this summons, to serve a notice of
`appearance, on the Plaintiffs attorneys within twenty (20) days after the service of this
`summons, exclusive of the day of service ( or within thirty (30) days after the service is complete
`if this summons is not personally delivered to you within the State of New York); and in case of
`your failure to appear or answer, judgment will be taken against you by default for the relief
`demanded herein.
`Dated: January _j_, 2022
`
`UNDERBERG & KESSLER LLP
`
`ErickaB.lliottEsq.
`Attorneys for Plaintiff
`300 Bausch & Lomb Place
`Rochester, New York 14604
`Telephone: (585) 258-2800
`
`Defendant's address:
`
`Rose Ann Matthews
`147 Wallins Corners Road, Apt 57
`Amsterdam, New York 12010
`
`1
`
`1 of 7
`
`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`STATE OF NEW YORK
`SUPREME COURT
`
`COUNTY OF MONTGOMERY
`
`ST. MARY'S HEALTHCARE
`d/b/a WILKINSON RESIDENTIAL HEAL TH CARE
`FACILITY,
`
`vs.
`
`ROSE ANN MATTHEWS,
`
`Plaintiff,
`
`Defendant.
`
`To the above named Defendant:
`
`Index No.
`
`Plaintiff designates Montgomery
`County as the place of trial
`
`The basis of venue is Plaintiffs
`place of business.
`
`SUMMONS
`
`Plaintiffs address:
`4988 State Highway 30
`Amsterdam, New York 12010
`
`

`

`2
`
`STATE OF NEW YORK
`SUPREME COURT
`
`COUNTY OF MONTGOMERY
`
`ST. MARY'S HEALTHCARE
`d/b/a WILKINSON RESIDENTIAL HEAL TH CARE
`FACILITY,
`
`vs.
`
`ROSE ANN MATTHEWS,
`
`Plaintiff,
`
`Defendant.
`
`Index No.
`
`VERIFIED
`COMPLAINT
`
`Plaintiff, St. Mary's Healthcare d/b/a Wilkinson Residential Health Care Facility, by its
`
`attorneys, Underberg & Kessler LLP, for its Verified Complaint against Defendant Rose Ann
`
`Matthews, herein alleges as follows:
`
`PARTIES
`
`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`1.
`
`At all times hereinafter mentioned, St. Mary's Healthcare d/b/a Wilkinson
`
`Residential Health Care Facility ("Wilkinson RHCF" or "Plaintiff' or the "Facility") was and is
`
`a not-for-profit corporation duly organized and existing under the laws of the State of New York,
`
`with an office and principal place of business located at 4988 State Highway 30, Amsterdam,
`
`New York, County of Montgomery, and is a licensed skilled nursing facility, which provides
`
`long-term healthcare services.
`
`2.
`
`Upon information and belief, at all times hereinafter mentioned, Edwin Matthews
`
`(hereinafter "Decedent") was an individual residing at Wilkinson RHCF, 3988 State Highway
`
`30, Amsterdam, New York, County of Montgomery, from December 5, 2013 through November
`
`15, 2021.
`
`2 of 7
`
`

`

`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`3.
`
`Upon
`
`information
`
`and
`
`belief,
`
`and
`
`at all
`
`times
`
`hereinafter
`
`mentioned,
`
`Rose
`
`Ann
`
`Matthews
`
`(hereinafter
`
`"Defendant
`
`Matthews")
`
`was
`
`the
`
`spouse
`
`of Decedent
`
`and
`
`is an individual
`
`residing
`
`at 147 Wallins
`
`Corners
`
`Road,
`
`Apt
`
`57, Amsterdam,
`
`New York,
`
`County
`
`of Montgomery.
`
`4.
`
`Upon
`
`information
`
`and
`
`belief,
`
`at all
`
`relevant
`
`times,
`
`Defendant
`
`Matthews
`
`was
`
`the
`
`and
`
`had
`
`access
`
`to Decedent's
`
`finances
`
`and
`
`assets.
`
`of
`
`the
`
`Power
`
`of Attorney
`
`for Decedent
`
`Power
`
`of Attorney
`
`appointing
`
`Rose
`
`Ann Matthews
`
`is attached
`
`hereto
`
`and
`
`as Exhibit
`
`BACKGROUND
`
`A copy
`
`"A."
`
`5.
`
`During
`
`the
`
`period
`
`from
`
`December
`
`5,
`
`2013
`
`through
`
`November
`
`15,
`
`2021,
`
`at
`
`the
`
`specific
`
`instance
`
`and
`
`request
`
`of Decedent
`
`and
`
`Defendant
`
`Matthews,
`
`Plaintiff
`
`rendered
`
`nursing
`
`home
`
`and
`
`healthcare
`
`services
`
`to Decedent.
`
`On
`
`or
`
`about
`
`December
`
`a Medicaid
`
`application
`
`was
`
`submitted
`
`to
`
`the
`
`6.
`
`5,
`
`2013,
`
`Montgomery
`
`County
`
`Department
`
`of Social
`
`Services
`
`("DSS")
`
`on behalf
`
`of Decedent.
`
`7.
`
`On May
`
`14,
`
`2015,
`
`DSS issued
`
`a Notice
`
`of
`
`Intent
`
`to Establish
`
`a Liability
`
`Toward
`
`Chronic
`
`Care
`
`("NOI")
`
`which
`
`1)
`
`approved
`
`Medicaid
`
`coverage
`
`starting
`
`December
`
`1, 2013;
`
`determined
`
`that
`
`Decedent
`
`must
`
`pay
`
`her
`
`gross
`
`monthly
`
`income
`
`to Wilkinson
`
`RHCF.
`
`Copies
`
`2)
`
`of
`
`said NOI
`
`are attached
`
`hereto
`
`as Exhibit
`
`"B."
`
`Decedent
`
`died
`
`on November
`
`8.
`
`9.
`
`15, 2021.
`
`Upon
`
`information
`
`and
`
`belief,
`
`as of
`
`the
`
`date
`
`of
`
`this
`
`pleading,
`
`no
`
`estate
`
`was
`
`filed
`
`on
`
`behalf
`
`of Decedent.
`
`10.
`
`As
`
`of November
`
`30,
`
`2021,
`
`there
`
`is a balance
`
`due
`
`and
`
`owing
`
`from
`
`Decedent
`
`in the
`
`amount
`
`of
`
`$30,455.75
`
`for
`
`services
`
`rendered
`
`to Decedent.
`
`A copy
`
`of
`
`the
`
`billing
`
`statement
`
`is
`
`annexed
`
`hereto
`
`and
`
`incorporated
`
`herein
`
`as Exhibit
`
`"C."
`
`3
`
`3 of 7
`
`

`

`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`AS FOR PLAINTIFF'S
`DEFENDANT
`AGAINST
`(Breach
`
`OF ACTION
`CAUSE
`ANN MATTHEWS
`
`FIRST
`ROSE
`of Contract)
`
`11.
`
`Plaintiff
`
`repeats
`
`and
`
`realleges
`
`each
`
`and
`
`every
`
`allegation
`
`contained
`
`in paragraphs
`
`"1"
`
`through
`
`"10"
`
`herein.
`
`of
`
`this
`
`complaint
`
`with
`
`the
`
`same
`
`force
`
`and
`
`effect
`
`as though
`
`set
`
`forth
`
`at
`
`length
`
`12.
`
`In
`
`consideration
`
`for
`
`providing
`
`care
`
`to
`
`Decedent,
`
`Defendant
`
`Matthews
`
`("Resident's
`
`Spouse/Sponsor")
`
`signed
`
`an
`
`Admission
`
`Agreement
`
`with
`
`the
`
`Facility
`
`dated
`
`of
`
`hereto
`
`December
`
`5, 2013
`
`(hereinafter
`
`the
`
`"Agreement").
`
`A copy
`
`the
`
`Agreement
`
`is attached
`
`and made
`
`a part
`
`hereof
`
`as Exhibit
`
`"D."
`
`13.
`
`Pursuant
`
`to
`
`the
`
`Agreement,
`
`Defendant
`
`Matthews
`
`agree[d]
`
`"The
`
`Resident
`
`understood
`
`that,
`
`upon
`
`Medicaid
`
`eligibility,
`
`DSS will
`
`require
`
`most
`
`monthly
`
`income
`
`(the
`
`"Net
`
`Available
`
`Monthly
`
`Income"
`
`or
`
`"NAMI")
`
`to be paid
`
`to the
`
`Facility
`
`as part
`
`of
`
`the Medicaid
`
`rate.
`
`a NAMI
`
`the
`
`Resident
`
`agrees
`
`(1
`
`to
`
`the NAMI
`
`10*
`
`each
`
`If DSS
`
`sets
`
`amount,
`
`pay
`
`by
`
`the
`
`of
`
`month..."
`
`See the Agreement,
`
`Exhibit
`
`D,
`
`at page
`
`8, ¶ 3G.
`
`14.
`
`Defendant
`
`Matthews
`
`further
`
`agree[d]
`
`"that
`
`any moneys
`
`or
`
`funds
`
`that
`
`are
`
`listed
`
`in
`
`the County
`
`DSS budget
`
`letter
`
`are the NAMI
`
`amounts
`
`which
`
`are required
`
`to be turned
`
`over
`
`to the
`
`Facility
`
`for
`
`payment
`
`to
`
`the
`
`Facility
`
`for
`
`care
`
`rendered
`
`to
`
`the
`
`Resident.
`
`The
`
`Resident
`
`and/or
`
`Representative
`
`acknowledge
`
`that
`
`be
`
`used
`
`the
`
`Designated
`
`hereby
`
`these
`
`funds
`
`are
`
`to
`
`to
`
`pay
`
`for
`
`care
`
`of
`
`the Resident
`
`at
`
`the
`
`Facility
`
`and
`
`agree
`
`to remit
`
`such
`
`funds
`
`promptly
`
`to the
`
`Facility."
`
`See
`
`id.
`
`at page
`
`8, ¶ 3G.
`
`15.
`
`Defendant
`
`Matthews
`
`further
`
`agree[d]
`
`"If Medicaid
`
`eligibility
`
`is
`
`established,
`
`Designated
`
`Representative
`
`and/or
`
`Spouse/Sponsor
`
`either
`
`(i)
`
`personally
`
`agrees
`
`to
`
`pay
`
`the
`
`the
`
`Resident's
`
`monthly
`
`NAMI..."
`
`See id.
`
`at page
`
`9, ¶ 4A.
`
`4
`
`4 of 7
`
`

`

`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`16.
`
`Defendant
`
`Matthews
`
`further
`
`agree[d]
`
`"The
`
`Designated
`
`Representative
`
`and/or
`
`Spouse/Sponsor
`
`agree
`
`to use
`
`their
`
`personal
`
`resources
`
`if necessary
`
`to pay
`
`damages
`
`to the Facility
`
`resulting
`
`from
`
`a breach
`
`of
`
`their
`
`personal
`
`and
`
`independent
`
`obligations
`
`of
`
`the
`
`Facility
`
`promised
`
`at
`
`Section
`
`4 above.
`
`Such
`
`damages
`
`include
`
`collection
`
`costs
`
`and
`
`fees."
`
`attorney
`
`See
`
`id.
`
`at page
`
`10, ¶
`
`4B.
`
`17.
`
`To
`
`date,
`
`the
`
`sum of
`
`$30,455.75
`
`is due
`
`and
`
`owing
`
`to Plaintiff
`
`for
`
`the
`
`services
`
`it
`
`rendered
`
`to Decedent
`
`pursuant
`
`to the Agreement.
`
`18.
`
`19.
`
`Plaintiff
`
`performed
`
`all
`
`if
`
`its obligations
`
`under
`
`the Agreement.
`
`Defendant
`
`Matthews
`
`breached
`
`the
`
`Agreement
`
`with
`
`Plaintiff
`
`by
`
`failing
`
`to
`
`pay
`
`Plaintiff
`
`pursuant
`
`to the Agreement.
`
`the
`
`20.
`
`By
`
`reason
`
`of Defendant
`
`Matthews's
`
`breach
`
`of
`
`Agreement,
`
`Plaintiff
`
`has
`
`been
`
`damaged
`
`in the
`
`sum of $30,455.75,
`
`plus
`
`attorneys'
`
`fees.
`
`WHEREFORE,
`
`Plaintiff
`
`respectfully
`
`requests
`
`that
`
`the
`
`Court
`
`grant
`
`Plaintiff
`
`the
`
`following:
`
`A.
`
`Judgment
`
`pursuant
`
`to
`
`the
`
`first
`
`cause
`
`of
`
`action
`
`against
`
`Defendant
`
`Rose
`
`Ann
`
`Matthews
`
`in the
`
`amount
`
`of $30,455.75;
`
`B.
`
`Judgment
`
`against
`
`Defendant
`
`Rose
`
`Ann
`
`Matthews
`
`for
`
`all
`
`costs
`
`of
`
`collection,
`
`including
`
`reasonable
`
`attorneys'
`
`fees
`
`pursuant
`
`to the Agreement;
`
`C.
`
`Judgment
`
`against
`
`Defendant
`
`Rose
`
`Ann
`
`Matthews
`
`for
`
`the
`
`costs
`
`and
`
`disbursements
`
`of
`
`this
`
`action;
`
`and
`
`D.
`
`For
`
`such
`
`other
`
`and
`
`further
`
`relief
`
`as the Court
`
`may
`
`deem just
`
`and
`
`proper.
`
`5
`
`5 of 7
`
`

`

`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`UNDERBERG & KESSLER LLP
`
`221��
`
`Ericka REiiott �
`Attorneys for Plaintiff
`300 Bausch & Lomb Place
`Rochester, New York 14604
`Telephone: (585) 258-2800
`
`Dated: January L 2022
`
`By:
`
`6
`
`6 of 7
`
`

`

`FILED: MONTGOMERY COUNTY CLERK 01/04/2022 12:54 PM
`NYSCEF DOC. NO. 1
`
`INDEX NO. EF2022-5
`
`RECEIVED NYSCEF: 01/04/2022
`
`VERIFICATION
`
`Keith
`
`Waters,
`
`being
`
`duly
`
`swom,
`
`deposes
`
`and
`
`says
`
`that
`
`deponent
`
`is the Vice
`
`President,
`
`Finance/CFO
`
`of St. Mary's
`
`Healthcare
`
`- Wilkinson
`
`Residential
`
`Health
`
`named
`
`in the within
`
`action;
`
`thereof;
`
`that
`
`the
`
`deponent
`
`has
`
`read
`
`the
`
`foregoing
`
`Verified
`
`Complaiñt
`
`and
`
`knows
`
`the
`
`contents
`
`and that
`
`the same
`
`is true
`
`to his own
`
`knowledge,
`
`except
`
`as to those matters
`
`therein
`
`which
`
`have
`
`been
`
`stated
`
`and
`
`alleged
`
`upon
`
`infernistius
`
`and
`
`belief,
`
`and
`
`as to those matters
`
`deponent
`
`believes
`
`it
`
`to be true.
`
`f
`
`Keith Waters
`
`to before me this
`Swp
`anuar
`day of
`
`.202
`
`No
`
`Public
`
`y g7-83-34
`
`8•didug
`
`coges unuo3 AN
`
`andy
`
`NyN
`
`!
`
`7
`
`7 of 7
`
`