8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 1/24
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 2/24
IN THE IOWA DISTRICT
COURT
FOR SAC
COUNTY
SMALL CLAIMS
D IV IS ION
L.
F. N OLL IN C
705
DOUGLAS STREET
SUITE
344
S I O U X
C IT Y
IA
51101
PLAINTIFF
VS
J E R R Y
L. RAHN
5 5
PLATTST
SAC
CITY
IA
50583
AMY L.
RAHN
FKA AMY
GERRY
5 5
PLATTST
S AC
CITY
IA
50583
DEFENDANT(S)
ORIG IN AL
NOTICE AN D PETITION
FOR
A
MONEY JUDGMENT
N O.
To
Defendant(s):
1. You are
notified that
the
above-named Plaintiff demands
of you the
amount
of 5191.74.
This claim
is
based on the value of goods and/or services supplied by the following persons or businesses in the amounts
indicated
below.
Said claims
are
assigned
to
Plaintiff.
CREDITOR
LORING HOSPITAL
PRINCIPAL
5000.00
INTEREST
191.74
2. Judgment
may be
entered
against you
unless
you
file
an
Appearance
and
Answer
within 20 days of the
service
of the
Original Notice upon you. Judgment
may
include
the
amount requested plus interest
and
court
costs.
3. You
must
electronically
file
the
Appearance
and
Answer using
the
Iowa Judicial Branch Electronic
Document Management System (EDMS) at
https://www.iowacourts.state.ia.us/EFile.
unless you obtain from
the court an exemption from electronic filing requirements.
4. If
your Appearance
and
Answer
is
filed within
20
days
and you
deny
the
claim,
you
will receive
electronic notification through EDMS
of the
place
and
time
of the
hearing
on
this matter.
5. if you electronically
file,
EDMS will serve a copy of the Appearance and Answer on Plaintiff s) or on the
attorney^) for Plaintiff(s). The Notice of Electronic
Filing
will indicate if Plaintiff(s) is (are) exempt from
electronic filing, and if you must
a copy of your Appearance and Answer to Plaintlff(s).
6. You must also notify the clerk's office of any address change.
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 3/24
NOLL AT0008873
70 5
Douglas
St., Ste 502
Sioux
City IA 51101
Phone
712)
224-2675
Fax 712) 252-4497
ATTORNEY FO R PLAINTIFF
0001875723
JUNE 9, 2014
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 4/24
IN
THE
IOWA DISTRICT
COURT FOR SAC C O U N T Y
S MA L L
CLAIMS DIV IS ION
L. F. N O L L IN C
PLAINTIFF
J E R R Y L . RAHN
A MY L .
RAHN
F KA A MY
GERRY
DEFENDANT(S)
V E R I F I C A T IO N O F ACCOUNT
I D E N T I F I C A T I O N O F JUDGMENT
D E B T O R A N D
C E R T I F I C A T E
R E
MILITARY SERVICE
N O.
For Defendant A MY L . RAHN F KA A MY GERR
1.
I,
T. L. Noll,
Vice President
of L. F.
Noll,
Inc.,
am a
party
or
employee
of
Plaintiff whose
ciaim(s) is
(are)
shown
in the
attached statement(s).
I
have personal knowledge that
the
attached
statement(s)
is
(are)
a
tru
copy
of the
original creditor's records showing
the
balance
due is
true
and
correct.
I
further state that
the sum
of
5191.74
is the
balance
due and
owing
as of
JUNE
9,
2014 from
Defendant(s)
to Plaintiff(s) and any
inter
amount owing
is
accurately stated
in the
Petition
and
Original Notice.
2.
further state
that
Defendant, AMY L. RAHN FKA AMY GE RRY, resides at 515
PLATT
ST SAC
CITY lA
50583,
is employed at STEWART MEMORIAL COMMUNITY HOS
1301
WMAIN ST LAKE
CiTY
IA 51449.
and Defendant s
occupation
is .
3. Check A, B, or C for Defendant:
A. X
Defendant
is not in the military
service
of the
United States
government, I
have verified this fa
by
(check one):
X
Checking
the
Defense Manpower Data Center (DMDC) (requires name
and SSN or
name
an d
date
of
birth)
httPs://www.dmdc.osd.mil/appi/scra/scraHome.do.
Contacting Defendant
who
informed me,
or
Regularly seeing Defendant
and
believing Defendant
is not
active
in the
U.S. military.
OR B. O I
have investigated,
and I am
unable
to
determine whether
or not
Defendant
is in the
military
OR
service of the United States government.
C.
O
Defendant
is in the
military service
of the
United States government.
4. I
also
state to the
best
of my knowledge (check
one):
Defendant
O is X is not
under
a
disability
or
confined
in any
reformatory,
jail, or
penitentiary.
I
certify under penalty
of
perjury
and
pursuant
to the laws of the
State
of
Iowa
that
these facts
are
true
and
correct.
L.F.
NOLL,
INC.
T. L. NOLL,
VICE
PRESIDENT
705
Douglas St., Suite
344
Sioux City,
1A51101
712-252-0583
875723
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 5/24
NOTICE OF
RIGHT
TO
CURE
DEFAULT
COLLECTION SERVICE
05
DOUGLAS
STREET,
SUITE
344
BOX 593
IA 51102-0593
25, 2014
L RAHN
Y
RAHN
C
CITY IA 50583
:
(LISTED BELOW IF MORE THAN ONE)
TOTAL AMOUNT DUE:
5876.36
AMOUNT IN DEFAULT: 5876.36
You are now in default on this credit transaction. You have a right to
ult within 20 days. If you do so, you may
continue
with the
a s though y o u d i d n o t
default.
.
DEFAULT CONSISTS OF:
by:
FAILURE TO PAY AS AGREED
Paying the amount in default, 5876.36 to
Noll Collection Service, agent for the above
creditor.
If you do not
correct this default within
20
days,
we may
exercise
our
If
you default again in the next year, we may exercise our rights without
ng you another notice like this one. If you have any questions, write or
promptly.
THIS
IS AN
ATTEMPT
TO
COLLECT
A
DEBT,
ANY AND ALL INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE
Client Name Client Ref No
Principal Interest Other
Total
HOSPITAL
HOSPITAL
HOSPITAL
HOSPITAL
HOSPITAL
50855
50855
50855
493712
493713
1,
2,
239.
94.
94.
671.
933.
21
00
00
78
36
3.
1.
.
64.
11.3.
37
09
82
81
72
.00
.00
.00
.00
.00
1,
•3 ,
242.
95.
94.
736.
047.
58
09
82
59
08
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 6/24
Client Name Client
Ref No
Principal Interest
-Other
-Total
HOSPITAL 558955 646.99 13.21 .00 660.20
5 876.36
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 7/24
NCS, INC DBA
NOLL COLLECTION
SERVICE
A Professional Debt Collection Service Since 1965
705 DOUGLAS STREET, SUITE 344
SIOUX CITY, IA 51101
(712)
252-0583
DATE: FEBRUARY 24,
2014
LORING
HOSPITAL 014345
ATTN JAN WISEMAN
211
HIGHLAND AVE
SAC CITY
IA 50583
ATTENTION:
RE: JERRY L RAHN
GERRY, -M» L 558955 $5679.34
01/14/14
The above debtor refuses to cooperate. We recommend further action, in
order to enforce collection. Before our attorney can proceed, we will require
* Completion of the assignment at the bottom of this page.
* Copy of the itemized statement showing balance due (if not
previously provided)
*
If the
original account
is a
contract
or
note,
we
must have
the
original.
Please return promptly. Court costs will
be
advanced
on
your behalf.
Do
not accept payments or make arrangements, without calling us first.
THANK YOU FOR YOUR
COOPERATION
ASSIGNMENT FOR PURPOSES OF
SUIT
For
valuable consideration, receipt hereby acknowledged, the undersigned hereby
assign, transfer, and set over unto L.F. Noll, Inc. that certain claim against
JERRY L RAHN
AMY
RAHN
for goods, wares and merchandise sold and delivered or services rendered and
performed in the principal amount of $5679.34
lawful
interest
thereon; and does hereby authorize said assignee to do and perform all acts
necessary
for
collection; commencement
of
suit
in the
name
of the
assignee,
settlement,
adjustment, compromise
or
satisfaction
of
said claim. Assignor
hereby certifies that said claim is justly due and owing and warrants
compliance with requirements of the Iowa Consumer Credit Code as well as
disclosure
and
other provisions
of
truth
in
lending,
and
that same
is
free
of
set-offs and
other defenses.
Dated
this
< t f > day of
LORING HOSPITAL
By: Qftxi \j^^k£L C^Q-r+^*&uJ$^^
J ame and Official Title)
^
THIS IS AN ATTEMPT TO COLLECT A DEBT,
ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE
0002949661
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 8/24
D O C T O R
Lo r i n ^ r Ho sp i ta l
BLESSINGTON KAY
BILLING
DA TE
08/21/09
PAGE
1
o .
> p
211
Highland Ave • Sac City , A 50583
TELEPHONE NO
712 662 0131
\N
MED REC
NO. / ADMISSION NO.
9501 /
493712
NO
INSURANCE
COMPANY
POLICY NUMBER
POLICY HO LD ER PLAN
05
SELF-PAY
481803956
RAHN JERRY L
GUA RA N TO R
PATIENT NAME
MED REC NO. / ADMISSION NO
JERRY L RAHN
202 S
13TH STREET
SAC
CITY
IA 50583
JERRY
t RAHN
9601
/ 493712
PATIENT
TYPE
ADMISSION D A T E
08/10/09
D ISC HA R G E D A T E
08/10/09
B IR T HD A T E SEX
M
AGE
39
G U A R A NT O R IS
RESPONSIBLE
FOR ANY AMOUN TS DUE AFTER THE INSURANCE COMPANIES MAKE THEIR PAYMENTS
DATE
C HA R G E
C O D E
DESCRIPT ION QUANTITY
C H A R G E
CRT
P Y
L ST
B L NCE
AMOUNT
08-10
08-10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08-10
08-10
08-10
08-10
08-10
08-10
08-10
08 10
08-10
EMERGENCY ROOM
LABORATORY
PHARMACY
RADIOLOGY PROFESS
RADIOLOGY TECH
MEDICAL SUPPLIES
IV
SOLUTIONS
711.000
102.000
12. 000
36.240
36.400
64.520
45.680
44.000
55.000
47
.500
38
480
69.000
2.
650
5.
020
87.830
47.630
135.000
7 .620
4.380
8
.000
DEPT
TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT
TOTAL
DEPT TOTAL
DEPT
TOT L
711.00
102.00
813.00
12.00
36.24
36.40
64.52
45.68
44.00
55.00
47 .50
38.48
373.82
69.00
69 .00
2.65
5 .02
175.66
183 .33
47
.63
47 . 63
135.00
135.00
7 .62
4.38
12.00
32. 00
32.00
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 9/24
D O C T O R
Loring- Hospital
BLESS
INGTON KAY
Q
^
BILLING DATE
|\
f?
08/21/09
PAGE 2
7 7
Highland Ave • Sac C ity IA 50583
TELEPHONE NO. EXTENSION
712-662-0131
MED
REC
NO. /
ADMISSION
NO.
9601
/
493712
N O I N S U R A N C E C O M P A N Y
POL I C Y
N U M B E R P O L I C Y H O L D E R P L A N
05 SELF-PAY 481803956 RAHN JERRY
L
G U A R A N T O R P A T I E N T
N A M E
M E D R E C N O /
A D M I S S I O N
N O
JERRY L RAHN JERRY L RAHN 9601 / 493712
202 S
13TH STREET
TYPE^
A D M I S S I O N D A T E D I S C H A R G E D A T E B I R T H D A T E SEX AGE
SAC CITY
IA
50583
11
08/10/09 08/10/09
0T H 1Q M 39
G U A R A N T O R I S R E S PO N S IB L E F O R A N Y A M O U N T S D U E A FT E R T H E IN S U R A N C E C O M P A N I E S M A K E THEIR P AYMEN TS
D A T E
C H A R G E
C O D E
DESCRIPTION
SUMMARY OF CHARGES
EMERGENCY ROOM
LABORATORY
EKG
PHARMACY
RADIOLOGY PROFESSIONAL
RADIOLOGY TECH
MEDICAL SUPPLIES
IV SOLUTIONS
TOTAL
CHARGES
BALANCE
QU A N T IT Y
C H A R G E
813.00
379.82
69.00
183.33
4 7 . 6 3
135.00
12 .00
32.00
1571.78
CP T
PAY LAST 1
BALANCE 1
A M O U N T
1671.78
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 10/24
D OC TOR
Lorin^
H ospita]
MILLER RODNEY
B I L L I N G DATE
09 11 09
PAGE
O-—. -x.O
211 Highland
Ave-Sac
City, A 50583
TELEPHONE NO
712 662 0131
EXTENSION
MED REG NO / ADMISSION NO
9601 / 493713
N O
POLICY NUMBER
P O L I Y
H O L D E R
PLAN
SELF-PAY
481803956 RAHN
JERRY L
GUARANTOR PATIENT NAME
MED REC
NO /
ADMISSION
NO
JERRY L
R HN
515 PLATT
STREET
SAC CITY IA 50583
JERRY L
R HN
9601 / 493713
P TIENT
TYPE
DMISSION D TE
08/10/09
DISCH RGE
D TE
08/12/09
BiRTHD TE
GU R NTOR IS RESPONSIBLE FOR NY MOUNTS DU E FTER TH E INSUR NCE COMP NIES M KE THEIR P YME NTS
D TE
CH RGE
CODE
DESCRIPTION
QU NTITY CH RGE
CP T
SE X
M
G E
39
P Y L ST
B L NCE
OUNT
08-12
08-11
08-11
08-12
08-11
08-11
08-12
08-11
08-11
08-12
08-11
08-11
08-12
08-11
08-11
08-12
08-12
08-11
08-11
08-11
OBSERVATION
ROOM
LABORATORY
REFERRAL
LABORATOR
EKG
495 840
12.000
12.000
12
.000
3S.400
36.400
36.400
64.520
64.520
64.520
45.680
17.720
81.120
55 .000
55 .000
55 .000
14.200
16.250
69.000
69.000
4.780
126 900
3
.130
3.130
2.650
2.650
14.250
279.240
279.240
87.830
57.500
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
PHARMACY
DEPT TOTAL
991.68
991.68
12. 00
12.00
12 .00
36.40
36.40
36.40
64.52
S4.52
64 .52
45.68
17.72
81.12
55. 00
55.00
55.00
14.20
662.48
16.25
16.25
69. 00
69.00
138 .00
9.56
126 .90
6.26
6.26
2 65
5.30
14.25
279.24
279.24
87.83
230 .00
1047.49
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 11/24
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 12/24
DOCTOR
spital
• L A N K F O R D ,
TONYA
BILLING DATE
07/23/13
PAGE
211 Highland Ave • Sac City, A 50583
r
-
TELEPHONE
NO.
712 651 8342
EXTENSION
MED. REC. NO 7 ADMISSION NO.
20253 / 558955
N O . • I N S U R A N C E COMPANY •
•
• POLICY N U M B E R
•
. , . - . ;
POLlC Y HO LDER -PLAN
. ,
04
BAAI
ABC 20Q41LA4605A RAHN,
JERRY
L
05
SELF-PAY
484252683 GERRY,
L«ft
L _ <
GU A R A N T O R , •
• • . -
. .
•
PATIENT NAME
. O
- / • M E D . R E C.
N O . /
A D M I S S I O N
N O .
JERRY
L
RAHN LJK
L
GERRY 20253
/ 558955
P A T I F N T
515
PLATT STREET
TY P E A D M I S S I O N D A T E D t S C H A R G E . D A T E . B I R T H D A T E SEX AGE
SAC CITY IA 50583 11 07/15/13 07/15/13 /l /96F 16
G U A R A N T O R
IS
R E S P O N S I B L E
FOR.
ANY
A M O U N T S
D U E.A F T ER T H E
I N S U RA NC E C O M P A N I E S M A KE T H E J R
P A Y M E N T S . - - , , ^HfTFWy H
D A TE
07-15
07-15
07-15
07-15
07-15
C H A R G E
- C O D E
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anmB*-
,
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i n
|| I H I B I
jiuiujm
.
D E S C R I P T I O N
• •
WflBVnHHVnKMVfe
E M E R G E N C Y ROOM
a m
m m n i H i i i i i
M I I I
P H A R M A C Y
•BfiBSBMMHHBOfe
RADIOLOGY,
PROFESS
WMHHHHHm
RADIOLOGY, TECH
S U MMA R Y
OF CHARGES
EMERGENCY
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P H A R M A C Y
RADIOLOGY,
PROFESSIONAL
RADIOLOGY,
TECH
TOTAL CHARGES
BALANCE
iS.Sti
Q U A N T I T Y
^
. C H A R G E . -.
405.000
183.620
82.990
4 0 . 60 3
148
.500
588
.62
82.99
40 .60
148 .50
•
860.71
r\
C P T
DEPT
TOTAL
DEPT TOTAL
DEPT TOTAL
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^pdl
( L A
A M O U N T
405.00
183.62
588
.62
82. 99
82.99
4 0 . 6 0
40 . 60
148
.50
148 . 50
860.71
O
\n
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 13/24
IN T HE IOWA DISTRICT COURT FOR SAC CO UNTY
SMALL CLAIMS DIVISION
F. NOLL INC
PLAINTIFF
JERRY L RAHN
AMY L RAHN FKA AMY GERRY
DEFENDANT(S)
V ERIF ICATIO N O F
ACCOUNT
IDENTIFICATION O F JUDGMENT
DEBTOR AND CERTIFICATE R E
MILITARY SERVICE
NO
For Defendant: JERRY
L
RAHN
1. I, T. L. Noll, Vice
President
of L. F. Noll,
Inc.,
am a
party
or
employee
of
Plaintiff whose clairn(s)
is
(are)
shown in the attached statement(s). I have personal knowledge that the attached
statement(s)
is (are) a true
copy
o f the original creditor's records showing the balance due is true an d correct. I further state that the sum
of
5191.74 is the balance due and owing as of JUNE 9,
2014
from Defendant(s) to Plaintiff(s) and any intere
amount
owing is accurately stated in the Petition and Original Notice.
2. I further state that Defendant, JERRY L. RAHN, resides at 515
PLATT
ST SAC CITY A 50583. is employe
at
,
and Defendant's occupation is .
3. Check A, B,
or
C for Defendant:
A. X
Defendant is not
in the
military service
of the
United States government,
I
have verified this fa
by (check one):
X Checking the Defense Manpower Data Center (DMDC) (requires name and SSN or name
and date of birth) https://www.dmdc.osd.mil/appi/scra/scraHome.do.
n Contacting Defendant who informed me, or
a Regularly seeing Defendant and believing Defendant is not active in the U.S. military.
OR
B. O I have investigated, and I am unable to determine whether or not Defendant is in the military
service of the United States government.
OR C. O Defendant
is
in the
military
service of the United States government.
4. I
also
state to the
best
of my knowledge (check
one):
Defendant O is X is
not
under a disability or confined in any reformatory, jail, or penitentiary.
I certify under penalty of perjury and pursuant to the laws of the State of Iowa that these facts are true and
correct.
L.F. NOLL, INC.
T. L MOLL, VICE PRESIDENT
70 5 Douglas St., Suite 344
Sioux City,
IA51101
712-252-0583
875723
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 14/24
NOTICE OF RIGHT TO CURE DEFAULT
ECTION SERVICE
STREET, SUITE
344
BOX 593
25,
2014
L RAHN
(LISTED BELOW IF MORE THAN ONE)
TOTAL AMOUNT DUE:
5876.36
AMOUNT
IN
DEFAULT: 5876.36
You are now in default on this credit transaction. You have a right to
rect this default within 20
days.
If you do so, you may
continue with
the
a s though y o u d i d n o t default. . . . .
DEFAULT CONSISTS OF:
by:
FAILURE TO PAY AS AGREED
Paying
the
amount
in
default, 5876.36
to
Noll Collection Service, agent
for
the above
creditor.
If
you do not
correct this default within
20
days,
we may
exercise
our
ts against you under the law.
If you default again in the next year, we may exercise our rights
without
otice like this one. If you have any questions, write or
promptly.
THIS
IS AN
ATTEMPT
TO
COLLECT
A
DEBT,
ANY
AND ALL
INFORMATION OBTAINED WILL
BE
USED
FOR
THAT PURPOSE
Client Name Client Ref No
Principal Interest
Other
Total
HOSPITAL
HOSPITAL
HOSPITAL
HOSPITAL
HOSPITAL
50855
50855
50855
493712
493713
239
94
94
1,671
2,933
.21
.00
.00
.78
36
3.
1.
.
64.
113.
37
09
82
81
72
.00
.00
.00
.00
.00
242.
95.
94.
1,736.
3 047-
58
09
8 2
59
08
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 15/24
Client
Name Client
Ref No
Principal Interest Other
Total
HOSPITAL 558955 646.99 13.21 . .00 660.20
5 876.36
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 16/24
NCS, ING DBA
NOLL COLLECTION SERVICE
A Professional Debt Collection Service Since
1965
705
DOUGLAS STREET, SUITE 344
SIOUX CITY, IA 51101
(712) 252-0583
DATE: FEBRUARY 24, 2014
LORING HOSPITAL 01434S
ATTN JAN WISEMAN
211 HIGHLAND AVE
SAC
CITY
IA
50S83
ATTENTION:
RE:
JERRY
L
RAHN
GERRY, *m L 558955 $5679.34 01/14/14
The
above debtor refuses
to
cooperate.
We
recommend further action,
in
order to
enforce collection. Before
our
attorney
can
proceed,
we
will require
* Completion of the assignment at the bottom of this page.
*
Copy
of the
itemized statement showing balance
due (if not
previously provided)
*
If the
original
account is a contract or note, we must have the
original.
Please
return promptly. Court costs will be advanced on your behalf.
Do not accept payments or make arrangements, without calling us first.
THANK YOU FOR YOUR COOPERATION
ASSIGNMENT FOR PURPOSES OF SUIT
For
valuable consideration, receipt hereby acknowledged,
the
undersigned hereby
assign,
transfer, and set over unto L.F. Noll, Inc. that certain claim against
JERRY L RAHN
AMY
RAHN
for goods,
wares and merchandise sold and delivered or services rendered and
performed
in the principal amount of $5679.34 lawful interest
thereon;
and
does hereby authorize said assignee
to do and
perform
all
acts
necessary for collection; commencement of suit in the name of the assignee,
settlement, adjustment, compromise or satisfaction of said claim. Assignor
hereby certifies that said claim is justly due and owing and warrants
compliance with requirements of the Iowa Consumer Credit Code as well as
disclosure
and
other provisions
of
truth
in
lending,
and
that same
is
free
of
set-offs
and
other defenses.
Dated this
c C o
day of
^J?yuxcuK^j^
s o l 1 - ^ - .
HOSPITAL
}~
Qft i.
\j^\l£tf a-rr - £yijJbJLSFSL^
[Name and Official
Title)^U °
THIS
IS AN
ATTEMPT
TO
COLLECT
A
DEBT,
ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
0002949661
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 17/24
D O C T O R
Lor i ng Hospital
BLESS INGTON , KAY
BILLING DATE
08/21/09
PAGE 1
o—
, p
2 1 1 Highland Ave • Sac
Ci ty IA 50583
T E L E P H O N E NO .
712 562 0131
E XT E NSI O N
MED. REC.
N O . /
A D M I S S I O N
N O .
9601 / 493712
N O
I N S U R A N C E C O M P A N Y
POLICY NUMBER
P O L I C Y H O L D E R
PLAN
O S
SELF PAY
481803956
RAHN,
JERRY
L
G U A R A N T O R
PATIENT
N A M E
M E D . R E C . N O . / A D M I S S I O N N O
JERRY L RAHN
202 S
13TH STREET
SAC
CITY
IA
50583
JERRY
L
RAHN
9601
/
493712
P T I E N T
T Y P E
A D M I S S I O N
D A T E
08/10/09
D I SC H A R G E D A T E
08/10/09
B I R T H D A T E
i W 7
S E X
M
G
39
G U A R A N T O R
IS
R E S P O N S IB L E F O R A N Y A M O U N T S D U E A F T E R T H E I N S U R A N C E C O M P A N I E S M A K E T H E IR P A Y M E N T S
D A T E
C H A R G E
C O D E
D E S R I P T I O N
QUANTITY
C H A R G E
C P T
P Y
L S T
B L NCE
AMOUNT
08-10
08-10
08 10
08-10
08 10
08 10
08 10
03 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
08 10
EMERGENCY ROOM
LABORATORY
PHARMACY
RADIOLOGY, PROFESS
RADIOLOGY,
TECH
MEDICAL SUPPLIES
IV SOLUTIONS
711.000
102.000
12.000
36.240
36.400
64.520
45.680
44.000
55.000
47
.500
38.480
69.000
2.650
5.020
87.830
47.630
135.000
7.620
4.380
8.000
DEPT TOTAL
DEPT TOTAL
DEPT
TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
711.00
102 .00
813.00
12 .00
36.24
36.40
64.52
45.68
44 .00
55 .00
47.50
38.48
379.82
69.00
69.00
2 65
5.02
175.66
183.33
47.
3
47 . 63
135.00
135 . 00
7
.62
4 38
12
.00
32.00
32 .00
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 18/24
O T O R
Lorin Hospital
BLESSINGTON KAY o °-v
BILLING DATE
|
~>°
8/21/03 PAGE 2 J 21 1
Highland
A ve • Sac Ci ty, A 50583
TELEPHONE
NO. EXTENSION
712-662-0131
M E D REC. NO. / ADMISSION NO.
9601
/
493712
N O I N S U R A N C E
C O M P A N Y P O L I C Y N U M BE R P O L I C Y H O L D E R P L A N
05 SELF-PAY 481803956 RAHN JERRY
L
GU A R A N T O R PATIENT N A M E MED. R E C N O / A D M I S S I O N N O
JERRY L RAHN JERRY L
RAHN
9601 / 493712
PAT1FNT
202
S
13
TH
STREET
TYPE A DM I S S I O N D A TE D IS C H A R G E DA T E
B1RTHDATE
SEX AGE
SAC CITY
IA 50583 11 08/10/09 08/10/09 -/ /7QM 39
G U A R A N T O R IS RESPONSIBLE F O R A N Y A M O U N T S D UE AFTER TH E INSURA NCE COMPANIES MAKE THEIR PAYMENTS
D A T E
C H A R G E
C O D E
D E S CRI P T I O N
SUMMARY
OF
CHARGES
EMERGENCY
R O O M
LABORATORY
EKG
PHARMACY
RADIOLOGY PROFESSIONAL
RADIOLOGY
TECH
MEDICAL
SUPPLIES
IV
SOLUTIONS
TOTAL CHARGES
BALANCE
Q U A N T I T Y
C H A R G E
813 .00
379 . 82
69. 00
183.33
47 .63
135.
00
12.00
32 .00
1671.78
OP T
PAY
LAST
BALANCE
A M O U N T
1671.78
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 19/24
DOCTOR
p t l
MILLER;
RODNEY
BILLING DATE
09/11/09
PAGE 1
O K J3
21 1
Highland
A ve
-Sac
City, A
50583
TELEPHONE NO .
712 662 0131
EXTENSION
MED.
REG.
NO . /
ADMISSION
NO .
9601
/ 493713
N O
INSURANCE COMPA NY
POLICY NUMBER
POLICY
HOLDER
PLAN
SELF-PAY
481803956
RAHN
JERRY L
G U A R A N T O R
PATIENT NAME
MED . REC . NO. / AD MISSION NO,
JERRY L RAHN
515
PLATT
STREET
SAC CITY
IA 50583
JERRY L RAHN
9601
/ 493713
P T I E N T
T Y P E
ADMISSION DATE
08/10/09
DISCHARGE DATE
08/12/09
BIRTHDATE
G U R N T O R IS
RESPONSIBLE
F O R N Y
AMOUNTS
D U E
AFTER
T H E
INSURANCE COMPANIES MAK E THEIR PAYMENTS
DATE
C H R G E
CODE
DESCRIPTION QUANTITY
CHARGE
C P T
SEX
A G E
39
P Y L ST
B L NCE
AMOUNT
08 12
08 11
08 11
08 12
08 11
08 11
08 12
08 11
08 11
08 12
08 11
08 11
08 12
08 11
08 11
08 12
08 12
08 11
08 11
08 11
OBSERVATION
ROOM
LABORATORY
REFERRAL
LABORATOR
EKG
495.840
12
.000
12.000
12.000
36.400
36.400
36.400
64.520
64.520
64.520
45.680
17.720
81.120
55.000
55
.000
55.000
14.200
16.250
69.000
69.000
4.780
126.900
3 .130
3 .130
2
.650
2 . 650
14 25
279.240
279.240
87.830
57.500
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
DEPT TOTAL
PHARMACY
DEPT TOTAL
991.68
991.68
12.00
12.00
12
.00
36.40
36.40
36.40
64.52
64.52
64 .52
45 .68
17.72
81.12
55.00
55.00
55.00
14.20
662.48
16.25
16.25
6S.OO
69.00
138.00
9.56
126.90
6.26
6.26
2.65
5 .30
14.25
279.24
279.24
87.83
230.00
1047
.49
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 20/24
DOCTOR
Lorin Hospital
MILLER
RODNEY
BILLING DATE
09/11/09 PAGE
21
Highland Ave • Sac Ci ty IA
50583
TELEPHONE
NO
712 662 0131
EXTENSION
ME REC.
NO. /
ADMISSION
NO.
9601 / 493713
_ . . . , , .
.
N O . I N S U R A N C E
C O M P A N Y P OLIC Y N U M B E R
POL ICY
H O L D E R P LA N
05
SELF-PAY
481803956
RAHN JERRY
L
G U A R A N T O R P A T I E N T N A M E M E D .
REC.
N O . / A D M I S S I O N N O .
JERRY L R A H N JERRY L
RAHN 9601
/ 493713
53 PLATT STREET
T P^
A D M I S S I O N D A T E D I S C H A R G E D A T E B I R T H D A T E
SEX AGE
SAC CITY IA 50583 13 08/10/09 08/12/09 / /70M 39
G U A R A N T O R I S R E S P O N S I B LE F O R A N Y A M O U N T S D U E
A F T E R
T H E I N S U R A N C E C O M P A N I E S M A K E T H E IR PA Y M E N T S
D A T E
08 10
08 11
08 10
08 10
08 10
C H A R G E
C O D E
tfEgSOl
4flHGH0
jpMBBpljffP
_jtIE
D E S C R I P T I O N
YBBHHHMHHHKSEM
-gma^BHMMEV
^ BHBWMHSSV
mnmnHME^RK
MEDICAL
SUPPLIES
jmnmmwwm Ku
IV SOLUTIONS
S U M M A R Y O F
CHARGES
OBSERVATION
R O O M
LABORATORY
REFERRAL LABORATORY
EKG
P H A R M A C Y
MEDICAL
SUPPLIES
IV
SOLUTIONS
TOTAL CHARGES
BALANCE
Q U A N T I T Y
1
1
3
C H A R G E
5 . 200
1.800
16.460
30.000
8 .000
991.68
662
. 48
16.25
138.00
1047 .49
53 .46
24 .00
2933 .36
C PT
DEPT
TOTAL
DEPT TOTAL
PAY
LAST 1
BALANCE 1
O U N T
5.20
1.80
16.46
30 .00
53 .46
24
.00
24. 00
2933.36
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 21/24
D O C T O R
.
1 ~ ~ ' Lorin Hospital
-
- L ANKFORD, TONYA
S ~
oT
i
B I L L I N G D A T E -
' • . |\
*f 0
07/23/13 PAGE 1
2
Highland
Ave -Sac
C / f y , IA 5 583
'
T E L E P H O N E
N O .
E X T E N S I O N
712-661-8342
M E D .
R E C . NO. 7 ADM ISSION'NO.
20253 / 558955
N O . '
' - I N S U R A N C E C O M P A N Y
• • \
P O L I C Y
N U M B E R • . .
/
. . . ; .
P O L I C Y
H O L D E R '/
P L A N '
. .
,
04 BAA ABC 20041LA4605A
R A H N ,
JERRY L
05 SELF-PAY 484252683 G E R R Y ,
L«R L
<f
G U A R A N T O R
' - • • . • • • • . ; • PATIENT
N A M E
. • • ;
* J . - V
. • . •
M E D . R E C .
N O . /
A D M I S S I O N
N O .
JERRY L RAHN LJK L GERRY 20253 /
558955
515 PLATT
PAT1FNT
STREET ' T Y P E A D M I S S IO N D A T E D I S C H A R G E . D A T E . B I R T H D A TE S E X A G E
SAC
CITY IA 50583 11
07/15/13 07/15/13
«B/Bfc/96 F 16
G U A R A N T O R I S R E S P O N S I B L E F O R . A N Y
A M O U N T S
D U E . A F T E R T H E
I N S U R A N C E
C O M P A N I E S - M A K E T H E l R
P A Y M E N T S
- .
DATE
07-15
07-15
07-15
07-15
07-15
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X
UANT1TY
1
1
1
1
1
L
C H A R G E . .
405. 000
183 .620
82.990
4 0 .6 0 3
148.500
588.62
82 .99
40. 60
14 8 . 5 0
860.71
L
.
C PT
D E P T
TOTAL
DEPT TOTAL
D E P T TOTAL
DEPT TOTAL
?£
PA Y LAST •
BALANCE
I
A M O U N T
4 0 5 . 0 0
133 .62
588.62
82
.99
82.99
4 0 . 6 0
4 0 .6 0
14 8 . 5 0
148.50
860.71
O
•
E-FILED 2014 JUN 13 2:56 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 22/24
E-FILED 2014 JUL 24 11:00 AM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 23/24
IN THE IOWA DISTRICT COURT IN AND FOR SAC COUNTY
Plaintiff(s), SMALL CLAIMS DIVISION LF NOLL, INC705 DOUGLAS ST, STE 344SIOUX CITY IA 51101
Case: 02811 SCSC015455
vs.
JUDGMENT ENTRYDefendant(s),
JERRY LYNN RAHN515 PLATT STREETSAC CITY IA 50583-2202
AMY LYNN RAHN515 PLATTSAC CITY IA 50583
The court file shows that the defendants have received proper notice and have failed to answer. Therelief is readily ascertainable from the Original Notice. Pursuant to Iowa Code Section 631.5(6), thedefendant is in default and judgment should enter accordingly.
It is therefore Ordered that judgment is entered in favor of the plaintiff and against the defendantin the amount of $ 5,000.00 with interest at the rate of 2.10 % from the 13th day of June, 2014 andcourt costs.
YOU ARE HEREBY NOTIFIED that you have a right to appeal the decision to the District Court bygiving written notice to the Small Claims Office within 20 days of the filing of this order. Filing Fee forappeal is $185.00. Appeal Bond is set in the amount of: $5,200.00
1 of 2
E-FILED 2014 JUL 24 1:13 PM SAC - CLERK OF DISTRICT COURT
8/12/2019 Judgment against Sac City couple in the amount $5,000.00
http://slidepdf.com/reader/full/judgment-against-sac-city-couple-in-the-amount-500000 24/24
State of Iowa Courts
Case Number Case TitleSCSC015455 L F NOLL INC VS JERRY & AMY RAHNType: ORDER FOR JUDGMENT
So Ordered
Electronically signed on 2014-07-24 13:13:21
E-FILED 2014 JUL 24 1:13 PM SAC - CLERK OF DISTRICT COURT