Party Statement: Bassett Medical Center v. Michael Jones

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                                FILED:         OTSEGO        COUNTY         CLERK        03/05/2020             02:14       PM                       INDEX    NO.   EF2019-354
   NYSCEF     DOC.   NO.   6                                                                                  RECEIVED      NYSCEF:     03/05/2020
         SUPREME         COURT      OF THE STATE           OF   NEW    YORK
         COUNTY        OF OTSEGO

         BASSETT       MEDICAL        CENTER
                                                                                                   AFFIDAVIT       OF
                                                                                                   FACTS
                                                                                                   Index   No. EF2019-354
                                                               Plaintiff,
                               -against-

         MICHAEL       JONES

                                                               Defendant(s).

         STATE      OF NEW YORK            : COUNTY       OF     Otsego              SS.:

         ROBERT       LOTTERMANN,            being   duly  sworn    deposes and       says;

         I am associated       with  plaintiff in the capacity     of
                                    Hospital    Billing Supervisor

         I have   personal    experience      and   general knowledge         of plaintiff's  billing and   collection   procedures.       I

         have   reviewed     plaintiff's  records    maintained     in the usual    and   ordinary    course    of plaintiff's business,
         and have     personal     knowledge      of the facts stated herein       as follows:

         1.  At all times hereinafter       mentioned,     plaintiff  was and remains        a domestic     corporation     authorized     to
         deliver medical      care, with    its principal  place   of business     at:
                                    One Atwell     Road , Cooperstown,          NY    13326

         2.  During    the period    of October     16,2013     through July      8, 2018, plaintiff,   at the   request    of the
         defendant(s), rendered         medical     care  to and/or    on behalf    of the  defendant(s)      on  one or more
         occasions       The   balance    due is more      fully set forth   in Exhibit   "A" annexed      hereto.


         3.  Plaintiff's  records    reveal that plaintiff    has applied     all payments      and   applicable    adjustments
         received    to date.    This is an    action  for  the balance     due for   the  agreed upon       price and reasonable
         value   of the services     rendered     by plaintiff.   The charges       are  plaintiff's prevailing    and   posted    rates,  and
         are the usual     and   customary      charges    for the particular     services    included    in this action.

         4.  As of this   date,   there   remains    an  agreed upon       sum   due   and owing in the       amount     of $2,4g2.24,     no
         part of which has       been   paid,  although     duly  demanded


                                                                                          ROBERT       LOTTERMANN
         Sworn


                                                                  KATHLEEN     E. PARK
                                                         NOTARY PUBLIC-STATE OF NEW YORK
                Notary    Public                                    No. 01 pA6362504                                 5303
                                                               Oualif ied In Otsego Countv
                                                           My Commission Expires 07-31-2021




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