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HomeMy WebLinkAbout09-1959IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA No. & / r /'9 7 e- j-d Civil Action - (X) Law ( ) Equity JURY TRIAL DEMANDED AMANDA D. MILLER, Individually, and as Parent and Natural Guardian for AUSTIN L. MILLER, a minor 108 West Main Street Newburg, PA 17240 Plaintiff(s) & Address(es) versus PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue writ of summons in the above-captioned action. XX Writ of Summons shall be issued and forwarded to ( ) Howard B. Krug. Esquire PURCELL, KRUG & HALLER 1719 N. Front Street Harrisburg. PA 17102 (717) 2344178 Name / Address / Telephone No. of Attorney WRIT OF SUMMONS Defendant(s) & Address(es) uire creme Court ID No. 16826 Date: 3 - a'7 - ),oo TO THE ABOVE NAMED DEFENDANTS: DR. JOSEPH A. GENSBIGLER and WEST SHORE FAMILY DENTISTRY. LTD. YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF HAS COMMENCED AN ACTION AGAINST YOU. Date: 2-ji" '?a. J66 9 DR. JOSEPH A. GENSBIGLER 40 N. 36th Street Camp Hill, PA 17011 AND WEST SHORE FAMILY DENTISTRY, LTD. 40 N. 36 h Street Camp Hill, PA 17011 Prothonotary by ( ) Check here if reverse is issued for additional information. Prothon. - 55 Cm I ?1 AMANDA D. MILLER, Individually, and as Parent and Natural Guardian for AUSTIN L. MILLER, a minor, Plaintiffs DR. JOSEPH A. GENSBIGLER and WEST SHORE FAMILY DENTISTRY, LTD., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA : NO. 09-1959 JURY TRIAL DEMANDED ACCEPTANCE OF SERVICE I, G. Thomas Miller, Esquire, hereby accept service of the Writ of Summons on behalf of my clients, Dr. Joseph A. Gensbigler and West Shore Family Dentistry, Defendants in the above-captioned action, and acknowledge that I am authorized to do so. DATE: r -Z G. Thomas Miller, Esquire I.D. No. 09'L I c( OF THE P^'-,- ii) tCTAR F 2009 APR -7 PPS 1: 29 AMANDA D. MILLER, Individually, and as Parent and Natural Guardian for AUSTIN L. MILLER, a minor, Plaintiffs vs. DR. JOSEPH A. GENSBIGLER and WEST SHORE FAMILY DENTISTRY, LTD., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-1959 CIVIL ACTION - LAW JURY TRIAL DEMANDED PETITION FOR APPROVAL OF SETTLEMENT AS TO MINOR NOW comes AMANDA D. MILLER, Individually and as parent and natural guardian of AUSTIN L. MILLER, by and through her attorneys, Purcell, Krug and Haller and files the following Petition for Approval of Settlement As to Minor: 1. Petitioner is Amanda D. Miller (hereinafter "Mother"), parent and natural guardian of Austin L. Miller, a minor, born June 26, 1997 (hereinafter "Child"). Petitioner resides at 108 West Main Street, Newburg, Cumberland County, Pennsylvania. 2. Respondent 1 is Dr. Joseph A. Gensbigler (hereinafter "Gensbigler"), an adult individual, with a current address of 40 North 36th Street, Camp Hill, Cumberland County, Pennsylvania. 3. Respondent 2 is West Shore Family Dentistry, LTD., (hereinafter "Dentistry"), a Corporation operating under the laws of the Commonwealth of Pennsylvania, with a registered address at 40 North 35th Street, Camp Hill, Cumberland County, Pennsylvania. 4. This matter arises out of an incident that occurred on March 29, 2007, wherein Child appeared for an appointment with Gensbigler to have a tooth filled in the lower left side of his mouth. 5. Without novocaine, Gensbigler extracted from the lower right side of Child's mouth a different tooth. 6. As a result, Child sustained severe pain for some four weeks, lost one day from school, suffered embarrassment from having a deep hole in his jaw, and worried for one year about the viability of the underlying adult tooth. 7. Mother has expended the sum of $275 for out-of-pocket costs, expenses and lost time from work. 8. There are no outstanding medical, psychological or other bills as a result of the subject incident, all treatment for Child having ceased, except for the lien balance stated in Paragraph 10C infra. 9. Dr. Ira Heller, Child's orthodontist, has examined the adult tooth coming in, and he has certified that the new tooth is viable and that Child should have no future problems with the tooth. See Exhibit "A" attached hereto. 10. The law firm of Purcell, Krug & Haller (hereinafter "PK&H") was retained to represent Child and Mother, and a settlement has been reached for a total payment of $37,500 payable as follows: A. Child - structured settlement with an approximate current value of $27,700; B. Mother - reimbursement for out-of-pocket expenses, costs, and lost time from work ($275). C. Department of Public Welfare (Medicaid) - lien ($71.05). See Exhibit "B" attached hereto. D. Attorneys Fees/Costs - 25% of the gross award ($9,375) and costs ($78.50) 11. The settlement for Child provides for structured, periodic payments, as follows: A. Guaranteed Payment of $9,900 at age 18 (6/26/2015); 2 B. Guaranteed Payment of $9,900 at age 19 (6/26/2016); C. Guaranteed Payment of $9,900 at age 20 (6/26/2017); D. Guaranteed Payment of $9,900 at age 21 (6/26/2018); A copy of the Plan of Benefits is attached hereto as Exhibit "C" and is incorporated herein by reference. 12. The liability to make the future payments defined herein shall be assigned to PASSCORP, the qualified assignee of the Prudential Insurance Company of America (hereinafter "Prudential'). The qualified assignee reserves the right to fund said liability by purchase of an annuity from Prudential, rated A+ (Superior) by A.M. Best Company, which obligation is further protected by a Prudential Guarantee and Pledge. (See Exhibit "D" attached hereto). 13. Pursuant to the Fee Agreement, PK&H is entitled to a fee of 33 1/3% after a lawsuit has been filed; however, PK&H has agreed to accept a fee of 25% of the gross award for Child, which comes to $9,375.00. A copy of the Fee Agreement, Billing and itemization of costs is attached hereto and made a part hereof as Exhibit "E". 14. In light of the foregoing, Mother would like to execute the Settlement Agreement and Release, attached hereto as Exhibit "F" with regard to the liability and claims of Child, and the Qualified Assignment and Release Agreement, attached hereto as Exhibit "G". 15. It is believed and therefore averred that the proposed settlement and allocation are fair, owing to there being no permanent harm to Child; the limited pain and suffering experienced; the expense and risk of litigation; the state of the law with potentials for 3 appeals and delay; the fact that Child has been completely discharged with respect to the issue of harm to the adult tooth by his treating orthodontist; Child is well adjusted and doing well in school; and the relatively high net settlement for Child. WHEREFORE, Petitioner respectfully requests that this Honorable Court: A. GRANT the Petition for Approval of Settlement as to Minor. B. Authorize and direct Petitioner to execute the Settlement Agreement and Release, the Qualified Assignment & Release Agreement, and any other structured settlement documents, for the purpose of settling the liability claim as to Respondents. C. Approve cash funds to Mother of $275.00 for reimbursement of out-of- pocket costs, expenses and lost time from work. D. Approve the structured settlement providing for the following periodic payments to Child: a) Guaranteed Payment of $9,900 at age 18; b) Guaranteed Payment of $9,900 at age 19; c) Guaranteed Payment of $9,900 at age 20; d) Guaranteed Payment of $9,900 at age 21; D. Approve payment of $71.05 to Department of Public Welfare from Child's settlement for reimbursement of lien. E. Approve payment of $9,453.95 to Purcell, Krug & Haller from Child's settlement for attorney's fees and expenses. PURCELL, KRUG & Date: 7_ r - 1:7-?0?9 BY: H B. t?rug, Esqui 1 1 o E H risburg, PA 17102 (717) 234-4178 I D#: 16826 Attorney for Petitioner 4 LLER IRA J. HELLERy D.D.S. PRACTICE LIMITED TO ORTHODONTICS March 24, 2009 Mr. Howard Krug 1719 N. Front Street Harrisburg, PA 17102 In re: Austin Miller, D.O,B. 06/26/97 108 N. Main Street, P.O. Box 228 Newburg, PA 17240 Subject: Questions raised concerning the development of the patient's secondary dentition - (mandibular right cuspid) - anticipated long-term prognosis; Dear Mr. Krug, With regard to the questions which have been raised with respect to the development of the patient's secondary dentition as referenced above, I do not anticipate that there will be any long-term adverse sequelae resulting from the timing of the removal of the overlying primary cuspid. The patient has been approved for orthodontic care by his insurer. With respect to the secondary (permanent) cuspid, it s not expected that the latter will complicate his care. Should any further questions arise, please feel free to call the office. es ec , Heller, D.D Ira J. IJH/jm EXHIBIT a a s-A Professional Center, 1106 Carlisle Road, Camp Hill, PA 17011 • (717) 763-11 401 N. Houcks Rd., Harrisburg, PA 17109 • (717) 652-2456 or 763-1104 r? N0, 60182 P, 2 MAY, 1, 2009 1:24PM 4 COMMONWEALTH OF PENNSYLVANIA DEPARTrdENTOF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS 0IVISIO14 OF THIRD PARTY LIABILrTY CASUALTY UNIT P.O.BOX B43o HARRISBURG. PA 17105-e496 May 1, 2009 Re: AUSTIN MILLER (minor) CIS #: 2610137934 Incident Date: 03/28/2007 Dear Atty Krug: The Department frpublic Welfare maintains a claim in the amount or 5479.00 for the above-referenced The Department has agreed to reduce its claim by 2L plus a prorata share of expenses and accept the net payment of 571.05 to satisfy the total claim amount. Checks should be made payable to the Department of Public welfare and sent to my attention at the above address. We request that with all transmittal of funds, you provide the Department with a copy of the final distribution 'sheet. In the event you have already brought or will bring recovery action resulting in a further recovery, we reserve the right to additional unpaid portion of our medical/cash claim. This settlement in no waY affects our future rights. Thank you for your cooperation in this matter. If you have any further ,qu,estions, please contact me. Sincerely, 4d?wu V- - AX?A Nathan L. Snyder TPL Program Investigator 717-772-6266 717-772-6553 FAY EXHIBIT National lb 4902 Carlisle Pike, PN4B 395 Mechanicsburg, PA 17050 Settlement Tel: 717-728-1500 Fax: 717-728-1502 Toll Free: 800-229-2228 Consultants ,vw4v.settlementconsultants.com Ora 4F?COMrnrn April 17, 2009 Individually Designed Settlement Austin Miller DIO/B 6127197 BENEFIT COST GUARANTEE D YIELD Annual Income Tax-free payments beginning 6-26-2015 (age 18) $9,990 per year 27,700 39,960 Guaranteed 4 years $27,700 $39,960 EXHIBIT The enclosed figures are for illustrative purposes only and should not be construed as a contract. All figures are subject to approval by the life insurance carrier prior to contract issuance. Contact our office to verify figures prior to court approval as the figures are time sensitive and vary upon funding dates. The Prudential Insurance Company of America 200 Wood Avenue South Iselin, NJ 08830 Whereas, The Prudential Insurance Company of America ("Prudential") is a New Jersey insurance company; and Whereas, Prudential Assigned Settlement Services Corporation ("PASSCorp"), a Prudential company, exists to service the needs of the structured settlement annuity market by assuming third party payment obligations to injured parties ("Claimants") pursuant to assignment agreements qualified under Section 130 of the Internal Revenue Code of 1986, as amended (the "Assignments"); and Whereas, in entering into said Assignments, PASSCorp purchases annuity contracts from Prudential; and Whereas, Prudential desires to facilitate such structured settlement arrangements; Now, therefore, in consideration of the premises, and for other good and valuable consideration, receipt of which is hereby acknowledged, Prudential hereby agrees as follows: 1. Prudential hereby unconditionally guarantees the payment obligations of PASSCorp to Claimants under any Assignment which PASSCorp enters into on or after the date hereof and in connection with which PASSCorp purchases annuity contracts from Prudential to fund the payment of PASSCorp's obligations under such Assignments. 2. Prudential agrees that if PASSCorp should fail to make any payment under an Assignment, Prudential will make such payment promptly after receipt of a written notice of PASSCorp's default. 3. This Guarantee will not obligate Prudential to guarantee or maintain the capital and/or surplus of PASSCorp at any level. 4. No policyholder or creditor of PASSCorp nor any other person, other than a Claimant or his or her properly designated beneficiary or estate to which PASSCorp is required to make payment(s) under the Assignments, will be entitled to any benefit or other right by virtue of this Guarantee. 5. Neither the bankruptcy, insolvency, nor reorganization of PASSCorp will affect this Guarantee. All outstanding Assignments of PASSCorp may be transferred (by agreement, consolidation, merger or otherwise) to another entity controlled by Prudential and this Guarantee will be simultaneously amended to substitute such transferee entity for PASSCorp hereunder. 6. Prudential reserves the right to revoke this guarantee upon 7 days written notice to PASSCorp; provided, however, that any such revocation will not affect Prudential's guarantee obligations under Assignments entered into by PASSCorp prior to the effective date of such revocation. 7. This Guarantee is binding upon the successors and assigns of Prudential and will be governed by and construed in accordance with the laws of the State of New Jersey. In witness whereof, The Prudential Insurance Company of America has caused this Guarantee to be signed in its corporate name by a corporate officer as of May 22, 1996, and amended as of October 31, 2001. The Prudential Insurance Company of America By: ms's Name: Scott G. Sleyster Title: Senior Vice President (ka Prudential EXHIBIT Prudential Retirement, Prudential Financial, PRU, Prudential and the Rock logo are r urance Company of America, Newark, NJ and its affiliates. 's GUFL035 Printed 11/2007 PURCELL, KRUG & HALLER Attorneys-at-Law 1719 North Front Street Harrisburg, Pennsylvania 17102 POWER OF ATTORNEY AND CONTINGENT FEE AGREEMENT We the undersigned, Y4gY? ?ir?-n??O S' 4Af YMl4 (hereinafter referred to as "client") do hereby point URCELL, KRUG & HALLER, Esquires, my a/ttor y with respect to a ca se of action risi g out of d t1 8,)A' with f 411Y power to make a inqui ies, to negotiate, r present, bring, conduct or prosecute any action or suit, and to execute and endorse any papers or orders on my behalf, in connection therewith. For their services, said Attorneys shall be entitled to a contingent fee from any recovery made or secured from all Defendants, of oZ 5 percent, if said cause of action is settled prior to commencing a lawsuit; ??3percent after a lawsuit is initiated. Costs, filing fees and expenses other than attorney's fees shall be paid by Client. WITNESS my 2005. WITNESS: hand and seal this / day of g u-" (SEAL) (SEAL) The above appointment and a reement is hereby approved and accepted this ?/jEni day of vy 200f. PURCELL, KRUG & HALLER EXHIBIT 9 By: HOWARD B. KRUG LEON P. HALLER JOHN W. PURCELL, JR. JILL M. WINEKA NICHOLE M. STALEY O'GORMAN LISA A. RYNARD LAW OFFICES Ax:/C/Wj P-Aw"Y 1719 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17102 TELEPHONE (717) 234-4178 FAX (717) 234-0409 June 26, 2009 Amanda Miller p/n/g Austin Miller 108 West Main Street Newburg, PA 17240 Re: Miller v. Gensbigler M04936-34235 FOR SERVICES RENDERED TOTAL AMOUNT COLLECTED LESS ATTORNEY'S FEES (25% of $37,500) ($9,375.00) LESS COSTS ADVANCED Date Item 3/27/09 Filing fee for Writ of Summons Postage TOTAL FEES & COSTS ADVANCED TOTAL DUE MEDICAID (LIEN) $9,453.50 divided by $37,500 = .25209 (25.21%) $95.00 multiplied by 25.21% = $23.95 $95.00 less $23.95 = $71.05 AMOUNT DUE CLIENT (Structured Settlement) AMOUNT DUE CLIENT Amount ($78.50) ($0.45) HERSHEY (717) 533-3836 JOHN W. PURCELL (1924-2009) JOSEPH NISSLEY (1910-1982) $37,500.00 ($9,453.95) ($71.05) $27,700.00 275.00 Settlement Agreement and Release This Settlement Agreement and Release (the "Settlement Agreement") is made and entered into this day of May, 2009, by, between, and among: "Claimants" Austin L. Miller, a minor, by and through Amanda D. Miller, his parent and natural guardian, and Amanda D. Miller, individually "Insured" Joseph A. Gensbigler, D.D.S. and West Shore Family Dentistry, Ltd. "Insurer" The Medical Protective Company Recitals A. On or about the 28th day of March, 2007, the minor Claimant, Austin L. Miller, (b. 6/26/97) was allegedly injured as a result of an incident occurring at 40 North 36th Street, Camp Hill, Pennsylvania. Claimants contend that the incident and resulting physical and personal injuries arose out of certain alleged negligent acts or omissions of Insured, and have made a claim seeking monetary damages on account of those injuries. Insured denies any negligence in treatment of the minor Claimant. B. Insurer is the liability insurer of the Insured, and as such, would be obligated to pay any claim made or judgment obtained against Insured which is covered by its policy with Insured. C. The parties desire to enter into this Settlement Agreement in order to provide for certain payments in full settlement and discharge of all claims which have, or might be made, by reason of the incident described in Recital A above, upon the terms and conditions set forth below. Agreement The parties agree as follows: EXHIB a 1.0 Release and Discharge 1.1 In consideration of the payments set forth in Section 2, Claimants hereby completely release and forever discharge Insured and insurer, their heirs, successors and assigns, from any and all past, present or future claims, demands, obligations, actions, causes of action, wrongful death claims, rights, damages, costs, losses of services, expenses and compensation of any nature whatsoever, whether based on a tort, contract or other theory of recovery, which the Claimants now have, or which may hereafter accrue or otherwise be acquired, on account of, or may in any way grow out of the incident described in Recital A above including, without limitation, any and all known or unknown claims for bodily and personal injuries to Austin L. Miller, or any future wrongful death claim of Claimants' representatives or heirs, which have resulted or may result from the alleged acts or omissions of the Insured. 1.2 This Release shall not apply as to the following, which Claimants shall have the continuing right to pursue. a. A claim or suit against any dental or medical health care provider or institution, other than Insured, who or which committed malpractice or was negligent in treating and diagnosing Claimant's condition after March 28, 2007; b. A claim or suit against the Prudential Insurance Company of America, PASSCORP, their affiliates or assignees for breach of any duty, arising pursuant to the terms of the Structured Settlement or the duty to make cash payments, required as a result of the said settlement. c. Claims or suits arising as a result of malpractice committed by professionals not currently associated or connected with Insured with respect to diagnosis and treatment of the area of the mouth allegedly involved in the claim against Insured. 1.3 This release, on the part of the Claimants, shall be a fully binding and complete settlement among the Claimants, the Insured and the Insurer, and their heirs, assigns and successors. 1.4 The Claimants acknowledge and agree that the release and discharge set forth above is a general release. Claimants expressly waive and assume the risk of any and all claims for damages which exist as of this date, but of which the Claimants do not know or suspect to exist, whether through ignorance, oversight, error, negligence, or otherwise, and which, if Page 2 of 8 i known, would materially affect Claimants' decision to enter into this Settlement Agreement. The Claimants further agree that Claimants have accepted payment of the sums specified herein as a complete compromise of matters involving disputed issues of law and fact. Claimants assume the risk that the facts or law may be other than Claimants believe. It is understood and agreed to by the parties that this settlement is a compromise of a disputed claim, and the payments are not to be construed as an admission of liability on the part of the Insured, by whom liability is expressly denied. 1.5 The Claimants hereby discharge and agree to indemnify and save harmless the Insured and the Insurer from any liens asserted by any health care provider, hospital, insurer, or attorney for medical expenses, hospital expenses, lost earnings, payments, attorneys liens, subrogation claims or liens and any workers' compensation liens as a result of this accident or occurrence. 2.0 Payments In consideration of the release set forth above, the Insured agrees to pay to the individual named below ("Payee") the sums outlined in this Section 2 below: 2.1 Payments due at the time of settlement as follows: $9,800.00 upfront cash, inclusive of attorney fees and expenses 2.2 Periodic payments made to Austin L. Miller ("Payee") according to the schedule as follows (the "Periodic Payments"): $9,900.00 annually, for only 4 payments, guaranteed, beginning on June 26, 2015 Any payments to be made after the death of the Payee, Austin L. Miller, pursuant to the terms of this Settlement Agreement, shall be made to the Estate of Austin L. Miller or to such person or entity as shall be designated in writing to the Insured, or the Insurer, or the Assignee, by the guardian of Austin L. Miller with court approval or from Austin L. Miller, himself, upon attaining the age of majority. If no person or entity is so designated by Austin L. Miller, or if the person designated is not living at the time of said Payee's death, such payments shall be made to the Estate of said Payee. No such designation, nor any revocation thereof, shall Page 3 of 8 be effective unless it is in writing and delivered to the Insured, or the Insurer or the Assignee. The designation must be in a form acceptable to the Insured, or the Insurer or the Assignee before such payments are made. All sums set forth herein constitute damages on account of personal physical injuries or physical sickness, within the meaning of Section 104 (a)(2) of the Internal Revenue Code of 1986, as amended. 2.3 Payee's Address The payments required under Section 2.2, above, shall be mailed to Austin L. Miller at: 108 West Main Street c/o Amanda D. Miller Newburg, PA 17240 Claimants shall promptly advise Prudential Insurance Company of America in writing of any address change. 3.0 Claimants' Rights to Payments Claimants acknowledge that the Periodic Payments cannot be accelerated, deferred, increased or decreased by the Claimants; nor shall the Claimants have the power to sell, mortgage, encumber, or anticipate the Periodic Payments, or any part thereof, by assignment or otherwise. 4.0 Consent to Qualified Assignment 4.1 Claimants acknowledge and agree that the Insured and/or the Insurer may make a "qualified assignment", within the meaning of Section 130 (c) of the Internal Revenue Code of 1986, as amended, of the Insured's and/or Insurer's liability to make the Periodic Payments set forth in Section 2.2 to Prudential Assigned Settlement Services Corporation/PASSCORP ("the Assignee"). The Assignee's obligation for payment of the Periodic Payments shall be no greater than that of Insured and/or the Insurer (whether by judgment or agreement) immediately preceding the assignment of the Periodic Payments obligation. Page 4 of 8 4.2 Any such assignment shall be accepted by the Claimants without right of rejection and shall completely release and discharge the Insured and the Insurer from the Periodic Payments obligation assigned to the Assignee. The Claimants recognize that the Assignee shall be the sole obligor with respect to the Periodic Payments obligation, and that all other releases with respect to the Periodic Payments obligation that pertain to the liability of the Insured and the Insurer shall thereupon become final, irrevocable and absolute. 4.3 Prudential Insurance Company of America will issue a letter irrevocably guaranteeing the performance of the obligations assigned to PASSCORP by way of a Qualified Assignment Agreement and for which PASSCORP purchases an annuity from Prudential Insurance Company of America to cover these same obligations. 5.0 Right to Purchase an Annuity The Insured and/or the Insurer, itself or through the Assignee, reserve the right to fund the liability to make the Periodic Payments through the purchase of an annuity policy from Prudential Insurance Company of America. The Insured, the Insurer or the Assignee shall be the sole owner of the annuity policy and shall have all rights of ownership. The Insured, the Insurer or the Assignee may have Prudential Insurance Company of America mail payments directly to the Payee. The Claimants shall be responsible for maintaining a current mailing address with Prudential Insurance Company of America. 6.0 Discharge of Obligation The obligation of the Insured, the Insurer and/or Assignee to make each Periodic Payment shall be discharged upon the mailing of a valid check in the amount of such payment to the designated address of the Payee named in Section 2.3 of this Settlement Agreement, or the deposit by electronic funds transfer in the amount of such payment to an account designated by the Payee identified in Section 2, or by his guardian if account designation is made during Payee's minority. Page 5 of 8 7.0 Representation of Comprehension of Document In entering into this Settlement Agreement, the Claimants represent that Claimants have relied upon the advice of their attorneys, who are the attorneys of their own choice, concerning the legal consequences of this Settlement Agreement; that the terms of this Settlement Agreement have been completely read and explained to Claimants by their attorneys; and that the terms of this Settlement Agreement are fully understood and voluntarily accepted by Claimants. 8.0 Warranty of Capacity to Execute Agreement Claimants represent and warrant that no other person or entity has, or has had, any interest in the claims, demands, obligations, or causes of action referred to in this Settlement Agreement, except as otherwise set forth herein; that Claimants have the sole right and exclusive authority to execute this Settlement Agreement and receive the sums specified in it; and that Claimants have not sold, assigned, transferred, conveyed or otherwise disposed of any of the claims, demands, obligations or causes of action referred to in this Settlement Agreement. 9.0 Insured's Denial of Liability In accord with the italicized sentence in paragraph 1.4, above, Claimants agree never to suggest or state to anyone, nor to state publicly, that Insured admitted responsibility for the damages herein claimed. 10.0 Governing Law This Settlement Agreement shall be construed and interpreted in accordance with the laws of the Commonwealth of Pennsylvania. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. 11.0 Additional Documents All parties agree to cooperate fully and execute any and all supplementary documents and to take all additional actions which may be necessary or appropriate to give full Page 6of8 force and effect to the basic terms and intent of this Settlement Agreement, including, but not limited to, obtaining approval of this settlement on the minor's behalf by the Cumberland County, Pennsylvania, Court of Common Pleas. 12.0 Entire Agreement and Successors in Interest This Settlement Agreement contains the entire agreement between the Claimants, the Insured and the Insurer with regard to the matters set forth in it and shall be binding upon and enure to the benefit of the executors, administrators, personal representatives, heirs, successors and assigns of each. 13.0 Tax Liability Clause It is understood between the parties that Claimants have not relied upon any representation, expressed or implied, made by Insurer, Insured, or any of their representatives, as to the tax consequences of this Settlement Agreement and that Claimants shall release Insured and Insurer, and their representatives from any and all liability in connection with any such tax consequences. However, neither Insured, Insurer, nor their respective representatives shall take any action whatsoever that will cause the Internal Revenue Service or other governmental entity to question the non-taxable nature of this Structured Settlement 14.0 Effectiveness This Settlement Agreement shall become effective immediately following execution by each of the parties, but payment of sums due hereunder shall not be made until Court approval of the settlement is obtained pursuant to Section 11.0, above. In the presence of: Claimant: Austin L. Miller, a minor By: Amanda D. Miller, as parent and natural guardian of Austin L. Miller, a minor Date: Amanda D. Miller Page 7of8 Claimant: Amanda D. Miller, individually Date: Amanda D. Miller Insured: By: Joseph A. Gensbigler, D.D.S. Title: General Partner, West Shore Family Dentistry, Ltd. Date: Joseph A. Gensbigler, D.D.S. Insurer: By: Joseph A. Gensbigler, D.D.S. Title: Insured under Insurer's Policy No.463198 Date: Joseph A. Gensbigler, D.D.S. on behalf of The Medical Protective Company Page 8of8 QUALIFIED ASSIGNMENT AND RELEASE AGREEMENT and PLEDGE SUPPLEMENT "Claimant(s)": Austin L. Miller, a minor, by Amanda D. Miller, his parent and natural guardian "Assignor": West Shore Family Dentistry, Ltd., by Joseph A. Gensbigler, D.D.S., general partner "Assignee": PASSCORP (Prudential Assigned Settlement Services Corporation) "Settlement Agreement": Settlement Agreement and Release executed by the parties on May , 2009 [Date and title of settlement agreement, order or other document embodying the Assignor's obligation to make the agreed periodic payments] "Prudential": The Prudential Insurance Company of America "Effective Date": "Annuity(ies)": * Policy No(s). (* To be completed by Prudential.) This Qualified Assignment and Release Agreement is made and entered into as of the Effective Date by and among the undersigned parties with reference to the following facts: A Claimant(s) and Assignor are parties to or are otherwise subject to or entitled to receive payments under the above referenced Settlement Agreement, under which Assignor has liability to make certain periodic payments to or for the benefit of Claimant(s) as specified or referred to in paragraph 12 of this Agreement (the "Periodic Payments"); and B Assignor and Assignee wish to effect a "qualified assignment" within the meaning and subject to the conditions of Section 130(c) of the Internal Revenue Code of 1986, as amended (the "Code"). Now, therefore, in consideration of the foregoing and for other good and valuable consideration, the parties agree as follows: 1. Assignment and Assumption; Release of Assignor. Assignor hereby assigns to Assignee, and Assignee hereby accepts and assumes, all of Assignor's liability to make the Periodic Payments. Each Claimant hereby accepts and consents to such assignment by Assignor and assumption by Assignee. Effective on the Effective Date, each Claimant hereby releases and discharges Assignor from all liability to make the Periodic Payments. 2. Nature of Periodic Payments. The Periodic Payments constitute i. damages (other than punitive damages), whether by suit or agreement, or EXHIBIT Prudential QARP - 2008-03-31 a a 9 ii. compensation under a workers' compensation act, on account of personal injury or sickness in a case involving physical injury or physical sickness, within the meaning of Sections 130(c) and 104(a) of the Code. Extent of Assignee's Liability. Assignee's liability to make the Periodic Payments shall be no greater than the liability of Assignor immediately prior to the Effective Date. Assignee assumes no liability other than the liability to make the Periodic Payments. Assignee's liability to make the Periodic Payments shall be unaffected by any bankruptcy or insolvency of Assignor. Qualified Funding Asset. Assignee will fund the Periodic Payments by purchasing from Prudential a "qualified funding asset," as defined in Section 130(d) of the Code, in the form of an annuity contract (the "Annuity") issued by Prudential and providing for payments corresponding to the Periodic Payments. Assignee shall be designated as the owner of the Annuity. All rights of legal ownership and control of the Annuity shall (subject to paragraph 9 of this Agreement) be and remain vested exclusively in Assignee; provided, however, that the Annuity shall be used by Assignee to fund the Periodic Payments and shall at all times be designated by Assignee on its records as being taken into account, under Section 130 of the Code, with respect to this Agreement. Notwithstanding anything to the contrary contained in this Agreement, neither any Claimant nor any Successor Payee (as defined in paragraph 8 of this Agreement) shall have any rights with respect to the Annuity or the payments thereunder that would cause any amount attributable to the Annuity to be currently includible in the recipient's income or would otherwise affect the determination of when any recipient is treated as having received any payment for income tax purposes, or would otherwise prevent this Agreement from satisfying all of the conditions for a "qualified assignment" within the meaning of Section 130(c) of the Code. 3. 4. Prudential will compensate the selling insurance agency in connection with Assignee's purchase of the Annuity. This compensation will include commissions and also may include marketing incentives. 5. Delivery of Payments. Assignee may have Prudential send payments directly to a Claimant, or, if applicable, to a Successor Payee, or deliver payments by electronic funds transfer to an FDIC-insured depository institution in the United States for credit (directly or indirectly) to an insured account in the name of such Claimant or Successor Payee. Such direction of payments under the Annuity shall not be deemed to afford the Claimant or any Successor Payee any rights of ownership or control of the Annuity. Each Claimant and any Successor Payee shall at all times keep Annuity Issuer apprised of such Claimant's or Successor Payee's current street address and telephone number and, if such Claimant or Successor Payee receives payments by electronic funds transfer, the name, address, bank identifier number (BIN) and telephone number of the applicable depository institution and the account number of the account to which the payments are to be credited. 6. Discharge of Liability. The Assignee's liability to make each Periodic Payment to the Claimant or Successor Payee designated to receive such payment shall be discharged automatically at such time as a corresponding payment is made to such Claimant or Successor Payee by Prudential. 7. Acceleration, Transfer of Payment Rights. None of the Periodic Payments and no rights to or interest in any of the Periodic Payments (all of the foregoing being hereinafter collectively referred to as "Payment Rights") can be Prudential QARP - 2008-03-31 L Accelerated, deferred, increased or decreased by any recipient of any of the Periodic Payments; or ii. Sold, assigned, pledged, hypothecated or otherwise transferred or encumbered, either directly or indirectly, unless such sale, assignment, pledge, hypothecation or other transfer or encumbrance (any such transaction being hereinafter referred to as a "Transfer") has been approved in advance in a "Qualified Order" as defined in Section 5891(b)(2) of the Code (a "Qualified Order") and otherwise complies with applicable state law, including without limitation any applicable state structured settlement protection statute. No Claimant or Successor Payee shall have the power to effect any Transfer of Payment Rights except as provided in sub-paragraph (ii) above, and any other purported Transfer of Payment Rights shall be wholly void. If Payment Rights under this Agreement become the subject of a Transfer approved in accordance with sub-paragraph (ii) above, then the rights of any direct or indirect transferee of such Transfer shall be subject to the terms of this Agreement and any defense or claim in recoupment arising hereunder. 8. Beneficiaries. Any Periodic Payments to be made after the death of any Claimant or Successor Payee shall be made to such party as shall have been designated in, or in accordance with, the Settlement Agreement or, if the Settlement Agreement does not provide for such designation, then to the party designated in conformity with this paragraph 8. Any party so designated is referred to in this Agreement as a "Contingent Beneficiary." If no Contingent Beneficiary is living at the time of the death of a Claimant or Successor Payee, payment shall be made to the decedent's estate. As used in this agreement the term "Successor Payee" refers to a Contingent Beneficiary or an estate that has become entitled to receive Periodic Payments following the death of a Claimant or a Successor Payee. Except as otherwise provided in the Settlement Agreement, no designation or change of designation of a Contingent Beneficiary shall be effective unless such change (i) is requested in a written request submitted to Assignee (or its authorized agent) in accordance with Assignee's customary procedures for processing such requests; and (ii) is confirmed by Assignee (or its authorized agent). Except for a designation that is expressly identified in the Settlement Agreement as irrevocable, any designation of a Contingent Beneficiary shall be deemed to be revocable; and no party that is designated as a Contingent Beneficiary (other than a party irrevocably designated as a Contingent Beneficiary in the Settlement Agreement) shall, solely by virtue of its designation as a Contingent Beneficiary, be deemed to have any cognizable interest in any Periodic Payments. 9. Failure to Satisfy Section 130(c). If at any time prior to completion of the Periodic Payments, the Settlement Agreement is declared terminated in a final, non-appealable order of a court of competent jurisdiction (or in the case of a workers' compensation settlement, a final order of the applicable workers' compensation authority) or if it is determined in any such final order that the requirements of Section 130(c) of the Code have not been satisfied in connection with this Agreement: (i) the assignment by Assignor to Assignee of the liability to make the Periodic Payments, Assignee's acceptance of such assignment, and the release by Claimant(s) of Assignor's liability shall be of no force or effect; (ii) Assignee shall be conclusively deemed to be acting as the agent of Assignor; (iii) the Annuity shall be owned by Assignor, which shall retain the liability to make the Periodic Payments; (iv) Assignee shall have no liability to make any Periodic Payments; and (v) the parties hereto agree to cooperate in taking such actions as may be necessary or appropriate to implement the foregoing. Prudential QARP - 2008-03-31 10. Governing Law; Disclosure of Certain Tax Information; Binding Effect. (i) This Agreement shall be governed by and interpreted in accordance with the internal laws of the State of New Jersey; provided, however, that any Transfer of Payment Rights under this Agreement may be subject to the laws of other states in addition to the state designated above. (ii) This Agreement shall be binding upon the parties hereto and their respective successors, heirs, executors, administrators and permitted assigns, including without limitation any party asserting an interest in Payment Rights. 11. Advice, Comprehension of Agreement. In entering into this Agreement, each Claimant represents and warrants that (i) such Claimant has relied solely upon the legal and tax advice of such Claimant's own attorneys and other advisors, who are the attorneys and advisors of such Claimant's choice, concerning the legal and income tax consequences of this Agreement; and (ii) the terms of this Agreement have been completely read by and explained to such Claimant and are fully understood and voluntarily accepted by such Claimant. 12. Description of Periodic Payments. The Periodic Payments are as set forth immediately below or (if not set forth below) as set forth in attached Addendum(s) described below, which is/are hereby incorporated in and made a part of this Agreement. Description of Periodic Payments: (Continued on Next Page) Prudential QARP - 2008-03-31 IN WITNESS WHEREOF, This Qualified Assignment and Release Agreement is executed in one or more counterparts as of the Effective Date by each of the following: Assignor: West Shore Family Dentistry, Ltd. By: (Signature of Authorized Representative) Claimant: Austin L. Miller, a minor By: Amanda D. Miller, individually, and as parent and natural guardian of Austin L. Miller, a minor Assignee: PASSCORP (Prudential Assigned Settlement Services Corporation) By: (Signature of Authorized Representative) Prudential QARP - 2008-03-31 PLEDGE SUPPLEMENT to the QUALIFIED ASSIGNMENT AND RELEASE AGREEMENT ("AGREEMENT") Dated as of Assignee hereby agrees as follows: 1. Assignee desires to grant each Claimant a security interest in any Annuity purchased to fund Periodic Payments on the terms and subject to the conditions set forth herein, as security for the obligation of Assignee to make such payments. 2. Assignee hereby pledges and grants to each Claimant, unless excluded by the. Agreement, a lien on and security interest in all of Assignee's right, title, and interest in the Annuity purchased to fund Assignee's obligations to such Claimant (the "Pledged Annuity") under the Agreement. The Pledged Annuity secures the obligation of Assignee to make such Periodic Payments. 3. Assignee shall have all ownership and control rights in the Pledged Annuity (including the right to receive and retain all benefits thereunder), which are not inconsistent with the security interest. No Claimant or Beneficiary shall have any right to anticipate, sell, assign, pledge, encumber, or otherwise exercise any right with respect to the Pledged Annuity, as long as Assignee has not breached its obligation to make the payments secured thereby. If such breach occurs and is continuing, Claimant shall have all of the rights and remedies of a secured party under laws then in effect in the State of New Jersey. 4. The Pledged Annuity will bear a legend substantially as follows: NOTICE This Annuity Contract has been delivered to the possession of Claimant for the sole purpose of perfecting a lien and security interest of such person in this Contract. Claimant is not the Owner of, and has no ownership rights in, this Contract and shall have no right to (i) accelerate, defer, increase or decrease any payments due hereunder; (ii) anticipate, sell or absolutely assign, by any means, regardless of form, any right to receive payments from Assignee, both directly and through its security interest in this Annuity Contract; or (iii) pledge, collaterally assign, grant any security interest in, encumber, or otherwise use any right to receive such payments and/or any security interest in this Annuity Contract as any form of collateral. 5. All provisions of the Agreement not inconsistent with this Pledge Supplement are hereby incorporated and included in this Pledge Supplement. AGREED TO AS OF THE EFFECTIVE DATE OF THE AGREEMENT: Assignee: PASSCORP (Prudential Assigned Settlement Services Corporation) By: Name: Title: Prudential QARP - 2008-03-31 Addendum No. [1] - Description of Periodic Payments Payee: Austin L. Miller Benefits: $9,900.00 annually, for only 4 payments, guaranteed, beginning on June 26, 2015 Beneficiary: Estate of Austin L. Miller A request for change of beneficiary may be submitted in writing from the guardian of Austin L. Miller prior to Austin L. Miller reaching age of majority with Court approval or from Austin L. Miller, himself, beginning at age 18. Initials: Assignor: Assignee: Claimant: Prudential QARP - 2008-03-31 kyj Prudential The Prudential Insurance Company of America Home Office: Prudential Plaza, Newark, NJ 07102-3777 In consideration of the receipt of the Purchase Payment, we issue this Annuity Certificate to the Certificate Holder named below, effective on the Certificate Date, subject to the terms of the Contract. Certificate Holder: Prudential Assigned Settlement Services Corporation Certificate No.: Certificate Date: Payee: Prudential Assigned Settlement Services Corporation Annuity Payments: See Payment Schedule This Certificate describes the Annuity Payments guaranteed under the Contract. Annuity Payment Dates and amounts of the Annuity Payments are shown in the Payment Schedule. Please read this Certificate carefully. If there is a question, contact us at the Designated Office for Communications. Right to Cancel: Prudential Assigned Settlement Services Corporation may cancel this Certificate within ten days after the date it receives it by giving notice in writing and by mailing the Certificate to the Designated Office for Communications. This notice must be postmarked on or before the tenth day after Prudential Assigned Settlement Services Corporation receives the Certificate. The Certificate will be canceled as of the Certificate Date and the Purchase Payment will be refunded, in accordance with applicable state law. 9PECM?W SINGLE PREMIUM STRUCTURED SETTLEMENT. . ANNUf.TY_CERTIFICATE.... . . . -NON-PARTICIPATING ................... ......•.......... ..................... ..................................................... . . . This.. . Certifica.. .. te.. does not provide for any lump sum death benefit pro tected by nonforfeiture law, or any cash surrender value, or any way to convert life contingent payments into a paid-up annuity. Prudential will make Annuity Payments to the person(s) or entity(ies), in the amount(s), and on the date(s) specifled under the terms of this Certificate. QSSA-2006-Cert DEFINITIONS We define below some of the terms used in this Certificate. • Annuity Payments: Annuity payments to be made under this Certificate, in the amounts shown on the Payment Schedule(s). • Certificate Holder: The "Certificate Holder" is the party identified on the first page of this Certificate, unless we have endorsed this Certificate to show otherwise. The Certificate Holder has certain rights and duties under this Certificate. • Contract: Group Annuity Contract Number GA- 40059. • Designated Office for Communications: The following address, or any other office we may specify in writing: Prudential Financial 2101 Welsh Road Dresher, Pennsylvania 19025-5001 • Payee: The entity identified as "Payee" on the first page of this Certificate. a Payment Date: The date each Annuity Payment stated in the Payment Schedule is due. • Payment Schedule: The schedule(s) attached and made part of this Certificate showing Annuity Payments and Payment Dates. a Purchase Payment: Amount agreed to be paid to us in connection with this Certificate. The Purchase Payment is the amount that, when improved with interest and/or mortality and morbidity contingencies, is sufficient to provide the Annuity Payments. • We, our, and us: The Prudential Insurance Company of America ('Prudential'). • You and yours: The Certificate Holder of this Certificate. GENERAL PROVISIONS Assignment of Certificate: This Certificate may not be assigned by the Certificate Holder without our consent. The Certificate Holder shall have sole and exclusive ownership rights in this Certificate. No other person shall have any right to anticipate, sell or absolutely assign (by any means, regardless of form) payments under this Certificate and any attempted assignment will be void at the outset. Certificate Errors: Please review this Certificate carefully and notify us promptly if you feel any information is incorrect. We are not bound by any incorrect information in this Certificate. We may issue a corrected Certificate in the same manner the original Certificate was issued, but we will clearly indicate on the face of the new Certificate that it is a "CORRECTED AND REISSUED" Certificate (or other words to that effect). Certificate Overview: This Certificate, including all its provisions and any attachments, endorsements, and schedules, forms the entire Certificate. This Certificate takes effect on the Certificate Date as shown on the first page only if the Purchase Payment has been made to us. If the Purchase Payment is not made to us, this Certificate will be void at the outset. We will own the Purchase Payment at the earlier of either the First Annuity Payment Date or the date on which we issue the Certificate for delivery. Communications: Any communication contemplated by this Certificate is subject to this provision. Unless we otherwise consent in writing, Beneficiary designations and revocations, and other notices, instructions, or consents related to this Certificate, must be (i) in writing, (ii) in form and content acceptable to us in our reasonable opinion, and (iii) delivered to our Designated Office for Communications. Compensation: Prudential will compensate the selling insurance agency in connection with the purchase of this Certificate. This compensation will include commissions and also may include marketing incentives. Currency: Any money we pay or which is paid to us, must be in United States currency. Minimum Benefits: The commuted value of payments or lump sum death benefit, if so provided under this Certificate, is not protected by non-forfeiture law and may be less than the benefit that would be payable if such law applied. Otherwise, all benefits provided under this Certificate are not less than the minimum benefits required in the state of New Jersey. QSSA-2006-Cert 2 GENERAL PROVISIONS (Continued) No Surrender and No Loan: You may neither surrender this Certificate to us for cash nor borrow from us on this Certificate. Non-participation of Certificate: This Certificate is not eligible for dividends. Ownership and Control: The Certificate Holder is entitled to any Certificate benefit and the exercise of any right or privilege granted by or related to the Certificate. As a convenience to the Certificate Holder, the Certificate Holder may instruct us to make Annuity Payments directly to (i) a corresponding person entitled to periodic payments under a Settlement, (ii) such person's guardian, (iii) a beneficiary entitled to payments following such person's death ("Beneficiary"), or (iv) a person named in a "Qualified Order" under section 5891(b)(2) of the Internal Revenue Code that otherwise complies with applicable state law. The Certificate Holder may instruct us to accept Beneficiary designations and revocations from such person without further authorization. If no Beneficiary is designated, remaining payments due to such person will be made to his or her estate. All Beneficiary designations may be revoked by the designating party. Beneficiary designations and revocations must be made by notice. This notice must be in form and content acceptable to us in our reasonable opinion. We may refuse to put into effect Beneficiary designations and revocations that do not comply with applicable law or any court order that has been provided to us at our Designated Office for Communications. Proof of Status as to Life, Death, Legal Capacity, and Legal Authority: We have the right to require proof satisfactory to us of the life or death of any person whose life or death is a factor determining whether and/or to whom we are obligated to make payment. We also have the right to require proof satisfactory to us of the legal capacity and/or the legal authority of any person (e.g., Payee, guardian, representative, power-of-attorney, estate administrator, etc.) claiming any right to payment under this Certificate or altering any right of payment. We may delay or otherwise withhold any payment, without interest, until we have received such proof or proofs of status, specified in this provision, that we may request. END QSSA-2006-Cert PAYMENT SCHEDULE CERTIFICATE NO.: • All payments under this Certificate are payable to the Payee. But pursuant to the Ownership and Control provisions, the Certificate Holder has instructed us to make payments under this Certificate directly to the person(s) named below. Name Sex Date of Birth All payments under this Certificate are subject to the Certificate Holder's right to direct payments as we describe in the Ownership and Control provision of this Certificate. • We will make Guaranteed Period Certain Annuity Payments under this Certificate as follows: Last Guaranteed Guarantee Periodic Amount First Payment Date Payment Date Periodic Date Period $ 1 st day of each 4 years month $: - 8th day of each 2 months month $ 8th day of each 2 months month $ 8th day of each 2 months month For each Period Certain Annuity shown above, starting on the First Payment date, we will pay the Periodic Amount on each Periodic Date. Payments end with the last Periodic Amount due on the Last Guaranteed Payment Date. • If dies before all of the Guaranteed Payments become due, we will make the rest of them on their due dates to the designated Beneficiary(ies). End of Provision QSSA-2006-Cert 4 VERIFICATION I, Amanda D. Miller, p1n/g of Austin L. Miller, hereby verify that the facts contained in the foregoing PETITION FOR APPROVAL OF SETTLEMENT AS TO MINOR are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. NDA D. MILLER Date:--7- C q CERTIFICATE OF SERVICE I, Angela S. Shaffer, employee for the law firm of Purcell, Krug & Haller, counsel for Plaintiffs, Amanda D. Miller, Individually and as P/N/G of Austin L. Miller, a minor, hereby certify that service of the foregoing Petition for Approval of Settlement as to Minor was made on the following via first class, regular mail on ' 2009: G. Thomas Miller, Esquire One South York Road Dillsburg, PA 17019 Attorney for Defendant 011A)lk-J. L?-A Ang a S. Shaffer OF FILM OF THE' { r` ? .f h f Y ?: GJ.° r JUL 0 6 2009 G, AMANDA D. MILLER, Individually, and as Parent and Natural Guardian for AUSTIN L. MILLER, a minor, Plaintiffs vs. DR. JOSEPH A. GENSBIGLER and WEST SHORE FAMILY DENTISTRY, LTD., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-1959 CIVIL ACTION - LAW JURY TRIAL DEMANDED ORDER AND NOW, this 13 day of , 2009, upon consideration of the Petition of Amanda D. Miller, parent and natural guardian of Austin L. Miller, for Approval of Settlement as to Minor, it is hereby ORDERED that: 1. The Petition is GRANTED. 2. Petitioner is authorized and directed to execute the Settlement Agreement and Release, the Qualified Assignment & Release Agreement, and any other structured settlement documents, for the purpose of settling the liability claim as to Respondents. 3. Mother shall receive cash funds of $275 for reimbursement of out-of-pocket costs, expenses, and lost time from work. 4. The structured settlement providing for the following periodic payments to child is approved: A. Guaranteed Payment of $9,900 at age 18; B. Guaranteed Payment of $9,900 at age 19; C. Guaranteed Payment of $9,900 at age 20; D. Guaranteed Payment of $9,900 at age 21; 5. Payment of $71.05 to Department of Public Welfare from Child's settlement is approved. 6. Payment of $9,453.95 to Purcell, Krug & Haller from Child's settlement is approved. BY THE COURT: J L , 'gtribution: Howard B. Krug, Esquire, 1719 North Front Street, H rrisburg, PA 17112 ?G. Thomas Miller, Esquire, 1 South York Road, Dillsburg, PA 17019 I J. ?a ? c +<s rn? cC£cC 7712 OF THE `?'!;{,, 2009 JU 13 Fie 2: 01