Request DismissalCal. Super. - 6th Dist.May 25, 2021ATTORNEY OR PARTY WITHOUT ATTORNEY (Nmw naia Sar aw oai and aafiswd Karlene Rogers-Aberman (237883) Stephenson, Acquisto & Co(man, Inc. 303 hi. Glenoaks Blvd. ¹700, Burbank, CA 91502-3226 TECEWIONE NO.. (818) 5594477 Fiui No (Om N) (818) 559 5484 EAIAI(ADDREEE(opfww) kabermanosacftrm.corn ATTDRNEY Foa (Nwm) Plaintiff. STANFORD HEALTH CARE sUPERloR coURT oF cALIFDRNIA, coUNTY oF Satyta Clara-Ullllmlted JUflsdlctlofl ETREEtADDREEE. 191 hk First Street MAILING ADDRESS Same OTYANDDPCODF San Jose, California 95113-1090 SRANOHNAME Downtown Superior Court PLAINTIFF/PETITIONER: STANFORD HEALTH CARE DEFENDANT/REsPQNDENT: California Physicians'ervice, et al. REQUEST FOR DISMISSAL FOR COURT USE Oasv cAsE NUMSER 21CV382953 CIV-110 A conformed copy will not be returned by the clerk unless a method of return is provided with the document This form may not be used for dismissal of a derivative action or a class action or of any party or cause of action in a class action. (Cal. Rules of Court, rules 3.760 and 3.770.) 1. TO THE CLERK: Please dismiss this action as follows: s (1) ~ with prejudice (2) ~v )/tlithout prejudice b. (1) tdRE( Complaint (2) ~ petition (3) ~ Crossdx)mp(aint filed by (name): on (dale): (4) ~ Cross-complaint filed by (name) on (dale) (5) C3 Entire action of afi parties and all causes of action (6) ~v'ther (SPeCify):* 888AS tO the ClaimS liSted On the attaChed EXhibit A Onlyaea 2. (Comp/ete in all cases except family law cases.) The court ~ did K did not waive court fees and costs fora party In this case. (This In/orms/ion may De oblained from the c/erk lf coun fees and cosls were waived, the dec/aration on the back of this form must be completed). Date II/9/202) L KASLEIYIE I(OGEI(STAI)PP4AH (TYPE OR PRINT NAME OF ~V ATTORNEY ~ PARTY WITHOUT ATTORNEY) (SIGNATURE) 'lf dmtnssal Iequsstsd is of speaded paibes only of spam(led causes o( acsoh Attorney or parly without attorney for: K Plaintiff/Petitioner C3 Defendant/Respondentcslnas of act)CO, tv cfoss.coieplslflts lo bs dlsuassed M Cross-Complainant 3. TO THE CLERK: Consent to the above dismissal is hereby given Date: OYPE OR PRINT NAME OF ~ ATTORNEY ~ PARTY WITHOUT ATTORNEYf If a mswcoosmmt-of Response (Family Law) seeluog afpwostive relief - a on file, the asomey for cross-complainant (Iespoodeht) must Mgo Ihts cooseol if required by Code of Civil Procedure section EEI (i) of 6) (To be comp/sled by clerk) 4. ~ Dismissal entered as requested on (dale). (SIGNATURE) Attorney or party without attorney for Plaintiff/Petitioner ~ Defendant/Respondent Cross-Complainant 5 ~ Dismissal entered on (dale): as to only (name)t 6. ~ Dismissal not entered as requested for the following reasons (specify): 7. a. C] Attorney or party vdithout attorney notified on (dele): b ~ Attorney or parly without attorney not notified Filing party failed to provide C3 a copy to be conformed ~ means to return conformed copy Date: Clerk, by , Deputy Form Adapted Mi Maadaloiy Uaa Judoal couodl of caaeaoa Cly.l I 0 IRav. Jaa I, f0131 REQUEST FOR DISMISSAL Pace I ot 3 coda of c ial piocadwa, 3 ssl ai s8E, Gov coda, 3 sss31(ch cel Rui of court oaa 3 13ai WWW Cowla Ca OiW Electronically Filed by Superior Court of CA, County of Santa Clara, on 11/16/2021 10:24 AM Reviewed By: R. Nguyen Case #21CV382953 Envelope: 7671459 21CV382953 Santa Clara - Civil R. Nguyen 11/16/2021 10:24 AM 11/16/2021 10:24 AM X 11/16/2021 10:24 AM R. Nguyen X PLAINTIFF/PETITIONER. STANFORD HEALTH CARE DEFENDANT/RESPONDENT California Physlmans'ervice, et al. CASE NUMBER 21CV382953 COURT'6 RECOVERY OF WAIVED COURT FEES AND COSTS If s party whose court fees end costs were inibssy wanred has recovered or vns recover $ 10,000 or more in value by wsy of settlement, compromise, arbitration award, mediabon settlement, or other means, the court hss s statutory lien on that recovery The coun may refuse lo dismas the case until the lien is satisfied (Gov. Code, 5 66637) Declaration Concerning Waived Court Fees 1. The court waived court fees and costs in this action for (name). 2 The persori named in item I is (check one below) a M not recovenng anything of value by this ection b ~ rsotvenng less than $10,000 in value by this aclmn. c ~ recovenng $10,000 or more in value by this Recon (ff Jfem 2c ir checked, item 3 musl be completed.) 3 M Ae court fees and court costs that were waived in lhis schon have been paid to the court (check one) ~ Yes ~ No I declare under penalty of pegury under the laws of the State of Caiifornra that the information above is true and correct Date lTYPE OR PRNT NAME Cr ~ ATTORNEY~ PART MARJNO DECTAJMT O IEIONATUIIE) clv- OIR J 11 EMEI REQUEST FOR DIS$$ISSAL ps r fr EXHIBIT AHI I Stanford v Blue Shield of California Civil No 21CV382953 Exhibit A No. Patient 1 A.M. 2 A.M. 3 A.C. 4 AJ. 5 B.E. 6 B.E. 7 B.E. 8 B.E. 9 B.E 10 B.E. 11 B.E. 12 B.E. 13 B.E. 14 B.l. 15 BJ. 16 C.P. 17 D.C. 18 G,R. 19 G.R. 20 HJ. 21 lam 22 K.M. 23 K.M. 24 K.M. 25 K.M. 26 K.M. 27 LB. 28 L.B. 29 Ll. 30 P.H. 31 R.R. 32 RD. 33 S.K. 34 D.l. 35 T.E. 36 T.M. 37 V.L. Pae Number 000065893087 000065767224 000064717026 000064972185 000065394928 000064408863 000064408883 000064903981 000065116207 000065090279 000065090280 DD0065395D84 000065394927 000064337250 000064706776 000065190633 000064787732 000066128851 OD0065909862 D00066043386 D00065397215 OD0065369280 D00065369235 000065369250 000065383118 OD0065369261 000065541723 000064690832 000065867985 OOD065671413 000064961492 000065126647 000065479512 000065823666 000065942461 000065487118 000063753745 Admit Date 11/4/2019 10/21/2019 5/22/2019 7/3/2019 10/9/2019 5/8/2019 6/19/2019 7/3/2019 7/31/2019 8/14/2019 8/28/2019 9/11/2019 9/25/2019 5/21/2019 7/16/2019 8/5/2019 6/27/2019 1/5/2020 12/8/2D19 12/2/2019 8/28/2019 10/7/2019 8/27/2019 9/11/2019 9/12/2019 9/23/2019 11/5/2019 5/21/2019 12/20/2019 11/11/2019 7/10/2019 7/25/2019 11/5/2019 12/16/2019 6/1/2020 10/3/2019 6/14/2019 Discharge Date 11/5/2019 10/21/2019 5/22/2019 7/3/2019 10/9/2019 5/29/2019 6/19/2019 7/19/2019 7/31/2019 8/14/2019 8/28/2019 9/11/2019 9/25/2019 5/31/2019 7/16/2019 8/28/2019 6/27/2019 1/5/2020 12/8/2019 12/2/2019 9/20/2019 1D/7/2019 8/27/2019 9/11/2D19 9/12/2019 9/23/2019 11/6/2019 5/21/2D19 12/20/2019 11/11/2019 7/10/2019 7/29/2019 11/5/2019 12/16/2019 6/4/2020 10/9/2019 6/14/2019 Total Charges 559,796.95 536,709 64 $ 134,196.00 $ 116,989.42 $88,429 16 5810,274 58 $405,071.48 $174,247.92 $89,190.16 589,190. 16 $89,190.16 $ 109,268.92 $89,177 16 $38,219.55 534,061.55 5903,254.03 $27,122.14 $91,517.64 591,518.21 $ 139,880.46 51,255,581 84 $ 16, 110.00 523,700.51 512,718.DO 515,703.65 $16, 110.00 $117,586.39 $36,667.00 $21,158.71 $ 120,379.76 $ 16,953.00 587,028.96 580,019.40 526,156.95 $318,206.61 5482,159.61 515,584.00 TOTAL DUE Underpaid $ 19,736.DO $36.880.64 5 19, 102.92 538,057.61 525,374.16 5259,10D.92 $122,785.82 550,748.32 $25,374.16 525,374.16 $25,374.16 525,374.16 525,374.16 $10,901 59 $10,425 54 $11,038.79 513,542.07 $28,912.06 $ 26,334.86 $6,713.48 $4,804.17 $6,209.29 $5,857 79 56,209. 29 $6,209 29 56,209.29 $50,710.66 $ 18,593.68 $21,158.71 $51,589.22 54,367.72 525,172.12 $44,883.17 526,563 95 547,916.01 580,031.00 $7,781.08 51,220,792 02 1 of 1 FC 28050 PROOF OF SERVICE I am employed in the county of Los Angeles, State of California. I am over the age of 18 and not a party to the within action; my business address is 303 North Glenoaks Boulevard, Suite 700, Burbank, California 91502-3226. On 16 November 2021, I served the foregoing document(s) entitled: REQUEST FOR DISMISSAL [PARTIAL] 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 by placing a true copy thereof enclosed in a sealed envelope addressed per the attached Service List. BY MAIL: I am "readily familiar" with the firm's practice of collection and processing correspondence for mailing. Under that practice it would be deposited with the United States Postal Service on that same day with postage thereon fully prepaid at Burbank, California in the ordinary course of business. I am aware that on motion of the party served, service is presumed invalid if postal cancellation date or postage meter date is more than one day after date of deposit for mailing in affidavit. [C.C.P. 1013a(3); F.R.C.P. 5(b)] [ ] BY PERSONAL SERVICE: I caused the above-stated document(s) to be served by personally delivering a true copy thereof to the individuals identified above. [C.C.P. 1011(a); F.R.C.P. 5(b)] [ ] BY TELECOPIER: Service was effected on all parties at approximately am/pm by transmitting said document(s) from this firm's facsimile machine (818/559-4477) to the facsimile machine number(s) shown above. Transmission to said numbers was successful as evidenced by a Transmission Report produced by the machine indicating the documents had been transmitted completely and without error. C.R.C. 2008(e), Cal. Civ. Proc. Code $ 1013(e). BY FEDERAL EXPRESS: I caused such envelope(s), with overnight Federal Express Delivery Charges to be paid by this firm, to be deposited with the Federal Express Corporation at a regularly maintained facility on the aforementioned date. [C.C.P. 1013(c) 1013(d)] 26 27 28 [X] BY ELECTRONIC SERVICE: By emailing true and correct copies to the persons at the electronic notification address(es) shown on the accompanying service list. The document(s) was/were served electronically and the transmission was reported as complete and without error. ] BY ELECTRONIC SERVICE [BY COURT]: by causing the foregoing document(s) to be electronically filed using the Court's Electronic Filing System which constitutes service of the filed document(s) at the electronic service address of the individual(s) listed on the attached mailing list. [X] State: I declare under penalty of perjury under the laws of the State of California that the above is true and correct. 9 10 12 ] Federal: I declare that I am employed in the office of a member of the bar of this court at whose direction the service was made. Executed on 16 November 2021 in Burbank, California. 13 14 15 16 ANGELA DEMERS 17 19 20 21 22 23 24 25 26 27 1 SERVICE LIST AMANDA L. MORAN, ESQ. SEAN A. NEWLAND, ESQ. DLA PIPER, LLP. 555 Mission Street, Suite 2400 San Francisco, CA 94105 amanda.morean@us.dlapiver.corn sean.newland @us.dlapiper.corn 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 CHARLES W. SWEERIS, ESQ. DLA PIPER, LLP 444 West Lake Street, Suite 900 Chicago, Illinois 60606 charles.sweeris@us.dlapiper.corn