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KRISTEN LAW SAGAFI (SBN 222249) 

ksagafi@tzlegal.com 

TYCKO & ZAVAREEI LLP

483 Ninth Street, Suite 200 

Oakland, CA 94607 

Telephone: (510) 254-6808 

Facsimile: (202) 973-0950 

Nicholas E. Chimicles (admitted pro hac vice) 

NEC@Chimicles.com 

Kimberly Donaldson-Smith (admitted pro hac vice) 

KMD@Chimicles.com 

Stephanie E. Saunders (admitted pro hac vice) 

SES@Chimicles.com 

CHIMICLES SCHWARTZ KRINER & 

DONALDSON-SMITH LLP

361 W. Lancaster Avenue 

Haverford, PA 19041 

(610) 642-8500 

Additional counsel for Plaintiffs on signature 

page 

Martin J. Bishop (admitted pro hac vice) 

mbishop@reedsmith.com 

Rebecca R. Hanson (admitted pro hac vice) 

rhanson@reedsmith.com 

REED SMITH LLP

10 South Wacker Drive, 40th Floor 

Chicago, IL 60606 

Telephone: +1 312 207 1000 

Facsimile: +1 312 207 6400 

Karen A. Braje (SBN 193900) 

kbraje@reedsmith.com 

REED SMITH LLP

101 Second Street, Suite 1800 

San Francisco, CA 94105-3659 

Telephone: +1 415 543 8700 

Facsimile: +1 415 391 8269 

Additional counsel for Defendants UnitedHealth 

Group Inc., UnitedHealthcare, Inc., 

UnitedHealthcare Insurance Company, United 

HealthCare Services, Inc., and UMR, Inc. on 

signature page

IN THE UNITED STATES DISTRICT COURT 

FOR THE NORTHERN DISTRICT OF CALIFORNIA 

RACHEL CONDRY, JANCE HOY, CHRISTINE

ENDICOTT, LAURA BISHOP, FELICITY

BARBER, and RACHEL CARROLL on behalf of

themselves and all others similarly situated,

 Plaintiffs,

v.

UnitedHealth Group Inc.; UnitedHealthcare, Inc.;

UnitedHealthcare Insurance Company;

UnitedHealthcare Services, Inc.; and UMR, Inc.,

 Defendants.

Case No.: 3:17-cv-00183-VC

JOINT LETTER BRIEF REGARDING

DISCOVERY DISPUTE

Honorable Sallie Kim 

Close of Discovery: March 29, 2019

Case 3:17-cv-00183-VC Document 215 Filed 06/21/19 Page 1 of 12
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On April 5, 2019, Plaintiffs filed a Joint Letter Brief Regarding Discovery Dispute [Dkt. 192,

“April 5 Letter Brief”], along with the Declaration of Kimberly Donaldson-Smith [Dkt. 193] attaching 

the Plaintiffs' Third Set of Requests for Production of Documents, and Defendants' Objections and 

Responses to Plaintiffs' Third Set of Requests for Production of Documents (“RFPs” or “RFP”). 

On May 23, 2019, the Court issued the Order Denying Motion for Class Certification (Dkt. 213, 

“May 23 Order”) and addressed the April 5 Letter Brief. Specifically, at page 6, fn. 2 of the Order, the 

Court stated that, “If the discovery dispute identified in the parties’ April 5, 2019 joint letter remains 

relevant in the wake of this ruling, the parties may resubmit a joint letter that grounds the dispute in this 

ruling. Any arguments regarding the requested documents’ relevance, particularly at this stage of the 

litigation, must be specific. The motion contained in the April 5, 2019 letter is therefore denied.” 

It is Plaintiffs’ position that the dispute identified in the April 5 Letter Brief remains relevant, 

and its relevancy is supported directly by the Court’s May 23 Order. Defendants disagree. 

Accordingly, this Letter Brief is submitted pursuant to the Court’s May 23 Order (Dkt. 213, at pg. 6, fn. 

2). 

Dated: June 21, 2019 

By: //s/ Kimberly M. Donaldson-Smith

 Kimberly Donaldson-Smith 

Attorneys for Plaintiffs 

CHIMICLES SCHWARTZ KRINER 

& DONALDSON-SMITH LLP

By: / s/ Rebecca R. Hanson 

Rebecca R. Hanson 

Attorneys for Defendants 

REED SMITH LLP 

Case 3:17-cv-00183-VC Document 215 Filed 06/21/19 Page 2 of 12
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June 21, 2019 

Honorable Magistrate Judge Sallie Kim 

United States District Court 

Northern District of California 

450 Golden Gate Avenue 

San Francisco, California 94102 

Dear Magistrate Judge Kim: 

The parties jointly submit this letter concerning a dispute arising from Plaintiffs’ Third Set of 

Requests for Production of Documents. Plaintiffs seek to compel a response to Request No. 5 

(modified as discussed herein). Discovery closed on March 29, 2019. 

I. PERTINENT PROCEDURAL BACKGROUND

On January 29, 2019, Plaintiffs served Defendants with a Third Set of Requests for Production 

of Documents (Exhibit A). On February 28, 2019, Defendants served their Objections and Reponses to

Plaintiffs’ Requests for Production (Exhibit B). Defendants’ Objections and Response to Request No. 

5 is the source of the instant discovery dispute. Request No. 5 requests all claims submitted to

Defendants for providers who appear on the “380 Lists.” The reference to “380” pertains to

Defendants’ specialty code applicable to Lactation Specialists (individuals and groups). The reference 

to the “380 Lists” pertains to documents produced by Defendants that include the identity of providers 

identified as 380 Lactation Specialists. Defendants objected to Request No. 5, stating that the request 

“seeks information regarding any and all claims pertaining to services rendered by the providers that 

appear on the 380 Lists, even those that did not involve coverage of lactation services,” and that, to the 

extent the providers appearing on the 380 Lists billed for services using codes previously agreed to by

the parties, such claims already appear in the previously produced claims data.

On March 11, 2019, the parties held a telephonic meet and confer (“3/11/2019 M&C Call”), 

during which the parties addressed Request No. 5. During that call, Defendants took the position that 

the providers who appear on the 380 Lists can and do provide services other than lactation services, 

and, thus, pulling all claims for all of the 380 providers on those 380 Lists would be, in Defendants’ 

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view, unduly burdensome and not proportional to the needs of the case. Plaintiffs stated that while they 

disagreed with Defendants’ position, Plaintiffs would undertake to address the foregoing by: reviewing 

and researching the providers identified by the Specialty Code Number 380; identifying of those 

providers those who exclusively provide lactation services; and, providing any other parameters that 

could be used to narrow the claims data for such providers sought by Request No. 5. Defendants 

indicated that they would consider a proposal made by Plaintiffs. Discovery closed on March 29, 2019. 

In a March 30, 2019 email, Plaintiffs provided Defendants with their proposal to narrow the scope of 

Request No. 5, and attached a list that narrowed the number of 380-identified providers. On April 1, 

2019, Defendants responded “that Plaintiffs waited too long to attempt to meaningfully work through 

the 380 specialist issue” and stated that Defendants would be “happy to find time to further meet and

confer.” No additional meet and confer was scheduled, and instead, pursuant to Rule 37-3, which 

requires that motions to compel discovery be filed within 7 days after the discovery cut-off, Plaintiffs 

filed the Letter Brief on April 5. The Class Certification Order denied the relief sought in the April 5

Letter Brief indicating that, “[i]f the discovery dispute identified in the parties’ April 5, 2019 joint letter 

remains relevant in the wake of this ruling, the parties may resubmit a joint letter that grounds the 

dispute in this ruling,” provided that “[a]ny arguments regarding the requested documents’ relevance, 

particularly at this stage of the litigation, must be specific.” The parties additionally met and conferred 

telephonically regarding this discovery dispute on June 14 and June 18, 2019.

II. PARTIES’ POSITIONS ON THE DISPUTE 

a. PLAINTIFFS’ POSITION 

In this action, Plaintiffs allege that Defendants did not provide insurance coverage for 

comprehensive breastfeeding support and counseling services (“CLS”) as required under the Affordable 

Care Act (the “ACA”). Among other things, Plaintiffs allege that Defendants improperly denied, or 

imposed cost-sharing with respect to, claims for CLS rendered by out-of-network lactation consultants. 

Request No. 5 seeks the production of all claims submitted to Defendants by those providers 

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who were identified internally at United by Code 380, United’s code for lactation specialist. Request 

No. 5 is pertinent to liability and class certification. Defendants do not credibly contend that Request 

No. 5 is irrelevant. Rather, Defendants contend it is too broad, burdensome and duplicative. 

First, Plaintiffs have agreed to limit their Request No. 5 to claims submitted for out-of-network

lactation consultants, which limitation ties directly to the May 23 Order. Second, Request No. 5 is

directly pertinent to United’s processing and adjudication of claims submitted for out-of-network 

lactation consultations. As the May 23 Order held (at page 3), the “classes even potentially appropriate 

for these claims would consist of people denied reimbursement for out-of-network lactation services...” 

The sought-after claims constitute direct evidence of how United auto-adjudicated the claims submitted 

by insureds for the out-of-network lactation consultations. They will demonstrate why those claims 

were adjudicated as a denial, or why United imposed cost-sharing on the insureds. At the Class 

Certification hearing, the Court specifically asked "[W]hat evidence is there in the record about the 

reasons why any particular person who received [ ] lactation services was denied coverage?”, 

Transcript (“Tr”) at 11:1-4. The claims data responds to that inquiry. 

Third, the claims data sought by Request No. 5 will include the denial and/or remark codes 

conveyed by United to the insureds which reflect United’s reasons for its treatment and adjudication of 

each out-of-network lactation claim. The ultimate adjudications of the out-of-network claims are 

directly pertinent to demonstrating: first, how the wrongful policies infected United’s decision-making 

process and auto-adjudication of the out-of-network lactation claims; and, second the resultant injury to 

the insureds. The claims data sought is evidence of how and why insureds were denied coverage for 

out-of-network claims and pursuant to what policy or United directive. See, e.g., Tr. at 14:9-17. For 

example, Plaintiffs’ analysis, which will include how Defendants adjudicated the claims for CLS 

performed by out-of-network lactation consultants, will respond to the Court’s statements such as that 

Plaintiffs’ proposal “presumes” “that the same sort of error was committed with respect to the denial of 

the claim for reimbursement for everybody who was denied...”. Id.; see also, id. at 29:2-3. 

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Fourth, the parties have disputed both the “scope” of CLS services and how out-of-network 

lactation consultants bill patients and payers for CLS services. There is not a single code used by

providers to reflect the provision of CLS. Defendants’ duplication argument misses the point. Absent 

the production of claims for these lactation specialists -- without the claims being limited by certain 

codes as they have been to date1

-- we cannot be assured of capturing all of the out-of-network CLS 

claims that were submitted using “real world” coding. Receipt of the claims is necessary to address, for 

example, the nature as well as the prevalence or uniformity of the Defendants’ conduct, which directly 

responds to the Court’s Order. Also, Defendants cannot certify that all CLS claims that would be 

captured by Request No. 5 have already been produced. For example, Defendants did not produce 

claims if, for example, the claims were denoted just by a pediatric code, such as P925 (Neonatal 

difficulty in feeding at breast) or P593 (Neonatal jaundice from breast milk inhibitor). The Court has 

stated the need for Plaintiffs to address Defendants’ policies and conduct. In Plaintiffs’ view, the 

policies include the treatment of out-of-network CLS claims and denial of CLS claims submitted by

lactation specialists who identified the baby as the patient. In sum, the claims data address the Court’s 

May 23 Order concerning Defendants’ specific policies at issue, conduct in adjudicating the claims, and 

the treatment of the insureds’ claims. 

 Finally, Request No. 5 is not burdensome or duplicative. As stated during the 3/11/2019 M&C 

Call, Plaintiffs diligently and timely undertook the work necessary to address Defendants’ objections 

that the request was overly broad and unduly burdensome. Defendants’ arguments about breadth 

remain theoretical. They argue about what claims could or may be pulled based on purportedly 

irrelevant codes. Tellingly, although the hard data is solely in their possession, they never reveal the 

actual number of any such claims. Also, Defendants ignore the limited scope of services provided by

the lactation specialists, rendering their arguments highly speculative. Notwithstanding Defendants’ 

 

1 Plaintiffs’ agreement to a production limited by certain codes was without prejudice to their review of the claims 

and to propounding further requests. After such review, Plaintiffs proceeded with Request No. 5. 

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failure to provide any hard data demonstrating burden, Plaintiffs agreed to and now further propose to

narrow Request No. 5 as follows: (1) Limit the request to out-of-network providers who were 

identified by the 380 code. (2) Exclude all Claims produced to date. (3) Exclude claims from hospitals 

based on the hospital’s MPIN, and only include claims associated with the NPI as rendering or billing 

NPI for an individual provider. (4) Notwithstanding Defendants’ failure to demonstrate with facts that

certain non-CLS claims would be included, Plaintiffs agree the claims pull can exclude: 

a. Claims that include S, J and L Codes; 

b. Claims for breast pumps (by excluding claims with codes beginning with A or E); 

c. Claims for “Cranial Therapy” (by excluding all claims for Manipulative Therapy, the codes 

for which are reflected in United’s Manipulative Therapy Policy, Number 2019T0541L); 

d. Services provided by “birth doulas.”

2

Plaintiffs are entitled to the claims data submitted for out-of-network lactation consultants. Plaintiffs’ 

proposal refines Request No. 5 to resolve Defendants’ objections. Plaintiffs respectfully request that

the Defendants be ordered to produce the documents responsive to Request No. 5, as modified. 

b. DEFENDANTS’ POSITION 

The Court should deny Plaintiffs’ request for an order compelling discovery for several reasons. 

First, Plaintiffs’ request fails to comply with the Court’s admonition that “[a]ny arguments regarding 

the requested documents’ relevance ... be specific” and grounded in the Court’s class certification 

Order. (Order at 6 n.2.) Plaintiffs argue that the claims data: “is pertinent to liability and class 

certification”; is “directly pertinent to United’s processing and adjudication of claims submitted for outof-network lactation consultations”; and “will include the denial and/or remark codes conveyed by 

United to the insureds.” But these conclusory statements do not explain how the requested claims data 

 

2 The following codes would be excluded: CPT 99499; and ICDs: Z32.2 (childbirth instruction); Z32.3 (childcare 

instruction); Z33.1 (pregnant state, incidental); Z39.0 (care and examination of mother immediately after 

delivery); Z39.2 (encounter for routine postpartum follow-up); V22.2 (pregnant state, incidental); V24.0 

(postpartum care and examination immediately after delivery); V24.2 (routine postpartum follow-up)). 

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will help Plaintiffs rectify the “[m]any problems” that “plague[d]” Plaintiffs’ efforts to certify a 

putative class, chief among them being Plaintiffs’ failure to show that they could establish a common, 

class-wide injury through common proof. (Id. at 2-3; see also id. at 3-4.) 

As this Court observed in its Order denying class certification, there is no indication in the evidence 

adduced during discovery “that UHC uniformly applied an unlawful policy to out-of-network claims.” 

(Id. at 3-4.) This is significant, since Plaintiffs have already obtained thousands of out-of-network 

claims in discovery, including but not limited to claims billed by the very same providers (i.e., out-ofnetwork providers who have the “Lactation Specialist” designation) that form the basis of this 

discovery dispute. These already produced claims include services billed with diagnosis codes that

contain the word “lactation” in their clinical descriptions, in addition to a host of claims billed with a 

myriad of other diagnosis codes that Plaintiffs requested, including claims for infants and the infant 

codes Plaintiffs claim above were not produced.3 Nevertheless, despite having all that claims data, 

Plaintiffs could not develop a viable class-wide argument that could persuade the Court to rule in their

favor. Plaintiffs provide no explanation whatsoever to support why they believe yet even more out-ofnetwork claims data will resurrect their attempt to certify a class here. Nevertheless, Plaintiffs can make 

the arguments they describe above using the existing claims data because they have not described any 

types of claims data that are not already available to them.

 Second, Plaintiffs’ proposal regarding Request No. 5 is overly broad, unduly burdensome, and not 

proportional to the needs of the case. See Fed. R. Civ. P. 26(b)(1). Plaintiffs apparently believe that

pulling additional claims information is warranted because they believe that the only services rendered 

by providers who have the 380 designation in Defendants’ records are those related to lactation. There 

 

3 Defendants produced claims data that included claims billed with infant codes P925 (Neonatal difficulty in

feeding at breast) and P593 (Neonatal jaundice from breast milk inhibitor), but Plaintiffs now complain that 

Defendants did not produce claims when billed only with those codes. That is a result of Plaintiffs’ own doing. 

Defendants objected to such a production on the basis that the Affordable Care Act benefit at issue is expressly 

for women and for “lactation support” as opposed to infant feeding issues, and Plaintiffs did not further pursue the 

production of such claims. 

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is no evidence for this bald assertion, which is contradicted by Plaintiffs’ (albeit insufficient) 

willingness to exclude a few codes for other services. Indeed, providers on Plaintiffs’ proposed list 

boast providing other services on their websites, and many of these providers are licensed as certified 

nurse midwives, nurse practitioners, and registered nurses who may be providing other non-lactation 

services within the scope of their licensures. Such providers and all other non-lactation services have 

not been culled out of Plaintiffs’ list as Plaintiffs suggest. 4 Plaintiffs describe these issues as

“theoretical,” ignoring the specific examples Defendants have provided and, more importantly, the fact 

that it is their burden, not Defendants’, to establish the relevance of the discovery sought. 

 While Plaintiffs recognize the Court’s ruling that “[t]he only classes even potentially appropriate for 

these claims would consist of people denied reimbursement for out-of-network lactation services,” 

(Order at 3 (emphasis added)), Plaintiffs still refuse to narrow their request for additional claims to

those that were billed with diagnoses codes that contain the word “lactation,” of which there are many. 

 

4 Plaintiffs attempt to ameliorate this problem by identifying a handful of codes that they are willing to exclude. 

Plaintiffs’ efforts, however, are insufficient. First, even if the Court were to allow Plaintiffs to narrow their 

request as Plaintiffs’ suggest, Plaintiffs have not gone far enough to recognize the myriad of services these 

providers could be providing in addition to lactation support given the scope of their practice as certified nurse 

midwives, nurse practitioners, doulas, and the like. For example, Plaintiffs only mention doula services and even 

then only attribute certain codes to those services when there are many others that such a provider could utilize for 

birth services. Along those same lines, Plaintiffs’ claim above that excluding a hospital’s MPIN (identification 

number) and focusing on the individual’s NPI number would exclude all services that are not lactation services is

not supported by any evidence, making this another hollow attempt to limit Plaintiffs’ requested claims pull to

lactation claims only. Further, through the meet and confer process, Defendants have provided non-exhaustive 

examples of procedure codes that are inappropriate for a claims pull, and, on a piecemeal basis, Plaintiffs agree to

exclude them (by adding “J” and “L” codes to the exclude list, for example) – but Plaintiffs miss the point by not 

excluding all the other irrelevant codes that would still be included in their proposal. No procedure level code is

appropriate for a claims pull for lactation services unless the claim is also billed with a diagnosis code that has the 

word “lactation” in it. As Defendants’ expert, Pam D’Apuzzo, explained in connection with class certification 

briefing, if a provider is trying to express to Defendants that they are providing “lactation” services, it ultimately 

makes sense that they would use a diagnosis code that contains the word “lactation” to indicate that such services 

were provided. Plaintiffs tellingly provide the Court with no information about how they will ensure that the 

claims pulled under their expansive approach are for lactation support – especially given the fact that many of 

these providers have wider scope of practices than simply lactation consultation. Indeed, Plaintiffs’ “compromise” 

still ignores that there are, for example, codes that providers use to bill “cranial therapy” other than those noted by 

Plaintiffs above and that their proposal still includes codes that would not be relevant to identify a claim for 

lactation support, such as “99999,” which is for unspecified services, “G” codes that can be used for Medicare 

claims that are not in scope here, “K” codes for durable medical equipment, etc. The only way to ensure the 

claims data is not overbroad is to limit claims to those billed with “lactation” diagnosis codes. 

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As a result, even if Defendants were to produce this additional data, Plaintiffs could not establish that 

the claims were for lactation services, absent an individual review of medical records, which Plaintiffs 

do not assert either party has. That is because many of these providers can provide non-lactation 

services within the scope of their practice, and there is nothing in the claims data itself that indicates the 

claims are definitively for lactation services. In any event, the individualized nature of this process 

necessarily defeats class certification. Plaintiffs’ unwillingness to narrow their request to claims billed 

with codes that contain the word “lactation” means that Plaintiffs have requested irrelevant information.

 Third, Plaintiffs’ request is untimely. Although the parties met and conferred on March 11, 2019,

Plaintiffs did not convey their proposal until nearly three weeks later and the day after discovery closed. 

Plaintiffs’ delay tactics undermine the purpose of discovery cutoffs, which is to provide the parties with 

certainty regarding their obligations. See Whittaker Corp. v. Execuair Corp., 736 F.2d 1341, 1347 (9th 

Cir. 1984). Plaintiffs’ delay continues to prejudice Defendants, who are forced to litigate a discovery 

dispute months after the close of discovery. 

In terms of compromise, Plaintiffs’ proposal is still entirely overbroad and does not consider a vast 

number of codes that are plainly not related to lactation counseling. If the Court is inclined to grant 

Plaintiffs’ request as modified above, Defendants request that the Court further narrow Plaintiffs’ 

proposal to claims submitted with procedure level codes for which claims data was not previously 

pulled (because the codes were not requested by Plaintiffs), but only when those claims also contain 

diagnosis level codes that contain the word “lactation” in their clinical descriptions. This approach will 

narrow the claims to those that actually might represent the benefit at issue in the case (i.e., the 

Affordable Care Act’s benefit for “lactation support” for women), depending on other circumstances 

associated with the claim. Otherwise, neither party will be able to ever establish that these additional 

claims are for “lactation support,” making the request overly broad and unduly burdensome. Further, 

Plaintiffs should cull the provider list to individual out-of-network providers only. To be clear, 

however, Plaintiffs’ request for an order compelling discovery should be denied in its entirety. 

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CHIMICLES SCHWARTZ KRINER

& DONALDSON-SMITH LLP

By: //s/ Kimberly M. Donaldson-Smith

Nicholas E. Chimicles (admitted pro hac vice)

Kimberly Donaldson-Smith (admitted pro hac vice)

Stephanie E. Saunders (admitted pro hac vice)

361 W. Lancaster Avenue

Haverford, PA 19041

Phone: (610) 642-8500

Fax: (610) 649-3633

NEC@Chimicles.com

KMD@Chimicles.com

SES@Chimicles.com

James E. Miller (admitted pro hac vice)

Laurie Rubinow (to seek admission pro hac vice)

SHEPHERD, FINKELMAN, MILLER AND

SHAH, LLP

65 Main Street

Chester, CT 06412

Phone: (860) 526-1100

Fax: (866) 300-7367

jmiller@sfmslaw.com

lrubinow@sfmslaw.com

Marc A. Goldich (admitted pro hac vice)

Noah Axler (admitted pro hac vice)

AXLER GOLDICH LLC

1520 Locust Street

Suite 301

Philadelphia, PA 19102

Phone: (267) 534-7400

Fax: (267) 534-7407

mgoldich@axgolaw.com

naxler@axgolaw.com

KRISTEN LAW SAGAFI,

California Bar No. 222249

TYCKO & ZAVAREEI LLP

483 Ninth Street, Suite 200

Oakland, CA 94607

Phone: (510) 254-6808

Fax: (202) 973-0950

ksagafi@tzlegal.com

Attorneys for Plaintiffs

REED SMITH LLP

By: /s/ Rebecca R. Hanson 

Martin J. Bishop

Rebecca R. Hanson

Thomas C. Hardy

Abraham J. Souza

Reed Smith LLP

10 S. Wacker Drive, 40th Floor

Chicago, IL 60606

mbishop@reedsmith.com

rhanson@reedsmith.com

thardy@reedsmith.com

asouza@reedsmith.com

Karen A. Braje

Reed Smith LLP

101 Second Street, Suite 1800

San Francisco, CA 94105

kbraje@reedsmith.com

Dianna C. Wyrick

Reed Smith LLP

Reed Smith Centre

225 Fifth Avenue

Pittsburgh, PA 15222

dwyrick@reedsmith.com 

Attorneys for Defendants UnitedHealth 

Group Inc., UnitedHealthcare, Inc., 

UnitedHealthcare Insurance Company, 

UnitedHealthcare Services, Inc., and UMR, 

Inc.

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ECF ATTESTATION 

 Pursuant to Civil Local Rule 5-1(i)(3), the filer of this document attests that concurrence in

the filing of this document has been obtained from the other signatory above. Executed this 21st 

day of June, 2019, at Haverford, Pennsylvania. 

By: /s/ Kimberly M. Donaldson-Smith 

Kimberly M. Donaldson-Smith 

Case 3:17-cv-00183-VC Document 215 Filed 06/21/19 Page 12 of 12