EXHIBIT A 

Case 2:15-cv-01933-DJH Document 1-1 Filed 09/28/15 Page 1 of 6
AUG 2 6 2015 

Date: 

Justice of the Peace 

HIGHIAND TiCE COURT 55E _MOWN Wan 

onsERtmasse 

AlS1 ICE " 

Maricopa County Justice Courts, Mit:MAID 

COUP 

2015 AUG 26 ret1 10: 55 

SurgCenter of Gilbert, LLC 

CASE NUMBER: CecR Of 5 he Dg5q 

Chritedhealthcare of Arizona, In)(R/A CT Corporation) 

3800 N. Central Avenue, Suite 460 

Phoenix, Arizona 85012 

Defendant(s) Name / Address! Phone 

3345 S. Val Vista Dr Suite 110 

Gilbert, Arizona 85297 

( 480 ) 725 _ 9777 

Plaintiff(s) Name / Address / Phone 

Serve on: 

Statutory Agent CT Corporation 

Address 3800 N. Central Avenue, Suite 460 

Phoenix, Arizona 85012 

CIVIL SUMMONS 

0 Replacement Summons JCRCP Rule 112 

REQUESTS FOR REASONABLE ACCOMMODATIONS FOR PERSONS WITH DISABILITIES MUST BE MADE TO 

THE COURT AT LEAST 3 JUDICIAL DAYS IN ADVANCE OF ANY SCHEDULED HEARING. 

THE STATE OF ARIZONA TO THE ABOVE-NAMED DEFENDANT(S): 

1. YOU ARE SUMMONED to respond to this complaint by filing a written ANSWER with this Court and by paying the 

required fee. If you bannbt afford to pay the required fee, you may request that theCourt either waive or defer the fee. 

2. If you were served with this summons in the State of Arizona, the Court must receive your answer within twenty (20) 

calendar days from the date you were served. If you were served outside the State of Arizona, the Court must receive 

your answer within thirty (30) calendar days from the date you were served. If the last day is a Saturday, Sunday, or legal 

holiday, you will have until the next working day to file your answer. When calculating time, do not count the day you were 

served with the summons. 

3. Your answer must be in writing. 

(a) You may obtain an answer form from this Court. 

(b) You may also obtain an answer form from the Form section of the 

Maricopa County Justice Courts website at http://justicecourts.maricopa.gov 

The direct link is: http://justicecourts.maricopa.gov/Forms/cvAnswer.pdf 

4. Provide a copy of your answer to the Plaintiff(s) or to the Plaintiffs attorney in accordance with JCRCP Rule 120. 

5. IF YOU FAIL TO FILE A WRITTEN ANSWER WITH THIS COURT WITHIN THE TIME INDICATED ABOVE, A DEFAULT 

JUDGMENT MAY BE ENTERED AGAINST YOU. 

You are required to keep the court advised of your current addressa phone number. 

The clerk can provide you with a Notice of Change of Address form. 

CV 8150-101.01 R: 3/4/13 

Case 2:15-cv-01933-DJH Document 1-1 Filed 09/28/15 Page 2 of 6
EXHIBIT B 

Case 2:15-cv-01933-DJH Document 1-1 Filed 09/28/15 Page 3 of 6
( 480 ) 725 - 9777 

Plaintiff(s) Name! Address! Phone 

Elliot S. Isaac, P.C. 

14820 N. Cave Creek Road, Suite 3 

Phoenix, AZ 85032 

Defendant(s) Name Address! Phone 

( 602 ) 404 - 

Attorney for Plaintiff(s) Name! Address! Phone Attorney for Defendant(s) Name! Address! Phone 

Vldricopa County Justice Courts, iikeiktinavsncecou-r 

Highland Justice Court 55 E. Civic Center Dr., #55, Gilbert, AZ 85296 602-372-ffl Sqvc 2r 

CASE NUMBER rAcAll '!D J

Unitedhealthcare of Arizona, Inc. (R/A CT Corporation) 

3800 N. Central Avenue, Suite 410 

Phoenix, Arizona 85012 

COMPLAINT JCRCP Rule 110 

SurgCenter of Gilbert, LLC 

3345 S. Val Vista Dr Suite 110 

Gilbert, Arizona 85297 

I allege that: 

EXI This court has jurisdiction over this matter. 

0 This court has venue because: 

0 Defendant resides within the precinct boundaries of this court. 

The debt or obligation that gives rise to this action occurred within this court's precinct, 

3345 S. Val Vista Dr Suite 110, Gilbert Arizona 85024 

0 Other, pursuant to ARS 12-401.1-19: 

at the following location: 

I also allege that (state the factual basis for each claim): 

1. On January 27, 2015, Plaintiff provided a medically necessary surgery to a patient with Defendant's health 

insurance. Plaintiff submitted charges to Defendant in the amount of $28,020. 

2 Defendant admitted that it owed Plaintiff $10,097.74. Nonetheless, to date Defendant has paid Plaintiff 

nothing. 

3 Defendant claims that it using the $10,097.74 to offset overpayaments it mistakenly made on unrelated 

cases for different patients. 

4. Plaintiff believes that Defendant has no right of offset and that its actions are improper. 

I am asking the court to award me judgment against the defendant(s) in the sum of $9,999.00 plus attys fees 

(state claimed damages) 

I am also asking for reimbursement of my court costs and interest at the legal rate from the date 

I state under penalty of perjury that the foregoing is true and correct. 

of judgment. 

Date: /y 

Plaintiff 

You are required to keep the court advised of your current address and telephone number. 

The clerk can provide you with a Notice of Change of Address form. 

CV 81 50-1 00 R: 2/25/13 

Case 2:15-cv-01933-DJH Document 1-1 Filed 09/28/15 Page 4 of 6
EXHIBIT C 

Case 2:15-cv-01933-DJH Document 1-1 Filed 09/28/15 Page 5 of 6
NOTICE TO THE DEFENDANT: 

A LAWSUIT HAS BEEN FILED AGAINST YOU IN JUSTICE COURTS 

You have rights and responsibilities in this lawsuit Read this notice carefully. 

1. In a justice court lawsuit, individuals have a right to represent themselves, or they may hire an attorney to 

represent them. A family member or a friend may not represent someone in justice court unless the family 

member or friend is an attorney. A corporation has a right to be represented by an officer of the corporation, 

and a limited liability company ("LLC") may be represented by a managing member. A corporation or an LLC 

may also be represented by an attorney. 

If you represent yourself, you have the responsibility to properly complete your court papers and to file them 

when they are due. The clerks and staff at the court are not allowed to give you legal advice. If you would like 

legal advice, you may ask the court for the name and phone number of a local lawyer referral service, the 

local bar association, or a legal aid organization. 

2. You have a responsibility to follow the Justice Court Rules of Civil Procedure ("JCRCP") that apply in your 

lawsuit. The rules are available in many public libraries, at the courthouse, and online at the Court Rules 

page of the Arizona Judicial Branch website, at http://www.azcourts.gov/,under the "AZ Supreme Court" tab. 

3. A "plaintiff' is someone who files a lawsuit against a 'defendant? You must file an answer or other response 

to the plaintiff's complaint in writing and within twenty (20) days from the date you were served with the 

summons and complaint (or thirty (30) days if you were served out-of-state.) If you do not file an answer 

within this time, the plaintiff may ask the court to enter a "default' and a "default judgment' against you. Your 

answer must state your defenses to the lawsuit. Answer forms are available at the courthouse, on the 

Maricopa County Justice Court website at http://justicecourts.maricopa.gov/,and on the Self-Service Center 

of the Arizona Judicial Branch website at http://www.azcourts.gov/ under the "Public Services" tab. You may 

also prepare your answer on a plain sheet of paper, but your answer must include the court location, the 

case number and the names of the parties. You must provide to the plaintiff a copy of any document that you 

file with the court, including your answer. 

4. You may bring a claim against the plaintiff if you have one. When you file your answer or written response 

with the court, you may also file your "counterclaim" against the plaintiff. 

5. You must pay a filing fee to the court when you file your answer. If you cannot afford to pay a filing fee, you 

may apply to the court for a fee waiver or deferral, but you must still file your answer on time. 

6. You may contact the plaintiff or the plaintiffs attorney and try to reach an agreement to settle the lawsuit. 

However, until an agreement is reached you must still file your answer and participate in the lawsuit. During 

the lawsuit, the court may require the parties to discuss settlement. 

7. Within forty (40) days after your answer has been filed, you and the plaintiff are required to provide a 

disclosure statement to each other. The disclosure statement provides information about witnesses and 

exhibits that will be used in the lawsuit. A party may also learn more about the other side's case through 

discovery. Read the Justice Court Rules of Civil Procedure for more information about disclosure statements 

and discovery. 

8. The court will notify you of all hearing dates and trial dates. You must appear at the time and place specified 

in each notice. If you fail to appear at a trial or a hearing, the court may enter a judgment against you. To 

assure that you receive these notices, you must keep the court informed, in writing, of your current address 

and telephone number until the lawsuit is over. 

CV 8150-101.02 R: 1/1/13 

Case 2:15-cv-01933-DJH Document 1-1 Filed 09/28/15 Page 6 of 6