Preview
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
EXHIBIT “A”
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ORANGE
---------------------------------------------------------------------X
KATHLEEN PETROVICS,
Plaintiff, RESPONSE TO
COMBINED DEMANDS
-against-
GARNET HEALTH MEDICAL CENTER, HORTON Index No.: EF005836-2021
MEDICAL CENTER, MB REAL ESTATE and JOHN
DOE COMPANY,
Defendants.
---------------------------------------------------------------------X
Defendants, GARNET HEALTH MEDICAL CENTER, by its attorneys, CATANIA, MAHON
& RIDER, PLLC, as and for their response to plaintiff's combined demands, set forth upon information
and belief, as follows:
CONTRACTS OF INSURANCE
Primary insurance coverage provided by MLMIC, policy #AH1003236, policy limits
$2million/$7million.
Excess #1 provided by AIG, policy #6798223, with limits of $10million/$10million;
Excess #2 provided by MedPro-National Fire, policy EN038279 with limits of
$10million/$10million;
Excess #3 provided by Ironshore, policy #HC6SAB2T37002, with limits of
$10million/$10million.
Excess #4 provided by Capital Specialty, policy #HX2021106401, with limits of
$5million/$5million.
LIABILITY POLICIES
See above.
RESERVATION OF RIGHTS
Answering defendant is not in possession of any such documents.
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO.
DED/ded 31 05579-66650 RECEIVED NYSCEF: 06/16/2022
Doc#2022237
EXCESS/UMBRELLA COVERAGE
See above.
CLAIMANT’S STATEMENTS
See attached Worker’s Compensation form. Answering defendant is not in possession of any other
statements at this time.
WRITTEN ACCIDENT REPORTS
Answering defendant is not in possession of any such accident reports.
NAMES OF WITNESSES
Answering defendant knows of no witnesses to the incident.
PHOTOS OF SCENE
Answering defendant is not in possession of any such photographs.
PHOTOS OF PLAINTIFF
Answering defendant is not in possession of any such photographs, videos, etc.
CONTRACTS, LEASES, AGREEMENTS
See attached.
CULPABLE THIRD PARTIES
Answering defendant is not currently aware of the identity of such third parties, however answering
defendant reserves the right to amend this response if/when such party or parties become known as
discovery proceeds in this matter.
EXPERT WITNESS INFORMATION
Defendants have not yet obtained any expert witnesses with regard to this matter. Upon
selection of any such expert, disclosure will be provided pursuant to CPLR 3101(d).
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO.
DED/ded 31 05579-66650 RECEIVED NYSCEF: 06/16/2022
Doc#2022237
Dated: Newburgh, New York
February 11, 2022
Yours, etc.,
CATANIA, MAHON, & RIDER, PLLC
By:
DAVID E. DECKER. ESQ.
Attorneys for Defendants
GARNET HEALTH MEDICAL CENTER
641 Broadway
Newburgh, New York 12550
Tel. No.: (845) 565-1100
Email: ddecker@cmrlaw.com
TO: FOULKE LAW FIRM, PLLC
Evan M. Foulke, Esq.
Attorneys for Plaintiff
55 Main Street, 2nd Floor
Goshen, New York 10924
Tel. No.: (845) 294-4308
Email: foulke@foulkelaw.com
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
DED/ded 05579-66650 Doc#2022237
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF ORANGE
___________________________________________________________________Ç
KATHLEEN PETROVICS,
Plaintiff,
AFFIDAVIT OF SERVICE
-against-
GARNET HEALTH MEDICAL CENTER, HORTON Index No.: EF005836-2021
MEDICAL CENTER, MB REAL ESTATE and JOHN
DOE COMPANY,
Defendants.
_________________________________________________________________Ç
STATE OF NEW YORK )
) ss.:
COUNTY OF ORANGE )
DANIELLE L. DUFFIE, being duly sworn, deposes and says:
1. I am not a party to this action, am over 18 years of age, and reside at Montgomery, New
York.
2. On 11, 2022, I served a true copy of the annexed RESPONSE TO COMBINED
February
DEMANDS, in the following manner:
a true electronic of the same, via email, addressed to the last known email
By sending copy
address of the addressee(s) as indicated below:
TO: FOULKE LAW FIRM, PLLC
Evan M. Foulke, Esq.
Attorneys for Plaintiff
2nd
55 Main Street, FlOOr
Goshen, New York 10924
Tel. No.: (845) 294-4308
Email: foulke@foulkelaw.com
Sworn to before me this
1Id'
day of February, 2022.
NŒfARY 1)UBLIC 1 DANIE LE . U IE
Jovanna Riccio Bamard
Notary State
Public, of New York
No. 01R16372389
Qualifiedin OrangeCounty Co ission
ExpiresMamh 19, 20.3
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
Gamet Health
DOCTORS
WORKER'S COMPENSATfON FORM-PLEASE PRINT CLEARLY .
, . Prior to seeking medical treatment itis thepattenes responsibilitytofileanincldentreportwithyour
Workers'
employerandphtalpallinformation from your Compensation Carrier.Fallure to provide this
Information can result in responsible for charges.
thepatientheingfinancially .
PATIENT NAME:Ó t.EE\ 0½CS DOB:- SS #:
_____
ADDRESS: & ÓIane.ndge AD MddMun /W /0W /
PHONE A Û^Â2 C(H. DATE OFINJURY:
HAVE YOU HAD ANYPREVIOUS IMAGING?
TREATMENT/
HAVE YOU PREVIOUSLY ATTEND THERAPY MR THIS INJURY?
ARE YOU CURRENTLY ATTENDING THERAPY FOR THIS INJURY?:
WHERE?"
IFSO,
EM PLOYMENT IN FORMATION
CURRENTLY WORKING (QRCLEONE) (IF LAST DAY OF EMPLOYMENT:
NO)
NAME OF FMPLOYPR: 6bPJr 9 r 0AP
ADDRFSS: ry$ht,f t¿dj /Lif /(MÔ
JOB TITIE M / 47./'} PHONENUMBER:
BODY PART(S) INJURED: 77 fi fyrk dMT /95fS
HOW DID THE INJURY OCCUR dS d)de A
Étrtrf
tH c c
. . HAVE YOU OR YOUR liMPLOYER REPORTED THE INJURY?
CLAIM INFORMATION
WC11 #: G CARRIER CASE #/CLAIM #
INSURANCE CARRIER:
ADDRESS:
NAME OF ADJUSTER:
AD jUSTERPHONE: ADJUSTER FAX
ATTORNEY IN.RMATION:
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
Fax Server 7 /13 /2021 11 : 32 ; 56 AM PAGE 2/ 002 Fax Server
PLEASE COMPLETE & FAX T0 77D7776390 WITHIN 24 HOURS OF EVALUAT.N
APPOINTEMNT SCHEDULED FOR 7/15/21
Re: ClientFile #: 180551585-001
Injured Worker Name: Kathleen Petrovles
Date of Injury: 6/17/2021
Employsir/Insurert SHERLOQ GROUP (NC
Broadspire Flte #r 08223-000001696
Physlogan InterviewForm
Doctor's Name: Michael Runer spoofalty:
Diagnosis: UnspecIfledfracturoof Ihe lower
ond of right
radius,Inlilal
oncounter forofosedfraóture
fo diagnos|s causallyrelatedto theinjury: Yes No
Prognosis:
Work/ Non-Work carrabilities
None Occasional Frequent Continuous
% of Workday D% 1-33% . 34-66% 67-100%
Repotltlons per hr. 4-6 G"12 M2
Litt/Carry:
Up to 10 /bs. ¡ ¡ O
f 1-20 /bs. ¡ ¡ ¡ .
21-50 Iba, ¡ O O
5F100 lbs, O O O
Bending O
twist/Turn O O O
Reach below knee
Push/ Pull O
Squal/Kneel O O O
stand/Walk
sa O O O
above
Llfting shoulders
Hand restricilone ¤ Len O Right No use of O tsh ¤ Right
¡ Must wear splIni Arm
No Ilhinggreaterthan lbs. Hand
No repetitive
activilles O Finger
No work with substances
hot or cold O Other
O Change position
every Work as splinl/
aollvlty bandage porn Its
Avold ddvlng ¤ Keep wound clean/dry Lin111work to Hrs/ Day
MMI (Meximum ;MedicalImprovement): Projected Date: ActualDate:
. ReturntoWork Date;: LiglitDuty FullDuty
RestrictionalLimitations:
Are the shove reefrlotlons Temporary: Perrnanent
Do7tofs sigt1stut ....... Date:
Sharon Simmons, RN, CCM (SuzIe)
TelephonfoCase Slanagetnent
Broadspire
1391 NW 100th Avenue
Sunrise FI 30320
phone: 318.87t8714
fax: 770.777.6390
emaitsharon,elmmonsechoosetirageÿomm
BROADSPIRE: 1991 NW 136th Avenue Sunrise. Flojids33323 3188718714
www.ohoossbroadspfle,corn
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
LEASE OF SPACE
Walikill Medical Development, LLC
a limited liability company
LANDLORD
and
Orange Regional Medical Center
TENANT
DATED:
3ul 1,
2 9
y
U:lPROPERTIES\WKMD - Adminstrative
- ORMC(Walkill)lleasinglProspectsCRMC Officesu.easingw946-18 Offices- FINAL.doc
LeaseORMCAdministrative
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
LEASE OF SPACE
TABLE OF CONTENTS
1. Demise .................................................................................................................
1
2. Building.................................................................................................................
1
3. Ground Lease.......................................................................................................
1
4. Demised Premises. ..............................................................................................
1
5. Use .......................................................................................................................
2
6. Right of First Refusal............................................................................................
2
7. Tenant Fit-Up........................................................................................................3
8. Beginning of Term .................................................................................................
6
9. Deadline for Beginning of Term............................................................................
6
10. End of Term..........................................................................................................
7
11. Optional Extension. ..............................................................................................
7
12. Rent......................................................................................................................
7
13. Property Operating Costs.....................................................................................
9
14. Rent Tax.............................................................................................................
13
15. Late Charge........................................................................................................
13
16. Signage ..............................................................................................................
14
17. Cleaning Repair & Maintenance............1..........................................................
14
18. Trash Removal. ..................................................................................................
14
19. Alterations ..........................................................................................................
15
20. Utilities................................................................................................................
16
21. UtilityOperation..................................................................................................
16
22. 24-Hour Operation..............................................................................................
16
23. Parking. ..............................................................................................................
16
24. Alterations to Property. .......................................................................................
17
25. Security Deposit. ................................................................................................
17
26. Liability Insurance...............................................................................................
17
27. Tenanes Indemnity .............................................................................................
18
28. Compliance with Laws and Rules.......................................................................
19
29. Hazardous Materials; Insurance Risks. ..............................................................
19
30. Nuisances...........................................................................................................
19
31. Casualty Damage...............................................................................................
19
- ORMC(Walkill)u.easinglProspects\ORMC
U:\PROPERTIES\WKMD - Adminstrative
Officesu.easingl09-06-18 Offices- FINALdoc
LeaseORMCAdministrative
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
32. Broker.................................................................................................................
20
33. Redelivery at End of Term..................................................................................
20
34. Default. ...............................................................................................................
21
35. Re-entry; Damages. ...........................................................................................
21
36. Expenses............................................................................................................
22
37. Partial Payments. ...............................................................................................
22
38. Quiet Enjoyment.................................................................................................
22
39. Estoppel. ............................................................................................................
22
40. Right to Access...................................................................................................
22
41. Subordination. ....................................................................................................
23
42. Condemnation ....................................................................................................
23
43. Holding Over.......................................................................................................
24
44. Jury Trial Waiver.................................................................................................
24
45. Exculpation of Landlord ......................................................................................
24
46. Merger. ...............................................................................................................
25
47. Notices. ..............................................................................................................
25
48. Financial Statements. .........................................................................................
25
49. Guaranty.............................................................................................................
25
50. Applicable Law. .......................................,..........................................................
25
51. Assignment or Sublease by Tenant....................................................................
26
52. Waiver of Counterclaim. .....................................................................................
26
Tenants'
53. Equitable Remedies.............................................................................
26
54. Binding Effect. ....................................................................................................
27
55. Landlord Defined. ...............................................................................................
27
56. Non-waiver. ........................................................................................................
27
57. Severability. ........................................................................................................
28
58. Headings. ...........................................................................................................
28
59. Non-representation by Landlord. ........................................................................
28
60. Counterparts.......................................................................................................
28
61. Landlors Right to Relocate Tenant ..................................................................
28
62. Memorandum of Lease....................................................................................
.. 28
63. Confidentiality. ....................................................................................................
28
64. Authority to Sign. ................................................................................................
29
- ORMC(Walkil0I..easinglProspectslORMC
U:PROPERTIES\WKMD - Adminstrative
OnicesV.easingi09-06-18 - FINAL.doc
LeaseORMCAdministrative
ONices
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
LEASE OF SPACE
This LEASE is made as of the day of , 200_, between Walikill
Joh
Medical Development, LLC ("Landlord"), a New York limited liability company
with an office at 200 Westage Business Center, Suite 120, Fishkill, NY 12524; and
Orange Regional Medical Center ("Tenant"),a not for profit corporation with an
office at 4 Harriman Drive, Goshen, New York 10924. In consideration of the
provisions hereof, the parties hereby agree as follows:
1. Demise. Landlord hereby leases and demises to Tenant, and Tenant hereby hires
from Landlord, premises (the "Demised Premises") consisting of a portion of a
building (the "Building") constructed or to be constructed by Landlord at 75 Crystal
Run Road Middletown, New York 10941.
2. Building. The Building constitutes a first class medical facility, constructed
substantially in accordance with the site plan attached hereto as Exhibit 1. The land,
together with the improvements now or hereafter existing on the land, is collectively
"Property."
described herein as the
3. Ground Lease. Itis expressly understood that the Tenanes interest in the Building .
as a Tenant is that of a sub-lessee under a ground lease dated December 16, 2004
between the Landlord and Orange Regional,Medical Center ("Ground Lease"). This
Lease is expressly subject and subordinate to all of the covenants, restrictions and
other provisions of said Ground Lease as though they were specifically set forth
herein.
4. Demised Premises.
4.1. The Demised Premises is shown on a diagram attached hereto as Exhibit 2A
and 2B. The Demised Premises is located on the Ground Floor and First Floor
of the Building and comprise approximately 17,717 Rentable Square Feet. In
the event the parties shall mutually agree to modify the amount of Rentable
Square Feet of the Demised Premises, the parties shall execute a memorandum
confirming the exact amount of Rentable Square Feet in the Demised Premises
promptly after determination of such amount, which memorandum shall be an
integral part of this Lease.
4.2. For purposes of this Lease, Rentable Square Feet and Usable Square Feet shall
be defined according to the respective standards of the Building Owners and
Managers Association ("BOMA") adopted June 7, 1996. At the time of the
execution of this Lease, the Rentable/Usable Ratio is 1.132%. Subject to the
- ORMC(Walkill)\LeasinglProspects\ORMC
U:\PROPERTIES\WKMD - Adminstrative Offices- FINAL.doc
LeaseORMCAdministrative
Offices\Leasing\09-06-18
- 1 -
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021
NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022
finalization of the design of the Building, that ratio may change prior to delivery
of the Demised Premises. In the event of such change, the parties agree to
execute a Letter Agreement to confirm the revised ratio.
5. Use. The Demised Premises shall be used only as follows:
5.1. The Use of the Demised Premises under this Lease is expressly limited to
Hospital Administrative Office Use and related services ancillary thereto, subject
to the use restrictions set forth in the Ground Lease from time to time and to
applicable laws and regulations, and no other purpose, whatsoever.
5.2. Tenant shall not change the Use or representation to the general public of the
Use of the Demised Premises without Landlord's prior written consent, which
change or representation is or may be restricted pursuant to this Lease and the
Ground Lease. Tenant specifically agrees that Tenant willnot actively engage in
the practice of medicine specializing in otolaryngology, orthopedics, physiatry, or
provide physical therapy services (collectively, the "Specialties"), nor will Tenant
represent to the generai public that Tenant concentrates its medical practice in
the Demised Premises in urgent care and provides services to patients primarily
on an unscheduled basis (collectively, "Urgent Care"), all so long as any other
tenant of the Building uses their demised premises in the Building to actively
engage in the Specialties or Urgent Care. For purposes of this section 5.2, only
Landlord shall have the right to determine, in its sole discretion, whether Tenant
or any other tenant is actively practicing in the Specialties or Urgent Care.
Tenant understands and agrees that certain other tenants of the Building are or
may be third party beneficiaries of thistsection 5.2 and may have the right to
enforce this section 5.2 and obtain relief, including injunctive relief,for Tenants
violation of this section 5.2. Any such rights of other Building tenants are in
addition to and not in lieu of the rights of Landlord to enforce this section 5.2 and
obtain equitable and legal relief for the violation thereof.
5.3. Tenant shall not use or permit the use of the Demised Premises or any part
thereof in any way that would violate any of the covenants, restrictions, terms
and provisions of this Lease and/or the Ground Lease or for any unlawful
purposes or manner or in violation of any applicable legal requirements,
including but not limited to the Certificate of Occupancy for the Demises
Premises and/or Building. Tenant shall not suffer or permit the Demised
Premises or any part thereof, to be used in any manner, or anything to be done
therein, or anything to be brought into or kept therein,
Preview
FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 EXHIBIT “A” FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ORANGE ---------------------------------------------------------------------X KATHLEEN PETROVICS, Plaintiff, RESPONSE TO COMBINED DEMANDS -against- GARNET HEALTH MEDICAL CENTER, HORTON Index No.: EF005836-2021 MEDICAL CENTER, MB REAL ESTATE and JOHN DOE COMPANY, Defendants. ---------------------------------------------------------------------X Defendants, GARNET HEALTH MEDICAL CENTER, by its attorneys, CATANIA, MAHON & RIDER, PLLC, as and for their response to plaintiff's combined demands, set forth upon information and belief, as follows: CONTRACTS OF INSURANCE Primary insurance coverage provided by MLMIC, policy #AH1003236, policy limits $2million/$7million. Excess #1 provided by AIG, policy #6798223, with limits of $10million/$10million; Excess #2 provided by MedPro-National Fire, policy EN038279 with limits of $10million/$10million; Excess #3 provided by Ironshore, policy #HC6SAB2T37002, with limits of $10million/$10million. Excess #4 provided by Capital Specialty, policy #HX2021106401, with limits of $5million/$5million. LIABILITY POLICIES See above. RESERVATION OF RIGHTS Answering defendant is not in possession of any such documents. FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. DED/ded 31 05579-66650 RECEIVED NYSCEF: 06/16/2022 Doc#2022237 EXCESS/UMBRELLA COVERAGE See above. CLAIMANT’S STATEMENTS See attached Worker’s Compensation form. Answering defendant is not in possession of any other statements at this time. WRITTEN ACCIDENT REPORTS Answering defendant is not in possession of any such accident reports. NAMES OF WITNESSES Answering defendant knows of no witnesses to the incident. PHOTOS OF SCENE Answering defendant is not in possession of any such photographs. PHOTOS OF PLAINTIFF Answering defendant is not in possession of any such photographs, videos, etc. CONTRACTS, LEASES, AGREEMENTS See attached. CULPABLE THIRD PARTIES Answering defendant is not currently aware of the identity of such third parties, however answering defendant reserves the right to amend this response if/when such party or parties become known as discovery proceeds in this matter. EXPERT WITNESS INFORMATION Defendants have not yet obtained any expert witnesses with regard to this matter. Upon selection of any such expert, disclosure will be provided pursuant to CPLR 3101(d). FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. DED/ded 31 05579-66650 RECEIVED NYSCEF: 06/16/2022 Doc#2022237 Dated: Newburgh, New York February 11, 2022 Yours, etc., CATANIA, MAHON, & RIDER, PLLC By: DAVID E. DECKER. ESQ. Attorneys for Defendants GARNET HEALTH MEDICAL CENTER 641 Broadway Newburgh, New York 12550 Tel. No.: (845) 565-1100 Email: ddecker@cmrlaw.com TO: FOULKE LAW FIRM, PLLC Evan M. Foulke, Esq. Attorneys for Plaintiff 55 Main Street, 2nd Floor Goshen, New York 10924 Tel. No.: (845) 294-4308 Email: foulke@foulkelaw.com FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 DED/ded 05579-66650 Doc#2022237 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ORANGE ___________________________________________________________________Ç KATHLEEN PETROVICS, Plaintiff, AFFIDAVIT OF SERVICE -against- GARNET HEALTH MEDICAL CENTER, HORTON Index No.: EF005836-2021 MEDICAL CENTER, MB REAL ESTATE and JOHN DOE COMPANY, Defendants. _________________________________________________________________Ç STATE OF NEW YORK ) ) ss.: COUNTY OF ORANGE ) DANIELLE L. DUFFIE, being duly sworn, deposes and says: 1. I am not a party to this action, am over 18 years of age, and reside at Montgomery, New York. 2. On 11, 2022, I served a true copy of the annexed RESPONSE TO COMBINED February DEMANDS, in the following manner: a true electronic of the same, via email, addressed to the last known email By sending copy address of the addressee(s) as indicated below: TO: FOULKE LAW FIRM, PLLC Evan M. Foulke, Esq. Attorneys for Plaintiff 2nd 55 Main Street, FlOOr Goshen, New York 10924 Tel. No.: (845) 294-4308 Email: foulke@foulkelaw.com Sworn to before me this 1Id' day of February, 2022. NŒfARY 1)UBLIC 1 DANIE LE . U IE Jovanna Riccio Bamard Notary State Public, of New York No. 01R16372389 Qualifiedin OrangeCounty Co ission ExpiresMamh 19, 20.3 FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 Gamet Health DOCTORS WORKER'S COMPENSATfON FORM-PLEASE PRINT CLEARLY . , . Prior to seeking medical treatment itis thepattenes responsibilitytofileanincldentreportwithyour Workers' employerandphtalpallinformation from your Compensation Carrier.Fallure to provide this Information can result in responsible for charges. thepatientheingfinancially . PATIENT NAME:Ó t.EE\ 0½CS DOB:- SS #: _____ ADDRESS: & ÓIane.ndge AD MddMun /W /0W / PHONE A Û^Â2 C(H. DATE OFINJURY: HAVE YOU HAD ANYPREVIOUS IMAGING? TREATMENT/ HAVE YOU PREVIOUSLY ATTEND THERAPY MR THIS INJURY? ARE YOU CURRENTLY ATTENDING THERAPY FOR THIS INJURY?: WHERE?" IFSO, EM PLOYMENT IN FORMATION CURRENTLY WORKING (QRCLEONE) (IF LAST DAY OF EMPLOYMENT: NO) NAME OF FMPLOYPR: 6bPJr 9 r 0AP ADDRFSS: ry$ht,f t¿dj /Lif /(MÔ JOB TITIE M / 47./'} PHONENUMBER: BODY PART(S) INJURED: 77 fi fyrk dMT /95fS HOW DID THE INJURY OCCUR dS d)de A Étrtrf tH c c . . HAVE YOU OR YOUR liMPLOYER REPORTED THE INJURY? CLAIM INFORMATION WC11 #: G CARRIER CASE #/CLAIM # INSURANCE CARRIER: ADDRESS: NAME OF ADJUSTER: AD jUSTERPHONE: ADJUSTER FAX ATTORNEY IN.RMATION: FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 Fax Server 7 /13 /2021 11 : 32 ; 56 AM PAGE 2/ 002 Fax Server PLEASE COMPLETE & FAX T0 77D7776390 WITHIN 24 HOURS OF EVALUAT.N APPOINTEMNT SCHEDULED FOR 7/15/21 Re: ClientFile #: 180551585-001 Injured Worker Name: Kathleen Petrovles Date of Injury: 6/17/2021 Employsir/Insurert SHERLOQ GROUP (NC Broadspire Flte #r 08223-000001696 Physlogan InterviewForm Doctor's Name: Michael Runer spoofalty: Diagnosis: UnspecIfledfracturoof Ihe lower ond of right radius,Inlilal oncounter forofosedfraóture fo diagnos|s causallyrelatedto theinjury: Yes No Prognosis: Work/ Non-Work carrabilities None Occasional Frequent Continuous % of Workday D% 1-33% . 34-66% 67-100% Repotltlons per hr. 4-6 G"12 M2 Litt/Carry: Up to 10 /bs. ¡ ¡ O f 1-20 /bs. ¡ ¡ ¡ . 21-50 Iba, ¡ O O 5F100 lbs, O O O Bending O twist/Turn O O O Reach below knee Push/ Pull O Squal/Kneel O O O stand/Walk sa O O O above Llfting shoulders Hand restricilone ¤ Len O Right No use of O tsh ¤ Right ¡ Must wear splIni Arm No Ilhinggreaterthan lbs. Hand No repetitive activilles O Finger No work with substances hot or cold O Other O Change position every Work as splinl/ aollvlty bandage porn Its Avold ddvlng ¤ Keep wound clean/dry Lin111work to Hrs/ Day MMI (Meximum ;MedicalImprovement): Projected Date: ActualDate: . ReturntoWork Date;: LiglitDuty FullDuty RestrictionalLimitations: Are the shove reefrlotlons Temporary: Perrnanent Do7tofs sigt1stut ....... Date: Sharon Simmons, RN, CCM (SuzIe) TelephonfoCase Slanagetnent Broadspire 1391 NW 100th Avenue Sunrise FI 30320 phone: 318.87t8714 fax: 770.777.6390 emaitsharon,elmmonsechoosetirageÿomm BROADSPIRE: 1991 NW 136th Avenue Sunrise. Flojids33323 3188718714 www.ohoossbroadspfle,corn FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 LEASE OF SPACE Walikill Medical Development, LLC a limited liability company LANDLORD and Orange Regional Medical Center TENANT DATED: 3ul 1, 2 9 y U:lPROPERTIES\WKMD - Adminstrative - ORMC(Walkill)lleasinglProspectsCRMC Officesu.easingw946-18 Offices- FINAL.doc LeaseORMCAdministrative FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 LEASE OF SPACE TABLE OF CONTENTS 1. Demise ................................................................................................................. 1 2. Building................................................................................................................. 1 3. Ground Lease....................................................................................................... 1 4. Demised Premises. .............................................................................................. 1 5. Use ....................................................................................................................... 2 6. Right of First Refusal............................................................................................ 2 7. Tenant Fit-Up........................................................................................................3 8. Beginning of Term ................................................................................................. 6 9. Deadline for Beginning of Term............................................................................ 6 10. End of Term.......................................................................................................... 7 11. Optional Extension. .............................................................................................. 7 12. Rent...................................................................................................................... 7 13. Property Operating Costs..................................................................................... 9 14. Rent Tax............................................................................................................. 13 15. Late Charge........................................................................................................ 13 16. Signage .............................................................................................................. 14 17. Cleaning Repair & Maintenance............1.......................................................... 14 18. Trash Removal. .................................................................................................. 14 19. Alterations .......................................................................................................... 15 20. Utilities................................................................................................................ 16 21. UtilityOperation.................................................................................................. 16 22. 24-Hour Operation.............................................................................................. 16 23. Parking. .............................................................................................................. 16 24. Alterations to Property. ....................................................................................... 17 25. Security Deposit. ................................................................................................ 17 26. Liability Insurance............................................................................................... 17 27. Tenanes Indemnity ............................................................................................. 18 28. Compliance with Laws and Rules....................................................................... 19 29. Hazardous Materials; Insurance Risks. .............................................................. 19 30. Nuisances........................................................................................................... 19 31. Casualty Damage............................................................................................... 19 - ORMC(Walkill)u.easinglProspects\ORMC U:\PROPERTIES\WKMD - Adminstrative Officesu.easingl09-06-18 Offices- FINALdoc LeaseORMCAdministrative FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 32. Broker................................................................................................................. 20 33. Redelivery at End of Term.................................................................................. 20 34. Default. ............................................................................................................... 21 35. Re-entry; Damages. ........................................................................................... 21 36. Expenses............................................................................................................ 22 37. Partial Payments. ............................................................................................... 22 38. Quiet Enjoyment................................................................................................. 22 39. Estoppel. ............................................................................................................ 22 40. Right to Access................................................................................................... 22 41. Subordination. .................................................................................................... 23 42. Condemnation .................................................................................................... 23 43. Holding Over....................................................................................................... 24 44. Jury Trial Waiver................................................................................................. 24 45. Exculpation of Landlord ...................................................................................... 24 46. Merger. ............................................................................................................... 25 47. Notices. .............................................................................................................. 25 48. Financial Statements. ......................................................................................... 25 49. Guaranty............................................................................................................. 25 50. Applicable Law. .......................................,.......................................................... 25 51. Assignment or Sublease by Tenant.................................................................... 26 52. Waiver of Counterclaim. ..................................................................................... 26 Tenants' 53. Equitable Remedies............................................................................. 26 54. Binding Effect. .................................................................................................... 27 55. Landlord Defined. ............................................................................................... 27 56. Non-waiver. ........................................................................................................ 27 57. Severability. ........................................................................................................ 28 58. Headings. ........................................................................................................... 28 59. Non-representation by Landlord. ........................................................................ 28 60. Counterparts....................................................................................................... 28 61. Landlors Right to Relocate Tenant .................................................................. 28 62. Memorandum of Lease.................................................................................... .. 28 63. Confidentiality. .................................................................................................... 28 64. Authority to Sign. ................................................................................................ 29 - ORMC(Walkil0I..easinglProspectslORMC U:PROPERTIES\WKMD - Adminstrative OnicesV.easingi09-06-18 - FINAL.doc LeaseORMCAdministrative ONices FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 LEASE OF SPACE This LEASE is made as of the day of , 200_, between Walikill Joh Medical Development, LLC ("Landlord"), a New York limited liability company with an office at 200 Westage Business Center, Suite 120, Fishkill, NY 12524; and Orange Regional Medical Center ("Tenant"),a not for profit corporation with an office at 4 Harriman Drive, Goshen, New York 10924. In consideration of the provisions hereof, the parties hereby agree as follows: 1. Demise. Landlord hereby leases and demises to Tenant, and Tenant hereby hires from Landlord, premises (the "Demised Premises") consisting of a portion of a building (the "Building") constructed or to be constructed by Landlord at 75 Crystal Run Road Middletown, New York 10941. 2. Building. The Building constitutes a first class medical facility, constructed substantially in accordance with the site plan attached hereto as Exhibit 1. The land, together with the improvements now or hereafter existing on the land, is collectively "Property." described herein as the 3. Ground Lease. Itis expressly understood that the Tenanes interest in the Building . as a Tenant is that of a sub-lessee under a ground lease dated December 16, 2004 between the Landlord and Orange Regional,Medical Center ("Ground Lease"). This Lease is expressly subject and subordinate to all of the covenants, restrictions and other provisions of said Ground Lease as though they were specifically set forth herein. 4. Demised Premises. 4.1. The Demised Premises is shown on a diagram attached hereto as Exhibit 2A and 2B. The Demised Premises is located on the Ground Floor and First Floor of the Building and comprise approximately 17,717 Rentable Square Feet. In the event the parties shall mutually agree to modify the amount of Rentable Square Feet of the Demised Premises, the parties shall execute a memorandum confirming the exact amount of Rentable Square Feet in the Demised Premises promptly after determination of such amount, which memorandum shall be an integral part of this Lease. 4.2. For purposes of this Lease, Rentable Square Feet and Usable Square Feet shall be defined according to the respective standards of the Building Owners and Managers Association ("BOMA") adopted June 7, 1996. At the time of the execution of this Lease, the Rentable/Usable Ratio is 1.132%. Subject to the - ORMC(Walkill)\LeasinglProspects\ORMC U:\PROPERTIES\WKMD - Adminstrative Offices- FINAL.doc LeaseORMCAdministrative Offices\Leasing\09-06-18 - 1 - FILED: ORANGE COUNTY CLERK 06/16/2022 11:56 AM INDEX NO. EF005836-2021 NYSCEF DOC. NO. 31 RECEIVED NYSCEF: 06/16/2022 finalization of the design of the Building, that ratio may change prior to delivery of the Demised Premises. In the event of such change, the parties agree to execute a Letter Agreement to confirm the revised ratio. 5. Use. The Demised Premises shall be used only as follows: 5.1. The Use of the Demised Premises under this Lease is expressly limited to Hospital Administrative Office Use and related services ancillary thereto, subject to the use restrictions set forth in the Ground Lease from time to time and to applicable laws and regulations, and no other purpose, whatsoever. 5.2. Tenant shall not change the Use or representation to the general public of the Use of the Demised Premises without Landlord's prior written consent, which change or representation is or may be restricted pursuant to this Lease and the Ground Lease. Tenant specifically agrees that Tenant willnot actively engage in the practice of medicine specializing in otolaryngology, orthopedics, physiatry, or provide physical therapy services (collectively, the "Specialties"), nor will Tenant represent to the generai public that Tenant concentrates its medical practice in the Demised Premises in urgent care and provides services to patients primarily on an unscheduled basis (collectively, "Urgent Care"), all so long as any other tenant of the Building uses their demised premises in the Building to actively engage in the Specialties or Urgent Care. For purposes of this section 5.2, only Landlord shall have the right to determine, in its sole discretion, whether Tenant or any other tenant is actively practicing in the Specialties or Urgent Care. Tenant understands and agrees that certain other tenants of the Building are or may be third party beneficiaries of thistsection 5.2 and may have the right to enforce this section 5.2 and obtain relief, including injunctive relief,for Tenants violation of this section 5.2. Any such rights of other Building tenants are in addition to and not in lieu of the rights of Landlord to enforce this section 5.2 and obtain equitable and legal relief for the violation thereof. 5.3. Tenant shall not use or permit the use of the Demised Premises or any part thereof in any way that would violate any of the covenants, restrictions, terms and provisions of this Lease and/or the Ground Lease or for any unlawful purposes or manner or in violation of any applicable legal requirements, including but not limited to the Certificate of Occupancy for the Demises Premises and/or Building. Tenant shall not suffer or permit the Demised Premises or any part thereof, to be used in any manner, or anything to be done therein, or anything to be brought into or kept therein,