Preview
INDEX NO. 152428/2023
NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023
OCA Official Form No.:960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of | Health}
Patient Name
Lauren Perkins
Patient Address
I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In
accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPPA), I
understand that:
i, This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTAL HIV* RELATED INFORMATION only if | place my initials on the
appropriate line in Item 9(a). In the event the health information described below included any of these types of information, and | initial the
line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If | am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is prohibited
from redisclosing such information without my authorization unless permitted to do so under federal or state law.
T understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I
experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division of
Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible
for protecting my rights.
3. [have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke
this authorization expect to the extent that action has already been taken based on this authorization.
4, Lunderstand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will
not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure
may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERMENTAL AGENY SPECIFIED IN ITEM 9b).
7. Name and address of health provider or entity to release this information:
‘The Microsoft Corporation — One Microsoft Way Redmond, WA 98052
Baie Asche Dc
8. Name and address or person(s) or category of person to whom this will be sent:
34 Bry Qam Flas NewYok NY low
9(a)Specific information to be released:
es
Medical Record from 2/22/2020 to Present
it ire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
ref¢rrals, consults, billing records, insurance records, and records sent to you by other health care providers.
her: Employment records including wages/salary/benefits information and attendance
W2’s from date of hire to present, disability information
— Include: (Indicate by Initialing)
a Alcohol/Drug Treatment
Mental Health Information
HIV-Related Information
Authorization to Discuss Heaith Information
(b)O By initiating here Tauthorize
Initials Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:
ee
a
(Attomey/Firm Name or Governmental Agency Name)
mn for release of information: 11. Date or event on which this authorization will expire:
request of individual
Other: LITIGATION CONCLUSION
OF CASE
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
John F. Alderson, authorized employee of Dell & Dean, PLLC, attorneys for Lauren Perkins by POWER OF ATTORNEY
All items on thi d and my questions about this form have been answered. In addition, I have been provided a
copy of this for rm.
Date: 11/15/2023
Signature of patient or representative aultorized by law.
*Human Immunodeficiency Virus that causes AIDS, The New You State Public Health Law protects information which reasonably could identify someone
as having HIV symptoms or infection and information regarding a person’s contacts.
INDEX NO. 152428/2023
NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023
Mie Corp Tel 4a5 982 8080
One Microsoft ay Fax 4 706 323
Redmond, weeowe on
B® Microsoft
June 224, 2022
Lauren Per Ss
n= DORE1D)
RE: Long Term Disability and Employment Status
Dear Lauren
hope you are doing well. As you know, you have been on disability leave for more than 15 months. We have been
informed by Prudential that you are approved for long-term disability (“LTD”) benefits through 12/31/2022.
Microsoft is not able to grant leave of absence for an indefinite period of time. Microsoft has carefully reviewed
your situation and determined that if you are not able to return by 07/22/2022, your employment and benefits
generally will be terminated.
If employment is terminated, Prudential will continue to manage your LTD benefits, which will not be affected by
the termination of your employment. if you have any concerns regarding your LTD coverage or benefits, please
contact your Prudential Disability Case Manager.
| want to provide additional information to assist with your transition from employment:
. If you are unable to return to work by 07/22/2022, and your employment terminates for that reason, you
will be offered Severance Benefits at that time. Your HR Manager will schedule a time to review severance
benefits options that may be available to you.
° Please note the following regarding LTD and severance:
° If you continue to receive benefits under Microsoft's LTD plan after your Microsoft termination
date, and the sum of your LTD payment and pro-rated severance payment for a given month
exceeds 100% of your pre-disability monthly earnings, your LTD payment will be reduced to the
extent of that excess. However, in no event will your LTD payment be reduced by more than
90%, even if the resulting sum of the (reduced) LTD and pro-rated severance payments for the
month exceeds 100% of your pre-disability monthly earnings. Once Prudential receives
confirmation from Microsoft that your severance payment has been processed, Prudential will
calculate and apply this reduction, if applicable.
° For example, if your pre-disability earnings were $4,000 monthly, your LTD payment is $2,400
monthly, and your pro-rated severance pay Is more than $1,600 monthly, your LTD payment will
be reduced so that the combined monthly LTD and pro-rated severance payment generally is no
more than $4,000. Your monthly LTD payment will not be reduced below $240, however, so it is
possible that your combined manthly LTD and pro-rated severance payment could exceed $4,000
in some cases.
You will receive, within 30 days of the termination date, a package of information from the Microsoft COBRA
Administrator, which will include an application for you to extend your health insurance ona self-pay basis.
You may be eligible for an additional payment towards this extended health care coverage, for a temporary
period of time, as part of your Severance and/or LTD Benefits. For more information, please contact your
Prudential Disability Claims Manager directly for assistance.
Migosoft Corpor ane at nppo tunity employer
INDEX NO. 152428/2023
NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023
The Life Insurance benefit will end when your employment ends and you may wish to look into Life
Insurance Conversion directly with our Life insurance Company. If you are totally and permanently disabled
and unable to work in any occupation due to your disability, you may be eligible to continue your Life
Insurance benefits under the Waiver of Premium Provision of the Microsoft Life Insurance contract. Please
contact Prudential at 800-524-0542 for assistance.
Additionally, if your termination of employment is the result of your total and permanent disability, the
Microsoft 2001 and/or 2017 Stock Plan would provide immediate vesting of all unvested stock awards. For
more details about the definition of “total and permanent disability” for this purpose, and whether you
would be eligible for such vesting, please review the Company's Stock Award and Stock Option Vesting
Policies for Leaves of Absence and Part-Time Employment, which can be found at
ittp://hrweb/iNFO/pay/Stock/Plan, S ISALOA. aspx.
Please contact me at 425-421-7626 if you have any questions regarding this letter.
Sincerely,
Nowy J LAlvoh. L—,
Nancy Abdelwahab
Sr. Benefits Business Partner
= INDEX NO. 152428/2023
NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023
Print Your Documents age
Microsoft Ship Request Form
Ship Request #: 8600100101295343 Package # 1of4
Requested Service:
Requested Carrier:
|
FedEx Priority Overnight®
FedEx
l
Saturday Delivery:
Delivery Confirmation: Signature Required
Sender Recipient
Name: Naney Abdelwahab Attn To: Lauren Perkins
sa
Company: NIA
Phone: (425) 4217626
Email: NANCYAB@microsoft. com
Mail Stop: City Laconia
Building State NH
Floor: Zip: 03246
Department: 101075200117735 Country: us
Package Details Time Log: 6/21/2022 3:17:25 PM
Weight: Opds. Bors.
Dimensions: L:9 W: 6 H:1
Shipping Instructions:
Please request a signature
[inten al/Batch
Use Only
{IM iit l il
https://azprodssiis0 1.redmond.corp.microsoft.com/sendsuite%20live/projects/image.aspx?. 6/21/2022
= YORK OUN DK WV ND NO 8 0
0:
NYSCEF DOC. NO. 51 RECEIVED NvSCER? 11/21/202
= INDEX NO. 152428/2023
NYSEREsiP
OG weiMlQ 1:35 140134-220A-4F2C-90 ‘B26B58A9FE7 RECEIVED NYSCEF: 11/21/2023
2022 FEDERAL INCOME TAX SUMMARY PAGE 1
LAUREN M PERKINS GD 127
2022 2021 DIFF
INCOME
WAGES, SALARIES, TIPS, ETC 249,398 222,673 26,725
INTEREST INCOME.
DIVIDEND INCOME. 1,502 108 1,394
CAPITAL GAIN OR LOSS. -3,000 16,209 -19,209
FORM 4797 GAINS OR LOSSES. -17,920 -17,920
RENT, ROYALTY, PARTNERSHIP, SCORP, TRUST -2,881 -18,071 15,190
OTHER INCOME. -18,071 18,071
TOTAL INCOME ceeeee 227,105 220,919 6,186
ADJUSTMENTS TO INCOME
TOTAL ADJUSTMENTS. ecee nee
ADJUSTED GROSS INCOME. 227,105 220,919 6,186
ITEMIZED DEDUCTIONS
MEDICAL & DENTAL 70,012 70,012
TAXES. 5,770 5,770
TOTAL 75,782 75,782
TAX COMPUTATION
STANDARD DEDUCTION cesses vests ee eee es 12,950 12,550 400
LARGER OF ITEMIZED OR STANDARD DEDUCTION 75,782 12,550 63,232
TAXABLE INCOME ceeeeees 151,323 208,369 -57,046
TAX BEFORE CREDITS.. 30,047 48,426 -18,379
< FE
CREDITS
TOTAL CREDITS. cesses
TAX AFTER CREDITS. 30,047
OTHER TAXES
OTHER TAXES. yo 1,659 1,659
i
TOTAL TAX BS 31,706 31,706
PAYMENTS & REFUNDABLE CREI
FEDERAL INCOME TAX WITHHELD.............. 55,532 48,098 7,434
OTHER PAYMENTS & REFUNDABLE CREDITS 319 -319
TOTAL PAYMENTS coe e eee ences cece ee eee esse ee eeeee 55,532 48,417 7,115
REFUND OR AMOUNT DUE
AMOUNT OVERPAID. ceeeeee cee 23,826 23,826
AMOUNT REFUNDED TO YOU. 23,826 23,826
AMOUNT YOU OWE.. -9
TAX RATES
MARGINAL TAX RATE. 24.0 0.0% 24.0%
EFFECTIVE TAX RATE 21.0% 0.0% 21.0%
= INDEX NO. 152428/2023
NYSG EE si OE veillQ 40236 140134-2204-4F2C-90 B26B58ASFE7 RECEIVED NYSCEF: 11/21/2023
2022 NEW YORK INCOME TAX SUMMARY PAGE 1
LAUREN M PERKINS aD 6487
NEW YORK SOURCE INCOME
WAGES, SALARIES, TIPS, ETC cee 45,609
TOTAL INCOME. ete eeeeceseeeeees 45,609
LESS ADJUSTMENTS TO INCOM
FEDERAL AGI (FROM NEW YORK SOURCES) . 45,609
RECOMPUTED FEDERAL AGI (FROM NEW YORK SOURCES) . 45,609
INCOME FROM ALL SOURCES
FEDERAL ADJUSTED GROSS _INCO! coc cee ete ee eee e es 227,105
RECOMPUTED FEDERAL ADJUSTED GROSS INCOME 227,105
NEW YORK SUBTRACTIONS
AGI (ALL SOURCES) cose eee eee eee eeeeeeeeeeeeeeeeeeeeveeeeeeees ceeceeeeeeeees cece eee ee veces 227,105
TAX AND CREDITS
ITEMIZED/STANDARD DEDUCTION 48,576
NEW YORK TAXABLE INCOME 178,529
NEW YORK STATE TAX 11,158
BASE TAX. eee eevee ee 11,158
INCOME PERCENTAGE 20.08%
ALLOCATED NEW YORK 2,241
TOTAL NEW YORK STATE TAXES 2,241
TOTAL STATE, CITY, MCTMT, & CONTRIBUTIONS 2,241
PAYMENTS
TOTAL NEW YORK STATE TAX WITHHELD. 5,336
TOTAL PAYMENTS. 5,336
REFUND OR AMOUNT DUE
AMOUNT OVERPAID.. . « FE 3,095
ot’
AMOUNT REFUNDED TO YO 3,095
AMOUNT YOU OWE..
TAX RATES
MARGINAL TAX RATE 6.25%
EFFECTIVE TAX RATE. 1.3%
NEW YORK CITY MARGIN: ‘AX RA 0.00%
YONKERS MARGINAL TAX RATE 0.00%
INDEX NO. 152428/2023
NYSCEE.D iC.
TvelopsNO, ID: od 4A134-220A-4F2C-90 IB26B58A9FE7 RECEIVED NYSCEF: 11/21/2023
2022
Department of the Treasury — Internal Revenue Service
Form 1 040 U.S. Individual Income Tax Return (OMB No. 1545-0074 IRS Use Only — Do not write or staple in this space.
Filing Status [3] single Qualifying surviving
[] Married fling jointly L warried filing separately (MFS) [| Head of household (HOH) oO spouse
Check only
‘one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or GSS box, enter the chilc's name if the qualifying
person is a child but not your dependent:
‘Your first name and middle initial Last name Your social security number
LAUREN M PERKINS
If joint return, spouse's first name and middle initial Last name ‘Spouse's social security number
Home address street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign
Check here if you, or your
aay a7=p) spouse if filing jointly, want $3
to go to this fund. Checking a
town, oF have a foreign address, also complete spaces below. State ZIP code
box below will not change
LACONIA, NH 03246 your tax or refund.
Foreign country name Foreign province/state/county Foreign postal code
[lyou []spouse
Digital ‘At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, es [_]No
Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.)
Standard Someone can claim: [J] You as a dependent oO Your spouse as a dependent
Deduction ‘Spouse itemizes on a separate return or you were a dual-status alien
Age/Blindness [] Were born before January 2, 1958
You: [_] Are bling Spouse: [_] Was bom before January 2, 1958 Lis biing
Dependents (see instructions): @ Social security @ Relatonship (@) Check the box if qualifies for (see instructions):
Last name number Child tax credit Credit for other dependents
(f more 0) First name
than four
dependents,
‘see instructions,
and check
here...
Ta Total amount from Form(s) W-2, box 1 (see instructions)........... ja 249,398.
Income
2
b Household employee wages not reported on Fi 1b
Attach Form(s) c Tip income not reported on line la (seeg Ic
01
W-2 here. Also
attach Forms d Medicaid waiver payme! ts, d ‘W. -2 (eee instructions). voce eeseeees 1d
W-2G and
1099-R if tax e Taxable dependent care Form 2441, line 26.... seseeeeereeeteneeneneeed le
was withheld. Employer-provided adopt enefits from Form 8839, line 29 if
It you did not g Wages from Form 8919, line 6... 1g
get a Form Other earned income (see instructions) th
W-2, see
instructions. Nontaxable combat pay election (see instructions). . li
z Add lines Ta through 1h......ccereeceecceee lz 249,398.
Attach 2a Tax-exempt interest .... 2a b Taxable interest. 2b 6.
Sch. B if
required, 3a Qualified dividends . . . 3a 1,175. b Ordinary dividends 3b 1,502.
4a IRA distributions. . 4a b Taxable amount.
5a Pensions and annuit Sa b Taxable amount. 5b
6a Social security benefits... . 6a b Taxable amount... 6b
¢ Ifyou elect to use the lump-sum election method, check here (see instructions)
7 Capital gain or (loss). Attach Schedule D if required. If not required, check here .. . lz -3,000.
[Standard 8 Other income from Schedule 1, line 10... -20,801.
Deduction for — 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. is your total incom 227,105.
10
‘separately, $14 2gso [10 Adjustments to income from Schedule 1, line 26.
Fated fi
le Married filing 1 Subtract line 10 from line 9. This is your adjusted gross income .... u 227,105.
pint / OF litying 12 75,782.
suyiving spouse, 72 Standard deduction or itemized deductions (from Schedule A)...
Qualified business income deduction from Form 8995 or Form 8995-A . 13
jeHead of 13
household, $19, 14 75,782.
lef you checked any 14 Add lines 12 and 13
bok under . This is your taxable income. 15 151, 323.
15 Subtract line 14 from line 11. If zero or less, enter -|
‘see instructions.
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
FOIAOTIAL 01/1123 Form 1040 (2022)
= INDEX NO. 152428/2023
NYSE
sR OE welll 10:-Ob
144 104-2204-4F20-8¢ )B26B58A9FE7 RECEIVED NYSCEF: 11/21/2023
Form 1040 (2022) LAUREN M PERKINS
Tax and 16 Tax (see instructions). Check if any from Form(s): 1[_] 8814
Credits 2 oO 4972 3a 16 30,047
7 Amount from Schedule 2, line 3 7
18 Add lines 16 and 17.. 18 30,047
19 Child tax credit or credit for other dependents from Schedule 8812 19
20 Amount from Schedule 3, line 8. 20
21 Add lines 19 and 20 21
Subtract line 21 from line 18. If zero or less, enter -0- 30,047
Other taxes, including self-employment tax, from Schedule 2, line 21 1,659
24 Add lines 22 and 23. This is your total tax 31,706
Payments 25 Federal income tax withheld from:
a Form(s) W-2 54,903
b Form(s) 1099
¢ Other forms (See instructions). 25 629
d Add lines 25a through 25¢ . 25d 55,532
you have a 26 2022 estimated tax payments and amount applied from 2021 return
qualifying child, 27 Earned income credit (EIC)
aun Sh TO
Additional child tax credit from Schedule 8812
29 American opportunity credit from Form 8863, line 8
30 Reserved for future use.
a
31 Amount from Schedule 3, line 15. 3
32 Add lines 27, 28, 29, and 31. These are your ‘total other payments
and refundable credits.. 32
33 Add lines 25d, 26, and 32. These are your total payments 33 55,532
Refund 34 If line 33 is more than line 24, subtract line 24 from line 33, Thi ‘overpaid. 34 23,826.
35a Amount of line 34 you want refunded to you. If 8 is fache check here O [asa 23,826
Direct deposit? b Routing number Wee [X] Checking LU savings
See instructions. d Account number. 9990000 70%
36 _ Amountof line 34 you wafff Rip dt oul 023 estimated tax. . | 36 |
Amount 37 Subtract line 33 from line i.) is is the amount you owe.
You Owe For details on how to pay, go to www. irs.gov/Payments or see instructions. 37
38 Estimated tax penalty (see instructions) | 38 |
Third Party Do you want to allow another person to discuss this return with the IRS?
Designee See instructions cece Yes. Complete below. [] No
Designee's nal identification
TERRY GELBER no. 480-331-3316 ‘umber 97314
Sign Under penalties of perjury, | declare that | have examined this return and accom: ying schedules and statements, and to the best of my knowiedge and belie, they
are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowle
Here Your signature Date Your occupation if the IRS sent{peste Pan
Joint return? Fin, ent
See instructions. DISABLED
Keep a copy for ‘Spouse's signature. if a joint return, both must sign. Date ‘Spouse's occupation if the iRs a spousean Identity
your records. it here (see inst.)
Preparer’s name Preparer's signature Date PTIN Check if
Paid TERRY GELBER TERRY GELBER P00057831 []set-omployed
Preparer Firm's name YOUR ACCOUNTANT'S OFFICE, LLC IPhoneno. 480-331-3316
Use Only
Firm's address. 4904 S POWER RD STE 103-215 Firm's EIN 27-2567305
MESA, AZ 85212
Go to www.irs.gov/Form 1040 for instructions and the latest information. Form 1040 (2022)
FOIAOII2L 08/03/22
= INDEX NO. 152428/2023
NYSCE ESAS we NQ 1D: raat 34-220A-4F2C-9C IB26B58A9FE7 RECEIVED NYSCEF: 11/21/2023
SCHEDULE 1 (OMB No. 1545-0074
(Form 1040) Additional Income and Adjustments to Income
Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. 2022
Internal Revenue Service Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01
Nama(s) shown on Form 1040, 1040-SR, or 1040-NR
LAUREN M PERKINS
[Parti | Additional Income
1 Taxable refunds, credits, or offsets of state and local income taxes.
2a Alimony received.
b Date of original divorce or separation agreement (see instructions):
Business income or (loss). Attach Schedule C . .
Other gains or (losses). Attach Form 4797 -17, 920
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E -2,881
Farm income or (loss). Attach Schedule F
Unemployment compensation
Other income:
Net operating loss.
Gambling.
Cancellation of debt.
ae
Foreign earned income exclusion from Form 2558.
Income from Form 8853
Income from Form 8889
yor
Alaska Permanent Fund dividends
Jury duty pay.
Prizes and awards ..............0+2005
Activity not engaged in for profit income.
pO cee ee sense essen es
‘Stock options. ceee eee eee et eee sent seen es
Income from the rental of personal property if you engaged in the rental for
profit but were not in the business of renting such property
Olympic and Paralympic medals and USOC prize money (see instructions) 8m
Section 951(a) inclusion (see instructions).
Section 951A(a) inclusion (see instructions).
Section 461(|) excess business loss adjustment. 8p
Taxable distributions from an ABLE account (see instructions)
Scholarship and fellowship grants not reported on Form W-2....... 8r
Nontaxable amount of Medicaid waiver payments included on
Form 1040, line laorId.............- 8s
Pension or annuity from a nonqualifed deferred compensation plan or
a nongovernmental section 457 plan
Wages earned while incarcerated 8u
Other income. List type and amount:
oe)
9 Total other income. Add lines 8a through 8z
10 Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8............. 10 -20, 801
BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIADIOaL 07/29/22 Schedule 1 (Form 1040) 2022
INDEX NO. 152428/2023
(FILED: NEW YORK COUNTY CLERK 11/21/2023 10:32 AM
NYSE ESPNS 1 Brant '34-220A-4F2C-80 B26B58A9FE7
RECEIVED NYSCEF: 11/21/2023
Schedule 1 (Form 1040) 2022 LAUREN M PERKINS
{Part I] Adjustments to Income
nN Educator expenses, nu
12 Certain business expenses of reservists, performing artists, and fee-basis government officials.
Attach Form 2106. . cee seed eee ee eed ce eee ee ete ee eee eeu eee eeeeeeeeuseer sense 12
13 Health savings account deduction. Attach Form 8889. 13
4 Moving expenses for members of the Armed Forces. Attach Form 3903. 4
15 Deductible part of self-employment tax. Attach Schedule SE. 15
16 Self-employed SEP, SIMPLE, and qualified plans 16
7 Self-employed health insurance deduction 7
18 Penalty on early withdrawal of savings 18
19a Alimony paid 19a
Recipient's SSN.
Preview
INDEX NO. 152428/2023 NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023 OCA Official Form No.:960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of | Health} Patient Name Lauren Perkins Patient Address I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPPA), I understand that: i, This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTAL HIV* RELATED INFORMATION only if | place my initials on the appropriate line in Item 9(a). In the event the health information described below included any of these types of information, and | initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If | am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law. T understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. [have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization expect to the extent that action has already been taken based on this authorization. 4, Lunderstand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERMENTAL AGENY SPECIFIED IN ITEM 9b). 7. Name and address of health provider or entity to release this information: ‘The Microsoft Corporation — One Microsoft Way Redmond, WA 98052 Baie Asche Dc 8. Name and address or person(s) or category of person to whom this will be sent: 34 Bry Qam Flas NewYok NY low 9(a)Specific information to be released: es Medical Record from 2/22/2020 to Present it ire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, ref¢rrals, consults, billing records, insurance records, and records sent to you by other health care providers. her: Employment records including wages/salary/benefits information and attendance W2’s from date of hire to present, disability information — Include: (Indicate by Initialing) a Alcohol/Drug Treatment Mental Health Information HIV-Related Information Authorization to Discuss Heaith Information (b)O By initiating here Tauthorize Initials Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: ee a (Attomey/Firm Name or Governmental Agency Name) mn for release of information: 11. Date or event on which this authorization will expire: request of individual Other: LITIGATION CONCLUSION OF CASE 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: John F. Alderson, authorized employee of Dell & Dean, PLLC, attorneys for Lauren Perkins by POWER OF ATTORNEY All items on thi d and my questions about this form have been answered. In addition, I have been provided a copy of this for rm. Date: 11/15/2023 Signature of patient or representative aultorized by law. *Human Immunodeficiency Virus that causes AIDS, The New You State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person’s contacts. INDEX NO. 152428/2023 NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023 Mie Corp Tel 4a5 982 8080 One Microsoft ay Fax 4 706 323 Redmond, weeowe on B® Microsoft June 224, 2022 Lauren Per Ss n= DORE1D) RE: Long Term Disability and Employment Status Dear Lauren hope you are doing well. As you know, you have been on disability leave for more than 15 months. We have been informed by Prudential that you are approved for long-term disability (“LTD”) benefits through 12/31/2022. Microsoft is not able to grant leave of absence for an indefinite period of time. Microsoft has carefully reviewed your situation and determined that if you are not able to return by 07/22/2022, your employment and benefits generally will be terminated. If employment is terminated, Prudential will continue to manage your LTD benefits, which will not be affected by the termination of your employment. if you have any concerns regarding your LTD coverage or benefits, please contact your Prudential Disability Case Manager. | want to provide additional information to assist with your transition from employment: . If you are unable to return to work by 07/22/2022, and your employment terminates for that reason, you will be offered Severance Benefits at that time. Your HR Manager will schedule a time to review severance benefits options that may be available to you. ° Please note the following regarding LTD and severance: ° If you continue to receive benefits under Microsoft's LTD plan after your Microsoft termination date, and the sum of your LTD payment and pro-rated severance payment for a given month exceeds 100% of your pre-disability monthly earnings, your LTD payment will be reduced to the extent of that excess. However, in no event will your LTD payment be reduced by more than 90%, even if the resulting sum of the (reduced) LTD and pro-rated severance payments for the month exceeds 100% of your pre-disability monthly earnings. Once Prudential receives confirmation from Microsoft that your severance payment has been processed, Prudential will calculate and apply this reduction, if applicable. ° For example, if your pre-disability earnings were $4,000 monthly, your LTD payment is $2,400 monthly, and your pro-rated severance pay Is more than $1,600 monthly, your LTD payment will be reduced so that the combined monthly LTD and pro-rated severance payment generally is no more than $4,000. Your monthly LTD payment will not be reduced below $240, however, so it is possible that your combined manthly LTD and pro-rated severance payment could exceed $4,000 in some cases. You will receive, within 30 days of the termination date, a package of information from the Microsoft COBRA Administrator, which will include an application for you to extend your health insurance ona self-pay basis. You may be eligible for an additional payment towards this extended health care coverage, for a temporary period of time, as part of your Severance and/or LTD Benefits. For more information, please contact your Prudential Disability Claims Manager directly for assistance. Migosoft Corpor ane at nppo tunity employer INDEX NO. 152428/2023 NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023 The Life Insurance benefit will end when your employment ends and you may wish to look into Life Insurance Conversion directly with our Life insurance Company. If you are totally and permanently disabled and unable to work in any occupation due to your disability, you may be eligible to continue your Life Insurance benefits under the Waiver of Premium Provision of the Microsoft Life Insurance contract. Please contact Prudential at 800-524-0542 for assistance. Additionally, if your termination of employment is the result of your total and permanent disability, the Microsoft 2001 and/or 2017 Stock Plan would provide immediate vesting of all unvested stock awards. For more details about the definition of “total and permanent disability” for this purpose, and whether you would be eligible for such vesting, please review the Company's Stock Award and Stock Option Vesting Policies for Leaves of Absence and Part-Time Employment, which can be found at ittp://hrweb/iNFO/pay/Stock/Plan, S ISALOA. aspx. Please contact me at 425-421-7626 if you have any questions regarding this letter. Sincerely, Nowy J LAlvoh. L—, Nancy Abdelwahab Sr. Benefits Business Partner = INDEX NO. 152428/2023 NYSCEF DOC. NO. 51 RECEIVED NYSCEF: 11/21/2023 Print Your Documents age Microsoft Ship Request Form Ship Request #: 8600100101295343 Package # 1of4 Requested Service: Requested Carrier: | FedEx Priority Overnight® FedEx l Saturday Delivery: Delivery Confirmation: Signature Required Sender Recipient Name: Naney Abdelwahab Attn To: Lauren Perkins sa Company: NIA Phone: (425) 4217626 Email: NANCYAB@microsoft. com Mail Stop: City Laconia Building State NH Floor: Zip: 03246 Department: 101075200117735 Country: us Package Details Time Log: 6/21/2022 3:17:25 PM Weight: Opds. Bors. Dimensions: L:9 W: 6 H:1 Shipping Instructions: Please request a signature [inten al/Batch Use Only {IM iit l il https://azprodssiis0 1.redmond.corp.microsoft.com/sendsuite%20live/projects/image.aspx?. 6/21/2022 = YORK OUN DK WV ND NO 8 0 0: NYSCEF DOC. NO. 51 RECEIVED NvSCER? 11/21/202 = INDEX NO. 152428/2023 NYSEREsiP OG weiMlQ 1:35 140134-220A-4F2C-90 ‘B26B58A9FE7 RECEIVED NYSCEF: 11/21/2023 2022 FEDERAL INCOME TAX SUMMARY PAGE 1 LAUREN M PERKINS GD 127 2022 2021 DIFF INCOME WAGES, SALARIES, TIPS, ETC 249,398 222,673 26,725 INTEREST INCOME. DIVIDEND INCOME. 1,502 108 1,394 CAPITAL GAIN OR LOSS. -3,000 16,209 -19,209 FORM 4797 GAINS OR LOSSES. -17,920 -17,920 RENT, ROYALTY, PARTNERSHIP, SCORP, TRUST -2,881 -18,071 15,190 OTHER INCOME. -18,071 18,071 TOTAL INCOME ceeeee 227,105 220,919 6,186 ADJUSTMENTS TO INCOME TOTAL ADJUSTMENTS. ecee nee ADJUSTED GROSS INCOME. 227,105 220,919 6,186 ITEMIZED DEDUCTIONS MEDICAL & DENTAL 70,012 70,012 TAXES. 5,770 5,770 TOTAL 75,782 75,782 TAX COMPUTATION STANDARD DEDUCTION cesses vests ee eee es 12,950 12,550 400 LARGER OF ITEMIZED OR STANDARD DEDUCTION 75,782 12,550 63,232 TAXABLE INCOME ceeeeees 151,323 208,369 -57,046 TAX BEFORE CREDITS.. 30,047 48,426 -18,379 < FE CREDITS TOTAL CREDITS. cesses TAX AFTER CREDITS. 30,047 OTHER TAXES OTHER TAXES. yo 1,659 1,659 i TOTAL TAX BS 31,706 31,706 PAYMENTS & REFUNDABLE CREI FEDERAL INCOME TAX WITHHELD.............. 55,532 48,098 7,434 OTHER PAYMENTS & REFUNDABLE CREDITS 319 -319 TOTAL PAYMENTS coe e eee ences cece ee eee esse ee eeeee 55,532 48,417 7,115 REFUND OR AMOUNT DUE AMOUNT OVERPAID. ceeeeee cee 23,826 23,826 AMOUNT REFUNDED TO YOU. 23,826 23,826 AMOUNT YOU OWE.. -9 TAX RATES MARGINAL TAX RATE. 24.0 0.0% 24.0% EFFECTIVE TAX RATE 21.0% 0.0% 21.0% = INDEX NO. 152428/2023 NYSG EE si OE veillQ 40236 140134-2204-4F2C-90 B26B58ASFE7 RECEIVED NYSCEF: 11/21/2023 2022 NEW YORK INCOME TAX SUMMARY PAGE 1 LAUREN M PERKINS aD 6487 NEW YORK SOURCE INCOME WAGES, SALARIES, TIPS, ETC cee 45,609 TOTAL INCOME. ete eeeeceseeeeees 45,609 LESS ADJUSTMENTS TO INCOM FEDERAL AGI (FROM NEW YORK SOURCES) . 45,609 RECOMPUTED FEDERAL AGI (FROM NEW YORK SOURCES) . 45,609 INCOME FROM ALL SOURCES FEDERAL ADJUSTED GROSS _INCO! coc cee ete ee eee e es 227,105 RECOMPUTED FEDERAL ADJUSTED GROSS INCOME 227,105 NEW YORK SUBTRACTIONS AGI (ALL SOURCES) cose eee eee eee eeeeeeeeeeeeeeeeeeeeveeeeeeees ceeceeeeeeeees cece eee ee veces 227,105 TAX AND CREDITS ITEMIZED/STANDARD DEDUCTION 48,576 NEW YORK TAXABLE INCOME 178,529 NEW YORK STATE TAX 11,158 BASE TAX. eee eevee ee 11,158 INCOME PERCENTAGE 20.08% ALLOCATED NEW YORK 2,241 TOTAL NEW YORK STATE TAXES 2,241 TOTAL STATE, CITY, MCTMT, & CONTRIBUTIONS 2,241 PAYMENTS TOTAL NEW YORK STATE TAX WITHHELD. 5,336 TOTAL PAYMENTS. 5,336 REFUND OR AMOUNT DUE AMOUNT OVERPAID.. . « FE 3,095 ot’ AMOUNT REFUNDED TO YO 3,095 AMOUNT YOU OWE.. TAX RATES MARGINAL TAX RATE 6.25% EFFECTIVE TAX RATE. 1.3% NEW YORK CITY MARGIN: ‘AX RA 0.00% YONKERS MARGINAL TAX RATE 0.00% INDEX NO. 152428/2023 NYSCEE.D iC. TvelopsNO, ID: od 4A134-220A-4F2C-90 IB26B58A9FE7 RECEIVED NYSCEF: 11/21/2023 2022 Department of the Treasury — Internal Revenue Service Form 1 040 U.S. Individual Income Tax Return (OMB No. 1545-0074 IRS Use Only — Do not write or staple in this space. Filing Status [3] single Qualifying surviving [] Married fling jointly L warried filing separately (MFS) [| Head of household (HOH) oO spouse Check only ‘one box. If you checked the MFS box, enter the name of your spouse. If you checked the HOH or GSS box, enter the chilc's name if the qualifying person is a child but not your dependent: ‘Your first name and middle initial Last name Your social security number LAUREN M PERKINS If joint return, spouse's first name and middle initial Last name ‘Spouse's social security number Home address street). If you have a P.O. box, see instructions. Apt. no. Presidential Election Campaign Check here if you, or your aay a7=p) spouse if filing jointly, want $3 to go to this fund. Checking a town, oF have a foreign address, also complete spaces below. State ZIP code box below will not change LACONIA, NH 03246 your tax or refund. Foreign country name Foreign province/state/county Foreign postal code [lyou []spouse Digital ‘At any time during 2022, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, es [_]No Assets exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)? (See instructions.) Standard Someone can claim: [J] You as a dependent oO Your spouse as a dependent Deduction ‘Spouse itemizes on a separate return or you were a dual-status alien Age/Blindness [] Were born before January 2, 1958 You: [_] Are bling Spouse: [_] Was bom before January 2, 1958 Lis biing Dependents (see instructions): @ Social security @ Relatonship (@) Check the box if qualifies for (see instructions): Last name number Child tax credit Credit for other dependents (f more 0) First name than four dependents, ‘see instructions, and check here... Ta Total amount from Form(s) W-2, box 1 (see instructions)........... ja 249,398. Income 2 b Household employee wages not reported on Fi 1b Attach Form(s) c Tip income not reported on line la (seeg Ic 01 W-2 here. Also attach Forms d Medicaid waiver payme! ts, d ‘W. -2 (eee instructions). voce eeseeees 1d W-2G and 1099-R if tax e Taxable dependent care Form 2441, line 26.... seseeeeereeeteneeneneeed le was withheld. Employer-provided adopt enefits from Form 8839, line 29 if It you did not g Wages from Form 8919, line 6... 1g get a Form Other earned income (see instructions) th W-2, see instructions. Nontaxable combat pay election (see instructions). . li z Add lines Ta through 1h......ccereeceecceee lz 249,398. Attach 2a Tax-exempt interest .... 2a b Taxable interest. 2b 6. Sch. B if required, 3a Qualified dividends . . . 3a 1,175. b Ordinary dividends 3b 1,502. 4a IRA distributions. . 4a b Taxable amount. 5a Pensions and annuit Sa b Taxable amount. 5b 6a Social security benefits... . 6a b Taxable amount... 6b ¢ Ifyou elect to use the lump-sum election method, check here (see instructions) 7 Capital gain or (loss). Attach Schedule D if required. If not required, check here .. . lz -3,000. [Standard 8 Other income from Schedule 1, line 10... -20,801. Deduction for — 9 Add lines 1z, 2b, 3b, 4b, 5b, 6b, 7, and 8. is your total incom 227,105. 10 ‘separately, $14 2gso [10 Adjustments to income from Schedule 1, line 26. Fated fi le Married filing 1 Subtract line 10 from line 9. This is your adjusted gross income .... u 227,105. pint / OF litying 12 75,782. suyiving spouse, 72 Standard deduction or itemized deductions (from Schedule A)... Qualified business income deduction from Form 8995 or Form 8995-A . 13 jeHead of 13 household, $19, 14 75,782. lef you checked any 14 Add lines 12 and 13 bok under . This is your taxable income. 15 151, 323. 15 Subtract line 14 from line 11. If zero or less, enter -| ‘see instructions. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. FOIAOTIAL 01/1123 Form 1040 (2022) = INDEX NO. 152428/2023 NYSE sR OE welll 10:-Ob 144 104-2204-4F20-8¢ )B26B58A9FE7 RECEIVED NYSCEF: 11/21/2023 Form 1040 (2022) LAUREN M PERKINS Tax and 16 Tax (see instructions). Check if any from Form(s): 1[_] 8814 Credits 2 oO 4972 3a 16 30,047 7 Amount from Schedule 2, line 3 7 18 Add lines 16 and 17.. 18 30,047 19 Child tax credit or credit for other dependents from Schedule 8812 19 20 Amount from Schedule 3, line 8. 20 21 Add lines 19 and 20 21 Subtract line 21 from line 18. If zero or less, enter -0- 30,047 Other taxes, including self-employment tax, from Schedule 2, line 21 1,659 24 Add lines 22 and 23. This is your total tax 31,706 Payments 25 Federal income tax withheld from: a Form(s) W-2 54,903 b Form(s) 1099 ¢ Other forms (See instructions). 25 629 d Add lines 25a through 25¢ . 25d 55,532 you have a 26 2022 estimated tax payments and amount applied from 2021 return qualifying child, 27 Earned income credit (EIC) aun Sh TO Additional child tax credit from Schedule 8812 29 American opportunity credit from Form 8863, line 8 30 Reserved for future use. a 31 Amount from Schedule 3, line 15. 3 32 Add lines 27, 28, 29, and 31. These are your ‘total other payments and refundable credits.. 32 33 Add lines 25d, 26, and 32. These are your total payments 33 55,532 Refund 34 If line 33 is more than line 24, subtract line 24 from line 33, Thi ‘overpaid. 34 23,826. 35a Amount of line 34 you want refunded to you. If 8 is fache check here O [asa 23,826 Direct deposit? b Routing number Wee [X] Checking LU savings See instructions. d Account number. 9990000 70% 36 _ Amountof line 34 you wafff Rip dt oul 023 estimated tax. . | 36 | Amount 37 Subtract line 33 from line i.) is is the amount you owe. You Owe For details on how to pay, go to www. irs.gov/Payments or see instructions. 37 38 Estimated tax penalty (see instructions) | 38 | Third Party Do you want to allow another person to discuss this return with the IRS? Designee See instructions cece Yes. Complete below. [] No Designee's nal identification TERRY GELBER no. 480-331-3316 ‘umber 97314 Sign Under penalties of perjury, | declare that | have examined this return and accom: ying schedules and statements, and to the best of my knowiedge and belie, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowle Here Your signature Date Your occupation if the IRS sent{peste Pan Joint return? Fin, ent See instructions. DISABLED Keep a copy for ‘Spouse's signature. if a joint return, both must sign. Date ‘Spouse's occupation if the iRs a spousean Identity your records. it here (see inst.) Preparer’s name Preparer's signature Date PTIN Check if Paid TERRY GELBER TERRY GELBER P00057831 []set-omployed Preparer Firm's name YOUR ACCOUNTANT'S OFFICE, LLC IPhoneno. 480-331-3316 Use Only Firm's address. 4904 S POWER RD STE 103-215 Firm's EIN 27-2567305 MESA, AZ 85212 Go to www.irs.gov/Form 1040 for instructions and the latest information. Form 1040 (2022) FOIAOII2L 08/03/22 = INDEX NO. 152428/2023 NYSCE ESAS we NQ 1D: raat 34-220A-4F2C-9C IB26B58A9FE7 RECEIVED NYSCEF: 11/21/2023 SCHEDULE 1 (OMB No. 1545-0074 (Form 1040) Additional Income and Adjustments to Income Department of the Treasury Attach to Form 1040, 1040-SR, or 1040-NR. 2022 Internal Revenue Service Go to www.irs.gov/Form1040 for instructions and the latest information. Sequence No. 01 Nama(s) shown on Form 1040, 1040-SR, or 1040-NR LAUREN M PERKINS [Parti | Additional Income 1 Taxable refunds, credits, or offsets of state and local income taxes. 2a Alimony received. b Date of original divorce or separation agreement (see instructions): Business income or (loss). Attach Schedule C . . Other gains or (losses). Attach Form 4797 -17, 920 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E -2,881 Farm income or (loss). Attach Schedule F Unemployment compensation Other income: Net operating loss. Gambling. Cancellation of debt. ae Foreign earned income exclusion from Form 2558. Income from Form 8853 Income from Form 8889 yor Alaska Permanent Fund dividends Jury duty pay. Prizes and awards ..............0+2005 Activity not engaged in for profit income. pO cee ee sense essen es ‘Stock options. ceee eee eee et eee sent seen es Income from the rental of personal property if you engaged in the rental for profit but were not in the business of renting such property Olympic and Paralympic medals and USOC prize money (see instructions) 8m Section 951(a) inclusion (see instructions). Section 951A(a) inclusion (see instructions). Section 461(|) excess business loss adjustment. 8p Taxable distributions from an ABLE account (see instructions) Scholarship and fellowship grants not reported on Form W-2....... 8r Nontaxable amount of Medicaid waiver payments included on Form 1040, line laorId.............- 8s Pension or annuity from a nonqualifed deferred compensation plan or a nongovernmental section 457 plan Wages earned while incarcerated 8u Other income. List type and amount: oe) 9 Total other income. Add lines 8a through 8z 10 Combine lines 1 through 7 and 9. Enter here and on Form 1040, 1040-SR, or 1040-NR, line 8............. 10 -20, 801 BAA For Paperwork Reduction Act Notice, see your tax return instructions. FDIADIOaL 07/29/22 Schedule 1 (Form 1040) 2022 INDEX NO. 152428/2023 (FILED: NEW YORK COUNTY CLERK 11/21/2023 10:32 AM NYSE ESPNS 1 Brant '34-220A-4F2C-80 B26B58A9FE7 RECEIVED NYSCEF: 11/21/2023 Schedule 1 (Form 1040) 2022 LAUREN M PERKINS {Part I] Adjustments to Income nN Educator expenses, nu 12 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106. . cee seed eee ee eed ce eee ee ete ee eee eeu eee eeeeeeeeuseer sense 12 13 Health savings account deduction. Attach Form 8889. 13 4 Moving expenses for members of the Armed Forces. Attach Form 3903. 4 15 Deductible part of self-employment tax. Attach Schedule SE. 15 16 Self-employed SEP, SIMPLE, and qualified plans 16 7 Self-employed health insurance deduction 7 18 Penalty on early withdrawal of savings 18 19a Alimony paid 19a Recipient's SSN.