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27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
STATE 0F MINNESOTA DISTRICT COURT
COUNTY OF HBNNEPIN FOURTH JUDICIAL DISTRICT
FAIRVIEW HEALTH SERVICES,
Plaintifl',
V- Summons
JENNA M ZUMWALT
2616 3lST AVE NE
ST ANTHONY MN 55418.
Defendant(s)
THIS SUMMONS IS DIRECTED T0: Defendant(s) named above.
l. YOU ARE BEING SUED. The Plaintiff has started a lawsuit against you. The Plaintiffs
Complaint against you is attached to this summons. Do not throw these papers away. They are
official papers that affect your rights. You must respond to this lawsuit even though it may not yet
be filed with the Court and there may be no court file number on this Summons.
2. YOU MUST REPLY WITHIN 21 DAYS T0 PROTECT YOUR RIGHTS.
You must give or mail to the person who signed this summons a written response called an Answer
within 21 days of the date on which you received this Summons. You must send a copy of your
Answer to the person who signed this summons located at: 7650 Edinborough Way, Suite 500,
Edina, MN 55435.
3. YOU MUST RESPOND T0 EACH CLAIM. The Answer is your written response to
the Plaintiff's Complaint. In your Answer you must state whether you agree or disagree with
each paragraph of the Complaint. If you believe the Plaintifi' should not be given everything asked
for in the Complaint, you must say so in your Answer.
27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
4. YOU WILL LOSE YOUR CASE IF YOU DO NOT SEND A WRITTEN
RESPONSE TO THE COMPLAINT TO THE PERSON WHO SIGNED THIS SUMMONS.
If you do not answer within 21 days, you will lose this case. You will not gel to tell your side of the
story, and the Court may decide against you and award the Plaintiff everythiiig asked for in the
Complaint. 1f you do not want to contest the claims stated in the Complaint, you do not need to
respond. A default judgment can then be entered against you for the relief requested in the
Complaint.
S. LEGAL ASSISTANCE. You may wish to get legal help from a lawyer. lf you do not
have a lawyer, the Court Administrator may have information about places where you can
get legal assistance. Even if you cannot get legal help, you must still provide a written
Answer to protect your rights or you may lose the case.
6. ALTERNATIVE DISPUTE RESOLUTION. The parties may agree to or be ordered to
participate in an alternative dispute resolution process under Rule 114 of the Minnesota General
Rules of Practice. You must still send your written response to the Complaint even if you expect
to use alternative means of resolving this dispute.
Dated: January 29, 2024
D.S. Erickson & Assoc
Firm File Number: 3877478
D. Scott Erickson (#0282212)
Timothy J. Hcnkel (#0389403)
Gregory E. Hanson (#0395404)
Christopher M. Venjohn (#0400707)
7650 Edinborough Way, Suite 500
Edina, MN 55435
(612) 333-7600
Attomeys for Plaintiff
27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
STATE OF MINNESOTA DISTRICT COURT
COUNTY OF HENNEPW FOURTH JUDICIAL DISTRICT
FAIRVIEW HEALTH SERVICES,
Plaintiff,
v.
Complaint
JENNA M ZUMWALT
2616 3lST AVE NE
ST ANTHONY MN 55418,
Defendant(s).
The Plaintifi', for its claims against the above-named Defendant(s), complains and alleges as follows:
l. This suit has been authorized and certified by FAIRVIEW HEALTH SERVICES in accordance
with Minn. Stat. 144.588 subd. l; attached as Exhibit A is a copy of the Affidavit of Expert
Review.
Claim I
Breach of Contract
2. Defendant received valuable health care goods and services from Plaintifi'.
3. Defendant is in breach of a contract for health care goods and services provided to
Defendant on account for the date(s) of service detailed on Exhibit A in the amount of $2805.33
for not having paid Plaintifi' for the health care goods and services provided to Defendant.
Claim II
Unjust Enrichment
4. Plaintiff incorporates each and every allegation contained in Paragraphs 1-3, inclusive,
with the same force and effect as if fully set forth herein.
5. Plaintifi' incurred time and resource expenses in rendering health care goods and
services to Defendant and Defendant accepted and received the goods and services.
6. Defendant's receipt of health care goods and services and its non-payment thereof
27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
results in Defendant's unjust enrichment. Plaintiff is therefore entitled to receive
payment of the value of the benefit received b}' Defendant in the amount of $2805.33
WHEREF ORE, Plaintiff demands judgment against Defendant in the amount of $2835.33
which includes the cost of personal service of process ($30.00) in this lawsuit, and any other
costs or disbursements herein as the Court deems appropriate.
Dated: January 29, 2024 D. S. Erickson & Associat
D. Scott Erickson (#0282212)
Timothy J. Henkel (#0389403)
Gregory E. Hanson (#0395404)
Christopher M. Venj ohn (#0400707)
7650 Edinborough Way, Suite 500
Edina, MN 55435
(612) 333-7600
Attorneys for Plaintiff
ACKNOWLEDGMENT
The undersigned hereby acknowledges that costs, disbursements, and reasonable attorney
and witness fees may be awarded pursuant to Minn. Stat. 549.211 subdivision 2, to the
party against whom the allegations in this pleading are asserted.
Dated: January 29, 2024 D.S. Erickson & Associates,
D. Scott Erickson (#0282212)
Timothy J. Henkel (#0389403)
Gregory E. Hanson (#0395404)
Christopher M. Venjohn (#0400707)
7650 Edinborough Way, Suite 500
Edina, MN 55435
(612) 333-7600
Attorneys for Plaintiff
27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
Exhibit A
27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
D.S. ERICKSON ASSOCIATES, PLLC
8:
ATTORNEYS AT LAW
7650 Edinborough Way, Suite Sill), Edina. MN 55435
Phone: 612-333-7600 Fax: 612-333-7611 Toll Free: 8664787611
Finn Filo No.: 3877478 - JF December 28. 2023
District Court
Affidavit of Expert Review-Lawsuit Authorization
0.5. Erickson & Associates, PLLC ("law Firm") represents Fairvlew Health Services ("Fairview") directly. Law
Firm received a file, previously reviewed by Falrview prior to Law Firm receiving the file, and Law Firm now
intends to bring a medical debt collection lawsuit with regard to JENNA M ZUMWALT
that:
("Patient/Guarantorisi") for a total of $2805.33. Law Firm represents
- Neither Patient/Guarantorls) nor Patient's/Guarantofs attorney has responded to law Firm and
resolved this matter; however, any such response will be made known to Falwiew or, in the alternative. any
such response will be resolved by law Firm or Fairview.
-
Law Finn has not received any new information suggesting that Patient/Guarantoris) may be eligible
for charity are, however; any such information learned subsequent to this request will be properly acted
upon by Law Firm, including the placement
of a hold on the case for charity care submission by
Patient/Guarantoris) and review by Fairview.
-
Neither Patient/Guarantoris) nor Patients/Guarantor's attorney has provided any new information
due and owing relating to the case, or
suggesting that a third-party is obligated to pay the amounts
indicated that Patient/Guarantor needs documentation concerning the medical debt that has not already
been provided. however; any such information learned subsequent to this request will be properly acted
hold on the case for review and the sending of
upon by Law Firm, including the placement of a
documentation to Patient/Guarantor.
Law Finn requests the authorization and permission of Fairvlew Health Services to initiate suit
and pursue
a default judgment (if appropriate) in this case regarding patient/guarantor accounts listed below. tow
Firm will proceed accordingly unless Patient/Guarantor answers the complaint, it is believed that
Patient/Guarantor may not have received the summons and complaint, or
if it is discovered that
Patient/Guarantor is sick, disabled, infirm or elderly so as to potentially
render Patient/Guarantor unable
to answer the complaint. Law Firm is under a continuing duty to work with Fairview and
the Minnesota Attorney General.
Patient/G uaiantorls) under the terms of Falwiew's agreement with
the
Law Firm has not been given any blanket authorization to take legal action. Fairview has reviewed
unless the declined to participate, Fair-view
above accounts and certifies that: 1) patient/guarantor
if the service was provided before November 1,
compiled with the requirements in Minn. Stat. 144.587 or,
2023. the requirements of Minn. Stat. 144.587 were not yet in effect; 2) there is a reasonable basis to
believe that the patient/guarantor owes the debt; 3) all known third-party payors have been properly
billed by Fairview, such that any remaining debt is the financial responsibility of the patient/guarantor, and
Fairview will not bill the patient/guarantor for any amount that an insurance company is obligated to pay;
4) the patient/guarantor has been given a reasonable opportunity to apply for charity care. if the facts and
circumstances suggest that the patient/guarantor may be eligible for charity care; 5) where the
the full amount of the debt in one payment and
patient/guarantor has indicated an inability to pay
to the full amount of the debt in one payment if
provided reasonable verification of the inability pay
requested by Fairvlew, Fairview has offered the patient/guarantor a reasonable payment plan; 6) there is
no reasonable basis to believe that the patient's or guarantor's wages or funds
at a financial institution are
in the event the case is pursued as a default Judgment
likely to be exempt from garnishment, and; 7)
basis to believe at this time: (i) that the patient/guarantor may
proceeding, there is not a reasonable
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27-CV-24-4181
Filed in District Court
State of Minnesota
3/20/2024 9:57 AM
already consider that the patient/guarantor has adequately answered the complaint by calling writing
or to
Fairvlew, its debt collection agency, or its attorney; (ii) that the patient/guarantor is potentially unable to
answer the complaint due to age, disability, or medical condition; or (iii) the patient/guarantor may not
have received service of the complaint. Should Falrvlew and/or the Law Firm become aware that any of the
above circumstances exist, the lawsuit will be dismissed or delayed prior to obtaining a judgment.
below.
Accordingly, Fairview has authorized that litigation is appropriate as to the accountls)
Client Account No. Date of Service Account Balance Guarantor No.
10128121 $236.36
12103121 $195.39
02120122 $1,052.16
02120122 31.16105
02128122 $108.55
03110122 $47.82
STATE OF MINNESOTA )
)ss
COUNTY OF RAMSEY )
document is true and correct. Minn.
Ideclare under penalty of perjury that everything I have stated in this
Stat. § 358.116.
. 12/28/23
774/7
Reviewer Signature Date
Reviewer Title:
PageZoiz