# Moody v. Secretary of Health and Human Services > United States Court of Federal Claims · June 24, 2014 URL: https://www.frixlaw.com/law-library/cases/2680311 ## Case - **Court:** United States Court of Federal Claims - **Decided:** June 24, 2014 - **Precedential status:** Unpublished - **Opinion:** Opinion - **Judges:** Nora Beth Dorsey - **Cited by:** 0 later opinions in the Frix Law Library ## Citator (automated) - No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases. - Full citator and citing cases: https://www.frixlaw.com/law-library/cases/2680311 ## Opinion text In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 13-190V (Filed: May 30, 2014) * * * * * * * * * * * * * * * TORY MOODY and SARAH MOODY, * UNPUBLISHED Parents of minor child, VEM, * Special Master Dorsey * Petitioners, * * v. * * Decision on Proffer; Damages; SECRETARY OF HEALTH * Measles, Mumps, Rubella AND HUMAN SERVICES, * (MMR) vaccine; Varicella vaccine; * Table Encephalopathy. Respondent. * * * * * * * * * * * * * * * * * David Porter Murphy, Greenfield, IN, for petitioners. Heather Lynn Pearlman, United States Department of Justice, Washington, DC, for respondent. DECISION AWARDING DAMAGES1 On March 12, 2012, Tory Moody and Sarah Moody (“petitioners”) filed a petition on behalf of a minor, VEM, pursuant to the National Vaccine Injury Compensation Program.2 42 U.S.C. §§ 300aa-1 to -34 (2006). The petition alleges that VEM received a measles, mumps, rubella (“MMR”) and varicella vaccines on April 1, 2010, and suffered “febrile status epilepticus after immunizations with subsequent decline, and now with intractable epilepsy which was caused-in-fact by the MMR and Varicella vaccinations . . . .” Petition at 2, 5. 1 Because this decision contains a reasoned explanation for the undersigned’s action in this case, the undersigned intends to post this ruling on the website of the United States Court of Federal Claims, in accordance with the E-Government Act of 2002, Pub. L. No. 107-347, § 205, 116 Stat. 2899, 2913 (codified as amended at 44 U.S.C. § 3501 note (2006)). As provided by Vaccine Rule 18(b), each party has 14 days within which to request redaction “of any information furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly unwarranted invasion of privacy.” Vaccine Rule 18(b). 2 The National Vaccine Injury Compensation Program is set forth in Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755, codified as amended, 42 U.S.C. §§ 300aa-1 to -34 (2006) (Vaccine Act or the Act). All citations in this decision to individual sections of the Vaccine Act are to 42 U.S.C.A. § 300aa. Respondent has conceded that petitioners have satisfied all legal prerequisites for compensation under the Vaccine Act and recommends that compensation be awarded to petitioners. Respondent’s Report at 2, 4-5, filed June 11, 2013. Informed by respondent’s concession that an award of damages is appropriate, the undersigned finds that petitioners are entitled to compensation under the Vaccine Act. On May 29, 2014, respondent filed a Proffer on Award of Compensation (“Proffer”). In the Proffer, respondent represented that petitioners agree with the proffered award. Based on the record as a whole, the undersigned finds that petitioners are entitled to an award as stated in the Proffer. Pursuant to the terms stated in the attached Proffer, the undersigned awards petitioners: A. A lump sum payment of $864,746.00, in the form of a check payable to petitioners, as guardians/conservators of VEM’s estate, for the benefit of VEM. No payments shall be made until petitioners provide the Secretary with documentation establishing the appointment of petitioners as the guardians/conservators of VEM’s estate. If petitioners are not authorized by a court of competent jurisdiction to serve as guardians/conservators of the estate of VEM, any such payment shall be made to the party or parties appointed by a court of competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of VEM upon submission of written documentation of such appointment to the Secretary. B. A lump sum payment of $3,747.89, representing compensation for past unreimbursable expenses, payable to Tory Moody and Sarah Moody, petitioners. C. A lump sum payment of $800,033.55, representing the trust seed which consists of the present year cost of five years of VEM’s non-medical life care items ($547,877.82) for the years 2048 through 2052 plus Year One life care expenses ($252,155.73), payable to PEOPLESBANK, a Codorus Valley Company of York, Pennsylvania, to establish an irrevocable reversionary trust for the benefit of VEM, by and among the United States, as Grantor, and PEOPLESBANK, a Codorus Valley Company of York, Pennsylvania, as Trustee and petitioners, as Guardians/Conservators. D. A lump sum payment of $108,846.13, representing compensation for satisfaction of the State of Indiana Medicaid lien, payable jointly to petitioners as guardians/conservators of the Estate of VEM and Indiana Medicaid: 2 Indiana Medicaid HP Enterprise Services Attn: TPL Casualty Dept. P.O. Box 7262 Indianapolis, IN 46207 Petitioners agree to endorse this payment to Indiana Medicaid. E. An amount sufficient to purchase an annuity contract, subject to the conditions described in the Proffer and the attachments to that Proffer. Proffer ¶ II. In the absence of a motion for review filed pursuant to RCFC Appendix B, the clerk of the court SHALL ENTER JUDGMENT herewith.3 IT IS SO ORDERED. s/ Nora Beth Dorsey Nora Beth Dorsey Special Master 3 Pursuant to Vaccine Rule 11(a), entry of judgment is expedited by the parties’ joint filing of notice renouncing the right to seek review. IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS TORY MOODY and SARAH MOODY, Parents of minor child, VEM, Petitioners, No. 13-190V v. Special Master Dorsey ECF SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. RESPONDENT’S PROFFER ON AWARD OF COMPENSATION I. Items of Compensation A. Life Care Items The parties engaged life care planners to provide an estimation of VEM’s future vaccine- injury related needs, and the parties’ planners came to a joint consensus regarding appropriate items of care. All items of compensation identified in the joint life care plan, filed on May 22, 2014 as Respondent’s Exhibit A, are supported by the evidence, and are illustrated by the chart entitled Items of Compensation for VEM, attached hereto as Tab A. 1 Respondent proffers that VEM should be awarded all items of compensation set forth in the joint life care plan and illustrated by the chart attached at Tab A. Petitioners agree. 1 The chart at Tab A illustrates the annual benefits provided by the life care plan. The annual benefit years run from the date of judgment up to the first anniversary of the date of judgment, and every year thereafter up to the anniversary of the date of judgment. 1 B. Lost Future Earnings The parties agree that based upon the evidence, VEM will never be gainfully employed. Therefore, respondent proffers that VEM should be awarded full lost future earnings as provided under the Vaccine Act, 42 U.S.C. § 300aa-15(a)(3)(B). Respondent proffers that the appropriate award for VEM’s lost future earnings is $614,746.00 at net present value. Petitioners agree. C. Pain and Suffering Respondent proffers that VEM should be awarded $250,000.00 in actual and projected pain and suffering. This amount reflects that the award for projected pain and suffering has been reduced to net present value. See 42 U.S.C. § 300aa-15(a)(4). Petitioners agree. D. Past Unreimbursable Expenses Evidence supplied by petitioner documents their expenditure of past unreimbursable expenses related to VEM’s vaccine-related injury. Respondent proffers that petitioners should be awarded past unreimbursable expenses in the amount of $3,747.89. Petitioners agree. E. Medicaid Lien Respondent proffers that VEM’s should be awarded funds to satisfy the State of Indiana Medicaid lien in the amount of $108,846.13, which represents full satisfaction of any right of subrogation, assignment, claim, lien, or cause of action the State of Indiana may have against any individual as a result of any Medicaid payments the State of Indiana has made to or on behalf of VEM from the date of her eligibility for benefits through the date of judgment in this case as a result of her vaccine-related injury suffered on or about April 1, 2010, under Title XIX of the Social Security Act. 2 F. Attorneys’ Fees and Costs This proffer does not address final attorneys’ fees and costs. Petitioners are entitled to reasonable final attorneys’ fees and costs, to be determined at a later date upon petitioners filing substantiating documentation. II. Form of the Award The parties recommend that the compensation provided to VEM should be made through a combination of lump sum payments and future annuity payments as described below, and request that the Special Master’s decision and the Court’s judgment award the following: 2 A. A lump sum payment of $864,746.00, representing compensation for lost future earnings ($614,746.00) and pain and suffering ($250,000.00), in the form of a check payable to petitioners, as guardians/conservators of VEM’s estate, for the benefit of VEM. No payments shall be made until petitioners provide the Secretary with documentation establishing the appointment of petitioners as the guardians/conservators of VEM’s estate. If petitioners are not authorized by a court of competent jurisdiction to serve as guardians/conservators of the estate of VEM, any such payment shall be made to the party or parties appointed by a court of competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of VEM upon submission of written documentation of such appointment to the Secretary; B. A lump sum payment of $3,747.89, representing compensation for past unreimbursable expenses, payable to Tory Moody and Sarah Moody, petitioners; C. A lump sum payment of $800,033.55, representing the trust seed which consists of the present year cost of five years of VEM’s non-medical life care items ($547,877.82) for the years 2048 through 2052 plus Year One life care expenses ($252,155.73), payable to 2 Should VEM die prior to the entry of judgment, the parties reserve the right to move the Court for appropriate relief. In particular, respondent would oppose any award for future medical expenses, future lost earnings, and future pain and suffering. 3 PEOPLESBANK, a Codorus Valley Company of York, Pennsylvania, to establish an irrevocable reversionary trust for the benefit of VEM, by and among the United States, as Grantor, and PEOPLESBANK, a Codorus Valley Company of York, Pennsylvania, as Trustee and petitioners, as Guardians/Conservators. D. A lump sum payment of $108,846.13, representing compensation for satisfaction of the State of Indiana Medicaid lien, payable jointly to petitioners as guardians/conservators of the Estate of VEM and Indiana Medicaid: Indiana Medicaid HP Enterprise Services Attn: TPL Casualty Dept. P.O. Box 7262 Indianapolis, IN 46207 Petitioners agree to endorse this payment to Indiana Medicaid. E. An amount sufficient to purchase an annuity contract, 3 subject to the conditions described below, that will provide payments for the life care items contained in the life care plan, as illustrated by the chart at Tab A attached hereto, paid to the life insurance company 4 from which the annuity will be purchased. Compensation for Year Two (beginning on the first anniversary of the date of judgment) and all subsequent years shall be provided through 3 To satisfy the conditions set forth herein, in respondent’s discretion, respondent may purchase one or more annuity contracts from one or more life insurance companies. 4 The Life Insurance Company must have a minimum of $250,000,000 capital and surplus, exclusive of any mandatory security valuation reserve. The Life Insurance Company must have one of the following ratings from two of the following rating organizations: a. A.M. Best Company: A++, A+, A+g, A+p, A+r, or A+s; b. Moody's Investor Service Claims Paying Rating: Aa3, Aa2, Aa1, or Aaa; c. Standard and Poor's Corporation Insurer Claims-Paying Ability Rating: AA-, AA, AA+, or AAA; d. Fitch Credit Rating Company, Insurance Company Claims Paying Ability Rating: AA-, AA, AA+, or AAA. 4 respondent's purchase of an annuity, which annuity shall make payments directly to PEOPLESBANK a Codorus Valley Company of York, Pennsylvania, as trustees for VEM’s Vaccine Trust, only so long as VEM is alive at the time a particular payment is due. At the Secretary’s sole discretion, the periodic payments may be provided to the Trust in monthly, quarterly, annual or other installments. The “annual amounts” set forth in the chart at Tab A describe only the total yearly sum to be paid to the guardian/conservator and do not require that the payment be made in one annual installment. 1. Growth Rate Respondent proffers that a four percent (4%) growth rate should be applied to all non- medical life care items, and a five percent (5%) growth rate should be applied to all medical life care items. Thus, the benefits illustrated in the chart at Tab A that are to be paid through annuity payments should grow as follows: four percent (4%) compounded annually from the date of judgment for non-medical items, and five percent (5%) compounded annually from the date of judgment for medical items. 2. Life-contingent annuity Petitioners will continue to receive the annuity payments from the Life Insurance Company only so long as VEM is alive at the time that a particular payment is due. Written notice shall be provided to the Secretary of Health and Human Services and the Life Insurance Company within twenty (20) days of VEM’s death. 3. Guardianship Issues No payments shall be made until petitioners provide respondent with documentation establishing that they have been appointed as the guardians/conservators of VEM’s estate. If petitioners are not authorized by a court of competent jurisdiction to serve as 5 guardians/conservators of the estate of VEM, any such payment shall be made to the party or parties appointed by a court of competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of VEM upon submission of written documentation of such appointment to the Secretary. III. Summary of Recommended Payments Following Judgment A. Lump Sum paid to petitioners as guardians/conservators of VEM’s estate: $864,746.00 B. Lump sum paid to petitioners: $ 3,747.89 C. PeoplesBank a Codorus Valley Company of York, Pennsylvania, for the benefit of VEM Vaccine Trust $800,033.55 D. Reimbursement for Medicaid lien: $108,846.13 E. An amount sufficient to purchase the annuity contract described above in section II. E. F. Reasonable final attorneys’ fees and litigation costs: TBD Respectfully submitted, STUART F. DELERY Assistant Attorney General RUPA BHATTACHARYYA Director Torts Branch, Civil Division VINCENT J. MATANOSKI Deputy Director Torts Branch, Civil Division ALTHEA W. DAVIS Senior Trial Counsel Torts Branch, Civil Division 6 s/ HEATHER L. PEARLMAN HEATHER L. PEARLMAN Senior Trial Attorney Torts Branch, Civil Division U.S. Department of Justice P.O. Box 146 Benjamin Franklin Station Washington, D.C. 20044-0146 Tel: (202) 353-2699 DATED: May 29, 2014 7 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH PAID IN CASH NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 0.00 13 INSERTION OF VNS - PROVIDER FEES 5% 0.00 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 0.00 15 REPLACEMENT OF VNS LEADS 5% 0.00 16 KETOGENIC DIET DIETICIAN 4% 658.35 59.85 59.85 59.85 17 DIGITAL SCALE FOR KETOGENIC DIET 4% 123.50 DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 1 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH PAID IN CASH NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34 32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 50,758.16 50,758.16 50,758.16 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39 ANNUAL PT or OT RE-EVALUATION 5% 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 4,000.00 4,000.00 4,000.00 4,000.00 2,200.00 2,200.00 2,200.00 2,200.00 42 CAMP 4% 467.33 467.33 467.33 467.33 467.33 467.33 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 2 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH PAID IN CASH NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 11,606.00 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 5,415.00 49 WIDEN 5 DOORWAYS 4% 2,875.00 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 11,000.00 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% 0.00 EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 6.00 2,400.00 480.00 480.00 480.00 56 ADAPTED TRICYCLE 4% 1,939.33 57 JOGGING STROLLER / WHEELCHAIR 4% 1,087.07 217.41 217.41 217.41 217.41 217.41 217.41 217.41 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 250.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 49.33 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 330.00 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 120.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 158.00 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 125.00 125.00 125.00 125.00 125.00 125.00 125.00 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 33.00 11.00 11.00 11.00 11.00 66 STANDER 4% 2,315.00 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 99.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 69 ANTI-BURST ROUND EXERCISE BALL 4% 24.99 8.33 8.33 8.33 8.33 8.33 8.33 8.33 70 THERAPY ROLL 4% 345.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 71 CHEWY TUBE 4% 30.00 30.00 72 SPECIAL NEEDS SWING WITH HARNESS 4% 554.90 ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 3 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH PAID IN CASH NO. ITEM RATE 2014 2015 2016 2017 2018 2019 2020 2021 SUPPLIES 74 DIAPERS 4% 1,200.85 1,200.85 1,200.85 1,200.85 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 120.45 120.45 120.45 120.45 120.45 120.45 120.45 120.45 77 DISPOSABLE GLOVES 4% 94.90 94.90 94.90 94.90 94.90 94.90 94.90 94.90 78 HAND SANITIZER 4% 92.16 92.16 92.16 92.16 92.16 92.16 92.16 92.16 79 WIPES 4% 102.20 80 BARRIER CREAM 4% 25.56 25.56 25.56 25.56 25.56 25.56 25.56 25.56 81 DRY DISPOSABLE WASHCLOTHS 4% 306.60 306.60 306.60 306.60 306.60 306.60 306.60 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 35.00 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% 116.00 116.00 116.00 116.00 116.00 116.00 116.00 116.00 TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 123.84 123.84 123.84 123.84 123.84 123.84 123.84 123.84 87 NEUROSURGEON AT IU - RILEY 4% 72.00 10.29 1.47 0.21 0.03 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 1,290.24 1,290.24 1,290.24 322.56 322.56 322.56 322.56 322.56 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 90 MODIFICATIONS FOR VAN 4% 27,000.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 95 RN - WEEKEND RESPITE CARE 5% 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 97 SKILLED NURSING FACILITY 5% ------------------- SUBTOTAL - 1ST YEAR EXPENSES 252,155.73 98 PAST UNREIMBURSED EXPENSES 3,747.89 99 PAIN AND SUFFERING 250,000.00 100 LOST WAGES 614,746.00 101 STATE OF INDIANA MEDICAID LIEN 108,846.13 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. 547,877.82 -------------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 1,777,373.57 189,627.65 190,056.16 138,368.06 139,321.68 137,401.65 137,401.65 137,401.65 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 4 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 5 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34 32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39 ANNUAL PT or OT RE-EVALUATION 5% 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 2,200.00 2,200.00 42 CAMP 4% 467.33 467.33 467.33 467.33 467.33 467.33 467.33 467.33 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 0.00 0.00 0.00 0.00 0.00 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 0.00 0.00 0.00 0.00 0.00 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 6 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 5,415.00 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 480.00 480.00 480.00 480.00 480.00 480.00 480.00 56 ADAPTED TRICYCLE 4% 2,684.33 57 JOGGING STROLLER / WHEELCHAIR 4% 217.41 217.41 217.41 217.41 217.41 217.41 217.41 217.41 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 50.00 50.00 50.00 50.00 50.00 50.00 50.00 50.00 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 125.00 125.00 125.00 125.00 125.00 125.00 125.00 125.00 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 11.00 11.00 11.00 11.00 11.00 11.00 11.00 11.00 66 STANDER 4% 2,652.00 5,716.00 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 33.00 33.00 33.00 33.00 33.00 33.00 33.00 33.00 69 ANTI-BURST ROUND EXERCISE BALL 4% 8.33 8.33 8.33 8.33 8.33 8.33 8.33 8.33 70 THERAPY ROLL 4% 69.00 69.00 69.00 69.00 69.00 69.00 69.00 69.00 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% 299.95 ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 7 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2022 2023 2024 2025 2026 2027 2028 2029 SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 120.45 120.45 120.45 120.45 120.45 120.45 120.45 120.45 77 DISPOSABLE GLOVES 4% 94.90 94.90 94.90 94.90 94.90 94.90 94.90 94.90 78 HAND SANITIZER 4% 92.16 92.16 92.16 92.16 92.16 92.16 92.16 92.16 79 WIPES 4% 80 BARRIER CREAM 4% 25.56 25.56 25.56 25.56 25.56 25.56 25.56 25.56 81 DRY DISPOSABLE WASHCLOTHS 4% 306.60 306.60 306.60 306.60 306.60 306.60 306.60 306.60 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% 116.00 116.00 116.00 116.00 116.00 116.00 116.00 116.00 TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 123.84 123.84 123.84 123.84 123.84 123.84 123.84 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 322.56 322.56 322.56 322.56 322.56 322.56 322.56 322.56 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 90 MODIFICATIONS FOR VAN 4% 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 2,700.00 HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 28,461.00 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 21,465.00 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 10,935.00 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 13,992.00 95 RN - WEEKEND RESPITE CARE 5% 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 8,910.00 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 97 SKILLED NURSING FACILITY 5% SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 140,053.65 137,401.65 143,300.98 135,201.65 135,201.65 135,501.60 135,201.65 140,417.01 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 8 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V RESIDENTIAL CARE GROWTH BEGINS NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 9 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V RESIDENTIAL CARE GROWTH BEGINS NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34 32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39 ANNUAL PT or OT RE-EVALUATION 5% 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 42 CAMP 4% 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 10 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V RESIDENTIAL CARE GROWTH BEGINS NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 56 ADAPTED TRICYCLE 4% 57 JOGGING STROLLER / WHEELCHAIR 4% 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 816.57 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 69 ANTI-BURST ROUND EXERCISE BALL 4% 70 THERAPY ROLL 4% 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 11 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V RESIDENTIAL CARE GROWTH BEGINS NO. ITEM RATE 2030 2031 2032 2033 2034 2035 2036 2037 SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 77 DISPOSABLE GLOVES 4% 78 HAND SANITIZER 4% 79 WIPES 4% 80 BARRIER CREAM 4% 81 DRY DISPOSABLE WASHCLOTHS 4% 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 34.08 6.82 6.82 6.82 6.82 6.82 6.82 6.82 90 MODIFICATIONS FOR VAN 4% HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 95 RN - WEEKEND RESPITE CARE 5% 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 97 SKILLED NURSING FACILITY 5% SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 121,854.36 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 12 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 13 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 107.34 107.34 107.34 107.34 107.34 107.34 32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 0.00 0.00 0.00 0.00 0.00 39 ANNUAL PT or OT RE-EVALUATION 5% 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 42 CAMP 4% 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 14 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 56 ADAPTED TRICYCLE 4% 57 JOGGING STROLLER / WHEELCHAIR 4% 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 816.57 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 69 ANTI-BURST ROUND EXERCISE BALL 4% 70 THERAPY ROLL 4% 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 15 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2038 2039 2040 2041 2042 2043 2044 2045 SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 77 DISPOSABLE GLOVES 4% 78 HAND SANITIZER 4% 79 WIPES 4% 80 BARRIER CREAM 4% 81 DRY DISPOSABLE WASHCLOTHS 4% 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 6.82 6.82 6.82 6.82 6.82 6.82 90 MODIFICATIONS FOR VAN 4% HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 95 RN - WEEKEND RESPITE CARE 5% 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 97 SKILLED NURSING FACILITY 5% SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 121,827.10 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 16 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V Medicare/ Medigap GROWTH Coverage NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 10,802.80 10,802.80 10,802.80 10,802.80 10,802.80 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 0.00 0.00 0.00 0.00 3 MEDICARE PART A 5% 0.00 0.00 0.00 0.00 0.00 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 1,405.80 1,405.80 1,405.80 1,405.80 1,405.80 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 17 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V Medicare/ Medigap GROWTH Coverage NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 107.34 107.34 0.00 0.00 0.00 32 CO-ENZYME Q 4% 0.00 0.00 0.00 0.00 0.00 NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 0.00 0.00 0.00 0.00 0.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 39 ANNUAL PT or OT RE-EVALUATION 5% 409.34 409.34 409.34 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 42 CAMP 4% 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 0.00 0.00 0.00 0.00 0.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 18 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V Medicare/ Medigap GROWTH Coverage NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 56 ADAPTED TRICYCLE 4% 57 JOGGING STROLLER / WHEELCHAIR 4% 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 0.00 0.00 0.00 0.00 0.00 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 0.00 0.00 0.00 0.00 0.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 66 STANDER 4% 816.57 816.57 0.00 0.00 0.00 0.00 0.00 816.57 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 69 ANTI-BURST ROUND EXERCISE BALL 4% 70 THERAPY ROLL 4% 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 19 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V Medicare/ Medigap GROWTH Coverage NO. ITEM RATE 2046 2047 2048 2049 2050 2051 2052 2053 SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 0.00 0.00 0.00 0.00 0.00 1,642.50 76 BED LINERS 4% 77 DISPOSABLE GLOVES 4% 78 HAND SANITIZER 4% 79 WIPES 4% 80 BARRIER CREAM 4% 81 DRY DISPOSABLE WASHCLOTHS 4% 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 0.00 0.00 0.00 0.00 0.00 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 0.00 0.00 0.00 0.00 0.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 0.00 0.00 0.00 0.00 0.00 36.96 86 NEUROLOGIST 4% 103.20 103.20 0.00 0.00 0.00 0.00 0.00 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 0.00 0.00 0.00 0.00 0.00 6.82 90 MODIFICATIONS FOR VAN 4% HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 95 RN - WEEKEND RESPITE CARE 5% 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 0.00 0.00 0.00 0.00 0.00 74,825.00 97 SKILLED NURSING FACILITY 5% SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 121,827.10 121,827.10 12,208.60 12,208.60 12,208.60 10,845.44 10,845.44 120,356.60 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 20 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 3 MEDICARE PART A 5% 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 21 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 32 CO-ENZYME Q 4% NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 39 ANNUAL PT or OT RE-EVALUATION 5% 409.34 409.34 409.34 409.34 409.34 409.34 409.34 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 42 CAMP 4% 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 22 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 56 ADAPTED TRICYCLE 4% 57 JOGGING STROLLER / WHEELCHAIR 4% 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 69 ANTI-BURST ROUND EXERCISE BALL 4% 70 THERAPY ROLL 4% 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 23 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2054 2055 2056 2057 2058 2059 2060 SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 77 DISPOSABLE GLOVES 4% 78 HAND SANITIZER 4% 79 WIPES 4% 80 BARRIER CREAM 4% 81 DRY DISPOSABLE WASHCLOTHS 4% 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 6.82 6.82 6.82 6.82 6.82 90 MODIFICATIONS FOR VAN 4% HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 95 RN - WEEKEND RESPITE CARE 5% 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 97 SKILLED NURSING FACILITY 5% SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 24 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2061 2062 2063 2064 2065 2066 2067 MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 3 MEDICARE PART A 5% 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 25 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2061 2062 2063 2064 2065 2066 2067 MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 32 CO-ENZYME Q 4% NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 39 ANNUAL PT or OT RE-EVALUATION 5% 409.34 409.34 409.34 409.34 409.34 409.34 409.34 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 42 CAMP 4% 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 26 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2061 2062 2063 2064 2065 2066 2067 ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 56 ADAPTED TRICYCLE 4% 57 JOGGING STROLLER / WHEELCHAIR 4% 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 69 ANTI-BURST ROUND EXERCISE BALL 4% 70 THERAPY ROLL 4% 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 27 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH NO. ITEM RATE 2061 2062 2063 2064 2065 2066 2067 SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 77 DISPOSABLE GLOVES 4% 78 HAND SANITIZER 4% 79 WIPES 4% 80 BARRIER CREAM 4% 81 DRY DISPOSABLE WASHCLOTHS 4% 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 6.82 6.82 6.82 6.82 6.82 90 MODIFICATIONS FOR VAN 4% HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 95 RN - WEEKEND RESPITE CARE 5% 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 97 SKILLED NURSING FACILITY 5% SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 28 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH 2074 NO. ITEM RATE 2068 2069 2070 2071 2072 2073 LIFE MEDICAL INSURANCE ANTHEM ESSENTIAL DIRECT ACCESS / ANTHEM BLUE CROSS BLUE SHIELD 1 PREMIUM, DEDUCTIBLE AND MAXIMUM OUT OF POCKET 5% 2 ANTHEM BLUE CROSS BLUE SHIELD PRESCRIPTION DRUGS (included in above costs) 5% 3 MEDICARE PART A 5% 4 MEDICARE PART B PREMIUM & DEDUCTIBLE 5% 5 MEDIGAP - MEDICARE ADVANTAGE PLAN / BLUE MEDICARE ACCESS VALUE (UNDER 65) 5% 7,256.00 7,256.00 7,256.00 7,256.00 7,256.00 6 BLUE MEDICARE ACCESS VALUE - DRUG COVERAGE 5% 3,180.10 3,180.10 3,180.10 3,180.10 3,180.10 7 MEDICARE SUPPLEMENT ( AGE 65 AND OVER) 5% 5,000.00 5,000.00 8 MEDICARE DRUG PLAN SUPPLEMENT (Premium & Medication Costs) 5% 3,797.04 3,797.04 ROUTINE MEDICAL CARE - (With Insurance Offsets) 9 NEUROLOGIST 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10 PRIMARY CARE PHYSICIAN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11 PHYSICAL MEDICINE AND REHABILITATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 EMERGENCY MEDICAL CARE/AGGRESSIVE TREATMENT (With Insurance Offsets) 12 INSERTION OF VNS - HOSPITAL CHARGES 5% 13 INSERTION OF VNS - PROVIDER FEES 5% 14 REPLACEMENT OF VNS GENERATOR - HOSPITAL CHARGES 5% 15 REPLACEMENT OF VNS LEADS 5% 16 KETOGENIC DIET DIETICIAN 4% 17 DIGITAL SCALE FOR KETOGENIC DIET 4% DIAGNOSTIC TESTING (With Insurance Offsets) 18 HIP X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19 SPINE SERIES X-RAYS 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20 LIPID PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21 BANZEL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22 PHENOBARBITAL LEVEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23 METABOLIC PANEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24 LAB DRAW 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 29 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH 2074 NO. ITEM RATE 2068 2069 2070 2071 2072 2073 LIFE MEDICATIONS (With Insurance Offsets) 25 LEVOCARNITIN 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26 ONFI (CLOBAZAM) 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27 CETIRIZINE 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28 DIAZEPAM 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29 BANZEL 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 30 PHENOBARB ELIXIR 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OVER THE COUNTER MEDICATIONS 31 POLYETHYLINE GLYCOL POWDER 4% 32 CO-ENZYME Q 4% NUTRITION AND FEEDING (With Insurance Offsets) 33 ELECARE JUNIOR VANILLA 4% 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 29,592.00 34 JOEY FEEDING BAG 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35 MicKEY BUTTON 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36 MicKEY RIGHT ANGLE V PORT 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 THERAPEUTIC MODALITIES (With Insurance Offsets) 37 SPEECH/ OCCUPATIONAL / PHYSICAL THERAPY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38 PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY 4% 39 ANNUAL PT or OT RE-EVALUATION 5% 409.34 409.34 409.34 409.34 409.34 409.34 409.34 40 SPEECH THERAPY RE-EVALUATION 5% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 41 MUSIC THERAPY 4% 42 CAMP 4% 43 NURSE CASE MANAGER 4% 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 2,400.00 EDUCATIONAL / VOCATIONAL 44 PARAPROFESSIONAL ASSISTANCE 4% 45 PSYCHOLOGICAL TESTING AND EDUCATIONAL ASSESSMENT 4% 46 VOCATIONAL / AVOCATIONAL EVALUATION 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 30 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH 2074 NO. ITEM RATE 2068 2069 2070 2071 2072 2073 LIFE ARCHITECTURAL MODIFICATIONS 47 MODIFICATION OF BATHROOM 4% 48 RAMPS FOR ENTRANCE AND EXIT TO HOME 4% 49 WIDEN 5 DOORWAYS 4% 50 SURE HANDS LIFT - CEILING MOUNTED LIFT SYSTEM 4% 51 REPLACEMENT SLINGS / BODY SUPPORTS FOR LIFT SYSTEM (Covered by Ins.) 4% EQUIPMENT (With Insurance Offsets) 52 TILT N SPACE CUSTOM MANUAL WHEELCHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53 WHEELCHAIR MAINTENANCE AND REPAIR (Includes tires/wheels) 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54 ACTIVITY CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55 SLEEPSAFE BED MATTRESS AND PADDING 4% 56 ADAPTED TRICYCLE 4% 57 JOGGING STROLLER / WHEELCHAIR 4% 58 ADAPTIVE TOYS / THERAPEUTIC TOYS 4% 59 KANGAROO FEEDING PUMP 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 60 WATERPIK CLASSIC WATER FLOSSER 4% 16.44 16.44 16.44 16.44 16.44 16.44 16.44 61 SEIZURE MONITOR 4% 62 SIMPLE ENVIRONMENTAL CONTROL UNIT 4% 24.00 24.00 24.00 24.00 24.00 24.00 24.00 63 ADAPTIVE EQUIPMENT FOR EATING 4% 64 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 65 ADAPTIVE EQUIPMENT FOR EATING - REPLACEMENTS 4% 66 STANDER 4% 816.57 816.57 816.57 816.57 816.57 816.57 816.57 67 COMMODE CHAIR / ROLLING SHOWER CHAIR 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 68 PEANUT EXERCISE BALLS, 2 SIZES 4% 69 ANTI-BURST ROUND EXERCISE BALL 4% 70 THERAPY ROLL 4% 71 CHEWY TUBE 4% 72 SPECIAL NEEDS SWING WITH HARNESS 4% ORTHOTICS AND PROSTHETICS (With Insurance Offsets) 73 BILATERAL HINGED AFOS 4% NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 31 of 32 Revised - May 21, 2014 ITEMS OF COMPENSATION V. E. M. CL. CT. NO. 13-0190V GROWTH 2074 NO. ITEM RATE 2068 2069 2070 2071 2072 2073 LIFE SUPPLIES 74 DIAPERS 4% 75 ADULT SIZE MEDIUM INCONTINENCE BRIEFS 4% 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 1,642.50 76 BED LINERS 4% 77 DISPOSABLE GLOVES 4% 78 HAND SANITIZER 4% 79 WIPES 4% 80 BARRIER CREAM 4% 81 DRY DISPOSABLE WASHCLOTHS 4% 82 MEDICAL ID BRACELET, SHOE TAG OR NECKLACE 4% 11.67 11.67 11.67 11.67 11.67 11.67 11.67 83 CONTOURED VINYL MATTRESS PROTECTOR 4% TRANSPORTATION 84 PRIMARY CARE PHYSICIAN 4% 36.00 36.00 36.00 36.00 36.00 36.00 36.00 85 PHYSICAL MEDICINE AND REHABILITATION PHYSICIAN 4% 36.96 36.96 36.96 36.96 36.96 36.96 36.96 86 NEUROLOGIST 4% 103.20 103.20 103.20 103.20 103.20 103.20 103.20 87 NEUROSURGEON AT IU - RILEY 4% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88 IU CHILDREN'S THERAPY CENTER - REHAB FOR THERAPIES 4% 89 NATIONALSEATING AND REHAB FOR WC/SEATING EVALUATION 4% 6.82 6.82 6.82 6.82 6.82 6.82 6.82 90 MODIFICATIONS FOR VAN 4% HOME CARE AND FACILITY CARE 91 HOME HEALTH AIDE - WEEKDAY CARE 4% 92 HOME HEALTH AIDE - WEEKDAY CARE DURING SCHOOL BREAKS 4% 93 RN - WEEKDAY CARE DURING SCHOOL BREAKS 5% 94 HOME HEALTH AIDE - WEEKEND RESPITE CARE 4% 95 RN - WEEKEND RESPITE CARE 5% 96 GROUP HOME OR LONG TERM CARE FACILITY FOR YOUNGER ADULTS 4% 74,825.00 74,825.00 74,825.00 74,825.00 74,825.00 97 SKILLED NURSING FACILITY 5% 71,175.00 71,175.00 SUBTOTAL - 1ST YEAR EXPENSES 98 PAST UNREIMBURSED EXPENSES 99 PAIN AND SUFFERING 100 LOST WAGES 101 STATE OF INDIANA MEDICAID LIEN 102 TRUST SEED: PEOPLES BANK, A CODORUS VALLEY CO. OF YORK,PA. ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- TOTAL: 120,356.60 120,356.60 120,356.60 120,356.60 120,356.60 115,067.54 115,067.54 NOTE: Items replaced every "X" years (e.g., 3 yrs., 5 yrs, etc.) are paid to last valid replacement date during years indicated in the life care plan. AEC Financial, Inc. Page 32 of 32 Revised - May 21, 2014 --- Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/2680311. Public record. Not legal advice.