ALAN HILLIARD LEGUM, P.A.

275 WEST STREET, SUITE 305

ANNAPOLIS, MARYLAND 21401
410-263-3001

SETTLEMENT STATEMENT

Michael Laughery v. Six Flags America

File Number: 10,573C

Amount of Settlement: $5,500.00

Less Attorney’s Fees $1,833.33

Less Costs Advanced:

Basic Expenses $ 75.00

Court Costs $ 38.00
$113.00

Total Attorney’s Fees and Costs $1,946.33

Unpaid Medicals

R&R Recovery 200.00

NET TO CLIENT: $3,353.67

I have read the above statement and agree to the disbursements as set forth above. I understand that
I am personally responsible for any outstanding medical bills not listed above.

________________________________________________
Michael Laughery Date

Health Insurance Paid

$284.38 Northwest Hospital (Contractual Adjustment of $14.85)
$654.00 Randall Emergency Physicians (Confirmed zero balance 10/1/14)
$617.00 Maryland Spine Center

Client Paid
$150.00 Maryland Orthopedics (Courtesy Adjustment of $165.00)

Client has informed our office that he will personally be responsible for any balance due to Dr.
Ingram at the Maryland Spine Center