Notice of Removal — Wisconsin Department of Health Services, Case No. 12-CV-432 (2013)

IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF WISCONSIN MELISSA BOYLE SPECIAL NEEDS TRUST, c/o Thomas P. Schwaba as co-trustee, and c/o Nicolet National Bank, of Marinette, Wisconsin, attn: David Maguire as co-trustee, Plaintiffs, Case No. 13-C-___ v. Marinette County Case No. 12-CV-432 DEPARTMENT OF HEALTH SERVICES, c/o Attorney General J.B. Van Hollen, Defendant. PETITION AND NOTICE OF REMOVAL Defendant, Wisconsin Department of Health Services (the “Department”), by its attorneys, J.B. Van Hollen, Attorney General, and Maria S. Lazar, Assistant Attorney General, hereby petition for removal and give notice of removal of this civil action filed in Circuit Court for Marinette County, Wisconsin, to the United States District Court for the Eastern District of Wisconsin. The grounds for this petition and notice are as follows: 1. A civil action was commenced in Branch 1 of the Circuit Court for Marinette County, Wisconsin, on December 19, 2012, and assigned Marinette County Case No. 12-CV-432. 2. Service of the Summons and Complaint was made on the Department on December 26, 2012. Pursuant to 28 U.S.C. § 1446(a), a true and complete copy of the Summons and Complaint, as served on the Department, is attached to this petition and notice as Exhibit 1. Case 1:13-cv-00082-WCG Filed 01/23/13 Page 1 of 3 Document 1

- 2 - 3. This action is timely removed within 30 days after service on December 26, 2012. Murphy Bros., Inc. v. Michetti Pipe Stringing, Inc., 516 U.S. 344, 353-54 (1999); 28 U.S.C. § 1446(b). 4. The civil action governed by the complaint remains pending. 5. The action arises under provisions of federal statutes and regulations (Complaint, ¶¶ 13, 22). The state statutes discussed in the Complaint, Wis. Stat. §§ 49.496(3) and 49.454(4), refer to the state’s Medicaid eligibility to obtain reimbursement from the Melissa Boyle Special Needs Trust pursuant to 28 U.S.C. § 1396p. 6. This Court has federal question removal jurisdiction over the action. 28 U.S.C. §§ 1331 and 1441-1447. Wisconsin Dept. of Corrections v. Schacht, 524 U.S. 381, 386 (1998). Removal is proper when federal law claims are asserted in state court, even when a statute provides that federal law claims may be initiated in state court. Breuer v. Jim’s Concrete of Brevard, Inc., 538 U.S. 691, 693 (2003). 7. The transactions are alleged to have occurred within the Eastern District of Wisconsin, and the action was commenced in a Wisconsin circuit court within this district. Venue lies in this district. 8. Defendant has given notice to plaintiffs and will promptly file a copy of the notice with the Clerk of Courts for Marinette County, as required by 28 U.S.C. § 1396p. 9. Pursuant to 28 U.S.C. § 1441(b), removal of this claim is mandatory upon compliance with 28 U.S.C. § 1446 as herein accomplished. Case 1:13-cv-00082-WCG Filed 01/23/13 Page 2 of 3 Document 1

- 3 - WHEREFORE, defendant represents that it has complied with the provisions of law and given notice that this action stands removed from the Circuit Court for Marinette County, Wisconsin, to the United States District Court for the Eastern District of Wisconsin. Dated this 23rd day of January, 2013. Respectfully submitted, J.B. VAN HOLLEN Attorney General s/Maria S. Lazar MARIA S. LAZAR Assistant Attorney General State Bar #1017150 Attorneys for Defendant, Department of Health Services Wisconsin Department of Justice Post Office Box 7857 Madison, Wisconsin 53707-7857 (608) 267-3519 (608) 267-2223 (Fax) [email protected] Case 1:13-cv-00082-WCG Filed 01/23/13 Page 3 of 3 Document 1

WIED-JS 44 (Rev. 12/12) CIVIL COVER SHEET The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.) Place an “X” in the appropriate box: Green Bay Division Milwaukee Division I. (a) PLAINTIFFS DEFENDANTS (b) County of Residence of First Listed Plaintiff County of Residence of First Listed Defendant (EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY) NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE TRACT OF LAND INVOLVED. (c) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known) II. BASIS OF JURISDICTION (Place an “X” in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X” in One Box for Plaintiff (For Diversity Cases Only) and One Box for Defendant) 1 U.S. Government 3 Federal Question PTF DEF PTF DEF Plaintiff (U.S. Government Not a Party) Citizen of This State 1 1 Incorporated or Principal Place 4 4 of Business In This State 2 U.S. Government 4 Diversity Citizen of Another State 2 2 Incorporated and Principal Place 5 5 Defendant (Indicate Citizenship of Parties in Item III) of Business In Another State Citizen or Subject of a 3 3 Foreign Nation 6 6 Foreign Country IV. NATURE OF SUIT (Place an “X” in One Box Only) CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES 110 Insurance PERSONAL INJURY PERSONAL INJURY 625 Drug Related Seizure 422 Appeal 28 USC 158 375 False Claims Act 120 Marine 310 Airplane 365 Personal Injury - of Property 21 USC 881 423 Withdrawal 400 State Reapportionment 130 Miller Act 315 Airplane Product Product Liability 690 Other 28 USC 157 410 Antitrust 140 Negotiable Instrument Liability 367 Health Care/ 430 Banks and Banking 150 Recovery of Overpayment 320 Assault, Libel & Pharmaceutical PROPERTY RIGHTS 450 Commerce & Enforcement of Judgment Slander Personal Injury 820 Copyrights 460 Deportation 151 Medicare Act 330 Federal Employers’ Product Liability 830 Patent 470 Racketeer Influenced and 152 Recovery of Defaulted Liability 368 Asbestos Personal 840 Trademark Corrupt Organizations Student Loans 340 Marine Injury Product 480 Consumer Credit (Excludes Veterans) 345 Marine Product Liability LABOR SOCIAL SECURITY 490 Cable/Sat TV 153 Recovery of Overpayment Liability PERSONAL PROPERTY 710 Fair Labor Standards 861 HIA (1395ff) 850 Securities/Commodities/ of Veteran’s Benefits 350 Motor Vehicle 370 Other Fraud Act 862 Black Lung (923) Exchange 160 Stockholders’ Suits 355 Motor Vehicle 371 Truth in Lending 720 Labor/Management 863 DIWC/DIWW (405(g)) 890 Other Statutory Actions 190 Other Contract Product Liability 380 Other Personal Relations 864 SSID Title XVI 891 Agricultural Acts 195 Contract Product Liability 360 Other Personal Property Damage 740 Railway Labor Act 865 RSI (405(g)) 893 Environmental Matters 196 Franchise Injury 385 Property Damage 751 Family and Medical 895 Freedom of Information 362 Personal Injury - Product Liability Leave Act Act Medical Malpractice 790 Other Labor Litigation 896 Arbitration REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS 791 Employee Retirement FEDERAL TAX SUITS 899 Administrative Procedure 210 Land Condemnation 440 Other Civil Rights Habeas Corpus: Income Security Act 870 Taxes (U.S. Plaintiff Act/Review or Appeal of 220 Foreclosure 441 Voting 463 Alien Detainee or Defendant) Agency Decision 230 Rent Lease & Ejectment 442 Employment 510 Motions to Vacate 871 IRS—Third Party 950 Constitutionality of 240 Torts to Land 443 Housing/ Sentence 26 USC 7609 State Statutes 245 Tort Product Liability Accommodations 530 General 290 All Other Real Property 445 Amer. w/Disabilities 535 Death Penalty IMMIGRATION Employment Other: 462 Naturalization Application 446 Amer. w/Disabilities 540 Mandamus & Other 465 Other Immigration Other 550 Civil Rights Actions 448 Education 555 Prison Condition 560 Civil Detainee - Conditions of Confinement V. ORIGIN (Place an “X” in One Box Only) Transferred from Another District (specify) 1 Original Proceeding 2 Removed from State Court 3 Remanded from Appellate Court 4 Reinstated or Reopened 5 6 Multidistrict Litigation VI. CAUSE OF ACTION Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity): Brief description of cause: VII. REQUESTED IN COMPLAINT: CHECK IF THIS IS A CLASS ACTION UNDER RULE 23, F.R.Cv.P. DEMAND $ CHECK YES only if demanded in complaint: JURY DEMAND: Yes No VIII. RELATED CASE(S) IF ANY (See instructions): JUDGE DOCKET NUMBER DATE SIGNATURE OF ATTORNEY OF RECORD FOR OFFICE USE ONLY RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE Case 1:13-cv-00082-WCG Filed 01/23/13 Page 1 of 2 Document 1-1 MELISSA BOYLE SPECIAL NEEDS TRUST c/o Thomas P. Schwaba as co-trustee and c/o Nicolet National Bank, of Marinette, Wisconsin, attn: David Maguire as co-trustee Marinette, WI Gregory B. Conway, Kurt A. Goehre; Liebmann, Conway, Olejniczak & Jerry, S.C., 231 South Adams Street, Green Bay, WI 54301 (920) 437-0476 DEPARTMENT OF HEALTH SERVICES c/o Attorney General J.B. Van Hollen Dane, WI Assistant Attorney General Maria S. Lazar, Wisconsin Department of Justice, P.O. Box 7857, Madison, WI 53707-7857 (608) 267-3519 42 U.S.C. sec. 1396p Reimbursement to State, from Special Needs Trust, of medical assistance payments made on behalf of M. Boyle Print Save As... Reset

JS 44 Reverse (Rev. 12/12) INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44 Authority For Civil Cover Sheet The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint filed. The attorney filing a case should complete the form as follows: I.(a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both name and title. (b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the "defendant" is the location of the tract of land involved.) (c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting in this section "(see attachment)". II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.Cv.P., which requires that jurisdictions be shown in pleadings. Place an "X" in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below. United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here. United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box. Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be marked. Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the different parties must be checked. (See Section III below; NOTE: federal question actions take precedence over diversity cases.) III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this section for each principal party. IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is sufficient to enable the deputy clerk or the statistical clerk(s) in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the most definitive. V. Origin. Place an "X" in one of the six boxes. Original Proceedings. (1) Cases which originate in the United States district courts. Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition for removal is granted, check this box. Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date. Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date. Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict litigation transfers. Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box is checked, do not check (5) above. VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes unless diversity. Example: U.S. Civil Statute: 47 USC 553 Brief Description: Unauthorized reception of cable service VII. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Rule 23, F.R.Cv.P. Demand. In this space enter the actual dollar amount being demanded or indicate other demand, such as a preliminary injunction. Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded. VIII. Related Cases. This section of the JS 44 is used to reference related pending cases, if any. If there are related pending cases, insert the docket numbers and the corresponding judge names for such cases. Date and Attorney Signature. Date and sign the civil cover sheet. Case 1:13-cv-00082-WCG Filed 01/23/13 Page 2 of 2 Document 1-1

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