27-CV-16-1269

Filed in Fourth Judicial District Court

8/28/2017 1:46 PM
Hennepin County, MN

STATE OF MINNESOTA DISTRICT COURT

COUNTY OF HENNEPIN FOURTH JUDICIAL DISTRICT

FILE NO. 27-CV161269

Edward Benningham IV, as trustee for the

next-ofkin of Nicole Benningham,

Plaintiff, SPECIAL VERDICT FORM

vs.

Patricia Eid, NR and Emergency Care

Consultants, P.A.,

Defendant.

We, the Jury impaneled and sworn in the above-entitled matter, answer the following
questions submitted by the Court as a Special Verdict:

1. Was Nurse Practitioner Patn'cia Eids negligence a direct cause of Nicole Bermjnghams
death?

2; Yes No

Regardless ofyour answer to the question above, you must answer these questions:

2. What amount of money, if any, will fairly and adequately compensate the nextof-kin of
Nicole Bermingham for their pecuniary loss resulting from her death up to the date of this
verdict for:

a. Lost earnings $ 00 >

b. Lost household services $

c. Loss of counsel, guidance, aid,
comfort, assistance, companionship,
and protection: 33
I 1:! E |
IM: )O

3. What amount of money, if any, will fairly and adequately compensate the nextofkjn of
Nicole Benningham for their pecuniary loss resulting from her death reasonably certain
to occur in the future?

a. Lost future aming capacity $ 4 C)

2'
D
b. Lost future household services :5
 27-CV-16-1269
Filed in Fourth Judicial District Court
8/28/2017 1:46 PM
Hennepin County, MN

0. Loss of counsel, guidance, aid,

Comfort, assistance, companionship, h

and protection: $ 1
L?
1 513 {[22 GO 0

Dated: August 232017 at M QM. Raw VQQW

Mpers \
I V

'

After six hours of deliberation, seven of the eight jurors may agree to a verdict. The seve ors
should sign in the spaces provided below:

Dated: August , 2017 at .M.