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SSA-1826 ITEMIZED STATEMENT OF EARNINGS* * * FOR SSN XXX-XX-9083 * .* *
EMPLOYER NUMBER: 61-0701721LANCE COAL CORPORATIONHC 85 BOX 177WHITESBURG KY 41858-0000
1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL1979 $18,635.371980 $13,069.67
EMPLOYER NUMBER: 62-0933838BLUE DIAMOND MINING INCPO BOX 59015KNOXVILLE TN 37950-9015
YEAR 1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL1981 $30,166.471982 $15,957.131984 $18,719.321985- $39,600.001986 $42,000.001987 $42,520.16
EMPLOYER NUMBER: 61-0875443ALLIANCE CORPORATION116 E COLLEGE STGLASGOW KY 42141-2514
YEAR19831984
EMPLOYER NUMBER: 61-1013907COFFEE CUP COAL COMPANY INC•PO BOX 14ISOM KY 41824-0014
YEAR 1ST QTR 21984
EMPLOYER NUMBER: 62-0133200BDCC HOLDING COMPANY INC901 E BYRD ST STE 1600RICHMOND VA 23219-4054
3RD QTR 4TH QTR TOTAL$9,638.00$1,656.00
3RD QTR 4TH QTR TOTAL$6,204.59
YEAR 1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL1988 $43,878.461989 $42,975.601990 $42,547.88
PAGE
Case 14-31848-KRH Doc 1528-25 Filed 12/15/15 Entered 12/15/15 15:08:47 Desc 1199 Page 1 of 4
SSA-1826 ITEMIZED STATEMENT OF EARNINGS* * * FOR SRN XXX-XX-9083 * * *
1991
EMPLOYER NUMBER: 61-0993751MAGDI FAHMY PSC85 LOYOLA DRORMOND BEACH FL 32176-7829
$20,628.58
YEAR 1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL1992 $1,872.50
EMPLOYER NUMBER: 61-1155722ADENA FUELS INC271 W SHORT ST STE 805LEXINGTON KY 40507-1217
1992.1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL
$1,700.00
EMPLOYER NUMBER: 61-1204007LEATHERWOOD- ENERGY INCPO BOX 11JEFF KY 41751-0011
Y19921993
1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL$27,414.78$14,180.40
EMPLOYER NUMBER: 61-0997055DIXON ELECTRIC INC516 W FOURTH STLEXINGTON KY 40508-1206
YEAR 1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL1993 $1,940.00
EMPLOYER -NUMBER: 61-1148318ARC ENERGIES INCPO BOX 3633PIKEVILLE KY 41502-3633
YEAR 1ST QTR 2ND QTR 3RD QTR 4TH QTR TOTAL1993 $788:25
Case 14-31848-KRH Doc 1528-25 Filed 12/15/15 Entered 12/15/15 15:08:47 Desc 1199 Page 2 of 4
FILED ENTERED TENDEREDCOSTS PAID SUMMONS DATE IZ 7 ROGER D. COLUNSPERRY CIT CLERK
COMMONWEALTH OF KENTUCKY BY' PERRY CIRCUIT COURT
CIVIL ACTION NO.: U7-Cr-O0753
CONNIE COX, EXECUTRIXOF ESTATE OF MERLE COX
vs.
3 M COMPANY, a foreign corporation, f/k/a MINNESOTAMINING AND MANUFACTURING COMPANY; MINE SAFETYAPPLIANCES COMPANY, a foreign corporation; AMERICANOPTICAL CORPORATION, a foreign corporation; MINESERVICE COMPANY, INC., a Kentucky corporation; KENTUCKYMINE SUPPLY COMPANY_ a Kentucky corporation; ANDJIM ZIMMERMAN, Executive Director, Office of WorkplaceStandards and. Acting Director, Division of Workers CompensationFunds, f/k/a the SPECIAL FUND,
PLAINTIFF
DEFENDANTS
COMPLAINT
Comes the above named Plaintiff and for her cause of action against the above
named Defendants, respectfully states:
INTRODUCTION
1) This Complaint is filed on behalf of the above named Plaintiff who:
a) was married to Merle Cox who worked as a coal miner within the
Commonwealth-of Kentucky, and who died September 30, 2006,
b) whose husband was exposed to coal, rock or sand dust as a result
of such coal mine employment,
whose husband suffered from an occupational lung disease known
as Coal Workers' Pneumoconiosis and/or Silicosis, commonly referred to as Black Lung
Page 1 of 18
0,C.
Case 14-31848-KRH Doc 1528-25 Filed 12/15/15 Entered 12/15/15 15:08:47 Desc 1199 Page 3 of 4
by virtue of the failure of the respirators/dust masks Plaintiff's husband used to protect
him from exposure to coal rock and sand dust while working as a coal mine employee.
2) Plaintiffs mailing address is 4398 Lotts Creek Road, Hazard, Kentucky
41701. The Plaintiff's husband worked as a coal miner within the Commonwealth of
Kentucky. Plaintiff was duly appointed Executrix of the Estate of her deceased husband
by Order of the Perry District Court-entered on 1211/06. Copy attached as Exhibit A.
PARTIES MADE. DEFENDANTS HEREIN
3) Defendants, 3M Company, formerly known as Minnesota Mining and
Manufacturing Company (3M) and Mine Safety Appliances Company (MSA) are or were
foreign corporations authorizing to do, have done, or are still doing business in the
Commonwealth of Kentucky in various counties, including Perry County, which
represents substantial and not isolated activities in this State and who manufactured the
respirators/dust masks used by one or more of the Plaintiffs. The agent for service of
process for Defendants 3M, and MSA is CT Corporation System, Kentucky Homelife
Building, Room 1102, Louisville, Kentucky 40202.
4) Defendant, American Optical Corporation (AO) is or was a foreign
corporation; authorizing to do, have done, or is still doing business in the
Commonwealth of Kentucky in various counties, including Perry County, vt.thich
represents substantial and not isolated activities in this State and who manufactured the
respirators/dust masks used by the Plaintiff. The agent for service of process for
Defendant, AO, is the Secretary of State.
5) Defendants, 3M, MSA, and AO are collectively referred to as the
Respiratory Protection Defendants. The Respiratory Protection Defendants
Page 2 of 18
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