In re: NorthShore University HealthSystem Antitrust Litigation
Instructions for Submitting Your Consumer Claim Form
If you received a notice in the mail, or by email, that includes your purchase amount and you agree with the amounts,
you should follow the instructions for submitting that Claim Form. If you did not receive a notice or believe that
you have additional amounts that you paid directly to NorthShore University HealthSystem (formerly known as Evanston
Northwestern Healthcare) (“NorthShore”) for inpatient hospital services, its wholly-owned hospitals, predecessors,
subsidiaries, or affiliates other than those acquired as a result of the merger with Rush North Shore Medical Center
in the United States of America and Puerto Rico between February 10, 2000, through December 31, 2015, you may file a
claim to ask for a share of the Settlement Fund. You must complete this Claim Form and mail it to the Notice and Claims
Administrator at the address provided below postmarked, or you can submit your claim online at
www.NorthShoreAntitrustLitigation.com no later than April 4, 2024.
• Complete all required portions of the attached Claim Form:
1. Complete Section A. You must provide your name and contact information.
2. Review and complete Section B to confirm you qualify to file a claim.
3. Complete Section C to provide information about the total amount paid directly to NorthShore University HealthSystem (formerly known as Evanston Northwestern Healthcare) (“NorthShore”) for inpatient hospital services, its wholly-owned hospitals, predecessors, subsidiaries, or affiliates other than those acquired as a result of the merger with Rush North Shore Medical Center in the United States of America and Puerto Rico between February 10, 2000, through December 31, 2015.
4. Review Section D and provide documents to show the amount you paid directly to NorthShore University HealthSystem (formerly known as Evanston Northwestern Healthcare) (“NorthShore”) for inpatient hospital services, its wholly-owned hospitals, predecessors, subsidiaries, or affiliates other than those acquired as a result of the merger with Rush North Shore Medical Center in the United States of America and Puerto Rico between February 10, 2000, through December 31, 2015.
5. Review Section E and sign the Claim Form to certify that the information you provided is true and correct to the best of your knowledge.
• Complete all required portions of the attached Claim Form:
1. Complete Section A. You must provide your name and contact information.
2. Review and complete Section B to confirm you qualify to file a claim.
3. Complete Section C to provide information about the total amount paid directly to NorthShore University HealthSystem (formerly known as Evanston Northwestern Healthcare) (“NorthShore”) for inpatient hospital services, its wholly-owned hospitals, predecessors, subsidiaries, or affiliates other than those acquired as a result of the merger with Rush North Shore Medical Center in the United States of America and Puerto Rico between February 10, 2000, through December 31, 2015.
4. Review Section D and provide documents to show the amount you paid directly to NorthShore University HealthSystem (formerly known as Evanston Northwestern Healthcare) (“NorthShore”) for inpatient hospital services, its wholly-owned hospitals, predecessors, subsidiaries, or affiliates other than those acquired as a result of the merger with Rush North Shore Medical Center in the United States of America and Puerto Rico between February 10, 2000, through December 31, 2015.
5. Review Section E and sign the Claim Form to certify that the information you provided is true and correct to the best of your knowledge.
• If you sign and submit the Claim Form, you are swearing under penalty of perjury that you qualify to submit a claim.
• You have two options to submit a Claim Form:
• If your completed Claim Form is not postmarked or filed online by April 4, 2024, you will not get a payment from this Settlement. Submitting this Claim Form does not guarantee that you will get a payment from the Settlement.
• You have two options to submit a Claim Form:
o You can mail your completed and signed Claim Form and supporting documents by First-Class U.S. Mail, postage prepaid, postmarked no later than
April 4, 2024, to:
o You can complete and submit the Claim Form and upload supporting documents on the Settlement website, www.NorthShoreAntitrustLitigation.com. If you complete the online Claim Form, you will receive a receipt saying that your claim was submitted. If you choose this option and file a claim electronically, your electronic signature and submission of the form will conform to the requirements of the Electronic Signatures Act, 15 U.S.C. § 7001, et seq., and will have the same force and effect as if you signed the Claim Form in hard copy.
NorthShore Antitrust Litigation
c/o A.B. Data, Ltd.
P.O. Box 170990
Milwaukee, WI 53217
ORc/o A.B. Data, Ltd.
P.O. Box 170990
Milwaukee, WI 53217
o You can complete and submit the Claim Form and upload supporting documents on the Settlement website, www.NorthShoreAntitrustLitigation.com. If you complete the online Claim Form, you will receive a receipt saying that your claim was submitted. If you choose this option and file a claim electronically, your electronic signature and submission of the form will conform to the requirements of the Electronic Signatures Act, 15 U.S.C. § 7001, et seq., and will have the same force and effect as if you signed the Claim Form in hard copy.
• If your completed Claim Form is not postmarked or filed online by April 4, 2024, you will not get a payment from this Settlement. Submitting this Claim Form does not guarantee that you will get a payment from the Settlement.