Case 1:05-md-01720-JG-JO Document 5783-1 Filed 06/12/13 Page 1 of 136 PageID #: 67148 EXHIBIT A [Public Version] Payment Card Interchange Settlement Case 1:05-md-01720-JG-JO Document 5783-1 Filed 06/12/13 Page 2 of 136 PageID #: Report of Exclusion Requests 67149 Report of Exclusion Requests – Publicly Filed Version includes submissions received thru June 7, 2013 The following report includes exclusion requests received by the Class Administrator through June 7, 2013. Epiq received exclusion requests that did not technically satisfy the requirements specified in Section 12 of the long-form notice and are potentially incomplete. At the direction of settlement counsel, Epiq will notify merchants by mail regarding their Incomplete submissions. It is anticipated that a revised Report will subsequently be filed with the Court. The publicly filed version of this report omits mailing address and Tax Identification Number information. A complete version has been filed under seal. Exclusion Requests by Status Timely and Properly Made 7,148 Timely and Possibly Incomplete 580 Late and Properly Made 71 Late and Possibly Incomplete 8 Total 7,807 Row Number Document Type Document ID Entity Name Postmark Date Received Date Status 1 Opt Out 900000001 A RENTMEISTER PLUMBER INC February 4, 2013 February 6, 2013 Timely and Properly Made 2 Opt Out 900000002 HOME MAINTENANCE CENTER, LLC February 4, 2013 February 7, 2013 Timely and Properly Made 3 Opt Out 900000003 ADD-ON February 5, 2013 February 7, 2013 Timely and Possibly Incomplete 4 Opt Out 900000004 JASMINE THAI February 5, 2013 February 7, 2013 Timely and Properly Made 5 Opt Out 900000005 TEAM INC February 5, 2013 February 7, 2013 Timely and Properly Made 6 Opt Out 900000006 IRONHORSE PIPE & STEEL February 6, 2013 February 8, 2013 Timely and Properly Made 7 Opt Out 900000007 CHRISTIAN LIGHT PUBLICATIONS INC February 6, 2013 February 8, 2013 Timely and Properly Made 8 Opt Out 900000008 KATHRYN ANN LIEVING February 5, 2013 February 8, 2013 Timely and Possibly Incomplete 9 Opt Out 900000009 BROTHERS AUTOMOTIVE SPECIALIST February 5, 2013 February 8, 2013 Timely and Possibly Incomplete 10 Opt Out 900000010 ENABLING TECHNOLOGIES INC February 5, 2013 February 8, 2013 Timely and Properly Made 11 Opt Out 900000011 CAMPBELL OIL COMPANY INC February 5, 2013 February 8, 2013 Timely and Properly Made 12 Opt Out 900000012 ZIMMERMAN GREENHOUSE February 9, 2013 February 11, 2013 Timely and Possibly Incomplete 13 Opt Out 900000013 TIMEKEEPERS February 9, 2013 February 11, 2013 Timely and Properly Made 14 Opt Out 900000014 ACCURATE VISION February 7, 2013 February 11, 2013 Timely and Properly Made 15 Opt Out 900000015 MT NGUYEN CHEVRON INC. & MT NGUYEN 76 INC. February 7, 2013 February 11, 2013 Timely and Possibly Incomplete 16 Opt Out 900000016 JAY Y CHERNER February 8, 2013 February 11, 2013 Timely and Possibly Incomplete 17 Opt Out 900000017 CHOLSONG ENTERPRISES, INC. February 8, 2013 February 11, 2013 Timely and Properly Made 18 Opt Out 900000018 MOUNTAIN STATES ENERGY ALLIANCE February 5, 2013 February 11, 2013 Timely and Possibly Incomplete 19 Opt Out 900000019 VICTORIAN ROSE TEAROOM February 12, 2013 February 12, 2013 Timely and Properly Made 20 Opt Out 900000020 ADCUENT, INC. February 8, 2013 February 12, 2013 Timely and Properly Made 21 Opt Out 900000021 ABC SHOP February 8, 2013 February 12, 2013 Timely and Properly Made 22 Opt Out 900000022 THROWNSTONE POTTERY February 7, 2013 February 12, 2013 Timely and Possibly Incomplete 23 Opt Out 900000023 PHYLLIS FOSTER ANTIQUES February 11, 2013 February 13, 2013 Timely and Properly Made 24 Opt Out 900000024 CREATURE COMFORTS BY ERICA February 11, 2013 February 13, 2013 Timely and Possibly Incomplete 25 Opt Out 900000025 LA BAI DRAPERIES INC February 11, 2013 February 13, 2013 Timely and Possibly Incomplete 26 Opt Out 900000026 ARTISTIC IMPRESSIONS February 11, 2013 February 13, 2013 Timely and Possibly Incomplete 27 Opt Out 900000027 PIZZA PINO AND KITCHEN February 11, 2013 February 13, 2013 Timely and Possibly Incomplete 28 Opt Out 900000028 TOTE-A-POKE February 11, 2013 February 13, 2013 Timely and Properly Made 29 Opt Out 900000029 SKIPPERS ELECTRIC AND FOLDING BICYCLES February 11, 2013 February 13, 2013 Timely and Possibly Incomplete 30 Opt Out 900000030 ART-TOO-GO - SUZANNE GUILLORY February 11, 2013 February 14, 2013 Timely and Possibly Incomplete 31 Opt Out 900000031 MOUNTAIN WEST VALVE INC February 12, 2013 February 14, 2013 Timely and Properly Made 32 Opt Out 900000032 SHAUN'S TIRE SERVICE February 11, 2013 February 14, 2013 Timely and Properly Made 33 Opt Out 900000033 LYN DESJARDINS OPTOMOETRY LLC February 13, 2013 February 15, 2013 Timely and Properly Made 34 Opt Out 900000034 LIQUID DEVELOPMENT COMPANY, INC February 13, 2013 February 15, 2013 Timely and Possibly Incomplete 35 Opt Out 900000035 MID-AMERICA REPS February 12, 2013 February 15, 2013 Timely and Properly Made 36 Opt Out 900000036 THE EGG LADY February 12, 2013 February 15, 2013 Timely and Possibly Incomplete 37 Opt Out 900000037 UNIQUE AUTO BOUTIQUE February 12, 2013 February 15, 2013 Timely and Possibly Incomplete 38 Opt Out 900000038 OLD MILL DESIGNS, INC. February 12, 2013 February 15, 2013 Timely and Possibly Incomplete 39 Opt Out 900000039 CURLY HORSE COUNTRY February 15, 2013 February 15, 2013 Timely and Possibly Incomplete 40 Opt Out 900000040 AZZ INCORPORATED February 12, 2013 February 15, 2013 Timely and Possibly Incomplete 41 Opt Out 900000041 PINE TREE WOODSHOP DBA EAST SIDE FURNITURE February 13, 2013 February 15, 2013 Timely and Properly Made 42 Opt Out 900000042 WESTWOOD OPHTHALMOLOGY ASSOC February 12, 2013 February 15, 2013 Timely and Properly Made 43 Opt Out 900000043 BLACKBEAN ICE CREAM INC. February 12, 2013 February 15, 2013 Timely and Possibly Incomplete 44 Opt Out 900000044 COMCO INC. February 12, 2013 February 15, 2013 Timely and Properly Made Page 1 of 135 Printed: June 10, 2013 Payment Card Interchange Settlement Case 1:05-md-01720-JG-JO Document 5783-1 Filed 06/12/13 Page 3 of 136 PageID #: Report of Exclusion Requests 67150 Row Number Document Type Document ID Entity Name Postmark Date Received Date Status 45 Opt Out 900000045 BLACKHAWK LIMOUSINE SERVICE February 12, 2013 February 15, 2013 Timely and Possibly Incomplete 46 Opt Out 900000046 TROY'S TOTAL AUTO REPAIR February 13, 2013 February 15, 2013 Timely and Possibly Incomplete 47 Opt Out 900000047 ABC SERVICES February 13, 2013 February 15, 2013 Timely and Properly Made 48 Opt Out 900000048 JAMES A. DONNER PSY D. P.A. February 13, 2013 February 15, 2013 Timely and Properly Made 49 Opt Out 900000049 CALIFORNIA PIZZA & THINGS February 13, 2013 February 15, 2013 Timely and Possibly Incomplete 50 Opt Out 900000050 JOHN P SMITH JR DDS February 13, 2013 February 15, 2013 Timely and Properly Made 51 Opt Out 900000051 KIM FORBES LCSW / STILLPOINT PSYCHOTHERAPY PC February 13, 2013 February 15, 2013 Timely and Properly Made 52 Opt Out 900000052 CHATTANOOGA MOBILITY CTR INC DBA CHATTANOOGA MOBILITY & LIFT February 12, 2013 February 15, 2013 Timely and Properly Made 53 Opt Out 900000053 ATOMY WELLNESS GROUP CORPORATION February 12, 2013 February 12, 2013 Timely and Possibly Incomplete 54 Opt Out 900000054 BOARD DADDY'S February 11, 2013 February 11, 2013 Timely and Possibly Incomplete 55 Opt Out 900000055 MARKING MACHINE CO February 15, 2013 February 18, 2013 Timely and Properly Made 56 Opt Out 900000056 TIVOLI ENTERPRISES, INC. DBA CLASSIC CINEMAS February 14, 2013 February 18, 2013 Timely and Properly Made 57 Opt Out 900000057 LAKE ISABELLE CREMATION & FUNERAL SOCIETY February 14, 2013 February 18, 2013 Timely and Possibly Incomplete 58 Opt Out 900000058 AIRPORT TRANSPORTER LLC February 16, 2013 February 18, 2013 Timely and Possibly Incomplete 59 Opt Out 900000059 ECO GREEN CLEANERS February 13, 2013 February 18, 2013 Timely and Properly Made 60 Opt Out 900000060 VICTORIAN ROSE TEAROOM February 14, 2013 February 18, 2013 Timely and Properly Made 61 Opt Out 900000061 VICTORIAN ROSE TEAROOM February 14, 2013 February 18, 2013 Timely and Properly Made 62 Opt Out 900000062 NATIVE AMERICAN FASHIONS INC February 13, 2013 February 18, 2013 Timely and Possibly Incomplete 63 Opt Out 900000063 CASPER PAYLESS DRUG COMPANY February 13, 2013 February 18, 2013 Timely and Properly Made 64 Opt Out 900000064 GRAY CHEM INC February 14, 2013 February 18, 2013 Timely and Possibly Incomplete 65 Opt Out 900000065 CRAWFORD ROAD GAS & GROCERY INC February 16, 2013 February 19, 2013 Timely and Properly Made 66 Opt Out 900000066 BRUNK'S OVERHEAD DOORS February 15, 2013 February 19, 2013 Timely and Properly Made 67 Opt Out 900000067 MARY KAY COSMETICS (NSR) February 16, 2013 February 19, 2013 Timely and Properly Made 68 Opt Out 900000068 STEPHEN J CANIS DMD PC February 16, 2013 February 19, 2013 Timely and Properly Made 69 Opt Out 900000069 BLYTHE ISLAND TECHNICAL SERVICES February 16, 2013 February 19, 2013 Timely and Properly Made 70 Opt Out 900000070 BITS BYTES N BUNS February 16, 2013 February 19, 2013 Timely and Properly Made 71 Opt Out 900000071 LAKE VIEW AUTO PARTS, INC. February 14, 2013 February 19, 2013 Timely and Possibly Incomplete 72 Opt Out 900000072 MERCADO CLEANERS February 13, 2013 February 19, 2013 Timely and Properly Made 73 Opt Out 900000073 TRIPLE E TRUCKING, LLC February 13, 2013 February 19, 2013 Timely and Properly Made 74 Opt Out 900000074 CHARLENE'S HAIR & NAILS February 13, 2013 February 19, 2013 Timely and Properly Made 75 Opt Out 900000075 CATERED AFFAIRS AND FLORAL DESIGNS INC. February 14, 2013 February