Case 1:19-cv-00597 Document 12-5 Filed 12/20/19 Page 1 of 2 PageID 181 UNSWORN DECLARATION OF RAYMOND E. DYE In the matter of: Graham et al. v. Justice Energy. Inc., et a1. 1, Raymond E. Dye, of PO Box 1036, Welch, WV 24801, pursuant to 28 U.S.C. 1746 do hereby solemnly declare the following: 1) I was formerly employed by Keystone Service Industries, Inc., with my last day of 2) 3) 4) 5) credited service on or about July 11, 1999. On or about that date I retired. During my years of service, Keystone Service Industries, Inc., was bound by a series of collective bargaining agreements with the United Mine Workers of America. Those collective bargaining agreements included promises by Keystone Service Industries, Inc. to provide pension, healthcare, and prescription drug bene?ts to quali?ed retirees. Under those collective bargaining agreements, and as a result of my credited service at Keystone Service Industries, Inc., I quali?ed for pension, healthcare, and prescription drug bene?ts. I am entitled to those bene?ts during my retirement. I have a build up of blood behind my left that prevents me from seeing out of that eye. A doctor prescribed medication to treat the condition. On or about September 17, 2019, I drove 70 miles from my home to get a prescription ?lled. The pharmacisr told me that my prescription drug coverage would not pay for the medicine. My plan was supposed to cover the medicine and I received no warning that my coverage was being cut off. I called the health plan to ?nd out why my prescription was not being paid. The health plan told me that my former employer was not paying its premiums and, as a result, the prescription drug coverage was suspended. Case Document 12-5 Filed 12/20/19 Page 2 of 2 PageID 182 6) I need the medication in order to see out of my left and I cannot afford to pay for the medicine out-of-pocket. I declare under penalty of perjury that the foregoing is true and correct. Executed on: graze 79 bate 6,3245%? 18 Rayrn dB. ye (Siwatug/?-