Department of Business and Industry Division of Insurance Self-Insured Employer List

C of A Employer 142274 AFFINITY GAMING Elizabeth Guth VP - Insurance & Benefits 3755 Breakthrough Way, Suite 300 NV 89135 702-341-2419

Association Name DBA Date Subsidiary Flamingo Paradise Gaming, LLC and 31-JAN-17 Subsidiary Plantation Investments, LLC Rail City Casino 31-JAN-17 Subsidiary Primadonna Company, LLC (The) Whiskey Pete's Hotel and Casino 31-JAN-17 Subsidiary Primadonna Company, LLC (The) Buffalo Bill's Resort and Casino 31-JAN-17 Subsidiary Primadonna Company, LLC (The) Primm Valley Resort and Casino 31-JAN-17 Third Party Administrator Sierra Nevada Administrators 31-JAN-17

C of A Employer 122997 ARCBEST CORPORATION (FKA ARKANSAS BEST CORPORATION) Lynette Woodie Manager, Loss Prevention & Administration 8401 McClure Drive Fort Smith AR 72916 479-785-6047

Association Name DBA Date Subsidiary ABF FREIGHT SYSTEM, INC. 15-DEC-81 Subsidiary AcrBest II 01-NOV-20 Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 15-DEC-81 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123211 BEST BUY CO INC Allison Klonne Senior Analyst - Casualty Risk 7601 Penn Avenue South B4 Richfield MN 55423 612-291-6958

Association Name DBA Date Subsidiary BEST BUY STORES LP 01-DEC-97 Subsidiary BEST BUY WAREHOUSING LOGISTICS LLC 01-APR-17 Subsidiary GREATCALL INC 01-OCT-18 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-DEC-97

C of A Employer 123005 CORPORATION Kim Cowley GL & WC Claims Manager 6465 South Rainbow Blvd Las Vegas NV 89118 702-792-7352

Association Name DBA Date Subsidiary ALIANTE CASINO AND HOTEL 27-SEP-16 Subsidiary BOYD ATLANTIC CITY, INC. 01-JAN-99 Subsidiary BOYD CENTRAL REGION, INC. 01-FEB-96 Subsidiary BOYD DEVELOPMENT CORPORATION 01-OCT-95 Subsidiary BOYD GAMING CORPORATION 01-NOV-90 Subsidiary BOYD SHARED SERVICES, INC. 01-JUN-07 Subsidiary BOYD TRAVEL, INC. VACATIONS-HAWAII 01-OCT-95 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List SAM'S TOWN HOTEL, GAMBLING HALL & Subsidiary CALIFORNIA HOTEL & CASINO 01-AUG-82 BOWLING CENTER Subsidiary CALIFORNIA HOTEL & CASINO CALIFORNIA HOTEL AND CASINO 01-AUG-82 Subsidiary 20-DEC-16 Subsidiary COAST HOTEL & CASINO 01-FEB-89 Subsidiary CONSTELLATION INSURANCE COMPANY 01-JUL-05 Subsidiary HOTEL AND CASINO 20-DEC-16 Subsidiary ELDORADO, INC. ELDORADO CASINO 01-APR-93 Subsidiary ELDORADO, INC. 01-APR-93 Subsidiary GOLD COAST HOTEL & CASINO 01-FEB-89 MAIN STREET STATION HOTEL, CASINO & Subsidiary M.S.W., INC. 22-NOV-96 BREWERY Subsidiary SAM-WILL, INC. 01-JUL-81 Subsidiary SUNCOAST HOTEL & CASINO, THE 01-FEB-89 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-81

C of A Employer 123011 CAESARS ENTERTAINMENT, INC. Tracey Hudson Director of Risk Management 100 West Liberty St., Suite 1150 Reno NV 89501 775-348-3343

Association Name DBA Date Subsidiary 3535 LV CORP. 20-JUL-20 Subsidiary 3535 LV NEWCO LLC HOTEL AND CASINO (fka The Quad) 20-JUL-20 Subsidiary 3535 LV NEWCO LLC THE LINQ 20-JUL-20 Subsidiary CAESARS ENTERPRISE SERVICES, LLC 20-JUL-20 CAESARS HOLDINGS FKA CAESARS Subsidiary CAESARS HOLDINGS INC. 20-JUL-20 ENTERTAINMENT CORPORATION Subsidiary CAESARS INTERACTIVE ENTERTAINMENT LLC 20-JUL-20 Subsidiary CAESARS LINQ, LLC THE LINQ 20-JUL-20 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Subsidiary CC-RENO, LLC 23-NOV-15 Subsidiary CEOC LLC HARRAH'S CASINO HOTEL RENO 20-JUL-20 Subsidiary CEOC LLC HARRAH'S RENO 20-JUL-20 Subsidiary CIRCUS AND ELDORADO JOINT VENTURE LLC Silver Legacy Hotel Casino 23-NOV-15 Subsidiary COLUMBIA PROPERTIES TAHOE LLC Montbleu 01-OCT-18 Subsidiary CORNER INVESTMENT COMPANY LLC THE CROMWELL 20-JUL-20 Subsidiary DESERT PALACE LLC LAS VEGAS 20-JUL-20 Subsidiary DESERT PALACE LLC CAESARS PALACE 20-JUL-20 Subsidiary EASTSIDE CONVENTION CENTER LLC 20-JUL-20 Subsidiary ELDORADO RESORTS, LLC Eldorado Hotel Casino 01-NOV-82 Subsidiary OPERATING COMPANY, LLC FLAMINGO LAS VEGAS 20-JUL-20 Subsidiary HARRAH SOUTH SHORE CORPORATION 20-JUL-20 Subsidiary HARRAH'S LAS VEGAS, LLC HARRAH'S LAS VEGAS 20-JUL-20 Subsidiary HARRAH'S LAS VEGAS, LLC HARRAH'S CASINO HOTEL, LAS VEGAS 20-JUL-20 Subsidiary HARRAH'S LAUGHLIN, LLC HARRAH'S LAUGHLIN 20-JUL-20 Subsidiary HARVEYS TAHOE MANAGEMENT COMPANY LLC HARRAH'S CASINO HOTEL LAKE TAHOE 20-JUL-20 Subsidiary HARVEYS TAHOE MANAGEMENT COMPANY LLC HARVEY'S /CASINO 20-JUL-20 Subsidiary HARVEYS TAHOE MANAGEMENT COMPANY LLC HARRAH'S LAKE TAHOE 20-JUL-20 Subsidiary HARVEYS TAHOE MANAGEMENT COMPANY LLC HARVEY'S LAKE TAHOE 20-JUL-20 Subsidiary PARBALL LLC 20-JUL-20 Subsidiary PARBALL NEWCO LLC THE SALON AT BALLY'S 20-JUL-20 Subsidiary PARBALL NEWCO LLC BALLY'S LAS VEGAS 20-JUL-20 Subsidiary OPERATING COMPANY, LLC PARIS LAS VEGAS 20-JUL-20 Subsidiary PHW MANAGER, LLC 20-JUL-20 Subsidiary PHWLV, LLC PLANET 20-JUL-20 Subsidiary RIO PROPERTIES, LLC RIO ALL-SUITES HOTEL & CASINO 20-JUL-20 Subsidiary TROPICANA LAUGHLIN LLC Tropicana Laughlin 01-OCT-18 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-NOV-82

C of A Employer 122973 CARSON CITY Cecilia Meyer, ASHM Risk Management Coordinator, CC Finance Division Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 201 North Carson Street Ste 3 Carson City NV 89701 775-283-7484

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-10

C of A Employer 122974 CARSON CITY SCHOOL DISTRICT Ann Cyr Risk Manager 1402 West King Street Carson City NV 89703 775-283-2006

Association Name DBA Date Third Party Administrator DAVIES CLAIMS SOLUTIONS, LLC 01-JUL-10

C of A Employer 122963 CATHOLIC CHARITIES OF SOUTHERN NEVADA Mary Spees

1501 Las Vegas Blvd North Las Vegas NV 89101 702-385-2662

Association Name DBA Date Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 01-OCT-12 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 130131 CHURCHILL COUNTY SCHOOL DISTRICT Christi Fielding Comptroller 690 S MAINE ST FALLON NV 89406-3807 775-428-7220

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-15

C of A Employer 123103 CITY OF HENDERSON Carol Banks Workers' Compensation Analyst 240 Water StreetPO Box 95050, MSC122 Henderson NV 89015 702-267-1922

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-APR-93

C of A Employer 123239 CITY OF LAS VEGAS John Raftery, Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 495 S. Main St. Las Vegas NV 89101 702-229-5048

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 29-DEC-85

C of A Employer 123155 CITY OF NORTH LAS VEGAS William Harty

2250 Las Vegas Blvd NorthSte. 820 North Las Vegas NV 89030 702-633-1462

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JAN-94

C of A Employer 123079 CITY OF RENO Mark Gregersen Director of HR BACK UP 1 E. First Street, 9th Floor Reno NV 89501 775-334-1284

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-SEP-92 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123097 CITY OF SPARKS Jill Valdez Human Resources Analyst 431 Prater Way Sparks NV 89432 775-353-4021

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-FEB-93

C of A Employer 122979 CITYCENTER HOLDINGS, LLC Mike Jokerst Director of Workers Compensation MGM Administration Building71 E Harmon Avenue Las Vegas NV 89109 702-692-9583

Association Name DBA Date Subsidiary LLC 30-NOV-11 Subsidiary CITY CENTER REALTY CORPORATION 30-NOV-11 Subsidiary PROJECT CC, LLC 30-NOV-11 Third Party Administrator SELF-ADMINISTERED 30-NOV-12

C of A Employer Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 123236 CLARK COUNTY Erin DeFrates Employee Benefits Manager Workers' Compensation500 S Grand Central Pkwy Las Vegas NV 89155 702-455-5524

Association Name DBA Date Subsidiary MCCARRAN INTERNATIONAL AIRPORT 15-JUL-85 Subsidiary UNIVERSITY MEDICAL CENTER 01-AUG-86 Subsidiary VOLUNTEER ACCOUNT 01-APR-86 Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 15-JUL-85

C of A Employer 123140 CLARK COUNTY SCHOOL DISTRICT Kimberly Krumland Director III, Risk and Environmental Services 4828 S. Pearl Street MS 200 Las Vegas NV 89121 702-799-6496 x 5690

Association Name DBA Date Third Party Administrator Sierra Nevada Administrators 01-JUL-90

C of A Employer 123152 CLARK COUNTY WATER RECLAMATION DISTRICT Brenda Pappas Assistant General Manager 5857 East Flamingo Road Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Las Vegas NV 89122 702-668-8051

Association Name DBA Date Third Party Administrator DAVIES CLAIMS SOLUTIONS, LLC 01-APR-92

C of A Employer 156199 COMMONSPIRIT HEALTH Alan McVay Insurance Specialist 3900 Olympic Blvd.Suite #400 Erlanger KY 41018 859-594-3039

Association Name DBA Date DIGNITY HEALTH MANAGEMENT SERVICES ORGANIZATION Subsidiary 01-FEB-20 LLP Subsidiary DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC 01-FEB-20 Subsidiary ST ROSE DOMINICAN HEALTH FOUNDATION 01-FEB-20 Subsidiary ST ROSE DOMINICAN HOSPITAL-DE LIMA CAMPUS 01-FEB-20 Subsidiary ST ROSE DOMINICAN HOSPITAL-SAN MARTIN CAMPUS 01-FEB-20 Subsidiary ST ROSE DOMINICAN HOSPITAL-SIENA CAMPUS 01-FEB-20 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-FEB-20

C of A Employer 123087 COSTCO WHOLESALE CORPORATION Uyen Nguyen Integrated Leave Data Analyst 999 Lake Drive Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Issaquah WA 98027 425-313-2874

Association Name DBA Date Third Party Administrator HELMSMAN MANAGEMENT SERVICES LLC 01-JAN-93

C of A Employer 143601 DOUGLAS COUNTY Wendy Lang HR Director PO Box 218 Minden NV 89423 775-782-9860

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-17

C of A Employer 123176 DOUGLAS COUNTY SCHOOL DISTRICT Leeann Caires Benefits & Risk Management Coordinator 1638 Mono Ave. Minden NV 89423 775-782-7177 x 1639

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-94 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123129 ELKO COUNTY SCHOOL DISTRICT Julie Davis Chief Finance Officer 850 Elm Street Elko NV 89801 775-738-5196

Association Name DBA Date Third Party Administrator DAVIES CLAIMS SOLUTIONS, LLC 01-NOV-93

C of A Employer 123143 ENCOMPASS HEALTH CORPORATION Sandy Gilbert Risk Insurance Coordinator 9001 Liberty Parkway Birmingham AL 35242 205-970-3553

Association Name DBA Date Encompass Health Rehabilitation Hospital of Desert Subsidiary Encompass Health Rehabilitation Hospital of Desert Canyon, LLC 01-JUN-10 Canyon Subsidiary Encompass Health Rehabilitation Hospital of Henderson, LLC HealthSouth Home Health of Henderson 01-OCT-01 Encompass Health Rehabilitation Hospital of Subsidiary Encompass Health Rehabilitation Hospital of Henderson, LLC 01-OCT-01 Henderson Encompass Health Rehabilitation Hospital of Las Subsidiary Encompass Health Rehabilitation Hospital of Las Vegas, LLC 01-FEB-96 Vegas Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-AUG-21 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 122931 FEDEX CORPORATION FOR FEDEX GROUND PACKAGE SYSTEM INC Jeff Kulbago Lead, Risk & Insurance 1000 Fedex Drive Moon Twp. PA 15108 412-747-8323

Association Name DBA Date Subsidiary FEDEX GROUND PACKAGE SYSTEM, INC. 01-AUG-96 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-AUG-96

C of A Employer 122936 FEDEX CORPORATION for Federal Express Corporation Gael Johnson Sr. Risk Analyst 3620 Hacks Cross Road Bldg B 2nd Floor Memphis TN 38125 901-434-4557

Association Name DBA Date Subsidiary FEDERAL EXPRESS CORPORATION 01-APR-81 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-APR-81

C of A Employer 123050 FEDEX CORPORATION for Fedex Freight Inc Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Kayla Quandt Advisor - Risk Management 2200 Forward Drive Delivery Code 2256 Harrison AR 72601 870-704-5187

Association Name DBA Date Subsidiary FEDEX FREIGHT INC. 01-NOV-91 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-NOV-91

C of A Employer 123109 LLC Brian Arlin VP/CFO 202 East Fremont Street Las Vegas NV 89101 702-387-5188

Doing Business As FOUR QUEENS HOTEL & CASINO Effective Date: 01-JUN-93

Association Name DBA Date Subsidiary TLC CASINO ENTERPRISES, INC. 01-JAN-08 Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 01-JUN-93

C of A Employer 122964 Focus Plumbing LLC Andrea Gould Risk Manager 1220 S Commerce Street, #120 Las Vegas NV 89102 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 702-220-5621

Association Name DBA Date Subsidiary Focus Concrete 01-JAN-10 Subsidiary Focus Electric 01-JUN-09 Subsidiary Focus Fire Protection LLC 10-JUL-18 Subsidiary Focus Framing, Door & Trim 15-SEP-11 Third Party Administrator SELF-ADMINISTERED 18-AUG-03

C of A Employer 122965 GAUGHAN SOUTH LLC Heather Hall Risk Manager 9777 Las Vegas Blvd South Las Vegas NV 89183 702-797-8245

Doing Business As SOUTH POINT HOTEL AND CASINO Effective Date: 25-OCT-06

Association Name DBA Date Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 25-OCT-06

C of A Employer 122987 GOLDEN NUGGET LLC Lea Ann Lopez Associate Director Risk Management 1510 W Loop South Houston TX 77027 713-386-7202 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

Association Name DBA Date Subsidiary GNL, LLC. GOLDEN NUGGET LAUGHLIN 23-JAN-04 Subsidiary GNLV, LLC 23-JAN-04 Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 23-JAN-04

C of A Employer 123118 HAMILTON HOLDING MANAGEMENT CORP Ashley Rife

4990 Energy Way Reno NV 89502 775-352-3286

Association Name DBA Date Subsidiary HAMILTON COMPANY 01-JUL-93 Third Party Administrator HOMETOWN HEALTH PROVIDERS INSURANCE COMPANY WorkersChoice 01-JUL-93

C of A Employer 123151 HAT LTD A NEVADA LIMITED PARTNERSHIP Kim Hill CFO 63 Keystone Avenue, Suite 202 Reno NV 89503 775-328-6020

Doing Business As MANPOWER TEMPORARY SERVICES Effective Date: 01-MAR-92

Association Name DBA Date Third Party Administrator SELF-ADMINISTERED 01-MAR-92 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123099 HCA HEALTHCARE INC. Leah Larkin Senior Compliance Analyst 2515 Park Plaza Bldg. 2-3E Nashville TN 37203 615-344-1487

Association Name DBA Date COLUMBIA/HCA HEALTHCARE CORPORATION OF CENTRAL Subsidiary 01-JAN-17 TEXAS Subsidiary COSCORP, LLC 23-APR-99 Subsidiary FAR WEST DIVISION, INC. 11-JUL-11 Subsidiary GALEN HEALTH INSTITUTES, INC. 02-JAN-20 Subsidiary HCA - INFORMATION TECHNOLOGY & SERVICES INC 26-APR-19 Subsidiary HCA ASD FINANCIAL OPERATIONS, LLC 03-JUN-11 Subsidiary HCA ASD SALES SERVICES, LLC 26-DEC-10 Subsidiary HCA HUMAN RESOURCES, LLC 01-JAN-15 Subsidiary HCA IT&S FIELD OPERATIONS, INC. IT&S FAR WEST SERVICE CENTER 11-MAY-08 Subsidiary HCA MANAGEMENT SERVICES, LP 01-JAN-99 HEALTHCARE SALES NATIONAL MANAGEMENT SERVICES Subsidiary 01-SEP-09 GROUP LLC Subsidiary INTENSIVE CARE CONSORTIUM, INC. 09-JUN-19 Subsidiary LAS VEGAS ASC, LLC 29-JUL-05 Subsidiary LAS VEGAS SURGICARE, INC. 01-DEC-94 Subsidiary MEDICREDIT, INC. 20-OCT-14 Subsidiary MIDAMERICA ONCOLOGY 26-JUN-17 Subsidiary NATIONAL CONTACT CENTER MANAGEMENT GROUP, LLC 01-APR-16 Subsidiary OUTPATIENT SERVICES HOLDINGS, INC. 18-MAR-13 Subsidiary PARALLON ENTERPRISES, LLC 01-JAN-12 Subsidiary SOUTHERN HILLS MEDICAL CENTER, LLC 01-MAR-04 Subsidiary SUN-MED, LLC 14-JAN-05 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Subsidiary SUNRISE HOSPITAL & MEDICAL CENTER, LLC 01-MAR-93 Subsidiary SUNRISE MOUNTAINVIEW HOSPITAL, INC. 30-JAN-97 Subsidiary SUNRISE MOUNTAINVIEW MULTI-SPECIALTY CLINICS, LLC 01-DEC-07 Subsidiary SURGICARE OF LAS VEGAS, INC. 01-OCT-92 Subsidiary TENNESSEE HEALTHCARE MANAGEMENT INC 01-MAR-05 Subsidiary UR SERVICES, LLC 15-DEC-20 Subsidiary URGENT CARE NEVADA, LLC 01-JAN-16 Third Party Administrator BROADSPIRE SERVICES INC 01-APR-04

C of A Employer 123059 HOME DEPOT USA INC Shemida Hamilton Risk Analyst Store Support Center, Bldg C-202455 Paces Ferry Road, N.W. Atlanta GA 30339 770-333-8211

Association Name DBA Date Subsidiary INTERLINE BRANDS, INC. 01-MAR-16 Subsidiary YOUR 'OTHER' WAREHOUSE 27-JUL-04 Third Party Administrator HELMSMAN MANAGEMENT SERVICES LLC 01-AUG-92

C of A Employer 122983 HUMBOLDT COUNTY SCHOOL DISTRICT Dr. David Jensen Superintendent 310 East Fourth St Winnemucca NV 89445 775-623-8218 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-12

C of A Employer 122842 HYATT CORPORATION Laurene Dufault Consultant, Aon Global Risk Consulting 5600 W. 83rd St. Suite. 1100Risk Management Minneapolis MN 55437 952-807-0701

Association Name DBA Date Subsidiary HYATT CORPORATION 01-FEB-98 Subsidiary HYATT RESIDENTIAL GROUP, INC. 01-NOV-12 Subsidiary SELECT HOTELS GROUP, LLC 05-JAN-08 Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-FEB-98

C of A Employer 123017 IKE GAMING INC Joe Woody Chief Financial Officer 600 East Fremont Street Las Vegas NV 89101 702-474-3613

Doing Business As HOTEL & CASINO Effective Date: 08-MAY-09

Association Name DBA Date Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 09-OCT-83 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 153613 Intermountain Health Care Inc. Harlan Hammond Asst. Vice President c/o Intermountain Health Care Inc.36 S. State Street, 16th Floor Salt Lake City UT 84111 801-381-6731

Association Name DBA Date Subsidiary IHC Health Services Inc. 28-JUN-19 Subsidiary SelectHealth, Inc. 28-JUN-19 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 28-JUN-19

C of A Employer 123048 KENNAMETAL INC Michael Murphy Director, Corporate Risk Management 1600 Technology Way Latrobe PA 15650 724-539-4647

Association Name DBA Date Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 01-OCT-07

C of A Employer 123021 KIEWIT CORPORATION Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Shannon Pechar Risk Management Specialist Kiewit Plaza Omaha NE 68131 402-271-2931

Association Name DBA Date Subsidiary AERO AUTOMATIC SPRINKLER COMPANY 26-AUG-09 Subsidiary CONTINENTAL FIRE SPRINKLER COMPANY 26-FEB-09 Subsidiary KIEWIT INFRASTRUCTURE CO. 01-NOV-99 Subsidiary KIEWIT INFRASTRUCTURE WEST CO. 01-SEP-12 Subsidiary KIEWIT POWER CONSTRUCTORS CO. 29-DEC-07 Subsidiary MASS. ELECTRIC CONSTRUCTION CO. 01-DEC-11 Subsidiary TIC-INDUSTRIAL COMPANY, THE 29-DEC-08 Subsidiary WESTERN SUMMIT CONSTRUCTORS, INC. 29-DEC-08 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-NOV-99

C of A Employer 123052 KINROSS GOLD CORPORATION Caroline Wild Director, Global Pension & Benefits 5075 South Syracuse Street, Suite 800 Denver CO 80237 303-802-1443

Association Name DBA Date Subsidiary KG MINING (BALD MOUNTAIN) INC. 01-JUN-16 Subsidiary ROUND MOUNTAIN GOLD CORP 01-DEC-91 Third Party Administrator TRISTAR RISK MANAGEMENT 01-DEC-91 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 146761 KNIGHT-SWIFT TRANSPORTATION HOLDINGS INC FOR KNIGHT TRANSPORTATION INC Brett Sant SVP - Safety and Risk Management 20002 N. 19th Avenue Phoenix AZ 85027 602-606-6218

Association Name DBA Date Subsidiary KNIGHT-SWIFT TRANSPORTATION HOLDINGS INC. 01-JAN-18 Third Party Administrator YORK RISK SERVICES GROUP INC 08-SEP-17

C of A Employer 122996 KROGER CO (THE) Nathan Fraley Corporate Claims Manager 1014 Vine Street Cincinnati OH 45202 513-762-4360

Association Name DBA Date Subsidiary FRED MEYER JEWELERS, INC 15-NOV-98 Subsidiary QUIK STOP MARKETS, INC. 11-OCT-01 Subsidiary SMITH'S FOOD & DRUG CENTERS, INC. 01-NOV-81 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-NOV-81 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123034 LAS VEGAS CONVENTION AND VISITORS AUTHORITY Jessica Lerner Sr. Manager of People Rewards 3150 PARADISE RD LAS VEGAS NV 89109-9096 702-892-2839

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-02

C of A Employer 123092 LAS VEGAS METROPOLITAN POLICE DEPARTMENT Jeff Roch Director of Risk Management 400 S. Martin Luther King Blvd. Las Vegas NV 89106 702-828-3406

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JAN-93

C of A Employer 122959 LAS VEGAS SANDS CORP George Batarseh Associate General Counsel 3355 Las Vegas Blvd South Las Vegas NV 89109 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 702-414-1395

Association Name DBA Date Subsidiary LAS VEGAS SANDS, LLC 28-APR-89 Subsidiary VENETIAN CASINO RESORT, LLC VENETIAN RESORT HOTEL CASINO 01-JAN-98 Third Party Administrator Sierra Nevada Administrators 28-APR-89

C of A Employer 123037 WATER DISTRICT Kenya Henderson EHS Manager 1001 South Valley View Blvd.m/s 380 Las Vegas NV 89153 702-822-8403

Association Name DBA Date Third Party Administrator Sierra Nevada Administrators 01-JAN-03

C of A Employer 161960 LS GROUP PARENT OPCO LLC Denny Carter Risk Services Manager 20900 Cooley Rd Bend OR 97701 541-416-5479

Association Name DBA Date Subsidiary Les Schwab Tire Centers of Nevada, LLC 02-NOV-20 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-DEC-97

C of A Employer 123040 LYON COUNTY SCHOOL DISTRICT Blake Smith Risk Management 25 East Goldfield Ave Yerington NV 89447 775-463-6800 x 10027

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-03

C of A Employer 122854 MACY'S INC Ann Back Senior Manager, Risk Mgmt Accounting Macy's Corporate ServicesAttn: Ann Back - Risk Accounting Springdale OH 45246 513-562-6647

Association Name DBA Date Subsidiary BLOOMINGDALE'S, INC. 01-NOV-02 Subsidiary Bluemercury, Inc. 29-AUG-16 Subsidiary MACY'S CORPORATE SERVICES, INC. 01-APR-99 Subsidiary MACY'S RETAIL HOLDINGS, INC. 01-MAY-95 Subsidiary MACY'S SYSTEMS AND TECHNOLOGY, INC. 01-APR-99 Subsidiary MACY'S WEST STORES, INC. 01-MAY-95 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 05-MAR-18 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 122999 MARRIOTT INTERNATIONAL INC Steve Huy Compliance Analyst 10400 Fernwood Road Dept 52/924.36 Bethesda MD 20817 301-380-4450

Association Name DBA Date Subsidiary COURTYARD MANAGEMENT CORPORATION 01-AUG-89 Subsidiary FAIRFIELD FMC, LLC 01-NOV-93 Subsidiary MARRIOTT CLAIMS SERVICES CORPORATION 01-OCT-06 Subsidiary MARRIOTT HOTEL SERVICES, INC. 01-DEC-99 Subsidiary MARRIOTT INTERNATIONAL ADMINISTRATIVE SERVICES, INC. 01-OCT-97 Subsidiary RESIDENCE INN BY MARRIOTT, LLC 01-AUG-89 Subsidiary SPRINGHILL SMC, LLC 01-OCT-11 Subsidiary THE RITZ-CARLTON HOTEL COMPANY, LLC 01-OCT-06 Subsidiary W Hotel Managment, Inc. 31-DEC-16 Third Party Administrator SELF-ADMINISTERED 01-FEB-82

C of A Employer 123131 MCDONALD'S CORPORATION Jody Sundquist Insurance Compliance Supervisor 110 North Carpenter Street Chicago IL 60607 630-306-9653 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Association Name DBA Date Subsidiary McDonald's Restaurants of Nevada, Inc. 01-DEC-93 Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-DEC-93

C of A Employer 123082 MCKESSON CORPORATION Debra Levy Director of Claims, Global Risk Management 1110 Sanctuary Parkway Alpharetta GA 30009 770-462-7611

Association Name DBA Date Subsidiary MCKESSON MEDICAL-SURGICAL INC. 01-DEC-97 Subsidiary MCKESSON PHARMACY OPTIMIZATION LLC 01-MAY-08 Subsidiary McKesson Specialty Arizona, Inc. 01-OCT-15 Subsidiary McKesson Specialty Health Technology Products LLC 01-APR-15 Subsidiary US ONCOLOGY RESEARCH LLC 01-JAN-12 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 28-FEB-11

C of A Employer 122978 MESQUITE GAMING LLC Deisy Duran Director, Benefits & Workers Compensation 950 W MESQUITE BLVD MESQUITE NV 89027-5204 702-346-4000 x 3916

Association Name DBA Date Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Subsidiary C&HRV, LLC 04-OCT-11 Subsidiary CasaBlanca Resort & Casino 01-AUG-11 Subsidiary Casablanca Resorts, LLC. 01-AUG-11 Subsidiary Oasis Recreational Properties, Inc. 01-AUG-11 Subsidiary Oasis Resort & Casino 01-AUG-11 Subsidiary RBG, LLC. 01-AUG-11 Subsidiary Virgin River Hotel, Casino, & Bingo 01-AUG-11 Third Party Administrator YORK RISK SERVICES GROUP INC 01-APR-95

C of A Employer 122995 MGM RESORTS INTERNATIONAL Mike Jokerst

MGM ADMINISTRATION BUILDING71 E HARMON AVE LAS VEGAS NV 89109-4539 702-692-9583

Association Name DBA Date Subsidiary 06-OCT-94 Subsidiary M.I.R. Travel 01-JAN-92 Subsidiary MGM Grand Las Vegas 01-DEC-93 Subsidiary MGM Grand Laundry, Inc. 01-DEC-93 Subsidiary MGM Resorts Design & Development 26-OCT-81 Subsidiary LLC 01-APR-98 Subsidiary Mandalay Place 01-MAY-01 Subsidiary Mandalay Resort Group 15-NOV-80 Subsidiary New Castle LLC Excalibur Hotel/Casino 01-OCT-89 Subsidiary New York New York Hotel & Casino 01-DEC-96 Subsidiary Park District Holdings, LLC 18-JUN-13 Subsidiary Ramparts, LLC Luxor Hotal/Casino 01-JUL-93 Subsidiary Shadow Creek 01-MAY-89 Subsidiary Slots-A-Fun 15-NOV-80 Subsidiary Casino-Hotel, LLC 01-MAY-89 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Subsidiary Victoria Partners Park MGM Las Vegas 01-JUL-96 Subsidiary Victoria Partners Monte Carlo 01-JUL-96 Third Party Administrator SELF-ADMINISTERED 26-OCT-81

C of A Employer 123160 MONARCH CASINO & RESORT INC Aaron Theis

3800 S VIRGINIA ST RENO NV 89502-6005 775-335-4534

Association Name DBA Date Subsidiary Golden Road Motor Inn, Inc. Atlantis Casino Resort 01-JAN-94 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JAN-94

C of A Employer 135181 Marnell Gaming, LLC Geri-Lynn VanOrman Risk & Insurance Manager 222 Via Marnell Way Las Vegas NV 89119 707-739-2000 x 2113

Doing Business As Colorado Bell Hotel & Casino Effective Date: 01-APR-15 Doing Business As Edgewater Hotel & Casino Effective Date: 01-APR-15

Association Name DBA Date Subsidiary Nugget Sparks, LLC Nugget Casino Resort 01-MAY-16 Third Party Administrator YORK RISK SERVICES GROUP INC 01-MAY-16 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 122873 NEV YELLOW NEV CHECKER & NEV STAR CAB CORP Zel Bales Payroll Manager/Assistant HR Manager 5225 W POST RD LAS VEGAS NV 89118-4331 702-933-1826

Association Name DBA Date Subsidiary Cab Transport, LLC 28-FEB-19 Subsidiary NewCab 21 LLC Operations Series 01-JUL-20 Subsidiary NewCab ACQ LLC Operations Series 01-JUL-20 Subsidiary NewCab CT LLC Operations Series 01-JUL-20 Subsidiary NewCab TT LLC Operations Series 01-JUL-20 Subsidiary Taxi Management, LLC 28-FEB-19 Subsidiary Taxi Transport, LLC 28-FEB-19 Subsidiary Twenty First Century Taxi, LLC 28-FEB-19 Subsidiary YCS Acquisition, LLC 28-FEB-19 Subsidiary YCS Checker LLC Operations Series 01-JUL-20 Subsidiary YCS Star LLC Operations Series 01-JUL-20 Subsidiary YCS Yellow LLC Operations Series 01-JUL-20 Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-JAN-95

C of A Employer 123170 NEVADA READY MIX CORPORATION Larry Miller Corporate Administrator 151 CASSIA WAY HENDERSON NV 89014-6616 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 702-457-1115 x 3038

Association Name DBA Date Third Party Administrator BENCHMARK ADMINISTRATORS, LLC 01-APR-20

C of A Employer 123045 NEVADA SYSTEM OF HIGHER EDUCATION Lisa Schaller Director of Insurance & Loss Mgt. 2601 Enterprise Rd., Mail Stop 014 Reno NV 89512-1666 775-784-3472

Association Name DBA Date Subsidiary COMMUNITY COLLEGE OF SOUTHERN NEVADA 01-JAN-04 Subsidiary DESERT RESEARCH INSTITUTE 01-JAN-04 Subsidiary GREAT BASIN COLLEGE 01-JAN-04 Subsidiary NEVADA STATE COLLEGE AT HENDERSON 01-JAN-04 Subsidiary TRUCKEE MEADOWS COMMUNITY COLLEGE 01-JAN-04 Subsidiary UNIVERSITY OF NEVADA LAS VEGAS 01-JAN-04 Subsidiary UNIVERSITY OF NEVADA RENO 01-JAN-04 Subsidiary WESTERN NEVADA COMMUNITY COLLEGE 01-JAN-04 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JAN-04

C of A Employer 123039 NEW-COM, INC. Mark Summers Risk Manager 6600 AMELIA EARHART CT STE B Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List LAS VEGAS NV 89119-3535 702-642-3331

Association Name DBA Date Subsidiary Biodiesel of Las Vegas, Inc. 29-JUL-03 Subsidiary L.L.O., Inc. Acme Electric 29-JUL-03 Subsidiary MMC, Inc. MMC Southwest, Inc. 29-JUL-03 Subsidiary TAB Contractors, Inc. 29-JUL-03 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 29-JUL-03

C of A Employer 122968 NEWMONT CORPORATION Jim Yates Sr. Director , Risk Finance 6900 E Layton AvenueSuite 800 Denver CO 80237 720-299-6147

Doing Business As Newmont Mining Corpoation Effective Date: 29-APR-08

Association Name DBA Date Subsidiary Battle Mountain Gold Company 29-APR-08 Subsidiary Elko Land and Livestock Company 29-APR-08 Subsidiary Fronteer Gold 06-APR-11 Subsidiary Newmont Exploration Ltd. 29-APR-08 Subsidiary Newmont Global Employment Ltd Partnership 29-APR-08 Subsidiary Newmont Gold Company 29-APR-08 Subsidiary Newmont Indonesia Investment Ltd 29-APR-08 Subsidiary Newmont International Services Ltd. 29-APR-08 Subsidiary Newmont Nevada Energy Investment, LLC 29-APR-08 Subsidiary Newmont USA Ltd Newmont Mining Corporation 20-SEP-08 Subsidiary Santa Fe Pacific Gold Corporation 29-APR-08 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Subsidiary Turquoise Ridge JV 29-APR-08 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 29-APR-08

C of A Employer 123064 NV ENERGY INC Eric Wright

6226 W SAHARA AVE LAS VEGAS NV 89146-3060 702-402-5343

Association Name DBA Date Subsidiary NV ENERGY POWER COMPANY 01-JUL-94 Subsidiary Nevada Power Company 28-JUL-99 Subsidiary Sierra Pacific Power Company 01-JUL-92 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-FEB-18

C of A Employer 122969 NYE COUNTY SCHOOL DISTRICT Raymond Ritchie CFO 484 S WEST ST PAHRUMP NV 89048-2104 775-727-7743 x 234

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-08 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 163132 Nye County Lorina Dellinger Assistant County Manager PO Box 153 Tonopah NV 89049 775-482-7319

Association Name DBA Date Subsidiary Amargosa Valley, Town of 18-JUN-21 Subsidiary Beatty General Improvement District 18-JUN-21 Subsidiary Beatty, Town of 18-JUN-21 Subsidiary Gabbs, Town of 18-JUN-21 Subsidiary Nye County Water District 18-JUN-21 Subsidiary Pahrump, Town of 18-JUN-21 Subsidiary Tonopah Ambulance 18-JUN-21 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-21

C of A Employer 122871 PACCAR INC Alison Lowe

PO BOX 1518 BELLEVUE WA 98009-1518 425-468-7384

Association Name DBA Date Subsidiary PACCAR PARTS DIVISION 01-JAN-95 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-JAN-95 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 122953 PEPPERMILL CASINOS INC Michael Heward Director of Risk Management 380 Brinkby Ave, Suite B Reno NV 89509 775-689-8992

Association Name DBA Date Subsidiary Nevada Properties Peppermill Hotel & Casino 01-JUL-98 Subsidiary Peppermill Hotel, Reno 01-JUL-98 Subsidiary Rainbow Associates, Inc. Rainbow Club 01-JUL-98 Subsidiary Rainbow Casino, The 31-JAN-95 Subsidiary Wendover Properties Peppermill Inn & Casino 01-JUL-88 Subsidiary Western Village Limited Partnership Western Village Casino 01-JUL-98 Third Party Administrator HOMETOWN HEALTH PROVIDERS INSURANCE COMPANY WorkersChoice 11-SEP-13

C of A Employer 122981 PILOT TRAVEL CENTERS, LLC Bill Beuchat Senior Risk Manager PO BOX 10146 KNOXVILLE TN 37939-0146 800-562-6210 x 2902

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-SEP-17

C of A Employer Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 122971 POLY-AMERICA FOR POLY-WEST INC Kelsey Pigneri Human Resources Manager 2000 West Marshall Drive Grand Prairie TX 75051 972-337-7619

Association Name DBA Date Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-FEB-09

C of A Employer 123219 PURCELL TIRE & RUBBER COMPANY Roxanna Wilson Claims Administrator 301 N HALL ST POTOSI MO 63664-1403 573-438-2131 x 1153

Association Name DBA Date Subsidiary Purcell Tire & Rubber Company Purcell Tire and Service Center 01-JAN-98 Subsidiary Purcell Tire Company Tires @ Wholesale 01-JAN-98 Subsidiary Purcell Tire Company Purcell's Western States Tire 01-JAN-98 Subsidiary Purcell Tire Company Purcell Tire and Service Center 01-JAN-98 Subsidiary Purcell Tire NW, Inc. 14-SEP-16 Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-JAN-98

C of A Employer 123242 RALEY'S INC Fiona Williams Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Senior Risk Manager 500 W Capitol Ave West Sacramento CA 95605 916-373-6214

Doing Business As RALEY'S AISLE 1 Effective Date: 30-JUN-14

Association Name DBA Date Subsidiary Warehouse Concepts, a California Corporation Beverage Market 17-FEB-11 Subsidiary Warehouse Concepts, a California Corporation Food Source 17-FEB-11 Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-JUL-86

C of A Employer 123237 RENOWN HEALTH Shawn Lavac Risk Management Workers' Compensation 1155 MILL ST MS J-11 RENO NV 89502-1576 775-982-6902

Association Name DBA Date Subsidiary HOMETOWN HEALTH MGT CO 01-JAN-89 Subsidiary HOMETOWN HEALTH PLAN INC. 01-JAN-89 Subsidiary RENOWN BUSINESSES 01-JAN-92 Subsidiary RENOWN HEALTH FOUNDATION 01-JAN-89 Subsidiary RENOWN NETWORK SERVICES 01-JAN-89 Subsidiary RENOWN REGIONAL MEDICAL CENTER 01-AUG-85 Subsidiary RENOWN SKILLED NURSING 17-JUN-04 Subsidiary RENOWN SOUTH MEADOWS MEDICAL CENTER 01-FEB-99 Third Party Administrator HOMETOWN HEALTH PROVIDERS INSURANCE COMPANY WorkersChoice 01-AUG-95 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123238 RIVERSIDE RESORT & CASINO Steve Willett Director Human Resources 1650 S Casino Center Drive Laughlin NV 89029 702-298-2535

Association Name DBA Date Subsidiary LAUGHLIN TRANSIT, INC. 09-JUL-03 Third Party Administrator YORK RISK SERVICES GROUP INC 28-SEP-85

C of A Employer 153157 Robertson's Ready Mix, Ltd. Hortick Roger

200 S. Main St., Suite 200 Corona CA 92882 951-493-6500

Association Name DBA Date Third Party Administrator MATRIX ABSENCE MANAGEMENT INC 11-JUN-19

C of A Employer 123217 SCHNEIDER NATIONAL INC Amy Sawyer Risk Insurance Analyst Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 3101 PACKERLAND DR GREEN BAY WI 54313-6187 920-592-3071

Association Name DBA Date Subsidiary SCHNEIDER LOGISTICS, INC. 01-JAN-98 Subsidiary SCHNEIDER NATIONAL BULK CARRIERS 01-JAN-98 Subsidiary SCHNEIDER NATIONAL CARRIERS 01-JAN-98 Subsidiary SCHNEIDER SPECIALIZED CARRIERS 01-JAN-98 Subsidiary SCHNEIDER TANK LINES 01-JAN-98 Subsidiary SCHNEIDER TRANSPORT, INC. 01-JAN-98 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-MAR-17

C of A Employer 123154 SHERWIN-WILLIAMS COMPANY Anthony Colangelo Manager Workers Comp 101 Prospect Avenue NW Cleveland OH 44115-1075 216-566-3095

Association Name DBA Date Subsidiary SHERWIN-WILLIAMS MANUFACTURING COMPANY 01-JAN-18 Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-AUG-17

C of A Employer 123201 SILVERTON CASINO LLC & MAJESTIC NV PROPERTY HOLDINGS LLC Darlene Koch HR Benefits Manager Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 3333 BLUE DIAMOND RD LAS VEGAS NV 89139-7888 702-914-8513

Association Name DBA Date Subsidiary MNPH Hotels, LLC Hyatt Place Las Vegas at Silverton Village 01-JUL-19 Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-97

C of A Employer 123167 SOUTHWEST AIRLINES CO Patti Colwell Manager Workers' Compensation 2195 Research Row, WGS-1SE DALLAS TX 75235 469-603-4828

Association Name DBA Date Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-MAR-94

C of A Employer 122955 SOUTHWEST GAS CORPORATION Bradley Anderson Corporate Risk Management PO BOX 98510 LAS VEGAS NV 89193-8510 702-876-7017

Association Name DBA Date Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Third Party Administrator SELF-ADMINISTERED 01-JUL-88

C of A Employer 122976 STATION CASINOS LLC Tim Cameron Corp Director Risk Management 1505 S PAVILION CENTER DR LAS VEGAS NV 89135-1403 702-495-3476

Association Name DBA Date Subsidiary FP Holding, L.P. dba 01-OCT-16 Subsidiary GREENS CAFE, LLC dba The Greens The Greens 14-JUN-11 Subsidiary N-M Ventures II LLC 01-OCT-16 Subsidiary N-M Ventures LLC 01-OCT-16 Subsidiary NP BOULDER LLC dba Hotel & Casino Boulder Station Hotel & Casino 14-JUN-11 Subsidiary NP FIESTA LLC dba Fiesta Casino Hotel Fiesta Casino Hotel 14-JUN-11 Subsidiary NP GOLD RUSH LLC dba Wildfire Sunset Wildfire Sunset 14-JUN-11 Subsidiary NP LAKE MEAD LLC dba Casino Hotel Fiesta Henderson Casino Hotel 14-JUN-11 Subsidiary NP LML LLC dba Wildfire Casino - Lake Mead Wildfire Casino - Lake Mead 14-JUN-11 Subsidiary NP MAGIC STAR LLC dba Wildfire Casino - Boulder Wildfire Casino - Boulder 14-JUN-11 Subsidiary NP PALACE LLC dba Hotel & Casino Palace Station Hotel & Casino 14-JUN-11 Subsidiary NP RANCHO LLC dba Wildfire Casino Wildfire Casino 14-JUN-11 Subsidiary NP RED ROCK LLC dba Red Rock Casino Resort Spa Red Rock Casino Resort Spa 14-JUN-11 Subsidiary NP SANTA FE LLC dba Hotel & Casino Santa Fe Station Hotel & Casino 14-JUN-11 Subsidiary NP SUNSET LLC dba Sunset Station Hotel & Casino Sunset Station Hotel & Casino 14-JUN-11 Subsidiary NP TEXAS LLC dba Gambling Hall & Hotel Texas Station Gambling Hall & Hotel 14-JUN-11 Subsidiary NP TROPICANA LLC dba Days Inn @ Wild Wild West Gambling Hall Days Inn @Wild Wild West Gambling Hall 14-JUN-11 Subsidiary PPII Holdings, L.L.C. 01-OCT-16 Subsidiary LLC dba Palms Place 01-OCT-16 Subsidiary SC SP 2 LLC dba Wildfire Valley View Wildfire Valley View 30-SEP-14 Subsidiary SC SP 4 LLC dba Wildfire Anthem Wildfire Anthem 30-SEP-14 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List STATION GVR ACQUISITION, LLC dba Resort Subsidiary Green Valley Ranch Resort Spa Casino 14-JUN-11 Spa Casino Subsidiary SUNSET GV, LLC dba Wildfire Casino and Lanes Wildfire Casino and Lanes 14-JUN-11 TOWN CENTER AMUSEMENTS, INC. A LIMITED LIABILITY Subsidiary Barley's Casino & Brewing Company 14-JUN-11 COMPANY dba Barley's Casino & Brewing Company Third Party Administrator YORK RISK SERVICES GROUP INC 11-SEP-13

C of A Employer 135224 T & R CONSTRUCTION GROUP HAGAI RAPPAPORT CEO 235 W BROOKS AVE NORTH LAS VEGAS NV 89030-3925 818-779-3828

Association Name DBA Date Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 01-DEC-97

C of A Employer 123055 TARGET CORPORATION Laurene Dufault Consultant - Risk Consulting AON Global Risk Consulting5600 W 83rd St. MINNEAPOLIS MN 55437 952-807-0701

Association Name DBA Date Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-FEB-92 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 122972 TREASURE ISLAND LLC Tara Cummins V/P Human Resources 2880 SOUTH LAS VEGAS BLVD LAS VEGAS NV 89109 702-894-7506

Association Name DBA Date Subsidiary CIRCUS CIRCUS LV LLC CIRCUS CIRCUS HOTEL & CASINO 20-MAR-20 Third Party Administrator YORK RISK SERVICES GROUP INC 01-AUG-09

C of A Employer 123180 TRUE BLUE INC Tori Livernash Risk Specialist 1015 A Street TACOMA WA 98402 253-680-8498

Association Name DBA Date Subsidiary PeopleReady. Inc. 20-SEP-16 Third Party Administrator ESIS INC 11-SEP-13

C of A Employer 123102 US FOODS INC Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List Cinthia Castillo Risk Analyst 9399 W. Higgins RoadSuite 100 Rosemont IL 60018 847-720-8206

Association Name DBA Date Subsidiary AMERISTAR MEATS, INC 13-SEP-19 Subsidiary FOOD SERVICES OF AMERICA, INC 13-SEP-19 Subsidiary SMART FOODSERVICE STORES, LLC 24-APR-20 Subsidiary STOCKYARDS OF LAS VEGAS HARRISON'S PRIMEMEATS AND PROVISIONS 01-MAR-97 Subsidiary STOCKYARDS OF LAS VEGAS OUTWEST MEAT COMPANY 01-APR-98 Subsidiary SYSTEM SERVICES OF AMERICA, INC 13-SEP-19 Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-APR-93 Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-NOV-16

C of A Employer 123153 VIAD CORP Matt Heacock Assistant Client Services Specialist 16220 N SCOTTSDALE RD STE 600 SCOTTSDALE AZ 85254-1804 602-787-6112

Association Name DBA Date Subsidiary Global Experience Specialists, Inc. 02-FEB-10 Subsidiary ON Services AV Specialists, Inc. 11-AUG-18 Subsidiary Shows Unlimited, Inc. 01-JAN-97 Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-SEP-91 Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List

C of A Employer 123024 WASHOE COUNTY Celeste Wallick Risk Analyst 1001 E. Ninth Street RENO NV 89520 775-328-2662

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-81

C of A Employer 123035 WASHOE COUNTY SCHOOL DISTRICT Brandon Perry Risk Coordinator PO BOX 30425 RENO NV 89520-3425 775-348-3854

Association Name DBA Date Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-86

C of A Employer 123036 WENDOVER CASINOS INC Michael Heward Director of Risk Management Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 380 Brinkby Ave, Suite B Reno NV 89509 775-689-8992

Doing Business As Montego Bay Casino and Resort Effective Date: 29-JUL-02

Association Name DBA Date Subsidiary PPLLC 19-DEC-02 Third Party Administrator HOMETOWN HEALTH PROVIDERS INSURANCE COMPANY WorkersChoice 19-DEC-02

C of A Employer 122888 WESTERN STATES CONTRACTING INC Kade Stratton CFO 4129 W Cheyenne, Suite A North Las Vegas NV 89032 702-644-1117

Association Name DBA Date Subsidiary BDF Employment Services LLC 15-JAN-13 Subsidiary Badger Underground 31-DEC-17 Subsidiary Tejas Underground LLC 01-MAY-98 Subsidiary WS-Dynoco II, LLC 21-FEB-14 Subsidiary Western States Ranches LLC 01-DEC-20 Third Party Administrator SELF-ADMINISTERED 01-SEP-95

C of A Employer 123231 YOUNG ELECTRIC SIGN COMPANY Clark Smith Director of Finance/Treasurer Department of Business and Industry Nevada Division of Insurance Self-Insured Employer List 1605 Gramercy Road Salt Lake City UT 84104 801-464-4600

Association Name DBA Date Subsidiary YESCO ADMINISTRATION LLC 01-JAN-08 Subsidiary YESCO OUTDOOR MEDIA LLC 01-JAN-08 Subsidiary YESCO, LLC 01-JAN-08 Third Party Administrator NEVADA ALTERNATIVE SOLUTIONS INC 05-JUL-84

C of A Employer 123240 YRC, INC. Greg Zinkiewicz Sr. Risk Analyst 10990 ROE AVE OVERLAND PARK KS 66211-1213 913-266-6573

Doing Business As YRC FREIGHT Effective Date: 01-FEB-12

Association Name DBA Date Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC Sedgwick 01-MAY-86