OKLAHOMA WORKERS' COMPENSATION COMMISSION and COURT of EXISTING CLAIMS Rpt ID: CARLST Time: 10:07 CARRIER LISTING Page: 1 TYPE: OWN RISK

Date: 01/04/2021 OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS Rpt ID: CARLST Time: 10:07 CARRIER LISTING Page: 1 TYPE: OWN RISK

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0083 C 4 STAR TRAILERS INC (OWN RISK) 0001 C AAON INC (OWN RISK) C/O INSURICA CLAIM MGMT - WAYNE OSMOND ATTN: NATALY KADDOURA PO BOX 25928 2425 S YUKON AVE OKLAHOMA CITY, OK 73125- TULSA, OK 74107-2728

0002 C ABF FREIGHT SYSTEM INC (OWN RISK) 0003 C ACME ENGINEERING & MANUFACTURING CORP (OWN RISK) ATTN: RACHELLE PRATT C/O CONSOLIDATED BENEFITS RESOURCES PO BOX 10048 ATTN: RICHARD FISHER FT SMITH, AR 72917-0048 PO BOX 581630 TULSA, OK 74158-1630

1340 C AHS HILLCREST HEALTHCARE SYSTEM LLC ( OWN RISK) 0008 S ALLIANCE STEEL INC (OWN RISK #18746) ATTN: SONYA WILBURN C/O RMS CLAIMS & RISK SERVICES - BEN ANDERSON ONE BURTON HILLS BLVD STE 250 PO BOX 21450 NASHVILLE, TN 37215- OKLAHOMA CITY, OK 73120-

0009 C ALLIED STEEL CONSTRUCTION CO LLC (OWN RISK) 1177 S AMERICAN ELECTRIC POWER CO (OWN RISK) C/O RMS CLAIMS & RISK SERVICES - SANDY CASSADY C/O CCMSI - MISTY JONES PO BOX 21450 1501 N UNIVERSITY AVE STE 767 OKLAHOMA CITY, OK 73156- LITTLE ROCK, AR 72207-5238

1329 S AMERICAN WASTE CONTROL INC (OWN RISK #19614) 0013 C AMITY CARE LLC (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISEHR ATTN: MICHAEL DEYONG PO BOX 581630 4350 WILL ROGERS PKWY STE 300 TULSA, OK 74158-1630 OKLAHOMA CITY, OK 73108-

0015 C ARCHDIOCESE OF OKLAHOMA CITY (OWN RISK) 1644 S ASCENSION HEALTH ALLIANCE (OWN RISK) SEDGWICK CLAIMS MGNT SERVICES - JHONNA GHRIGSBY C/O SEDGWICK CMS 131 SAUNDERVILLE RD STE 220 ATTN: MICHAEL BROWNING HENDERSONVILLE, TN 37075- 111 WESTPORT PLAZA DR STE 900 ST LOUIS, MO 63146-

* Inv Flag 'S' indicates Service Company, 'C' indicates Corporate Date: 01/04/2021 OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS Rpt ID: CARLST Time: 10:07 CARRIER LISTING Page: 2 TYPE: OWN RISK

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0019 S ASSOCIATED WHOLESALE GROCERS INC (OWN RISK) 0022 C BAMA COMPANIES INC (OWN RISK #14563) C/O SEDGWICK CMS - MERISSA RIOS UNITED SAFETY & CLAIMS - CHALI STEVENS 6100 TENNYSON PKWY SUITE 230 PO BOX 471647 PLANO, TX 75024- TULSA, OK 74147-1647

1611 S BANCFIRST CORP (OWN RISK #20060) 0023 S BAPTIST GENERAL CONVENTION OF OKLAHOMA (OWN RISK) C/O RMS CLAIMS & RISK SERVICES - VERN STONECIPHER CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 21450 PO BOX 581630 OKLAHOMA CITY, OK 73156- TULSA, OK 74158-1630

1246 C BECCO CONTRACTORS INC (OWN RISK) 0026 S BELGER CARTAGE SERVICE INC (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER SMARTCASUALTYCLAIMS PO BOX 581630 ATTN: JENE HUCKABAY TULSA, OK 74158- PO BOX 42048 OKLAHOMA CITY, OK 73134-

1793 S BEN E KEITH COMPANY (OWN RISK) 1279 S BENNETT STEEL INC (OWN RISK) C/O TERRY M KOLLMORGEN GALLAGHER BASSETT SERVICES - STACY KARBS 401 S BOSTON AVE STE 1100 14000 QUAIL SPRINGS PARKWAY STE 3000 TULSA, OK 74103- OKLAHOMA CITY, OK 73134-

0028 S BILLINGS FAIRCHILD CENTER INC (OWN RISK) 0033 C BRAUMS INC (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER ATTN: STEVE VANARSDEL PO BOX 581630 3000 NE 63 ST TULSA, OK 74158- OKLAHOMA CITY, OK 73121-

0035 S BROKEN ARROW PUBLIC SCHOOLS (OWN RISK #18680) 0036 S BRUNSWICK CORP (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER C/O ESIS - JENNIFER HARDEMAN PO BOX 581630 PO BOX 6563 TULSA, OK 74158-1630 SCRANTON, PA 18505-6563

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0045 C CHEVRON USA INC (OWN RISK #16347) 0004 S CITY OF ADA (OWN RISK) C/O BROADSPIRE SERVICES INC - EMMA WILLIAMS C/O UNITED SAFETY & CLAIMS - CHALI STEVENS PO BOX 14351 PO BOX 471647 LEXINGTON, KY 40512- TULSA, OK 74147-1647

0016 C CITY OF ARDMORE (OWN RISK) 0024 C CITY OF BARTLESVILLE (OWN RISK) C/O RMS CLAIMS & RISK SERVICES - BEN ANDERSON CONSOLIDATED BENEFITS RESOURCES- R FISHER PO BOX 21450 PO BOX 581630 OKLAHOMA CITY, OK 73156- TULSA, OK 74158-1630

0034 S CITY OF BROKEN ARROW (OWN RISK #14157) 1620 S CITY OF CLAREMORE (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER C/O UNITED SAFETY & CLAIMS - JEFF MORRISON PO BOX 581630 PO BOX 471647 TULSA, OK 74158-1630 TULSA, OK 74147-

0061 S CITY OF DEL CITY (OWN RISK) 0066 S CITY OF DUNCAN (OWN RISK #11051) ATTN: MADONNA SANDERS C/O RISK MANAGEMENT SERV INC - BEN ANDERSON 3701 SE 15TH PO BOX 21450 DEL CITY, OK 73115- OKLAHOMA CITY, OK 73156-

0068 C CITY OF DURANT (OWN RISK) 0071 S CITY OF EDMOND (OWN RISK #14514) C/O BARNUM & CLINTON PLLC - CATHY C BARNUM C/O CCMSI 1011 24TH AVE NW ATTN: LASHAWNA SEARS NORMAN, OK 73069- 1501 N UNIVERSITY STE 767 LITTLE ROCK, AR 72207-

0072 S CITY OF EL RENO (OWN RISK) 0075 S CITY OF ENID (OWN RISK) C/O SMARTCASUALTYCLAIMS ATTN: CAROL LAHMAN ATTN: JENE HUCKABAY PO BOX 1768 PO BOX 42048 ENID, OK 73702- OKLAHOMA CITY, OK 73123-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0129 S CITY OF LAWTON (OWN RISK) 0145 S CITY OF MCALESTER (OWN RISK) C/O UNITED SAFETY & CLAIMS - CHALI STEVENS CONSOLIDATED BENEFITS SOLUTIONS - R FISHER PO BOX 471647 PO BOX 581630 TULSA, OK 74147-1647 TULSA, OK 74158-1630

0665 C CITY OF MIAMI (OWN RISK) 0149 C CITY OF MIDWEST CITY (OWN RISK #13308) CONSOLIDATED BENEFITS RESOURCES - R FISHER CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 58160 PO BOX 581630 TULSA, OK 74158-1630 TULSA, OK 74158-1630

0152 S CITY OF MOORE (OWN RISK) 0156 S CITY OF MUSKOGEE (OWN RISK) C/O CONSOLIDATED BENEFITS RESOURCES C/O UNITED SAFETY & CLAIMS - JEFF MORRISON ATTN: RICHARD FISHER PO BOX 471647 PO BOX 581630 TULSA, OK 74147- TULSA, OK 74158-1630

0158 C CITY OF MUSTANG (OWN RISK) 0161 C CITY OF NORMAN (OWN RISK) SMARTCASUALTYCLAIMS - JENE HUCKABAY ATTN: KATHRYN WALKER PO BOX 42048 PO BOX 370 OKLAHOMA CITY, OK 73123- NORMAN, OK 73070-

0164 C CITY OF OKLAHOMA CITY (OWN RISK) 0175 S CITY OF OWASSO (OWN RISK) C/O CITY OF OKC RISK MGMT DIVISION C/O UNITED SAFETY & CLAIMS - ROD RANDALL ATTN: LA VETA BREATH PO BOX 471647 420 W MAIN ST STE 630 TULSA, OK 74147-1647 OKLAHOMA CITY, OK 73102-

0180 S CITY OF PONCA CITY (OWN RISK) 0190 C CITY OF SHAWNEE (OWN RISK) UNITED SAFETY & CLAIMS - JANET KNOERNSCHILD CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 471647 PO BOX 581630 TULSA, OK 74147-1647 TULSA, OK 74158-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0208 S CITY OF STILLWATER (OWN RISK #11364) 0213 C CITY OF TULSA (OWN RISK #10435) CONSOLIDATED BENEFITS RESOURCES - R FISHER C/O BRANDON DODD PO BOX 581630 175 E 2 ST STE 1450 TULSA, OK 74158-1630 TULSA, OK 74127-

0057 S COF AGGREGATE HOLDINGS INC FKA CUST O FAB INC (OWN 0048 S COMANCHE COUNTY MEMORIAL HOSPITAL (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER C/O SMARTCASUALTYCLAIMS PO BOX 581630 ATTN: JENE HUCKABAY TULSA, OK 74158- PO BOX 42048 OKLAHOMA CITY, OK 73123-

0056 C CUMMINS CONSTRUCTION CO INC (OWN RISK) 0063 C DOLESE BROS CO (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - F FISHER C/O CONSOLIDATED BENE RES - JERRY WHORTON PO BOX 581630 PO BOX 581630 TULSA, OK 74158-1630 TULSA, OK 74158-

0064 C DOLLAR GENERAL CORP (OWN RISK) 1354 C DUNCAN REGIONAL HOSPITAL INC (OWN RISK) ATTN: MICHELLE HUGHES C/O UNITED SAFETY & CLAIMS - CHALI STEVENS PO BOX 1728 PO BOX 471647 GOODLETTSVILLE, TN 37070-1728 TULSA, OK 74147-

1738 S EJ AMERICAS LLC (OWN RISK #19189) 1362 C EVANS & ASSOCIATES ENTERPRISES INC (OWN RISK #1972 C/O THE ASU GROUP - CHAD JOHNSON EVANS & ASSOCIATES ENTERPRISES INC - BRAD FOX PO BOX 77 PO BOX 30 OKEMOS, MI 48805- PONCA CITY, OK 74602-

0077 C FEDERAL EXPRESS CORP (OWN RISK) 0011 C FEDEX FREIGHT INC (OWN RISK #16728) C T CORPORATION C/O SEDGWICK CMS - ANTHONY CHAPPELL 1833 S MORGAN RD PO BOX 14499 OKLAHOMA CITY, OK 73128- LEXINGTON, KY 40512-4499

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

1134 C FEDEX GROUND PACKAGE SYSTEM INC (OWN RISK) 0084 S FRANKLIN ELECTRIC CO INC (OWN RISK) C/O SEDGWICK CLAIMS MANAGEMENT SERVICES INC C/O HELMSMAN MGMT SERV INC -MATT SEKULA ATTN: LATRICE HAYES 175 BERKELEY STREET PLAZA OF AMERICAS 600 N PEARL ST STE 1200 BOSTON, MA 02116- DALLAS, TX 75201-

1922 C GGP PARKS LLC 0091 C GOODYEAR TIRE & RUBBER CO (OWN RISK) ATTN: WILLIAM STAVA III C/O HELMSMAN MGMT SERV LLC - MATT SEKULA 7030 S YALE AVE STE 600 175 BERKELEY ST TULSA, OK 74136- BOSTON, MA 02116-

0092 C GRADY MEMORIAL HOSPITAL (OWN RISK) 1601 S HAC INC (OWN RISK #20023) C/O SMARTCASUALTYCLAIMS THE CORPORATION COMPANY ATTN: JENE HUCKABAY 1833 S MORGAN RD PO BOX 42048 OKLAHOMA CITY, OK 73128- OKLAHOMA CITY, OK 73123-

0098 C HARPS FOOD STORES (OWN RISK #18353) 0099 C HASKELL LEMON CONSTRUCTION CO (OWN RISK #16937) C/O CANNON COCHRAN MGMT SERV INC CONSOLIDATED BENEFITS RESOURCES - R FISHER ATTN: DAN EVERSOLE PO BOX 581630 133 S 11 ST STE 430 TULSA, OK 74158- ST LOUIS, MO 63102-

1395 S HEALTH CARE SERVICE CORP (OWN RISK) 0055 C HILLCREST HOLDINGS DBA CRST INTL INC (OWN RISK) C/O BROADSPIRE SERVICES INC ATTN: JASON M STEFFENS ATTN: KATY PINEDA PO BOX 68 8827 W SAM HOUSTON PKWY NORTH STE 110 CEDAR RAPIDS, IA 52406- HOUSTON, TX 77040-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0103 S HITCH ENTERPRISES INC (OWN RISK) 0105 S HOLCIM US INC (OWN RISK #18482) UNITED SAFETY & CLAIMS - ROD RANDALL C/O SEDGWICK CMS - V VANSYCKLE PO BOX 471647 PO BOX 14152 TULSA, OK 74147- LEXINGTON, KY 40512-

0107 C HUDIBURG AUTO GROUP (OWN RISK #17922) 0108 S HUGHES ANDERSON HEAT EXCHANGERS INC (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 581630 PO BOX 581630 TULSA, OK 74158- TULSA, OK 74158-1630

1300 C INDEPENDENT OPPORTUNITIES INC (OWN RISK) 0214 C INDEPENDENT SCHOOL DISTRICT#1-TULSA SCHOOLS(OWN RI C/O SMARTCASUALTYCLAIMS C/O SEDGWICK CLAIMS MGMT SERV INC - HARMONY KMOSKO ATTN: JENE HUCKABAY 10535 BOYER BLVD STE 100 PO BOX 42048 AUSTIN, TX 78758- OKLAHOMA CITY, OK 73123-

0111 S INTEGRIS HEALTH INC (OWN RISK) 0112 S INTERNATIONAL PAPER CO (OWN RISK #14354) JOHN VERA C/O SEDGWICK CMS 3366 NW EXPRESSWAY STE 800 ATTN: DOROTHY FRITZ OKLAHOMA CITY, OK 73112- PO BOX 14484 LEXINGTON, KY 40512-

0858 C JM FARMS LLC FKA JM FARMS INC (OWN RISK #17737) 0120 C JOHN CHRISTNER TRUCKING LLC (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - RICHARD FISHER CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 581630 PO BOX 581630 TULSA, OK 74158- TULSA, OK 74158-

1298 C JOHNS MANVILLE CORP (OWN RISK) 0122 S KAISER FRANCIS OIL CO (OWN RISK #14631) C/O ESIS C/O UNITED SAFETY & CLAIMS - JEFF MORRISON ATTN: FRANCES BROWN PO BOX 471647 PO BOX 6563 TULSA, OK 74147- SCRANTON, PA 18505-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0087 C KELVION INC FKA GEA HEAT EXCHNGRS INC (OWN RISK) 0125 C KIEWIT CORP (OWN RISK #17830) C/O UNITED SAFETY & CLAIMS - JEFF MORRISON C/O SEDGWICK CLAIMS MGMT SERV- DAVID WITHERS PO BOX 471647 4141 N 156 ST 2 FL TULSA, OK 74147- OMAHA, NE 68116-

0802 S KIMBERLY CLARK CORP (OWN RISK) 0126 C KIMRAY INC (OWN RISK) C/O PARKER SERVICES LLC - G KONKOL C/O MIDLANDS CLAIMS ADMINISTRATORS PO BOX 8032 ATTN: HEATHER JENNINGS STEVENS POINT, WI 54481- 3817 NW EXPY STE 1000 OKLAHOMA CITY, OK 73112-

1398 C KNIGHT TRANSPORTATION INC (OWN RISK) 0135 S LOPEZ FOODS INC (OWN RISK) C/O YORK RISK SERVICES - MISUM YUN C/O UNITED SAFETY & CLAIMS - CHALI STEVENS PO BOX 619079 PO BOX 471647 PHOENIX, AZ 85027- TULSA, OK 74147-

0137 S LOWES HOME CENTERS LLC (OWN RISK) 1392 S MACYS INC (OWN RISK) C/O SEDGWICK CMS - LAFONDA THOMPSON CHAD WHITTEN PO BOX 14671 9422 S ELWOOD AVE LEXINGTON, KY 40512- JENKS, OK 74037-

0141 S MARRIOTT INTERNATIONAL INC (OWN RISK) 1317 C MATHIS BROS OKLAHOMA CITY LLC (OWN RISK #19602) C/O MARRIOTT CLAIMS SERV CORP - GENE CONE ATTN: CHARLES FOLKNER 2701 DALLAS PKWY 234 QUADRUM DR PLANO, TX 75093- OKLAHOMA CITY, OK 73108-

0144 C MAZZIOS LLC (OWN RISK) 1145 S MD BUILDING PRODUCTS INC (OWN RISK #19104) ATTN: HEATHER MATHIAS C/O RMS CLAIMS & RISK SERVICES LLC - V STONECIPHER 4441 S 72ND E AVE PO BOX 21450 TULSA, OK 74145- OKLAHOMA CITY, OK 73156-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0146 C MELTON TRUCK LINES INC (OWN RISK) 0196 S MERCY HEALTH FKA SISTERS OF MERCY (OWN RISK) ATTN: SCOTT STEPHAN ATTN: SANDI MOORE 808 N 161 E AVE 14528 S OUTER FORTY RE STE 100 TULSA, OK 74116- CHESTERFIELD, MO 63017-

0147 S MICHELIN NORTH AMERICA INC (OWN RISK) 1250 C MILL CREEK LUMBER & SUPPLY CO (OWN RISK) C/O GALLAGHER BASSETT SERVICES INC CONSOLIDATED BENEFITS RESOURCES - R FISHER ATTN: JODI SULLIVAN PO BOX 581630 2402 WILDWOOD AVE STE 128 TULSA, OK 74158- SHERWOOD, AR 72120-

1320 S MILLER TRUCK LINES LLC (OWN RISK) 1416 S MONTEREAU INC (OWN RISK #19896) C/O UNITED SAFETY & CLAIMS - JEFF MORRISON CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 471647 PO BOX 581630 TULSA, OK 74147- TULSA, OK 74158-1630

1633 C MOORE PUBLIC SCHOOLS (OWN RISK #20127) 0160 C NEWELL COACH CORP (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 581630 PO BOX 581630 TULSA, OK 74158-1630 TULSA, OK 74158-1630

1290 C NOBLE RESEARCH INSTITUTE FKA SAMUEL ROBERTS NOBLE 0162 C NORMAN REGIONAL HEALTH SYSTEM (OWN RISK #14225) SMARTCASUALTYCLAIMS C/O GALLAGHER BASSETT SERVICES INC ATTN: JENE HUCKABAY ATTN: STACY GOBLE PO BOX 42048 14000 QUAIL SPRINGS PKWY STE 3000 OKLAHOMA CITY, OK 73123- OKLAHOMA CITY, OK 73134-

0176 C O-I GLASS INC FKA OWENS ILLINOIS INC (OWN RISK) 0167 C OGE ENERGY CORP (OWN RISK) C/O GALLAGHER BASSETT SERV - T TARTER ATTN: FELICHA DAVIS PO BOX 2934 PO BOX 321 MC 502 CLINTON, IA 52733-2964 OKLAHOMA CITY, OK 73101-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0163 C OK FOODS INC FKA OK INDUSTRIES INC (OWN RISK #1692 0043 C OKLAHOMA ALL RISK LLC (OWN RISK) ATTN: CAROL WEBB ATTN: JEFF CHAPPELL PO BOX 1119 PO BOX 1095 FT SMITH, AR 72902- GUTHRIE, OK 73044-

1130 C OKLAHOMA COUNTY (OWN RISK) 1201 S OKLAHOMA FARM BUREAU MUTUAL INSURANCE (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER C/O SMARTCASUALTYCLAIMS - JENE HUCKABAY PO BOX 581630 PO BOX 42048 TULSA, OK 74158-1630 OKLAHOMA CITY, OK 73123-

1375 C OKLAHOMA HEART HOSPITAL LLC (OWN RISK) 0848 S OKLAHOMA NURSING HOMES LTD (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER CONSOLIDATED BENEFITS RESOURCES - R FISHER PO BOX 581630 PO BOX 581630 TULSA, OK 74158- TULSA, OK 74158-

0172 S OKLAHOMA STATE UNIVERSITY (OWN RISK #14526) 1651 S ONE GAS INC (OWN RISK) C/O BROADSPIRE SERVICES INC - ANNETTE SIMPSON C/O BROADSPIRE SERVICES - ANNETTE SIMPSON PO BOX 14348 PO BOX 14348 LEXINGTON, KY 40512-4348 LEXINGTON, KY 40512-

0173 C ONEOK INC (OWN RISK) 1837 S OU HEALTH SCIENCES CENTER (OWN RISK) ATTN: MICHAEL DAILEY CANNON COCHRAN MGMT SERV - LASHAWNA SEARS PO BOX 871 1501 N UNIVERSITY AVE STE 767 TULSA, OK 74102-0871 LITTLE ROCK, AR 72207-5238

0177 C PACCAR INC (OWN RISK) 0890 C PAM TRANSPORT INC (OWN RISK) C/O SEDGWICK CMS ATTN: ANGELA CLARK ATTN: TIM NOCKELS PO BOX 188 PO BOX 14497 TONTITOWN, AR 72770- LEXINGTON, KY 40512-4497

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

1225 C PEOPLEREADY INC FKA LABOR READY MID ATLANTIC (OWN 0183 S QUIK TRIP CORPORATION (OWN RISK) ESIS INC - JENNIFER HARDEMAN ATTN: SARAH BRYAN PO BOX 6563 PO BOX 3475 SCRANTON, PA 18505-6563 TULSA, OK 74101-

0184 S REASORS LLC (OWN RISK) 1880 S ROGERS COUNTY (OWN RISK) CONSOLIDATED BENEFITS RESOURCES - R FISHER UNITED SAFETY & CLAIMS - JEFF MORRISON PO BOX 581630 7418 E 42ND PL TULSA, OK 74158- TULSA, OK 74145-

0187 S ROMAN CATHOLIC DIOCESE OF TULSA (OWN RISK) 0191 S SHAWNEE MILLING CO (OWN RISK) C/O GALLAGHER BASSETT SERVICES INC CONSOLIDATED BENEFITS RESOURCES - R FISHER ATTN: CHRISTOPHER SPALA PO BOX 581630 TWO PIERCE PL TULSA, OK 74158- ITASCA, IL 60143-

0195 S SIMMONS FOODS INC (OWN RISK) 0200 C SOUTHWEST ELECTRIC CO (OWN RISK #15824) C/O SEDGWICK CMS - ATTM JEFF RICE CONSOLIDATED BENEFITS RESOURCES - R FISHER 501 W PRESIDENT GEORGE BUSH HWY STE 200 PO BOX 581630 RICHARDSON, TX 75080- TULSA, OK 74158-

1139 S SSM HEALTH CARE CORP (OWN RISK) 0203 C ST FRANCIS HEALTH SYSTEM INC (OWN RISK) C/O CCMSI - REBECCA CULLINS ATTN: CHARLOTTE SMITH 1501 N UNIVERSITY AVE STE 767 6161 S YALE AVE LITTLE ROCK, AR 72207- TULSA, OK 74136-

1756 C STATE OF OKLAHOMA 1280 C STILLWATER MEDICAL CENTER (OWN RISK) GALLAGHER BASSETT SERVICES - 132 OKLAHOMA CITY SMARTCASUALTYCLAIMS - JENE HUCKABAY ATTN: STACY KARBS PO BOX 42048 14000 QUAIL SPRINGS PKWY STE 3000 OKLAHOMA CITY, OK 73123- OKLAHOMA CITY, OK 73134-

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0059 S TARGET CORP (OWN RISK) 1212 C TEXTRON INC (OWN RISK) C/O SEDGWICK CMS INC - MARIA ABRAHIM-PETRONE C/O BROADSPIRE SERVICES INC - ROBIN HLADIK PO BOX 14155 1861 N ROCK RD STE 202 LEXINGTON, KY 40512-4155 WICHITA, KS 67206-1284

0174 C THE BOLDT CO (OWN RISK) 0194 S THE SHERWIN WILLIAMS CO (OWN RISK #15596) ATTN: TERI WHITMAN C/O GALLAGHER BASSETT SERVICES - PAMELA HALESY PO BOX 419 PO BOX 2934 APPLETON, WI 54912-0419 CLINTON, IA 52733-2934

0044 C THE TORO COMPANY FKA THE CHARLES MACHINE WORKS INC 0235 C THE WILLIAMS COMPANIES INC (OWN RISK #13136) GALLACHER BASSETT SERVICES - STACY GOBLE ATTN: JED RICE 14000 QUAIL SPRINGS PKWY STE 3000 PO BOX 3483 OKLAHOMA CITY, OK 73134- TULSA, OK 74101-

0677 S TULSA COUNTY (OWN RISK) 0215 S TURNER ROOFING & SHEET METAL (OWN RISK #15768) C/O UNITED SAFETY & CLAIMS SMARTCASUALTYCLAIMS - JENE HUCKABAY ATTN: CHALI STEVENS PO BOX 42048 PO BOX 471647 OKLAHOMA CITY, OK 73123- TULSA, OK 74147-

0216 S TYSON FOODS INC (OWN RISK) 1628 C UNIMECH INC (OWN RISK) ATTN: MELISA YOPP CONSOLIDATED BENEFITS RESOURCES -R FISHER 2231 W MARTIN LUTHER KING BLVD PO BOX 581630 SPRINGDALE, AR 72701- TULSA, OK 74158-

0217 C UNIT CORP (OWN RISK) 0221 C UNIVERSITY OF OKLAHOMA (OWN RISK) C/O MIDLANDS CLAIMS ADMINISTRATORS INC C/O CANNON COCHRAN MANAGEMENT SERVICES INC ATTN: HEATHER JENNINGS ATTN: LASHAWNA SEARS PO BOX 238808 1501 N UNIVERSITY AVE STE 767 OKLAHOMA CITY, OK 74132- LITTLE ROCK, AR 72207-5238

Carrier ID Inv Flag Carrier Name/Service Agent Name & Address Carrier ID Inv Flag Carrier Name/Service Agent Name & Address

0227 C WAFFLE HOUSE INC (OWN RISK #16206) 0228 C WAGGONERS TRUCKING (OWN RISK) C/O BRENTWOOD SERVICES ADMINISTRATORS INC ATTN: RENA COMPTON ATTN: JOHN SMITHERMAN 600 OAK FOREST RD PO BOX 1125 SPARTANBURG, SC 29301- BRENTWOOD, TN 37024-1125

1560 C WAL MART ASSOCIATES INC (OWN RISK) 0231 C WEBCO INDUSTRIES INC (OWN RISK) C/O WALMART CLAIMS SERVICES INC - KARI ROBINSON ATTN: ROBERT FIELD PO BOX 5020 PO BOX 100 ROGERS, AR 72756- SAND SPRINGS, OK 74063-

0233 C WEYERHAEUSER CO (OWN RISK) 0234 S WHIRLPOOL CORP (OWN RISK) C/O SEDGWICK CMS - TRENISHA BRYANT C/O GALLAGHER BASSETT SERVICES INC PO BOX 14152 ATTN: STACY KARBS LEXINGTON, KY 40512-4152 14000 QUAIL SPRINGS PKWY STE 3000 OKLAHOMA CITY, OK 73134-

1449 C ZEECO INC (OWN RISK #19939) C/O UNITED SAFETY AND CLAIMS ATTN: JEFF MORRISON PO BOX 471647 TULSA, OK 74147-

Records printed: 149

* Inv Flag 'S' indicates Service Company, 'C' indicates Corporate