TEXAS CERTIFIED SELF-INSURERS' THIRD-PARTY …

TEXAS CERTIFIED SELF-INSURERS' THIRD-PARTY ADMINISTRATOR/AUSTIN REPRESENTATIVE LIST Produced by Self-Insurance Regulation As of April 30, 2021

Certified Self-Insurer

AAA Cooper Transportation P.O. Box 6827 Dothan, AL 36302-6827

Company Contact

Mr. Scott Bowers, VP Human Resources Phone: (334) 671-3145 Fax: (334) 702-1872

AAA Cooper Transportation ***2nd Third Party Administrator***

ABF Freight System, Inc. P.O. Box 10048 Fort Smith, AR 72917-0048

Mr. Mark Stallings Director, Risk Management Phone: (479) 785-6324 Fax: (479) 785-6396

Third-Party Administrator

North American Risk Service, Inc. Ms. Michele Kirkland, Claims Examiner P.O. Box 166002 Altamonte Springs, FL 32716-6002 Phone: (800) 315-6090 ext. 1410 Fax: (866) 261-8507 02/01/1994 through 01/31/2001, and 02/01/2004 through Present

Gallagher Bassett Services Mr. Terry Tarter, Branch Manager 4120 International Pkwy, Ste. 1050 Carrollton, TX 75007-1958 Phone: (866) 544-0486 Fax: (972) 931-6256 02/01/2001 through 01/31/2004

ArcBest Corporation Mr. Travis Sharp, Supervisor, Workers' Compensation P.O. Box 10048 Fort Smith, AR 72917-0048 Phone: (479) 785-6320 Fax: (479) 785-6320 09/01/1993 through Present

Austin Representative Flahive, Ogden & Latson Mr. James Sheffield, Senior Partner P.O. Box 201329 Austin, TX 78720-1329 Phone: (512) 435-2169 Fax: (512) 241-3303

J.T. Parker & Associates, L.L.C. Mr. Kevin McGillicuddy Director of WC Services 7600 Chevy Chase Dr., Ste 350 Austin, TX 78752-1566 Phone: (512) 320-9950 Fax: (512) 320-9967

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Part I ? Certified

Certified Self-Insurer

American Electric Power Company, Inc. 1 Riverside Plaza, 15th Floor Columbus, OH 43215-2355

Company Contact

Mr. Loyd A. Hudson Integrated Disability Programs Mgr. Phone: (614) 716-4064 Fax: (866) 574-8303

Ascension Health Alliance P.O. Box 45998 St. Louis, MO 63145-5998

Ms. Molly Abshear Risk Management Coordinator Phone: (314) 733-8710 Fax: (314) 733-8710

Associated Wholesale Grocers, Inc. 5000 Kansas Ave. Kansas City, KS 66106-1135

Mr. Sam Mynatt Sr. Supervisor-Claims Phone: (913) 288-1434 Fax: (913) 288-1154

Baptist Hospitals of Southeast Texas P.O. Drawer 1591 Beaumont, TX 77704-1591

Ms. Deborah Verret V.P. of Quality & Risk Management Phone: (409) 212-6040 Fax: (409) 212-5639

Third-Party Administrator

Austin Representative

Cannon Cochran Management Services, Flahive, Ogden & Latson

Inc.

Mr. Steve Tipton

Mr. Timothy Lott, Branch Manager

Managing Shareholder

PO Box 802082

P.O. Box 201329

Dallas, TX 75380

Austin, TX 78720-1329

Phone: (713) 268-7814

Phone: (512) 477-4405

Fax: (972) 386-7918

Fax: (512) 241-3300

02/06/1998 through Present

Sedgwick Claims Management Services, Downs & Stanford PC

Inc.

Mr. Stuart Colburn

Mr. Michael Browning, Director Client 115 Wild Basin Rd. Ste 207

Services

Westlake Hills, TX 78746

P.O. Box 14562

Phone: (512) 891-7771

Lexington, KY 40512-4562

Fax: (512) 891-9630

Phone: (314) 514-2313

Fax: (314) 514-2399

06/20/2003 through Present

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. Steve Tipton

Ms. Deborah Fadely, Claims Examiner Managing Shareholder

2620 Thousand Oaks Blvd., Ste 3100 P.O. Box 201329

Memphis, TN 38118-2483

Austin, TX 78720-1329

Phone: (727) 474-3054

Phone: (512) 477-4405

Fax: (614) 601-9524

Fax: (512) 241-3300

03/01/2008 through Present

Johnston & Associates, Inc. Mr. Kevin Gallagher, 830 Crescent Center Drive, Ste 220 Franklin, TN 37067 Phone: (615) 515-1808 Fax: (615) 377-4735 08/01/2014 through Present

Flahive, Ogden & Latson Mr. Steve Tipton Managing Shareholder P.O. Box 201329 Austin, TX 78720-1329 Phone: (512) 477-4405 Fax: (512) 241-3300

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Part I ? Certified

Certified Self-Insurer

Baptist Hospitals of Southeast Texas ***2nd Third Party Administrator***

Company Contact

Bradford Holding Company, Inc. 4646 Corona, Ste. 100 Corpus Christi, TX 78411-4383

Mr. Garry Bradford President Phone: (361) 852-6392 Fax: (361) 852-6397

Chevron Corporation 6001 Bollinger Canyon Rd, A2114 San Ramon, CA 94583-2324

Ms. Megan O'Boyle Sr. Workers' Compensation Program Admn. Phone: (925) 842-8161 Fax: (925) 842-8185

FedEx Freight, Inc. P.O. Box 840 Harrison, AR 72602-0840

Ms. Kayla Quandt Sr. Advisor-Risk & Insurance Phone: (870) 704-5187 Fax: (870) 391-7651

Third-Party Administrator

Austin Representative

Broadspire Services, Inc. Mr. Jarod Hunter, ARM, Sr. Account Executive 1503 LBJ Freeway, Ste 600 Dallas, TX 75234-9700 Phone: (214) 640-4524 Fax: (770) 723-8653 08/01/2002 through 7/31/2014

Johnston & Associates Ms. Rebecca Lewis, Chief Financial Officer 830 Crescent Center Drive, Ste 220 Franklin, TN 37067 Phone: (615) 373-0500 Fax: (615) 377-4735 03/01/2005 through Present

Parker & Associates, LLC Mr. Kevin McGillicuddy Director of Workers' Comp. Services 7600 Chevy Chase Dr., Ste 350 Austin, TX 78752-1566 Phone: (512) 320-9950 Fax: (512) 320-9967

Broadspire Services, Inc.

Flahive, Ogden & Latson

Ms. Emma Williams, Indemnity Adjuster Ms. Heather Terrones

8827 W. Sam Houston Pkwy N., Ste 110 Compliance Paralegal

Houston, TX 77040

P.O. Box 201329

Phone: (713) 780-9826

Austin, TX 78720-1329

Fax: (770) 777-6394

Phone: (512) 435-2234

07/01/2001 through Present

Fax: (512) 241-3301

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. Robert Stokes

Mr. Stephen Kesselring,

Managing Partner

255 Primera Blvd

P.O. Box 201329

Lake Mary, FL 32746

Austin, TX 78720-1329

Phone: (407) 833-4115

Phone: (512) 435-2150

Fax: (407) 833-4002

Fax: (512) 241-3301

01/01/2004 through Present

Page 3 of 32

Part I ? Certified

Certified Self-Insurer

FedEx Ground Package System, Inc. 1000 FedEx Dr. Moon Township, PA 15108-9373

Company Contact

Mr. Gary Raymond Lead, Risk & Insurance Phone: (412) 747-8323 Fax: (412) 747-8320

General Motors LLC

Mr. Sherman Perkins

300 Renaissance Center, MC 482-C07- Manager, Workers' Comp,

D24

Disability & FMLA Admin.

Detroit, MI 48265-3000

Phone: (248) 320-8571

Fax: (313) 667-1355

Hyatt Corporation 150 N. Riverside Plz. Chicago, IL 60606

James Construction Group, LLC P.O. Box 90022 Baton Rouge, LA 70809-9022

Mr. Jonathan Cox Senior Manager, Global Risk & Insurance Phone: (312) 780-5914 Fax: (312) 780-5278

Ms. Blanche Arceneaux Segment CFO Phone: (225) 442-6448 Fax: (866) 728-7863

Third-Party Administrator

Austin Representative

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. James Sheffield

Ms. Latrice Hayes, Claims Team Lead Attorney at Law

Plaza of Americas

P.O. Box 201329

600 N. Pearl St., Ste 1200

Austin, TX 78720

Dallas, TX 75201

Phone: (512) 477-4405

Phone: (214) 922-0600

Fax: (512) 241-3300

Fax: (214) 922-0625

01/01/1999 through Present

Sedgwick Claims Management Services, Burns, Anderson, Jury & Brenner, L.L.P.

Inc.

Mr. Nick Huestis

Ms. Lisa O'Hara, Claims Supervisor

Workers' Compensation Consultant

600 N. Pearl St., Plaza of Americas

P.O. Box 26300

Dallas, TX 75201

Austin, TX 78755-6300

Phone: (214) 922-0636

Phone: (512) 338-5322

Fax: (214) 922-0650

Fax: (512) 338-5363

09/01/1994 through Present

Gallagher Bassett Services, Inc. Mr. Terry Tarter, Branch Manager 4120 International Pkwy, Ste. 1050 Carrollton, TX 75007-1958 Phone: (866) 544-0486 Fax: (972) 931-6256 01/01/1995 through Present

Gallagher Bassett Services, Inc. Ms. Diana Johnson Compliance Director PO Box 19347 Austin, TX 78760 Phone: (210) 395-5023 Fax: (210) 490-1606

Helmsman Management Services, LLC Mr. Peter J. Clas, V.P. and Manager of Products & Services 175 Berkeley Street Boston, MA 02117 Phone: (888) 425-9098 Fax: (985) 624-8684 04/15/2011 through Present

Flahive, Ogden & Latson Ms. Patsy Shelton Compliance Paralegal P.O. Box 201329 Austin, TX 78720-1329 Phone: (512) 477-4405 Fax: (512) 241-3300

Page 4 of 32

Part I ? Certified

Certified Self-Insurer Johns Manville 717 17th Street Denver, CO 80202

Kiewit Corporation 3555 Farnam St. Omaha, NE 68131

Leonard Family Corporation 2001 S. Laredo St. San Antonio, TX 78207

Lockheed Martin Corporation P.O. Box 748, MZ 6463 Fort Worth, TX 76101-7450

Company Contact Ms. Kristin L. Jacobs Insurance Manager Phone: (303) 978-2118 Fax:

Ms. Melissa Woitalewicz Workers' Compensation Claims Manager Phone: (402) 536-3641 Fax:

Ms. Lynn Taylor CFO Phone: (210) 912-3151 Fax: (210) 532-5033

Ms. Courtney Gleghorn Workers' Compensation Analyst Staff Phone: (817) 777-2782 Fax: (817) 655-9579

Third-Party Administrator

Austin Representative

ESIS, Inc. Mr. Anthony Pullen, Claims Vice President 2001 Bryan St. #3600 Dallas, TX 75201-3068 Phone: (214) 754-8578 Fax: (800) 373-5156 07/01/2004 through Present

Downs & Stanford, PC Ms. Frances Owings Board Representative 115 Wild Basin Rd., Ste 207 West Lake Hills, TX 78746-3347 Phone: (512) 891-7771 Fax: (512) 891-7772

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. Steve Tipton

Mr. David Withers, Account Manager Managing Shareholder

P.O. Box 14152

P.O. Box 201329

Lexington, KY 40512-4152

Austin, TX 78720-1329

Phone: (402) 963-2849

Phone: (512) 477-4405

Fax: (859) 264-4061

Fax: (512) 241-3300

10/01/1993 through Present

York Risk Services Group, Inc. Ms. Michelle Ryan, Assistant Vice President, Client Services 99 Cherry Hill Rd. Parsippany, NJ 07054 Phone: (480) 323-8839 Fax: (614) 932-8212 02/06/2013 through Present

Adami, Shuffield, Scheihing & Burns Ms. LeeAnna Gainer Mask Attorney at Law 32 Wingreen Loop Austin, TX 78738-1525 Phone: (512) 322-9400 Fax: (512) 322-9497

ESIS Mr. Anthony Pullen, Claim Vice President P.O. Box 6563 Scranton, PA 18505-6563 Phone: (800) 937-7460 Fax: (800) 373-5156 01/01/1994 through Present

Downs & Stanford, PC Ms. Frances Owings 115 Wild Basin Rd., Ste 207 West Lake Hills, TX 78746-3347 Phone: (512) 891-7771 Fax: (512) 891-0977

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Part I ? Certified

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