TEXAS CERTIFIED SELF-INSURERS' THIRD-PARTY …

TEXAS CERTIFIED SELF-INSURERS' THIRD-PARTY ADMINISTRATOR/AUSTIN REPRESENTATIVE LIST ? Part I

Produced by Self-Insurance Regulation As of July 31 2023

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. Michelle Green, WC Director P.O. Box 166002 Altamonte Springs, FL 32716-6002 Phone: (800) 315-6090 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 Ms. Tracy Burns, 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

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

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

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

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

Ms. Molly Abshear Risk Management Coordinator Phone: (314) 733-8710 Fax: M(636) 696-6034

Ms. Katie Toyne Corporate Insurance Manager Phone: (913) 288-1434 Fax:

Ms. Stacey Ojemeni 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

Ms. Nicole Winchester, Claims

Managing Shareholder

Supervisor

P.O. Box 201329

PO Box 802082

Austin, TX 78720-1329

Dallas, TX 75380

Phone: (512) 477-4405

Phone: 972-419-0415

Fax: (512) 241-3300

Fax: 2174775496

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, Client Services Managing Shareholder

Director

P.O. Box 201329

2620 Thousand Oaks Blvd., Ste 3100 Austin, TX 78720-1329

Memphis, TN 38118-2483

Phone: (512) 477-4405

Phone: (727) 474-3054

Fax: (512) 241-3300

Fax: (614) 601-9524

03/01/2008 through Present

Johnston & Associates, Inc.

Flahive, Ogden & Latson

Mr. Kevin Gallagher,

Mr. Steve Tipton

830 Crescent Center Drive, Ste 220

Managing Shareholder

Franklin, TN 37067

P.O. Box 201329

Phone: (615) 515-1808

Austin, TX 78720-1329

Fax: (615) 377-4735

Phone: (512) 477-4405

08/01/2014 through Present

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 Risk Manager, Workers' Compensation and OSIP Phone: (925) 842-8161 Fax: (925) 842-8185

Covenant Health System 1801 Lind Avenue SW, STE 9016 Renton, WA 98057-9016

Ms. Schandra Wiltse Phone: 206-590-1573 Fax:

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

Parker & Associates, LLC

Ms. Rebecca Lewis, Chief Financial

Mr. Kevin McGillicuddy

Officer

Director of Workers' Comp. Services

830 Crescent Center Drive, Ste 220

7600 Chevy Chase Dr., Ste 350

Franklin, TN 37067

Austin, TX 78752-1566

Phone: (615) 373-0500

Phone: (512) 320-9950

Fax: (615) 377-4735

Fax: (512) 320-9967

03/01/2005 through Present

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, JT Parker & Associates

Inc.

Mr. Kevin McGillicuddy

Ms. Trenisha Bryant, AVP Claims

Director of Workers Compensation

6100 Tennyson Pkwy, Ste 230

Services

Plano, TX 75024

7600 Chevy Chase Dr., Ste 350

Phone: 972-372-6189

Austin, TX 78752

Fax: (959) 264-4061

Phone: 512-320-9950

08/01/1993 through present

Fax: 512-320-9967

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Part I ? Certified

Certified Self-Insurer FedEx Freight, Inc. P.O. Box 840 DC 2256 Harrison, AR 72602-0840

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

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

Mr. Jim English Managing Director Phone: 412-859-2287 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

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

Third-Party Administrator

Austin Representative

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

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. James Sheffield

Mr Mason Jojola, 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.

Ms. Jennifer H. Brenner

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.

Gallagher Bassett Services, Inc.

Ms. Denise Silva, Branch Manager

Ms. Diana Johnson

4120 International Pkwy, Ste. 1050

Compliance Director

Carrollton, TX 75007-1958

PO Box 90374

Phone: (866) 544-0486

Austin, TX 78709

Fax: (972) 931-6256

Phone: (210) 395-5023

01/01/1995 through Present

Fax: (210) 490-1606

Page 4 of 32

Part I ? Certified

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

Johns Manville 717 17th Street Denver, CO 80202

Kiewit Corporation 1550 Mike Fahey St. Omaha, NE 68102

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

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

Mr. Josh Quick Claims Manager Phone: (303) 978-2118 Fax: M(720) 326-0745

Ms. Whitney Douglas Risk Management Phone: 402-938-4026 Fax:

Ms. Lynn Taylor VP Corporate Services Phone: (210)531-1241 Fax: (210) 531-1241

Third-Party Administrator

Austin Representative

Helmsman Management Services, LLC Dean G. Pappas PLLC

Mr. Peter J. Clas, V.P. and Manager of Mr. Dean G. Pappas

Products & Services

Attorney at Law

175 Berkeley Street

8588 Katy Frwy, Ste 100

Boston, MA 02117

Houston, TX 77024-1813

Phone: (888) 425-9098

Phone: (713) 914-6200

Fax: (985) 624-8684

Fax: (512) 374-0848

04/15/2011 through Present

ESIS, Inc.

Downs & Stanford, PC

Mr. Anthony Pullen, Claims Vice

Ms. Frances Owings

President

Board Representative

2001 Bryan St. #3600

115 Wild Basin Rd., Ste 207

Dallas, TX 75201-3068

West Lake Hills, TX 78746-3347

Phone: (214) 754-8578

Phone: (512) 891-7771

Fax: (800) 373-5156

Fax: (512) 891-7772

07/01/2004 through Present

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. Steve Tipton

Ms. Leona Fox, Claim Examiner

Managing Shareholder

P.O. Box 14152

P.O. Box 201329

Lexington, KY 40512-4152

Austin, TX 78720-1329

Phone: (972) 372-6154

Phone: (512) 477-4405

Fax: (859) 264-4061

Fax: (512) 241-3300

10/01/1993 through Present

Sedgwick Claims Management Services, Adami, Shuffield, Scheihing & Burns

Inc.

Ms. LeeAnna Gainer Mask

Ms. Michelle Ryan, Assistant Vice

Attorney at Law

President, Client Services

32 Wingreen Loop

99 Cherry Hill Rd.

Austin, TX 78738-1525

Parsippany, NJ 07054

Phone: (512) 322-9400

Phone: (480) 323-8839

Fax: (512) 322-9497

Fax: (614) 932-8212

02/06/2013 through Present

Page 5 of 32

Part I ? Certified

Certified Self-Insurer Louisiana-Pacific Corporation 414 Union St., Ste 2000 Nashville, TN 37219

MasTec, Inc. 800 Douglas Rd., 12th Flr Coral Gables, FL 33134-3125

PACCAR Inc Health & Welfare Benefits P.O. Box 1518 Bellevue, WA 98009-1518

Parker-Hannifin Corporation 6035 Parkland Blvd. Mayfield Heights, OH 44124

Company Contact Mr. Logan Parkhurst Treasury Manager Phone: (615) 986-5849 Fax: (217) 477-3110

Ms. Patricia Sanchez Risk Manager Phone: (305) 406-1814 Fax: (305) 795-8185

Ms. Perla Vigil WC Program Manager I Phone: (425) 468-7939 Fax: (425) 468-8206

Mr. Jim Meehan Risk & Insurance Management Analyst Phone: (216) 896-2486 Fax:

Third-Party Administrator

Austin Representative

Cannon Cochran Management Services, Christopher Ameel, Attorney at Law,

Inc.

PLLC

Ms. Jackie Stovall, Claims Adjuster

Mr. Christopher J. Ameel

5001 Spring Valley Rd., Ste. 750

P.O. Box 5624

Dallas, TX 75244

Austin, TX 78763

Phone: (972) 419-0413

Phone: (512) 469-5896

Fax: (217) 477-6681

Fax: (512) 347-0222

05/01/1993 through Present

ESIS, Inc.

Downs & Stanford, P.C.

Mr. Anthony Pullen, Claim Vice

Ms. Frances Owings

President, SW Claims Center

Board Representative

PO Box 5129

115 Wild Basin Rd., Ste 207

Scranton, PA 18505-0568

West Lake Hills, TX 78746-3347

Phone: (214) 754-8578

Phone: (512) 891-7771

Fax: (972) 465-7645

Fax: (512) 891-7772

09/14/2010 through Present

Sedgwick Claims Management Services, Flahive, Ogden & Latson

Inc.

Mr. Robert D. Stokes

Mr. Tim Nockels, Claims

Attorney

P.O. Box 14497

P.O. Box 201329

Lexington, KY 40512-4497

Austin, TX 78720-1329

Phone: (214) 922-0616

Phone: (512) 435-2150

Fax: (214) 922-0650

Fax: (512) 241-3300

06/20/1996 through Present

Underwriters Safety & Claims, Inc.

Flahive, Ogden & Latson

Ms. Leigh Smith,

Ms. Heather Terrones

307 Shawnee Ave.

Office Manager

Big Stone Gap, VA 24219

P.O. Box 201329

Phone: (877) 871-3777

Austin, TX 78720-1329

Fax: (276) 523-6120

Phone: (512) 477-4405

01/01/1996 through Present

Fax: (512) 241-3300

Page 6 of 32

Part I ? Certified

Certified Self-Insurer Poly-America, L.P. 2000 W. Marshall Dr. Grand Prairie, TX 75051-2709

Company Contact Ms. Kelsey Pigneri Human Resource Operations Manager Phone: (972) 337-7227 Fax: (972) 337-8227

Poly Trucking, Inc. 2000 W. Marshall Dr. Grand Prairie, TX 75051-2709

Ms. Kelsey Pigneri Human Resource Operations Manager Phone: (972) 337-7227 Fax: (972) 337-8227

Southeastern Freight Lines, Inc. P.O. Box 1691 Columbia, SC 29202

Mr. Richard Connor Director Insurance Administration Phone: (803) 939-3301 Fax: (803) 926-5154

Space Exploration Technologies Corp. Mr. Cameron Carter

1 Rocket Rd.

Purchasing & Government

Hawthorne, CA 90250

Operations Specialist

Phone: (310) 682-1818

Fax: (202) 649-2701

Third-Party Administrator Gallagher Bassett Services, Inc. Ms. Tina Guimon, Account Manager 2850 Golf Rd. Rolling Meadows, IL 60008 Phone: (630) 228-6691 Fax: (855) 572-4371 08/15/1994 through Present

Gallagher Bassett Services, Inc. Ms. Tina Guimon, Account Manager 2850 Golf Rd. Rolling Meadows, IL 60008 Phone: (630) 228-6691 Fax: (855) 572-4371 12/01/2014 through Present

Gallagher Bassett Services, Inc. Mr. Terry Tarter, Branch Manager 4120 International Pkwy, Ste. 1050 Carrolton, TX 75007-1958 Phone: (866) 544-0486 Fax: (972) 931-6256 07/01/2014 through Present CorVel Corporation Ms. Lynne Polk, Claims Manager 10000 North Central Expressway, #300 Dallas, TX 75231-4198 Phone: (972) 628-2812 Fax: (866) 782-8959 03/01/2015 through Present

Austin Representative Cunningham Lindsey Claims Management, Inc. Mr. Tom Lang Manager 314 Highland Mall Blvd, Ste 200 Austin, TX 78752 Phone: (512) 415-4275 Fax: (512) 452-7004

Cunningham Lindsey Claims Management, Inc. Mr. Tom Lang Manager 314 Highland Mall Blvd, Ste 200 Austin, TX 78752 Phone: (512) 415-4275 Fax: (512) 452-7004

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

Flahive, Ogden & Latson Mr. Robert D. Stokes Shareholder P.O. Box 201329 Austin, TX 78720-1329 Phone: (512) 477-4405 Fax: (512) 241-3301

Page 7 of 32

Part I ? Certified

Certified Self-Insurer Starbucks Corporation 2401 Utah Ave. S. MS:S Rm 1 Seattle, WA 98134

Textron Inc. 40 Westminster St. Providence, RI 02903-2525

The Procter & Gamble Company 2 Procter & Gamble Plaza TE-8 Cincinnati, OH 45202

The Sherwin-Williams Company 101 Prospect Ave. NW Cleveland, OH 44115-1093

Company Contact Mr. Anthony Spacciante Senior Risk Analyst Phone: 206-594-7584 Fax: (206) 318-2024

Ms. Kiley Powers Risk Mgmt-Sr. Financial Analyst Phone: (401) 457-3654 Fax: (401) 457-3533

Ms. Sheila Neal Workers' Compensation Dept. Phone: 513-983-1749 Fax:

Ms. Jessica Oslin Manager, Workers' Comp. Phone: (216) 566-2035 Fax: (216) 348-1004

Third-Party Administrator

Austin Representative

Sedgwick Claims Management Services, White Espey, PLLC

Inc.

Mr. Timothy R. White

Ms. Kristin Hammock, Claims Manager Attorney

Custer Court I, 501 W. Pres. George W. P.O. Box 152949

Bush Hwy.

Austin, TX 78715

Richardson, TX 75080

Phone: (512) 983-2994

Phone: (469) 624-1000

Fax: (512) 201-4432

Fax: (866) 315-0607

10/01/2005 through Present

Broadspire Services, Inc.

Burns, Anderson, Jury & Brenner, L.L.P.

Ms. Deborah Green, Sr. Claim

Mr. Nick Huestis

Representative

Workers' Compensation Consultant

1503 LBJ Freeway, Ste 600

P.O. Box 26300

Dallas, TX 75234

Austin, TX 78755-6300

Phone: (972) 563-3790

Phone: (512) 338-5322

Fax: (866) 296-0052

Fax: (512) 338-5363

05/01/1993 through Present

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

Inc.

Mr. Nick Huestis

Mr. Julie Swift, Claims Examiner

Workers' Compensation Consultant

PO Box 14997

P.O. Box 26300

Lexington, KY 40512

Austin, TX 78755-6300

Phone: 2149220712

Phone: (512) 338-5322

Fax: (214) 922-0650

Fax: (512) 338-5363

05/03/1993 through Present

Gallagher Bassett Services, Inc.

Gallagher Bassett Services, Inc.

Mr. Terry Tarter, Branch Manager

Ms. Diana Johnson

4120 International Pkwy, Ste. 1050

Compliance Director

Carrollton, TX 75007-1958

P.O. Box 19347

Phone: (866) 544-0486

Austin, TX 78760

Fax: (972) 931-6256

Phone: (210)395-5023

03/01/94 - 06/30/03, 08/01/17 through Fax: (210) 490-1606

Present

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Part I ? Certified

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