Page 1
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
142274 AFFINITY GAMING
Elizabeth Guth
VP - Insurance & Benefits
3755 Breakthrough Way, Suite 300
Las Vegas NV 89135
702-341-2419
Association Name DBA Date
Subsidiary Flamingo Paradise Gaming, LLC Silver Sevens Hotel and Casino 31-JAN-17
Subsidiary Plantation Investments, LLC Rail City Casino 31-JAN-17
Subsidiary Primadonna Company, LLC (The) Primm Valley Resort and 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
Third Party Administrator SIERRA NEVADA ADMINISTRATORS INC 31-JAN-17
C of A Employer
122997 ARCBEST CORPORATION (FKA ARKANSAS BEST CORPORATION)
Allen King
Sr. Manager, Risk Management
8401 McClure Drive
Fort Smith AR 72916
479-785-6218
Association Name DBA Date
Subsidiary ABF FREIGHT SYSTEM, INC. 15-DEC-81
Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 15-DEC-81
C of A Employer
Page 2
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
123211 BEST BUY CO INC
Soleta Dawn
Risk Manager, Insurance
7601 Penn Avenue South
Richfield MN 55423
612-291-4284
Association Name DBA Date
Subsidiary BEST BUY STORES LP 01-DEC-97
Subsidiary BEST BUY WAREHOUSING LOGISTICS INC. 01-APR-17
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-DEC-97
C of A Employer
123005 BOYD GAMING CORPORATION
Amber Dippre
Industrial Insurance Analyst
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
Subsidiary CALIFORNIA HOTEL & CASINO CALIFORNIA HOTEL AND CASINO 01-AUG-82
Subsidiary CALIFORNIA HOTEL & CASINOSAM'S TOWN HOTEL, GAMBLING HALL &BOWLING CENTER
01-AUG-82
Page 3
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Subsidiary CANNERY CASINO AND HOTEL 20-DEC-16
Subsidiary COAST CASINOS THE ORLEANS HOTEL & CASINO 01-FEB-89
Subsidiary CONSTELLATION INSURANCE COMPANY 01-JUL-05
Subsidiary EASTSIDE CANNERY HOTEL AND CASINO 20-DEC-16
Subsidiary ELDORADO, INC. JOKERS WILD CASINO 01-APR-93
Subsidiary ELDORADO, INC. ELDORADO CASINO 01-APR-93
Subsidiary GOLD COAST HOTEL & CASINO 01-FEB-89
Subsidiary M.S.W., INC.MAIN STREET STATION HOTEL, CASINO &BREWERY
22-NOV-96
Subsidiary SAM-WILL, INC. FREMONT HOTEL AND CASINO 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
123146 CAESARS ENTERTAINMENT CORPORATION
Christopher Ashley
Treasury & Risk Sr. Analyst
One Caesars Palace Drive
Las Vegas NV 89019
702-407-6188
Association Name DBA Date
Subsidiary 3535 LV CORP. 08-SEP-05
Subsidiary CAESARS ENTERPRISE SERVICES, LLC 31-JUL-14
Subsidiary CAESARS ENTERTAINMENT CORPORATION 12-JUL-80
Subsidiary CAESARS GROWTH PROPERTIES HOLDINGS, LLC 06-OCT-17
Subsidiary CAESARS LINQ, LLC 29-MAR-11
Subsidiary CAESARS MARKETING SERVICES CORPORATION 23-NOV-10
Subsidiary CAESARS PALACE SPORTS PROMOTIONS 01-JAN-03
Subsidiary CG SERVICES, LLC 29-AUG-13
Subsidiary DESERT PALACE LLC CAESARS PALACE LAS VEGAS 01-JUN-10
Subsidiary FLAMINGO LAS VEGAS OPERATING COMPANY, LLC FLAMINGO LAS VEGAS 14-SEP-07
Page 4
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Subsidiary HARRAH SOUTH SHORE CORPORATION 12-NOV-97
Subsidiary HARRAH'S LAS VEGAS, LLC 01-JUN-83
Subsidiary HARRAH'S LAUGHLIN, LLC 28-APR-88
Subsidiary HARVEYS TAHOE MANAGEMENT COMPANY LLC 01-AUG-01
Subsidiary PARBALL LLC 03-AUG-98
Subsidiary PARIS LAS VEGAS OPERATING COMPANY, LLC PARIS LAS VEGAS 30-JAN-08
Subsidiary PHW LAS VEGAS, LLC 01-JUN-13
Subsidiary PHW MANAGER, LLC 20-NOV-09
Subsidiary RIO PROPERTIES, LLC RIO ALL-SUITE HOTEL & CASINO 24-FEB-92
Third Party Administrator ESIS INC 15-AUG-80
C of A Employer
122973 CARSON CITY
Cecilia Meyer, ASHM
Risk Management Coordinator, CC Finance Division
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
PO Box 603
Carson City NV 89702
775-283-2006
Page 5
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Association Name DBA Date
Third Party Administrator ALTERNATIVE SERVICE CONCEPTS LLC 01-JUL-10
C of A Employer
122963 CATHOLIC CHARITIES OF SOUTHERN NEVADA
Marcus Valerio
1501 Las Vegas Blvd
North Las Vegas NV 89101
702-387-2292
Association Name DBA Date
C of A Employer
132789 CDS U.S. Intermediate Holdings, Inc.
Kristen Griffiths
Disability Management & Group Insurance Advisor
6775 Edmond Street, Suite 300
LAS VEGAS NV 89118
702-352-0181
Association Name DBA Date
Subsidiary Cirque Apple Administration, LLC 08-JUL-15
Subsidiary Cirque du Soleil (US), Inc. 08-JUL-15
Subsidiary Cirque du Soleil Holding USA, Inc. 08-JUL-15
Subsidiary Cirque du Soleil Illusion LLC 08-JUL-15
Subsidiary Cirque du Soleil My Call L.L.C. 08-JUL-15
Subsidiary Cirque du Soleil Nevada, Inc. 08-JUL-15
Subsidiary Cirque du Soleil, Inc. 08-JUL-15
Page 6
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Third Party Administrator SIERRA NEVADA ADMINISTRATORS INC 08-JUL-15
C of A Employer
130131 CHURCHILL COUNTY SCHOOL DISTRICT
Phyllys Dowd
Director of Business Services
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
Mary Sexton
Workers' Compensation Analyst
240 Water StreetPO Box 95050, MSC122
Henderson NV 89009-5050
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
Vincent Zamora
Page 7
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
HR Manager
495 S. Main St.
Las Vegas NV 89101
702-229-5043
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
David Childress
Risk Management
2250 Las Vegas Blvd North, Ste. 700
North Las Vegas NV 89030
702-633-1745
Association Name DBA Date
Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JAN-94
C of A Employer
123079 CITY OF RENO
Arreygue, Andrena Maxwell, Jennifer
[email protected] BACK UPs
PO Box 1900
Reno NV 89505
775-334-2285
Association Name DBA Date
Page 8
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-SEP-92
C of A Employer
123097 CITY OF SPARKS
Jill Valdez
Human Resources Analyst
431 Prater Way
Sparks NV 89431
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
Denise Parr
Manager Workers' Compensation
MGM Administration Building71 E Harmon Avenue
Las Vegas NV 89109
702-692-9586
Association Name DBA Date
Subsidiary ARIA RESORT AND CASINO 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
Page 9
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
123236 CLARK COUNTY
Les Lee Shell
Chief Administrative Officer
Workers' Compensation500 S Grand Central Pkwy
Las Vegas NV 89155
702-455-6538
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
Roque Lapuz, Jr.
Workers Comp Coordinator
4828 S. Pearl Street MS 200
Las Vegas NV 89121
702-799-0060 x 5601
Association Name DBA Date
Third Party Administrator SIERRA NEVADA ADMINISTRATORS INC 01-JUL-90
C of A Employer
123152 CLARK COUNTY WATER RECLAMATION DISTRICT
Martin Flynn
Page 10
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Assistant to General Manager
5857 East Flamingo Road
Las Vegas NV 89122
702-668-8066
Association Name DBA Date
Third Party Administrator NELSON DAVISON ADMINISTRATORS INC 01-APR-92
C of A Employer
123087 COSTCO WHOLESALE CORPORATION
Uyen Nguyen
Integrated Leave Data Analyst
999 Lake Drive
Issaquah WA 98027
425-313-2874
Association Name DBA Date
Third Party Administrator HELMSMAN MANAGEMENT SERVICES LLC 01-JAN-93
C of A Employer
123026 DIGNITY HEALTH
Terri Kielhorn
Vice President Risk Services
185 Berry StreetSuite 300
San Francisco CA 94107
415-438-5530
Association Name DBA Date
Page 11
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Subsidiary DIGNITY HEALTH MEDICAL GROUP NEVADA, LLC 01-OCT-13
Subsidiary ST ROSE DOMINICAN HEALTH FOUNDATION 01-OCT-00
Subsidiary ST ROSE DOMINICAN HOSPITAL-DE LIMA CAMPUS 01-OCT-00
Subsidiary ST ROSE DOMINICAN HOSPITAL-SAN MARTIN CAMPUS 01-OCT-00
Subsidiary ST ROSE DOMINICAN HOSPITAL-SIENA CAMPUS 01-AUG-06
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-OCT-00
C of A Employer
143601 DOUGLAS COUNTY
Whitney Lehr
HR Coordinator
PO Box 218
Minden NV 89423
775-782-9891
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
Cori Isherwood
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
Page 12
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
123011 ELDORADO RESORTS, INC.
Tracey Hudson
Director of Risk Management
345 North Virginia Street
Reno NV 89501
775-325-7040
Association Name DBA Date
Subsidiary CC-Reno, LLC Circus Circus Reno 23-NOV-15
Subsidiary Circus and Eldorado Joint Venture LLC Silver Legacy Hotel Casino 23-NOV-15
Subsidiary Eldorado Resorts, LLC Eldorado Hotel Casino 01-NOV-82
Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-NOV-82
C of A Employer
123129 ELKO COUNTY SCHOOL DISTRICT
Jerri Norton
Alternate contact
850 Elm StreetPO Box 1012
Elko NV 89803
775-738-5196
Association Name DBA Date
Third Party Administrator ALTERNATIVE SERVICE CONCEPTS LLC 01-NOV-93
C of A Employer
Page 13
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
123143 ENCOMPASS HEALTH CORPORATION
Cassie Reed
Sr. Workers' Compensation Claims Coordinator
3660 Grandview Parkway Ste 200
Birmingham AL 35243
205-970-3540
Association Name DBA Date
Subsidiary HealthSouth Rehabilitation Hospital of Desert Canyon, LLC HealthSouth Desert Canyon Rehabilitation Hospital 01-JUN-10
Subsidiary HealthSouth Rehabilitation Hospital of Henderson, LLC HealthSouth Home Health of Henderson 01-OCT-01
Subsidiary HealthSouth Rehabilitation Hospital of Henderson, LLC HealthSouth Rehabilitation Hospital of Henderson 01-OCT-01
Subsidiary HealthSouth Rehabilitation Hospital of Las Vegas, LLC HealthSouth Rehabilitation Hospital of Las Vegas 01-FEB-96
Third Party Administrator YORK RISK SERVICES GROUP INC 01-OCT-90
C of A Employer
122931 FEDEX CORPORATION (PARENT)(Ground)
Justin Blashock
Manager Risk Analysis & Insurance
1000 Fedex Drive
Moon Twp. PA 15108
412-859-2268
Association Name DBA Date
Subsidiary FEDEX GROUND PACKAGE SYSTEM, INC. 01-AUG-96
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-AUG-96
C of A Employer
122936 FEDEX CORPORATION for Federal Express Corporation
Gael Johnson
Page 14
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Sr. Risk Analyst
3620 Hacks Cross Road Bldg B 3rd Floor
Memphis TN 38120
901-434-4557
Association Name DBA Date
Subsidiary FEDERAL EXPRESS CORPORATION 01-APR-81
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-APR-81
C of A Employer
123050 FEDEX CORPORATION for Fedex Freight Inc
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 01-NOV-91
C of A Employer
123109 FOUR QUEENS LLC
Brian Arlin
VP/CFO
202 East Fremont Street
Las Vegas NV 89101
702-387-5188
Page 15
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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
123073 FRIAS HOLDING COMPANY LLC
Bonet Allosada
Vice President of Administrative Operations
5010 South Valley View Blvd
Las Vegas NV 89118
702-798-3424
Association Name DBA Date
Subsidiary A NLV CAB LLC ANLV CAB 01-JUL-92
Subsidiary ACE CAB LLC ACE CAB 01-JUL-92
Subsidiary FRIAS MANAGEMENT, LLC FRIAS TRANSPORTATION MANAGEMENT 01-JUL-10
Subsidiary FRIAS STANDARD CAPITAL INC. 02-JAN-15
Subsidiary UNION CAB LLC UNION CAB 01-JUL-92
Subsidiary VEGAS-WESTERN CAB LLC VEGAS-WESTERN CAB 01-JUL-92
Subsidiary VIRGIN VALLEY CAB LLC VIRGIN VALLEY CAB 01-AUG-94
Third Party Administrator R A WONG 01-JUL-92
C of A Employer
122964 Focus Plumbing LLC
Andrea Gould
Risk Manager
1220 S Commerce Street #120
Las Vegas NV 89102
Page 16
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
702-220-5621
Association Name DBA Date
Subsidiary Built Right Contractors Corporation 29-SEP-14
Subsidiary Focus Concrete 01-JAN-10
Subsidiary Focus Electric 01-JUN-09
Subsidiary Focus Framing, Door & Trim 15-SEP-11
Subsidiary General Landscape LLC 23-MAY-14
Subsidiary Green Image LLC G T I 01-FEB-11
Subsidiary Nevada Concrete Contractors LLC Dynascapes 27-MAR-14
Subsidiary SUN CITY ELECTRIC INC 18-AUG-03
Subsidiary Wire Power Electric Daylight Electric 15-APR-13
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
C of A Employer
145691 GOLDEN ENTERTAINMENT INC.
Jennifer Stiffler
Corporate Director of Employee and Labor Relations
Page 17
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
6595 S. JONES BLVD.
LAS VEGAS NV 89118
702-383-5387
Association Name DBA Date
Subsidiary GEI (Corporate) 20-OCT-17
Subsidiary Pahrump 20-OCT-17
Subsidiary Routes/Taverns (N/S) 20-OCT-17
Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 20-OCT-17
C of A Employer
122987 GOLDEN NUGGET INC
Lea Ann Lopez
Associate Director Risk Management
1510 W Loop South
Houston TX 77027
713-386-7202
Association Name DBA Date
Subsidiary GNL, CORP. GOLDEN NUGGET LAUGHLIN 23-JAN-04
Subsidiary GNLV, CORP. GOLDEN NUGGET LAS VEGAS 23-JAN-04
Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 23-JAN-04
C of A Employer
123118 HAMILTON HOLDING MANAGEMENT CORP
Carolyn Cooper
HR Sr. Business Partner
4990 Energy Way
Reno NV 89502
Page 18
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
775-858-3000 x 284
Association Name DBA Date
Subsidiary HAMILTON COMPANY 01-JUL-93
Subsidiary HAMILTON ROBOTICS 10-DEC-09
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
C of A Employer
123099 HCA HEALTHCARE INC.
Leah Larkin
Senior Compliance Analyst
1100 Charlotte Ave., Suite 800
Nashville TN 37203
615-344-1487
Association Name DBA Date
Page 19
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
SubsidiaryCOLUMBIA/HCA HEALTHCARE CORPORATION OF CENTRALTEXAS
01-JAN-17
Subsidiary COSCORP, LLC 23-APR-99
Subsidiary FAR WEST DIVISION, INC. 11-JUL-11
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
SubsidiaryHEALTHCARE SALES NATIONAL MANAGEMENT SERVICESGROUP LLC
01-SEP-09
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
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 URGENT CARE NEVADA, LLC 01-JAN-16
Third Party Administrator BROADSPIRE SERVICES INC 01-JAN-86
C of A Employer
123067 HCR ManorCare, Inc.
Lisa Jurski
Director - Mgr Workers Comp Program
333 N Summit StPO Box 10086
Page 20
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Toledo OH 43699-0086
419-254-5416
Association Name DBA Date
Subsidiary HEARTLAND EMPLOYMENT SERVICES, LLC 01-JAN-02
Third Party Administrator BROADSPIRE SERVICES INC 01-JUN-99
C of A Employer
123059 HOME DEPOT USA INC
Matt Rushing
Senior Risk Analyst
Store Support Center, Bldg C-202455 Paces Ferry Road, N.W.
Atlanta GA 30339
770-433-8211 x 85195
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
Page 21
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Association Name DBA Date
Third Party Administrator NELSON DAVISON ADMINISTRATORS INC 01-JUL-12
C of A Employer
122842 HYATT HOTELS 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 EL CORTEZ HOTEL & CASINO Effective Date: 08-MAY-09
Association Name DBA Date
Page 22
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
123048 KENNAMETAL INC (PARENT)
Michael Murphy
Director, Corporate Risk Management
1600 Technology Way
Latrobe PA 15650
724-539-4647
Association Name DBA Date
C of A Employer
123021 KIEWIT CORPORATION
Debra Prochaska
Claims Analyst
Kiewit Plaza
Omaha NE 68131
402-271-2862
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 01-NOV-99
Page 23
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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
C of A Employer
146761 KNIGHT TRANSPORTATION INC
Michele Redlin
Workers' Compensation Manager
20002 N. 19th Avenue
Phoenix AZ 85027
985-807-0879
Association Name DBA Date
C of A Employer
122996 KROGER COMPANY
Nathan Fraley
Page 24
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 01-NOV-91
C of A Employer
123034 LAS VEGAS CONVENTION AND VISITORS AUTHORITY
Jessica Lerner
Sr. Manager Total 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
Page 25
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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
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 INC 28-APR-89
C of A Employer
123037 LAS VEGAS VALLEY WATER DISTRICT
James Curbeam
Risk Manager
1001 South Valley View Blvd.m/s 380
Las Vegas NV 89153
702-822-8390
Association Name DBA Date
Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JAN-03
Third Party Administrator SIERRA NEVADA ADMINISTRATORS INC 01-JAN-18
Page 26
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
123210 LES SCHWAB WAREHOUSE CENTER, INC. AND LES SCHWAB TIRE CENTERS OF NEVADA, INC.
Denny Carter
Risk Services Manager
20900 Cooley Road
Bend OR 97701
541-416-5434
Association Name DBA Date
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-DEC-97
C of A Employer
123040 LYON COUNTY SCHOOL DISTRICT
Shani Dues
Risk Management
25 East Goldfield Ave
Yerington NV 89447
775-463-6800 x 127
Association Name DBA Date
Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-JUL-03
C of A Employer
122854 MACY'S INC
Ben Danker
Accountant
Page 27
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
7 West Seventh Street
Cincinnati OH 45202
513-579-7015
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 THE ZURICH SERVICES CORPORATION 01-FEB-16
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
Page 28
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Third Party Administrator SELF-ADMINISTERED 01-FEB-82
C of A Employer
123131 MCDONALD'S CORPORATION
Jody Sundquist
Insurance Compliance Supervisor
McDonald's Corporation2915 Jorie Boulevard
Oak Brook IL 60523
630-623-8037
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
Kirsti Lawson
Director of Risk Management
One Post Street 34th Floor
San Francisco CA 94104-5296
415-596-9206
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 28-FEB-11
Page 29
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
122978 MESQUITE GAMING LLC
Paula Farrell
Director, Benefits & Workers Compensation
950 W MESQUITE BLVD
MESQUITE NV 89027-5204
702-346-4000 x 3414
Association Name DBA Date
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
Denise Parr
Manager Workers' Compensation Dept.
MGM ADMINISTRATION BUILDING71 E HARMON AVE
LAS VEGAS NV 89109-4539
702-692-9586
Association Name DBA Date
Subsidiary Bellagio 06-OCT-94
Page 30
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Subsidiary Circus Circus Hotel (Las Vegas) 15-NOV-80
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 Mandalay Bay 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 The Mirage Casino-Hotel, LLC 01-MAY-89
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
John Harn
General Counsel
3800 S VIRGINIA ST
RENO NV 89502-6005
775-824-4448
Association Name DBA Date
Subsidiary Golden Road Motor Inn, Inc. Atlantis Casino Resort 01-JAN-94
Third Party Administrator NELSON DAVISON ADMINISTRATORS INC 11-SEP-13
Page 31
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 Colorado Belle Gaming LLC 15-APR-16
Subsidiary Edgewater Gaming 15-APR-16
Subsidiary Nugget Sparks, LLC Nugget Casino Resort 22-APR-16
Third Party Administrator YORK RISK SERVICES GROUP INC 01-MAY-16
C of A Employer
122873 NEV YELLOW NEV CHECKER & NEV STAR CAB CORP
Maranda Fisher
Director of Human Resources
5225 W POST RD
LAS VEGAS NV 89118-4331
702-933-1809
Association Name DBA Date
Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-JAN-95
C of A Employer
123170 NEVADA READY MIX CORPORATION
Page 32
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Larry Miller
Corporate Administrator
151 CASSIA WAY
HENDERSON NV 89014-6616
702-457-1115 x 3038
Association Name DBA Date
Third Party Administrator S & C CLAIMS SERVICES INC 01-JUL-17
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
Page 33
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
123039 NEW-COM, INC.
Mark Summers
Risk Manager
6600 AMELIA EARHART CT STE B
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 11-SEP-13
C of A Employer
122968 NEWMONT MINING CORPORATION
Jim Yates
6363 S. Fiddlers Green Cr.
Greenwood Village CO 80111
303-837-6021
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
Page 34
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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
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 Inc 01-JUL-94
Subsidiary Nevada Power Company 28-JUL-99
Subsidiary Sierra Pacific Power Company 01-JUL-92
Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-JUL-92
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
Page 35
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
123688 Ocean Spray Cranberries
Anja Rittling
Risk Manager
1 OCEAN SPRAY DR
LAKEVILLE-MIDDLEBORO MA 02349-1000
508-923-3379
Association Name DBA Date
Third Party Administrator HELMSMAN MANAGEMENT SERVICES LLC 01-SEP-94
C of A Employer
122871 PACCAR INC
DeeAnne Flegel
Manager, Workplace Absence Programs Health & Welfa
PO BOX 1518
BELLEVUE WA 98009-1518
425-468-7939
Association Name DBA Date
Subsidiary PACCAR PARTS DIVISION 01-JAN-95
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-JAN-95
C of A Employer
122953 PEPPERMILL CASINOS INC
Michael Heward
Page 36
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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
122971 POLY-AMERICA FOR POLY-WEST INC
Eric Anderson
Human Resources Manager
Page 37
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
251 CONESTOGA WAY
HENDERSON NV 89002-9400
702-207-5629
Association Name DBA Date
Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-FEB-09
C of A Employer
123219 PURCELL TIRE & RUBBER COMPANY
Tim Price
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 Purcell's Western States Tire 01-JAN-98
Subsidiary Purcell Tire Company Tires @ Wholesale 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
Senior Risk Manager
500 W Capitol Ave
West Sacramento CA 95605
Page 38
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 Food Source 17-FEB-11
Subsidiary Warehouse Concepts, a California Corporation Beverage Market 17-FEB-11
Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-JUL-86
C of A Employer
123141 RENO SPARKS CONVENTION & VISITORS AUTHORITY
Julie Williams
HR GEneralist
4001 S. Virginia St., #G
Reno NV 89502
775-827-7695
Association Name DBA Date
Third Party Administrator ALTERNATIVE SERVICE CONCEPTS LLC 01-JUL-90
C of A Employer
123237 RENOWN HEALTH
Michael Munda
IHN Director of Accreditation & reg Compliance
1155 MILL ST MS J-11
RENO NV 89502-1576
775-982-4798
Association Name DBA Date
Page 39
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Subsidiary HOMETOWN HEALTH MGT CO 01-JAN-89
Subsidiary HOMETOWN HEALTH PLAN INC. 01-JAN-89
Subsidiary NEVADA HEALTHCARE COOPERATIVE 15-OCT-04
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
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
123217 SCHNEIDER NATIONAL INC
Amy Deprey
Risk Insurance Analyst
3101 PACKERLAND DR
GREEN BAY WI 54313-6187
920-591-3071
Page 40
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 HELMSMAN MANAGEMENT SERVICES LLC 11-SEP-13
C of A Employer
123154 SHERWIN-WILLIAMS COMPANY
Anthony Colangelo
Manager Workers Comp
101 Prospect Avenue NW
Cleveland OH 44115-1075
216-566-3717
Association Name DBA Date
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
3333 BLUE DIAMOND RD
LAS VEGAS NV 89139-7888
702-914-8513
Page 41
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Association Name DBA Date
Third Party Administrator CANNON COCHRAN MANAGEMENT SERVICES INC CCMSI 01-OCT-09
C of A Employer
123041 SOUTHERN NEVADA HARLEY DAVIDSON SALES INC & RED ROCK MOTORCYCLE SALES INC
Jeffry Rosenblatt
Controller
5191 LAS VEGAS BOULEVARD SOUTH
LAS VEGAS NV 89119
702-876-2884
Doing Business As Las Vegas Harley-Davidson Effective Date: 06-AUG-03
Doing Business As Red Rock Harley-Davidson Effective Date: 05-DEC-07
Association Name DBA Date
C of A Employer
123167 SOUTHWEST AIRLINES CO
Patti Colwell
Manager Workers' Compensation
2702 LOVE FIELD DR
DALLAS TX 75235-1908
214-792-6462
Association Name DBA Date
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-MAR-94
Page 42
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
C of A Employer
122955 SOUTHWEST GAS CORPORATION
Bradley Anderson
Administrator/Corporate Risk Management
PO BOX 98510
LAS VEGAS NV 89193-8510
702-876-7017
Association Name DBA Date
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 Palms Casino Resort 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 Boulder Station 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 Fiesta Henderson 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 Palace Station Hotel & Casino Palace Station Hotel & Casino 14-JUN-11
Page 43
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 Santa Fe Station 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 Texas Station 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 Palms Place 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
SubsidiarySTATION GVR ACQUISITION, LLC dba Green Valley Ranch ResortSpa Casino
Green Valley Ranch Resort Spa Casino 14-JUN-11
Subsidiary SUNSET GV, LLC dba Wildfire Casino and Lanes Wildfire Casino and Lanes 14-JUN-11
SubsidiaryTOWN CENTER AMUSEMENTS, INC. A LIMITED LIABILITYCOMPANY dba Barley's Casino & Brewing Company
Barley's Casino & Brewing Company 14-JUN-11
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 STORES
Laurene Dufault
Page 44
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 11-SEP-13
C of A Employer
122972 TREASURE ISLAND LLC
Gayle Kurokawa
V/P Human Resources
3300 LAS VEGAS BLVD S
LAS VEGAS NV 89148
702-894-7506
Association Name DBA Date
Third Party Administrator YORK RISK SERVICES GROUP INC 01-AUG-09
C of A Employer
123180 TRUE BLUE INC
Alison Fent
Risk Specialist
PO BOX 2910
TACOMA WA 98401-2910
800-610-8920 x 8491
Association Name DBA Date
Page 45
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Subsidiary PeopleReady. Inc. 20-SEP-16
Third Party Administrator ESIS INC 11-SEP-13
C of A Employer
123234 UNITED AIR LINES INC
Neil Blauvelt
Work Comp & Corporate Insurance Sr. Manager
233 S Wacker Drive - HDQCI
Chicago IL 60606
872-825-9774
Association Name DBA Date
Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-MAR-85
C of A Employer
123102 US FOODS INC
Dena Abdallah
Director-Risk Management
9399 W. Higgins Road
Rosemont IL 60018
847-720-1689
Association Name DBA Date
Subsidiary STOCKYARDS OF LAS VEGAS HARRISON'S PRIMEMEATS AND PROVISIONS 01-MAR-97
Subsidiary STOCKYARDS OF LAS VEGAS OUTWEST MEAT COMPANY 01-APR-98
Third Party Administrator GALLAGHER BASSETT SERVICES, INC.(TPA) 01-APR-93
Third Party Administrator SEDGWICK CLAIMS MANAGEMENT SERVICES INC 01-NOV-16
Page 46
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 SHOWS UNLIMITED, INC. 01-JAN-97
Third Party Administrator CORVEL ENTERPRISE COMP INC HRMS 01-SEP-91
C of A Employer
123024 WASHOE COUNTY
Celeste Wallick
Risk Analyst
PO BOX 11130
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
Page 47
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
Jackie James
Risk Manager
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
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
123030 WESTERN CAB COMPANY INC
Martha Sarver
General Manager
801 S MAIN ST
LAS VEGAS NV 89101-6424
Page 48
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
702-382-7100
Association Name DBA Date
Third Party Administrator R A WONG 01-SEP-01
C of A Employer
122888 WESTERN STATES CONTRACTING INC
Troy Shiozawa
Risk Manager
4129 W Cheyenne
North Las Vegas NV 89032
702-336-4656
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 WS-Dynoco Petroleum Management LLC Wesley's 15-JAN-13
Third Party Administrator SELF-ADMINISTERED 01-SEP-95
C of A Employer
123231 YOUNG ELECTRIC SIGN COMPANY
Clark Smith
Director of Finance/Treasurer
2401 Foothill Drive
Salt Lake City UT 84109
801-464-4600
Page 49
Department of Business and Industry
Nevada Division of InsuranceSelf-Insured Employer List
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 01-MAY-86