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Department of Business and Industry Nevada Division of Insurance Self-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
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Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

Apr 11, 2018

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Page 1: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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

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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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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

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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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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

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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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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

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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

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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

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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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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

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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

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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

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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

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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

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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

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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

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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

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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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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: Nevada Division of Insurance Department of Business …di.nv.gov/sdc/EmployerList.pdf · David Childress Risk Management 2250 Las Vegas Blvd North, Ste. 700 North Las Vegas NV 89030

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