Self insured list - Colorado Department of Labor and Employment

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SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER 826 03/01/93 OREGON STEEL MILLS, INC. (d.b.a. Rocky Mr. John Walker Ms. Carolyn Bjur Mountain Steel Mills) Operations Manager Corporation Manager Sedgwick CMS, Inc. Workers’ Compensation 7400 East Orchard Road, Suite 4015 Rocky Mountain Steel Mills P. O. Box 5107 (80155-5107) P. O. Box 5368 Greenwood Village, CO 80111-2518 Portland, OR 97228-5368 OFFICE: 303-713-6030 OFFICE: 503-240-5239 800-507-9656 FAX: 503-240-5798 FAX: 303-713-6056 EMAIL: bjurc@osm.com EMAIL: jewalker@sedgwickcms.com 472 04/15/04 PEABODY ENERGY CORPORATION Ms. Stacy Ross Shannon Orlando State Director Manager--Insurance Claims CCMSI Peabody Energy Corporation 7600 East Orchard Road, #360N 701 Market Street, Suite 600 P.O. Box 4998 (80155-4998) St. Louis, MO 63101-1826 Greenwood Village, CO 80111-2517 OFFICE: 314-342-3469 OFFICE: 303-804-2032 FAX: 314-342-7740 FAX: 303-804-2005 EMAIL: sorlando@peabodyenergy.com EMAIL: sross@ccmsi.com Lynnette M. Rasch LEFT Peabody Feb 2009 Wendy Garcia, Acct Supervisor 828 01/01/93 PITKIN COUNTY Ms. Stacy Ross Laura Laubhan State Director Human Resources manager §8-42-124 CCMSI Pitkin County 7600 East Orchard Road, #360N 530 East Main Street, Suite 202 P. O. Box 4998 (80155-4998) Aspen, CO 81611-1948 Greenwood Village, CO 80111-2518 krisj@co.pitkin.co.us Kris Jewkes Risk Mgmt Coordina OFFICE: 303-804-2032 OFFICE: 970-429-2792 FAX: 303-804-2005 FAX: 970-920-5049 EMAIL: sross@ccmsi.com EMAIL: laural@co.pitkin.co.us Vicky Roden Account Mgr CCMSI vroden@ccmsi.com Page 26 6/22/2009
SELF INSURED LIST PERMIT ANNIVERSARY DATE NAME OF PERMIT TPA OR LOCAL PERMIT HOLDER 885 01/01/88 PORTERCARE ADVENTIST HEALTH Ms. Stacy Ross Mr. Richard Osborn SYSTEM State Director Director, Risk Management CCMSI PorterCare Adventist Health System 7600 East Orchard Road, #360N 2525 South Downing Street P. O. Box 4998 (80155-4998) Denver, CO 80210-5876 Canceled effective midnight 1/31/09 Greenwood Village, CO 80111-2518 In Adventist Health Systems effective 2/1/09 OFFICE: 303-804-2032 OFFICE: 303-778-2538 FAX: 303-804-2005 FAX: 303-778-5295 EMAIL: sross@ccmsi.com EMAIL: richardosborn@centura.org 897 01/01/87 POUDRE SCHOOL DISTRICT R-1 Ms. Stacy Ross Ms. Kristin Bennett State Director Benefits Manager §8-42-124 CCMSI Poudre School District R-1 7600 East Orchard Road, #360N 2407 LaPorte Avenue P. O. Box 4998 (80155-4998) Ft. Collins, CO 80521-2297 Greenwood Village, CO 80111-2518 A1 OFFICE: 303-804-2032 OFFICE: 970-490-3627 FAX: 303-804-2005 FAX: 970-490-3529 EMAIL: sross@ccmsi.com EMAIL: kbennett@psdschools.org Kathy Lindgren 871 04/01/89 POUDRE VALLEY HEALTH CARE, INC. Vicky Roden Diane M Gross CCMSI Associate General Counsel Original 7600 East Orchard Road, #360N Poudre Valley Health System Anniversary P. O. Box 4998 (80155-4998) 2315 Harmony Rd Suite 200 Date: 01/01/89 Mr. Gary Swenson till 12/31/08 Greenwood Village CO 80111-2518 Ft. Collins, CO 80528-3929 Director 303-804-2031 Support Services, Inc. 217-477-3007 Fax OFFICE: 970-237-7030 7335 East Orchard Road, Suite 200 FAX: 970-237-7094 Greenwood Village, CO 80111-2518 vroden@ccmsi.com EMAIL: dmg5@pvhs.org OFFICE: 720-489-9300 FAX: 720-489-1166 EMAIL: gary.swenson@cha.com All SI period claims adjusted by CCMSI Page 27 6/22/2009
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Self insured list - Colorado Department of Labor and Employment

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