Advantage Workers Compensation Insurance Company 10/21/14 Client ID Gallagher Bassett Claim Offices

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1 ALABAMA Gallagher Bassett Services Vestavia Pkwy., Suite 251 Birmingham, AL Phone: Fax: Toll Free #: Branch Manager: Jim Colli Ph# ALASKA Wilton Adjustment Service, Inc E. 34 th Avenue, Suite 400 Anchorage, AK Phone: Fax: Branch Manager: Joanne Pride Ph# , x joanne-pride@wiltonalaska.com ARKANSAS Gallagher Bassett Services P.O. Box 7140 North Little Rock, AR Phone: Fax: Toll Free: Branch Manager: Jodi Sullivan Jodi_Sullivan@gbtpa.com CONNECTICUT DELAWARE Gallagher Bassett Services (Philadelphia) P.O. Box 1508 Mt. Laurel, NJ Phone: Fax: Toll Free: Branch Manager: Debbe Dempster Debbe_Dempster@gbtpa.com DC Gallagher Bassett Services (Wash. DC) P.O. Box 2007 Columbia, MD Phone: Fax: Toll Free: Branch Manager: Glenn Elseroad Glenn_Elseroad@gbtpa.com

2 FLORIDA Gallagher Bassett Services P.O. Box Orlando, FL Phone: Fax: Toll Free: Branch Manager: Keith Leahy Keith_Leahy@gbtpa.com GEORGIA Gallagher Bassett Services Crescent Center Parkway, Suite 600 Tucker, GA Phone: Fax: Toll Free: Branch Manager: Patricia Barber Patricia_Barber@gbtpa.com HAWAII Gallagher Bassett Services Fort Street, Suite 420 Honolulu, HI Phone: Fax: Toll Free: Branch Manager: Nadine Kurihara-Nakasu Nadine_Kurihara-Nakasu@gbtpa.com ILLINOIS Gallagher Bassett Services P.O. Box 8009 Itasca, IL Phone: Toll Free: Branch Manager: Bronwyn Kossman Bronwyn_Kossman@gbtpa.com INDIANA Gallagher Bassett Services Nimtz Parkway, Suite 100 South Bend, IN Phone: Fax: Toll Free: Branch Manager: Marge Rzepka Marge_Rzepka@gbtpa.com IOWA Gallagher Bassett Services Waterford Blvd., Suite 120 Oklahoma City, OK Phone: Fax: Toll Free:

3 KANSAS Gallagher Bassett Services E. 104th Street, Suite 200 Kansas City, MO Phone: Fax: Toll Free: KENTUCKY Gallagher Bassett Services P.O. Box 6928 Louisville, KY Phone: Fax: Toll Free: Branch Manager: Andrea Treadway Andrea_Treadway@gbtpa.com LOUISIANA Gallagher Bassett Services Highlandia Drive, Suite 101 Baton Rouge, LA Phone: Fax: Toll Free: Branch Manager: James Colli Phone: MAINE MARYLAND Gallagher Bassett Services (Wash. DC) P.O. Box 2007 Columbia, MD Phone: Fax: Toll Free: Branch Manager: Glenn Elseroad Glenn_Elseroad@gbtpa.com MASSACHUSETTS

4 MICHIGAN Gallagher Bassett Services (Lansing) Arbor Glen Office Park 300 W Lake Lansing Rd East Lansing, MI Phone: Fax: Toll Free: Branch Manager: Michael Wyman Michael_Wyman@gbtpa.com MINNESOTA Gallagher Bassett Services 075 P.O. Box 1300 Maple Grove, MN Phone: Fax: Toll Free: Branch Manager: Kevin Frommelt Kevin_Frommelt@gbtpa.com MISSISSIPPI Gallagher Bassett Services Highlandia Drive, Suite 101 Baton Rouge, LA Phone: Fax: Toll Free: Branch Manager: James Colli Phone: MISSOURI Gallagher Bassett Services Des Peres Road, Suite 140 St. Louis, MO Phone: Fax: Toll Free: Branch Manager: Christina Rauscher Christina_Rauscher@gbtpa.com NEBRASKA Gallagher Bassett Services E. 104th Street, Suite 200 Kansas City, MO Phone: Fax: Toll Free: NEW HAMPSHIRE

5 NEW JERSEY Gallagher Bassett Services (Philadelphia) P.O. Box 1508 Mt. Laurel, NJ Phone: Fax: Toll Free: Branch Manager: Debbe Dempster Debbe_Dempster@gbtpa.com NEW YORK Gallagher Bassett Services (Syracuse) 3300 Vickery Road North Syracuse, NY Phone: Fax: Toll Free: Branch Manager: Mary Fitzgerald Mary_Fitzgerald@gbtpa.com NORTH CAROLINA Gallagher Bassett Services Red Oak Boulevard, Suite 240 Charlotte, NC Phone: Fax: Toll Free: Branch Manager: Regina Woodberry-Stith Regina_Woodberry-Stith@gbtpa.com OKLAHOMA Gallagher Bassett Services Waterford Blvd., Suite 120 Oklahoma City, OK Phone: Fax: Toll Free: OREGON Gallagher Bassett Services 155 Portland 4550 Kruse Way, Suite 155 Lake Oswego, OR Phone: Fax: Toll Free: Branch Manager: Eric Sorem Eric_Sorem@gbtpa.com PENNSYLVANIA Gallagher Bassett Services (Philadelphia) P.O. Box 1508 Mt. Laurel, NJ Phone: Fax: Toll Free: Branch Manager: Debbe Dempster Debbe_Dempster@gbtpa.com

6 RHODE ISLAND SOUTH CAROLINA Gallagher Bassett Services Red Oak Boulevard, Suite 240 Charlotte, NC Phone: Fax: Toll Free: Branch Manager: Regina Woodberry-Stith Regina_Woodberry-Stith@gbtpa.com SOUTH DAKOTA Gallagher Bassett Services Waterford Blvd., Suite 120 Oklahoma City, OK Phone: Fax: Toll Free: TENNESSEE Gallagher Bassett Services P.O. Box Nashville, TN Phone: Fax: Toll Free: Branch Manager: Jim Colli Phone: TEXAS Gallagher Bassett Services (Dallas) 6404 International Parkway, Suite 2300 Plano, Texas Phone: Fax: Toll Free: Branch Manager: Terry Tarter Terry_Tarter@gbtpa.com VERMONT

7 VIRGINIA Gallagher Bassett Services 066 P.O. Box Richmond, VA Phone: Fax: Toll Free: Branch Manager: Alicia Barnett WISCONSIN Gallagher Bassett Services Two Honey Creek Corporate Center 115 S. 84th Street, Suite 215 Milwaukee, WI Phone: Fax: Toll Free: Branch Manager: Andrew Johnson Andrew_Johnson@gbtpa.com Mailing address for all medical bills: Gallagher Bassett Services Scanning Center PO Box Tucson, AZ 85734

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