MASTER SERVICE LIST FOR INTERVENORS

Use of this list: The entities on this list have provided the following information to allow parties in workers’ compensation cases to easily contact the company and its representatives regarding an intervention interest under Minn. Stat. § 176.361 in a workers’ compensation case. The left column “intervenor” lists the address to use to serve a Notice of Right to Intervene in a workers’ compensation proceeding along with the date the information was updated. The middle column lists contact information for settlement or case resolution purposes. The right column provides, where available, an alternate contact person if the primary contact person is unavailable. If a Motion to Intervene in an individual case lists a different contact person or persons, please contact the persons listed in the motion. This list is updated per the request of the entities on this list. We cannot guarantee that the information remains accurate.

Potential Intervenors: To update this list, please complete and follow the instructions on the Workers’ Compensation Intervenor Contact Information form.

To find additional contact information for health care providers, try these links:

Hospitals: www.theagapecenter.com/Hospitals/Minnesota.htm

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONAdvanced Care Chiropractic, P.A.14001 Ridgedale Drive, Suite 390Minnetonka, MN 55305(5/16)

Sheldon Osvold, D.C.(952) 893-8900Fax (952) 893-7399drsosvold@gmail.com

Alaena Wocking(952) 893-8900Fax (952) 893-7399awocking@uwcenter.com

Advanced Pain Management4131 West Loomis Road, Suite 300Greenfield, WI 53221(5/17)

Kyle A. Fromm(414) 585-8721Fax (414) 585-8761Kyle.fromm@apmhealth.com

Alexandria Orthopaedic Associatesk/n/a Heartland Orthopedic Specialists(5/09)

See: Heartland Orthopedic Specialists

Allied Craftworkers Fringe Benefit Fund(1/08)

See Rosene, Haugrud & Staab, Chtd.

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONAllina HospitalsInternal Zip 10202P.O. Box 43Minneapolis, MN 55440-0043(10/16)

Kris Wittwer/Jessica Syverson (attorneys)1700 Highway 36 W, Suite 640Roseville, MN 55113(651) 493-2934Fax (651) 493-2987kwittwer@wittwerlaw.comjsyverson@wittwerlaw.com

Use this information for Abbott Northwestern, Cambridge, Buffalo, Owatonna, Mercy, New Ulm Medical Center, River Falls Area, United, Unity, St. Francis Hospitals, Regina Hospital, Courage Kenny Rehab. Institute, and Phillips Eye Institute.

Allina Medical ClinicsConsolidated Business Office Attn: Workers’ Comp InterventionInternal Zip 10202P.O. Box 43Minneapolis, MN 55440-0043(10/16)

Use this information for all Allina medical clinics.

Altru Health SystemP.O. Box 13780Grand Forks, ND 58208-3780(10/15)

Lori Jacquemart (Alpha A-L)(701) 780-4385Fax (701) 780-1046Ljacquemart@altru.org

Diane Schlenk (Alpha M-Z)(701) 780-6164Fax (701)780-1046Ljacquemart@altru.org

Apple Valley Medical Clinic14655 Galaxie AvenueApple Valley, MN 55124(1/16)

Debra Kirk(952) 953-4296Fax (952) 891-3921njennissen@dchospital.com

Diane Grant(952) 953-9160Fax (952) 891-3921dgrant@applevalleymc.com

Asbestos Workers Local 34 Health & Welfare PlanP.O. Box 220 Minneapolis, MN 55440-0220(952) 544-8332 (3/06)

Gary Boline(952) 541-6335Fax (952) 544-8287gabohline@flexcompensation.com

Aspen Medical Group1021 Bandana Blvd. EastSt. Paul, MN 55108(8/07)

Pat Van Ert(651) 642-2726Fax (651) 642-9441pvanert@aspenmed.org

Beth Bolton(651) 642-2768Fax (651) 642-9441bbolton@aspenmed.org

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONBenedictine Health System503 E. Third St. Suite 400Duluth, MN 55805(3/06)

Thomas R. Crook(218) 786-2370Fax (218) 786-7271tom.crook@bhshealth.org

Kristina Hamann(612) 845-6375

kris.hamann@bhslth.org

Blaine Chiropractic Center, P.A.11919 Central Avenue NEBlaine, MN 55434-3911

Thomas C. Rice, D.C.(763) 757-1660Fax (763) 757 4108blainechiro@qwestoffice.net

Blue Cross Blue Shield of IL3200 Robbins RoadSpringfield, IL 62704(12/11)

Jennifer Moore(800) 582-6418 Ext. 2130Fax (217) 698-0718

Blue Cross Blue Shield of MNP.O. Box 64560St. Paul, MN 55164(4/06)

Greg Walsh (651) 662-6278Fax (651) 662-1099greg_walsh@bluecrossmn.com

Blue Cross Blue Shield of ND4510 13th Avenue SouthFargo, ND 58121(5/10)

Kristi Schlosser Carlson(701) 277-2539Fax (701) 282-1554kristi.carlson@bcbsnd.com

Britton Center360 Sherman Street, Suite 400St. Paul, MN 55102-2425(9/15)www.brittoncenter.com

Abigail M. Thomas(651) 340-3854Athomas@brittoncenter.com

Burke Chiropractic Center7250 France Avenue South, Suite 111Edina, MN 55435

Adam Burke(952) 835-0006Fax (952) 835-9355dr.adamburke@yahoo.com

Danielle Burke(952) 224-4423Fax (952) 835-9355burkebilling2@yahoo.com

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONCarpenters & Joiners Health & Welfare Fund3001 Metro Drive, Suite 500Bloomington, MN 55425(9/17)

Bryan Morben(612) 435-6352Fax (612) 435-6379Anderson, Helgen, Davis & Nissen, P.A.bjm@andersonhelgen.com

Kim Tuckner(612) 435-6358Fax (612) 435-6379bjm@andersonhelgen.com

Cass Lake Indian Hospital(4/07)

See U.S. Department of Health and Human Services

Center for Diagnostic Imaging (CDI)5775 Wayzata Blvd. Suite 500ASt. Louis Park, MN 55416 (7/17)

Houa Heikkinen(855) 566-6386Fax (952) 513-6880houa.heikkinen@cdirad.com

Kris Wittwer/Jessica Syverson (attorneys)(651) 493-2934Fax (651) 493-2987kwittwer@wittwerlaw.comjsyverson@wittwerlaw.com

Center for Sports Medicine & Rehabilitation - Northfield2000 North AvenueNorthfield, MN 55057(5/13)

Laura Peterson(507) 646-1176Fax (507) 646-1486petersonl@northfieldhospital.org

Construction Suppliers Health and Welfare Trust Fund A(1/08)

Consulting Radiologists, Ltd.7505 Metro Boulevard, Suite 400Edina, MN 55439 (6/15)

Sarah Pfiffner(612) 573-2260Fax (612) 573-2273sarah.pfiffner@crlmed.com

Mary Wall(612) 573-2228Fax (612) 573-2273mary.wall@crlmed.com

Department of Employment and Economic Development

See MN Department of Employment and Economic Development

Department of Human Services See MN Department of Human Services

Department of Labor and IndustryVocational Rehabilitation Unit

See MN Department of Labor and Industry

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONDouglas County Hospital111 17th Avenue EastAlexandria, MN 56308(1/16)

Sue N.(320) 762-6061Fax (320) 762-6101snack@dchospital.com

Nancy J.(320) 762-6054Fax (320) 762-6101njennissen@dchospital.com

Drews Family Chiropractic(12/15)

See HealthSource of Woodbury

Duluth Clinic See St. Mary’s Duluth Clinic Health System

East Metro Imaging(11/10)

See St. Paul Radiology

Eastview Family Chiropractic Clinic1125 Woodbury Drive, Suite 500Woodbury, MN 55125(10/14)

Andrew Erlandson, D.C.(651) 436-2606Fax (651) 436-2909andrewerlandsondc@gmail.com

Emergency Physicians, P.A.5435 Feltl RoadMinnetonka, MN 55343(12/11)

John Iden(952) 857-1526Fax (952-835-4403)jiden@emer-phys.com

Erin Lombardo(952) 857-1500Fax (952) 835-4403elombardo@emer-phys.com

Essentia Health(6/15)

See St. Mary’s Duluth Clinic Health System

Fairview Health ServicesWork Comp Interventions400 Stinson Boulevard NEMinneapolis, MN 55413-2614(9/17)Includes all Fairview facilities [hospitals, clinics, home care, etc., also includes Institute for Athletic Medicine, University of MN Heart, Surgical Consultants, (Fairview) Diagnostic Labs] (excluding Mesaba/Hibbing/Range area)

Melissa Dietrich(612) 672-7679Fax (612) 672-2833(Attn: Interventions)mdietri1@fairview.org

***Prefer notice to be e-mailed instead of by fax, if possible. If applicable, on cover sheet list sites you are serving.

Sarah Bishop(612) 672-5010Fax (612) 672-2833(Attn: Interventions)sbishop1@fairview.org

Family Health Medical Clinics2000 North AvenueNorthfield, MN 55057(5/13)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONFamily Practice Medical Center502 Second Street S.W.P.O. Box 957Willmar, MN 56201

Anne Moudry(320) 231-8627Fax (320) 231-8609amoudry@fpmc-willmar.com

Gary McDowell(320) 231-8642gmcdowell@fpmc-willmar.com

First Class Recoveries, Inc. (for Preferred One Administrative Services7900 International Drive, Suite 300Bloomington, MN 55425(10/14)

Bill Brady(952) 883-3250bill.brady@FirstClassRecoveries.com

First Plan of MN525 S. Lake Ave. Suite 222Duluth, MN 55802(4/06)

Greg WalshP. O. Box 64560St. Paul, MN 55164(651) 662-6278Fax (651) 662-1099greg_walsh@bluecrossmn.com

First Unum Life Insurance Company1 Fountain SquareChattanooga, TN 3740212/17

Jennifer Majic(423) 294-5673Fax (423) 294-2424jmajic@unum.com

Firstlight Health System301 South Highway 65Mora, MN 55051

Kelly Caswell(320) 225-3337Fax (320) 225-3345kcaswell@fl-hs.org

Lisa Wren(320) 225-3534Fax (320) 225-3345lwren@fl-hs.org

Fortis Benefits Insurance Company (see Union Security Insurance Company) (3/06)Gallery Imaging(11/10)

Galvin Rehabilitation ServicesP.O. Box 66New Ulm, MN 56073(3/06)

Craig Galvin(507) 233-7733Fax (507) 354-7287galvin@newulmtel.net

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONGold Cross Ambulance and Mayo Medical TransportAttn: Business Office 501 Sixth Ave. NWRochester, MN 55901(2/16)

Charles S. Bierman (atty)Mayo Clinic200 First St. SWRochester, MN 55905(507) 266-0484Fax (507) 284-9229bierman.charles@mayo.edu

Stacie SchmidMayo Clinic200 First St. SWRochester, MN 55905(507) 266-0484Fax (507) 284-9229Schmid.Stacie@mayo.edu

Greater Metropolitan Hotel-Employers-Employees Health and Welfare Fund(1/08)

Group Health Plan d/b/a HealthPartnersP.O. Box 244Mailstop 25508BMinneapolis, MN 55440(8/15)

Hartford See The HartfordHealthPartnersP.O. Box 1309Mail Stop 21114ABloomington, MN 55440(9/16)

Jacquie Hakes(952) 883-5192Fax (952) 853-8728Jacquie.L.Hakes@HealthPartners.com

Brian Albrecht(952) 883-5687Fax (952) 853-8728Brian.J.Albrecht@HealthPartners.com

HealthSource of Woodbury7060 Valley Creek Plaza, Suite 121Woodbury, MN 55125(12/15)

(Drews Family Chiropractic d/b/a HealthSource of Woodbury)

Christopher Drews, D.C.(651) 735-8646Fax (651) 730-9210cdrews@healthsourcechiro.com

651-329-3124

Heartland Orthopedic Specialists1500 Irving StreetAlexandria, MN 56308(5/09)

Melissa Baas(320) 762-0857 Ext. 6061Fax (320) 762-1935mbaas@heartlandorthopedics.com

Kim Blake(320) 762-0857 Ext. 6058Fax (320) 762-1935kblake@heartlandorthopedics.com

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONHennepin County Medical Center & Physicians701 Park Ave., S8.200Minneapolis, MN 55415-1829(11/17)

Korrie Murphy(816) 524-9477, Ext. 274Fax (816) 524-2328korrie.murphy@hcmed.org

Latasha Pettis(816) 524-9477, Ext. 231Fax (816) 524-2328latasha.pettis@hcmed.org

High Point Surgery Center8650 Hudson Blvd. Suite 235Lake Elmo, MN 55042(3/06)

Lori A. Gavin(651)702-7401Fax (651)702-7414lgavin@hpsurgery.com

Traci Albers(651) 702-7408Fax (651)702-7414talbers@hpsurgery.com

Hospitals-For Allina Hospitals,See Allina Hospitals Health System

Humana1850 Wayzata Boulevard West, Suite 100Long Lake, Minnesota 55356(5/17)

Kathryn Hipp Carlson(612) 333-8600Fax (612) 333-9100kathy@hippcarlsonlaw.com

Indian Health Service(4/07)

Independent School District #465307 East 6th Street, Suite 100Litchfield, MN 55355

Rebecca Boll(320) 693-2444, Ext. 8105(320) 593-6528rboll@isd465.org

Barba Wagner(320) 693-2444, Ext. 8104(320) 593-6528bwagner@isd465.org

Institute for Low Back and Neck Care, PA (ILBNC)3001 Metro Drive, Suite 330Bloomington, MN 55425(6/07)

Laura Tolbert(952) 814-6663ltolbert@ilbnc.com

Nicole Taft(952) 814-6619ntaft@ilbnc.com

International Brotherhood of Electrical Workers 292 Health Care Plan312 Central Avenue SE, Suite 292Minneapolis, MN 55414 (10/15)

Thomas McCormick (atty)222 South 9th StreetSuite 1600Minneapolis, MN 55402(612) 337-9550Fax (612) 337-9049tom@mccormicklawoffice.com

Julie Gessell(952) 591-7733Fax (952) 591-7728julie@ibew292benefits.com

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONItasca Medical Care1219 S.E. 2nd AvenueGrand Rapids, MN 55744(9/17)

Jason Johnson(218) 327-6766Fax (218) 327-5545jason.johnson@co.itasca.mn.us

Laura Grover(218) 327-6769Fax (218) 327-5545laura.grover@co.itasca.mn.us

Kittson Memorial Healthcare Center1010 South Birch AvenueHallock, MN 56728(2/16)

Kim Klegstad(218) 843-3810Fax (218) 843-2311kim.klegstad@kmhc.net

Liz LaPlant(218) 843-3612Fax (218) 843-2311liz.laplant@kmhc.net

Lakeview Hospital927 West Churchill StreetStillwater, MN 55082(8/15)

Scott Phillips(651) 430-4533Fax (651) 430-8591

Lakewalk Surgery Center1420 London Road, Suite 100Duluth, MN 55805(11/15)

Joe Majerus(218) 728-8505Fax (281) 728-8557jmajerus@lakewalk.com

Billing Specialist (Gloria, Jody or Tina)(218) 728-0650Fax (218) 728-8557billers@lakewalk.com

Landmark Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(4/16)

Cynthia Spano-WeyerOffice (651) 968-5022 Cell (651) 795-1111 Fax (651) 968-5900cspanoweyer@summitortho.com

Jim Cleary(651) 968-5007Fax (651) 968-5900jcleary@summitortho.com

Leno Chiropractic Clinic, Ltd.123 Avenue CCloquet, MN 55720(5/17)

Bri Simmons(218) 879-1556Fax (218) 879-1568bsimmons@lenochiropractic.com

Kayla Ellison, D.C.(218) 879-1556Fax (218) 879-1568drellison@lenochiropractic.com

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMadison National Life Insurance Co., Inc.P.O. Box 5008Madison, WI 53705(10/07)

Joe E. Thompson (atty)JMSK LawP.O. Box 913Willmar, MN 56201Office (320) 235-2000Cell (320) 212-7273Fax (320) 235-0480joethompson@jmsklaw.com

Paul Butters(608) 830-2411pjb@madisonlife.com

Maple Grove HospitalIntervention Notice-Business Office3300 Oakdale Avenue NorthRobbinsdale, MN 55442(8/15)

North Memorial Health Care(763) 520-5400

MAPS See Medical Advanced Pain Specialists

Mayo Clinic Health – Albert LeaAttn: Business Office404 Fountain St.Albert Lea, MN 56007(2/16)

Mayo Clinic Health System - AustinAttn: Business Office 1000 First Drive NWAustin, MN 55912(2/16)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMayo Clinic Health System – Cannon Falls32021 County 24 BoulevardCannon Falls, MN 55009(2/16)

Mayo Clinic Health System - FairmontAttn: Business Office 800 Medical Center DriveFairmont, MN 56031(2/16)

Mayo Clinic Health System - FaribaultAttn: Business Office 924 First St. NEFaribault, MN 55021(2/16)

Mayo Clinic Health System - Franciscan Medical Center, Inc.Attn: Business Office 700 West Ave. SouthLa Crosse, WI 54601(2/16)

Mayo Clinic Health System – Lake CityAttn: Business Office 500 West Grant St.Lake City, MN 55041(2/16)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMayo Clinic Health System – Lake CityAttn: Business Office 1202 Fifth Grant Blvd. WP.O. Box 30Wabasha, MN 55981(2/16)

Mayo Clinic Health System - MankatoAttn: Business Office 1025 Marsh St.P.O. Box 8673Mankato, MN 56002(2/16)

Mayo Clinic Health System – New Prague301 Second Street NENew Prague, MN 56071(2/16)

Mayo Clinic Health System - OwatonnaAttn: Business Office 134 Southview Ave.Owatonna, MN 55060(2/16)

Charles S. Bierman (atty)Mayo Clinic200 First St. SWRochester, MN 55905(507) 266-0484Fax (507) 284-9229 bierman.charles@mayo.edu

Mayo Clinic Health System – Red Wing 1407 W. 4th StreetP.O. Box 54Red Wing, MN 55066-0054(2/16)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMayo Clinic Health System – Springfield625 North Jackson AvenueSpringfield, MN 56087(2/16)

Mayo Clinic Health System – St. James1101 Moulton & Parsons DriveSt. James, MN 56081(2/16)

Mayo Clinic Health System - WasecaAttn: Business Office 501 N. State St.Waseca, MN 56093(2/16)

Mayo Clinic/St. Mary’s Hospital/Rochester Methodist Hospital/Mayo Clinic Pharmacy/Mayo StoreAttn: Business Office 200 First St. SWRochester, MN 55912(2/16)

McGuire Family Chiropractic, P.A.215 3rd StreetP.O. Box 226Gaylord, MN 55334

Dr. Cassie McGuire(507) 237-2777Fax (507) 237-3777mcguirefamilychiro@gmail.com

Melissa Cochrane(507) 237-2777Fax (507) 237-3777mcguirefamilychiro@gmail.com

Medica Health Plans/Optum(4/14)

See Optum

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMedical Advanced Pain Specialists (MAPS) 4131 West Loomis Road, Suite 300Greenfield, WI 53221(5/17)

Meds-1 Ambulance Service, Inc.1328 N.W. 5th StreetGrand Rapids, MN 55744

Timothy J. George(218) 326-0020Fax (218) 326-1402tjgeorge@meds-1.com

Sherri L. Beddoe(218) 326-0020Fax (218) 326-1402Meds1billing@gmail.com

Methodist HospitalThird Party-Workers’ Compensation6500 Excelsior Blvd.St. Louis Park, MN 55426(11/09)

Midwest Radiology(6/07)

Midwest Spine & Brain Institute, L.L.C.1950 Northwestern Avenue, Suite 102Stillwater, MN 55082(10/15)

Christi Wulf(651) 430-9884Fax (651) 430-3827Businessoffice@midwestspine.net

Gayle Schaber(651) 430-9884Fax (651) 430-3827Businessoffice@midwestspine.net

MII Life, Inc.P.O. Box 64560St. Paul, MN 55164(4/06)

Greg Walsh (651) 662-6278Fax (651) 662-1099greg_walsh@bluecrossmn.com

Miller Dwan Medical Center(3/06)

Dr. Gary Miller2627 E. Franklin, Suite 201Minneapolis, MN 55406(9/15)

Dr. Gary Miller(612) 870-1500Fax (612) 870-1551ohwdc@msn.com

Mary Miller(612) 870-1500Fax (612) 870-1551sreysau@comcast.net

Minneapolis On-Sale Liquor Trust Fund(01/08)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMinneapolis Pain Centers4131 West Loomis Road, Suite 300Greenfield, WI 53221(5/17)

MMSIAttn: Subrogation Unit4001 41st St. NWRochester, MN 55901(2/16)

MN and North Dakota Bricklayers and Allied Craftworkers Fringe Benefit Funds(1/08)

MN and North Dakota Bricklayers and Allied Craftworkers Health Fund(1/08)

MN Cement Masons Health and Welfare Fund(1/08)

MN Department of Employment and Economic Development332 Minnesota St. Suite E200St. Paul, MN 55101-1351Tax ID# 41-1681137(1/15)

Rachel Cornell (atty)(651) 259-7633Fax (651) 205-4007workcomp.DEED@state.mn.us

MN Department of Human ServicesBenefit Recovery Section/Tort Recovery UnitP.O. Box 64994St. Paul, MN 55164-0994(12/17)

Kalli Bennett (651) 431-3137Fax (651) 431-7431 kalli.bennett@state.mn.us

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONMN Department of Labor and IndustryVocational Rehabilitation Unit443 Lafayette Rd. N.St. Paul, MN 55155www.doli.state.mn.us (3/06)

Cheryl Eliason(651) 284-5414Fax (651) 284-5734cheryl.eliason@state.mn.us

Gerald Meyer, Director(651) 284-5007Fax (320) 255-3951gerald.meyer@state.mn.us

MN Surgery Center4131 West Loomis Road, Suite 300Greenfield, WI 53221(7/15)

Je’Nean Lessard(414) 324-4625Fax (414) 324-3720jlessard@apmhealth.com

MN Teamsters Health & Welfare FundC/o Wilson McShane Co.3001 Metro DriveSuite 500Bloomington, MN 55425(3/06)

Mike Theirl(952) 854-0795Fax (952) 854-1632mtheirl@wilson-mcshane.com

Thomas McCormick (atty)222 South 9th StreetSuite 1600Minneapolis, MN 55402 (612) 337-9550Fax (612) 337-9049tom@mccormicklawoffice.com

Minnesota Occupational Health710 Commerce Drive, Suite 200Woodbury, MN 55125(4/16)

Minnetonka Imaging MRI, P.A.13767 Nicollet Avenue SouthBurnsville, MN 553374/6/15

Dr. Carlos A. Rivera, D.C.(952) 303-6648Fax (952) 426-1826carlos@riverachiropraticcenter.com

Jose A. Rivera(612) 803-0589jose@riverachiropracticcenter.com

Mobile Imaging(3/06)

See Consulting Radiology

MSPRC-NGHP (Medicare)P.O. Box 138832Oklahoma City, OK 73113Toll free: 866-677-7220Fax: (405) 869-3309(08/12)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONNeurosurgical Associates, Ltd.Piper Building, Suite 305800 E. 28th St.Minneapolis, MN 55407-3723(9/15)

Carrean Wallraff(612) 879-7157Fax (612) 879-7189cwallraff@neurosurgicalassocs.com

Kathy Kleinboehl(612) 879-7156Fax (612) 879-7189kklienboehl@neurosurgicalassocs.com

New River Medical Center1013 Hart BoulevardMonticello, MN 55362www.newrivermedical.com(08/12)

Lynn Wicezorek (attorney)(763) 271-1365Fax (763) 271-2299lynn.wicezorek@newrivermedical.com

Heather Hooper (Business Office)(763) 271-2306Fax (763) 271-2344Heather.hooper@newrivermedical.com

North Memorial Health CareIntervention Notice-Business Office3300 Oakdale Avenue NorthRobbinsdale, MN 55442(11/09)

North Memorial Health Care(763) 520-5400

Northfield Hospital & Clinics2000 North AvenueNorthfield, MN 55057(5/13)

NovaCare Rehabilitation555 Railroad Drive, Suite CElk River, MN 55330(6/15)

Peggy PattenCell (763) 350-2058 Office (763)-441-8111 Fax (717) 635-3915ppatten@selectmedical.com

Operating Engineers Local 49 Health & Welfare Fund3001 Metro Dr. Suite 500Bloomington, MN 55425(10/15)

Erickson, Bell, Beckman & Quinn (attys)Caroline Bell Beckman or Kari Quinn1700 West Highway 36, Suite 110Roseville, MN 55113(651) 223-4999Fax (651) 223-4987

Mike TheirlWilson McShane(952) 854-0795Fax (952) 854-1632

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONOptum (for Medica, UCare and United HealthCare)11000 Optum CircleMN102-0300Eden Prairie, MN 55344(2/18)

Amelia Diedrich-Koch(952) 205-1590Fax (844) 881-2839amelia.diedrich-koch1@optum.com

Kristie Viscasillas(952) 205-0661Fax (800) 708-6401kristie.viscasillas@optum.com

Orthopedic & Fracture Clinic - Northfield2000 North AvenueNorthfield, MN 55057(5/13)

Pain Centers of Minnesota-Chaska4131 West Loomis Road, Suite 300Greenfield, WI 53221(5/17)

Pain Centers of Minnesota-Mankato4131 West Loomis Road, Suite 300Greenfield, WI 53221(5/17)

Park Nicollet Health ServicesThird Party-Workers’ Compensation3800 Park Nicollet Blvd.St. Louis Park, MN 55426(11/09)

Parker Chiropractic, P.A.1320 S. Frontage Rd. Suite 102Hastings, MN 55033(3/06)

Dr. Bill Parker (651) 480-2200Fax (651) 480-1551billparkerdc@earthlink.net

Physical Therapy Consultants, Inc.139 Main StreetBethel, MN 550053/16

Nicole Pietila(763) 269-8065Fax (763) 269-8053npietila@physicaltherapyptc.com

Beth Churchsmith(763) 269-8065Fax (763) 269-8053bchurchsmith@physicaltherapyptc.com

Plumbers and Steamfitters Local 6 Health and Welfare Fund(1/08)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSON Polinski Rehabilitation Center (3/06) See St. Mary’s Duluth Clinic Health

SystemPreferred One Administrative Services/First Class Recoveries, Inc.(3/09)

See First Class Recoveries, Inc.

Primary Behavioral Health Clinics, Inc.3433 Broadway St. NE Suite 160Minneapolis, MN 55413(9/15)

John Patrick Cronin, Ph.D., MPH, LP(612) 378-2363(612) 791-1119Fax (612) 378-2215pbhc423280@aol.comFax (612) 378-2215

Carol SaxOffice (612) 378-2363Cell (612) 743-3447Fax (612) 378-2215pbhc423280@aol.com

Prime Meridian, Inc.2627 E Franklin, Suite 201Minneapolis, MN 55406(9/15)

Jared Madsen, LAC(612) 870-1500Fax (612) 870-1551jedmadsen@hotmail.com

Mary Miller(612) 870-1500Fax (612) 870-1551sreysau@comcast.net

Prime West Health3905 Dakota StreetAlexandria, MN 56308(10/15)

Shelly Steidl(320) 335-5271Fax (320) 335-5323shelly.steidl@primewest.org

Professional Associates of Rehabilitation, Inc. (PAR, Inc.)P.O. Box 270100St. Paul, MN 55127(2/12)

Lisa Fischer(651) 330-5151Fax (651) 330-5426lisaf@minnworkcomp.com

Deb Rush(651) 330-5151Fax (651) 330-5426debr@minnworkcomp.com

Public Health Service(4/07)

Red Lake Indian Hospital(4/07)

Regions Hospital640 Jackson St.Mail Stop 12403ASt. Paul, MN 55101(6/15)

Work Comp Billing Manager(651) 254-4791Fax (651) 254-5649

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONRehabauthority, LLC1560 South Carol StreetMeridian, ID 836469/17

Amy Roe(888) 467-9117(Fax) (208) 287-9426amy@premierbillingsolutions.com

Rivera Chiropractic Center, L.L.C.13767 Nicollet Avenue SouthBurnsville, MN 553374/6/15

Dr. Carlos A. Rivera, D.C.(952) 303-6648Fax (952) 426-1826carlos@riverachiropraticcenter.com

Jose A. Rivera(612) 803-0589jose@riverachiropracticcenter.com

Roofers Local No. 96 Health andWelfare Fund(1/08)

Sanford HealthLegal DepartmentP.O. Box 2010Fargo, ND 58122-0786(8/10)

Penny Hoppe, Business Services(701) 234-1232Fax (701) 234-1005penny.hoppe@sanfordhealth.org

St. Cloud Orthopedic Associates, Ltd.1901 Connecticut Avenue SouthSartell, MN 563774/14

Elaine Poulsen(320) 257-7838

St. Croix County Department of Health & Human ServicesOffice of Corporation CounselSt. Croix County Government Center1101 Carmichael RoadHudson, WI 54016(8/06)

Donald GillenAssistant Corporation Counsel(715) 381-4313Fax (715) 381-4301donjg@co.saint-croix.wi.us

Nancy MullerFraud/FEV Coordinator(715) 246-8304Fax (715)246-8220nancym@co.saint-croix.wi.us

St. Croix Orthopedics5803 Neal Avenue NorthOak Park Heights, MN 55082(12/16)

Prior to 7/1/15: St. Croix Orthopedics7/1/15-Present: See Twin Cities

Orthopedics

Laura EggenBusiness Office Manager(651) 439-8807Fax (651) 439-0232lauraeggen@tcomn.com

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONSt. Luke’s Hospital and Regional Trauma Center915 East 1st StreetDuluth, MN 55805(218) 733-5737(2/15)

Bernadette Katich(218) 249-6871Fax (218) 249-6880bkatich@SLHduluth.com

Kelly M. Johnson(218) 249-6878Fax (218) 249-6879Kelly.Johnson4@SLHduluth.com

St. Mary’s Duluth Clinic Health Systemd/b/a Essentia Health400 E. Third St.Duluth, MN 55805(7/14)

Karen A. Sirois, Paralegal(218) 786-3122Fax (218) 723-8093karen.sirois@essentiahealth.org

Wendy S. Schwartz(218) 786-3394Fax (218) 723-8093wendy.schwartz@essentiahealth.org

St. Mary’s Hospital1216 Second St. SWRochester, MN 55902(507) 255-5123 (3/06)

See Mayo Clinic

St. Mary’s Medical Center,Duluth or St. Mary’s Hospital, Superior (3/06)

St. Paul Radiology166 Fourth St. East, Suite 100St. Paul, MN 55101(11/17)

Katie Sampson(651) 292-2051Fax (651) 292-2156ksampson@stpaulrad.com

South Lake Chiropractic24000 Highway 7, Suite 215Shorewood, MN 55331(5/16)

Kelly O’Donoghue(952) 474-2395Fax (952) 401-1690office@slchiro.com

Jane Wickstrom(952) 474-2395Fax 952-401-1690office@slchiro.com

State Farm InsuranceLincoln Operations Center500 South 84th St.Lincoln, NE 68510-2611(4/10)

Mark Tolzin(402) 327-3460Fax (402) 327-3469mark.tolzin.a4g1@statefarm.com

Jay Rine(402) 327-3580Fax (402) 327-3469jay.rine.i54r@statefarm.com

StoneRiver Pharmacy Solutions(f/k/a Third Party Solutions and Working RX)6410 Poplar Avenue, Suite 800Memphis, TN 38119(1/16)

Michael Crislip(800) 541-5234 - Ext. 1638Fax (901) 260-6194michael.crislip@helioscomp.com

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONSuburban Imaging or Suburban Radiologic Consultants4810 W. 81st St. #108Minneapolis, MN 55437(11/12)

Debra Erickson(952) 837-9700, Ext. 2068Fax (952) 837-9701derickson@subrad.com

Marcia Raven(952) 837-9785Fax (952) 837-9701mraven@subrad.com

Summit Orthopedics Business Office710 Commerce Drive, Suite 200Woodbury, MN 55125(4/16)

Teamsters See MN TeamstersThe HartfordP.O. Box 14305Lexington, KY 40512-4305(5/17)

Tamilyn McNeely(866) 509-3574 - Ext. 2304411Fax (860) 947-3779tamilyn.mcneely@thehartford.com

Frederick E. Kaiser(651) 332-8719Fax (651) 482-8909fkaiser@hansendordell.com

Therapy Partners, Inc.7581 9th Street N., Suite 100 Oakdale, MN 55128(10/06)Website: www.therapypartners.com

Jennifer Mazzara(651) 747-4317Fax (651)-748-2892jmazzara@therapypartners.com

Jenny Wyland(651)-747-4326Fax (651)-748-2892jwyland@therapypartners.com

Third Party Solutions n/k/a StoneRiver Pharmacy Solutions(3/09)

See StoneRiver Pharmacy Solutions

Tieri Chiropractic L.L.C.d/b/a Total Spine Health and Injury Center13324 Bass Lake RoadMaple Grove, MN 55311(6/16)

Brent Tieri(763) 568-7869Fax (763) 568-7872drtieri@yahoo.com

Tria Orthopaedic Center3800 Park Nicollet BoulevardSt. Louis Park, MN 55426(8/15)

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONTrustmark Insurance Co.c/o Erickson, Bell, Beckman & Quinn1700 West Highway 36, Suite 110Roseville, MN 55113(10/15)

Caroline Bell Beckman (atty)(651) 223-4999Fax (651)223-4987

Kari Quinn (atty)(651) 223-4999Fax (651) 223-4987

Twin Cities Iron Workers Health and Welfare Fundc/o Wilson-McShane Co.3001 Metro Drive Suite 500Bloomington, MN 55425(3/06)

Rick Lemke(952) 854-0795Fax (952) 854-1632rlemke@wilson-mcshane.com

Thomas McCormick (atty)222 South 9th StreetSuite 1600Minneapolis, MN 55402 (612) 337-9550Fax (612) 337-9049tom@mccormicklawoffice.com

Twin Cities Orthopedics4200 Dahlberg Drive, Suite 300Golden Valley, MN 55422(11/17)

Christine HelmbrechtSupervisor, Patient Financial Services(952) 345-7755 or(952) 512-5600 x21180Fax (952) 512-5651christinehelmbrect@tcomn.com

Twin Cities Spine Center (Allina Health d/b/a)913 E 26th Street, Suite 600Minneapolis, MN 55404(8/15)

Twin City Pipe Trades Health & Welfare FundAttention: Gail C.700 Transfer Rd.St. Paul, MN 55114(651) 645-4540(3/06)

James J. Hynes(651) 645-4540Fax (651) 645-8119

William A. Cumming (atty)60 S. 6TH Street, Suite 3700Minneapolis, MN 55402(612) 746-5775Fax (612) 746-5777wcumming@hessianmckasy.com

UCare MN/Optum(4/14)

See Optum

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONUnion Security Insurance Company (f/k/a Fortis Benefits Insurance Company)(3/06)

Dana L. Boyle (atty)411 E. Wisconsin St. Suite 1800Milwaukee, WI 53202(414) 273-3910Fax (414) 273-1986dboyle@lindner-marsack.com website: lindner-marsack.com

United Food & Commercial Workers Local 789 Health & Welfare Fund3001 Metro Drive Suite 500Bloomington, MN 55425(3/06)

McGrann Shea Law Firm (Amy Court)800 Nicollet Mall Suite 2600Minneapolis, MN 55402(612) 338-2525Fax (612) 339-2386

Mary Pat Baily(952) 854-0795Fax (952) 851-3521

UFCW National Health and Welfare Fund66 Grand AvenueEnglewood, NJ 07631-3545(6/15)

Maurce Hodos, Fund Administrator(201) 569-8801Fax (201) 569-1085mhodos@ufcwnationalfund.orgwww.ufcwnationalfund.org

United Healthcare/Optum(4/14)

See Optum

U.S. Department of Health and Human ServicesOffice of General Counsel233 N. Michigan Ave., Ste. 700Chicago, IL 60601(4/07)

C. Douglas FergusonAssistant Regional CounselOffice of the General Counsel(312) 886-3605Fax (312) 886-1718Douglas.ferguson@hhs.gov

Barbara Altman, Assistant Regional CounselOffice of the General Counsel(312) 353-1640Fax (312) 886-1718

U.S. Department of Veterans AffairsOffice of Regional Counsel (438/02)2506 West 22nd Street, Building 16P.O. Box 5046Sioux Falls, SD 57117(7/14)

Sara DannenOffice of Regional Counsel (605) 336-3230 x6015Fax (605) 333-6884Sarah.dannen@va.gov

Unum Life Insurance Company of America1 Fountain SquareChattanooga, TN 3740212/17

Jennifer Majic(423) 294-5673Fax (423) 294-2424jmajic@unum.com

V.A. Medical Center See U.S. Dept. of Veteran’s Affairs

INTERVENOR CONTACT PERSON ALTERNATE CONTACT PERSONVadnais Heights Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(4/16)

Walgreen Co.1901 E. Voorhees Mail Stop 615Danville, IL 61834(3/06)

Various Collectors(217) 554-8888 for contact nameFax (217)554-8620

Wausau Benefits, Inc.115 W. Wausau Ave.P.O. Box 8073Wausau, WI 54402(3/06)

Barb Schubring(715) 841-2113Fax (715) 841-7254subrogation@wausaubenefits.com

Subrogation Technician(715) 841-2113Fax (715) 841-7254subrogation@wausaubenefits.com

White Earth Health Center(4/07)

West Wind Village1001 Scotts AvenueMorris, MN 56267(1/16)

Paul Viker(320) 589-7900Fax (320) 589-7955pviker@sfhs.org

Deb Starner(320) 589-4948Fax (320) 585-5398dstarner@sfhs.org

Wisconsin Physicians Service Insurance Corporation1717 West BroadwayP.O. Box 8190Madison, WI 53708-8190(2/09)

Beth Eyster Shore (atty)(608) 221-7137Fax (608) 223-5898Beth.Shore@wpsic.com

Holly D. Jensen (atty)(608) 221-5062Fax (608) 223-5898Holly.Jensen@wpsic.com

Woodbury Ambulatory Surgery Center710 Commerce Drive, Suite 200Woodbury, MN 55125(4/16)

Cynthia Spano-WeyerOffice (651) 968-5022 Cell (651) 795-1111Fax (651) 968-5900cspanoweyer@summitortho.com

Updated 2/5/18

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