Bankruptcy Forms - Bankrupt.com

Fill in this information to identify your case: United States Bankruptcy Court for the: EASTERN DISTRICT OF WASHINGTON Case number (if known)

Chapter

11

 Check if this an amended filing

Official Form 201

Voluntary Petition for Non-Individuals Filing for Bankruptcy

4/16

If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor's name and case number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available. 1.

Debtor's name

NORTHWEST HEALTH SUMMIT, P.S.

2.

All other names debtor used in the last 8 years

FKA DBA DBA DBA DBA

Include any assumed names, trade names and doing business as names

WOMEN'S HEALTH CONNECTION, P.S. MEN'S HEALTH CONNECTION METABOLIC HEALTH CONNECTION NORTHWEST PSYCHIATRY AND TMS CENTER WOMEN'S HEALTH CONNECTION

3.

Debtor's federal Employer Identification Number (EIN)

20-3717917

4.

Debtor's address

Principal place of business

Mailing address, if different from principal place of business

16201 East Indiana Avenue Spokane Valley, WA 99216

P.O. BOX 28220 SPOKANE, WA 99228-8220

Number, Street, City, State & ZIP Code

P.O. Box, Number, Street, City, State & ZIP Code

Spokane

Location of principal assets, if different from principal place of business

County

Number, Street, City, State & ZIP Code 5.

Debtor's website (URL)

6.

Type of debtor



Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP))

 Partnership (excluding LLP)  Other. Specify:

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Debtor

Case number (if known)

NORTHWEST HEALTH SUMMIT, P.S. Name

7.

Describe debtor's business

A. Check one:



Health Care Business (as defined in 11 U.S.C. § 101(27A))

     

Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B)) Railroad (as defined in 11 U.S.C. § 101(44)) Stockbroker (as defined in 11 U.S.C. § 101(53A)) Commodity Broker (as defined in 11 U.S.C. § 101(6)) Clearing Bank (as defined in 11 U.S.C. § 781(3)) None of the above

B. Check all that apply

 Tax-exempt entity (as described in 26 U.S.C. §501)  Investment company, including hedge fund or pooled investment vehicle (as defined in 15 U.S.C. §80a-3)  Investment advisor (as defined in 15 U.S.C. §80b-2(a)(11)) C. NAICS (North American Industry Classification System) 4-digit code that best describes debtor. See http://www.uscourts.gov/four-digit-national-association-naics-codes.

62 8.

Under which chapter of the Bankruptcy Code is the debtor filing?

Check one:

 Chapter 7  Chapter 9



Chapter 11. Check all that apply:



Debtor's aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are less than $2,566,050 (amount subject to adjustment on 4/01/19 and every 3 years after that).

 The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D). If the debtor is a small business debtor, attach the most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or if all of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).

 A plan is being filed with this petition.  Acceptances of the plan were solicited prepetition from one or more classes of creditors, in accordance with 11 U.S.C. § 1126(b).

 The debtor is required to file periodic reports (for example, 10K and 10Q) with the Securities and Exchange Commission according to § 13 or 15(d) of the Securities Exchange Act of 1934. File the attachment to Voluntary Petition for Non-Individuals Filing for Bankruptcy under Chapter 11 (Official Form 201A) with this form.

 The debtor is a shell company as defined in the Securities Exchange Act of 1934 Rule 12b-2.  Chapter 12

9.

Were prior bankruptcy cases filed by or against the debtor within the last 8 years?

 No.  Yes.

If more than 2 cases, attach a separate list.

10. Are any bankruptcy cases pending or being filed by a business partner or an affiliate of the debtor?

District

When

Case number

District

When

Case number

 No  Yes.

List all cases. If more than 1, attach a separate list

Debtor

Relationship

District

Official Form 201

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Debtor



11. Why is the case filed in this district?

12. Does the debtor own or have possession of any real property or personal property that needs immediate attention?

Check all that apply:



Debtor has had its domicile, principal place of business, or principal assets in this district for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other district.



A bankruptcy case concerning debtor's affiliate, general partner, or partnership is pending in this district.

 No  Yes. Answer below for each property that needs immediate attention. Attach additional sheets if needed. Why does the property need immediate attention? (Check all that apply.)

 It poses or is alleged to pose a threat of imminent and identifiable hazard to public health or safety. What is the hazard?

 It needs to be physically secured or protected from the weather.  It includes perishable goods or assets that could quickly deteriorate or lose value without attention (for example, livestock, seasonal goods, meat, dairy, produce, or securities-related assets or other options).

 Other Where is the property? Number, Street, City, State & ZIP Code Is the property insured?

 No  Yes. Insurance agency Contact name Phone

Statistical and administrative information 13. Debtor's estimation of available funds

.

Check one:

 Funds will be available for distribution to unsecured creditors.  After any administrative expenses are paid, no funds will be available to unsecured creditors.

14. Estimated number of creditors

 1-49

 1,000-5,000  5001-10,000  10,001-25,000

 25,001-50,000  50,001-100,000  More than100,000

 $0 - $50,000  $50,001 - $100,000  $100,001 - $500,000  $500,001 - $1 million

 $1,000,001 - $10 million

 $500,000,001 - $1 billion  $1,000,000,001 - $10 billion  $10,000,000,001 - $50 billion  More than $50 billion

 $0 - $50,000  $50,001 - $100,000  $100,001 - $500,000  $500,001 - $1 million

 $1,000,001 - $10 million

 50-99  100-199  200-999

15. Estimated Assets

16. Estimated liabilities

Official Form 201

16-03406-FPC11

 $10,000,001 - $50 million  $50,000,001 - $100 million  $100,000,001 - $500 million

 $10,000,001 - $50 million  $50,000,001 - $100 million  $100,000,001 - $500 million


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 $500,000,001 - $1 billion  $1,000,000,001 - $10 billion  $10,000,000,001 - $50 billion  More than $50 billion

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Fill in this information to identify the case: Debtor name NORTHWEST HEALTH SUMMIT, P.S. United States Bankruptcy Court for the: EASTERN DISTRICT OF WASHINGTON Case number (if known):

 Check if this is an amended filing

Official Form 204 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims and Are Not Insiders 12/15 A list of creditors holding the 20 largest unsecured claims must be filed in a Chapter 11 or Chapter 9 case. Include claims which the debtor disputes. Do not include claims by any person or entity who is an insider, as defined in 11 U.S.C. § 101(31). Also, do not include claims by secured creditors, unless the unsecured claim resulting from inadequate collateral value places the creditor among the holders of the 20 largest unsecured claims. Name of creditor and Name, telephone number Nature of claim (for example, trade complete mailing address, and email address of debts, bank loans, including zip code creditor contact professional services, and government contracts)

BEN BURR, LLC 16201 EAST INDIANA AVENUE SUITE 1000 SPOKANE VALLEY, WA 99216 COMPUTERWILD, INC. 1430 WEST TONI RAE DRIVE SPOKANE, WA 99218 DAVIS WRIGHT TREMAINE LLP SUITE 2200 1201 THIRD AVENUE SEATTLE, WA 98101-3045 GLAXOSMITHKLINE PHARMACEUTICAL S P.O. BOX 740415 ATLANTA, GA 30374-0415 HENRY SCHEIN DEPT. CH 14125 PALATINE, IL 60055-4125 INHS P.O. BOX 469 SPOKANE, WA 99202-0469 INTRINIUM 609 NORTH ARGONNE ROAD SPOKANE, WA 99212 Official form 204

Indicate if claim is contingent, unliquidated, or disputed

Amount of claim If the claim is fully unsecured, fill in only unsecured claim amount. If claim is partially secured, fill in total claim amount and deduction for value of collateral or setoff to calculate unsecured claim. Total claim, if Deduction for value Unsecured claim partially secured of collateral or setoff

Lease arrearages, utilities, insurance

$31,998.82

Trade debt

$9,531.72

Legal fees

$22,152.00

Medical supplies

$8,685.63

Trade debt

$23,633.39

Trade debt

$17,831.59

Trade debt

$5,928.93

Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured claims

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com

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Debtor



Name of creditor and Name, telephone number Nature of claim (for example, trade complete mailing address, and email address of debts, bank loans, including zip code creditor contact professional services, and government contracts)

KELLY IMAGING SYSTEMS 22710 - 72ND AVENUE SOUTH KENT, WA 98032 KLUNT HOSMER 216 WEST PACIFIC AVENUE, SUITE 201 SPOKANE, WA 99201 NEURONETICS 3222 PHOENIXVILLE PIKE MALVERN, PA 19355 OMLIN GUNNING & ASSOCIATES, P.S. 9515 NORTH DIVISION STREET SUITE 200 SPOKANE, WA 99218 PREMERA 7001 - 220TH SW MOUNTLAKE TERRACE, WA 98043-2124 QUEST DIAGNOSTICS 8403 FALLBROOK AVENUE WEST HILLS, CA 91304 RANDALL & DANSKIN, P.S. 1500 BANK OF AMERICA FINANCIAL CNTR. 601 WEST RIVERSIDE AVENUE SPOKANE, WA 99201 SCW CONSULTING 9116 EAST SPRAGUE, #150 SPOKANE VALLEY, WA 99206 STRYKER 1410 LAKESIDE PARKWAY FLOWER MOUND, TX 75028

Official form 204



Trade debt

$4,668.57

Trade debt

$6,000.00

Trade debt

$33,653.97

Trade debt

$12,187.15

Health insurance premiums

$6,623.50

$177,706.72

Laboratory services

Legal services

$5,143.20

Trade debt

$4,500.00

Trade debt

$21,091.93



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Debtor



Name of creditor and Name, telephone number Nature of claim (for example, trade complete mailing address, and email address of debts, bank loans, including zip code creditor contact professional services, and government contracts)

TEL WEST 7311 EAST BROADWAY SPOKANE, WA 99212 THERACOM PAYMENT CENTER P.O. BOX 640105 CINCINNATI, OH 45264-0105 UMPQUA BANK SPOKANE PRIVATE BANKING 111 NORTH WALL STREET SPOKANE, WA 99201 WELLS FARGO P.O. BOX 6415 CAROL STREAM, IL 60197-6415

Official form 204



Trade debt

$9,870.65

Trade debt

$17,466.44

Visa charges

$47,232.47

Visa charges

$44,220.37



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NWHS.txt AAAASF P.O. BOX 9500 GURNEE, IL 60031 ACCOUNTS RECEIVABLE SYSTEMS ALM, KRISTYN S. 1124 EAST BARTEY BRAE COURT SPOKANE, WA 99208 ANDREWS, BETTY I. 4680 WEST FERREL ROAD COEUR D'ALENE, ID 83814 ANGLE, SHAWNA K. 10827 NORTH WAIKIKI ROAD SPOKANE, WA 99218 ATTORNEY GENERAL'S OFFICE BANKRUPTCY & COLLECTIONS UNIT 800 FIFTH AVENUE, SUITE 2000 SEATTLE, WA 98104 AUTOMATED ACCOUNTS, INC. 430 WEST SHARP AVENUE SPOKANE, WA 99201 AVAILITY 10752 DEERWOOD PARK BLVD. SOUTH SUITE 110 JACKSONVILLE, FL 32256 BAILEY, REBECCA R. 15720 EAST HEROY SPOKANE VALLEY, WA 99216 BASQUE, VANESSA L. 4915 EAST UPRIVER DRIVE, #C‐24 SPOKANE, WA 99217 BECERRA‐AGOSTINO, AMELIA E. 411 WEST ALICE SPOKANE, WA 99205 BEN BURR, LLC 16201 EAST INDIANA AVENUE SUITE 1000 SPOKANE VALLEY, WA 99216 Page 1

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NWHS.txt BLUE RIBBON LINEN SUPPLY 2322 ‐ 16TH AVENUE P.O. BOX 798 LEWISTON, ID 83501 BLUMIG, DEZIREA N. 10218 EAST DRIFTWOOD COURT SPOKANE VALLEY, WA 99206 BURNS, MAKEALA M. 6905 NORTH SMITH SPOKANE, WA 99217 BURNSIDE, HEATHER M. 14410 WEST JACOBS ROAD SPOKANE, WA 99224 BUTLER, BAILEIGH F. 928 EAST 17TH AVENUE SPOKANE, WA 99203 CHRISTOPHER MICHAEL RAMAGE, D.O. CHURCH, KAYLEY J. 12925 EAST MANSFIELD AVENUE APT. P102 SPOKANE VALLEY, WA 99216 COMCAST P.O. BOX 37601 PHILADELPHIA, PA 19101‐0601 COMCAST P.O. BOX 34227 SEATTLE, WA 98124‐1227 COMCAST CABLE COMMUNICATIONS MANAGEMENT, LLC P.O. BOX 34744 SEATTLE, WA 98124‐1744 COMMERCIAL READER SERVICE P.O. BOX 959 NORMAL, IL 61761‐0959 COMPUTERWILD, INC. 1430 WEST TONI RAE DRIVE Page 2

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NWHS.txt SPOKANE, WA 99218 CONDOS, KIAH A. 1211 NORTH MURRAY LANE LIBERTY LAKE, WA 99019 COOPER SURGICAL P.O. BOX 712280 CINCINNATI, OH 45271‐2280 DANIEL, SHAYLA M. 1822 SOUTH SHAMROCK DRIVE SPOKANE VALLEY, WA 99016 DASOVICH, LAUREN D. 4216 NORTH ELM STREET SPOKANE, WA 99205 DAVIS WRIGHT TREMAINE LLP SUITE 2200 1201 THIRD AVENUE SEATTLE, WA 98101‐3045 DAVIS, TANAYA A. 12411 EAST MANSFIELD AVENUE, #9 SPOKANE VALLEY, WA 99216 DE LAGE LANDEN FINANCIAL SVS P.O. BOX 41602 PHILADELPHIA, PA 19101‐1602 DIAGNOS ‐ TECHS P.O. BOX 389662 TUKWILA, WA 98138‐0662 DRAGOO, MELANIE A. 806 SOUTH ROBINHOOD SPOKANE VALLEY, WA 99216 DRUG ENFORCEMENT AGENCY 300 ‐ 5TH AVENUE, SUITE 1300 SEATTLE, WA 98104 ELECTRIC LIGHTWAVE FKA INTEGRA 18110 SE 345TH STREET BUILDING ONE, SUITE 100 VANCOUVER, WA 98683‐9497 Page 3

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NWHS.txt EMPIRE OFFICE MACHINES 1411 NORTH MONROE SPOKANE, WA 99201 ENGAGE 601 WEST 1ST AVENUE SPOKANE, WA 99201 ENLIN HEALTH INTELLIGENCE 3600 NW JOHN OLSEN PLACE SUITE 300 HILLSBORO, OR 97214 FED EX P.O. BOX 94515 PALATINE, IL 60094‐4515 FLOWERS, COURTNEY R. 5820 NORTH ASH STREET SPOKANE, WA 99205 FP MAILING SOLUTIONS P.O. BOX 4510 CAROL STREAM, IL 60197‐4510 GILMORE, RACHEL A. 3210 EAST 44TH AVENUE, APT. E305 SPOKANE, WA 99223 GLAXOSMITHKLINE PHARMACEUTICALS P.O. BOX 740415 ATLANTA, GA 30374‐0415 GOODWIN, JOSI V. 1732 WEST SIENNA LANE SPOKANE, WA 99208 GREAT AMERICA P.O. BOX 660831 DALLAS, TX 75266‐0831 HART, DANIELLE Y. 4242 EAST 12TH SPOKANE, WA 99202 HEALTH DIAGNOSTIC LABORATORY, INC. C/O HUNTON & WILLIAMS LLP RIVERFRONT PLAZA, EAST TOWER Page 4

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NWHS.txt 951 EAST BYRD STREET RICHMOND, VA 23219 HEALTH DIAGNOSTIC LABORATORY, INC. LIQUIDATING TRUST ATTN: CULLEN SPECKHART 200 BENDIX ROAD, SUITE 300 VIRGINIA BEACH, VA 23452 HEALTHCO INFORMATION SYSTEMS 7657 SW MOHAWK TUALATIN, OR 97062 HEDRICK, MARY E. 1823 SOUTH MAPLE BLVD. SPOKANE, WA 99203 HEFLING, TRACI C. 1226 EAST ROWAN SPOKANE, WA 99207 HENRY SCHEIN DEPT. CH 14125 PALATINE, IL 60055‐4125 HEWLETT‐PACKARD FINANCIAL SERVICES COMPANY 200 CONNELL DRIVE, SUITE 5000 BERKELEY HEIGHTS, NJ 07922 HOLMES, JORDAN T. 124 WEST WESTVIEW AVENUE SPOKANE, WA 99208 HOLOGIC, INC. 24506 NETWORK PLACE CHICAGO, IL 60673‐1245 HORNBUCKLE, JAMIE R. 4211 EAST FAIRVIEW SPOKANE, WA 99217 HP FINANCIAL SVC CO. 200 CONNELL DRIVE, SUITE 5000 BERKELEY HEIGHTS, NJ 07922 HUTCHINSON, DANNIEL S. 27928 NORTH MILL LANE Page 5

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NWHS.txt DEER PARK, WA 99006 INHS P.O. BOX 469 SPOKANE, WA 99202‐0469 INTEGRA BUSINESS NKA ELECTRIC LIGHTWAVE 201 WEST NORTHRIVER DRIVE, SUITE 380 SPOKANE, WA 99201 INTERNAL REVENUE SERVICE P.O. BOX 7346 PHILADELPHIA, PA 19101‐7346 INTRINIUM 609 NORTH ARGONNE ROAD SPOKANE, WA 99212 INVENTORY OPTIMIZATION SOLUTIONS LLC 27068 LA PAZ ROAD, #607 ALISO VIEJO, CA 92656 ISALUS 232 WEST 10TH STREET, SUITE B120 INDIANAPOLIS, IN 46202 JANSSEN, KATHERN M. 2010 WEST WEDGEWOOD SPOKANE, WA 99208 JOHNSON, ISABEL K. 7620 NORTH JULIA STREET SPOKANE, WA 99217 JOHNSON, SAMANTHA J. 4320 WEST DESKA DRIVE, APT. 503 SPOKANE, WA 99224 KELLY IMAGING SYSTEMS 22710 ‐ 72ND AVENUE SOUTH KENT, WA 98032 KERRY CANNON 8909 NORTH COLTON STREET, #82 SPOKANE, WA 99218 KHRAIS, DONNA L. Page 6

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NWHS.txt 4909 EAST UPRIVER DRIVE, APT. N205 SPOKANE, WA 99217 KING, SHANETTE 840 WEST CORA AVENUE, #C304 SPOKANE, WA 99205 KLUNT HOSMER 216 WEST PACIFIC AVENUE, SUITE 201 SPOKANE, WA 99201 LABORIE 400 AVENUE D, SUITE 10 WILLISTON, VT LEVIN, MICHELLE 4728 EAST PLEASANT ORCHARD LANE SPOKANE, WA 99217 MARLIN BUSINESS BANK P.O. BOX 13604 PHILADELPHIA, PA 19101‐3604 MARLIN LEASING CORPORATION HEALTHCARE DIVISION 300 FELLOWSHIP ROAD MOUNT LAUREL, NJ 08054 MCKAY, KATIE E. 9805 NORTH IVANHOE ROAD SPOKANE, WA 99218 MDSCRIPTS 8930 STATE ROAD 84, #222 DAVIE, FL 33324 MENG, TAMMI L. 13803 NORTH MEADOWLARK COURT MEAD, WA 99021 MERCK SHARP & DOHME CORP. P.O. BOX 5254 CAROL STREAM, IL 60197‐5254 MIKHAYLICHENKO, OKSANA M. 7510 NORTH WISCOMB DRIVE SPOKANE, WA 99208 Page 7

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NWHS.txt NAC ARCHITECTURE 1203 WEST RIVERSIDE AVENUE SPOKANE, WA 99201‐1107 NATUS NEUROLOGY, INC. 3150 PLEASANT VIEW ROAD MIDDLETON, WI 53562 NETWORKS RX MEDICAL IT SOLUTIONS 25 WEST CATALDO, SUITE C SPOKANE, WA 99201 NEURONETICS 3222 PHOENIXVILLE PIKE MALVERN, PA 19355 NORTHWEST VITAL RECORDS CENTER, INC. P.O. BOX 2199 SPOKANE, WA 99210 NUGENT, STEPHANIE P. 139 SOUTH ALKI LANE CHENEY, WA 99004 OMLIN GUNNING & ASSOCIATES, P.S. 9515 NORTH DIVISION STREET SUITE 200 SPOKANE, WA 99218 PARVIN, REBECCA A. 6905 NORTH SMITH SPOKANE, WA 99207 PERFECT TRANSCRIPTION P.O. BOX 933306 ATLANTA, GA 31193‐3306 PHYSICIAN INSURANCE P.O. BOX 84453 SEATTLE, WA 98124‐5753 PREMERA 7001 ‐ 220TH SW MOUNTLAKE TERRACE, WA 98043‐2124 PREMERA BLUE CROSS NASCO CLAIMS MS 242 Page 8

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NWHS.txt P.O. BOX 91080 SEATTLE, WA 98111‐9180 PREMERAFIRST, INC. P.O. BOX 327 SEATTLE, WA 98111‐0327 PROVIDENCE HEALTH & SERVICES ATTN: ACCT ‐ CASH DESK P.O. BOX 389672 SEATTLE, WA 98138‐9672 PROVIDENCE HEALTH PLANS ATTN: REFUNDS P.O. BOX 6456 PORTLAND, OR 97228‐6456 PROVIDENCE SACRED HEART MEDICAL CNTR MEDICAL STAFF SERVICES 101 WEST 8TH AVENUE SPOKANE, WA 99204 PURITY MEDICAL PRODUCTS P.O. BOX 940 PLACENTIA, CA 92871 QUEST DIAGNOSTICS 8403 FALLBROOK AVENUE WEST HILLS, CA 91304 QUEST DIAGNOSTICS P.O. BOX 91514 LOS ANGELES, CA 90074‐1514 RADKE‐SNEAD, JESSICA M. 6102 SOUTH BROOKHAVEN STREET SPOKANE, WA 99224 RANDALL & DANSKIN, P.S. 1500 BANK OF AMERICA FINANCIAL CNTR. 601 WEST RIVERSIDE AVENUE SPOKANE, WA 99201 RAVASIA, M.D., DEBRA J. 3926 WEST CENTER LANE SPOKANE, WA 99208 RAVASIA, M.D., SAJID Page 9

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NWHS.txt 3926 WEST CENTER LANE SPOKANE, WA 99208 RIENDEAU, CINDY S. 6915 NORTH STEVENS STREET SPOKANE, WA 99208 ROSENBLIT, MICHELLE 28504 NORTH COTTONWOOD CHATTAROY, WA 99003 ROYAL BUSINESS SYSTEMS, INC. 1515 EAST HOUSTON AVENUE SPOKANE, WA 99217 SABOWITZ, BRIAN N., M.D. 5120 SOUTH FELTS LANE SPOKANE VALLEY, WA 99206 SACRED HEART LABORATORY MEDICINE 108 WEST 8TH AVENUE SPOKANE, WA 99204 SALO, HEATHER A. 11611 NORTH HOWARD COURT SPOKANE, WA 99218 SCHMEDDING, KRISTINE A. 9427 WEST BALLESTERO COURT CHENEY, WA 99004 SCW CONSULTING 9116 EAST SPRAGUE, #150 SPOKANE VALLEY, WA 99206 SHAGINA, JORDAN A. 7300 NORTH CARRINGTON LANE COEUR D'ALENE, ID 83815 SHORE, LEAH J. 1403 EAST 11TH AVENUE SPOKANE, WA 99202 SMART MD 1515 NORTH UNIVERSITY DRIVE SUITE 207 CORAL SPRINGS, FL 33071 Page 10

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NWHS.txt SMITHERS, KATHY J. 14207 EAST ROCKWELL SPOKANE VALLEY, WA 99216 SOLIS, RUBEN N. 1116 EAST 29TH AVENUE SPOKANE, WA 99203 SPOKANE COUNTY TREASURER 1116 WEST BROADWAY AVENUE SECOND FLOOR SPOKANE, WA 99260 STAPLES DEPT. LA P.O. BOX 83689 CHICAGO, IL 60696‐3689 STATE OF WASHINGTON DEPARTMENT OF ECOLOGY 4601 NORTH MONROE SPOKANE, WA 99205‐1295 STATE OF WASHINGTON DEPARTMENT OF LABOR & INDUSTRIES 3RD FLOOR LEGAL P.O. BOX 44170 OLYMPIA, WA 98504 STATE OF WASHINGTON DEPARTMENT OF ECOLOGY P.O. BOX 34050 SEATTLE, WA 98124‐1050 STERN, IVY J. 521 WEST EUCLID AVENUE SPOKANE, WA 99205 STOREBO, RONALD B. 6506 C WEST END ROAD FRUITLAND, WA 99129 STRYKER 1410 LAKESIDE PARKWAY FLOWER MOUND, TX 75028 STUART, BRIANNE M. 3711 SOUTH HIGHWAY 27 Page 11

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NWHS.txt APT. J303 SPOKANE, WA 99206 TEL WEST 7311 EAST BROADWAY SPOKANE, WA 99212 THERACOM PAYMENT CENTER P.O. BOX 640105 CINCINNATI, OH 45264‐0105 TOSHIBA TELECOM FINANCE P.O. BOX 644006 CINCINNATI, OH 45264‐4006 TRANSWORLD SYSTEMS, INC. P.O. BOX 15618 WILMINGTON, DE 19850 TRUE HEALTH DIAGNOSTICS 6170 RESEARCH ROAD, SUITE 211 FRISCO, TX 75033 TRYTHALL, ALYSHA M. 1813 NORTH HUTCHINSON ROAD, #14 SPOKANE VALLEY, WA 99212 UMPQUA BANK SPOKANE PRIVATE BANKING 111 NORTH WALL STREET SPOKANE, WA 99201 UMPQUA BANK ATTN: MARGHERITA STUTZ 7777 ALVARADO ROAD, SUITE 515 LA MESA, CA 91942 UNIVERSAL COMPANIES 18260 OAK PARK DRIVE ABINGDON, VA 24210 UNIVERSAL HOSPITAL SERVICES, INC. SDS 12‐0940 P.O. BOX 86 MINNEAPOLIS, MN 55486‐0940 UROVAL, INC. Page 12

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NWHS.txt 1220 MARLATT AVENUE MANHATTAN, KS 66502 US SECURITIES AND EXCHANGE COMM SAN FRANCISCO REGIONAL OFFICE 44 MONTGOMERY STREET, SUITE 2800 SAN FRANCISCO, CA 94104 VANEATON, TIFFANY 139 SOUTH ALKI LANE CHENEY, WA 99004 VISION SERVICE PLAN P.O. BOX 452000 SAN FRANCISCO, CA 94145‐5200 WA STATE DEPT. EMPLOYMENT SECURITY INSOLVENCY UNIT P.O. BOX 9046 OLYMPIA, WA 98507 WA STATE DEPT. OF REVENUE BANKRUPTCY / CLAIMS UNIT 2101 FOURTH AVENUE, #1400 SEATTLE, WA 98121‐2300 WACHLER & ASSOCIATES, P.C. 210 EAST THIRD STREET, SUITE 204 ROYAL OAK, MI 48067 WADSWORTH, MITCHELL 16320 NORTH HATCH ROAD, UNIT 727 COLBERT, WA 99005 WASHINGTON STATE DEPT. OF HEALTH RIVER VIEW CORPORATE CENTER 16201 EAST INDIANA AVE., SUITE 1500 SPOKANE VALLEY, WA 99216 WASTE MANAGEMENT ‐ VALLEY 8111 ‐ 1ST AVENUE SOUTH SEATTLE, WA 98108 WASTE MANAGEMENT ‐ VALLEY P.O. BOX 541065 LOS ANGELES, CA 90054‐1065 WELLS FARGO Page 13

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NWHS.txt P.O. BOX 6415 CAROL STREAM, IL 60197‐6415 WEST CORPORATION DEPT. #1343 DENVER, CO 80256‐0001 WHITMAN, HOLLY A. 9415 SOUTH LABRADOR LANE SPOKANE, WA 99223 WINDHAM PROFESSIONALS 382 MAIN STREET SALEM, NH 03079 WM HEALTHCARE SOLUTIONS OF WASHINGTON 8111 ‐ 1ST AVENUE SOUTH SEATTLE, WA 98108 WOOD‐STEENVOORDEN, LORETTA D. 4325 NE 114TH STREET VANCOUVER, WA 98686 WORTHY ENTERPRISES, LLC 16201 EAST INDIANA AVENUE SUITE 1000 SPOKANE VALLEY, WA 99216 YERMAKOV, NATALIA 22809 EAST COUNTRY VISTA ROAD APT. 269 LIBERTY LAKE, WA 99019 YOURMEMBERSHIP.COM, INC. DEPT. 3461 P.O. BOX 3461 DALLAS, TX 75312‐3461 AARP PO BOX 740819 ATLANTA, GA 30374‐0819 AARP HEALTH CARE OPTIONS UNITED HEALTHCARE CLAIMS DIVISION PO BOX 13999 PHILADELPHIA, PA 19187‐0216 Page 14

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NWHS.txt AARP MEDICARE COMPLETE PLUS PLAN 1 PO BOX 31362 SALT LAKE CITY, UT 84131‐0362 ADMINISTRATORS WEST 320 NE 97TH STREET STE B SEATTLE, WA 98115‐2042 ADVANTRA FREEDOM PO BOX 7154 LONDON, KY 40742 AETNA PO BOX 981204 EL PASO, TX 79998‐1204 AETNA PO BOX 30258 TAMPA, FL 33630‐3258 AETNA PO BOX 981107 EL PASO, TX 79998‐1107 AETNA PO BOX 981109 EL PASO, TX 79998 AETNA PO BOX 14079 LEXINGTON, KY 40512‐4079 AETNA PO BOX 14089 LEXINGTON, KY 40512‐4089 AETNA PO BOX 14586 LEXINGTON, KY 40512‐4586 AETNA GLOBAL BENEFITS PO BOX 981543 EL PASO, TX 79998‐1543 AETNA STUDENT HEALTH PO BOX 15708 BOSTON, MA 02215 Page 15

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NWHS.txt AETNA/GEHA‐ASA PO BOX 981707 EL PASO, TX 79998 AETNA/MERITAIN PO BOX 41790 MINNEAPOLIS, MN 55441 AETNA/UFCW/ALASKA ELECTRICAL HEALTH & WE PO BOX 981106 EL PASO, TX 79998‐1106 AG ADMINSTRATORS PO BOX 979 VALLEY FORGE, PA 19482 ALASKA ELECTRICAL HEALTH AND WELFARE FUND 2600 DENALI, SUITE 200 ANCHORAGE, AK 99503 ALASKA LABORERS CONSTRUCTION INDUSTRY HEALTH PO BOX 34567 SEATTLE, WA 98124‐1567 ALASKA TEAMSTERS TRUST 520 E 34TH AVE, SUITE 107 ANCHORAGE, AK 99503‐4416 ALASKACARE/HEALTHSMART BENEFIT SOLUTIONS PO BOX 99004 ANCHORAGE, AK 99509 ALLEGIANCE BENEFIT PLAN MANAGEMENT PO BOX 3018 MISSOULA, MT 59806 ALTIUS HEALTH PLAN PO BOX 7147 LONDON, KY 40742 AMERIBEN/IEC GROUP PO BOX 7186 BOISE, ID 83707 AMERICAN HERITAGE LIFE INSURANCE CO ATTN: GROUP CLAIM DEPARTMENT Page 16

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NWHS.txt PO BOX 853916 RICHARDSON, TX 75085‐3916 AMERICAN STERLING INSURANCE SERVICES PO BOX 26103 OVERLAND PARK, KS 66225 ANTHEM BLUE CROSS PO BOX 173681 DENVER, CO 80217 APWU PO BOX 740810 ATLANTA, GA 30374 APWU HEALTH PLAN PO BOX 967 SILVER SPRING, MD 20910 APWU HEALTH PLAN P O BOX 188004 CHATTANOOGA, TN 37422 ASSURANT HEALTH PO BOX 981602 EL PASO, TX 79998 ASSURANT HEALTH PO BOX 3175 MILWAUKEE, WI 53201‐3175 ASSURANT HEALTH PO BOX 2806 CLINTON, IA 52733 ASSURANT HEALTH PO BOX 2877 CLINTON, IA 52733‐2877 ASURIS PO BOX 21267 SEATTLE, WA 98111‐3267 ASURIS NORTHWEST HEALTH DSHS PO BOX 30271 SALT LAKE CITY, UT 84130‐0271 AVMA GROUP HEALTH AND LIFE Page 17

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NWHS.txt INSURANCE TRUST PO BOX 909720 CHICAGO, IL 60690‐9720 BAKERY, CONFECTIONERS INTERNATIONAL HEALTH BENEFIT 1828 "L" ST NW WASHINGTON, DC 20336 BANKERS FIDELITY PO BOX 105652 ATLANTA, GA 30348 BANKERS LIFE AND CASUALTY PO BOX 66927 CHICAGO, IL 60666 BANKERS LIFE AND CASUALTY COMPANY PO BOX 1935 CARMEL, IN 46082 BANKERS LIFE AND CASUALTY COMPANY 222 MERCHANDISE MART PLAZA CHICAGO, IL 60654‐2001 BCBS BEACON HEALTH OPTIONS PO BOX 930321 WIXOM, MI 48393‐0321 BENEFIT MANAGEMENT PO BOX 1090 GREAT BEND, KS 67530 BENEFIT MD PO BOX 1818 TACOMA, WA 98401 BENEFIT PLANNERS PO BOX 690450 SAN ANTONIO, TX 78269‐0450 BLUE CROSS BLUE SHIELD OF MINNESOTA PO BOX 64338 ST PAUL, MN 55164‐0338 BLUE CROSS BLUE SHIELD OF MONTANA Page 18

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NWHS.txt PO BOX 5004 GREAT FALLS, MT 59403 BLUE CROSS BLUE SHIELD OF NEW MEXICO ATTN: NMRHCA DSU PO BOX 27630 ALBUQUERQUE, NM 87125‐7630 BLUE CROSS BLUE SHIELD REGENCE BLUE CROSS IDAHO PO BOX 7408 BOISE, ID 83707 BLUE CROSS OF CALIFORNIA PO BOX 60007 LOS ANGELES, CA 90060‐0007 BOARD OF PENSIONS SEABURY & SMITH PO BOX 14426 DES MOINES, IA 50306 BOULDER ADMINISTRATION SERVICES PO BOX 1046 BOULDER, MT 59632 CALIFORNIA IRONWORKERS FIELD WELFARE PLAN 131 N EL MOLINO AVE, STE 330 PASADENA, CA 91101 CAREMARK/FIRST CHOICE HEALTH NETWORK PO BOX 9554 SALT LAKE CITY, UT 84109 CARPENTERS TRUST OF WESTERN WASHINGTON PO BOX 1929 SEATTLE, WA 98111 CAS/GTESS C/O MULTIPLAN PO BOX 6090 DEPERE, WI 54115 CAS/MULTIPLAN PO BOX 6090 DEPERE, WI 54115 Page 19

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NWHS.txt CBCA ADMINISTRATION (BEACH STREET) PO BOX 1479 MINNEAPOLIS, MN 55440 CBCA GENERAL DYNAMICS PO BOX 9888 SAVANNAH, GA 31412 CHAMPVA PO BOX 469064 DENVER, CO 80246‐9064 CHOICE BENEFITS PO BOX 10048 FORT SMITH, AK 72917 CHOICE NET/INTERCARE HEALTH PLANS PO BOX 3559 ENGLEWOOD, CO 80155‐3559 CIGNA 1000 GREAT‐WEST DR KENNETT, MO 63857 CIGNA PO BOX 188061 CHATTANOOGA, TN 37422‐8061 CIGNA BEHAVIORAL HEALTH PO BOX 188022 CHATTANOOGA, TN 37422 CIGNA CONNECTICUT GENERAL PO BOX 182223 CHATTANOOGA, TN 37422‐7223 CIGNA HEALTHCARE (APWU PRIMARY) PO BOX 188004 CHATTANOOGA, TN 37422 CIGNA INTERNATIONAL PO BOX 15050 WILMINGTON, DE 19850‐5050 CIGNA MEDICARE ACCESS PLUS PO BOX 696018 SAN ANTONIO, TX 78269 Page 20

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NWHS.txt COLVILLE CONFEDERATED TRIBES PO BOX 5433 SPOKANE, WA 99205 COMBINED INSURANCE COMPANY OF AMERICA PO BOX 638 BELLINGHAM, WA 98227‐0638 COMMERCE BENEFITS GROUP PO BOX 900 ELYRIA, OH 44036 COMMUNITY HEALTH PLAN DSHS PO BOX 91008 SEATTLE, WA 98111‐9108 COMMUNITY HEALTH PLAN OF WA PO BOX 91008 SEATTLE, WA 98111 COMMUNITY HEALTH PLAN PEBB PO BOX 790 PUEBLO, CO 81002‐0790 CONNECTICUT GENERAL LIFE INSURANCE COMPANY PO BOX 55270 PHOENIX, AZ 85078‐5270 CONTINENTAL GENERAL PO BOX 29136 SHAWNEE MISSION, KS 66201 COOPERATIVE BENEFIT ADMINISTRATORS PO BOX 6249 LINCOLN, NE 68506 CORESOURCE PO BOX 2920 CLINTON, IA 52733‐2920 CORPORATE BENEFIT SERVICES OF AMERICA PO BOX 12953 CHARLOTTE, NC 28220 COVENTRY HEALTHCARE PO BOX 7404 Page 21

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NWHS.txt LONDON, KY 40742 CULINARY HEALTHFUND PO BOX 94469 SEATTLE, WA 98124 DEFINITY HEALTH/UNITED HEALTHCARE PO BOX 740810 ATLANTA, GA 30374‐0810 DESERET MUTUAL PO BOX 30783 SALT LAKE CITY, UT 84130‐0783 EBMS PO BOX 1400 PORTLAND, OR 97207‐1400 EBMS PO BOX 21367 BILLINGS, MT 59104‐1367 EMPIRE PLAN/UHC PO BOX 1600 KINGSTON, NY 12402 ESSENCE HEALTHCARE PO BOX 12488 ST. LOUIS, MO 63132 EUCON HEALTH PLAN C/O AMERIBEN IEC GROUP PO BOX 7186 BOISE, ID 83707 FEDERAL BLUE CROSS PO BOX 91059 SEATTLE, WA 98111 FIRST ADMINISTRATORS, INC. PO BOX 9900 SIOUX CITY, IA 51102 FIRST CHOICE HEALTH PO BOX 21367 BILLINGS, MT 59104 FIRST CHOICE HEALTH Page 22

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NWHS.txt PO BOX 13128 SACRAMENTO, CA 95813 FIRST CHOICE HEALTH ADMINISTRATORS PO BOX 12659 SEATTLE, WA 98111‐4659 FIRST CHOICE HEALTH CARE PO BOX 218 ALBANY, OR 97321 FIRST CHOICE HEALTH CAREMARK PO BOX 3777 MISSOULA, MT 59806 FIRST CHOICE HEALTH NETWORK PO BOX 2289 SEATTLE, WA 98111‐2289 FIRST CHOICE MASONRY WELFARE TRUST FUND 9848 E BURNSIDE PORTLAND, OR 97216 FIRST CHOICE OPERATING ENGINEERS 302, 61 PO BOX 34684 SEATTLE, WA 98124 FIRST CHOICE PLUMBER STEAMFITTER 1305 S W 12TH AVENUE PORTLAND, OR 97201 FIRST CHOICE SOUND HEALTH AND WELLNESS TRUST PO BOX 21391 SEATTLE, WA 98111 FIRST CHOICE SOUND HEALTH NETWORK REHN & ASSOC: ATT:FIRST CHOICE SOUND HEALTH NETWOR PO BOX 5433 SPOKANE, WA 99205 FIRST CHOICE SOUND HEALTH NETWORK PO BOX 12707 SEATTLE, WA 98111‐4707 FIRST CHOICE, WFCA PO BOX 2950 TACOMA, WA 98401 Page 23

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NWHS.txt FIRST CHOICE/BEECH STREET PO BOX 21003 SEATTLE, WA 98111 FIRST HEALTH PO BOX 8400 LONDON, KY 40742 FIRSTIER ADMINISTRATORS PO BOX 2519 LYNNWOOD, WA 98036‐2519 FISERV HEALTH PO BOX 450 PUEBLO, CO 81002 FISERV HEALTH PO BOX 360 PUEBLO, CO 81002 FISERV HEALTH PO BOX 720 PUEBLO, CO 81002 FISERV HEALTH PO BOX 690450 SAN ANTONIO, TX 78269‐0450 FISERV HEALTH PO BOX 8013 WAUSAU, WI 54402‐8013 FISERV HEALTH PHCS PO BOX 2847 CLINTON, IA 52733 GE LIFE & ANNUITY ASSURANCE CO. ATTN CLAIMS DEPT PO BOX 8118 FORT WASHINGTON, PA 19034‐8118 GEHA PO BOX 2289 SEATTLE, WA 98111‐2289 GEHA/UHC PO BOX 30783 Page 24

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NWHS.txt SALT LAKE CITY, UT 84130‐0783 GEO ENGINEERS, INC. HEALTHCARE PLAN PO BOX 1400 PORTLAND, OR 97207‐1400 GHP PO BOX 7374 LONDON, KY 40742 GREAT WEST HEALTHCARE 1000 GREAT WEST DRIVE KENNETT, MO 63857‐3749 GROUP HEALTH COOPERATION GROUP HEALTH COOPERATIVE PO BOX 34585 SEATTLE, WA 98124‐1585 GUARDIAN PO BOX 8024 APPLETON, WI 54912‐8024 GUARDIAN LIFE INSURANCE COMPANY PO BOX 26200 LEIGH VALLEY, PA 18002 H.E.R.E. HEALTH TRUST PO BOX 34355 SEATTLE, WA 98124 HCC MEDICAL INSURANCE SERVICES PO BOX 2005 FARMINGTON HILLS, MI 48333‐2005 HEALTH ASSURANCE PO BOX 7089 LONDON, KY 40742 HEALTH CARE MANAGEMENT REGENTS PO BOX 85008 BELLEVUE, WA 98015 HEALTH CLAIM SERVICES PO BOX 1067 BOISE, ID 83701‐1067 Page 25

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NWHS.txt HEALTH COMP PO BOX 45018 FRESNO, CA 93718 HEALTH FIRST TPA PO BOX 130217 TYLER, TX 75713 HEALTH NET PO BOX 14225 LEXINGTON, KY 40512‐4225 HEALTH NET CLAIMS PO BOX 2225 AUGUSTA, GA 30903 HEALTH NET CLAIMS PO BOX 14130 LEXINGTON, KY 40512 HEALTH NET COMMERCIAL CLAIMS PO BOX 14702 LEXINGTON, KY 40512 HEALTH NET PEARL PO BOX 870501 SURFSIDE BEACH, CA 29587‐8711 HEALTH PARTNERS PO BOX 1289 MINNEAPOLIS, MN 55440 HECLA MINING COMPANY PO BOX 5434 SPOKANE, WA 99205‐0434 HMA PO BOX 85008 BELLEVUE, WA 98015 HPN CLAIMS PO BOX 15645 LAS VEGAS, NV 89114‐5645 HUMANA CHOICE CARE PO BOX 14601 LEXINGTON, KY 40512‐4601 Page 26

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NWHS.txt HUMANA CLAIMS PO BOX 14610 LEXINGTON, KY 40512‐4610 HUMANA CLAIMS PO BOX 14635 LEXINGTON, KY 40512‐4635 INDIPENDENT HEALTH PO BOX 9066 BUFFALO, NY 14231 INLAND EMPIRE ELECTRICAL WORKERS TRUST PO BOX 5433 SPOKANE, WA 99205‐0433 INLAND EMPIRES TEAMSTER TRUST PO BOX 5433 SPOKANE, WA 99205‐0433 INTERNATIONAL CLAIMS SERVICES 27092 BURBANK FOOTHILL RANCH, CA 92610 KAISER PERMANENTE PO BOX 12378 PORTLAND, OR 97212 KBA PO BOX 2050 FORT MILL, SC 29716 KBA ‐ KEYSOLUTION PO BOX 129 FORT MILL, SC 29716 KPS HEALTH PLANS PO BOX 339 BREMERTON, WA 98337 LEOFF HEALTH & WELFARE TRUST PO BOX 5433 SPOKANE, WA 99205 LEOFF/AW REHN PO BOX 5433 SPOKANE, WA 99205 Page 27

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NWHS.txt LGIC/FERRY COUNTY PO BOX 5433 SPOKANE, WA 99205 LGIC/LINCOLN COUNTY PO BOX 5433 SPOKANE, WA 99205 LIFEWISE HEALTH PLAN OF WASHINGTON PO BOX 91059 SEATTLE, WA 98111 LIFEWISE HEALTHPLAN OF OREGON PO BOX 7709 BEND, OR 97708‐7709 M S ADMINISTRATIVE SERVICES, INC. PO BOX 45073 BOISE, ID 83711 MAIL HANDLERS PO BOX 8402 LONDON, KY 40742 MAKSIN MANAGEMENT CORP PO BOX 557 PENNSAUKEN, NJ 08110‐0557 MAKSIN MANAGEMENT CORP. PO BOX 2677 CAMDEN, NJ 08101‐2677 MARK'S HALLMARK SHOPS HEALTHCARE PLAN PO BOX 1400 PORTLAND, OR 97207 MARSH ADVANTAGE AMERICA PO BOX 1520 IOWA CITY, IA 52244 MARSH ADVANTAGE AMERICA PO BOX 2305 SPOKANE, WA 99210 MASONRY WELFARE TRUST ADMINISTRATION 9848 E BURNSIDE PORTLAND, OR 97216 Page 28

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NWHS.txt MED IMPACT 10680 TREENA ST, STOP 5 ATTN: CLAIMS DEPT, 4TH FLOOR SAN DIEGO, CA 92131 MEDICAID OF WA PO BOX 9248 OLYMPIA, WA 98507‐9248 MEDICAL MUTUAL OF OH PO BOX 6018 CLEVELAND, OH 44101 MEDICARE AS SECONDARY PO BOX 6700 FARGO, ND 58101 MEDICARE PART B PO BOX 6700 FARGO, ND 58108‐6700 MEDICARE RAILROAD MEDIPLUS PO BOX 9126 DES MOINES, IA 50306 MEDISHARE/PHCS PO BOX 674 STERLING, IL 61081 MEGA LIFE HEALTH INSURANCE CO INSURANCE CENTER PO BOX 981606 EL PASO, TX 79998 MERCER ADMINISTRATION PO BOX 4542 IOWA CITY, IA 52244‐4542 MERITAIN PO BOX 270226 MINNEAPOLIS, MN 55427 MERITAIN PO BOX 853921 RICHARDSON, TX 85085‐3921 Page 29

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NWHS.txt MICROCHIP/MOUNTAIN STATES ADMINISTRATIVE PO BOX 981693 EL PASO, TX 79998‐1693 MID WEST NATIONAL LIFE INSURANCE CO OF TN, INSURANCE CENTER PO BOX 982017 NORTH RICHLAND HILLS, TX 76182 MODA/ODS PO BOX 40384 PORTLAND, OR 97240 MOLINA HEALTH PLAN PO BOX 22612 CLAIMS DEPARTMENT LONG BEACH, CA 90801‐5612 MONTANA ACCESS HEALTH PO BOX 8000 HELENA, MT 59604 MONTANA MEDICAID PO BOX 8000 HELENA, MT 59604 MSC BLUE CROSS MUTUAL OF OMAHA MUTUAL OF OMAHA PLAZA OMAHA, NE 68175 MUTUAL OF OMAHA MANUFACTURING SERV PO BOX 3608 OMAHA, NE 68103 NAHGA 88 MAIN STREET PO BOX 189 BRIDGTON, ME 04009 NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND 8000 CORPORATE DRIVE LANDOVER, MD 20785 NEW WEST HEALTH SERVICES PO BOX 548 KALISPELL, MT 59903‐0548 Page 30

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NWHS.txt NORTHEAST WASHINGTON MEDICAL GROUP PO BOX 5433 SPOKANE, WA 99205 NORTHERN CALIFORNIA GENERAL TEAMSTERS SECURITY FUND PO BOX 80 STOCKTON, CA 95201‐3080 NORTHERN NV OPERATING ENGINEERS H&W TRUST PO BOX 11337 RENO, NV 89510 NORTHWEST ADMINISTRATORS 2323 EASTLAKE AVE E SEATTLE, WA 98102 NORTHWEST IRONWORKERS TRUST PO BOX 34464 SEATTLE, WA 98124‐1464 NORTHWEST ROOFERS & EMPLOYERS HEALTH TRUST PO BOX 34498 SEATTLE, WA 98124‐1498 NORTHWEST SHEET METAL WORKERS PO BOX 5433 SPOKANE, WA 99205‐0433 NW PLUMBING & PIPEFITTING INDUSTRY HEALTH & WELFARE PO BOX 34203 SEATTLE, WA 98124‐1203 OPERATING ENGINEERS HEALTH & SECURITY FUND PO BOX 34684 SEATTLE, WA 98124‐1684 OPERATING ENGINEERS HEALTH AND WELFARE TRUST PO BOX 68 SPOKANE, WA 99210 OPTUM BEHAVORIAL HEALTH Page 31

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NWHS.txt PO BOX 30602 SALT LAKE CITY, UT 84130 OXFORD PO BOX 7082 BRIDGEPORT, CT 06601 PACIFIC CARE SIGNATURE OPTIONS PO BOX 6098 CYPRESS, CA 90630 PACIFIC SOURCE HEALTH PLAN PO BOX 7068 EUGENE, OR 97401 PACIFIC UNDERWRITERS PO BOX 66040 SEATTLE, WA 98166 PACIFICSOURCE PO BOX 7068 SPRINGFIELD, OR 97475‐0068 PEACE CORPS ATTENTION: CLAIMS PO BOX 3370 CARMEL, IN 46082 PHCO PO BOX 490 SPOKANE, WA 99210 PHCS PO BOX 2568 FRISCO, TX 75034 PHCS PO BOX 674 STERLING, IL 61081 PHCS/MULTIPLAN PO BOX 1008 HORSHAM, PA 19044 PHILLIPS ADMINISTRATIVE SERVICES INC P O BOX 218 ALBANY, OR 97321 Page 32

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NWHS.txt PHYSICIANS CLINIC OF SPOKANE PO BOX 5433 SPOKANE, WA 99205 PHYSICIANS HEALTH CARE ORGANIZATION PO BOX 490 SPOKANE, WA 99210‐0490 PIONEER MANAGEMENT SYSTEMS PO BOX 1146 WEST SPRINGFIELD, MA 01090‐1146 PIONEER MANAGEMENT SYSTEMS PO BOX 9040 WEST SPRINGFIELD, MA 01090 PLAN ADMINISTRATORS INCORPORATED PO BOX 6702 COLUMBIA, SC 29260 PREMERA PO BOX 91059 SEATTLE, WA 98111‐9159 PREMERA BLUE CROSS PO BOX 91080 SEATTLE, WA 98111 PREMERA BLUE CROSS BLUE SHIELD OF ALASKA PO BOX 240609 ANCHORAGE, AK 99524‐0609 PREMERA FEDERAL EMPLOYEE PROGAM PO BOX 33932 SEATTLE, WA 98133 PRESTIGE CARE, INC. (FIRST CHOICE) 1220 SW MORRISON, SUITE 300 PORTLAND, OR 97205 PRIMARY HEALTH NETWORK PO BOX 5679 BOISE, ID 83705 PRINCIPAL LIFE INSURANCE COMPANY PO BOX 39710 COLORADO SPRINGS, CO 80949‐3910 Page 33

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NWHS.txt PRIVATE PAY ‐ HIPAA RESTRICTED VISIT PROVIDENCE HEALTH PLAN PO BOX 3125 PORTLAND, OR 97208‐3125 PROVIDENCE HEALTH PLAN/FIRST CHOICE PO BOX 4447 PORTLAND, OR 97208 PROVIDENCE HEALTH PLAN/FIRST CHOICE PO BOX 2289 SEATTLE, WA 98111‐2289 RAILROAD MEDICARE PART B PALMETTO GBA PO BOX 10066 AUGUSTA, GA 30999‐0001 RBMS, LLC PO BOX 241569 ANCHORAGE, AK 99524 REGENCE NDEX PO BOX 52890 BELLEVUE, WA 98015‐2730 RETAIL DRUG EMPLOYEES TRUST PO BOX 34927 SEATTLE, WA 98124‐1927 RETIREE'S WELFARE TRUST PO BOX 188004 CHATTANOOGA, TN 37422 RIVERSIDE BENEFIT ADMINISTRATORS PO BOX 5429 BOISE, ID 83705 ROJW HEALTH CARE SUPPORT PO BOX 817 BUCKEYSTOWN, MD 21717 SECURE HORIZONS PO BOX 12466 PENSACOLA, FL 32591‐2466 SECURE HORIZONS DIRECT Page 34

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NWHS.txt PO BOX 31353 SALT LAKE CITY, UT 84131‐0353 SECURE HORIZONS SUPPLEMENT PO BOX 12466 PENSACOLA, FL 32591 SECURITY HEALTH PLAN ATTN: CLAIMS DEPARTMENT PO BOX 8000 MARSHFIELD, WI 54449‐8000 SELECT BENEFIT ADMINISTRATORS OF AMERICA PO BOX 440 ASHLAND, WI 54806 SEVEN CORNERS ATTN: CLAIMS PO BOX 3430 CARMEL, IN 46082‐3430 SHASTA PO BOX 1747 REDMOND, OR 97756 SHAW MEDICAL CLAIMS CENTER ACORDIA NATIONAL PO BOX 11522 CHARLESTON, WV 25339‐1522 SHL ATTN: FIRST HEALTH CLAIMS PO BOX 15645 LAS VEGAS, NV 89114 SIERRA PACIFIC INDUSTRIES HEALTH BENEFIT PO BOX 496011 REDDING, CA 96049‐6011 SISCO PO BOX 389 DUBUQUE, IA 52004‐0389 SMITH ADMINISTRATORS PO BOX 853937 RICHARDSON, TX 75085 SMITH ADMINISTRATORS Page 35

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NWHS.txt PO BOX 572070 SALT LAKE CITY, UT 84157‐2070 SOMI FIRST CHOICE PO BOX 2289 SEATTLE, WA 98111 SOMI FIRST HEALTH PO BOX 5190 TAMPA, FL 33675 SOUND HEALTH/RETAIL CLERKS WELFARE TRUST PO BOX 2265 SEATTLE, WA 98111‐2265 SOUTHERN CALIFORNIA PIPE TRADES TRUST FUND 501 SHATTO PLACE FIFTH FLOOR LOS ANGELES, CA 90020 SOUTHERN IDAHO PHYSICIAN HOSPITAL ORGANIZATION SPOKANE COMMUNITY CARE ARCADIAN HEALTH PLAN PO BOX 4946 COVINA, CA 91723 SRC ‐ AN AETNA COMPANY PO BOX 23759 COLUMBIA, SC 29224 STARBRIDGE CHOICES PO BOX 55270 PHOENIX, AZ 85078‐5270 STATE FARM HEALTH INSURANCE PO BOX 339403 GREELEY, CO 80633‐9403 STERLING PO BOX 269003 PLANO, TX 75026‐9003 STERLING MEDICARE SELECT PO BOX 5348 BELLINGHAM, WA 98227 Page 36

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NWHS.txt STERLING OPTION 1 PO BOX 69314 HARRISBURG, PA 17106‐9314 SUMMIT AMERICA INSURANCE SERVICES PO BOX 25936 OVERLAND PARK, KS 66225‐5936 SYMETRA SELECT BENEFIT ADMINISTRATORS PO BOX 4250 HOUSTON, TX 77210 TEAMSTERS CONSTRUCTION INDUSTRY WELFARE NORTHWEST ADMINISTRATORS 2323 EASTLAKE AVE E SEATTLE, WA 98102‐3393 THE LOOMIS COMPANY/BENEFITS DIVISION PO BOX 7011 WYOMISSING, PA 19610‐6011 THE MAIL HANDLERS BENEFIT PLAN PO BOX 8402 LONDON, KY 40742 TIMBER PRODUCTS MANUFACTURERS TRUST PO BOX 4867 MISSOULA, MT 59806 TOWER LIFE INSURANCE COMPANY 310 S SAINT MARIES ST SAN ANTONIO, TX 78205 TPSC PO BOX 1894 TACOMA, WA 98401 TRANSAMERICA PO BOX 559017 AUSTIN, TX 78755 TRICARE WEST REGION CLAIMS PO BOX 77028 MADISON, WI 53707‐1028 TRICARE PRIME Page 37

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NWHS.txt WEST REGION CLAIMS PO BOX 77028 MADISON, WI 53707‐1028 TRUSTEED PLANS SERVICE CORPORATION PO BOX 2950 TACOMA, WA 98401 UCT PO BOX 159019 COLUMBUS, OH 43215‐8619 UFCW WELFARE TRUST PO BOX 5433 SPOKANE, WA 99205 UGS‐GLOBALCARE, INC. PO BOX 247 ALPHARETTA, GA 30009‐0247 UMR/FIRST CHOICE PLAN PO BOX 30541 SALT LAKE CITY, UT 84130 UMR/UHC PO BOX 30541 SALT LAKE CITY, UT 84130‐0541 UNICARE PO BOX 4458 CHICAGO, IL 60680 UNICARE PO BOX 795180 SAN ANTONIO, TX 78279 UNIFORM MEDICAL PLAN PO BOX 34850 SEATTLE, WA 98124‐1850 UNION PACIFIC RAILROAD EMPLOYEES HEALTH PO BOX 161020 SALT LAKE CITY, UT 84116 UNITED AMERICAN INSURANCE COMPANY PO BOX 8080 MCKINNEY, TX 75070 Page 38

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NWHS.txt UNITED EMPLOYEES BENEFIT TRUST PO BOX 8130 TACOMA, WA 98418 UNITED FOOD & COMMERCIAL WORKERS WELFARE PO BOX 5433 SPOKANE, WA 99205 UNITED HEALTH CARE PO BOX 31374 SALT LAKE CITY, UT 84131‐0374 UNITED HEALTHCARE PO BOX 31359 SALT LAKE CITY, UT 84131‐0359 UNITED HEALTHCARE PO BOX 30304 SALT LAKE CITY, UT 84130‐0304 UNITED HEALTHCARE PO BOX 14711 LEXINGTON, KY 40512 UNITED HEALTHCARE PO BOX 740800 ATLANTA, GA 30374‐0800 UNITED HEALTHCARE PO BOX 30985 SALT LAKE CITY, UT 84130‐0985 UNITED HEALTHCARE PO BOX 981502 EL PASO, TX 79998‐1502 UNITED HEALTHCARE PO BOX 30555 SALT LAKE CITY, UT 84130‐0555 UNITED HEALTHCARE MEDICA PO BOX 30990 SALT LAKE CITY, UT 84130 UNITED HEALTHCARE/EVERCARE ADV. PL PO BOX 31350 SALT LAKE CITY, UT 84131‐0350 Page 39

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NWHS.txt UNITED HEALTHCARE/UMRTREX PO BOX 145804 CINCINNATI, OH 45250 UNIVERA HEALTHCARE PO BOX 23000 ROCHESTER, NY 14692 US BENEFITS PO BOX 13190 PORTLAND, OR 97213 USAA VA MEDICAL CENTER SPOKANE 4815 N ASSEMBLY STREET SPOKANE, WA 99205 WASHINGTON BAKERS TRUST PO BOX 91013 SEATTLE, WA 98111‐9103 WASHINGTON EMPLOYERS TRUST PO BOX 850898 RICHARDSON, TX 75085‐0898 WASHINGTON IDAHO CARPENTERS HEALTH & SECURITY TRUST PO BOX 1929 SEATTLE, WA 98111 WASHINGTON IDAHO OPERATING ENGINEERS PO BOX 68 SPOKANE, WA 99210 WASHINGTON IDAHO OPERATING ENGINEERS HEALTH AND WELFARE TRUST FUND OFFICE PO BOX 68 SPOKANE, WA 99210 WASHINGTON TEAMSTERS WELFARE TRUST FIRST CHOICE/BEECH STREET PO BOX 188004 CHATTANOOGA, TN 37422 WAUSAU BENEFITS PO BOX 8013 Page 40

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NWHS.txt WAUSAU, WI 54402‐8013 WEB‐TPA PO BOX 99906 GRAPEVINE, TX 76099‐9706 WELLCARE PO BOX 4438 SCRANTON, PA 18505 WELLS FARGO INSURANCE SERVICES PO BOX 99004 ANCHORAGE, AK 99509 WILLIAM J SUTTON & CO LTD ‐ FIRST HEALTH 266 ELMWOOD AVE #535 BUFFALO, NY 14222 WPA NORTHWEST PLUMBING & PIPEFITTING PO BOX 34687 SEATTLE, WA 98124 YOUNG LIFE BENEFITS PLAN PO BOX 520 COLORADO SPRINGS, CO 80901 ZENITH ADMINISTRATORS PO BOX 900932 SEATTLE, WA 98109 ZENITH ADMINISTRATORS PO BOX 2523 SPOKANE, WA 99220 ZENITH ADMINISTRATORS, INC. PO BOX 21968 SEATTLE, WA 98111‐3968

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