930113 Valley Grinding Service and Supply (800) 279-6772 (866) 726-6584 20270 930112 Utschig, Inc. (800) 279-6772 (866) 726-6584 20270 W909 Weyco Inc (800) 279-6772 (866) 726-6584 20270 2722 Rukert Mielke (800) 279-6772 866-726-6584 20270 Waterstone Bank/ Waterstone W753 Mortgage (800) 279-6772 866-726-6584 20270 Heresite Protective H889 Coating (800) 279-6772 866-726-6584 20270 City of Manitowoc/Man itowoc Public M614 Utilities (800) 279-6772 800-333-4043 20270 N787 W865 North Shore Bank (800) 279-6772 866-726-6584 20270 Watry Industries, LLC (800) 279-6772 866-726-6584 20270 P754 Purity Dialysis (800) 279-6772 866-726-6584 20270 Claims EOB Claims Status Lubbock TX 79493 (888) 477-7968 55 Little Chute 4/1/2008 Yes Lubbock TX 79493 (888) 477-7968 9 Greenville 4/1/2008 Yes Lubbock TX 79493 (888) 477-7968 150 Milwaukee 7/1/2008 Yes - ER only Lubbock TX 79493 (888) 477-7968 97 Waukesha 8/1/2008 Yes - TMJ only Lubbock TX 79493 (888) 477-7968 166 Milwaukee, Waukesha, Oak Creek 10/1/2008 Yes Lubbock TX 79493 (888) 477-7968 28 Manitowoc 10/1/2008 Yes Lubbock TX 79493 (888) 477-7968 398 Manitowoc 10/1/2008 No Lubbock TX 79493 (888) 477-7968 309 Milwaukee Brookfield Pewaukee Green Bay Sturgeon Bay Appleton 10/1/2008 Yes Lubbock TX 79493 (888) 477-7968 107 Sheboygan 11/1/2008 Yes Lubbock TX 79493 (888) 477-7968 76 Delafield 11/1/2008 Yes P814 PyraMax Bank (800) 279-6772 866-726-6584 20270 Lubbock TX 79493 (888) 477-7968 79 Greenfield, Milwaukee, Franklin, West Allis, Waukesha, Mukwonago 12/1/2008 Yes 930111 WOW Logistics Company (800) 279-6772 866-726-6584 20270 M905 Midland Plastics (800) 279-6772 866-726-6584 20270 Lubbock TX 79493 (888) 477-7968 220 Grafton, Menasha, Marshfield, Wisconsin Rapids, Chippewa Falls, Ashwaubenon, Little Chute, Oshkosh, Mosinee, Schofield 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 125 Green Bay, New Berlin 1/1/2009 Yes
A587 W808 Apple Steel Rule Die (800) 279-6772 866-726-6584 20270 Wisconsin & Southern Railroad (800) 279-6772 866-726-6584 20270 G757 Glenroy, Inc. (800) 279-6772 866-726-6584 20270 Oostburg Concrete O893 Products, Inc. (800) 279-6772 866-726-6584 20270 B777-1 V878 Bentley World Packaging (800) 279-6772 866-726-6584 20270 Van Horn Automotive (800) 279-6772 866-726-6584 20270 F789 City of Franklin (800) 279-6772 866-726-6584 20270 S885 M899 P886 Shepherds Baptist Ministry (800) 279-6772 866-726-6584 20270 Marine Credit Union (800) 279-6772 866-726-6584 20270 Plyco Corporation (800) 279-6772 866-726-6584 20270 P917 Primex Inc. (800) 279-6772 866-726-6584 20270 Johnson Brass & Machine J906 Foundry, Inc. (800) 279-6772 866-726-6584 20270 B918 H862 M790 City of Burlington (800) 279-6772 866-726-6584 20270 Household Utilities (800) 279-6772 866-726-6584 20270 Milwaukee Stove & Furnace (800) 279-6772 866-726-6584 20270 V523 VL Tool (800) 279-6772 866-726-6584 20270 Claims EOB Claims Status Lubbock TX 79493 (888) 477-7968 53 Milwaukee 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 250 Milwaukee, Janesville, Horicon, Madison 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 154 Menomonee Falls 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 130 Oostburg 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 159 Milwaukee 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 71 Fond du Lac, Sheboygan, Plymouth 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 217 Franklin 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 138 Union Grove 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 122 Fond du lac, LaCrosse 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 113 Elkhart Lake 1/1/2009 Yes - ER only Lubbock TX 79493 (888) 477-7968 154 Lake Geneva 1/1/2009 No Lubbock TX 79493 (888) 477-7968 84 Saukville 1/1/2009 Yes - ER only Lubbock TX 79493 (888) 477-7968 75 Burlington 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 129 Kiel 1/1/2009 No Lubbock TX 79493 (888) 477-7968 74 Milwaukee, Madison, Green Bay 1/1/2009 No Lubbock TX 79493 (888) 477-7968 68 Waukesha 1/1/2009 Yes
C904 Cost of Wisconsin (800) 279-6772 866-726-6584 20270 E892 Essco (800) 279-6772 866-726-6584 20270 930115 Norka (800) 279-6772 866-726-6584 20270 O907 Orion Energy (800) 279-6772 866-726-6584 20270 U791 C908 M770 Universal s (800) 279-6772 866-726-6584 20270 Cher-Make Sausage Company (800) 279-6772 866-726-6584 20270 McAdams Graphics (800) 279-6772 866-726-6584 20270 K740 KSM Industries (800) 279-6772 866-726-6584 20270 M824 A792 G780 B765 C794 K924 M742 Midwest Dialysis & Midwest Nephrology (800) 279-6772 866-726-6584 20270 American State Equipment (800) 279-6772 866-726-6584 20270 Great Midwest Bank (800) 279-6772 866-726-6584 20270 Bader Rutter & Associates (800) 279-6772 866-726-6584 20270 Craft Cast Holdings (800) 279-6772 866-726-6584 20270 Kitchen Fresh Foods (800) 279-6772 866-726-6584 20270 Manitowoc Tool & Machining (800) 279-6772 866-726-6584 20270 A926 Air Cargo (800) 279-6772 866-726-6584 20270 Claims EOB Claims Status Lubbock TX 79493 (888) 477-7968 101 Jackson 1/1/2009 yes Lubbock TX 79493 (888) 477-7968 58 Green Bay 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 25 Appleton 1/1/2009 Yes Manitowoc, Plymouth, Lubbock TX 79493 (888) 477-7968 225 Sheboygan 3/1/2009 Yes Lubbock TX 79493 (888) 477-7968 165 Whitewater 3/1/2009 Yes Lubbock TX 79493 (888) 477-7968 124 Manitowoc 4/1/2009 Yes - ER only Lubbock TX 79493 (888) 477-7968 102 Oak Creek 4/1/2009 Yes Lubbock TX 79493 (888) 477-7968 65 Germantown 4/1/2009 Yes Lubbock TX 79493 (888) 477-7968 153 13 locations in SE Wisconsin 4/1/2009 Yes Milwaukee, Little Lubbock TX 79493 (888) 477-7968 74 Chute, Wausau 4/1/2009 No Brookfield, Madison, Lubbock TX 79493 (888) 477-7968 108 Chilton, Appleton 5/1/2009 Yes Lubbock TX 79493 (888) 477-7968 88 Brookfield 5/1/2009 Lubbock TX 79493 (888) 477-7968 59 Jackson 5/1/2009 Yes Lubbock TX 79493 (888) 477-7968 150 Yes - ER MRI Only Green Bay, Madison, Milwaukee 5/1/2009 Unsure Lubbock TX 79493 (888) 477-7968 244 Manitowoc 6/1/2009 Yes Lubbock TX 79493 (888) 477-7968 100 Hartford, Milwaukee 6/1/2009 Unsure
Claims EOB Claims Status Date Co-Pays D866 Diversatek,Adap tive Engineering Labs, Medovations, Sunlight Plastics (800) 279-6772 866-726-6584 20270 K867 Krier Foods (800) 279-6772 866-726-6584 20270 T910 Times Printing (800) 279-6772 866-726-6584 20270 W852 C927 S868 Washington County (800) 279-6772 866-726-6584 20270 Clintonville Lumber/Torberg s Lumber (800) 279-6772 866-726-6584 20270 Shawano School District (800) 279-6772 866-726-6584 20270 K896 Karl's Transport (800) 279-6772 866-726-6584 20270 Q828 Quadra (800) 279-6772 866-726-6584 20270 W852 M929 C925 Washington County (800) 279-6772 866-726-6584 20270 Metropolitan Associates (800) 279-6772 866-726-6584 20270 Country Springs Hotel (800) 279-6772 866-726-6584 20270 B912 Brotoloc (800) 279-6772 866-726-6584 20270 W931 WOW Distributing (800) 279-6772 866-726-6584 20270 T871 Timber Creek (800) 279-6772 866-726-6584 20270 Lubbock TX 79493 (888) 477-7968 74 Germantown, Milwaukee 6/1/2009 Yes Lubbock TX 79493 (888) 477-7968 74 Brown Deer 6/1/2009 No Lubbock TX 79493 (888) 477-7968 300 Random Lake 6/1/2009 8/31/2009 Unsure Lubbock TX 79493 (888) 477-7968 529 West Bend 6/1/2009 Yes Clintonville, Shawano, Lubbock TX 79493 (888) 477-7968 95 Waupaca 7/1/2009 Yes Lubbock TX 79493 (888) 477-7968 334 Shawano 7/1/2009 ER Only Lubbock TX 79493 (888) 477-7968 124 Antigo 7/1/2009 Yes Lubbock TX 79493 (888) 477-7968 74 Sturtevant 7/1/2009 ER Only Lubbock TX 79493 (888) 477-7968 522 West Bend 7/1/2009 Yes Lubbock TX 79493 (888) 477-7968 77 Milwaukee 8/1/2009 ER & Chiro Lubbock TX 79493 (888) 477-7968 100 Milwaukee 8/1/2009 Unsure Lubbock TX 79493 (888) 477-7968 216 Ellsworth, Eau Claire, Kenosha, Whitewater, West Allis, Hortonville 9/1/2009 Yes Lubbock TX 79493 (888) 477-7968 150 Sussex 9/1/2009 Yes Lubbock TX 79493 (888) 477-7968 58 Milwaukee 8/1/2009 Yes
A932 Acro Automation (800) 279-6772 866-726-6584 20270 M833 Mariott Construction (800) 279-6772 866-726-6584 20270 M833-1 Mariott Drywall (800) 279-6772 866-726-6584 20270 I873 W262 Iola Living Assistance (800) 279-6772 866-726-6584 20270 Walworth County (800) 279-6772 866-726-6584 20270 K752 Klein Dickert (800) 279-6772 866-726-6584 20270 W931-1 Beer Capitol (800) 279-6772 866-726-6584 20270 Experimental Aircraft E916 Association (800) 279-6772 866-726-6584 20270 SVA Certified Public S935 Accountants (800) 279-6772 866-726-6584 20270 Commercial Communications C854 Inc. (800) 279-6772 866-726-6584 20270 C854-1 Coakley Tech (800) 279-6772 866-726-6584 20270 F809 FABCO (800) 279-6772 866-726-6584 20270 K936 S939 Kaysun Corporation (800) 279-6772 866-726-6584 20270 SMC Metal Fabricators (800) 279-6772 866-726-6584 20270 H858 H.O. Bostrom (800) 279-6772 866-726-6584 20270 V937 VanVreede's (800) 279-6772 866-726-6584 20270 Claims EOB Claims Status Lubbock TX 79493 (888) 477-7968 55 Milwaukee 10/1/2009 Unsure Lubbock TX 79493 (888) 477-7968 50 Waukesha 9/1/2009 Yes Lubbock TX 79493 (888) 477-7968 9 Waukesha 9/1/2009 Yes Lubbock TX 79493 (888) 477-7968 30 Iola 11/1/2009 No Lubbock TX 79493 (888) 477-7968 1200 Elkhorn 11/1/2009 Unsure Green Bay, Marinette, Lubbock TX 79493 (888) 477-7968 16 Oshkosh, Milwaukee 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 187 Wauwatosa 12/1/2009 Unsure Lubbock TX 79493 (888) 477-7968 117 Oshkosh 1/1/2010 ER Only Lubbock TX 79493 (888) 477-7968 125 Brookfield, Neenah 1/1/2010 Unsure Racine, Green Bay, Lubbock TX 79493 (888) 477-7968 150 Milwaukee 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 150 Racine, Green Bay, Milwaukee 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 225 Madison 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 142 Manitowoc 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 54 Oshkosh 1/1/2010 No Lubbock TX 79493 (888) 477-7968 32 Waukesha 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 67 Green Bay, Appleton 1/1/2010 Yes
C938 S855 The Coleman, inc. (800) 279-6772 866-726-6584 20270 Scan-Pac Mfg, Inc. (800) 279-6772 866-726-6584 20270 H903 Holt Dental (800) 279-6772 866-726-6584 20270 N837 B940 W883 R853 N.E.W. Industries, Inc. (800) 279-6772 866-726-6584 20270 BANNER Welder, Inc. (800) 279-6772 866-726-6584 20270 Willman Industries, Inc. (800) 279-6772 866-726-6584 20270 Rice Healthcare Facilities (800) 279-6772 866-726-6584 20270 2631 Hillcrest Lumber (800) 279-6772 866-726-6584 20270 Conservent Benefit Plan 900000K Weyco Inc (888) 882-5882 (800) 432-8421 20270 CYP (920) 968-4613 (866) 232-8677 20270 C91 Jim Pankow Inc 877-236-0844 (866) 232-8677 20270 Y62 Services Plus 877-236-0844 888-279-0700 20270 C28 Kadant Grantek, Inc 877-236-0844 888-289-0700 20270 C78 Shallbetter 877-236-0844 888-236-4021 20270 Claims EOB Claims Status Lubbock TX 79493 (888) 477-7968 119 Elkhorn 1/1/2010 Unsure Lubbock TX 79493 (888) 477-7968 85 Menomonee Falls 1/1/2010 No Lubbock TX 79493 (888) 477-7968 51 Waukesha 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 103 Sturgeon Bay 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 54 Germantown 1/1/2010 No Lubbock TX 79493 (888) 477-7968 77 Cedar Grove 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 467 Appleton, Little Chute, Shawano, Stevens Point, WI Rapis, Marshfield, Two Rivers, Chilton, Plymouth,New Holstein, Ellsworth, Williams Bay 2/1/2010 Yes Lubbock TX 79493 (888) 477-7968 33 Brillion, DePere 2/1/2010 No Lubbock TX 79493 (888) 477-7968 150 Milwaukee 1/1/2008 6/30/2008 Yes - ER only Lubbock TX 79493 (888) 477-7968 40 Appleton 5/1/2008 No Lubbock TX 79493 (888) 477-7968 55 Plymouth 10/1/2008 5/1/2009 Yes Lubbock TX 79493 (888) 477-7968 120 Green Bay 12/1/2008 Yes Lubbock TX 79493 (888) 477-7968 26 Green Bay 12/1/2008 Yes Lubbock TX 79493 (888) 477-7968 51 Oshkosh 1/1/2009 No
C87 C57 Magnum Products, LLC 877-236-0844 888-236-4021 20270 City of Lake Geneva 877-236-0844 888-236-4021 20270 C90 Bay Towel 877-236-0844 888-236-4021 20270 C55 Milwaukee Plating 877-236-0844 888-236-4021 20270 Y33 Schenk 877-236-0844 888-236-4021 20270 Y47 Miller St. Nazianz 877-236-0844 888-236-4021 20270 Y50 Steel Craft 877-236-0844 888-236-4021 20270 C58 TTI Trucking 877-236-0844 888-236-4021 20270 Y15 C88 The Boldt Company 877-236-0844 888-236-4021 20270 Unlimited Services of Wisconsin, Inc. 877-236-0844 888-236-4021 20270 Y37 Fox World Travel 877-236-0844 888-236-4021 20270 Fabio Perini North America, Y17 Inc. 877-236-0844 888-236-4021 20270 Y56 Y20 Y68 Door County Co- Op 877-236-0844 888-236-4021 20270 Castle Sales Company 877-236-0844 888-236-4021 20270 North American Hydro Holdings 877-236-0844 888-236-4021 20270 Y62 Boston, Inc. 877-236-0844 888-236-4021 20270 Claims EOB Claims Status Lubbock TX 79493 (888) 477-7968 190 Berlin 2/1/2009 09/31/09 Yes Lubbock TX 79493 (888) 477-7968 77 Lake Geneva 3/1/2009 Yes Lubbock TX 79493 (888) 477-7968 77 Green Bay 5/1/2009 Yes Lubbock TX 79493 (888) 477-7968 31 Milwaukee 6/1/2009 Yes Lubbock TX 79493 (888) 477-7968 531 Appleton 7/1/2009 Yes Lubbock TX 79493 (888) 477-7968 150 St. Nazianz 9/1/2009 No Lubbock TX 79493 (888) 477-7968 260 Hartford 9/1/2009 Yes Lubbock TX 79493 (888) 477-7968 45 Eden 10/1/2009 Yes Appleton, Waukesha, Lubbock TX 79493 (888) 477-7968 250 Madison 1/1/2010 No Lubbock TX 79493 (888) 477-7968 127 Oconto 1/1/2010 Yes Green Bay, Oshkosh, Lubbock TX 79493 (888) 477-7968 105 Appleton 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 67 Green Bay 1/1/2010 Yes Green Bay, Sturgeon Lubbock TX 79493 (888) 477-7968 31 Bay 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 17 Green Bay 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 37 Neshkoro 1/1/2010 Yes Stevens Point, Green Bay, Plover, Appleton, Oshkosh, Wausau, Lubbock TX 79493 (888) 477-7968 95 Rhinelander, DePere 1/1/2010 No
Y30 C81 Y38 Valley Added Distributors, LLC 877-236-0844 888-236-4021 20270 Utica Energy, LLC 877-236-0844 888-236-4021 20270 ACE Manufacturing, Inc. 877-236-0844 888-236-4021 20270 Y28 ST Paper, LLC 877-236-0844 888-236-4021 20270 Y64 Lakeshore Display Mfg, Inc. 877-236-0844 888-236-4021 20270 Claims EOB Claims Status Shawano, Neenah, Lubbock TX 79493 (888) 477-7968 65 DePere 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 50 Oshkosh 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 52 Green Bay 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 53 oconto Falls 1/1/2010 Unsure Lubbock TX 79493 (888) 477-7968 50 Sheboygan 1/1/2010 Unsure Benefit Consultants, Inc. M-04005 Benefit Consultants, Inc. M-055 Sadoff & Rudoy Industries 800-558-7798 800-426-9317 20270 Proteus Packaging 800-558-7798 800-426-9317 20270 Lubbock TX 79493 (888) 477-7968 196 Fond Du Lac 11/1/2009 Yes - ER only Lubbock TX 79493 (888) 477-7968 52 Franklin 11/1/2009 Unsure Benefit Consultants, Inc. M-055-02 Transpak Corp. 800-558-7798 800-426-9317 20270 SCE NEM NLA JGS Sheboygan County 800-615-7020 800-615-7020 20270 Nemschoff Chairs 800-615-7020 800-615-7020 20270 Northern Labs, Inc. 800-615-7020 800-615-7020 20270 Jagemann Stamping 800-615-7020 800-615-7020 20270 RCS RCS Empowers 800-615-7020 800-615-7020 20270 KIE Kieffer & Company 800-615-7020 800-615-7020 20270 STK Stecker Machine 800-615-7020 800-615-7020 20270 Lubbock TX 79493 (888) 477-7968 40 Franklin 11/1/2009 Unsure Lubbock TX 79493 (888) 477-7968 900 Sheboygan, Plymouth, Sheboygan Falls 11/1/2008 Yes - ER only Lubbock TX 79493 (888) 477-7968 300 Sheboygan 1/1/2009 12/31/2009 Yes Lubbock TX 79493 (888) 477-7968 243 Manitowoc 1/1/2009 Yes Lubbock TX 79493 (888) 477-7968 160 Manitowoc 7/1/2009 No Lubbock TX 79493 (888) 477-7968 55 Sheboygan 8/1/2009 No Lubbock TX 79493 (888) 477-7968 50 Sheboygan 9/1/2009 Yes Lubbock TX 79493 (888) 477-7968 50 Manitowoc 10/1/2009 Yes
PLU/PLY RAP SAR City of Plymouth/Plymo uth Public Utililites 800-615-7020 800-615-7020 20270 Red Arrow Products 800-615-7020 800-615-7020 20270 Sartori Food Corporation 800-615-7020 800-615-7020 20270 OSH City of Oshkosh 800-615-7020 800-615-7020 20270 KSL Kahler Slater, Inc. 800-615-7020 800-615-7020 20270 Claims EOB Claims Status Date Co-Pays Lubbock TX 79493 (888) 477-7968 75 Plymouth 10/1/2009 No Lubbock TX 79493 (888) 477-7968 140 Manitowoc 1/1/2010 Unsure Lubbock TX 79493 (888) 477-7968 100 Plymouth 1/1/2010 No Lubbock TX 79493 (888) 477-7968 610 Oshkosh 1/1/2010 Yes Lubbock TX 79493 (888) 477-7968 95 Milwaukee 1/1/2010 Yes