Self-Insured Individual Employer List - State of Michigan

BISSELL Inc. Mr. William J Brennan 2345 Walker Avenue, N.W. P.O. Box 1888 Walker, MI 49501 Self-Insured Carrier ID: 35028220 Michigan Claim Service DB...

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

A B F Freight System, Inc. Mr. Stan McDaniel 3801 Old Greenwood Road P.O. Box 10048 Fort Smith, AR 72917-0048 Self-Insured Carrier ID: 42090248 Self-Administered A C O, Inc. Mr. Mark Vandenberg 27555 Farmington Road Suite 110 Farmington Hills, MI 48334 Self-Insured Carrier ID: 53093406 York Risk Services Group, Inc.

Allegan County Board of Commissioners Ms. Vickie Herzberg 3283 - 122nd Avenue Allegan, MI 49010 Self-Insured Carrier ID: 99900203 Mackinaw Administrators, LLC Alro Steel Corporation Mr. Jim Norman 3100 E. High Street P.O. Box 927 Jackson, MI 49204-0927 Self-Insured Carrier ID: 33047766 Parker Services, LLC

A J M Packaging Corporation Mr. Robert A Epstein Suite 100 E-4111 Andover Road Bloomfield Hills, MI 48302 Self-Insured Carrier ID: 26022282 Constitution State Services LLC

Alticor Inc. Ms. Sue Kocher 7575 Fulton Street East Mail Code: 56-3T Ada, MI 49355-0001 Self-Insured Carrier ID: 59090441 Self-Administered

A. D. Transport Express, Inc. Mr. Gary A Percy 5601 Belleville Road Canton, MI 48188 Self-Insured Carrier ID: 42091119 CompOne Administrators, Inc.

American Electric Power Company, Inc. Mr. Loyd Hudson 1 Riverside Plaza 15th Floor IDM Center Columbus, OH 43215-2355 Self-Insured Carrier ID: 49092102 Cannon Cochran Management Services, Inc.

ABM Industries Incorporated Mr. Chris Ridge 4151 Ashford Dunwoody Road Atlanta, GA 30319 Self-Insured Carrier ID: 30057710 ESIS, Inc.

American National Red Cross Mr. Muluneh Woldetsadik 2025 E Street, NW Washington, DC 20006 Self-Insured Carrier ID: 80001585 Sedgwick Claims Management Services, Inc.

ADAC Plastics, Inc. Mr. Terrance Leberfinger 5920 Tahoe Dr. P.O. Box 888375 Grand Rapids, MI 49588-8375 Self-Insured Carrier ID: 30043041 Eagle Claims Management, LLC

American Plastic Toys, Inc. Mr. James W Grau 799 Ladd Road Walled Lake, MI 48390 Self-Insured Carrier ID: 29018264 Comprehensive Risk Services, Inc.

AK Steel Corporation Mr. David Weber 9227 Centre Pointe Drive West Chester, OH 45069 Self-Insured Carrier ID: 33080791 CompOne Administrators, Inc.

Andersons, Inc. (The) Ms. Jan LaPlant P.O. Box 119 1947 Briarfield Blvd. Maumee, OH 43537 Self-Insured Carrier ID: 07032385 Mackinaw Administrators, LLC

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Andrews University Mr. Daniel A Agnetta 4150 Administration Drive Human Resources Berrien Springs, MI 49104-0860 Self-Insured Carrier ID: 82000011 CompOne Administrators, Inc.

Avon Automotive Holdings, Inc. Ms. Cindy Branch 603 West Seventh Street Cadillac, MI 49601 Self-Insured Carrier ID: 39047135 CompOne Administrators, Inc.

Android Industries, LLC Ms. Tricia DeClercq 2155 Executive Hills Blvd. Auburn Hills, MI 48326 Self-Insured Carrier ID: 39024123 Gallagher Bassett Services, Inc.

AWI Holdings Inc. Mr. Gregory D Hinkle 440 Kirtland S.W. Grand Rapids, MI 49507 Self-Insured Carrier ID: 50018741 York Risk Services Group, Inc.

Ann Arbor Area Transportation Authority Mr. Philip C Webb 2700 S Industrial Hwy Ann Arbor, MI 48104 Self-Insured Carrier ID: 99022100 Eagle Claims Management, LLC

Balkema Excavating, Inc. Mr. Clarence Batts 5300 Miller Road Kalamazoo, MI 49048 Self-Insured Carrier ID: 17007112 Eagle Claims Management, LLC

Ann Arbor Public Schools Mr. David Comsa 2555 S. State Street Ann Arbor, MI 48104 Self-Insured Carrier ID: 82000181 Broadspire Services, Inc.

Bay City Public Schools Mrs. Jill Mulders 910 N. Walnut Street Bay City, MI 48706 Self-Insured Carrier ID: 82000309 Eagle Claims Management, LLC

Art Van Furniture, LLC Mr. David Ladd 6500 Fourteen Mile Road Warren, MI 48092 Self-Insured Carrier ID: 57012809 CompOne Administrators, Inc.

Bay County Ms. Tiffany Jerry 515 Center Avenue Bay City, MI 48708 Self-Insured Carrier ID: 99900009 York Risk Services Group, Inc.

Asama Coldwater Manufacturing, Inc. Mr. David Sutherland 180 Asama Parkway Coldwater, MI 49036 Self-Insured Carrier ID: 39017030 Eagle Claims Management, LLC

Beaumont Health Mr. Kent Teeters 16500 W Twelve Mile Road Southfield, MI 48076 Self-Insured Carrier ID: 80000910 Sedgwick Claims Management Services, Inc.

Ascension Health Alliance Ms. Molly Abshear 11775 Borman-Suite 300 P.O. Box 46944 St. Louis, MO 63146-4134 Self-Insured Carrier ID: 80000101 Sedgwick Claims Management Services, Inc.

Benteler Automotive Corporation Mr. Armin Grossklans 2650 N. Opdyke Rd., Suite B Auburn Hills, MI 48326 Self-Insured Carrier ID: 37058041 Constitution State Services LLC Besser Company USA Mr. Scott Foerstner 801 Johnson Street Alpena, MI 49707 Self-Insured Carrier ID: 14010942 Comprehensive Risk Services, Inc. 12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List BISSELL Inc. Mr. William J Brennan 2345 Walker Avenue, N.W. P.O. Box 1888 Walker, MI 49501 Self-Insured Carrier ID: 35028220 Michigan Claim Service DBA The ASU Group

Boyne USA, Inc. Mr. Edward Dembek 3951 Charlevoix Ave. Petoskey, MI 49770 Self-Insured Carrier ID: 70087534 York Risk Services Group, Inc.

Bloomfield Hills School District Ms. Karen Healy 7273 Wing Lake Road Bloomfield Hills, MI 48301 Self-Insured Carrier ID: 82000463 CompOne Administrators, Inc.

Brembo North America, Inc. Mr. Daniel M Sandberg 47765 Halyard Drive Plymouth, MI 48170 Self-Insured Carrier ID: 39009915 Mackinaw Administrators, LLC

Blue Cross Blue Shield of Michigan Mutual Insurance Company Ms. Lisa Holinski 600 E. Lafayette MC1801 Detroit, MI 48226 Self-Insured Carrier ID: 80012082 CompOne Administrators, Inc.

Bronson Healthcare Group, Inc. Ms. Robin Welch 601 John Street Box G Kalamazoo, MI 49007 Self-Insured Carrier ID: 80000839 ProSelect Insurance Company

Board of Water & Light of the City of Lansing Mr. Richard R Peffley P.O. Box 13007 Lansing, MI 48901 Self-Insured Carrier ID: 49059333 CompOne Administrators, Inc. Boldt Company (The) Ms. Teri Whitman 2525 N. Roemer Rd. P.O. Box 419 Appleton, WI 54912-0419 Self-Insured Carrier ID: 15031001 Self-Administered Bopp-Busch Manufacturing Company Mr. William A Busch 545 E. Huron P.O. Box 589 Au Gres, MI 48703 Self-Insured Carrier ID: 34023820 Eagle Claims Management, LLC Bouma Corporation (The) Mr. Daniel DeRyke 4101 Roger B. Chaffee Memorial Blvd. SE Grand Rapids, MI 49548 Self-Insured Carrier ID: 25042660 Eagle Claims Management, LLC

Burr Oak Tool Inc. Mr. Andrew F Boyd 405 W. South Street Sturgis, MI 49091 Self-Insured Carrier ID: 35013675 York Risk Services Group, Inc. Cadillac Casting, Inc. Ms. Michael T Quibell 1500 4th Ave Cadillac, MI 49601 Self-Insured Carrier ID: 37004225 CompOne Administrators, Inc. Cadillac Products, Inc. Mr. Roger K Williams 5800 Crooks Road Troy, MI 48098 Self-Insured Carrier ID: 52000798 York Risk Services Group, Inc. Capital Area Transportation Authority Mr. Mark M Murray 4615 Tranter Street Lansing, MI 48910 Self-Insured Carrier ID: 41046543 CompOne Administrators, Inc.

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Carman-Ainsworth Community Schools Mr. Russell Parks G-3475 W. Court Street Flint, MI 48532 Self-Insured Carrier ID: 82000625 Eagle Claims Management, LLC

Charter Township of Waterford Ms. Margaret Birch Treasurer's Office 5200 Civic Center Drive Waterford, MI 48329-3773 Self-Insured Carrier ID: 99901063 Comprehensive Risk Services, Inc.

Cascade Engineering, Inc. Mr. Joseph Maier 3400 Innovation Ct. S.E. Grand Rapids, MI 49512 Self-Insured Carrier ID: 30044567 Eagle Claims Management, LLC

Chelsea Milling Company Mr. John Powers 201 West North Street Chelsea, MI 48118 Self-Insured Carrier ID: 20044114 York Risk Services Group, Inc.

Cassens Corp Mr. William Molter 145 North Kansas St. Edwardsville, IL 62025 Self-Insured Carrier ID: 42095685 Broadspire Services, Inc.

Chippewa County War Memorial Hospital, Inc Ms. Susan Sliger 500 Osborn Boulevard Sault Ste. Marie, MI 49783 Self-Insured Carrier ID: 80000317 Eagle Claims Management, LLC

Center Line Public Schools Mr. Charles Roddis 26400 Arsenal Avenue Center Line, MI 48015 Self-Insured Carrier ID: 82000050 Eagle Claims Management, LLC

Chippewa Valley Schools Mr. Scott Sederlund 19120 Cass Clinton Township, MI 48038 Self-Insured Carrier ID: 82001250 York Risk Services Group, Inc.

Central Michigan University Ms. Tammy Griffin CHIP Facility South Grounds Building Mt. Pleasant, MI 48859 Self-Insured Carrier ID: 82000037 CompOne Administrators, Inc.

City of Ann Arbor Mr. Tom Crawford 301 E. Huron Ann Arbor, MI 48107-8647 Self-Insured Carrier ID: 99900181 CompOne Administrators, Inc.

Challenge Mfg. Holdings, Inc. Mr. Mike Rodgers 3200 Fruit Ridge Avenue NW Walker, MI 49544 Self-Insured Carrier ID: 34097018 Constitution State Services LLC

City of Battle Creek Ms. Joyce Snow 10 N. Division Street Battle Creek, MI 49014 Self-Insured Carrier ID: 99900113 Eagle Claims Management, LLC

Charter Township of Canton Ms. Kerreen Conley 1150 S. Canton Center Road Canton, MI 48188 Self-Insured Carrier ID: 99900001 Eagle Claims Management, LLC

City of Bay City Ms. Mikki Manion Room 305 301 Washington Avenue Bay City, MI 48708 Self-Insured Carrier ID: 99900209 CompOne Administrators, Inc.

Charter Township of Shelby Ms. Lisa Suida 52700 Van Dyke Avenue Shelby Township, MI 48316 Self-Insured Carrier ID: 99900475 York Risk Services Group, Inc. 12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List City of Dearborn Ms. Licia A Yangouyian Suite 14 16901 Michigan Avenue Dearborn, MI 48126-2967 Self-Insured Carrier ID: 99900182 Michigan Claim Service DBA The ASU Group

City of Garden City Ms. Allyson Bettis 6000 Middlebelt Road Garden City, MI 48135 Self-Insured Carrier ID: 99901001 Broadspire Services, Inc.

City of Dearborn Heights Mr. John Laub 6045 Fenton Dearborn Heights, MI 48127 Self-Insured Carrier ID: 99901682 Broadspire Services, Inc.

City of Grand Rapids Mr. Craig Coulson Risk Management Office 300 Monroe Ave., NW Grand Rapids, MI 49503 Self-Insured Carrier ID: 99900141 CompOne Administrators, Inc.

City of Detroit Mr. Donald D Settles Coleman A. Young Municipal Center 2 Woodward Avenue, Suite 801 Detroit, MI 48226 Self-Insured Carrier ID: 99900482 York Risk Services Group, Inc.

City of Grosse Pointe Farms Mr. Shane L Reeside 90 Kerby Road Grosse Pointe Farms, MI 48236 Self-Insured Carrier ID: 99901782 CompOne Administrators, Inc.

City of East Lansing Ms. Jill Feldpausch 410 Abbot Road East Lansing, MI 48823 Self-Insured Carrier ID: 99900233 CompOne Administrators, Inc.

City of Grosse Pointe Woods Ms. Catherine Behrens 20025 Mack Plaza Grosse Pointe Woods, MI 48236 Self-Insured Carrier ID: 99900663 York Risk Services Group, Inc.

City of Escanaba Mr. Robert Valentine 410 Ludington Street P.O. Box 948 Escanaba, MI 49829 Self-Insured Carrier ID: 99900121 Comprehensive Risk Services, Inc.

City of Hamtramck Ms. Katrina Powell 3401 Evaline Hamtramck, MI 48212 Self-Insured Carrier ID: 99900282 Eagle Claims Management, LLC

City of Ferndale Ms. Jenny Campos 300 E. Nine Mile Ferndale, MI 48220-1797 Self-Insured Carrier ID: 99900763 Broadspire Services, Inc.

City of Inkster Ms. Kim Watkins 26215 Trowbridge St Inkster, MI 48141 Self-Insured Carrier ID: 99901382 CompOne Administrators, Inc.

City of Flint Mr. Charley McClendon Human Resources 1101 S. Saginaw Street, RM #9 Flint, MI 48502 Self-Insured Carrier ID: 99900125 Eagle Claims Management, LLC

City of Jackson Mr. Jonathon Greene 161 W. Michigan Avenue, 6th Floor Jackson, MI 49201 Self-Insured Carrier ID: 99900138 Broadspire Services, Inc.

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List City of Kalamazoo Mr. Thomas C Skrobola 241 W. South Street Kalamazoo, MI 49007-4796 Self-Insured Carrier ID: 99900139 Eagle Claims Management, LLC

City of Roseville Mr. Paul VanDamme 29777 Gratiot P.O. Box 290 Roseville, MI 48066 Self-Insured Carrier ID: 99900850 York Risk Services Group, Inc.

City of Lansing Ms. Kathy Woodman 8th Floor City Hall 124 W. Michigan Avenue Lansing, MI 48933 Self-Insured Carrier ID: 99900133 CompOne Administrators, Inc.

City of Royal Oak Mr. Donald E Johnson 211 Williams Street P.O. Box 64 Royal Oak, MI 48068-0064 Self-Insured Carrier ID: 99900463 York Risk Services Group, Inc.

City of Livonia Mr. Michael T Slater 33000 Civic Center Drive Livonia, MI 48154 Self-Insured Carrier ID: 99900982 York Risk Services Group, Inc.

City of Saginaw Ms. Lisa K Crook Room 202 1315 South Washington Avenue Saginaw, MI 48601 Self-Insured Carrier ID: 99900173 York Risk Services Group, Inc.

City of Madison Heights Ms. Amy Misczak 300 W. Thirteen Mile Rd. Madison Heights, MI 48071 Self-Insured Carrier ID: 99901263 York Risk Services Group, Inc.

City of Saint Clair Shores Mr. Douglas M Haag 27600 Jefferson Avenue St. Clair Shores, MI 48081 Self-Insured Carrier ID: 99900150 York Risk Services Group, Inc.

City of Monroe Ms. Peggy A Howard 120 East First Street Monroe, MI 48161 Self-Insured Carrier ID: 99900158 Comprehensive Risk Services, Inc.

City of Southfield Garnett Carr 26000 Evergreen Road P.O. Box 2055 Southfield, MI 48037-2055 Self-Insured Carrier ID: 99900963 Cannon Cochran Management Services, Inc.

City of Port Huron Ms. Julie A Davis 100 McMorran Boulevard Room 201 Port Huron, MI 48060 Self-Insured Carrier ID: 99900174 York Risk Services Group, Inc. City of Portage Ms. Tracy Schmitt 7900 South Westnedge Avenue Portage, MI 49002 Self-Insured Carrier ID: 99900339 Eagle Claims Management, LLC

City of Southgate Mr. David Angileri 14400 Dix Toledo Road Southgate, MI 48195 Self-Insured Carrier ID: 99901582 Broadspire Services, Inc. City of Sterling Heights Ms. Kate Baldwin 40555 Utica Road P.O. Box 8009 Sterling Heights, MI 48311-8009 Self-Insured Carrier ID: 99900750 CompOne Administrators, Inc.

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List City of Taylor Ms. Sheila Gorski-Schulte 23555 Goddard Road Taylor, MI 48180 Self-Insured Carrier ID: 99900782 CompOne Administrators, Inc.

Cleveland-Cliffs Iron Company (The) Ms. Jennifer Frame 200 Public Square Suite 3300 Cleveland, OH 44114 Self-Insured Carrier ID: 10059318 Sedgwick Claims Management Services, Inc.

City of Warren Mr. Mark Simlar Suite 410 One City Square Warren, MI 48093 Self-Insured Carrier ID: 99901150 CompOne Administrators, Inc.

Cold Heading Co. Mr. Daniel Morrell 21777 Hoover Road Warren, MI 48089 Self-Insured Carrier ID: 33033782 Mackinaw Administrators, LLC

City of Wayne Ms. Carrie Venus 3355 South Wayne Road Wayne, MI 48184 Self-Insured Carrier ID: 99901282 Michigan Claim Service DBA The ASU Group

Comau LLC Ms. Lisa Cormier 21000 Telegraph Road Southfield, MI 48033 Self-Insured Carrier ID: 34040999 Maxcis, Inc.

City of Westland Ms. Cindy C King 36300 Warren Road Westland, MI 48185-1214 Self-Insured Carrier ID: 99901082 Alternative Service Concepts LLC

Commercial Steel Treating Corporation Mr. Greg B Schankin 31440 Stephenson Highway Madison Heights, MI 48071 Self-Insured Carrier ID: 33016001 Eagle Claims Management, LLC

City of Wyandotte Mr. Todd A Drysdale 3200 Biddle Avenue Wyandotte, MI 48192 Self-Insured Carrier ID: 99900682 Broadspire Services, Inc.

Consumers Energy Company Ms. Catherine M Reynolds One Energy Plaza EP12-244 Jackson, MI 49201 Self-Insured Carrier ID: 48092036 Self-Administered

City of Wyoming Ms. Rosa Ooms 1155 - 28th Street S.W. P.O. Box 905 Wyoming, MI 49509 Self-Insured Carrier ID: 99900341 CompOne Administrators, Inc.

Contractors Steel Company Mr. Donald R Simon 36555 Amrhein Road P.O. Box 3364 Livonia, MI 48151-3364 Self-Insured Carrier ID: 50070854 Mackinaw Administrators, LLC

Clark Retirement Community, Inc. Ms. Lindy Bonter 1551 Franklin Street SE Grand Rapids, MI 49506-3331 Self-Insured Carrier ID: 80000341 Eagle Claims Management, LLC

Costco Wholesale Corporation Ms. Carrie Freeland 999 Lake Drive Issaquah, WA 98027 Self-Insured Carrier ID: 53091300 Helmsman Management Services, LLC

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List County of Berrien Mr. William A Wolf Berrien County Administration 701 Main Street St. Joseph, MI 49085 Self-Insured Carrier ID: 99900011 Broadspire Services, Inc.

County of Kent Ms. Stephanie Lee Fiscal Services, County Admin. Bldg. 300 Monroe Avenue, N.W. Grand Rapids, MI 49503 Self-Insured Carrier ID: 99900041 ProSelect Insurance Company

County of Calhoun Ms. Kim Archambault 315 W. Green Street Marshall, MI 49068 Self-Insured Carrier ID: 99900013 York Risk Services Group, Inc.

County of Lapeer Mr. John Biscoe 255 Clay Street Suite 301 Lapeer, MI 48446 Self-Insured Carrier ID: 99900044 York Risk Services Group, Inc.

County of Charlevoix Ms. Cheryl Potter Browe County Clerk 203 Antrim Street Charlevoix, MI 49720 Self-Insured Carrier ID: 99900015 York Risk Services Group, Inc.

County of Macomb Mr. John P Anderson Finance-Risk & Insurance 120 N. Main Street Mt. Clemens, MI 48043 Self-Insured Carrier ID: 99900050 York Risk Services Group, Inc.

County of Eaton Mr. John Fuentes 1045 Independence Boulevard Charlotte, MI 48813 Self-Insured Carrier ID: 99900023 Michigan Claim Service DBA The ASU Group

County of Mason Mr. Fabian Knizacky 304 E. Ludington Avenue Ludington, MI 49431 Self-Insured Carrier ID: 99900101 Eagle Claims Management, LLC

County of Hillsdale Ms. Stephenie Kyser County Court House 29 N. Howell Street Hillsdale, MI 49242 Self-Insured Carrier ID: 99900130 Broadspire Services, Inc.

County of Midland Mr. Craig Maxwell 220 W. Ellsworth Street Midland, MI 48640-5194 Self-Insured Carrier ID: 99900056 Eagle Claims Management, LLC

County of Huron Ms. Debra McCollum P.O. Box 69 Bad Axe, MI 48413-0069 Self-Insured Carrier ID: 99900032 York Risk Services Group, Inc.

County of Monroe Mr. Michael Bosanac 125 East Second Street Monroe, MI 48161 Self-Insured Carrier ID: 99900058 Michigan Claim Service DBA The ASU Group

County of Jackson Mr. Michael Overton 120 West Michigan Avenue Jackson, MI 49201 Self-Insured Carrier ID: 99900038 Eagle Claims Management, LLC

County of Muskegon Ms. Kristen N Wade 316 Morris Avenue, Suite 200 Muskegon, MI 49440 Self-Insured Carrier ID: 99900061 Michigan Claim Service DBA The ASU Group

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List County of Oakland (The), a Michigan Constitutional Corporation Mr. Dean J Schultz Risk Management & Safety 2100 Pontiac Lake Rd. Waterford, MI 48328 Self-Insured Carrier ID: 99900063 York Risk Services Group, Inc. County of Saginaw Mr. Robert Belleman 111 South Michigan Avenue Saginaw, MI 48602 Self-Insured Carrier ID: 99900073 Eagle Claims Management, LLC County of Saint Clair Ms. Kimberly Woolman Suite 206 200 Grand River Port Huron, MI 48060 Self-Insured Carrier ID: 99900374 Mackinaw Administrators, LLC County of Wayne Ms. Shirley Priskorn 500 Griswold, 14th Floor Detroit, MI 48226 Self-Insured Carrier ID: 99900082 Mackinaw Administrators, LLC Covenant Medical Center, Inc. dba Covenant Healthcare Mr. Tyler Danek 1447 N. Harrison Saginaw, MI 48602 Self-Insured Carrier ID: 80000573 ProSelect Insurance Company Cranbrook Educational Community, Inc. Ms. Beth Beadle 39221 N. Woodward Avenue P.O. Box 801 Bloomfield Hills, MI 48303-0801 Self-Insured Carrier ID: 82003063 CompOne Administrators, Inc. Creative Foam Corporation Mr. Bruce G Graham 300 N. Alloy Drive Fenton, MI 48430 Self-Insured Carrier ID: 30049025 CompOne Administrators, Inc.

Dana Incorporated Ms. Heather Taylor 3939 Technology Drive P.O. Box 537 Toledo, OH 43537 Self-Insured Carrier ID: 37090323 Sedgwick Claims Management Services, Inc. Daniel L. Jacob and Co., Inc. Mr. Matthew P Gleeson 2403 East High Street Jackson, MI 49203-3421 Self-Insured Carrier ID: 51017338 Eagle Claims Management, LLC Dart Container Corporation of California dba DTX, Inc. c/o Aon Global Risk Consulting Ms. Paula Greve 5600 West 83rd Street Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 30104200 Self-Administered Dart Container of Michigan LLC C/O Aon Global Risk Consulting Mr. Jared Carlisle 5600 West 83rd Street Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 30099099 Self-Administered Dean Transportation Inc. Mr. Brian Thrasher 4812 Aurelius Rd Lansing, MI 48910 Self-Insured Carrier ID: 41002033 Eagle Claims Management, LLC Delaco Steel Corporation Mr. Dave Trela 8111 Tireman Dr Dearborn, MI 48126 Self-Insured Carrier ID: 50019330 CompOne Administrators, Inc. Denso Air Systems Michigan Inc. Mr. Grant Penrod 300 Fritz Keiper Blvd. Battle Creek, MI 49037 Self-Insured Carrier ID: 37044000 CompOne Administrators, Inc.

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Detroit Diesel Corporation Mr. Dan Holden Daimler Trucks North America LLC 2701 N W Vaughn Street, Suite 900 Portland, OR 97210 Self-Insured Carrier ID: 37055082 Sedgwick Claims Management Services, Inc.

Dunn Paper, Inc. Mr. Richard Harter 218 Riverview Street Port Huron, MI 48060 Self-Insured Carrier ID: 26014425 Gallagher Bassett Services, Inc.

Detroit Entertainment, L.L.C. Mr. Bruce R Dall 2901 Grand River Detroit, MI 48201 Self-Insured Carrier ID: 70037700 CompOne Administrators, Inc.

E.I. Du Pont de Nemours & Company Ms. Kelly A Scott c/o Broadspire Three Coliseum Centre, 2550 W. Tyvola Road, Suite 500 Charlotte, NC 28217 Self-Insured Carrier ID: 28091314 Broadspire Services, Inc.

Detroit Public Schools Community District Office of Risk Management Mr. Douglas Gniewek 3011 W. Grand Blvd Fisher Bldg Ste 1101A Detroit, MI 48202 Self-Insured Carrier ID: 82000482 York Risk Services Group, Inc.

Eagle Alloy, Inc. Ms. Lisa Price 5142 Evanston Avenue Muskegon, MI 49442 Self-Insured Carrier ID: 26014061 Eagle Claims Management, LLC

Dexter Fastener Technologies, Inc. Mr. Jim Cremering 2110 Bishop Circle East Dexter, MI 48130 Self-Insured Carrier ID: 34016440 York Risk Services Group, Inc.

Eastern Michigan University Ms. Tracey Piercecchi Legal Affairs 11 Welch Hall Ypsilanti, MI 48197 Self-Insured Carrier ID: 82000081 York Risk Services Group, Inc.

Dickinson County Healthcare System Ms. Eileen Sparpana 1721 S. Stephenson Avenue Iron Mountain, MI 49801 Self-Insured Carrier ID: 80050022 York Risk Services Group, Inc.

Edison Institute (The) DBA The Henry Ford Ms. Anne Marie DeGrazia 20900 Oakwood Boulevard P.O. Box 1970 Dearborn, MI 48121-1970 Self-Insured Carrier ID: 84001082 Mackinaw Administrators, LLC

Domestic Linen Supply & Laundry Company Mr. Evan Lacross 30555 Northwestern Highway Suite 300 Farmington Hills, MI 48334 Self-Insured Carrier ID: 72008446 York Risk Services Group, Inc. DTE Energy Company Mr. Jerome K Hooper One Energy Plaza, 252 GO Detroit, MI 48226 Self-Insured Carrier ID: 49090153 Self-Administered

Edw. C. Levy Co. Mr. Don Liepa 9300 Dix Avenue Dearborn, MI 48120 Self-Insured Carrier ID: 15052604 Michigan Claim Service DBA The ASU Group Edward W. Sparrow Hospital Association Ms. Michelle Leach Suite 235 1200 East Michigan Avenue Lansing, MI 48912 Self-Insured Carrier ID: 80000533 Coverys Insurance Services, Inc.

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Edwards Brothers Malloy, Inc. Ms. Kathy Graham 5411 Jackson Road Ann Arbor, MI 48103 Self-Insured Carrier ID: 27051221 York Risk Services Group, Inc.

Evangelical Homes of Michigan Ms. Denise Rabidoux 34024 W. 8-Mile, Suite 101 Farmington, MI 48335 Self-Insured Carrier ID: 80000821 Eagle Claims Management, LLC

EJ USA, Inc. Mrs. Fay Keane 301 Spring Street P.O. Box 439 East Jordan, MI 49727 Self-Insured Carrier ID: 33000821 Michigan Claim Service DBA The ASU Group

F.C.S. Industries, Inc. Mr. Matthew D Drain 9850 Pelham Road Taylor, MI 48180-3852 Self-Insured Carrier ID: 42008282 Self-Administered

Ella E.M. Brown Charitable Circle d/b/a Oaklawn Hospital Ms. Marta Ross 200 N. Madison Marshall, MI 49068 Self-Insured Carrier ID: 80000913 York Risk Services Group, Inc.

Farmington Public Schools Mr. Jeff Danziger 32500 Shiawassee Farmington, MI 48336 Self-Insured Carrier ID: 82000763 Mackinaw Administrators, LLC

Emergent Health Partners Ms. Barbara Bachman 1200 State Circle Ann Arbor, MI 48108-1691 Self-Insured Carrier ID: 80000381 CompOne Administrators, Inc. Empire Iron Mining Partnership c/o Cleveland Cliffs Iron Company Ms. Jennifer Frame 200 Public Square Suite 3300 Cleveland, OH 44114 Self-Insured Carrier ID: 10090885 Sedgwick Claims Management Services, Inc.

Faygo Beverages, Inc. c/o National Beverage Corp. Mr. Richard Berkes Suite 4000 8100 SW Tenth St. Ft. Lauderdale, FL 33324 Self-Insured Carrier ID: 20036782 Constitution State Services LLC FCA US LLC Ms. Debbie White Project Manager 1000 Chrysler Drive CIMS 485-07-26 Auburn Hills, MI 48326 Self-Insured Carrier ID: 37666000 Sedgwick Claims Management Services, Inc.

EPI Printers, Inc. Mr. Timothy R Czerney 5404 Wayne Road Battle Creek, MI 49037 Self-Insured Carrier ID: 27050706 Eagle Claims Management, LLC

Federal Express Corporation Ms. Gael Johnson Building B - 3rd Floor 3620 Hacks Cross Rd. Memphis, TN 38125-8800 Self-Insured Carrier ID: 43057760 Sedgwick Claims Management Services, Inc.

Ervin Industries, Inc. Mr. Tom Tsallis 3893 Research Park Drive Ann Arbor, MI 48106-1168 Self-Insured Carrier ID: 35028870 Sedgwick Claims Management Services, Inc.

Federal Screw Works Mr. Scott Rozema 34846 Goddard Rd Romulus, MI 48174 Self-Insured Carrier ID: 34090708 Comprehensive Risk Services, Inc.

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Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Federated Logistics, Inc. Mr. Robert S Wierzbicki 32500 VanBorn Rd Ste 100 Wayne, MI 48184 Self-Insured Carrier ID: 43058981 Mackinaw Administrators, LLC

Ford Motor Company Mr. Alan Gorosh Workers' Compensation P.O. Box 607 Dearborn, MI 48121-0607 Self-Insured Carrier ID: 374F0000 Self-Administered

FedEx Freight, Inc. Ms. Kayla Quandt 2200 Forward Drive P.O. Box 840 Harrison, AR 72602-0840 Self-Insured Carrier ID: 42009485 Sedgwick Claims Management Services, Inc.

Frankenmuth Bavarian Inn, Inc. Mr. Vernon Schiefer 713 S. Main Street Frankenmuth, MI 48734 Self-Insured Carrier ID: 58011873 York Risk Services Group, Inc.

FedEx Ground Package System, Inc. Ms. Leigh A Ferron 1000 FedEx Drive P.O. Box 535859 Moon Twp, PA 15108 Self-Insured Carrier ID: 42008585 Sedgwick Claims Management Services, Inc.

Futuramic Tool & Engineering Co. Mr. Michael J Scott 24680 Gibson Warren, MI 48089 Self-Insured Carrier ID: 35040050 Eagle Claims Management, LLC

Ferris State University Mr. Michael Grandy Finance 420 Oak Street - Prakken Building 153 Big Rapids, MI 49307-2020 Self-Insured Carrier ID: 82000101 CompOne Administrators, Inc.

G.A. Richards Company Mr. Phillip M Verwys 1060 Ken-O-Sha Industrial Grand Rapids, MI 49508-8216 Self-Insured Carrier ID: 25047125 York Risk Services Group, Inc.

Fisher & Company, Inc. Ms. Rosalyn Rottier 33300 Fisher Drive St. Clair Shores, MI 48082 Self-Insured Carrier ID: 37002950 Michigan Claim Service DBA The ASU Group

General Motors LLC Ms. Susan Azar P.O. Box 69 Southfield, MI 48034-0069 Self-Insured Carrier ID: 37999000 Self-Administered

Flexfab Horizons International, Inc. Mr. Matthew P Nusbaum 203 Cook Road Hastings, MI 49058 Self-Insured Carrier ID: 30013322 York Risk Services Group, Inc.

Genesee County Mr. Nerahoo Nemraj Controller's Office 1101 Beach Street 3rd Floor Flint, MI 48502 Self-Insured Carrier ID: 99900225 Michigan Claim Service DBA The ASU Group

Flint Mass Transportation Authority Mr. Edgar H Benning 1401 South Dort Highway Flint, MI 48503 Self-Insured Carrier ID: 75098776 Eagle Claims Management, LLC

Genesee Health System Mr. Brian Swiecicki 420 W. Fifth Avenue Fifth Floor Flint, MI 48503 Self-Insured Carrier ID: 80000134 Eagle Claims Management, LLC

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Gill Industries, Inc. Mrs. Rita Woodruff 5271 Plainfield Ave, N.E. Grand Rapids, MI 49525 Self-Insured Carrier ID: 35033841 Comprehensive Risk Services, Inc.

Great Lakes Water Authority Mr. Michael J Tilley 735 Randolph St Detroit, MI 48226 Self-Insured Carrier ID: 73016819 Broadspire Services, Inc.

Grand Rapids Public Schools Ms. Dawn M Berenyi 1331 Franklin Street, S.E. P.O. Box 117 Grand Rapids, MI 49501-0117 Self-Insured Carrier ID: 82000141 Michigan Claim Service DBA The ASU Group

Greektown Casino, LLC Ms. Tameika Moore 555 E. Lafayette Blvd. Detroit, MI 48226 Self-Insured Carrier ID: 70091455 York Risk Services Group, Inc.

Grand Traverse Band of Ottawa & Chippewa Indians (The) Mr. Charles Stewart 2331 N. West Bayshore Drive Peshawbestown, MI 49682 Self-Insured Carrier ID: 99000450 CompOne Administrators, Inc.

Griffin Beverage Co. Mr. Robert T Griffin 1901 North Dam Road West Branch, MI 48661 Self-Insured Carrier ID: 20070012 York Risk Services Group, Inc.

Grand Traverse County Ms. Jody Lundquist 400 Boardman Avenue Traverse City, MI 49684 Self-Insured Carrier ID: 99900028 York Risk Services Group, Inc. Grand Traverse Pavilions Mr. Kory Hansen 1000 Pavilions Circle Traverse City, MI 49684 Self-Insured Carrier ID: 80001150 Eagle Claims Management, LLC

Grosse Pointe Public School System Dee Ann Irby 389 St. Clair Grosse Pointe, MI 48230 Self-Insured Carrier ID: 82001082 Alternative Service Concepts LLC Haworth, Inc. Ms. Sue Butler One Haworth Center 3-E13 Holland, MI 49423 Self-Insured Carrier ID: 73016843 Gallagher Bassett Services, Inc.

Grand Valley State University Ms. Natalie Trent 1 Campus Drive Allendale, MI 49401 Self-Insured Carrier ID: 82001441 CompOne Administrators, Inc.

HealthSource Saginaw, Inc. Ms. Lisa Lapham 3340 Hospital Rd. Saginaw, MI 48603 Self-Insured Carrier ID: 80001773 ProSelect Insurance Company

Great Lakes Home Health Services, Inc. Mr. Lakshu Sundaram 900 Cooper Street Jackson, MI 49202 Self-Insured Carrier ID: 80001791 Mackinaw Administrators, LLC

Henry Ford Health System Mr. John R Mucha 1 Ford Place, 4B HFHS Risk Finance & Insurance Services Detroit, MI 48202-3450 Self-Insured Carrier ID: 80000982 Comprehensive Risk Services, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Herb Ritsema Company (The) Mr. William J Ritsema 3000 Dormax Grandville, MI 49418 Self-Insured Carrier ID: 17001041 York Risk Services Group, Inc.

Houghton County Mr. Eric E Forsberg 401 East Houghton Avenue Houghton, MI 49931 Self-Insured Carrier ID: 99900031 York Risk Services Group, Inc.

Hercules Drawn Steel Corp. Mr. Mark Goodman 38901 Amrhein Road Livonia, MI 48150 Self-Insured Carrier ID: 33078882 Michigan Claim Service DBA The ASU Group

Howard Ternes Packaging Company Mr. William R Morrison 35275 Industrial Rd Livonia, MI 48150 Self-Insured Carrier ID: 26036682 York Risk Services Group, Inc.

Holcim (US) Inc. Mr. Hunter Falk 6211 Ann Arbor Road Dundee, MI 48131 Self-Insured Carrier ID: 14046058 Gallagher Bassett Services, Inc.

Howell Public Schools Ms. Liza M Kelly 411 N. Highlander Way, Ste B Howell, MI 48843 Self-Insured Carrier ID: 82000347 York Risk Services Group, Inc.

Holland Community Hospital Mr. Michael Matthews 602 Michigan Avenue Holland, MI 49423 Self-Insured Carrier ID: 80000295 ProSelect Insurance Company

Huntington Bancshares Incorporated Ms. Heather Myerscough 37 West Broad St, HP 0225 Columbus, OH 43215 Self-Insured Carrier ID: 60055885 Sedgwick Claims Management Services, Inc.

Holland Home Mr. Adam Kinder 2100 Raybrook Ave., S.E. #300 Grand Rapids, MI 49546 Self-Insured Carrier ID: 80000741 Eagle Claims Management, LLC

Huron Casting, Inc. Mr. Matthew Davis 7050 Hartley Street Pigeon, MI 48755 Self-Insured Carrier ID: 33000988 CompOne Administrators, Inc.

Hollywood Holding Company, LLC Ms. Kimberly Welch Harlan 2670 W. Maple Road Troy, MI 48084 Self-Insured Carrier ID: 54022112 Michigan Claim Service DBA The ASU Group

Huron Valley Schools Ms. Nancy Coratti, Ph.D. 2390 S. Milford Road Highland, MI 48357 Self-Insured Carrier ID: 82002063 CompOne Administrators, Inc.

Home Depot U.S.A., Inc. Mr. Jim Bramlett 2455 Paces Ferry Road Building C, Floor 20 Atlanta, GA 30339 Self-Insured Carrier ID: 52030085 Helmsman Management Services, LLC

Hyatt Corporation Ms. Laurene Dufault AON Global Risk Consulting 5600 West 83rd Street, Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 70091386 Gallagher Bassett Services, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Inalfa Roof Systems, Inc. Mr. Jarrod Fiengo 1370 Pacific Drive Auburn Hills, MI 48326 Self-Insured Carrier ID: 37002320 CompOne Administrators, Inc.

Kelly Services, Inc. Mr. Gary A Pearce 999 West Big Beaver Road Troy, MI 48084 Self-Insured Carrier ID: 73039449 ESIS, Inc.

Ingham County and Ingham County Medical Care Facility Ms. Jill Rhode 121 E. Maple P.O. Box 319 Mason, MI 48854 Self-Insured Carrier ID: 99900033 Eagle Claims Management, LLC

Key Plastics L.L.C. Mr. Kevin Koshowsky 19575 Victor Parkway Suite 400 Livonia, MI 48152 Self-Insured Carrier ID: 33085220 Comprehensive Risk Services, Inc.

International Industrial Contracting Corporation Mr. Jonathan H Firsht 35900 Mound Road Sterling Heights, MI 48310 Self-Insured Carrier ID: 17045050 Michigan Claim Service DBA The ASU Group

Knape & Vogt Manufacturing Company Mr. Nathan R VanRyn 2700 Oak Industrial Drive NE Grand Rapids, MI 49505 Self-Insured Carrier ID: 25048162 CompOne Administrators, Inc.

Iron County Medical Care Facility Ms. Robin Caron 1523 US Highway 2 Crystal Falls, MI 49920 Self-Insured Carrier ID: 80001236 Eagle Claims Management, LLC

Kroger Co. (The) an Ohio Corporation, dba Michigan Dairy Mr. Nathan Fraley 1014 Vine St. 8th Floor Cincinnati, OH 45202 Self-Insured Carrier ID: 54021957 Sedgwick Claims Management Services, Inc.

John E. Green Company Inc. Mr. John R Stelter 220 Victor Avenue Highland Park, MI 48203 Self-Insured Carrier ID: 36070127 CompOne Administrators, Inc.

L & L Products, Inc. Ms. Susan R Deeb 160 McLean Drive Romeo, MI 48065 Self-Insured Carrier ID: 30013450 York Risk Services Group, Inc.

Kalamazoo County Ms. Kristine Cunningham 201 W. Kalamazoo Avenue Kalamazoo, MI 49007 Self-Insured Carrier ID: 99900039 York Risk Services Group, Inc.

L'Anse Creuse Public Schools Ms. Rochelle Gauthier 24076 F.V. Pankow Blvd Clinton Township, MI 48036 Self-Insured Carrier ID: 82000450 Eagle Claims Management, LLC

Kalamazoo Public Schools Mr. Daniel L Emmons 1220 Howard Street Kalamazoo, MI 49008 Self-Insured Carrier ID: 82000139 Eagle Claims Management, LLC

L. Perrigo Company Ms. Devon Morgan 515 Eastern Avenue Allegan, MI 49010 Self-Insured Carrier ID: 28091100 Michigan Claim Service DBA The ASU Group

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List La-Z-Boy, Incorporated Mr. Greg A Brinks One La-Z-Boy Drive Monroe, MI 48162 Self-Insured Carrier ID: 25055577 Sedgwick Claims Management Services, Inc.

Lincoln Consolidated Schools Mr. Sean R McNatt 8970 Whittaker Road Ypsilanti, MI 48197 Self-Insured Carrier ID: 82000481 Broadspire Services, Inc.

Lacks Enterprises, Inc. Mr. Jim Green 5460 Cascade Road SE Grand Rapids, MI 49546 Self-Insured Carrier ID: 30036101 York Risk Services Group, Inc.

Little Caesar Enterprises, Inc. Mr. Michael J Niehaus 2211 Woodward Avenue Detroit, MI 48201-3400 Self-Insured Carrier ID: 58011999 Sedgwick Claims Management Services, Inc.

Lake Orion Community Schools Ms. Laura Wernette 315 North Lapeer Street Lake Orion, MI 48362 Self-Insured Carrier ID: 82001463 York Risk Services Group, Inc.

Livonia Public Schools School District Ms. Alison Smith 15125 Farmington Road Livonia, MI 48154-5474 Self-Insured Carrier ID: 82000782 Cannon Cochran Management Services, Inc.

Lake Shore Public Schools Dr. Joseph DiPonio 28850 Harper Avenue St. Clair Shores, MI 48081 Self-Insured Carrier ID: 82000003 CompOne Administrators, Inc.

Louisiana-Pacific Corporation Mr. Guy Boileau Suite 1000 805 SW Broadway Portland, OR 97205-3344 Self-Insured Carrier ID: 24048042 Cannon Cochran Management Services, Inc.

Lake Superior State University Ms. Wendy Beach 650 West Easterday Avenue Sault Ste. Marie, MI 49783 Self-Insured Carrier ID: 82000221 Michigan Claim Service DBA The ASU Group

Lowe's Home Centers, LLC Ms. Tia W Schweikert 1000 Lowe's Blvd. Mail Code A2ERM Mooresville, NC 28117 Self-Insured Carrier ID: 52005310 Sedgwick Claims Management Services, Inc.

Lakeland Regional Health System Ms. Rita Brandt 1234 Napier Avenue St. Joseph, MI 49085 Self-Insured Carrier ID: 80000275 ProSelect Insurance Company

Lutheran Homes of Michigan Inc. dba Wellspring Lutheran Services Ms. Amy E Storms 4100 Pier North Blvd Flint, MI 48504 Self-Insured Carrier ID: 80000819 York Risk Services Group, Inc.

Lapeer Community Schools Mr. Mark Rajter 250 Second Street Lapeer, MI 48446 Self-Insured Carrier ID: 82000644 York Risk Services Group, Inc. Lefere Forge & Machine Company Ms. Beth E Perez 665 Hupp Avenue Jackson, MI 49203 Self-Insured Carrier ID: 34030986 CompOne Administrators, Inc.

Mac Valves, Inc. Ms. Martha C Welch 30569 Beck Road P.O. Box 111 Wixom, MI 48393 Self-Insured Carrier ID: 35028135 Alternative Service Concepts LLC

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List MacAllister Machinery Co. dba Michigan CAT Mr. Sosthenes Behn 25000 Novi Road Novi, MI 48375 Self-Insured Carrier ID: 50090463 York Risk Services Group, Inc.

Masco Corporation Ms. Susan Campion 17450 College Parkway Livonia, MI 48152 Self-Insured Carrier ID: 33013705 Constitution State Services LLC

Macy's Retail Holdings, Inc. Ms. Jean Kollmann Director, Risk Management 7 West 7th Street Cincinnati, OH 45202 Self-Insured Carrier ID: 53092700 Self-Administered

McLaren Health Care Corporation One McLaren Parkway Ms. Sonja S Wilcox-Berriel

Magnesium Products of America, Inc. Ms. Anna Ramey Human Resource Manager 2001 Industrial Drive Eaton Rapids, MI 48827 Self-Insured Carrier ID: 33050123 York Risk Services Group, Inc.

Mebus Manufacturing, Inc. Mr. Christopher Mebus 30350 Ecorse Road Romulus, MI 48174 Self-Insured Carrier ID: 33093543 York Risk Services Group, Inc.

Manor Care, Inc. Ms. Lisa Jurski 333 N. Summit Street P.O. Box 10086 Toledo, OH 43699-0086 Self-Insured Carrier ID: 80001485 Self-Administered

Meijer Companies, Ltd. Ms. Sandy Calderon 2929 Walker, N.W. Grand Rapids, MI 49544 Self-Insured Carrier ID: 53090114 Self-Administered

Manthei, Inc. Mr. Luke Manthei 3996 Charlevoix Ave Petoskey, MI 49770 Self-Insured Carrier ID: 24058072 Comprehensive Risk Services, Inc. Marriott International, Inc. Mr. Steve Huy Dept. 52/924.36 10400 Fernwood Rd Bethesda, MD 20817 Self-Insured Carrier ID: 70008085 Self-Administered Mary Free Bed Hospital & Rehab. Center Ms. Hayley Scott 235 Wealthy Street, S.E. Grand Rapids, MI 49503-5299 Self-Insured Carrier ID: 80001441 Eagle Claims Management, LLC

Grand Blanc, MI 48439 Self-Insured Carrier ID: 80000525 Comprehensive Risk Services, Inc.

Melling Tool Company Mr. Mark L Mandrick 2620 Saradan Drive P.O. Box 1188 Jackson, MI 49204 Self-Insured Carrier ID: 35011038 York Risk Services Group, Inc. Memorial Hospital (The) dba Memorial Healthcare Mr. Brian Long 826 West King Owosso, MI 48867 Self-Insured Carrier ID: 80000178 ProSelect Insurance Company Meritor, Inc. Ms. Wendy Fair 2135 W. Maple Rd. Troy, MI 48084 Self-Insured Carrier ID: 37090462 York Risk Services Group, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Metalworks, Inc. Ms. Bobbi L Spence 902 E. Fourth St. Ludington, MI 49431 Self-Insured Carrier ID: 34007390 CompOne Administrators, Inc.

Michigan Sugar Company Ms. Cheryl Ridenour 122 Uptown Drive, Suite 300 Bay City, MI 48708 Self-Insured Carrier ID: 20016773 York Risk Services Group, Inc.

Metropolitan Hospital Ms. Karrie Custer Metro Health Hospital 5900 Byron Center Ave. Wyoming, MI 49519 Self-Insured Carrier ID: 80000241 Eagle Claims Management, LLC

Michigan Technological University Ms. Renee L Hiller 1400 Townsend Drive Houghton, MI 49931 Self-Insured Carrier ID: 82000432 York Risk Services Group, Inc.

MGM Resorts International Ms. Denise Parr MGM Administration Building 71 E. Harmon Avenue Las Vegas, NV 89109 Self-Insured Carrier ID: 70092555 ESIS, Inc.

MidMichigan Health Mr. Victor Morgan 4000 Wellness Drive Midland, MI 48670 Self-Insured Carrier ID: 80000556 ProSelect Insurance Company

Michigan Catholic Conference Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 83000902 Gallagher Bassett Services, Inc. Michigan Conference Association of Seventh Day Adventists Ms. Edie Ellis 320 W. St. Joseph Street P.O. Box 24187 Lansing, MI 48909 Self-Insured Carrier ID: 86012333 Eagle Claims Management, LLC Michigan Paving & Materials Company Ms. Kelley Grant 2575 Haggerty Rd. Suite 100 Canton, MI 48818 Self-Insured Carrier ID: 17091566 Helmsman Management Services, LLC Michigan State University Ms. Renee Rivard Suite 140 1407 S. Harrison East Lansing, MI 48823 Self-Insured Carrier ID: 82000033 Self-Administered

MNP Corporation Ms. Loretta Dickey P.O. Box 189002 44225 Utica Road Utica, MI 48318-9002 Self-Insured Carrier ID: 34023050 CompOne Administrators, Inc. Mobis North America LLC Mrs. Maizie Perez 6401 W. Fort St Detroit, MI 48209 Self-Insured Carrier ID: 37091596 Mackinaw Administrators, LLC Monroe County Road Commission Ms. Camden Regis 840 South Telegraph Road Monroe, MI 48161 Self-Insured Carrier ID: 99900258 CompOne Administrators, Inc. Monroe Public Schools Mrs. Katherine Eighmey 1275 North Macomb Street P.O. Box 733 Monroe, MI 48162 Self-Insured Carrier ID: 82000558 York Risk Services Group, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Morbark, LLC HR Director Mr. Brian Pickelman 8507 S. Winn Road Winn, MI 48896 Self-Insured Carrier ID: 39041122 Eagle Claims Management, LLC

Nordstrom, Inc. Mr. Steve Tolan P.O. Box 21865 Seattle, WA 98111-3865 Self-Insured Carrier ID: 53069985 Self-Administered

Mot Allev Enterprises, LC dba Hubert Distributors Mr. Thomas Vella 1200 Auburn Pontiac, MI 48342 Self-Insured Carrier ID: 51091463 York Risk Services Group, Inc.

North Ottawa Community Hospital Mr. Mark Gross 1309 Sheldon Road Grand Haven, MI 49417 Self-Insured Carrier ID: 80001270 ProSelect Insurance Company

Munson Health Care Mr. Jeff Rose 1105 Sixth Street Traverse City, MI 49684-2386 Self-Insured Carrier ID: 80000128 ProSelect Insurance Company

Northern Michigan University Ms. Kristen I Bjorne Human Resources - Northern MI University 1401 Presque Isle Marquette, MI 49855 Self-Insured Carrier ID: 82001552 Comprehensive Risk Services, Inc.

Newcor, Inc. Mr. Scott Wright 715 South Blvd E. Suite 101 Rochester Hills, MI 48307 Self-Insured Carrier ID: 35009763 Alternative Service Concepts LLC

NYX, LLC Mr. Mark Greer 36111 Schoolcraft Livonia, MI 48150 Self-Insured Carrier ID: 30012991 York Risk Services Group, Inc.

NewPage Corporation c/o Verso Corporation Mr. Craig Brooks 6775 Lenox Center Court Memphis, TN 38115 Self-Insured Carrier ID: 26016995 Sedgwick Claims Management Services, Inc.

O S F Healthcare System DBA St. Francis Hospital Ms. Amanda Lowry 800 N.E. Glen Oak Avenue Peoria, IL 61603 Self-Insured Carrier ID: 80000625 ProSelect Insurance Company

Nexteer Automotive Corporation Ms. Lori A Grunow 3900 E. Holland Road Saginaw, MI 48601-9494 Self-Insured Carrier ID: 55092405 Sedgwick Claims Management Services, Inc. none , -- 48226 Self-Insured Carrier ID: No Service Company

Oakland Community College Ms. Margaret Carroll 2480 Opdyke Road Bloomfield Hills, MI 48304 Self-Insured Carrier ID: 82001863 Broadspire Services, Inc. Oakland University Mr. Kevin Venet 371 Wilson Blvd. Rochester, MI 48309-4486 Self-Insured Carrier ID: 82000063 Michigan Claim Service DBA The ASU Group

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List ODL, Inc. Ms. Cheri Durant 215 E. Roosevelt Zeeland, MI 49464 Self-Insured Carrier ID: 24067700 CompOne Administrators, Inc.

Pilkington North America, Inc. Mrs. Elizabeth Feltman 811 Madison Ave. Toledo, OH 43604 Self-Insured Carrier ID: 28090210 Sedgwick Claims Management Services, Inc.

Ottawa County Ms. Marcie VerBeek Room 359 12220 Fillmore Street West Olive, MI 49460 Self-Insured Carrier ID: 99900270 York Risk Services Group, Inc.

Pilot Travel Centers, LLC Mr. Bill Beuchat 5508 Lonas Road P.O. Box 10146 Knoxville, TN 37939 Self-Insured Carrier ID: 55092185 Self-Administered

Ottawa County Road Commission Mr. Brett A Laughlin P.O. Box 739 Grand Haven, MI 49417 Self-Insured Carrier ID: 99900070 Eagle Claims Management, LLC

Pine Rest Christian Mental Health Services Ms. Veonica York 300 - 68th Street, S.E. P.O. Box 165 Grand Rapids, MI 49508 Self-Insured Carrier ID: 80000650 Eagle Claims Management, LLC

P G P Corporation Mr. Paul Michael Voss 7925 Beech Daly Road Taylor, MI 48180 Self-Insured Carrier ID: 33016904 York Risk Services Group, Inc.

Pinecrest Medical Care Facility Mrs. Darlene Smith N15995 Main Street P.O. Box 603 Powers, MI 49874-0603 Self-Insured Carrier ID: 80000655 York Risk Services Group, Inc.

Parker Hannifin Corporation Mr. Curt Gross 6035 Parkland Boulevard Cleveland, OH 44124-4141 Self-Insured Carrier ID: 34091478 Underwriters Safety & Claims Inc.

Plymouth-Canton Community Schools Mrs. Dawn Schaller 454 South Harvey Street Plymouth, MI 48170 Self-Insured Carrier ID: 82000982 Cannon Cochran Management Services, Inc.

Perfection Bakeries, Inc. DBA Aunt Millies Mr. George Long 350 Pearl Street Fort Wayne, IN 46802 Self-Insured Carrier ID: 20030330 Michigan Claim Service DBA The ASU Group

Port Huron Area School District Ms. Katherine Peternel 2720 Riverside Drive Port Huron, MI 48061-5013 Self-Insured Carrier ID: 82000074 York Risk Services Group, Inc.

Petitpren, Inc. Ms. Jerri L Baker 44500 Groesbeck Clinton Township, MI 48036-1111 Self-Insured Carrier ID: 51038082 Eagle Claims Management, LLC

Porter Hills Presbyterian Village Ms. Kim Hoppe 4450 Cascade Road, Suite 200 Grand Rapids, MI 49546 Self-Insured Carrier ID: 80001341 Eagle Claims Management, LLC

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Pridgeon & Clay, Inc. Ms. Therese Labenz 50 Cottage Grove, S.W. Grand Rapids, MI 49507 Self-Insured Carrier ID: 35096648 Eagle Claims Management, LLC

Redford Union Schools-District #1 Mr. Gregory R McIntyre 17715 Brady Redford, MI 48240 Self-Insured Carrier ID: 82001482 Eagle Claims Management, LLC

Procter & Gamble Distributing LLC (The) Ms. Terri Donahue 6300 Center Hill Avenue Box 112 Cincinnati, OH 45224 Self-Insured Carrier ID: 26025284 Sedgwick Claims Management Services, Inc.

Regents of the University of MI (The) Mr. G. Paul Moggach Argus II Building 400 South Fourth Street Ann Arbor, MI 48103-4816 Self-Insured Carrier ID: 82000581 Self-Administered

ProMedica Health System Ms. Heather Allred 100 Madison - MSC-S29932 Toledo, OH 43604 Self-Insured Carrier ID: 80000846 Eagle Claims Management, LLC

Road Commission for Oakland County Mr. Drew Dunsky 31001 Lahser Road Beverly Hills, MI 48025 Self-Insured Carrier ID: 99900263 Mackinaw Administrators, LLC

PTM Corporation Mr. John Tucker 6560 Bethuy Rd Fair Haven, MI 48023 Self-Insured Carrier ID: 33014678 Eagle Claims Management, LLC

Rochester Community Schools Mrs. Kristine Davis 501 West University Drive Rochester, MI 48307 Self-Insured Carrier ID: 82000663 Cannon Cochran Management Services, Inc.

Quality Dairy Company Ms. Elizabeth Goeckel 111 W. Mt. Hope Avenue Lansing, MI 48910 Self-Insured Carrier ID: 54021933 CompOne Administrators, Inc.

Roman Catholic Archdiocese of Detroit and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000200 Gallagher Bassett Services, Inc.

Quality Metalcraft, Inc. Mr. Matthew Pulliam 33355 Glendale Livonia, MI 48150 Self-Insured Carrier ID: 33000803 York Risk Services Group, Inc.

Roman Catholic Diocese of Gaylord and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000600 Gallagher Bassett Services, Inc.

Quality Temporary Services, Inc. dba Qualified Staffing Ms. Susan Church Risk Manager 5361 Gateway Centre, Suite A Flint, MI 48507 Self-Insured Carrier ID: 73026025 CompOne Administrators, Inc.

Roman Catholic Diocese of Grand Rapids and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000700 Gallagher Bassett Services, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Roman Catholic Diocese of Kalamazoo and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000400 Gallagher Bassett Services, Inc. Roman Catholic Diocese of Lansing and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000300 Gallagher Bassett Services, Inc. Roman Catholic Diocese of Marquette and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000900 Gallagher Bassett Services, Inc. Roman Catholic Diocese of Saginaw and all related entities Mr. Vincent P Andrews 510 South Capitol Avenue Lansing, MI 48933 Self-Insured Carrier ID: 86000500 Gallagher Bassett Services, Inc. Romeo Community Schools School District Ms. Vicki Laseke 316 North Main Street Romeo, MI 48065 Self-Insured Carrier ID: 82001350 York Risk Services Group, Inc. Royal Technologies Corporation Mr. Kirk Lambers 3765 Quincy Hudsonville, MI 49426 Self-Insured Carrier ID: 30012045 Eagle Claims Management, LLC Rudolph/Libbe Companies Inc. Ms. Denise Honsberger 6494 Latcha Road Walbridge, OH 43465 Self-Insured Carrier ID: 15065900 Mackinaw Administrators, LLC

Ryder System, Inc. c/o Aon Global Risk Consulting Mr. Jared Carlisle Attn: Jared Carlisle 5600 West 83rd Street, Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 42056445 Self-Administered S. Abraham & Sons Inc. Mr. John Reinke P.O. Box 1768 4001 Three Mile Road NW Grand Rapids, MI 49501-1768 Self-Insured Carrier ID: 59063737 York Risk Services Group, Inc. Samaritas dba Lutheran Social Services of Michigan Ms. Cyndie Szczur 8131 East Jefferson Ave Detroit, MI 48214 Self-Insured Carrier ID: 80066082 Michigan Claim Service DBA The ASU Group School Dist. of the City of Birmingham Mr. Dean Niforos 31301 Evergreen Road Human Resources Beverly Hills, MI 48025 Self-Insured Carrier ID: 82000563 Broadspire Services, Inc. School District of the City of Dearborn Mr. Thomas S Wall 18700 Audette Dearborn, MI 48124 Self-Insured Carrier ID: 82000182 York Risk Services Group, Inc. School District of the City of Flint Ms. Jorgina Rubin 923 East Kearsley Street Flint, MI 48503-1900 Self-Insured Carrier ID: 82000125 York Risk Services Group, Inc. School District of the City of Pontiac Mr. Michael Emerson 47200 Woodward Avenue Pontiac, MI 48342 Self-Insured Carrier ID: 82000163 Cannon Cochran Management Services, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List School District of the City of Wyandotte Mr. Kenneth Laub 639 Oak Street Wyandotte, MI 48192 Self-Insured Carrier ID: 82000682 Mackinaw Administrators, LLC

Sodecia USA Automotive Corp. Ms. Sheryl McGowan 24331 Sherwood Center Line, MI 48015-1060 Self-Insured Carrier ID: 34002210 York Risk Services Group, Inc.

Schoolcraft College Ms. Brenda K Leavens 18600 Haggerty Road Livonia, MI 48152-2696 Self-Insured Carrier ID: 82002082 York Risk Services Group, Inc.

Spartan Motors, Inc. Mr. Robert McCallum 1541 Reynolds Road Charlotte, MI 48813 Self-Insured Carrier ID: 37009823 Constitution State Services LLC

Schreiber Corporation Mr. Brian R Moore 29945 Beck Rd. Wixom, MI 48393 Self-Insured Carrier ID: 17091663 Mackinaw Administrators, LLC

SpartanNash Company Mr. Charles R Behrend P. O. Box 8700 (MCGR5371102) 850 - 76th Street S.W. Grand Rapids, MI 49518 Self-Insured Carrier ID: 53091346 Self-Administered

SEMCO Energy, Inc. Mr. Richard W Straney 1411 Third Street, Suite A P.O. Box 5004 Port Huron, MI 48061-5004 Self-Insured Carrier ID: 49092074 York Risk Services Group, Inc.

Spectrum Health System Mr. Richard P Mieskowski Spectrum Health Human Resources 100 Michigan NE Mail Code 108 Grand Rapids, MI 49503 Self-Insured Carrier ID: 80000941 ProSelect Insurance Company

Sherriff-Goslin Company Mr. William Ticknor 10 Avenue C Battle Creek, MI 49037 Self-Insured Carrier ID: 17005000 CompOne Administrators, Inc.

SPX Corporation Ms. Carol Brocci 13320-A Ballantyne Corporate Place Charlotte, NC 28277 Self-Insured Carrier ID: 37090204 Sedgwick Claims Management Services, Inc.

Sherwin-Williams Company Mr. Anthony J Colangelo 101 Prospect Avenue N.W. Cleveland, OH 44115 Self-Insured Carrier ID: 28087088 Helmsman Management Services, LLC

State of Michigan Office of the State Employer, Employee Health Mgmt. Ms. Cheryl Schmittdiel Capital Commons Ctr., 4th Floor 400 S. Pine Street Lansing, MI 48933 Self-Insured Carrier ID: 99904433 York Risk Services Group, Inc.

Shiawassee County Ms. Patricia A Fitnich Surbeck Building 201 North Shiawassee Street Corunna, MI 48817 Self-Insured Carrier ID: 99900078 Broadspire Services, Inc.

Steelcase Inc. Ms. Gina Amante 901 44th S.E. P. O. Box 1967 Grand Rapids, MI 49508 Self-Insured Carrier ID: 33006641 Sedgwick Claims Management Services, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Stryker Corporation Mr. Steve F Jaeger 2825 Airview Boulevard Kalamazoo, MI 49002 Self-Insured Carrier ID: 38041001 Sedgwick Claims Management Services, Inc.

Thai Summit America Corporation Mr. Jason Street 1480 W. McPherson Park Drive Howell, MI 48843 Self-Insured Carrier ID: 39013147 York Risk Services Group, Inc.

Sturgis Hospital, Inc. Ms. Mary Kay Schultz 916 Myrtle Avenue Sturgis, MI 49091 Self-Insured Carrier ID: 80001375 Eagle Claims Management, LLC

Thor Industries, Inc. Mr. Les Thimlar 601 E. Beardsley Ave. Elkhart, IN 46514 Self-Insured Carrier ID: 37020804 Cannon Cochran Management Services, Inc.

Suburban Mobility Auth. for Regional Transportation Mr. Avery E Gordon Suite 600 535 Griswold Detroit, MI 48226 Self-Insured Carrier ID: 35034894 Michigan Claim Service DBA The ASU Group

Tilden Mining Company L. C. Ms. Jennifer Frame 200 Public Square Suite 3300 Cleveland, OH 44114 Self-Insured Carrier ID: 10057085 Sedgwick Claims Management Services, Inc.

Summit Polymers, Inc. Mr. Timothy A Eccles 6715 S. Sprinkle Road Portage, MI 49002 Self-Insured Carrier ID: 28090239 Eagle Claims Management, LLC Target Corporation c/o Aon Global Risk Consulting Ms. Laurene Dufault 5600 W. 83rd St., Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 53001952 Sedgwick Claims Management Services, Inc. Taylor School District Mr. Benjamin Williams 23033 Northline Road Taylor, MI 48180 Self-Insured Carrier ID: 82000282 Gallagher Bassett Services, Inc. Textron Inc. Ms. Sarah Woodward Aon Global Risk Consulting 5600 W. 83rd St., 8200 Tower, Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 35013580 Broadspire Services, Inc.

Township of Clinton Mr. William S Smith 40700 Romeo Plank Road Clinton Township, MI 48038 Self-Insured Carrier ID: 99900250 York Risk Services Group, Inc. Trinity Health-Michigan Ms. Barbara Cook 20555 Victor Parkway Livonia, MI 48152 Self-Insured Carrier ID: 80000163 ESIS, Inc. TrueBlue, Inc. Ms. Jennifer Smith 1015 A Street P.O. Box 2910 Tacoma, WA 98401 Self-Insured Carrier ID: 73013485 ESIS, Inc. Tyson Foods, Inc. Ms. Connie Downum 2200 Don Tyson Parkway P. O. Box 2020 Springdale, AR 72762 Self-Insured Carrier ID: 02469085 Self-Administered

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List U.S. Farathane LLC Mr. Jim Curtis, Jr. 2700 High Meadow Circle Auburn Hills, MI 48236 Self-Insured Carrier ID: 39040812 Comprehensive Risk Services, Inc.

Utica Community Schools Mr. Michael Sturm 11303 Greendale Sterling Heights, MI 48312 Self-Insured Carrier ID: 82000750 Broadspire Services, Inc.

United Airlines, Inc. Ms. Maureen Zahnow 233 S. Wacker Drive-HDQCI Chicago, IL 60606 Self-Insured Carrier ID: 41048000 Sedgwick Claims Management Services, Inc.

Vail Rubber Works, Inc. Mr. Brian Nimtz 521 Langley Avenue P.O. Box 64 St. Joseph, MI 49085 Self-Insured Carrier ID: 30072202 Eagle Claims Management, LLC

United Jewish Foundation of Metropolitan Detroit Ms. Dorothy Benyas 6735 Telegraph Road P.O. Box 2030 Bloomfield Hills, MI 48303 Self-Insured Carrier ID: 86011198 CompOne Administrators, Inc.

VHS of Michigan, Inc. Ms. Tracelyn T Wilson University Health Center 4201 St. Antoine, Suite 5. D.6 Detroit, MI 48201 Self-Insured Carrier ID: 80012084 Sedgwick Claims Management Services, Inc.

United Methodist Retirement Communities, Inc. Ms. Michelle Baldwin Henderson 805 West Middle Street Chelsea, MI 48118-1397 Self-Insured Carrier ID: 80000642 York Risk Services Group, Inc.

VR US Holdings, Inc. dba Mt. Brighton Ski Area Ms. Tracy Venter 390 Interlocken Cresent Broomfield, CO 80021 Self-Insured Carrier ID: 67000300 Gallagher Bassett Services, Inc.

United States Gypsum Company Mr. David M Carlson c/o USG Corporation 550 West Adams Street, Dept. 198 Chicago, IL 60661-3676 Self-Insured Carrier ID: 32091099 Gallagher Bassett Services, Inc.

W. A. Foote Memorial Hospital Inc. d/b/a Henry Ford Allegiance Health Mr. MaryBeth Morgan 205 North East Avenue Jackson, MI 49201 Self-Insured Carrier ID: 80000999 CompOne Administrators, Inc.

United States Steel Corporation Dr. Mohannad Kusti 600 Grant Street Room 1656 Pittsburgh, PA 15219-2800 Self-Insured Carrier ID: 33030718 Broadspire Services, Inc.

Warren Consolidated Schools Ms. Sharon Irvine 31300 Anita Drive - Administration Bldg. Warren, MI 48093 Self-Insured Carrier ID: 82000150 Broadspire Services, Inc.

USF Holland LLC Mr. Greg Zinkiewicz c/o YRC Worldwide Inc. 10990 Roe Avenue Overland Park, KS 66211 Self-Insured Carrier ID: 42096114 Sedgwick Claims Management Services, Inc.

Washtenaw Community College Mr. William Johnson 4800 E Huron River Dr Ann Arbor, MI 48105-4800 Self-Insured Carrier ID: 82000881 York Risk Services Group, Inc.

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Washtenaw County Ms. Monica Boote 220 North Main P.O. Box 8645 Ann Arbor, MI 48107 Self-Insured Carrier ID: 99900081 Michigan Claim Service DBA The ASU Group

Western Michigan University Mrs. Laura Weber Business Services 2080 Seibert Administration Building Kalamazoo, MI 49008-5222 Self-Insured Carrier ID: 82000039 CompOne Administrators, Inc.

Waterford School District Mr. James E Beaver Security & Risk Management 1145 Tee Cee Drive Waterford, MI 48328 Self-Insured Carrier ID: 82000263 Meadowbrook, Inc., dba Meadowbrook Claims Service

Weyerhaeuser Company Ms. Susan LaPrairie Workers' Compensation 1785-B Weyerhaeuser Vanceboro, NC 28586 Self-Insured Carrier ID: 26091257 Sedgwick Claims Management Services, Inc.

Wayne County Airport Authority Ms. Cheryl Smith Mezzanine Level 1 LC Smith Bldg. #603 Detroit, MI 48242 Self-Insured Carrier ID: 99901882 Comprehensive Risk Services, Inc.

Whirlpool Corporation Mr. Rafael V Silva 2000 North M-63 MD 3007 Benton Harbor, MI 49022 Self-Insured Carrier ID: 39036578 Gallagher Bassett Services, Inc.

Wayne County Community College District Mr. Furquan Ahmed 801 West Fort Street Detroit, MI 48226 Self-Insured Carrier ID: 82002182 Broadspire Services, Inc.

White Castle System, Inc. Ms. Melissa Harrison 555 West Goodale Street Columbus, OH 43215-1158 Self-Insured Carrier ID: 58034085 Broadspire Services, Inc.

Wayne State University Office of Risk Management Academic/Admin. Bldg. Ms. Angela M Moss Suite 4622 5700 Cass Avenue Detroit, MI 48202 Self-Insured Carrier ID: 82000082 Self-Administered

Wirtz Manufacturing Co., Inc. Mr. Keith Lepla 1105 24th Street P.O. Box 5006 Port Huron, MI 48061-5006 Self-Insured Carrier ID: 30012799 York Risk Services Group, Inc.

Wayne Westland Community School District Mr. Jim Larson-Shidler 36745 Marquette Westland, MI 48185 Self-Insured Carrier ID: 82001182 Michigan Claim Service DBA The ASU Group

Wisconsin Electric Power Company Mr. Paul W Glessner Room P378 231 West Michigan Street Milwaukee, WI 53203 Self-Insured Carrier ID: 49092100 Self-Administered

Western and Southern Life Insurance Company (The) Ms. Melissa Davis 400 Broadway Cincinnati, OH 45202 Self-Insured Carrier ID: 63074853 Sedgwick Claims Management Services, Inc.

WM Limited Partnership-1998 dba Wendys of Michigan Ms. Megan Horrocks 45 Ottawa Ave SW Suite 600 Grand Rapids, MI 49503 Self-Insured Carrier ID: 58077076 Eagle Claims Management, LLC

12/26/2017 12:04:30 PM

Workers' Compensation Agency Self-Insured Programs Individual Self-Insured Employer List Wolverine Packing Company Mr. Brian Bartes 2535 Rivard Detroit, MI 48207 Self-Insured Carrier ID: 20043617 Comprehensive Risk Services, Inc. Zehnder's of Frankenmuth, Inc. Ms. Martha Shelton 730 S. Main Street Frankenmuth, MI 48734 Self-Insured Carrier ID: 58034765 York Risk Services Group, Inc.

12/26/2017 12:04:30 PM