Self-Insured Programs 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:

A B F Freight System, Inc.Mr. Stan McDaniel3801 Old Greenwood RoadP.O. Box 10048Fort Smith, AR 72917-0048Self-Insured Carrier ID: 42090248Self-Administered

A C O, Inc.Mr. Mark Vandenberg27555 Farmington RoadSuite 110Farmington Hills, MI 48334Self-Insured Carrier ID: 53093406York Risk Services Group, Inc.

A J M Packaging CorporationMr. Robert A EpsteinSuite 100E-4111 Andover RoadBloomfield Hills, MI 48302Self-Insured Carrier ID: 26022282Constitution State Services LLC

A. D. Transport Express, Inc.Mr. Gary A Percy5601 Belleville RoadCanton, MI 48188Self-Insured Carrier ID: 42091119CompOne Administrators, Inc.

ABM Industries IncorporatedMr. Chris Ridge4151 Ashford Dunwoody RoadAtlanta, GA 30319Self-Insured Carrier ID: 30057710ESIS, Inc.

ADAC Plastics, Inc.Mr. Terrance Leberfinger5920 Tahoe Dr.P.O. Box 888375Grand Rapids, MI 49588-8375Self-Insured Carrier ID: 30043041Eagle Claims Management, LLC

AK Steel CorporationMr. David Weber9227 Centre Pointe DriveWest Chester, OH 45069Self-Insured Carrier ID: 33080791CompOne Administrators, Inc.

Allegan CountyBoard of CommissionersMs. Vickie Herzberg3283 - 122nd AvenueAllegan, MI 49010Self-Insured Carrier ID: 99900203Mackinaw Administrators, LLC

Alro Steel CorporationMr. Jim Norman3100 E. High StreetP.O. Box 927Jackson, MI 49204-0927Self-Insured Carrier ID: 33047766Parker Services, LLC

Alticor Inc.Ms. Sue Kocher7575 Fulton Street EastMail Code: 56-3TAda, MI 49355-0001Self-Insured Carrier ID: 59090441Self-Administered

American Electric Power Company, Inc.Mr. Loyd Hudson1 Riverside Plaza15th Floor IDM CenterColumbus, OH 43215-2355Self-Insured Carrier ID: 49092102Cannon Cochran Management Services, Inc.

American National Red CrossMr. Muluneh Woldetsadik2025 E Street, NWWashington, DC 20006Self-Insured Carrier ID: 80001585Sedgwick Claims Management Services, Inc.

American Plastic Toys, Inc.Mr. James W Grau799 Ladd RoadWalled Lake, MI 48390Self-Insured Carrier ID: 29018264Comprehensive Risk Services, Inc.

Andersons, Inc. (The)Ms. Jan LaPlantP.O. Box 1191947 Briarfield Blvd.Maumee, OH 43537Self-Insured Carrier ID: 07032385Mackinaw Administrators, LLC

12/26/2017 12:04:30 PM

Workers' Compensation AgencySelf-Insured Programs

Individual Self-Insured Employer List

Andrews UniversityMr. Daniel A Agnetta4150 Administration DriveHuman ResourcesBerrien Springs, MI 49104-0860Self-Insured Carrier ID: 82000011CompOne Administrators, Inc.

Android Industries, LLCMs. Tricia DeClercq2155 Executive Hills Blvd.Auburn Hills, MI 48326Self-Insured Carrier ID: 39024123Gallagher Bassett Services, Inc.

Ann Arbor Area Transportation AuthorityMr. Philip C Webb2700 S Industrial HwyAnn Arbor, MI 48104Self-Insured Carrier ID: 99022100Eagle Claims Management, LLC

Ann Arbor Public SchoolsMr. David Comsa2555 S. State StreetAnn Arbor, MI 48104Self-Insured Carrier ID: 82000181Broadspire Services, Inc.

Art Van Furniture, LLCMr. David Ladd6500 Fourteen Mile RoadWarren, MI 48092Self-Insured Carrier ID: 57012809CompOne Administrators, Inc.

Asama Coldwater Manufacturing, Inc.Mr. David Sutherland180 Asama ParkwayColdwater, MI 49036Self-Insured Carrier ID: 39017030Eagle Claims Management, LLC

Ascension Health AllianceMs. Molly Abshear11775 Borman-Suite 300P.O. Box 46944St. Louis, MO 63146-4134Self-Insured Carrier ID: 80000101Sedgwick Claims Management Services, Inc.

Avon Automotive Holdings, Inc.Ms. Cindy Branch603 West Seventh StreetCadillac, MI 49601Self-Insured Carrier ID: 39047135CompOne Administrators, Inc.

AWI Holdings Inc.Mr. Gregory D Hinkle440 Kirtland S.W.Grand Rapids, MI 49507Self-Insured Carrier ID: 50018741York Risk Services Group, Inc.

Balkema Excavating, Inc.Mr. Clarence Batts5300 Miller RoadKalamazoo, MI 49048Self-Insured Carrier ID: 17007112Eagle Claims Management, LLC

Bay City Public SchoolsMrs. Jill Mulders910 N. Walnut StreetBay City, MI 48706Self-Insured Carrier ID: 82000309Eagle Claims Management, LLC

Bay CountyMs. Tiffany Jerry515 Center AvenueBay City, MI 48708Self-Insured Carrier ID: 99900009York Risk Services Group, Inc.

Beaumont HealthMr. Kent Teeters16500 W Twelve Mile RoadSouthfield, MI 48076Self-Insured Carrier ID: 80000910Sedgwick Claims Management Services, Inc.

Benteler Automotive CorporationMr. Armin Grossklans2650 N. Opdyke Rd., Suite BAuburn Hills, MI 48326Self-Insured Carrier ID: 37058041Constitution State Services LLC

Besser Company USAMr. Scott Foerstner801 Johnson StreetAlpena, MI 49707Self-Insured Carrier ID: 14010942Comprehensive Risk Services, Inc.

12/26/2017 12:04:30 PM



BISSELL Inc.Mr. William J Brennan2345 Walker Avenue, N.W.P.O. Box 1888Walker, MI 49501Self-Insured Carrier ID: 35028220Michigan Claim Service DBA The ASU Group

Bloomfield Hills School DistrictMs. Karen Healy7273 Wing Lake RoadBloomfield Hills, MI 48301Self-Insured Carrier ID: 82000463CompOne Administrators, Inc.

Blue Cross Blue Shield of Michigan Mutual Insurance CompanyMs. Lisa Holinski600 E. LafayetteMC1801Detroit, MI 48226Self-Insured Carrier ID: 80012082CompOne Administrators, Inc.

Board of Water & Lightof the City of LansingMr. Richard R PeffleyP.O. Box 13007Lansing, MI 48901Self-Insured Carrier ID: 49059333CompOne Administrators, Inc.

Boldt Company (The)Ms. Teri Whitman2525 N. Roemer Rd.P.O. Box 419Appleton, WI 54912-0419Self-Insured Carrier ID: 15031001Self-Administered

Bopp-Busch Manufacturing CompanyMr. William A Busch545 E. HuronP.O. Box 589Au Gres, MI 48703Self-Insured Carrier ID: 34023820Eagle Claims Management, LLC

Bouma Corporation (The)Mr. Daniel DeRyke4101 Roger B. Chaffee Memorial Blvd. SEGrand Rapids, MI 49548Self-Insured Carrier ID: 25042660Eagle Claims Management, LLC

Boyne USA, Inc.Mr. Edward Dembek3951 Charlevoix Ave.Petoskey, MI 49770Self-Insured Carrier ID: 70087534York Risk Services Group, Inc.

Brembo North America, Inc.Mr. Daniel M Sandberg47765 Halyard DrivePlymouth, MI 48170Self-Insured Carrier ID: 39009915Mackinaw Administrators, LLC

Bronson Healthcare Group, Inc.Ms. Robin Welch601 John StreetBox GKalamazoo, MI 49007Self-Insured Carrier ID: 80000839ProSelect Insurance Company

Burr Oak Tool Inc.Mr. Andrew F Boyd405 W. South StreetSturgis, MI 49091Self-Insured Carrier ID: 35013675York Risk Services Group, Inc.

Cadillac Casting, Inc.Ms. Michael T Quibell1500 4th AveCadillac, MI 49601Self-Insured Carrier ID: 37004225CompOne Administrators, Inc.

Cadillac Products, Inc.Mr. Roger K Williams5800 Crooks RoadTroy, MI 48098Self-Insured Carrier ID: 52000798York Risk Services Group, Inc.

Capital Area Transportation AuthorityMr. Mark M Murray4615 Tranter StreetLansing, MI 48910Self-Insured Carrier ID: 41046543CompOne Administrators, Inc.

12/26/2017 12:04:30 PM



Carman-Ainsworth Community SchoolsMr. Russell ParksG-3475 W. Court StreetFlint, MI 48532Self-Insured Carrier ID: 82000625Eagle Claims Management, LLC

Cascade Engineering, Inc.Mr. Joseph Maier3400 Innovation Ct. S.E.Grand Rapids, MI 49512Self-Insured Carrier ID: 30044567Eagle Claims Management, LLC

Cassens CorpMr. William Molter145 North Kansas St.Edwardsville, IL 62025Self-Insured Carrier ID: 42095685Broadspire Services, Inc.

Center Line Public SchoolsMr. Charles Roddis26400 Arsenal AvenueCenter Line, MI 48015Self-Insured Carrier ID: 82000050Eagle Claims Management, LLC

Central Michigan UniversityMs. Tammy GriffinCHIP Facility South Grounds BuildingMt. Pleasant, MI 48859Self-Insured Carrier ID: 82000037CompOne Administrators, Inc.

Challenge Mfg. Holdings, Inc.Mr. Mike Rodgers3200 Fruit Ridge Avenue NWWalker, MI 49544Self-Insured Carrier ID: 34097018Constitution State Services LLC

Charter Township of CantonMs. Kerreen Conley1150 S. Canton Center RoadCanton, MI 48188Self-Insured Carrier ID: 99900001Eagle Claims Management, LLC

Charter Township of ShelbyMs. Lisa Suida52700 Van Dyke AvenueShelby Township, MI 48316Self-Insured Carrier ID: 99900475York Risk Services Group, Inc.

Charter Township of WaterfordMs. Margaret BirchTreasurer's Office5200 Civic Center DriveWaterford, MI 48329-3773Self-Insured Carrier ID: 99901063Comprehensive Risk Services, Inc.

Chelsea Milling CompanyMr. John Powers201 West North StreetChelsea, MI 48118Self-Insured Carrier ID: 20044114York Risk Services Group, Inc.

Chippewa County War Memorial Hospital, IncMs. Susan Sliger500 Osborn BoulevardSault Ste. Marie, MI 49783Self-Insured Carrier ID: 80000317Eagle Claims Management, LLC

Chippewa Valley SchoolsMr. Scott Sederlund19120 CassClinton Township, MI 48038Self-Insured Carrier ID: 82001250York Risk Services Group, Inc.

City of Ann ArborMr. Tom Crawford301 E. HuronAnn Arbor, MI 48107-8647Self-Insured Carrier ID: 99900181CompOne Administrators, Inc.

City of Battle CreekMs. Joyce Snow10 N. Division StreetBattle Creek, MI 49014Self-Insured Carrier ID: 99900113Eagle Claims Management, LLC

City of Bay CityMs. Mikki ManionRoom 305301 Washington AvenueBay City, MI 48708Self-Insured Carrier ID: 99900209CompOne Administrators, Inc.

12/26/2017 12:04:30 PM



City of DearbornMs. Licia A YangouyianSuite 1416901 Michigan AvenueDearborn, MI 48126-2967Self-Insured Carrier ID: 99900182Michigan Claim Service DBA The ASU Group

City of Dearborn HeightsMr. John Laub6045 FentonDearborn Heights, MI 48127Self-Insured Carrier ID: 99901682Broadspire Services, Inc.

City of DetroitMr. Donald D SettlesColeman A. Young Municipal Center2 Woodward Avenue, Suite 801Detroit, MI 48226Self-Insured Carrier ID: 99900482York Risk Services Group, Inc.

City of East LansingMs. Jill Feldpausch410 Abbot RoadEast Lansing, MI 48823Self-Insured Carrier ID: 99900233CompOne Administrators, Inc.

City of EscanabaMr. Robert Valentine410 Ludington StreetP.O. Box 948Escanaba, MI 49829Self-Insured Carrier ID: 99900121Comprehensive Risk Services, Inc.

City of FerndaleMs. Jenny Campos300 E. Nine MileFerndale, MI 48220-1797Self-Insured Carrier ID: 99900763Broadspire Services, Inc.

City of FlintMr. Charley McClendonHuman Resources1101 S. Saginaw Street, RM #9Flint, MI 48502Self-Insured Carrier ID: 99900125Eagle Claims Management, LLC

City of Garden CityMs. Allyson Bettis6000 Middlebelt RoadGarden City, MI 48135Self-Insured Carrier ID: 99901001Broadspire Services, Inc.

City of Grand RapidsMr. Craig CoulsonRisk Management Office300 Monroe Ave., NWGrand Rapids, MI 49503Self-Insured Carrier ID: 99900141CompOne Administrators, Inc.

City of Grosse Pointe FarmsMr. Shane L Reeside90 Kerby RoadGrosse Pointe Farms, MI 48236Self-Insured Carrier ID: 99901782CompOne Administrators, Inc.

City of Grosse Pointe WoodsMs. Catherine Behrens20025 Mack PlazaGrosse Pointe Woods, MI 48236Self-Insured Carrier ID: 99900663York Risk Services Group, Inc.

City of HamtramckMs. Katrina Powell3401 EvalineHamtramck, MI 48212Self-Insured Carrier ID: 99900282Eagle Claims Management, LLC

City of InksterMs. Kim Watkins26215 Trowbridge StInkster, MI 48141Self-Insured Carrier ID: 99901382CompOne Administrators, Inc.

City of JacksonMr. Jonathon Greene161 W. Michigan Avenue, 6th FloorJackson, MI 49201Self-Insured Carrier ID: 99900138Broadspire Services, Inc.

12/26/2017 12:04:30 PM



City of KalamazooMr. Thomas C Skrobola241 W. South StreetKalamazoo, MI 49007-4796Self-Insured Carrier ID: 99900139Eagle Claims Management, LLC

City of LansingMs. Kathy Woodman8th Floor City Hall124 W. Michigan AvenueLansing, MI 48933Self-Insured Carrier ID: 99900133CompOne Administrators, Inc.

City of LivoniaMr. Michael T Slater33000 Civic Center DriveLivonia, MI 48154Self-Insured Carrier ID: 99900982York Risk Services Group, Inc.

City of Madison HeightsMs. Amy Misczak300 W. Thirteen Mile Rd.Madison Heights, MI 48071Self-Insured Carrier ID: 99901263York Risk Services Group, Inc.

City of MonroeMs. Peggy A Howard120 East First StreetMonroe, MI 48161Self-Insured Carrier ID: 99900158Comprehensive Risk Services, Inc.

City of Port HuronMs. Julie A Davis100 McMorran BoulevardRoom 201Port Huron, MI 48060Self-Insured Carrier ID: 99900174York Risk Services Group, Inc.

City of PortageMs. Tracy Schmitt7900 South Westnedge AvenuePortage, MI 49002Self-Insured Carrier ID: 99900339Eagle Claims Management, LLC

City of RosevilleMr. Paul VanDamme29777 GratiotP.O. Box 290Roseville, MI 48066Self-Insured Carrier ID: 99900850York Risk Services Group, Inc.

City of Royal OakMr. Donald E Johnson211 Williams StreetP.O. Box 64Royal Oak, MI 48068-0064Self-Insured Carrier ID: 99900463York Risk Services Group, Inc.

City of SaginawMs. Lisa K CrookRoom 2021315 South Washington AvenueSaginaw, MI 48601Self-Insured Carrier ID: 99900173York Risk Services Group, Inc.

City of Saint Clair ShoresMr. Douglas M Haag27600 Jefferson AvenueSt. Clair Shores, MI 48081Self-Insured Carrier ID: 99900150York Risk Services Group, Inc.

City of Southfield Garnett Carr26000 Evergreen RoadP.O. Box 2055Southfield, MI 48037-2055Self-Insured Carrier ID: 99900963Cannon Cochran Management Services, Inc.

City of SouthgateMr. David Angileri14400 Dix Toledo RoadSouthgate, MI 48195Self-Insured Carrier ID: 99901582Broadspire Services, Inc.

City of Sterling HeightsMs. Kate Baldwin40555 Utica RoadP.O. Box 8009Sterling Heights, MI 48311-8009Self-Insured Carrier ID: 99900750CompOne Administrators, Inc.

12/26/2017 12:04:30 PM



City of TaylorMs. Sheila Gorski-Schulte23555 Goddard RoadTaylor, MI 48180Self-Insured Carrier ID: 99900782CompOne Administrators, Inc.

City of WarrenMr. Mark SimlarSuite 410One City SquareWarren, MI 48093Self-Insured Carrier ID: 99901150CompOne Administrators, Inc.

City of WayneMs. Carrie Venus3355 South Wayne RoadWayne, MI 48184Self-Insured Carrier ID: 99901282Michigan Claim Service DBA The ASU Group

City of WestlandMs. Cindy C King36300 Warren RoadWestland, MI 48185-1214Self-Insured Carrier ID: 99901082Alternative Service Concepts LLC

City of WyandotteMr. Todd A Drysdale3200 Biddle AvenueWyandotte, MI 48192Self-Insured Carrier ID: 99900682Broadspire Services, Inc.

City of WyomingMs. Rosa Ooms1155 - 28th Street S.W.P.O. Box 905Wyoming, MI 49509Self-Insured Carrier ID: 99900341CompOne Administrators, Inc.

Clark Retirement Community, Inc.Ms. Lindy Bonter1551 Franklin Street SEGrand Rapids, MI 49506-3331Self-Insured Carrier ID: 80000341Eagle Claims Management, LLC

Cleveland-Cliffs Iron Company (The)Ms. Jennifer Frame200 Public SquareSuite 3300Cleveland, OH 44114Self-Insured Carrier ID: 10059318Sedgwick Claims Management Services, Inc.

Cold Heading Co.Mr. Daniel Morrell21777 Hoover RoadWarren, MI 48089Self-Insured Carrier ID: 33033782Mackinaw Administrators, LLC

Comau LLCMs. Lisa Cormier21000 Telegraph RoadSouthfield, MI 48033Self-Insured Carrier ID: 34040999Maxcis, Inc.

Commercial Steel Treating CorporationMr. Greg B Schankin31440 Stephenson HighwayMadison Heights, MI 48071Self-Insured Carrier ID: 33016001Eagle Claims Management, LLC

Consumers Energy CompanyMs. Catherine M ReynoldsOne Energy PlazaEP12-244Jackson, MI 49201Self-Insured Carrier ID: 48092036Self-Administered

Contractors Steel CompanyMr. Donald R Simon36555 Amrhein RoadP.O. Box 3364Livonia, MI 48151-3364Self-Insured Carrier ID: 50070854Mackinaw Administrators, LLC

Costco Wholesale CorporationMs. Carrie Freeland999 Lake DriveIssaquah, WA 98027Self-Insured Carrier ID: 53091300Helmsman Management Services, LLC

12/26/2017 12:04:30 PM



County of BerrienMr. William A WolfBerrien County Administration701 Main StreetSt. Joseph, MI 49085Self-Insured Carrier ID: 99900011Broadspire Services, Inc.

County of CalhounMs. Kim Archambault315 W. Green StreetMarshall, MI 49068Self-Insured Carrier ID: 99900013York Risk Services Group, Inc.

County of CharlevoixMs. Cheryl Potter BroweCounty Clerk203 Antrim StreetCharlevoix, MI 49720Self-Insured Carrier ID: 99900015York Risk Services Group, Inc.

County of EatonMr. John Fuentes1045 Independence BoulevardCharlotte, MI 48813Self-Insured Carrier ID: 99900023Michigan Claim Service DBA The ASU Group

County of HillsdaleMs. Stephenie KyserCounty Court House29 N. Howell StreetHillsdale, MI 49242Self-Insured Carrier ID: 99900130Broadspire Services, Inc.

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

County of JacksonMr. Michael Overton120 West Michigan AvenueJackson, MI 49201Self-Insured Carrier ID: 99900038Eagle Claims Management, LLC

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

County of LapeerMr. John Biscoe255 Clay StreetSuite 301Lapeer, MI 48446Self-Insured Carrier ID: 99900044York Risk Services Group, Inc.

County of MacombMr. John P AndersonFinance-Risk & Insurance120 N. Main StreetMt. Clemens, MI 48043Self-Insured Carrier ID: 99900050York Risk Services Group, Inc.

County of MasonMr. Fabian Knizacky304 E. Ludington AvenueLudington, MI 49431Self-Insured Carrier ID: 99900101Eagle Claims Management, LLC

County of MidlandMr. Craig Maxwell220 W. Ellsworth StreetMidland, MI 48640-5194Self-Insured Carrier ID: 99900056Eagle Claims Management, LLC

County of MonroeMr. Michael Bosanac125 East Second StreetMonroe, MI 48161Self-Insured Carrier ID: 99900058Michigan Claim Service DBA The ASU Group

County of MuskegonMs. Kristen N Wade316 Morris Avenue, Suite 200Muskegon, MI 49440Self-Insured Carrier ID: 99900061Michigan Claim Service DBA The ASU Group

12/26/2017 12:04:30 PM



County of Oakland (The), a Michigan Constitutional CorporationMr. Dean J SchultzRisk Management & Safety2100 Pontiac Lake Rd.Waterford, MI 48328Self-Insured Carrier ID: 99900063York Risk Services Group, Inc.

County of SaginawMr. Robert Belleman111 South Michigan AvenueSaginaw, MI 48602Self-Insured Carrier ID: 99900073Eagle Claims Management, LLC

County of Saint ClairMs. Kimberly WoolmanSuite 206200 Grand RiverPort Huron, MI 48060Self-Insured Carrier ID: 99900374Mackinaw Administrators, LLC

County of WayneMs. Shirley Priskorn500 Griswold, 14th FloorDetroit, MI 48226Self-Insured Carrier ID: 99900082Mackinaw Administrators, LLC

Covenant Medical Center, Inc. dba Covenant HealthcareMr. Tyler Danek1447 N. HarrisonSaginaw, MI 48602Self-Insured Carrier ID: 80000573ProSelect Insurance Company

Cranbrook Educational Community, Inc.Ms. Beth Beadle39221 N. Woodward AvenueP.O. Box 801Bloomfield Hills, MI 48303-0801Self-Insured Carrier ID: 82003063CompOne Administrators, Inc.

Creative Foam CorporationMr. Bruce G Graham300 N. Alloy DriveFenton, MI 48430Self-Insured Carrier ID: 30049025CompOne Administrators, Inc.

Dana IncorporatedMs. Heather Taylor3939 Technology DriveP.O. Box 537Toledo, OH 43537Self-Insured Carrier ID: 37090323Sedgwick Claims Management Services, Inc.

Daniel L. Jacob and Co., Inc.Mr. Matthew P Gleeson2403 East High StreetJackson, MI 49203-3421Self-Insured Carrier ID: 51017338Eagle Claims Management, LLC

Dart Container Corporation of California dba DTX, Inc.c/o Aon Global Risk ConsultingMs. Paula Greve5600 West 83rd StreetSuite 1100Minneapolis, MN 55437Self-Insured Carrier ID: 30104200Self-Administered

Dart Container of Michigan LLCC/O Aon Global Risk ConsultingMr. Jared Carlisle5600 West 83rd StreetSuite 1100Minneapolis, MN 55437Self-Insured Carrier ID: 30099099Self-Administered

Dean Transportation Inc.Mr. Brian Thrasher4812 Aurelius RdLansing, MI 48910Self-Insured Carrier ID: 41002033Eagle Claims Management, LLC

Delaco Steel CorporationMr. Dave Trela8111 Tireman DrDearborn, MI 48126Self-Insured Carrier ID: 50019330CompOne Administrators, Inc.

Denso Air Systems Michigan Inc.Mr. Grant Penrod300 Fritz Keiper Blvd.Battle Creek, MI 49037Self-Insured Carrier ID: 37044000CompOne Administrators, Inc.

12/26/2017 12:04:30 PM



Detroit Diesel CorporationMr. Dan HoldenDaimler Trucks North America LLC2701 N W Vaughn Street, Suite 900Portland, OR 97210Self-Insured Carrier ID: 37055082Sedgwick Claims Management Services, Inc.

Detroit Entertainment, L.L.C.Mr. Bruce R Dall2901 Grand RiverDetroit, MI 48201Self-Insured Carrier ID: 70037700CompOne Administrators, Inc.

Detroit Public Schools Community DistrictOffice of Risk ManagementMr. Douglas Gniewek3011 W. Grand BlvdFisher Bldg Ste 1101ADetroit, MI 48202Self-Insured Carrier ID: 82000482York Risk Services Group, Inc.

Dexter Fastener Technologies, Inc.Mr. Jim Cremering2110 Bishop Circle EastDexter, MI 48130Self-Insured Carrier ID: 34016440York Risk Services Group, Inc.

Dickinson County Healthcare SystemMs. Eileen Sparpana1721 S. Stephenson AvenueIron Mountain, MI 49801Self-Insured Carrier ID: 80050022York Risk Services Group, Inc.

Domestic Linen Supply & Laundry CompanyMr. Evan Lacross30555 Northwestern Highway Suite 300Farmington Hills, MI 48334Self-Insured Carrier ID: 72008446York Risk Services Group, Inc.

DTE Energy CompanyMr. Jerome K HooperOne Energy Plaza, 252 GODetroit, MI 48226Self-Insured Carrier ID: 49090153Self-Administered

Dunn Paper, Inc.Mr. Richard Harter218 Riverview StreetPort Huron, MI 48060Self-Insured Carrier ID: 26014425Gallagher Bassett Services, Inc.

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

Eagle Alloy, Inc.Ms. Lisa Price5142 Evanston AvenueMuskegon, MI 49442Self-Insured Carrier ID: 26014061Eagle Claims Management, LLC

Eastern Michigan UniversityMs. Tracey PiercecchiLegal Affairs11 Welch HallYpsilanti, MI 48197Self-Insured Carrier ID: 82000081York Risk Services Group, Inc.

Edison Institute (The)DBA The Henry FordMs. Anne Marie DeGrazia20900 Oakwood BoulevardP.O. Box 1970Dearborn, MI 48121-1970Self-Insured Carrier ID: 84001082Mackinaw Administrators, LLC

Edw. C. Levy Co.Mr. Don Liepa9300 Dix AvenueDearborn, MI 48120Self-Insured Carrier ID: 15052604Michigan Claim Service DBA The ASU Group

Edward W. Sparrow Hospital AssociationMs. Michelle LeachSuite 2351200 East Michigan AvenueLansing, MI 48912Self-Insured Carrier ID: 80000533Coverys Insurance Services, Inc.

12/26/2017 12:04:30 PM



Edwards Brothers Malloy, Inc.Ms. Kathy Graham5411 Jackson RoadAnn Arbor, MI 48103Self-Insured Carrier ID: 27051221York Risk Services Group, Inc.

EJ USA, Inc.Mrs. Fay Keane301 Spring StreetP.O. Box 439East Jordan, MI 49727Self-Insured Carrier ID: 33000821Michigan Claim Service DBA The ASU Group

Ella E.M. Brown Charitable Circled/b/a Oaklawn HospitalMs. Marta Ross200 N. MadisonMarshall, MI 49068Self-Insured Carrier ID: 80000913York Risk Services Group, Inc.

Emergent Health PartnersMs. Barbara Bachman1200 State CircleAnn Arbor, MI 48108-1691Self-Insured Carrier ID: 80000381CompOne Administrators, Inc.

Empire Iron Mining Partnershipc/o Cleveland Cliffs Iron CompanyMs. Jennifer Frame200 Public SquareSuite 3300Cleveland, OH 44114Self-Insured Carrier ID: 10090885Sedgwick Claims Management Services, Inc.

EPI Printers, Inc.Mr. Timothy R Czerney5404 Wayne RoadBattle Creek, MI 49037Self-Insured Carrier ID: 27050706Eagle Claims Management, LLC

Ervin Industries, Inc.Mr. Tom Tsallis3893 Research Park DriveAnn Arbor, MI 48106-1168Self-Insured Carrier ID: 35028870Sedgwick Claims Management Services, Inc.

Evangelical Homes of MichiganMs. Denise Rabidoux34024 W. 8-Mile, Suite 101Farmington, MI 48335Self-Insured Carrier ID: 80000821Eagle Claims Management, LLC

F.C.S. Industries, Inc.Mr. Matthew D Drain9850 Pelham RoadTaylor, MI 48180-3852Self-Insured Carrier ID: 42008282Self-Administered

Farmington Public SchoolsMr. Jeff Danziger32500 ShiawasseeFarmington, MI 48336Self-Insured Carrier ID: 82000763Mackinaw Administrators, LLC

Faygo Beverages, Inc.c/o National Beverage Corp.Mr. Richard BerkesSuite 40008100 SW Tenth St.Ft. Lauderdale, FL 33324Self-Insured Carrier ID: 20036782Constitution State Services LLC

FCA US LLCMs. Debbie WhiteProject Manager1000 Chrysler Drive CIMS 485-07-26Auburn Hills, MI 48326Self-Insured Carrier ID: 37666000Sedgwick Claims Management Services, Inc.

Federal Express CorporationMs. Gael JohnsonBuilding B - 3rd Floor3620 Hacks Cross Rd.Memphis, TN 38125-8800Self-Insured Carrier ID: 43057760Sedgwick Claims Management Services, Inc.

Federal Screw WorksMr. Scott Rozema34846 Goddard RdRomulus, MI 48174Self-Insured Carrier ID: 34090708Comprehensive Risk Services, Inc.

12/26/2017 12:04:30 PM



Federated Logistics, Inc.Mr. Robert S Wierzbicki32500 VanBorn RdSte 100Wayne, MI 48184Self-Insured Carrier ID: 43058981Mackinaw Administrators, LLC

FedEx Freight, Inc.Ms. Kayla Quandt2200 Forward DriveP.O. Box 840Harrison, AR 72602-0840Self-Insured Carrier ID: 42009485Sedgwick Claims Management Services, Inc.

FedEx Ground Package System, Inc.Ms. Leigh A Ferron1000 FedEx DriveP.O. Box 535859Moon Twp, PA 15108Self-Insured Carrier ID: 42008585Sedgwick Claims Management Services, Inc.

Ferris State UniversityMr. Michael GrandyFinance420 Oak Street - Prakken Building 153Big Rapids, MI 49307-2020Self-Insured Carrier ID: 82000101CompOne Administrators, Inc.

Fisher & Company, Inc.Ms. Rosalyn Rottier33300 Fisher DriveSt. Clair Shores, MI 48082Self-Insured Carrier ID: 37002950Michigan Claim Service DBA The ASU Group

Flexfab Horizons International, Inc.Mr. Matthew P Nusbaum203 Cook RoadHastings, MI 49058Self-Insured Carrier ID: 30013322York Risk Services Group, Inc.

Flint Mass Transportation AuthorityMr. Edgar H Benning1401 South Dort HighwayFlint, MI 48503Self-Insured Carrier ID: 75098776Eagle Claims Management, LLC

Ford Motor CompanyMr. Alan GoroshWorkers' CompensationP.O. Box 607Dearborn, MI 48121-0607Self-Insured Carrier ID: 374F0000Self-Administered

Frankenmuth Bavarian Inn, Inc.Mr. Vernon Schiefer713 S. Main StreetFrankenmuth, MI 48734Self-Insured Carrier ID: 58011873York Risk Services Group, Inc.

Futuramic Tool & Engineering Co.Mr. Michael J Scott24680 GibsonWarren, MI 48089Self-Insured Carrier ID: 35040050Eagle Claims Management, LLC

G.A. Richards CompanyMr. Phillip M Verwys1060 Ken-O-Sha IndustrialGrand Rapids, MI 49508-8216Self-Insured Carrier ID: 25047125York Risk Services Group, Inc.

General Motors LLCMs. Susan AzarP.O. Box 69Southfield, MI 48034-0069Self-Insured Carrier ID: 37999000Self-Administered

Genesee CountyMr. Nerahoo NemrajController's Office1101 Beach Street 3rd FloorFlint, MI 48502Self-Insured Carrier ID: 99900225Michigan Claim Service DBA The ASU Group

Genesee Health SystemMr. Brian Swiecicki420 W. Fifth AvenueFifth FloorFlint, MI 48503Self-Insured Carrier ID: 80000134Eagle Claims Management, LLC

12/26/2017 12:04:30 PM



Gill Industries, Inc.Mrs. Rita Woodruff5271 Plainfield Ave, N.E.Grand Rapids, MI 49525Self-Insured Carrier ID: 35033841Comprehensive Risk Services, Inc.

Grand Rapids Public SchoolsMs. Dawn M Berenyi1331 Franklin Street, S.E.P.O. Box 117Grand Rapids, MI 49501-0117Self-Insured Carrier ID: 82000141Michigan Claim Service DBA The ASU Group

Grand Traverse Band of Ottawa & Chippewa Indians (The)Mr. Charles Stewart2331 N. West Bayshore DrivePeshawbestown, MI 49682Self-Insured Carrier ID: 99000450CompOne Administrators, Inc.

Grand Traverse CountyMs. Jody Lundquist400 Boardman AvenueTraverse City, MI 49684Self-Insured Carrier ID: 99900028York Risk Services Group, Inc.

Grand Traverse PavilionsMr. Kory Hansen1000 Pavilions CircleTraverse City, MI 49684Self-Insured Carrier ID: 80001150Eagle Claims Management, LLC

Grand Valley State UniversityMs. Natalie Trent1 Campus DriveAllendale, MI 49401Self-Insured Carrier ID: 82001441CompOne Administrators, Inc.

Great Lakes Home Health Services, Inc.Mr. Lakshu Sundaram900 Cooper StreetJackson, MI 49202Self-Insured Carrier ID: 80001791Mackinaw Administrators, LLC

Great Lakes Water AuthorityMr. Michael J Tilley735 Randolph StDetroit, MI 48226Self-Insured Carrier ID: 73016819Broadspire Services, Inc.

Greektown Casino, LLCMs. Tameika Moore555 E. Lafayette Blvd.Detroit, MI 48226Self-Insured Carrier ID: 70091455York Risk Services Group, Inc.

Griffin Beverage Co.Mr. Robert T Griffin1901 North Dam RoadWest Branch, MI 48661Self-Insured Carrier ID: 20070012York Risk Services Group, Inc.

Grosse Pointe Public School System Dee Ann Irby389 St. ClairGrosse Pointe, MI 48230Self-Insured Carrier ID: 82001082Alternative Service Concepts LLC

Haworth, Inc.Ms. Sue ButlerOne Haworth Center 3-E13Holland, MI 49423Self-Insured Carrier ID: 73016843Gallagher Bassett Services, Inc.

HealthSource Saginaw, Inc.Ms. Lisa Lapham3340 Hospital Rd.Saginaw, MI 48603Self-Insured Carrier ID: 80001773ProSelect Insurance Company

Henry Ford Health SystemMr. John R Mucha1 Ford Place, 4BHFHS Risk Finance & Insurance ServicesDetroit, MI 48202-3450Self-Insured Carrier ID: 80000982Comprehensive Risk Services, Inc.

12/26/2017 12:04:30 PM



Herb Ritsema Company (The)Mr. William J Ritsema3000 DormaxGrandville, MI 49418Self-Insured Carrier ID: 17001041York Risk Services Group, Inc.

Hercules Drawn Steel Corp.Mr. Mark Goodman38901 Amrhein RoadLivonia, MI 48150Self-Insured Carrier ID: 33078882Michigan Claim Service DBA The ASU Group

Holcim (US) Inc.Mr. Hunter Falk6211 Ann Arbor RoadDundee, MI 48131Self-Insured Carrier ID: 14046058Gallagher Bassett Services, Inc.

Holland Community HospitalMr. Michael Matthews602 Michigan AvenueHolland, MI 49423Self-Insured Carrier ID: 80000295ProSelect Insurance Company

Holland HomeMr. Adam Kinder2100 Raybrook Ave., S.E. #300Grand Rapids, MI 49546Self-Insured Carrier ID: 80000741Eagle Claims Management, LLC

Hollywood Holding Company, LLCMs. Kimberly Welch Harlan2670 W. Maple RoadTroy, MI 48084Self-Insured Carrier ID: 54022112Michigan Claim Service DBA The ASU Group

Home Depot U.S.A., Inc.Mr. Jim Bramlett2455 Paces Ferry RoadBuilding C, Floor 20Atlanta, GA 30339Self-Insured Carrier ID: 52030085Helmsman Management Services, LLC

Houghton CountyMr. Eric E Forsberg401 East Houghton AvenueHoughton, MI 49931Self-Insured Carrier ID: 99900031York Risk Services Group, Inc.

Howard Ternes Packaging CompanyMr. William R Morrison35275 Industrial RdLivonia, MI 48150Self-Insured Carrier ID: 26036682York Risk Services Group, Inc.

Howell Public SchoolsMs. Liza M Kelly411 N. Highlander Way, Ste BHowell, MI 48843Self-Insured Carrier ID: 82000347York Risk Services Group, Inc.

Huntington Bancshares IncorporatedMs. Heather Myerscough37 West Broad St, HP 0225Columbus, OH 43215Self-Insured Carrier ID: 60055885Sedgwick Claims Management Services, Inc.

Huron Casting, Inc.Mr. Matthew Davis7050 Hartley StreetPigeon, MI 48755Self-Insured Carrier ID: 33000988CompOne Administrators, Inc.

Huron Valley SchoolsMs. Nancy Coratti, Ph.D.2390 S. Milford RoadHighland, MI 48357Self-Insured Carrier ID: 82002063CompOne Administrators, Inc.

Hyatt CorporationMs. Laurene DufaultAON Global Risk Consulting5600 West 83rd Street, Suite 1100Minneapolis, MN 55437Self-Insured Carrier ID: 70091386Gallagher Bassett Services, Inc.

12/26/2017 12:04:30 PM



Inalfa Roof Systems, Inc.Mr. Jarrod Fiengo1370 Pacific DriveAuburn Hills, MI 48326Self-Insured Carrier ID: 37002320CompOne Administrators, Inc.

Ingham Countyand Ingham County Medical Care FacilityMs. Jill Rhode121 E. MapleP.O. Box 319Mason, MI 48854Self-Insured Carrier ID: 99900033Eagle Claims Management, LLC

International Industrial Contracting CorporationMr. Jonathan H Firsht35900 Mound RoadSterling Heights, MI 48310Self-Insured Carrier ID: 17045050Michigan Claim Service DBA The ASU Group

Iron County Medical Care FacilityMs. Robin Caron1523 US Highway 2Crystal Falls, MI 49920Self-Insured Carrier ID: 80001236Eagle Claims Management, LLC

John E. Green Company Inc.Mr. John R Stelter220 Victor AvenueHighland Park, MI 48203Self-Insured Carrier ID: 36070127CompOne Administrators, Inc.

Kalamazoo CountyMs. Kristine Cunningham201 W. Kalamazoo AvenueKalamazoo, MI 49007Self-Insured Carrier ID: 99900039York Risk Services Group, Inc.

Kalamazoo Public SchoolsMr. Daniel L Emmons1220 Howard StreetKalamazoo, MI 49008Self-Insured Carrier ID: 82000139Eagle Claims Management, LLC

Kelly Services, Inc.Mr. Gary A Pearce999 West Big Beaver RoadTroy, MI 48084Self-Insured Carrier ID: 73039449ESIS, Inc.

Key Plastics L.L.C.Mr. Kevin Koshowsky19575 Victor Parkway Suite 400Livonia, MI 48152Self-Insured Carrier ID: 33085220Comprehensive Risk Services, Inc.

Knape & Vogt Manufacturing CompanyMr. Nathan R VanRyn2700 Oak Industrial Drive NEGrand Rapids, MI 49505Self-Insured Carrier ID: 25048162CompOne Administrators, Inc.

Kroger Co. (The)an Ohio Corporation, dba Michigan DairyMr. Nathan Fraley1014 Vine St.8th FloorCincinnati, OH 45202Self-Insured Carrier ID: 54021957Sedgwick Claims Management Services, Inc.

L & L Products, Inc.Ms. Susan R Deeb160 McLean DriveRomeo, MI 48065Self-Insured Carrier ID: 30013450York Risk Services Group, Inc.

L'Anse Creuse Public SchoolsMs. Rochelle Gauthier24076 F.V. Pankow BlvdClinton Township, MI 48036Self-Insured Carrier ID: 82000450Eagle Claims Management, LLC

L. Perrigo CompanyMs. Devon Morgan515 Eastern AvenueAllegan, MI 49010Self-Insured Carrier ID: 28091100Michigan Claim Service DBA The ASU Group

12/26/2017 12:04:30 PM



La-Z-Boy, IncorporatedMr. Greg A BrinksOne La-Z-Boy DriveMonroe, MI 48162Self-Insured Carrier ID: 25055577Sedgwick Claims Management Services, Inc.

Lacks Enterprises, Inc.Mr. Jim Green5460 Cascade Road SEGrand Rapids, MI 49546Self-Insured Carrier ID: 30036101York Risk Services Group, Inc.

Lake Orion Community SchoolsMs. Laura Wernette315 North Lapeer StreetLake Orion, MI 48362Self-Insured Carrier ID: 82001463York Risk Services Group, Inc.

Lake Shore Public SchoolsDr. Joseph DiPonio28850 Harper AvenueSt. Clair Shores, MI 48081Self-Insured Carrier ID: 82000003CompOne Administrators, Inc.

Lake Superior State UniversityMs. Wendy Beach650 West Easterday AvenueSault Ste. Marie, MI 49783Self-Insured Carrier ID: 82000221Michigan Claim Service DBA The ASU Group

Lakeland Regional Health SystemMs. Rita Brandt1234 Napier AvenueSt. Joseph, MI 49085Self-Insured Carrier ID: 80000275ProSelect Insurance Company

Lapeer Community SchoolsMr. Mark Rajter250 Second StreetLapeer, MI 48446Self-Insured Carrier ID: 82000644York Risk Services Group, Inc.

Lefere Forge & Machine CompanyMs. Beth E Perez665 Hupp AvenueJackson, MI 49203Self-Insured Carrier ID: 34030986CompOne Administrators, Inc.

Lincoln Consolidated SchoolsMr. Sean R McNatt8970 Whittaker RoadYpsilanti, MI 48197Self-Insured Carrier ID: 82000481Broadspire Services, Inc.

Little Caesar Enterprises, Inc.Mr. Michael J Niehaus2211 Woodward AvenueDetroit, MI 48201-3400Self-Insured Carrier ID: 58011999Sedgwick Claims Management Services, Inc.

Livonia Public Schools School DistrictMs. Alison Smith15125 Farmington RoadLivonia, MI 48154-5474Self-Insured Carrier ID: 82000782Cannon Cochran Management Services, Inc.

Louisiana-Pacific CorporationMr. Guy BoileauSuite 1000805 SW BroadwayPortland, OR 97205-3344Self-Insured Carrier ID: 24048042Cannon Cochran Management Services, Inc.

Lowe's Home Centers, LLCMs. Tia W Schweikert1000 Lowe's Blvd.Mail Code A2ERMMooresville, NC 28117Self-Insured Carrier ID: 52005310Sedgwick Claims Management Services, Inc.

Lutheran Homes of Michigan Inc.dba Wellspring Lutheran ServicesMs. Amy E Storms4100 Pier North BlvdFlint, MI 48504Self-Insured Carrier ID: 80000819York Risk Services Group, Inc.

Mac Valves, Inc.Ms. Martha C Welch30569 Beck RoadP.O. Box 111Wixom, MI 48393Self-Insured Carrier ID: 35028135Alternative Service Concepts LLC

12/26/2017 12:04:30 PM



MacAllister Machinery Co.dba Michigan CATMr. Sosthenes Behn25000 Novi RoadNovi, MI 48375Self-Insured Carrier ID: 50090463York Risk Services Group, Inc.

Macy's Retail Holdings, Inc.Ms. Jean KollmannDirector, Risk Management7 West 7th StreetCincinnati, OH 45202Self-Insured Carrier ID: 53092700Self-Administered

Magnesium Products of America, Inc.Ms. Anna RameyHuman Resource Manager2001 Industrial DriveEaton Rapids, MI 48827Self-Insured Carrier ID: 33050123York Risk Services Group, Inc.

Manor Care, Inc.Ms. Lisa Jurski333 N. Summit StreetP.O. Box 10086Toledo, OH 43699-0086Self-Insured Carrier ID: 80001485Self-Administered

Manthei, Inc.Mr. Luke Manthei3996 Charlevoix AvePetoskey, MI 49770Self-Insured Carrier ID: 24058072Comprehensive Risk Services, Inc.

Marriott International, Inc.Mr. Steve HuyDept. 52/924.3610400 Fernwood RdBethesda, MD 20817Self-Insured Carrier ID: 70008085Self-Administered

Mary Free Bed Hospital & Rehab. CenterMs. Hayley Scott235 Wealthy Street, S.E.Grand Rapids, MI 49503-5299Self-Insured Carrier ID: 80001441Eagle Claims Management, LLC

Masco CorporationMs. Susan Campion17450 College ParkwayLivonia, MI 48152Self-Insured Carrier ID: 33013705Constitution State Services LLC

McLaren Health Care CorporationOne McLaren ParkwayMs. Sonja S Wilcox-Berriel

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

Mebus Manufacturing, Inc.Mr. Christopher Mebus30350 Ecorse RoadRomulus, MI 48174Self-Insured Carrier ID: 33093543York Risk Services Group, Inc.

Meijer Companies, Ltd.Ms. Sandy Calderon2929 Walker, N.W.Grand Rapids, MI 49544Self-Insured Carrier ID: 53090114Self-Administered

Melling Tool CompanyMr. Mark L Mandrick2620 Saradan DriveP.O. Box 1188Jackson, MI 49204Self-Insured Carrier ID: 35011038York Risk Services Group, Inc.

Memorial Hospital (The)dba Memorial HealthcareMr. Brian Long826 West KingOwosso, MI 48867Self-Insured Carrier ID: 80000178ProSelect Insurance Company

Meritor, Inc.Ms. Wendy Fair2135 W. Maple Rd.Troy, MI 48084Self-Insured Carrier ID: 37090462York Risk Services Group, Inc.

12/26/2017 12:04:30 PM



Metalworks, Inc.Ms. Bobbi L Spence902 E. Fourth St.Ludington, MI 49431Self-Insured Carrier ID: 34007390CompOne Administrators, Inc.

Metropolitan HospitalMs. Karrie CusterMetro Health Hospital5900 Byron Center Ave.Wyoming, MI 49519Self-Insured Carrier ID: 80000241Eagle Claims Management, LLC

MGM Resorts InternationalMs. Denise ParrMGM Administration Building71 E. Harmon AvenueLas Vegas, NV 89109Self-Insured Carrier ID: 70092555ESIS, Inc.

Michigan Catholic ConferenceMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 83000902Gallagher Bassett Services, Inc.

Michigan Conference Associationof Seventh Day AdventistsMs. Edie Ellis320 W. St. Joseph StreetP.O. Box 24187Lansing, MI 48909Self-Insured Carrier ID: 86012333Eagle Claims Management, LLC

Michigan Paving & Materials CompanyMs. Kelley Grant2575 Haggerty Rd. Suite 100Canton, MI 48818Self-Insured Carrier ID: 17091566Helmsman Management Services, LLC

Michigan State UniversityMs. Renee RivardSuite 1401407 S. HarrisonEast Lansing, MI 48823Self-Insured Carrier ID: 82000033Self-Administered

Michigan Sugar CompanyMs. Cheryl Ridenour122 Uptown Drive, Suite 300Bay City, MI 48708Self-Insured Carrier ID: 20016773York Risk Services Group, Inc.

Michigan Technological UniversityMs. Renee L Hiller1400 Townsend DriveHoughton, MI 49931Self-Insured Carrier ID: 82000432York Risk Services Group, Inc.

MidMichigan HealthMr. Victor Morgan4000 Wellness DriveMidland, MI 48670Self-Insured Carrier ID: 80000556ProSelect Insurance Company

MNP CorporationMs. Loretta DickeyP.O. Box 18900244225 Utica RoadUtica, MI 48318-9002Self-Insured Carrier ID: 34023050CompOne Administrators, Inc.

Mobis North America LLCMrs. Maizie Perez6401 W. Fort StDetroit, MI 48209Self-Insured Carrier ID: 37091596Mackinaw Administrators, LLC

Monroe County Road CommissionMs. Camden Regis840 South Telegraph RoadMonroe, MI 48161Self-Insured Carrier ID: 99900258CompOne Administrators, Inc.

Monroe Public SchoolsMrs. Katherine Eighmey1275 North Macomb StreetP.O. Box 733Monroe, MI 48162Self-Insured Carrier ID: 82000558York Risk Services Group, Inc.

12/26/2017 12:04:30 PM



Morbark, LLCHR DirectorMr. Brian Pickelman8507 S. Winn RoadWinn, MI 48896Self-Insured Carrier ID: 39041122Eagle Claims Management, LLC

Mot Allev Enterprises, LCdba Hubert DistributorsMr. Thomas Vella1200 AuburnPontiac, MI 48342Self-Insured Carrier ID: 51091463York Risk Services Group, Inc.

Munson Health CareMr. Jeff Rose1105 Sixth StreetTraverse City, MI 49684-2386Self-Insured Carrier ID: 80000128ProSelect Insurance Company

Newcor, Inc.Mr. Scott Wright715 South Blvd E.Suite 101Rochester Hills, MI 48307Self-Insured Carrier ID: 35009763Alternative Service Concepts LLC

NewPage Corporation c/o Verso CorporationMr. Craig Brooks6775 Lenox Center CourtMemphis, TN 38115Self-Insured Carrier ID: 26016995Sedgwick Claims Management Services, Inc.

Nexteer Automotive CorporationMs. Lori A Grunow3900 E. Holland RoadSaginaw, MI 48601-9494Self-Insured Carrier ID: 55092405Sedgwick Claims Management Services, Inc.

none

, -- 48226Self-Insured Carrier ID: No Service Company

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

North Ottawa Community HospitalMr. Mark Gross1309 Sheldon RoadGrand Haven, MI 49417Self-Insured Carrier ID: 80001270ProSelect Insurance Company

Northern Michigan UniversityMs. Kristen I BjorneHuman Resources - Northern MI University1401 Presque IsleMarquette, MI 49855Self-Insured Carrier ID: 82001552Comprehensive Risk Services, Inc.

NYX, LLCMr. Mark Greer36111 SchoolcraftLivonia, MI 48150Self-Insured Carrier ID: 30012991York Risk Services Group, Inc.

O S F Healthcare SystemDBA St. Francis HospitalMs. Amanda Lowry800 N.E. Glen Oak AvenuePeoria, IL 61603Self-Insured Carrier ID: 80000625ProSelect Insurance Company

Oakland Community CollegeMs. Margaret Carroll2480 Opdyke RoadBloomfield Hills, MI 48304Self-Insured Carrier ID: 82001863Broadspire Services, Inc.

Oakland UniversityMr. Kevin Venet371 Wilson Blvd.Rochester, MI 48309-4486Self-Insured Carrier ID: 82000063Michigan Claim Service DBA The ASU Group

12/26/2017 12:04:30 PM



ODL, Inc.Ms. Cheri Durant215 E. RooseveltZeeland, MI 49464Self-Insured Carrier ID: 24067700CompOne Administrators, Inc.

Ottawa CountyMs. Marcie VerBeekRoom 35912220 Fillmore StreetWest Olive, MI 49460Self-Insured Carrier ID: 99900270York Risk Services Group, Inc.

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

P G P CorporationMr. Paul Michael Voss7925 Beech Daly RoadTaylor, MI 48180Self-Insured Carrier ID: 33016904York Risk Services Group, Inc.

Parker Hannifin CorporationMr. Curt Gross6035 Parkland BoulevardCleveland, OH 44124-4141Self-Insured Carrier ID: 34091478Underwriters Safety & Claims Inc.

Perfection Bakeries, Inc. DBA Aunt MilliesMr. George Long350 Pearl StreetFort Wayne, IN 46802Self-Insured Carrier ID: 20030330Michigan Claim Service DBA The ASU Group

Petitpren, Inc.Ms. Jerri L Baker44500 GroesbeckClinton Township, MI 48036-1111Self-Insured Carrier ID: 51038082Eagle Claims Management, LLC

Pilkington North America, Inc.Mrs. Elizabeth Feltman811 Madison Ave.Toledo, OH 43604Self-Insured Carrier ID: 28090210Sedgwick Claims Management Services, Inc.

Pilot Travel Centers, LLCMr. Bill Beuchat5508 Lonas RoadP.O. Box 10146Knoxville, TN 37939Self-Insured Carrier ID: 55092185Self-Administered

Pine Rest Christian Mental Health ServicesMs. Veonica York300 - 68th Street, S.E.P.O. Box 165Grand Rapids, MI 49508Self-Insured Carrier ID: 80000650Eagle Claims Management, LLC

Pinecrest Medical Care FacilityMrs. Darlene SmithN15995 Main StreetP.O. Box 603Powers, MI 49874-0603Self-Insured Carrier ID: 80000655York Risk Services Group, Inc.

Plymouth-Canton Community SchoolsMrs. Dawn Schaller454 South Harvey StreetPlymouth, MI 48170Self-Insured Carrier ID: 82000982Cannon Cochran Management Services, Inc.

Port Huron Area School DistrictMs. Katherine Peternel2720 Riverside DrivePort Huron, MI 48061-5013Self-Insured Carrier ID: 82000074York Risk Services Group, Inc.

Porter Hills Presbyterian VillageMs. Kim Hoppe4450 Cascade Road, Suite 200Grand Rapids, MI 49546Self-Insured Carrier ID: 80001341Eagle Claims Management, LLC

12/26/2017 12:04:30 PM



Pridgeon & Clay, Inc.Ms. Therese Labenz50 Cottage Grove, S.W.Grand Rapids, MI 49507Self-Insured Carrier ID: 35096648Eagle Claims Management, LLC

Procter & Gamble Distributing LLC (The)Ms. Terri Donahue6300 Center Hill AvenueBox 112Cincinnati, OH 45224Self-Insured Carrier ID: 26025284Sedgwick Claims Management Services, Inc.

ProMedica Health SystemMs. Heather Allred100 Madison - MSC-S29932Toledo, OH 43604Self-Insured Carrier ID: 80000846Eagle Claims Management, LLC

PTM CorporationMr. John Tucker6560 Bethuy RdFair Haven, MI 48023Self-Insured Carrier ID: 33014678Eagle Claims Management, LLC

Quality Dairy CompanyMs. Elizabeth Goeckel111 W. Mt. Hope AvenueLansing, MI 48910Self-Insured Carrier ID: 54021933CompOne Administrators, Inc.

Quality Metalcraft, Inc.Mr. Matthew Pulliam33355 GlendaleLivonia, MI 48150Self-Insured Carrier ID: 33000803York Risk Services Group, Inc.

Quality Temporary Services, Inc.dba Qualified StaffingMs. Susan ChurchRisk Manager5361 Gateway Centre, Suite AFlint, MI 48507Self-Insured Carrier ID: 73026025CompOne Administrators, Inc.

Redford Union Schools-District #1Mr. Gregory R McIntyre17715 BradyRedford, MI 48240Self-Insured Carrier ID: 82001482Eagle Claims Management, LLC

Regents of the University of MI (The)Mr. G. Paul MoggachArgus II Building400 South Fourth StreetAnn Arbor, MI 48103-4816Self-Insured Carrier ID: 82000581Self-Administered

Road Commission for Oakland CountyMr. Drew Dunsky31001 Lahser RoadBeverly Hills, MI 48025Self-Insured Carrier ID: 99900263Mackinaw Administrators, LLC

Rochester Community SchoolsMrs. Kristine Davis501 West University DriveRochester, MI 48307Self-Insured Carrier ID: 82000663Cannon Cochran Management Services, Inc.

Roman Catholic Archdiocese of Detroitand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000200Gallagher Bassett Services, Inc.

Roman Catholic Diocese of Gaylordand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000600Gallagher Bassett Services, Inc.

Roman Catholic Diocese of Grand Rapidsand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000700Gallagher Bassett Services, Inc.

12/26/2017 12:04:30 PM



Roman Catholic Diocese of Kalamazooand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000400Gallagher Bassett Services, Inc.

Roman Catholic Diocese of Lansingand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000300Gallagher Bassett Services, Inc.

Roman Catholic Diocese of Marquetteand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000900Gallagher Bassett Services, Inc.

Roman Catholic Diocese of Saginawand all related entitiesMr. Vincent P Andrews510 South Capitol AvenueLansing, MI 48933Self-Insured Carrier ID: 86000500Gallagher Bassett Services, Inc.

Romeo Community Schools School DistrictMs. Vicki Laseke316 North Main StreetRomeo, MI 48065Self-Insured Carrier ID: 82001350York Risk Services Group, Inc.

Royal Technologies CorporationMr. Kirk Lambers3765 QuincyHudsonville, MI 49426Self-Insured Carrier ID: 30012045Eagle Claims Management, LLC

Rudolph/Libbe Companies Inc.Ms. Denise Honsberger6494 Latcha RoadWalbridge, OH 43465Self-Insured Carrier ID: 15065900Mackinaw Administrators, LLC

Ryder System, Inc.c/o Aon Global Risk ConsultingMr. Jared CarlisleAttn: Jared Carlisle5600 West 83rd Street, Suite 1100Minneapolis, MN 55437Self-Insured Carrier ID: 42056445Self-Administered

S. Abraham & Sons Inc.Mr. John ReinkeP.O. Box 17684001 Three Mile Road NWGrand Rapids, MI 49501-1768Self-Insured Carrier ID: 59063737York Risk Services Group, Inc.

Samaritasdba Lutheran Social Services of MichiganMs. Cyndie Szczur8131 East Jefferson AveDetroit, MI 48214Self-Insured Carrier ID: 80066082Michigan Claim Service DBA The ASU Group

School Dist. of the City of BirminghamMr. Dean Niforos31301 Evergreen RoadHuman ResourcesBeverly Hills, MI 48025Self-Insured Carrier ID: 82000563Broadspire Services, Inc.

School District of the City of DearbornMr. Thomas S Wall18700 AudetteDearborn, MI 48124Self-Insured Carrier ID: 82000182York Risk Services Group, Inc.

School District of the City of FlintMs. Jorgina Rubin923 East Kearsley StreetFlint, MI 48503-1900Self-Insured Carrier ID: 82000125York Risk Services Group, Inc.

School District of the City of PontiacMr. Michael Emerson47200 Woodward AvenuePontiac, MI 48342Self-Insured Carrier ID: 82000163Cannon Cochran Management Services, Inc.

12/26/2017 12:04:30 PM



School District of the City of WyandotteMr. Kenneth Laub639 Oak StreetWyandotte, MI 48192Self-Insured Carrier ID: 82000682Mackinaw Administrators, LLC

Schoolcraft CollegeMs. Brenda K Leavens18600 Haggerty RoadLivonia, MI 48152-2696Self-Insured Carrier ID: 82002082York Risk Services Group, Inc.

Schreiber CorporationMr. Brian R Moore29945 Beck Rd.Wixom, MI 48393Self-Insured Carrier ID: 17091663Mackinaw Administrators, LLC

SEMCO Energy, Inc.Mr. Richard W Straney1411 Third Street, Suite AP.O. Box 5004Port Huron, MI 48061-5004Self-Insured Carrier ID: 49092074York Risk Services Group, Inc.

Sherriff-Goslin CompanyMr. William Ticknor10 Avenue CBattle Creek, MI 49037Self-Insured Carrier ID: 17005000CompOne Administrators, Inc.

Sherwin-Williams CompanyMr. Anthony J Colangelo101 Prospect Avenue N.W.Cleveland, OH 44115Self-Insured Carrier ID: 28087088Helmsman Management Services, LLC

Shiawassee CountyMs. Patricia A FitnichSurbeck Building201 North Shiawassee StreetCorunna, MI 48817Self-Insured Carrier ID: 99900078Broadspire Services, Inc.

Sodecia USA Automotive Corp.Ms. Sheryl McGowan24331 SherwoodCenter Line, MI 48015-1060Self-Insured Carrier ID: 34002210York Risk Services Group, Inc.

Spartan Motors, Inc.Mr. Robert McCallum1541 Reynolds RoadCharlotte, MI 48813Self-Insured Carrier ID: 37009823Constitution State Services LLC

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

Spectrum Health SystemMr. Richard P MieskowskiSpectrum Health Human Resources100 Michigan NE Mail Code 108Grand Rapids, MI 49503Self-Insured Carrier ID: 80000941ProSelect Insurance Company

SPX CorporationMs. Carol Brocci13320-A Ballantyne Corporate PlaceCharlotte, NC 28277Self-Insured Carrier ID: 37090204Sedgwick Claims Management Services, Inc.

State of MichiganOffice of the State Employer, Employee Health Mgmt.Ms. Cheryl SchmittdielCapital Commons Ctr., 4th Floor400 S. Pine StreetLansing, MI 48933Self-Insured Carrier ID: 99904433York Risk Services Group, Inc.

Steelcase Inc.Ms. Gina Amante901 44th S.E.P. O. Box 1967Grand Rapids, MI 49508Self-Insured Carrier ID: 33006641Sedgwick Claims Management Services, Inc.

12/26/2017 12:04:30 PM



Stryker CorporationMr. Steve F Jaeger2825 Airview BoulevardKalamazoo, MI 49002Self-Insured Carrier ID: 38041001Sedgwick Claims Management Services, Inc.

Sturgis Hospital, Inc.Ms. Mary Kay Schultz916 Myrtle AvenueSturgis, MI 49091Self-Insured Carrier ID: 80001375Eagle Claims Management, LLC

Suburban Mobility Auth. for Regional TransportationMr. Avery E GordonSuite 600535 GriswoldDetroit, MI 48226Self-Insured Carrier ID: 35034894Michigan Claim Service DBA The ASU Group

Summit Polymers, Inc.Mr. Timothy A Eccles6715 S. Sprinkle RoadPortage, MI 49002Self-Insured Carrier ID: 28090239Eagle Claims Management, LLC

Target Corporationc/o Aon Global Risk ConsultingMs. Laurene Dufault5600 W. 83rd St., Suite 1100Minneapolis, MN 55437Self-Insured Carrier ID: 53001952Sedgwick Claims Management Services, Inc.

Taylor School DistrictMr. Benjamin Williams23033 Northline RoadTaylor, MI 48180Self-Insured Carrier ID: 82000282Gallagher Bassett Services, Inc.

Textron Inc.Ms. Sarah WoodwardAon Global Risk Consulting5600 W. 83rd St., 8200 Tower, Suite 1100Minneapolis, MN 55437Self-Insured Carrier ID: 35013580Broadspire Services, Inc.

Thai Summit America CorporationMr. Jason Street1480 W. McPherson Park DriveHowell, MI 48843Self-Insured Carrier ID: 39013147York Risk Services Group, Inc.

Thor Industries, Inc.Mr. Les Thimlar601 E. Beardsley Ave.Elkhart, IN 46514Self-Insured Carrier ID: 37020804Cannon Cochran Management Services, Inc.

Tilden Mining Company L. C.Ms. Jennifer Frame200 Public SquareSuite 3300Cleveland, OH 44114Self-Insured Carrier ID: 10057085Sedgwick Claims Management Services, Inc.

Township of ClintonMr. William S Smith40700 Romeo Plank RoadClinton Township, MI 48038Self-Insured Carrier ID: 99900250York Risk Services Group, Inc.

Trinity Health-MichiganMs. Barbara Cook20555 Victor ParkwayLivonia, MI 48152Self-Insured Carrier ID: 80000163ESIS, Inc.

TrueBlue, Inc.Ms. Jennifer Smith1015 A StreetP.O. Box 2910Tacoma, WA 98401Self-Insured Carrier ID: 73013485ESIS, Inc.

Tyson Foods, Inc.Ms. Connie Downum2200 Don Tyson ParkwayP. O. Box 2020Springdale, AR 72762Self-Insured Carrier ID: 02469085Self-Administered

12/26/2017 12:04:30 PM



U.S. Farathane LLCMr. Jim Curtis, Jr.2700 High Meadow CircleAuburn Hills, MI 48236Self-Insured Carrier ID: 39040812Comprehensive Risk Services, Inc.

United Airlines, Inc.Ms. Maureen Zahnow233 S. Wacker Drive-HDQCIChicago, IL 60606Self-Insured Carrier ID: 41048000Sedgwick Claims Management Services, Inc.

United Jewish Foundation of Metropolitan DetroitMs. Dorothy Benyas6735 Telegraph RoadP.O. Box 2030Bloomfield Hills, MI 48303Self-Insured Carrier ID: 86011198CompOne Administrators, Inc.

United Methodist Retirement Communities, Inc.Ms. Michelle Baldwin Henderson805 West Middle StreetChelsea, MI 48118-1397Self-Insured Carrier ID: 80000642York Risk Services Group, Inc.

United States Gypsum CompanyMr. David M Carlsonc/o USG Corporation550 West Adams Street, Dept. 198Chicago, IL 60661-3676Self-Insured Carrier ID: 32091099Gallagher Bassett Services, Inc.

United States Steel CorporationDr. Mohannad Kusti600 Grant Street Room 1656Pittsburgh, PA 15219-2800Self-Insured Carrier ID: 33030718Broadspire Services, Inc.

USF Holland LLCMr. Greg Zinkiewiczc/o YRC Worldwide Inc.10990 Roe AvenueOverland Park, KS 66211Self-Insured Carrier ID: 42096114Sedgwick Claims Management Services, Inc.

Utica Community SchoolsMr. Michael Sturm11303 GreendaleSterling Heights, MI 48312Self-Insured Carrier ID: 82000750Broadspire Services, Inc.

Vail Rubber Works, Inc.Mr. Brian Nimtz521 Langley AvenueP.O. Box 64St. Joseph, MI 49085Self-Insured Carrier ID: 30072202Eagle Claims Management, LLC

VHS of Michigan, Inc.Ms. Tracelyn T WilsonUniversity Health Center4201 St. Antoine, Suite 5. D.6Detroit, MI 48201Self-Insured Carrier ID: 80012084Sedgwick Claims Management Services, Inc.

VR US Holdings, Inc. dba Mt. Brighton Ski AreaMs. Tracy Venter390 Interlocken CresentBroomfield, CO 80021Self-Insured Carrier ID: 67000300Gallagher Bassett Services, Inc.

W. A. Foote Memorial Hospital Inc. d/b/a Henry Ford Allegiance HealthMr. MaryBeth Morgan205 North East AvenueJackson, MI 49201Self-Insured Carrier ID: 80000999CompOne Administrators, Inc.

Warren Consolidated SchoolsMs. Sharon Irvine31300 Anita Drive - Administration Bldg.Warren, MI 48093Self-Insured Carrier ID: 82000150Broadspire Services, Inc.

Washtenaw Community CollegeMr. William Johnson4800 E Huron River DrAnn Arbor, MI 48105-4800Self-Insured Carrier ID: 82000881York Risk Services Group, Inc.

12/26/2017 12:04:30 PM



Washtenaw CountyMs. Monica Boote220 North MainP.O. Box 8645Ann Arbor, MI 48107Self-Insured Carrier ID: 99900081Michigan Claim Service DBA The ASU Group

Waterford School DistrictMr. James E BeaverSecurity & Risk Management1145 Tee Cee DriveWaterford, MI 48328Self-Insured Carrier ID: 82000263Meadowbrook, Inc., dba Meadowbrook Claims Service

Wayne County Airport AuthorityMs. Cheryl SmithMezzanine Level1 LC Smith Bldg. #603Detroit, MI 48242Self-Insured Carrier ID: 99901882Comprehensive Risk Services, Inc.

Wayne County Community College DistrictMr. Furquan Ahmed801 West Fort StreetDetroit, MI 48226Self-Insured Carrier ID: 82002182Broadspire Services, Inc.

Wayne State UniversityOffice of Risk Management Academic/Admin. Bldg.Ms. Angela M MossSuite 46225700 Cass AvenueDetroit, MI 48202Self-Insured Carrier ID: 82000082Self-Administered

Wayne Westland Community School DistrictMr. Jim Larson-Shidler36745 MarquetteWestland, MI 48185Self-Insured Carrier ID: 82001182Michigan Claim Service DBA The ASU Group

Western and Southern Life Insurance Company (The)Ms. Melissa Davis400 BroadwayCincinnati, OH 45202Self-Insured Carrier ID: 63074853Sedgwick Claims Management Services, Inc.

Western Michigan UniversityMrs. Laura WeberBusiness Services2080 Seibert Administration BuildingKalamazoo, MI 49008-5222Self-Insured Carrier ID: 82000039CompOne Administrators, Inc.

Weyerhaeuser CompanyMs. Susan LaPrairieWorkers' Compensation1785-B WeyerhaeuserVanceboro, NC 28586Self-Insured Carrier ID: 26091257Sedgwick Claims Management Services, Inc.

Whirlpool CorporationMr. Rafael V Silva2000 North M-63MD 3007Benton Harbor, MI 49022Self-Insured Carrier ID: 39036578Gallagher Bassett Services, Inc.

White Castle System, Inc.Ms. Melissa Harrison555 West Goodale StreetColumbus, OH 43215-1158Self-Insured Carrier ID: 58034085Broadspire Services, Inc.

Wirtz Manufacturing Co., Inc.Mr. Keith Lepla1105 24th StreetP.O. Box 5006Port Huron, MI 48061-5006Self-Insured Carrier ID: 30012799York Risk Services Group, Inc.

Wisconsin Electric Power CompanyMr. Paul W GlessnerRoom P378231 West Michigan StreetMilwaukee, WI 53203Self-Insured Carrier ID: 49092100Self-Administered

WM Limited Partnership-1998dba Wendys of MichiganMs. Megan Horrocks45 Ottawa Ave SWSuite 600Grand Rapids, MI 49503Self-Insured Carrier ID: 58077076Eagle Claims Management, LLC

12/26/2017 12:04:30 PM



Wolverine Packing CompanyMr. Brian Bartes2535 RivardDetroit, MI 48207Self-Insured Carrier ID: 20043617Comprehensive Risk Services, Inc.

Zehnder's of Frankenmuth, Inc.Ms. Martha Shelton730 S. Main StreetFrankenmuth, MI 48734Self-Insured Carrier ID: 58034765York Risk Services Group, Inc.

12/26/2017 12:04:30 PM



Documents

Self-Insured Programs 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: