Individual Self-Insured Employer List

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

A B F Freight System, Inc. Alro Steel Corporation Ms. Lynette Woodie Mr. Jim Norman 3801 Old Greenwood Road 3100 E. High Street P.O. Box 10048 P.O. Box 927 Fort Smith, AR 72917-0048 Jackson, MI 49204-0927 Self-Insured Carrier ID: 42090248 Self-Insured Carrier ID: 33047766 Self-Administered Parker Services, LLC Alticor Inc. A J M Packaging Corporation Ms. Judy Chavis Mr. Terry Jackson 7575 Fulton Street East Suite 100 Mail Code: 56-3T E-4111 Andover Road Ada, MI 49355-0001 Bloomfield Hills, MI 48302 Self-Insured Carrier ID: 59090441 Self-Insured Carrier ID: 26022282 Self-Administered Constitution State Services LLC A. D. Transport Express, Inc. American Electric Power Company, Inc. Mr. Gary A Percy Mr. Loyd Hudson 5601 Belleville Road 1 Riverside Plaza Canton, MI 48188 15th Floor IDM Center Self-Insured Carrier ID: 42091119 Columbus, OH 43215-2355 CompOne Administrators, Inc. Self-Insured Carrier ID: 49092102 Cannon Cochran Management Services, Inc. ABM Industries Incorporated American National Red Cross Mr. Chris Ridge Mr. Mark Sherman 4151 Ashford Dunwoody Road 431 18th St. NW Suite 600 Washington, DC 20006 Atlanta, GA 30319 Self-Insured Carrier ID: 80001585 Self-Insured Carrier ID: 30057710 Sedgwick Claims Management Services, Inc. ESIS, Inc. Andersons, Inc. (The) ADAC Plastics, Inc. Ms. Jan LaPlant Mr. Lucas McCotter P.O. Box 119 5690 Eagle Dr. 1947 Briarfield Blvd. Grand Rapids, MI 49512 Maumee, OH 43537 Self-Insured Carrier ID: 30043041 Self-Insured Carrier ID: 07032385 Eagle Claims Management, LLC ESIS, Inc. AKWEL CADILLAC USA, INC Andrews University Ms. Cindy Branch Ms. Darcy de Leon 603 West Seventh Street 4150 Administration Drive Cadillac, MI 49601 Human Resources Self-Insured Carrier ID: 39047135 Berrien Springs, MI 49104-0860 CompOne Administrators, Inc. Self-Insured Carrier ID: 82000011 CompOne Administrators, Inc. Allegan County Android Industries, LLC Board of Commissioners Ms. Tricia DeClercq Ms. Vickie Herzberg 2155 Executive Hills Blvd. 3283 - 122nd Avenue Auburn Hills, MI 48326 Allegan, MI 49010 Self-Insured Carrier ID: 39024123 Self-Insured Carrier ID: 99900203 Gallagher Bassett Services, Inc. Michigan Claim Service DBA The ASU Group

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Ann Arbor Area Transportation Authority Bay County Ms. LaTasha Thompson Ms. Tiffany Jerry 2700 S Industrial Hwy 515 Center Avenue Ann Arbor, MI 48104 Bay City, MI 48708 Self-Insured Carrier ID: 99022100 Self-Insured Carrier ID: 99900009 Eagle Claims Management, LLC York Risk Services Group, Inc.

Ann Arbor Public Schools Beaumont Health Mr. David Comsa Ms. Jennifer Harris 2555 S. State Street Beaumont Service Center - 433 5B Ann Arbor, MI 48104 26901 Beaumont Blvd Self-Insured Carrier ID: 82000181 Southfield, MI 48033 Broadspire Services, Inc. Self-Insured Carrier ID: 80000910 Sedgwick Claims Management Services, Inc. Asama Coldwater Manufacturing, Inc. Benteler Automotive Corporation Mr. David Sutherland Ms. Stacy Muehlheim 180 Asama Parkway 2650 N. Opdyke Rd; Suite B Coldwater, MI 49036 Auburn Hills, MI 48326 Self-Insured Carrier ID: 39017030 Self-Insured Carrier ID: 37058041 Eagle Claims Management, LLC CompOne Administrators, Inc.

Ascension Health Alliance Besser Company USA Ms. Molly Abshear Mr. Jason Rensberry 11775 Borman-Suite 102 801 Johnson Street P.O. Box 46944 Alpena, MI 49707 St. Louis, MO 63146-4134 Self-Insured Carrier ID: 14010942 Self-Insured Carrier ID: 80000101 Comprehensive Risk Services LLC Sedgwick Claims Management Services, Inc. AWI Holdings Inc. Birmingham Public Schools Mr. Keith Scott Mr. Dean Niforos 440 Kirtland S.W. 31301 Evergreen Road Grand Rapids, MI 49507 Human Resources Self-Insured Carrier ID: 50018741 Beverly Hills, MI 48025 Eagle Claims Management, LLC Self-Insured Carrier ID: 82000563 Michigan Claim Service DBA The ASU Group AZO Services, Inc. BISSELL Inc. Ms. Amanda Otto Mr. Michael D Sukenik 5300 Miller Road 2345 Walker Avenue, N.W. Kalamazoo, MI 49048 P.O. Box 1888 Self-Insured Carrier ID: 17007112 Walker, MI 49501 Eagle Claims Management, LLC Self-Insured Carrier ID: 35028220 Michigan Claim Service DBA The ASU Group Bay City Public Schools BJ's Wholesale Club, Inc Mrs. Jennifer Grigg Ms. Kristyn Sugrue 910 N. Walnut Street 25 Research Dr Bay City, MI 48706 Westborough, MA 01581 Self-Insured Carrier ID: 82000309 Self-Insured Carrier ID: 51017214 Eagle Claims Management, LLC Sedgwick Claims Management Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Bloomfield Hills School District Bronson Healthcare Group, Inc. Ms. Karen Healy Mr. David Mays 7273 Wing Lake Road 601 John Street Bloomfield Hills, MI 48301 Box G Self-Insured Carrier ID: 82000463 Kalamazoo, MI 49007 CompOne Administrators, Inc. Self-Insured Carrier ID: 80000839 ProSelect Insurance Company Blue Cross Blue Shield of Michigan Mutual Burr Oak Tool Inc. Insurance Company Mr. Andrew F Boyd Ms. Jamie Wire 405 W. South Street 600 E. Lafayette Sturgis, MI 49091 MC1801 Self-Insured Carrier ID: 35013675 Detroit, MI 48226 CompOne Administrators, Inc. Self-Insured Carrier ID: 80012082 CompOne Administrators, Inc. Cadillac Casting, Inc. Board of Water & Light Mr. Michael T Quibell of the City of Lansing 1500 4th Ave Mr. Richard R Peffley Cadillac, MI 49601 P.O. Box 13007 Self-Insured Carrier ID: 37004225 Lansing, MI 48901 CompOne Administrators, Inc. Self-Insured Carrier ID: 49059333 CompOne Administrators, Inc. Cadillac Products, Inc. Boldt Company (The) Mr. Roger K Williams Ms. Teri Whitman 5800 Crooks Road 2525 N. Roemer Rd. Troy, MI 48098 P.O. Box 419 Self-Insured Carrier ID: 52000798 Appleton, WI 54912-0419 Comprehensive Risk Services LLC Self-Insured Carrier ID: 15031001 Self-Administered Capital Area Transportation Authority Bouma Corporation (The) Ms. Marshea Brown Mr. Daniel DeRyke 4615 Tranter Street 4101 Roger B. Chaffee Memorial Blvd. SE Lansing, MI 48910 Grand Rapids, MI 49548 Self-Insured Carrier ID: 41046543 Self-Insured Carrier ID: 25042660 CompOne Administrators, Inc. Eagle Claims Management, LLC Carman-Ainsworth Community Schools Boyne USA, Inc. Mr. Russell Parks Mr. Edward Dembek G-3475 W. Court Street 3951 Charlevoix Ave. Flint, MI 48532 Petoskey, MI 49770 Self-Insured Carrier ID: 82000625 Self-Insured Carrier ID: 70087534 Eagle Claims Management, LLC Comprehensive Risk Services LLC Cascade Engineering, Inc. Mr. Joseph Maier Brembo North America, Inc. 3400 Innovation Ct. S.E. Mr. Daniel M Sandberg Grand Rapids, MI 49512 47765 Halyard Drive Self-Insured Carrier ID: 30044567 Plymouth, MI 48170 Eagle Claims Management, LLC Self-Insured Carrier ID: 39009915 Mackinaw Administrators, LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Cassens Corp Chelsea Milling Company Mr. William Molter Mr. John Powers 145 North Kansas St. 201 West North Street Edwardsville, IL 62025 Chelsea, MI 48118 Self-Insured Carrier ID: 42095685 Self-Insured Carrier ID: 20044114 Broadspire Services, Inc. York Risk Services Group, Inc.

Center Line Public Schools Chippewa County War Memorial Hospital, Inc Mr. Charles Roddis Ms. Susan Sliger 26400 Arsenal Avenue 500 Osborn Boulevard Center Line, MI 48015 Sault Ste. Marie, MI 49783 Self-Insured Carrier ID: 82000050 Self-Insured Carrier ID: 80000317 Michigan Claim Service DBA The ASU Group Eagle Claims Management, LLC

Central Michigan University Chippewa Valley Schools Ms. Kristen Skiver Mr. Scott Sederlund 109 Rowe Hall 19120 Cass Mt. Pleasant, MI 48859 Clinton Township, MI 48038 Self-Insured Carrier ID: 82000037 Self-Insured Carrier ID: 82001250 Eagle Claims Management, LLC Michigan Claim Service DBA The ASU Group

Challenge Mfg. Holdings, Inc. City of Ann Arbor Mr. Mike Rodgers Mr. David McNulty 3200 Fruit Ridge Avenue NW 301 E. Huron Walker, MI 49544 Ann Arbor, MI 48107-8647 Self-Insured Carrier ID: 34097018 Self-Insured Carrier ID: 99900181 Constitution State Services LLC CompOne Administrators, Inc.

Charter Township of Canton City of Battle Creek Ms. Kerreen Conley Ms. Michelle Hull 1150 S. Canton Center Road 10 N. Division Street Canton, MI 48188 Battle Creek, MI 49014 Self-Insured Carrier ID: 99900001 Self-Insured Carrier ID: 99900113 Eagle Claims Management, LLC Eagle Claims Management, LLC

Charter Township of Shelby City of Bay City Ms. Lisa Suida Mr. Edward Bromberg 52700 Van Dyke Avenue Room 305 Shelby Township, MI 48316 301 Washington Avenue Self-Insured Carrier ID: 99900475 Bay City, MI 48708 York Risk Services Group, Inc. Self-Insured Carrier ID: 99900209 Mackinaw Administrators, LLC Charter Township of Waterford City of Dearborn Ms. Margaret Birch Ms. Licia A Yangouyian Treasurer's Office 16901 Michigan Avenue 5200 Civic Center Drive Suite 14 Waterford, MI 48329-3773 Dearborn, MI 48126-2967 Self-Insured Carrier ID: 99901063 Self-Insured Carrier ID: 99900182 Comprehensive Risk Services LLC CompOne Administrators, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

City of Dearborn Heights City of Grand Rapids Ms. Linda Vance Mr. Craig Coulson 6045 Fenton Risk Management Office Dearborn Heights, MI 48127 300 Monroe Ave., NW Self-Insured Carrier ID: 99901682 Grand Rapids, MI 49503 Broadspire Services, Inc. Self-Insured Carrier ID: 99900141 CompOne Administrators, Inc. City of Detroit City of Grosse Pointe Farms Mr. Donald D Settles Mr. Shane L Reeside Coleman A. Young Municipal Center 90 Kerby Road 2 Woodward Avenue, Suite 801 Grosse Pointe Farms, MI 48236 Detroit, MI 48226 Self-Insured Carrier ID: 99901782 Self-Insured Carrier ID: 99900482 CompOne Administrators, Inc. CompOne Administrators, Inc. City of East Lansing City of Grosse Pointe Woods Ms. Jill Feldpausch The Shawn Murphy 410 Abbot Road 20025 Mack Plaza East Lansing, MI 48823 Grosse Pointe Woods, MI 48236 Self-Insured Carrier ID: 99900233 Self-Insured Carrier ID: 99900663 CompOne Administrators, Inc. York Risk Services Group, Inc.

City of Escanaba City of Hamtramck Ms. Kim Gustafson Ms. Nicole Bierie 410 Ludington Street 3401 Evaline P.O. Box 948 Hamtramck, MI 48212 Escanaba, MI 49829 Self-Insured Carrier ID: 99900282 Self-Insured Carrier ID: 99900121 Eagle Claims Management, LLC Comprehensive Risk Services LLC City of Ferndale City of Inkster Mr. Daniel Jacey Ms. Dai-Jaya Rose 300 E. Nine Mile 26215 Trowbridge St Ferndale, MI 48220-1797 Inkster, MI 48141 Self-Insured Carrier ID: 99900763 Self-Insured Carrier ID: 99901382 Broadspire Services, Inc. CompOne Administrators, Inc.

City of Flint City of Jackson Mr. Eddie Smith Mr. Jonathan Greene Human Resources and Labor Relations Dept. 161 W. Michigan Avenue, 6th Floor 1101 S. Saginaw Street, RM #9 Jackson, MI 49201 Flint, MI 48502 Self-Insured Carrier ID: 99900138 Self-Insured Carrier ID: 99900125 Broadspire Services, Inc. Eagle Claims Management, LLC City of Kalamazoo City of Garden City Ms. Melissa Fuller Ms. Martha Griggs 241 W. South Street 6000 Middlebelt Road Kalamazoo, MI 49007-4796 Garden City, MI 48135 Self-Insured Carrier ID: 99900139 Self-Insured Carrier ID: 99901001 Eagle Claims Management, LLC Broadspire Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

City of Lansing City of Royal Oak Ms. Kathy Woodman Ms. Linda Simonsen 8th Floor City Hall 203 S. Troy Street 124 W. Michigan Avenue P.O. Box 64 Lansing, MI 48933 Royal Oak, MI 48068-0064 Self-Insured Carrier ID: 99900133 Self-Insured Carrier ID: 99900463 CompOne Administrators, Inc. Sedgwick Claims Management Services, Inc. City of Livonia City of Saginaw Mr. Michael T Slater Ms. Lisa K Crook 33000 Civic Center Drive Room 202 Livonia, MI 48154 1315 South Washington Avenue Self-Insured Carrier ID: 99900982 Saginaw, MI 48601 Michigan Claim Service DBA The ASU Group Self-Insured Carrier ID: 99900173 Comprehensive Risk Services LLC City of Madison Heights City of Saint Clair Shores Ms. Amy Misczak Mr. Laura L Stowell 300 W. Thirteen Mile Rd. 27600 Jefferson Avenue Madison Heights, MI 48071 St. Clair Shores, MI 48081 Self-Insured Carrier ID: 99901263 Self-Insured Carrier ID: 99900150 York Risk Services Group, Inc. York Risk Services Group, Inc.

City of Monroe City of Southfield Ms. Peggy A Howard Garnett Carr 120 East First Street 26000 Evergreen Road Monroe, MI 48161 P.O. Box 2055 Self-Insured Carrier ID: 99900158 Southfield, MI 48037-2055 Michigan Claim Service DBA The ASU Group Self-Insured Carrier ID: 99900963 Cannon Cochran Management Services, Inc. City of Port Huron City of Southgate Ms. Julie A Davis Mr. David Angileri 100 McMorran Boulevard 14400 Dix Toledo Road Room 201 Southgate, MI 48195 Port Huron, MI 48060 Self-Insured Carrier ID: 99901582 Self-Insured Carrier ID: 99900174 Broadspire Services, Inc. Comprehensive Risk Services LLC City of Portage City of Sterling Heights Ms. Tracy Schmitt Ms. Kate Baldwin 7900 South Westnedge Ave 40555 Utica Road Portage, MI 49002 P.O. Box 8009 Self-Insured Carrier ID: 99900339 Sterling Heights, MI 48311-8009 Eagle Claims Management, LLC Self-Insured Carrier ID: 99900750 CompOne Administrators, Inc. City of Roseville City of Taylor Mr. Paul VanDamme Ms. Sheila Gorski-Schulte 29777 Gratiot 23555 Goddard Road P.O. Box 290 Taylor, MI 48180 Roseville, MI 48066 Self-Insured Carrier ID: 99900782 Self-Insured Carrier ID: 99900850 CompOne Administrators, Inc. York Risk Services Group, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

City of Warren Cleveland-Cliffs Steel Corporation Mr. George L Dimas Mr. David Weber One City Square 9227 Centre Pointe Drive Suite 410 West Chester, OH 45069 Warren, MI 48093 Self-Insured Carrier ID: 33080791 Self-Insured Carrier ID: 99901150 CompOne Administrators, Inc. CompOne Administrators, Inc. City of Wayne Cold Heading Co. Ms. Alyse Leslie Mr. Daniel Morrell 3355 South Wayne Road 21777 Hoover Road Wayne, MI 48184 Warren, MI 48089 Self-Insured Carrier ID: 99901282 Self-Insured Carrier ID: 33033782 Michigan Claim Service DBA The ASU Group Mackinaw Administrators, LLC

City of Westland Comau LLC Ms. Stephani Field Ms. Lisa Cormier 36300 Warren Road 21000 Telegraph Road Westland, MI 48185-1214 Southfield, MI 48033 Self-Insured Carrier ID: 99901082 Self-Insured Carrier ID: 34040999 Alternative Service Concepts LLC dba Davies Claims Maxcis, Inc. Solutions Consumers Energy Company City of Wyandotte Shaun M Johnson Mr. Todd A Drysdale One Energy Plaza 3200 Biddle Avenue EP12-241 Wyandotte, MI 48192 Jackson, MI 49201 Self-Insured Carrier ID: 99900682 Self-Insured Carrier ID: 48092036 Broadspire Services, Inc. Self-Administered City of Wyoming Contractors Steel Company Ms. Kate Balfoort Mr. Mike Greco 1155 - 28th Street S.W. 1400 16th Street P.O. Box 905 Suite 250 Wyoming, MI 49509 Oak Brook, IL 60523 Self-Insured Carrier ID: 99900341 Self-Insured Carrier ID: 50070854 CompOne Administrators, Inc. Mackinaw Administrators, LLC Clark Retirement Community, Inc. Costco Wholesale Corporation Ms. Kelly Timmer Ms. Cindy Schmertzler 1551 Franklin Street SE 999 Lake Drive Grand Rapids, MI 49506-3331 Issaquah, WA 98027 Self-Insured Carrier ID: 80000341 Self-Insured Carrier ID: 53091300 Eagle Claims Management, LLC Helmsman Management Services, LLC

Cleveland-Cliffs Iron Company (The) County of Berrien Ms. Shelly Hillyer Mr. Brian Dissette 200 Public Square Berrien County Administration Suite 3300 701 Main Street Cleveland, OH 44114 St. Joseph, MI 49085 Self-Insured Carrier ID: 10059318 Self-Insured Carrier ID: 99900011 Sedgwick Claims Management Services, Inc. Broadspire Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

County of Calhoun County of Macomb Ms. Kim Archambault Mr. John P Anderson 315 W. Green Street Finance-Risk & Insurance Marshall, MI 49068 120 N. Main Street Self-Insured Carrier ID: 99900013 Mt. Clemens, MI 48043 Comprehensive Risk Services LLC Self-Insured Carrier ID: 99900050 Comprehensive Risk Services LLC County of Eaton County of Mason Mr. John Fuentes Mr. Fabian Knizacky 1045 Independence Boulevard 304 E. Ludington Avenue Charlotte, MI 48813 Ludington, MI 49431 Self-Insured Carrier ID: 99900023 Self-Insured Carrier ID: 99900101 Michigan Claim Service DBA The ASU Group Eagle Claims Management, LLC

County of Hillsdale County of Midland Ms. Stephenie Kyser Mr. Craig Maxwell County Office Building 220 W. Ellsworth Street 33 McCollum St., Room 205 Midland, MI 48640-5194 Hillsdale, MI 49242 Self-Insured Carrier ID: 99900056 Self-Insured Carrier ID: 99900130 Eagle Claims Management, LLC Broadspire Services, Inc. County of Huron County of Monroe Ms. Debra McCollum Mr. Michael Bosanac P.O. Box 69 125 East Second Street Bad Axe, MI 48413-0069 Monroe, MI 48161 Self-Insured Carrier ID: 99900032 Self-Insured Carrier ID: 99900058 York Risk Services Group, Inc. Michigan Claim Service DBA The ASU Group

County of Jackson County of Muskegon Mr. Michael Karabetsos Ms. Kristen N Wade 120 West Michigan Avenue 97 E. Apple Ave., Suite 110 Jackson, MI 49201 Muskegon, MI 49442 Self-Insured Carrier ID: 99900038 Self-Insured Carrier ID: 99900061 Eagle Claims Management, LLC Michigan Claim Service DBA The ASU Group

County of Kent County of Oakland (The), a Michigan Constitutional Ms. Stephanie Lee Corporation Fiscal Services, County Admin. Bldg. Mr. Dean J Schultz 300 Monroe Avenue, N.W. Risk Management & Safety Grand Rapids, MI 49503 2100 Pontiac Lake Rd. Self-Insured Carrier ID: 99900041 Waterford, MI 48328 ProSelect Insurance Company Self-Insured Carrier ID: 99900063 County of Lapeer York Risk Services Group, Inc. Ms. Jacqueline Arnold County of Saginaw 255 Clay Street Mr. Robert Belleman Suite 301 111 South Michigan Avenue Lapeer, MI 48446 Saginaw, MI 48602 Self-Insured Carrier ID: 99900044 Self-Insured Carrier ID: 99900073 Comprehensive Risk Services LLC Eagle Claims Management, LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

County of Saint Clair Dart Container Corporation of California dba DTX, Ms. Kimberly Woolman Inc. Suite 206 c/o Aon Global Risk Consulting 200 Grand River Mr. Jared Carlisle Port Huron, MI 48060 5600 West 83rd Street Self-Insured Carrier ID: 99900374 Suite 1100 Mackinaw Administrators, LLC Minneapolis, MN 55437 County of Wayne Self-Insured Carrier ID: 30104200 Ms. Shirley Priskorn Helmsman Management Services, LLC 500 Griswold, 14th Floor Dart Container of Michigan LLC Detroit, MI 48226 C/O Aon Global Risk Consulting Self-Insured Carrier ID: 99900082 Mr. Jared Carlisle Mackinaw Administrators, LLC 5600 West 83rd Street Suite 1100 Covenant Medical Center, Inc. dba Covenant Minneapolis, MN 55437 Healthcare Self-Insured Carrier ID: 30099099 Mr. Tyler Danek Helmsman Management Services, LLC 1447 N. Harrison Dean Transportation Inc. Saginaw, MI 48602 Mr. Eric J Toomey Self-Insured Carrier ID: 80000573 4812 Aurelius Rd ProSelect Insurance Company Lansing, MI 48910 Cranbrook Educational Community, Inc. Self-Insured Carrier ID: 41002033 Ms. Beth Beadle Eagle Claims Management, LLC 39221 N. Woodward Avenue P.O. Box 801 Delaco Steel Corporation Bloomfield Hills, MI 48303-0801 Mr. Dave Trela Self-Insured Carrier ID: 82003063 8111 Tireman Dr CompOne Administrators, Inc. Dearborn, MI 48126 Creative Foam Corporation Self-Insured Carrier ID: 50019330 Mr. Eric Beckett CompOne Administrators, Inc. 300 N. Alloy Drive Fenton, MI 48430 Detroit Diesel Corporation Self-Insured Carrier ID: 30049025 Ms. Lindsay Boeckman CompOne Administrators, Inc. Daimler Trucks North America LLC 4555 North Channel Ave., 6th Fl Risk/Insurance Dana Incorporated Portland, OR 97217 Ms. Amy Hankins Self-Insured Carrier ID: 37055082 3939 Technology Drive Sedgwick Claims Management Services, Inc. P.O. Box 537 Detroit Entertainment, L.L.C. Toledo, OH 43537 Mr. Bruce R Dall Self-Insured Carrier ID: 37090323 2901 Grand River Sedgwick Claims Management Services, Inc. Detroit, MI 48201 Daniel L. Jacob and Co., Inc. Self-Insured Carrier ID: 70037700 Mr. Matthew P Gleeson CompOne Administrators, Inc. 2403 East High Street Jackson, MI 49203-3421 Detroit Public Schools Community District Self-Insured Carrier ID: 51017338 Office of Risk Management Eagle Claims Management, LLC Mr. Douglas Gniewek 3011 W. Grand Blvd Fisher Bldg Ste 1101A Detroit, MI 48202 Self-Insured Carrier ID: 82000482 York Risk Services Group, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Dexter Fastener Technologies, Inc. Edw. C. Levy Co. Mr. Tom Derderian Mr. Don Liepa 2110 Bishop Circle East 9300 Dix Avenue Dexter, MI 48130 Dearborn, MI 48120 Self-Insured Carrier ID: 34016440 Self-Insured Carrier ID: 15052604 Eagle Claims Management, LLC Michigan Claim Service DBA The ASU Group

Dickinson County Healthcare System Edward W. Sparrow Hospital Association Mr. Brian Donahue Mr. Kurt Batteen 1721 S. Stephenson Avenue Suite 235 Iron Mountain, MI 49801 1200 East Michigan Avenue Self-Insured Carrier ID: 80050022 Lansing, MI 48912 Comprehensive Risk Services LLC Self-Insured Carrier ID: 80000533 Coverys Insurance Services, Inc. Domestic Linen Supply & Laundry Company EJ USA, Inc. Mr. Evan Lacross Mrs. Fay Keane 30555 Northwestern Highway Suite 300 301 Spring Street Farmington Hills, MI 48334 P.O. Box 439 Self-Insured Carrier ID: 72008446 East Jordan, MI 49727 Comprehensive Risk Services LLC Self-Insured Carrier ID: 33000821 Michigan Claim Service DBA The ASU Group DTE Energy Company Ella E.M. Brown Charitable Circle Mr. Jerome K Hooper d/b/a Oaklawn Hospital One Energy Plaza, 252 GO Mrs. Marla E Stuck Detroit, MI 48226 200 N. Madison Self-Insured Carrier ID: 49090153 Marshall, MI 49068 Self-Administered Self-Insured Carrier ID: 80000913 York Risk Services Group, Inc. Eagle Alloy, Inc. Ms. Lisa Price Emergent Health Partners 5142 Evanston Avenue Ms. Ann Gaudet-Beach Muskegon, MI 49442 1200 State Circle Self-Insured Carrier ID: 26014061 Ann Arbor, MI 48108-1691 Eagle Claims Management, LLC Self-Insured Carrier ID: 80000381 CompOne Administrators, Inc. Eastern Michigan University c/o Human Resources Benefits Empire Iron Mining Partnership Ms. Tracey Piercecchi c/o Cleveland Cliffs Iron Company 140 McKenny Ms. Shelly Hillyer Ypsilanti, MI 48197 200 Public Square Self-Insured Carrier ID: 82000081 Suite 3300 Michigan Claim Service DBA The ASU Group Cleveland, OH 44114 Self-Insured Carrier ID: 10090885 Edison Institute (The) Sedgwick Claims Management Services, Inc. DBA The Henry Ford Mr. Brent Ott EPI Printers, Inc. 20900 Oakwood Boulevard Mr. Timothy R Czerney P.O. Box 1970 5404 Wayne Road Dearborn, MI 48121-1970 Battle Creek, MI 49037 Self-Insured Carrier ID: 84001082 Self-Insured Carrier ID: 27050706 Mackinaw Administrators, LLC Eagle Claims Management, LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Ervin Industries, Inc. Federal Screw Works Mr. Tom Tsallis Mr. Scott Rozema 3893 Research Park Drive 34846 Goddard Rd Ann Arbor, MI 48106-1168 Romulus, MI 48174 Self-Insured Carrier ID: 35028870 Self-Insured Carrier ID: 34090708 Sedgwick Claims Management Services, Inc. Comprehensive Risk Services LLC

Evangelical Homes of Michigan Federated Logistics, Inc. Mr. Thomas Hosinski Mr. Robert S Wierzbicki 400 West Russell St. 32500 VanBorn Rd Saline, MI 48176 Ste 100 Self-Insured Carrier ID: 80000821 Wayne, MI 48184 Eagle Claims Management, LLC Self-Insured Carrier ID: 43058981 Mackinaw Administrators, LLC F.C.S. Industries, Inc. FedEx Freight, Inc. Mr. Matthew D Drain Ms. Kayla Quandt 9850 Pelham Road 2200 Forward Drive Taylor, MI 48180-3852 P.O. Box 840 Self-Insured Carrier ID: 42008282 Harrison, AR 72602-0840 Self-Administered Self-Insured Carrier ID: 42009485 Sedgwick Claims Management Services, Inc. Farmington Public Schools FedEx Ground Package System, Inc. Mr. Jeff Danziger Mr. Jeff Kulbago 32500 Shiawassee 1000 FedEx Drive Farmington, MI 48336 Moon Twp, PA 15108 Self-Insured Carrier ID: 82000763 Self-Insured Carrier ID: 42008585 Mackinaw Administrators, LLC Sedgwick Claims Management Services, Inc. Faygo Beverages, Inc. Ferris State University c/o National Beverage Corp. Mr. Michael Grandy Mr. Richard Berkes Finance Suite 4000 420 Oak Street - Prakken Building 153 8100 SW Tenth St. Big Rapids, MI 49307-2020 Ft. Lauderdale, FL 33324 Self-Insured Carrier ID: 82000101 Self-Insured Carrier ID: 20036782 CompOne Administrators, Inc. Constitution State Services LLC Flexfab Horizons International, Inc. FCA US LLC Mr. Matthew P Nusbaum Ms. Debbie White 102 Cook Road Manager, WC & Group Insurance Programs Hastings, MI 49058 1000 Chrysler Drive CIMS 485-07-26 Self-Insured Carrier ID: 30013322 Auburn Hills, MI 48326 CompOne Administrators, Inc. Self-Insured Carrier ID: 37666000 Sedgwick Claims Management Services, Inc. Flint Mass Transportation Authority Federal Express Corporation Mr. Edgar H Benning Ms. Gael Johnson 1401 South Dort Highway Building B - 3rd Floor Flint, MI 48503 3620 Hacks Cross Rd. Self-Insured Carrier ID: 75098776 Memphis, TN 38125-8800 Eagle Claims Management, LLC Self-Insured Carrier ID: 43057760 Sedgwick Claims Management Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Ford Motor Company Grand Rapids Public School District Mr. Alan Gorosh Ms. Dawn M Berenyi Workers' Compensation 1331 Franklin Street, S.E. P.O. Box 607 P.O. Box 117 Dearborn, MI 48121-0607 Grand Rapids, MI 49501-0117 Self-Insured Carrier ID: 374F0000 Self-Insured Carrier ID: 82000141 Self-Administered Michigan Claim Service DBA The ASU Group Frankenmuth Bavarian Inn, Inc. Grand Traverse Band of Ottawa & Chippewa Indians Mr. Vernon Schiefer (The) 713 S. Main Street Mr. David Bernard Frankenmuth, MI 48734 2331 N. West Bayshore Drive Self-Insured Carrier ID: 58011873 Peshawbestown, MI 49682 Comprehensive Risk Services LLC Self-Insured Carrier ID: 99000450 CompOne Administrators, Inc. Futuramic Tool & Engineering Co. Grand Valley State University Mr. Eric Petersen Ms. Natalie Trent 24680 Gibson 1 Campus Drive Warren, MI 48089 Allendale, MI 49401 Self-Insured Carrier ID: 35040050 Self-Insured Carrier ID: 82001441 Eagle Claims Management, LLC CompOne Administrators, Inc.

G.A. Richards Company Great Lakes Home Health Services, Inc. Mrs. Jenny Seckinger c/o Elara Caring 1060 Ken-O-Sha Industrial Dr. SE Ms. Shelly Mirus Grand Rapids, MI 49508-8216 14295 Midway Rd., Ste 400 Self-Insured Carrier ID: 25047125 Addison, TX 75001 CompOne Administrators, Inc. Self-Insured Carrier ID: 80001791 Mackinaw Administrators, LLC General Motors LLC Great Lakes Water Authority c/o Compliance Management Mr. Michael J Tilley Mr. Jared Carlisle 9300 W. Jefferson 5600 West 83rd Street 19th Floor Suite 1100 Detroit, MI 48209 Minneapolis, MN 55437 Self-Insured Carrier ID: 73016819 Self-Insured Carrier ID: 37999000 Broadspire Services, Inc. Self-Administered Griffin Beverage Co. Genesee County Mr. Robert T Griffin Mr. Stephen Cooperrider 1901 North Dam Road Office of Fiscal Services West Branch, MI 48661 1101 Beach Street 3rd Floor Self-Insured Carrier ID: 20070012 Flint, MI 48502 Comprehensive Risk Services LLC Self-Insured Carrier ID: 99900225 Michigan Claim Service DBA The ASU Group Grosse Pointe Public School System Genesee Health System Dee Ann Irby Mr. Glen Chipman 389 St. Clair 420 W. Fifth Avenue Grosse Pointe, MI 48230 Fifth Floor Self-Insured Carrier ID: 82001082 Flint, MI 48503 Alternative Service Concepts LLC dba Davies Claims Self-Insured Carrier ID: 80000134 Solutions Eagle Claims Management, LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Haworth, Inc. Holland Home Mr. Daniel Zona Mr. Adam Kinder One Haworth Center 3-E13 2100 Raybrook Ave., S.E. Holland, MI 49423 Grand Rapids, MI 49546 Self-Insured Carrier ID: 73016843 Self-Insured Carrier ID: 80000741 Gallagher Bassett Services, Inc. Eagle Claims Management, LLC

HCR ManorCare, Inc. Hollywood Holding Company, LLC Ms. Lisa Jurski Ms. Kimberly Welch Harlan 333 N. Summit Street 2670 W. Maple Road P.O. Box 10086 Troy, MI 48084 Toledo, OH 43699-0086 Self-Insured Carrier ID: 54022112 Self-Insured Carrier ID: 80001485 Michigan Claim Service DBA The ASU Group Self-Administered HealthSource Saginaw, Inc. Home Depot U.S.A., Inc. Ms. Wendy A Dornseifer Mr. Matt Ward 3340 Hospital Rd. 2455 Paces Ferry Road Saginaw, MI 48603 Building C, Floor 20 Self-Insured Carrier ID: 80001773 Atlanta, GA 30339 ProSelect Insurance Company Self-Insured Carrier ID: 52030085 Helmsman Management Services, LLC Henry Ford Health System Houghton County Mr. Sam Vogel Mr. Ben Larson 1 Ford Place, 4B 401 East Houghton Avenue HFHS Risk Finance & Insurance Services Houghton, MI 49931 Detroit, MI 48202-3450 Self-Insured Carrier ID: 99900031 Self-Insured Carrier ID: 80000982 Comprehensive Risk Services LLC Self-Administered Hercules Drawn Steel Corp. Howard Ternes Packaging Company Mr. Mark Goodman Mr. Micheal Sheatzley 38901 Amrhein Road 35275 Industrial Rd Livonia, MI 48150 Livonia, MI 48150 Self-Insured Carrier ID: 33078882 Self-Insured Carrier ID: 26036682 Michigan Claim Service DBA The ASU Group York Risk Services Group, Inc.

Holcim Participations (US) Inc Howell Public Schools Mr. Dominic Foley Ms. Liza M Kelly 6211 Ann Arbor Rd 411 N. Highlander Way, Ste B Dundee, MI 48131 Howell, MI 48843 Self-Insured Carrier ID: 14046058 Self-Insured Carrier ID: 82000347 Sedgwick Claims Management Services, Inc. York Risk Services Group, Inc.

Holland Community Hospital Huntington Bancshares Incorporated Ms. Sandra Trammell Ms. Jennifer Mountcastle 602 Michigan Avenue 41 S. High Street HC0323 Holland, MI 49423 Columbus, OH 43287 Self-Insured Carrier ID: 80000295 Self-Insured Carrier ID: 60055885 ProSelect Insurance Company Sedgwick Claims Management Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Huron Casting, Inc. John E. Green Company Inc. Mr. Matthew Davis Mr. John R Stelter 7050 Hartley Street 220 Victor Avenue Pigeon, MI 48755 Highland Park, MI 48203 Self-Insured Carrier ID: 33000988 Self-Insured Carrier ID: 36070127 CompOne Administrators, Inc. CompOne Administrators, Inc.

Huron Valley Schools Kalamazoo County Mr. Paul Salah, Ph.D. Ms. Kristine Cunningham 2390 S. Milford Road 201 W. Kalamazoo Avenue Highland, MI 48357 Kalamazoo, MI 49007 Self-Insured Carrier ID: 82002063 Self-Insured Carrier ID: 99900039 CompOne Administrators, Inc. CompOne Administrators, Inc.

Hyatt Corporation Kalamazoo Public Schools c/o Compliance Management Mr. Daniel L Emmons Ms. Laurene Dufault 1220 Howard Street 5600 West 83rd Street Kalamazoo, MI 49008 Suite 1100 Self-Insured Carrier ID: 82000139 Minneapolis, MN 55437 Michigan Claim Service DBA The ASU Group Self-Insured Carrier ID: 70091386 Gallagher Bassett Services, Inc. Kelly Services, Inc. Inalfa Roof Systems, Inc. Ms. Lesley Zielinski Mr. Jarrod Fiengo 999 West Big Beaver Road 1370 Pacific Drive Troy, MI 48084 Auburn Hills, MI 48326 Self-Insured Carrier ID: 73039449 Self-Insured Carrier ID: 37002320 ESIS, Inc. CompOne Administrators, Inc. Knape & Vogt Manufacturing Company Ingham County Mr. Nathan R VanRyn and Ingham County Medical Care Facility 2700 Oak Industrial Drive NE Ms. Susan Graham Grand Rapids, MI 49505 121 E. Maple Self-Insured Carrier ID: 25048162 P.O. Box 319 CompOne Administrators, Inc. Mason, MI 48854 Self-Insured Carrier ID: 99900033 Kroger Co. (The) Eagle Claims Management, LLC an Ohio Corporation, dba Michigan Dairy International Industrial Contracting Corporation Mr. Nathan Fraley Mr. Jonathan H Firsht 1014 Vine St. 35900 Mound Road 5th Floor Sterling Heights, MI 48310 Cincinnati, OH 45202 Self-Insured Carrier ID: 17045050 Self-Insured Carrier ID: 54021957 Michigan Claim Service DBA The ASU Group Sedgwick Claims Management Services, Inc. L & L Products, Inc. Iron County Medical Care Facility Ms. Susan R Deeb Ms. Robin Caron 160 McLean Drive 1523 US Highway 2 Romeo, MI 48065 Crystal Falls, MI 49920 Self-Insured Carrier ID: 30013450 Self-Insured Carrier ID: 80001236 CompOne Administrators, Inc. Eagle Claims Management, LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

L'Anse Creuse Public Schools Louisiana-Pacific Corporation Ms. Rochelle Gauthier c/o Cannon Cochran Management Services, Inc. 24076 F.V. Pankow Blvd Mr. Dalton Bowman Clinton Township, MI 48036 565 Marriott Drive Self-Insured Carrier ID: 82000450 Suite 800 Eagle Claims Management, LLC Nashville, TN 37214 Self-Insured Carrier ID: 24048042 L. Perrigo Company Cannon Cochran Management Services, Inc. Ms. Carmen Schreiber Lowe's Home Centers, LLC 515 Eastern Avenue Ms. Tia W Schweikert Allegan, MI 49010 1000 Lowe's Blvd. Self-Insured Carrier ID: 28091100 Mail Code RMT Michigan Claim Service DBA The ASU Group Mooresville, NC 28117 Self-Insured Carrier ID: 52005310 Lacks Enterprises, Inc. Sedgwick Claims Management Services, Inc. Mr. Jim Green Lutheran Homes of Michigan Inc. 5460 Cascade Road SE dba Wellspring Lutheran Services Grand Rapids, MI 49546 Mr. Tim Kalbfleisch Self-Insured Carrier ID: 30036101 4100 Pier North Blvd York Risk Services Group, Inc. Flint, MI 48504 Self-Insured Carrier ID: 80000819 Lake Shore Public Schools Comprehensive Risk Services LLC Dr. Joseph DiPonio 28850 Harper Avenue Mac Valves, Inc. St. Clair Shores, MI 48081 Ms. Martha C Welch Self-Insured Carrier ID: 82000003 30569 Beck Road CompOne Administrators, Inc. P.O. Box 111 Wixom, MI 48393 Self-Insured Carrier ID: 35028135 Lapeer Community Schools Alternative Service Concepts LLC dba Davies Claims Mr. Mark Rajter Solutions 250 Second Street Lapeer, MI 48446 MacAllister Machinery Co. Self-Insured Carrier ID: 82000644 dba Michigan CAT York Risk Services Group, Inc. Ms. Melanie Orcher 24800 Novi Road Lincoln Consolidated Schools Novi, MI 48375 Mr. Robert Jansen Self-Insured Carrier ID: 50090463 7425 Willis Road Eagle Claims Management, LLC Ypsilanti, MI 48197 Macy's Retail Holdings, LLC Self-Insured Carrier ID: 82000481 Mrs. Ann Back Broadspire Services, Inc. Manager-Risk Management 145 Progress Place Little Caesar Enterprises, Inc. Cincinnati, OH 45246 Mr. Michael J Niehaus Self-Insured Carrier ID: 53092700 2211 Woodward Avenue Sedgwick Claims Management Services, Inc. Detroit, MI 48201340 Magnesium Products of America, Inc. Self-Insured Carrier ID: 58011999 Ms. Anna Ramey Sedgwick Claims Management Services, Inc. Human Resource Manager 2001 Industrial Drive Livonia Public Schools School District Eaton Rapids, MI 48827 Ms. Alison Smith Self-Insured Carrier ID: 33050123 15125 Farmington Road York Risk Services Group, Inc. Livonia, MI 48154-5474 Self-Insured Carrier ID: 82000782 Cannon Cochran Management Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Manthei, Inc. Memorial Hospital (The) Ms. Amanda Hanorth dba Memorial Healthcare 3996 Charlevoix Ave Mr. Brian Long Petoskey, MI 49770 826 West King Self-Insured Carrier ID: 24058072 Owosso, MI 48867 Comprehensive Risk Services LLC Self-Insured Carrier ID: 80000178 ProSelect Insurance Company Marriott International, Inc. Metalworks, Inc. Mr. Steve Huy Ms. Valerie Ruhlig Dept. 52/924.36 902 E. Fourth St. 10400 Fernwood Rd Ludington, MI 49431 Bethesda, MD 20817 Self-Insured Carrier ID: 34007390 Self-Insured Carrier ID: 70008085 CompOne Administrators, Inc. Self-Administered Mary Free Bed Hospital & Rehab. Center Metropolitan Hospital Ms. Madeline Dekker Ms. Karrie Custer 235 Wealthy Street, S.E. Metro Health Hospital Grand Rapids, MI 49503-5299 5900 Byron Center Ave Self-Insured Carrier ID: 80001441 Wyoming, MI 49519 Eagle Claims Management, LLC Self-Insured Carrier ID: 80000241 Eagle Claims Management, LLC Masco Corporation MGM Resorts International Ms. Bonita Felder Mr. Michael Jokerst 17450 College Parkway MGM Administration Building Livonia, MI 48152 71 E. Harmon Avenue Self-Insured Carrier ID: 33013705 Las Vegas, NV 89109 Constitution State Services LLC Self-Insured Carrier ID: 70092555 ESIS, Inc. McLaren Health Care Corporation Michigan Catholic Conference One McLaren Parkway Mr. Vincent P Andrews Ms. Sonja S Wilcox-Berriel 510 South Capitol Avenue Lansing, MI 48933 Grand Blanc, MI 48439 Self-Insured Carrier ID: 83000902 Self-Insured Carrier ID: 80000525 Gallagher Bassett Services, Inc. Broadspire Services, Inc. Meijer Companies, Ltd. Michigan Conference Association Mr. Chris Hieftje of Seventh Day Adventists 2929 Walker, N.W. Ms. Edie Ellis Grand Rapids, MI 49544 5801 W. Michigan Ave. Self-Insured Carrier ID: 53090114 P.O. Box 24187 Self-Administered Lansing, MI 48909 Self-Insured Carrier ID: 86012333 Melling Tool Company Eagle Claims Management, LLC Mr. Mark L Mandrick Michigan Paving & Materials Company 2620 Saradan Drive Ms. Marlene VanPatten P.O. Box 1188 2575 Haggerty Rd. Suite 100 Jackson, MI 49204 Canton, MI 48818 Self-Insured Carrier ID: 35011038 Self-Insured Carrier ID: 17091566 Eagle Claims Management, LLC Helmsman Management Services, LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Michigan State University Munson Health Care Ms. Renee Rivard Ms. Vicki Graczyk Suite 140 1105 Sixth Street 1407 S. Harrison Traverse City, MI 49684-2386 East Lansing, MI 48823 Self-Insured Carrier ID: 80000128 Self-Insured Carrier ID: 82000033 ProSelect Insurance Company Self-Administered Michigan Sugar Company Newcor, Inc. Ms. Cheryl Ridenour Ms. Traci Shell 122 Uptown Drive, Suite 300 401 S. Chestnut Bay City, MI 48708 Owosso, MI 48867 Self-Insured Carrier ID: 20016773 Self-Insured Carrier ID: 35009763 CompOne Administrators, Inc. Alternative Service Concepts LLC dba Davies Claims Solutions Michigan Technological University Nexteer Automotive Corporation Ms. Renee L Hiller Mr. Joel Horvat 1400 Townsend Drive 1272 Doris Road Houghton, MI 49931 Auburn Hills, MI 48326-2617 Self-Insured Carrier ID: 82000432 Self-Insured Carrier ID: 55092405 Comprehensive Risk Services LLC Sedgwick Claims Management Services, Inc.

MidMichigan Health Nordstrom, Inc. Mr. Victor Morgan Ms. Suzanne Kinsey 4000 Wellness Drive P.O. Box 25799 Midland, MI 48670 Santa Anna, CA 92799 Self-Insured Carrier ID: 80000556 Self-Insured Carrier ID: 53069985 ProSelect Insurance Company Self-Administered

Mobis North America LLC North Ottawa Community Hospital Mr. Jordan Bush Mr. Tim Gengle 6401 W. Fort St 1309 Sheldon Road Detroit, MI 48209 Grand Haven, MI 49417 Self-Insured Carrier ID: 37091596 Self-Insured Carrier ID: 80001270 Michigan Claim Service DBA The ASU Group ProSelect Insurance Company

Monroe County Road Commission Northern Michigan University Ms. Camden Regis Ms. Kristen I Bjorne 840 South Telegraph Road Human Resources - Northern MI University Monroe, MI 48161 1401 Presque Isle Self-Insured Carrier ID: 99900258 Marquette, MI 49855 CompOne Administrators, Inc. Self-Insured Carrier ID: 82001552 Comprehensive Risk Services LLC Monroe Public Schools Novares, US, LLC Mrs. Katherine Eighmey Mr. Kevin Koshowsky 1275 North Macomb Street 19575 Victor Parkway Suite 400 P.O. Box 733 Livonia, MI 48152 Monroe, MI 48162 Self-Insured Carrier ID: 33085220 Self-Insured Carrier ID: 82000558 Comprehensive Risk Services, Inc. Michigan Claim Service DBA The ASU Group

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

NYX, LLC Parker Hannifin Corporation Mr. Mark Greer Mr. Curt Gross 36111 Schoolcraft 6035 Parkland Boulevard Livonia, MI 48150 Cleveland, OH 44124-4141 Self-Insured Carrier ID: 30012991 Self-Insured Carrier ID: 34091478 Comprehensive Risk Services LLC Underwriters Safety & Claims Inc.

O S F Healthcare System Perfection Bakeries, Inc. DBA Aunt Millies DBA St. Francis Hospital Mr. George Long Ms. Amanda Lowry 350 Pearl Street 800 N.E. Glen Oak Avenue Fort Wayne, IN 46802 Peoria, IL 61603 Self-Insured Carrier ID: 20030330 Self-Insured Carrier ID: 80000625 Michigan Claim Service DBA The ASU Group ProSelect Insurance Company Oakland Community College Petitpren, Inc. Ms. Julie Hoyt Ms. Jerri L Baker 2480 Opdyke Road 44500 Groesbeck Bloomfield Hills, MI 48304 Clinton Township, MI 48036-1111 Self-Insured Carrier ID: 82001863 Self-Insured Carrier ID: 51038082 Broadspire Services, Inc. Eagle Claims Management, LLC

Oakland University Pilkington North America, Inc. Mr. Eric Herppich Mrs. Roberta Weisz 371 Wilson Blvd. 811 Madison Ave. Room 414 Toledo, OH 43604 Rochester, MI 48309-4486 Self-Insured Carrier ID: 28090210 Self-Insured Carrier ID: 82000063 Sedgwick Claims Management Services, Inc. Michigan Claim Service DBA The ASU Group Pilot Travel Centers, LLC ODL, Incorporated Mr. Bill Beuchat Ms. Dawn Vredeveld 5508 Lonas Road 215 E. Roosevelt Ave. P.O. Box 10146 Zeeland, MI 49464 Knoxville, TN 37939 Self-Insured Carrier ID: 24067700 Self-Insured Carrier ID: 55092185 CompOne Administrators, Inc. Self-Administered Ottawa County Pine Rest Christian Mental Health Services Ms. Marcie VerBeek Ms. Sara Ballou Room 359 300 - 68th Street, S.E. 12220 Fillmore Street P.O. Box 165 West Olive, MI 49460 Grand Rapids, MI 49508 Self-Insured Carrier ID: 99900270 Self-Insured Carrier ID: 80000650 York Risk Services Group, Inc. Eagle Claims Management, LLC P G P Corporation Pinecrest Medical Care Facility Mr. Paul Michael Voss Ms. Tina Koski 7925 Beech Daly Road N15995 Main Street Taylor, MI 48180 P.O. Box 603 Self-Insured Carrier ID: 33016904 Powers, MI 49874-0603 York Risk Services Group, Inc. Self-Insured Carrier ID: 80000655 Comprehensive Risk Services LLC

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Plymouth-Canton Community Schools Redford Union Schools-District #1 Mrs. Dawn Schaller Ms. Teresa A Arriola 454 South Harvey Street 17715 Brady Plymouth, MI 48170 Redford, MI 48240 Self-Insured Carrier ID: 82000982 Self-Insured Carrier ID: 82001482 Cannon Cochran Management Services, Inc. Eagle Claims Management, LLC

Port Huron Area School District Regents of the University of MI (The) Ms. Katherine Peternel Mr. G. Paul Moggach 2720 Riverside Drive 3050 Wolverine Tower Port Huron, MI 48061-5013 3003 South State Street Self-Insured Carrier ID: 82000074 Ann Arbor, MI 48109-1287 Comprehensive Risk Services LLC Self-Insured Carrier ID: 82000581 Self-Administered Pridgeon & Clay, Inc. Road Commission for Oakland County Ms. Elizabeth Hanning Mr. Drew Dunsky 50 Cottage Grove, S.W. 31001 Lahser Road Grand Rapids, MI 49507 Beverly Hills, MI 48025 Self-Insured Carrier ID: 35096648 Self-Insured Carrier ID: 99900263 Eagle Claims Management, LLC Mackinaw Administrators, LLC

Procter & Gamble Distributing LLC (The) Rochester Community Schools Ms. Terri Donahue Mrs. Amy Gora 2 Proctor & Gamble Plaza - TN-3 501 West University Drive Workers' Compensation Department Rochester, MI 48307 Cincinnati, OH 45202 Self-Insured Carrier ID: 82000663 Self-Insured Carrier ID: 26025284 Cannon Cochran Management Services, Inc. Sedgwick Claims Management Services, Inc. ProMedica Health System Inc. Roman Catholic Archdiocese of Detroit Ms. Heather Allred and all related entities 100 Madison - MSC-S29932 Mr. Vincent P Andrews Toledo, OH 43604 510 South Capitol Avenue Self-Insured Carrier ID: 80000846 Lansing, MI 48933 Eagle Claims Management, LLC Self-Insured Carrier ID: 86000200 Gallagher Bassett Services, Inc. Quality Dairy Company Roman Catholic Diocese of Gaylord Mr. Trevor Rutan and all related entities 111 W. Mt. Hope Avenue Mr. Vincent P Andrews Lansing, MI 48910 510 South Capitol Avenue Self-Insured Carrier ID: 54021933 Lansing, MI 48933 CompOne Administrators, Inc. Self-Insured Carrier ID: 86000600 Gallagher Bassett Services, Inc. Quality Temporary Services, Inc. Roman Catholic Diocese of Grand Rapids dba Qualified Staffing and all related entities Ms. Susan Church Mr. Vincent P Andrews VP of HR & Risk 510 South Capitol Avenue 5361 Gateway Centre, Suite A Lansing, MI 48933 Flint, MI 48507 Self-Insured Carrier ID: 86000700 Self-Insured Carrier ID: 73026025 Gallagher Bassett Services, Inc. CompOne Administrators, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Roman Catholic Diocese of Kalamazoo S. Abraham & Sons Inc. and all related entities Mr. Jason Tilley Mr. Vincent P Andrews P.O. Box 1768 510 South Capitol Avenue 4001 Three Mile Road NW Lansing, MI 48933 Grand Rapids, MI 49501-1768 Self-Insured Carrier ID: 86000400 Self-Insured Carrier ID: 59063737 Gallagher Bassett Services, Inc. York Risk Services Group, Inc. Roman Catholic Diocese of Lansing Samaritas and all related entities dba Lutheran Social Services of Michigan Mr. Vincent P Andrews Ms. Cyndie Szczur 510 South Capitol Avenue 8131 East Jefferson Ave. Lansing, MI 48933 Detroit, MI 48214 Self-Insured Carrier ID: 86000300 Self-Insured Carrier ID: 80066082 Gallagher Bassett Services, Inc. Michigan Claim Service DBA The ASU Group Roman Catholic Diocese of Marquette School District of the City of Dearborn and all related entities Mr. Thomas S Wall Mr. Vincent P Andrews 18700 Audette 510 South Capitol Avenue Dearborn, MI 48124 Lansing, MI 48933 Self-Insured Carrier ID: 82000182 Self-Insured Carrier ID: 86000900 Comprehensive Risk Services LLC Gallagher Bassett Services, Inc. Roman Catholic Diocese of Saginaw School District of the City of Flint and all related entities Ms. Cassandra Washington Mr. Vincent P Andrews 923 East Kearsley Street 510 South Capitol Avenue Flint, MI 48503-1900 Lansing, MI 48933 Self-Insured Carrier ID: 82000125 Self-Insured Carrier ID: 86000500 Comprehensive Risk Services LLC Gallagher Bassett Services, Inc. Royal Technologies Corporation School District of the City of Pontiac Mr. Michael Buitenhuis Mr. Michael Emerson 3765 Quincy 47200 Woodward Avenue Hudsonville, MI 49426 Pontiac, MI 48342 Self-Insured Carrier ID: 30012045 Self-Insured Carrier ID: 82000163 Eagle Claims Management, LLC Cannon Cochran Management Services, Inc. School District of the City of Wyandotte Rudolph/Libbe Companies Inc. Mr. Kenneth Laub Ms. Denise Honsberger 639 Oak Street 6494 Latcha Road Wyandotte, MI 48192 Walbridge, OH 43465 Self-Insured Carrier ID: 82000682 Self-Insured Carrier ID: 15065900 Mackinaw Administrators, LLC Mackinaw Administrators, LLC Schoolcraft College Ryder System, Inc. Ms. Brenda K Leavens c/o Compliance Management 18600 Haggerty Road Mr. Jared Carlisle Livonia, MI 48152-2696 Attn: Jared Carlisle Self-Insured Carrier ID: 82002082 5600 West 83rd Street, Suite 1100 Comprehensive Risk Services LLC Minneapolis, MN 55437 Self-Insured Carrier ID: 42056445 Self-Administered

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

SEMCO Energy, Inc. State of Michigan Mrs. Terri J Amey, ARM Office of the State Employer, Employee Health 1411 Third Street, Suite A Mgmt. P.O. Box 5004 Ms. Cheryl Schmittdiel Port Huron, MI 48061-5004 Capital Commons Ctr., 4th Floor Self-Insured Carrier ID: 49092074 400 S. Pine Street York Risk Services Group, Inc. Lansing, MI 48933 Sherwin-Williams Company Self-Insured Carrier ID: 99904433 Mr. Anthony Colangelo York Risk Services Group, Inc. 101 Prospect Avenue Steelcase Inc. Cleveland, OH 44115 Mr. Steve Waugh Self-Insured Carrier ID: 28087088 901 44th S.E. Gallagher Bassett Services, Inc. P. O. Box 1967 Grand Rapids, MI 49508 Shiawassee County Self-Insured Carrier ID: 33006641 Dr. Brian Boggs Sedgwick Claims Management Services, Inc. Surbeck Building Stryker Corporation 201 North Shiawassee Street Mr. Steve F Jaeger Corunna, MI 48817 2825 Airview Boulevard Self-Insured Carrier ID: 99900078 Kalamazoo, MI 49002 Broadspire Services, Inc. Self-Insured Carrier ID: 38041001 Sodecia USA Automotive Corp. Sedgwick Claims Management Services, Inc. Mr. Dale Williams 969 Chicago Road Suburban Mobility Auth. for Regional Troy, MI 48083 Transportation Self-Insured Carrier ID: 34002210 Mr. Darrell Taylor Eagle Claims Management, LLC Suite 600 535 Griswold SpartanNash Company Detroit, MI 48226 Ms. Andromeda Matz Self-Insured Carrier ID: 35034894 P. O. Box 8700 (MCGR5371102) Michigan Claim Service DBA The ASU Group 850 - 76th Street S.W. Summit Polymers, Inc. Grand Rapids, MI 49518 Mr. Timothy A Eccles Self-Insured Carrier ID: 53091346 6715 S. Sprinkle Road Self-Administered Portage, MI 49002 Spectrum Health System Self-Insured Carrier ID: 28090239 Ms. Lindsay Pierce Eagle Claims Management, LLC Spectrum Health Human Resources 100 Michigan NE Mail Code 108 Taylor School District Grand Rapids, MI 49503 Mr. Mark Kleinhans Self-Insured Carrier ID: 80000941 23033 Northline Road ProSelect Insurance Company Taylor, MI 48180 SPX Corporation Self-Insured Carrier ID: 82000282 Ms. Carol Brocci Gallagher Bassett Services, Inc. 13320-A Ballantyne Corporate Place Charlotte, NC 28277 Textron Inc. Self-Insured Carrier ID: 37090204 Ms. Sarah Woodward Sedgwick Claims Management Services, Inc. Aon Global Risk Consulting 5600 W. 83rd St., 8200 Tower, Suite 1100 Minneapolis, MN 55437 Self-Insured Carrier ID: 35013580 Broadspire Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Thai Summit America Corporation Tyson Foods, Inc. Mr. Jason Street Ms. Connie Downum 1480 W. McPherson Park Drive 2200 Don Tyson Parkway Howell, MI 48843 P. O. Box 2020 Self-Insured Carrier ID: 39013147 Springdale, AR 72762 Comprehensive Risk Services LLC Self-Insured Carrier ID: 02469085 Self-Administered The Shyft Group Inc. U.S. Farathane LLC Mr. Thomas Sisk Mr. Jim Curtis, Jr. 603 Earthway Blvd. 2700 High Meadow Circle Bristol, IN 46507 Auburn Hills, MI 48236 Self-Insured Carrier ID: 37009823 Self-Insured Carrier ID: 39040812 Constitution State Services LLC Comprehensive Risk Services LLC

Thor Industries, Inc. United Jewish Foundation of Metropolitan Detroit Mr. Tim Edwards Ms. Dorothy Benyas 601 E. Beardsley Ave. 6735 Telegraph Road Elkhart, IN 46514 P.O. Box 2030 Self-Insured Carrier ID: 37020804 Bloomfield Hills, MI 48303 Cannon Cochran Management Services, Inc. Self-Insured Carrier ID: 86011198 CompOne Administrators, Inc. Tilden Mining Company L. C. United Methodist Retirement Communities, Inc. Ms. Shelly Hillyer Ms. Michelle Baldwin Henderson 200 Public Square 805 West Middle Street Suite 3300 Chelsea, MI 48118-1397 Cleveland, OH 44114 Self-Insured Carrier ID: 80000642 Self-Insured Carrier ID: 10057085 Eagle Claims Management, LLC Sedgwick Claims Management Services, Inc. Township of Clinton United States Steel Corporation Mr. William S Smith Mr. Sean M Dalton 40700 Romeo Plank Road 600 Grant Street Room 1656 Clinton Township, MI 48038 Pittsburgh, PA 15219-2800 Self-Insured Carrier ID: 99900250 Self-Insured Carrier ID: 33030718 York Risk Services Group, Inc. Broadspire Services, Inc.

Trinity Health-Michigan USF Holland LLC Ms. Barbara Cook Mr. Greg Zinkiewicz 20555 Victor Parkway c/o YRC Worldwide Inc. Livonia, MI 48152 10990 Roe Avenue Self-Insured Carrier ID: 80000163 Overland Park, KS 66211 ESIS, Inc. Self-Insured Carrier ID: 42096114 Sedgwick Claims Management Services, Inc. TrueBlue, Inc. Utica Community Schools Mrs. Tori Livernash Mr. Michael Sturm 1015 A Street 11303 Greendale P.O. Box 2910 Sterling Heights, MI 48312 Tacoma, WA 98401 Self-Insured Carrier ID: 82000750 Self-Insured Carrier ID: 73013485 Broadspire Services, Inc. ESIS, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

Vail Rubber Works, Inc. Wayne County Airport Authority Mr. Brian Nimtz Ms. Heather Day 521 Langley Avenue 11050 Rogell Drive, #602 P.O. Box 64 Michael Berry Administration Building St. Joseph, MI 49085 Detroit, MI 48242 Self-Insured Carrier ID: 30072202 Self-Insured Carrier ID: 99901882 Eagle Claims Management, LLC CompOne Administrators, Inc. Verso Paper Holding LLC Wayne County Community College District Mr. Tim Nusbaum Mr. Furquan Ahmed 8540 Gander Creek Drive 801 West Fort Street Miamisburg, OH 45342 Detroit, MI 48226 Self-Insured Carrier ID: 26016995 Self-Insured Carrier ID: 82002182 Gallagher Bassett Services, Inc. Broadspire Services, Inc.

VHS of Michigan, Inc. Wayne State University Ms. Tracelyn T Wilson Office of Risk Management Academic/Admin. Bldg. University Health Center Ms. Angela M Moss 4201 St. Antoine, Suite 5 Suite 4622 Detroit, MI 48201 5700 Cass Avenue Self-Insured Carrier ID: 80012084 Detroit, MI 48202 Sedgwick Claims Management Services, Inc. Self-Insured Carrier ID: 82000082 Warren Consolidated Schools Self-Administered Ms. Christine Lewis Wayne Westland Community School District 31300 Anita Drive - Administration Bldg. Ms. Chanda Cleaves Warren, MI 48093 36745 Marquette Self-Insured Carrier ID: 82000150 Westland, MI 48185 Broadspire Services, Inc. Self-Insured Carrier ID: 82001182 Michigan Claim Service DBA The ASU Group Washtenaw Community College Mr. William Johnson Western Michigan University 4800 E Huron River Dr Mrs. Laura Weber Ann Arbor, MI 48105-4800 Business Services Self-Insured Carrier ID: 82000881 2080 Seibert Administration Building Comprehensive Risk Services LLC Kalamazoo, MI 49008-5222 Self-Insured Carrier ID: 82000039 Washtenaw County CompOne Administrators, Inc. Ms. Monica Boote Weyerhaeuser Company 220 North Main Ms. Susan LaPrairie P.O. Box 8645 Workers' Compensation Ann Arbor, MI 48107 1785-B Weyerhaeuser Self-Insured Carrier ID: 99900081 Vanceboro, NC 28586 Michigan Claim Service DBA The ASU Group Self-Insured Carrier ID: 26091257 Waterford School District Sedgwick Claims Management Services, Inc. Mr. James E Beaver Whirlpool Corporation Security & Risk Management Ms. Lorin Klein 1145 Tee Cee Drive 2000 North M-63 Waterford, MI 48328 MD 3007 Self-Insured Carrier ID: 82000263 Benton Harbor, MI 49022 Meadowbrook, Inc., dba Meadowbrook Claims Service Self-Insured Carrier ID: 39036578 Gallagher Bassett Services, Inc.

8/2/2021 10:49:51 AM Workers' Disability Compensation Agency Self-Insured Programs Individual Self-Insured Employer List

White Castle System, Inc. Ms. Ashley Geiger 555 Edgar Waldo Way Columbus, OH 43215-1158 Self-Insured Carrier ID: 58034085 Broadspire Services, Inc.

Wirtz Manufacturing Co., Inc. Mr. Keith Lepla 1105 24th Street P.O. Box 5006 Port Huron, MI 48061-5006 Self-Insured Carrier ID: 30012799 Eagle Claims Management, LLC Wisconsin Electric Power Company Mr. Scott Meise Room P378 231 West Michigan Street Milwaukee, WI 53203 Self-Insured Carrier ID: 49092100 Self-Administered WM Limited Partnership-1998 dba Wendys of Michigan Ms. Tracey Smith 45 Ottawa Ave SW Suite 600 Grand Rapids, MI 49503 Self-Insured Carrier ID: 58077076 Gallagher Bassett Services, Inc. Wolverine Packing Company Mr. Brian Bartes 2535 Rivard Detroit, MI 48207 Self-Insured Carrier ID: 20043617 Comprehensive Risk Services LLC

Zehnder's of Frankenmuth, Inc. Ms. Martha Shelton 730 S. Main Street Frankenmuth, MI 48734 Self-Insured Carrier ID: 58034765 Comprehensive Risk Services LLC

8/2/2021 10:49:51 AM