2001 annual report

STATE OF GEORGIA
SUBSEQUENT INJURY TRUST FUND
2001 ANNUAL REPORT
If you wish to acquire this report in an alternative format, please contact the SITF at the address and phone numbers inside.

STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND

Suite 500 North Tower 1720 Peachtree Street, NW
Atlanta, Georgia 30309
Website: www.ganet.org/sitf/

Telephone Number: (404) 206-6360

TDD Number:

(404) 206-5053

Facsimile:

(404) 206-6363

BOARD OF TRUSTEES
James C. Thompson, Chairman Janis Murray, Secretary Lewis Lowe
EX-OFFICIO MEMBERS
Julie Y. John John W. Oxendine
ADMINISTRATOR
Anne D. Burnett
DEPUTY ADMINISTRATOR
David L. Taylor

ii

On July 1, 1977, the Georgia General Assembly enacted legislation establishing
the Subsequent Injury Trust Fund. It is designed to reduce the impact of singularly large workers' compensation claims in the event a worker with a disability, injured on the job, aggravates a pre-existing impairment.
The Subsequent Injury Trust Fund is a separate state agency, governed by a fivemember Board of Trustees appointed by the Governor for six-year terms. An administrator and staff totaling 30 employees conduct the actual administration of the Fund.
The Fund helps workers with disabilities by providing employers, who are not subject to the Americans with Disabilities Act with incentives to hire or retain qualified workers with disabilities, assists insured employers by keeping workers' compensation premiums under control, and if an employer is self-insured, keeps the workers' compensation exposure at the deductible levels.
In order for an employer/insurer to be eligible for reimbursement from the Fund, the employee's subsequent injury must be directly caused by the prior impairment, or combine with a prior impairment to create greater employer liability for lost time benefits and medical expenses. In addition, the employee must have a pre-existing impairment that the employer considered to be permanent and likely to be a hindrance to employment, and the employer must have knowledge of the prior impairment before the subsequent injury occurs.
The law also contains a list of conditions that are presumed to be permanent and likely to be a hindrance to employment provided the employer could demonstrate prior knowledge.
Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks, for 50% of all medical and rehabilitation expenses between $5,000 and $10,000, and for 100% of all medical and rehabilitation expenses in excess of $10,000. If the subsequent injury was not caused by or related to a prior impairment, the reimbursement for medical expenses may be reduced or denied completely. The employer/insurer files a claim for reimbursement directly with the fund. The Fund investigates the claim to determine eligibility for reimbursement. When a reimbursement agreement is reached between the Fund and the employer or insurer, it must be approved by the State Board of Workers' Compensation. If an agreement cannot be reached, either party may request a mediation conference or a hearing with the State Board of Workers' Compensation.
iii

Subsequent Injury Trust Fund Mission Statement
The Subsequent Injury Trust Fund provides reimbursements and information to employers, insurers, and their agents, in those Workers' Compensation claims involving individuals
with a pre-existing permanent impairment.
Vision Statement
The Board of Trustees and staff of the Subsequent Injury Trust Fund commit to bringing awareness of the financial benefits available to employers, insurers, and their agents
by continuing our efforts to build positive relations in the risk management arena.
iv

Table of Contents
REIMBURSEMENTS PAID TO INSURANCE COMPANIES REIMBURSEMENTS PAID TO GROUP SELF-INSURED EMPLOYERS REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS CLAIMS REPORTED BY INSURANCE COMPANIES CLAIMS REPORTED BY GROUP SELF-INSURED EMPLOYERS CLAIMS REPORTED BY SELF-INSURED EMPLOYERS REVENUES, EXPENDITURES AND FUND BALANCE 2001 CLAIMS ACTIVITY 2001 SECTION 34-9-358 OF THE OFFICIAL CODE OF GEORGIA ASSESSMENT CALCULATION FOR 2000 ASSESSMENT CALCULATION FOR 2001 ASSESSMENT - INSURANCE COMPANIES ASSESSMENT - GROUP SELF-INSURERS ASSESSMENT - SELF-INSURERS

PAGE
1 7
8 16
50 56 57 64 64 65 66 66 67 76 77

V

REIMBURSEMENTS PAID TO INSURANCE COMPANIES January 1, 2001 - December 31, 2001

Name ACE AMERICAN INSURANCE CO ACE PROPERTY & CASUALTY INS ACTAVA RISK RETENTION GROUP AIU INSURANCE CO ALFA INSURANCE CORP ALLSTATE INSURANCE CO AMERICAN ALTERNATIVE INS AMERICAN AUTOMOBILE INS CO AMERICAN CAS CO OF READING PA AME~CANHOMEASSURANCECO AMERICAN INSURANCE CO AMERICAN INTER INS CO OF GA AMERICAN INTERN. SOUTH INS CO AMERICAN MFG. MUTUAL INS AMERICAN MOTORISTS INS CO AMERICAN PROTECTION INS CO AMERICAN STATES INS CO AMERICAN ZURICH INS CO AMERISURE INSURANCE CO ARGONAUT INSURANCE CO ASSOCIATED INDEMNITY CORP ATLANTIC MUTUAL INS. CO AUTO OWNERS INS. CO BANKERS STANDARD INS CO BITUMINOUS CASUALTY CORP BUILDERS INSURANCE CALIFORNIA COMP INS CO CANAL INSURANCE CO CAPITAL CITY INS CO CASUALTY RECIPROCAL EXCHG CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO

Amount
$38,987.35 $60,285.95 $86,204.12 $11,359.89 $68,411.31 $38,445.97 $35,577.81 $53,942.06 $21,159.76 $15,953.99 $235,637.38 $42,978.34
$3,674.15 $420,948.93 $1,237,730.08 $167,270.00
$25,758.73 $1,832.86
$98,296.77 $38,738.83
$2,138.20 $226,280.98
$98,831.41 $41,327.20 $31,959.58 $840,404.17 $36,571.91 $201,446.66 $125,491.41 $219,344.94 $275,850.51 $32,188.63

-1 -

REIMBURSEMENTS PAID TO INSURANCE COMPANIES January 1, 2001 - December 31, 2001

Name CENTRE INSURANCE CO CHARTER OAK FIRE INS CO CHUBB INDEMNITY INS CO CHURCH MUTUAL INS CO CINCINNATI INSURANCE CO CITIZENS INS CO OF AMERICA CLARENDON NATIONAL INS CO COLUMBIA NATIONAL INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL MUTUAL INS CO COMPANION PROP & CAS CONNECTICUT INDEMNITY CO CONTINENTAL CASUALTY CO CONTINENTAL INSURANCE CO CORNERSTONE MUTUAL INS CO CORNERSTONE MUTUAL INS CO CYPRESS INSURANCE CO DISCOVER PROPERTY & CAS ELECTRIC INSURANCE CO ELECTRIC MUTUAL LIAB INS LTD EMC PROPERTY & CASUALTY EMPLOYERS INS OF WAUSAU EMPLOYERS MUTUAL CAS INS CO FARMINGTON CASUALTY CO FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FIDELITY & CAS CO OF NY
FIDELITY & GUARANTY INS CO FIRE & CASUALTY INS CO OF CT
FIREMAN'S FUND INS CO FIREMAN'S FUND INS CO OF GA FIREMAN'S FUND INS OF GA

Amount $381,471.38
$36,294.05 $62,346.86 $48,515.71 $195,691.95 $43,146.56 $221,698.18 $18,195.17 $18,003.00 $678,580.22 $139,027.25 $78,796.60 $1,471,655.99 $102,881.05 $388,234.99 $12,394.25 $102,025.49 $18,511.85 $23,105.50 $19,864.95
$1,395.27 $1,449,056.65
$1,183.26 $14,977.58 $42,083.80 $111,672.26 $108,527.45 $46,678.12
$4,913.88 $583,582.04 $731,721.74
$16,294.88

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REIMBURSEMENTS PAID TO INSURANCE COMPANIES January 1, 2001 - December 31, 2001

Name FIRST NATL INS CO OF AMER FLORISTS' MUTUAL INS CO FREMONT INDUSTRIAL IND FRONTIER INSURANCE CO GA INSURERS INSOLVENCY POOL GA TIMBER HARVERSTERS' GENERAL ACCIDENT INS OF AMER GENERAL INS CO OF AMERIC GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GLENS FALLS INS CO GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GREAT AMER INS CO OF NY GREAT AMERICAN INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALITY INS HARTFORD ACCIDENT & INDEMNITY HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD UNDERWRITERS INS HIGHLANDS INSURANCE CO HOME INSURANCE CO HOUSTON GENERAL INS CO INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INTERNATIONAL IND-LIQUIDATION JEFFERSON PILOT FIN INS CO LEGION INS CO-IN REHAB. LIBERTY INSURANCE CORP

Amount $14,758.33 $28,567.54 $44,435.90 $34,764.30 $584,890.24 $65,492.38 $452,725.39
$310.27 $384,431.68 $386,650.34 $299,525.71
$36,034.90 $9,190.73
$22,168.41 $23,132.35 $162,466.10 $42,586.14 $134,404.76 $38,091.73 $735,478.60 $283,797.37 $73,675.68 $58,789.95 $45,707.74 $436,261.46 $1,209,929.24 $52,699.17 $1,184,094.62 $95,100.05 $230,916.98 $578,454.72
$3.40

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REIMBURSEMENTS PAID TO INSURANCE COMPANIES January 1, 2001 - December 31, 2001

Name LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LMI INSURANCE CO LUMBER MUTUAL INSURANCE CO LUMBERMENS MUTUAL CAS CO LUMBERMEN'S UNDERWRITING MANAGEDCARE MUT CAPTIVE INS MARYLAND CASUALTY COMPANY MASSACHUSETTS BAY INSURANCE CO MONUMENTALGENERALCAS NATIONAL AMERICAN INSURANCE CO NATIONAL FIRE INS CO HARTFORD NATIONAL LIABILITY & FIRE INS NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE MUTUAL INS CO NEW HAMPSHIRE INSURANCE CO NORTH AMERICAN SPECIALTY INS NORTHBROOK PROP & CAS INS CO OCCIDENTAL FIRE & CASCO OF NC OHIO CASUALTY INSURANCE CO OLD REPUBLIC INSURANCE CO OLD REPUBLIC UNION INS CO ONEBEACON AMERICA INS CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PENN MFG ASSOC INS PHOENIX INSURANCE CO REALM NATIONAL INSURANCE REDLAND INSURANCE CO RELIANCE INSURANCE CO

Amount $80,642.75 $1,112,444.75 $113,485.02 $39,956.00 $710,688.72 $62,643.39 $33,526.00 $189,996.44
$4,200.00 $12,089.70 $75,609.85 $39,917.76
$100.02 $67,760.06
$4,824.49 $833,855.86
$39,646.59 $55,813.80
$2,142.25 $33,844.13
$8,247.30 $52,955.00 $685,299.51 $27,838.97 $228,310.78 $825,844.86 $75,650.04 $15,244.93 $30,975.94
$1,772.30 $35,431.69 $359,499.06

-4-

REIMBURSEMENTS PAID TO INSURANCE COMPANIES January 1, 2001 - December 31, 2001

Name RELIANCE NAT IND - LIQUDATION RELIANCE NAT INS CO IN LIQ. RENAISSANCE MUTUAL CAP INS REPUBLIC-FRANKLIN INSURANCE CO ROYAL & SUNALLIANCE INS. CO ROYAL INS CO OF AMERICA SAFECO INS CO OF ILLINOIS SAFECO INSURANCE CO AMERICA SECURITY INS CO OF HARTFORD SELECT INSURANCE CO SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SOUTHEAST SELECTIVE INSURANCE CO OF SC SENTRY INSURANCE A MUTUAL CO SOUTH CAROLINA INSURANCE CO SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INSURANCE CO SOUTHERN MUTUAL CHURCH INS SOUTHERN TRUST INSURANCE CO ST PAUL FIRE & CASUALTY INS CO ST PAUL FIRE & MARINE INS CO STANDARD FIRE INSURANCE CO STAR INSURANCE CO STATE AUTOMOBILE MUTUAL INS STATE FARM FIRE & CASUALTY CO SUMITOMO MARINE & FIRE INS CO TIG INSURANCE CO TIG PREMIER INSURANCE CO TOKIO MARINE & FIRE INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO TRANSPORTATION INSURANCE CO

Amount
$310,884.66 $124,973.85 $139,340.00
$10,891.52 $75,605.97 $503,985.52 $22,410.95 $217,617.43 $72,598.42 $34,949.65 $50,545.55 $47,853.52 $56,695.36 $407,907.65 $13,539.97 $229,599.00
$2,315.00 $104.13
$6,257.32 $9,964.96 $209,611.43 $10,981.66 $179,441.14 $16,394.56 $167,791.80 $27,413.90 $270,953.27 $26,484.72 $96,740.72 $710,203.36 $2,860.00 $1,589,157.35

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REIMBURSEMENTS PAID TO INSURANCE COMPANIES January 1, 2001 - December 31, 2001

Name TRAVELERS CAS & SUR CO TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY CO OF IL TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMER TRAVELERS INSURANCE-ALT TRAVELERS INSURANCE CO TRAVELERS PROP & CAS INS CO TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS UNITED PACIFIC INSURANCE CO UNITED STATES FIRE INSURANCE UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO VALLEY FORGE INSURANCE CO VIGILANT INSURANCE CO WAUSAU UNDERWRITERS INS CO WESTFIELD INSURANCE CO ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Grand Total:

Amount $891,326.67
$38,447.51 $420,937.29 $142,295.12
$50,467.11 $5,260.14
$1,571,241.96 $156, 143.29 $175,820.31 $67,714.99 $3,780.00 $25,876.59 $7,316.95 $38,426.36 $150,517.95 $14,968.68 $315, 124.87 $141,455.35 $101,287.63 $283,478.52 $882,103.42
$36,747,417.00

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REIMBURSEMENTS PAID TO GROUP SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name AGRITRUST OF GEORGIA
AMERICAN APPAREL CONT. ASSOC ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GEORGIA CONDITIONED AIR ASSOCIATION GA CONSTRUCTION SUPPLIERS' ASSOC GA ASSOC OF CONVENIENCE STORES GA AUTO DEALERS ASSOCIATION SI GA CONCRETE & PRODUCTS ASSOC GA EDUCATION WC TRUST FUND GA HIGHWAY CONTRACTORS SITF GA HOSPITAL ASSOC WCSI FUND GA MFG WORKERS' COMP. FUND GA MUNICIPAL ASSN WCSIF GA NURSING HOME SELECTIVE WC GA OILMEN'S ASSOCIATION GA OPERATORS SELF-INSURERS GA RETAIL MERCHANTS' GA SCHOOL BO ASSOC W C FUND GA WHOLESALE & RETAIL WC FUND GEMC WORKERS' COMP FUND HOSPITALITY SELF-INSURER'S METRO ATLANTA LANDSCAPE/TURF PRINTING INDUSTRY ASSOC OF GA
ROOFING & SHEET METAL ASSOC
W. C. FUND FOR HEALTH CARE Grand Total:

Amount $78,199.23 $137,754.35 $1,702,952.52 $534,873.33 $35,123.47 $161,936.26 $115,633.30 $344,775.81 $180,329.57 $566,547.23 $248,982.25 $1,209, 120.66 $30,123.14 $967,281.73 $134,581.95 $187,632.71 $35,500.81
$7,804.17 $616,439.74 $167,825.91 $336,807.45
$52,498.73 $249,785.28
$9,727.70 $25,147.17 $104,63.2.16 $8,242,016.63

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REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name AAA COOPER TRANSPORTATION AGL RESOURCES, INC. ALADDIN MILLS INC ALBANY, CITY OF ALPHARETTA, CITY OF AMSTED INDUSTRIES INC ANHEUSER-BUSCH COMPANIES, INC. ANSON AGGREGATES ASPLUNDH TREE EXPERT CO ATHENS-CLARKE COUNTY ATLANTA CITY OF ATLANTIC STEEL INDUSTRIES INC AUTOMOTIVE MOULDING COMPANY AUTOZONE, INC AVONDALE MILLS INC BANKHEAD ENTERPRISES, INC BARTOW COUNTY BD OF EDUCATION BAYLINER MARINE CORPORATION BEAULIEU OF AMERICA BELLSOUTH CORPORATION BELLSOUTH ENTERPRISES INC BET USA, INC BIBB COMPANY BIG B, INCORPORATED BLACK & DECKER CORPORATION BLUE BIRD BODY COMPANY BLUE CIRCLE AMERICA BRUNO'S INC & SUBSIDIARIES C T HARRIS INC C. W. MATTHEWS CONTRACTING INC CAGLE FOODS, JV, LLC CAGLE'S INC, & SUBSIDIARIES

Amount
$3,418.87 $157,962.18
$47,099.81 $30,326.14
$8,329.50 $10,655.20
$9,477.81 $13,275.00 $112,175.79 $130,744.40 $350,209.58 $75,054.87 $115,688.97
$5,000.00 $8,247.64 $9,176.81 $11,043.91 $21,931.24 $195,779.13 $300,463.84 $32,812.30
$324.32 $325,102.25
$7,600.00 $866.39
$167,333.58 $117,949.58
$71,513.34 $114,470.53
$80,440.24 $4,666.64
$51,622.75

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REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name
CANDLER HEALTH SYSTEM CAREMORE INC CATOOSA CO. BD. OF EDUCATION CEMEX (SOUTHDOWN INC.) CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHATHAM AREA TRANSIT AUTHORITY CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHILDREN'S HEALTHCARE OF ATL CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS COACHMAN REC. VEHICLE CO OF GA COASTALTRANSPORTINC COBB COUNTY BO/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC
COLLINS & AIKMAN FLOORCOVERING
COLLIS FOODS INC COLQUITT REGIONAL MEDICAL CENT COLUMBIA CO BOARD OF EDUCATION COLUMBUSFOUNDruESINC COLUMBUS REGIONAL HEALTHCARE CONAGRA FOODS, INC CONTI GROUP COMPANIES, INC CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER COTTRELL INC COX ENTERPRISES INC
-9-

Amount $10,370.37 $30,167.60 $26,500.72
$9,245.00 $70,895.38 $53,589.49 $81,662.00 $230,292.26 $68,980.48 $24,856.56 $54,136.34 $266,212.64 $19,066.15 $177, 139.45 $11,000.00 $44,708.16 $277,050.13 $125,076.04 $12,134.80 $79,964.33
$7,749.37 $31,128.43
$8,724.60 $82,850.31 $21,918.10
$7,258.41 $82,675.96
$4,084.93 $140,725.04
$13,548.65 $83,525.05
$7,142.50 $100,550.91

REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name
CRAWFORD W LONG MEM HOSPITAL CRIDER'$ POULTRY INC CROWN CENTRAL PETROLEUM CORP D L LEE & SONS INC DALTON CITY OF DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HLTHCARE SYS DELHAIZE AMERICA INC. DELTA AIRLINES, INC.
DIXIE GROUP & SUBSIDIARIES
DOLLAR GENERAL CORP DOREL JUVENILE GRP (COSCO, INC DOUGHERTY COUNTY COMMISSION DOUGLAS CO BD OF COMMISSIONERS DOUGLAS, CITY OF DRY BRANCH KAOLIN COMPANY DURKAN PATTERNED CARPET
E I DUPONT DE NEMOURS & CO
EAST POINT, CITY OF ELBERTON GRANITE ASSOCIATION EMORY UNIVERSITY ENGELHARD CORPORATION ESTES EXPRESS LINES EVANS GRADING CO., INC FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS FEDERATED DEPARTMENT STORES FIELDALE FARMS CORPORATION FIELDCREST CANNON INC FLEETWOOD HOMES OF GA INC
FLORIDA ROCK & TANK LINES INC
FLOWERS INDUSTRIES INC
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Amount
$20,540.25 $2,315.90 $5.46 $1,343.82
$228,320.00 $275,867.51
$20,222.50 $111,280.55 $308, 163.55
$70,143.07 $162,231.30
$8,011.67 $35,392.80
$2,316.60 $18,788.57 $13,080.00 $148,031.21 $11,725.00
$21.48 $2,266.00 $175,757.95 $5,824.49 $1,168.31
$159.63 $54,777.02
$842.95 $137,118.28
$17,340.89 $138,604.86
$19,855.20 $16,427.73 $112,900.00 $155,663.06

REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name
FORD MOTOR COMPANY FORSYTH CO BD OF COMMISSIONERS FORT JAMES CORP. FREUDENBERG-NOK FRIGIDAIRE CO MICROWAVE PRODS. FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHY GA MEDCORP, INC. GA S.I. GUARANTY TRUST FUND GAINESVILLE CITY OF GALAXY CARPET MILLS INC GEIGER INTERNATIONAL, INC GENUINE PARTS COMPANY GEORGIA POWER CO GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GLYNN COUNTY BOARD OF COMMSNRS GOLD KIST INC GOLDEN PANTRY FOOD STORES INC GOLDEN PEANUT COMPANY GRAND UNION COMPANY GREAT DANE LTD PARTNERSHIP GULFSTREAM AEROSPACE CORP GWINNETT CO BD OF EDUCATION GWINNETT COUNTY BD OF COMMISS GWINNETT HOSPITAL SYSTEM HALL COUNTY BOARD OF EDUCATION HAMILTON HEALTH CARE SYSTEM HARRISON POULTRY, INC HCA - THE HEALTHCARE CO. HILLCREST FOODS, INC
- 11 -

Amount $707,672.25
$20,961.29 $199,314.07
$92,291.01 $47,762.70 $117,115.55 $310,074.08 $21,372.58 $27,820.93 $218,705.48 $171,521.95 $74,221.04 $49,694.17 $72,282.54 $398,575.83 $6,135,509.77 $341,854.96 $56,389.88 $87,600.00 $246,576.83 $75,160.68 $19,806.05 $51,039.88 $21,567.08 $79,328.23 $23,061.26 $87,530.27 $122,567.63 $44,879.89
$4,750.00 $38,781.80 $162,767.46 $133,928.48

REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name
HOME DEPOT INC/HOME DEPOT USA HORTON HOMES, INC HOUSTON COUNTY BD OF EDUCATION HUTCHESON MEDICAL CENTER HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION INGLES MARKETS INC INTERNATIONAL PAPER COMPANY J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. KEEBLER COMPANY KLEEN-TEX INDUSTRIES KLLM TRANSPORT
K-MART CORP & SUBSIDIARIES
LINDALE MANUFACTURING INC LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC LOXCREEN COMPANY, INC. MACON CITY OF MARIETTA CITY SERVICES MARTA MASTEC, INC SUBSIDIARIES MCDONALD'$ OF GEORGIA INC MCKENZIE TANK LINES INC MCKESSON CORPORATION MCLANE COMPANY, INC. MEAD CORPORATION MEMORIAL MEDICAL CENTER, INC. METALPLATE GALVANIZING LP METROMEDIA INTERNATIONAL GRP MOHAWK CARPET CORPORATION
-12 -

Amount $14,417.92 $23,986.72 $12,678.74 $51,359.22 $18,590.11
$2,440.35 $31,625.40
$4,115.01 $146,193.00 $197,981.93
$14,516.00 $157,266.20
$15,895.01 $55,950.00 $245,207.29 $14,393.17 $64,950.00
$5,942.94 $34,233.74
$3,949.28 $72,061.98 $81,305.75 $312,830.92
$12.70 $25,753.25 $64,575.00
$1,547.35 $22,449.20 $23,660.87 $44,436.45
$497.60 $12,925.00 $131,089.82

REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name
MOUNT VERNON MILLS MULLITE CO OF AMERICA NABISCO, INC NATIONAL SERVICES INDUSTRIES NORTHEAST GEORGIA HEALTH SYS OLIVER RUBBER CO OVERNITE TRANSPORTATION CO OWENS-CORNING FIBERGLASS PATTERSON PUMP COMPANY PCC AIRFOILS INC PEPSICO, INC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL PIGGLY WIGGLY CAROLINA CO INC QUEEN CARPET CORPORATION RACETRAC PETROLEUM, INC RALSTON PURINA COMPANY RANDSTAD STAFFING SERVICES RICHMOND COUNTY BD OF COMMISS RICHMOND CTY BD OF EDUCATION ROADWAY EXPRESS, INC. ROME, CITY OF ROOKER ADMINISTRATIVE SERVICES ROPER CORPORATION RYDER SYSTEMS INC SAINT JOSEPH'S HEALTH SYSTEM SAINT MARY'S HEALTH CARE SAVANNAH CITY OF SCIENTIFIC-ATLANTA INC
. SEARS, ROEBUCK & CO
SHAW INDUSTRIES INC SHERWIN-WILLIAMS COMPANY $HONEY'S INC
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Amount $49,319.71 $19,069.21 $223,452.42 $285,008.62 $48,672.98 $27,919.40 $144,723.10 $18,996.15 $173,439.31 $64,171.05 $33,747.96 $18,298.93 $20,458.68 $28,518.78 $54,174.78 $42,913.44 $28,294.18
$8,737.32 $10,098.53 $19,111.04
$5,368.94 $158,671.32
$3.00 $9,571.95 $8,325.00 $6,390.30 $32,673.93 $194,737.24 $162,579.34 $4,400.00 $753,980.27 $22,839.65 $47,753.81

REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name
SIZEMORE ,INC. SKF USA INC SOUTHEASTERN MILLS, INC
SOUTHERN BELL TEL & TEL
SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN NUCLEAR OPERATING CO SOUTHWIRE COMPANY SPALDING & EVENFLO COMPANIES ST FRANCIS HOSPITAL STONE CONTAINER CORPORATION STONE SAVANNAH PULP/PAPER
SUPERIOR RIGGING & ERECTING CO
SYNTHETIC INDUSTRIES, INC T. M. POLYFILM, INC TARGET CORPORATION TENNECO AUTOMOTIVE, INC TERMINIX SERVICE, INC TEXTRON, INC THERMAL CERAMICS TIFT GENERAL HOSPITAL TIFTON ALUMINUM CO INC/ALCOA I TIP TOP POULTRY INC TYCO INTERNATIONAL LTD. TYSON FOODS INC UNION CAMP CORPORATION UNITED HEALTH SERVICES INC UNIVERSITY HOSPITAL US GYPSUM/L & W SUPPLY & SUBS VF CORPORATION VISITING NURSE HEALTH SYSTEM VULCAN MATERIALS COMPANY WACHOVIA
-14-

Amount $2,014.68 $48,697.79 $7,746.48 $9,285.87 $59,667.25 $13,361.62 $58,600.00 $367,367.14 $1,191.95 $9,450.00 $107,906.59 $7,263.26 $17,113.86 $19,231.25 $12,941.47 $4,319.79 $202,104.86
$74.24 $15,959.13 $119,653.10 $30,068.13 $44,247.78 $85,445.56
$6,447.77 $15,536.24 $153,795.24 $32,966.64 $18,897.08
$1,404.52 $376.10
$1,971.83 $7,020.00 $30,127.29

REIMBURSEMENTS PAID TO SELF-INSURED EMPLOYERS January 1, 2001 - December 31, 2001

Name WAFFLE HOUSE WAGGONER$ TRUCKING CO., THE WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WARREN SEWELL MFG. CO. WATKINS ASSOCIATED INDUSTRIES WATKINS ENGINEERS & CONST WAYCROSS, CITY OF WELLINGTON LEISURE PRODUCTS WELLSTAR HEALTH SYSTEM WEST GEORGIA HEALTH SYSTEM WEST POINT STEVENS, INC WESTVACO CORPORATION & SUBS WEYERHAEUSER COMPANY WHITFIELD CO-BD OF EDUCATION WHITFIELD COUNTY BD OF COMMISS WINN-DIXIE STORES INC WORLD CARPETS INC YELLOW FREIGHT SYSTEM INC YKK CORPORATION OF AMERICA ZARTIC INC Grand Total:

Amount $216,754.77
$1,649.04 $232,891.40
$56,829.88 $73,798.33 $33,450.20
$1,781.80 $225,105.00
$52,008.78 $16,701.61 $18,363.61 $52,502.40 $158,923.36 $33,873.65 $114,734.86
$6,583.47 $24,385.42 $402,379.65 $55,923.43
$4,334.30 $32,642.86 $25,357,816.59

-15 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emelo~er Name

Total

Ci~

State

Reimbursed

76 LUBRICANTS COMPANY

SAVANNAH

GA

A & B PAINTING SERVICE

LAWRENCEVILLE

GA

A & E MECHANICAL CONTRACTORS LAWRENCEVILLE

GA

A.A. FRIEDMAN, INC.

AUGUSTA

GA

A.J.'s FOOD STORE

BOGART

GA

A.O.K. HEATING & COOLING

McDONOUGH

GA

AAA AUTO CLUB SOUTH

MARIETTA

GA

AAA FLORIDA/GEORGIA, INC.

ATLANTA

GA

AACTION AUTO PARTS

SAVANNAH

GA

AB & G FIRE RESTORATION

DOUGLASVILLE

GA

AB DICK CO.

ATLANTA

GA

ABB C-E SERIVCES, INC.

SUWANEE

GA

ABB DAIMLER-BENZ TRANS.

ATLANTA

GA

ABB OVERHEAD DISTRIBUTION

ATHENS

GA

ABB SERVICE INC

NORCROSS

GA

ABC HOME HEALTH CARE

WARNER ROBINS

GA

ACANDS, INC.

CONYERS

GA

ACOUSTI, INC.

ATLANTA

GA

ACTION BLUE PRINT CO.

ATLANTA

GA

ACTION ELECTRIC COMPANY, INC.

SMYRNA

GA

ACTION GROUP, INC.

FOREST PARK

GA

ADAMS-WARNOCK INC

SAVANNAH

GA

ADC SYSTEMS INTEGRATION

CHICKAMAUGA

GA

ADC TELECOMMUNICATION

CHICKAMAUGA

GA

ADCOX SERVICE CO. INC

LAKE CITY

GA

ADDISON STEEL

ALBANY

GA

ADVANCE EMPLOYMENT CONCEPTS SANANTONIO

TX

ADVENTIST HEALTH SYSTEM

CALHOUN

GA

AE GOETZE - LAGRANGE

LANGRANGE

GA

AEC ELECTRIC

THOMASVILLE

GA

AEP INDUSTRIES, INC.

GRIFFIN

GA

AFC/CHURCH'S

ATLANTA

GA

AFFILIATED BUILDING SERVICE

ATLANTA

GA

AGCO

DULUTH

GA

AIR CONDITIONING CORP.

EAST POINT

GA

AIR CONDITIONING TECH.& SVCS

THOMASVILLE

GA

$28,158.62 $13,967.69 $11,791.04 $20,356.42 $13,436.82 $13,238.63 $86,106.60 $15,956.65
$6,422.41 $245.79
$54,207.83 $593.47 $894.34
$56,487.00 $112,000.00
$628.00 $21,323.67 $35,562.74 $19,513.33 $28,214.02 $21,079.60
$1,899.89 $6,246.32 $25,945.25 $17,587.45 $21,900.73 $27,296.34
$463.84 $821.00 $909.62 $10,228.11 $198,211.49 $4,400.00 $193.00 $9,991.95 $628.00

-16 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em~lol(er Name AIR PRODUCTS & CHEMICALS ALABAMA ELECTRIC CO. OF DALTON ALBANY BEVERAGE CO ALBANY HERALD PUBLISHING CO. ALBANY NEON SIGNS ALBANY UROLOGY CLINIC, P.C. ALDEAN DUKES LOGGING INC ALEX FOODS INC ALEXANDER & ALEXANDER SVC INC ALFRED MCCANNON WELL BORING ALL AMERICAN QUALITY FOODS INC ALL CITY SECURITY ALL METAL, INC. ALL SOUTH SUPPLY ALL SOUTH TERMINALS, INC. ALLEN TERMITE & PEST CONTROL ALLGOOD ELECTRIC CO. ALLGOOD OUTDOORS, INC. ALLIED ASPHALT CO ALLIED WASTE ALLIED WHEELER CORP. ALLISON SMITH CO. ALPHA FLOOR COVERING, INC. ALPHA PRODUCTS, INC. AMEDISYS AGENCIES AMERCORD, INC. AMERICAN EGG PRODUCTS AMERICAN EXTRUSIONS AMERICAN FOOD CORP/DUNKIN DN'T AMERICAN GLASS & MIRROR AMERICAN LANDMARK FENCE AMERICAN NATIONAL CAN AMERICAN RAILROAD IND AMERICAN RUG CRAFTSMEN AMERICAN SECURITY INSURANCE CO AMERICAN SUZUKI MOTOR CORP

Citl(
CONYERS DOTHAN ALBANY ALBANY ADEL ALBANY VALDOSTA ATLANTA ATLANTA COMER STOCKBRIDGE HAPEVILLE TOCCOA CARTERSVILLE ATLANTA BRUNSWICK CENTERVILLE CUMMING MACON SCOTTSDALE DOUGLASVILLE ATLANTA ALPHARETTA ATLANTA LAVONIA LUMBER CITY BLACKSHEAR DALTON CANTONMENT VALDOSTA MABLETON FOREST PARK ATLANTA SUGAR VALLEY ATLANTA ATLANTA

State
GA
AL GA GA GA
GA
GA GA
GA
GA GA GA
GA
GA
GA GA
GA GA GA AZ GA GA GA GA GA GA GA GA FL GA GA GA GA
GA
GA GA

Total Reimbursed
$22,595.14 $59,433.19
$8,033.50 $8,265.29
$644.58 $13,535.47 $32,744.85
$48.43 $10,125.00
$2,596.46 $5,246.87 $76,187.14 $74,003.77 $12,982.11 $94,173.64 $87,213.23
$619.18 $341.10 $5,496.83 $5,056.84 $8,400.00 $86,450.18 $43,726.18 $187.30 $10,426.52 $207,303.74 $10,225.65 $57,267.99 $144,572.72 $42,978.34 $27,213.78 $10,735.00 $36,292.80 $139.80 $2,690.01 $5,720.65

-17 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo~er Name
AMERICAN VENDING CO., INC. AMERIPRIDE UNIFORM AMERISUITES AMERSON COMPANY AMF BAKERY SYSTEMS ANCHOR GLASS CONTAINER CORP.
ANCHOR HEATING & AIR
ANDERSON & ASSOCIATES ANDERSON MERCHANDISERS ANGLO AMERICAN ENGLISH CH ANSLEY ONE, INC. ANTHONY CRANE RENTAL, INC. APB, INC. AQUA-CHEM, INC. ARAMARK CORP. ARCHER DANIELS MIDLAND CO. ARCHITECTURAL ACCENTS ARLINGTON MEMORIAL PARK ARNALL GROCERY ARNOLDJOHNSON ARROW CO. ART PLUMBING CO. ARTISTIC JANITORIAL SERVICES ASSOCIATED RUBBER CO. ASTECHNOLOGIES, INC. ATC HEALTHCARE SERVICES ATHENS SEED CO. ATLANTA BONDED WAREHOUSE ATLANTA FENCE COMPANY ATLANTA FURNITURE ATLANTA HAULING-WASTE MGMNT ATLANTA HILTON & TOWERS ATLANTA HISTORICAL SOCIETY ATLANTA SOUTHEAST AIRLINES ATLANTA STEEL ERECTORS, INC. ATLANTA UTILITY CO

Cit~ EAST POINT ATHENS DULUTH MACON RICHMOND WARNER ROBINS DOUGLASVILLE ALBANY LAWRENCEVILLE SANDERSVILLE SAVANNAH ATLANTA ELLENWOOD THOMASVILLE ATLANTA MACON ATLANTA ATLANTA NEWNAN FOLKSTON BUCHANAN JONESBORO MARIETTA TALLAPOOSA ROSWELL MACON WATKINSVILLE KENNESAW LITHONIA DECATUR SMYRNA ATLANTA ATLANTA ATLANTA SMYRNA EAST POINT

State
GA GA
GA GA
VA
GA GA GA GA
GA GA
GA GA GA GA GA
GA
GA GA GA GA GA
GA
GA
GA
GA GA
GA
GA GA GA
GA
GA GA GA GA

Total Reimbursed
$2,315.00 $30,474.02
$5,541.32 $16,050.43
$7,816.25 $10,981.66 $138,774.19
$9,618.56 $11,553.71 $104,428.44 $14,284.92 $33,097.86
$9,603.23 $9,564.95 $40,875.97 $8,133.60 $114,583.60 $14,428.12 $34,571.90 $101,702.19 $79,376.01 $2,573.46 $19,350.12 $19,069.10 $75,272.58 $72,213.05 $12,508.55 $27,186.51 $6,480.00 $13,206.60 $9,339.68 $4,975.70 $5,855.89 $1,062.96 $138,286.99 $8,564.80

- 18 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo)l:er Name

Total

Cit){:

State

Reimbursed

ATLANTA WEST CARPETS, INC.

AUSTELL

GA

ATLANTA WIRE WORKS, INC.

JONESBORO

GA

ATLANTIC COAST FIRE PROTECTION DULUTH

GA

ATLANTIC HOME HEALTH CARE

PEARSON

GA

ATLAS TECHNOLOGIES INC

FENTON

Ml

AUBREY SILVEY ENT. INC.

CARROLLTON

GA

AUGUSTA NEWSPRINT CENTER

AUGUSTA

GA

AUGUSTA READY MIX, INC.

AUGUSTA

GA

AUTOMATIC DATA PROCESSING

ATLANTA

GA

AUTOZONE, INC.

ROME

GA

AVON PRODUCTS, INC.

SUWANEE

GA

AYRES CORP

ALBANY

GA

B & M WOOD PRODUCTS, INC

MANOR

GA

B&RSALVAGE

EAST POINT

GA

B &W PIPELINE & BOARDING CO.

COVINGTON

GA

BABB'S AUTO SERVICE

DALTON

GA

BABCOCK & WILCOX COMPANY

BRUNSWICK

GA

BACON COUNTY BD OF EDUCATION ALMA

GA

BALLARD BROTHERS ELECTRIC

MACON

GA

BANK SOUTH

ATLANTA

GA

BARDI HEATING/AIR CONDITIONING

NORCROSS

GA

BARNES & NOBLE

GRIFFIN

GA

BARNETT BANK OF SOUTHEAST GA BRUNSWICK

GA

BARRINGTON HALL DEVELOPMENT WARNER ROBINS

GA

BARRY MFG. CO.

STONE MOUNTAIN GA

BARTENFELD ELECTRIC COMPANY

ATLANTA

GA

BARTON PROTECTIVE SERVICES

ATLANTA

GA

BARTON SOUTHERN CO.

CONYERS

GA

BATES HARDWARD CO.

ATLANTA

GA

BATSON-COOK COMPANY

WEST POINT

GA

BATTLE LUMBER COMPANY, INC.

WADLEY

GA

BAXTER INTERNATIONAL

NORCROSS

GA

BEALL'S 1860 RESTAURANT

MACON

GA

BEDWAY SECURITY AGENCY, INC.

VALDOSTA

GA

BEECH ISLAND KNITTING

QUITMAN

GA

BEKAERT CORP.

ROME

GA

$30,308.93 $5,064.29
$15,000.28 $584.65
$16,466.56 $14,937.30 $30,986.95
$4,445.90 $5,652.55 $2,143.88 $62,315.08 $7,638.51 $13,322.47 $1,519.91 $1,743.74 $13,100.53 $21,716.44 $5,375.46 $11,045.00 $15,411.87 $1,431.12 $1,822.20 $10,488.09 $161,194.82 $14,815.11 $13,547.54 $7,408.78
$759.50 $12,723.52
$127.20 $10,575.00 $83,546.19
$4,040.99 $231.25
$68,122.10 $55,504.35

-19 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo)ler Name
BELK SIMPSON COMPANY
BELK STORES & AFFILIATES BELL COMPANIES UNLIMITED BELL TRANSPORTATION BEN KENNEDY TRUCKING CO. BENCHMARK ASSOCIATES BERENDSEN FLUID POWER BERRIEN COUNTY HOSPITAL BERRIEN NURSING CENTER BEST BUilT FENCES, INC. BEST INNS AMERICA BEST MANUFACTURING, INC. BEST WESTERN - SAVANNAH BETTER BACKERS, INC. BETTY'S DIAL-A-MAID BETZ DEARBORN, INC. BEVIS ROPE MANUFACTURING INC B-H TRANSFER COMPANY BILL HEARD CHEVROLET Bl-LO, INC. BLAKE CONSTRUCTION CO. BLOUNT CONSTRUCTION BLUE BEACON INTERNATIONAL BLUE CIRCLE BOEING BO'S OF TIFTON BOY SCOUTS OF AMERICA BRAD COLE CONSTRUCTION BRADLEY PLYWOOD CORP. BRENCOR ASSET BRENT WALKER FORD INC BROCKWAY STANDARD INC BROOKS CO BD OF EDUCATION BROOKSTONESCHOOL BROWN & WILLIAMSON TOBACCO
BRUNSWICK/U.S. MARINE

Cit)
BAINBRIDGE
CARROLLTON
WATKINSVILLE ATLANTA PRESTON DOUGLASVILLE MARIETTA NASHVILLE NASHVILLE COLUMBUS DALTON CORDELE
SAVANNAH
CHATSWORTH CORDELE TREVOSE ROSSVILLE
SANDERSVILLE
COLUMBUS
MAULDIN
ST. MARYS ATHENS JACKSON MARIETTA DULUTH TIFTON
ATLANTA
CARROLLTON
SAVANNAH ATLANTA
GLENVILLE HOMERVILLE
QUITMAN
COLUMBUS
MACON VALDOSTA

State
GA GA GA GA GA GA
GA
GA GA GA GA GA GA GA GA PA GA GA
GA
SC GA GA
GA
GA GA GA GA GA GA GA GA GA GA
GQ
GA GA

Total Reimbursed
$4,935.47 $135,071.77
$25,445.80 $59,544.08 $27,751.65 $15,670.77 $30,899.11
$9,576.66 $3,161.66 $11,359.89 $111,568.13 $113,806.67 $6,477.28 $9,906.75 $10,806.76 $23,740.69 $12,375.00 $9,764.62 $39,378.11 $38,661.83 $8,115.00 $8,046.92 $5,291.16 $28,090.70 $15,241.61 $6,257.32 $5,384.93 $79,182.99
$367.18 $4,680.00 $1,760.00 $11,307.10 $1,486.74 $10,891.52 $194,031.21 $67,283.58

-20 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12loy:er Name BUILDING TECHNOLOGY BURGER KING BURLINGTON INDUSTRIES BURLINGTON NORTHERN BURNS JANITOR SERVICE BURTON INC. BUSINESS GRAPHICS CONSULTANTS BUSINESS TEMPS/TEMP MASTER C & D CHARTER POWER SYSTEMS C & H INVESTMENT, INC. C & H MECHANICAL & PLUMBING C &J COMPANY C.T. BROKERAGE, INC. CALHOUN MILLWORKS INC CAL-MAINE FOODS, INC. CALVARY CHRISTIAN SCHOOL CAMBRIDGE BUILDERS CAMPBELL DECORATING CO. CANADA LIFE ASSURANCE CO. CAP ENTERPRISES,INC. CAPITOL MATERIALS INC CAR CRAFT CARAVELLE MARINE, INC. CARD CAGE-SUMMIT CORP CARDINAL SPECIALTY PRODUCTS CARE GIVER'S INC CARE MASTER CARMICHAEL OIL OF WALTER B CARROLL & CARROLL CARTER & ASSOCIATES CARTER MECHANICAL, INC. CARTERSVILLE COUNTRY CLUB CARWOOD MANUFACTURING CASTECH, INC. CASTLEBERRY'$ FOOD CO, INC CATOOSA COUNTY BD OF COMM.

Ci~ TALLAPOOSA DOUGLASVILLE SHANNON ALBANY MACON HUTCHINSON FT OGLETHORPE AUGUSTA CONYERS BRUNSWICK DEMOREST DALTON ALPHARETTA CALHOUN SHADYDALE COLUMBUS ATLANTA ATLANTA ATLANTA JONESBORO ATLANTA ATHENS
AMERICUS
COLUMBUS CALHOUN MACON GRIFFIN RICHMOND HILL
SAVANNAH
ATLANTA MACON CARTERSVILLE WINDER JONESBORO AUGUSTA RINGGOLD

State
GA GA
GA GA
GA
KS GA GA
GA GA
GA GA
GA
GA GA
GA GA
GA
GA
GA
GA
GA GA
GA GA
GA GA
GA
GA GA GA GA GA GA GA
GA

Total Reimbursed
$18,348.00 $11,150.00 $10,009.16 $13,826.75
$898.98 $649.00 $3,734.35 $17,035.62 $2,383.81 $9,311.53 $7,920.03 $2,456.63 $9,707.85 $37,420.62 $11,086.87 $18,376.17 $10,069.00 $145,158.35 $1,475.68 $3,214.83 $38,903.16 $4,950.66 $2,146.06 $17,184.33 $48,723.83 $43,146.56 $17,163.69 $730.90 $189.40 $13,910.40 $1,643.75 $46,258.01 $9,596.34 $8,691.88 $324.90 $440.55

- 21 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo)ler Name
CBS RECORDS, INC CEBCOR/EBBA IRON, INC. CECIL MALONE COMPANY CENTER BROTHERS , INC. CENTRAL FOOD MANAGEMENT CENTRAL GA EYE CENTER PC CENTRAL HEALTH HOLDING CENTURY CARTAGE CO. CENTURY COMMUNICATIONS CHALLENGE FIRE PROTECTION CHAMBERS DEVELOPMENT CO. CHAMPION INTERNATIONAL CORP CHAPARRAL BOATS, INC. CHARLES HOMES CHARTER CENTRAL GA. CHARTER MOBILE HOMES, INC. CHATHAM STEEL CORPORATION CHEMCO, INC. CHEMICAL LEAMAN TRUCK LINES CHEMLAWN CHEROKEE TOWN & COUNTRY CHESTNUT RIDGE NURSING CHICOPEE MANUFACTURING CO CHUMLEY'S PAVING & GRADING INC CHURCH OF JESUS CHRIST LDS CHURCHWELL'S DRYWALL CIBA VISION CORPORATION CIRCLE K CORPORATION CIRCLE K STORES, INC.
CITIZENS BANK OF SWAINSBORO
CITY OF COVINGTON CITY OF EAST POINT POLICE DEPT CITY OF FORT VALLEY CITY OF GRIFFIN CITY OF HOGANSVILLE CITY OF LINWOOD

Cit)l
CARROLLTON DALLAS ATLANTA ATLANTA ATLANTA MACON FT. OGLETHORPE DULUTH BRUNSWICK GRAYSON ATLANTA
WAYCROSS
NASHVILLE MARIETTA ATLANTA HINESVILLE
SAVANNAH ATLANTA
JONESBORO COLLEGE PARK ATLANTA CUMMING GAINESVILLE ACWORTH ATLANTA COCHRAN ATLANTA NORCROSS FORT MILL SWAINSBORO COVINGTON EAST POINT FT VALLEY GRIFFIN HOGANSVILLE LINWOOD

State
GA
TX
GA
GA
GA GA
GA
GA GA
GA GA
GA GA GA GA GA GA GA GA GA GA
GA GA GA GA GA GA
GA
SC GA GA GA GA GA GA GA

Total Reimbursed
$1,062.07 $2,687.64 $24,407.82 $1,158.25 $11,181.11 $16,873.39 $16,876.83
$308.00 $137,449.15
$40,749.65 $69,668.18
$7,949.00 $14,860.06 $98,743.60 $48,569.77 $14,797.03 $15,697.10
$894.47 $7,740.74 $1,092.50 $2,822.00 $25,500.59 $6,662.00 $13,539.97 $24,040.70 $11,977.86 $165,384.89 $2,610.28
$358.27 $32,188.63 $31,991.16
$7,178.73 $8,966.58 $58,070.00 $3,244.75 $16,870.88

- 22 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em~loli!er Name
CITY OF METTER CITY OF QUITMAN CITY OF ROME CITY OF WAYCROSS CIVITAN REGIONAL BLOOD CTR. CJT INDUSTRIAL CONTRACTORS CKS PACKAGING COMPANY CLARKE BUMPER TO BUMPER CLARK'S SUPER MARKET CLASSIC COLLISION CLASSIC HOME DETAILING CLASSIC PAINT & CONSTRUCT! CLATON NEWS & DAILY CLAY-RIC, INC. CLEVELAND CONSOLIDATED, INC. CLIMATE CARE, INC. CLOROX CO. CLYOE GILLELAND CONTRACTOR COAL TRUCK TRANSPORT COBB COUNTY TRACTOR CO. COCA COLA BOTTLING COMPANY COCHRAN CEILING COMPANY, INC. COCHRAN'S AUTO TRUCK STOP COLEMAN AMERICAN MOVING COLONIAL OIL INDUSTRIES COLONIAL PAINTING COMPANY COLORMASTER COLUMBIA DR. ANIMAL CLINIC COLUMBUS PRODUCTIONS COLUMBUS SPRINKLER & IRRI COMBINED MECHANICAL COMBUSTION ENGINEERING COMBUSTION TECHNOLOGIES INC COMMERCIAL MANAGEMENT COMMUNITY NEWSPAPER, INC. CON MAC

Citli! METTER QUITMAN ROME WAYCROSS GAINESVILLE MACON MABLETON ATHENS GRIFFIN CHAMBLEE MCDONOUGH LILBURN JONESBORO
SAVANNAH
WAYNESBORO ROME FOREST PARK CANTON LAWRENCEVILLE MARIETTA AUGUSTA COCHRAN RINGGOLD MIDLAND CITY SAVANNAH CHAMBLEE CALHOUN DECATUR COLUMBUS COLUMBUS MARIETTA JULIETTE FLOWERY BRCH WAYCROSS DAHLONEGA ATLANTA

State
GA GA
GA
GA
FL GA GA GA GA GA
GA GA GA
GA
GA
GA GA GA
GA
GA GA GA GA AL GA GA GA GA
GA
GA GA GA GA GA GA GA

Total Reimbursed
$585.99 $2,653.75 $49,085.63 $11,326.00 $4,824.49 $26,197.89
$732.83 $7,316.95 $19,983.16 $18,195.17 $60,745.89 $4,747.29 $11,088.45 $17,115.00 $9,300.00 $15,208.22 $44,710.32 $57,061.86 $2,008.11 $28,547.00 $7,530.00 $40,365.57 $8,660.03 $11,866.13 $23,711.43 $9,679.86 $2,970.00 $51,984.56 $5,189.15 $36,411.62 $124,615.67 $15,887.30 $18,558.73 $166,036.99 $2,507.82 $198,370.00

- 23 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo~er Name
CONSOLIDATED FREIGHTWAYS CONSOLIDATED SERVICES CONTAINER GENERAL CORP. CONTAINER MARKETING, INC. CONTINENTAL BAKING COMPANY CONTINENTAL CAN CO CONTINENTAL GRAIN CONTINENTAL PRODUCTS CONTINENTAL TELEPHONE CO. COOKSON GROUP COOPER DDS, PC COOPERATIVE PURCHASING AGENCY COOSAWATTEE RIVER RESORT CORNELIA VENEER COMPANY CORONET INDUSTRIES CORPORATE PRINTERS, INC. CORROSION SERVICES, INC. COUNTRY HOME BAKERY, INC. COUNTRY PRIDE FOODS, INC. COVINGTON INDUSTRIES, INC. COWETA CO BD OF EDUCATION CPS TRUCKING CRAVEN POTTERY, INC. CRUM'S GARDEN CENTER CRYSTAL FARMS INC CRYSTAL SPRINGS PRINT WORKS CS INTEGRATED LOGISTICS CUMMINS SOUTH INC CURT'S D & N ELECTRIC COMPANY, INC. D & S ELECTRIC, INC. D.R. HORTON DAIRY QUEEN DANNY MCGRAW LOGGING CO DARBY PRINTING COMPANY DARRELL HUTCHESON

Cit~ NORCROSS COLUMBUS FOREST PARK AMERICUS ROME PERRY CORDELE DALTON ATLANTA ALPHARETTA WAYCROSS CLEVELAND ELLIJAY CORNELIA DALTON CUMMING CEDAR SPRINGS ATLANTA GAINESVILLE
ATLANTA
NEWNAN ALTO COMMERCE BAINBRIDGE, CHESTNUT MTN. CHICKAMAUGA EAST POINT COLLEGE PARK OAKWOOD HAPEVILLE CONYERS
SMYRNA
MCRAE SUMMERVILLE ATLANTA GARDEN CITY

State
GA GA
GA
GA GA GA
GA
GA GA
GA
GA
GA
GA GA
GA GA
GA
GA GA GA GA
GA GA GA GA GA GA
GA
GA
GA GA
GA GA
GA
GA GA

Total Reimbursed
$71,937.17 $723,638.36
$9,366.85 $181.43
$13,532.60
$11,446.90
$39,909.57
$14,386.17 $10,444.90
$1,514.18 $83,575.66
$81,983.13
$23,132.35 $347.59
$18,820.06 $1,675.18
$36,285.11
$9,166.40 $14,986.49
$2,286.35
$15,363.02 $44,436.66 $16,294.88
$9,520.56
$9,527.20 $1,271.39 $11,791.23 $60,166.52
$42,988.60
$52,508.77 $3,605.75
$5,721.34 $5,755.62
$155.00 $3,729.24
$22,365.54

24

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo~er Name
DAVE & SONS, INC. DAVEY TREE EXPERT COMPANY DAVID SHAPIRO & COMPANY, INC. DAVIDSON-KENNEDY CO. DAY STAR LAWN MAINTENANCE DAYS INN DAYS INN-ROME DECATUR COUNTY BOARD OF ED. DEERFIELD SPECIALTY PAPERS INC DEL MAR WINDOW COVERINGS DELCO INDUSTRIES DELTA AIRLINES, INC. DELTA LIFE INS. CO. DELTA REFRIGERATION DESTER PRODUCTION CORP DESTINY INDUSTRIES DEVEREUX CENTER OF GA. DEVOTIE CONSTRUCTION DEVRO-TEEPAK, INC. DIAMOND HOLDING CORP. DIAMOND PLASTIC CORP DILLARD SMITH CONSTRUCTION CO. DIMAC CORP. DITTLER BROTHERS, INC DIVERSCO, INC DIVERSIFIED CABINETS DIXON TIMBER CO. DJC ENTERPRISES, INC. DOBBS INTERNATIONAL SERVICES DODGE COUNTY HOSP AUTHORITY DOLPHIN REALTY CORP. DON HOSMER, INC.
DON SWANN DISTRIBUTORS, INC.
DORSEY TRAILERS, INC. DOUGLAS & LOMASON DRILLERS SERVICES, INC.

Cit~
ALBANY CHAMBLEE VALDOSTA ATLANTA DALLAS UNION CITY ROME BAINBRIDGE AUGUSTA ATHENS TUCKER ATLANTA MACON NORCROSS THOMASTON MOULTRIE KENNESAW KENNESAW ATLANTA MARIETTA MACON
SMYRNA
AUSTELL OAKWOOD SPARTANBURG NORCROSS JESUP MARIETTA ATLANTA EASTMAN ATLANTA EATONTON ATLANTA CARTERSVILLE CARROLLTON ASHBURN

State
GA GA
GA GA GA GA GA GA
GA
GA
GA GA GA
GA GA GA GA GA GA
GA
GA
GA
GA GA SC GA GA GA
GA
GA GA GA
GA
GA GA
GA

Total Reimbursed
$5,479.92 $8,299.68
$833.46 $102,869.91
$30,453.70 $21,756.45
$1,074.24 $897.42
$27,776.11 $43,283.34 $10,940.49
$4,875.81 $10,624.14 $139,340.00
$6,332.35 $46,203.23 $41,565.93 $6,164.43 $10,286.45 $15,453.06 $13,568.07 $17,927.34 $33,113.72 $108,899.38 $22,955.40 $22,410.95 $7,456.59 $36,528.35 $8,662.50 $19,379.21 $26,864.45 $40,694.34 $38,766.88
$4,503.20 $98,296.77 $17,806.42

- 25 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo~er Name
DRUG EMPORIUM 117 DUBARD'S TIRE & ALIGNMENT DUBLIN INDUSTRIAL SERVICES DUKES ELECTRIC CO. DUNAGAN & SONS, INC. DUNWOODY HOME HEALTH DUNWOODY MEDICAL CENTER DURAND GRACE REALTY DURANGO PAPER, INC. DURDEN ENTERPRISES DURO-MED INDUSTRIES DWB CARPET HOLDINGS DYKES PAVING & CONSTRUCTION DYSON-KISSNER-MORAN CORP. EARL SMALL'S HARLEY DAVIDS EAST WEST ENTERPRISES EASTERN AIRLINES, INC. ECC INTERNATIONAL ECKERD DRUG EDWARDS BAKING CO. ELECTRICAL TECHNOLOGY SERVICE3 ELECTROMAGNETIC SERVICES, INC ELLENWOOD MACHINERY, INC ELLIOTT MACHINE SHOP ELLIS CROOKS, INC. ELLSWORTH FOODS, INC EMPIRE GAS CORP. EMPLOYEE SOLUTIONS INC EMPLOYER SOLUTIONS, INC. EMS VENTURES, INC. ENGELHARD CORP. ENGINEERED FABRICS CORP. ENGLEHARD CORP. ENGLISH CHINA CLAY'S INT. ENICHEM OF AMERICA EPICURE MANAGEMENT SERVICES

Cit~ ATHENS AUSTELL DUBLIN LAGRANGE ROME ATLANTA ATLANTA LAGRANGE ST. MARY'S AUBURN JESUP CHATSWORTH NORCROSS ROSSVILLE MARIETTA TOCCOA ATLANTA SANDERSVILLE SHENANDOAH ATLANTA ATLANTA NORCROSS ELLENWOOD MACON SENOIA TIFTON CLERMONT WAYCROSS PHOENIX GAINESVILLE GORDON ROCKMART ATTAPULGUS SANDERSVILLE CONYERS MACON

State
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA AZ GA GA GA GA GA GA GA

Total Reimbursed
$9,314.63 $14,300.00
$309.51 $1,890.15 $6,223.99 $92,963.54 $3,296.03 $10,787.00 $7,593.02 $12,324.80
$92.10 $15,400.00
$4,750.86 $28,075.65 $33,841.60
$723.99 $23,882.00 $17,756.68 $14,797.78 $13,423.10 $97,335.04 $10,575.63
$5,270.00 $19,267.39 $84,014.27
$4,553.57 $83,000.00 $37,643.20
$7,155.47 $150,616.45
$6,300.00 $32,815.88 $10,400.00 $10,175.00 $15,120.00
$1,040.79

26

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo)ler Name

Total

Cit)

State

Reimbursed

ERNST ENTERPRISES OF GA.

LAWRENCEVILLE

GA

ETHICON, INC.

CORNELIA

GA

EVANS MEMORIAL HOSPITAL

CLAXTON

GA

EXCEL LOGISTICS, INC.

FAIRBURN

GA

EXIDE CORP

ISLAMORADA

FL

F & L SEDOWICZ

SNELLVILLE

GA

F & W FARM SERVICE, INC

THOMASVILLE

GA

F & W FORESTRY

ALBANY

GA

F R GRANTHAM CONTRACTING

DECATUR

GA

FAMILY DOLLAR, INC.

VALDOSTA

GA

FASHION AVE.

MACON

GA

FAYETTE CO BD OF EDUCATION

FAYETTEVILLE

GA

FAYETTEVILLE BOWLING CENTER

FAYETTEVILLE

GA

FEDERAL PAPER BOARD CO., INC.

AUGUSTA

GA

FIBER ONE

DALTON

GA

FIBERVISIONS, INC.

COVINGTON

GA

FIRESTONE TIRE COMPANY

ALBANY

GA

FIRST AMERICAN HEALTHCARE

CARROLLTON

GA

FIRST AMERICAN RENTAL

LITHONIA

GA

FIRST DATA CORP.-FDR.

ATLANTA

GA

FIRST FEDERAL S & L ASSOC

ATLANTA

GA

FISHER PAINT, BODY & FRAME

FT OGLETHORPE

GA

FISHER SCIENTIFIC

SUWANEE

GA

FITZGERALD UNDERWEAR CORP

TIFTON

GA

FLIGHT SAFETY INTERNATIONAL

SAVANNAH

GA

FLINT CONSTRUCTION CO.

LAWRENCEVILLE

GA

FLINT RIVER TEXTILES, INC

ALBANY

GA

FLORAL HILLS MEMORY GARDE

TUCKER

GA

FLOWERS INC

ATHENS

GA

FOLGER POULTRY FARMS

DAHLONEGA

GA

FOLKS, INC.

NORCROSS

GA

FORDS & GANTT COMPANY, INC.

MACON

GA

FORSTMANN & COMPANY, INC

DUBLIN

GA

FORT OGLETHORPE NURSING CTR.

FT OGLETHORPE

GA

FOSTER INDUSTRIES

CORNELIA

GA

FRANKLIN'S OF ATHENS

BOGART

GA

$2,323.44 $27,440.57
$123.19 $81,578.31
$435.94 $18,298.79 $33,259.28 $52,208.94 $45,567.63 $141,553.81
$5,760.00 $55,813.80 $17,548.72 $31,870.00 $155,765.17 $15,275.00
$2,422.61 $76,241.14 $11,601.25
$2,310.00 $3,521.30 $22,168.41 $5,056.10 $3,337.65 $16,875.00 $9,821.72 $1,375.65 $7,417.52 $9,007.92 $4,860.00 $28,841.99 $19,046.64 $1,469.63 $17,680.12 $9,423.31 $4,399.89

- 27 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emi2loxer Name FRAZIER SERVICES FRED CHILDRESS FREIGHTLINER CORP. FRESENIUS MEDICAL CARE FRUEHAUF CORPORATION FULGHUM INDUSTRIES, INC. FULTON PAPER COMPANY G & MSS TRUCKING G.N.B. TECHNOLOGIES GABLE ELECTRIC COMPANY GAINESVILLE IRON WORKS GALAXY CARPET MILLS, INC. GALEY & LORD INDUSTRIES, INC. GARDEN TERRACE NURSING CENTER GARLAND SALES, INC. GARY'S PULPWOOD & LOGGING GATEWAY HEALTH CARE GATX CORP. GAY & TAYLOR, INC. GAY CONSTRUCTION COMPANY GEICO GEM CLEANERS OBA EASY WASH GEN MANUFACTURED HOUSING GENE BUSH GENERAL CABLE CORP. GENERAL ELECTRIC CO GENERAL NUTRITION CTRS GENERAL NUTRITION PRODUCTS GENUINE PARTS GEORGE MUSE CLOTHING COMPANY GEORGE WALTON ACADEMY GEORGIA BAPTIST CONVENTION GEORGIA BOOT INC GEORGIA CROWN GEORGIA DUPLICATING PRODUCTS GEORGIA FINE FOODS INC

Ci!x ATLANTA LAGRANGE PORTLAND AUGUSTA CONLEY WADLEY ATLANTA ROME COLUMBUS
SMYRNA
GAINESVILLE CHATSWORTH
SHANNON
DOUGLAVILLE DALTON COLLEGE PARK CLEVELAND WAYCROSS CARTERSVILLE ATLANTA
MACON
MACON WAYCROSS THOMASVILLE WATKINSVILLE ROME PITTSBURGH PITTSBURGH SYLVESTER ATLANTA MONROE ATLANTA BLAIRSVILLE COLUMBUS MACON LAWRENCEVILLE

State
GA GA
OR
GA
GA GA
GA
GA
GA GA GA GA GA
GA
GA GA
GA GA
GA
GA GA
GA GA
GA
GA
GA
PA PA
GA
GA
GA GA
GA
GA GA GA

Total Reimbursed
$15,996.24 $34,040.00
$2,126.00 $997.85
$5,500.00 $52.50
$52,757.50 $8,322.50 $684.00
$38,258.11 $9,800.00 $4,733.00
$134,854.07 $5,817.99 $86,879.33
$65,492.38 $272.54
$55,288.94 $977.25
$23,272.33 $39,478.95
$2,534.20 $172,400.58
$15,948.15 $83,405.05 $42,970.45 $57,748.13
$600.00 $17,326.46
$5,333.39 $11,819.27
$3,452.00 $14,679.73 $20,215.51 $26,256.21 $18,692.06

28 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em(!loxer Name
GEORGIA PERIODONTICS, P.C. GEORGIA SYNTHETICS GEORGIA TECH ATHLETIC ASSOC. GERALD L. DAVIS ASSOC., INC. GFA TRANSPORTATION COMPANY GIBSON GREETINGS, INC. GILBERT & BENNETT GILMAN BUILDING PRODUCTS GILMAN PAPER CO. GILMER CO BOARD OF EDUCATION GLEN ARVEN COUNTRY CLUB GLOBE UNION INC GLYNN COUNTY GNB TECHNOLOGIES GOLDEN GALLON, INC. GOLDEN STATE FOODS GOLDKIST, INC. GOODWILL INDUSTRIES GOODY PRODUCTS, INC. GOODYEAR TIRE & RUBBER GORDON COUNTY FARM COMPANY GRACON CORPORATION GRAND COURT LIFESTYLES GRAND MANOR, INC. GRAVES FIREPLACE GREAT AMER. STEAK & BUFFETT GREAT AMERICAN COOKIE CO. GREAT OAKS NURSING HOME GREAT SOUTH CONSTRUCTION CO. GREAT SOUTHERN PAPER CO. GREEN THUMB, INC. GREENWOOD CEMETARY GREIF BROTHERS CORP GRESS FOODS, INC. GREYHOUND LINES, INC. GRIFFIN INDUSTRIES

Citx ATLANTA ELBERTON ATLANTA STONE MOUNTAIN FOREST PARK CINCINNATI TOCCOA DUDLEY ST. MARY'S ELLIJAY THOMASVILLE ATLANTA BRUNSWICK DECATUR CHATTANOOGA CONYERS DOUGLAS SAVANNAH MANCHESTER CEDARTOWN CALHOUN ARMUCHEE CARROLLTON THOMASVILLE CUMMING LAWRENCEVILLE ATHENS ROSWELL PELHAM CEDAR SPRINGS JESUP ATLANTA TUCKER GAINESVILLE ATLANTA ELLENWOOD

State
GA GA GA GA GA OH GA GA GA GA GA GA GA GA TN GA GA GA GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA

Total Reimbursed
$23,550.62 $7,020.00
$29,354.01 $4,593.94 $6,155.75 $1,214.82
$26,703.11 $13.49
$58,821.71 $2,268.46 $352.97
$17,940.92 $21,175.89
$182.08 $72,474.92 $2,756.09 $174,607.40 $30,556.02 $25,336.51 $33,776.07 $18,414.46 $5,684.10 $1,562.25 $42,076.14 $14,851.42 $16,596.04
$394.11 $29,475.96 $148,269.44
$726.00 $4,317.75 $1,616.65
$288.46 $154.95 $109,321.88 $51,539.71

- 29 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo)ler Name
GRUMA CORP./MISSION FOODS GUARDSMARK, INC. GULF LIFE INSURANCE COMPANY GUNTER CONSTRUCTION H.J. RUSSELL & COMPANY HA SACK COMPANY, INC. HALEY FARMS, INC. HALL VALLEY MARBLE INC. HAMBERSHAM MEDICAL GROUP PC HANCOCK FABRICS HANCOR, INC HANES HOSIERY, INC. HARMONY PROPERTIES, INC. HARRIS CALORIFIC HARRIS INSULATION HARRIS SAMPLE BOOK, INC. HARRY MOSES CONSTRUCTION CO. HARVEY'S PERSONAL CARE HAYES MICRO COMPUTER HAYGOOD CONTRACTING, INC. HAZARDOUS ENVIR. PRODUCTS HCA REDMOND REGIONAL MEDICAL HEALTHDYNE TECHNOLOGIES HEALTHFIELD, INC. - HUG CTR. HEILIG MEYERS HELEN'S ENTERPRISES, INC. HENDERSON ELECTRIC CO HENDRIX HAULING CO. HENKEL OF AMERICA CORP. HEPACO HERTZ PENSKE/GEICO TRUCK LSNG HI BRAND FOODS HIDDEN HILLS GRILL HIGGINS GENERAL HOSPITAL HIGH PERFORMANCE TUBE HIGHTOWER TV

Cit)l
PENDERGRASS ATLANTA STATESBORO LAWRENCEVILLE ATLANTA STATESBORO CANTON FLOWERY BRCH. CLARKESVILLE SAVANNAH CORDELE LAGRANGE ATLANTA GAINESVILLE ATLANTA MONTICELLON VIDALIA WAYCROSS NORCROSS WOODSTOCK TUCKER ROME MARIETTA ATLANTA THOMASVILLE ATHENS STONE MOUNTAIN JESUP CEDARTOWN TUCKER FOREST PARK PEACHTREE CITY STONE MTN. BREMAN BRUNSWICK ROME

State
GA
GA GA GA GA
GA GA
GA GA GA GA GA GA GA GA GA GA
GA GA
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed
$18,896.47 $19,372.90
$9,395.16 $106,564.10
$79.33 $23,461.24
$4,370.12 $100,375.00
$72,971.46 $3,025.24 $5,150.56
$8,654.15
$20,428.27 $10,151.54 $16,800.90 $11,863.49 $32,255.75 $17,506.30 $12,425.00 $31,335.32 $55,967.61 $23,909.60 $3,323.15
$2,106.29 $8,020.49 $11,088.05 $12,770.54 $174,977.43 $54,042.42 $18,800.00 $60,578.19 $9,443.00 $11,982.62 $8,247.30 $9,724.50 $22,087.84

- 30 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

EmRlo~er Name
HILL STATION ENGINEERS, INC. HINESVILLE RED & WHITE HI-TECH HEALTH CARE, INC. Hl-TEK ASSOC, INC HOLLIS TRANSPORT AGENCY HOLLOWAY CONSTRUCTION CO. HOLLYE EQUIPMENT CO., INC. HOMETONW FOOD PRIDE HON INDUSTRIES HOOVER-HANES TRUCKING CO. HOST MARRIOTT SERVICES CORP. HOTEL VENTURA OF AUGUSTA HOUSE MOVERS, INC. HOUSE OF DENMARK HOUSE OF TYROL HOUSTON CO. ASSOCIATION HOUSTON STEEL, INC. HOWARD'S LANDSCAPING & HP PELZER HUBBARD CO HUBERT MOORE LUMBER HUDDLE HOUSE HUGHES LOGGING COMPANY HYPONEX CORP IBM CORPORATION IHS OF ATLANTA AT SHOREHAM IMAGE CARPETS IMCVIGORO 1-MEDEX USA, INC. IMPERIAL PACKAGING CORP. INDEPENDENT LIFE INSURANCE CO. INDUSTRIAL PLASTICS CORP INDUSTRIAL TOOL & SUPPLY INGERSOL RAND INGLETT & STRUBBS, INC. INGRAM SHEET METAL

Ci~ COLUMBUS HINESVILLE NORCROSS
BRUNSWICK
GAINESVILLE
BALLGROUND
GAINESVILLE BRUNSWICK CEDARTOWN TALLAPOOSA ATLANTA AUGUSTA CALHOUN DORAVILLE CLEVELAND WARNER ROBINS BYRON LILBURN THOMASON BREMEN
ALAPAHA
DAHLONEGA ARLINGTON JACKSON ATLANTA MARIETTA ROME ATHENS ALPHARETTA THOMASVILLE SAVANNAH FITZGERALD
SAVANNAH
AUGUSTA ATLANTA ATHENS

State
GA GA GA GA GA GA GA GA GA
GA GA
GA GA
GA
GA GA GA
GA
GA GA GA
GA
GA GA
GA
GA GA
GA
GA GA GA
GA
GA GA
GA GA

Total Reimbursed
$3,393.83 $9,414.93 $51,972.24 $86,777.72 $60,034.93 $3,780.00 $6,629.00 $6,119.85 $52,538.35 $6,206.91 $1,660.23 $8,732.26 $25,659.99 $171,997.49 $8,785.04 $8,143.64 $25,750.92 $14,780.66 $1,821.71 $2,046.51 $30,511.67 $6,304.93 $12,234.25 $4,350.00 $31,092.52 $4,535.30 $26,112.02 $9,165.00 $20,765.05 $91,646.79 $14,184.33 $16,264.00 $15,950.83 $30,339.79 $4,486.37 $3,780.00

- 31 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo)ler Name

Total

Cit)

State

Reimbursed

INLAND CONTAINER CORP.

ROME

GA

INSURAMERICA

LILBURN

GA

INTERIM PERSONNEL

ATLANTA

GA

INTERNATIONAL AUTO PROCESSING BRUNSWICK

GA

INTERNATIONAL PROCESSING CORP CONLEY

GA

INTERNATIONAL RESCUE COMM

NEW YORK

NY

INTERSTATE BRANDS CORP

COLUMBUS

GA

INTERSTATE DISTRIBUTORS, INC.

NORCROSS

GA

INTERSTATE GENERAL GOV.

SAVANNAH

GA

INTREPID CORP/BAKER BROTHERS

ALBANY

GA

IRWIN COUNTY HOSPITAL

OCILLA

GA

ITEL CORPORATION

SUWANEE

GA

ITHACA INDUSTRIES INC.

GLENNVILLE

GA

ITT AUTOMOTIVE

ROME

GA

ITT THOMPSON

ADEL

GA

ITT-RAYONIER, INC.

MIDVILLE

GA

J & M LABORATORIES, INC.

DAWSONVILLE

GA

J & M TRUCK LINES

AMERICUS

GA

J & P TRANSFER CO.

COLLEGE PARK

GA

J. C. PENNEY COMPANY

STONE MOUNTAIN GA

J.P. BEAMER CO., INC.

CALHOUN

GA

J.A. JONES MGM'T. SERVICES

KINGS BAY

GA

J.L. MURRAY & ASSOCIATES

CANTON

GA

J.M. CLAYTON CO.

ATLANTA

GA

J.P. STEVENS & COMPANY, INC.

LOUISVILLE

GA

JACKSON CO BD OF EDUCATION

JEFFERSON

GA

JAMES GAMBLE MASONARY

VALDOSTA

GA

JAMES HILL CONTRACTOR

ACWORTH

GA

JARVIS WEBB

MARIETTA

GA

JEAN THOMAS

COMMERCE

GA

JEBCO, INC.

WARRENTON

GA

JERED INDUSTRIES, INC.

BRUNSWICK

GA

JERRY GRAVITT DRYWALL

EATONTON

GA

JET CORR, INC. - PLANT 1

CONYERS

GA

JILLYS - THE PLACE FOR RIBS-

STONE MOUNTAIN GA

JIM'S FORMAL WEAR

LITHIA SPRINGS

GA

$75,746.16 $4,914.50
$73,302.56 $12,648.08 $38,037.56
$9,405.00 $89,652.92 $12,221.49 $100,815.23
$26.40 $24,058.05
$1,192.26 $45,941.95
$1,003.06 $14,942.33 $44,340.00 $64,439.15 $12,012.00 $51,872.62 $20,533.83 $22,756.59 $55,996.41 $84,007.31
$148.50 $15,315.68 $24,950.06
$8,657.19 $5,390.00 $33,233.67 $11,487.00 $33,720.03 $30,739.04 $1,092.26 $13,022.14 $1,853.81 $24,520.24

- 32 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em52lo~er Name

Total

Cit~

State

Reimbursed

JOE & GUY CO, INC.

ATLANTA

GA

JOHN D. STEPHENS, INC.

STONE MOUNTAIN GA

JOHN DEMORE LOCK & KEY SVC.

NEWNAN

GA

JOHN PITTS COMPANY, INC.

FORSYTH

GA

JOHNNY PHILLIP HEATING

CHAMBLEE

GA

JOHNSON & JOHNSON

CORNELIA

GA

JOHNSON CONTROLS, INC.

ATLANTA

GA

JRH OPTICS/PEARL VISION EXPRES

DULUTH

GA

JUNCTION CITY PLANT UNIMIN

MAULK

GA

JWI GROUP PRESS FABRIC

JONESBORO

GA

K & C MACHINE DEVELOPMENT, INC BUFORD

GA

K & F INDUSTRIES

ROCKMART

GA

K & M MAINTENANCE SERVICES INC WARNER ROBINS

GA

KASON INDUSTRIES, INC

SHENANDOAH

GA

KATSUSHICO ROME CORP.

ROME

GA

KAWNEER COMPANY

JONESBORO

GA

KEMIRA, INC.

SAVANNAH

GA

KENDRICK TOOL & ENGINEERING CO MABLETON

GA

KENTUCKY-TENNESSEE CLAY CO.

SANDERSVILLE

GA

KING MUFFLER SHOP

WAYCROSS

GA

KING PACKAGING COMPANY

BREMEN

GA

KINNETT DAIRIES, INC

COLUMBUS

GA

KIRKLAND$

KENNESAW

GA

KLIKLOK CORPORATION

DECATUR

GA

KLOCKNER NAMASCO CORP.

SUWANEE

GA

KNIGHT RIDER NEWSPAPER/MACON MACON

GA

KNIGHT'S ELECTRIC CO.

MOULTRIE

GA

KOLE INVESTMENT CO.

SAVANNAH

GA

KRAFT FOOD SERVICE, INC

NORCROSS

GA

KRAM TIRE

CONLEY

GA

KROGER CO.

ATLANTA

GA

KRYSTAL/M.A.E. THOMASVILLE

THOMASVILLE

GA

KUPPENHEIMER MFG. CO.

LOGANVILLE

GA

KYSOR WARREN

CONYERS

GA

L & H SHEET METAL CO.

JONESBORO

GA

LAT SPORTSWEAR

DORAVILLE

GA

$25,433.66 $15,103.61 $68,411.31 $23,617.13 $27,323.53 $23,809.72
$4,665.29 $38,153.00
$8,431.20 $14,377.90 $24,069.21 $112,008.12
$1,052.96 $113,707.38
$20,583.31 $6,279.00
$12,120.75 $29,727.76 $83,498.00 $32,961.80 $20,646.89 $143,885.67 $67,046.77 $18,582.86 $13,404.61 $73,540.86
$158.00 $20,399.40 $15,708.51 $12,589.43 $488,594.11 $10,597.67
$9,452.45 $3,127.06 $1,948.82 $127,076.76

33

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emeloxer Name

Total

Ci~

State

Reimbursed

LAGRANGE MACHINE SHOP

LAGRANGE

GA

LAGRANGE MEMORIAL LIBRARY

LAGRANGE

GA

LAGRANGE SCHOOL SYSTEM

LAGRANGE

GA

LAIDLAW TRANSIT SERVICES, INC

SAVANNAH

GA

LANCE, INC.

CHARLOTTE

NC

LAND O'SUN DAIRIES

ATLANTA

GA

LANIER HOME HEALTH/COLUMBIA

LAVONIA

GA

LAPP INSULATOR CO.

SANDERSVILLE

GA

LARSON & JUHL

ADAIRSVILLE

GA

LAW COMPANIES GROUP, INC.

ATLANTA

GA

LAW ENGINEERING CO

ATLANTA

GA

LAWLER HOSIERY MILL INC

CARROLLTON

GA

LCP CHEMICALS

BRUNSWICK

GA

LEARD HUGGINS, INC.

SAVANNAH

GA

LEASEWAY PERSONNEL CORP.

READING

PA

LEGACY TOYOTA

UNION CITY

GA

LEGGETT & PLATT INC

SOCIAL CIRCLE

GA

LEGION INDUSTRIES, INC.

WAYNESBORO

GA

LENBROOK SQUARE

ATLANTA

GA

LEON FARMER & CO.

ATHENS

GA

LEON JONES FEED & GRAIN

CUMMING

GA

LESHNER MILLS, INC

HAWKINSVILLE

GA

LESLIE FAY SPORTSWEAR

MORROW

GA

LESTER PRECISION

ROME

GA

LEVI STRAUSS & COMPANY

VALDOSTA

GA

LEVITON MANUFACTURING CO.

ATLANTA

GA

LEWIS M. CARTER MFG. CO., INC.

DONALSONVILLE

GA

LEXINGTON COMPONENTS, INC

JASPER

GA

LIBERTY REGIONAL MED CENT

HINESVILLE

GA

LIFT ATLANTA, INC.

DECATUR

GA

LOCKHEED MARTIN CORP.

MARIETTA

GA

LOGAN PAVING COMPANY

ATHENS

GA

LOOK PRODUCTS

MILLEN

GA

LOOKOUT MTN FAIRYLAND CLUB

LOOKOUT MTN.

TN

LORAL SPACE & COMMUNICATIONS ROCKMART

GA

LOWE ELECTRIC -PLUMBING

MACON

GA

$482.00 $8,746.23 $5,571.40 $133,639.61 $31,742.57 $38,791.80 $7,791.94 $7,109.29 $81,280.95 $14,977.58 $8,750.00 $73,749.41 $64,281.03 $26,095.77 $126,919.16 $6,731.65 $24,035.60 $118,729.01 $22,038.12 $1,357.07 $58,372.02 $144,440.06 $17,052.39 $1,034.98 $12,232.96 $12,389.24 $4,858.74
$445.36 $621.15 $15,497.66 $628,995.39 $5,625.00 $54,957.13 $12,497.57 $57,307.74 $29,730.05

-34-

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emelo3ter Name

Total

Cit)

State

Reimbursed

LOWE'S CARPET CORP.

CHATSWORTH

GA

LOWE'S COMPANIES

ALBANY

GA

LUCAS INDUSTRIES

MACON

GA

LUKE'S SERVICE STATION

LENOX

GA

LUMMUS INDUSTRIES, INC.

COLUMBUS

GA

M & M CONTRACTING OF JASPER

JASPER

GA

M & S CLEANING SERVICE

WARNER ROBINS

GA

MABUS BROS. CONSTRUCTION

AUGUSTA

GA

MACGREGOR GOLF CO.

ALBANY

GA

MACON HEALTH CARE CENTER

MACON

GA

MACON KRAFT

MACON

GA

MACON MALL/COLONIAL PROP. TR.

MACON

GA

MACON NORTHSIDE HOSPITAL

MACON

GA

MACY'S HOMESTORE

MARIETTA

GA

MAIER & BERKELE

ATLANTA

GA

MAIL CONTRACTORS OF ARKANSAS LITTLE ROCK

AR

MAIL-WELL, INC.

ATLANTA

GA

MAIN AUTO PARTS/

AUSTELL

GA

MAKITA CORP. OF AMERICA

BUFORD

GA

MANHATTAN SHIRT COMPANY

AMERICUS

GA

MANN MECHANICAL CO

AVONDALE ESTS.

GA

MAPLEHURST, INC.

CARROLLTON

GA

MARBLE MASTERS

WARNER ROBINS

GA

MARI STAFF, INC.

ATLANTA

GA

MARIETTA CITY SCHOOLS

MARIETTA

GA

MARION CO. BD. OF EDUCATION

BUENA VISTA

GA

MARK'S & MORGAN JEWELERS, INC. MACON

GA

MARLEY COOLING TOWER

OVERLAND PARK

KS

MARSHALL'S

STONE MTN.

GA

MARTIN CONSTRUCTION COMPANY

SYLVESTER

GA

MASTER PROMOTIONS

LITHIA SPRINGS

GA

MATSUSHITA STORAGE BATTERY

COLUMBUS

GA

MATTHEWS SERVICES GROUP

GRIFFIN

GA

MATTHEWS TRUCKING, INC.

BAXLEY

GA

MAXWELL CHASE TECH.

SMYRNA

GA

MAYO CHEMICAL CO., INC.

SMYRNA

GA

$15,708.69 $2,310.00 $9,563.21 $80.00
$41,650.00 $9,128.86 $1,863.21
$50,604.75 $14,879.67 $15,404.59 $18,003.00 $34,628.55 $58,126.65
$3,091.69 $15,170.06 $170,525.20 $29,641.67 $53,942.06 $10,604.17 $13,200.00 $40,478.79 $16,099.44 $40,423.50
$4,336.89 $21,669.00 $27,192.15 $65,704.46
$3,091.29 $30,905.87
$2,657.90 $2,777.50 $26,411.15 $23,285.49 $9,295.00 $31,433.67 $145,322.96

- 35 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em(;!lo~er Name
MAZZIO'S CORPORATION MCC PANASONIC MCCLESKY MILLS MCCORKLE NURSERIES MCCOY GRADING, INC. MCDONALD GROUP/LAKE DIVISION MCELROY SPEC. INT. MCKENNEYS, INC. MCMASTER CARR SUPPLY CO. MCPHERSON & ASSOCIATES MCRAE MANOR NURSING HOME MEAD CORPORATION MEADOWDALE NURSERIES MEARLCORP. MECHANICAL MAINTENANCE MED CARE INC/ COOSA VALLEY MENLO PARK, INC. MERICO, INC. MERRITT MAINTENANCE & WELD METAL BUILDINGS, INC. METAL PRODUCTS COMPANY METRAC, INC. MGA D/B/A MOVIE GALLARY MGR HOMECARE, INC. MICHAEL'S STORES, INC. MID GEORGIA AMBULANCE MIDAS, INC. MIDDLE GA. COMMUNITY MIDDLE GEORGIA HOSPITAL MIDDLE GEORGIA ROAD BUILDERS MIDSTATE STEEL, INC. MILAN EXPRESS CO MILES MOTES ELECTRIC MILLBROOK SALES MILLER BREWING CO MILLER PRECAST, INC.

Ci~ TULSA PEACHTREE CITY SMITHVILLE DEARING LUTHERSVILLE GAINESVILLE MARIETTA ATLANTA ATLANTA DULUTH MCRAE SPARTANBURG WARNER ROBINS HARTWELL AUGUSTA ROME P'TREECITY FOREST PARK ALBANY THOMASVILLE SUWANEE MACON MARIETTA GRIFFIN TUCKER MACON PANAMA CITY WARNER ROBINS MACON EAST DUBLIN MACON TIFTON ACWORTH LESTER ALBANY COLUMBUS

State
OK GA GA GA GA GA GA GA GA GA GA SC GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA MA GA GA

Total Reimbursed
$363.12 $30,762.79
$4,040.41 $6,684.16 $4,186.49 $11,230.97 $1,192.94 $1,654.00 $15,008.34 $64,238.60 $12,047.31 $7,175.00 $23,797.08 $18,875.73 $10,593.78 $26,681.56 $8,990.22 $10,675.00 $1,495.60 $61,773.92 $32,082.54 $24,266.73 $13,493.95 $21,566.19 $5,345.31 $2,826.46 $11,044.30 $24,376.54 $368,510.43 $3,628.72 $26,764.08 $8,564.94 $16,890.00 $1,146.98 $20,675.15 $57,665.46

- 36 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emgloier Name
MILLIKEN & COMPANY MINI JOBS CONTRACTING MITSUBISHI CONSUMER ELECT. MMT ENTERPRISES MOBIL CHEMICAL CO. MOBIL OIL MODERN FIBERS MONROE AUTO EQUIPMENT MOORMANS, INC. MORSE AUTOMOTIVE CORP MA MORTENSEN WOODWORK, INC. MORTON HEATING & AIR MOULTRIE PULPWOOD/TIMBER MOUNTAIN LAKES CLUB, INC. MTC-TURNER JOB CORPS CENTER MUSCOGEE MANOR NURSING HOME NAMES FOR DAMES, INC. NASHVILLE TEXTILE CORP NATIONAL CEMENT CO., INC NATIONAL EMPLOYER SOLUTIONS NATIONAL GYPSUM COMPANY NATIONAL HEALTH LABORATORIES NATIONSBANK CORP. NATIONWISE AUTOMOTIVE, INC. NEFF MOTIVATION, INC. NEIGHBORHOOD VARIETY, INC NESTLE TRANSPORTATION CO. NETCARE HEALTH SYSTEMS, INC. NOLAND COMPANY NORCOM, INC. NORCROSS EXCAVATING, INC. NORELL TASCOR NORTH CO NORTH BROAD BAPTIST CHURCH NORTH EAST GA. CARPET, INC. NORTH FULTON REGIONAL HOSP NORTH GA. POURED WALLS INC.

Cit)
LAGRANGE ATLANTA BRASELSTON AUGUSTA LAGRANGE GA COVINGTON FITZGERALD HARTWELL CORDELE CARTERSVILLE UNION CITY CHAMBLEE MOULTRIE HELEN ALBANY COLUMBUS CALHOUN NASHVILLE LAWRENCEVILLE HAZELHURST ATLANTA MARIETTA ATLANTA ATLANTA UNADILLA ST.SIMONS MCDONOUGH ELLIJAY MACON NORCROSS BUFORD MARIETTA ROME BALDWIN ROSWELL DALTON

State
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed
$82,074.04 $67,727.62 $18,197.35
$5,717.92 $43,042.74 $234,516.68 $151,426.13
$7,116.00 $29,538.00
$5,449.17 $156.30 $962.00
$17,370.31 $6,917.07
$995.52 $11,374.17
$288.90 $10,181.17
$7,035.84 $1,278.10 $6,512.75 $14,187.27 $13,156.47 $22,678.75
$373.40 $3,277.87 $20,445.28 $40,169.38 $16,141.67 $32,363.62 $69,226.38 $8,236.78 $5,253.10 $1,566.74 $2,289.87
$70.00

37 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emelo~er Name

Total

Cit~

State

Reimbursed

NORTH ROSWELL AMOCO

ROSWELL

GA

NORTHERN TELECOM, INC.

STONE MOUNTAIN GA

NORTHLAKE PLUMBING

LILBURN

GA

NORTHLAKE REGIONAL MED CTR

TUCKER

GA

NORTHROP GRUMMAN CORP.

MILLEDGEVILLE

GA

NORTHWEST AIRLINES, INC.

ATLANTA

GA

NOVOSTE CORP

NORCROSS

GA

NSR, INC.

CHAMBLEE

GA

OCEAN PROPERTIES LTD.

COLUMBUS

GA

OCTAGON AIR SYSTEMS

CONLEY

GA

ODYSSEY SVCS/WARREN SCOTT

FT WORTH

TX

OELSCHIG'S NURSERY, INC.

SAVANNAH

GA

OIL-ORI CORPORATION OF GA.

OCHLOCKNEE

GA

OLIN WOOTEN TRANSPORT CO. INC. HAZLEHURST

GA

OLYMPIC TRANSPORT

HOBOKEN

GA

OMC

CALHOUN

GA

ONEDA CORPORATION

COLUMBUS

GA

OPTI-WORLD, INC.

ATLANTA

GA

ORGILL , INC.

TIFTON

GA

ORIGINAL BRAND FOODS

ATLANTA

GA

ORRBILT COMPRESSORS, INC.

ATLANTA

GA

OUTBOARD MARINE CORP.

CALHOUN

GA

OVERHEAD DOOR CO. OF ATL.

ATLANTA

GA

OVERHEAD DOOR CORP.

ATHENS

GA

OWENS & PRIDGEN, INC.

BRUNSWICK

GA

OXFORD INDUSTRIES

VIDALIA

GA

OXFORD OF DUBLIN

DUBLIN

GA

P.L. GARMENT FINISHERS

DUBLIN

GA

P.S.I.INC.

MARIETTA

GA

PALM CREEK FARM

DACULA

GA

PALM HARBOR HOMES

LAGRANGE

GA

PALMER INSTALLATIONS

FLOWERY BRCH.

GA

PALMER JOHNSON

SAVANNAH

GA

PARADYME HUMAN RESOURCES

COLUMBIA

SC

PARISIAN, INC.

ATLANTA

GA

PARKWAY MEDICAL CTR.

LITHIA SPRINGS

GA

$8,759.39 $14,432.62
$88.19 $46,575.00 $102,272.20
$1,491.14 $2,050.14 $13,305.04 $49,462.75 $34,293.49 $22,495.00 $19,559.62 $82,642.59 $10,325.00 $66,010.00 $14,008.89 $18,034.65 $108,542.83 $13,906.79 $1,008.97 $30,446.44 $101,319.69 $27,107.58 $9,766.65 $1,102.48 $14,111.01 $4,813.59 $104,580.69 $1,024.43 $76,272.76 $27,197.97
$228.73 $5,770.61 $2,356.58 $35,665.65 $12,805.19

- 38 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo3ter Name
PARKWOOD NURSING & REHAB
PARRISH DRUG STORE PARSONS BRINCKERHOFF/TUDOR PCS PHOSPATE COMPANY
PDS MECHANICAL
PEACH AUTO PAINTING PEACHTREE PARK, INC. PEARSON & SON, INC. PEAVY SPREADER PERSONAL CARE HOMES MGMNT PIERCE TIMBER COMPANY, INC. PIGGLY WIGGLY SOUTHERN PILOT PROPERTY COMPANY PINE KNOLL NURSING & REHAB. PIPE ORGAN SALES-SERVICE PITNEY BOWES PITTS ELECTRIC CO. PIZZA HUT, INC. PLAYTEX APPAREL PLEASANT VIEW NURSING CTR. PLYMARTS, INC. POLITEX US, INC. PONCE DE LEON CHEVRON POREX TECHNOLOGIES POST PROPERTIES, INC. PRECISE MAINTENANCE, INC. PRECISION COMPONENTS PRECISION MFG. TECH, INC. PREMARK INTERNATIONAL INC. PREMIUM BEVERAGE PREMIUM PORK, INC. PREMIUM ROOFING SERVICE PRESTOLITE WIRE CORP. PRICE FLOOR COVERING PRIME CHILD CARE OF MACON PRIME FOOD SERVICE

Cit)l
SNELLVILLE JACKSON ATLANTA MOULTRIE JESUP TUCKER ASHBURN WAYCROSS PINEHURST PERRY BLACKSHEAR VIDALIA ATLANTA CARROLLTON LITHONIA NORCROSS
MACON
DOUGLASVILLE NEWNAN METTER NORCROSS MACON ATLANTA FAIRBURN ATLANTA DOUGLASVILLE COLUMBUS VIDALIA CHAMBLEE ATLANTA MOULTRIE AVONDALE ESTS. TIFTON CALHOUN MACON DALTON

State
GA GA GA GA GA GA GA GA GA GA
GA
GA
GA
GA GA GA GA GA
GA GA GA GA GA GA GA GA
GA
GA GA GA GA GA GA
GA
GA GA

Total Reimbursed
$31,423.35 $5,397.48 $5,250.00
$49,203.47 $9,494.70
$22,558.49 $16,319.79 $27,838.97 $12,180.68
$9,190.73 $40,429.08
$6,450.16 $7,475.51 $19,983.80 $12,497.70 $59,206.32
$252.74 $135,509.81
$12,197.95 $23,300.93
$155.00 $530.76 $43,154.26 $9,964.96 $18,481.68 $58,770.07 $36,671.28 $9,900.80 $4,688.72 $21,991.34 $19,653.39 $886.65 $122,138.51 $21,384.07 $109,714.78 $42,076.80

- 39 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo~er Name
PRINCETON CARPETS PROCHEM PROFESSIONAL EMPLOYEE MGM'T. PROFESSIONAL MEDICAL SERVICES PROFILE EXTRUSION CO. PRO-TECH FIRE PROTECTION, INC. PROVIDENCE WASHINGTON INS CO PUBLIX SUPERMARKETS, INC. PUMPHREY PLUMBING CO., INC. PURCELL SERVICE COMPANY PUTZEL ELECTRICAL PYRAMID MASONRY CONTRACT QUAD GRAPHICS QUEBECOR ATLANTA QUIKSET DEKALB
QUIKSET-ARCHWAY
QUIKTRIP CORP. R & D MANUFACTURING CO., INC. R & R ENTERPRISES, INC. R & R SUPERIOR PLUMBING R. M. HURST R.C. PIERCE ROOFING CO. R.W. ALEXANDER CONTRACTORS R/S EXPRESS, INC. RACETRAC PETROLEUM RACO, INC. RADISSON HOTEL ATLANTA RANDY JOHNSON CONSTRUCT RAYLOC RAY-O-LITE RCS-SOUTHSIDE DISTR. CTR. REACH,INC. REAMES & SON CONSTRUCTION CO. REDDING$ HEATING REDMOND REGIONAL MEDICAL CTR. REECE CONSTRUCTION, INC.

Cit~ ADAIRSVILLE ALPHARETTA SARASOTA ORLANDO ROME TALBOTTON ATLANTA MARIETTA AUSTELL DOUGLASVILLE MACON DECATUR THE ROCK ATLANTA TOCCOA TOCCOA TULSA GAINESVILLE CARROLLTON ACWORTH SYLVESTER EAST POINT VALDOSTA ATLANTA CORDELE GRETNA ATLANTA ELLABELE ATLANTA ATLANTA FAYETTEVILLE ATLANTA VALDOSTA DORAVILLE ROME DALTON

State
GA GA
FL FL GA GA
GA
GA GA GA
GA GA GA
GA
GA GA
OK GA
GA
GA GA
GA
GA
GA
GA
VA
GA
GA
GA GA GA GA GA GA GA GA

Total Reimbursed
$211.67 $55,300.00 $11,814.50
$7,754.15 $19,229.00
$381.22 $1,525.01 $155,965.88 $2,007.53 $14,957.32 $20,004.87 $37,337.50 $103,101.02 $20,549.60 $1,897.19 $45,409.43 $6,922.86 $5,983.49 $1,515.25 $11,992.07 $13,216.18 $113,441.06 $1,914.02 $2,650.76 $48,846.67 $83,714.44 $1,446.85 $28,536.45
$120.75 $26,845.55
$1,931.11 $65,038.44 $70,162.66 $12,915.00 $26,459.57
$3,846.94

-40 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo~er Name REEVES TRUCKING CO., INC. REGAL RUGS REIMBURSEMENT CONSULTANTS RELAXERS COMFORT FOOTWEAR RELIABLE SUPPLY COMPANY RELIANCE GAS CORPORATION REMEDIATION SERVICES, INC. RENTOKIL CONTRACT SVC., INC. RESORTQUEST INT'L. REYNOLDS, INC. RHEEM MANUFACTURING CO. RHODES COOLING & HEATING RHODES, INC. RHONE POULNEC, INC. RICHARDS LIGHTING CENTER RIDDLE ACOUSTICS, INC. RITE AID PHARMACY RIVERWOOD INT'L. CORP. RIVES WORRELL RMS FAMILY RESTURANTS, INC. ROAD ATLANTA ROBERT SHAW CONTROLS CO. ROBERTA NURSING HOME ROCHE BIOMEDICAL LABS ROCK TENN CO. ROCKMART NURSING & REHAB. ROME CITY SCHOOLS ROME HEALTH CARE ROME PLUMBING AND AIR ROME TOOL & DYE COMPANY, INC. ROPER PUMP ROSEDALE TRANSPORT, INC. ROSES DEPARTMENT STORE# 235 ROSIEK CONSTRUCTION CO. ROUNTREE TRUCKING COMPANY ROYAL TEN CATE USA INC

Cit~
FITZGERALD ELLIJAY ROSWELL BUFORD ATLANTA COLUMBUS FITZGERALD DULUTH ST. SIMONS ISL.
FAIRBURN
MILLEDGEVILLE MOULTRIE DECATUR WOODBINE HOLLY SPRINGS HAHIRA MCRAE
MACON SAVANNAH
MACON BRASELTON ELLIJAY ROBERTA TUCKER NORCROSS ROCKMART ROME ROME ROME ROME COMMERCE DALTON
ALBANY
BRUNSWICK
SWAINSBORO
CORNELIA

State
GA
GA
GA
GA
GA GA
GA
GA GA GA
GA
GA
GA
GA GA GA GA GA
GA
GA
GA
GA
GA GA
GA
GA GA
GA
GA GA
GA GA GA GA
GA
GA

Total Reimbursed
$7,875.00 $21,614.02 $128,170.83
$474.89 $23,810.70
$2,745.73 $11,993.00 $108,131.70 $27,497.40 $76,075.13 $54,940.04 $87,200.05
$7,042.33 $37,147.60
$5,426.93 $46,529.71 $73,226.88 $40,378.36 $47,931.72 $34,283.69 $12,643.64 $25,246.23 $11,358.38 $129,005.01
$1,528.34 $10,503.63
$1,698.46 $6,523.27
$773.80 $30,910.62 $54,746.57 $96,359.98
$2,138.20 $15,900.00
$372.56 $41,734.38

- 41 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo)ler Name
RTM FAMILY RESTAURANTS RUSSELL & YOUNG BUILDERS S & H RIGGERS & ERECTORS S & S CONTRACTORS S & S ELECTRIC S & S GRILL S P RICHARDS COMPANY S. MARK SHAFER S.B. PHILLIPS STAFFING SADDLE CREEK CORP. SALEM CARPET MILLS SALLY BEAUTY COMPANY SANDERSON INDUSTRIES, INC. SAVANNAH COCA-COLA BOTTLING SAVANNAH COCOA, INC. SAVANNAH FOODS INDUSTRIAL SAVANNAH LUGGAGE RUNNERS SAVANNAH NEWS PRESS SCAPA, INC. SCAPE DRYER FABRICS SCOTT BRIDGE CO. SCRIPPS HOWARD CABLE SE BUILDING MAINTENANCE SEA ISLAND COMPANY SEABOARD FARMS OF ATHENS SEALYINC SEARS ROEBUCK & CO. SEASON'S FOUR, INC. SEQUA COR/MENS APPAREL SERVICEMASTER CONSUMER SERV. SERVPRO OF EAST COBB SEVEN HILLS FIRE PROTECTION SEWELL MANUFACTURING CO SGMHA, INC. SHARP SYSTEMS SHEPHERD CONSTRUCTION CO

Cit)
LAVONIA MARIETTA CONLEY LITHONIA WINDER ELBERTON ATLANTA JEFFERSON GRIFFIN MACON RINGGOLD COLUMBUS ATLANTA POOLER SAVANNAH PT WENTWORTH VIADALIA SAVANNAH WAYCROSS WAYCROSS OPELIKA ROME LOGANVILLE SEA ISLAND ATHENS CONYERS CHICAGO DOUGLASVILLE ATHENS LAWRENCEVILLE MARIETTA ROME BREMEN AMERICUS LESLIE ATLANTA

State
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA IL GA GA GA GA GA GA GA GA GA

Total Reimbursed
$2,095.72 $10,978.61 $35,431.69
$3,344.22 $30,650.70 $10,471.82 $12,103.46 $26,347.05
$4,796.42 $22,260.32 $17,393.43
$3,671.44 $9,437.85 $16,409.97 $88,000.00 $52,475.58 $8,037.02 $6,600.00
$205.80 $13,716.50 $5,364.75
$231.47 $16,353.18 $25,885.16 $36,603.50 $23,372.50 $231,203.15 $15,372.45
$3,674.15 $32,961.70 $13,812.99 $101,606.16
$1,484.39 $1,939.89 $28,605.40 $25,680.09

-42 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo~er Name SHO/LINK,INC. SHOE CITY, INC. SHOEMAKER IRRIGATION CO SIEMANS ENERGY CORP. SIEMENS CORPORATION SIEMENS ENERGY & AUTOMATION SIGNATURE FLIGHT SUPPORT SILVER EAGLE TRANSPORT, INC SIMKINS INDUSTRIES, INC. SINGLETON FURNITURE CO SIPCO, INC. SMITH BROTHERS MECH. CONTROL SMITH INDUSTRIES SMITHKLINE BEECHAM SNAPPER INC. SOLOMON WHITE SONNY'S BBQ SONY MUSIC SOSSNERTAP & TOOL CORP. SOUTHCORP PKG. USA,INC. SOUTHEASTERN METAL SOUTHERN CONTRACTORS SOUTHERN CRAFT MASTERS SOUTHERN CROSS CORP SOUTHERN ELECTRONICS SOUTHERN PAPER RECOVERY INC SOUTHERN PIZZA VENTURES SOUTHERN SAW SERVICE, INC. SOUTHERN TILE AND CARPET SOUTHERN TRADITIONS SOUTHERN VENETIAN BLINDS SOUTHLAND ASSOCIATES, INC. SOUTHLAND LOGGING SPCCOMPANY SPECIALTY TRANSPORTATION SPIRIT CONSTRUCTION SERVICES

Cit~ ATLANTA MONTGOMERY ATHENS ALPHARETTA ALPHARETTA TUCKER GARDEN CITY ALBANY MARIETTA WAYCROSS ATLANTA AUGUSTA CUMMING TUCKER MCDONOUGH DALTON DORAVILLE Carrollton BRUNSWICK TOCCOA LYONS VALDOSTA LOGANVILLE NORCROSS TUCKER SAVANNAH COMMERCE ATLANTA VALDOSTA BUCHANAN SAVANNAH THOMASVILLE FITZGERALD LAGRANGE CONLEY SAVANNAH

State
GA AL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA Ml GA GA GA GA GA GA GA GA GA

Total Reimbursed
$14,755.00 $264,098.66
$800.00 $189.95 $1,327.28 $99,985.67 $43,281.29 $15,573.09 $18,688.75 $4,975.00 $76,377.85 $5,904.90 $125,434.22 $60,446.03 $86,204.12 $3,645.57 $7,334.94 $18,306.09 $3,922.35 $50,805.03 $891.22 $1,758.57 $370,471.31 $36,162.50 $18,442.07 $4,996.53 $12,664.74 $23,502.82 $41,990.56 $1,562.66 $199,017.09 $11,965.07 $108,746.35 $38,847.35 $42,725.00 $30,564.47

-43 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo~er Name
SPORTRAN, INC. SPRING CITY KNITTING SPW INDUSTRIES STAFF LEASING STAR MANUFACTURING COMPANY STEPHEN CHENG, M.D. STEPHENS CO PUBLIC SCHOOLS STEVE CRAWFORD FOREST PROD. STEVENS GRAPHICS, INC. STONE MOUNTAIN GROUP STONEY'S FAMILY RESTAURANT STORK GAMCO, INC. STOUFFER PINEISLE RESORT SUHNER MANUFACTURING SUITT CONSTRUCTION COMPANY SUMMIT MARKETING GROUP SUN LYNN ENTERPRISES SUNBELT EQUIPMENT & RENTAL SUNBELT PLASTIC EXTRUSIONS SUNDANCE PLUMBING, INC. SUNGLASS HUT CORPORATION SUNSHINE BISQUITS, INC SUPERIOR ELECTRIC SUPERIOR INSURANCE COMPANY SUPERIOR PANTS COMPANY SUPREME CARPET, INC. SUPREME INDUSTRIES, INC. SWEETHEART CUP CO., INC. SWIFT INDEPENDENT PACKING CO SWINFORD CARPETS SWISHER INTERNATIONAL ,INC. SYNOVUS FINANCIAL CORP. SYSCO FOODS T & L INSTALLATION COMPANY T & L SERVICES, INC. T.M. POLYFILM, INC.

Cit~ LAWRENCEVILLE CARTERSVILLE LAKE CITY COLUMBUS CEDARTOWN
SAVANNAH
TOCCOA WAYNESBORO ATLANTA SNELLVILLE CLARKESVILLE GAINESVILLE LAKE LANIER ISL. ROME ALBANY ATLANTA DALLAS CHARLOTTE CENTERVILLE MARIETTA
MIAMI
COLUMBUS JULIETTE ATLANTA ATHENS CHATSWORTH GOSHEN AUGUSTA MOULTRIE ATHENS JACKSONVILLE COLUMBUS COLLEGE PARK MARIETTA PALMETTO VALDOSTA

State
GA GA GA GA GA GA GA GA GA GA
GA
GA GA GA GA GA GA NC GA GA FL GA GA GA GA GA
GA GA
GA
GA
FL GA GA GA GA GA

Total Reimbursed
$6,796.26 $12,586.00 $18,695.44 $53,468.42 $56,995.35
$72.00 $21,974.07 $15,038.89
$1,027.43 $9,381.47 $12,089.70 $9,207.56
$81.90 $64,999.10
$6,257.95 $30,345.00 $16,556.48 $56,305.37 $68,183.93 $11,060.00 $24,155.15 $17,237.93 $12,549.31
$8,149.07 $72,711.23 $13,771.28 $48,595.48 $27,498.42 $16,050.00
$8,581.19 $17,741.20 $68,181.16 $186,719.89 $39,256.54 $11,767.24
$934.35

-44 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo~er Name
TACO BELL TARA MATERIALS, INC. TARMAC AMERICAN, INC. TAYLOR GAS TC BAYCOR TDK ELECTRONICS CORP. TECH CON, INC. TEETS INTERNATIONAL TRUCKS INC TELAMON CORP TEMPLE INLAND, INC. TEMPWORKS, INC. TENNECO AUTOMOTIVE TENNECO OIL CO. TERMINIX (SERVICEMASTER) TERMINIX AT CHAMBLEE TERMINIX AT LAWRENCEVILLE TEXAS PERSONNEL SERVICES THE ATHLETE'S FOOT GROUP INC THE DARIEN NEWS, INC. THE FUN CO. THE GILBERT COMPANIES THE GREATER TRAVELERS REST THE HAYS CORP. THE KINGS CARPENTERS, INC. THE LANDINGS, CLUB, INC. THE MOTOR CONVOY, INC. THE RAYMOND KING CO., INC. THE STANDARD CLUB THE TAPPAN COMPANY THE WILLIAM L BONNELL CO., INC THERMAL INDUSTRIES/HEAT, INC. THIELE KAOLIN COMPANY THOMAS COUNTY PUBLIC SCHOOLS THOMAS J. TAYLOR THOMAS PACKING CO. THOMASTON-UPSON CO. BD. OF ED.

Cit~
AUGUSTA LAWRENCEVILLE LITHONIA FAIRBURN CORNELIA PEACHTREE CITY BLUE RIDGE AUGUSTA BLACKSHEAR MACON AUGUSTA HARTWELL COVINGTON FOREST PARK CHAMBLEE STONE MTN. HOUSTON COLUMBUS DARIEN ATLANTA PARKER CITY DECATUR MACON CANTON SAVANNAH ATLANTA CALHOUN DULUTH DALTON
NEWNAN
MARIETTA SANDERSVILLE THOMASVILLE MIDWAY GRIFFIN THOMASTON

State
GA
GA
GA GA GA GA GA
GA
GA GA
GA
GA GA GA GA GA TX GA GA
GA
IN GA GA GA GA GA
GA
GA GA
GA
GA GA GA GA GA GA

Total Reimbursed
$2,634.84 $24,740.13 $13,059.60 $54,613.38
$5,152.26 $16,654.90 $15,766.56
$4,598.00 $1,583.86 $23,285.16 $71,472.64 $17,225.00 $112,140.59 $45,453.38 $15,074.59 $3,183.10 $5,152.53 $3,860.51 $3,773.31 $10,899.96 $100,377.08 $1,418.00 $9,295.70 $10,393.28 $67,030.63 $2,860.00 $21,731.77 $4,113.41 $23,450.33 $9,721.33 $1,134.65 $1,313.93 $1,134.65
$275.00 $11,794.20
$1,047.52

- 45

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em12lo~er Name THOMPSON CONSTRUCTION CO. THOMPSON'S FARM SUPPLY THOMSON OAK FLOORING CO. THORNWOOD BUILDERS INC TIC-THE INDUSTRIAL COMPANY TIFT COUNTY BOE TIM JONES COMMUNICATIONS TIMBER HARVESTING, INC. TIMBERLINE TRANSPORT/ES! TMP CONSTRUCTION INC TOBACCO EXPORTERS INT'L TOGA/ADV. FORM TOMMY GIBSON BUILDERS INC TOM'S FOOD, INC. TONY'S FOOD MART. TOOMBS COUNTY MANUFACTURING TOPCON AMERICA CORP. TORRINGTON TOSCO MARKETING CO. TOWN OF TRION POLICE DEPT. TOWNS COUNTY BD OF EDUCATION TRAILMOBILE, INC. TRANS WORLD AIRLINES, INC. TRANSAC, INC TRANSPOWER TRENT TUBE DIVISION TRIBUNE COMPANY TRINOVA CORPORPATION TROJAN BATTERY COMPANY TROY PEELE TRUS JOIST MACMILLIAN TUFTCO CORP. TUFTING MACHINE CO., INC. TURNER BROADCASTING SYSTEM TWIGGS. COUNTY BOE TWIN CITY QUALITY BUILDERS

Ci~ CHAMBLEE VIDALIA THOMSON LILBURN STEAMBOAT SPGS. TIFTON JONESBORO DANVILLE PHOENIX POWDER SPRINGS TUCKER JACKSON MACON COLUMBUS ROCKMART LYONS PARAMUS DALHONEGA NORCROSS TRION HIAWASSEE CONLEY ATLANTA MACON
ALBANY
CARROLLTON ATLANTA ATLANTA LITHONIA WOODSTOCK COLBERT DALTON DALTON ATLANTA JEFFERSONVILLE TWIN CITY

State
GA GA GA GA
co
GA GA GA AZ GA GA GA GA GA
GA GA
NJ GA GA GA GA
GA GA
GA
GA GA
GA
GA
GA GA GA GA GA GA GA GA

Total Reimbursed
$15,315.01 $9,945.51 $5,489.24
$331.18 $2,165.98 $4,491.21 $3,635.85 $38,998.93 $41,440.74
$262.85 $17,929.39
$2,893.57 $17,710.34 $34,958.16 $17,709.88
$915.11 $6,566.74 $18,174.26 $136,717.52 $39,821.97
$640.26 $12,325.66 $249,470.25
$1,672.15 $373.21
$22,020.17 $4,760.54
$16,248.81 $2,142.25 $1,772.30
$67,884.09 $1,275.52
$263,557.68 $5,513.06 $828.48 $9,643.49

-46 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Emglo~er Name
U F I MICRO FIBERS U.S. CAN CO U.S. FILTER U.S. FILTER WHEELABRATOR U.S. TEAM HANDBALL U-CAN RENT, INC. UHAUL CO. U-HAUL COMPANY WESTERN GA UNDERWOOD ADMINISTRATIVE SVCS UNION MISSION INC. UNION STATION APARTMENTS UNITED DISTRIBUTORS, INC. UNITED INSURANCE CO OF AMER. UNITED NATURAL FOODS, INC. UNITED PARCEL SERVICE UNIVERSAL CERAMICS, INC. UNIVERSAL DISPERSIONS US XPRESS, INC. USA WASTE SERVICES UVALDA MANUFACTURING CO V.F. CORPORATION/LEE CO. V.T. INDUSTRIES, INC. VALDOSTA KWIK WASH VALLEY HOME CARE VARN WOOD PRODUCTS VAUGHAN CONSTRUCTION VENCOR ANCILLARY SERVICES VENCOR REHAB CTR. VENDOR'S SUPPLY OF GEORGIA VIACON,INC VICTORY BAPTIST CHURCH VINCE HOSIERY MILL VINING FUNERAL HOME VISITING NURSES ASSOCIATION VITAL CARE EMS VIVRA RENAL CARE, INC.

Cit~
JASPER TALLAPOOSA THOMASVILLE LAGRANGE CO. SPRINGS BOGART COLUMBUS ATLANTA ATLANTA
SAVANNAH
UNION CITY ALBANY SAVANNAH ATLANTA ATLANTA ADAIRSVILLE FITZGERALD TUNNEL HILL MARIETTA UVALDA JASPER HOLSTEIN VALDOSTA FORT VALLEY HOBOKEN LAWRENCEVILLE LAKE CITY MARIETTA LITHONIA NORCROSS STONE MTN. VILLA RICA EATON BAXLEY NEWNAN MARTINEZ

State
GA GA GA GA
co
GA
GA
GA GA
GA
GA GA
GA
GA GA GA GA GA
GA
GA GA
IA GA
GA GA
GA
GA
GA GA
GA GA GA GA
GA
GA GA

Total Reimbursed
$63,763.42 $33,632.21 $22,492.86
$9,374.63 $52,037.85 $45,705.50
$7,000.00 $123,480.00
$79.80 $69,728.53 $113,485.02
$6,634.60 $21,624.44 $35,448.59 $90,120.42 $3,342.16 $5,639.25 $29,167.88 $3,577.65 $7,141.52 $8,702.89
$310.27 $84,893.47 $4,961.88 $43,877.77 $2,279.80 $14,469.30 $40,269.65 $4,725.00 $41,513.13 $20,894.98 $36,103.61 $4,065.20 $22,425.25 $34,365.00 $21,720.05

-47 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

Em(;!lo~er Name
i
VOLUME TRANSPORTATION,INC. VUGHT AIRCRAFT INDUSTRIES W&J, INC. W. GARNER CONSTRUCTION W. GILBERT JONES FARMS, INC. W.C. BRADLEY CO. W.T. HARVEY CO INC WADA METALS OF AMERICA WADE & SONS INC WALDEN HALL CHRISTIAN SCHOOL WALDON ROCK SERVICES WALLER DRYWALL CO WAL-MART DISTRIBUTION CENTER WAL-MART STORES, INC. WALTON MONROE MILLS, INC. WARNACO, INC. WASTE MANAGEMENT OF AUGUSTA WASTE MGMT. OF ATLANTA WATER VISTA APARTMENTS WATER, GAS & LIGHT COMMISSION WATTYL PAINT CORP. WAYCROSS COCA-COLA WAYFIELD FOODS, INC. WAYNE POULTRY WEEKS CONSTRUCTION CO WEEKS TEXTILE WENDY'S INTERNATIONAL INC WESLEY TURTON D/B/A RAMADA WESLEYAN COLLEGE WEST GEORGIA AUTO PARTS INC WESTERN SIZZLIN' WESTVALE MANUFACTURING CO WHEELABRATOR CORP. WHITAKER ELECTRIC CO., INC. WHITE CONSOLIDATED INDUSTRIES WIGGINS ENTERPRISE

Cit~ LITHONIA MILLEDGEVILLE SMYRNA MCDONOUGH CAMILLA COLUMBUS COLUMBUS ROME MACON AUGUSTA ADAIRSVILLE TUCKER DOUGLAS DOUGLAS MONROE SYLVANIA AUGUSTA LAKE CITY LAWRENCEVILLE ALBANY ATLANTA WAYCROSS ATLANTA PENDERGRASS SPARKS QUITMAN MARIETTA CORDELE MACON CARROLLTON COLUMBUS CANTON LAGRANGE APPLING NORCROSS BAXLEY

State
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed
$163.64 $10,597.78 $90,318.77
$415.05 $21,371.61 $100,381.74
$5,157.23 $62,990.31 $22,475.72
$4,744.58 $6,621.22 $1,438.74 $9,212.31 $165,134.31 $7,290.00 $8,532.86 $15,966.90 $6,539.55 $42,999.92 $69,832.58 $66,849.56 $20,374.45 $19,015.31 $8,282.71
$497.93 $13,674.59
$2,726.08 $28,630.90 $14,777.41
$7,084.00 $18,855.91
$4,369.36 $224.75 $501.67
$4,052.36 $6,880.52

-48 -

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

January 1, 2001 - December 31, 2001

EmE!lo~er Name

Total

Cit~

State

Reimbursed

WIL MAC CONTAINER WILBERT BURIAL VAULT CO WILDES VENDING COMPANY, INC WILKINSON CO. BD OF EDUCATION WILLIAM CARTER CO. WILLIAM HEATH WILLIAM J. LUMLEY & CO. WILLIAM LLOYD SMITH WILLIAMS ENTERPRISES OF GA INC WILSON CROSBY/CROSBY PULP WINN MGMY CORP MKT PL. WOODBURY BUSINESS FORMS WORTH CO. BD. OF EDUCATION WRIGHT NURSERIES WS BADCOCK CORP. YAMAHA MUSIC MFG YORK BEE CO ZARTRAN, INC. ZESTO CHUBBY DECKER, INC. ZUA AUTO PARTS1INC Total:

CONYERS ATLANTA VALDOSTA IRWINGTON BARNESVILLE MACON ADRIAN CLAYTON SMYRNA LAKE PARK BOSTON WOODBURY SYLVESTER CAIRO MULBERRY THOMASTON JESUP CEDARTOWN ATLANTA OAKWOOD

GA

$76,353.57

GA

$25,788.06

GA

$15,341.85

GA

$2,584.40

GA

$252,301.60

GA

$1,127.37

GA

$37,701.23

GA

$2,389.80

GA

$12,424.13

GA

$26,121.69

MA

$87,502.59

GA

$17,153.30

GA

$3,233.11

GA

$42.04

FL

$71,859.57

GA

$27,413.90

GA

$6,750.00

GA

$48,948.86

GA

$129,640.00

GA

1421381.97

$36,681,997.74

-49 -

CLAIMS REPORTED BY INSURANCE COMPANIES

Name

January 1, 2001 - December 31, 2001
Claims Reported

ACE AMERICAN INSURANCE CO

9

ACE FIRE UNDERWRITERS INS. CO

1

ACE INDEMNITY INSURANCE CO

3

ACE PROPERTY & CASUALTY INS

1

AIG NATIONAL INS. CO.

4

AIU INSURANCE CO

2

ALL AMERICA INS. CO

3

ALLMERICA FIN BENEFIT INS CO

4

AMERICAN ALTERNATIVE INS

60

AMERICAN AUTOMOBILE INS CO

7

AMERICAN CASCO OF READING PA

61

AMERICAN CENTRAL INS CO

1

AMERICAN ECONOMY INS CO

4

AMERICAN GUAR & LIAB INS CO

2

AMERICAN HOME ASSURANCE CO

164

AMERICAN INSURANCE CO

80

AMERICAN INTER INS CO OF GA

78

AMERICAN INTERN. SOUTH INS CO

49

AMERICAN INTERNATIONAL INS CO

3

AMERICAN MFG. MUTUAL INS

47

AMERICAN MOTORISTS INS CO

12

AMERICAN PROTECTION INS CO

35

AMERICAN SAFETY CASUALTY INS

2

AMERICAN STATES INS CO

4

AMERICAN STATES INS CO OF TX

1

AMERICAN ZURICH INS CO

2

AMGUARD INSURANCE CO.

1

ARGONAUT GREAT CNTRL INS CO

2

ASSOCIATED INDEMNITY CORP

14

ASSOCIATED INDUSTRIES INS CO

1

ATLANTIC MUTUAL INS. CO

17

AUTO OWNERS INS. CO

12

BANCINSURE, INC.

1

BANKERS STANDARD FIRE & MARINE

2

BANKERS STANDARD INS CO

76

BITUMINOUS CASUALTY CORP

5

BITUMINOUS FIRE & MARINE INS

2

BUILDERS INSURANCE

136

CANAL INSURANCE CO

34

- 50 -

CLAIMS REPORTED BY INSURANCE COMPANIES

January 1, 2001 - December 31, 2001

Name

Claims Reported

CAPITAL CITY INS CO

27

CASUALTY RECIPROCAL EXCHG

30

CATAWBA INSURANCE CO

1

CATERPILLAR INSURANCE CO

1

CENTRAL MUTUAL INS CO

2

CENTRE INSURANCE CO

2

CHARTER OAK FIRE INS CO

24

CHUBB INDEMNITY INS CO

5

CHURCH MUTUAL INS CO

30

CINCINNATI CASUALTY CO

4

CINCINNATI INSURANCE CO

53

CITIZENS INS CO OF AMERICA

25

CLARENDON NATIONAL INS CO

54

COLUMBIA NATIONAL INS CO

4

COMMERCIAL MUTUAL INS CO

52

COMPANION COMMERICAL INS CO

1

COMPANION PROP & CAS

54

CONNECTICUT INDEMNITY CO

8

CONTINENTAL CASUALTY CO

113

CONTINENTAL INSURANCE CO

1

CORNERSTONE MUTUAL INS CO

24

CORNERSTONE MUTUAL INS CO

2

CREDIT GENERAL INS CO

18

CRUM & FOSTER INDEMNITY CO

1

CYPRESS INSURANCE CO

38

DEERFIELD INSURANCE CO

8

DISCOVER PROPERTY & CAS

3

ELECTRIC INSURANCE CO

4

EMPLOYERS INS OF WAUSAU

49

EMPLOYERS MUTUAL CAS INS CO

2

EVEREST NATIONAL INS

30

FAIRMONT INSURANCE CO

4

FARMINGTON CASUALTY CO

1

FARMLAND MUTUAL

6

FEDERAL INSURANCE CO

44

FEDERATED MUTUAL INS CO

48

FEDERATED RURAL ELECTRIC INS

3

FFVA MUTUAL INS CO

3

FIDELITY & CAS CO OF NY

1

FIDELITY & DEPOSIT CO OF MD

2

- 51 -

CLAIMS REPORTED BY INSURANCE COMPANIES

January 1, 2001 - December 31, 2001

Name

Claims Reported

FIDELITY & GUAR UNDERWRITERS

2

FIDELITY & GUARANTY INS CO

35

FIREMAN'S FUND INS CO

77

FIREMAN'S FUND INS CO OF GA

9

FIREMAN'S FUND INS OF GA

4

FIREMAN'S FUND OF WISCONSIN

7

FIRST NATL INS CO OF AMER

7

FLORISTS' MUTUAL INS CO

2

FRANKENMUTH MUTUAL INS

1

FREMONT COMPENSATION

7

FREMONT PACIFIC INS CO

1

FRONTIER INSURANCE CO

1

GA FARM BUREAU CAS INS CO

1

GA INSURERS INSOLVENCY POOL

6

GA RESTAURANT MUTUAL CAP INS C

2

GA TIMBER HARVERSTERS'

4

GCAP MUTUAL CAPTIVE INS

3

GENERAL ACCIDENT INS OF AMER

10

GENERAL INS CO OF AMERIC

12

GEORGIA CASUALTY & SURETY CO

70

GEORGIA INSURANCE CO

9

GERBER LIFE INS CO

1

GLENS FALLS INS CO

1

GRAPHIC ARTS MUTUAL INS CO

1

GREAT AMER INS CO OF NY

2

GREAT AMERICAN INS CO

30

GREAT NORTHERN INS CO

6

GREENWICH INSURANCE CO

2

GROCERS INSURANCE CO

1

GUIDEONE MUTUAL INS CO

7

GULF INSURANCE COMPANY

3

HANOVER INSURANCE CO

25

HARBOUR SPECIALITY INS

17

HARLEYSVILLE MUTUAL INS CO

4

HARLEYSVILLE-ATLANTIC INS CO

4

HARTFORD ACCIDENT & INDEMNITY

8

HARTFORD CASUALTY INS CO

138

HARTFORD FIRE INSURANCE CO

18

HARTFORD INS OF THE MIDWEST

2

HARTFORD UNDERWRITERS INS

24

- 52 -

CLAIMS REPORTED BY INSURANCE COMPANIES

January 1, 2001 - December 31, 2001

Name

Claims Reported

HEALTH CARE MUTUAL CAPTIVE

59

HOME INSURANCE CO OF IN

1

INDEMNITY INS OF NORTH AMER

2

INSURANCE CO OF N.A.

16

INSURANCE CO OF STATE OF PA

133

INTERNATIONAL BUS & MERCANTILE

1

INTERNATIONAL IND-LIQUIDATION

1

LEGION INS CO-IN REHAB.

165

LIBERTY INSURANCE CORP

20

LIBERTY MUTUAL FIRE INS

78

LIBERTY MUTUAL INSURANCE CO

53

LM INSURANCE CORP

3

LUMBER MUTUAL INSURANCE CO

1

LUMBERMENS MUTUAL CAS CO

79

LUMBERMEN'S UNDERWRITING

54

MADISON INSURANCE CO

2

MAG MUTUAL INS CO

3

MANAGEDCARE MUT CAPTIVE INS

1

MARYLAND CASUALTY COMPANY

3

MASSACHUSETTS BAY INSURANCE CO

4

MONUMENTAL GENERAL CAS

15

NATIONAL FARMERS UNION P & C

1

NATIONAL FIRE INS CO HARTFORD

40

NATIONAL SURETY CORP

18

NATIONAL TRUST INSURANCE CO

61

NATIONAL UNION FIRE OF PITT PA

27

NATIONWIDE MUTUAL FIRE INS CO

2

NATIONWIDE MUTUAL INS CO

5

NEW HAMPSHIRE INSURANCE CO

4

NORTH AMERICAN SPECIALTY INS

3

NORTH RIVER INSURANCE CO

3

OHIO CASUALTY INSURANCE CO

9

OLD REPUBLIC INSURANCE CO

38

ONEBEACON AMERICA INS CO

26

ONEBEACONINSURANCECO

2

ONEBEACON MIDWEST INS CO

2

PACIFIC EMPLOYERS INSURANCE

235

PACIFIC INDEMNITY CO

13

PENN MFG ASSOC INS

23

PENN MILLERS MUTUAL

3

- 53 -

CLAIMS REPORTED BY INSURANCE COMPANIES

January 1, 2001 - December 31, 2001

Name

Claims Reported

PENNSYLVANIA GENERAL INS CO

5

PHOENIX INSURANCE CO

9

PREFERRED PROFESSIONAL INS CO

1

PRINCETON INSURANCE CO

36

PROVIDENCE WA INS CO OF N Y

1

REALM NATIONAL INSURANCE

53

REDLAND INSURANCE CO

11

RELIANCE INSURANCE CO

32

RELIANCE NAT IND - LIQUDATION

81

RELIANCE NAT INS CO IN LIQ.

42

REPUBLIC-FRANKLIN INSURANCE CO

2

ROYAL & SUNALLIANCE INS. CO

320

ROYAL INDEMNITY CO

7

ROYAL INS CO OF AMERICA

8

S.E. EMPLOYER MUT. CAP. INS CO

2

SAFECO INS CO OF ILLINOIS

10

SAFECO INSURANCE CO AMERICA

27

SECURITY INS CO OF HARTFORD

1

SELECT INSURANCE CO

2

SELECTIVE INS CO OF AMERICA

11

SELECTIVE INS CO OF SOUTHEAST

7

SELECTIVE INSURANCE CO OF SC

8

SELECTIVE WAY INSURANCE CO

6

SENTRY INSURANCE A MUTUAL CO

23

SENTRY SELECT INSURANCE CO

2

SOUTHERN GUARANTY INSURANCE CO

2

ST PAUL FIRE & CASUALTY INS CO

6

ST PAUL FIRE & MARINE INS CO

37

ST PAUL MERCURY INS CO

1

STAR INSURANCE CO

45

STATE FARM FIRE & CASUALTY CO

14

STATE FARM GENERAL INS CO

5

SUMITOMO MARINE & FIRE INS CO

2

SUPERIOR PACIFIC CASUALTY CO

1

TIG INSURANCE CO

42

TIG PREMIER INSURANCE CO

1

TOKIO MARINE & FIRE INS CO

18

TRANSCONTINENTAL INS CO

171

TRANSPORTATION INSURANCE CO

133

TRAVELERS INDEMNITY CO OF CT

24

-54-

CLAIMS REPORTED BY INSURANCE COMPANIES

January 1, 2001 - December 31, 2001

Name

Claims Reported

TRAVELERS INDEMNITY CO OF IL

495

TRAVELERS INDEMNITY COMPANY

24

TRAVELERS INDEMNITY OF AMER

3

TRAVELERS INSURANCE-ALT

2

TRAVELERS INSURANCE CO

22

TRINITY UNIVERSAL INS CO

2

TRUCK INSURANCE EXCHANGE

1

TWIN CITY FIRE INSURANCE CO

28

U.S. FIDELITY & GUARANTY INS

9

U.S. SPECIALTY INS. CO.

6

UNITED PACIFIC INSURANCE CO

1

UNITED SOUTHERN ASSURANCE CO

1

UNITED STATES FIRE INSURANCE

17

UNIVERSAL UNDERWRITERS INS

4

UTICA MUTUAL INSURANCE CO

7

UTICA NATIONAL ASSURANCE CO

4

VALIANT INSURANCE CO

3

VALLEY FORGE INSURANCE CO

69

VIRGINIA SURETY CO INC

7

WAUSAU BUSINESS INSURANCE

3

WAUSAU GENERAL INS CO

11

WAUSAU UNDERWRITERS INS CO

3

WESTFIELD INSURANCE CO

23

WILLIAMSBURG NATIONAL INS CO

3

WORLDWIDE INSURANCE CO

1

YASUDA FIRE & MAR INS OF AMER

13

YORK INSURANCE CO

1

ZENITH INSURANCE CO

10

ZURICH AMERICAN INS CO

332

ZURICH AMERICAN INS CO OF IL

133

Total # of Companies: 230

Total:

5944

- 55 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

Name

January 1, 2001 - December 31, 2001
Claims Reported

AGRITRUST OF GEORGIA

5

ASSOCIATION CTY COM GA SI

179

COMPTRUST AGC OF GEORGIA

6

CONSTRUCTION SUPPLIERS' ASSOC

7

GA AUTO DEALERS ASSOCIATION SI

14

GA EDUCATION WC TRUST FUND

26

GA HOSPITAL ASSOC WCSI FUND

95

GA MUNICIPAL ASSN WCSIF

99

GA OILMEN'S ASSOCIATION

94

GA OPERATORS SELF-INSURERS

43

GA SCHOOL BD ASSOC WC FUND

29

GEMC WORKERS' COMP FUND

29

METRO ATLANTA LANDSCAPE/TURF

1

ROOFING & SHEET METAL ASSOC

6

Total# of Companies: 14

Total:

633

- 56 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name AT&T

Claims Reported 11

AAA COOPER TRANSPORTATION

11

ABF FREIGHT SYSTEM, INC

4

AGL RESOURCES, INC.

8

ALBANY, CITY OF

5

ALLIED SYSTEMS LTD

2

AMOCO CORPORATION

9

ANHEUSER-BUSCH COMPANIES, INC.

1

ARCHBOLD MEDICAL CENTER

6

ARCHDIOCESES OF ATLANTA

5

ARCHER-DANIELS-MIDLAND CO

1

ASPLUNDH TREE EXPERT CO

6

ATCO RUBBER PRODUCTS, INC.

1

ATHENS-CLARKE COUNTY

10

ATLANTA BOARD OF EDUCATION

14

ATLANTA CITY OF

3

ATLANTA HOUSING AUTHORITY

1

AUGUSTA-RICHMOND CO BD COMM

3

AUTOMOTIVE MOULDING COMPANY

1

AUTOZONE, INC

2

AVERITT EXPRESS, INC

3

AVONDALE MILLS INC

1

BANKHEAD ENTERPRISES, INC

2

BARTOW COUNTY BD OF EDUCATION

4

BAYLINER MARINE CORPORATION

1

BEAULIEU OF AMERICA

16

BELLSOUTH CORPORATION

8

BERRY COLLEGE

2

BIBB COUNTY BO-COMMISSION

1

BLOSSMAN COMPANIES, INC

1

BLUE BIRD BODY COMPANY

41

BLUE CIRCLE AMERICA

13

BRUNSWICK, CITY OF

1

BURLEN CORPORATION

5

CT HARRIS INC

1

C. W. MATTHEWS CONTRACTING INC

2

CAGLE FOODS, JV, LLC

6

CAGLE'$ INC, & SUBSIDIARIES

22

CALIBER SYSTEM, INC.

2

CANDLER HEALTH SYSTEM

3

CARROLL CO. BOARD OF EDUCATION

2

- 57 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name

Claims Reported

CATOOSA CO. BO. OF EDUCATION

2

CEMEX (SOUTHDOWN INC.)

1

CENTRAL GEORGIA HEALTH SYSTEMS

13

CERTAINTEED CORPORATION

3

CHATHAM COUNTY BO OF EDUCATION

6

CHATHAM COUNTY GEORGIA

4

CHEROKEE CO BO OF COMMISSIONER

1

CHEROKEE CO BO OF EDUCATION

1

CHILDREN'S HEALTHCARE OF A TL

7

CITIGROUP INC.

1

CLAYTON COUNTY BO OF EDUCATION

24

CLAYTON COUNTY COMMISSIONERS

52

COACHMAN REC. VEHICLE CO OF GA

1

COBB COUNTY BO/COMMISSIONERS

6

COBB COUNTY SCHOOL SYSTEM

20

COCA-COLA COMPANY

9

COCA-COLA ENTERPRISES INC

91

COLQUITT CO BO OF EDUCATION

5

COLUMBIA CO BOARD OF EDUCATION

1

COLUMBUS CITY OF

4

COLUMBUS REGIONAL HEALTHCARE

1

CONAGRA FOODS, INC

3

CONSOLIDATED FREIGHWAYS/DELWAR

4

CONTI GROUP COMPANIES, INC

8

CONTINENTAL TIRE N. AMER., INC

8

COOPER INDUSTRIES, INC

3

COOPER TIRE AND RUBBER

2

COWETA CO BOARD OF EDUCATION

2

CRACKER BARREL OLD CNTRY STORE

17

CRAWFORD & COMPANY

18

CRAWFORD W LONG MEM HOSPITAL

1

CRIDER'$ POULTRY INC

1

CRISP COUNTY BO OF EDUCATION

2

DALTON CITY OF

2

DEKALB COUNTY BOARD-ED

5

DEKALB COUNTY GOVERNMENT

18

DEKALB REGIONAL HLTHCARE SYS

3

DELHAIZE AMERICA INC.

7

DELTA AIRLINES, INC.

198

DIXIE GROUP & SUBSIDIARIES

3

DOLLAR GENERAL CORP

10

DOUGHERTY COUNTY COMMISSION

7

DOUGHERTY COUNTY SCHOOL SYSTEM

6

- 58 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name

Claims Reported

DOUGLAS CO BD OF COMMISSIONERS

4

DOUGLAS COUNTY SCHOOLS

1

DOUGLAS, CITY OF

3

EIDUPONTDENEMOURS&CO

2

EAST POINT, CITY OF

5

EATON CORPORATION

1

ELBERTON GRANITE ASSOCIATION

1

EMERSON ELECTRIC CO

3

EMORY CLINIC, INC.,

8

EMORY UNIVERSITY

100

ENCOMPASS GROUP, LLC

6

ENGELHARD CORPORATION

4

ESTES EXPRESS LINES

5

FAYETTE COUNTY BD OF COMM

1

FAYETTE COUNTY BD OF EDUCATION

1

FEDERAL EXPRESS

17

FEDERATED DEPARTMENT STORES

4

FIELDALE FARMS CORPORATION

13

FIELDCREST CANNON INC

2

FLEETWOOD HOMES OF GA INC

12

FLEXSTEEL INDUSTRIES INC

3

FLOWERS INDUSTRIES INC

8

FLOYD COUNTY BD OF EDUCATION

3

FLOYD HLTHCARE MGMT INC

7

FLYING J, INC.

7

FORD MOTOR COMPANY

3

FORSYTH CO BD OF COMMISSIONERS

3

FORSYTH CO. BD. OF EDUCATION

1

FORT JAMES CORP.

4

FREUDENBERG-NOK

3

FRIGIDAIRE CO MICROWAVE PRODS.

1

FULTON COUNTY BD OF EDUCATION

6

FULTON COUNTY, GEORGIA

14

FULTON-DEKALB HOSPITAL AUTHY

5

GA BAPTIST HEALTH CARE SYSTEM

4

GA INTAL HEALTH/SOUTH FULTON

1

GA MEDCORP, INC.

2

GA S.I. GUARANTY TRUST FUND

1

GANNETT CO. INC & SUBSIDIARIES

4

GENERAL MOTORS CORPORATION

28

GEORGIA DUCK & CORDAGE MILL

2

GEORGIA STATE OF

688

GEORGIA-PACIFIC CORPORATION

13

- 59 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name

Claims Reported

GLYNN COUNTY BOARD OF COMMSNRS

1

GLYNN COUNTY SCHOOLS

14

GOLDEN PANTRY FOOD STORES INC

1

GOODY PRODUCTS, INC.

1

GREAT DANE LTD PARTNERSHIP

13

GULFSTREAM AEROSPACE CORP

6

GWINNETT CO BD OF EDUCATION

19

GWINNETT COUNTY BD OF COMMISS

25

GWINNETT HOSPITAL SYSTEM

15

HALL COUNTY BOARD OF EDUCATION

3

HAMILTON HEALTH CARE SYSTEM

2

HENRY CO BOARD OF EDUCATION

9

HERCULES INCORPORATED

1

HOME DEPOT INC/HOME DEPOT USA

1

HORMEL FOODS CORP

7

HORTON HOMES, INC

16

HOSPITAL AUTHORITY HOUSTON CTY

1

HOUSTON COUNTY BD OF EDUCATION

3

HOUSTON COUNTY COMMISSIONERS

1

HUTCHESON MEDICAL CENTER

5

HYATT CORPORATION

3

IDA CASON CALLAWAY FOUNDATION

2

IKON OFFICE SOLUTIONS

1

INGLES MARKETS INC

62

INTERFACE, INC

2

INTERNATIONAL PAPER COMPANY

9

J H HARVEY COMPANY

3

J. C. PENNEY COMPANY, INC.

3

JEFFERSON SMURFIT CORP. U.S.

1

JOHN WIELAND HOMES, INC

3

JOHNSTON INDUSTRIES, INC.

2

K-MART CORP & SUBSIDIARIES

27

KEEBLER COMPANY

32

KELLEY MANUFACTURING COMPANY

2

KING & PRINCE SEAFOOD CORP.

1

KLEEN-TEX INDUSTRIES

4

KROGER COMPANY, THE

31

LABOR READY SE Ill LP

3

LAWRENCEVILLE, CITY OF

2

LEVI STRAUSS & CO

3

LOW TEMP INDUSTRIES

1

LOWE'S HOME CENTERS, INC

49

LOXCREEN COMPANY, INC.

2

- 60 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name

Claims Reported

LUCENT TECHNOLOGIES INC.

1

MACON CITY OF

31

MACON/BIBB CO WATER & SEWERAGE

1

MARIETTA CITY SERVICES

38

MARMON INDUSTRIAL CORP

3

MARRIOTT INTERNATIONAL, INC.

10

MARTA

41

MAYER ELECTRIC SUPPLY CO

1

MEAD CORPORATION

6

MEMORIAL MEDICAL CENTER, INC.

3

METROMEDIA INTERNATIONAL GRP

4

MOBIL OIL CORPORATION

1

MOHAWK CARPET CORPORATION

193

MONROE, CITY OF

1

MONTGOMERY WARD

1

MOUNT VERNON MILLS

7

MULLITE CO OF AMERICA

1

MURPHY-HARPST-VASHTI, INC.

1

NABISCO, INC

5

NATIONAL SERVICES INDUSTRIES

13

NEWTON COUNTY BD OF EDUCATION

3

NO COVERAGE

1

NORDSTROM, INC.

1

NORMAN W FRIES/CLAXTON POULTRY

6

NORTHEAST GEORGIA HEALTH SYS

4

NORTHSIDE HOSPITAL

8

OLD DOMINION FREIGHT LINES INC

4

OLIVER RUBBER CO

1

OVERNITE TRANSPORTATION CO

1

OWENS-ILLINOIS INC

1

PARKER HANNIFIN CORPATION

4

PCC AIRFOILS INC

8

PHOEBE PUTNEY MEMORIAL HOSP

1

PIEDMONT HOSPITAL

1

PIGGLY WIGGLY CAROLINA CO INC

2

PRINTPACK, INC

7

PROCTER & GAMBLE COMPANY AND

2

QUITRIP

2

RACETRAC PETROLEUM, INC

5

RIVERDALE, CITY OF

1

ROCKDALE CO. BD OF EDUCATION

2

ROCKWELL INTERNATIONAL

11

ROCOR INTERNATIONAL

1

- 61 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name

Claims Reported

ROLLINS INC

2

ROME, CITY OF

3

ROPER CORPORATION

2

ROSWELL CITY OF

1

RTM, INC.

5

RUBY TUESDAY INC

11

RYAN'S FAMILY STEAK HOUSES

5

RYDER SYSTEMS INC

1

SAINT JOSEPH'S HEALTH SYSTEM

2

SAINT JOSEPH'S OF SAVANNAH

2

SATILLA HEALTH SERVICES INC

7

SAVANNAH CITY OF

12

SCIENTIFIC-ATLANTA INC

1

SHAW INDUSTRIES INC

27

SHERWIN-WILLIAMS COMPANY

6

SHONEY'S INC

15

SIX CONTINENTS HOTELS, INC

11

SOUTHEAST GA HLTH SYSTEMS

3

SOUTHEAST-ATLANTIC BEVERAGE

1

SOUTHERN COMPANY

30

SOUTHERN MILLS INC

3

SOUTHWIRE COMPANY

1

SPALDING & EVENFLO COMPANIES

1

SPALDING CO BOARD OF COMM

1

SPARTAN MILLS

1

SPRINGS INDUSTRIES INC

9

STAFFMARK, INC.

7

STONE CONTAINER CORPORATION

1

SUPER DISCOUNT MARKETS

10

SYNTHETIC INDUSTRIES, INC

2

TANNER HEALTH SERVICES

3

TARGET CORPORATION

58

TECUMSEH PRODUCTS COMPANY

3

TENNECO AUTOMOTIVE, INC

1

TEXTILE RUBBER & CHEMICAL

1

TEXTRON, INC

24

THERMAL CERAMICS

18

THOMASTON MILLS INC

3

THREE SPRINGS INC.

3

TIFTON ALUMINUM CO INC/ALCOA I

1

TRC STAFFING SERVICES, INC

5

TYCO INTERNATIONAL LTD.

1

TYSON FOODS INC

36

- 62 -

CLAIMS REPORTED BY SELF-INSURED EMPLOYERS

January 1, 2001 - December 31, 2001

Name

Claims Reported

UNILEVER UNITED STATES

2

UNITED AIRLINES

3

UNITED CATALYSTS, INC

3

UNIVERSITY HOSPITAL

4

USF HOLLAND, INC.

7

VALDOSTA CITY OF

1

VISITING NURSE HEALTH SYSTEM

3

VULCAN MATERIALS COMPANY

1

WACHOVIA

2

WAFFLE HOUSE

40

WALKER COUNTY BD OF EDUCATION

3

WAREHOUSE HOME FURNISHINGS

15

WARNER ROBINS CITY OF

3

WARREN SEWELL MFG. CO.

4

WAYCROSS MOLDED PRODUCTS INC

1

WAYCROSS, CITY OF

2

WELLINGTON LEISURE PRODUCTS

6

WELLSTAR HEALTH SYSTEM

8

WENDY'S INTERNATIONAL INC

1

WEST GEORGIA HEALTH SYSTEM

4

WEST POINT STEVENS, INC

4

WESTVACO CORPORATION & SUBS

2

WEYERHAEUSER COMPANY

3

WHITFIELD CO-BD OF EDUCATION

2

WHITFIELD COUNTY BD OF COMMISS

1

WINN-DIXIE STORES INC

46

YELLOW FREIGHT SYSTEM INC

6

Total # of Companies: 283

Total:

3174

-63 -

REVENUES, EXPENDITURES AND FUND BALANCE For Year Ended December 2001

BEGINNING BALANCE, January 1, 2001 Prior Year (2000) Adjustment
REVENUES Assessment - 2000, Adjusted 1999; payments and refunds from prior
years Interest Miscellaneous Income TOTAL REVENUES
EXPENDITURES Operating Cost Reimbursements (Negotiated Checks) TOTAL EXPENDITURES

$63,479,516.06 871,459.94

$64,350,975.97

$63,342,526.34 2,609,208.20 4,286.59 $65,956,021.13
$ 2,015,778.86 69,593,011.28
$71,608,790.14

Net Loss ENDING BALANCE, December 31, 2001

($5,652,769.01) $58,698,206.96

CLAIMS ACTIVITY 2001

Open Claims

January 1, 2001

Claims Received

2001

Previously Closed Claims Reopened

2001

Claims Closed

2001

Open Claims

December 31, 2001

Claims Accepted

2001

Claims Denied

2001

Notices in Pending Status

January 1, 2001 - December 31, 2001

10,822 9,687 601 8,432
12,678 891 111
2,651

- 64 -

SECTION 34-9-358 OF THE OFFICIAL CODE OF GEORGIA Payment of assessments to fund by insurers and self-insurers. (a) Each insurer and self-insurer under this Title shall, under regulations prescribed by the Board of Trustees, make payments to the fund in an amount equal to that proportion of 175% of the total disbursement made from the fund during the preceding calendar year less the amount of the net assets in the fund as of December 31 of the preceding calendar year which the total workers' compensation claims paid by the insurer or self-insurer bears to the total workers' compensation claims paid by all insurers and self-insurers during the preceding calendar year. The Administrator is authorized to reduce or suspend assessments for the fund when a completed actuarial survey shows further assessments are not needed. An employer who has ceased to be a self-insurer prior to the end of the calendar year shall be liable to the fund for the assessment of the calendar year. The initial assessment of each insurer or self-insurer for the purpose of generating revenue to begin operation of the fund shall be in the amount of one-half of 1 percent of the workers' compensation premiums collected by the insurer for the preceding calendar years from and employer who is subject to this Chapter or the equivalent of such in the case of a self-insurer.
- 65 -

ASSESSMENT CALCULATION ADJUSTED FOR 2000

The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2000 amounted to $64,681,955.91. This was computed in the following manner:

Total Fund disbursements/calendar year 2000 $73,235,126.84

X

175%

- Net Assets $63,479,516.06

= Fund Assessment $64,681,955.91

Based on insurer/self-insurers' assessment reports, the total actual workers' compensation benefits (indemnity and medical) paid in Georgia during calendar year 2000 was $994,391,940.38. This amount ($994,391,940.38) divided into the Fund assessment ($64,681,955.91) yields an assessment rate of .06504674~

ASSESSMENT CALCULATION FOR 2001

The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2001 amounted to $66,617,175.79. This was computed in the following manner:

Total Fund disbursements/calendar year 2001 $71,608,790.14

X

175%

- Net Assets $58,698,206.96

= Fund Assessment $66,617,175.79

Based on insurer/self-insurers' assessment reports, the total actual workers' compensation benefits (indemnity and medical) paid in Georgia during calendar year 2001 was $1,067,327,013.90. This amount ($1,067,327,013.90) divided into the Fund assessment ($66,617,175.79) yields an assessment rate of .06241496.

In addition to the assessment ($66,617,175.79), an additional $246,148.79 in penalties for late filing of Claims Losses report forms will be levied.

66 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit
2001 Assessment 2000 Assessment Adjustment
Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

ACCEPTANCE INSURANCE CO

$499.33

ACE AMERICAN INSURANCE CO

$156,127.66

ACE FIRE UNDERWRITERS INS. CO $7,302.36

ACE INDEMNITY INSURANCE CO

$1,537.43

ACE PROPERTY & CASUALTY INS $16,697.17

AIU INSURANCE CO

$134,168.73

ALFA INSURANCE CORP

$4,263.15

ALL AMERICA INS. CO

$10,983.49

ALLIANZ INSURANCE CO

$104.84

AMCOMP ASSURANCE

$6,868.50

AMCOMP PREFERRED

$0.00

AMERICAN & FOREIGN INS CO.

$34,608.46

AMERICAN ALTERNATIVE INS

$558,491.60

AMERICAN AUTOMOBILE INS CO

$56,200.75

AMERICAN CASCO OF READING PA $165,398.12

AMERICAN CENTRAL INS CO

$18,254.15

AMERICAN ECONOMY INS CO

$34,763.38

AMERICAN EMPLOYERS INS CO

$10,908.39

AMERICAN FIRE & CASUALTY CO

$8,003.78

AMERICAN GUAR & LIAB INS CO

$69,917.81

AMERICAN HARDWARE MUT INS

$3,646.96

AMERICAN HOME ASSURANCE CO $464,572.05

AMERICAN INSURANCE CO

$294,297.01

AMERICAN INTER INS CO OF GA $729,494.06

AMERICAN INTERN. SOUTH INS CO $85,019.01

AMERICAN MFG. MUTUAL INS

$460,758.95

AMERICAN MOTORISTS INS CO

$301,073.75

AMERICAN PROTECTION INS CO $344,235.95

AMERICAN RESOURCES INS CO

$26,847.49

AMERICAN STATES INS CO

$85,286.31

AMERICAN STATES INS CO OF TX

$9,045.58

AMERICAN ZURICH INS CO

$231,033.47

AMERISURE INSURANCE CO

$27,473.10

AMERISURE MUTUAL INS CO

$42,601.32

AMGUARD INSURANCE CO.

$0.00

ARGONAUT GREAT CNTRL INS CO $19,448.47

ARGONAUT INSURANCE CO

$16,334.89

$500.01 $156,340.06
$7,312.30 $1,539.53 $16,719.88 $134,351.25 $4,268.95 $10,998.43
$104.99 $6,877.85
$0.00 $34,655.54 $559,251.38 $56,277.20 $165,623.13 $18,278.98 $34,810.67 $10,923.23
$8,014.67 $70,012.93
$3,651.92 $465,204.06 $294,697.38 $730,486.47 $85,134.67 $461,385.77 $301,483.34 $344,704.26 $26,884.01 $85,402.34
$9,057.89 $231,347.77
$27,510.48 $42,659.28
$0.00 $19,474.93 $16,357.11

ARGONAUT-MIDWEST INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES INS CO

$39.17 $20,930.37 $3,342.76

$39.22 $20,958.84
$3,347.31

2001

2001

Claims Paid Assessment Amt

$965.00 $1,793,435.31
$116,547.00 $23,464.00
$176,270.05 $2,408,024.11
$0.00 $372,243.28
$138.00 $165.00 $302,436.00 $790,733.00 $8,344,777.00 $1,217,887.00 $8, 139,050.13 $245,997.00 $566,016.00 $240,383.00 $84,564.00 $940,233.18 $78,546.00 $12,924,203.42 . $4,112,715.00 $12,941,260.66 $7,364,634.60 $8,181,147.35 $3,707,975.86 $6,423,522.33 $444,523.00 $1,493,183.85 $242,654.00 $3,512,706.52 $135,401.00 $921,222.77 $118,302.00 $377,012.80 $58,826.00 $2,577.00 $979,701.00 $139,334.00

$60.23 $111,937.19
$7,274.28 $1,464.50 $11,001.89 $150,296.73
$0.00 $23,233.55
$8.61 $10.30 $18,876.53 $49,353.57 $520,838.92 $76,014.37 $507,998.49 $15,353.89 $35,327.87 $15,003.50 $5,278.06 $58,684.62 $4,902.45 $806,663.64 $256,694.94 $807,728.27 $459,663.37 $510,625.98 $231,433.16 $400,923.89 $27,744.89 $93,197.01 $15,145.24 $219,245.44 $8,451.05 $57,498.08 $7,383.81 $23,531.24 $3,671.62 $160.84 $61,148.00 $8,696.53

2000 Balance Due

2000 And 2001 Total Assessment

$0.68 $212.40
$9.94 $2.10 $22.71 $182.52 $5.80 $14.94 $0.15 $9.35 $0.00 $47.08 $759.78 $76.45 $225.01 $24.83 $47.29 $14.84 $10.89 $95.12 $4.96 $632.01 $400.37 $992.41 $115.66 $626.82 $409.59 $468.31 $36.52 $116.03 $12.31 $314.30 $37.38 $57.96 $0.00 $26.46 $22.22 $0.05 $28.47 $4.55

$60.91 $112,149.59
$7,284.22 $1,466.60 $11,024.60 $150,479.25
$5.80 $23,248.49
$8.76 $19.65 $18,876.53 $49,400.65 $521,598.70 $76,090.82 $508,223.50 $15,378.72 $35,375.16 $15,018.34 $5,288.95 $58,779.74 $4,907.41 $807,295.65 $257,095.31 $808,720.68 $459,779.03 $511,252.80 $231,842.75 $401,392.20 $27,781.41 $93,313.04 $15,157.55 $219,559.74 $8,488.43 $57,556.04 $7,383.81 $23,557.70 $3,693.84 $160.89 $61,176.47 $8,701.08

-67 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

ASSOCIATION CASUALTY INS CO

$0.00

ASSURANCE CO. OF AMERICA

$34,597.22

ATLANTIC MUTUAL INS. CO

$116,993.60

AUTO OWNERS INS. CO

$250,385.28

AUTOMOBILE INS OF HARTFORD CT $5,883.35

BANCINSURE, INC.

$0.00

BANKERS STANDARD INS CO

$29,922.88

BITUMINOUS CASUALTY CORP

$70,065.58

BITUMINOUS FIRE & MARINE INS

$56,743.09

BOSTON OLD COLONY INS CO

$0.00

BROTHERHOOD MUTUAL INS CO

$9,989.28

BUILDERS INSURANCE

~1,665,228. 73

CANAL INSURANCE CO

$538,479.21

CAPITAL CITY INS CO

$193,973.94

CAROLINA CASUALTY INS CO

$1,444.41

CASUALTY RECIPROCAL EXCHG $133,684.00

CENTENNIAL INSURANCE CO

$56,219.72

CENTRAL MUTUAL INS CO

$18,874.04

CENTRE INSURANCE CO

$225,185.27

CENTURY INDEMNITY CO

$13,861.74

CHARTER OAK FIRE INS CO

$249,316.62

CHUBB INDEMNITY INS CO

$73.08

CHURCH MUTUAL INS CO

$29,251.99

CINCINNATI CASUALTY CO

$145,438.41

CINCINNATI INDEMNITY CO

$41,360.16

CINCINNATI INSURANCE CO

$64,007.83

CITIZENS INS CO OF AMERICA

$117,180.67

CLARENDON NATIONAL INS CO

$333,491.46

COLONIAL CASUALTY INS CO

$12.86

COLUMBIA MUTUAL INS CO

$91.53

COLUMBIA NATIONAL INS CO

$43,898.43

COMMERCE & INDUSTRY INS CO

$0.00

COMMERCIAL INS OF NEWARK NJ

$911.04

COMMERCIAL MUTUAL INS CO

$253,096.93

COMPANION COMMERICAL INS CO $7,782.99

COMPANION PROP & CAS

$198,304.13

CONNECTICUT INDEMNITY CO

$338,466.89

CONTINENTAL CASUALTY CO

~1,950,627 .55

CONTINENTAL INSURANCE CO

$80,610.11

CORNERSTONE MUTUAL INS CO $233,669.90

$0.00 $34,644.28 $117,152.76 $250,725.91
$5,891.35 $0.00
$29,963.58 $70,160.90 $56,820.28
$0.00 $10,002.87 $1,667,494.12 $539,211.77 $194,237.83
$1,446.38 $133,865.87
$56,296.20 $18,899.72 $225,491.61 $13,880.59 $249,655.79
$73.18 $29,291.78 $145,636.27 $41,416.43 $64,094.91 $117,340.09 $333,945.15
$12.88 $91.65 $43,958.15
$0.00 $912.28 $253,441.25 $7,793.58 $198,573.91 $338,927.34 $1,953,281.20 $80,719.77 $233,987.78

2001

2001

Claims Paid Assessment Amt

$2,433.00 $828,702.00 $2,263,081.00 $2,986,028.65 $59,191.00
$1,924.06 $2,478,482.07 $1,541,754.14
$378,166.70 $8,990.00
$192,793.00 $25,393,683.00 $10,912,107.48
$3,861,309.00 $25,973.00
$2,255,586.00 $678,797.00 $234,706.26
$2,376,423.00 $222,328.00
$4,018,660.00 $1,843.00
$536,907.00 $2,678,144.67
$975,328.11 $1,931,993.70 $2,424,140.54 $3,720,217.00 .
$1,667.00 $0.00
$937,452.00 $261,488.00
$14,300.00 $6,000,926.34
$311,072.00 $3,981,868.00 $5,125,543.00 $26,732,921.75 $3,672,113.25
$0.00

$151.86 $51,723.40 $141,250.11 $186,372.86
$3,694.40 $120.09
$154,694.36 $96,228.52 $23,603.26 $561.11 $12,033.17
$1,584,945.71 $681,078.75 $241,003.45 $1,621.10 $140,782.31 $42,367.09 $14,649.18 $148,324.35 $13,876.59 $250,824.50 $115.03 $33,511.03 $167,156.29 $60,875.06 $120,585.31 $151,302.63 $232,197.20 $104.05 $0.00 $58,511.03 $16,320.76 $892.53 $374,547.58 $19,415.55 $248,528.13 $319,910.56
$1,668,534.24 $229,194.80 $0.00

2000 Balance Due

2000 And 2001 Total Assessment

$0.00 $47.06 $159.16 $340.63 $8.00 $0.00 $40.70 $95.32 $77.19 $0.00 $13.59 $2,265.39 $732.56 $263.89 $1.97 $181.87 $76.48 $25.68 $306.34 $18.85 $339.17 $0.10 $39.79 $197.86 $56.27 $87.08 $159.42 $453.69 $0.02 $0.12 $59.72 $0.00 $1.24 $344.32 $10.59 $269.78 $460.45 $2,653.65 $109.66 $317.88

$151.86 $51,770.46 $141,409.27 $186,713.49 $3,702.40
$120.09 $154,735.06
$96,323.84 $23,680.45
$561.11 $12,046.76 $1,587,211.10 $681,811.31 $241,267.34
$1,623.07 $140,964.18
$42,443.57 $14,674.86 $148,630.69 $13,895.44 $251,163.67
$115.13 $33,550.82 $167,354.15 $60,931.33 $120,672.39 $151,462.05 $232,650.89
$104.07 $0.12
$58,570.75 $16,320.76
$893.77 $374,891.90
$19,426.14 $248,797.91 $320,371.01 $1,671,187.89 $229,304.46
$317.88

- 68 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

CORNERSTONE MUTUAL INS CO

$0.00

CRUM & FOSTER INDEMNITY CO

$81.72

CUMIS INS SOCIETY INC

$11,997.04

CYPRESS INSURANCE CO

$32,233.64

DAIMLERCHRYSLER INSURANCE CC $4,410.87

DEERFIELD INSURANCE CO

$223,472.19

DISCOVER PROPERTY & CAS

$3,327.53

EASTGUARD INSURANCE CO

$0.00

ELECTRIC INSURANCE CO

$56,442.65

EMC PROPERTY & CASUALTY

$13,695.76

EMCASCO INSURANCE CO

$0.00

EMPLOYERS FIRE INS CO

$11,438.06

EMPLOYERS INS OF WAUSAU

$960, 181.25

EMPLOYERS MUTUAL CAS INS CO $11,710.76

EVEREST NATIONAL INS

$116,134.13

EXCELSIOR INSURANCE CO

$2,724.90

FAIRFIELD INSURANCE CO

$613.58

FAIRMONT INSURANCE CO

$438,930.01

FARMINGTON CASUALTY CO

$27,848.87

FARMLAND MUTUAL

$59.63

FCCI INSURANCE COMPANY

$0.00

FEDERAL INSURANCE CO

$127,535.89

FEDERATED MUTUAL INS CO

$167,892.64

FEDERATED RURAL ELECTRIC INS $12,686.95

FEDERATED SERVICE INS CO

$2,714.81

FFVA MUTUAL INS CO

$9,889.65

FIDELITY & CAS CO OF NY

$40,801.06

FIDELITY & DEPOSIT CO OF MD

$16,999.54

FIDELITY & GUAR UNDERWRITERS $35,696.64

FIDELITY & GUARANTY INS CO

$94,952.25

FIRE & CASUALTY INS CO OF CT

$48,756.58

FIREMAN'S FUND INS CO

$562,103.03

FIREMAN'S FUND INS CO OF GA

$110,261.70

FIREMAN'S FUND OF WISCONSIN

$13,652.95

FIREMAN'S INS CO OF NEWARK NJ $2,183.51

FIRST LIBERTY INS CORP

$5,191.67

FIRST NATL INS CO OF AMER

$70,048.36

FLORISTS INSURANCE CO

$0.00

FLORISTS' MUTUAL INS CO

$7,370.05

FRANKENMUTH MUTUAL INS

$0.00

$0.00 $81.83 $12,013.36 $32,277.49 $4,416.87 $223,776.20 $3,332.06
$0.00 $56,519.44 $13,714.39
$0.00 $11,453.63 $961,487.49 $11,726.69 $116,292.12
$2,728.61 $614.42
$439,527.13 $27,886.76 $59.71 $0.00 $127,709.39 $168,121.04 $12,704.21 $2,718.50 $9,903.11 $40,856.57 $17,022.67 $35,745.20 $95,081.43 $48,822.91 $562,867.72 $110,411.70 $13,671.52 $2,186.48 $5,198.73 $70,143.65 $0.00 $7,380.08 $0.00

2001

2001

2000

Claims Paid Assessment Amt Balance Due

2000 And 2001 Total Assessment

$4,463,933.01 $10,823.00
$287,979.80 $790,656.00
$18,654.00 $1,537,440.00
$56,263.90 $25,089.00 $943,350.17 $315,865.00 $24,190.00 $123,275.00 $6,727,673.30 $385,828.00 $3,645,402.00
$4,500.00 $245,115.00 $7,657,939.00 $2,275,758.61
$0.00 $150,522.00 $2,012,817.00 $3,268,203.00 $258,022.00 $331,878.00 $618,268.00 $521,297.99 $102,792.00 $644,817.73 $6,701,724.23 $1,040,561.00 $5,882,807.00 $1,667,139.00 $484,461.00 $38,065.00 $125,815.15 $810,395.76 $104,091.30 $59,089.32 $1,111,586.14

$278,616.20 $675.52
$17,974.25 $49,348.76
$1,164.29 $95,959.26
$3,511.71 $1,565.93 $58,879.16 $19,714.70 $1,509.82 $7,694.20 $419,907.46 $24,081.44 $227,527.62
$280.87 $15,298.84 $477,969.96 $142,041.38
$0.00 $9,394.82 $125,629.89 $203,984.76 $16,104.43 $20,714.15 $38,589.17 $32,536.79 $6,415.76 $40,246.27 $418,287.85 $64,946.57 $367,175.16 $104,054.41 $30,237.61 $2,375.83 $7,852.75 $50,580.82 $6,496.85 $3,688.06 $69,379.60

$0.00 $0.11 $16.32 $43.85 $6.00 $304.01 $4.53 $0.00 $76.79 $18.63 $0.00 $15.57 $1,306.24 $15.93 $157.99 $3.71 $0.84 $597.12 $37.89 $0.08 $0.00 $173.50 $228.40 $17.26 $3.69 $13.46 $55.51 $23.13 $48.56 $129.18 $66.33 $764.69 $150.00 $18.57 $2.97 $7.06 $95.29 $0.00 $10.03 $0.00

$278,616.20 $675.63
$17,990.57 $49,392.61
$1,170.29 $96,263.27 $3,516.24 $1,565.93 $58,955.95 $19,733.33 $1,509.82 $7,709.77 $421,213.70 $24,097.37 $227,685.61
$284.58 $15,299.68 $478,567.08 $142,079.27
$0.08 $9,394.82 $125,803.39 $204,213.16 $16,121.69 $20,717.84 $38,602.63 $32,592.30 $6,438.89 $40,294.83 $418,417.03 $65,012.90 $367,939.85 $104,204.41 $30,256.18 $2,378.80 $7,859.81 $50,676.11 $6,496.85 $3,698.09 $69,379.60

-69 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

FREMONT COMPENSATION

$41,681.45

FREMONT INDEMNITY CO

$53,734.80

FREMONT INDUSTRIAL IND

$83,752.39

FREMONT PACIFIC INS CO

$12,941.01

FRONTIER INSURANCE CO

$64,063.83

GA FARM BUREAU MUTUAL INS CO $36,214.39

GA RESTAURANT MUTUAL CAP INS t $35,911.78

GA TIMBER HARVERSTERS'

$68,401.49

GCAP MUTUAL CAPTIVE INS

$70,145.06

GENERAL ACCIDENT INS OF AMER $102,240.38

GENERAL CASUALTY CO OF WI

$2,657.32

GENERAL INS CO OF AMERIC

$76,514.14

GEORGIA CASUALTY & SURETY CO $418,907.30

GEORGIA INSURANCE CO

$237,084.86

GERBER LIFE INS CO

$254,587.90

GLENS FALLS INS CO

$15,156.54

GLOBE INDEMNITY CO

$7,772.72

GRANITE STATE INS CO

$197,017.25

GRAPHIC ARTS MUTUAL INS CO

$28,619.07

GRAY INSURANCE CO

$0.00

GREAT AMER ALLIANCE INS CO

$178,548.47

GREAT AMER INS CO OF NY

$95,581.32

GREAT AMERICAN ASSUR CO

$25,392.84

GREAT AMERICAN INS CO

$125,035.11

GREAT NORTHERN INS CO

$18,631.03

GREAT WEST CASUALTY CO

$6,350.72

GREATER NEW YORK MUTUAL INS $6,241.72

GREENWICH INSURANCE CO

$12.67

GROCERS INSURANCE CO

$5,935.57

GUIDEONE MUTUAL INS CO

$39,174.70

GULF INSURANCE COMPANY

$99,761.51

HANOVER INSURANCE CO

$111,456.14

HARBOUR SPECIALITY INS

$190,740.31

HARCO NATIONAL INS CO

$190.13

HARLEYSVILLE MUTUAL INS CO

$23,432.56

HARLEYSVILLE-ATLANTIC INS CO $91,547.19

HARTFORD ACCIDENT & INDEMNITY $46,014.37

HARTFORD CASUALTY INS CO

$847,677.95

HARTFORD FIRE INSURANCE CO $152,464.31

HARTFORD INS CO OF S.E.

$68,643.59

$41,738.15 $53,807.90 $83,866.32 $12,958.61 $64,150.98 $36,263.66 $35,960.63 $68,494.54 $70,240.49 $102,379.47 $2,660.93 $76,618.23 $419,477.19 $237,407.40 $254,934.24 $15,177.16 $7,783.30 $197,285.28 $28,658.01
$0.00 $178,791.37
$95,711.35 $25,427.38 $125,205.21 $18,656.38
$6,359.36 $6,250.21
$12.68 $5,943.65 $39,228.00 $99,897.22 $111,607.77 $190,999.80
$190.39 $23,464.44 $91,671.74 $46,076.96 $848,831.14 $152,671.72 $68,736.97

2001 Claims Paid

2001 Assessment Amt

$909,403.00 $0.00
$2,309,808.00 $583,834.00 $564,036.00
$1,202,099.00 $612,426.00 $897,881.00 $514,037.72 $0.00 $26,296.00
$1,316,078.87 $6,825,911.00 $2,156,529.00 $1,691,279.29
$109,248.00 $184,447.00 $1,121,026.27 $697,712.03
$15,375.00 $1,653,449.60
$579,017.57 $326,296.80 $841,629.79 $325,996.00 $266,579.00
$72,832.00 $468,237.24 $529,978.00 $845,980.00 $1,429,193.00 $2,398,381.79 $3,074,775.00
$24,323.00 $284,070.00 $1,540,630.00 $578,430.00 $17,536,355.00 $2,012,292.00 $878,261.00

$56,760.35 $0.00
$144,166.57 $36,439.98 $35,204.28 $75,028.96 $38,224.54 $56,041.21 $32,083.64 $0.00 $1,641.26 $82,143.01
$426,038.96 $134,599.67 $105,561.13
$6,818.71 $11,512.25 $69,968.81 $43,547.67
$959.63 $103,199.99
$36,139.36 $20,365.80 $52,530.29 $20,347.03 $16,638.52
$4,545.81 $29,225.01 $33,078.56 $52,801.81 $89,203.02 $149,694.90 $191,911.96
$1,518.12 $17,730.22 $96,158.36 $36,102.69 $1,094,530.90 $125,597.12 $54,816.63

2000 Balance Due

2000 And 2001 Total Assessment

$56.70 $73.10 $113.93 $17.60 $87.15 $49.27 $48.85 $93.05 $95.43 $139.09 $3.61 $104.09 $569.89 $322.54 $346.34 $20.62 $10.58 $268.03 $38.94 $0.00 $242.90 $130.03 $34.54 $170.10 $25.35 $8.64 $8.49 $0.01 $8.08 $53.30 $135.71 $151.63 $259.49 $0.26 $31.88 $124.55 $62.59 $1,153.19 $207.41 $93.38

$56,817.05 $73.10
$144,280.50 $36,457.58 $35,291.43 $75,078.23 $38,273.39 $56,134.26 $32,179.07 $139.09 $1,644.87 $82,247.10
$426,608.85 $134,922.21 $105,907.47
$6,839.33 $11,522.83 $70,236.84 $43,586.61
$959.63 $103,442.89
$36,269.39 $20,400.34 $52,700.39 $20,372.38 $16,647.16 $4,554.30 $29,225.02 $33,086.64 $52,855.11 $89,338.73 $149,846.53 $192,171.45 $1,518.38 $17,762.10 $96,282.91 $36,165.28 $1,095,684.09 $125,804.53 $54,910.01

- 70 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000 Assessment Amt

2000 Assessment Adjustment Amt

HARTFORD INS OF THE MIDWEST $111,625.24

HARTFORD UNDERWRITERS INS $260,609.28

HEALTH CARE MUTUAL CAPTIVE

$0.00

HIGHLANDS INSURANCE CO

$13,104.44

HIGHLANDS UNDERWRITERS INS

$129.38

HOME INSURANCE CO

$112,532.13

HOSPITALITY MUT CAPTIVE INS

$0.00

HOUSTON GENERAL INS CO

$229,347.61

INDEMNITY INS OF NORTH AMER

$26,547.39

INDIANA LUMBERMENS MUTUAL INS $4,533.64

INSURA PROP & CAS INS CO

$2,960.22

INSURANCE CO OF N.A.

$6,640.66

INSURANCE CO OF STATE OF PA ~1,934,874.51

INSURANCE COMPANY OF THE WES

$0.00

INSURANCE CORP. OF NEW YORK

$0.00

INTERNATIONAL IND-LIQUIDATION $97,808.21

INTERNATIONAL INSURANCE CO

$47,745.31

JEFFERSON PILOT FIN INS CO

$80,320.89

KANSAS CITY FIRE & MARINE INS

$4,259.39

KEY RISK INSURANCE CO

$12.54

LEGION INS CO-IN REHAB.

~1,848,690.92

LIBERTY INSURANCE CORP

$399,568.66

LIBERTY LIFE OF BOSTON

$7,198.30

LIBERTY MUTUAL FIRE INS

~1,668,866.17

LIBERTY MUTUAL INSURANCE CO $772,544.26

LM INSURANCE CORP

$263,896.70

LUMBER MUTUAL INSURANCE CO $59,841.27

LUMBERMEN$ MUTUAL CAS CO

$716,877.98

LUMBERMEN'$ UNDERWRITING

$327,834.29

MADISON INSURANCE CO

$17,617.81

MAG MUTUAL INS CO

$22,366.47

MANAGEDCARE MUT CAPTIVE INS $118,635.42

MANUFACTURER'S ALLIANCE INS

$367.34

MARKEL INSURANCE CO

$509.66

MARYLAND CASUALTY COMPANY $67,977.96

MASSACHUSETTS BAY INSURANCE $43,479.12

$111,777.10 $260,963.81
$0.00 $13,122.27
$129.55 $112,685.22
$0.00 $229,659.61
$26,583.50 $4,539.81 $2,964.24 $6,649.69
$1,937,506.73 $0.00 $0.00
$97,941.27 $47,810.26 $80,430.16
$4,265.18 $12.55
$1,851,205.89 $400, 112.24 $7,208.09
$1,671, 136.52 $773,595.24 $264,255.71 $59,922.68 $717,853.23 $328,280.27 $17,641.78 $22,396.89 $118,796.81 $367.84 $510.36 $68,070.44 $43,538.27

MID-CENTURY INSURANCE CO MIDDLESEX INSURANCE CO

$3,261.41 $6,560.73

$3,265.85 $6,569.66

MIDWEST EMPLOYERS CASUALTY C $3,496.84

MILLERS MUTUAL INS ASSOC OF IL

$30.27

$3,501.60 $30.31

2001 Claims Paid

2001 Assessment Amt

$922,377.00 $4,874,918.00
$459,000.53 $48,847.00 $342.00
$3,342,971.00 $67,772.00
$1,228,344.00 $252,117.87 $165,054.00 $29,207.00 $92,132.12
$17,741,646.99 $331.72
$296,617.00 $0.00
$1,960,997.00 $1,563,773.00
$132,329.00 $74,038.00
$32,882,332.71 $8,414,307.19 $128,896.98
$33,430,143.94 $13,322,488.87
$4,308,704.88 $790,901.00
$15,291,017.71 $6,352,730.31 $463,671.00 $393,732.00 $1,820,043.00 $170,627.00 $600.00 $1,418,766.00 $600,898.07 $0.00 $127,485.00 $24,502.00 $0.00

$57,570.12 $304,267.81
$28,648.50 $3,048.78 $21.35
$208,651.40 $4,229.99
$76,667.04 $15,735.93 $10,301.84
$1,822.95 $5,750.42 $1,107,344.19
$20.70 $18,513.34
$0.00 $122,395.55
$97,602.83 $8,259.31 $4,621.08
$2,052,349.48 $525, 178.65 $8,045.10
$2,086,541.10 $831,522.61 $268,927.64 $49,364.05 $954,388.26 $396,505.41 $28,940.01 $24,574.77 $113,597.91 $10,649.68 $37.45 $88,552.22 $37,505.03 $0.00 $7,956.97 $1,529.29 $0.00

2000 Balance Due

2000 And 2001 Total Assessment

$151.86 $354.53
$0.00 $17.83
$0.17 $153.09

$57,721.98 $304,622.34
$28,648.50 $3,066.61 $21.52
$208,804.49

$0.00 $312.00
$36.11 $6.17 $4.02 $9.03
$2,632.22 $0.00 $0.00
$133.06

$4,229.99 $76,979.04 $15,772.04 $10,308.01
$1,826.97 $5,759.45 $1,109,976.41
$20.70 $18,513.34
$133.06

$64.95 $109.27
$5.79

$122,460.50 $97,712.10 $8,265.10

$0.01 $2,514.97

$4,621.09 $2,054,864.45

$543.58 $9.79
$2,270.35

$525,722.23 $8,054.89
$2,088,811.45

$1,050.98 $359.01 $81.41 $975.25 $445.98

$832,573.59 $269,286.65
$49,445.46 $955,363.51 $396,951.39

$23.97 $30.42

$28,963.98 $24,605.19

$161.39 $0.50

$113,759.30 $10,650.18

$0.70 $92.48 $59.15

$38.15 $88,644.70 $37,564.18

$4.44

$4.44

$8.93 $4.76 $0.04

$7,965.90 $1,534.05
$0.04

- 71 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000 Assessment Amt

2000 Assessment Adjustment Amt

MONUMENTAL GENERAL CAS

$224,471.51

MUTUAL ASSURANCE INC.

$0.00

NATIONAL AMERICAN INSURANCE C $6,630.76

NATIONAL FARMERS UNION P & C

$491.09

NATIONAL FARMERS UNION STANDf $15,311.01

NATIONAL FIRE INS CO HARTFORD $69,715.86

NATIONAL LIABILITY & FIRE INS

$827.44

NATIONAL SURETY CORP

$99,593.91

NATIONAL TRUST INSURANCE CO $66,634.51

NATIONAL UNION FIRE OF PITT PA $517,250.24

NATIONWIDE AGRIBUSINESS

$19,536.88

NATIONWIDE MUTUAL FIRE INS CO $57,239.56

NATIONWIDE MUTUAL INS CO

$32,566.88

NEW HAMPSHIRE INSURANCE CO $16,855.36

NIAGARA FIRE INSURANCE CO

$714.22

NIPPOKAO INS CO, LTD US BRANCH

$64.62

NN INSURANCE COMPANY

$3,924.04

NORGUARD INSURANCE CO.

$0.00

NORTH AMERICAN LUMBER INS CO $4,689.99

NORTH AMERICAN SPECIALTY INS

$4,157.27

NORTH RIVER INSURANCE CO

$52,818.30

NORTHBROOK INDEMNITY CO

$1,207.60

NORTHBROOK PROP & CAS INS CO $10,545.49

NORTHERN ASSUR CO OF AMER

$1,803.83

NORTHERN INS CO OF NY

$46,458.29

NORTHWESTERN NATIONAL CAS CC $16,219.89

NORTHWESTERN NATIONAL INS CO $2,852.58

OCCIDENTAL FIRE & CASCO OF NC

$0.00

OHIO CASUALTY INSURANCE CO

$87,910.44

OHIO FARMERS INS CO

$43,871.65

OHIO SECURITY INSURANCE CO

$246.32

OLD REPUBLIC INSURANCE CO

$341,634.71

OLD REPUBLIC UNION INS CO

$11,082.09

ONEBEACON AMERICA INS CO

$89,627.16

ONEBEACON INSURANCE CO

$0.00

ONEBEACON MIDWEST INS CO

$2,135.51

OWNERS INSURANCE CO

$43,193.75

PACIFIC EMPLOYERS INSURANCE ~1.133,016.40

PACIFIC INDEMNITY CO

$104,541.27

PATRIOT GENERAL INSURANCE CO $43,190.76

$224,776.88 $0.00
$6,639.78 $491.75
$15,331.84 $69,810.70
$828.57 $99,729.40 $66,725.16 $517,953.92 $19,563.46 $57,317.43 $32,611.18 $16,878.29
$715.19 $64.70
$3,929.38 $0.00
$4,696.37 $4,162.93 $52,890.15 $1,209.24 $10,559.83 $1,806.28 $46,521.49 $16,241.96 $2,856.46
$0.00 $88,030.03 $43,931.33
$246.66 $342,099.47
$11,097.17 $89,749.09
$0.00 $2,138.41 $43,252.51 $1,134,557.76 $104,683.49 $43,249.51

2001 Claims Paid

2001 Assessment Amt

2000 Balance Due

2000 And 2001 Total Assessment

$3,497,276.75 $2,025.00
$330,051.00 $7,247.00
$143,762.00 $1,923,773.56
$273.00 $855,270.00 $3,666,155.00 $3,929,323.69 $366,201.00 $1,388,888.00 $540,540.00 $202,853.20
$14,923.00 $617.00
$11,237.90 $123,082.00
$0.00 $215,089.00 $572,891.00
$19,277.00 $240,764.56
$48,921.00 $1,052,064.53
$259,493.50 $122,712.00
$42,636.67 $1,109,398.00
$612,167.64 $1,892.00
$7,812,584.00 $28,620.00
$1,703,252.00 $1,498,026.00
$152,570.00 $1,186,344.50 $18,448,237.81 $1,213,645.00 $1,054,053.00

$218,282.39 $126.39
$20,600.12 $452.32
$8,972.90 $120,072.25
$17.04 $53,381.64 $228,822.92 $245,248.58 $22,856.42 $86,687.39 $33,737.78 $12,661.07
$931.42 $38.51
$701.41 $7,682.16
$0.00 $13,424.77 $35,756.97
$1,203.17 $15,027.31
$3,053.40 $65,664.57 $16,196.28
$7,659.06 $2,661.17 $69,243.03 $38,208.42
$118.09 $487,622.12
$1,786.32 $106,308.41
$93,499.23 $9,522.65
$74,045.64 $1,151,446.02
$75,749.60 $65,788.68

$305.37 $0.00 $9.02 $0.66
$20.83 $94.84
$1.13 $135.49
$90.65 $703.68
$26.58 $77.87 $44.30 $22.93
$0.97 $0.08 $5.34 $0.00 $6.38 $5.66 $71.85 $1.64 $14.34 $2.45 $63.20 $22.07 $3.88 $0.00 $119.59 $59.68 $0.34 $464.76 $15.08 $121.93 $0.00 $2.90 $58.76 $1,541.36 $142.22 $58.75

$218,587.76 $126.39
$20,609.14 $452.98
$8,993.73 $120,167.09
$18.17 $53,517.13 $228,913.57 $245,952.26 $22,883.00 $86,765.26 $33,782.08 $12,684.00
$932.39 $38.59
$706.75 $7,682.16
$6.38 $13,430.43 $35,828.82
$1,204.81 $15,041.65
$3,055.85 $65,727.77 $16,218.35
$7,662.94 $2,661.17 $69,362.62 $38,268.10
$118.43 $488,086.88
$1,801.40 $106,430.34
$93,499.23 $9,525.55
$74,104.40 $1,152,987.38
$75,891.82 $65,847.43

- 72 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

PENN LUMBERMEN$ MUTUAL PENN MFG ASSOC INS PENN MFG IND. CO PENN MILLERS MUTUAL PENN NATIONAL MUTUAL CAS PENNSYLVANIA GENERAL INS CO PETROLEUM CASUALTY CO PHICO INSURANCE CO PHOENIX INSURANCE CO POTOMAC INSURANCE CO OF IL PRINCETON INSURANCE CO PROTECTIVE INSURANCE CO PROTECTIVE LIFE INS/DIAMOND PROVIDENCE WA INS CO OF NY

$16,120.46 $61,619.83 $43,656.31 $12,533.00
$8,876.30 $31,144.88
$289.66 $4,885.45 $58,530.84 $57,209.55 $146,212.00
$661.56 $5,225.44 $3,320.87

$16,142.39 $61,703.66 $43,715.70 $12,550.05
$8,888.38 $31,187.24
$290.06 $4,892.10 $58,610.46 $57,287.38 $146,410.91
$662.46 $5,232.55 $3,325.38

PROVIDENCE WASHINGTON INS CO $16,905.03

PUBLIC SERVICE MUTUAL INS CO

$1,770.38

RANGER INSURANCE CO

$11,740.06

REALM NATIONAL INSURANCE

$625,082.05

REDLAND INSURANCE CO

$23,294.33

REGENT INSURANCE CO

$2,658.03

RELIANCE INS CO IN LIQUIDATION $269,370.28

RELIANCE NAT INS CO IN LIQ.

$442,257.69

$16,928.02 $1,772.78
$11,756.03 $625,932.42
$23,326.02 $2,661.65
$269,736.73 $442,859.35

RELIANCE NAT. IND. IN LIQ.

$878,826.14

RENAISSANCE MUTUAL CAP INS

$13,424.99

REPUBLIC-FRANKLIN INSURANCE C $37,158.16

ROYAL & SUNALLIANCE INS. CO

$200.79

ROYAL INDEMNITY CO

$316, 193,25

ROYAL INS CO OF AMERICA

$185,865.03

S.E. EMPLOYER MUT. CAP. INS CO $13,557.20

S.E. US CAPTIVE INS., INC.

$0.00

SAFECO INS CO OF ILLINOIS

$122,819.09

SAFECO INSURANCE CO AMERICA $51,360.39

$880,021.70 $13,443.25 $37,208.71 $201.06
$316,623.40 $186,117.89
$13,575.64 $0.00
$122,986.18 $51,430.26

SAFEGUARD INSURANCE CO SAFETY NATIONAL CASUALTY

$36,900.45 $1,871.26

$36,950.65 $1,873.80

SECURITY INS CO OF HARTFORD $122,025.21

$122, 191.21

SECURITY NATIONAL INS CO SELECT INSURANCE CO SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SOUTHEAST SELECTIVE INSURANCE CO OF SC

$8,235.81 $2,226.51 $47,664.69 $31,841.07 $48,525.10

$8,247.02 $2,229.54 $47,729.54 $31,884.38 $48,591.11

2001 Claims Paid

2001 Assessment Amt

$146,292.61 $2,096,286.00
$618,868.00 $296,931.00
$72,842.00 $288, 116.00 $129,483.86 $130,190.00 $1,114,819.00
$90,345.00 $3,992,181.57
$111,245.66 $18,339.01 $23,395.00
$396,224.00 $10,002.00
$158,273.00 $7,118,981.00
$923,803.00 $48,226.00
$19,144,643.00 $0.00 $0.00
$170,838.90 $885,830.99
$24,870.00 $7,364,993.00 $2,748,191.00
$163,464.00 $3,541.00
$1,141,604.75 $787,493.42 $983,734.00 $0.00 $708,298.00 $225,280.23 $103,176.00 $610,500.03 $366,839.44 $651,300.07 .

$9,130.85 $130,839.61
$38,626.62 $18,532.94
$4,546.43 $17,982.75
$8,081.73 $8,125.80 $69,581.38 $5,638.88 $249,171.85 $6,943.39 $1,144.63 $1,460.20 $24,730.31
$624.27 $9,878.60 $444,330.91 $57,659.13 $3,010.02 $1,194,912.13
$0.00 $0.00 $10,662.90 $55,289.11 $1,552.26 $459,685.74 $171,528.23 $10,202.60 $221.01 $71,253.21 $49,151.37 $61,399.72 $0.00 $44,208.39 $14,060.86 $6,439.73 $38,104.33 $22,896.27 $40,650.87

2000 Balance Due

2000And 2001 Total Assessment

$21.93 $83.83 $59.39 $17.05 $12.08 $42.36
$0.40 $6.65 $79.62 $77.83 $198.91 $0.90 $7.11 $4.51 $22.99 $2.40 $15.97 $850.37 $31.69 $3.62 $366.45 $601.66 $1,195.56 $18.26 $50.55 $0.27 $430.15 $252.86 $18.44 $0.00 $167.09 $69.87 $50.20 $2.54 $166.00 $11.21 $3.03 $64.85 $43.31 $66.01

$9,152.78 $130,923.44
$38,686.01 $18,549.99
$4,558.51 $18,025.11
$8,082.13 $8,132.45 $69,661.00 $5,716.71 $249,370.76 $6,944.29 $1,151.74 $1,464.71 $24,753.30
$626.67 $9,894.57 $445,181.28 $57,690.82 $3,013.64 $1, 195,278.58
$601.66 $1,195.56 $10,681.16 $55,339.66 $1,552.53 $460,115.89 $171,781.09 $10,221.04
$221.01 $71,420.30 $49,221.24 $61,449.92
$2.54 $44,374.39 $14,072.07
$6,442.76 $38,169.18 $22,939.58 $40,716.88

- 73 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

SELECTIVE WAY INSURANCE CO

$14,302.22

SENTRY INSURANCE A MUTUAL CO $229,776.83

SENTRY SELECT INSURANCE CO

$58,438.95

SHELBY INSURANCE CO

$0.00

SOUTH CAROLINA INSURANCE CO

$7,874.12

SOUTHERN FIRE & CASUALTY CO

$7,872.63

SOUTHERN GUARANTY INS CO GA

$6,161.37

SOUTHERN MUTUAL CHURCH INS

$1,036.35

SOUTHERN PILOT INSURANCE CO

$5,092.09

SOUTHERN STATES INS EXCH

$0.00

SOUTHERN TRUST INSURANCE CO $8,580.29

ST PAUL FIRE & CASUALTY INS CO $220,390.08

ST PAUL FIRE & MARINE INS CO

$141,381.12

ST PAUL GUARDIAN INS CO

$178,318.21

ST PAUL MERCURY INS CO

$3,225.36

STANDARD FIRE INSURANCE CO

$47,929.01

STAR INSURANCE CO

$174,159.63

STATE AUTO PROP & CAS

$11,231.95

STATE AUTOMOBILE MUTUAL INS $10,023.86

STATE CAPITAL INSURANCE CO

$167.06

STATE FARM FIRE & CASUALTY CO $199,484.82

SUMITOMO MARINE & FIRE INS CO $47,907.12

THE CAMDEN FIRE INS ASSOC

$54,777.05

TIG INSURANCE CO

$63,272.05

TIG PREMIER INSURANCE CO

$298,261.29

TOKIO MARINE & FIRE INS CO

$66,615.26

TRANS PACIFIC INS CO

$14,018.47

TRANSCONTINENTAL INS CO

S1 ,051,628.18

TRANSPORT INSURANCE CO

$4,796.53

TRANSPORTATION CASUALTY INS C $1,184.00

TRANSPORTATION INSURANCE CO $682,406.24

TRAVELERS CAS & SUR CO

$379,708.07

TRAVELERS CAS & SUR CO OF AME

$616.05

TRAVELERS CAS & SUR CO OF ILL $7,280.51

TRAVELERS INDEMNITY CO OF CT $90,495.42

TRAVELERS INDEMNITY CO OF IL S1 ,638,518.50

$14,321.68 $230,089.42
$58,518.45 $0.00
$7,884.84 $7,883.34 $6,169.75 $1,037.76 $5,099.01
$0.00 $8,591.96 $220,689.90 $141,573.45 $178,560.79 $3,229.75 $47,994.22 $174,396.55 $11,247.23 $10,037.49
$167.29 $199,756.20
$47,972.30 $54,851.57 $63,358.13 $298,667.05 $66,705.89 $14,037.54 $1,053,058.83
$4,803.05 $1,185.61 $683,334.59 $380,224.63
$616.89 $7,290.42 $90,618.53 $1,640,747.56

TRAVELERS INDEMNITY COMPANY $260,265.26

TRAVELERS INDEMNITY OF AMER $290,256.86

TRAVELERS INSURANCE-ALT

$64,906.27

TRAVELERS INSURANCE CO

$118,277.99

$260,619.33 $290,651.73
$64,994.57 $118,438.89

2001 Claims Paid

2001 Assessment Amt

$389,470.74 $2,574,510.44
$887,202.00 $20,273.00 $161,048.00
$0.00 $197,723.00
$1,551.00 $34,454.00 $196,439.79 $236,275.00 $5,628,716.82 $3,629,108.07 $2,455,587.73 $188,666.40 $615,773.00 $3,870,566.00 $212,628.00 $59,131.00
$4,311.55 $3,216,790.00
$703,430.00 $503,655.00
$0.00 $4,028,570.00
$929,906.00 $142,694.00 $15,937,632.31 $131,643.00
$36,945.00 $10,085,144.59
$4,703,345.00 $9,631.00 $20,547.00
$2,774,979.00 $27,100,657.00
$5,683,926.00 $5,126,735.00
$330,307.00 $2,388,891.00

$24,308.80 $160,687.97
$55,374.68 $1,265.34
$10,051.80 $0.00
$12,340.87 $96.81
$2,150.45 $12,260.78 $14,747.09 $351,316.14 $226,510.64 $153,265.41 $11,775.61 $38,433.45 $241,581.22 $13,271.17
$3,690.66 $269.11
$200,775.82 $43,904.56 $31,435.61 $0.00
$251,443.04 $58,040.05 $8,906.24 $994,746.68 $8,216.49 $2,305.92 $629,463.90 $293,559.09 $601.12 $1,282.44 $173,200.20
$1,691,486.42 $354,762.01 $319,984.96 $20,616.10 $149,102.54

2000 Balance Due

2000 And 2001 Total Assessment

$19.46 $312.59
$79.50 $0.00
$10.72 $10.71
$8.38 $1.41 $6.92 $0.00 $11.67 $299.82 $192.33 $242.58 $4.39 $65.21 $236.92 $15.28 $13.63 $0.23 $271.38 $65.18 $74.52 $86.08 $405.76 $90.63 $19.07 $1,430.65 $6.52 $1.61 $928.35 $516.56 $0.84 $9.91 $123.11 $2,229.06 $354.07 $394.87 $88.30 $160.90

$24,328.26 $161,000.56
$55,454.18 $1,265.34 $10,062.52
$10.71 $12,349.25
$98.22 $2,157.37 $12,260.78 $14,758.76 $351,615.96 $226,702.97 $153,507.99 $11,780.00 $38,498.66 $241,818.14 $13,286.45 $3,704.29
$269.34 $201,047.20
$43,969.74 $31,510.13
$86.08 $251,848.80
$58,130.68 $8,925.31
$996,177.33 $8,223.01 $2,307.53
$630,392.25 $294,075.65
$601.96 $1,292.35 $173,323.31 $1,693,715.48 $355,116.08 $320,379.83 $20,704.40 $149,263.44

- 74 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Insurance Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

2001 Claims Paid

2001

2000

Assessment Amt Balance Due

2000And2001 Total Assessment

TRINITY UNIVERSAL INS CO

$28,007.39

TRINITY UNIVERSAL INS CO OF KS $49,409.09

TRUCK INSURANCE EXCHANGE

$2,710.27

TRUSTGUARD INSURANCE CO

$80.16

TWIN CITY FIRE INSURANCE CO

$283,745.18

U.S. FIDELITY & GUARANTY INS

$125,367.24

U.S. SPECIALTY INS. CO.

$0.00

ULICO CASUALTY CO

$210.66

UNITED PACIFIC INS CO IN LIQ.

$301,647.12

UNITED STATES FIRE INSURANCE $72,461.52

UNIVERSAL UNDERWRITERS INS

$87,330.75

UTICA MUTUAL INSURANCE CO

$45,336.93

UTICA NATIONAL ASSURANCE CO $12,868.88

VALIANT INSURANCE CO

$72,122.37

VALLEY FORGE INSURANCE CO $393,181.12

VANLINER INSURANCE CO

$7,256.37

VIGILANT INSURANCE CO

$5,951.03

VILLANOVA INS CO-IN REHAB.

$0.00

VIRGINIA INSURANCE RECIPROCAL $11,120.35

VIRGINIA SURETY CO INC

$90,572.95

WAUSAU BUSINESS INSURANCE

$85,579.92

WAUSAU GENERAL INS CO

$14,360.05

WAUSAU UNDERWRITERS INS CO $204,580.22

WEST AMERICAN INSURANCE CO $20,109.03

WESTFIELD INSURANCE CO

$83,589.93

WILLIAMSBURG NATIONAL INS CO $9,447.94

XL SPECIALTY INSURANCE CO

$2,267.96

YASUDA FIRE & MAR INS OF AMER $86,004.69

YORK INSURANCE CO

$19,470.30

ZENITH INSURANCE CO

$82,674.73

ZURICH AMERICAN INS CO

~1. 107,928.96

ZURICH AMERICAN INS CO OF IL

$32,473.10

$28,045.49 $49,476.31
$2,713.96 $80.27
$284,131.19 $125,537.80
$0.00 $210.95 $302,057.48 $72,560.09 $87,449.55 $45,398.61 $12,886.39 $72,220.48 $393,716.01 $7,266.24 $5,959.13
$0.00 $11,135.48 $90,696.17 $85,696.34 $14,379.58 $204,858.54 $20,136.39 $83,703.65
$9,460.79 $2,271.04 $86,121.69 $19,496.78 $82,787.20 $1,109,436.20 $32,517.27

$439,594.67 $913,773.47
$55,000.00 $3,540.00
$6,596,614.00 $1,329,359.91 $4,295,457.00
$1,331.00 $0.00
$1,726,342.00 $1,977,872.00
$695,308.24 $241,173.37 $2, 190,308.00 $7,407,321.59 $158,278.00 $210,836.00 $101,518.00
$87,741.00 $1,630,280.00 $1,606,751.00
$245,610.00 $2,774,250.85
$270,796.00 $2,083,069.85
$407,975.00 $188,086.00 $2,145, 166.00 $296,500.00 $1,868,680.04 $21,573,208.07
$84,759.63

$27,437.28 $57,033.13
$3,432.82 $220.95
$411,727.40 $82,971.95
$268,100.78 $83.07 $0.00
$107,749.57 $123,448.80
$43,397.64 $15,052.83 $136,707.99 $462,327.68
$9,878.92 $13,159.32
$6,336.24 $5,476.35 $101,753.86 $100,285.30 $15,329.74 $173,154.76 $16,901.72 $130,014.72 $25,463.74 $11,739.38 $133,890.45 $18,506.04 $116,633.59 $1,346,490.92 $5,290.27

$38.10 $67.22
$3.69 $0.11 $386.01 $170.56 $0.00 $0.29 $410.36 $98.57 $118.80 $61.68 $17.51 $98.11 $534.89 $9.87 $8.10 $0.00 $15.13 $123.22 $116.42 $19.53 $278.32 $27.36 $113.72 $12.85 $3.08 $117.00 $26.48 $112.47 $1,507.24 $44.17

$27,475.38 $57,100.35
$3,436.51 $221.06
$412,113.41 $83,142.51
$268,100.78 $83.36
$410.36 $107,848.14 $123,567.60
$43,459.32 $15,070.34 $136,806.10 $462,862.57 $9,888.79 $13,167.42 $6,336.24 $5,491.48 $101,877.08 $100,401.72 $15,349.27 $173,433.08 $16,929.08 $130,128.44 $25,476.59 $11,742.46 $134,007.45 $18,532.52 $116,746.06 $1,347,998.16 $5,334.44

Total:

352 Grand Total: $45, 170,245.48

$45,231,695.50 $753, 117,649.19 $47,005,807.96

$61,450.02

$47,067,257.98

- 75 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Groue Self-Insured Comeanies

Company Name

2000

2000 Assessment

2001

2001

2000

Assessment Amt Adjustment Amt Claims Paid Assessment Amt Balance Due

2000And2001 Total Assessment

AGRITRUST OF GEORGIA

$99,917.00

ASSOCIATION CTY COM GA SI

$641,144.40

COMPTRUST AGC OF GEORGIA

$273,147.69

CONSTRUCTION SUPPLIERS' ASSOC $175,048.33

GA AUTO DEALERS ASSOCIATION SI $188,864.40

GA EDUCATION WC TRUST FUND $85,268.15

GA HOSPITAL ASSOC WCSI FUND $213,478.07

GA MUNICIPAL ASSN WCSIF

$533,745.62

GA OILMEN'S ASSOCIATION

$99,083.30

GA OPERATORS SELF-INSURERS $71,336.60

GA SCHOOL BD ASSOC WC FUND $155,463.09

GEMC WORKERS' COMP FUND

$120,123.97

ROOFING & SHEET METAL ASSOC $38,304.98

$100,052.93 $642,016.62 $273,519.29 $175,286.46 $189,121.34
$85,384.15 $213,768.49 $534,471.73
$99,218.09 $71,433.65 $155,674.58 $120,287.39 $38,357.09

$2,245,459.27 $9,105,532.39 $4,065,585.00 $2,570,416.42 $4,411,876.50 $1,870,398.00 $4,236,949.34 $8,992,360.15 $2,855,701.17 $1,239,834.27 $3,160,933.94 $1,637,052.22
$492,458.52

$140,150.25 $568,321.44 $253,753.33 $160,432.44 $275,367.10 $116,740.82 $264,449.02 $561,257.80 $178,238.47
$77,384.21 $197,289.57 $102,176.55
$30,736.78

$135.93 $872.22 $371.60 $238.13 $256.94 $116.00 $290.42 $726.11 $134.79
$97.05 $211.49 $163.42
$52.11

$140,286.18 $569,193.66 $254,124.93 $160,670.57 $275,624.04 $116,856.82 $264,739.44 $561,983.91 $178,373.26 $77,481.26 $197,501.06 $102,339.97 $30,788.89

Total:

13 Grand Total: $2,694,925.60

$2,698,591.81 $46,884,557.19

$2,926,297.78

$3,666.21

$2,929,963.99

- 76 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Companies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

AT&T

$117,388.82

AAA COOPER TRANSPORTATION

$33,778.98

ABF FREIGHT SYSTEM, INC

$24,999.29

ACUITY BRANDS

$0.00

AGL RESOURCES, INC.

$42,552.48

ALBANY INTERNATIONAL CORP

$0.00

ALBANY, CITY OF

$45,596.09

ALLIED SYSTEMS LTD

$60,542.83

ALPHARETTA, CITY OF

$0.00

ALTERMAN TRANSPORT LINES

$1,266.55

AMERICAN FREIGHTWAYS INC

$8,648.23

AMERICAN NATIONAL RED CROSS $6,961.13

AMERICAN PROTEINS, INC

$12,704.35

ANHEUSER-BUSCH COMPANIES, INC $15,845.96

ARCHBOLD MEDICAL CENTER

$10,707.89

ARCHDIOCESES OF ATLANTA

$7,714.39

ARCHER-DANIELS-MIDLAND CO

$11,303.72

ASPLUNDH TREE EXPERT CO

$19,619.70

ATCO RUBBER PRODUCTS, INC.

$6,217.76

ATHENS REG. HLTH SYS INC

$8,725.86

ATHENS-CLARKE COUNTY

$21,752.90

ATLANTA BOARD OF EDUCATION $106,351.61

ATLANTA CITY OF

$519,736.16

ATLANTA HOUSING AUTHORITY

$7,917.42

AUGUSTA-RICHMOND CO BD COMM $41,849.80

AUTOMOTIVE MOULDING COMPANY $23,835.21

AUTOZONE, INC

$43,726.01

AVERITT EXPRESS, INC

$20,719.66

AVONDALE MILLS INC

$10,402.62

BALDWIN COUNTY COMMISSIONER! $3,781.39

BANKHEAD ENTERPRISES, INC

$33,198.66

BARTOW COUNTY BD OF EDUCATIO $4,991.18

BAYLINER MARINE CORPORATION $29,706.95

BEAULIEU OF AMERICA

$177,597.57

BELLSOUTH CORPORATION

$179,774.03

BELLSOUTH ENTERPRISES INC

$36,478.52

BENTON-GEORGIA INC

$6,234.17

BERRY COLLEGE

$6,322.61

BHA GROUP INC

$1,513.49

BIBB COUNTY SD-COMMISSION

$38,260.53

$117,548.51 $33,824.93 $25,033.30 $0.00 $43,065.69 $0.00 $45,658.12 $60,625.19 $0.00 $1,268.27 $8,660.00 $6,970.60 $12,721.64 $15,867.52 $10,722.45 $7,724.88 $11,319.09 $19,646.39 $6,226.22 $8,737.73 $21,782.49 $106,496.30 $520,443.21 $7,928.19 $41,906.74 $23,867.64 $79,430.46 $20,747.85 $10,416.77 $3,786.53 $33,243.83 $4,997.97 $29,747.37 $177,839.17 $180,018.60 $36,528.14 $6,242.65 $6,331.21 $1,515.55 $38,312.58

2001

2001

Claims Paid Assessment Amt

$900,347.21 $680,798.36 $405,911.00 $214,790.93 $966,972.52
$1,803.45 $615,037.51 $1,450,021.00 $329,202.99
$6,977.56 $254,484.48 $121,741.00 $321,552.02 $168,777.13 $228,450.91
$73,261.22 $144,871.00 $974,407.01
$19,313.55 $394,210.81 $387,321.58 $1,655,092.64 $7,795, 130.90 $147,168.47 $693,995.94 $253,328.00 $1,356,211.97 $411,272.02 $246,616.20
$59,543.00 $791,334.00 $128,060.11 $724,059.12 $1,788,429.75 $2,975,879.86 $171,919.20 $166,008.70 $112,501.66
$56,643.54 $1,029,248.57

$56,195.14 $42,492.00 $25,334.92 $13,406.17 $60,353.55
$112.56 $38,387.54 $90,503.00 $20,547.19
$435.50 $15,883.64
$7,598.46 $20,069.66 $10,534.22 $14,258.75
$4,572.60 $9,042.12 $60,817.57 $1,205.45 $24,604.65 $24,174.66 $103,302.54 $486,532.78 $9,185.51 $43,315.73 $15,811.46 $84,647.92 $25,669.53 $15,392.54 $3,716.37 $49,391.08 $7,992.87 $45,192.12 $111,624.77 $185,739.42 $10,730.33 $10,361.43 $7,021.79 $3,535.40 $64,240.51

2000 Balance Due

2000 And 2001 Total Assessment

$159.69 $45.95 $34.01 $0.00
$513.21 $0.00 $62.03
$82.36 $0.00 $1.72
$11.77 $9.47 $17.29 $21.56 $14.56 $10.49 $15.37 $26.69 $8.46 $11.87 $29.59 $144.69 $707.05 $10.77 $56.94 $32.43 $35,704.45 $28.19 $14.15 $5.14 $45.17 $6.79 $40.42 $241.60 $244.57 $49.62 $8.48 $8.60 $2.06 $52.05

$56,354.83 $42,537.95 $25,368.93 $13,406.17 $60,866.76
$112.56 $38,449.57 $90,585.36 $20,547.19
$437.22 $15,895.41 $7,607.93 $20,086.95 $10,555.78 $14,273.31 $4,583.09 $9,057.49 $60,844.26 $1,213.91 $24,616.52 $24,204.25 $103,447.23 $487,239.83 $9,196.28 $43,372.67 $15,843.89 $120,352.37 $25,697.72 $15,406.69 $3,721.51 $49,436.25 $7,999.66 $45,232.54 $111,866.37 $185,983.99 $10,779.95 $10,369.91 $7,030.39 $3,537.46 $64,292.56

- 77 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

BIBB COUNTY BOARD OF EDUCATIO $14,823.82

BIRMINGHAM SOUTHEAST, LLC

$35,698.76

BLACK & DECKER CORPORATION

$8,568.90

BLOSSMAN COMPANIES, INC

$8,256.01

BLUE BIRD BODY COMPANY

$137,266.80

BLUE CIRCLE AMERICA

$75,927.77

BOBS CANDIES, INC.

$13,251.79

BROWN INDUSTRIES

$6,337.34

BRUNSWICK, CITY OF

$7,848.93

BULL MOOSE TUBE CO

$4,888.38

BURLEN CORPORATION

$9,774.48

C T HARRIS INC

$19,905.69

C. W. MATTHEWS CONTRACTING INC $46,531.06

CAGLE FOODS, JV, LLC

$49,561.76

CAGLE'$ INC, & SUBSIDIARIES

$75,918.27

CAHABA GOV'T BENEFIT ADMIN.

$2,894.92

CALDWELL TANKS ALLIANCE, INC.

$0.00

CALFEE COMPANY OF DALTON, INC $5,724.60

CANDLER HEALTH SYSTEM

$20,909.40

CAREMORE INC

$29,457.32

CARROLL CO. BOARD OF EDUCATIO $17,753.63

CASCADE CORPORATION

$2,154.67

CATOOSA CO. BD. OF EDUCATION

$8,636.48

CEMEX (SOUTHDOWN INC.)

$7,449.50

CENTRAL GEORGIA HEALTH SYSTEI $43,272.63

CERTAINTEED CORPORATION

$16,077.83

CERULEAN COMPANIES INC.

$8,079.20

CHAMPION INTERNATIONAL CORP $19,671.31

CHATHAM AREA TRANSIT AUTHORIT $10,564.89

CHATHAM COUNTY BD OF EDUCATI< $36,807.10

CHATHAM COUNTY GEORGIA

$34,158.26

CHEROKEE BRICK & TILE

$10,460.21

CHEROKEE CO BD OF COMMISSION $7,414.16

CHEROKEE CO BD OF EDUCATION $20,562.07

CHEVRON USA INC SOU DIV

$1,645.16

CHILDREN'S HEALTHCARE OF ATL $33,156.31

CLAYTON COUNTY BD OF EDUCATIC $25,000.47

CLAYTON COUNTY COMMISSIONERl $46,869.13

CLAYTON COUNTY WATER AUTHORI $6,971.48

CMI INDUSTRIES INC.

$3,405.78

$14,843.99 $35,747.32 $8,580.55 $8,267.24 $137,453.54 $76,031.06 $13,269.82
$6,345.96 $7,859.60 $4,895.03 $9,787.78 $19,932.77 $46,594.36 $49,629.18 $76,021.55 $2,898.86
$0.00 $5,732.39 $20,937.85 $29,497.39 $17,777.78 $2,157.60 $8,648.22 $7,459.63 $43,331.50 $16,104.15 $8,090.19 $19,698.07 $10,579.26 $36,857.17 $34,204.73 $10,474.44 $7,424.25 $20,590.05 $1,647.40 $33,201.42 $25,034.48 $46,932.89 $6,980.96 $3,410.41

2001 Claims Paid

2001 Assessment Amt

2000 Balance Due

2000 And 2001 Total Assessment

$374,011.00 $161,159.02 $145,480.12 $141,173.21 $2,166,760.64 $1,046,757.90 $114,139.67 $132,819.43 $330,144.64
$0.00 $168,354.88 $162,862.16 $400,642.78 $509,347.89 $1,045,195.52
$24,678.75 $1,814.85
$225,645.29 $342,571.22
$0.00 $346,242.71
$17,766.24 $10,644.55 $45,966.91 $1,081,181.02 $358,043.97 $138,186.32
$0.00 $142, 193.67 $419,259.27 $614,971.75 $146,511.85 $129,439.91 $485,444.00
$11,316.96 $675,439.68 $516,777.25 $694,753.13
$26,467.63 $19,861.37

$23,343.88 $10,058.73 $9,080.14 $8,811.32 $135,238.28 $65,333.35
$7,124.02 $8,289.92 $20,605.96
$0.00 $10,507.86 $10,165.04 $25,006.10 $31,790.93 $65,235.84
$1,540.32 $113.27
$14,083.64 $21,381.57
$0.00 $21,610.72 $1,108.88
$664.38 $2,869.02 $67,481.87 $22,347.30 $8,624.89
$0.00 $8,875.01 $26,168.05 $38,383.44 $9,144.53 $8,078.99 $30,298.97
$706.35 $42,157.54 $32,254.63 $43,362.99 $1,651.98 $1,239.65

$20.17 $48.56 $11.65 $11.23 $186.74 $103.29 $18.03
$8.62 $10.67 $6.65 $13.30 $27.08 $63.30 $67.42 $103.28 $3.94 $0.00 $7.79 $28.45 $40.07 $24.15 $2.93 $11.74 $10.13 $58.87 $26.32 $10.99 $26.76 $14.37 $50.07 $46.47 $14.23 $10.09 $27.98 $2.24 $45.11 $34.01 $63.76 $9.48 $4.63

$23,364.05 $10,107.29 $9,091.79 $8,822.55 $135,425.02 $65,436.64 $7,142.05 $8,298.54 $20,616.63
$6.65 $10,521.16 $10,192.12 $25,069.40 $31,858.35 $65,339.12
$1,544.26 $113.27
$14,091.43 $21,410.02
$40.07 $21,634.87
$1,111.81 $676.12
$2,879.15 $67,540.74 $22,373.62 $8,635.88
$26.76 $8,889.38 $26,218.12 $38,429.91 $9,158.76 $8,089.08 $30,326.95
$708.59 $42,202.65 $32,288.64 $43,426.75 $1,661.46 $1,244.28

-78 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Companies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

COACHMAN REC. VEHICLE CO OF G, $13,049.16

COASTAL TRANSPORT INC

$44,248.09

COATS & CLARK, INC.

$17,624.03

COBB COUNTY BO/COMMISSIONER~ $83,888.44

COBB COUNTY SCHOOL SYSTEM $105,835.30

COCA-COLA COMPANY

$15,293.83

COCA-COLA ENTERPRISES INC

$92,921.06

COLLEGE PARK CITY OF

$9,522.67

COLLIS FOODS INC

$244.84

COLONIAL GROUP

$5,147.13

COLQUITT CO BD OF EDUCATION

$4,015.12

COLQUITT REGIONAL MEDICAL CEN $15,904.35

COLUMBIA CO BOARD OF EDUCATIC $14,362.63

COLUMBIA GEORGIA CORP.

$7,464.71

COLUMBUS CITY OF

$19,272.71

COLUMBUS FOUNDRIES INC

$18,532.00

COLUMBUS REGIONAL HEALTHCAR $25,507.97

COLUMBUS WATER WORKS

$4,058.95

CONAGRA FOODS, INC

$101,636.20

CONOCO INC.

$886.81

CONSOLIDATED STORES CORP.

$13,574.18

CONTI GROUP COMPANIES, INC

$42,045.14

CONTINENTAL TIRE N. AMER., INC $32,716.38

COOPER INDUSTRIES, INC

$29,722.19

COOPER TIRE AND RUBBER

$65,634.96

CORPORATION OF MERCER UNIV

$3,436.52

COSTCO WHOLESALE CORP.

$3,670.28

COTTRELL INC

$12,986.41

COVINGTON, CITY OF

$577.22

COWETA CO BOARD OF EDUCATION $9,676.00

CRACKER BARREL OLD CNTRY STO $56,471.41

CRAWFORD & COMPANY

$13,493.24

CRIDER'S POULTRY INC

$22,944.10

CRISP COUNTY BD OF EDUCATION $2,820.32

CROWN CORK & SEAL COMPANY IN' $1,889.16

CWW GROUP, INC

$6,333.33

D L LEE & SONS INC

$13,306.81

DALTON CITY OF

$20,735.89

DAN RIVER, INC.

$10,592.05

DART CONTAINER CORPORATION $12,950.69

$13,066.91 $44,308.28 $17,648.01 $84,002.56 $105,979.28 $15,314.63 $93,047.47
$8,723.04 $245.17
$5,154.13 $4,020.59 $15,925.99 $14,450.50 $7,474.86 $19,298.93 $18,557.21 $25,542.67 $4,064.47 $101,774.47
$888.02 $13,592.65 $42,102.33 $32,760.89 $29,762.62 $65,724.25
$3,441.19 $3,675.27 $13,004.08
$578.01 $9,689.16 $56,548.24 $13,511.59 $22,975.31 $2,824.16 $1,891.73 $6,341.94 $13,324.92 $20,764.10 $10,606.46 $12,968.30

2001 Claims Paid

2001 Assessment Amt

$159,308.00 $732,867.93 $428,794.75 $1,038, 192.14 $2,257,791.10 $183,375.54 $1,529,330.00 $96,203.25
$0.00 $171,349.38 $107,353.40 $246,406.73 $107,005.56 $116,621.50 $464,927.72 $558,434.90 $494,568.22
$40,029.94 $1,779,448.14
$48,982.00 $183,992.00 $600,656.39 $473,906.69 $509,843.75 $1,207,181.14
$46,383.85 $89,241.00 $122,831.36 $15,513.19 $243,020.99 $1,435,835.16 $237,504.00 $292,484.93 $46,974.18 $43,972.79 $105,525.55 $91,118.77 $262,270.92 $216,737.58 $74,222.00

$9,943.20 $45,741.92 $26,763.21 $64,798.72 $140,919.94 $11,445.38 $95,453.07
$6,004.52 $0.00
$10,694.76 $6,700.46
$15,379.47 $6,678.75 $7,278.93
$29,018.45 $34,854.69 $30,868.46
$2,498.47 $111,064.18
$3,057.21 $11,483.85 $37,489.94 $29,578.87 $31,821.88 $75,346.16
$2,895.05 $5,569.97 $7,666.51
$968.26 $15,168.15 $89,617.59 $14,823.80 $18,255.44
$2,931.89 $2,744.56 $6,586.37 $5,687.17 $16,369.63 $13,527.67 $4,632.56

2000 Balance Due

2000And 2001 Total Assessment

$17.75 $60.19 $23.98 $114.12 $143.98 $20.80 $126.41 ($799.63) $0.33 $7.00 $5.47 $21.64 $87.87 $10.15 $26.22 $25.21 $34.70 $5.52 $138.27 $1.21 $18.47 $57.19 $44.51 $40.43 $89.29 $4.67 $4.99 $17.67 $0.79 $13.16 $76.83 $18.35 $31.21 $3.84 $2.57 $8.61 $18.11 $28.21 $14.41 $17.61

$9,960.95 $45,802.11 $26,787.19 $64,912.84 $141,063.92 $11,466.18 $95,579.48 $5,204.89
$0.33 $10,701.76
$6,705.93 $15,401.11
$6,766.62 $7,289.08 $29,044.67 $34,879.90 $30,903.16 $2,503.99 $111,202.45 $3,058.42 $11,502.32 $37,547.13 $29,623.38 $31,862.31 $75,435.45 $2,899.72 $5,574.96 $7,684.18
$969.05 $15,181.31 $89,694.42 $14,842.15 $18,286.65 $2,935.73 $2,747.13 $6,594.98 $5,705.28 $16,397.84 $13,542.08 $4,650.17

- 79 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

DEAN FOODS COMPANY

$11,046.87

DECATUR, CITY OF

$888.92

DEKALB COUNTY BOARD-ED

$131,731.29

DEKALB COUNTY GOVERNMENT $156,831.77

DEKALB FARMERS MARKET

$6,298.09

DEKALB REGIONAL HLTHCARE SYS $24,324.35

DELHAIZE AMERICA INC.

$40,831.95

DELPHI AUTOMOTIVE SYS INC.

$13,644.53

DELTA AIRLINES, INC.

$495,861.25

DIAGEO, INC.

$1,206.15

DIXIE GROUP & SUBSIDIARIES

$70,948.12

DOLLAR GENERAL CORP

$72,154.09

DOREL JUVENILE GRP (COSCO, INC $8,326.77

DOUGHERTY COUNTY COMMISSION $12,500.13

DOUGHERTY COUNTY SCHOOL SYS' $20,158.04

DOUGLAS ASPHALT COMPANY

$62,783.02

DOUGLAS CO BD OF COMMISSIONE $20,271.99

DOUGLAS COUNTY SCHOOLS

$11,082.61

DOUGLAS, CITY OF

$5,603.67

DOUGLASVILLE-DOUGLAS COUNTY $1,099.94

DSM CHEMICALS N. AMERICA

$6,737.14

DULUTH, CITY OF

$690.66

DURAND-WAYLAND, INC

$1,343.39

E I DUPONT DE NEMOURS & CO

$11,093.61

EAST POINT, CITY OF

$21,955.02

EATON CORPORATION

$10,469.56

ELBERTA CRATE & BOX COMPANY $14,516.35

ELBERTON GRANITE ASSOCIATION $41,344.93

ELBERTON, CITY OF

$882.29

EMERSON ELECTRIC CO

$12,950.43

EMORY CLINIC, INC.,

$6,917.02

EMORY UNIVERSITY

$247,402.53

ENCOMPASS GROUP, LLC

$7,098.94

ENGELHARD CORPORATION

$22,049.00

ESTES EXPRESS LINES

$11,509.53

EVANS GRADING CO., INC

$1,580.55

EVENFLO COMPANY INC

$21,057.13

FAYETTE COUNTY BD OF COMM

$8,019.28

FAYETTE COUNTY BD OF EDUCATIO $9,256.76

FEDERAL EXPRESS

$153,879.01

$14,702.08 $890.13
$131,910.50 $157,045.13
$6,306.66 $24,357.44 $40,887.50 $13,663.09 $496,535.83
$1,207.79 $71,044.64 $72,785.65 $8,338.10 $12,517.14 $20,185.46 $62,868.43 $20,299.57 $11,097.69
$5,611.30 $1,101.44 $6,746.31
$691.60 $1,373.22 $11,108.70 $21,984.89 $10,483.80 $14,536.10 $41,401.17
$883.49 $12,968.04
$6,926.43 $247,739.10
$7,108.60 $22,078.99 $11,525.18
$1,582.70 $21,085.78
$8,030.19 $9,269.35 $154,088.34

2001

2001

2000

Claims Paid Assessment Amt Balance Due

2000 And 2001 Total Assessment

$355, 114.00 $41,390.58 $2,368,482.99 $2,325,885.04 $82,154.77 $437,091.32 $473,138.40 $194,624.22 $9,225,897.97
$0.00 $679,649.93 $788,896.65
$91,305.25 $441,976.68 $468,972.11 $895,408.50 $387,210.20 $353,459.67 $161,718.88
$22,042.96 $290,174.00 $10,507.25 $63,708.65 $200,517.64 $334,853.97 $176,507.62 $84,610.41 $673,353.56 $25,580.91 $364,322.00 $296,239.94 $2,602,423.59 $124,332.94 $301,019.39 $274,160.40 $35,584.06 $448,832.65 $62,271.12 $83,634.06 $2,637,170.72

$22,164.43 $2,583.39
$147,828.77 $145,170.02
$5,127.69 $27,281.04 $29,530.91 $12,147.46 $575,834.05
$0.00 $42,420.32 $49,238.95
$5,698.81 $27,585.96 $29,270.88 $55,886.89 $24,167.71 $22,061.17 $10,093.68
$1,375.81 $18,111.20
$655.81 $3,976.37 $12,515.30 $20,899.90 $11,016.72 $5,280.96 $42,027.34 $1,596.63 $22,739.14 $18,489.80 $162,430.16 $7,760.24 $18,788.11 $17,111.71 $2,220.98 $28,013.87 $3,886.65 $5,220.02 $164,598.91

$3,655.21 $1.21
$179.21 $213.36
$8.57 $33.09 $55.55 $18.56 $674.58
$1.64 $96.52 $631.56 $11.33 $17.01 $27.42 $85.41 $27.58 $15.08 $7.63
$1.50 $9.17 $0.94 $29.83 $15.09 $29.87 $14.24 $19.75 $56.24 $1.20 $17.61 $9.41 $336.57 $9.66 $29.99 $15.65 $2.15 $28.65 $10.91 $12.59 $209.33

$25,819.64 $2,584.60 $148,007.98 $145,383.38 $5,136.26 $27,314.13 $29,586.46 $12,166.02 $576,508.63
$1.64 $42,516.84 $49,870.51
$5,710.14 $27,602.97 $29,298.30 $55,972.30 $24,195.29 $22,076.25 $10,101.31 $1,377.31 $18,120.37
$656.75 $4,006.20 $12,530.39 $20,929.77 $11,030.96 $5,300.71 $42,083.58 $1,597.83 $22,756.75 $18,499.21 $162,766.73 $7,769.90 $18,818.10 $17,127.36 $2,223.13 $28,042.52 $3,897.56 $5,232.61 $164,808.24

- 80 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Seit-Insured Companies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

FEDERAL RESERVE BANK/ATLANTA $4,367.22

FEDERATED DEPARTMENT STORES $37,634.06

FEDEX GROUND PKG SYS

$6,894.02

FE DEX SUPPLY CHAIN SERV INC

$3,409.60

FIELDALE FARMS CORPORATION $53,987.19

FLEETWOOD HOMES OF GA INC

$85,136.38

FLEXSTEEL INDUSTRIES INC

$19,763.19

FLORIDA ROCK & TANK LINES INC $22,986.94

FLORIDA ROCK INDUSTRIES INC

$3,234.11

FLOWERS INDUSTRIES INC

$26,490.43

FLOYD CO. BD. OF COMMISSIONERf $22,625.53

FLOYD COUNTY BD OF EDUCATION $11,502.82

FLOYD HLTHCARE MGMT INC

$36,161.36

FLYING J, INC.

$5,049.90

FORD MOTOR COMPANY

$111,584.05

FOREST PARK, CITY OF

$7,506.98

FORSYTH CO BD OF COMMISSIONEI $32,134.03

FORSYTH CO. BO. OF EDUCATION $10,490.28

FORT JAMES CORP.

$19,012.47

FREUDENBERG-NOK

$12,706.35

FROZEN FOOD EXPRESS IND

$3,649.75

FULTON COUNTY BO OF EDUCATIO~ $72,875.86

FULTON COUNTY, GEORGIA

$85,076.32

FULTON-DEKALB HOSPITAL AUTHY $90,890.67

GA BAPTIST HEALTH CARE SYSTEM $56,717.79

GA MEDCORP, INC.

$15,980.68

GANNETT CO. INC & SUBSIDIARIES $1,608.25

GENERAL MOTORS CORPORATION $233,054.91

GEORGIA CRATE & BASKET CO

$3,801.18

GEORGIA DUCK & CORDAGE MILL $25,285.97

GEORGIA STATE OF

S2,566,894.69

GEORGIA-PACIFIC CORPORATION $145,901.25

GFF HOLDING CO/GENERAL FIBERS $7,074.72

GLYNN COUNTY BOARD OF COM MS $26,129.34

GLYNN COUNTY SCHOOLS

$13,459.07

GOLDEN PANTRY FOOD STORES INC $9,213.77

GOODY PRODUCTS, INC.

$4,753.00

GREAT ATLANTIC & PACIFIC TEA

$11,973.71

GREAT DANE LTD PARTNERSHIP

$51,034.72

GRIFFIN-SPALDING SCHOOLS

$6,682.09

$4,373.16 $37,685.26
$6,903.39 $3,414.24 $54,060.63 $85,252.20 $19,790.08 $23,018.21 $3,238.51 $26,526.46 $22,656.31 $11,518.47 $36,210.55 $5,056.77 $111,735.85 $7,517.19 $32,177.74 $10,504.55 $19,038.34 $12,723.63 $3,654.72 $72,975.00 $85,192.06 $91,014.32 $56,794.95 $16,002.42 $1,610.44 $233,371.96 $3,806.35 $25,320.37 $2,570,386.72 $146,099.74 $7,084.34 $26,164.89 $13,477.38 $9,226.31 $4,759.47 $11,990.00 $51,104.15 $6,691.19

2001 Claims Paid

2001 Assessment Amt

$0.00 $633,903.65 $230,302.00
$68,643.00 $792,916.63 $1,568,066.01 $207,522.00 $205,349.76
$77,849.92 $518,013.84 $410,853.97 $325,753.40 $303,553.64 $222,466.72 $1,733,936.55
$48,681.07 $161,832.96 $280,492.78 $311,110.95 $148,503.21
$1,556.11 $1,208,537.82 $2,076,261.00
$653,408.90 . $380,215.00 $397,279.02
$58,614.85 $4,833,499.00
$11,015.68 $315,271.52 $35,384,351.51 $4,461,311.28 $159,789.93 $690,565.61 $478,792.87
$74,413.53 $95,156.00 $217,815.63 $782,829.73 $128,281.39

$0.00 $39,565.07 $14,374.29
$4,284.35 $49,489.86 $97,870.78 $12,952.48 $12,816.90
$4,859.00 $32,331.81 $25,643.43 $20,331.89 $18,946.29 $13,885.25 $108,223.58
$3,038.43 $10,100.80 $17,506.95 $19,417.98
$9,268.82 $97.12
$75,430.84 $129,589.75
$40,782.49 $23,731.10 $24,796.15
$3,658.44 $301,682.65
$687.54 $19,677.66 $2,208,512.88 $278,452.57
$9,973.28 $43,101.62 $29,883.84 $4,644.52 $5,939.16 $13,594.95 $48,860.29
$8,006.68

2000 Balance Due

2000And2001 Total Assessment

$5.94 $51.20 $9.37 $4.64 $73.44 $115.82 $26.89 $31.27 $4.40 $36.03 $30.78 $15.65 $49.19 $6.87 $151.80 $10.21 $43.71 $14.27 $25.87 $17.28 $4.97 $99.14 $115.74 $123.65 $77.16 $21.74 $2.19 $317.05 $5.17 $34.40 $3,492.03 $198.49 $9.62 $35.55 $18.31 $12.54 $6.47 $16.29 $69.43 $9.10

$5.94 $39,616.27 $14,383.66 $4,288.99 $49,563.30 $97,986.60 $12,979.37 $12,848.17 $4,863.40 $32,367.84 $25,674.21 $20,347.54 $18,995.48 $13,892.12 $108,375.38 $3,048.64 $10,144.51 $17,521.22 $19,443.85 $9,286.10
$102.09 $75,529.98 $129,705.49 $40,906.14 $23,808.26 $24,817.89
$3,660.63 $301,999.70
$692.71 $19,712.06 $2,212,004.91 $278,651.06
$9,982.90 $43,137.17 $29,902.15
$4,657.06 $5,945.63 $13,611.24 $48,929.72 $8,015.78

- 81 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Companies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

GULFSTREAM AEROSPACE CORP $11,307.42

GWINNETT CO BO OF EDUCATION $106,455.16

GWINNETT COUNTY BD OF COMMIS: $102,402.00

GWINNETT HOSPITAL SYSTEM

$30,281.35

HALL COUNTY BOARD OF EDUCATIC $9,654.53

HAMILTON HEALTH CARE SYSTEM $15,981.66

HAPEVILLE CITY OF

$2,361.69

HARRIET & HENDERSON YARNS

$0.00

HARRISON POULTRY, INC

$8,800.31

HAVERTYS FURNITURE

$12,675.06

HENRY CO BOARD OF EDUCATION $17,020.74

HERCULES INCORPORATED

$19,813.80

HILLCREST FOODS, INC

$8,833.63

HILTON HOTELS CORPORATION

$2,491.46

HON INDUSTRIES, INC.

$13,890.16

HORMEL FOODS CORP

$38,510.95

HORTON HOMES, INC

$33,107.13

HOSPITAL AUTHORITY HOUSTON Cl $14,326.46

HOUSTON COUNTY BD OF EDUCATIC $10,223.89

HOUSTON COUNTY COMMISSIONER $5,775.77

HOWARD SHEPPARD INC

$10,343.67

HUTCHESON MEDICAL CENTER

$24,207.07

HYATT CORPORATION

$11,781.80

IDA CASON CALLAWAY FOUNDATIOI $14,422.45

IKON OFFICE SOLUTIONS

$13,063.53

ILLINOIS TOOL WORKS INC

$22,956.59

INGLES MARKETS INC

$166,936.53

INTERFACE, INC

$20,579.85

INTERNATIONAL PAPER COMPANY $93,108.07

INTERSTATE PAPER LLC

$302.95

J & J INDUSTRIES INC

$25,118.56

J H HARVEY COMPANY

$43,934.53

J.C. PENNEY COMPANY, INC.

$66,778.84

JEFFERSON SMURFIT CORP. U.S.

$7,736.48

JESUP CITY OF

$997.22

JOHN WIELAND HOMES, INC

$103,827.81

$11,322.80 $106,599.98 $102,541.31 $30,322.55
$9,667.66 $16,003.41
$2,364.90 $0.00
$8,812.28 $12,692.30 $17,043.90 $19,840.75
$8,845.64 $2,494.85 $13,909.05 $38,563.34 $33,152.17 $14,345.95 $10,237.79 $5,783.63 $10,357.74 $24,240.00 $11,797.82 $14,442.07 $13,081.30 $22,987.82 $167,163.64 $20,607.85 $93,234.74
$303.98 $25,152.73 $43,994.30 $66,869.68
$7,747.00 $998.58
$103,969.06

JOHNS MANVILLE INT'L., INC. JOHNSTON INDUSTRIES, INC. JONES COMPANY (THE) K & F INDUSTRIES

$11,998.85 $1,957.25 $0.00 $0.00

$12,015.17 $1,959.91 $0.00 $0.00

2001

2001

Claims Paid Assessment Amt

$332,614.88 $1,435,250.75

$20,760.14 $89,581.12

$1,830,486.41 $776,744.25 $226,013.59 $390,920.20

$114,249.74 $48,480.46 $14,106.63 $24,399.27

$47,698.69 $72,998.68

$2,977.11 $4,556.21

$92,251.06

$5,757.85

$390,765.73 $363,106.26

$24,389.63 $22,663.26

$245,238.00

$15,306.52

$146,739.95

$9,158.77

$91,261.05

$5,696.05

$72,303.70 $740,391.48 $781,497.43

$4,512.83 $46,211.50 $48,777.13

$204,493.42 $242,351.68
$80,681.98 $121,819.91 $347,985.63 $213,717.63 $233,842.08 $364,527.12

$12,763.45 $15,126.37 $5,035.76 $7,603.38 $21,719.51 $13,339.18 $14,595.24 $22,751.95

$220,382.20 $3,148,078.60

$13,755.15 $196,487.20

$220,526.77 $2,388,386.38

$13,764.17 $149,071.04

$12,798.31 $200,119.20 $708,458.50 $1,052,525.42 $120,753.00
$29,816.00 $1,033,057.86
$95,135.00

$798.81 $12,490.43 $44,218.41 $65,693.33
$7,536.79 $1,860.96 $64,478.27 $5,937.85

$30,264.29 $231,564.85

$1,888.94 $14,453.11

$64,455.00

$4,022.96

2000 Balance Due

2000 And 2001 Total Assessment

$15.38 $144.82 $139.31 $41.20 $13.13 $21.75
$3.21 $0.00 $11.97 $17.24 $23.16 $26.95 $12.01 $3.39 $18.89 $52.39 $45.04 $19.49 $13.90 $7.86 $14.07 $32.93 $16.02 $19.62 $17.77 $31.23 $227.11 $28.00 $126.67 $1.03 $34.17 $59.77 $90.84 $10.52 $1.36 $141.25 $16.32 $2.66 $0.00 $0.00

$20,775.52 $89,725.94 $114,389.05 $48,521.66 $14,119.76 $24,421.02 $2,980.32 $4,556.21
$5,769.82 $24,406.87 $22,686.42 $15,333.47 $9,170.78 $5,699.44 $4,531.72 $46,263.89 $48,822.17 $12,782.94 $15,140.27 $5,043.62 $7,617.45 $21,752.44 $13,355.20 $14,614.86 $22,769.72 $13,786.38 $196, 714.31 $13,792.17 $149,197.71
$799.84 $12,524.60 $44,278.18 $65,784.17 $7,547.31 $1,862.32 $64,619.52
$5,954.17 $1,891.60 $14,453.11 $4,022.96

- 82 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Com~anies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

KAHN CONSTRUCTION COMPANY IN

$8.31

KEEBLER COMPANY

$50,749.31

KELLEY MANUFACTURING COMPAN $3,562.12

KERR-MCGEE PIGMENTS (SAV) INC. $23,277.56

KIMBERLY-CLARK CORP

$14,144.49

KING & PRINCE SEAFOOD CORP.

$3,490.04

KLEEN-TEX INDUSTRIES

$7,453.45

KLLM TRANSPORT

$20,290.86

K-MART CORP & SUBSIDIARIES

$260,029.18

KROGER COMPANY, THE

$48,311.22

LABOR READY SE Ill LP

$73,540.69

LAGRANGE, CITY OF

$4,444.10

LANGDALE INDUSTRIES

$25,024.36

LAWRENCEVILLE, CITY OF

$6,584.77

LEVI STRAUSS & CO

$129,693.84

LIBERTY NATIONAL LIFE INS CO

$1,784.64

LIFE INSURANCE CO OF GEORGIA

$540.26

LIMITED, INC., THE

$5,804.94

LINDALE MANUFACTURING INC

$19,756.31

LOUISIANA-PACIFIC CORP

$30,468.18

LOW TEMP INDUSTRIES

$7,560.89

LOWE'S HOME CENTERS, INC

$167,686.20

LOXCREEN COMPANY, INC.

$2,118.01

LUCENT TECHNOLOGIES INC.

$10,242.36

MACON CITY OF

$77,238.88

MACON/BIBB CO WATER & SEWERA $4,505.72

MANAGEMENT ANALYSIS & UTILIZA" $3,505.67

$15.07 $50,818.35
$3,566.97 $23,445.37 $14,163.73
$3,494.78 $7,463.59 $20,318.46 $260,382.93 $48,376.95 $73,640.74 $4,450.14 $25,058.40 $6,593.72 $129,870.28 $1,787.06
$540.99 $5,812.84 $19,783.18 $30,509.63 $7,571.18 $167,914.32 $2,120.89 $10,256.30 $77,343.96 $4,511.85 $3,510.44

MARIETTA CITY SERVICES

$20,782.57

MAR-JAC POULTRY, INC.

$9,485.35

MARMON INDUSTRIAL CORP

$9,228.44

MARRIOTT INTERNATIONAL, INC.

$53,193.05

MARTA

$232,173.10

MAY DEPARTMENT STORES CO/DBA $569.53

MCLANE COMPANY, INC.

$13,823.98

$20,810.84 $12,071.71
$9,240.99 $53,265.41 $232,488.95
$570.31 $13,842.79

M-D BUILDING PRODUCTS MEAD CORPORATION MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC METALPLATE GALVANIZING LP METROMEDIA INTERNATIONAL GAP

$9,640.33 $29,230.89 $14,042.19 $32,333.22
$4,779.05 $6,282.88

$9,653.45 $29,270.65 $14,061.29 $32,377.21
$4,785.55 $6,291.43

2001

2001

2000

Claims Paid Assessment Amt Balance Due

2000And2001 Total Assessment

$12,141.15 $809,898.36
$60,177.83 $226,714.27 $294,354.00
$41,259.73 $363,127.70
$69,411.44 $4,266,841.71 $1,258,217.86
$734,770.59 $84,526.05
$350,326.60 $78,463.24
$1,832,034.48 $183,912.65 $0.00 $88,938.00 $350, 139.16 $207,117.80 $102,459.20
$1,934,877.62 $84,357.99
$724,896.85 $1,895,650.39
$247,034.18 $0.00
$495,157.57 $225,874.26
$48,385.80 $934,999.87 $3,480,778.37 $26,302.74 $81,716.25 $154,434.35 $859,375.35 $439,453.66 $329,797.29 . $37,827.50 $216,397.38

$757.79 $50,549.77
$3,756.00 $14,150.36 $18,372.09
$2,575.22 $22,664.60
$4,332.31 $266,314.75
$78,531.62 $45,860.68
$5,275.69 $21,865.62
$4,897.28 $114,346.36
$11,478.90 $0.00
$5,551.06 $21,853.92 $12,927.25
$6,394.99 $120,765.31
$5,265.20 $45,244.41 $118,316.94 $15,418.63
$0.00 $30,905.24 $14,097.93 $3,020.00 $58,357.98 $217,252.64 $1,641.68 $5,100.32 $9,639.01 $53,637.88 $27,428.48 $20,584.28 $2,361.00 $13,506.43

$6.76 $69.04
$4.85 $167.81
$19.24 $4.74 $10.14 $27.60 $353.75 $65.73 $100.05 $6.04 $34.04 $8.95 $176.44 $2.42 $0.73 $7.90 $26.87 $41.45 $10.29 $228.12 $2.88 $13.94 $105.08 $6.13 $4.77 $28.27 $2,586.36 $12.55 $72.36 $315.85 $0.78 $18.81 $13.12 $39.76 $19.10 $43.99 $6.50 $8.55

$764.55 $50,618.81 $3,760.85 $14,318.17 $18,391.33 $2,579.96 $22,674.74 $4,359.91 $266,668.50 $78,597.35 $45,960.73 $5,281.73 $21,899.66 $4,906.23 $114,522.80 $11,481.32
$0.73 $5,558.96 $21,880.79 $12,968.70 $6,405.28 $120,993.43 $5,268.08 $45,258.35 $118,422.02 $15,424.76
$4.77 $30,933.51 $16,684.29 $3,032.55 $58,430.34 $217,568.49 $1,642.46 $5,119.13 $9,652.13 $53,677.64 $27,447.58 $20,628.27 $2,367.50 $13,514.98

- 83 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

MICROMERITICS INSTRUMENTS COi $199.70

MILLEDGEVILLE, CITY OF

$14,435.22

MILTON J. WOOD COMPANY

$4,347.98

MOHAWK CARPET CORPORATION $437,833.84

MONROE, CITY OF

$9,186.45

MOUNT VERNON MILLS

$81,336.44

MURPHY-HARPST-VASHTI, INC.

$0.00

MURRAY COUNTY BO OF EOUCATIOI $5,869.25

MUSCOGEE COUNTY SCHOOL DIST $28,164.80

NABISCO, INC

$43,759.50

NASH JOHNSON & SONS' FARMS INC $737.42

NATIONAL SERVICES INDUSTRIES $100,351.10

NEWTON COUNTY

$2,442.08

NEWTON COUNTY BO OF EDUCATIO $9,790.53

NORDSON CORPORATION

$5,225.96

NORDSTROM, INC.

$2,233.03

NORMAN W FRIES/CLAXTON POULTl $37,682.04

NORTHEAST GEORGIA HEALTH SYS $23,796.23

NORTHSIDE HOSPITAL

$69,683.28

OLD DOMINION FREIGHT LINES INC $34,548.44

OLIN CORPORATION

$864.61

OVERNITE TRANSPORTATION CO $31,767.08

OWENS-CORNING FIBERGLASS

$38,140.57

OWENS-ILLINOIS INC

$44,260.75

OXFORD CONSTRUCTION CO

$0.00

PARKER HANNIFIN CORPATION

$4,896.11

PATTERSON PUMP COMPANY

$3,172.73

PCC AIRFOILS INC

$41,592.95

PHOEBE PUTNEY MEMORIAL HOSP $11,457.27

PIEDMONT HOSPITAL

$63,703.29

PIEDMONT LABORATORIES, INC

$931.31

PIGGLY WIGGLY CAROLINA CO INC $10,378.72

PILOT CORPORATION

$2,443.77

PLANTATION PIPE LINE COMPANY

$560.69

PPG INDUSTRIES INC.

$4,532.98

PRESBYTERIAN HOMES OF GA

$0.00

PRINTPACK, INC

$6,440.95

PROCTER & GAMBLE COMPANY ANI $21,454.59

QUITRIP

$2,738.55

RACETRAC PETROLEUM, INC

$15,032.11

$199.98 $14,454.86
$4,353.90 $438,429.47
$9,198.95 $81,447.09
$0.00 $5,877.23 $28,203.11 $43,819.03
$738.43 $100,487.62
$2,445.40 $9,803.84 $5,233.07 $2,236.07 $37,733.30 $23,828.60 $69,778.08 $34,595.44
$865.79 $31,810.30 $38,192.46 $44,320.96
$0.00 $4,902.77 $3,177.05 $41,649.54 $11,472.86 $63,789.95
$932.58 $10,392.84
$2,447.09 $561.46
$4,539.15 $0.00
$6,449.71 $21,483.78
$2,742.28 $15,052.56

2001

2001

Claims Paid Assessment Amt

$5,954.55 $220,694.00 $148,785.90 $7,717,171.05
$56,690.64 $1,108,725.77
$79,143.96 $93,635.04 $593,456.85
$0.00 $39,588.08 $1,267,384.38 $32,834.65 $97,209.20 $119,229.86 $81,649.01 $700,042.03 $531,247.00 $1,227,268.37 $725,548.94
$182.00 $644.81 $660,939.00 $1,179,624.17 $16,748.26 $280,215.54 $166,251.13 $507,085.61 $240,161.07 $864,263.77 $45,017.48 $147,332.00 $103,402.57
$0.00 $39,266.11 $11,188.72 $154,841.00 $295,315.58 $269,140.63 $152,539.91

$371.65 $13,774.61
$9,286.47 $481,666.92
$3,538.34 $69,201.07
$4,939.77 $5,844.23 $37,040.59
$0.00 $2,470.89 $79,103.75 $2,049.37 $6,067.31 $7,441.73 $5,096.12 $43,693.10 $33,157.76 $76,599.91 $45,285.11
$11.36 $40.25 $41,252.48 $73,626.20 $1,045.34 $17,489.64 $10,376.56 $31,649.73 $14,989.64 $53,942.99 $2,809.76 $9,195.72 $6,453.87
$0.00 $2,450.79
$698.34 $9,664.39 $18,432.11 $16,798.40 $9,520.77

2000 Balance Due

2000And2001 Total Assessment

$0.28 $19.64
$5.92 $595.63 $12.50 $110.65
$0.00 $7.98 $38.31 $59.53 $1.01 $136.52 $3.32 $13.31 $7.11 $3.04 $51.26 $32.37 $94.80 $47.00 $1.18 $43.22 $51.89 $60.21 $0.00 $6.66 $4.32 $56.59 $15.59 $86.66 $1.27 $14.12 $3.32 $0.77 $6.17 $0.00 $8.76 $29.19 $3.73 $20.45

$371.93 $13,794.25
$9,292.39 $482,262.55
$3,550.84 $69,311.72 $4,939.77 $5,852.21 $37,078.90
$59.53 $2,471.90 $79,240.27 $2,052.69 $6,080.62 $7,448.84 $5,099.16 $43,744.36 $33,190.13 $76,694.71 $45,332.11
$12.54 $83.47 $41,304.37 $73,686.41 $1,045.34 $17,496.30 $10,380.88 $31,706.32 $15,005.23 $54,029.65 $2,811.03 $9,209.84 $6,457.19 $0.77 $2,456.96 $698.34 $9,673.15 $18,461.30 $16,802.13 $9,541.22

- 84 -

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

RANDOLPH COUNTY HOSP AUTHORI

$11.64

RHODES NURSING HOME

$1,272.12

RICHMOND CTY BD OF EDUCATION $44,130.45

RIVERDALE, CITY OF

$3,573.25

RMC INDUSTRIES

$16,616.61

ROCKDALE CO. BD OF EDUCATION $6,446.44

$11.66 $1,273.85 $44,190.49 $3,578.12 $16,639.22 $6,455.21

ROCKWELL INTERNATIONAL

$40,308.65

ROCOR INTERNATIONAL

$25,767.23

ROLLINS INC

$13,271.99

ROME, CITY OF

$26,070.88

ROOKER ADMINISTRATIVE SERVICE $18,360.21

ROPER CORPORATION

$25,844.09

ROSWELL CITY OF

$6,600.91

RTM,INC.

$16,303.71

RUBY TUESDAY INC

$15,199.54

RUSSELL CORPORATION

$768.36

RYAN'S FAMILY STEAK HOUSES

$18,004.63

RYDER SYSTEMS INC

$52,847.07

SAINT JOSEPH'S OF SAVANNAH

$8,397.10

SATILLA HEALTH SERVICES INC

$27,991.94

SAVANNAH CITY OF

$133,523.62

SAVANNAH ELECTRIC & POWER CO $12,106.99

SCIENTIFIC-ATLANTA INC

$18,726.64

SHAW INDUSTRIES INC

$536,350.18

SHEPHERD MEDICAL CENTER

$10,913.34

SHERWIN-WILLIAMS COMPANY

$7,628.45

$HONEY'S INC

$85,194.27

SILVER DOLLAR CITY INC

$12,897.13

SIX CONTINENTS HOTELS, INC

$581.31

SIZEMORE ,INC.

$22,763.67

SKF USA INC

$3,860.15

SNELL CONTRACTORS

$9,177.17

$40,363.49 $25,802.28 $13,290.04 $26,106.35 $11,651.60 $25,879.25
$6,609.89 $16,325.89 $15,220.22
$769.40 $18,029.12 $52,918.97
$8,408.52 $28,030.03 $133,705.27 $12,255.45 $18,752.11 $537,079.84 $10,928.18
$7,638.83 $85,310.17 $12,914.68
$582.10 $22,794.64
$4,060.54 $9,189.65

SONOCO PRODUCTS COMPANY

$4,943.40

SOUTH GEORGIA MEDICAL CENTER $27,273.72

$4,950.13 $27,310.83

SOUTHEAST GA HLTH SYSTEMS

$48,409.58

SOUTHEAST-ATLANTIC BEVERAGE $4,566.21

$48,824.06 $4,637.47

SOUTHEASTERN FREIGHT LINES SOUTHEASTERN MILLS, INC

$30,508.51 $57,156.12

$30,550.01 $57,233.87

SOUTHERN COMPANY SOUTHERN MILLS INC

$159,498.72 $10,003.59

$159,715.70 $10,017.20

2001

2001

Claims Paid Assessment Amt

$29,275.60 $42,645.27 $716,727.78 $30,817.58 $279,068.00 $141,077.18 $778,395.90
$0.00 $455,098.77 $420,143.71 $240,763.59 $479,796.95 $191,502.78 $212,887.18 $276,431.00
$4,313.40 $457,317.12 $946,594.47 $125,070.70 $441,042.66 $1,864,039.50
$0.00 $125,960.35 $9,030,465.06 $184,388.00 $510,050.00 $1,425,687.15
$88,609.80 $75,096.00 $588,516.55 $42,406.87 $92,990.28 $68,323.71 $539,856.99 $764,826.54

$1,827.24 $2,661.70 $44,734.54 $1,923.48 $17,418.02 $8,805.33 $48,583.55
$0.00 $28,404.97 $26,223.25 $15,027.25 $29,946.51 $11,952.64 $13,287.34 $17,253.43
$269.22 $28,543.43 $59,081.66
$7,806.28 $27,527.66 $116,343.95
$0.00 $7,861.81 $563,636.12 $11,508.57 $31,834.75 $88,984.21 $5,530.58 $4,687.11 $36,732.24 $2,646.82 $5,803.98 $4,264.42 $33,695.15 $47,736.62

$57,870.54 $450,021.20
$0.00 $3,480,378.00
$155,162.30

$3,611.99 $28,088.06
$0.00 $217,227.65
$9,684.45

2000 Balance Due

2000 And 2001 Total Assessment

$0.02 $1.73 $60.04 $4.87 $22.61 $8.77 $54.84 $35.05 $18.05 $35.47 ($6,708.61) $35.16 $8.98 $22.18 $20.68 $1.04 $24.49 $71.90 $11.42 $38.09 $181.65 $148.46 $25.47 $729.66 $14.84 $10.38 $115.90 $17.55 $0.79 $30.97 $200.39 $12.48 $6.73 $37.11 $414.48 $71.26 $41.50 $71.75 $216.98 $13.61

$1,827.26 $2,663.43 $44,794.58 $1,928.35 $17,440.63 $8,814.10 $48,638.39
$35.05 $28,423.02 $26,258.72 $8,318.64 $29,981.67 $11,961.62 $13,309.52 $17,274.11
$270.26 $28,567.92 $59,153.56 $7,817.70 $27,565.75 $116,525.60
$148.46 $7,887.28 $564,365.78 $11,523.41 $,31,845.13 $89,100.11 $5,548.13 $4,687.90 $36,763.21 $2,847.21 $5,816.46 $4,271.15 $33,732.26 $48,151.10 $3,683.25 $28,129.56
$77.75 $217,444.63
$9,698.06

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Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Comeanies

Company Name

2000

2000 Assessment

Assessment Amt Adjustment Amt

SOUTHERN NUCLEAR OPERATING C $22,731.34

SOUTHERN PAN SERVICES

$25,742.16

SOUTHWIRE COMPANY

$100,874.97

SPALDING CO BOARD OF COMM

$4,680.97

SPARTA CITY OF

$0.00

SPRINGS INDUSTRIES INC

$72,697.35

ST FRANCIS HOSPITAL

$14,485.39

ST JOSEPH HOSPITAL/AUGUSTA

$13,528.61

STAFFMARK INVESTMENT LLC

$0.00

STAFFMARK, INC.

$26,758.86

STANLEY WORKS & SUBSIDIARIES $1,661.51

STONE CONTAINER CORPORATION $4,244.87

SUPER DISCOUNT MARKETS

$41,094.77

SUPERIOR RIGGING & ERECTING CC $11,802.95

SUPERIOR UNIFORM GROUP

$1,675.46

SUTHERLAND'S FOODSERVICE, INC. $2,838.02

SYNTHETIC INDUSTRIES, INC

$77,203.76

T. M. POLYFILM, INC

$2,774.82

TANNER HEALTH SERVICES

$15,150.21

TARGET CORPORATION

$83,546.96

TECUMSEH PRODUCTS COMPANY $39,324.70

TENNECO AUTOMOTIVE, INC

$7,894.94

TERMINIX SERVICE, INC

$738.82

TEXTILE RUBBER & CHEMICAL

$13,827.62

TEXTRON, INC

$69,471.94

THERMAL CERAMICS

$10,364.33

THOMASTON MILLS INC

$19,799.43

THOMASVILLE CITY OF

$11,192.83

THREE SPRINGS INC.

$7,053.21

TIFTON ALUMINUM CO INC/ALCOA I $2,469.96

TIP TOP POULTRY INC

$17,553.22

TRC STAFFING SERVICES, INC

$23,338.48

TROUP CO. BOARD OF EDUCATION $3,290.24

TYSON FOODS INC

$140,648.68

UNILEVER UNITED STATES

$5,497.71

UNITED AIRLINES

$15,373.77

UNITED CATALYSTS, INC

$1,510.82

UNIVERSITY HOSPITAL

$26,171.32

USF HOLLAND, INC.

$2,278.55

USG CORPORATION

$5,886.80

$22,762.26 $25,777.18 $101,012.20
$4,687.33 $0.00
$72,796.25 $14,505.10 $13,547.01
$0.00 $26,795.26
$1,663.77 $4,250.65 $41,150.67 $11,819.01 $1,677.74 $2,841.88 $77,308.79 $2,778.60 $15,170.82 $83,660.62 $39,378.20 $7,905.68
$739.82 $13,846.43 $69,566.45 $10,378.43 $19,826.37 $11,208.06
$7,062.80 $2,473.32 $17,577.10 $23,370.23 $3,294.71 $140,840.02 $5,505.19 $15,394.69 $1,512.87 $26,206.92 $2,281.65 $5,894.81

2001

2001

Claims Paid Assessment Amt

$129,329.00 $254,007.71 $1,343,886.65 $182,737.40
$9,271.50 $791,225.62 $192,096.31 $73,884.37 $536,907.00
$0.00 $50,651.00 . $100,985.26 $432,559.00 $199,707.97 $16,824.27 $107,590.45
$0.00 $26,956.21 . $331,472.84 $1,227,746.74 $851,910.00
$0.00 $1,785.22 $35,182.07 $860,500.87 $268,536.90
$0.00 $95,226.78 $149,709.61 $57,700.28 $215,488.17 $393,198.79 $143,922.40 $2,367,280.00 $150,838.62 $856,377.26 $17,719.00 $413,817.88 $83,839.84 $78,258.53

$8,072.06 $15,853.88 $83,878.63 $11,405.55
$578.68 $49,384.32 $11,989.68 $4,611.49 $33,511.03
$0.00 $3,161.38 $6,302.99 $26,998.15 $12,464.76 $1,050.09 $6,715.25
$0.00 $1,682.47 $20,688.86 $76,629.76 $53,171.93
$0.00 $111.42 $2,195.89 $53,708.13 $16,760.72
$0.00 $5,943.58 $9,344.12 $3,601.36 $13,449.69 $24,541.49 $8,982.91 $147,753.69 $9,414.59 $53,450.75 $1,105.93 $25,828.43 $5,232.86 $4,884.50

2000 Balance Due

2000 And 2001 Total Assessment

$30.92 $35.02 $137.23
$6.36 $0.00 $98.90 $19.71 $18.40 $0.00 $36.40 $2.26 $5.78 $55.90 $16.06 $2.28 $3.86 $105.03 $3.78 $20.61 $113.66 $53.50 $10.74 $1.00 $18.81 $94.51 $14.10 $26.94 $15.23 $9.59 $3.36 $23.88 $31.75 $4.47 $191.34 $7.48 $20.92 $2.05 $35.60 $3.10 $8.01

$8,102.98 $15,888.90 $84,015.86 $11,411.91
$578.68 $49,483.22 $12,009.39
$4,629.89 $33,511.03
$36.40 $3,163.64 $6,308.77 $27,054.05 $12,480.82 $1,052.37 $6,719.11
$105.03 $1,686.25 $20,709.47 $76,743.42 $53,225.43
$10.74 $112.42 $2,214.70 $53,802.64 $16,774.82
$26.94 $5,958.81 $9,353.71 $3,604.72 $13,473.57 $24,573.24 $8,987.38 $147,945.03 $9,422.07 $53,471.67 $1,107.98 $25,864.03 $5,235.96 $4,892.51

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Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2001 Assessment
2000 Assessment Adjustment Self-Insured Companies

Company Name

2000 Assessment Amt

2000 Assessment Adjustment Amt

2001 Claims Paid

2001 Assessment Amt

2000 Balance Due

2000 And 2001 Total Assessment

VALDOSTA CITY OF

$13,572.96

VARIETY WHOLESALERS

$0.00

VERMONT AMERICAN CORPORATIOI

$175.70

VISITING NURSE HEALTH SYSTEM $13,876.01

VULCAN MATERIALS COMPANY

$22,434.78

WACHOVIA

$27,674.47

WAFFLE HOUSE

$104,360.22

WAGGONERS TRUCKING CO., THE $16,246.42

WALKER COUNTY BD OF EDUCATIOi $5,600.31

WAREHOUSE HOME FURNISHINGS $48,862.90

WARNER ROBINS CITY OF

$16,311.53

WARREN FEATHERBONE COMPANY $1,969.08

WARREN SEWELL MFG. CO.

$38,890.80

WATKINS ASSOCIATED INDUSTRIES $70,505.30

WATKINS ENGINEERS & CONST

$25,651.32

WAYCROSS MOLDED PRODUCTS IN1 $22,111.99

WAYCROSS, CITY OF

$8,909.71

WCI OUTDOOR PRODUCTS INC

$36,873.84

WELLINGTON LEISURE PRODUCTS $8,549.36

WELLSTAR HEALTH SYSTEM

$113,898.97

WENDY'S INTERNATIONAL INC

$6,750.99

WEST GEORGIA HEALTH SYSTEM $15,304.26

WEST POINT STEVENS, INC

$20,645.72

WESTVACO CORPORATION & SUBS $7,193.34

WEYERHAEUSER COMPANY

$34,153.88

WHITFIELD CO-BD OF EDUCATION $10,318.60

WHITFIELD COUNTY BD OF COMMIS $10,831.74

WILLAMETTE INDUSTRIES, INC.

$3,551.21

WINN-DIXIE STORES INC

$269,458.19

YELLOW FREIGHT SYSTEM INC

$35,228.23

YKK CORPORATION OF AMERICA $13,916.91

$13,591.43 $0.00
$175.94 $13,894.89 $22,465.30 $27,712.12 $104,502.19 $16,268.52
$5,607.93 $48,929.38 $16,333.72
$1,971.76 $38,943.71 $70,601.22 $25,686.22 $22,142.08
$8,921.83 $36,924.01
$8,560.99 $114,053.92
$6,760.17 $15,325.08 $20,673.81
$7,203.13 $34,200.34 $10,332.63 $10,846.47
$3,556.04 $269,824.76
$35,276.15 $13,935.84

$400,105.34 $17,000.06 $0.00
$236,737.06 $643,082.85 $470,883.03 $1,668,853.70 $225,945.00 $119,412.94 $249,551.37 $160,279.55
$41,836.71 $407,663.93 $942,427.04 $203,323.84 $285,908.10
$29,758.05 $500,423.66 $196,473.46 $2,198,721.42 $199,061.03 $173,409.39 $240,532.19
$98,104.97 $801,429.47
$6,586.72 $229,203.79 $103,942.00 $4,684,576.14 $472,482.28 $439,877.68

$24,972.56 $1,061.06 $0.00
$14,775.93 $40,137.99 $29,390.15 $104, 161.44 $14,102.35
$7,453.15 $15,575.74 $10,003.84
$2,611.24 $25,444.33 $58,821.55 $12,690.45 $17,844.94
$1,857.35 $31,233.92 $12,262.88 $137,233.11 $12,424.39 $10,823.34 $15,012.81
$6,123.22 $50,021.19
$411.11 $14,305.75
$6,487.54 $292,387.63
$29,489.96 $27,454.95

$18.47 $0.00 $0.24
$18.88 $30.52 $37.65 $141.97 $22.10
$7.62 $66.48 $22.19
$2.68 $52.91 $95.92 $34.90 $30.09 $12.12 $50.17 $11.63 $154.95
$9.18 $20.82 $28.09
$9.79 $46.46 $14.03 $14.73
$4.83 $366.57
$47.92 $18.93

$24,991.03 $1,061.06 $0.24
$14,794.81 $40,168.51 $29,427.80 $104,303.41 $14,124.45
$7,460.77 $15,642.22 $10,026.03
$2,613.92 $25,497.24 $58,917.47 $12,725.35 $17,875.03
$1,869.47 $31,284.09 $12,274.51 $137,388.06 $12,433.57 $10,844.16 $15,040.90
$6,133.01 $50,067.65
$425.14 $14,320.48
$6,492.37 $292,754.20
$29,537.88 $27,473.88

Total:

431 Grand Total: $16,692,671.56

$16,751,666.63 $267,324,807.52 $16,685,067.18

$58,995.07

$16,744,062.25

- 87 -