2003 annual report

STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND
2003 ANNUAL REPORT
If you wish to acquire this report in an alternative format, please contact our office at the address and telephone numbers listed inside.

Subsequent Injury Trust Fund 2003 Annual Report

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STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND
Suite 500 North Tower 1720 Peachtree Street, NW Atlanta, Georgia 30309-2462
Website: www.sitf.georgia.gov
Telephone: (404) 206-6360
Facsimile: (404) 206-6363

This publication can be downloaded from the SITF Website.

Subsequent Injury Trust Fund 2003 Annual Report

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For additional copies, please call the telephone number listed above or write to our address.

Subsequent Injury Trust Fund 2003 Annual Report

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OFFICIALS
BOARD OF TRUSTEES James C. Thompson, Chairman
Janis Murray, Secretary Lewis Lowe, Member
John Fervier (Appointed April 2004) Donald Avery (Appointed April 2004)
EX-OFFICIO MEMBERS Stan Carter, State Board of Workers' Compensation John W. Oxendine, Insurance, Safety Fire Commissioner
ADMINISTRATOR Anne D. Burnett (Retired November 2003) Richard W. McGee (Appointed May 2004)
DEPUTY ADMINISTRATOR David L. Taylor

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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.

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Table of Contents
Fund Administration ................................................................................................1
Introduction ______________________________________________________________ 1 How the Fund Works ______________________________________________________ 1 Reimbursement from the Fund _____________________________________________ 1 Claims Administration _____________________________________________________ 2 Claims Activity 2003 _____________________________________________________ 2 Financial Activity - 2003 ___________________________________________________ 3
Claims Filed in 2003 ...............................................................................................4
Insurance Companies _____________________________________________________ 4 Group Self-Insured Employers_____________________________________________ 10 Self-Insured Employers ___________________________________________________ 11
Reimbursements Paid ..........................................................................................19
Insurance Companies ____________________________________________________ 19 Group Self-Insured Employers_____________________________________________ 24 Self-Insured Employers ___________________________________________________ 25 Individual Employers _____________________________________________________ 32
Assessment 2003..................................................................................................63
Legal Requirements______________________________________________________ 63 Assessment Calculation __________________________________________________ 64 Assessment Adjustment for 2002 __________________________________________ 64 Assessment Rate for 2003 ________________________________________________ 64 Assessments Due for 2003________________________________________________ 65 Insurance Companies ____________________________________________________ 65 Group Self-Insured Employers_____________________________________________ 74 Self-Insured Employers ___________________________________________________ 75

Subsequent Injury Trust Fund 2003 Annual Report

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FUND ADMINISTRATION
Introduction 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 preexisting permanent impairment.
The Subsequent Injury Trust Fund is a separate state agency, governed by a five-member 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.
How the Fund Works 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. The fund supports 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 on-the-job injury of the employee must be directly caused by or combined with a prior impairment to create a greater 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.
O.C.G.A.34-9-361 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.
Reimbursement from the Fund All licensed workers' compensation insurance carriers and self-insured employers authorized by the State Board of Workers' Compensation in the state of Georgia may access the fund.
Employers/insurers must notify the fund of a possible claim by filing a Notice of Claim no later than 78 weeks following the date of injury.
In addition to the mandatory Notice of Claim, the employer must submit a notarized Employer's Knowledge Affidavit, certifying prior knowledge of the worker's pre-existing permanent impairment.
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.

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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.
Claims Administration The employer/insurer maintains management of the employee's claim for the life of that claim. Once the fund has been notified of the claim, the employer/insurer must keep the fund apprised of all developments, including settlement negotiations.
The fund investigates the claim to determine eligibility for reimbursement. When a reimbursement agreement is reached between the fund and the employer/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.
Claims Activity 2003 The following is a breakdown of claims activity for calendar year 2003. For information on prior
years, please call (404) 206-6356 or visit our website at www.sitf.georgia.gov.

Open Claims Claims Received Closed Claims Reopened Claims Closed Open Claims Claims Accepted Claims Denied Notices in Pending

January 1, 2003 Calendar Year 2003 Calendar Year 2003 Calendar Year 2003 December 31, 2003 Calendar Year 2003 Calendar Year 2003 Calendar Year 2003

15,600 15,491
755 11,701 20,145
985 88
3,415

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Financial Activity - 2003
The following table depicts the fund's revenues, expenditures, and fund balance for the calendar year ending December 31, 2003. The fund's year-end balance is part of the formula for establishing the annual assessment. For information on prior years, please call (404) 206-6357
or visit our website at www.sitf.georgia.gov.

Beginning Balance January 1, 2003
Revenues Assessments 2002, adjusted assessments 2001, and payments and refunds for prior years
Interest Earned
Miscellaneous Income Total Revenues
Expenditures Operating Cost
Reimbursements (negotiated checks)
Total Expenditures
Net Gain Ending Balance December 31, 2003

121,959,129.72

$31,439,524.08

599,119.38 176.02 $122,558,425.12
1,996,600.17
88,546,770.22 $90,543,370.39
$32,015,054.73 $63,454,578.81

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CLAIMS FILED IN 2003

Insurance Companies
The following is a list of insurance companies that filed a Notice of Claim with the Subsequent Injury Trust Fund in 2003. A total of 241 insurance companies filed approximately 10,492 claims.

Claims Reported by Insurance Companies

Claims Reported

ACE AMERICAN INSURANCE CO

42

ACE PROPERTY & CASUALTY INS

8

AIG NATIONAL INS. CO.

45

AMCOMP ASSURANCE

6

AMERICAN ALTERNATIVE INS

71

AMERICAN CAS CO OF READING PA

790

AMERICAN ECONOMY INS CO

8

AMERICAN GUAR & LIAB INS CO

4

AMERICAN HOME ASSURANCE CO

272

AMERICAN INSURANCE CO

21

AMERICAN INTER INS CO OF GA

59

AMERICAN INTERN. SOUTH INS CO

72

AMERICAN INTERNATIONAL INS CO

6

AMERICAN MFG. MUTUAL INS

16

AMERICAN MOTORISTS INS CO

14

AMERICAN PROTECTION INS CO

41

AMERICAN SAFETY CASUALTY INS

2

AMERICAN STATES INS CO

33

AMERICAN ZURICH INS CO

11

AMERISURE INSURANCE CO

2

AMGUARD INSURANCE CO.

12

APAG MUTUAL CAPTIVE

1

ARCH INSURANCE CO

2

ARGONAUT GREAT CENTRAL INS CO

1

ARGONAUT INSURANCE CO

3

ASSOCIATED INDEMNITY CORP

5

ASSOCIATED INDUSTRIES INS CO

1

ASSOCIATION INSURANCE CO

15

ASSURANCE CO. OF AMERICA

7

ATLANTIC MUTUAL INS. CO

30

ATLANTIC SPECIALTY INS CO

1

AUTO OWNERS INS. CO

17

BANCINSURE, INC.

1

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Insurance Companies
BANKERS STANDARD FIRE & MARINE BANKERS STANDARD INS CO BENCHMARK INS CO BITUMINOUS CASUALTY CORP BRIDGEFIELD CASUALTY BROTHERHOOD MUTUAL INS CO BUILDERS INSURANCE CANAL INSURANCE CO CAPITAL CITY INS CO CASUALTY RECIPROCAL EXCHANGE CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO CENTURY INDEMNITY CO CHARTER OAK FIRE INS CO CHUBB INDEMNITY INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY CO CINCINNATI INSURANCE CO CITIZENS INS CO OF AMERICA CLARENDON NATIONAL INS CO COLUMBIA NATIONAL INS CO COMBINED SPECIALTY INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL INS OF NEWARK NJ COMMERCIAL MUTUAL INS CO COMPANION PROP & CAS CONNECTICUT INDEMNITY CO CONTINENTAL CASUALTY CO CONTINENTAL INSURANCE CO COREGIS INSURANCE CO CORNERSTONE MUTUAL INS CO CRUM & FOSTER INDEMNITY CO CUMIS INS SOCIETY INC CYPRESS INSURANCE CO DISCOVER PROPERTY & CAS EASTGUARD INSURANCE CO ELECTRIC INSURANCE CO EMC PROPERTY & CASUALTY EMPLOYERS INS OF WAUSAU EMPLOYERS MUTUAL CAS INS CO EVEREST NATIONAL INS EVEREST SECURITY INS CO

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Claims Reported
2 138 47 13 41
1 324 100 19
4 3 1 1 25 3 16 1 112 1 95 13 5 49 1 228 62 4 472 6 1 276 8 3 22 17 24 11 11 43 1 58 1

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Insurance Companies
EXCELSIOR INSURANCE CO FAIRFIELD INSURANCE CO FARMLAND MUTUAL FCCI INSURANCE COMPANY FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FEDERATED RURAL ELECTRIC INS FFVA MUTUAL INS CO FIDELITY & DEPOSIT CO OF MD FIDELITY & GUAR UNDERWRITERS FIDELITY & GUARANTY INS CO FIRE & CASUALTY INS CO OF CT FIREMAN'S FUND INS CO FIREMAN'S FUND OF WISCONSIN FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FLORISTS INSURANCE CO FLORISTS' MUTUAL INS CO FRANKENMUTH MUTUAL INS FREMONT COMP.-IN LIQUIDATION FREMONT INDUSTRIAL IND-IN LIQ. GA INSURERS INSOLVENCY POOL GA RESTAURANT MUTUAL CAP INS C GA TIMBER HARVESTERS' GCAP MUTUAL CAPTIVE INS GENERAL INS CO OF AMERICA GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GRANGE MUTUAL CASUALTY COMPANY GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GREAT AMERICA INS CO OF NY GREAT AMERICAN ASSURANCE CO GREAT AMERICAN INS CO GREAT WEST CASUALTY CO GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALTY INS HARLEYSVILLE MUTUAL INS CO HARLEYSVILLE-ATLANTIC INS CO

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Claims Reported
2 5 2 39 36 29 4 11 20 2 27 9 26 1 2 2 3 5 3 17 1 22 4 15 4 4 85 6 2 1 7 1 10 1 4 4 17 6 8 7 9 18

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Insurance Companies
HARTFORD ACCIDENT & INDEMNITY HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF S.E. HARTFORD INS OF THE MIDWEST HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HOSPITALITY MUTUAL CAPTIVE INS INDEMNITY INS CO OF NA INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INSURANCE CORP. OF NEW YORK KEY RISK INSURANCE CO LEGION INS CO-IN LIQUIDATION LIBERTY INSURANCE CORP LIBERTY INSURANCE CORP. LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LM INSURANCE CORP LUMBERMEN'S MUTUAL CAS CO LUMBERMEN'S UNDERWRITING LYNDON PROPERTY INS MADISON INSURANCE CO MAG MUTUAL INS CO MARYLAND CASUALTY COMPANY MEDMARC CASUALTY INS MIDWEST EMPLOYERS CASUALTY CO MITSUI SUMITOMO INS CO OF AMERICA NATIONAL FARMERS UNION P & C NATIONAL FIRE INS CO HARTFORD NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE MUTUAL FIRE INS CO NETHERLANDS INSURANCE CO NEW HAMPSHIRE INSURANCE CO NORGUARD INSURANCE CO. NORTH RIVER INSURANCE CO NORTHERN INS CO OF NY OHIO CASUALTY INSURANCE CO OLD DOMINION INSURANCE CO OLD REPUBLIC INSURANCE CO

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Claims Reported
2 136
7 14 22 12 292 10 44 9 212 17 5 54 7 15 198 40 6 92 55 2 4 5 46 13 1 8 1 480 4 56 11 2 8 1 61 2 14 3 1 80

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Insurance Companies
ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PEERLESS INSURANCE COMPANY PENN LUMBERMEN'S MUTUAL PENN MFG ASSOC INS PENN MILLERS MUTUAL PENNSYLVANIA GENERAL INS CO PHOENIX INSURANCE CO PRINCETON INSURANCE CO PROVIDENCE PROPERTY & CASUALTY REALM NATIONAL INSURANCE RELIANCE INS CO IN LIQUIDATION RELIANCE NAT INS CO IN LIQ. RELIANCE NAT. IND. IN LIQ. REPUBLIC-FRANKLIN INSURANCE CO ROCHDALE INSURANCE COMPANY ROYAL & SUNALLIANCE INS. CO ROYAL INDEMNITY CO ROYAL INS CO OF AMERICA S.E. EMPLOYER MUTUAL. CAP. INS CO SAFECO INSURANCE CO AMERICA SAFEGUARD INSURANCE CO SAFETY NATIONAL CASUALTY SECURITY INS CO OF HARTFORD SELECT INSURANCE CO SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SE SELECTIVE INSURANCE CO OF SC SELECTIVE WAY INSURANCE CO SENTRY INSURANCE A MUTUAL CO SOUTHEASTERN US CAP. INS, INC SOUTHERN STATES INS EXCHANGE ST PAUL FIRE & CASUALTY INS CO ST PAUL FIRE & MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO STAR INSURANCE CO STATE AUTO PROP & CAS STATE FARM FIRE & CASUALTY CO STATE FARM GENERAL INS CO

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Claims Reported
5 9 322 5 3 2 325 1 1 26 31 3 18 6 10 8 1 6 449 5 18 44 7 2 4 5 3 9 8 6 15 36 127 1 7 68 1 3 4 3 15 1

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Claims Reported by Insurance Companies
TIG INSURANCE CO TOKIO MARINE & FIRE INS CO TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO TRANSPORTATION INSURANCE CO TRAVELERS CAS & SURETY CO TRAVELERS CAS & SURETY CO OF ILL TRAVELERS CASUALTY CO OF CT TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY CO OF IL TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMERICA TRAVELERS INSURANCE - ALT TRAVELERS INSURANCE CO TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS U.S. SPECIALTY INS. CO. UNITED BUSINESS INS CO (A MUTUAL UNITED STATES FIRE INSURANCE UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO UTICA NATIONAL ASSURANCE CO VALIANT INSURANCE CO VALLEY FORGE INSURANCE CO VANLINER INSURANCE CO VIGILANT INSURANCE CO WAUSAU BUSINESS INSURANCE WAUSAU GENERAL INS CO WAUSAU UNDERWRITERS INS CO WESTFIELD INSURANCE CO WESTPORT INSURANCE CORP XL SPECIALTY INSURANCE CO YASUDA FIRE & MAR INS OF AMERICA ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL ZURICH/AMERICAN GUARANTEE Total of Companies 241

Total

Claims Reported
15 49 36 69 5 268 1 1 1 7 741 16 47 3 40 19 48 9 7 9 19 2 2 10 198 16 1 2 12 5 22 31 6 3 20 81 632 1 10,492

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Group Self-Insured Employers
Following is a list of group self-insured employers that filed a Notice of Claim with the Subsequent Injury Trust Fund in 2003. A total of 14 group self-insured employers filed approximately 696 claims.

Claims Reported by Group Self-Insured Employers

Claims Reported

AGRITRUST OF GEORGIA ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GEORGIA CONSTRUCTION SUPPLIERS' ASSOC GA AUTO DEALERS ASSOCIATION SI GA EDUCATION WC TRUST FUND GA HOSPITAL ASSOC WCSI FUND GA MUNICIPAL ASSN WCSIF GA OILMEN'S ASSOCIATION GA OPERATORS SELF-INSURERS GA SCHOOL BD ASSOC W C FUND GEMC WORKERS' COMP FUND GTMA/AYSA SELF INSURANCE ROOFING & SHEET METAL ASSOC Total of Companies 14

6

169

51

2

18

11

71

105

135

43

47

15

19

4

Total

696

Subsequent Injury Trust Fund 2003 Annual Report

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Self-Insured Employers
Following is a list of self-insured employers that filed a Notice of Claim with the Subsequent Injury Trust Fund in 2003. A total of 298 self-insured employers filed approximately 4,364 claims.

Claims Reported by Self-Insured Employers

Claims Reported

AAA COOPER TRANSPORTATION

9

ABF FREIGHT SYSTEM, INC

2

ACUITY BRANDS

22

AGL RESOURCES, INC.

5

ALBANY, CITY OF

4

ALLIED SYSTEMS LTD

2

ALPHARETTA, CITY OF

1

ANHEUSER-BUSCH COMPANIES, INC.

1

ARCHBOLD MEDICAL CENTER

4

ARCHDIOCESES OF ATLANTA

3

ARCHER-DANIELS-MIDLAND CO

1

ASPLUNDH TREE EXPERT CO

4

ATHENS REG. HEALTH SYS INC

24

ATHENS-CLARKE COUNTY

5

ATLANTA BOARD OF EDUCATION

7

AUGUSTA-RICHMOND CO BD COMM

3

AUTOZONE, INC

4

AVERITT EXPRESS, INC

4

BANKHEAD SERVICES, INC

2

BARTOW COUNTY BD OF EDUCATION

5

BEAULIEU OF AMERICA

6

BELLSOUTH CORPORATION

8

BENTON-GEORGIA INC

3

BERRY COLLEGE

1

BIBB COUNTY BD-COMMISSION

14

BIBB COUNTY BOARD OF EDUCATION

1

BJ'S WHOLESALE CLUB INC

6

BLACK & DECKER CORPORATION

2

BLOSSMAN COMPANIES, INC

2

BLUE BIRD BODY COMPANY

47

BRUNSWICK, CITY OF

7

BURLEN CORPORATION

2

C T HARRIS INC

2

C. W. MATTHEWS CONTRACTING INC

2

CAGLE'S INC, & SUBSIDIARIES

5

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Self-Insured Employers
CALFEE COMPANY OF DALTON, INC CANDLER HEALTH SYSTEM CARROLL CO. BOARD OF EDUCATION CATOOSA CO. BD. OF EDUCATION CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHILDREN'S HEALTHCARE OF ATL CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS CLAYTON COUNTY WATER AUTHORITY COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLONIAL PIPELINE COMPANY COLQUITT CO BD OF EDUCATION COLUMBIA COUNTY BOE COLUMBUS CITY OF COLUMBUS FOUNDRIES INC COLUMBUS REGIONAL HEALTHCARE COLUMBUS WATER WORKS CONAGRA FOODS, INC CONTI GROUP COMPANIES, INC CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER COSTCO WHOLESALE CORP. COTTRELL INC COVINGTON, CITY OF COWETA CO BOARD OF EDUCATION CRACKER BARREL OLD CNTRY STORE CRAWFORD & COMPANY CRISP COUNTY BD OF EDUCATION DALTON CITY OF DEAN FOODS COMPANY DECATUR, CITY OF

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Claims Reported
1 14 4 4 25 2 21 5 1 1 32 33 14 127 132 2 24 13 15 25 2 3 3 1 4 24 2 9 5 4 6 10 3 1 2 14 26 8 4 1 1 4

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Self-Insured Employers
DEKALB COUNTY BOARD-ED DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HEALTHCARE SYS DELHAIZE AMERICA INC. DELPHI AUTOMOTIVE SYS INC. DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOLLAR GENERAL CORP DOUGHERTY COUNTY BOC DOUGLAS ASPHALT COMPANY DOUGLAS CO BD OF COMMISSIONERS DOUGLAS COUNTY SCHOOLS DOUGLAS, CITY OF DOUGLASVILLE-DOUGLAS COUNTY DSM CHEMICALS N. AMERICA DULUTH, CITY OF E I DUPONT DE NEMOURS & CO EAST POINT, CITY OF ELBERTA CRATE & BOX COMPANY ELBERTON GRANITE ASSOCIATION ELBERTON, CITY OF EMORY CLINIC, INC., EMORY UNIVERSITY ENGELHARD CORPORATION EQUITY GROUP GA DIVISION ESTES EXPRESS LINES EVENFLO COMPANY INC FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FEDERATED DEPARTMENT STORES FIELDALE FARMS CORPORATION FLEETWOOD HOMES OF GA INC FLEXSTEEL INDUSTRIES INC FLOWERS INDUSTRIES INC FLOYD CO. BD. OF COMMISSIONERS FLOYD COUNTY BD OF EDUCATION FLOYD HEALTHCARE MGMT INC FLYING J, INC. FORD MOTOR COMPANY FOREST PARK, CITY OF FORSYTH CO. BD. OF EDUCATION FREUDENBERG-NOK

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Claims Reported
15 47 2 5 1 367 4 3 13 10 27 4 4 2 2 2 1 10 5 2 4 8 118 3 7 3 2 13 31 6 21 3 4 5 3 2 3 2 11 1 15 14

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Self-Insured Employers
FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHORITY GA S.I. GUARANTY TRUST FUND GANNETT CO. INC & SUBSIDIARIES GENERAL MOTORS CORPORATION GEORGIA DUCK & CORDAGE MILL GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GLYNN COUNTY BOARD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GREAT DANE LTD PARTNERSHIP GRIFFIN-SPALDING SCHOOLS 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 HAPEVILLE CITY OF HARRISON POULTRY, INC HAVERTYS FURNITURE HEALTHMASTER, INC HENRY CO BOARD OF EDUCATION HERSCHEND FAMILY ENTERTAINMENT HILLCREST FOODS, INC HON INDUSTRIES, INC. HORMEL FOODS CORP HORTON HOMES, INC HOUSTON COUNTY BD OF EDUCATION HOUSTON COUNTY COMMISSIONERS HOWARD SHEPPARD INC HUTCHESON MEDICAL CENTER HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION INGLES MARKETS INC INTERFACE, INC INTERNATIONAL PAPER COMPANY J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC.

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Claims Reported
7 22 14 1 2 232 3 679 13 27 10 8 11 6 8 30 19 6 9 4 1 1 3 1 31 5 4 3 20 8 3 1 7 11 5 6 104 2 10 1 1 30

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Self-Insured Employers
JOHN WIELAND HOMES, INC JONES COMPANY (THE) K & F INDUSTRIES KEEBLER COMPANY KERR-MCGEE PIGMENTS (SAV) INC. KLEEN-TEX INDUSTRIES K-MART CORP-IN BANKRUPTCY KROGER COMPANY, THE LABOR READY SE III LP LANGDALE INDUSTRIES LAWRENCEVILLE, CITY OF LEVI STRAUSS & CO LIBERTY NATIONAL LIFE INS CO LIMITED, INC., THE LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC MACON CITY OF MARIETTA CITY SERVICES MAR-JAC POULTRY, INC. MARRIOTT INTERNATIONAL, INC. MARTA MCDONALD'S OF GEORGIA INC MCLANE COMPANY, INC. MEAD WESTVACO MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC MILLEDGEVILLE, CITY OF MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC MONROE, CITY OF MOUNT VERNON MILLS MULLITE CO OF AMERICA MUSCOGEE COUNTY SCHOOL DIST NABISCO, INC NATIONAL SERVICES INDUSTRIES NEWTON COUNTY NO COVERAGE NORDSON CORPORATION NORMAN W FRIES/CLAXTON POULTRY NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL

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Claims Reported
7 41 4 10 1 4 18 42 3 5 3 4 2 2 1 1 59 34 14 5 25 28 2 9 1 6 2 1 2 100 8 5 1 5 1 3 1 5 1 6 4 21

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Self-Insured Employers
OLD DOMINION FREIGHT LINES INC OVERNITE TRANSPORTATION CO OWENS-CORNING FIBERGLASS OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORPORATION PCC AIRFOILS LLC PEPSICO, INC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL PIEDMONT LABORATORIES, INC PIGGLY WIGGLY CAROLINA CO INC PPG INDUSTRIES INC. PRESBYTERIAN HOMES OF GA QUITRIP RACETRAC PETROLEUM, INC RANDOLPH COUNTY HOSP AUTHORITY RIVERDALE, CITY OF RMC INDUSTRIES ROCKDALE CO. BD OF EDUCATION ROCKWELL AUTOMATION, INC ROLLINS INC ROPER CORPORATION ROSWELL CITY OF RTM, INC. RYAN'S FAMILY STEAK HOUSES RYDER SYSTEMS INC SAINT JOSEPH'S OF SAVANNAH SATILLA HEALTH SERVICES INC SAVANNAH CITY OF SHAW INDUSTRIES INC SHERWIN-WILLIAMS COMPANY SHONEY'S INC SI CORPORATION SIX CONTINENTS HOTELS, INC SIZEMORE ,INC. SNELL CONTRACTORS SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GA HEALTH SYSTEMS SOUTHEAST-ATLANTIC BEVERAGE SOUTHEASTERN FREIGHT LINES SOUTHERN COMPANY

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Claims Reported
8 6 1 13 8 1 2 1 3 1 1 13 1 4 1 1 2 2 10 7 4 1 7 4 7 13 3 4 4 28 68 4 1 22 3 7 1 5 5 1 16 39

Subsequent Injury Trust Fund 2003 Annual Report
Claims Reported by Self-Insured Employers
SOUTHERN MILLS INC SOUTHERN NUCLEAR OPERATING CO SOUTHERN PAN SERVICES SOUTHERN REGIONAL HEALTH SYS. SOUTHWIRE COMPANY SPALDING CO BOARD OF COMM SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL ST JOSEPH HOSPITAL/AUGUSTA STAFFMARK, INC. STONE CONTAINER CORPORATION SUTHERLAND'S FOODSERVICE, INC. SYNTHETIC INDUSTRIES, INC TALON EQUITIES, INC TANNER HEALTH SERVICES TARGET CORPORATION TECUMSEH PRODUCTS COMPANY TENNECO AUTOMOTIVE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS THOMASVILLE CITY OF TIFTON ALUMINUM CO INC/ALCOA I TROUP CO. BOARD OF EDUCATION TYSON FOODS INC UNILEVER UNITED STATES UNITED CATALYSTS, INC UNIVERSITY HOSPITAL USF HOLLAND, INC. VALDOSTA CITY OF VISITING NURSE HEALTH SYSTEM WACHOVIA WAFFLE HOUSE WALKER COUNTY BD OF EDUCATION WALTON CO BOARD OF ED WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WARREN SEWELL MFG. CO. WATKINS ASSOCIATED INDUSTRIES WAYCROSS MOLDED PRODUCTS INC WAYCROSS, CITY OF WCI OUTDOOR PRODUCTS INC

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Claims Reported
2 1 1 3 1 3 25 15 4 2 7 1 5 1 10 34 5 1 3 4 11 1 1 2 30 2 1 11 7 28 13 3 77 8 3 8 4 2 5 1 2 1

Subsequent Injury Trust Fund 2003 Annual Report

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Claims Reported by Self-Insured Employers
WELLINGTON LEISURE PRODUCTS WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYSTEM WEST POINT STEVENS, INC WEYERHAEUSER COMPANY WHITFIELD COUNTY BD OF COMMISS WHITFIELD COUNTY BOE WINN-DIXIE STORES INC YELLOW FREIGHT SYSTEM INC YKK CORPORATION OF AMERICA Total of Companies 298

Claims Reported

Total

1 33 3 2 2 8 1 6 85 16 2 4,364

Subsequent Injury Trust Fund 2003 Annual Report

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REIMBURSEMENTS PAID

Insurance Companies
Following is a list of insurance companies that were reimbursed by the Subsequent Injury Trust Fund in calendar year 2003. A total of 194 insurance companies were reimbursed a combined total of $47,955,217.97.

Reimbursements Paid to Insurance Companies

$ Amount

ACE AMERICAN INSURANCE CO ACE PROPERTY & CASUALTY INS AIU INSURANCE CO ALFA INSURANCE CORP ALLIED INSURANCE COMPANY ALLSTATE INSURANCE CO AMERICAN ALTERNATIVE INS AMERICAN AUTOMOBILE INS CO AMERICAN CAS CO OF READING PA AMERICAN ECONOMY INS CO AMERICAN HOME ASSURANCE CO AMERICAN INSURANCE CO AMERICAN INTER INS CO OF GA AMERICAN INTERN. SOUTH INS CO AMERICAN INTERNATIONAL INS CO AMERICAN MFG. MUTUAL INS AMERICAN MOTORISTS INS CO AMERICAN PROTECTION INS CO AMERICAN RESOURCES INS CO AMERICAN SAFETY CASUALTY INS AMERICAN STATES INS CO AMERICAN STATES INS CO OF TX 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 CANAL INSURANCE CO CAPITAL CITY INS CO CASUALTY RECIPROCAL EXCHANGE

117,559.15 52,154.05
499,083.50 48,650.15 2,054.41
100,856.45 131,341.62 105,446.72 298,347.25
4,383.48 597,821.47 288,268.32
66,374.32 61,534.90 28,787.68 398,922.59 149,896.24 170,028.84 36,313.85 157,389.80 23,659.32 40,222.93 186,657.71 62,459.34 55,984.01 117,343.70 362,201.65 108,708.92 163,783.58 1,296,520.25 938,219.28 223,633.46 49,522.49

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Insurance Companies
CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO 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 COMBINED SPECIALTY 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 CYPRESS INSURANCE CO DEERFIELD INSURANCE CO DISCOVER PROPERTY & CAS ELECTRIC INSURANCE CO ELECTRIC MUTUAL LIAB INS LTD EMC PROPERTY & CASUALTY EMPLOYERS INS OF WAUSAU FARMINGTON CASUALTY CO FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FFVA MUTUAL INS CO FIDELITY & CAS CO OF NY FIDELITY & GUARANTY INS CO FIREMAN'S FUND INS CO FIREMAN'S FUND INS CO OF GA FIREMAN'S FUND INS OF GA FIRST NATIONAL INS CO OF AMERICA FLORISTS' MUTUAL INS CO FRONTIER INS CO-IN REHAB. GA INSURERS INSOLVENCY POOL GA TIMBER HARVESTERS' GCAP MUTUAL CAPTIVE INS GENERAL ACCIDENT INS OF AMERICA GENERAL INS CO OF AMERICA

Page 20
$ Amount
199,893.22 14,226.52
344,838.45 163,628.34
215.77 87,838.36 520,969.82 307,548.78 242,047.73 22,607.43 14,381.21 17,325.00 391,855.35 98,397.61 300,627.16 1,420,071.48 98,739.63 153,156.94 17,582.15 281,996.56 38,422.46 310,130.05 21,471.67 44,712.29 1,715,851.04
6,262.74 116,112.09 724,018.38 197,356.73
15,008.25 283,501.22 368,017.14 171,447.61 120,116.57
34,583.78 18,085.83
5,566.53 1,491,007.26
30,366.39 19,337.20 298,521.37 52,296.76

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Insurance Companies
GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GLENS FALLS INS CO GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN INS CO GREAT WEST CASUALTY CO GROCERS INSURANCE CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALTY INS HARLEYSVILLE MUTUAL INS CO HARLEYSVILLE-ATLANTIC INS CO HARTFORD ACCIDENT & INDEMNITY HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF S.E. HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HIGHLANDS INS CO HOME INS. CO-IN LIQUIDATION HOUSTON GENERAL INS CO INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INTERNATIONAL IND-LIQUIDATION INTERNATIONAL INSURANCE CO JEFFERSON PILOT FIN INS CO KEY RISK INSURANCE CO LEGION INS CO-IN LIQUIDATION LIBERTY INSURANCE CORP LIBERTY INSURANCE CORP. LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LM INSURANCE CORP LUMBER MUTUAL INSURANCE CO LUMBERMEN'S MUTUAL CAS CO LUMBERMEN'S UNDERWRITING MANAGEDCARE MUTUAL CAPTIVE INS MARYLAND CASUALTY COMPANY MASSACHUSETTS BAY INSURANCE CO MITSUI SUMITOMO INS CO OF AMERICA MONUMENTAL GENERAL CAS

Page 21
$ Amount
585,102.64 61,483.48 33,222.17 30,354.36 19,738.31
297,068.97 247,937.81
35,852.76 26,771.78 80,701.76 59,319.88 68,085.12 31,224.71 593,355.79 692,151.12 292,790.99 12,485.72 353,190.27 12,249.74 114,376.68 670,229.08 242,188.50 35,539.88 1,212,268.09 19,682.53
146.62 225,758.75
16,591.91 322,281.39 148,585.91 152,400.00 589,758.85 2,040,885.90 146,545.52
5,613.80 448,092.57 1,094,470.84 1,245,077.19 338,259.25
11,725.00 76,302.59 137,387.57

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Insurance Companies
NATIONAL AMERICAN INSURANCE CO NATIONAL FIRE INS CO HARTFORD NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY & CAS INS NEW HAMPSHIRE INSURANCE CO NORTH AMERICAN SPECIALTY INS NORTHBROOK PROP & CAS INS CO OCCIDENTAL FIRE & CAS CO OF NC OHIO CASUALTY INSURANCE CO OHIO FARMERS INS CO OLD REPUBLIC INSURANCE CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO ONEBEACON MIDWEST INS CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PATRIOT GENERAL INSURANCE CO PENN MFG ASSOC INS PENN MFG IND. CO PENN MILLERS MUTUAL PENN NATIONAL MUTUAL CAS PHOENIX INSURANCE CO PRINCETON INSURANCE CO REALM NATIONAL INSURANCE REDLAND INSURANCE CO REPUBLIC-FRANKLIN INSURANCE CO ROYAL & SUNALLIANCE INS. CO ROYAL INS CO OF AMERICA S.E. EMPLOYER MUTUAL CAP. INS CO SAFECO INSURANCE CO AMERICA SECURITY INS CO OF HARTFORD SELECT INSURANCE CO SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SE SELECTIVE INSURANCE CO OF SC SENTRY INSURANCE A MUTUAL CO SOUTH CAROLINA INSURANCE CO SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INSURANCE CO

Page 22
$ Amount
115,436.38 217,444.44
58,606.81 144,827.68 193,993.42
20,156.87 4,403.68
13,415.33 29,164.01 72,215.78 11,205.00
3,462.32 1,364.00 663,522.14 314,488.98 4,057.39 35,347.41 899,830.41 129,162.85 2,906.04 126,610.73 55,359.15 97,297.12 197,554.10 28,502.02 180,608.68 291,692.71 106,457.29 22,820.08 646,477.86 346,005.00 277,480.95 424,719.07 214,535.46 24,844.60 110,451.45 50,471.14 136,168.44 178,217.36 28,206.52 66,594.66 35,541.49

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Insurance Companies
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 STATE FARM GENERAL INS CO TIG INSURANCE CO TIG PREMIER INSURANCE CO TOKIO MARINE & FIRE INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO TRANSPORTATION INSURANCE CO TRAVELERS CAS & SURETY CO TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY CO OF IL TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMERICA TRAVELERS INSURANCE CO TRAVELERS PROP & CAS INS CO TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS UNISUN INSURANCE COMPANY 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 YASUDA FIRE & MAR INS OF AMERICA ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Grand Total:

Page 23
$ Amount
2,093.99 26,109.90 606,328.59 11,398.61 171,586.47 13,138.80 168,099.41 27,362.04 159,928.60 19,430.36 113,029.42 955,382.89
440.00 1,731,294.55
951,846.56 105,078.77 878,011.97
93,060.70 129,098.57 1,415,179.71 288,298.75
30,590.59 79,806.73
7,733.62 13,455.90 97,921.35 22,197.26 235,786.71 20,304.30 166,710.86 110,980.48 96,718.07
7,873.22 967,978.38 1,097,806.92 $47,955,217.97

Subsequent Injury Trust Fund 2003 Annual Report

Page 24

Group Self-Insured Employers
Following is a list of group self-insured employers that were reimbursed by the Subsequent Injury Trust Fund in calendar year 2003. A total of 22 group self-insured employers were reimbursed a combined total of $6,371,260.00.

Reimbursements Paid to Group Self-Insured Employers

$ Amount

AGRITRUST OF GEORGIA AMERICAN APPAREL CONT. ASSOC ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GEORGIA CONDITIONED AIR ASSOCIATION GA CONSTRUCTION SUPPLIERS' ASSOC 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 OILMEN'S ASSOCIATION GA OPERATORS SELF-INSURERS GA RETAIL MERCHANTS' GA SCHOOL BD ASSOC W C FUND GA WHOLESALE & RETAIL WC FUND GEMC WORKERS' COMP FUND ROOFING & SHEET METAL ASSOC SOUTHEASTERN LUMBER MFR ASSOC W. C. FUND FOR HEALTH CARE Grand Total:

82,679.67 88,096.10 1,406,320.44 192,634.29 71,314.70 183,311.63 207,980.22 39,764.27 421,076.89 77,173.12 1,167,336.92 97,744.37 1,121,952.63 242,841.24 177,476.26 12,694.80 202,677.29 36,281.40 446,749.46 11,096.30
6,711.70 77,346.30 $6,371,260.00

Subsequent Injury Trust Fund 2003 Annual Report

Page 25

Self-Insured Employers
Following is a list of self-insured employers that were reimbursed by the Subsequent Injury Trust Fund in calendar year 2003. A total of 259 self-insured employers were reimbursed a combined total of $34,732,418.89.

Reimbursements Paid to Self-Insured Employers

$ Amount

AAA COOPER TRANSPORTATION AGL RESOURCES, INC. ALBANY, CITY OF ALLIED SYSTEMS LTD ALPHARETTA, CITY OF ANSON AGGREGATES ARCHBOLD MEDICAL CENTER ARCHER-DANIELS-MIDLAND CO ARMSTRONG WORLD INDUSTRIES INC ATHENS REG. HEALTH SYS INC ATHENS-CLARKE COUNTY ATLANTA BOARD OF EDUCATION ATLANTA CITY OF ATLANTIC STEEL INDUSTRIES INC AVERITT EXPRESS, INC AVONDALE MILLS INC BANKHEAD SERVICES, INC BARTOW COUNTY BD OF EDUCATION BAYLINER MARINE CORPORATION BEAULIEU OF AMERICA BELLSOUTH CORPORATION BELLSOUTH ENTERPRISES INC BENTON-GEORGIA INC BERRY COLLEGE BLUE BIRD BODY COMPANY BLUE CIRCLE AMERICA BRUNO'S INC & SUBSIDIARIES C T HARRIS INC C. W. MATTHEWS CONTRACTING INC CAGLE'S INC, & SUBSIDIARIES CALDWELL TANKS ALLIANCE, INC. CANDLER HEALTH SYSTEM CAREMORE INC CARROLL CO. BOARD OF EDUCATION CATOOSA CO. BD. OF EDUCATION CEMEX (SOUTHDOWN INC.)

8,928.07 122,258.17 299,134.92
22,775.00 24.61
21,150.00 87,194.31 98,650.00
7,475.00 137,483.88
56,700.56 252,883.73 315,946.03
16,225.00 135,573.11
13,477.00 70,564.47 40,105.55
3,374.29 1,558,729.15
243,507.91 18,306.44 14,193.57
231,425.27 239,182.87 367,084.67 187,821.44
21,578.19 136,991.44
28,105.00 25,329.53 16,435.54
656.60 50,076.98 226,850.91 16,450.00

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Self-Insured Employers
CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CERULEAN COMPANIES INC. CHAMPION INTERNATIONAL CORP CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHILDREN'S HEALTHCARE OF ATL CITIGROUP INC. CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS COACHMAN REC. VEHICLE CO OF GA COATS & CLARK, INC. COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLLINS & AIKMAN FLOORCOVERING COLUMBIA COUNTY BOE COLUMBUS CITY OF COLUMBUS FOUNDRIES INC CONAGRA FOODS, INC CONOCO INC CONTI GROUP COMPANIES, INC CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER COX ENTERPRISES INC CRACKER BARREL OLD CNTRY STORE CRAWFORD W LONG MEM HOSPITAL CRIDER'S POULTRY INC DALTON CITY OF DAN RIVER, INC. DEKALB COUNTY BOARD-ED DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HEALTHCARE SYS DELHAIZE AMERICA INC. DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOREL JUVENILE GRP (COSCO, INC

Page 26
$ Amount
36,089.68 42,084.88
10.33 18,561.04 179,489.56 39,844.63
6,670.49 13,271.60 55,657.62 174,938.55 14,716.26 15,581.24 147,561.23 34,205.72 28,684.04 302,756.71 259,240.42 24,294.69 351,176.97
7,742.14 37,820.43 29,432.30 195,834.39 308,212.63
5,066.71 2,737.84 374,464.94 92,149.21 16,566.15 101,917.26 57,192.49 2,084.79 8,592.52 79,935.13 131,683.54 103,588.20 372,386.02 132,660.60 19,507.76 539,337.36 61,947.17 65,826.30

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Self-Insured Employers
DOUGHERTY COUNTY BOC DOUGLAS CO BD OF COMMISSIONERS DOUGLAS, CITY OF DRY BRANCH KAOLIN COMPANY E I DUPONT DE NEMOURS & CO EAST POINT, CITY OF EATON CORPORATION ELBERTON GRANITE ASSOCIATION EMERSON ELECTRIC CO EMORY CLINIC, INC., EMORY UNIVERSITY ENGELHARD CORPORATION ESTES EXPRESS LINES FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FIELDALE FARMS CORPORATION FIELDCREST CANNON INC FLEETWOOD HOMES OF GA INC FLEXSTEEL INDUSTRIES INC FLOWERS INDUSTRIES INC FORD MOTOR COMPANY FORSYTH CO BD OF COMMISSIONERS FRIGIDAIRE CO MICROWAVE PRODS. FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHORITY GA BAPTIST HEALTH CARE SYSTEM GA S.I. GUARANTY TRUST FUND GENERAL MOTORS CORPORATION GENUINE PARTS COMPANY GEORGIA DUCK & CORDAGE MILL GEORGIA KRAFT CO GEORGIA POWER CO GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GOLD KIST INC GREAT DANE LTD PARTNERSHIP GULFSTREAM AEROSPACE CORP GWINNETT CO BD OF EDUCATION GWINNETT COUNTY BD OF COMMISS

Page 27
$ Amount
55,325.28 37,736.51 87,612.76 19,438.29
9,450.00 59.00
77,250.00 44,707.85 121,425.16 36,053.35 758,577.18 21,325.15 50,276.09 100,478.69
9,432.68 208,057.34 217,778.46
22,213.92 350,409.90
25,764.78 12,452.19 299,916.18 44,874.69 48,278.28 188,880.40 172,342.17 50,273.95 129,425.67 208,260.50 197,876.08
9,769.92 54,808.59 40,921.58 157,728.39 8,155,562.74 112,064.61 49,190.02 53,305.93 214,352.00 44,541.59
8,308.49 240,487.45

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Self-Insured Employers
GWINNETT HOSPITAL SYSTEM HALL COUNTY BOARD OF EDUCATION HAMILTON HEALTH CARE SYSTEM HCA, INC. HENRY CO BOARD OF EDUCATION HERCULES INCORPORATED HORMEL FOODS CORP HORTON HOMES, INC HOSPITAL AUTHORITY HOUSTON CTY HOUSTON COUNTY BD OF EDUCATION HOWARD SHEPPARD INC HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION ILLINOIS TOOL WORKS INC INGLES MARKETS INC INTERNATIONAL PAPER COMPANY J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JONES COMPANY K & F INDUSTRIES KEEBLER COMPANY KENNESTONE REGIONAL HEALTH KERR-MCGEE PIGMENTS (SAV) INC. KLEEN-TEX INDUSTRIES K-MART CORP-IN BANKRUPTCY KROGER COMPANY, THE LINDALE MANUFACTURING INC LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC LOXCREEN COMPANY, INC. LUCENT TECHNOLOGIES INC. MACON CITY OF MARIETTA CITY SERVICES MARRIOTT INTERNATIONAL, INC. MARTA MCKENZIE TANK LINES INC MCLANE COMPANY, INC. MEAD CORPORATION MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC

Page 28
$ Amount
20,145.21 153,504.51 121,521.86
16,203.39 132,069.86
986.27 17,127.95 200,816.47 35,306.33 23,240.54
1,017.84 27,597.84 53,463.02
16.48 107,240.32
88,431.89 31,914.43 197,637.67 279,470.63 19,512.35
6,654.34 472,952.56
39,219.13 16.95
49,926.15 372,111.85
66,166.30 223,126.53
13,035.00 52,172.37 355,965.08
2,181.11 54.20
74,797.61 104,784.56
49,350.78 411,869.33
45.00 2,159.37 38,562.70 1,531.18 16,425.23

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Self-Insured Employers
MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC MOUNT VERNON MILLS MULLITE CO OF AMERICA MURRAY COUNTY BD OF EDUCATION MUSCOGEE COUNTY SCHOOL DIST NABISCO, INC NATIONAL SERVICES INDUSTRIES NORDSON CORPORATION NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OLIVER RUBBER CO OVERNITE TRANSPORTATION CO OWENS-CORNING FIBERGLASS OXFORD CONSTRUCTION CO PARKER HANNIFIN CORPORATION PATTERSON PUMP COMPANY PCC AIRFOILS LLC PEPSICO, INC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL PIGGLY WIGGLY CAROLINA CO INC PIKE ELECTRIC, INC. PRINTPACK, INC QUEEN CARPET CORPORATION RACETRAC PETROLEUM, INC RALSTON PURINA COMPANY RICHMOND COUNTY BD OF COMMISSIONERS ROCKWELL AUTOMATION, INC ROLLINS INC ROME, CITY OF RTM, INC. RYDER SYSTEMS INC SAINT JOSEPH'S HEALTH SYSTEM SAINT JOSEPH'S OF SAVANNAH SAINT MARY'S HEALTH CARE SATILLA HEALTH SERVICES INC SAVANNAH CITY OF SCIENTIFIC-ATLANTA INC SEARS, ROEBUCK & CO SHAW INDUSTRIES INC SHERWIN-WILLIAMS COMPANY

Page 29
$ Amount
58,925.94 1,299,941.76
323,147.49 19,142.13 16,705.07 10,731.80 88,880.86
182,753.82 4,089.58
84,432.51 310,167.71
12,958.73 21,490.46 14,779.98
90.00 13,607.75
1,291.79 160,200.50
38,417.94 85,179.07 30,846.44 57,734.32 42,264.40
534.10 37,306.14
1,500.74 52,009.11 15,837.52 20,475.00 107,760.75 341,089.58
17.33 7,013.29 29,038.08 28,538.70 45,336.73 243,248.18 56,816.57 217,000.83 7,590.00 561,331.34 197,870.06

Subsequent Injury Trust Fund 2003 Annual Report
Reimbursements Paid to Self-Insured Employers
SHONEY'S INC SI CORPORATION SIX CONTINENTS HOTELS, INC SNELL CONTRACTORS SOUTHEAST GA HEALTH SYSTEMS SOUTHEASTERN FREIGHT LINES SOUTHEASTERN MILLS, INC SOUTHERN BELL TEL & TEL SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN NUCLEAR OPERATING CO SOUTHERN REGIONAL HEALTH SYS. SOUTHWIRE COMPANY SPALDING & EVENFLO COMPANIES SPARTAN MILLS SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL SUPERIOR RIGGING & ERECTING CO SYNTHETIC INDUSTRIES, INC T. M. POLYFILM, INC TANNER HEALTH SERVICES TARGET CORPORATION TECUMSEH PRODUCTS COMPANY TENNECO AUTOMOTIVE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS TIFT GENERAL HOSPITAL TIFTON ALUMINUM CO INC/ALCOA I TRANSUS, INC. TYSON FOODS INC UNION CAMP CORPORATION UNITED HEALTH SERVICES INC UNIVERSITY HOSPITAL US GYPSUM/L & W SUPPLY & SUBS VALDOSTA CITY OF VF CORPORATION VISITING NURSE HEALTH SYSTEM VULCAN MATERIALS COMPANY WAFFLE HOUSE WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF

Page 30
$ Amount
4,713.16 79,396.04
1,519.48 28,578.32 115,675.07
508.88 6,528.88 24,133.07 120,931.36 81,411.38 3,510.27 29,869.31 186,493.40 6,709.45 28,286.50 3,466.72 110,748.02 9,900.00 157,651.94 83,676.18 183,579.58 17,780.29 25,138.16 311,600.52 42,430.62 140,934.57 63,403.56 16,068.00 99,056.87 9,075.00 89,325.55 186,299.40 3,657.56 69,316.90
553.53 81,773.07
1,406.15 27,661.97
8,829.00 40,441.52 54,537.21 29,333.60

Subsequent Injury Trust Fund 2003 Annual Report

Page 31

Reimbursements Paid to Self-Insured Employers
WARREN SEWELL MFG. CO. WATKINS ASSOCIATED INDUSTRIES WAYCROSS, CITY OF WELLINGTON LEISURE PRODUCTS WELLSTAR HEALTH SYSTEM WESLEY HOMES, INC WEST GEORGIA HEALTH SYSTEM WEST POINT STEVENS, INC WESTVACO CORPORATION & SUBS WEYERHAEUSER COMPANY WINN-DIXIE STORES INC YELLOW FREIGHT SYSTEM INC ZARTIC INC Grand Total:

$ Amount
188,173.77 11,133.78
223,862.44 26,451.77 92,479.35 704.91 49,175.14 47,759.46
107,425.00 42,592.88
239,938.82 41,007.75 16,212.91
$34,732,418.89

Subsequent Injury Trust Fund 2003 Annual Report

Page 32

Individual Employers
An employer, regardless of whether or not it is subject to the Americans with Disabilities Act, is protected from excess liability for disability and medical expenses through reimbursement from the fund.

When the fund accepts a claim for reimbursement, and the employer returns the injured employee to work, the same employer does not face new deductibles if the employee has a new on-the-job injury.

Additionally, the fund supports insured employers by helping keep workers' compensation premiums under control.

The following is a list of more than 1,360 individual employers on behalf of whom the Subsequent Injury Trust Fund made reimbursement payments to insurance companies. These reimbursements totaled $47,954,772.37.

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

A & B PAINTING SERVICE

LAWRENCEVILLE

GA

A & E MECHANICAL CONTRACTORS LAWRENCEVILLE

GA

A.A. FRIEDMAN, INC.

AUGUSTA

GA

A.B. DICK CO

MARIETTA

GA

A.M. BRASWELL JR. FOOD

STATESBORO

GA

A.O.K. HEATING & COOLING

MCDONOUGH

GA

A.W. HUTCHINSON & ASSOC.

ATLANTA

GA

AAA ASPHALT PRODUCTS, INC.

BRYON

GA

AAA CONCRETE PRODUCTS, INC. ALBANY

GA

AAA COOPER TRANSPORTATION

DOTHAN

AL

AACTION AUTO PARTS

SAVANNAH

GA

ABB DAIMLER-BENZ TRANS.

ATLANTA

GA

ABB OVERHEAD DISTRIBUTION

ATHENS

GA

ABB SERVICE INC

NORCROSS

GA

ABC SCHOOL SUPPLY

DULUTH

GA

ABRAMS FIXTURE CORP.

ATLANTA

GA

ACOUSTI, INC.

ATLANTA

GA

ACTION BLUE PRINT CO.

ATLANTA

GA

ACTION ELECTRIC COMPANY, INC. SMYRNA

GA

ACTION GROUP, INC.

FOREST PARK

GA

ADA MAINTENANCE & CONST.

PASADENA

TX

ADC SYSTEMS INTEGRATION

CHICKAMAUGA

GA

ADCOX SERVICE CO. INC

LAKE CITY

GA

ADDISON STEEL

ALBANY

GA

ADMINISTRATION MANAGERS, INC. WARNER ROBINS

GA

ADVANCE AUTO PARTS

DOUGLASVILLE

GA

ADVANCED ELECTRICAL

POWDER

GA

Total $ Reimbursed
8,958.32 6,750.00 14,523.53 18,370.05 7,943.79 2,257.50 1,678.05 7,568.37 3,143.75 4,500.00 19,682.53 4,676.50 76,990.20 43,907.19 2,566.65 2,786.47 34,940.85 22,197.26 15,562.97 13,546.00 167,640.30 29,184.89 24,989.40 18,270.38 42,216.98 76,466.42 9,340.11

Subsequent Injury Trust Fund 2003 Annual Report

Page 33

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

ADVENTIST HEALTH SYSTEM

CALHOUN

GA

AE GOETZE - LAGRANGE

LAGRANGE

GA

AEC ELECTRIC

THOMASVILLE

GA

AFC/CHURCH'S

ATLANTA

GA

AGL PROPANE

SUMMERVILLE

GA

AIM HEALTHCARE SERVICES

BRENTWOOD

TN

AIR CANADA

ATLANTA

GA

AIR CONDITIONING CORP.

EAST POINT

GA

AIR PRODUCTS & CHEMICALS

CONYERS

GA

AIRGAS, INC

AUGUSTA

GA

AKZO NOBEL COATINGS, INC.

BAXLEY

GA

ALBANY BEVERAGE CO

ALBANY

GA

ALBANY UROLOGY CLINIC, P.C.

ALBANY

GA

ALCON ASSOCIATES, INC.

ALBANY

GA

ALDEAN DUKES LOGGING INC

VALDOSTA

GA

ALEX FOODS INC

ATLANTA

GA

ALEXANDER & ALEXANDER SVC

ATLANTA

GA

ALFRED MCCANNON WELL

COMER

GA

ALL AMERICAN QUALITY FOODS

STOCKBRIDGE

GA

ALL SOUTH SUPPLY

CARTERSVILLE

GA

ALLEN TERMITE & PEST CONTROL BRUNSWICK

GA

ALLIED FOODS, LLC

ATLANTA

GA

ALLIED WHEELER CORP.

DOUGLASVILLE

GA

ALLISON SMITH CO.

ATLANTA

GA

ALLTELL GEORGIA COMM.

CORNELIA

GA

ALPHA FLOOR COVERING, INC.

ALPHARETTA

GA

ALPHA PRODUCTS, INC.

ATLANTA

GA

AMERCORD, INC.

LUMBER CITY

GA

AMERICAL CORPORATION

CARROLLTON

GA

AMERICAN COMMERCIAL

ADEL

GA

AMERICAN EGG PRODUCTS

BLACKSHEAR

GA

AMERICAN EXCELSIOR CO. INC.

GRIFFIN

GA

AMERICAN EXTRUSIONS

DALTON

GA

AMERICAN FOOD GROUP

GREEN BAY

WI

AMERICAN LANDMARK FENCE

MABLETON

GA

AMERICAN NATIONAL CAN

FOREST PARK

GA

AMERICAN RAILROAD IND

ATLANTA

GA

AMERICAN SECURITY INSURANCE ATLANTA

GA

AMERICAN VENDING CO., INC.

EAST POINT

GA

AMERISOURCE DISTRIBUTION

ORLANDO

FL

AMERSON COMPANY

MACON

GA

AMF BAKERY SYSTEMS

RICHMOND

VA

AMI SPALDING REGIONAL

GRIFFIN

GA

ANCHOR GLASS CONTAINER

WARNER ROBINS

GA

ANDERSON & ASSOCIATES

ALBANY

GA

Total $ Reimbursed
503.52 555.60 401.76 15,190.64
48.00 3,995.29 35,547.42
392.31 193,698.48
4,660.86 15,849.24
4,530.89 7,729.01 43,357.67 17,062.58
77.00 12,866.85 17,962.12
8,715.75 8,080.43 26,705.37 6,421.66 65,280.00 33,444.90 30,655.77 8,140.92 54,504.49 19,255.72 29,023.85 7,264.64 56,886.54 13,425.70 27,929.81 25,057.19 48,818.05 11,609.00 15,223.23 2,588.03 3,855.72 8,668.01 29,960.08 11,700.00 24,518.54 11,398.61
695.94

Subsequent Injury Trust Fund 2003 Annual Report

Page 34

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

ANDERSON MERCHANDISERS

LAWRENCEVILLE

GA

ANDREW CORP.

NEWNAN

GA

ANDREW ELECTRIC

LAWRENCEVILLE

GA

ANECO ELECTRICAL

CLEARWATER

FL

ANESTHESIOLOGY CONSULTANTS SAVANNAH

GA

ANGLO AMERICAN ENGLISH CHINA SANDERSVILLE

GA

APB, INC.

ELLENWOOD

GA

APEX SUPPLY CO

LAWRENCEVILLE

GA

APPALACHIAN SURVEYORS

CUMMING

GA

APPAREL SOURCING GROUP

NORCROSS

GA

AQUARIUS POOLS

COLUMBUS

GA

ARATEX

CHARLOTTE

NC

ARCHER DANIELS MIDLAND CO.

MACON

GA

ARROW CO.

BUCHANAN

GA

ART PLUMBING CO.

JONESBORO

GA

ARTISTIC JANITORIAL SERVICES

MARIETTA

GA

ASSET RELOCATION SERVICES

FOREST PARK

GA

ASSOCIATED BUILDERS

CLEVELAND

GA

ASSOCIATED RUBBER CO.

TALLAPOOSA

GA

ASTECHNOLOGIES, INC.

ROSWELL

GA

ATHENS COMMUNITY COUNCIL ON ATHENS

GA

ATHENS DOWNTOWN DEV.

ATHENS

GA

ATI SALES CO., INC.

BYRON

GA

ATLANTA BONDED WAREHOUSE

KENNESAW

GA

ATLANTA FENCE COMPANY

LITHONIA

GA

ATLANTA FREIGHTLINER TRUCK

JEFFERSON

GA

ATLANTA FURNITURE

DECATUR

GA

ATLANTA HILTON NORTHEAST

NORCROSS

GA

ATLANTA HISTORICAL SOCIETY

ATLANTA

GA

ATLANTA SOUTH 75 INC

JACKSON

GA

ATLANTA STEEL ERECTORS, INC. SMYRNA

GA

ATLANTA UTILITY CO

EAST POINT

GA

ATLANTA WEST CARPETS, INC.

AUSTELL

GA

ATLANTA WIRE WORKS, INC.

JONESBORO

GA

ATLANTIC COAST FIRE PROTECTION DULUTH

GA

ATLANTIC FORMING CO., INC.

STONE MTN.

GA

ATLANTIC SOUTHEAST AIRLINES

ATLANTA

GA

ATLAS TECHNOLOGIES INC

FENTON

MI

ATRIA

ATLANTA

GA

AUBREY SILVEY ENTERPRISES INC. CARROLLTON

GA

AUGUSTA READY MIX, INC.

AUGUSTA

GA

AUGUSTA REGIONAL MED CTR

AUGUSTA

GA

AUSTELL HEALTH

AUSTELL

GA

AUTOZONE, INC.

ROME

GA

AVERY DENNISON

NEWNAN

GA

Total $ Reimbursed
32,232.57 48,877.58 102,609.63 21,354.76
932.33 33,895.61 25,539.76 12,888.56
7,388.10 102,320.99 150,787.12
20,000.00 3,850.00
46,832.95 5,449.68 6,939.47
26,340.00 14,773.39
1,259.88 24,662.30 12,869.67 56,036.97 49,119.75 58,642.49
9,570.00 36,408.56 16,650.00
5,606.81 59,152.71 30,349.26 114,782.97
5,968.58 13,475.90
4,841.48 17,395.65
1,492.20 6,682.18 45,890.78 1,276.55 16,245.21 9,417.66 5,201.96 19,827.17
261.30 9,295.21

Subsequent Injury Trust Fund 2003 Annual Report

Page 35

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

AVON PRODUCTS, INC.

SUWANEE

GA

AWH CORPORATION

JASPER

GA

AYRES CORP

ALBANY

GA

B & H HOME-AUTO INC

JASPER

GA

B & M WOOD PRODUCTS, INC

MANOR

GA

B & R SALVAGE CO, INC.

EAST POINT

GA

B & S INDUSTRIAL CONTRACTOR

DUBLIN

GA

B.H. TRANSFER

SANDERSVILLE

GA

BABB'S AUTO SERVICE

DALTON

GA

BABCOCK & WILCOX COMPANY

BRUNSWICK

GA

BACON COUNTY B. O. E.

ALMA

GA

BAGCRAFT CORP. OF AMERICA

FOREST PARK

GA

BAGEL BREAK

COLUMBUS

GA

BAGGETT CONSTRUCTION

DECATUR

GA

BAILEY CO

NASHVILLE

TN

BALLARD BROTHERS ELECTRIC

MACON

GA

BANK SOUTH

FOREST PARK

GA

BARLOW LOGGING

WAYNESBORO

GA

BARNSLEY INN & GOLF

ADAIRSVILLE

GA

BARRETT PROPERTIES & CLUB

BOGART

GA

BARRINGTON HALL

WARNER ROBINS

GA

BARRY MFG. CO.

STONE MOUNTAIN

GA

BARTENFELD ELECTRIC COMPANY ATLANTA

GA

BARTON SOUTHERN CO.

CONYERS

GA

BATES HARDWARE CO.

ATLANTA

GA

BATSON-COOK CO

WEST POINT

GA

BATTLE LUMBER COMPANY, INC.

WADLEY

GA

BAX-STEEL

BAXLEY

GA

BEERS, INC.

ATLANTA

GA

BEKAERT CORP.

ROME

GA

BELCOURT APARTMENTS

ROSWELL

GA

BELK OF SAVANNAH

SAVANNAH

GA

BELK SIMPSON COMPANY

BAINBRIDGE

GA

BELK STORES & AFFILIATES

CARTERSVILLE

GA

BELL MINOR HOME INC

GAINESVILLE

GA

BELLSOUTH ADV. & PUBLISH

ATLANTA

GA

BEMAC PETROLEUM

BYRON

GA

BEN KENNEDY TRUCKING CO.

PRESTON

GA

BENCHMARK ASSOCIATES

DOUGLASVILLE

GA

BENSON CONSTRUCTION CO

TIFTON

GA

BERLIN & HODGES

MACON

GA

BERRIEN COUNTY HOSPITAL

NASHVILLE

GA

BEST BUILT FENCES, INC.

COLUMBUS

GA

BEST MANUFACTURING, INC.

ARABIA

GA

BEST WESTERN - SAVANNAH

SAVANNAH

GA

Total $ Reimbursed
9,778.69 4,589.32 9,223.89 2,437.78 3,108.17 65,309.87 67,376.30 201,633.27 10,122.39 29,912.65 15,815.45 28,622.20
230.30 128,133.28
26,652.88 21,375.00 37,972.71 14,235.00 10,447.96 87,464.59 79,023.17 22,629.00 13,943.82
3,292.00 29,257.30 37,951.87 10,800.00 115,498.97
6.81 88,774.68
1,625.31 5,121.54 3,465.33 36,443.24 25,269.97 106,280.95 242,263.07 53,900.52 12,977.60
408.72 12,169.65 16,962.05 89,270.43
392.09 9,317.71

Subsequent Injury Trust Fund 2003 Annual Report

Page 36

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

BETTER BACKERS, INC.

CHATSWORTH

GA

BETTY'S DIAL-A-MAID

CORDELE

GA

BETZ DEARBORN, INC.

TREVOSE

PA

BETZ LAB'S

JACKSONVILLE

FL

BEVERLY HEALTH & REHAB-JESUP JESUP

GA

BEVIS ROPE MANUFACTURING

ROSSVILLE

GA

B-H TRANSFER COMPANY

SANDERSVILLE

GA

BICKERSTAFF CLAY PRODUCTS

SMYRNA

GA

BIG C PARTS, INC.

GAINESVILLE

GA

BILLY GERRELL GRADING CO.

CUMMING

GA

BI-LO, INC.

MAULDIN

SC

BI-LO, INC.

CARTERSVILLE

GA

BLAKE CONSTRUCTION CO.

ST. MARY'S

GA

BLOUNT CONSTRUCTION CO., INC ATHENS

GA

BLOUNT CONSTRUCTION CO., INC MARIETTA

GA

BLUE RIBBON RENTAL, INC.

CUYAHOGA FALLS

OH

BOAEN MECHANICAL

SAVANNAH

GA

BOCK HOMES

MARIETTA

GA

BODDIFORD FARMS SERVICES

SYLVANIA

GA

BOEING

DULUTH

GA

BORG WARNER PONY EXPRESS

ATLANTA

GA

BO'S OF TIFTON

TIFTON

GA

BOSTIK, INC.

CALHOUN

GA

BOWDEN LITTLETON

MINDY HILL

GA

BRADLEY PLYWOOD CORP.

SAVANNAH

GA

BRENT WALKER FORD INC

GLENVILLE

GA

BRG OF GA, INC.

OCILLA

GA

BRIGGS ENTERPRISES

WINSTON

GA

BRIGHTON BEST SOCKET

NORCROSS

GA

BROCKWAY STANDARD INC

HOMERVILLE

GA

BROOKS INSTRUMENTS DIVISION STATESBORO

GA

BROWN & WILLIAMSON TOBACCO MACON

GA

BROWN STEEL CONTRACTORS,

NEWNAN

GA

BRUNOS SUPERMARKETS

WARNER ROBINS

GA

BRUNSWICK CORP.

NORCROSS

GA

BRUNSWICK/U.S. MARINE

VALDOSTA

GA

BRYANT NURSING CENTER

COCHRAN

GA

BUILDER'S STEEL SUPPLY

LILBURN

GA

BUILDING TECHNOLOGY

TALLAPOOSA

GA

BURGER KING

DUNWOODY

GA

BURLINGTON INDUSTRIES

SHANNON

GA

BURLINGTON NORTHERN

ALBANY

GA

BUSH LEASING

WILMINGTON

OH

BUSINESS TEMPS/TEMP MASTER AUGUSTA

GA

C & H MECHANICAL & PLUMBING

DEMOREST

GA

Total $ Reimbursed
3,622.00 499.70
3,274.45 4,982.15 185,191.64 8,775.00 9,839.18 9,391.63 8,502.42 3,139.90 4,528.92 24,369.07 7,595.00 6,256.60 2,462.35 18,603.95 24,896.77
15.00 19,836.80 19,745.64
6,910.91 2,093.99 55,287.58 8,657.25 67,631.65 4,290.00 30,563.77 4,267.21 2,906.04 41,349.77 43,094.23 14,879.25 8,742.55 3,972.34 46,477.64 2,647.14 38,934.01 16,868.96 23,875.98 1,704.98 15,018.58 13,505.00 55,110.25 15,330.00 6,263.40

Subsequent Injury Trust Fund 2003 Annual Report

Page 37

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

C & J'S FOOD PRIDE

MACON

GA

C.D. DANGLER CONSTRUCTION

ADAIRSVILLE

GA

CADY BAG CO.

PEARSON

GA

CALHOUN MILLWORKS INC

CALHOUN

GA

CAMBRIDGE BUILDERS

ATLANTA

GA

CAMDEN COUNTY

WOODBINE

GA

CAMP OIL CO.

ROME

GA

CAMPBELL DECORATING CO.

ATLANTA

GA

CANTON NURSING CENTER

CANTON

GA

CAPRO INC

SWAINSBORO

GA

CAR CRAFT

ATHENS

GA

CARDINAL SPECIALTY PRODUCTS CALHOUN

GA

CARMICHAELS LANDSCAPING

WOODSTOCK

GA

CAROLINA POTTERY

MACON

GA

CARPET COLLECTION

BOGART

GA

CARPET SALVAGE

MACON

GA

CARRIAGE INDUSTRIES, INC.

CALHOUN

GA

CARROLLTON MANOR, INC.

CARROLLTON

GA

CARSON, INC.

SAVANNAH

GA

CARTER & ASSOCIATES

ATLANTA

GA

CARWOOD MANUFACTURING

WINDER

GA

CASWELL, INC.

NEWNAN

GA

CATOOSA UTILITY DISTRICT

RINGGOLD

GA

CEBCOR/TABLES & CHAIRS, INC.

ATLANTA

GA

CECIL MALONE COMPANY

ATLANTA

GA

CEDARTOWN PAPER BOARD CO

CEDARTOWN

GA

CELLOFOAM NORTH AMERICA

CONYERS

GA

CENTRAL FOOD MANAGEMENT

ATLANTA

GA

CENTRAL GA EYE CENTER PC

MACON

GA

CENTRAL GA HOME HEALTH

MACON

GA

CENTRAL GEORGIA HOME CARE

MACON

GA

CENTRAL HEALTH HOLDING

FT. OGLETHORPE

GA

CENTRAL MACHINE, INC.

EASTONOLEE

GA

CENTURION INDUSTRIES

FREDONIA

KS

CETCO ( PC AMCOL INTL' GRP)

VILLA RICA

GA

CHAMBERS DEVELOPMENT CO.

ATLANTA

GA

CHAMPION INTERNATIONAL CORP WAYCROSS

GA

CHAPARRAL BOATS, INC.

NASHVILLE

GA

CHARTER BEHAVIORAL HEALTH

MACON

GA

CHARTER MOBILE HOMES, INC.

HINESVILLE

GA

CHATEAU ELAN RESORT

BRASELTON

GA

CHATHAM STEEL CORPORATION

SAVANNAH

GA

CHATSWORTH HEALTH CARE

CHATSWORTH

GA

CHECKERS DRIVE-IN

JONESBORO

GA

CHEMICAL LEAMAN TRUCK LINES JONESBORO

GA

Total $ Reimbursed
35,852.76 4,303.28
10,497.27 115,146.30
70,400.00 1,224,388.47
37,738.39 55,454.27 157,547.76 19,798.04
8,487.18 26,068.97
4,582.41 425.70
40,357.77 127,719.34
8,480.31 55,359.15 11,762.52
2,925.00 13,819.86 16,215.48 15,317.71 11,423.32
6,983.12 3,848.10 119,278.85 7,288.68 57,612.33 28,033.76 47,391.93 25,058.31 146,092.90 4,840.51 34,022.78 99,152.30 10,471.48 16,743.81 66,470.43 11,775.64 30,953.82
117.57 1,854.74 157,949.31 6,891.82

Subsequent Injury Trust Fund 2003 Annual Report

Page 38

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

CHEROKEE SPRINGS, INC.

MARBLE HILL

GA

CHESTNUT RIDGE NURSING

CUMMING

GA

CHIEF CONTAINER CO.

MARIETTA

GA

CHIPMAN-UNION, INC.

UNION POINT

GA

CHOO-CHOO TRUCK WASH

TUNNEL HILL

GA

CHUMLEY'S PAVING & GRADING

ACWORTH

GA

CHURCH OF JESUS CHRIST LDS

ATLANTA

GA

CIBA VISION CORPORATION

ATLANTA

GA

CIMCO

WAYNESBORO

GA

CITIZENS BANK OF SWAINSBORO SWAINSBORO

GA

CITIZENS BANK OF WASHINGTON SANDERSVILLE

GA

CITY OF COVINGTON

COVINGTON

GA

CITY OF EAST POINT POLICE DEPT EAST POINT

GA

CITY OF ELBERTON

ELBERTON

GA

CITY OF HOGANSVILLE

HOGANSVILLE

GA

CITY OF LINWOOD

LINWOOD

GA

CITY OF ROME

ROME

GA

CITY OF WAYCROSS

WAYCROSS

GA

CJT INDUSTRIAL CONTRACTORS

MACON

GA

CKS PACKAGING

ATLANTA

GA

CLAIRSON INDUSTRIES CORP.

NORCROSS

GA

CLARKE COUNTY SCHOOL

ATHENS

GA

CLARKLIFT OF ATLANTA

ATLANTA

GA

CLARK'S SUPER MARKET

GRIFFIN

GA

CLASSIC CITY BEVERAGES INC

ATHENS

GA

CLASSIC COLLISION

CHAMBLEE

GA

CLAYTON HOMES INC

WAYCROSS

GA

CLEVELAND CONSOLIDATED, INC. WAYNESBORO

GA

CLEVELAND ELECTRIC COMPANY MACON

GA

CLEVELAND GROUP, INC.

ATLANTA

GA

COALE TRUCK TRANSPORT

LAWRENCEVILLE

GA

COBB COUNTY TRACTOR CO.

MARIETTA

GA

COCA-COLA ENTERPRISES, INC.

DECATUR

GA

COCHRAN'S AUTO TRUCK STOP

RINGGOLD

GA

COHEN BROTHERS DRESS CORP WAYCROSS

GA

COLCRAFT INC.

STILLMORE

GA

COLEMAN AMERICAN MOVING

MIDLAND CITY

AL

COLISEUM PSYCHIATRIC HOSP.

MACON

GA

COLONIAL OIL INDUSTRIES

SAVANNAH

GA

COLONIAL PAINTING COMPANY

CHAMBLEE

GA

COLQUITT COUNTY

MOULTRIE

GA

COLUMBIA DR. ANIMAL CLINIC

DECATUR

GA

COLUMBIA-HCA EASTSIDE MED

SNELLVILLE

GA

COLUMBUS LEDGER ENQUIRE

COLUMBUS

GA

COLUMBUS PRODUCTIONS

COLUMBUS

GA

Total $ Reimbursed
29,955.48 31,851.28
3,197.92 24,584.94 12,485.72 28,206.52 61,614.75 289,991.73 24,570.00 14,226.52 31,685.77 14,955.74 19,323.12
6,908.61 12,485.53 17,299.61 23,333.45 27,006.42 22,908.73 19,465.89 135,933.59
6,522.40 37,782.94
3,150.58 1,521.00 22,607.43 38,565.30 2,945.00 5,060.84 4,170.68 18,211.93 14,116.81 3,482.04 5,043.34 116,652.05
747.64 17,561.85 101,692.87 24,419.91
6,559.60 7,481.13
169.98 19,257.66
5,257.38 1,179.86

Subsequent Injury Trust Fund 2003 Annual Report

Page 39

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

COLUMBUS ROOFING, INC.

COLUMBUS

GA

COMBINED INSURANCE

CHICAGO

IL

COMBINED MECHANICAL

MARIETTA

GA

COMBINED SERVICES, INC.

DECATUR

GA

COMBUSTION ENGINEERING

JULIETTE

GA

COMBUSTION TECHNOLOGIES

FLOWERY BRANCH

GA

COMMERCE ELECTRIC CO.

MONROE

GA

CON MAC

ATLANTA

GA

CONCRETE EXPRESS

SAVANNAH

GA

CONCRETE SERVICES, INC.

WAYCROSS

GA

CONK TAYLOR, LLC-QUALITY LII

SAVANNAH

GA

CONQUEST CARPET MILL

ROSSVILLE

GA

CONSOLIDATED SERVICES

COLUMBUS

GA

CONTAINER GENERAL CORP.

FOREST PARK

GA

CONTINENTAL BAKING COMPANY ROME

GA

CONTINENTAL CAN CO

PERRY

GA

CONTINENTAL GRAIN

CORDELE

GA

CONTINENTAL TELEPHONE CO.

ATLANTA

GA

COOK SALES INC

ANNA

IL

COOPER DDS, PC

WAYCROSS

GA

CORESLAB STRUCTURES, INC.

JONESBORO

GA

CORONET INDUSTRIES

DALTON

GA

COUNTRY PRIDE FOODS, INC.

GAINESVILLE

GA

COWETA CO BD OF EDUCATION

NEWNAN

GA

CRAVEN POTTERY INC.

COMMERCE

GA

CREEKSIDE TIMBER CO.

DANVILLE

GA

CRESWELL CONVALESCENT CTR. ROME

GA

CROTTS ENTERPRISES, INC.

ROSWELL

GA

CROWN CRAFTS, INC.

CALHOUN

GA

CRUM'S GARDEN CENTER

BAINBRIDGE

GA

CRYSTAL SPRINGS PRINT WORKS CHICKAMAUGA

GA

CS INTEGRATED LOGISTICS

EAST POINT

GA

CSI-SPEEDY DISPOSAL SERVICE

ELLENWOOD

GA

CSRA PRIVATE DUTY INC

WASHINGTON

GA

CUMMINS SOUTH INC

COLLEGE PARK

GA

CYPRESS RESTAURANTS, INC.

ORLANDO

FL

D & N ELECTRIC COMPANY, INC.

HAPEVILLE

GA

D L LEE & SONS

ALMA

GA

DAIMLER CHRYSLER CORP

MORROW

GA

DAIRY FRESH CORP

COWARTS

AL

DAIRY QUEEN

MCRAE

GA

DALLAS WILLIAMS dba BRICKMASTER DULUTH

GA

DALTON FRUIT CO

DALTON

GA

DALTON PAVING & CONSTRUCTION DALTON

GA

DANIEL LUMBER CO. INC.

LAGRANGE

GA

Total $ Reimbursed
24,596.01 57,269.89 80,376.21
3,575.83 6,651.51 4,780.00 66,419.72 3,939.01 5,977.30 3,710.36 116,147.56 40,582.34 67,675.22 9,855.81 16,140.90 12,309.70 20,195.26 11,429.08 3,462.32 8,114.08 5,788.93 30,139.70 47,983.57 7,113.82 25,660.27 30,366.39 17,719.71 70,690.61 96,127.20 27,008.86 1,221.53 120,430.71 77,375.00 59,089.98 3,668.49 4,609.94 68,814.47 6,675.61 25,639.71 10,062.25 1,942.28 20,013.76
499.39 39,476.49 40,371.52

Subsequent Injury Trust Fund 2003 Annual Report

Page 40

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

DARBY PRINTING COMPANY

ATLANTA

GA

DATA TECH

ALPHARETTA

GA

DAVCO CORP.

MEMPHIS

TN

DAVE & SONS, INC.

ALBANY

GA

DAVEY TREE EXPERT COMPANY

CHAMBLEE

GA

DAVIS WATER & WASTE IND INC

THOMASVILLE

GA

DAY STAR LAWN MAINTENANCE

DALLAS

GA

DAYMARK GROUP, INC.

INDIANAPOLIS

IN

DAYS GLASS SERVICE

DOUGLAS

GA

DAYS INN

ATLANTA

GA

DAYS INN-ROME

ROME

GA

DE STER CORP.

THOMASTON

GA

DEERFIELD SPECIALTY PAPERS

AUGUSTA

GA

DEL MAR WINDOW COVERINGS

ATHENS

GA

DELCO INDUSTRIES

TUCKER

GA

DEL-COOK LUMBER COMPANY

ADEL

GA

DELTA AIRLINES, INC.

ATLANTA

GA

DELTA LIFE INS. CO.

ALBANY

GA

DELTA LIFE INS. CO.

MACON

GA

DEMPSEY ELECTRIC, INC.

ROSWELL

GA

DENNIS TAYLOR & CO, INC.

DULUTH

GA

DENON DIGITAL INDUSTRIES

MADISON

GA

DERST BAKING CO

SAVANNAH

GA

DEVEREUX CENTER OF GA.

KENNESAW

GA

DEVRO-TEEPAK, INC.

ATLANTA

GA

DIAMOND HOLDING CORP.

MARIETTA

GA

DIAMOND PLASTIC CORP

MACON

GA

DIGS ATLANTA

ATLANTA

GA

DILLARD SMITH CONSTRUCTION

SMYRNA

GA

DIPLOMAT HOTELS, ETAL

ATLANTA

GA

DITTLER BROTHERS, INC

OAKWOOD

GA

DIVERSCO, INC.

SPARTANBURG

SC

DIXIE INDUSTRIAL FINISHING CO. TUCKER

GA

DIXIE ROADBUILDERS, INC.

WAYCROSS

GA

DIXIELAND FUN PARK, INC.

FAYETTEVILLE

GA

DIXON MGMT INC

BRUNSWICK

GA

DOBBS INTERNATIONAL

ATLANTA

GA

DODGE COUNTY HOSP AUTHORITY EASTMAN

GA

DOGWOOD HOUSING

MILLEDGEVILLE

GA

DOMINO'S PIZZA

MARIETTA

GA

DON HOSMER, INC.

EATONTON

GA

DORSEY TRAILERS, INC.

CARTERSVILLE

GA

DOUGLAS & LOMASON

CARROLLTON

GA

DOUGLAS GENERAL HOSPITAL

DOUGLASVILLE

GA

D'PEACH OF GEORGIA INC

CORNELIA

GA

Total $ Reimbursed
26,117.26 300,375.28
14,697.60 11,481.78 14,406.77
8,050.00 1,940.00 8,241.10 7,926.77 117,930.36 20,743.32 108,784.02 18,077.50 21,471.28 2,456.61 123,774.37 151,722.35 20,560.09 5,686.86
469.00 4,225.00 22,148.58 7,776.70 3,085.70 7,786.38 3,304.07 68,350.00 31,393.38 23,590.03 26,901.33 10,490.89 7,636.71 41,106.41
535.18 3,099.75 2,320.84 53,327.00 57,853.71 1,410.95 1,206.66 2,806.76
134.00 74,178.51
4,730.70 66,814.02

Subsequent Injury Trust Fund 2003 Annual Report

Page 41

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

DRILLERS SERVICES, INC.

ASHBURN

GA

DRIVERS MANAGEMENT, INC.

OMAHA

NE

DRUG TRANSPORT, INC.

TUCKER

GA

DRUID HILLS GOLF CLUB, INC.

ATLANTA

GA

DUBARD'S TIRE & ALIGNMENT

AUSTELL

GA

DUBLIN INDUSTRIAL SERVICES

DUBLIN

GA

DUBLINAIR NURSING HOME

DUBLIN

GA

DUCHERN IND., INC.

FAYETTEVILLE

GA

DUNNS TRAILER SERVICE

MABLETON

GA

DUNWOODY HOME HEALTH

ATLANTA

GA

DURAND-WAYLAND, INC.

LAGRANGE

GA

DURANGO GEORGIA PAPER CO.

SAINT MARY'S

GA

DURDEN ENTERPRISES

AUBURN

GA

DURHAM STAFFING

CARTERSVILLE

GA

DWB CARPET HOLDINGS

CHATSWORTH

GA

DYNCORP

ATLANTA

GA

E. SMITH HEATING & AIR

MARIETTA

GA

EAGLE UTILITY CONTRACTING

BISHOP

GA

EARL SMALL'S HARLEY DAVIDSON MARIETTA

GA

EARTHGRAINS BAKING CO

AUGUSTA

GA

EAST POINT FOUNDRY

EAST POINT

GA

EAST POINT PACKAGE STORE

EAST POINT

GA

EASTERN AIRLINES, INC.

ATLANTA

GA

EASTSIDE MEDICAL CENTER

SNELLVILLE

GA

ECC INTERNATIONAL

SANDERSVILLE

GA

ECI MANAGEMENT

MARIETTA

GA

ECKERD DRUG

SHENANDOAH

GA

EDWARD BOSHEARS

BRUNSWICK

GA

EDWARDS BAKING CO.

ATLANTA

GA

EDWARDS PIPELINE

ATHENS

GA

ELLIOTT MACHINE SHOP

MACON

GA

ELLIOTT TRANSPORT

GAINESVILLE

GA

EMPLOYER SOLUTIONS, INC.

PHOENIX

AZ

EMPLOYMENT MATCH MAKERS

MACON

GA

ENGELHARD CORP.

GORDON

GA

ENGELHARD CORP.

ATTAPULGUS

GA

ENGINEERED FABRICS CORP.

ROCKMART

GA

ENGLISH CHINA CLAY'S INT.

SANDERSVILLE

GA

EPIX

WOODBRIDGE

NJ

ESSEX GROUP

LITHONIA

GA

ETHICON, INC.

CORNELIA

GA

ETHRIDGE BACKHOE & YARDWORK HARTWELL

GA

EUGENE MILLER POULTRY

DOUGLAS

GA

EWC/PROFESSIONAL TEMP SVCS THOMASVILLE

GA

EXPRESS PERSONNEL

WOODSTOCK

GA

Total $ Reimbursed
137.00 59,540.00 106,079.26 18,704.09 19,619.05
3,637.38 13,279.60 51,370.71 43,930.69
7,394.47 279.00
311,719.04 9,401.26 6,149.95
12,375.00 10,925.67 43,577.41 24,151.52
1,872.22 16,561.18 44,396.59
9,750.00 20,535.38 147,285.46 32,987.08 42,670.89 46,764.80
57.38 6,200.00 18,519.91 41,706.21 193,098.84 2,133.65 4,383.48 8,312.63 33,750.00 55,943.11
603.23 24,557.71
4,451.61 13,666.15
9,554.24 157,980.66
63,554.92 33,578.01

Subsequent Injury Trust Fund 2003 Annual Report

Page 42

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

F & R LANDSCAPING, INC.

LITHONIA

GA

F & W FORESTRY

ALBANY

GA

F R GRANTHAM CONTRACTING

DECATUR

GA

FAIRVIEW PARK HOSPITAL

DUBLIN

GA

FALCONS NEST I & II

FLOWERY BRANCH

GA

FAMILY DOLLAR, INC.

CHARLOTTE

NC

FANNIN COUNTY BD. OF

BLUE RIDGE

GA

FANTASTIC SAMS

LAGRANGE

GA

FASHION AVE.

MACON

GA

FAYETTE CO BD OF EDUCATION

FAYETTEVILLE

GA

FAYETTEVILLE BOWLING CENTER FAYETTEVILLE

GA

FEDERAL PAPER BOARD CO., INC. AUGUSTA

GA

FEDERAL STATE INSPECTION

ALBANY

GA

FIBERVISIONS, INC.

COVINGTON

GA

FIDELITY ASSOC.

GASTONIA

NC

FIDELITY NATIONAL CORP

ATLANTA

GA

FINANCIAL SERVICE CORP

ATLANTA

GA

FIRESTONE TIRE COMPANY

ALBANY

GA

FIRST AMERICAN RENTAL

LITHONIA

GA

FIRST DATA CORP.-FDR.

ATLANTA

GA

FIRST NATIONAL BANK

GRIFFIN

GA

FISHER SCIENTIFIC

SUWANEE

GA

FITZGERALD UNDERWEAR CORP TIFTON

GA

FIVE STAR QUALITY CARE

COLLEGE PARK

GA

FLASH FOODS

WAYCROSS

GA

FLINT CONSTRUCTION CO.

LAWRENCEVILLE

GA

FLINT RIVER TEXTILES, INC

ALBANY

GA

FLOYD CO. BD OF EDUCATION

ROME

GA

FLUOR CORP. C/O GA POWER

ALISO VIEJO

CA

FMC

ATLANTA

GA

FMT ENTERPRISES LLC

ATLANTA

GA

FOCAL POINT NOMACO, INC.

SMYRNA

GA

FOLGER POULTRY FARMS

DAHLONEGA

GA

FORDS & GANTT COMPANY, INC.

MACON

GA

FORSTMANN & COMPANY, INC.

DUBLIN

GA

FORSTMANN & COMPANY, INC.

TIFTON

GA

FORT OGLETHORPE NURSING

FT OGLETHORPE

GA

FOXWORTH PAINTING

COLUMBUS

GA

FRANKLIN INDUSTRIES

LAVONIA

GA

FRANKLIN'S OF ATHENS

BOGART

GA

FREEPORT KAOLIN CO

GORDON

GA

FRIENDLY EXPRESS, INC.

WAYCROSS

GA

FRITO LAY, INC.

KATHLEEN

GA

FRUEHAUF CORPORATION

CONLEY

GA

FUEL SOUTH / JONES COMP.

WAYCROSS

GA

Total $ Reimbursed
18,497.86 41,110.92 24,582.13 167,284.54
7,696.50 200,563.45
1,211.22 4,403.68 11,004.00 13,415.33 10,281.88 11,500.00 31,095.00 34,775.00 65,478.15 4,747.86 30,404.38 12,360.55 12,394.50
108.00 1,539.39 1,634.37 4,192.22 5,700.08
33.00 9,200.06 9,210.20
315.50 1,291.75 71,019.92 90,251.21 162,438.95 15,120.00 150,260.00 127,963.99 9,485.00 8,686.00 7,571.60 16,072.87 2,642.54 20,723.00
890.82 63,412.59 31,483.00
4,864.72

Subsequent Injury Trust Fund 2003 Annual Report

Page 43

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

G & A CONTRACTING, INC.

BLAIRSVILLE

GA

G & K

BUFORD

GA

G & L MARBLE, INC.

WINSTON

GA

G W IVEY CONSTRUCTION, INC.

ST MARY'S

GA

G&G INVESTMENTS

WARNER ROBINS

GA

GA ALLTEL TELECOM-HOMERVILLE HOMERVILLE

GA

GA OPTIONS

BOGART

GA

GA. BAPTIST HEALTH CARE

WARM SPRINGS

GA

GABLE ELECTRIC COMPANY

SMYRNA

GA

GABRIEL DESSERTS, INC.

MARIETTA

GA

GAF MATERIALS CORP.

SAVANNAH

GA

GALAXY CARPET MILLS, INC.

CHATSWORTH

GA

GALEY & LORD INDUSTRIES, INC.

SHANNON

GA

GARDEN TERRACE NURSING

DOUGLASVILLE

GA

GARDENER DENVER

PEACHTREE CITY

GA

GARNER BROTHERS CO

ROME

GA

GARY CONCRETE PRODUCTS

MARTINEZ

GA

GAY CONSTRUCTION COMPANY

ATLANTA

GA

GE CAPITAL

ATLANTA

GA

GEICO CORP.

MACON

GA

GENE STEPHENS CO., INC.

REX

GA

GENERAL ELECTRIC CO

ROME

GA

GENERAL NUTRITION CTRS

PITTSBURGH

PA

GENERAL SHALE BRICK

ATLANTA

GA

GENERAL STEEL COMPANY

MACON

GA

GENTRY'S LANDSCAPE

ROSWELL

GA

GENUINE PARTS CO

SYLVESTER

GA

GEORGE HORMELL & COMPANY

TUCKER

GA

GEORGE MUSE CLOTHING CO

ATLANTA

GA

GEORGE WALTON ACADEMY

MONROE

GA

GEORGIA BAPTIST CONVENTION

ATLANTA

GA

GEORGIA BOOT INC

BLAIRSVILLE

GA

GEORGIA CHAIR COMPANY

GAINESVILLE

GA

GEORGIA CROWN DISTRIBUTING

COLUMBUS

GA

GEORGIA DUPLICATING

MACON

GA

GEORGIA MARBLE COMPANY

ATLANTA

GA

GEORGIA PERIODONTICS, P.C.

ATLANTA

GA

GEORGIA TECH ATHLETIC ASSOC. ATLANTA

GA

GERALD L. DAVIS ASSOC., INC.

STONE MOUNTAIN

GA

GFA TRANSPORTATION COMPANY FOREST PARK

GA

GILBERT & BENNETT

TOCCOA

GA

GILMAN BUILDING PRODUCTS

DUDLEY

GA

GILMAN PAPER CO.

ST. MARY'S

GA

GILMER COUNTY OF B. O. E.

ELLIJAY

GA

GLEN FREELS DRYWALL

WOODSTOCK

GA

Total $ Reimbursed
16,955.05 76,991.84 18,637.26
122.00 2,748.78 65,488.83 6,092.06 20,610.81 10,279.43 4,220.33 18,842.50 6,630.40 65,882.50 93,832.83 1,050.00 64,332.15 12,539.45 21,505.74 93,392.99 64,322.94 236,019.99 70,568.43 22,670.32 45,823.94 1,444.09 1,730.65 44,763.51 15,832.19 4,333.42 23,426.30 6,290.25 7,448.15 5,613.80 12,608.86 39,324.49 31,947.23 3,042.51 14,716.21 17,150.00 2,639.66 5,746.14 35,010.93 442,143.70 9,982.16 8,271.65

Subsequent Injury Trust Fund 2003 Annual Report

Page 44

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

GLOBAL PERSONNEL SERVICE

COLUMBUS

GA

GLOBE UNION INC

ATLANTA

GA

GLYNN COUNTY

BRUNSWICK

GA

GMT INT'L. CORP.

VILLA RICA

GA

GOLD KIST, INC.

CARROLLTON

GA

GOLD KIST, INC.

BALLGROUND

GA

GOLD KIST, INC.

ELLIJAY

GA

GOLDEN GALLON, INC.

CHATTANOOGA

TN

GOLDEN'S FOUNDRY & MACHINE

COLUMBUS

GA

GOLF COURSE CREATIONS, INC

BLACK CREEK

GA

GOODMAN DECORATING

ATLANTA

GA

GOODWILL INDUSTRIES

MACON

GA

GOODWILL INDUSTRIES-N. GA

ATLANTA

GA

GOODY PRODUCTS, INC.

EASTMAN

GA

GOODYEAR AEROSPACE

ROCKMART

GA

GOODYEAR TIRE & RUBBER

CARTERSVILLE

GA

GORDON COUNTY FARM COMPANY CALHOUN

GA

GRAHAM BROTHERS

DUBLIN

GA

GREAT AMERICAN COOKIE CO.

ATHENS

GA

GREAT AMERICAN EATERY

ATLANTA

GA

GREAT ATLANTIC NEWS

ATLANTA

GA

GREAT BARRIER INSULATION

BIRMINGHAM

AL

GREAT OAKS NURSING HOME

ROSWELL

GA

GREAT SOUTH CONSTRUCTION

PELHAM

AL

GREEN OAKS CENTER

MOULTRIE

GA

GREEN THUMB, INC.

JESUP

GA

GREENWOOD CEMETERY

ATLANTA

GA

GRIFFIN INDUSTRIES

EAST DUBLIN

GA

GULF LIFE INSURANCE COMPANY STATESBORO

GA

GUNTER CONSTRUCTION CO.

LAWRENCEVILLE

GA

H & H ELECTRIC

ACWORTH

GA

H & H LOGGING

WASHINGTON

GA

H.H. TIMBER & LOGGING CO.

CUTHBERT

GA

H.J. RUSSELL & COMPANY

ATLANTA

GA

HA SACK COMPANY, INC.

STATESBORO

GA

HAIR CUTTERY- RATNER COMPANIES PEACHTREE CITY

GA

HALL EXPRESS

ALBANY

GA

HAMBERSHAM MEDICAL GROUP

CLARKESVILLE

GA

HANCOCK FABRICS

SAVANNAH

GA

HANCOR, INC

CORDELE

GA

HANES HOSIERY, INC.

LAGRANGE

GA

HARBISON WALKER

CALHOUN

GA

HARMONY PROPERTIES, INC.

ATLANTA

GA

HARRIS CALORIFIC

GAINESVILLE

GA

HARRIS INSULATION & SUPPLY

ATLANTA

GA

Total $ Reimbursed
7,468.00 4,671.38 6,931.97 1,331.19 268,498.48
594.20 942.88 1,981.14
16.52 2,519.89 71,557.54 1,345.25 51,106.20 16,093.61 9,124.16 72,762.44 33,968.96 23,625.00
680.59 6,160.00
864.40 7,294.90 51,515.73 10,992.19 55,824.67 19,213.88
224.70 19,136.85 35,960.38 13,565.78 19,252.49 19,888.66 15,172.12
346.32 14,065.04
607.25 448.06 98,816.02 4,832.35 20,032.45 14,242.99
49.50 16,860.03
2,226.52 17,800.00

Subsequent Injury Trust Fund 2003 Annual Report

Page 45

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

HARRIS SAMPLE BOOK, INC.

MONTICELLO

GA

HARRIS SERVICE CENTER

DALTON

GA

HARRIS TEETER

DUNWOODY

GA

HARRISON'S BODY SHOP

MACON

GA

HARRY MOSES CONSTRUCTION

VIDALIA

GA

HARTWELL CO. WAREHOUSE

HARTWELL

GA

HARTWELL SPORTS, INC.

HARTWELL

GA

HARVEY'S PERSONAL CARE

WAYCROSS

GA

HAYES MICRO COMPUTER

NORCROSS

GA

HAYGOOD CONTRACTING, INC.

WOODSTOCK

GA

HAZARDOUS ENVIR. PRODUCTS

TUCKER

GA

HEALTHCARE SERVICES GROUP

INDIANAPOLIS

IN

HEALTHCARE SERVICES GROUP

BENSALEM

PA

HEDGEWOOD PROPERTIES, INC.

CUMMING

GA

HELEN'S ENTERPRISES, INC.

ATHENS

GA

HENDERSON ELECTRIC CO

STONE MOUNTAIN

GA

HENDRIX HAULING CO.

JESUP

GA

HENKEL OF AMERICA CORP.

CEDARTOWN

GA

HENKELS & MCCOY

PERRY

GA

HENRY COUNTY TRAINING

MCDONOUGH

GA

HERTZ PENSKE/GEICO TRUCK

FOREST PARK

GA

HICKS PAVING CO., INC.

ATHENS

GA

HIDDEN HILLS GRILL

STONE MOUNTAIN

GA

HIGGINS GENERAL HOSPITAL

BREMEN

GA

HIGHTOWER TV

ROME

GA

HILL TIRE CO.

FOREST PARK

GA

HILLHAVEN REHABILITATION CTR MARIETTA

GA

HILLIARD, INC.

EASTMAN

GA

HINESVILLE RED & WHITE

HINESVILLE

GA

HI-TECH HEALTH CARE, INC.

NORCROSS

GA

HOLCOMBE' S SUPER VALUE

TALLAPOOSA

GA

HOLIDAY INN-MCDONOUGH

MCDONOUGH

GA

HOLLAND ELECTRIC PLUMBING

DOUGLASVILLE

GA

HOLLIS TRANSPORT AGENCY

GAINESVILLE

GA

HOLLOWAY CONSTRUCTION CO.

BALLGROUND

GA

HOLLYE EQUIPMENT CO., INC.

GAINESVILLE

GA

HOME DELIVERY FOOD SERVICES JEFFERSON

GA

HOME DEPOT

SAVANNAH

GA

HOME GROWN INDUSTRIES

ATLANTA

GA

HON INDUSTRIES

CEDARTOWN

GA

HOOVER-HANES TRUCKING CO.

TALLAPOOSA

GA

HOSPITAL HOUSEKEEPING

JACKSON

GA

HOTEL VENTURA OF AUGUSTA

AUGUSTA

GA

HOUSE OF DENMARK

DORAVILLE

GA

HOUSE OF TYROL

CLEVELAND

GA

Total $ Reimbursed
27,667.54 16,022.67 25,829.81 97,921.35
8,311.95 20,557.15
1,088.44 22,886.02 18,843.50 19,216.39
6,388.67 5,246.43
753.66 80.00
23,888.12 30,003.90 23,053.65
4,838.20 81,538.08
5,516.01 68,977.90 30,994.41 22,967.00 11,205.00 34,634.96
589.50 11,021.62 16,099.44 20,125.51
709.50 38,634.28
9,696.93 61,274.17 16,250.96
8,100.00 7,284.20 15,466.51 215,239.80 15,891.41 73,997.23 19,823.27 16,002.72 12,417.28 7,180.78 10,450.89

Subsequent Injury Trust Fund 2003 Annual Report

Page 46

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

HOUSTON CO. ASSOCIATION

WARNER ROBINS

GA

HOUSTON STEEL, INC.

BYRON

GA

HOWARD'S LANDSCAPING &

LILBURN

GA

HP PELZER

THOMSON

GA

HUBERT MOORE LUMBER

ALAPAHA

GA

HUDDLE HOUSE

DAHLONEGA

GA

HUDDLE HOUSE OF ALMA

ALMA

GA

HUGHES CABINET SHOP

DANIELSVILLE

GA

HUMAN RESOURCE CO.

IRVING

TX

HUMAN RESOURCE CO.

DALLAS

TX

HUNT-MILLER INSURANCE

WARNER ROBINS

GA

HURST BOILER & WELDING CO

COOLIDGE

GA

HUSKY FOUNDATIONS, INC

SUWANEE

GA

HYDROBLAST INDUSTRIAL SVC

MACON

GA

IBM CORPORATION

ATLANTA

GA

IDEAL ELECTRIC

LAGRANGE

GA

INDEPENDENT LIFE INSURANCE

SAVANNAH

GA

INDUSTRIAL MAINTENANCE SVC

SUWANEE

GA

INDUSTRIAL PIPE & SUPPLY

GAINESVILLE

GA

INDUSTRIAL PLASTICS CORP

FITZGERALD

GA

INDUSTRIAL TOOL & SUPPLY

SAVANNAH

GA

INGLETT & STUBBS, INC.

SMYRNA

GA

INLAND CONTAINER CORP.

MACON

GA

INSURAMERICA

LILBURN

GA

INTERIM PERSONNEL

ATLANTA

GA

INTERIORS BY DAWSON

COVINGTON

GA

INTERNATIONAL AUTO

BRUNSWICK

GA

INTERNATIONAL PROCESSING

CONLEY

GA

INTERNATIONAL RESCUE COMM

NEW YORK

NY

INTERSTATE BRANDS CORP.

COLUMBUS

GA

INTERSTATE BRANDS CORP.

JACKSONVILLE

FL

INTERSTATE DISTRIBUTORS, INC. NORCROSS

GA

IRWIN COUNTY HOSPITAL

OCILLA

GA

IRWIN MFG. CORP.

OCILLA

GA

ITHACA INDUSTRIES INC.

GLENNVILLE

GA

ITT AUTOMOTIVE

ROME

GA

ITT-RAYONIER, INC.

MIDVILLE

GA

J & J FOODS, INC.

GAINESVILLE

GA

J & M TRANSPORT

MARIETTA

GA

J&M TRANSPORTATION

LAS CRUCES

NM

J. L. LESTER & SON

ROCKMART

GA

J. P. BEAMER CO., INC.

CALHOUN

GA

J.A. JONES MANAGEMENT

KINGS BAY

GA

J.C. PENNEY COMPANY

ATLANTA

GA

J.G. DAVIDSON JR. ELECTRICAL

LAGRANGE

GA

Total $ Reimbursed
2,513.42 7,839.63 4,706.40 20,398.50 9,331.52 12,778.84 15,894.48 11,596.78 29,991.60 103,553.96 76,419.78 14,160.99 4,073.30 1,428.92 7,616.56
814.26 47,221.08 17,081.96 86,978.19
4,185.00 10,276.09 78,981.22 123,686.68
5,883.78 8,754.49 1,862.41 20,811.49 6,740.87 10,450.00 5,735.11 2,097.00 13,101.74 2,289.27 1,911.00 55,590.57 3,710.42 70,858.09 118,043.31 123,183.55 10,349.66 14,791.02 20,156.87 33,680.23 95,706.68 7,704.88

Subsequent Injury Trust Fund 2003 Annual Report

Page 47

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

JACKSON CO BD OF EDUCATION

JEFFERSON

GA

JAMES AUTO PARTS

NASHVILLE

GA

JAMES F. HOOVER

LAVONIA

GA

JAMES GAMBLE MASONRY

VALDOSTA

GA

JAMES HILL CONTRACTOR

ACWORTH

GA

JEAN THOMAS

COMMERCE

GA

JEBCO, INC.

WARRENTON

GA

JENKINS PLUMBING CO.

SPRINGFIELD

GA

JET CORR, INC. - PLANT 1

CONYERS

GA

JETT SERVICE CENTERS, INC.

MARIETTA

GA

JIM WALTER HOMES, INC.

TAMPA

FL

JIM WALTER HOMES, INC.

FOREST PARK

GA

JIM WILKERSON CONSTRUCTION

MARIETTA

GA

JOE & GUY CO, INC.

ATLANTA

GA

JOE A. MUSTIN BUILDER

GAINESVILLE

GA

JOHN D. STEVENS, INC.

STONE MOUNTAIN

GA

JOHN DEMORE LOCK & KEY SVC. NEWNAN

GA

JOHN H. HARLAND CO

CONYERS

GA

JOHN PITTS COMPANY, INC.

FORSYTH

GA

JOHNNY PHILLIP HEATING

CHAMBLEE

GA

JOHNSON & JOHNSON

CORNELIA

GA

JOHNSON CO. BD. OF ED.

WRIGHTSVILLE

GA

JOHNSON CONTROLS, INC.

ATLANTA

GA

JRH OPTICS/PEARL VISION

DULUTH

GA

JULIOUS HARDCASH GRANITE

DEWY ROSE

GA

JWI GROUP PRESS FABRIC

JONESBORO

GA

K & C MACHINE DEVELOPMENT

BUFORD

GA

K & F INDUSTRIES

ROCKMART

GA

K&K MECHANICAL, LLC

LAGRANGE

GA

K.B.S. HEATING & COOLING

DOUGLASVILLE

GA

KASON INDUSTRIES, INC

SHENANDOAH

GA

KATSUSHIRO ROME CORP.

ROME

GA

KAWNEER COMPANY

JONESBORO

GA

KEANE, INC.

ATLANTA

GA

KELLWOOD COMPANY

ST. LOUIS

MO

KELLY LANDSCAPE MAINTENANCE DALLAS

GA

KEMIRA, INC.

SAVANNAH

GA

KENDALL ELECTRICAL SERVICE

MARIETTA

GA

KENDRICK TOOL & ENGINEERING MABLETON

GA

KEY HEALTH CENTER

MACON

GA

KEYSTONE MEMORIALS, INC.

ELBERTON

GA

KIDS KONDO INCORPORATED

ATLANTA

GA

KINDER-CARE LEARNING CENTER MARIETTA

GA

KING MAXI-MINI, INC.

DALTON

GA

KING MUFFLER SHOP

WAYCROSS

GA

Total $ Reimbursed
19,638.34 14,132.06
5,964.59 11,274.48
2,310.00 5,284.02 32,542.82 47,292.54 12,320.00 4,069.92 67,000.23 11,033.91 623,826.24 172,620.65
50.00 14,419.29 48,650.15 52,438.35 66,065.27 36,156.83
7,152.06 50,191.49
1,476.58 61,114.22 76,835.61 49,923.69 61,556.48 15,614.00 130,522.44 171,756.72
827.12 33,304.22 12,170.35
4,225.00 40,212.66 177,703.21 119,508.05 22,751.00
4,528.58 76,150.29 14,418.51 19,738.31 160,128.94 40,728.89 39,050.51

Subsequent Injury Trust Fund 2003 Annual Report

Page 48

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

KING PACKAGING COMPANY

BREMEN

GA

KINNETT DAIRIES, INC

COLUMBUS

GA

KINNEY CONSTRUCTION CO

LEESBURG

GA

KIRKLANDS

KENNESAW

GA

K-K MECHANICAL CONT., INC.

CONYERS

GA

KLIKLOK CORPORATION

DECATUR

GA

KLOCKNER NAMASCO CORP.

SUWANEE

GA

KNIGHT RIDER

MACON

GA

KOGER'S AUTO CARE INC.

HINESVILLE

GA

KOLE INVESTMENT CO.

SAVANNAH

GA

KRAFT FOOD SERVICE, INC

NORCROSS

GA

KROGEL FREIGHT SYSTEMS OF GA MACON

GA

KROGER CO.

ATLANTA

GA

KRYSTAL/M.A.E. THOMASVILLE

THOMASVILLE

GA

KYSOR WARREN

CONYERS

GA

LABORATORY CORP. OF AMERICA SAVANNAH

GA

LAGRANGE COLLEGE

LAGRANGE

GA

LAGRANGE MACHINE SHOP

LAGRANGE

GA

LAMAR ADVERTISING

AUGUSTA

GA

LAMAR COUNTY BOE

BARNESVILLE

GA

LANCE, INC.

CHARLOTTE

NC

LANIER CTY. BD. OF ED.

LAKELAND

GA

LANIER INDUSTRIES, INC.

ALPHARETTA

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

LEARD HUGGINS, INC.

SAVANNAH

GA

LEASEWAY PERSONNEL CORP.

READING

PA

LEGACY TOYOTA

UNION CITY

GA

LEGGETT & PLATT INC

SOCIAL CIRCLE

GA

LEMAY ELECTRIC

MARIETTA

GA

LENBROOK SQUARE

ATLANTA

GA

LEON FARMER & CO.

GAINESVILLE

GA

LEON JONES FEED & GRAIN

CUMMING

GA

LESLIE FAY SPORTSWEAR

MORROW

GA

LEVI STRAUSS & COMPANY

VALDOSTA

GA

LEWIS TRUCKING

LITHONIA

GA

LIFE LIKE, INC.

KENNESAW

GA

LIFT ATLANTA, INC.

DECATUR

GA

LIN R. ROGERS ELECTRICAL

ROSWELL

GA

LIQUID TRANSPORT CORP.

NORTH GREENFIELD IN

LITHONIA SIGNS, INC.

LITHONIA

GA

LOCKHEED MARTIN CORP.

MARIETTA

GA

Total $ Reimbursed
16,513.76 1,040.66
50,212.96 3,345.36
65,966.52 21,860.17 12,141.55 121,209.51 14,420.00 33,612.78 31,395.26
5,383.70 598,522.18
4,417.33 26,663.23 17,362.27 10,673.00
2,007.13 46,393.91
1,172.57 41,319.24 22,820.08 22,100.13
4,550.00 33,903.04
3,939.92 12,501.27
4,657.87 30,533.36 260,578.89 46,042.06 19,801.74
8,894.09 5,250.00 3,159.05 3,190.37 12,286.69 8,867.94 2,990.98 11,826.00 2,006.35 5,647.75 247,937.81 6,216.21 786,570.15

Subsequent Injury Trust Fund 2003 Annual Report

Page 49

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

LODINS SERVICES # 1, INC.

DECATUR

GA

LOGAN PAVING COMPANY

ATHENS

GA

LOMBARDI'S

ATLANTA

GA

LOOK PRODUCTS

MILLEN

GA

LOOKOUT MTN FAIRYLAND CLUB

LOOKOUT MTN.

TN

LORAL SPACE & COMMUNICATIONS ROCKMART

GA

LORD & STEPHENS FUNERAL

ATHENS

GA

LOWE'S CARPET CORP.

CHATSWORTH

GA

LOWE'S COMPANIES

ALBANY

GA

LTC HEALTHCARE

FT. VALLEY

GA

LULABELLE'S GOURMET COOKIES ATLANTA

GA

LYNN HAVEN NURSING HOME

MACON

GA

M & S DRYWALL

HINESVILLE

GA

M.A.P.S.S., INC.

BARNESVILLE

GA

MAAX USA, INC.

VALDOSTA

GA

MAC EQUIPMENT HUMAN RESO

ST PETERSBURG

FL

MACON HEALTH CARE CENTER

MACON

GA

MACON KRAFT

MACON

GA

MACON MALL/COLONIAL PROP.

MACON

GA

MACON NORTHSIDE HOSPITAL

MACON

GA

MACON-BIBB CO WATER & SEWAGE MACON

GA

MACY'S

ATLANTA

GA

MAGELLAN HEALTH SERVICES

MACON

GA

MAGNA LOMASON, INC.

CARROLLTON

GA

MAIL CONTRACTORS OF ARKANSAS LITTLE ROCK

AR

MAIL-WELL, INC.

ATLANTA

GA

MAIN AUTO PARTS

AUSTELL

GA

MAKITA CORP. OF AMERICA

BUFORD

GA

MANHEIM'S GA DEALERS AUTO

ATLANTA

GA

MANN MECHANICAL CO. INC.

AVONDALE ESTATES GA

MANNINGTON CARPETS, INC.

CALHOUN

GA

MANPOWER TEMP. SERVICES

DUBLIN

GA

MANSFIELD OIL/KANGAROO

GAINESVILLE

GA

MAPLEHURST, INC.

CARROLLTON

GA

MARBLE MASTERS

WARNER ROBINS

GA

MAREK INTERIOR SYSTEMS, INC. HOUSTON

TX

MARELL POULTRY COMPANY INC. MURRAYVILLE

GA

MARI STAFF, INC.

ATLANTA

GA

MARIETTA CITY SCHOOLS

MARIETTA

GA

MARK'S & MORGAN JEWELERS,

MACON

GA

MARLEY COOLING TOWER

OVERLAND PARK

KS

MARSHALL'S

STONE MOUNTAIN

GA

MARTIN CONSTRUCTION COMPANY SYLVESTER

GA

MASSEY SERVICE, INC

MAITLAND

FL

MASTER PROMOTIONS

LITHIA SPRINGS

GA

Total $ Reimbursed
32,567.96 6,075.00 8,976.67 7,434.26 3,107.20 870.90
17,441.43 9,321.84 5,964.44
48,409.14 61,500.00 44,299.94 277,480.95 41,704.31 15,528.28
458.74 100,112.11
17,325.00 27,193.72 32,901.15
7,955.85 25,885.00 16,279.51 225,586.98 48,590.41 20,691.16 105,446.72 165,460.80 93,286.60 18,226.67
287.10 3,863.79 89,292.79 17,309.89 1,807.36 18,762.14 3,666.47 3,482.09 3,472.00 15,754.35 11,387.50 62,379.60
193.61 2,443.90 11,882.87

Subsequent Injury Trust Fund 2003 Annual Report

Page 50

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

MASTERCORP

CROSSVILLE

TN

MATSUSHITA ELECTRIC CORP.

COLUMBUS

GA

MATTHEWS SERVICES GROUP

GRIFFIN

GA

MATTHEWS TRUCKING, INC.

BAXLEY

GA

MAXWELL CHASE TECH.

SMYRNA

GA

MC DESIGNS

CANTON

GA

MCBURNEY CORP.

NORCROSS

GA

MCC PANASONIC

PEACHTREE CITY

GA

MCCLESKY MILLS

SMITHVILLE

GA

MCCLURE LOGGING, INC.

JERSEY

GA

MCCOY GRADING, INC.

LUTHERSVILLE

GA

MCDONALD GROUP/LAKE

GAINESVILLE

GA

MCELROY SPEC. INT.

MARIETTA

GA

MCELWAIN MOVING & STORAGE

GAINESVILLE

GA

MCKENNEY'S, INC.

ATLANTA

GA

MCKENZIE TANK LINES

TALLAHASSEE

FL

MCMASTER-CARR SUPPLY CO

ATLANTA

GA

MC'S PAINTING & DECORATING

HIRAM

GA

MCWHORTER TECHNOLOGIES

COLUMBUS

GA

MDO HOMES, INC

LOGANSVILLE

GA

MEAD CORPORATION

SPARTANBURG

SC

MEADOWDALE NURSERIES

WARNER ROBINS

GA

MECO, INC. OF AUGUSTA

AUGUSTA

GA

MED CARE INC/ COOSA VALLEY

ROME

GA

MEDIQ INCORPORATED

PENNSAUKEN

NJ

MEMORIAL HOSPITAL & MANOR

BAINBRIDGE

GA

MENLO PARK, INC.

PEACHTREE CITY

GA

MERCHANTS METALS, INC.

FOREST PARK

GA

MERISTAR RESORTS &

RALEIGH

NC

METAL BUILDINGS, INC.

THOMASVILLE

GA

METAL CONCEPTS

MACON

GA

METAL PRODUCTS COMPANY

SUWANEE

GA

METRO METALS MFG.

AUSTELL

GA

METROMONT PRESTRESS

HIRAM

GA

MGA D/B/A MOVIE GALLERY

MARIETTA

GA

MGR HOMECARE, INC.

GRIFFIN

GA

MICRO-MED

BOCA RATON

FL

MID AMERICA APARTMENT COM

THOMASVILLE

GA

MIDAS, INC.

PANAMA CITY

FL

MIDDLE GA EASTER SEALS

DUBLIN

GA

MIDDLE GA. COMMUNITY

WARNER ROBINS

GA

MIDDLE GEORGIA HOSPITAL

MACON

GA

MIDDLE GEORGIA WILDERNESS INST COCHRAN

GA

MIDLAND EMPLOYER SERVICE

BRENTWOOD

TN

MILAN EXPRESS CO

TIFTON

GA

Total $ Reimbursed
57,439.25 2,931.85 3,095.38
10,406.62 28,003.20 90,357.47
1,722.42 45,025.45
8,224.52 20,718.45
686.48 38,028.20 21,558.30 83,637.21 77,307.63
1,230.04 245,003.00
9,120.95 11,326.71 47,111.80 10,096.00
6,821.50 35,347.41 10,814.95 29,962.22 22,047.11 22,048.55
6,470.41 16,179.50 56,503.12
7,957.14 39,570.57 12,553.54
777.83 3,184.70 19,685.00 4,344.24 35,139.90 16,612.88 29,164.01 11,535.07 66,216.63 14,975.86 19,970.20 9,635.01

Subsequent Injury Trust Fund 2003 Annual Report

Page 51

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

MILLER BREWING CO

ALBANY

GA

MILLIKEN & COMPANY

LAGRANGE

GA

MINI JOBS CONTRACTING

ATLANTA

GA

MISCELLANEOUS ERECTORS, INC. POWDER SPRINGS

GA

MOBIL CHEMICAL CO.

LAGRANGE

GA

MODERN FIBERS, INC.

FITZGERALD

GA

MODULAR CONTAINER SYSTEM

LAVONIA

GA

MONDO BAKING/KELLOGG

ROME

GA

MONROE AUTO EQUIPMENT

HARTWELL

GA

MOORE & MOORE PULPWOOD

CUTHBERT

GA

MOREHOUSE SCHOOL OF

ATLANTA

GA

MORMONS, INC.

CORDELE

GA

MORSE AUTOMOTIVE

CARTERSVILLE

GA

MOTIVATION CORP.

ALPHARETTA

GA

MRS. FIELDS HOLDING CO, INC

ATLANTA

GA

MAC-TURNER JOB CORPS

ALBANY

GA

MULLIN GROUP INC.

STATESBORO

GA

MUSCOGEE TEXTILES

COLUMBUS

GA

NASHVILLE TEXTILE CORP

NASHVILLE

GA

NATIONAL CEMENT CO., INC

LAWRENCEVILLE

GA

NATIONAL EMPLOYER SOLUTIONS ALPHARETTA

GA

NATIONAL EMPLOYERS SOLUTIONS ATLANTA

GA

NATIONAL ENVELOPE CORP.

AUSTELL

GA

NATIONAL FREIGHT, INC.

VINELAND

NJ

NATIONAL GYPSUM COMPANY

ATLANTA

GA

NATIONAL HEALTH LABORATORIES MARIETTA

GA

NATIONAL PIPE & PLASTICS, INC.

THOMASVILLE

GA

NATIONAL PUBLIC RADIO, INC.

WASHINGTON

DC

NATIONWIDE AUTOMOTIVE, INC.

ATLANTA

GA

NATURAL STONE of GEORGIA

JASPER

GA

NCR CORP.

PEACHTREE CITY

GA

NESS-MATERIAL STORAGE PROD VALDOSTA

GA

NESTLE TRANSPORTATION CO.

MCDONOUGH

GA

NET CARE HEALTH SYSTEMS, INC. ELLIJAY

GA

NETWORK COMMUNICATIONS

LAWRENCEVILLE

GA

NEW RIVERSIDE OCHRE CO.

CARTERSVILLE

GA

NICHOLLS LOGGING, INC.

DOUGLAS

GA

NICHOLSON ENTERPRISES, INC.

YOUNG HARRIS

GA

NICHOLSON ENTERPRISES, INC.

HOLLY SPRINGS

GA

NORCO, INC.

NORCROSS

GA

NERD KAOLIN CO

JEFFERSONVILLE

GA

NORDIC REFRIGERATED SVCS

DORAVILLE

GA

NORTH CENTRAL SOUTH COBB

MARIETTA

GA

NORTHERN TELECOM, INC.

STONE MOUNTAIN

GA

NORTHLAKE REGIONAL MED CTR TUCKER

GA

Total $ Reimbursed
83,568.41 30,380.52 16,226.19
4,457.94 20,108.68 154,165.18 51,152.16 49,514.91 24,963.62
3,630.53 65,000.00 32,610.69 33,955.36 20,427.26 28,821.12 16,033.62 14,110.72
18.66 9,922.00 1,294.62 8,626.48 14,260.75 26,489.73 35,686.65
299.00 16,314.94
9,832.55 76,629.74 77,646.80 52,623.70
5,878.34 55,205.25 24,762.82 27,018.92 18,078.40 57,318.49
9,310.00 30,351.46 13,611.32 160,798.55 12,305.69
249.62 5,186.12 14,043.81 96,614.83

Subsequent Injury Trust Fund 2003 Annual Report

Page 52

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

NORTHROP GRUMMAN CORP.

ST MARY'S

GA

NORTHROP GRUMMAN CORP.

MILLEDGEVILLE

GA

NORTHWEST GEORGIA PAVING

CALHOUN

GA

NOVOSTE CORP

NORCROSS

GA

NUTRASWEET KELCO CO. INC.

CHICAGO

IL

O.L. JOLLAY INC.

AVONDALE

GA

OCMULGEE FIELDS

MACON

GA

OELSCHIG'S NURSERY, INC.

SAVANNAH

GA

OFFICE DEPOT

LAWRENCEVILLE

GA

OFFICE INSTALLATION WORKS

ALPHARETTA

GA

OGLEBAY NORTON/ELLIJAY MT.

ELLIJAY

GA

OGLETHORPE COUNTY SCHOOL

LEXINGTON

GA

OLIN WOOTEN TRANSPORT CO.

HAZLEHURST

GA

OMC

CALHOUN

GA

ONE UP GOLF NORTH POINT LT

ALPHARETTA

GA

ONEDA CORPORATION

COLUMBUS

GA

ORIGINAL BRAND FOODS

ATLANTA

GA

ORRBILT COMPRESSORS, INC.

ATLANTA

GA

OSBORNE HEATING & AIR

SNELLVILLE

GA

OSHKOSH TRUCK CORP

VILLA RICA

GA

OTIS SPUNKMEYER, INC

NORCROSS

GA

OUR WAY, INC.

TUCKER

GA

OUTBOARD MARINE CORP.

CALHOUN

GA

OUTDOOR SYSTEMS, INC.

ATLANTA

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&M TRUCKING

DOUGLAS

GA

P.L. GARMENT FINISHERS

DUBLIN

GA

PACE AMERICA

EASTMAN

GA

PALMER FURNITURE CO.

VIDALIA

GA

PAPER PAK PRODUCTS

WASHINGTON

GA

PARKWOOD NURSING & REHAB

SNELLVILLE

GA

PARRISH DRUG STORE

JACKSON

GA

PARSONS

ATLANTA

GA

PARTITIONS, INC.

CLARKSTON

GA

PATRICK RENTALS

STOCKBRIDGE

GA

PAULDING CONCRETE

DALLAS

GA

PAYCHEX BUSINESS SOLUTION

JONESBORO

GA

PCI PROCOATERS INC

DECATUR

GA

PCL CIVIL CONSTRUCTORS

CORAL SPRINGS

FL

PDS MECHANICAL

JESUP

GA

PEACH AUTO PAINTING

TUCKER

GA

Total $ Reimbursed
42,047.12 3,958.95 2,296.20
10,910.56 52,175.32 29,235.04 24,259.09 18,085.83
165.60 61,189.56 27,381.88
8,529.13 16,288.66 37,624.17
7,973.34 18,851.25
2,310.16 14,276.35
202.50 67,186.13 57,236.94 11,312.88 44,183.70 72,361.48 16,077.22
98.04 41,157.24
3,596.19 7,640.00 204,342.19 15,448.58 83,937.79 6,309.35 1,461.45 137,171.07 6,535.04 4,200.00 171,908.25 35,936.00 161,929.16 113,542.67 2,888.14 14,335.19 16,072.21 25,597.37

Subsequent Injury Trust Fund 2003 Annual Report

Page 53

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

PEACHTREE CORNERS BAPTIST

NORCROSS

GA

PEACHTREE PROFESSIONAL

ROME

GA

PEBBLE HILL FOUNDATION

THOMASVILLE

GA

PEELER JERSEY FARMS, INC.

ATHENS

GA

PENHALL INT'L.

ANAHEIM

CA

PENSKE TRUCK LEASING

ATLANTA

GA

PEPSI-COLA COMPANY

ATLANTA

GA

PERRY M. ALEXANDER

HOMER

GA

PHENIX MECHANICAL CONTRACT COLUMBUS

GA

PHOTOCIRCUITS CORP

ATLANTA

GA

PIEDMONT WATER COMPANY

ATLANTA

GA

PIGGLY WIGGLY SOUTHERN

VIDALIA

GA

PILGRIM MILL CAFE

CUMMING

GA

PILZ AUTOMATION SAFETY

CANTON

MI

PINE KNOLL NURSING & REHAB.

CARROLLTON

GA

PINE MTN. WILD ANIMAL PARK

PINE MOUNTAIN

GA

PITNEY BOWES

NORCROSS

GA

PIZZA HUT, INC.

DOUGLASVILLE

GA

PLANT CONTRACTORS INC

AUGUSTA

GA

PLAYTEX APPAREL

NEWNAN

GA

PLEASANT VIEW NURSING CTR.

METTER

GA

POETIC LICENSE, INC.

ATLANTA

GA

POLITEX US, INC.

MACON

GA

POLK SCHOOL DISTRICT BD OF

ROCKMART

GA

POLLARD LAND CO, INC.

APPLING

GA

POLLUTION EQUIPMENT MGMT.

ATLANTA

GA

PONCE DE LEON CHEVRON

ATLANTA

GA

PONDER & ASSOCIATES

BETHLEHEM

GA

PONDER ENTERPRISES

DONALSONVILLE

GA

POREX TECHNOLOGIES

FAIRBURN

GA

PORTEC INC

WINDER

GA

POST PROPERTIES, INC.

ATLANTA

GA

POWELL CLEANERS

CUMMING

GA

PRECISE MAINTENANCE, INC.

DOUGLASVILLE

GA

PRECISION COMPONENTS, INT'L.

COLUMBUS

GA

PREMARK INTERNATIONAL INC.

CHAMBLEE

GA

PREMIER METAL PRODUCTS

DOUGLASVILLE

GA

PREMIER TRANSPORTATION

FOREST PARK

GA

PRESIDENT BAKING CO.

AUGUSTA

GA

PRESTOLITE WIRE CORP.

TIFTON

GA

PRIME CHILD CARE OF MACON

MACON

GA

PRIME FOOD SERVICE

DALTON

GA

PRIME SOURCE

SAVANNAH

GA

PRINTED FABRICS, INC

CARROLLTON

GA

PROCHEM

ALPHARETTA

GA

Total $ Reimbursed
63,555.56 10,331.81
3,197.96 18.50
7,325.38 36,589.03
9,252.00 97,781.60
809.74 6,067.21 94,799.34 9,510.34 3,536.00 152,400.00 9,665.00 49,467.70 39,573.62 100,220.12 15,290.00 6,392.11 1,405.09 36,212.61 15,355.00
682.76 10,863.30 12,544.49
2,113.27 128,155.99
2,073.26 26,109.90
6,120.00 2,205.13 7,951.00 27,270.17 30,124.28 1,959.44 19,400.47 48,044.06 19,200.00 109,520.01
475.96 25,364.43
2,874.96 10,570.00 22,543.35

Subsequent Injury Trust Fund 2003 Annual Report

Page 54

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

PROFESSIONAL EMPLOYEE MGM'T. SARASOTA

FL

PROFESSIONAL MEDICAL

ORLANDO

FL

PROGRESSIVE LIGHTING

DULUTH

GA

PTREE/CARADON DOORS & WINDOW GAINESVILLE

GA

PUBLIX SUPERMARKETS, INC.

NEWNAN

GA

PUBLIX SUPERMARKETS, INC.

SMYRNA

GA

PUBLIX SUPERMARKETS, INC.

KENNESAW

GA

PUTNAM COUNTY BOARD OF

EATONTON

GA

PYE-BARKER

SMYRNA

GA

PYRAMID MASONRY

DECATUR

GA

QUAD GRAPHICS

THE ROCK

GA

QUALITY FOOD OF COMMERCE

COMMERCE

GA

QUALITY MACHINE & FAB.

LAFAYETTE

GA

QUALITY MECHANICAL INC

LAWRENCEVILLE

GA

QUEBECOR ATLANTA

ATLANTA

GA

QUEST DIAGNOSTICS

TUCKER

GA

QUIKSET DEKALB

TOCCOA

GA

QUIKSET-ARCHWAY

TOCCOA

GA

R & D MANUFACTURING CO., INC. GAINESVILLE

GA

R. M. HURST

SYLVESTER

GA

R.E. SERVICES

LAFAYETTE

GA

R. GRIFFIN FEED, SEED & FERTILIZER DOUGLAS

GA

R.W. ALEXANDER CONTRACTORS VALDOSTA

GA

R/S EXPRESS, INC.

ATLANTA

GA

RABERN NASH CO., INC.

DECATUR

GA

RAINES PLUMBING

CORDELE

GA

RAM PARTNERS INC

ATLANTA

GA

RANDY JOHNSON CONSTRUCTION ELLABELL

GA

RAY M WRIGHT

COLUMBUS

GA

RAYLOC

ATLANTA

GA

RAY-O-LITE

ATLANTA

GA

RCS-GRIFFON CORP.

KENNESAW

GA

RECREATIONAL FACTORY WAREHSE JONESBORO

GA

RECREATIONAL LAKE ARROWHEAD WALESKA

GA

RED LOBSTER/DARDEN RESTAURAN DOUGLASVILLE

GA

REDMOND REGIONAL MEDICAL

ROME

GA

REEVES CONSTRUCTION CO.

AMERICUS

GA

REEVES CONSTRUCTION CO.

MACON

GA

REEVES TRUCKING CO., INC.

FITZGERALD

GA

REGAL RUGS

ELLIJAY

GA

RELAXERS COMFORT FOOTWEAR BUFORD

GA

RELIABLE SUPPLY COMPANY

ATLANTA

GA

RELIANCE STEEL & ALUMINUM

LOS ANGELES

CA

REMEDIATION SERVICES, INC.

FITZGERALD

GA

RENTOKIL CONTRACT SVC., INC.

DULUTH

GA

Total $ Reimbursed
49,595.06 3,063.33 6,638.26
33,769.68 61,184.18
8,832.57 472,851.41
2,001.60 1,080.90
643.38 12,581.77
1,844.28 62,675.06 19,828.15 30,502.73 16,281.71 29,893.61 24,594.54
292.06 83,801.10
8,122.74 77,460.32
1,208.27 14,425.04
1,364.00 72,775.85
2,449.33 1,468.16
541.45 8,575.00 11,515.57
34.65 44,517.63 49,326.89 32,332.78 32,077.22 25,234.71 36,884.70
6,075.00 13,101.44 136,485.61 16,450.00 82,680.31 27,030.09 117,908.18

Subsequent Injury Trust Fund 2003 Annual Report

Page 55

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

RESORTQUEST INT'L.

ST. SIMONS ISLAND

GA

RESTAURANT CONCEPTS

AUGUSTA

GA

RGIS INVENTORY SPECIALIST

ATLANTA

GA

RHEEM MANUFACTURING CO.

MILLEDGEVILLE

GA

RHODES CONSTRUCTION

AUGUSTA

GA

RHODES COOLING & HEATING

MOULTRIE

GA

RHONE POULNEC, INC.

WOODBINE

GA

RICHARDSON REAL ESTATE

ST. SIMONS ISLAND

GA

RICHPORT PROPERTIES INC.

TUCKER

GA

RICH'S

ATLANTA

GA

RISK MGMT DISASTER SERV

ALPHARETTA

GA

RITE HITE CORPORATION

DULUTH

GA

RIVERDALE PLUMBING INC

RIVERDALE

GA

RIVERSIDE INN

ROME

GA

RIVERWOOD INTERNATIONAL USA MACON

GA

RMS FAMILY RESTURANTS, INC.

MACON

GA

ROADWAY EXPRESS

ATLANTA

GA

ROBBINS PACKING COMPANY

STATESBORO

GA

ROBERT SHAW CONTROLS CO.

ELLIJAY

GA

ROBERTA NURSING HOME

ROBERTA

GA

ROCHE BIOMEDICAL LABS

TUCKER

GA

ROCKDALE PIPELINE

CONYERS

GA

ROGER'S CARTHER COMPANY

FORTSON

GA

ROME CITY SCHOOLS

ROME

GA

ROME TOOL & DYE COMPANY, INC. ROME

GA

ROOMS TO GO FURNITURE

SUWANEE

GA

ROPER INDUSTRIES

COMMERCE

GA

ROPER PUMP

COMMERCE

GA

ROSEDALE TRANSPORT, INC.

DALTON

GA

ROSES DEPARTMENT STORE # 235 ALBANY

GA

ROSIEK CONSTRUCTION CO.

BRUNSWICK

GA

ROSS MEMORIAL HEALTH CARE

KENNESAW

GA

ROSWELL ST. BAPTIST CHURCH

MARIETTA

GA

ROTARY CORP

GLENNVILLE

GA

RTM, INC.

ATLANTA

GA

RUAN LEASING

AUGUSTA

GA

RUNNERS DIVERSIFIED

VIDALIA

GA

RUSSELL & YOUNG BUILDERS

MARIETTA

GA

RUSSELL STANLEY

LITHONIA

GA

S & S CONTRACTORS

LITHONIA

GA

S & S ELECTRIC

WINDER

GA

S & S GRILL

ELBERTON

GA

S I CORPORATION

CHICKAMAUGA

GA

S P RICHARDS COMPANY

ATLANTA

GA

S. MARK SHAFER

JEFFERSON

GA

Total $ Reimbursed
18,682.29 7,119.75
19,427.20 185,682.45
20,777.38 352.56
13,125.00 70,534.15
8,268.58 23,468.68
7,838.75 171,400.00 157,389.80
96,257.32 29,079.34
4,328.84 5,641.17
483.94 75,694.84 108,062.71
7,656.44 4,199.35 20,022.12 1,479.13 29,972.94 39,755.68 6,329.92 73,130.00 146,383.00 6,500.37 10,800.00 2,948.19 3,922.91 8,137.54
61.75 26,194.27 33,865.00 161,175.34 115,800.89 12,447.00 69,473.05
9,542.87 111,044.21
19,546.46 208,099.77

Subsequent Injury Trust Fund 2003 Annual Report

Page 56

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

SAKS INCORPORATED

COLUMBUS

GA

SALLY BEAUTY COMPANY

COLUMBUS

GA

SAVANNAH COCA-COLA BOTTLING POOLER

GA

SAVANNAH DISTRIBUTING CO.

SAVANNAH

GA

SAVANNAH FOODS INDUSTRY

PT WENTWORTH

GA

SAVANNAH INT'NL TRADE

SAVANNAH

GA

SAVANNAH NEWS PRESS

SAVANNAH

GA

SCAPE DRYER FABRICS

WAYCROSS

GA

SCHNADIG CORP.

DES PLAINES

IL

SCHUSTER ENTERPRISES, INC

COLUMBUS

GA

SCIENTIFIC ATLANTA

NORCROSS

GA

SCOTT BRIDGE CO.

OPELIKA

AL

SCOVILL

CLARKESVILLE

GA

SCRIPPS HOWARD CABLE

ROME

GA

SE BUILDING MAINTENANCE

LOGANVILLE

GA

SEA ISLAND COMPANY

SEA ISLAND

GA

SEABOARD FARMS OF ATHENS

ATHENS

GA

SEAGRAVES ENTERPRISES INC.

ATLANTA

GA

SEALY INC

CONYERS

GA

SEARS ROEBUCK & CO.

BRUNSWICK

GA

SEASON'S FOUR, INC.

DOUGLASVILLE

GA

SELIG ENTERPRISES, INC

ATLANTA

GA

SERVICE MERCHANDISE

BRENTWOOD

TN

SERVICEMASTER CONSUMER

MARIETTA

GA

SERVPRO OF EAST COBB

MARIETTA

GA

SETCO GRADING CO

CARROLLTON

GA

SEWELL MANUFACTURING CO

BREMEN

GA

SHARP SYSTEMS

LESLIE

GA

SHAW ALMEX USA INC.

CLARKSTON

GA

SHAW INVESTMENTS INC

ROCKY FACE

GA

SHC ASSOCIATES

BUFORD

GA

SHENANDOAH ELECTRICAL SE

NEWNAN

GA

SHEPARD EXPOSITION SERVICES ATLANTA

GA

SHEPHERD CONSTRUCTION CO

ATLANTA

GA

SHO/LINK, INC.

ATLANTA

GA

SHOE CITY, INC.

MONTGOMERY

AL

SIEMENS ENERGY & AUTOMATION TUCKER

GA

SIEMENS ENERGY CORP

ALPHARETTA

GA

SIG COX INC

AUGUSTA

GA

SIGNATURE FLIGHT SUPPORT

GARDEN CITY

GA

SIMKINS INDUSTRIES, INC.

MARIETTA

GA

SIMMONS POWDER CO

ATLANTA

GA

SINGLETON FURNITURE CO

WAYCROSS

GA

SISSON DUPONT & CARDER IND.

BLUE RIDGE

GA

SKILSTAFF INC

ALEXANDER CITY

AL

Total $ Reimbursed
12,884.66 13,521.89 19,801.18
9,437.40 27,240.79
4,791.48 16,311.92 29,000.24 59,416.04 30,683.31
1,841.45 72,513.36 60,401.05 12,653.32 21,000.30 43,459.45
2,598.20 4,962.63 4,701.70 63,572.01 2,884.95 4,433.55 22,510.86 6,805.23 14,568.40 83,451.31 26,220.93 197,356.73 13,485.13
35.00 2,693.18
65.00 201.46 48,844.17 54,810.00 161,920.51 42,988.15 11,161.64 125,919.90 61,154.15 21,118.92 10,953.33 12,341.34 402.00 13,058.49

Subsequent Injury Trust Fund 2003 Annual Report

Page 57

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

SKYLINE PLUMBING SERVICES

DALLAS

GA

SMITH & SONS FOOD, INC.

ATLANTA

GA

SMITH BROTHERS MECH.

AUGUSTA

GA

SMITH INDUSTRIES

CUMMING

GA

SMITHS MARKET

TALLAPOOSA

GA

SMOKER - CRAFT

LAGRANGE

GA

SOLOMON WHITE

DALTON

GA

SONNY'S BBQ

DORAVILLE

GA

SONY MUSIC

CARROLLTON

GA

SOUTHEASTERN FREIGHT LINE

SUWANEE

GA

SOUTHEASTERN MEAT CO INC

ATLANTA

GA

SOUTHERN AMBULANCE

LAGRANGE

GA

SOUTHERN CROSS CORP

NORCROSS

GA

SOUTHERN ELECTRONICS

TUCKER

GA

SOUTHERN HOME CARE SERV.

VALDOSTA

GA

SOUTHERN MANOR FURNITURE

THOMASVILLE

GA

SOUTHERN PIZZA VENTURES

COMMERCE

MI

SOUTHERN SAW SERVICE, INC.

ATLANTA

GA

SOUTHERN TRADITIONS

BUCHANAN

GA

SOUTHLAND ASSOCIATES, INC.

THOMASVILLE

GA

SOUTHLAND LOGGING

FITZGERALD

GA

SOUTHLAND NURSING HOME

PEACHTREE CITY

GA

SOUTHWAY CRANE & RIGGING

ATLANTA

GA

SP RECYCLING CORP.

LAWRENCEVILLE

GA

SPARTAN MECHANICAL INC

CHAMBLEE

GA

SPC COMPANY

LAGRANGE

GA

SPECIAL PROJECTS, INC.

DALTON

GA

SPECIALTY TRANSPORTATION

CONLEY

GA

SPECTRUM CABLE SERVICES

JONESBORO

GA

SPECTRUM STORES

WEST POINT

GA

SPIRIT CONSTRUCTION SERVICES SAVANNAH

GA

SPORTRAN, INC.

LAWRENCEVILLE

GA

SPRINGS INDUSTRIES, INC.

CALHOUN

GA

STAFF LEASING

BRADENTON

FL

STAFF LEASING GROUP

THOMASVILLE

GA

STAFF LEASING-GEVITY HR

NORCROSS

GA

STAFFING PROFESSIONALS

MADISON

GA

STANDARD TELEPHONE COMPANY CORNELIA

GA

STANLEY STEEL & CONCRETE,

LITHIA SPRINGS

GA

STAR CHOICES INC

MACON

GA

STAR MANUFACTURING COMPANY CEDARTOWN

GA

STARWOOD HOTELS & RESORT

PHOENIX

AZ

STEIN MART

PEACHTREE CITY

GA

STEPHENS COUNTY HOSPITAL

TOCCOA

GA

STERCHI BROTHERS STORES INC ATLANTA

GA

Total $ Reimbursed
79,752.66 4,672.59 214.50 1,270.74
27,362.04 66.73
2,033.99 36,656.54 158,442.89 21,466.36
7,923.52 52,129.45
7,650.00 21,689.44 288,587.05 22,580.01 70,099.36 16,734.34
4,546.96 13,800.45 47,105.27
4,187.87 158,391.07
1,508.79 27,974.28 15,205.56
4,585.60 147.35
26,455.87 323.50
17,414.20 39,195.00 48,554.76 43,298.95
419.00 2,027.25 17,695.86 1,616.38 4,966.12 12,249.74 54,752.79 105,286.48 18,629.13 15,194.73 9,914.40

Subsequent Injury Trust Fund 2003 Annual Report

Page 58

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

STEVE CRAWFORD FOREST

WAYNESBORO

GA

STEVENS GRAPHICS, INC.

ATLANTA

GA

STOKES TEMPORARY SERVICE

BLOOMINGDALE

GA

STONE MOUNTAIN GROUP

SNELLVILLE

GA

STONEMARK MGM'T.

ATLANTA

GA

STORK GAMCO, INC.

GAINESVILLE

GA

STRAIN POULTRY

GAINESVILLE

GA

SUITT CONSTRUCTION COMPANY ALBANY

GA

SULLIVAN LAWNS

MARTINEZ

GA

SUN DATA, INC.

NORCROSS

GA

SUNBELT PLASTIC EXTRUSIONS

CENTERVILLE

GA

SUNDANCE PLUMBING, INC.

MARIETTA

GA

SUNGLASS HUT CORPORATION

MIAMI

FL

SUPER VALU

ATLANTA

GA

SUPERIOR ELECTRIC

JULIETTE

GA

SUPERIOR INSURANCE COMPANY ATLANTA

GA

SUPERIOR PANTS COMPANY

ATHENS

GA

SUPREME CARPET, INC.

CHATSWORTH

GA

SUPREME INDUSTRIES, INC.

GOSHEN

GA

SWEETHEART CUP CO., INC.

CONYERS

GA

SWIFT INDEPENDENT PACKING

MOULTRIE

GA

SWISHER INTERNATIONAL ,INC.

JACKSONVILLE

FL

SYNOVUS FINANCIAL CORP.

COLUMBUS

GA

SYNTHETIC INDUSTRIES

CHICKAMAUGA

GA

SYSCO FOODS

COLLEGE PARK

GA

SYSTEM SERVICES AND

SAVANNAH

GA

T & L INSTALLATION COMPANY

MARIETTA

GA

T & L SERVICES, INC.

PALMETTO

GA

T & R PAINTING

ALTO

GA

T & S MECHANICAL, INC

SANDERSVILLE

GA

T.T.C. ILLINOIS, INC.

KANKAKEE

IL

TALON INC

CHARLOTTE

NC

TARA MATERIALS, INC.

LAWRENCEVILLE

GA

TARMAC AMERICAN, INC.

LITHONIA

GA

TARTAN TEXTILE SERVICES

ROME

GA

TAYLOR ORCHARDS, INC.

REYNOLDS

GA

TBN OF GA., INC./TBN OF TENN.

BRUNSWICK

GA

TC BAYCOR

CORNELIA

GA

TDK ELECTRONICS CORP.

PEACHTREE CITY

GA

TECH CON, INC.

BLUE RIDGE

GA

TEETS INTERNATIONAL TRUCKS

AUGUSTA

GA

TELEMED, INC.

ATLANTA

GA

TELEPHONE & DATA SYSTEMS

SAINT MARY'S

GA

TELFAIR COUNTY SCHOOLS

MCRAE

GA

TELIGENT

VIENNA

VA

Total $ Reimbursed
29,833.70 12,237.20
3,591.55 21,750.04 81,607.48 17,460.04
6,300.00 7,847.65 40,108.91 2,561.83
452.75 9,450.00 30,859.69
524.24 11,758.06 30,271.41
1,699.99 10,270.60 20,372.67
3,133.75 13,905.00 36,976.61 16,212.18 35,971.40 15,419.84
9,079.74 98.00
2,954.36 11,604.05
1,772.08 25,985.66 25,692.08
3,012.75 860.00
3,280.00 42,945.94 15,285.90 104,348.18
3,140.99 13,138.80
3,520.00 1,067.58 2,949.62 1,417.44 42,185.51

Subsequent Injury Trust Fund 2003 Annual Report

Page 59

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

TEMPLE INLAND, INC.

MACON

GA

TENET-NORTH FULTON REGIONAL ROSWELL

GA

TENNECO AUTOMOTIVE

HARTWELL

GA

TENNECO OIL CO.

EAST POINT

GA

TERMINIX AT GAINESVILLE

CUMMING

GA

TERMINIX AT MARIETTA

MARIETTA

GA

TERMINIX OF SAVANNAH

POOLER

GA

TERRY STOVER CONSTRUCTION

KINGSLAND

GA

TETON INDUSTRIAL

CEDAR SPRINGS

GA

TFE GROUP

KENNESAW

GA

THE BOOK WAREHOUSE

KNOXVILLE

TN

THE CONCRETE CO., INC.

COLUMBUS

GA

THE DARIEN NEWS, INC.

DARIEN

GA

THE DRESS BARN

CUMMINGS

GA

THE FARM GOLF CLUB

ROCKY FACE

GA

THE GILBERT COMPANIES

MADISON

GA

THE GREATER TRAVELERS REST DECATUR

GA

THE HOLLAND GROUP

CARROLLTON

GA

THE HUBBARD CO.

BREMEN

GA

THE KINGS CARPENTERS, INC.

CANTON

GA

THE LANDINGS

SAVANNAH

GA

THE MORRIS LIVING CENTER

MARIETTA

GA

THE MOTOR CONVOY, INC.

ATLANTA

GA

THE MOUAT CO.

ALBANY

GA

THE NETWORK, INC.

NORCROSS

GA

THE RAYMOND KING CO., INC.

CALHOUN

GA

THE RETREAT

NASHVILLE

GA

THE SPORT SHOE, INC.

NORCROSS

GA

THE TAPPAN COMPANY

DALTON

GA

THE WILLIAM L BONNELL CO.,

NEWNAN

GA

THE WINSTON GROUP

LAWRENCEVILLE

GA

THIELE KAOLIN COMPANY

SANDERSVILLE

GA

THOMAS AND BETTS

BAINBRIDGE

GA

THOMAS CONCRETE

ATLANTA

GA

THOMAS COUNTY PUBLIC

THOMASVILLE

GA

THOMAS PACKING CO.

GRIFFIN

GA

THOMASTON MILLS INC

THOMASTON

GA

THOMPSON HARDWOODS, INC.

HAZELHURST

GA

THOMPSON CONSTRUCTION CO.

CHAMBLEE

GA

THOMPSON INTERNATIONAL

ADEL

GA

THOMPSON'S FARM SUPPLY

VIDALIA

GA

THOMSON OAK FLOORING CO.

THOMSON

GA

TIDEWATER COMPANIES, INC.

BRUNSWICK

GA

TIDEWATER EQUIPMENT CO.

THOMASVILLE

GA

TIFT COUNTY BOE

TIFTON

GA

Total $ Reimbursed
93,880.02 83,796.73 14,925.00 55,174.44 21,489.73
1,602.36 9,849.80 32,790.88 35,114.99 30,350.45 66,772.14 7,065.08 3,162.22 2,308.68
243.36 299,382.44
51,210.25 45,630.20 16,638.57
7,995.44 55,096.51 25,951.57 28,805.00 167,550.00 15,064.09 12,741.03
8,310.66 40,222.93 25,334.27 13,021.08
1,698.52 100.45
23,643.18 97.80
1,438.29 4,503.24 103,225.20 27,440.00 33,243.85 8,361.81 17,760.42 10,015.86 51,955.95 22,121.18 14,506.48

Subsequent Injury Trust Fund 2003 Annual Report

Page 60

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

TIM JONES COMMUNICATIONS

JONESBORO

GA

TIMBER HARVESTING, INC.

DANVILLE

GA

TJ MAXX

BRUNSWICK

GA

TMP CONSTRUCTION INC

POWDER

GA

TNS MILLS, INC.

LAVONIA

GA

TOBACCO EXPORTERS INT'L

TUCKER

GA

TOBUTSU AMERICA

DULUTH

GA

TOCCOA METAL TECHNOLOGIES

TOCCOA

GA

TOCCOA TIRE & RECAPPING

TOCCA

GA

TOLLESON LUMBER CO

PERRY

GA

TOMMY GIBSON BUILDERS INC

MACON

GA

TOMMY L GRIFFIN PLUMBING

MACON

GA

TOM'S FOOD, INC.

COLUMBUS

GA

TONY'S FOOD MART

ROCKMART

GA

TOPCON AMERICA CORP.

PARAMUS

NJ

TORRINGTON

CALHOUN

GA

TOSCO MARKETING CO.

NORCROSS

GA

TOWN OF TRION POLICE DEPT.

TRION

GA

TOWNS COUNTY B. O. E.

HIAWASSEE

GA

TOWNSEND TREE/GILBERT CO.

PARKER CITY

IN

TRAILMOBILE, INC.

CONLEY

GA

TRANE UNITARY PRODUCTS

VIDALIA

GA

TRANS WORLD AIRLINES, INC.

ATLANTA

GA

TRANSIT GROUP CORP.

OVERLAND

KS

TRANSPOWER

ALBANY

GA

TRATON CORPORATION

MARIETTA

GA

TRENT TUBE DIVISION

CARROLLTON

GA

TRILLIUM COOKIE CO

ALBANY

GA

TRINOVA CORPORATION

ATLANTA

GA

TRI-SOUTH CONTRACTORS, INC

STONE MTN.

GA

TROJAN BATTERY COMPANY

LITHONIA

GA

TROOPER, INC.

AUGUSTA

GA

TRU SERV

JONESBORO

GA

TRUCKS, INC.

JACKSON

GA

TRUCKSTOPS OF AMERICA

BRUNSWICK

GA

TRUGREEN CHEMLAWN SVC

ATLANTA

GA

TRUS JOIST MACMILLIAN

COLBERT

GA

TRW AERONAUTICAL SYSTEMS

MACON

GA

TUCKER CONCRETE CO INC

TUCKER

GA

TUFTCO CORP.

DALTON

GA

TUFTING MACHINE CO., INC.

DALTON

GA

TURNER BROADCASTING SYSTEM ATLANTA

GA

TURNER FOOD SYSTEMS, INC.

ROME

GA

TURNER PLUMBING, HEATING &

COLUMBUS

GA

U.S. CAN CO

TALLAPOOSA

GA

Total $ Reimbursed
2,666.62 23,781.56
1,044.07 149,668.00
2,835.72 14,824.68 76,302.59 18,435.31 78,738.03 110,677.95 19,131.98 41,575.47
5,463.65 7,439.22 11,270.60 9,091.25 12,762.29 42,126.54 2,563.94 4,057.39 16,986.26 10,932.38 25,190.46 6,000.00 3,480.01
562.50 10,846.46
3,121.40 6,790.95 3,595.53 53,951.64 15,315.80
312.00 14,381.21 14,073.85
1,909.62 25,111.49
6,822.90 10,216.15
854.78 1,383.79 11,403.53 7,807.59 3,903.53 32,190.08

Subsequent Injury Trust Fund 2003 Annual Report

Page 61

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

U.S. FILTER

THOMASVILLE

GA

UNION MISSION INC.

SAVANNAH

GA

UNITED DISTRIBUTORS, INC.

ALBANY

GA

UNITED INSURANCE CO OF AMER. SAVANNAH

GA

UNITED PARCEL SERVICE

UNADILLA

GA

UNITED WATER SERVICES ATL.

ATLANTA

GA

UNITY CONSTRUCTION

POWDER SPRINGS

GA

UPSON COUNTY

THOMASTON

GA

US XPRESS, INC.

TUNNEL HILL

GA

USFILTER DISTRIBUTION

BUFORD

GA

UTILITIES CONST. CO OF SC

CHARLESTON

SC

V.F. CORPORATION/LEE CO.

JASPER

GA

V.T. INDUSTRIES, INC.

ARMUCHEE

GA

VANGUARD SERVICES

INDIANAPOLIS

IN

VANTAGE PRODUCTS CORP.

CONYERS

GA

VARN TURPENTINE & CATTLE

JACKSONVILLE

FL

VAUGHAN CARTAGE CO., INC.

LAGRANGE

GA

VENDOR'S SUPPLY OF GEORGIA

LITHONIA

GA

VIACON, INC

NORCROSS

GA

VICTORY BAPTIST CHURCH

STONE MTN.

GA

VILLAGE PODIATRY, INC.

SMYRNA

GA

VINCE HOSIERY MILL

VILLA RICA

GA

VINING FUNERAL HOME

EATON

GA

VISITING NURSES ASSOCIATION

BAXLEY

GA

VISTA HOSPITAL CARE

MACON

GA

VOS ELECTRIC

GREEN BAY

WI

VOUGHT AIRCRAFT

MILLEDGEVILLE

GA

W & J, INC.

SMYRNA

GA

W.A. BRAGG & CO.

AUGUSTA

GA

W.B. RODDENBERRY CO., INC.

CAIRO

GA

W.C. BRADLEY CO.

COLUMBUS

GA

WADE & SONS INC

MACON

GA

WADE INVESTMENTS

COLUMBUS

GA

WALDON ROCK SERVICES

ADAIRSVILLE

GA

WAL-MART

HINESVILLE

GA

WAL-MART

CEDARTOWN

GA

WALTON MONROE MILLS, INC.

MONROE

GA

WARE COUNTY DEVELOPMT SVC WAYCROSS

GA

WASTE MANAGEMENT OF AUGUSTA AUGUSTA

GA

WATER VISTA APARTMENTS

LAWRENCEVILLE

GA

WATER, GAS & LIGHT COMMISSION ALBANY

GA

WATTYL PAINT CORP.

ATLANTA

GA

WAYCROSS COCA-COLA

WAYCROSS

GA

WAYFIELD FOODS, INC.

ATLANTA

GA

WAYNE POULTRY

PENDERGRASS

GA

Total $ Reimbursed
26,894.25 84,140.39
8,176.90 236,653.73
14,331.03 30,036.87 26,469.23 23,455.75 50,942.58
674.00 6,145.28 9,914.45 16,725.09 515,840.24 38,574.35 28,294.67 9,215.94 5,062.50 39,501.80 5,908.46 31,333.12 6,013.25
265.00 38,893.69 62,135.01 16,954.72 34,171.37 66,442.84 73,011.29
135.00 2,922.93 8,750.00
981.06 3,669.50 70,908.35 40,085.55 7,290.00 6,213.69 8,558.35 16,609.29 3,410.00 97,126.85 37,793.31 26,936.03 15,551.08

Subsequent Injury Trust Fund 2003 Annual Report

Page 62

Individual Employers Benefiting from Reimbursements Paid to Insurance Companies

Total $ Reimbursed

WAYNE S. HADDOCK

WAYCROSS

GA

49,653.05

WBTR

CARROLLTON

GA

44,712.29

WEEKS TEXTILE

QUITMAN

GA

12,375.00

WELLESLEY INN

ALPHARETTA

GA

23,330.87

WESLEYAN COLLEGE

MACON

GA

47,540.50

WEST ACRES BAPTIST CHURCH

EVANS

GA

30,403.44

WEST GEORGIA AUTO PARTS INC CARROLLTON

GA

5,390.00

WEST PLUMBING SALES & SER

WARNER

GA

171,849.31

WESTERN SIZZLIN'

TIFTON

GA

107,570.44

WESTVALE MANUFACTURING CO CANTON

GA

18,171.33

WHITECREST DORSETT

CHATSWORTH

GA

19,193.56

WHITEHALL CORPORATION

MACON

GA

12,310.32

WIKA INSTRUMENT CORP

LAWRENCEVILLE

GA

335.80

WIL MAC CONTAINER

CONYERS

GA

5,146.82

WILKINS INDUSTRIES

ATHENS

GA

7,978.92

WILKINSON CO. BD OF

IRWINGTON

GA

3,873.15

WILLIAM CARTER CO

BARNESVILLE

GA

378,613.65

WILLIAM J. LUMLEY & CO.

ADRIAN

GA

18,150.00

WILLIAMS BROS. TRUCKING

HAZELHURST

GA

46,490.27

WILLIAMS ENTERPRISES OF GA

SMYRNA

GA

74,904.74

WILLIAMS POWER CORP

STONE MOUNTAIN

GA

141,872.93

WILSON CROSBY/CROSBY PULP

LAKE PARK

GA

1,038.25

WOLVERINE METAL STAMPING,

DECATUR

GA

27,041.64

WORLEY LOGISTICS

DECATUR

GA

101.47

WWF, INC.

ATHENS

GA

31,514.44

WYATT CONSTR. CO., INC.

GRANITEVILLE

SC

197,554.10

YOKOGAWA CORP OF AMERICA

NEWNAN

GA

96,718.07

YORK BEE CO

JESUP

GA

23,469.60

YOUNG REFINING CORP.

DOUGLASVILLE

GA

83.00

ZARTRAN, INC.

CEDARTOWN

GA

56,325.75

Total:

$47,954,772.37

Subsequent Injury Trust Fund 2003 Annual Report

Page 63

ASSESSMENT 2003
Legal Requirements
O.C.G.A.34-9-358 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 an employer who is subject to this Chapter or the equivalent of such in the case of a self-insurer.
O.C.G.A. 34-9-359 (a) As soon as practicable after January 1 but not later than January 31 of each calendar year, the administrator shall forward to each insurer and self-insured employer a questionnaire asking for the total amount of compensation, medical benefits, and rehabilitation benefits paid by each insurer and self-insured employer during the preceding calendar year. This report is to be completed and returned to the administrator no later than March 1 of the same calendar year in which the request for this information is submitted. Failure to submit the report to the administrator of the fund by March 1 shall result in an automatic penalty of $50.00 per day for each day the report is delinquent or 10 percent of the assessment, whichever is greater. This penalty will be added to the assessment.
(b) Any assessment levied or established in accordance with this article in a specified amount as may be determined pursuant to this article shall constitute a personal debt of every employer or insurer so assessed and shall be due and payable to the Subsequent Injury Trust Fund when payment is called for by the administrator. In the event of failure to pay any assessment upon the date determined by the administrator, the administrator may file a complaint for collection against the employer or insurer in a court of competent jurisdiction.
(c) In the event any employer or insurer duly assessed fails to pay to the administrator on behalf of the Subsequent Injury Trust Fund the amount so assessed on or before the date specified by the administrator, the administrator is authorized to add to the unpaid assessment an amount not exceeding 10 percent of the unpaid assessment and reasonable attorney's fees to defray the cost of enforcing collection.

Subsequent Injury Trust Fund 2003 Annual Report

Page 64

Assessment Calculation
The assessment and assessment rate are derived from the fund's financial activity for the calendar year and the claims loss data provided by insurance companies and self-insured employers. This claims loss data is obtained on an annual basis in the form of an Annual Assessment Report. As required in O.C.G.A.34-9-359, this is a report of the total amount of compensation, medical benefits, and rehabilitation benefits paid by each insurer and selfinsured employer during the calendar year.

Assessment Adjustment for 2002
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2002 was $126,601,810.12. This was computed in the following manner:

Total Fund disbursements/calendar year 2002

$90,309,333.83

(minus) Net Assets (as of 12/31/2002) Fund Assessment

x

175%

- 31,439,524.08

$126,601,810.12

The assessment rate is based on data provided by insurers and self-insured employers' in the Annual Assessment Reports; the actual total of workers' compensation benefits (indemnity, medical, and rehabilitation) paid in Georgia during calendar year 2002 was $1,082,971,269.81. This amount is divided into the fund assessment of $126,601,810.12 and yields an (adjusted) assessment rate of .11690228. This adjustment has caused an increase to be applied to the 2002 assessment.

Assessment Rate for 2003
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2003 is $94,996,319.37. This was computed in the following manner:

Total Fund disbursements/calendar year 2003

$90,543,370.39

(minus) Net Assets (as of 12/31/2003) Fund Assessment

x

175%

158,450,898.18

- 63,454,578.81

$94,996,319.37

Based on data received from insurers and self-insured employers, the reported total of workers' compensation benefits paid in Georgia during calendar year 2003 was $1,120,885,538.34. This amount is divided into the fund assessment $94,996,319.37, which yields an assessment rate of .08475113.

In addition to the assessment, an additional $187,492.98 in penalties for late filing of Claims Loss report forms will be levied.

Subsequent Injury Trust Fund 2003 Annual Report

Page 65

Assessments Due for 2003 Combined with the assessment adjustment for 2002 and the assessment amount for 2003, the total 2002 - 2003 assessment payment is payable to the Subsequent Injury Trust Fund.
A ten percent (10%) penalty is applied for assessment payments postmarked or hand delivered to the fund after the established deadline date.

Insurance Companies The following is the 2002-2003 assessment amount due from insurance companies.

Insurance Company Name ACCEPTANCE INSURANCE CO ACE AMERICAN INSURANCE CO ACE FIRE UNDERWRITERS INS. CO ACE INDEMNITY INSURANCE CO ACE PROPERTY & CASUALTY INS ACIG INSURANCE COMPANY ADVANTAGE WORKERS COMP. INS. AIU INSURANCE CO ALEA NORTH AMERICA ALFA INSURANCE CORP ALL AMERICA INS. CO AMCOMP ASSURANCE AMCOMP PREFERRED AMERICAN & FOREIGN INS CO. AMERICAN ALTERNATIVE INS AMERICAN AUTOMOBILE INS CO AMERICAN CAS CO OF READING PA AMERICAN CENTRAL INS CO AMERICAN ECONOMY INS CO AMERICAN EMPLOYERS INS CO AMERICAN FIRE & CASUALTY CO AMERICAN GUAR & LIAB INS CO AMERICAN HARDWARE MUTUAL INS AMERICAN HOME ASSURANCE CO 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 RESOURCES INS CO AMERICAN RISK FUNDING

2002
$ Assessment 24.56
310,606.21 31,725.52 5,124.36 62,078.19
0.00 27.67 188,614.77 0.00 2,390.26 77,391.70 82,906.81 26,732.68 89,111.23 1,206,530.93 111,099.67 1,649,757.38 22,131.71 62,405.78 33,141.59 100,295.10 98,790.09 14,163.00 2,920,370.26 477,185.88 1,398,043.87 734,998.46 957,603.17 494,864.41 1,076,952.51 70,670.35 0.00

2002 Assessment $ Adjustment
24.67 311,984.25 31,866.28
5,147.09 62,353.61
0.00 27.79 189,451.59 0.00 2,400.86 77,735.05 83,274.64 26,851.28 89,506.58 1,211,883.85 111,592.58 1,657,076.73 22,229.90 62,682.65 33,288.63 100,740.07 99,228.39 14,225.84 2,933,326.83 479,302.97 1,404,246.46 738,259.36 961,851.69 497,059.93 1,081,730.54 70,983.88 13,559.85

2003 Claims Paid
0.00 6,038,775.00
287,773.00 75,081.00 602,846.00 117,489.00 12,540.00 1,109,556.00
994.00 8,964.00 402,854.00 1,658,567.00 347,832.00 151,726.00 7,968,603.00 819,568.00 16,328,431.29 290,745.00 191,770.36 86,127.00 1,096,423.00 924,531.34 24,181.00 28,567,707.00 3,415,958.00 13,942,412.11 5,617,472.00 7,028,334.65 4,925,831.93 8,520,274.25 631,771.00
0.00

2003
$ Assessment 0.00
511,793.01 24,389.09 6,363.20 51,091.88 9,957.33 1,062.78 94,036.12
84.24 759.71 34,142.33 140,565.43 29,479.16 12,858.95 675,348.11 69,459.31 1,383,853.00 24,640.97 16,252.75 7,299.36 92,923.09 78,355.08 2,049.37 2,421,145.45 289,506.30 1,181,635.18 476,087.10 595,659.30 417,469.82 722,102.87 53,543.31
0.00

2002 $ Balance
Due 0.11
1,378.04 140.76 22.73 275.42 0.00 0.12 836.82 0.00 10.60 343.35 367.83 118.60 395.35
5,352.92 492.91
7,319.35 98.19 276.87 147.04 444.97 438.30 62.84
12,956.57 2,117.09 6,202.59 3,260.90 4,248.52 2,195.52 4,778.03
313.53 13,559.85

2002 and 2003 Total
Assessment

$

0.11

$ 513,171.05

$ 24,529.85

$

6,385.93

$ 51,367.30

$

9,957.33

$

1,062.90

$ 94,872.94

$

84.24

$

770.31

$ 34,485.68

$ 140,933.26

$ 29,597.76

$ 13,254.30

$ 680,701.03

$ 69,952.22

$ 1,391,172.35

$ 24,739.16

$ 16,529.62

$

7,446.40

$ 93,368.06

$ 78,793.38

$

2,112.21

$ 2,434,102.02

$ 291,623.39

$ 1,187,837.77

$ 479,348.00

$ 599,907.82

$ 419,665.34

$ 726,880.90

$ 53,856.84

$ 13,559.85

Subsequent Injury Trust Fund 2003 Annual Report

Page 66

Insurance Company Name AMERICAN SAFETY CASUALTY INS AMERICAN STATES INS CO AMERICAN STATES INS CO OF TX AMERICAN ZURICH INS CO AMERISURE INSURANCE CO AMERISURE MUTUAL INS CO AMGUARD INSURANCE CO. ARCH INSURANCE CO ARGONAUT GREAT CENTRAL INS CO ARGONAUT INSURANCE CO ARGONAUT-MIDWEST INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES INS CO ASSOCIATION CASUALTY INS CO ASSOCIATION INSURANCE CO ASSURANCE CO. OF AMERICA ATLANTIC MUTUAL INS. CO AUTO OWNERS INS. CO AUTOMOBILE INS OF HARTFORD CT BANCINSURE, INC. BANKERS STANDARD INS CO BENCHMARK INS CO BIRMINGHAM FIRE INS CO OF PA BITUMINOUS CASUALTY CORP BITUMINOUS FIRE & MARINE INS BRIDGEFIELD CASUALTY BROTHERHOOD MUTUAL INS CO BUILDERS INSURANCE CANAL INSURANCE CO CAPITAL CITY INS CO CAROLINA CASUALTY INS CO CASUALTY RECIPROCAL EXCHANGE CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO CENTRE INSURANCE CO CENTURY INDEMNITY CO CHARTER OAK FIRE INS CO CHRYSLER INSURANCE CO CHUBB INDEMNITY INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY CO CINCINNATI INDEMNITY CO CINCINNATI INSURANCE CO CITIZENS INS CO OF AMERICA

2002
$ Assessment 135,934.80 150,836.84 24,522.28 463,952.06 7,115.02 82,255.63 27,107.79 0.00 34,171.49 126,087.04 3,880.77 85,017.82 34,389.56 31,386.72 43,180.20 89,684.43 324,685.99 327,592.45 6,953.59 770.60 308,510.22 0.00 1,551.42 200,041.68 72,436.97 188,503.06 49,704.47
3,090,629.91 1,471,311.49
439,755.82 3,814.66
317,844.24 82,647.85 55,092.07 234,952.45 14,383.09 318,990.76
25.26 97.18 62,617.02 267,847.88 66,270.72 154,391.39 238,324.99

2002 Assessment $ Adjustment
136,537.89 151,506.05 24,631.08 466,010.44
7,146.59 82,620.57 27,228.06
0.00 34,323.10 126,646.44 3,897.99 85,395.01 34,542.14 31,525.97 43,371.78 90,082.33 326,126.50 329,045.86 6,984.44
774.01 309,878.96
0.00 1,558.31 200,929.18 72,758.34 189,339.37 49,924.99 3,104,341.86 1,477,839.14 441,706.85 3,831.59 319,254.40 83,014.53 55,336.49 235,994.84 14,446.90 320,406.00
25.37 97.61 62,894.83 269,036.22 66,564.74 155,076.37 239,382.35

2003 Claims Paid
899,003.00 1,762,738.16
0.00 4,788,617.74
188,324.00 774,119.00 529,181.00 195,351.00 277,250.00 807,622.00 154,171.00 686,951.00 407,511.00 476,391.00 1,667,153.00 561,631.00 2,168,348.00 2,057,871.00 58,430.00
6,735.00 3,977,846.00
801,446.00 21,809.00 2,422,276.00 237,290.00 4,526,155.00 225,547.00 29,271,971.00 12,269,801.12 4,888,649.00 17,250.00 1,800,963.00 696,550.00 392,540.00 1,051,177.00 129,340.00 2,339,507.00 4,660.00 3,817.00 611,530.00 2,312,206.00 865,302.00 988,818.00 1,200,082.32

2003
$ Assessment 76,191.52 149,394.05 0.00 405,840.76 15,960.67 65,607.46 44,848.69 16,556.22 23,497.25 68,446.88 13,066.17 58,219.87 34,537.02 40,374.68 141,293.10 47,598.86 183,769.94 174,406.89 4,952.01 570.80 337,126.94 67,923.45 1,848.34 205,290.63 20,110.60 383,596.75 19,115.36
2,480,832.62 1,039,879.51
414,318.53 1,461.96
152,633.65 59,033.40 33,268.21 89,088.44 10,961.71 198,275.86
394.94 323.50 51,827.86 195,962.07 73,335.32 83,803.44 101,708.33

2002 $ Balance
Due 603.09 669.21 108.80
2,058.38 31.57 364.94 120.27 0.00 151.61 559.40 17.22 377.19 152.58 139.25 191.58 397.90
1,440.51 1,453.41
30.85 3.41 1,368.74 0.00 6.89 887.50 321.37 836.31 220.52 13,711.95 6,527.65 1,951.03 16.93 1,410.16 366.68 244.42 1,042.39 63.81 1,415.24 0.11 0.43 277.81 1,188.34 294.02 684.98 1,057.36

2002 and 2003 Total
Assessment

$ 76,794.61

$ 150,063.26

$

108.80

$ 407,899.14

$ 15,992.24

$ 65,972.40

$ 44,968.96

$ 16,556.22

$ 23,648.86

$ 69,006.28

$ 13,083.39

$ 58,597.06

$ 34,689.60

$ 40,513.93

$ 141,484.68

$ 47,996.76

$ 185,210.45

$ 175,860.30

$

4,982.86

$

574.21

$ 338,495.68

$ 67,923.45

$

1,855.23

$ 206,178.13

$ 20,431.97

$ 384,433.06

$ 19,335.88

$ 2,494,544.57

$ 1,046,407.16

$ 416,269.56

$

1,478.89

$ 154,043.81

$ 59,400.08

$ 33,512.63

$ 90,130.83

$ 11,025.52

$ 199,691.10

$

395.05

$

323.93

$ 52,105.67

$ 197,150.41

$ 73,629.34

$ 84,488.42

$ 102,765.69

Subsequent Injury Trust Fund 2003 Annual Report

Page 67

Insurance Company Name CLARENDON NATIONAL INS CO COLUMBIA NATIONAL INS CO COMBINED SPECIALTY INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL INS OF NEWARK NJ COMMERCIAL MUTUAL INS CO COMPANION COMMERCIAL INS CO COMPANION PROP & CAS CONNECTICUT INDEMNITY CO CONTINENTAL CASUALTY CO CONTINENTAL INSURANCE CO COREGIS INSURANCE CO CORNERSTONE MUTUAL INS CO CRUM & FOSTER INDEMNITY CO CUMIS INS SOCIETY INC CYPRESS INSURANCE CO DAIMLER CHRYSLER INS CO DEERFIELD INSURANCE CO DELTA FIRE & CASUALTY INS DISCOVER PROPERTY & CAS EASTGUARD INSURANCE CO ELECTRIC INSURANCE CO EMC PROPERTY & CASUALTY EMCASCO INSURANCE CO EMPLOYERS FIRE INS CO EMPLOYERS INS OF WAUSAU EMPLOYERS MUTUAL CAS INS CO EVEREST NATIONAL INS EVEREST SECURITY INS CO EVERGREEN NATIONAL IND EXCELSIOR INSURANCE CO FAIRFIELD INSURANCE CO FAIRMONT INSURANCE CO FARMINGTON CASUALTY CO FARMLAND MUTUAL FCCI INSURANCE COMPANY FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FEDERATED RURAL ELECTRIC INS FEDERATED SERVICE INS CO FFVA MUTUAL INS CO FIDELITY & CAS CO OF NY FIDELITY & DEPOSIT CO OF MD FIDELITY & GUAR UNDERWRITERS

2002
$ Assessment 480,781.39 103,716.43 133,882.33 288,824.23 224.04 936,613.54 46,817.75 472,500.30 338,951.65
2,122,437.35 24,649.01 0.00 766,594.80 14,922.77 43,229.00 90,157.31 157.11 120,493.76 83,260.86 2,328.79 109,140.66 69,759.38 25,770.05 4,111.91 22,761.83
1,462,516.98 79,523.36 848,666.92 36,506.31 949.71 11,119.63 63,712.54 863,548.73 36,964.40 108.70 115,085.42 311,111.32 515,120.01 25,060.80 85,078.34 117,187.35 126,247.13 20,867.88 27,815.02

2002 Assessment $ Adjustment
482,914.43 104,176.58 134,476.32 290,105.63
225.04 940,768.94 47,025.46 474,596.60 340,455.45 2,131,853.80 24,758.37
0.00 769,995.88 14,988.98 43,420.79 90,557.30
157.81 121,028.35 83,630.25
2,339.12 109,624.88 70,068.88 25,884.39
4,130.16 22,862.81 1,469,005.61 79,876.17 852,432.14 36,668.27
953.92 11,168.96 63,995.21 867,379.96 37,128.40
109.19 115,596.01 312,491.60 517,405.40 25,171.98 85,455.80 117,707.27 126,807.25 20,960.46 27,938.42

2003 Claims Paid 7,501,649.00 1,162,569.00 1,546,279.00 8,276,837.00
21,776.37 7,784,881.67
707,800.00 5,647,620.00 2,940,420.00 21,829,178.80
0.00 82,374.00 9,279,894.09 188,140.00 180,921.00 1,084,605.00 1,659.40 14,772.00 542,934.00 17,087.89 960,382.00 983,046.00 246,877.00 150,695.00 71,386.00 10,655,434.00 636,215.00 6,561,639.00 1,887,389.00 12,018.00 302,420.00 1,114,389.52 4,802,518.00 74,018.00 1,269.00 2,418,780.22 3,734,978.00 4,254,627.00 338,557.00 362,535.00 2,047,818.00 1,321,994.69 169,147.00 190,110.20

2003
$ Assessment 635,773.23 98,529.04 131,048.89 701,471.29 1,845.57 659,777.52 59,986.85 478,642.18 249,203.92
1,850,047.57 0.00
6,981.29 786,481.51 15,945.08 15,333.26 91,921.50
140.64 1,251.94 46,014.27 1,448.22 81,393.46 83,314.26 20,923.10 12,771.57 6,050.04 903,060.07 53,919.94 556,106.32 159,958.35 1,018.54 25,630.44 94,445.77 407,018.83 6,273.11
107.55 204,994.36 316,543.61 360,584.45 28,693.09 30,725.25 173,554.89 112,040.54 14,335.40 16,112.05

2002 $ Balance
Due 2,133.04 460.15 593.99 1,281.40 1.00 4,155.40 207.71 2,096.30 1,503.80 9,416.45 109.36 0.00 3,401.08 66.21 191.79 399.99 0.70 534.59 369.39 10.33 484.22 309.50 114.34 18.25 100.98 6,488.63 352.81 3,765.22 161.96 4.21 49.33 282.67 3,831.23 164.00 0.49 510.59 1,380.28 2,285.39 111.18 377.46 519.92 560.12 92.58 123.40

2002 and 2003 Total
Assessment

$ 637,906.27

$ 98,989.19

$ 131,642.88

$ 702,752.69

$

1,846.57

$ 663,932.92

$ 60,194.56

$ 480,738.48

$ 250,707.72

$ 1,859,464.02

$

109.36

$

6,981.29

$ 789,882.59

$ 16,011.29

$ 15,525.05

$ 92,321.49

$

141.34

$

1,786.53

$ 46,383.66

$

1,458.55

$ 81,877.68

$ 83,623.76

$ 21,037.44

$ 12,789.82

$

6,151.02

$ 909,548.70

$ 54,272.75

$ 559,871.54

$ 160,120.31

$

1,022.75

$ 25,679.77

$ 94,728.44

$ 410,850.06

$

6,437.11

$

108.04

$ 205,504.95

$ 317,923.89

$ 362,869.84

$ 28,804.27

$ 31,102.71

$ 174,074.81

$ 112,600.66

$ 14,427.98

$ 16,235.45

Subsequent Injury Trust Fund 2003 Annual Report

Page 68

Insurance Company Name 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 OF WISCONSIN FIREMAN'S INS CO OF NEWARK NJ FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FLORISTS INSURANCE CO FLORISTS' MUTUAL INS CO FRANKENMUTH MUTUAL INS FRONTIER INS CO-IN REHAB. GA FARM BUREAU MUTUAL INS CO GA RESTAURANT MUTUAL CAP INS GA TIMBER HARVESTERS' GENERAL CASUALTY CO OF WI GENERAL INS CO OF AMERICA GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GLENS FALLS INS CO GLOBE INDEMNITY CO GRANGE MUTUAL CASUALTY CO GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GRAY INSURANCE CO GREAT AMERICA ALLIANCE INS CO GREAT AMERICA INS CO OF NY GREAT AMERICAN ASSURANCE CO GREAT AMERICAN INS CO GREAT NORTHERN INS CO GREAT WEST CASUALTY CO GREATER NEW YORK MUTUAL INS GREENWICH INSURANCE CO GROCERS INSURANCE CO GUIDEONE ELITE INS CO GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALTY INS HARCO NATIONAL INS CO HARLEYSVILLE MUTUAL INS CO HARLEYSVILLE-ATLANTIC INS CO HARTFORD ACCIDENT & IND.

2002
$ Assessment 959,647.15 153,859.04 482,939.88 124,381.17 106,951.10 1,818.88 42,099.78 137,699.46 23,676.86 18,076.95 365,788.96 21,818.64 67,692.26 78,139.88 130,325.46 5,511.92 101,685.34 692,478.88 132,025.39 115,715.65 6,753.38 6,665.07 0.00 111,530.39 76,122.39 9,638.42 151,052.91 64,804.13 33,794.99 43,028.52 19,641.06 15,902.97 32,196.19 69,291.17 91,114.35 1,072.26 97,717.04 110,801.14 204,284.66 394,871.59 369.06 40,150.00 207,712.79 100,438.95

2002 Assessment $ Adjustment
963,904.74 154,541.66 485,082.50 124,933.00 107,425.60
1,826.95 42,286.56 138,310.38 23,781.91 18,157.15 367,411.83 26,336.68 67,992.59 78,486.55 130,903.67 5,536.38 102,136.48 695,551.15 132,611.14 116,229.03 6,783.35 6,694.64
0.00 112,025.21 76,460.11
9,681.18 151,723.07 65,091.64 33,944.92 43,219.42 19,728.19 15,973.53 32,339.03 69,598.59 91,518.59
1,077.02 98,150.57 111,292.72 205,190.99 396,623.48
370.70 40,328.13 208,634.33 100,884.56

2003 Claims Paid 11,097,330.05 1,761,831.00 2,533,143.00
848,142.00 679,403.00 13,800.00 228,211.00 1,139,309.06 282,544.44 315,228.88 2,184,078.00 121,083.00 130,148.00 795,820.00 1,813,287.00
8,703.00 619,470.52 4,905,652.00 1,947,653.00 310,287.09 118,608.62 198,939.00 108,820.00 1,989,880.00 414,560.18 21,149.72 1,410,879.36 809,358.92 421,847.57 832,303.66 210,167.00 695,666.00
9,324.00 623,845.00
0.00 131.00 1,197,468.00 952,872.00 1,557,830.39 1,190,314.00 3,255.00 266,467.04 1,079,771.90 395,168.00

2003
$ Assessment 940,511.26 149,317.17 214,686.73 71,880.99 57,580.17 1,169.57 19,341.14 96,557.73 23,945.96 26,716.00 185,103.08 10,261.92 11,030.19 67,446.64 153,678.12 737.59 52,500.83 415,759.55 165,065.79 26,297.18 10,052.21 16,860.31 9,222.62 168,644.58 35,134.44 1,792.46 119,573.62 68,594.08 35,752.06 70,538.68 17,811.89 58,958.48 790.22 52,871.57 0.00 11.10 101,486.77 80,756.98 132,027.89 100,880.46 275.86 22,583.38 91,511.89 33,490.93

2002 $ Balance
Due 4,257.59 682.62 2,142.62 551.83 474.50 8.07 186.78 610.92 105.05 80.20 1,622.87 4,518.04 300.33 346.67 578.21 24.46 451.14 3,072.27 585.75 513.38 29.97 29.57 0.00 494.82 337.72 42.76 670.16 287.51 149.93 190.90 87.13 70.56 142.84 307.42 404.24 4.76 433.53 491.58 906.33 1,751.89 1.64 178.13 921.54 445.61

2002 and 2003 Total
Assessment

$ 944,768.85

$ 149,999.79

$ 216,829.35

$ 72,432.82

$ 58,054.67

$

1,177.64

$ 19,527.92

$ 97,168.65

$ 24,051.01

$ 26,796.20

$ 186,725.95

$ 14,779.96

$ 11,330.52

$ 67,793.31

$ 154,256.33

$

762.05

$ 52,951.97

$ 418,831.82

$ 165,651.54

$ 26,810.56

$ 10,082.18

$ 16,889.88

$

9,222.62

$ 169,139.40

$ 35,472.16

$

1,835.22

$ 120,243.78

$ 68,881.59

$ 35,901.99

$ 70,729.58

$ 17,899.02

$ 59,029.04

$

933.06

$ 53,178.99

$

404.24

$

15.86

$ 101,920.30

$ 81,248.56

$ 132,934.22

$ 102,632.35

$

277.50

$ 22,761.51

$ 92,433.43

$ 33,936.54

Subsequent Injury Trust Fund 2003 Annual Report

Page 69

Insurance Company Name HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF S.E. HARTFORD INS OF THE MIDWEST HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HIGHLANDS INS CO HOME INS. CO-IN LIQUIDATION HOSPITALITY MUTUAL CAPTIVE INS HOUSTON GENERAL INS CO INDEMNITY INS CO OF NA INDIANA LUMBERMEN'S MUTL INS INSURA PROP & CAS INS CO INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INSURANCE CO. OF THE WEST INSURANCE CORP. OF NEW YORK JEFFERSON PILOT FIN INS CO KANSAS CITY FIRE & MARINE INS KEY RISK INSURANCE CO LEGION INS CO-IN LIQUIDATION LIBERTY INSURANCE CORP LIBERTY LIFE OF BOSTON LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LM INSURANCE CORP LUMBER MUTUAL INSURANCE CO LUMBERMEN'S MUTUAL CAS CO LUMBERMEN'S UNDERWRITING LYNDON PROPERTY INS MADISON INSURANCE CO MAG MUTUAL INS CO MANUFACTURER'S ALLIANCE INS MARYLAND CASUALTY COMPANY MASSACHUSETTS BAY INS. CO MEDMARC CASUALTY INS MID-CENTURY INSURANCE CO MIDDLESEX INSURANCE CO MIDWEST EMPLOYERS CASUALTY MITSUI SUMITOMO INS OF AMERICA MITSUI SUMITOMO INS USA, INC MONUMENTAL GENERAL CAS NATIONAL AMERICAN INSURANCE NATIONAL FARMERS UNION P & C

2002
$ Assessment 1,769,910.01 303,760.15 106,881.38 421,518.96 680,576.09 169,655.01 4,000.40 40,947.36 30,094.22 6,654.48 64,970.81 12,269.17 4,337.94 33,432.10 1,377,458.34 2,514.17 43,110.27 107,190.97 1,496.10 36,571.48 3,666,451.71 1,007,892.16 17,031.03 3,909,812.34 1,390,557.44 497,322.80 19,147.00 1,672,190.94 958,315.95 18,768.86 48,848.80 74,583.71 27,656.32 282,578.50 62,249.73 84,599.18 290.96 43,438.72 9,672.97 77,427.94 0.00 256,838.64 22,634.50 826.10

2002 Assessment $ Adjustment
1,777,762.43 305,107.82 107,355.57 423,389.08 683,595.55 170,407.71 4,018.15 41,129.03 30,227.73 6,684.00 65,259.06 12,323.60 4,357.18 33,580.42
1,383,569.60 2,525.32 43,301.53
107,666.53 1,502.74 36,733.74
3,682,718.36 1,012,363.79
17,106.59 3,927,158.68 1,396,726.81
499,529.23 19,231.94 1,679,609.81 962,567.63 18,852.13 49,065.52 74,914.60 27,779.02 283,832.19 62,525.91 84,974.51
292.26 43,631.44 9,715.88 77,771.46
0.00 257,978.13 22,734.92
829.77

2003 Claims Paid 13,638,302.00 1,679,829.00 1,627,085.00 7,100,996.00 7,368,582.00 2,330,181.69
0.00 0.00 560,368.00 181,037.00 0.00 111,544.00 21,479.00 647,223.00 12,383,719.00 18,851.00 510,058.00 608,584.00 13,669.62 2,495,698.00 12,663,870.00 7,499,006.00 0.00 16,973,170.00 9,727,363.00 5,232,035.00 63,772.00 16,404,486.82 5,441,769.00 207,584.00 387,327.00 1,096,850.00 1,034,149.00 3,013,474.60 452,422.14 860,579.00 0.00 726,764.00 202,742.00 355,720.00 40,665.00 1,719,362.00 201,339.00 0.00

2003
$ Assessment 1,155,861.51 142,367.41 137,897.29 601,817.44 624,495.65 197,485.53 0.00 0.00 47,491.82 15,343.09 0.00 9,453.48 1,820.37 54,852.88 1,049,534.18 1,597.64 43,227.99 51,578.18 1,158.52 211,513.23 1,073,277.29 635,549.23 0.00 1,438,495.34 824,405.01 443,420.88 5,404.75 1,390,298.80 461,196.07 17,592.98 32,826.40 92,959.28 87,645.30 255,395.38 38,343.29 72,935.04 0.00 61,594.07 17,182.61 30,147.67 3,446.40 145,717.87 17,063.71 0.00

2002 $ Balance
Due 7,852.42 1,347.67 474.19 1,870.12 3,019.46 752.70 17.75 181.67 133.51 29.52 288.25 54.43 19.24 148.32 6,111.26 11.15 191.26 475.56 6.64 162.26 16,266.65 4,471.63 75.56 17,346.34 6,169.37 2,206.43 84.94 7,418.87 4,251.68 83.27 216.72 330.89 122.70 1,253.69 276.18 375.33 1.30 192.72 42.91 343.52 0.00 1,139.49 100.42 3.67

2002 and 2003 Total
Assessment

$ 1,163,713.93

$ 143,715.08

$ 138,371.48

$ 603,687.56

$ 627,515.11

$ 198,238.23

$

17.75

$

181.67

$ 47,625.33

$ 15,372.61

$

288.25

$

9,507.91

$

1,839.61

$ 55,001.20

$ 1,055,645.44

$

1,608.79

$ 43,419.25

$ 52,053.74

$

1,165.16

$ 211,675.49

$ 1,089,543.94

$ 640,020.86

$

75.56

$ 1,455,841.68

$ 830,574.38

$ 445,627.31

$

5,489.69

$ 1,397,717.67

$ 465,447.75

$ 17,676.25

$ 33,043.12

$ 93,290.17

$ 87,768.00

$ 256,649.07

$ 38,619.47

$ 73,310.37

$

1.30

$ 61,786.79

$ 17,225.52

$ 30,491.19

$

3,446.40

$ 146,857.36

$ 17,164.13

$

3.67

Subsequent Injury Trust Fund 2003 Annual Report

Page 70

Insurance Company Name NATIONAL FARMERS UNION STD NATIONAL FIRE INS CO HARTFORD NATIONAL INTERSTATE INS NATIONAL LIABILITY & FIRE INS NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE AGRIBUSINESS NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NETHERLANDS INSURANCE CO NEW HAMPSHIRE INSURANCE CO NIAGARA FIRE INSURANCE CO NIPPOKAO INS CO, LTD US BRANCH NORGUARD INSURANCE CO NORTH AMERICAN SPECIALTY INS NORTH RIVER INSURANCE CO NORTHBROOK INDEMNITY CO NORTHBROOK PROP & CAS INS NORTHERN ASSURANCE CO OF AMERICA NORTHERN INS CO OF NY NORTHWESTERN NAT CAS CO NORTHWESTERN NATIONAL INS OCCIDENTAL FIRE & CAS OF NC OHIO CASUALTY INSURANCE CO OHIO FARMERS INS CO OHIO SECURITY INSURANCE CO OLD REPUBLIC INSURANCE CO OLD REPUBLIC UNION INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO ONEBEACON MIDWEST INS CO OWNERS INSURANCE CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PATRIOT GENERAL INSURANCE PEERLESS INSURANCE COMPANY PENN LUMBERMEN'S MUTUAL PENN MFG ASSOC INS PENN MFG IND. CO PENN MILLERS MUTUAL PENN NATIONAL MUTUAL CAS PENNSYLVANIA GENERAL INS CO PETROLEUM CASUALTY CO

2002
$ Assessment 42,788.88 369,735.94 0.00 2,200.16 183,245.91 516,719.15 0.00 30,541.41 130,843.15 53,122.61 14,840.60 27,300.12 1,156.73 0.00 30,795.95 77,499.96 58,161.30 0.00 2,613.75 4,450.60 217,177.41 28,773.16 9,317.51 6,161.35 88,393.94 43,343.40 7,262.71
1,098,245.12 3,200.38
148,487.37 276,840.79 19,869.52 205,051.34 2,651,060.35 109,860.51 140,939.51
721.01 14,376.57 498,192.49 76,932.26 38,950.06 3,899.01 49,376.14 39,470.19

2002 Assessment $ Adjustment
42,978.72 371,376.32
0.00 2,209.92 184,058.90 519,011.64
0.00 30,676.91 131,423.65 53,358.29 14,906.44 27,421.24 1,161.86
0.00 30,932.58 80,974.94 58,419.34
0.00 2,625.35 4,470.34 218,140.94 28,900.82 9,358.85 6,188.69 88,786.11 43,535.69 7,294.94 1,103,117.62 3,214.58 149,146.15 278,069.02 19,957.67 205,961.07 2,662,822.10 110,347.92 141,564.80
724.21 14,440.35 500,402.78 77,273.58 39,122.87 3,916.31 49,595.21 39,645.30

2003 Claims Paid
592,974.00 5,347,076.06
188.00 0.00
522,272.00 5,742,819.57 4,175,480.00
219,075.00 581,040.00 287,933.00 275,443.00 255,807.00 10,967.96
1,035.00 671,034.00 391,904.00 386,377.00
9,376.00 144,795.59 24,165.00 1,342,648.00
0.00 18,663.00 54,592.00 862,127.00 71,087.00 130,925.00 11,119,676.00 41,691.00 1,244,395.00 1,869,365.00 541,012.00 2,998,124.00 22,604,603.00 716,881.00 1,111,977.00 391,479.00 293,840.00 6,077,853.00 291,741.00 320,709.00 208,313.00 84,606.00 102,537.00

2003
$ Assessment 50,255.22 453,170.74 15.93 0.00 44,263.14 486,710.45 353,876.65 18,566.85 49,243.80 24,402.65 23,344.11 21,679.93 929.55 87.72 56,870.89 33,214.31 32,745.89 794.63 12,271.59 2,048.01 113,790.94 0.00 1,581.71 4,626.73 73,066.24 6,024.70 11,096.04 942,405.11 3,533.36 105,463.88 158,430.80 45,851.38 254,094.40
1,915,765.65 60,756.47 94,241.31 33,178.29 24,903.27 515,104.91 24,725.38 27,180.45 17,654.76 7,170.45 8,690.13

2002 $ Balance
Due 189.84
1,640.38 0.00 9.76
812.99 2,292.49
0.00 135.50 580.50 235.68 65.84 121.12
5.13 0.00 136.63 3,474.98 258.04 0.00 11.60 19.74 963.53 127.66 41.34 27.34 392.17 192.29 32.23 4,872.50 14.20 658.78 1,228.23 88.15 909.73 11,761.75 487.41 625.29 3.20 63.78 2,210.29 341.32 172.81 17.30 219.07 175.11

2002 and 2003 Total
Assessment

$ 50,445.06

$ 454,811.12

$

15.93

$

9.76

$ 45,076.13

$ 489,002.94

$ 353,876.65

$ 18,702.35

$ 49,824.30

$ 24,638.33

$ 23,409.95

$ 21,801.05

$

934.68

$

87.72

$ 57,007.52

$ 36,689.29

$ 33,003.93

$

794.63

$ 12,283.19

$

2,067.75

$ 114,754.47

$

127.66

$

1,623.05

$

4,654.07

$ 73,458.41

$

6,216.99

$ 11,128.27

$ 947,277.61

$

3,547.56

$ 106,122.66

$ 159,659.03

$ 45,939.53

$ 255,004.13

$ 1,927,527.40

$ 61,243.88

$ 94,866.60

$ 33,181.49

$ 24,967.05

$ 517,315.20

$ 25,066.70

$ 27,353.26

$ 17,672.06

$

7,389.52

$

8,865.24

Subsequent Injury Trust Fund 2003 Annual Report

Page 71

Insurance Company Name PHOENIX INSURANCE CO POTOMAC INSURANCE CO OF IL PRINCETON INSURANCE CO PROTECTIVE INSURANCE CO PROTECTIVE LIFE INS/DIAMOND PROVIDENCE PROP. & CAS. PROVIDENCE WA INS CO OF N Y PROVIDENCE WASHINGTON INS PUBLIC SERVICE MUTUAL INS CO RANGER INSURANCE CO REALM NATIONAL INSURANCE RECIPROCAL OF AMERICA-IN LIQ. REDLAND INSURANCE CO REGENT INSURANCE CO REPUBLIC-FRANKLIN INSURANCE ROCHDALE INSURANCE COMPANY ROYAL INDEMNITY CO ROYAL INS CO OF AMERICA S.E. EMPLOYER MUT. CAP. INS CO SAFECO INS CO OF ILLINOIS SAFECO INSURANCE CO AMERICA SAFEGUARD INSURANCE CO SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY SECURITY INS CO OF HARTFORD SECURITY NATIONAL INS CO SELECT INSURANCE CO SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SE SELECTIVE INSURANCE CO OF SC SELECTIVE WAY INSURANCE CO SENTRY INSURANCE A MUTUAL SENTRY SELECT INSURANCE CO SHELBY INSURANCE CO SOMPO JAPAN INS, OF AMERICA SOUTH CAROLINA INSURANCE CO SOUTHEASTERN US CAP. INS, INC SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INS CO GA SOUTHERN INS CO OF VIRGINIA SOUTHERN MUTUAL CHURCH INS SOUTHERN PILOT INSURANCE CO SOUTHERN STATES INS EXCH. SOUTHERN TRUST INSURANCE

2002
$ Assessment 135,214.95 0.00 657,003.41 25,334.14 4,561.15 0.00 14,107.72 54,238.40 103.58 15,767.03 654,454.55 10,128.02 86,993.47 3,093.42 96,839.40 30,710.17
1,173,589.41 556,109.50 66,028.37 73,055.37 99,762.98 167,069.89 0.00 601.95 134,716.00 21,022.78 6,329.76 59,017.41 40,700.08 50,036.84 61,290.35 503,650.63 53,437.31 7,166.11 0.00 12,032.79 132,974.17 34,623.71 39,860.08 0.00 644.66 9,626.51 19,240.22 21,411.40

2002 Assessment $ Adjustment
135,814.85 0.00
659,918.28 25,446.54 4,581.38
0.00 14,170.31 54,479.03
104.04 15,836.99 657,358.12 10,172.95 87,379.43 3,107.15 97,269.04 30,846.42 1,178,796.18 558,576.75 66,321.31 73,379.49 100,205.59 167,811.12
0.00 604.62 135,313.69 21,116.05 6,357.85 59,279.25 40,880.65 50,258.83 61,562.27 505,885.14 53,674.40 7,197.91
0.00 12,086.18 133,564.13 34,777.33 40,036.93
0.00 647.52 9,669.22 19,325.58 21,506.40

2003 Claims Paid
957,492.00 126,260.00 3,878,912.00 440,794.12 42,532.00 462,969.98 36,993.00 501,170.00
0.00 136,340.00 2,653,524.00 45,223.74 123,729.00 42,977.00 751,495.95 896,823.00 9,767,422.00 5,441,523.00 1,084,956.90 353,577.73 448,002.51 1,562,013.00 21,813.00 74,128.00 1,347,785.00 65,228.00 55,734.00 678,865.00 1,091,657.00 449,008.00 1,061,737.00 5,506,485.73 269,161.00
2,049.00 1,631,581.00
228,119.00 5,607,569.00
292,248.00 472,484.00
635.00 10,236.00 87,260.00 417,826.00 133,053.00

2003
$ Assessment 81,148.53 10,700.68 328,742.18 37,357.80 3,604.64 39,237.23 3,135.20 42,474.72 0.00 11,554.97 224,889.16 3,832.76 10,486.17 3,642.35 63,690.13 76,006.76 827,800.05 461,175.22 91,951.32 29,966.11 37,968.72 132,382.37 1,848.68 6,282.43 114,226.30 5,528.15 4,723.52 57,534.58 92,519.16 38,053.94 89,983.41 466,680.89 22,811.70 173.66 138,278.33 19,333.34 475,247.81 24,768.35 40,043.55 53.82 867.51 7,395.38 35,411.23 11,276.39

2002 $ Balance
Due 599.90 0.00
2,914.87 112.40 20.23 0.00 62.59 240.63 0.46 69.96
2,903.57 44.93 385.96 13.73 429.64 136.25
5,206.77 2,467.25
292.94 324.12 442.61 741.23
0.00 2.67 597.69 93.27 28.09 261.84 180.57 221.99 271.92 2,234.51 237.09 31.80 0.00 53.39 589.96 153.62 176.85 0.00 2.86 42.71 85.36 95.00

2002 and 2003 Total
Assessment

$ 81,748.43

$ 10,700.68

$ 331,657.05

$ 37,470.20

$

3,624.87

$ 39,237.23

$

3,197.79

$ 42,715.35

$

0.46

$ 11,624.93

$ 227,792.73

$

3,877.69

$ 10,872.13

$

3,656.08

$ 64,119.77

$ 76,143.01

$ 833,006.82

$ 463,642.47

$ 92,244.26

$ 30,290.23

$ 38,411.33

$ 133,123.60

$

1,848.68

$

6,285.10

$ 114,823.99

$

5,621.42

$

4,751.61

$ 57,796.42

$ 92,699.73

$ 38,275.93

$ 90,255.33

$ 468,915.40

$ 23,048.79

$

205.46

$ 138,278.33

$ 19,386.73

$ 475,837.77

$ 24,921.97

$ 40,220.40

$

53.82

$

870.37

$

7,438.09

$ 35,496.59

$ 11,371.39

Subsequent Injury Trust Fund 2003 Annual Report

Page 72

Insurance Company Name ST PAUL FIRE & CASUALTY INS CO ST PAUL FIRE & MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO STANDARD FIRE INSURANCE CO STAR INSURANCE CO STATE AUTO PROP & CAS STATE AUTOMOBILE MUTUAL INS STATE CAPITAL INS CO STATE FARM FIRE & CASUALTY TECHNOLOGY INSURANCE CO THE CAMDEN FIRE INS ASSOC TIG INSURANCE CO TIG PREMIER INSURANCE CO TOKIO MARINE & FIRE INS CO TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO TRANSPORTATION CASUALTY INS TRANSPORTATION INSURANCE TRAVELERS CAS & SURETY CO TRAVELERS CAS & SURETY OF AMERICA TRAVELERS CAS & SURETY CO OF ILL TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY CO OF IL TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMERICA TRAVELERS INSURANCE - ALT TRAVELERS INSURANCE CO TRINITY UNIVERSAL INS CO TRINITY UNIVERSAL INS CO OF KS TRUCK INSURANCE EXCHANGE TRUSTGUARD INSURANCE CO TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS U.S. SPECIALTY INS. CO. ULICO CASUALTY CO UNISUN INSURANCE COMPANY UNITED BUS. INS (A MUTUAL CAP) UNITED STATES FIRE INSURANCE UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO UTICA NATIONAL ASSURANCE CO

2002
$ Assessment 494,672.85 661,153.85 269,784.70 33,046.18 72,073.96 403,229.61 19,619.99 10,987.30 97.05 468,643.50 0.00 74,880.26 161,508.97 388,091.53 125,021.06 39,040.61
1,148,848.43 14,878.19 2,043.81
1,405,826.37 560,953.37 1,313.42 4,627.74 14.43 200,578.21
3,519,822.37 315,809.82 325,819.12 2,792.68 140,296.94 87,362.85 106,747.42 2,250.21 10,530.71 857,382.72 206,053.76 433,145.10 16.88 0.00 1,482.64 234,737.25 309,311.88 74,826.70 30,892.19

2002 Assessment $ Adjustment
496,867.52 664,087.14 270,981.63 33,192.79 72,393.72 405,018.59 19,707.04 11,036.04
97.48 470,722.70
0.00 75,212.47 162,225.53 389,813.34 125,575.73 39,213.82 1,153,945.43 14,944.20 2,052.88 1,412,063.48 563,442.10 1,319.24 4,648.27
14.50 201,468.10 3,535,438.48 317,210.95 327,264.66
2,805.07 140,919.39 87,750.44 107,221.01
2,260.19 10,577.44 861,186.60 206,967.94 435,066.80
16.95 0.00 1,489.22 235,778.69 310,684.18 75,158.68 31,029.25

2003 Claims Paid 5,618,609.25 9,013,751.40 1,562,545.14
237,643.49 745,029.00 2,283,354.00 458,824.00 55,907.00
0.00 3,522,207.00
110.00 122,725.00 958,967.00 3,034,816.00 1,484,388.00 157,588.00 6,904,295.70 105,481.68 19,568.00 8,423,826.24 3,040,580.00
9,237.00 5,840.00
0.00 1,493,439.00 35,553,739.00 2,180,806.00 3,349,265.00
52,156.00 47,114.00 474,911.00 508,646.00 39,904.00 99,683.00 8,195,513.00 2,169,495.28 3,488,354.00
0.00 38,371.00 220,778.00 2,514,293.00 3,137,013.00 875,162.39 172,553.78

2003
$ Assessment 476,183.48 763,925.62 132,427.47 20,140.55 63,142.05 193,516.83 38,885.85 4,738.18 0.00 298,511.02 9.32 10,401.08 81,273.54 257,204.09 125,803.56 13,355.76 585,146.86 8,939.69 1,658.41 713,928.79 257,692.59 782.85 494.95 0.00 126,570.64
3,013,219.56 184,825.77 283,853.99 4,420.28 3,992.96 40,249.24 43,108.32 3,381.91 8,448.25 694,578.99 183,867.18 295,641.94 0.00 3,251.99 18,711.18 213,089.17 265,865.40 74,171.00 14,624.13

2002 $ Balance
Due 2,194.67 2,933.29 1,196.93 146.61 319.76 1,788.98 87.05 48.74 0.43 2,079.20 0.00 332.21 716.56 1,721.81 554.67 173.21 5,097.00 66.01 9.07 6,237.11 2,488.73 5.82 20.53 0.07 889.89 15,616.11 1,401.13 1,445.54 12.39 622.45 387.59 473.59 9.98 46.73 3,803.88 914.18 1,921.70 0.07 0.00 6.58 1,041.44 1,372.30 331.98 137.06

2002 and 2003 Total
Assessment

$ 478,378.15

$ 766,858.91

$ 133,624.40

$ 20,287.16

$ 63,461.81

$ 195,305.81

$ 38,972.90

$

4,786.92

$

0.43

$ 300,590.22

$

9.32

$ 10,733.29

$ 81,990.10

$ 258,925.90

$ 126,358.23

$ 13,528.97

$ 590,243.86

$

9,005.70

$

1,667.48

$ 720,165.90

$ 260,181.32

$

788.67

$

515.48

$

0.07

$ 127,460.53

$ 3,028,835.67

$ 186,226.90

$ 285,299.53

$

4,432.67

$

4,615.41

$ 40,636.83

$ 43,581.91

$

3,391.89

$

8,494.98

$ 698,382.87

$ 184,781.36

$ 297,563.64

$

0.07

$

3,251.99

$ 18,717.76

$ 214,130.61

$ 267,237.70

$ 74,502.98

$ 14,761.19

Subsequent Injury Trust Fund 2003 Annual Report

Page 73

Insurance Company Name

VALIANT INSURANCE CO

VALLEY FORGE INSURANCE CO

VANLINER INSURANCE CO

VIGILANT INSURANCE CO

VILLANOVA INS CO-IN LIQUIDATION

WAUSAU BUSINESS INSURANCE

WAUSAU GENERAL INS CO

WAUSAU UNDERWRITERS INS CO

WEST AMERICAN INSURANCE CO

WESTFIELD INSURANCE CO

WESTPORT INSURANCE CORP

WILLIAMSBURG NATIONAL INS CO

XL SPECIALTY INSURANCE CO

YASUDA FIRE & MAR INS OF AMERICA

YORK INSURANCE CO

ZENITH INSURANCE CO

ZURICH AMERICAN INS CO

ZURICH AMERICAN INS CO OF IL

Total: 358

Grand Total:

2002
$ Assessment 229,881.80 463,036.68 22,644.98 66,027.94 0.00 197,661.00 4,382.28 298,360.91 42,869.24 292,162.29 68,348.56 30,209.59 70,252.52 291,346.31 49,856.70 265,515.95
3,132,619.19 0.00
$89,211,914.97

2002 Assessment $ Adjustment
230,901.70 465,091.00 22,745.44 66,320.88
0.00 198,537.95
4,401.72 299,684.62 43,059.44 293,458.51 68,651.80 30,343.62 70,564.20 292,638.91 50,077.90 266,693.94 3,146,517.43
0.00 $89,628,826.54

2003 Claims Paid 1,535,893.00 4,249,646.86
306,963.00 271,913.00 162,549.00 798,730.00 80,655.00 1,964,173.00 314,067.00 2,684,229.00 1,675,091.00 112,326.00 1,127,040.00
0.00 180,267.00 3,691,473.00 34,945,938.45 81,718.00 $782,631,275.89

2003
$ Assessment 130,168.67 360,162.37 26,015.46 23,044.93 13,776.21 67,693.27 6,835.60 166,465.88 26,617.53 227,491.44 141,965.86 9,519.76 95,517.91 0.00 15,277.83 312,856.51
2,961,707.77 6,925.69
$66,328,885.04

2002 $ Balance
Due 1,019.90 2,054.32 100.46 292.94 0.00 876.95 19.44 1,323.71 190.20 1,296.22 303.24 134.03 311.68 1,292.60 221.20 1,177.99 13,898.24 0.00
$416,911.57

2002 and 2003 Total
Assessment

$ 131,188.57

$ 362,216.69

$ 26,115.92

$ 23,337.87

$ 13,776.21

$ 68,570.22

$

6,855.04

$ 167,789.59

$ 26,807.73

$ 228,787.66

$ 142,269.10

$

9,653.79

$ 95,829.59

$

1,292.60

$ 15,499.03

$ 314,034.50

$ 2,975,606.01

$

6,925.69

$ 66,745,796.61

Subsequent Injury Trust Fund 2003 Annual Report

Page 74

Group Self-Insured Employers The following is the 2002-2003 assessment amount due from group self-insured employers.

Group Self-Insured Employers Company Name

AGRITRUST OF GEORGIA

ASSOCIATION CTY COM GA SI

COMPTRUST AGC OF GEORGIA

CONSTRUCTION SUPPLIERS' ASSOC

GA AUTO DEALERS ASSOCIATION SI

GA EDUCATION WC TRUST FUND

GA HOSPITAL ASSOC WCSI FUND

GA MUNICIPAL ASSN WCSIF

GA OILMEN'S ASSOCIATION

GA OPERATORS SELF-INSURERS

GA SCHOOL BD ASSOC W C FUND

GEMC WORKERS' COMP FUND

GTMA/AYSA SELF INSURANCE

ROOFING & SHEET METAL ASSOC

Total : 14

Grand Total:

2002
$ Assessment 180,428.61
1,222,825.40 406,472.47 301,867.17 375,238.23 202,023.15 385,662.62
1,335,024.53 232,622.24 144,782.62 272,515.80 170,365.47 9,756.79 33,044.40
$5,272,629.50

2002 Assessment $ Adjustment
181,229.11 1,228,250.61
408,275.84 303,206.44 376,903.02 202,919.45 388,018.59 1,340,947.52 233,654.30 145,424.96 273,724.84 171,121.32
9,800.08 33,191.01 $5,296,667.09

2003 Claims Paid 1,671,863.40 14,550,650.07 4,516,070.00 2,698,840.37 3,813,576.81 2,416,637.00 4,238,191.11 11,511,883.00 2,739,213.81 1,468,915.61 3,529,828.20 1,716,276.05
435,946.30 684,343.70 $55,992,235.43

2003
$ Assessment 141,692.31
1,233,184.04 382,742.04 228,729.77 323,204.94 204,812.72 359,191.49 975,645.09 232,151.47 124,492.26 299,156.93 145,456.33 36,946.94 57,998.90
$4,745,405.23

2002 $ Balance
Due 800.50
5,425.21 1,803.37 1,339.27 1,664.79
896.30 2,355.97 5,922.99 1,032.06
642.34 1,209.04
755.85 43.29 146.61 $24,037.59

2002 and 2003 Total
Assessment $ 142,492.81 $ 1,238,609.25 $ 384,545.41 $ 230,069.04 $ 324,869.73 $ 205,709.02 $ 361,547.46 $ 981,568.08 $ 233,183.53 $ 125,134.60 $ 300,365.97 $ 146,212.18 $ 36,990.23 $ 58,145.51 $ 4,769,442.82

Subsequent Injury Trust Fund 2003 Annual Report

Page 75

Self-Insured Employers The following is the 2002-2003 assessment amount due from self-insured employers.

Self-Insured Employers Company Name A T & T AAA COOPER TRANSPORTATION ABF FREIGHT SYSTEM, INC ACUITY BRANDS AGL RESOURCES, INC. ALBANY INTERNATIONAL CORP ALBANY, CITY OF ALEXIS PLAYSAFE, INC. ALLIED SYSTEMS LTD ALPHARETTA, CITY OF ALTERMAN TRANSPORT LINES AMERICAN NATIONAL RED CROSS AMERICAN PROTEINS, INC ANHEUSER-BUSCH COMPANIES, INC. ARCHBOLD MEDICAL CENTER ARCHDIOCESES OF ATLANTA ARCHER-DANIELS-MIDLAND CO ASPLUNDH TREE EXPERT CO ATCO RUBBER PRODUCTS, INC. ATHENS REG. HEALTH SYS INC ATHENS-CLARKE COUNTY ATLANTA BOARD OF ED ATLANTA CITY OF ATLANTA HOUSING AUTHORITY AUGUSTA-RICHMOND CO BD COMM AUTOMOTIVE MOULDING CO AUTOZONE, INC AVERITT EXPRESS, INC AVONDALE MILLS INC BALDWIN COUNTY COMMISSIONERS BANKHEAD SERVICES, INC BARTOW CO BOARD OF ED BEAULIEU OF AMERICA BELLSOUTH CORPORATION BELLSOUTH ENTERPRISES INC BENTON-GEORGIA INC BERRY COLLEGE BHA GROUP INC BIBB COUNTY BD-COMMISSION BIBB CO BOARD OF ED BIG LOTS STORES, INC. BJ'S WHOLESALE CLUB INC BLACK & DECKER CORPORATION

2002
$ Assessment 97,643.41 34,906.28 37,725.22 43,946.51 84,520.66 3,434.90 47,118.62 2,943.27 70,188.36 0.00 7,019.02 14,718.51 29,712.54 33,886.75 30,482.96 13,206.72 14,707.45 100,233.28 2,558.90 44,966.93 44,275.80 125,871.19 935,152.50 11,786.97 113,227.94 21,940.26 167,588.80 38,740.68 17,365.59 5,571.98 53,534.96 9,111.94 324,082.72 327,453.78 36,609.15 20,437.85 18,536.14 6,561.15 108,562.59 45,641.32 24,136.73 4,362.38 13,409.53

2002 Assessment $ Adjustment
98,076.62 35,061.14 37,892.59 44,141.48 84,895.64 3,450.14 47,327.67 2,956.33 70,499.76
0.00 7,050.16 14,783.81 29,844.36 32,971.26 30,618.20 13,254.30 14,772.71 100,677.97 2,570.25 45,166.43 44,472.24 126,429.63 939,301.41 11,839.26 113,730.29 22,037.60 168,332.33 38,912.56 17,442.63 5,596.70 53,772.48 9,152.36 325,520.55 328,906.56 36,771.57 20,528.52 18,618.38 6,590.26 109,044.25 45,843.81 24,243.82 4,381.73 13,469.02

2003 Claims Paid 1,049,871.50
642,377.75 516,089.00 768,667.00 413,573.81
8,734.34 337,642.72 19,733.08 1,089,244.00 70,572.08
0.00 97,180.00 696,260.40 219,421.10 333,434.51 247,237.08 89,920.65 2,582,736.23 38,696.52 163,324.80 488,514.99 1,841,170.39 8,171,452.64 69,766.68 1,235,287.20 255,153.00 1,515,942.28 226,360.67 149,150.66 117,439.79 409,825.00 155,076.87
0.00 3,263,173.53
166,241.20 137,086.11 179,066.12 94,101.32 672,618.20 559,028.00 296,708.26 104,010.46 57,557.56

2003
$ Assessment 88,977.80 54,442.24 43,739.13 65,145.40 35,050.85 740.25 28,615.60 1,672.40 92,314.66 5,981.06 0.00 8,236.11 59,008.86 18,596.19 28,258.95 20,953.62 7,620.88 218,889.81 3,279.57 13,841.96 41,402.20 156,041.27 692,539.84 5,912.80 104,691.99 21,624.51 128,477.82 19,184.32 12,640.69 9,953.15 34,733.13 13,142.94 0.00 276,557.64 14,089.13 11,618.20 15,176.06 7,975.19 57,005.15 47,378.25 25,146.36 8,815.00 4,878.07

2002 $ Balance
Due 433.21 154.86 167.37 194.97 374.98 15.24 209.05 13.06 311.40 0.00 31.14 65.30 131.82
(915.49) 135.24 47.58 65.26 444.69 11.35 199.50 196.44 558.44
4,148.91 52.29 502.35 97.34 743.53 171.88 77.04 24.72 237.52 40.42
1,437.83 1,452.78
162.42 90.67 82.24 29.11 481.66 202.49 107.09 19.35 59.49

2002 and 2003 Total
Assessment

$ 89,411.01

$ 54,597.10

$ 43,906.50

$ 65,340.37

$ 35,425.83

$

755.49

$ 28,824.65

$ 1,685.46

$ 92,626.06

$ 5,981.06

$

31.14

$ 8,301.41

$ 59,140.68

$ 17,680.70

$ 28,394.19

$ 21,001.20

$ 7,686.14

$ 219,334.50

$ 3,290.92

$ 14,041.46

$ 41,598.64

$ 156,599.71

$ 696,688.75

$ 5,965.09

$ 105,194.34

$ 21,721.85

$ 129,221.35

$ 19,356.20

$ 12,717.73

$ 9,977.87

$ 34,970.65

$ 13,183.36

$ 1,437.83

$ 278,010.42

$ 14,251.55

$ 11,708.87

$ 15,258.30

$ 8,004.30

$ 57,486.81

$ 47,580.74

$ 25,253.45

$ 8,834.35

$ 4,937.56

Subsequent Injury Trust Fund 2003 Annual Report

Page 76

Self-Insured Employers Company Name BLOSSMAN COMPANIES, INC BLUE BIRD BODY COMPANY BOBS CANDIES, INC. BREMEN-BOWDEN INVESTMENT CO. BROWN INDUSTRIES BRUNSWICK, CITY OF BURLEN CORPORATION C T HARRIS INC C. W. MATTHEWS CONTRACTING INC CAGLE'S INC, & SUBSIDIARIES CAHABA GOV'T BENEFIT ADMIN. CALDWELL TANKS ALLIANCE, INC. CALFEE COMPANY OF DALTON, INC CANDLER HEALTH SYSTEM CARROLL CO BOARD OF ED CASCADE CORPORATION CATOOSA CO BOARD OF ED CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHATHAM AREA TRANSIT AUTHORITY CHATHAM CO BOARD OF ED CHATHAM COUNTY GEORGIA CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BOARD OF ED CHEVRON USA INC SOUTH DIV CHILDREN'S HEALTHCARE OF ATL CLAYTON CO BOARD OF ED CLAYTON COUNTY COMMISSIONERS CLAYTON COUNTY WATER AUTHORITY COACHMAN REC. VEHICLE CO OF GA COASTAL TRANSPORT INC COATS & CLARK, INC. COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLLEGE PARK CITY OF COLLIS FOODS INC COLONIAL GROUP COLONIAL PIPELINE COMPANY COLQUITT CO BD OF EDUCATION COLQUITT REGIONAL MEDICAL CENT COLUMBIA COUNTY BOE COLUMBIA GEORGIA CORP. COLUMBUS CITY OF

2002
$ Assessment 9,390.62
281,268.71 15,584.93
0.00 24,336.29 31,511.85 11,346.91 30,667.32 47,483.37 141,602.65 4,394.64 8,005.74 13,568.91 37,578.55 47,897.21 4,466.09 37,822.83 119,376.02 19,950.56 21,643.86 59,424.24 34,528.05 1,056.43 18,948.68 24,890.68 77,708.70 13,855.20 80,008.26 73,520.88 67,254.33 9,183.53 14,994.80 78,794.26 43,749.36 125,981.16 231,621.95 27,440.05 221,525.65 9,737.98 3,221.33 6,743.30
0.00 29,167.27 20,854.89 19,061.30
642.29 20,788.79

2002 Assessment $ Adjustment
9,432.28 282,516.59 15,654.07
0.00 24,444.26 31,651.66 11,397.25 30,803.37 47,694.04 142,230.88 4,414.14 8,041.26 13,629.11 37,745.27 48,109.71 4,485.90 37,990.64 119,905.65 20,039.08 21,739.88 59,687.88 34,681.24 1,061.12 19,032.74 25,001.11 78,053.46 5,929.28 80,363.22 73,847.06 67,552.72 9,224.27 15,061.32 79,088.80 43,943.46 126,540.09 232,649.57 27,561.80 222,508.48 9,781.18 3,235.63 6,773.22
0.00 29,296.67 20,947.41 19,145.87
645.14 20,881.02

2003 Claims Paid
59,238.03 3,220,961.99
159,677.88 317,381.37 212,893.56 736,112.90 87,875.80 328,543.62 133,698.01 970,034.00 18,932.60
0.00 97,545.78 519,891.71 292,936.34 18,748.49 16,216.70 1,556,699.63 172,932.65 193,400.00 385,132.39 2,044,816.26 84,311.61 123,919.81 317,904.94 527,886.69 38,860.81 625,489.05 677,393.33 530,825.60 23,148.18 88,980.33 490,312.05 442,374.08 1,030,585.24 1,847,659.50 340,835.11 2,184,036.24 142,357.65 44,629.00 162,752.22 15,649.96 142,685.00 154,814.51 170,446.41 1,171.44
0.00

2003
$ Assessment 5,020.49
272,980.17 13,532.88 26,898.43 18,042.97 62,386.40 7,447.57 27,844.44 11,331.06 82,211.48 1,604.56
0.00 8,267.12 44,061.41 24,826.69 1,588.96 1,374.38 131,932.05 14,656.24 16,390.87 32,640.41 173,300.49 7,145.50 10,502.34 26,942.80 44,738.99 3,293.50 53,010.90 57,409.85 44,988.07 1,961.83 7,541.18 41,554.50 37,491.70 87,343.26 156,591.23 28,886.16 185,099.54 12,064.97 3,782.36 13,793.43 1,326.35 12,092.71 13,120.70 14,445.53
99.28 0.00

2002 $ Balance
Due 41.66
1,247.88 69.14 0.00 107.97 139.81 50.34 136.05 210.67 628.23 19.50 35.52 60.20 166.72 212.50 19.81 167.81 529.63 88.52 96.02 263.64 153.19 4.69 84.06 110.43 344.76
(7,925.92) 354.96 326.18 298.39 40.74 66.52 294.54 194.10 558.93
1,027.62 121.75 982.83 43.20 14.30 29.92 0.00 129.40 92.52 84.57 2.85 92.23

2002 and 2003 Total
Assessment

$ 5,062.15

$ 274,228.05

$ 13,602.02

$ 26,898.43

$ 18,150.94

$ 62,526.21

$ 7,497.91

$ 27,980.49

$ 11,541.73

$ 82,839.71

$ 1,624.06

$

35.52

$ 8,327.32

$ 44,228.13

$ 25,039.19

$ 1,608.77

$ 1,542.19

$ 132,461.68

$ 14,744.76

$ 16,486.89

$ 32,904.05

$ 173,453.68

$ 7,150.19

$ 10,586.40

$ 27,053.23

$ 45,083.75

$ (4,632.42)

$ 53,365.86

$ 57,736.03

$ 45,286.46

$ 2,002.57

$ 7,607.70

$ 41,849.04

$ 37,685.80

$ 87,902.19

$ 157,618.85

$ 29,007.91

$ 186,082.37

$ 12,108.17

$ 3,796.66

$ 13,823.35

$ 1,326.35

$ 12,222.11

$ 13,213.22

$ 14,530.10

$

102.13

$

92.23

Subsequent Injury Trust Fund 2003 Annual Report

Page 77

Self-Insured Employers Company Name COLUMBUS FOUNDRIES INC COLUMBUS REGIONAL HEALTHCARE COLUMBUS WATER WORKS CONAGRA FOODS, INC CONTI GROUP COMPANIES, INC CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER CORPORATION OF MERCER UNIV COSTCO WHOLESALE CORP. COTTRELL INC COVINGTON, CITY OF COWETA CO BOARD OF ED CRACKER BARREL OLD CNTRY STORE CRAWFORD & COMPANY CRIDER'S POULTRY INC CRISP COUNTY BD OF EDUCATION CROWN CORK & SEAL COMPANY INC CWW GROUP, INC D L LEE & SONS INC DALTON CITY OF DAN RIVER, INC. DART CONTAINER CORPORATION DEAN FOODS COMPANY DECATUR, CITY OF DEKALB COUNTY BOARD-ED DEKALB COUNTY GOVERNMENT DEKALB FARMERS MARKET DEKALB REGIONAL HEALTHCARE SYS DELHAIZE AMERICA INC. DELPHI AUTOMOTIVE SYS INC. DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOLLAR GENERAL CORP DOREL JUVENILE GRP (COSCO, INC DOUGHERTY COUNTY BOC DOUGHERTY COUNTY SCHOOL SYSTEM DOUGLAS ASPHALT COMPANY DOUGLAS CO BD OF COMMISSIONERS DOUGLAS COUNTY SCHOOLS DOUGLAS, CITY OF DOUGLASVILLE-DOUGLAS COUNTY DSM CHEMICALS N. AMERICA DULUTH, CITY OF DURAND-WAYLAND, INC E I DUPONT DE NEMOURS & CO EAST POINT, CITY OF

2002
$ Assessment 58,026.06 59,635.03 1,448.83 215,937.61 53,683.97 69,959.46 27,309.68 199,988.75 8,547.86 31,789.80 16,259.79 2,969.38 47,248.29 143,412.91 32,116.81 22,764.08 2,089.50 175.35 27,757.44 14,966.57 38,486.51 21,158.91 14,318.03 46,444.56 2,024.10 237,005.84 196,955.35 7,313.59 69,778.26 77,393.24 17,496.36 987,641.98 91,784.96 147,260.93 17,472.45 33,266.97 66,165.36 78,696.29 41,241.92 26,050.80 17,000.83 2,887.92 14,820.65 3,008.17 5,508.20 10,391.28 22,830.38

2002 Assessment $ Adjustment
58,283.50 59,899.61 1,455.26 216,895.64 53,922.15 70,269.85 27,430.84 200,876.02 8,585.78 31,930.84 16,331.93 2,982.55 47,457.91 144,049.17 32,259.30 22,865.08 2,098.77
176.13 27,880.59 15,032.97 38,657.26 21,252.78 14,381.55 46,650.62 2,033.08 238,057.35 197,829.17 7,346.04 70,087.84 77,736.60 17,573.98 992,023.77 92,192.18 147,914.27 17,549.97 33,414.57 66,458.91 79,045.44 41,424.90 26,166.38 17,076.26 2,900.73 14,886.40 3,021.52 5,532.64 10,437.38 22,931.67

2003 Claims Paid
742,689.00 715,797.02 42,444.00 1,425,419.63 433,277.34 128,927.85 180,460.31 1,654,661.25 177,934.03 339,778.00 146,082.20 135,413.14 483,177.32 1,421,417.67 286,401.60 463,678.42 100,220.81
0.00 222,457.09 76,095.04 572,630.54 146,643.05 63,662.00 661,623.89 32,807.86 1,784,322.57 2,384,465.79 46,376.41 738,123.40 686,501.84 211,451.59 6,876,536.03 1,059,966.00 1,889,034.45
0.00 542,059.41 178,470.05 666,888.56 357,010.17 305,087.45 264,297.73 63,264.92 367,281.16 13,868.84 105,839.30 281,082.89 476,555.61

2003
$ Assessment 62,943.73 60,664.61 3,597.18 120,805.92 36,720.74 10,926.78 15,294.22 140,234.41 15,080.11 28,796.57 12,380.63 11,476.42 40,949.82 120,466.75 24,272.86 39,297.27 8,493.83 0.00 18,853.49 6,449.14 48,531.09 12,428.16 5,395.43 56,073.37 2,780.50 151,223.35 202,086.17 3,930.45 62,556.79 58,181.81 17,920.76 582,794.20 89,833.32 160,097.80 0.00 45,940.15 15,125.54 56,519.56 30,257.02 25,856.51 22,399.53 5,361.77 31,127.49 1,175.40 8,970.00 23,822.09 40,388.63

2002 $ Balance
Due 257.44 264.58 6.43 958.03 238.18 310.39 121.16 887.27 37.92 141.04 72.14 13.17 209.62 636.26 142.49 101.00 9.27 0.78 123.15 66.40 170.75 93.87 63.52 206.06 8.98
1,051.51 873.82 32.45 309.58 343.36 77.62
4,381.79 407.22 653.34 77.52 147.60 293.55 349.15 182.98 115.58 75.43 12.81 65.75 13.35 24.44 46.10 101.29

2002 and 2003 Total
Assessment

$ 63,201.17

$ 60,929.19

$ 3,603.61

$ 121,763.95

$ 36,958.92

$ 11,237.17

$ 15,415.38

$ 141,121.68

$ 15,118.03

$ 28,937.61

$ 12,452.77

$ 11,489.59

$ 41,159.44

$ 121,103.01

$ 24,415.35

$ 39,398.27

$ 8,503.10

$

0.78

$ 18,976.64

$ 6,515.54

$ 48,701.84

$ 12,522.03

$ 5,458.95

$ 56,279.43

$ 2,789.48

$ 152,274.86

$ 202,959.99

$ 3,962.90

$ 62,866.37

$ 58,525.17

$ 17,998.38

$ 587,175.99

$ 90,240.54

$ 160,751.14

$

77.52

$ 46,087.75

$ 15,419.09

$ 56,868.71

$ 30,440.00

$ 25,972.09

$ 22,474.96

$ 5,374.58

$ 31,193.24

$ 1,188.75

$ 8,994.44

$ 23,868.19

$ 40,489.92

Subsequent Injury Trust Fund 2003 Annual Report

Page 78

Self-Insured Employers Company Name EATON CORPORATION ELBERTA CRATE & BOX CO ELBERTON GRANITE ASSOCIATION ELBERTON, CITY OF EMERSON ELECTRIC CO EMORY CLINIC, INC., EMORY UNIVERSITY ENCOMPASS GROUP, LLC ENGELHARD CORPORATION EQUITY GROUP GA DIVISION ESTES EXPRESS LINES EVANS GRADING CO., INC EVENFLO COMPANY INC FAYETTE COUNTY BD OF COMM FAYETTE CO BOARD OF ED FEDERAL EXPRESS CORP FEDERATED DEPARTMENT STORES FEDEX FREIGHT EAST FEDEX GROUND PKG SYS FEDEX SUPPLY CHAIN SERV INC FIELDALE FARMS CORP FLEETWOOD HOMES OF GA INC FLEXSTEEL INDUSTRIES INC FLORIDA ROCK & TANK LINES INC FLORIDA ROCK INDUSTRIES INC FLOWERS INDUSTRIES INC FLOYD CO. BD. OF COMMISSIONERS FLOYD CO BOARD OF ED FLOYD HEALTHCARE MGMT INC FLYING J, INC. FORD MOTOR COMPANY FOREST PARK, CITY OF FORSYTH CO BD OF COMMISSIONERS FORSYTH CO BOARD OF ED FREUDENBERG-NOK FROZEN FOOD EXPRESS IND FULTON CO BOARD OF ED FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHORITY GANNETT CO. INC & SUBSIDIARIES GENERAL MOTORS CORPORATION GEORGIA CRATE & BASKET CO GEORGIA DUCK & CORDAGE MILL GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GLYNN COUNTY BOARD OF COMMSNRS

2002
$ Assessment 33,826.05 16,450.75 73,238.02 4,400.98 38,459.38 29,860.80 396,523.90 22,446.86 9,591.32 71,438.96 43,322.85 19,206.08 52,749.39 20,946.42 9,742.22 275,457.99 126,251.62 38,851.79 29,380.69 8,420.99 76,147.64 164,235.93 21,946.08 28,207.73 23,971.71 84,360.22 36,528.75 37,913.11 46,889.66 32,170.30 167,009.21 6,014.95 52,499.05 43,852.11 11,103.10 417.18 169,316.96 230,010.70 154,559.78 19,860.58 589,461.72 2,644.27 30,360.76
4,648,928.24 385,176.08 16,594.07 75,500.62

2002 Assessment $ Adjustment
33,976.13 16,523.73 73,562.95 4,420.50 38,630.01 29,993.28 398,283.12 22,546.45 9,633.87 71,755.90 43,515.05 19,291.29 52,983.42 21,039.35 9,785.44 276,680.09 126,811.75 39,024.16 29,511.05 8,458.35 76,485.48 164,964.58 22,043.44 28,332.87 24,078.06 84,734.49 36,690.82 38,081.32 47,097.69 32,313.03 167,750.17 6,041.63 52,731.97 44,046.67 11,152.36
419.03 170,068.15 231,031.17 155,245.50 19,948.70 592,076.94
2,656.00 30,495.46 4,669,553.76 386,884.96 16,667.70 75,835.58

2003 Claims Paid
0.00 262,760.55 824,005.10 28,636.10 160,557.08
0.00 2,436,000.69
142,413.77 0.00
465,617.58 186,635.37 136,154.69 1,022,502.56 142,747.90 311,642.97 2,431,949.25 1,404,649.79 332,301.74 272,887.00 109,462.00 722,381.66 307,562.90 254,047.23 627,086.75 275,682.35 890,482.58 510,097.94 324,443.99 304,266.07 230,246.72 1,900,889.68 36,914.25
0.00 220,385.15 295,000.82
0.00 2,251,056.41 2,225,592.16 1,024,113.04
133,710.33 4,945,318.67
28,495.09 977,863.74 40,872,860.68 3,655,095.09 26,651.12 134,438.67

2003
$ Assessment 0.00
22,269.25 69,835.36 2,426.94 13,607.39
0.00 206,453.81 12,069.73
0.00 39,461.62 15,817.56 11,539.26 86,658.25 12,098.05 26,412.09 206,110.45 119,045.66 28,162.95 23,127.48 9,277.03 61,222.66 26,066.30 21,530.79 53,146.31 23,364.39 75,469.40 43,231.38 27,496.99 25,786.89 19,513.67 161,102.55 3,128.52
0.00 18,677.89 25,001.65
0.00 190,779.57 188,621.45 86,794.74 11,332.10 419,121.35
2,414.99 82,875.06 3,464,021.13 309,773.44 2,258.71 11,393.83

2002 $ Balance
Due 150.08 72.98 324.93 19.52 170.63 132.48
1,759.22 99.59 42.55 316.94 192.20 85.21 234.03 92.93 43.22
1,222.10 560.13 172.37 130.36 37.36 337.84 728.65 97.36 125.14 106.35 374.27 162.07 168.21 208.03 142.73 740.96 26.68 232.92 194.56 49.26 1.85 751.19
1,020.47 685.72 88.12
2,615.22 11.73 134.70
20,625.52 1,708.88
73.63 334.96

2002 and 2003 Total
Assessment

$

150.08

$ 22,342.23

$ 70,160.29

$ 2,446.46

$ 13,778.02

$

132.48

$ 208,213.03

$ 12,169.32

$

42.55

$ 39,778.56

$ 16,009.76

$ 11,624.47

$ 86,892.28

$ 12,190.98

$ 26,455.31

$ 207,332.55

$ 119,605.79

$ 28,335.32

$ 23,257.84

$ 9,314.39

$ 61,560.50

$ 26,794.95

$ 21,628.15

$ 53,271.45

$ 23,470.74

$ 75,843.67

$ 43,393.45

$ 27,665.20

$ 25,994.92

$ 19,656.40

$ 161,843.51

$ 3,155.20

$

232.92

$ 18,872.45

$ 25,050.91

$

1.85

$ 191,530.76

$ 189,641.92

$ 87,480.46

$ 11,420.22

$ 421,736.57

$ 2,426.72

$ 83,009.76

$ 3,484,646.65

$ 311,482.32

$ 2,332.34

$ 11,728.79

Subsequent Injury Trust Fund 2003 Annual Report

Page 79

Self-Insured Employers Company Name GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GOODY PRODUCTS, INC. GREAT ATLANTIC & PACIFIC TEA GREAT DANE LTD PARTNERSHIP GRIFFIN-SPALDING SCHOOLS GULFSTREAM AEROSPACE CORP GWINNETT CO BOARD OF ED GWINNETT COUNTY BD OF COMMISS GWINNETT HOSPITAL SYSTEM HALL CO BOARD OF ED HAMILTON HEALTH CARE SYSTEM HAPEVILLE CITY OF HARRIET & HENDERSON YARNS HARRISON POULTRY, INC HAVERTYS FURNITURE HENRY CO BOARD OF EDUCATION HERCULES INCORPORATED HERSCHEND FAMILY ENTERTAINMENT HILLCREST FOODS, INC HILTON HOTELS CORPORATION HON INDUSTRIES, INC. HORMEL FOODS CORP HORTON HOMES, INC HOSPITAL AUTHORITY HOUSTON CTY HOUSTON CO BOARD OF ED HOUSTON COUNTY COMMISSIONERS HOWARD SHEPPARD INC HUTCHESON MEDICAL CENTER HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION IKON OFFICE SOLUTIONS INGLES MARKETS INC INTERFACE, INC INTERNATIONAL PAPER COMPANY INTERSTATE PAPER LLC J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JEFFERSON SMURFIT CORP. U. S. JESUP CITY OF JOHN WIELAND HOMES, INC JOHNS MANVILLE INT'L., INC. JOHNSTON INDUSTRIES, INC. JONES COMPANY (THE) K & F INDUSTRIES KAHN CONSTRUCTION COMPANY INC

2002
$ Assessment 42,267.13 15,556.59 3,822.11 46,832.89 67,587.32 9,264.12 52,129.93 223,446.26 84,371.45 99,256.11 23,206.83 55,381.66 4,021.39 14,394.71 5,986.72 16,936.45 44,217.08 15,125.53 12,424.84 21,281.05 8,626.16 13,170.75 82,357.51 91,647.12 10,919.60 27,121.58 10,234.81 20,243.04 57,045.88 39,249.37 16,909.02 66,491.46 407,526.77 35,858.82 168,177.06 2,985.03 36,454.61 109,646.22 209,417.56 17,973.36 6,156.58 109,076.74 10,105.09 6,999.14 42,087.57 15,842.89 6,218.66

2002 Assessment $ Adjustment
42,454.65 15,625.61 3,839.07 47,040.67 67,887.18 9,305.22 52,361.21 224,437.60 84,745.78 99,696.47 23,309.79 55,627.37 4,039.23 14,458.58 6,013.28 17,011.59 44,413.25 15,192.63 12,479.96 21,375.47 8,664.43 13,229.19 82,722.90 92,053.73 10,968.05 27,241.90 10,280.22 20,332.85 57,298.97 39,423.51 16,984.04 66,786.45 409,334.81 36,017.91 168,923.20 2,998.28 36,616.34 110,132.67 210,346.66 18,053.10 6,183.90 109,560.68 10,149.92 7,030.20 42,274.29 15,913.18 6,246.25

2003 Claims Paid
643,518.11 173,021.31
7,633.00 229,822.96 518,806.11 81,477.83 454,847.38 2,783,176.24
0.00 1,021,004.09
288,445.56 444,898.43 36,300.87 65,498.39 99,830.01 442,739.41 335,341.54 295,944.73 106,081.84 175,908.84 32,073.84 185,714.62 861,888.10 392,066.75 179,265.18 231,204.68 103,608.67 448,889.08 760,520.24 417,275.80
6,646.30 672,132.89 2,900,781.68 588,411.71 2,264,276.34 53,369.90 364,209.95 469,762.62 2,140,096.37 427,140.00 44,082.21 1,053,314.51 109,300.00
0.00 669,123.48 51,494.85 31,414.68

2003
$ Assessment 54,538.89 14,663.75 646.91 19,477.76 43,969.40 6,905.34 38,548.83 235,877.33 0.00 86,531.25 24,446.09 37,705.64 3,076.54 5,551.06 8,460.71 37,522.67 28,420.57 25,081.65 8,990.56 14,908.47 2,718.29 15,739.52 73,045.99 33,228.10 15,192.93 19,594.86 8,780.95 38,043.86 64,454.95 35,364.60 563.28 56,964.02 245,844.53 49,868.56 191,899.98 4,523.16 30,867.20 39,812.91 181,375.59 36,200.60 3,736.02 89,269.59 9,263.30 0.00 56,708.97 4,364.25 2,662.43

2002 $ Balance
Due 187.52 69.02 16.96 207.78 299.86 41.10 231.28 991.34 374.33 440.36 102.96 245.71 17.84 63.87 26.56 75.14 196.17 67.10 55.12 94.42 38.27 58.44 365.39 406.61 48.45 120.32 45.41 89.81 253.09 174.14 75.02 294.99
1,808.04 159.09 746.14 13.25 161.73 486.45 929.10 79.74 27.32 483.94 44.83 31.06 186.72 70.29 27.59

2002 and 2003 Total
Assessment

$ 54,726.41

$ 14,732.77

$

663.87

$ 19,685.54

$ 44,269.26

$ 6,946.44

$ 38,780.11

$ 236,868.67

$

374.33

$ 86,971.61

$ 24,549.05

$ 37,951.35

$ 3,094.38

$ 5,614.93

$ 8,487.27

$ 37,597.81

$ 28,616.74

$ 25,148.75

$ 9,045.68

$ 15,002.89

$ 2,756.56

$ 15,797.96

$ 73,411.38

$ 33,634.71

$ 15,241.38

$ 19,715.18

$ 8,826.36

$ 38,133.67

$ 64,708.04

$ 35,538.74

$

638.30

$ 57,259.01

$ 247,652.57

$ 50,027.65

$ 192,646.12

$ 4,536.41

$ 31,028.93

$ 40,299.36

$ 182,304.69

$ 36,280.34

$ 3,763.34

$ 89,753.53

$ 9,308.13

$

31.06

$ 56,895.69

$ 4,434.54

$ 2,690.02

Subsequent Injury Trust Fund 2003 Annual Report

Page 80

Self-Insured Employers Company Name KEEBLER COMPANY KELLEY MANUFACTURING COMPANY KIMBERLY-CLARK CORP KING & PRINCE SEAFOOD CORP. KNIGHT TRANSPORTATION KLEEN-TEX INDUSTRIES KLLM TRANSPORT K-MART CORP-IN BANKRUPTCY KROGER COMPANY, THE LABOR READY SE III LP LAGRANGE, CITY OF LANGDALE INDUSTRIES LAWRENCEVILLE, CITY OF LEVI STRAUSS & CO LIBERTY NATIONAL LIFE INS CO LIMITED, INC., THE LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC LOXCREEN COMPANY, INC. MACON CITY OF MACON/BIBB CO WATER & SEWERAGE MARGLEN INDUSTRIES INC MARIETTA CITY SERVICES MAR-JAC POULTRY, INC. MARRIOTT INTERNATIONAL, INC. MARTA MAY DEPARTMENT STORES CO/DBA MCLANE COMPANY, INC. M-D BUILDING PRODUCTS MEAD CORPORATION MEAD WESTVACO MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC METAL PLATE GALVANIZING L P METRO MEDIA INTERNATIONAL GRP MICROMERITICS INSTRUMENTS CORP MILLEDGEVILLE, CITY OF MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC MONROE, CITY OF MOUNT VERNON MILLS MULLITE CO OF AMERICA MURRAY CO BOARD OF ED MUSCOGEE CO SCHOOL DIST NASH JOHNSON & SONS' FARMS INC NATIONAL SERVICES INDUSTRIES

2002
$ Assessment 93,751.18 6,305.54 13,694.78 11,268.29 0.00 25,703.19 59,259.36 525,505.12 424,452.12 52,715.88 12,370.02 66,610.45 5,632.19 192,038.55 10,278.35 14,595.96 30,914.45 29,631.31 264,062.86 12,954.12 141,139.30 9,662.02 32,478.18 62,503.33 25,330.03 109,088.14 376,784.43 3,883.78 29,026.83 21,086.67 69,498.58 0.00 33,059.47 25,572.95 277.19 38,359.33 4,500.89 30,881.58 10,099.14 883,713.25 14,540.40 95,096.79 1,529.65 3,976.21 53,943.90 15,285.93 45,618.50

2002 Assessment $ Adjustment
94,167.12 6,333.51 13,755.54 11,318.28
0.00 25,817.23 59,522.27 527,836.58 426,335.25 52,949.76 12,424.90 66,905.98 5,657.17 192,890.56 10,323.95 14,660.71 31,051.61 29,762.78 265,234.41 13,011.59 141,765.48 9,704.89 32,622.27 62,780.63 25,442.41 109,572.12 378,456.08 3,901.01 29,155.61 21,180.22 69,806.92
0.00 33,206.14 25,686.41
278.42 38,529.52 4,520.86 31,018.59 10,143.95 887,633.95 14,604.91 95,518.70 1,536.44 3,993.85 54,183.23 15,353.75 45,820.89

2003 Claims Paid
889,785.62 50,764.84 102,130.15 51,762.78 3,100.58 149,519.56 227,641.79 3,856,153.00 3,296,660.15 514,847.13 205,798.12 442,647.15 131,013.94 1,981,087.01 54,473.63 161,530.52 326,088.98 40,575.95 2,693,642.26
0.00 1,234,474.29
206,020.53 0.00
551,033.93 283,493.16 1,012,040.95 4,127,417.00 39,796.03 369,816.48 134,509.34
0.00 604,342.89 256,190.14 158,119.20
5,635.39 170,801.62 17,976.81 282,172.54 142,870.41 6,273,331.64 122,100.29 851,399.00 72,342.99 48,539.12 535,254.99 46,374.43
0.00

2003
$ Assessment 75,410.34 4,302.38 8,655.65 4,386.95 262.78 12,671.95 19,292.90 326,813.32 279,395.67 43,633.88 17,441.62 37,514.85 11,103.58 167,899.36 4,616.70 13,689.89 27,636.41 3,438.86 228,289.23 0.00 104,623.09 17,460.47 0.00 46,700.75 24,026.37 85,771.61 349,803.25 3,372.76 31,342.36 11,399.82 0.00 51,218.74 21,712.40 13,400.78 477.61 14,475.63 1,523.55 23,914.44 12,108.43 531,671.95 10,348.14 72,157.03 6,131.15 4,113.75 45,363.47 3,930.29 0.00

2002 $ Balance
Due 415.94 27.97 60.76 49.99 0.00 114.04 262.91
2,331.46 1,883.13
233.88 54.88 295.53 24.98 852.01 45.60 64.75 137.16 131.47 1,171.55 57.47 626.18 42.87 144.09 277.30 112.38 483.98 1,671.65 17.23 128.78 93.55 308.34 0.00 146.67 113.46 1.23 170.19 19.97 137.01 44.81 3,920.70 64.51 421.91 6.79 17.64 239.33 67.82 202.39

2002 and 2003 Total
Assessment

$ 75,826.28

$ 4,330.35

$ 8,716.41

$ 4,436.94

$

262.78

$ 12,785.99

$ 19,555.81

$ 329,144.78

$ 281,278.80

$ 43,867.76

$ 17,496.50

$ 37,810.38

$ 11,128.56

$ 168,751.37

$ 4,662.30

$ 13,754.64

$ 27,773.57

$ 3,570.33

$ 229,460.78

$

57.47

$ 105,249.27

$ 17,503.34

$

144.09

$ 46,978.05

$ 24,138.75

$ 86,255.59

$ 351,474.90

$ 3,389.99

$ 31,471.14

$ 11,493.37

$

308.34

$ 51,218.74

$ 21,859.07

$ 13,514.24

$

478.84

$ 14,645.82

$ 1,543.52

$ 24,051.45

$ 12,153.24

$ 535,592.65

$ 10,412.65

$ 72,578.94

$ 6,137.94

$ 4,131.39

$ 45,602.80

$ 3,998.11

$

202.39

Subsequent Injury Trust Fund 2003 Annual Report

Page 81

Self-Insured Employers Company Name NEWTON COUNTY NEWTON CO BOARD OF ED NORDSON CORPORATION NORDSTROM, INC. NORMAN W FRIES/CLAXTON POULTRY NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OLD DOMINION FREIGHT LINES INC OLIN CORPORATION OVERNITE TRANSPORTATION CO OWENS-CORNING FIBERGLASS OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORPORATION PATTERSON PUMP COMPANY PCC AIRFOILS LLC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL PIEDMONT LABORATORIES, INC PIGGLY WIGGLY CAROLINA CO INC PILOT TRAVEL CENTERS PPG INDUSTRIES INC. PRESBYTERIAN HOMES OF GA PRINTPACK, INC PROCTER & GAMBLE COMPANY AND QUITRIP RACETRAC PETROLEUM, INC RANDOLPH CO HOSP AUTHORITY RECONSERVE RHODES NURSING HOME RICHMOND CO BOARD OF ED RIVERDALE, CITY OF RMC INDUSTRIES ROCKDALE CO BOARD OF ED ROCKWELL AUTOMATION, INC ROLLINS INC ROOKER ADMINISTRATIVE SVCS ROPER CORPORATION ROSWELL CITY OF RTM, INC. RUBY TUESDAY INC RUSSELL CORPORATION RYAN'S FAMILY STEAK HOUSES RYDER SYSTEMS INC SAINT JOSEPH'S OF SAVANNAH SATILLA HEALTH SERVICES INC SAVANNAH CITY OF

2002
$ Assessment 3,706.15 11,313.78 15,238.68 11,544.31 49,252.19 34,835.92
120,795.88 38,352.07
308.66 22,240.77 62,580.29 108,852.34 13,235.83 23,570.48 2,156.25 50,426.69 38,834.54 97,691.94 7,117.35 8,796.63 3,800.66 11,514.69 5,025.99 27,333.10 69,074.83 37,919.73 28,001.32 1,987.15
0.00 7,473.55 88,395.98 6,381.30 32,024.63 16,377.39 60,274.07 23,583.16 24,640.16 57,878.38 21,839.58 36,736.14 40,461.80
581.43 81,598.28 115,057.32 4,335.34 33,492.71 189,639.88

2002 Assessment $ Adjustment
3,722.59 11,363.98 15,306.29 11,595.53 49,470.70 34,990.47 121,331.81 38,522.22
310.02 22,339.44 62,857.93 109,335.27 13,294.55 23,675.05 2,165.82 50,650.41 39,006.84 98,125.36 7,148.93 8,835.66 3,817.52 11,565.77 5,048.29 27,454.37 69,381.29 38,087.97 28,125.55 1,995.97
0.00 7,506.71 88,788.16 6,409.61 32,166.71 16,450.05 60,541.48 23,687.79 24,749.48 58,135.17 21,936.48 36,899.13 40,641.31
584.01 81,960.31 115,567.79 4,354.57 33,641.31 190,481.24

2003 Claims Paid
57,199.56 153,817.46 199,013.10 116,206.00 642,409.41 289,216.83 1,560,562.32 1,001,218.93
1,179.03 290,574.00 561,861.20 1,192,992.00 20,430.31 401,452.22 36,287.20 264,290.28 626,671.25 976,679.40 73,521.00 115,960.55 63,728.89 208,729.06 81,191.93 127,053.23 365,224.01 827,188.45 118,192.68 39,631.50 15,130.00 16,541.11 770,972.92 49,653.24 468,040.00 178,103.45 569,720.23 154,880.15 212,163.00 700,678.31 428,215.08 442,794.20 272,989.00
3,642.96 438,269.85 517,805.29 189,744.85 743,534.21 1,971,517.73

2003
$ Assessment 4,847.73 13,036.20 16,866.59 9,848.59 54,444.92 24,511.45
132,259.42 84,854.44
99.92 24,626.47 47,618.37 101,107.42 1,731.49 34,023.53 3,075.38 22,398.90 53,111.10 82,774.68 6,230.99 9,827.79 5,401.10 17,690.02 6,881.11 10,767.90 30,953.15 70,105.16 10,016.96 3,358.81 1,282.28 1,401.88 65,340.83 4,208.17 39,666.92 15,094.47 48,284.43 13,126.27 17,981.05 59,383.28 36,291.71 37,527.31 23,136.13
308.74 37,143.87 43,884.58 16,081.09 63,015.36 167,088.36

2002 $ Balance
Due 16.44 50.20 67.61 51.22 218.51 154.55 535.93 170.15 1.36 98.67 277.64 482.93 58.72 104.57 9.57 223.72 172.30 433.42 31.58 39.03 16.86 51.08 22.30 121.27 306.46 168.24 124.23 8.82 0.00 33.16 392.18 28.31 142.08 72.66 267.41 104.63 109.32 256.79 96.90 162.99 179.51 2.58 362.03 510.47 19.23 148.60 841.36

2002 and 2003 Total
Assessment

$ 4,864.17

$ 13,086.40

$ 16,934.20

$ 9,899.81

$ 54,663.43

$ 24,666.00

$ 132,795.35

$ 85,024.59

$

101.28

$ 24,725.14

$ 47,896.01

$ 101,590.35

$ 1,790.21

$ 34,128.10

$ 3,084.95

$ 22,622.62

$ 53,283.40

$ 83,208.10

$ 6,262.57

$ 9,866.82

$ 5,417.96

$ 17,741.10

$ 6,903.41

$ 10,889.17

$ 31,259.61

$ 70,273.40

$ 10,141.19

$ 3,367.63

$ 1,282.28

$ 1,435.04

$ 65,733.01

$ 4,236.48

$ 39,809.00

$ 15,167.13

$ 48,551.84

$ 13,230.90

$ 18,090.37

$ 59,640.07

$ 36,388.61

$ 37,690.30

$ 23,315.64

$

311.32

$ 37,505.90

$ 44,395.05

$ 16,100.32

$ 63,163.96

$ 167,929.72

Subsequent Injury Trust Fund 2003 Annual Report

Page 82

Self-Insured Employers Company Name SCIENTIFIC-ATLANTA INC SHAW INDUSTRIES INC SHEPHERD CONSTRUCTION SHEPHERD MEDICAL CENTER SHERWIN-WILLIAMS COMPANY SHONEY'S INC SI CORPORATION SIX CONTINENTS HOTELS, INC SIZEMORE ,INC. SKF USA INC SNELL CONTRACTORS SONOCO PRODUCTS COMPANY SOUTH GEORGIA MEDICAL CTR SOUTHEAST GA HEALTH SYSTEMS SOUTHEAST-ATLANTIC BEVERAGE SOUTHEASTERN FREIGHT LINES SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN PAN SERVICES SOUTHERN REGIONAL HEALTH SYS. SOUTHWIRE COMPANY SPALDING CO BOARD OF COMM SPARTA CITY OF SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL ST JOSEPH HOSPITAL/AUGUSTA STAFFMARK INVESTMENT LLC STANLEY WORKS & SUBSIDIARIES STONE CONTAINER CORP SUPERIOR RIGGING & ERECTING CO SUPERIOR UNIFORM GROUP SUTHERLAND'S FOODSERVICE, INC. T. M. POLYFILM, INC TALON EQUITIES, INC TANNER HEALTH SERVICES TARGET CORPORATION TECUMSEH PRODUCTS CO TERMINIX SERVICE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS THOMASVILLE CITY OF THREE SPRINGS INC. TIP TOP POULTRY INC TRC STAFFING SERVICES, INC TROUP CO. BOARD OF ED TYSON FOODS INC

2002
$ Assessment 60,303.62
1,069,347.11 0.00
21,868.68 21,587.84 104,602.72 35,449.99 16,571.50 52,791.39 2,856.22 50,153.98 10,228.92 64,036.59 80,061.98 12,453.58 52,847.00 398,260.52 14,389.47 32,647.68 40,888.47 205,147.01 20,802.52 4,952.36 63,273.76 26,478.67 33,827.33 11,919.31 3,823.16 8,508.25 52,882.68 1,724.78 10,929.88 3,839.73 1,010.69 81,272.68 161,542.82 77,546.24
110.35 22,498.03 87,694.18 62,979.00 10,920.37 25,591.58 21,656.94 38,219.29 23,531.72 328,473.54

2002 Assessment $ Adjustment
60,571.16 1,074,091.40
0.00 21,965.70 21,683.62 105,066.80 35,607.27 16,645.02 53,025.60 2,868.89 50,376.50 10,274.30 64,320.69 80,417.19 12,508.83 53,081.46 400,027.45 14,453.31 32,792.53 41,069.87 206,057.17 20,894.81 4,974.33 63,554.48 26,596.14 33,977.41 11,972.20 3,840.12 8,546.00 53,117.30 1,732.43 10,978.37 3,856.77 1,015.17 81,633.25 162,259.52 77,890.29
110.84 22,597.85 88,083.24 63,258.41 10,968.82 25,705.12 21,753.02 38,388.86 23,636.12 329,930.85

2003 Claims Paid
673,322.32 8,788,913.18
44,786.65 212,109.57
3,401.00 680,805.84 942,041.81 24,543.84 253,520.21 90,892.00 275,647.14 260,848.94 476,967.50 863,097.84 163,043.34 598,647.52 4,861,240.37 86,725.24 144,740.90 580,484.81 1,728,309.62 264,320.58 38,481.90 587,559.31 163,250.34 159,608.30
0.00 47,465.74 272,587.00 178,819.39 181,865.38 126,931.27 48,083.29 10,655.70 300,850.93 1,394,434.71 886,315.65 1,094.81 257,336.44 760,045.80 394,176.68 73,628.80 112,675.74 220,454.55 291,232.60 277,774.42 3,233,637.45

2003
$ Assessment 57,064.83 744,870.32 3,795.72 17,976.53 288.24 57,699.06 79,839.11 2,080.12 21,486.12 7,703.20 23,361.41 22,107.24 40,423.53 73,148.52 13,818.11 50,736.05 411,995.61 7,350.06 12,266.95 49,196.74 146,476.19 22,401.47 3,261.38 49,796.32 13,835.65 13,526.98 0.00 4,022.78 23,102.06 15,155.15 15,413.30 10,757.57 4,075.11 903.08 25,497.46 118,179.92 75,116.25 92.79 21,809.55 64,414.74 33,406.92 6,240.12 9,549.40 18,683.77 24,682.29 23,541.70 274,054.43

2002 $ Balance
Due 267.54
4,744.29 0.00 97.02 95.78
464.08 157.28 73.52 234.21 12.67 222.52 45.38 284.10 355.21 55.25 234.46 1,766.93 63.84 144.85 181.40 910.16 92.29 21.97 280.72 117.47 150.08 52.89 16.96 37.75 234.62
7.65 48.49 17.04 4.48 360.57 716.70 344.05 0.49 99.82 389.06 279.41 48.45 113.54 96.08 169.57 104.40 1,457.31

2002 and 2003 Total
Assessment

$ 57,332.37

$ 749,614.61

$ 3,795.72

$ 18,073.55

$

384.02

$ 58,163.14

$ 79,996.39

$ 2,153.64

$ 21,720.33

$ 7,715.87

$ 23,583.93

$ 22,152.62

$ 40,707.63

$ 73,503.73

$ 13,873.36

$ 50,970.51

$ 413,762.54

$ 7,413.90

$ 12,411.80

$ 49,378.14

$ 147,386.35

$ 22,493.76

$ 3,283.35

$ 50,077.04

$ 13,953.12

$ 13,677.06

$

52.89

$ 4,039.74

$ 23,139.81

$ 15,389.77

$ 15,420.95

$ 10,806.06

$ 4,092.15

$

907.56

$ 25,858.03

$ 118,896.62

$ 75,460.30

$

93.28

$ 21,909.37

$ 64,803.80

$ 33,686.33

$ 6,288.57

$ 9,662.94

$ 18,779.85

$ 24,851.86

$ 23,646.10

$ 275,511.74

Subsequent Injury Trust Fund 2003 Annual Report

Page 83

Self-Insured Employers Company Name UNILEVER UNITED STATES UNITED AIRLINES UNITED CATALYSTS, INC UNIVERSITY HOSPITAL USF HOLLAND, INC. VALDOSTA CITY OF VARIETY WHOLESALERS VISITING NURSE HEALTH SYS VULCAN MATERIALS COMPANY WACHOVIA WAFFLE HOUSE WAGGONERS TRUCKING CO., THE WALKER CO BOARD OF ED WALTON CO BOARD OF ED WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WARREN SEWELL MFG. CO. WATKINS ASSOCIATED INDUSTRIES WATKINS ENGINEERS & CONST WAYCROSS MOLDED PRODUCTS INC WAYCROSS, CITY OF WCI OUTDOOR PRODUCTS INC WELLINGTON LEISURE PRODUCTS WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYSTEM WEST POINT STEVENS, INC WESTVACO CORPORATION & SUBS
WEYERHAEUSER COMPANY WHITFIELD COUNTY BD OF COMMISS WHITFIELD CO BOARD OF ED WINN-DIXIE STORES INC YELLOW FREIGHT SYSTEM INC YKK CORPORATION OF AMERICA Total: 406 Grand Total:

2002
$ Assessment 18,445.54 34,427.39 15,442.67 63,657.04 31,879.72 51,130.91 10,018.67 15,233.88 77,171.94 35,520.97 211,682.05 49,750.16 17,883.21 1,408.60 50,494.61 12,222.97 48,828.60 99,971.62 18,353.13 30,991.80 31,563.50 16,151.73 14,156.95 355,249.83 9,949.30 24,704.47 27,834.96 11,610.20 94,070.02 7,916.99 0.00 643,813.32 67,633.85 18,495.74
$31,188,403.79

2002 Assessment $ Adjustment
18,527.37 34,580.13 15,511.18 63,939.46 32,021.15 51,357.75 10,063.12 15,301.47 77,514.33 35,678.56 212,621.21 49,970.88 17,962.55 1,414.84 50,718.64 12,277.20 49,045.24 100,415.16 18,434.55 31,129.30 31,703.53 16,223.39 14,219.76 356,825.93 9,993.44 24,814.07 27,958.45 11,661.71
94,487.37 7,952.11
0.00 646,669.67 67,933.92 18,577.80 $31,317,655.47

2003 Claims Paid
135,498.00 316,379.27 168,676.19 501,216.60 329,484.00 471,103.86 198,131.30 213,738.00 555,991.22
0.00 1,836,998.69 1,142,316.09
276,769.34 72,195.59 789,104.53 283,162.96
0.00 780,706.45
0.00 169,027.08
0.00 0.00 299,758.35 4,369,377.76 241,263.60 286,709.13 253,474.20 0.00
753,035.36 0.00
256,224.70 4,529,563.20
705,043.17 245,250.72 $282,262,027.02

2003
$ Assessment 11,483.61 26,813.50 14,295.50 42,478.67 27,924.14 39,926.58 16,791.85 18,114.54 47,120.88 0.00 155,687.71 96,812.58 23,456.51 6,118.66 66,877.50 23,998.38 0.00 66,165.75 0.00 14,325.24 0.00 0.00 25,404.86 370,309.70 20,447.36 24,298.92 21,482.22 0.00 63,820.60 0.00 21,715.33 383,885.60 59,753.21 20,785.28
$23,922,025.68

2002 $ Balance
Due 81.83 152.74 68.51 282.42 141.43 226.84 44.45 67.59 342.39 157.59 939.16 220.72 79.34 6.24 224.03 54.23 216.64 443.54 81.42 137.50 140.03 71.66 62.81
1,576.10 44.14 109.60 123.49 51.51
417.35 35.12 0.00 2,856.35 300.07 82.06 $129,251.68

2002 and 2003 Total
Assessment

$ 11,565.44

$ 26,966.24

$ 14,364.01

$ 42,761.09

$ 28,065.57

$ 40,153.42

$ 16,836.30

$ 18,182.13

$ 47,463.27

$

157.59

$ 156,626.87

$ 97,033.30

$ 23,535.85

$ 6,124.90

$ 67,101.53

$ 24,052.61

$

216.64

$ 66,609.29

$

81.42

$ 14,462.74

$

140.03

$

71.66

$ 25,467.67

$ 371,885.80

$ 20,491.50

$ 24,408.52

$ 21,605.71

$

51.51

$ 64,237.95

$

35.12

$ 21,715.33

$ 386,741.95

$ 60,053.28

$ 20,867.34

$ 24,051,277.36