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