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 Page ii STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND Suite 500 North Tower 1720 Peachtree Street, NW Atlanta, Georgia 30309-2462 Website: www.sitf.georgia.gov Telephone: (404) 206-6360 Facsimile: (404) 206-6363 This publication can be downloaded from the SITF Website. Subsequent Injury Trust Fund 2003 Annual Report Page iii For additional copies, please call the telephone number listed above or write to our address. Subsequent Injury Trust Fund 2003 Annual Report Page iv 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 Subsequent Injury Trust Fund 2003 Annual Report Page v 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. Subsequent Injury Trust Fund 2003 Annual Report Page vi 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 Page 1 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. Subsequent Injury Trust Fund 2003 Annual Report Page 2 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 Subsequent Injury Trust Fund 2003 Annual Report Page 3 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 Subsequent Injury Trust Fund 2003 Annual Report Page 4 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 Page 5 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 Page 6 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 Page 7 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 Page 8 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 Subsequent Injury Trust Fund 2003 Annual Report Page 9 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 Subsequent Injury Trust Fund 2003 Annual Report Page 10 Group Self-Insured Employers Following is a list of group self-insured employers that filed a Notice of Claim with the Subsequent Injury Trust Fund in 2003. A total of 14 group self-insured employers filed approximately 696 claims. Claims Reported by Group Self-Insured Employers Claims Reported AGRITRUST OF GEORGIA ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GEORGIA CONSTRUCTION SUPPLIERS' ASSOC GA AUTO DEALERS ASSOCIATION SI GA EDUCATION WC TRUST FUND GA HOSPITAL ASSOC WCSI FUND GA MUNICIPAL ASSN WCSIF GA OILMEN'S ASSOCIATION GA OPERATORS SELF-INSURERS GA SCHOOL BD ASSOC W C FUND GEMC WORKERS' COMP FUND GTMA/AYSA SELF INSURANCE ROOFING & SHEET METAL ASSOC Total of Companies 14 6 169 51 2 18 11 71 105 135 43 47 15 19 4 Total 696 Subsequent Injury Trust Fund 2003 Annual Report Page 11 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 Page 12 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 Page 13 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. Page 14 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 Page 15 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 Page 16 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 Page 17 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 Page 18 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 Page 19 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