- Collection:
- Georgia Government Publications
- Serial:
- Annual report..
- Title:
- 2004 annual report
- Creator:
- Georgia. Subsequent Injury Trust Fund
- Contributor to Resource:
- Georgia. Subsequent Injury Trust Fund
- Publisher:
- Atlanta, Ga. : Georgia. Subsequent Injury Trust Fund
- Date of Original:
- 2004
- Subject:
- Subsequent Injury Trust Fund (Ga.)--Periodicals.
Workers' compensation claims--Georgia--Statistics--Periodicals.
Workers' compensation claims--Georgia--Finance--Statistics--Periodicals.
Georgia Government Documents--Serial - Location:
- United States, Georgia, 32.75042, -83.50018
- Medium:
- publications (documents)
- Type:
- Text
- Format:
- application/pdf
- Description:
- Some issues may lack title.
2011; title from PDF title page (Georgia Government Publications database, viewed August 21, 2023).
2017 (Harvested on July 19, 2019 from sitf.georgia.gov); (Georgia Government Publications database, viewed August 21, 2023). - External Identifiers:
- Call Number GA I575 .A1 2004
- Metadata URL:
- https://dlg.galileo.usg.edu/id:dlg_ggpd_y-ga-bi575-b-pa1-b2004-belec-p-btext
- Digital Object URL:
- https://dlg.galileo.usg.edu/do:dlg_ggpd_y-ga-bi575-b-pa1-b2004-belec-p-btext
- Language:
- eng
- Holding Institution:
- University of Georgia. Map and Government Information Library
- Rights:
-
STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND
2004 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 2004 Annual Report
STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND
Page ii
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. For additional copies, please call the telephone number listed
above or write to our address.
Subsequent Injury Trust Fund 2004 Annual Report
OFFICIALS
BOARD OF TRUSTEES John T. Fervier, II Chairman
Don Avery, Member Jim C. Beck, Sr. Member James F. Braswell, Member James C. Thompson, Member
Page iii
EX-OFFICIO MEMBERS Stan Carter, State Board of Workers' Compensation John W. Oxendine, Insurance, Safety Fire Commissioner
ADMINISTRATOR Richard W. McGee
DEPUTY ADMINISTRATOR David L. Taylor
Subsequent Injury Trust Fund 2004 Annual Report
Page iv
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 2004 Annual Report
Page v
Table of Contents
Fund Administration ................................................................................................1
Introduction ______________________________________________________________ 1 How the Fund Works ______________________________________________________ 1 Reimbursement from the Fund _____________________________________________ 1 Claims Administration _____________________________________________________ 2 Claims Activity 2004 _____________________________________________________ 2 Financial Activity - 2004 ___________________________________________________ 3
CLAIMS FILED IN 2004 .........................................................................................4
Insurance Companies _____________________________________________________ 4 Group Self-Insured Employers______________________________________________ 9 Self-Insured Employers ___________________________________________________ 10
Reimbursements Paid ..........................................................................................17
Insurance Companies ____________________________________________________ 17 Group Self-Insured Employers_____________________________________________ 22 Self-Insured Employers ___________________________________________________ 23 Individual Employers _____________________________________________________ 29
Assessment 2004..................................................................................................60
Legal Requirements______________________________________________________ 60 Assessment Calculation __________________________________________________ 61 Assessment Adjustment for 2003 __________________________________________ 61 Assessment Rate for 2004 ________________________________________________ 61 Assessments Due for 2003 - 2004 _________________________________________ 62 Insurance Companies ____________________________________________________ 62 Group Self-Insured Employers_____________________________________________ 70 Self-Insured Employers ___________________________________________________ 71
Subsequent Injury Trust Fund 2004 Annual Report
FUND ADMINISTRATION
Page 1
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. The administrator with a staff of 30 employees conducts 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.
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.
Subsequent Injury Trust Fund 2004 Annual Report
Page 2
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 2004 The following is a breakdown of claims activity for calendar year 2004. For information on prior
years, please call (404) 206-6357 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, 2004 Calendar Year 2004 Calendar Year 2004 Calendar Year 2004 December 31, 2004 Calendar Year 2004 Calendar Year 2004 Calendar Year 2004
19,450 18,071
981 16,313 22,279
1531 128
2,043
Subsequent Injury Trust Fund 2004 Annual Report
Page 3
Financial Activity - 2004
The following table depicts the fund's revenues, expenditures, and fund balance for the calendar year ending December 31, 2004. 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, 2004
Revenues
Assessments 2003, adjusted assessments 2002, and payments and refunds for prior years
Interest Earned
Miscellaneous Income Total Revenues
Expenditures Operating Cost
Reimbursements (negotiated checks)
Total Expenditures
Net Loss Ending Balance December 31, 2004
63,454,578.81
$63,454,578.81
94,242,106.79 704,774.58 132.35
94,947,013.72
2,023,763.78
101,362,256.55 103,386,020.33
(8,439,006.61) $55,015,572.20
Subsequent Injury Trust Fund 2004 Annual Report
CLAIMS FILED IN 2004
Page 4
Insurance Companies
The following is a list of insurance companies that filed a Notice of Claim with the Subsequent Injury Trust Fund in 2004. A total of 229 insurance companies filed approximately 11,064 claims.
Claims Reported by Insurance Companies
Claims Reported
ACE AMERICAN INSURANCE CO
193
ACE FIRE UNDERWRITERS INS. CO
1
ACE PROPERTY & CASUALTY INS
10
AIG NATIONAL INS. CO.
105
AIU INSURANCE CO
1
ALEA NORTH AMERICA
2
AMCOMP ASSURANCE
38
AMCOMP PREFERRED
13
AMERICAN & FOREIGN INS CO.
4
AMERICAN ALTERNATIVE INS
8
AMERICAN CAS CO OF READING PA
562
AMERICAN ECONOMY INS CO
4
AMERICAN GUAR & LIAB INS CO
7
AMERICAN HOME ASSURANCE CO
304
AMERICAN INSURANCE CO
19
AMERICAN INTER INS CO OF GA
49
AMERICAN INTERN. SOUTH INS CO
67
AMERICAN MFG. MUTUAL INS
18
AMERICAN MOTORISTS INS CO
10
AMERICAN PROTECTION INS CO
35
AMERICAN RESOURCES INS CO
2
AMERICAN STATES INS CO
48
AMERICAN ZURICH INS CO
16
AMERISURE INSURANCE CO
1
AMGUARD INSURANCE CO.
16
ARCH INSURANCE CO
2
ARGONAUT GREAT CENTRL INS CO
1
ARGONAUT INSURANCE CO
10
ASSOCIATED INDEMNITY CORP
6
ASSOCIATED INDUSTRIES INS CO
2
ASSOCIATION INSURANCE CO
8
ASSURANCE CO. OF AMERICA
1
ATLANTIC MUTUAL INS. CO
11
ATLANTIC SPECIALTY INS CO
3
AUTO OWNERS INS. CO
27
Subsequent Injury Trust Fund 2004 Annual Report
BANCINSURE, INC. BANKERS STANDARD INS CO BENCHMARK INS CO BITUMINOUS CASUALTY CORP BRIDGEFIELD CASUALTY BUILDERS INSURANCE CANAL INSURANCE CO CAPITAL CITY INS CO CASUALTY RECIPROCAL EXCHG CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHUBB INDEMNITY INS CO CHURCH MUTUAL INS CO CINCINNATI INSURANCE CO 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 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 EVEREST NATIONAL INS EVEREST SECURITY INS CO EXCELSIOR INSURANCE CO FAIRFIELD INSURANCE 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
3 41 41 4 71 1313 53 20 4 1 2 29 12 8 71 97 2 8 57 2 86 81 1 371 5 5 2 88 5 2 25 46 11 4 12 90 145 1 6 1 3 21 108 87 4 3 14
Page 5
Subsequent Injury Trust Fund 2004 Annual Report
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 INS CO OF GA FIRST LIBERTY INS CORP FIRST NATL INS CO OF AMER FLORISTS' MUTUAL INS CO GA INSURERS INSOLVENCY POOL GA RESTAURANT MUTUAL CAP INS C GA TIMBER HARVERSTERS' GENERAL INS CO OF AMERIC GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GLOBE INDEMNITY CO GRANGE MUTUAL CASUALTY COMPANY GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GREAT AMER INS CO OF NY GREAT AMERICAN INS CO GREAT NORTHERN INS CO GREAT WEST CASUALTY CO GROCERS INSURANCE CO GUARANTEE INSURANCE CO GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARCO NATIONAL INS CO 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 INS OF THE MIDWEST HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HOSPITALITY MUT CAPTIVE INS HOUSTON GENERAL INS CO 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
Page 6
7 1 53 1 5 1 4 3 12 30 19 7 1 76 4 2 1 10 2 2 2 10 4 4 1 1 2 11 3 2 2 6 3 256 11 92 70 18 162 11 1 187 4 128 1 11 4
Subsequent Injury Trust Fund 2004 Annual Report
LIBERTY INSURANCE CORP. LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LM INSURANCE CORP LUMBERMENS MUTUAL CAS CO LUMBERMEN'S UNDERWRITING MADISON INSURANCE CO MAG MUTUAL INS CO MARYLAND CASUALTY COMPANY MEDMARC CASUALTY INS MIDWEST EMPLOYERS CASUALTY CO MITSUI SUMITOMO INS CO OF AMER MUTUAL ASSURANCE INC. 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 NETHERLANDS INSURANCE CO NEW HAMPSHIRE INSURANCE CO NORGUARD INSURANCE CO. NORTHERN INS CO OF NY OHIO CASUALTY INSURANCE CO OLD DOMINION INSURANCE CO OLD REPUBLIC INSURANCE CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PEERLESS INSURANCE COMPANY PENN LUMBERMENS MUTUAL PENN MFG ASSOC INS PETROLEUM CASUALTY CO PHOENIX INSURANCE CO PRINCETON INSURANCE CO PROTECTIVE INSURANCE CO PROVIDENCE PROPERTY & CASUALTY PROVIDENCE WASHINGTON INS CO REALM NATIONAL INSURANCE REDLAND INSURANCE CO RELIANCE INS CO IN LIQUIDATION REPUBLIC-FRANKLIN INSURANCE CO ROCHDALE INSURANCE COMPANY ROYAL & SUNALLIANCE INS. CO ROYAL INDEMNITY CO ROYAL INS CO OF AMERICA
Page 7
156 155 32
4 54 28 1 6 55 6 4 11 1 1 183 1 29 4 6 1 3 30 3 3 9 110 2 3 176 6 18 4 286 1 22 21 1 10 4 4 1 6 1 35 195 43 44
Subsequent Injury Trust Fund 2004 Annual Report
S.E. EMPLOYER MUT. CAP. INS CO SAFECO INS CO OF ILLINOIS SAFECO INSURANCE CO AMERICA SAFEGUARD INSURANCE CO SAFETY NATIONAL CASUALTY SECURITY INS CO OF HARTFORD SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SE SELECTIVE INSURANCE CO OF SC SELECTIVE WAY INSURANCE CO SENTRY INSURANCE A MUTUAL CO SOMPO JAPAN INS, OF AMERICA SOUTHEASTERN US CAP. INS, INC SOUTHERN GUARANTY INSURANCE CO 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 FARM FIRE & CASUALTY CO TECHNOLOGY INSURANCE CO TIG INSURANCE CO TOKIO MARINE & NICHIDO FIRE TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORTATION INSURANCE CO TRAVELERS CAS & SUR CO TRAVELERS CAS & SUR CO OF AMER TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMER TRAVELERS INSURANCE CO TRAVELERS PROP CAS CO OF AMER TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS U.S. SPECIALTY INS. CO. UNITED BUSINESS INS CO (A MUTU UNITED STATES FIRE INSURANCE UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INSURANCE CO VANLINER INSURANCE CO VIGILANT INSURANCE CO VILLANOVA INS CO-IN LIQUIDATIO WAUSAU BUSINESS INSURANCE WAUSAU UNDERWRITERS INS CO
Page 8
499 4 4 5 8 36 30 13 8 19 26 1 4 1 5
119 9 5 5 14 56 8 62 16 44
203 14 1 5 8 556 8 453 19 19 3 16 4 16 1 2 75 34 1 2 1 7
Subsequent Injury Trust Fund 2004 Annual Report
WESTFIELD INSURANCE CO WESTPORT INSURANCE CORP XL SPECIALTY INSURANCE CO ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Total of Companies 229
Total
16 29 3 51 82 737 11,064
Page 9
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 2004. A total of 17 group self-insured employers filed approximately 1,004 claims.
Claims Reported by Group Self-Insured Employers
Claims Reported
AGRITRUST OF GEORGIA AMBULANCE PROVIDERS ASSOC. ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GEORGIA CONSTRUCTION SUPPLIERS' ASSOC GA ASSOC OF CONVENIENCE STORES 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 SOUTHEASTERN LUMBER MFR ASSOC Total of Companies 17
Total
23 4 182 30 21 1 10 74 49 101 127 38 105 191 38 8 2 1,004
Subsequent Injury Trust Fund 2004 Annual Report
Page 10
Self-Insured Employers
Following is a list of self-insured employers that filed a Notice of Claim with the Subsequent Injury Trust Fund in 2004. A total of 305 self-insured employers filed approximately 6,277 claims.
Claims Reported by Self-Insured Employers
Claims Reported
AAA COOPER TRANSPORTATION
22
ABF FREIGHT SYSTEM, INC
6
ACUITY BRANDS
44
AGL RESOURCES, INC.
10
ALEXIS PLAYSAFE, INC.
1
ALLIED SYSTEMS LTD
4
ANHEUSER-BUSCH COMPANIES, INC.
2
ARCHBOLD MEDICAL CENTER
11
ARCHDIOCESES OF ATLANTA
10
ARCHER-DANIELS-MIDLAND CO
1
ASPLUNDH TREE EXPERT CO
4
ATHENS REG. HLTH SYS INC
23
ATHENS-CLARKE COUNTY
10
ATLANTA BOARD OF EDUCATION
13
ATLANTA CITY OF
502
ATLANTA HOUSING AUTHORITY
3
AUGUSTA-RICHMOND CO BD COMM
29
AUTOZONE, INC
4
AVERITT EXPRESS, INC
8
AVONDALE MILLS INC
2
BARTOW COUNTY BD OF EDUCATION
11
BEAULIEU OF AMERICA
4
BELLSOUTH CORPORATION
16
BERRY COLLEGE
2
BHA GROUP INC
1
BIBB COUNTY BD-COMMISSION
21
BIBB COUNTY BOARD OF EDUCATION
1
BIG LOTS STORES, INC.
2
BJ'S WHOLESALE CLUB INC
8
BLOSSMAN COMPANIES, INC
1
BLUE BIRD BODY COMPANY
66
BLUE CIRCLE AMERICA
2
BOBS CANDIES, INC.
1
BREMEN-BOWDEN INVESTMENT CO.
4
BROWN INDUSTRIES
2
BRUNSWICK, CITY OF
10
BURLEN CORPORATION
2
C T HARRIS INC
6
Subsequent Injury Trust Fund 2004 Annual Report
C. W. MATTHEWS CONTRACTING INC CAGLE'S INC, & SUBSIDIARIES CANDLER HEALTH SYSTEM CATOOSA CO. BD. OF EDUCATION CEMEX (SOUTHDOWN INC.) CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CERULEAN COMPANIES INC. CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA 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 CMI INDUSTRIES INC. COACHMAN REC. VEHICLE CO OF GA COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLONIAL GROUP COLONIAL PIPELINE COMPANY COLQUITT CO BD OF EDUCATION COLUMBIA COUNTY BOE COLUMBUS FOUNDRIES INC COLUMBUS REGIONAL HEALTHCARE 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 COWETA COUNTY BOC CRACKER BARREL OLD CNTRY STORE CRAWFORD & COMPANY CRIDER'S POULTRY INC CRISP COUNTY BD OF EDUCATION DALTON CITY OF DAN RIVER, INC. DART CONTAINER CORPORATION DECATUR, CITY OF DEKALB COUNTY BOARD-ED
Page 11
3 1 7 7 2 14 1 1 7 2 50 24 24 112 179 7 1 1 12 19 20 74 1 1 4 3 1 10 10 5 7 12 43 2 2 3 13 3 15 17 3 3 2 24 1 1 13
Subsequent Injury Trust Fund 2004 Annual Report
DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HLTHCARE 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 DULUTH, CITY OF DURAND-WAYLAND, INC EAST POINT, CITY OF ELBERTA CRATE & BOX COMPANY ELBERTON GRANITE ASSOCIATION ELBERTON, CITY OF EMORY UNIVERSITY ENGELHARD CORPORATION EQUITY GROUP GA DIVISION ESTES EXPRESS LINES FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FEDERATED DEPARTMENT STORES FEDEX GROUND PKG SYS FIELDALE FARMS CORPORATION FLEETWOOD HOMES OF GA INC FLEXSTEEL INDUSTRIES INC FLORIDA ROCK INDUSTRIES INC FLOWERS FOODS INC. FLOYD CO. BD. OF COMMISSIONERS FLOYD COUNTY BD OF EDUCATION FLOYD HLTHCARE MGMT INC FLYING J, INC. FORD MOTOR COMPANY FORSYTH CO BD OF COMMISSIONERS FORSYTH CO. BD. OF EDUCATION FREUDENBERG-NOK FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHY GA INTAL HEALTH/SOUTH FULTON GA S.I. GUARANTY TRUST FUND GANNETT CO. INC & SUBSIDIARIES GENERAL MOTORS CORPORATION
Page 12
58 13 11 1 338 2 10 4 7 27 21 1 7 2 22 1 3 3 72 13 4 5 3 13 9 4 1 18 3 1 1 11 37 8 10 4 28 2 2 13 45 17 8 1 1 4 218
Subsequent Injury Trust Fund 2004 Annual Report
GEORGIA DUCK & CORDAGE MILL GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GLYNN COUNTY BOARD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GOODY PRODUCTS, INC. GREAT DANE LTD PARTNERSHIP GRESS FOODS INC GRIFFIN-SPALDING SCHOOLS GUARDIAN AUTOMOTIVE CORP 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 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 HOUSTON COUNTY BD OF EDUCATION HOUSTON COUNTY COMMISSIONERS HOWARD SHEPPARD INC HUTCHESON MEDICAL CENTER HYATT CORPORATION IKON OFFICE SOLUTIONS INGLES MARKETS INC INTERNATIONAL PAPER COMPANY J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JOHN WIELAND HOMES, INC JOHNS MANVILLE INT'L., INC. JONES COMPANY (THE) KAHN CONSTRUCTION COMPANY INC KEEBLER COMPANY KELLEY MANUFACTURING COMPANY KIMBERLY-CLARK CORP KING & PRINCE SEAFOOD CORP.
6 1622 141
5 6 18 9 3 10 1 1 3 12 78 18 8 14 5 1 2 9 24 1 2 3 2 1 6 3 1 6 1 7 4 1 11 34 38 3 13 1 43 1 9 3 1 1
Page 13
Subsequent Injury Trust Fund 2004 Annual Report
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 BRANDS, INC LOUISIANA-PACIFIC CORP LOWE'S HOME CENTERS, INC MACON CITY OF MACON/BIBB CO WATER & SEWERAGE MARIETTA CITY SERVICES MAR-JAC POULTRY, INC. MARRIOTT INTERNATIONAL, INC. MARTA MCLANE COMPANY, INC. MEADWESTVACO MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC MICROMERITICS INSTRUMENTS CORP MILAN EXPRESS COMPANY, INC MOHAWK INDUSTRIES, INC MONROE, CITY OF MOUNT VERNON MILLS MULLITE CO OF AMERICA MUSCOGEE COUNTY SCHOOL DIST NATIONAL SERVICES INDUSTRIES NEWTON COUNTY NORDSON CORPORATION NORDSTROM, INC. NORMAN W FRIES/CLAXTON POULTRY NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OLD DOMINION FREIGHT LINES INC OVERNITE TRANSPORTATION CO OWENS-CORNING OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORPATION PATTERSON PUMP COMPANY PCC AIRFOILS LLC PHOEBE PUTNEY MEMORIAL HOSP PIGGLY WIGGLY CAROLINA CO INC
Page 14
2 3 6 33 5 1 8 4 5 2 6 1 33 30 1 12 3 39 144 1 1 13 1 1 1 76 7 28 1 5 2 1 3 1 6 5 54 5 7 24 2 14 1 1 5 5 6
Subsequent Injury Trust Fund 2004 Annual Report
PRESBYTERIAN HOMES OF GA RACETRAC PETROLEUM, INC RANDOLPH COUNTY HOSP AUTHORITY RIVERDALE, CITY OF RMC USA, INC. ROCKDALE CO. BD OF EDUCATION ROCKWELL AUTOMATION, INC ROME, CITY OF ROOKER ADMINISTRATIVE SERVICES ROPER CORPORATION ROSWELL CITY OF RTM, INC. RUBY TUESDAY INC RYAN'S FAMILY STEAK HOUSES RYDER SYSTEMS INC SAINT JOSEPH'S OF SAVANNAH SATILLA HEALTH SERVICES INC SAVANNAH CITY OF SHAW INDUSTRIES INC SHEPHERD MEDICAL CENTER SHERWIN-WILLIAMS COMPANY SHONEY'S LLC SI CORPORATION SIZEMORE ,INC. SKF USA INC SNELL CONTRACTORS SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GA HLTH SYSTEM SOUTHEASTERN FREIGHT LINES SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN REGIONAL HEALTH SYS. SPALDING CO BOARD OF COMM SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL ST JOSEPH HOSPITAL/AUGUSTA STANLEY WORKS & SUBSIDIARIES STONE CONTAINER CORPORATION SUPERIOR RIGGING & ERECTING CO T. M. POLYFILM, INC TALON EQUITIES, INC TANNER HEALTH SERVICES TARGET CORPORATION TERMINIX SERVICE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS
Page 15
1 4 1 2 7 11 1 2 1 1 9 4 5 12 5 9 7 35 9 1 4 2 14 16 1 2 6 9 23 22 2 12 4 15 9 7 2 1 2 1 1 11 24 1 2 3 4
Subsequent Injury Trust Fund 2004 Annual Report
THREE SPRINGS INC. TIP TOP POULTRY INC TRC STAFFING SERVICES, INC TROUP CO. BOARD OF EDUCATION TYSON FOODS INC UNILEVER UNITED STATES UNITED AIRLINES UNITED CATALYSTS, INC UNITED HEALTH SERVICES INC UNIVERSITY HOSPITAL USF HOLLAND, INC. USG CORPORATION VALDOSTA CITY OF VARIETY WHOLESALERS VISITING NURSE HEALTH SYSTEM WAFFLE HOUSE WALKER COUNTY BD OF EDUCATION WALTON CO BOARD OF ED WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WATKINS ASSOCIATED INDUSTRIES WCI OUTDOOR PRODUCTS INC WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYSTEM WEST POINT STEVENS, INC WESTVACO CORPORATION & SUBS WEYERHAEUSER COMPANY WHITFIELD COUNTY BOE WINN-DIXIE STORES INC YELLOW FREIGHT SYSTEM INC YKK CORPORATION OF AMERICA Total of Companies 305
Total
1 2 4 3 69 1 7 4 1 11 8 1 20 16 4 61 7 1 16 4 2 2 55 11 9 2 3 4 1 49 22 19 6,277
Page 16
Subsequent Injury Trust Fund 2004 Annual Report
REIMBURSEMENTS PAID
Page 17
Insurance Companies
Following is a list of insurance companies that were reimbursed by the Subsequent Injury Trust Fund in calendar year 2004. A total of 200 insurance companies were reimbursed a combined total of $54,774,503.79.
Reimbursements Paid to Insurance Companies
$ Amount
ACE AMERICAN INSURANCE CO ACE PROPERTY & CASUALTY INS AIG NATIONAL INS. CO. 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 AMERICAN ZURICH INS CO AMERISURE INSURANCE CO ARGONAUT GREAT CENTRL INS CO ARGONAUT INSURANCE CO ASSOCIATED INDEMNITY CORP ATLANTIC MUTUAL INS. CO AUTO OWNERS INS. CO BANKERS STANDARD FIRE & MARINE BANKERS STANDARD INS CO BENCHMARK INS CO BITUMINOUS CASUALTY CORP BRIDGEFIELD CASUALTY
113,642.47 96,563.52 46,890.76 5,054.01 52,663.75 21,440.64 58,896.18
205,971.19 29,497.84
843,480.20 19,870.18
444,269.29 547,352.42 231,836.43 241,569.48
19,989.06 406,953.03 130,254.23 434,590.75
62,731.44 205,351.52 171,312.20
6,582.62 8,713.21 204,017.25 62,317.29 15,065.42 17,908.27 192,976.16 234,309.75 1,121.40 726,946.69 1,806.21 106,664.24 1,809.52
Subsequent Injury Trust Fund 2004 Annual Report
BUILDERS INSURANCE CANAL INSURANCE CO CAPITAL CITY INS CO CENTENNIAL INSURANCE 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 CORNERSTONE MUTUAL INS CO CYPRESS INSURANCE CO DEERFIELD INSURANCE CO DISCOVER PROPERTY & CAS ELECTRIC INSURANCE CO ELECTRIC MUTUAL LIAB INS LTD EMPLOYERS INS OF WAUSAU EVEREST NATIONAL INS FAIRFIELD INSURANCE CO FAIRMONT INSURANCE CO FARMINGTON CASUALTY CO FCCI INSURANCE COMPANY FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FEDERATED RURAL ELECTRIC INS 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 FIREMAN'S FUND OF WISCONSIN FIRST NATL INS CO OF AMER FLORISTS' MUTUAL INS CO GA INSURERS INSOLVENCY POOL GA RESTAURANT MUTUAL CAP INS C GA TIMBER HARVERSTERS'
1,427,577.85 943,376.75 338,046.16 154,005.53 141,531.33 23,479.34 377.58 137,170.23
1,366,816.18 48,527.49
130,774.41 34,636.25 93,136.95 11,742.36
288,736.08 470,466.99 315,585.00 672,204.18
76,408.65 21,675.59 42,537.70 75,506.32 282,312.32 136,443.79 12,014.54 16,383.50 806,066.55 42,352.36 131,131.17 15,437.04
212.75 189,143.28 469,123.83 693,836.31
29,609.42 328,221.92
34,558.47 50,705.48 314,465.97 115,932.21
209.00 111,124.25
41,363.11 43,761.62 3,229,618.87 148,852.86 229,477.35
Page 18
Subsequent Injury Trust Fund 2004 Annual Report
GCAP MUTUAL CAPTIVE INS GENERAL ACCIDENT INS OF AMER GENERAL INS CO OF AMERIC GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GLENS FALLS INS CO GRAPHIC ARTS MUTUAL INS CO GREAT AMER INS CO OF NY GREAT AMERICAN INS CO GROCERS INSURANCE CO GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALITY 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 INS OF THE MIDWEST HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HIGHLANDS INS CO HOME INS. CO-IN LIQUIDATION HOSPITALITY MUT CAPTIVE INS HOUSTON GENERAL INS CO INDEMNITY INS CO OF NA INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA JEFFERSON PILOT FIN INS CO KEY RISK INSURANCE CO LEGION INS CO-IN LIQUIDATION LIBERTY INSURANCE CORP LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LM INSURANCE CORP LUMBER MUTUAL INSURANCE CO LUMBERMENS MUTUAL CAS CO LUMBERMEN'S UNDERWRITING MANAGEDCARE MUT CAPTIVE INS MARYLAND CASUALTY COMPANY MONUMENTAL GENERAL CAS NATIONAL AMERICAN INSURANCE CO NATIONAL FIRE INS CO HARTFORD NATIONAL SURETY CORP
55,026.11 118,649.99 113,952.29 401,872.30
41,718.78 119,222.48
33,309.12 10,266.04 18,545.78 92,051.77
601.45 62,721.94 45,885.23
1,643.54 5,401.13 28,991.65 68,994.89 671,019.13 1,018,348.61 131,280.76 100,329.49 62,335.80 321,613.16 59,410.72 103,813.80 280,034.06 28,733.21 206,171.32 50,406.69 344,178.75 739,477.21 73,671.57 23,776.07 332,858.42 302,176.91 314,204.79 1,766,777.41 131,157.56 48,930.15 745,932.70 1,405,258.92 1,481,922.41 390,719.52 9,473.43 41,655.36 398,759.65 99,688.33
Page 19
Subsequent Injury Trust Fund 2004 Annual Report
NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE MUTUAL INS CO NETHERLANDS INSURANCE CO NEW HAMPSHIRE INSURANCE CO NORTH AMERICAN SPECIALTY INS NORTHBROOK PROP & CAS INS CO OCCIDENTAL FIRE & CAS CO OF NC OHIO CASUALTY INSURANCE CO OLD REPUBLIC INSURANCE CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PENN LUMBERMENS MUTUAL PENN MFG ASSOC INS PHOENIX INSURANCE CO PRINCETON INSURANCE CO PROVIDENCE WA INS CO OF N Y REALM NATIONAL INSURANCE RELIANCE INS CO IN LIQUIDATION RELIANCE NAT INS CO IN LIQ. ROYAL & SUNALLIANCE INS. CO ROYAL INS CO OF AMERICA S.E. EMPLOYER MUT. 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 SOUTHEASTERN US CAP. INS, INC SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INSURANCE 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 & NICHIDO FIRE TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO
466,540.05 229,532.48
16,689.63 35,865.32
6,888.00 46,780.64 96,999.05
4,860.00 17,932.08 779,744.37 304,450.66 161,238.55 1,607,767.85 169,724.75 170,601.67 270,756.88 156,184.57 303,741.09 58,694.49 242,268.60 504,039.67 20,951.42 1,248,273.82 104,700.24
6,487.75 247,230.81
56,094.75 1,057.02
98,513.61 15,523.66 98,146.39 109,424.23 21,724.74 260,432.81
3,542.65 717,958.13
8,558.38 3,175.61 4,817.56 470,677.00 37,615.78 699,524.02 13,604.22 219,490.58 158,660.70 1,098,934.77 17,820.00
Page 20
Subsequent Injury Trust Fund 2004 Annual Report
TRANSPORTATION INSURANCE CO TRAVELERS CAS & SUR CO TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMER TRAVELERS INSURANCE CO TRAVELERS PROP CAS CO OF AMER TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS U.S. SPECIALTY INS. CO. UNISUN INSURANCE COMPANY UNITED STATES FIRE INSURANCE UTICA MUTUAL INSURANCE CO VALIANT INSURANCE CO VALLEY FORGE INSURANCE CO VIGILANT INSURANCE CO WAUSAU GENERAL INS CO WAUSAU UNDERWRITERS INS CO WESTFIELD INSURANCE CO WESTPORT INSURANCE CORP YASUDA FIRE & MAR INS OF AMER YORK INSURANCE CO ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Grand Total
1,539,214.06 811,531.97 176,521.61 24,552.69
1,299,680.13 1,315,835.97
208,079.23 152,556.02 196,801.36
4,239.27 367,959.87
20,225.78 89,567.38 229,299.39
4,552.99 27,995.21 376,960.93 151,751.33
2,452.22 84,766.02 61,790.12 14,524.38 1,542,215.95 1,517,122.95 $54,774,503.79
Page 21
Subsequent Injury Trust Fund 2004 Annual Report
Page 22
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 2004. A total of 22 group self-insured employers were reimbursed a combined total of $7,399,901.24.
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
57,820.27 8,780.70
1,563,045.32 321,662.59 194,484.54 274,952.37 277,506.78 12,794.15 587,424.99 95,217.69 890,785.85 148,694.42
1,295,741.78 648,489.90 156,269.01 30,332.68 276,805.37 127,276.99 308,332.28 57,650.00 6,711.70 59121.86
$ 7,399,901.24
Subsequent Injury Trust Fund 2004 Annual Report
Page 23
Self-Insured Employers
Following is a list of self-insured employers that were reimbursed by the Subsequent Injury Trust Fund in calendar year 2004. A total of 265 self-insured employers were reimbursed a combined total of $39,446,413.08.
Reimbursements Paid to Self-Insured Employers
$ Amount
ABF FREIGHT SYSTEM, INC ACUITY BRANDS AGL RESOURCES, INC. ALBANY, CITY OF ALLIED SYSTEMS LTD AMERICAN NATIONAL RED CROSS ANHEUSER-BUSCH COMPANIES, INC. ANSON AGGREGATES ARCHBOLD MEDICAL CENTER ARMSTRONG WORLD INDUSTRIES INC ATHENS REG. HLTH SYS INC ATHENS-CLARKE COUNTY ATLANTA BOARD OF EDUCATION ATLANTA CITY OF AUGUSTA-RICHMOND CO BD COMM 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 BHA GROUP INC BLUE BIRD BODY COMPANY BLUE CIRCLE AMERICA BRUNO'S INC & SUBSIDIARIES BRUNSWICK, CITY OF BURLEN CORPORATION C T HARRIS INC C. W. MATTHEWS CONTRACTING INC CAGLE'S INC, & SUBSIDIARIES CALDWELL TANKS ALLIANCE, INC. CALIBER SYSTEM, INC. CANDLER HEALTH SYSTEM
91,533.10 1,200.00
143,510.91 90,336.11 14,625.00
103,948.14 11,009.60 7,425.00 55,740.22
141,635.00 17,331.75 8,669.73
146,191.98 124,761.53
8,191.75 9,368.79 9,840.10 65,618.43 32,612.18 2,548.60 1,283,808.66 312,541.40 9,091.68 3,909.16 70,056.02 31,805.74 496,307.95 17,764.50 280,602.41
558.22 193,740.50
17,841.65 192,773.37
14,418.00 6,896.88
12,045.62 118,111.13
Subsequent Injury Trust Fund 2004 Annual Report
CARROLL CO. BOARD OF EDUCATION CEMEX (SOUTHDOWN INC.) CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHAMPION INTERNATIONAL CORP CHATHAM AREA TRANSIT AUTHORITY CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHEVRON USA INC SOU DIV CHILDREN'S HEALTHCARE OF ATL CITIGROUP INC. CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS CLAYTON COUNTY WATER AUTHORITY COACHMAN REC. VEHICLE CO OF GA COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLQUITT CO BD OF EDUCATION COLUMBIA COUNTY BOE COLUMBUS CITY OF COLUMBUS FOUNDRIES INC COLUMBUS WATER WORKS CONAGRA FOODS, INC CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER COVINGTON, CITY OF COX ENTERPRISES INC CRACKER BARREL OLD CNTRY STORE CRAWFORD W LONG MEM HOSPITAL CRIDER'S POULTRY INC D L LEE & SONS INC DALTON CITY OF DAN RIVER, INC. DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HLTHCARE SYS DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOLLAR GENERAL CORP DOREL JUVENILE GRP (COSCO, INC DOUGLAS ASPHALT COMPANY
Page 24
103,596.69 7,359.97
57,893.20 62,888.65 367,318.65
1,648.69 108,432.83
76,347.75 320.52
41,893.84 303.02
85,285.23 4,632.42
111,682.37 3,295.10
15,728.75 102,106.27
2,102.86 146,541.27 118,573.98 324,685.16
49,637.11 55,157.31 110,766.78 30,362.35
7,361.20 8,617.69 1,389.65 198,225.62 90,547.91 184,195.73 187,231.18 65,728.15 5,425.00 9,038.48
84.50 24,700.63 11,265.37 247,251.90 165,516.84 342,297.48
7,645.10 679,052.95
25,156.27 146.00 258.05
52,150.00
Subsequent Injury Trust Fund 2004 Annual Report
DOUGLAS COUNTY SCHOOLS DOUGLAS, CITY OF DRY BRANCH KAOLIN COMPANY ELBERTON GRANITE ASSOCIATION EMERSON ELECTRIC CO EMORY CLINIC, INC., EMORY UNIVERSITY ENGELHARD CORPORATION EQUITY GROUP GA DIVISION ESTES EXPRESS LINES FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FIELDALE FARMS CORPORATION FLEETWOOD HOMES OF GA INC FLOWERS INDUSTRIES INC FORD MOTOR COMPANY FOREST PARK, CITY OF FORSYTH CO BD OF COMMISSIONERS FORSYTH CO. BD. OF EDUCATION FORT JAMES CORP. FRIGIDAIRE CO MICROWAVE PRODS. FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHY 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 SUBSEQUENT INJURY TRUS GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GLYNN COUNTY BOARD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLD KIST INC GOLDEN PANTRY FOOD STORES INC GREAT ATLANTIC & PACIFIC TEA GREAT DANE LTD PARTNERSHIP GULFSTREAM AEROSPACE CORP GWINNETT CO BD OF EDUCATION GWINNETT COUNTY BD OF COMMISS GWINNETT HOSPITAL SYSTEM HALL COUNTY BOARD OF EDUCATION
Page 25
848.01 1,693.28 10,125.00 48,225.30 317,781.09 8,227.26 455,620.89 36,988.89 42,071.41 28,653.86 11,610.19 7,136.02 42,923.08 116,636.78 126,986.48 8,493.20 349,887.41
756.95 82,144.47 50,855.07
2,273.26 9,900.00 235,409.36 265,455.10 14,824.85 327,565.04 793,831.71 358,221.22 36,996.20 17,657.32
31.00 235,592.36 10,028,920.74
375.00 373,529.94
37,229.74 162,925.31
6,049.73 25,951.72 57,496.36 143,981.45 123,015.63 277,125.36
2,509.27 445,719.77 185,270.29 127,255.83
Subsequent Injury Trust Fund 2004 Annual Report
HAMILTON HEALTH CARE SYSTEM HCA, INC. HENRY CO BOARD OF EDUCATION HERCULES INCORPORATED HOME DEPOT INC/HOME DEPOT USA HORMEL FOODS CORP HORTON HOMES, INC HOSPITAL AUTHORITY HOUSTON CTY HOUSTON COUNTY BD OF EDUCATION HOWARD SHEPPARD INC HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION INGLES MARKETS INC INTERNATIONAL PAPER COMPANY J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JONES COMPANY K & F INDUSTRIES KEEBLER COMPANY KENNESTONE REGIONAL HEALTH KING & PRINCE SEAFOOD CORP. KLEEN-TEX INDUSTRIES KLLM TRANSPORT K-MART CORP-IN BANKRUPTCY KROGER COMPANY, THE LA MAR & BOWDON MFG CO LEVI STRAUSS & CO LINDALE MANUFACTURING INC LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC LOXCREEN COMPANY, INC. MACON CITY OF MARGLEN INDUSTRIES INC MARIETTA CITY SERVICES MARRIOTT INTERNATIONAL, INC. MARTA MCKENZIE TANK LINES INC MCLANE COMPANY, INC. MEAD CORPORATION MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC MOHAWK INDUSTRIES, INC MOUNT VERNON MILLS MULLITE CO OF AMERICA MURRAY COUNTY BD OF EDUCATION MUSCOGEE COUNTY SCHOOL DIST
Page 26
150,520.88 23,743.43 31,277.23
105,511.66 154,575.48
90,894.30 104,572.07
9,473.55 85,352.63
632.14 55,136.44
2,780.17 958,028.89 258,601.16
96,589.97 187,514.84
55,800.93 8,403.39 2,357.67
297,666.03 18,598.00 31,525.00 6,817.92 33,341.61
359,262.60 145,821.77
27,609.51 334,999.83 189,160.20
15,631.67 98,244.42
8,583.84 239,947.09
47,648.53 106,460.02 192,234.71 341,564.04
39,825.00 5,236.22
28,229.59 248,445.65
35,115.04 1,710,660.36
72,976.15 14,990.84 44,309.37 12,364.90
Subsequent Injury Trust Fund 2004 Annual Report
NABISCO, INC NATIONAL SERVICES INDUSTRIES NEWTON COUNTY BD OF EDUCATION NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OLD DOMINION FREIGHT LINES INC OVERNITE TRANSPORTATION CO OWENS-CORNING FIBERGLASS PATTERSON PUMP COMPANY PCC AIRFOILS LLC PEPSICO, INC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL PIGGLY WIGGLY CAROLINA CO INC QUEEN CARPET CORPORATION QUIKTRIP CORPORATION RACETRAC PETROLEUM, INC RALSTON PURINA COMPANY RICHMOND COUNTY BD OF COMMISS RICHMOND CTY BD OF EDUCATION ROADWAY EXPRESS, INC. ROCKWELL AUTOMATION, INC ROLLINS INC ROME, CITY OF ROPER CORPORATION 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 SHEPHERD MEDICAL CENTER SI CORPORATION SNELL CONTRACTORS SOUTHEAST GA HLTH SYSTEMS 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
Page 27
59,981.72 98,332.73 53,458.21
225.00 479,935.02 114,697.78
12,150.00 13,744.06
2,370.55 64,400.07 20,831.00
8,560.83 118,833.18
8,689.96 32,663.04
1,814.03 1,795.63 17,023.70 19,772.68 72,331.30 11,343.81 197,118.51 75,087.05 244,412.74 27,833.21 175,865.36 13,963.37 38,634.74 49,628.56 24,362.16 22,187.79 151,157.35 278,145.23 13,283.58 600,798.99 4,010.55 50,166.62 39,180.80 119,621.08 20,250.28 16,482.87 754,337.99 38,192.48 10,834.48 152,382.06 42,278.15 1,225.22
Subsequent Injury Trust Fund 2004 Annual Report
SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL STONE CONTAINER CORPORATION SUPERIOR RIGGING & ERECTING CO SYNTHETIC INDUSTRIES, INC TECUMSEH PRODUCTS COMPANY TENNECO AUTOMOTIVE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS THREE SPRINGS INC. TIFTON ALUMINUM CO INC/ALCOA I TIP TOP POULTRY INC TRANSUS, INC. TROUP CO. BOARD OF EDUCATION 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 WACHOVIA WAFFLE HOUSE WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WARREN SEWELL MFG. CO. WATKINS ASSOCIATED INDUSTRIES WAYCROSS, CITY OF 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
Page 28
12,331.45 36,174.77 19,240.61
9,000.00 55,157.92
4,431.73 193,681.58 186,343.29 167,434.25 166,865.85
7,381.22 195,584.65
24,840.00 26,994.55 18,559.70 104,263.32 37,007.87 44,480.19 121,859.57
675.24 1,774.40
220.02 146,626.56
5,265.00 97,336.81 102,763.31 207,855.14 111,012.65 138,688.08 67,079.96 46,171.77 170,398.96
519.84 43,008.37 66,416.98
392.70 276,340.38 536,469.99
20,567.06 18,769.60 $ 39,446,413.08
Subsequent Injury Trust Fund 2004 Annual Report
Page 29
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 1,400 individual employers on behalf of whom the Subsequent Injury Trust Fund made reimbursement payments to insurance companies. These reimbursements totaled $54,612,056.78.
Employer Name
515 BUILDING SUPPLY A & B PAINTING SERVICE A & B SHEET METAL A & E MECHANICAL CONTRACTORS A.B. DICK CO. A.M. BRASWELL JR. FOOD AAA ASPHALT PRODUCTS, INC. AAA AUTO CLUB SOUTH AACTION AUTO PARTS ABB DAIMLER-BENZ TRANS. ABB OVERHEAD DISTRIBUTION ABC SCHOOL SUPPLY ABRAMS FIXTURE CORP. ACCORD HUMAN RESOURCES ACOUSTI OF COLUMB INCUS ACOUSTI, INC. ACTION BLUE PRINT CO. ACTION ELECTRIC COMPANY, INC. ADC SYSTEMS INTEGRATION ADDISON STEEL ADMINISTAFF ADMINISTRATION MANAGERS, INC. ADP-AQUAGUA ADVANCE AUTO ADVANCE AUTO PARTS ADVANCED DISPOSAL SERVICE
Total
City
State $ Reimbursed
ELLIJAY
GA
LAWRENCEVILLE GA
FOREST PARK
GA
LAWRENCEVILLE GA
NILES
IL
STATESBORO
GA
BRYON
GA
MARIETTA
GA
SAVANNAH
GA
ATLANTA
GA
ATHENS
GA
DULUTH
GA
ATLANTA
GA
MONROE
GA
COLUMBUS
GA
ATLANTA
GA
ATLANTA
GA
SMYRNA
GA
CHICKAMAUGA
GA
ALBANY
GA
ATLANTA
GA
WARNER ROBINS GA
MARIETTA
GA
DOUGLAS
GA
CUMMING
GA
SUWANEE
GA
62,702.49 6,300.00
178,126.96 679.70
8,713.21 3,366.34 122,089.04 30,159.24 17,870.47 1,549.71 26,125.36 10,352.15 37,657.25 176,752.91 189,143.28 183,657.76 20,225.78 18,157.82 86,032.13 14,060.15 120,491.79 15,096.89 15,218.01
301.82 65,400.40
9,757.04
Subsequent Injury Trust Fund 2004 Annual Report
ADVANCED ELECTRICAL CONTRACTOR ADVANCED ENVIRONMENTAL TECH. ADVANCED ENVIRONMENTAL TECH. AEC ELECTRIC AERUS, LLC AFC/CHURCH'S AGNES SCOTT COLLEGE AIR CANADA AIR PRODUCTS & CHEMICALS AIRGAS, INC AIR-RIDE, INC. AIRXCEL HOLDING CORP. AKZO NOBEL COATINGS, INC. ALBANY BEVERAGE CO ALBANY UROLOGY CLINIC, P.C. ALBRIGHTS FLOOR COVERING ALCON ASSOCIATES, INC. ALDEAN DUKES LOGGING INC ALEX FOODS INC ALEXANDER & ALEXANDER SVC INC ALEXANDER CONSTRUCTION ALFRED MCCANNON WELL BORING ALL AMERICAN QUALITY FOODS INC ALL SOUTH SUPPLY ALLEN TERMITE & PEST CONTROL ALLIED FOODS, LLC ALLISON-SMITH CO. ALLTEL GEORGIA COMMUNICATIONS ALLTEL GEORGIA COMMUNICATIONS ALPHA PRODUCTS, INC. ALUM-A-LIFT AMERICAL CORP. AMERICAN COMMERCIAL HOLDINGS, AMERICAN EGG PRODUCTS AMERICAN EXCELSIOR CO. INC. AMERICAN GEN LIFE & ACC AMERICAN HONDA MOTOR CO. AMERICAN LANDMARK FENCE AMERICAN NATIONAL CAN AMERICAN RAILROAD IND AMERICAN SECURITY INSURANCE CO AMERICAN SOUTHERN TIMBER AMERICAN SUZUKI MOTOR CORP AMERICAN VENDING CO., INC. AMERICAN WAREHOUSE ASSOC. AMERIGAS PARTNERS LP AMERIPRIDE UNIFORM
POWDER SPRINGS GA
ALBANY
GA
DOTHAN
AL
THOMASVILLE
GA
TIFTON
GA
ATLANTA
GA
DECATUR
GA
ATLANTA
GA
CONYERS
GA
AUGUSTA
GA
SWANTON
OH
CORDELE
GA
BAXLEY
GA
ALBANY
GA
ALBANY
GA
LOGANVILLE
GA
ALBANY
GA
VALDOSTA
GA
ATLANTA
GA
ATLANTA
GA
CARTERSVILLE
GA
COMER
GA
STOCKBRIDGE
GA
CARTERSVILLE
GA
BRUNSWICK
GA
ATLANTA
GA
ATLANTA
GA
CANTON
GA
CORNELIA
GA
ATLANTA
GA
WINSTON
GA
CARROLLTON
GA
ADEL
GA
BLACKSHEAR
GA
GRIFFIN
GA
ALBANY
GA
ALPHARETTA
GA
MABLETON
GA
FOREST PARK
GA
ATLANTA
GA
ATLANTA
GA
MOULTRIE
GA
ATLANTA
GA
EAST POINT
GA
MACON
GA
DORAVILLE
GA
ATHENS
GA
Page 30
24,347.68 48,984.41 95,721.23
924.88 60,511.79 22,529.10
5,677.85 8,851.05 5,428.18 2,738.54 44,590.57 4,250.18 45,326.70 4,820.10 10,950.24 68,163.68 24,055.65 5,106.02 10,108.15 14,707.16 8,394.15 7,919.96 23,576.11 23,688.03 29,534.36 1,252.33 132,589.49 5,750.00 46,427.97 29,174.41 148,843.19 27,852.44
580.93 141,903.25
16,774.67 41,387.10 33,773.49 197,448.13
3,825.00 18,095.72
2,069.39 31,727.91 55,000.00
3,542.65 21,165.10
9,601.00 227,982.28
Subsequent Injury Trust Fund 2004 Annual Report
AMERISOURCE DISTRIBUTION CORP. AMERISUITES AMERSON COMPANY AMF BAKERY SYSTEMS AMI SPALDING REGIONAL HOSPITAL AMR CORP/AMERICAN AIRLINES ANCHOR GLASS CONTAINER CORP. ANCHOR HEATING & AIR ANDERSON MERCHANDISERS ANDREW CORP. ANDREW CORP. ANDREW ELECTRIC ANECO ELECTRICAL CONSTRUCTION ANGLO AMERICAN ENGLISH CH ANSLEY ONE, INC. APB, INC. APEX SUPPLY CO APPALACHIAN SURVEYORS APPAREL SOURCING GROUP AQUA SUN INVESTMENTS AQUARIUS POOLS CONSTRUCTION CO ARAMARK CORP. ARAMARK CORP. ARANON CORPORATION ARCHER DANIELS MIDLAND CO. ARROW CO. ARROW CO. ART PLUMBING CO. ARTISTIC JANITORIAL SERVICES ASHBURN HEALTH CARE ASSOCIATED BUILDERS ASSOCIATED RUBBER CO. ASTECHNOLOGIES, INC. ATC HEALTHCARE SERVICES ATHENS COMMUNITY COUNCIL ON AG ATHENS DOWNTOWN DEVELOP ATI SALES CO., INC. ATLANTA FALCONS ATLANTA BEVERAGE CO ATLANTA BRAVES ATLANTA ECONOMY DRUG COMPANY ATLANTA FENCE COMPANY ATLANTA FREIGHTLINER TRUCK SAL ATLANTA FURNITURE ATLANTA HAULING-WASTE MGMNT ATLANTA HISTORICAL SOCIETY ATLANTA HOCKEY CLUB, INC.
ORLANDO
FL
DULUTH
GA
MACON
GA
RICHMOND
VA
GRIFFIN
GA
ATLANTA
GA
WARNER ROBINS GA
DOUGLASVILLE GA
LAWRENCEVILLE GA
NEWNAN
GA
MONTGOMERY
AL
LAWRENCEVILLE GA
CLEARWATER
FL
SANDERSVILLE GA
SAVANNAH
GA
ELLENWOOD
GA
LAWRENCEVILLE GA
CUMMING
GA
NORCROSS
GA
MARIETTA
GA
COLUMBUS
GA
ATLANTA
GA
LAWRENCEVILLE GA
HIAHEAH
FL
MACON
GA
BUCHANAN
GA
ATLANTA
GA
JONESBORO
GA
MARIETTA
GA
ASHBURN
GA
CLEVELAND
GA
TALLAPOOSA
GA
ROSWELL
GA
MACON
GA
ATHENS
GA
ATHENS
GA
BRYON
GA
FLOWERY BRANCH GA
MARIETTA
GA
ATLANTA
GA
ATLANTA
GA
LITHONIA
GA
JEFFERSON
GA
DECATUR
GA
SMYRNA
GA
ATLANTA
GA
ATLANTA
GA
Page 31
669.38 833.20 36,078.87 21,320.00 32,092.70 72,675.82 8,558.38 1,344.40 53,716.37 125,820.17 7,526.70 61,269.55 950.20 322.34 17,933.23 23,678.01 53,359.91 16,107.30 126,744.55 10,971.15 9,848.64
40.95 1,210.56 26,779.60 11,900.00 13,797.39 20,025.91
151.38 35,967.42 26,633.38 19,152.16
5,773.00 44,498.29 29,530.54
9,597.72 20,662.23 197,843.06 39,284.43 61,236.50 56,032.91 29,114.00
5,280.00 41,276.77
7,875.00 25,393.32 16,420.69
7,257.80
Subsequent Injury Trust Fund 2004 Annual Report
ATLANTA PRICING SYSTEMS ATLANTA SOUTH 75 INC ATLANTA STEEL ERECTORS, INC. ATLANTA UTILITY WORKS, INC. ATLANTA WEST CARPETS ATLANTIC COAST FIRE PROTECTION ATLANTIC FORMING CO., INC. ATLANTIC SOUTHEAST AIRLINES ATLAS TECHNOLOGIES INC ATS, INC AUBREY SILVEY ENTERPRISES AUBURN DISTRIBUTION CENTER AUGUSTA REGIONAL MEDICAL CENTE AUSTELL HEALTH AUTOMATIC DATA PROCESSING, INC AUTOZONE, INC. AVON PRODUCTS, INC. AWH CORP a/k/a ROYSTON LLC B & M WOOD PRODUCTS, INC B & R SALVAGE CO, INC. B & S INDUSTRIAL CONTRACTO B.H. TRANSFER BABB'S AUTO SERVICE BABCOCK & WILCOX COMPANY BACON COUNTY B. O. E. BAGCRAFT CORP. OF AMERICA BAILEY CO BAKER & TAYLOR BAKER CARPET MILLS, INC. BALLARD BROTHERS ELECTRIC BANK SOUTH BANK SOUTH BAPCO BAR-JEAN, INC. BARKING HOUND VILLAGE BARRETT & ASSOCIATES BARRETT PROPERTIES & CLUB BARRINGTON HALL DEVELOPMENT BARRY MFG. CO. BARTENFELD ELECTRIC COMPANY BASSETT FURNITURE INDUSTRIES BATES HARDWARD CO. BATTLE LUMBER COMPANY, INC. BAXLEY WILDERNESS INSTITUTE BAYCOR BEAULIEU OF AMERICA BEKAERT CORP.
ATLANTA
GA
JACKSON
GA
SMYRNA
GA
EAST POINT
GA
LITHIA SPRING
GA
DULUTH
GA
STONE MOUNTAIN GA
ATLANTA
GA
FENTON
MI
THOMASVILLE
GA
CARROLLTON
GA
AUBURN
GA
AUGUSTA
GA
AUSTELL
GA
ALPHARETTA
GA
ROME
GA
SUWANEE
GA
JASPER
GA
MANOR
GA
EAST POINT
GA
DUBLIN
GA
SANDERSVILLE
GA
DALTON
GA
BRUNSWICK
GA
ALMA
GA
FOREST PARK
GA
NASHVILLE
TN
COMMERCE
GA
DALTON
GA
MACON
GA
FOREST PARK
GA
ATLANTA
GA
TUCKER
GA
GAINESVILLE
GA
ATLANTA
GA
ATLANTA
GA
BOGART
GA
WARNER ROBINS GA
STONE MOUNTAIN GA
ATLANTA
GA
DUBLIN
GA
ATLANTA
GA
WADLEY
GA
BAXLEY
GA
CORNELIA
GA
GAINESVILLE
GA
ROME
GA
Page 32
132,812.23 30,934.79 83,764.41 22,879.64 30,102.75 25,882.13 275.00 1,014.04 18,605.64 19,118.06 28,882.05 323.98 1,784.95 121.00 10,518.67 7,455.38 31,241.96 24,619.81 5,593.60 223.53 9,473.43 16,423.60 28,286.30 26,482.35 8,770.06 12,938.98
188,022.42 37,991.96
112,817.20 45,577.66 34,383.64 8,037.16 7,997.63 7,904.71 5,452.40 41,542.50
187,974.18 48,668.19 21,632.41 3,500.00 2,307.27 25,092.56 11,700.00 35,963.18 19,067.79 16,563.60 83,348.14
Subsequent Injury Trust Fund 2004 Annual Report
BELCOURT APARTMENTS
ROSWELL
GA
BELK INC.
GAINESVILLE
GA
BELK OF SAVANNAH
SAVANNAH
GA
BELK STORES & AFFILIATES
CARTERSVILE
GA
BELK STORES & AFFILIATES
MACON
GA
BELL MINOR HOME INC
GAINESVILLE
GA
BELLSOUTH ADV. & PUBLISH
ATLANTA
GA
BELTMANN GROUP, INC
NORCROSS
GA
BEMAC PETROLEUM
BYRON
GA
BEN MCELROY ASSOCIATES
ATHENS
GA
BENSON CONSTRUCTION CO
TIFTON
GA
BERLIN & HODGES
MACON
GA
BERRY PLUMBING & EQUIPMEN
CLERMONT
GA
BEST TEXTILES LLC
CORDELE
GA
BETTER BACKERS, INC.
CHATSWORTH
GA
BETTER BRANDS OF ATLANTA
ATLANTA
GA
BETZ DEARBORN, INC.
TREVOSE
PA
BETZ LAB'S
JACKSONVILLE
FL
BEVERLY ENTERPRISES
DOUGLASVILLE GA
BEVIS ROPE MANUFACTURING INC
ROSSVILLE
GA
B-H TRANSFER COMPANY
SANDERSVILLE
GA
BICKERSTAFF CLAY PRODUCTS CO
SMYRNA
GA
BILL HEARD CHEVROLET
COLUMBUS
GA
BILL THOMPSON TIRE
ALBANY
GA
BILLY GERRELL GRADING CO.
CUMMING
GA
BLAKE CONSTRUCTION CO.
ST. MARYS
GA
BLOUNT CONSTRUCTION
ATHENS
GA
BLUE RIBBON RENTAL, INC.
CUYAHOGA FALLS OH
BOAEN MECHANICAL CONTRACTOR
SAVANNAH
GA
BOEING
DULUTH
GA
BOLES PARTS SUPPLY INC
ATLANTA
GA
BOOMERSHINE PONTIAC
SMYRNA
GA
BORING SMITH/IND. DIST. GROUP
TUCKER
GA
BOSTIK, INC.
CALHOUN
GA
BOWDEN LITTLETON CONSTRUCTION MINDY HILL
GA
BRIGHT HORIZONS FAMILY SOL.
ATLANTA
GA
BRITTS HOME FURNISHINGS
SNELLVILLE
GA
BROCK PLUMBING
MARIETTA
GA
BROCKWAY STANDARD INC
HOMERVILLE
GA
BROOKS INSTRUMENTS DIVISION
STATESBORO
GA
BROWN & WILLIAMSON TOBACCO
MACON
GA
BROWN STEEL CONTRACTORS, INC.
NEWNAN
GA
BROWN TRANSPORT CORPORATION
TIFTON
GA
BRUNSWICK CORP.
NORCROSS
GA
BRYANTS MILLWRIGHT & CONSTRUCTION NORMAN PARK
GA
BUILDER'S STEEL SUPPLY
LILBURN
GA
BUILDING TECHNOLOGY
TALLAPOOSA
GA
Page 33
44,513.12 18,555.03
4,239.18 55,134.10 44,898.74 54,670.86 24,570.91 52,875.54
5,054.01 80,345.78
160.11 4,730.70 9,122.92 12,056.16 7,290.00 89,567.38 74,931.51
126.40 73,235.05 20,231.27
7,440.60 11,905.06 19,403.28 52,321.80 230,998.12
6,239.00 7,817.38
39.00 27,536.49 14,246.17 12,481.81 17,388.15 61,378.72 19,691.03
306.90 22,876.00 273,178.29 11,568.88 16,470.80
8,470.08 41,986.85
2,160.00 17,280.00 16,367.25
9,095.35 2,253.60 11,181.43
Subsequent Injury Trust Fund 2004 Annual Report
BULLINGTON LIFT TRUCKS
MACON
GA
BURGER KING
MACON
GA
BURLINGTON INDUSTRIES
SHANNON
GA
BURLINGTON NORTHERN
ALBANY
GA
BURNHAM SERVICE
COLUMBUS
GA
BUSH LEASING
WILMINGTON
OH
BUSINESS TEMPS/TEMP MASTER
AUGUSTA
GA
C & D CHARTER POWER SYSTEMS
CONYERS
GA
C & H MECHANICAL & PLUMBING
DEMOREST
GA
C & J'S FOOD PRIDE
MACON
GA
C. MATHIS LOGGING
HADDOCK
GA
C.W. MATTHEWS CONTRACT.
MARIETTA
GA
CADY BAG CO.
PEARSON
GA
CAMDEN COUNTY BOC
WOODBINE
GA
CAMP OIL CO.
ROME
GA
CAMPBELL DECORATING CO.
ATLANTA
GA
CANOOCHEE EMC
REIDSVILLE
GA
CAPRO INC
SWAINSBORO
GA
CAR CRAFT
ATHENS
GA
CARDINAL PLUMB CO.
SUWANEE
GA
CARDINAL SPECIALTY PRODUCTS
CALHOUN
GA
CAREMORE INC. TREUTLEN
SOPERTON
GA
CAROLINA HOLDINGS
ACWORTH
GA
CARPET COLLECTION
BOGART
GA
CARPET SALVAGE
MACON
GA
CARRIAGE INDUSTRIES, INC.
CALHOUN
GA
CARSON, INC.
SAVANNAH
GA
CARTER & ASSOCIATES
ATLANTA
GA
CARTERSVILLE CHURCH
CARTERSVILLE
GA
CARWOOD MANUFACTURING COMPANY WINDER
GA
CASWELL, INC.
NEWNAN
GA
CATOOSA UTILITY DISTRICT
RINGGOLD
GA
CECIL MALONE COMPANY
ATLANTA
GA
CEDARTOWN PAPER BOARD CO
CEDARTOWN
GA
CEDARWOOD APTS
AUGUSTA
GA
CELLOFOAM NORTH AMERICA
CONYERS
GA
CELLO-FOIL PRODUCTS, INC.
ALBANY
GA
CENTRAL FOOD MANAGEMENT
ATLANTA
GA
CENTRAL GA EYE CENTER PC
MACON
GA
CENTRAL GA HOME HEALTH AGENCY 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
CH2M HILL COMPANIES LTD
ROSWELL
GA
CHAMBERS DEVELOPMENT CO.
ATLANTA
GA
Page 34
19,657.04 1,354.39 6,818.60
16,459.39 792.00
7,050.77 6,972.00 1,008.19 1,973.92
601.45 100,599.43
4,833.14 16,211.61 1,467,934.06 131,109.23 11,237.61 29,609.42
5,257.05 9,159.51 42,624.00 21,026.55 39,108.05 20,672.18
979.74 253,976.80
8,400.00 40,792.52 30,089.00 43,540.44 18,262.75 11,576.41
1,762.64 24,092.57
2,053.46 36,283.13
9,102.37 66,560.00
3,123.72 27,194.34
2,917.39 36,230.07 18,744.26
1,855.48 4,039.88 65,130.65 1,355.10 46,120.92
Subsequent Injury Trust Fund 2004 Annual Report
CHAMPION INTERNATIONAL CORP CHAPARRAL BOATS, INC. CHARLES BLACK CONSTRUCTION CHARTER MOBILE HOMES, INC. CHATEAU ELAN RESORT CHATHAM STEEL CORPORATION CHECKERS DRIVE-IN CHECKERS RESTAURANTS CHEMICAL LEAMAN TRUCK LINES CHEMICAL PRODUCTS CORP. CHESTNUT RIDGE NURSING CHOO-CHOO TRUCK WASH CHURCH OF JESUS CHRIST LDS CHURCH'S FRIED CHICKEN CHURCHWELL'S DRYWALL CIBA VISION CORPORATION CICSO TRAVEL PLAZA CIMCO CINTAS CORP. CITY OF COVINGTON CITY OF EAST POINT POLICE DEPT CITY OF FORT VALLEY CITY OF HOGANSVILLE CITY OF WAYCROSS CJT INDUSTRIAL CONTRACTORS CKS PACKAGING CLAIRSON INDUSTRIES CORP. CLARKLIFT OF ATLANTA CLASSIC COLLISION CLAYTON HOMES # 930 CLEVELAND CONSOLIDATED, INC. CLEVELAND GROUP, INC. CLOTHING FABRICS INC CMC, INC. COALE TRUCK TRANSPORT COASTAL PLAIN AREA EOA COBB COUNTY TRACTOR CO. COCHRAN'S AUTO TRUCK STOP COI COLCRAFT INC. COLDWAY CARRIERS COLEMAN AMERICAN MOVING COLISEUM PSYCHIATRIC HOSP COLONIAL BAKING COMPANY COLONIAL OIL INDUSTRIES COLONIAL PAINTING COMPANY COLUMBIA NATIONAL INS CO
WAYCROSS
GA
NASHVILLE
GA
CLEVELAND
GA
HINESVILLE
GA
BRASELTON
GA
SAVANNAH
GA
JONESBORO
GA
JONESBORO
GA
JONESBORO
GA
CARTERSVILLE
GA
CUMMING
GA
TUNNEL HILL
GA
ATLANTA
GA
SAVANNAH
GA
COCHRAN
GA
DULUTH
GA
KINGSLAND
GA
WAYNESBORO
GA
CINCINNATI
OH
COVINGTON
GA
EAST POINT
GA
FT VALLEY
GA
HOGANSVILLE
GA
WAYCROSS
GA
MACON
GA
ATLANTA
GA
NORCROSS
GA
ATLANTA
GA
CHAMBLEE
GA
WAYCROSS
GA
WAYNESBORO
GA
ATLANTA
GA
WAYCROSS
GA
MCDONOUGH
GA
LAWRENCEVILLE GA
VALDOSTA
GA
MARIETTA
GA
RINGGOLD
GA
TIFTON
GA
STILLMORE
GA
AMERICUS
GA
MIDLAND CITY
AL
MACON
GA
MACON
GA
SAVANNAH
GA
CHAMBLEE
GA
LILBURN
GA
Page 35
8,050.00 23,957.39 29,236.53
4,095.77 40,037.92
924.90 237.50 26,465.39 3,916.00 69,004.80 37,114.22 9,012.56 21,993.49 105,498.71 16,800.00 82,389.17 23,584.51 6,475.00 27,867.85 9,851.56 9,692.33 7,473.10 9,950.51 1,000.39 15,441.89 1,844.13 77,807.70 22,665.93 10,905.10 7,863.86 1,922.00 5,301.39 8,649.54 78,996.21 25,569.35 2,345.32 14,008.60 13,131.71 7,996.73 3,536.60 39,534.32 15,525.74 36,613.81 34,582.07 8,528.67 9,250.78 6,620.10
Subsequent Injury Trust Fund 2004 Annual Report
COLUMBUS ROOFING, INC.
COLUMBUS
GA
COMBINED INSURANCE
CHICAGO
IL
COMBINED MECHANICAL
MARIETTA
GA
COMBINED SERVICES, INC.
DECATUR
GA
COMBUSTION ENGINEERING
JULIETTE
GA
COMMERCIAL CONSTRUCTION SPECIA KENNESAW
GA
COMMUNITY NEWSPAPER, INC.
DAHLONEGA
GA
COMPASS @ CO. D RAY JAMES ST P
FOLKSTON
GA
COMPLETE PROPERTY SERVICES INC SAFETY HARBOR FL
CONFEDERATE PACKAGING
DUBLIN
GA
CONQUEST CARPET MILL
ROSSVILLE
GA
CONSTANTINE DYEING
CALHOUN
GA
CONTAINER GENERAL CORP.
FOREST PARK
GA
CONTINENTAL BAKING COMPANY
ROME
GA
CONTINENTAL CAN CO
PERRY
GA
CONTINENTAL GRAIN
SAVANNAH
GA
CONTINENTAL GRAIN
CORDELE
GA
CONTINENTAL TELEPHONE CO.
ATLANTA
GA
CONTINENTAL WINGATE, INC./
ATLANTA
GA
CONVENIENCE USA
LAKELAND
GA
COOK SALES INC
ANNA
IL
COOPER DDS, PC
WAYCROSS
GA
CORBETT PLYWOOD
TENNILLE
GA
CORVEL CORP
ATLANTA
GA
COUNTRY PRIDE FOODS, INC.
GAINESVILLE
GA
COUNTRYSIDE CONSTRUCTION
CLARKSVILLE
GA
CRAVEN POTTERY INC.
COMMERCE
GA
CRAWLEY ENTERPRISES
MARIETTA
GA
CROTTS ENTERPRISES, INC.
ROSWELL
GA
CRUM'S GARDEN CENTER
BAINBRIDGE,
GA
CRYSTAL FARMS INC
CHESTNUT MTN. GA
CRYSTAL SPRINGS PRINT WORKS
CHICKAMAUGA
GA
CS INTEGRATED LOGISTICS
EAST POINT
GA
CS INTEGRATED LOGISTICS
ATLANTA
GA
CSI
EAST POINT
GA
CSRA PRIVATE DUTY INC
WASHINGTON
GA
CTF HOLDINGS LTD
LAKE LANIER
GA
CUMMINGS GRADING COMPANY
NEWBURN
GA
CUMMINS SOUTH INC
COLLEGE PARK GA
CUSTOM BUILDING PRODUCTS
LITHIA SPRINGS GA
CYPRESS RESTAURANTS, INC.
ORLANDO
FL
D L LEE & SONS
ALMA
GA
D M & N TRUCKING
SWAINSBORO
GA
DAIRY QUEEN
MCRAE
GA
DALLAS WILLIAMS dba BRICKMASTE
DULUTH
GA
DALTON PAVING & CONSTRUCTION
DALTON
GA
DANIEL LUMBER CO. INC.
LAGRANGE
GA
Page 36
6,015.15 12,228.08 21,080.84 27,048.10 24,397.26 35,865.32 13,412.17
3,166.33 63,925.00 74,518.54 12,114.43 15,259.01 17,420.48
8,400.00 8,096.92 5,681.73 6,349.50 7,171.04 134,446.52 3,589.95 17,932.08 7,702.65 2,193.89 81,351.43 30,566.40 3,024.97 30,748.36 1,978.00 231,076.16 6,331.64 24,669.01 3,633.34 83,398.93 102,735.77 45,480.04
351.00 25,343.07 33,932.17
620.46 48,765.48
1,114.97 17,787.49 18,834.58 26,489.72 10,547.00 30,961.65
1,510.00
Subsequent Injury Trust Fund 2004 Annual Report
DARBY PRINTING COMPANY
ATLANTA
GA
DATA TECH
ALPHARETTA
GA
DAVEY TREE EXPERT COMPANY
CHAMBLEE
GA
DAVIS WATER & WASTE IND INC
THOMASVILLE
GA
DAWN FOOD PRODUCTS
DOUGLASVILLE GA
DAWSON MANUFACTURING CO
DAWSON
GA
DAYS GLASS SERVICE
DOUGLAS
GA
DAYS INN-ROME
ROME
GA
DE STER CORP.
THOMASTON
GA
DEERFIELD SPECIALTY PAPERS INC
AUGUSTA
GA
DEL MAR WINDOW COVERINGS
ATHENS
GA
DEL-COOK LUMBER COMPANY
ADEL
GA
DELTA AIRLINES, INC.
ATLANTA
GA
DELTA LIFE INS. CO.
ALBANY
GA
DELTA LIFE INS. CO.
MACON
GA
DENON DIGITAL INDUSTRIES
MADISON
GA
DESTINY INDUSTRIES
MOULTRIE
GA
DEVEREUX CENTER OF GA.
KENNESAW
GA
DEVEREUX FOUNDATION
KENNESAW
GA
DEVRO-TEEPAK, INC.
ATLANTA
GA
DIAMOND HOLDING
MARIETTA
GA
DIAMOND PLASTIC CORP
MACON
GA
DIGS ATLANTA
ATLANTA
GA
DILLARD SMITH CONSTRUCTION CO.
SMYRNA
GA
DIMAC CORP.
AUSTELL
GA
DIPLOMAT HOTELS, ETAL
ATLANTA
GA
DIVERSCO, INC
SPARTANBURG SC
DIXIE INDUSTRIAL FINISHING CO.
TUCKER
GA
DIXIE ROADBUILDERS, INC.
WAYCROSS
GA
DIXON MGMT INC
BRINSWICK
GA
DIXON TIMBER CO.
JESUP
GA
DOBBS HOUSES, INC
ATLANTA
GA
DODGE COUNTY HOSPITAL
EASTMAN
GA
DOGWOOD HOUSING
MILLEGEVILLE
GA
DOUGLAS & LOMASON CO.
CARROLLTON
GA
DOUGLAS GENERAL HOSPITAL
DOUGLASVILLE GA
DRUG TRANSPORT, INC.
MACON
GA
DRUG TRANSPORT, INC.
TUCKER
GA
DRUID HILLS GOLF CLUB, INC.
ATLANTA
GA
DUBARD'S TIRE & ALIGNMENT
AUSTELL
GA
DUBLINAIR NURSING HOME
DUBLIN
GA
DUCHERN IND., INC.
FAYETTEVILLE
GA
DURAND GRACE REALTY
LAGRANGE
GA
DURANGO GEORGIA PAPER CO
ST MARY'S
GA
DURDEN ENTERPRISES
AUBURN
GA
DURHAM STAFFING
CARTERSVILLE
GA
DWB CARPET HOLDINGS
CHATSWORTH
GA
Page 37
34,907.80 54,691.45
9,377.87 2,275.00 59,402.73 63,692.06 14,649.87 11,848.86 3,714.38 8,087.00 36,480.32 17,647.94 20,250.61 3,322.85 1,239.63 2,558.38 36,288.10 7,023.85 2,384.20 15,965.58 94,555.63 1,350.52
422.66 12,665.28
1,829.60 10,966.24
3,035.07 12,080.26 23,065.82
107.26 1,462.68 13,983.62 12,121.32 20,766.14 204,017.25 8,562.02 80,388.32 89,576.30 5,547.64 13,512.48 10,589.11 34,111.10 31,123.86 513,927.86
640.85 93,004.22 147,000.00
Subsequent Injury Trust Fund 2004 Annual Report
DYNCORP DYSON LOGGING E. COBB LAND DEVELOPMENT CO. EAGLE UTILITY CONTRACTING EARL SMALL'S HARLEY DAVIDS EARTHGRAINS BAKING CO EAST POINT PACKAGE STORE EASTERN AIRLINES, INC. EASTSIDE MEDICAL CENTER EATON'S ORNAMENTAL ECC INTERNATIONAL ECI MANAGEMENT ECKERD DRUGS ECKERD DRUGS ECKERD DRUGS ECOLAB, INC. EDDIE'S FOREIGN AUTO EDWARDS BAKING CO. EDWARDS PIPELINE ELECTROMAGNETIC SERVICES, INC ELKINS AMERICA ELLIOTT MACHINE SHOP ELLIOTT TRANSPORT ELLIS & GROSS INC EMPLOYER ADVANTAGE GROU EMPLOYMENT MATCH MAKERS EMRO MARKETING/MARATHON ENCOMPASS/HOLDER CONSTRUCTION ENGELHARD CORP. ENGELHARD CORP. ENGINEERED FABRICS CORP. EPIX ESSEX GROUP ESTATE OF FULLER E CALLAW ETHICON, INC. ETHRIDGE BACKHOE & YARDWORK EUGENE MILLER POULTRY EVERETT ENVIRONMENT EWC/PROFESSIONAL TEMP SVCS INC EWC-PIONEER HOUSING SYSTEM EXPRESS PERSONNEL F & W FARM SERVICE, INC F R GRANTHAM CONTRACTING FALCON STEEL/HELLMARK STEEL FAMILY DOLLAR, INC. FAMILY DOLLAR, INC. FAMILY RESOURCE AGENCY
ATLANTA
GA
SPRINGFIELD
GA
MARIETTA
GA
BISHOP
GA
MARIETTA
GA
AUGUSTA
GA
EAST POINT
GA
ATLANTA
GA
SNELLVILLE
GA
TIFTON
GA
SANDERSVILLE
GA
MARIETTA
GA
COLUMBUS
GA
SHENANDOAH
GA
CANTON
GA
MCDONOUGH
GA
MACON
GA
ATLANTA
GA
ATHENS
GA
NORCROSS
GA
CANTON
GA
MACON
GA
GAINESVILLE
GA
KINGSLAND
GA
COLUMBUS
OH
MACON
GA
SPRINGFIELD
OH
STONE MOUNTAIN GA
GORDON
GA
ATTAPULGUS
GA
ROCKMART
GA
WOODBRIDGE
NJ
LITHONIA
GA
LAGRANGE
GA
CORNELIA
GA
HARTWELL
GA
DOUGLAS
GA
ARMUCHEE
GA
THOMASVILLE
GA
FITZGERALD
GA
WOODSTOCK
GA
THOMASVILLE
GA
DECATUR
GA
MARIETTA
GA
ROME
GA
CHARLOTTE
NC
ROSSVILLE
GA
Page 38
42,724.85 97,690.77 32,375.00
963.81 1,320.14 38,156.15 1,950.00 54,205.30 93,281.90
365.97 11,550.00 27,734.26 23,039.09 12,704.10 46,890.76 120,269.50 17,111.05 10,385.00 18,486.06
7,692.72 3,435.20 5,629.34 41,849.27 197,558.71 10,020.54 19,870.18
732.09 17,831.37
7,841.00 26,500.00 146,243.16 141,116.97
309.57 23,928.67 12,635.64 87,748.26
156.17 21,790.70 15,515.18 39,975.07
3,251.25 6,600.80 11,817.76 17,919.91
516.69 31,815.72 23,575.04
Subsequent Injury Trust Fund 2004 Annual Report
FANNIN COUNTY BD. OF EDUCATION
BLUE RIDGE
GA
FAYETTE CO BD OF EDUCATION
FAYETTEVILLE
GA
FEDERAL PAPER BOARD CO., INC.
AUGUSTA
GA
FEDERAL STATE INSPECTION
ALBANY
GA
FEPCO TRUCKING
CONLEY
GA
FIBER ONE
DALTON
GA
FIBERVISIONS, INC.
COVINGTON
GA
FIDELITY ASSOC.
GASTONIA
NC
FINANCIAL SERVICE CORP
ATLANTA
GA
FIRE SUPPRESSION SYSTEMS
NORCROSS
GA
FIREMAN'S FUND INS CO.
ATLANTA
GA
FIRST AMERICAN RENTAL
LITHONIA
GA
FIRST BAPTIST CHURCH
LAFAYETTE
GA
FITZGERALD UNDERWEAR CORP
TIFTON
GA
FIVE STAR QUALITY CARE COLLEGE
COLLEGE PARK 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
FOLGER POULTRY FARMS
DAHLONEGA
GA
FORSTMAN & CO.
DUBLIN
GA
FORSTMANN & COMPANY, INC
TIFTON
GA
FORT OGLETHORPE NURSING CTR.
FT OGLETHORPE GA
FOWLER-FLIMESTER CONCRETE, INC MILLEDGEVILLE GA
FOXWORTH PAINTING CONTRACTORS COLUMBUS
GA
FPIS
OCOEE
FL
FRANK SHELTON, INC.
PERRY
GA
FRANKLIN INDUSTRIES
LAVONIA
GA
FREEPORT KAOLIN CO
GORDON
GA
FREIGHTLINER CORP.
PORTLAND
OR
FRESH FROZEN FOOD
JEFFERSON
GA
FRUEHAUF CORPORATION
CONLEY
GA
FUTURE COMMUNICATIONS, INC.
MABLETON
GA
FUTURECALL TELEMARKITING WEST
AUGUSTA
GA
G & L MARBLE, INC.
WINSTON
GA
GA ALLTEL TELECOM-HOMERVILLE
HOMERVILLE
GA
GA. BAPTIST HEALTH CARE
WARM SPRINGS GA
GABRIEL DESSERTS, INC.
MARIETTA
GA
GAF MATERIALS CORP.
SAVANNAH
GA
GALAXY CARPET MILLS, INC.
CHATSWORTH
GA
GALEY & LORD INDUSTRIES, INC.
SHANNON
GA
GAMBRO HEALTHCARE
SAVANNAH
GA
GARNER BROTHERS CO
ROME
GA
GAY CONSTRUCTION COMPANY
ATLANTA
GA
GEICO CORP
MACON
GA
Page 39
4,239.27 6,888.00 129,605.75 9,551.43 104,622.75
600.00 13,975.00 606,687.37 61,147.19
2,785.70 24,016.92
5,453.58 6,984.72
55.00 10,652.62
5,020.07 14,547.95
4,341.25 50,133.02 23,669.94 47,868.59
8,370.00 238.95
11,467.00 61.60
55,026.11 1,063.34
64,289.92 8,601.11 7,708.03 6,118.00 50.00
23,436.83 7,292.56
72,803.92 21,408.14
3,776.10 26,124.27
351.00 3,886.76 39,532.50 5,400.00 65,186.13 117,629.59 69,289.85 13,628.09 119,161.59
Subsequent Injury Trust Fund 2004 Annual Report
GENERAL ELECTRIC CO GENERAL NUTRITION CTRS GENTRY MACHINE GENUINE PARTS GENUINE PARTS GEORGE HORMELL & COMPANY GEORGE MUSE CLOTHING CO GEORGIA BAPTIST CONVENTION GEORGIA BOOT INC GEORGIA CHAIR COMPANY GEORGIA DUPLICATING PRODUCTS GEORGIA ENVIRONMENTAL GEORGIA FARM BUREAU INS. CO. GEORGIA MARBLE COMPANY GEORGIA OPTIONS GEORGIA RUBBER & SUPPLY GEORGIA TECH ATHLETIC ASSOC. GERALD L. DAVIS ASSOC., INC. GILBERT & BENNETT GILMAN BUILDING PRODUCTS GILMAN PAPER CO. GILMAN PAPER CO. GILMER COUNTY OF B. O. E. GLENAYRE TECHNOLOGIES GLOBE TICKET & LABEL CO GLOBE UNION INC GOBER PAINT & CONTRACTING GOLD KIST INC GOLD KIST INC GOLD KIST INC GOLD KIST INC GOLD KIST INC GOLDEN GALLON, INC. GOLDEN STATE FOODS GOLDEN'S FOUNDRY & MACHINE CO GOOCH TRUCKING GOODWILL INDUSTRIES GOODWILL INDUSTRIES-N. GA GOODYEAR TIRE & RUBBER GOODYEAR TIRE & RUBBER GOODYEAR TIRE & RUBBER GOODYEAR TIRE & RUBBER GORDON COUNTY FARM COMPANY GPS ENTERPRISES, INC. GRACEMORE NURSING & REHAB GRAY CONCRETE SERV. GREAT AMERICAN EATERY
ROME
GA
PITTSBURGH
PA
COLUMBUS
GA
SYLVESTER
GA
NORCROSS
GA
TUCKER
GA
ATLANTA
GA
ATLANTA
GA
BLAIRSVILLE
GA
GAINESVILLE
GA
MACON
GA
MORROW
GA
MACON
GA
ATLANTA
GA
BOGART
GA
ATLANTA
GA
ATLANTA
GA
STONE MOUNTAIN GA
TOCCOA
GA
DUDLEY
GA
ST. MARY'S
GA
BLACKSHEAR
GA
ELLIJAY
GA
DULUTH
GA
ATLANTA
GA
ATLANTA
GA
LOGANVILLE
GA
ATHENS
GA
ATLANTA
GA
ELLIJAY
GA
CARROLLTON
GA
DOUGLAS
GA
CHATTANOOGA TN
CONYERS
GA
COLUMBUS
GA
BLAIRSVILLE
GA
SAVANNAH
GA
ATLANTA
GA
REX
GA
CEDARTOWN
GA
CARTERSVILLE
GA
ROCKMART
GA
CALHOUN
GA
AUBURN
GA
BRUNSWICK
GA
GRAY
GA
ATLANTA
GA
Page 40
28,398.04 152,966.26
8,614.63 9,527.20
397.60 34,451.71
8,346.83 4,788.00 5,485.84 40,736.39 19,699.08 48,524.43 1,806.21 8,986.43 17,521.87 163,364.30 9,917.71 5,250.00 28,119.44 208,769.31 364,825.55 32,229.82 7,564.70 62,335.80 32,120.18 1,733.18 331,835.80 130,162.17
382.04 188,439.84
41,955.11 87,205.58
1,979.52 7,614.07 96,401.79 259,794.61 11,278.53 5,039.47 36,837.50 5,861.32 185,792.52 7,324.02 10,137.71 32,761.37 1,703.56 81,802.16 15,400.00
Subsequent Injury Trust Fund 2004 Annual Report
GREAT ATLANTIC NEWS GREAT OAKS NURSING HOME GREEN OAKS CENTER GREEN THUMB, INC. GREENWOOD CEMETARY GRIFFIN INDUSTRIES GRIFFON CORP. GULF LIFE INSURANCE COMPANY GULF LIFE INSURANCE COMPANY H & H LOGGING H.H. TIMBER & LOGGING CO. HA SACK COMPANY, INC. HABERSHAM PLANTATION CORP HABITAT FOR HUMANITY HALL EXPRESS HALLING RERFUSE/ALLIED WA HAMBERSHAM MEDICAL GROUP PC HAMBY'S GARAGE HANCOCK FABRICS HANCOR, INC HANES HOSIERY, INC. HARBISON WALKER REFRACTORIES HARMONY PROPERTIES, INC. HARRIS CALORIFIC HARRIS INSULATION & SUPPLY INC HARRIS TEETER HARTMAN & HARTMAN HARTWELL CO. WAREHOUSE HARTWELL INDUSTRIES, INC. HARVEY'S PERSONAL CARE HAYES MICRO COMPUTER PRODUCTS HAYGOOD CONTRACTING, INC. HAZARDOUS ENVIR. PRODUCTS HCI USA DISTRIBUTION CO. HEALTH CARE SERVICES HEALTHCARE SERVICES GROUP HENDERSON ELECTRIC CO HENDRIX HAULING CO. HENKELS & MCCOY HENRY COUNTY TRAINING CENTER HENRY PLUMBING CO., INC. HERTZ PENSKE/GEICO TRUCK LSNG HI BRAND FOODS HI-BOY GROUP HICKS PAVING CO., INC. HIDDEN HILLS GRILL HIGGINS GENERAL HOSPITAL
ATLANTA
GA
ROSWELL
GA
MOULTRIE
GA
JESUP
GA
ATLANTA
GA
ELLENWOOD
GA
NORCROSS
GA
ALBANY
GA
STATESBORO
GA
WASHINGTON
GA
CUTHBERT
GA
STATESBORO
GA
TOCCOA
GA
ATLANTA
GA
ALBANY
GA
ATLANTA
GA
CLARKESVILLE
GA
CUMMING
GA
SAVANNAH
GA
CORDELE
GA
LAGRANGE
GA
CALHOUN
GA
ATLANTA
GA
GAINESVILLE
GA
ATLANTA
GA
DUNWOODY
GA
DECATUR
GA
HARTWELL
GA
HARTWELL
GA
WAYCROSS
GA
NORCROSS
GA
WOODSTOCK
GA
TUCKER
GA
KENNESAW
GA
AUGUSTA
GA
BENSALEM
PA
STONE MOUNTAIN GA
JESUP
GA
PERRY
GA
MCDONOUGH
GA
SAVANNAH
GA
FOREST PARK
GA
PEACHTREE CITY GA
FORSYTH
GA
ATHENS
GA
STONE MTN.
GA
BREMAN
GA
Page 41
82,543.21 12,779.69 36,966.23 29,283.92
4,369.88 18,545.78 10,005.45 12,075.00
9,771.76 615.74
18,691.12 78,682.59
9,316.46 86,513.35
1,306.44 25,354.71 21,775.27 30,829.12
3,005.76 12,959.13 14,208.47
774.95 1,846.85 34,480.87 17,372.59
231.00 4,663.92 16,244.99 29,201.35 14,271.99 30,558.68 26,406.95
907.20 3,844.05 3,398.68 13,400.95 14,045.27 131,624.12 29,174.01 3,221.54 64,229.96 71,029.90 15,522.60 3,433.66 12,841.48 14,978.06 4,860.00
Subsequent Injury Trust Fund 2004 Annual Report
HIGH FALLS GRADING INC. HIGHTOWER TV HILLHAVEN CONVALLESCENT CTR HILLIARD, INC. HINESVILLE RED & WHITE HOGAN TRANSPORT INC HOLBROOK SERVICES HOLCOMBE' S SUPER VALUE HOLDER'S LOGGING CO HOLLAND ELECTRIC/PLUMBING HOLLANDER HOME FASHIONS CORP. HOLLEY STEEL CO HOLLIS TRANSPORT AGENCY HOLLOWAY CONSTRUCTION CO. HOLLYE EQUIPMENT CO., INC. HOLT & HOLT, INC HOME DELIVERY FOOD SERVICES HOME DEPOT HOME DEPOT HOME DEPOT HOME DEPOT HOME GROWN INDUSTRIES HOMEWOOD RESIDENCE AT W HON INDUSTRIES HOOBLER ENTERPRISES, INC. HOOVER PRECISION PRODUCT HOOVER-HANES TRUCKING CO. HOSPITAL HOUSEKEEPING SYSTEMS HOTEL VENTURA OF AUGUSTA HOUSTON CO. ASSOCIATION HOUSTON STEEL, INC. HOUSTON WIRE & CABLE COMPANY HOWARD & SONS AUTOMOTIVE HOWARD'S LANDSCAPING & GRADING HP PELZER HUBERT MOORE LUMBER HUDDLE HOUSE HUGHES CABINET SHOP HUGHES LOGGING COMPANY HUMAN RESOURCES, INC. HUNT-MILLER INSURANCE ILLINOIS TOOL WORKS IMERYS KAOLIN INC. INCO SERVICES, INC. INDALEX AMERICA INC INDEPENDENT LIFE INSURANCE CO. INDUSTRIAL MAINTENANCE SER
WOODSTOCK
GA
ROME
GA
SAVANNAH
GA
EASTMAN
GA
HINESVILLE
GA
COLUMBUS
GA
COLUMBUS
GA
TALLAPOOSA
GA
GOOD HOPE
GA
DOUGLASVILLE GA
TIGNALL
GA
SYCAMORE
GA
GAINESVILLE
GA
BALLGROUND
GA
GAINESVILLE
GA
SMYRNA
GA
JEFFERSON
GA
GARDEN CITY
GA
ATHENS
GA
ATLANTA
GA
AUSTELL
GA
ATLANTA
GA
MARIETTA
GA
CEDARTOWN
GA
HIRAM
GA
CUMMING
GA
TALLAPOOSA
GA
JACKSON
GA
AUGUSTA
GA
WARNER ROBINS GA
BYRON
GA
SUWANEE
GA
SMYRNA
GA
LILBURN
GA
THOMSON
GA
ALAPAHA
GA
DAHLONEGA
GA
DANIELSVILLE
GA
ARLINGTON
GA
POULAND
GA
WARNER ROBINS GA
CHAMBLEE
GA
DRY BRANCH
GA
ALPHARETTA
GA
GAINESVILLES
GA
ROME
GA
SUWANEE
GA
Page 42
142,960.30 23,820.47 10,787.28 3,325.63 8,449.91 65,857.90 3,831.61 2,349.51
111,124.25 15,897.90 22,160.34 5,681.96 67,601.61 10,422.00 10,205.41 47,100.00 3,499.95 50,929.67 8,550.28 65,830.67 10,246.05 45,143.78 256.45 44,752.01
193,373.28 65,534.33 28,132.31 7,922.59 63,075.06 230.00 14,245.48 1,040.50 36,500.12 8,044.10 9,972.60 16,045.59 5,899.11 2,232.40 2,590.45 25,572.07 21,042.63 25,472.81 72,463.15 38,709.36 6,029.62 7,461.20 21,318.75
Subsequent Injury Trust Fund 2004 Annual Report
INDUSTRIAL PIPE & SUPPLY INDUSTRIAL TOOL & SUPPLY INGERSOLL RAND CO INGLETT & STUBBS, INC. INLAND CONTAINER CORP. INLAND CONTAINER CORP. INTERNATIONAL AUTO PROCESSING INTERNATIONAL BUSINESS INTERNATIONAL RESCUE COMM INTERSTATE BRANDS CORP. INTERSTATE BRANDS CORP. INTERSTATE BRANDS CORP. IRWIN COUNTY HOSPITAL ITHACA INDUSTRIES INC. ITHACA INDUSTRIES INC. ITT AUTOMOTIVE ITT-RAYONIER, INC. ITT-RAYONIER, INC. J & J FOODS, INC. J & M TRANSPORT J & S, INC. J&M TRANSPORTATION J. C. PENNEY COMPANY J. P. BEAMER CO., INC. J.A. JONES MANAGEMENT J.A. JONES MANAGEMENT J.B. HUNT CORP. J.G. DAVIDSON JR. ELECTRICAL J.J. PRECAST COMPANY JACKSON CO BD OF EDUCATION JAMES F. HOOVER JAMES GAMBLE MASONRY JAMES HILL CONTRACTOR JAMES K BEGLEY,DMD JARVIS WEBB JASPER LUMBER CO JEAN THOMAS JEBCO, INC. JENKINS PLUMBING CO. JERRY GRAVITT DRYWALL JERRY JOHNSON & ASSOCIATES JERVIS B. WEBB COMPANY JET CORR, INC. - PLANT 1 JIFFY MANAGEMENT JIM WALTER HOMES, INC. J-M MANUFACTURING CO., INC. JM WILKERSON CONSTRUCTION
GAINESVILLE
GA
SAVANNAH
GA
CAIRO
GA
SMYRNA
GA
ROME
GA
MACON
GA
BRUNSWICK
GA
ATLANTA
GA
NEW YORK
NY
MACON
GA
COLUMBUS
GA
JACKSONVILLE
FL
OCILLA
GA
MEIGS
GA
GLENNVILLE
GA
ROME
GA
JESUP
GA
MIDVILLE
GA
GAINESVILLE
GA
MARIETTA
GA
INDIANOLA
PA
LASCRUSES
NM
STONE MOUNTAIN GA
CALHOUN
GA
KINGS BAY
GA
CHARLOTTE
NC
LOWELL
AR
LAGRANGE
GA
NEWNAN
GA
JEFFERSON
GA
LAVONIA
GA
VALDOSTA
GA
ACWORTH
GA
DULUTH
GA
MARIETTA
GA
KENNESAW
GA
COMMERCE
GA
WARRENTON
GA
SPRIGFILED GA GA
EATONTON
GA
MORROW
GA
MARIETTA
GA
CONYERS
GA
SAVANNAH
GA
FOREST PARK
GA
ADEL
GA
MARIETTA
GA
Page 43
5,034.00 14,415.36
4,920.39 72,536.64 41,664.93 109,494.80 11,250.24 74,000.00
5,500.00 135,461.27
41,641.96 25.30 62.87
56,022.69 10,504.03
5,719.50 32,634.91
4,725.00 209.00 510.70
211,631.11 4,352.37
29,717.81 16,689.63 35,350.27 23,440.40 72,160.64 16,477.44 61,697.85 10,728.83 31,796.65 55,356.51
5,940.00 194,106.04
31,054.74 159,490.91
7,811.16 43,359.93 21,384.93
2,454.98 13,534.84 114,336.53 91,737.50 16,979.07
3,687.60 76,977.30 103,487.09
Subsequent Injury Trust Fund 2004 Annual Report
JOE & GUY CO, INC.
ATLANTA
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
JOHNS MANVILLE CORP.
EDENBURG
VA
JOHNSON & JOHNSON
ROYSTON
GA
JOHNSON & JOHNSON
CORNELIA
GA
JONATHAN R. JOWERS
MARTINEZ
GA
JOSEPH FOODSERVICE, INC.
VALDOSTA
GA
JRH OPTICS/PEARL VISION EXPRES
DULUTH
GA
JT INDUSTRIAL CONTRACTORS
MACON
GA
JULIOUS HARDCASH GRANITE
DEWY ROSE
GA
JUST FOR YOU
RIVERDALE
GA
JWI GROUP PRESS FABRIC
JONESBORO
GA
K & F INDUSTRIES
ROCKMART
GA
K&K MECHANICAL, LLC
LAGRANGE
GA
K.B.S. HEATING & COOLING
DOUGLASVILLE GA
KATSUSHIRO ROME CORP.
ROME
GA
KAWNEER COMPANY
JONESBORO
GA
KEANE, INC.
ATLANTA
GA
KELLWOOD COMPANY
ST. LOUIS
MO
KELLY LANDSCAPE MAINTENAN
DALLAS
GA
KEMIRA, INC.
SAVANNAH
GA
KEN SHEPPARD LOGGING
AILEY
GA
KENNESAW TRANSPORTATION
WHITE
GA
KEN'S CONSTRUCTION, INC.
BUCKHEAD
GA
KEY HEALTH CENTER
MACON
GA
KEYSTONE MEMORIALS, INC.
ELBERTON
GA
KICKBUSH CONSTRUCTION
BISHOP
GA
KIDS KONDO INCORPORATED
ATLANTA
GA
KILLEARN PROPERTIES OF GEORGIA STCOKBRIDGE
GA
KINDER-CARE LEARNING CENT
MARIETTA
GA
KING GREEN, INC
NORCROSS
GA
KING MUFFLER SHOP
WAYCROSS
GA
KING PACKAGING COMPANY
BREMEN
GA
KINNEY CONSTRUCTION CO
LEESBURG
GA
KIRKLANDS
KENNESAW
GA
KLIKLOK CORPORATION
DECATUR
GA
KLOCKNER NAMASCO CORP.
SUWANEE
GA
KOCH MATERIALS SYSTEMS
ALPHARETTA
GA
KOGER'S AUTO CARE INC.
HINESVILLE
GA
KOLE INVESTMENT CO.
SAVANNAH
GA
KRAFT FOOD INC
NORCROSS
GA
KROGER CO.
ATLANTA
GA
KROGER CO.
MABLETON
GA
KRYSTAL/M.A.E. THOMASVILLE
THOMASVILLE
GA
Page 44
10,360.19 36,112.39 140,405.06 49,675.49 17,549.70 48,498.89 170,278.77
218.45 146,309.38
15,295.31 48,330.80 17,379.49
9,608.12 44,971.65 33,930.87 13,468.52
1,177.80 115.10 690.11
64,198.17 22,425.00 15,614.88
77.00 59,204.50 97,807.60 96,840.00 102,824.73 15,332.81 101,256.63 28,105.06 10,266.04 126,556.28
3,751.66 164,490.34
22,599.96 2,505.10
35,517.96 1,977.23
21,394.02 14,029.35 340,811.75 90,864.34 17,193.36 90,703.84 91,641.20
4,782.12 2,273.15
Subsequent Injury Trust Fund 2004 Annual Report
LAGRANGE MACHINE SHOP LAGRANGE MOLDED PRODUCTS LAGRANGE SCHOOL SYSTEM LAKES CONSTRUCTION LAKEWOOD BAPTIST CHURCH LAMAR ADVERTISING LAMAR COUNTY BOE LANCE, INC. LAND O'SUN DAIRIES LAPP INSULATOR CO. LARSON & JUHL LARSON & JUHL LAW COMPANIES GROUP, INC. LAW ENGINEERING CO LAWSON AIR CONDITIONING LEAR CORP LEARD HUGGINS, INC. LEASEWAY PERSONNEL CORP. LEGACY TOYOTA LEGGETT & PLATT INC LEGGETT & PLATT INC LEMAY ELECTRIC LEON FARMER & CO. LEON JONES FEED & GRAIN LEVI STRAUSS & COMPANY LEVITON MANUFACTURING CO. LIBERTY REGIONAL LIFE LIKE, INC. LILBURN DEVELOPERS, INC LIN R. ROGERS ELECTRICAL LITTLE PEOPLE'S CORNER CHILD C LOCKHEED MARTIN LOCKHEED MARTIN LOCKHEED MARTIN LODINS SERVICES # 1, INC. LOGAN PAVING COMPANY LOOK PRODUCTS LOOKOUT MTN FAIRYLAND CLUB LORAL SPACE & COMMUNICATIONS LORD & STEPHENS FUNERAL L'OREAL USA INC. LOW COUNTRY CANDLE, INC. LOWE'S CARPET CORP. LOWE'S COMPANIES LTC HEALTHCARE LYNN HAVEN NURSING HOME M & M DEVELOPMENT
LAGRANGE
GA
LAGRANGE
GA
LAGRANGE
GA
ROME
GA
GAINESVILLE
GA
AUGUSTA
GA
BARNESVILLE
GA
CHARLOTTE
NC
ATLANTA
GA
SANDERSVILLE
GA
NORCROSS
GA
ADAIRSVILLE
GA
ATLANTA
GA
ATLANTA
GA
GAINESVILLE
GA
ATLANTA
GA
SAVANNAH
GA
READING
PA
UNION CITY
GA
SOCIAL CIRCLE GA
MONROE
GA
MARIETTA
GA
GAINESVILLE
GA
CUMMING
GA
VALDOSTA
GA
ATLANTA
GA
HINESVILLE
GA
KENNESAW
GA
LILBURN
GA
ROSWELL
GA
CANTON
GA
MARIETTA
GA
BETHESADA
GA
KINGS BAY
GA
DECATUR
GA
ATHENS
GA
MILLEN
GA
LOOKOUT MTN. TN
ROCKMART
GA
ATHENS
GA
SAVANNAH
GA
ST. SIMONS ISLAND GA
CHATSWORTH
GA
ALBANY
GA
FT. VALLEY
GA
MACON
GA
LAVONIA
GA
Page 45
7,876.23 27,445.31
4,900.00 13,974.58 62,317.29
187.48 1,130.70 203,287.45 43,372.95 28,683.60 11,321.84 24,296.43
56.00 10,500.00
75.00 34,140.19 17,996.93 154,485.85 176,598.40 12,076.60 95,278.81 99,385.38
2,145.03 64,450.00
8,282.82 75,210.82
1,505.86 35,958.77
4,729.03 23,385.28 21,063.35 1,222,405.20
1,843.36 43,872.49 14,610.45 16,485.00
5,091.26 296.00
59,800.98 14,121.07 21,727.23 19,116.02
7,838.82 4,451.70 25,745.64 6,339.20 46,932.32
Subsequent Injury Trust Fund 2004 Annual Report
M & S DRYWALL M S & ASSOCIATES M.A.P.S.S., INC. MAAX USA, INC. MAC PAPER MACON BEVERAGE CO. MACON HEALTH CARE CENTER MACON KRAFT MACON MALL/COLONIAL PROP. TR. MACON NORTHSIDE HOSPITAL MACON-BIBB CO WATER & SEWAGE MACY'S MAGNA LOMASON, INC. MAIL CONTRACTORS OF ARKANSAS MAIL-WELL, INC. MAIN AUTO PARTS MAKITA CORP. OF AMERICA MANFREDI MOTOR TRANSIT MANHATTAN SHIRT COMPANY MANHEIM'S GA DEALERS AUTO AUCT MANN MECHANICAL CO. INC. MAPLEHURST, INC. MARCELLA CORPORATION MAREK INTERIOR SYSTEMS, INC. MARELL POULTRY COMPANY INC MARI STAFF, INC. MARINER POST ACUTE NETWORK MARK'S & MORGAN JEWELERS, INC. MARK'S & MORGAN JEWELERS, INC. MARLEY COOLING TOWER MARSHALL'S MARTIN CONSTRUCTION COMPANY MARTINS RESTAURANT SYSTEM MASTER PROMOTIONS MASTERCORP MATSUSHITA BATTERY INDUSTRIES MATTEL CARPET & RUG INC MAXELL CORP OF AMERICA MAXELL CORP OF AMERICA MAXWELL CHASE TECH. MC DESIGNS MCC PANASONIC MCCLESKY MILLS MCCLURE LOGGING, INC. MCCOY ENVIRONMENTAL TECH MCDONALD'S MCELROY SPEC. INT.
HINESVILLE
GA
KENNESAW
GA
BARNESVILLE
GA
VALDOSTA
GA
ATLANTA
GA
MACON
GA
MACON
GA
MACON
GA
MACON
GA
MACON
GA
MACON
GA
ATLANTA
GA
CARROLLTON
GA
LITTLE ROCK
AR
ATLANTA
GA
AUSTELL
GA
BUFORD
GA
NEWBURY
OH
AMERICUS
GA
ATLANTA
GA
AVONDALE ESTS. GA
CARROLLTON
GA
ATLANTA
GA
HOUSTON
TX
MURRAYVILLE
GA
ATLANTA
GA
LUMBER CITY
GA
MACON
GA
AUGUSTA
GA
OVERLAND PARK KS
STONE MOUNTAIN GA
SYLVESTER
GA
MABLETON
GA
LITHIA SPRINGS GA
CROSSVILLE
TN
COLUMBUS
GA
DALTON
GA
CONYERS
GA
FAIR LAWN
NJ
SMYRNA
GA
CANTON
GA
PEACHTREE CITY GA
SMITHVILLE
GA
JERSEY
GA
COLUMBUS
GA
UNION CITY
GA
MARIETTA
GA
Page 46
6,487.75 6,210.79 32,832.68 14,292.70 10,280.93 21,724.74
768.94 7,525.00 33,412.56 21,004.27 6,107.10 8,060.00 60,541.89 46,694.15 14,658.75 29,497.84 35,072.81 7,480.95
227.39 161.34 16,566.51 12,818.10 3,767.00 7,987.69 1,155.58 9,030.03 137,749.79 8,470.31 1,369.22 2,292.42 6,419.59 8,428.95 16,726.48 9,191.93 18,374.94 692.39 36,243.95 6,410.11 17,853.60 29,039.57 17,803.68 25,061.23 16,333.77 26,228.56 26,331.56 464.74 139,519.78
Subsequent Injury Trust Fund 2004 Annual Report
MCMASTER CARR SUPPLY CO. MCRAE MANOR NURSING HOME MC'S PAINTING & DECORATING CO. McWHORTER TECHNOLOGIES MD HODGES ENTERPRISES, INC. MDO HOMES, INC MEAD CORPORATION MEAD CORPORATION MEADOWDALE NURSERIES MEADOWS REG. MED. CTR. MECHANICAL MAINTENANCE MED CARE INC/ COOSA VALLEY MEDIA ONE MEDICAL CENTER LLP MEDIQ INCORPORATED MEMORIAL HOSPITAL & MANOR MENLO PARK, INC. MERICO, INC. MERIDIAN BEVERAGE CO INC MERRILL GARDENS OF CARROLLTON MERRY ACRES METAL BUILDINGS, INC. METAL CONCEPTS METAL PRODUCTS COMPANY METALS USA, INC. METOKOTE CORP. METRO BUILDERS SUPPLY INC. MGR HOMECARE, INC. MICRO-MED MID GEORGIA AMBULANCE MID GEORGIA INVENTORY MIDDLE GA. COMMUNITY MIDDLE GEORGIA HOSPITAL MIDDLE GEORGIA WILDERNESS INST MIDLAND EMPLOYER SERVICE MILL POND PLANTATION MILLER BREWING CO MILLER BREWING CO MILLIKEN & COMPANY MILLIKEN & COMPANY MINI JOBS CONTRACTING MIRALINK GROUP MISCELLANEOUS ERECTORS, INC. MOBIL CHEMICAL CO. MODERN FIBERS, INC. MONDO BAKING CO MONROE AUTO EQUIPMENT
ATLANTA
GA
MCRAE
GA
HIRAM
GA
COLUMBUS
GA
ATLANTA
GA
LOGANSVILLE
GA
ATLANTA
GA
SPARTANBURG SC
WARNER ROBINS GA
VIDALIA
GA
AUGUSTA
GA
ROME
GA
LAWRENCE
GA
DUBLIN
GA
PENNSAUKEN
NJ
BAINBRIDGE
GA
PEACHTREE CITY GA
FOREST PARK
GA
NORCROSS
GA
CARROLLTON
GA
ALBANY
GA
THOMASVILLE
GA
MACON
GA
SUWANEE
GA
OAKWOOD
GA
STATESBORA
GA
FAIRBURN
GA
GRIFFIN
GA
BOCA RATON
FL
MACON
GA
ADRAIN
GA
WARNER ROBINS GA
MACON
GA
COCHRAN
GA
BRENTWOOD
TN
THOMASVILLE
GA
ALBANY
GA
MOULTRIE
GA
TOCCOA
GA
LAGRANGE
GA
ATLANTA
GA
KINGSLAND
GA
POWDER SPRINGS GA
LAGRANGE GA
GA
FITZGERALD
GA
ROME
GA
HARTWELL
GA
Page 47
189,810.76 35,686.78 12,072.00 24,225.00 22,954.41 48,889.03 16,060.00 13,650.00 13,604.22 3,776.33 10,968.07 3,507.02 99,210.92 32,995.40 47,975.09 23,317.76 21,235.84 9,794.72 18,523.04 13,723.49 7,426.44 31,072.39 179.10
106,662.96 8,371.19
24,221.27 31,265.24 23,736.75
636.05 16,139.50 81,549.79 14,105.95 361,110.48 53,103.22 39,010.54 43,965.00 313,047.66 16,585.08
9,180.00 89,668.50
555.68 46,127.53
4,931.19 12,978.09 10,456.38 43,903.71 14,778.37
Subsequent Injury Trust Fund 2004 Annual Report
MOORE TRUCK LINES INC MOORMANS, INC. MORI LUGGAGE & GIFTS MORSE AUTOMOTIVE MOTOROLA INC MOTOVARIO CORP. MOUNTAIN BUILDING SUPPLY MOWREY ELEVATOR COMPANY MTC-TURNER JOB CORPS CENTER MUELLIN GROUP INC. MUSCOGEE MANOR CENTER MUSCOGEE MANOR NURSING HOME MUSCOGEE TEXTILES N. GA. COMMUNITY SYSTEM NASHVILLE TEXTILE CORP NATIONAL CEMENT CO., INC NATIONAL EMPLOYER SOLUTIONS NATIONAL ENVELOPE CORP. NATIONAL EXPRESS CORP NATIONAL FREIGHT, INC. NATIONAL GYPSUM COMPANY NATIONAL HEALTH LABORATORIES NATIONAL PUBLIC RADIO, INC. NAU, INC. NCR CORP. NESTLE TRANSPORTATION CO. NETCARE HEALTH SYSTEMS, INC. NETWORK COMMUNICATIONS NEW RIVERSIDE OCHRE CO. NEWBERRY INDUSTRIES NEWCOMB SPRING CORP NEWSPAPER HOLDINGS NICHOLLS LOGGING, INC. NICHOLSON ENTERPRISES, INC. NICHOLSON ENTERPRISES, INC. NOLAND COMPANY NORD KAOLIN CO NORITAKE CO., INC. NORTH EAST GA. CARPET, INC. NORTH GEORGIA READY MIX NORTHERN TELECOM, INC. NORTHLAKE REGIONAL MED CTR NORTHROP GRUMMAN CORP. NORTHROP GRUMMAN CORP. NORTHWEST AIRLINES CORP NOVOSTE CORP NSR, INC.
ALAPAHA
GA
CORDELE
GA
ATLANTA
GA
CARTERSVILLE
GA
LAWRENCEVILLE GA
ALPHARETTA
GA
BLAIRSVILLE
GA
MARIANNA
FL
ALBANY
GA
STATESBORO
GA
COLUMBUS
GA
COLUMBUS
GA
COLUMBUS
GA
JASPER
GA
NASHVILLE
GA
LAWRENCEVILLE GA
ALPHARETTA
GA
AUSTELL
GA
AUSTIN
TX
VINELAND
NJ
ATLANTA
GA
MARIETTA
GA
WASHINGTON
DC
AUGUSTA
GA
PEACHTREE CITY GA
MCDONOUGH
GA
ELLIJAY
GA
LAWRENCEVILLE GA
CARTERSVILLE
GA
FRANKLIN
GA
DECATUR
GA
DALTON
GA
DOUGLAS
GA
YOUNG HARRIS GA
HOLLY SPRINGS GA
MACON
GA
JEFFERSONVILLE GA
SAVANNAH
GA
BALDWIN
GA
DALTON
GA
STONE MOUNTAIN GA
TUCKER
GA
PERRY
GA
ST MARYS
GA
ATLANTA
GA
NORCROSS
GA
CHAMBLEE
GA
Page 48
17,760.00 16,306.72 121,118.45
774.85 49,728.74 60,985.18 107,899.18
1,809.52 71,558.25
7,500.00 2,172.80 5,910.08 8,412.65 2,423.14 6,689.38 18,226.46 289,350.32 66,282.00 1,447.83 16,785.46 15,646.68 9,880.18 61,668.15
46.75 3,926.01 27,795.42 22,044.47 39,782.08 53,021.68
257.25 1,489.64 14,975.00 8,890.00 22,576.02 18,766.40 8,250.00 5,168.59 39,178.07 2,222.43 53,972.19 16,347.93
374.31 9,928.53 19,999.40 5,333.72 80,455.66 68,861.10
Subsequent Injury Trust Fund 2004 Annual Report
NUTRASWEET KELCO CO. INC.
CHICAGO
IL
OASIS/LAKELAND MOTOR FREIGHT
SARASOTA
FL
OCMULGEE FIELDS
MACON
GA
OCTAGON AIR SYSTEMS
CONLEY
GA
OELSCHIG'S NURSERY, INC.
SAVANNAH
GA
OGLEBAY NORTON/ELLIJAY MT.
ELLIJAY
GA
OGLETHORPE COUNTY SCHOOL
LEXINGTON
GA
OLIN WOOTEN TRANSPORT CO. INC.
HAZLEHURST
GA
OLYMPUS BUILDING SERVICE
DOYLESTOWN
PA
OMC
CALHOUN
GA
OMNI HEALTH CARE, INC.
COLUMBUS
GA
O'NEAL STEEL, INC
BIRMINGHAM
AL
ONEDA CORPORATION
COLUMBUS
GA
OPEN DOOR COMMUNITY HOUSE
COLUMBUS
GA
ORRBILT COMPRESSORS, INC.
ATLANTA
GA
OSAN PETROLEUM CO
MACON
GA
OSBORNE HEATING & AIR
SNELLVILLE
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
OWENS-ILLINOIS
TOLEDO
OH
OXFORD OF DUBLIN
DUBLIN
GA
P&M TRUCKING
DOUGLAS
GA
PACE AMERICA
EASTMAN
GA
PACKAGING CORPORATION OF AMERICA VALDOSTA
GA
PACTIV
COVINGTON
GA
PALM CREEK FARM
DACULA
GA
PAPER PAK PRODUCTS
WASHINGTON
GA
PAPERCON
ATLANTA
GA
PARAMONT GRADING INC.
CUMMING
GA
PARKING COMPANY OF AMERIC
ATLANTA
GA
PARKWOOD NURSING & REHAB
SNELLVILLE
GA
PARSEC
ATLANTA
GA
PARTITIONS, INC.
CLARKSTON
GA
PAULDING CONCRETE
DALLAS
GA
PAYLESS SHOE SOURCE INC
ATHENS
GA
PCI PROCOATERS INC
DECATUR
GA
PEACH AUTO PAINTING
TUCKER
GA
PEACH REGIONAL MEDICAL CENTER
FORT VALLEY
GA
PEACHFORD BEHAVIORAL
ATLANTA
GA
PEACHTREE DOORS AND WINDOWS
GAINESVILLE
GA
PEAVY SPREADER
PINEHURST
GA
PEBBLE HILL FOUNDATION
THOMASVILLE
GA
Page 49
104.80 4,174.85 15,694.49 33,410.00 13,486.60
677.00 14,059.98
9,593.73 50,382.30 17,342.86
1,568.09 95,747.13 27,438.91 62,721.94 154,193.20
3,789.92 126.00
5,566.44 122,475.70
28,925.72 26,422.27 24,689.62 20,123.60 37,361.00
3,155.92 3,329.20 4,613.95 216,348.06 40,030.00 29,066.86 12,236.46 46,634.08 6,338.78 19,233.08 125,754.95 17,698.49 248,711.60 60,730.66 374,275.08 14,129.27 1,130.40 137,252.06 23,776.07 40,190.93 60,518.37 171,548.81
44.00
Subsequent Injury Trust Fund 2004 Annual Report
PEEKS FIFTH AVE. PELICAN ELECTRIC INC PENHALL INT'L. PENSKE AUTO CENTER PEPSI-COLA COMPANY PETSMART PHARMACIA CORPORATION PHASE 3 ELECTRIC INC PHILLIPS & BROOKS-GLADWIN INC PHOTOCIRCUITS CORP PIERCE & COMPANY, INC. PIGGLY WIGGLY PIGGLY WIGGLY #214/McLAIN'S PIGGLY WIGGLY SOUTHERN PIKE COUNTY BOE PINE KNOLL NURSING & REHAB. PINE MTN. WILD ANIMAL PARK PIOLAX CORPORATION PIONEER CONCRETE PUMPING PIONEER HOUSING SYSTEMS PIPE ORGAN SALES-SERVICE PITNEY BOWES PIZZA HUT, INC. PIZZA HUT, INC. PIZZA HUT, INC. PLANT CORPORATION PLAYTEX APPAREL PLOOF CARRIERS CORP POETIC LICENSE, INC. POLITEX US, INC. POLLUTION EQUIPMENT MGMT. CO. PONDER & ASSOCIATES POST PROPERTIES, INC. PRECISE MAINTENANCE, INC. PRECISION COMPONENTS, INT'L. PREMARK INTERNATIONAL INC. PREMIER METAL PRODUCTS PRESIDENT BAKING CO. PRESS FABRICS PRESTOLITE WIRE CORP. PRIME FOOD SERVICE PRIME SOURCE PRIMERICA FINANCIAL SERVICE PRINTED FABRICS, INC PROAM SOUTHEAST PROFESSIONAL EMPLOYEE MGM'T. PROFORCE STAFFING
ROME
GA
JONESBORO
GA
ANAHEIM
CA
VALDOSTA
GA
ATLANTA
GA
MORROW
GA
AUGUSTA
GA
PORTAL
GA
ALPHARETTA
GA
PEACHTREE CITY GA
CONYERS
GA
BLUE RIDGE
GA
BOWDEN
GA
VIDALIA
GA
ZEBULON
GA
CARROLLTON
GA
PINE MOUNTAIN GA
CANTON
GA
SMYRNA
GA
FITZGERALD
GA
LITHONIA
GA
NORCROSS
GA
CUMMING
GA
DOUGLASVILLE GA
WOODSTOCK
GA
CALHOUN
GA
NEWNAN
GA
JACKSONVILLE
FL
ATLANTA
GA
MACON
GA
ATLANTA
GA
BETHLEHEM
GA
ATLANTA
GA
DOUGLASVILLE GA
COLUMBUS
GA
CHAMBLEE
GA
DOUGLASVILLE GA
AUGUSTA
GA
JONESBORO
GA
TIFTON
GA
DALTON
GA
SAVANNAH
GA
DULUTH
GA
CARROLLTON
GA
PITTSBURGH
PA
SARASOTA
FL
MARIETTA
GA
Page 50
54,715.27 14,122.82
314.65 20,682.05
2,800.00 4,428.62 73,400.00 185,881.46 63,233.50 241,853.90 140,120.73 114,152.10 31,000.00 5,909.60 19,565.53 10,441.99 52,710.39 19,086.97 15,437.04 13,988.35
980.00 61,492.66 24,803.26
49.50 5,600.00 41,445.68 16,398.77 67,436.34 76,549.79 4,225.00 12,864.44 10,790.49 2,100.59 240,733.73 184,571.73 4,616.65 1,846.01 12,032.00 5,070.00 1,201.00 5,848.03 10,345.59 10,579.67 12,636.78 227,087.08 5,181.49 103,474.99
Subsequent Injury Trust Fund 2004 Annual Report
PROGESSIVE LIGHTING
DULUTH
GA
PTREE/CARDON DOORS & WINDOWS GAINSVILLE
GA
PUBLIX
THOMASVILLE
GA
PUBLIX
FLOWERY BRANCH GA
PUBLIX
DACULA
GA
PUBLIX
KENNESAW
GA
PUBLIX
ALPHARETTA
GA
PUBLIX
SMYRNA
GA
PUBLIX
ATHENS
GA
PUBLIX
EVANS
GA
PUBLIX
LITHONIA
GA
PUBLIX
LOGANVILLE
GA
PUBLIX
STOCKBRIDGE
GA
PURVIS CONSTRUCTION
LINDLEY
GA
PUTNAM COUNTY BOARD OF EDUCATION EATONTON
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-ARCHWAY
TOCCOA
GA
R & D MANUFACTURING CO., INC.
GAINESVILLE
GA
R. M. HURST
SYLVESTER
GA
R.E. SERVICES
LAFAYETTE
GA
R.W. ALEXANDER CONTRACTORS
VALDOSTA
GA
R/S EXPRESS, INC.
ATLANTA
GA
RAM PARTNERS INC
ATLANTA
GA
RAMEY BUILDERS, INC.
LAKEMONT
GA
RANDALL BROTHERS
ATLANTA
GA
RAY M WRIGHT
COLUMBUS
GA
RAYLOC
ATLANTA
GA
RAYONIER, INC.
EATONTON
GA
RCS-GRIFFON CORP
CONYERS
GA
READERS DIGEST
PLEASANTVILLE NY
RECREATIONAL FACTORY WAREHOUSE JONESBORO
GA
RECREATIONAL LAKE ARROWHEAD
WALESKA
GA
RED LOBSTER/DARDEN RESTAURANTS DOUGLASVILLE GA
REDMOND REGIONAL MEDICAL CTR.
ROME
GA
REEVES CONSTRUCTION CO
AMERICUS
GA
REEVES TRUCKING CO., INC.
FITZGERALD
GA
REGAL RUGS
ELLIJAY
GA
REIMBURSEMENT CONSULTANTS
ROSWELL
GA
RELIABLE FASTENERS INC
SMYRNA
GA
REMEDIATION SERVICES, INC.
FITZGERALD
GA
RENTOKIL CONTRACT SVC., INC.
DULUTH
GA
RESIDENTIAL SOLID WASTE
WINDER
GA
Page 51
564.48 37,741.77 21,029.86 76,998.94 89,521.43 30,931.21
5,122.14 63,927.81 19,237.85 12,262.57 21,909.79 26,509.63
5,725.85 199,919.41
25,368.18 19,242.04
603.02 17,888.24 125,330.26 12,379.20 21,260.00 13,539.15
220.00 1,154.31 8,397.53 7,600.00 202,026.84
146.24 12,373.12 44,574.02
28.25 7,525.00 197,988.14 118,200.20 37,594.16 41,685.16
37.83 2,473.98 28,294.76 17,589.07 16,955.88 10,288.78 5,928.28 61,790.12 10,786.80 245,359.53 36,588.79
Subsequent Injury Trust Fund 2004 Annual Report
RESOURCING SERVICE OF ATLANTA
ATLANTA
GA
REYNOLDS METAL CO.
EASTMAN
GA
REYNOLDS PLANTATION
GREENSBORO
GA
RGIS INVENTORY SPECIALIST
ATLANTA
GA
RHEEM MANUFACTURING CO.
MILLEDGEVILLE GA
RHODES CONSTRUCTION
AUGUSTA
GA
RHODES INCORPORATED
POWDER SPRINGS GA
RHONE POULNEC, INC.
WOODBINE
GA
RICHARD H. BISHOFF, P.C.
THOMASTON
GA
RICHPORT PROPERTIES INC.
TUCKER
GA
RISK MGMT DISASTER SERV
ALPHARETTA
GA
RIVERDALE PLUMBING INC
RIVERDALE
GA
RIVERSIDE INN
ROME
GA
RIVERWOOD INT'L. CORP.
MACON
GA
RJB PROPERTIES
HOMEWOOD
IL
RMC SERVICES
ATLANTA
GA
ROADWAY EXPRESS
ATLANTA
GA
ROADWAY EXPRESS
SAVANNAH
GA
ROADWAY EXPRESS
LAKE PARK
GA
ROBBINS PACKING COMPANY
STATESBORO
GA
ROBERT SHAW CONTROLS CO.
ELLIJAY
GA
ROGER'S CARTHER COMPANY
FORSTON
GA
ROGERS CASH & CARRY
THOMASTON
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 CENTER KENNESAW
GA
ROTARY CORP.
GLENNVILLE
GA
ROUNTREE CONSTRUCTION COMPANY VALDOSTA
GA
RTG FURNITURE WAREHOUSE
SWANEE
GA
RUSHDAH INC
NEWNAN
GA
RUSSELL STANLEY
LITHONIA
GA
RUSSELL STOVER
KANSAS CITY
MO
S & S ELECTRIC
WINDER
GA
S & S GRILL
ELBERTON
GA
S I CORPORATION
CHICKAMAUGA
GA
SAIA MOTOR FREIGHT
ATLANTA
GA
SAKS INCORPORATED
COLUMBUS
GA
SAVANNAH COCA-COLA BOTTLING CO POOLER
GA
SAVANNAH FOODS INDUSTRY
PT WENTWORTH GA
SAVANNAH NEWS PRESS
SAVANNAH
GA
SCAPE DRYER FABRICS
WAYCROSS
GA
Page 52
783.70 3,897.73 28,733.21 128,125.00 109,256.83 40,343.43 29,294.47 7,525.00 58,953.70 1,367.63 18,783.57 60,645.88 189,338.26 25,370.28 40,632.66 16,214.08 2,003.12 4,926.03 16,574.83
77.00 26,383.25 23,336.71
8,210.00 1,743.11 8,150.97 19,148.22 97,523.19
304.50 147,921.48
2,840.72 17,700.00 181,319.95
2,465.18 34,807.88 20,455.36
2,452.22 9,001.06 80,060.51 24,104.38 22,058.88 9,283.91 35,889.23
208.32 36,546.21 26,794.82
6,050.00 29,810.31
Subsequent Injury Trust Fund 2004 Annual Report
SCHNADIG CORPORATION SCHULLER WOODWORKING SCIENTIFIC ATLANTA SCIENTIFIC ATLANTA SCOTSMAN INDUSTRIES SCOTT BRIDGE CO. SCOVILL SE BUILDING MAINTENANCE SE NORTHPOINT/FORD SEA ISLAND COMPANY SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SERVICE MERCHANDISE SERVICEMASTER CONSUMER SERV. SERVPRO OF EAST COBB SEWELL MANUFACTURING CO SHADY VENT ALUM PROD SHARP SYSTEMS SHAW ALMEX USA INC. SHAW INVESTMENTS INC SHC ASSOCIATES SHEPARD EXPOSITION SERVICES SHEPHERD CONSTRUCTION CO SHILOH INDUSTRIES SHOE CITY, INC. SIDELINES GRILL SIEMENS ENERGY & AUTOMATION SIEMENS ENERGY CORP SIGNATURE FLIGHT SUPPORT SILVER EAGLE TRANSPORT, INC SIMKINS INDUSTRIES, INC. SINGLETON FURNITURE CO SKILSTAFF INC SKYLINE PLUMBING SERVICES SMEAD MFG. SMITH & SONS FOOD, INC. SMITH BROTHERS MECH. CONTROL SMITH INDUSTRIES SMITH-GRAY ELECTRIC CO SMITHS MARKET SOFTSHEEN-CARSON
CORNELIA
GA
AUGUSTA
GA
NORCROSS
GA
LAWRENCEVILLE GA
CONYERS
GA
OPELIKA
AL
CLARKESVILLE
GA
LOGANVILLE
GA
ALPHARETTA
GA
SEA ISLAND
GA
MACON
GA
AUGUSTA
GA
ALBANY
GA
ATLANTA
GA
BRUNSWICK
GA
CHICAGO
IL
TUCKER
GA
COLLEGE PARK GA
BRENTWOOD
TN
LAWRENCEVILLE GA
MARIETTA
GA
BREMEN
GA
POWDER SPRINGS GA
LESLIE
GA
CLARKSTON
GA
ROCKY FACE
GA
BUFORD
GA
ATLANTA
GA
ATLANTA
GA
PENDERGRASS GA
MONTGOMERY
AL
ROSWELL
GA
TUCKER
GA
ALPHARETTA
GA
GARDEN CITY
GA
ALBANY
GA
MARIETTA
GA
WAYCROSS
GA
ALEXANDER CITY AL
DALLAS
GA
LOCUST GROVE GA
ATLANTA
GA
AUGUSTA
GA
CUMMING
GA
COLUMBUS
GA
TALLAPOOSA
GA
SAVANNAH
GA
Page 53
1,796.89 55,262.50
1,866.38 81,200.26 30,994.49 12,265.67 34,886.09 22,526.36
410.37 30,657.98
6,082.94 97,482.56
732.48 16,668.36
6,975.00 34,520.34
1,525.08 93,904.86 33,825.00 81,115.60
5,835.84 784.42 397.08
328,221.92 60,860.00 52,850.00 24,623.36 477.20 15,836.69 53,740.69
119,621.89 96,169.07
100,354.63 1,920.83
25,647.89 75,136.00 54,829.15
5,941.64 12,964.07
6,678.84 21,163.25
4,278.88 739.05 95.65
60,128.13 37,615.78
3,743.89
Subsequent Injury Trust Fund 2004 Annual Report
SONY MUSIC SOUTH CENTRAL POOL SUPPLY SOUTH GEORGIA CLEANING, INC. SOUTHEASTERN FREIGHT LINE SOUTHEASTERN MEAT CO INC SOUTHERN AG CARIERS, INC. SOUTHERN AMBULANCE BUILDERS SOUTHERN CRAFT MASTERS SOUTHERN CROSS CORP SOUTHERN ELECTRONICS SOUTHERN HOME CARE SERV. SOUTHERN MANOR FURNITURE CO. SOUTHERN MERCHANDISING GROUP SOUTHERN PAPER RECOVERY INC SOUTHERN SAW SERVICE, INC. SOUTHERN SHAVINGS SOUTHLAND ASSOCIATES, INC. SOUTHLAND LOGGING SOUTHLAND NURSING HOME SOUTHTRUST BANK SOUTHWAY CRANE & RIGGING SP NEWSPRINT CO-DUBLIN SP RICHARDS SPARTAN MECHANICAL INC SPC COMPANY SPECIAL PROJECTS, INC. SPECTRUM CABLE SERVICES SPIRIT CONSTRUCTION SERVICES STAFF LEASING STAFF LEASING GROUP STAFFORD DEVELOPMENT , INC. STAIRCASE AND MILLWORK STANDARD CANDY COMPANY STANDARD TELEPHONE COMPANY STAPLES INC STAR MANUFACTURING COMPANY STARR HEATING & A/C, INC. STARWOOD HOTELS & RESORT STARWOOD HOTELS & RESTAURANT STEPHENS COUNTY HOSPITAL STEPHENS COUNTY SCHOOL STEVE CRAWFORD FOREST PROD. STEVENS GRAPHICS, INC. STEWART & STEVENSON SRVCS, INC STONE MOUNTAIN GROUP STORES AUTOMATED SYSTEMS STORK GAMCO, INC.
CARROLLTON
GA
NORCROSS
GA
VALDOSTA
GA
SUWANEE
GA
ATLANTA
GA
ALBANY
GA
LAGRANGE
GA
LOGANVILLE
GA
NORCROSS
GA
TUCKER
GA
VALDOSTA
GA
THOMASVILLE
GA
NORCROSS
GA
SAVANNAH
GA
ATLANTA
GA
PELHAM
GA
THOMASVILLE
GA
FITZGERALD
GA
PEACHTREE CITY GA
COLUMBUS
GA
ATLANTA
GA
DUBLIN
GA
SMYRNA
GA
CHAMBLEE
GA
LAGRANGE
GA
DALTON
GA
JONESBORO
GA
SAVANNAH
GA
BRADENTON
FL
THOMASVILLE
GA
TIFTON
GA
ALPHARETTA
GA
EASTMAN
GA
CORNELIA
GA
MARIETTA
GA
CEDARTOWN
GA
FORSYTH
GA
PHOENIX
AZ
ATLANTA
GA
TOCCOA
GA
TOCCOA
GA
WAYNESBORO
GA
ATLANTA
GA
HOUSTON
TX
SNELLVILLE
GA
BRISTOL
PA
GAINESVILLE
GA
Page 54
46,909.77 62,760.31 14,073.52 13,442.64
2,712.36 58,694.49
849.57 289,606.45
14,175.00 26,391.21 21,407.90
3,985.07 71,213.83
307.60 9,858.40 21,200.00 20,121.24 79,872.32
21.15 6,275.83 3,175.61 9,367.53 79,478.85 21,864.08 12,427.19 1,908.94 39,406.44 39,360.74 4,992.54 1,291.00 171,601.11 8,193.76 132,571.40
545.55 45,928.32 42,601.07 19,987.96
663.02 6,815.14 5,056.80 43,663.26 27,640.35 1,913.10 20,060.64 48,048.89 21,810.81 19,814.75
Subsequent Injury Trust Fund 2004 Annual Report
STRAIN POULTRY STRIKER ELECTRIC INC. SUITT CONSTRUCTION COMPANY SULLIVAN'S ADMINISTRATIVE SERV SUMMERHILL SUN DATA, INC. SUN LYNN ENTERPRISES SUNDANCE PLUMBING, INC. SUNGLASS HUT CORPORATION SUNSHINE BISQUITS, INC SUNSHINE CLEANING SERVICE SUPERIOR ELECTRIC SUPERIOR INSURANCE COMPANY SUPERIOR INTERNATIONAL INDUSTRIES SUPERIOR PANTS COMPANY SUPREME CARPET, INC. SUPREME INDUSTRIES, INC. SUSSEX CORP. SUWANEE TIMBER INC SWEETHEART CUP CO., INC. SWIFT DENIM SWISHER INTERNATIONAL ,INC. SYNOVUS FINANCIAL CORP. SYNTHETIC INDUSTRIES SYSTEM SERVICES AND INDUSTRIAL T & L INSTALLATION COMPANY T & L SERVICES, INC. T & M TILT-UP, INC. T.T.C. ILLINOIS, INC. TALLULAH FALLS SCHOOL TALON INC TAYLOR ORCHARDS, INC. TAYLOR REPO, INC. TBN OF GA., INC./TBN OF TENN. TC BAYCOR TDK ELECTRONICS CORP. TECH CON, INC. TEETS INTERNATIONAL TRUCKS INC TELIGENT TENNECO AUTOMOTIVE TENNECO OIL CO. TERMINIX AT GAINESVILLE TERRY HICKS ELECTRIC CO TERRY STOVER CONSTRUCTION TETON INDUSTRIAL TFE GROUP THE BOOK WAREHOUSE
GAINESVILLE
GA
GRIFFIN
GA
ALBANY
GA
SAVANNAH
GA
PERRY
GA
NORCROSS
GA
DALLAS
GA
MARIETTA
GA
MIAMI
FL
COLUMBUS
GA
COLUMBUS
GA
JULIETTE
GA
ATLANTA
GA
MIAMI
FL
ATHENS
GA
CHATSWORTH
GA
GOSHEN
GA
CANTON
GA
FARGO
GA
AUGUSTA
GA
COLUMBUS
GA
JACKSONVILLE
FL
COLUMBUS
GA
CHICKAMAUGA
GA
SAVANNAH
GA
MARIETTA
GA
PALMETTO
GA
BETHLEHEM
GA
KANKAKEE
IL
TALLULAH
GA
CHAROLETTE
NC
REYNOLDS
GA
WEST BLACKSHEAR GA
BRUNSWICK
GA
CORNELIA
GA
PEACHTREE CITY GA
BLUE RIDGE
GA
AUGUSTA
GA
VIENNA
VA
HARTWELL
GA
MOULTRIE
GA
CUMMING
GA
COVINGTON
GA
KINGSLAND
GA
CEDAR SPRINGS GA
KENNESAW
GA
KNOXVILLE
TN
Page 55
8,460.00 10,959.80
2,036.35 45,331.50
503.70 2,561.83 4,820.23 7,175.00
224.00 26,452.58 230,024.76
5,828.79 16,064.92 38,153.42
3,811.80 10,110.80 33,066.66 31,957.79 131,669.75
7,024.83 26,678.38 37,707.66 22,402.05
3,685.64 13,763.46
3,364.93 140.59
50,253.52 86,532.30 36,767.21
8,500.05 67,126.35 16,994.32 50,125.37
2,792.04 6,245.61 4,817.56 7,260.00 407,832.44 200,013.88 17,767.82
197.16 17,679.68
9,851.14 19,792.07 14,191.87 79,077.73
Subsequent Injury Trust Fund 2004 Annual Report
THE CHEESECAKE FACTORY
ATLANTA
GA
THE CLASSIC CENTER
ATHENS
GA
THE CONCRETE CO., INC.
COLUMBUS
GA
THE DARIEN NEWS, INC.
DARIEN
GA
THE FARM GOLF CLUB
ROCKY FACE
GA
THE GILBERT COMPANIES
MUNCIE
IN
THE GREATER TRAVELERS REST
DECATUR
GA
THE KINGS CARPENTERS, INC.
CANTON
GA
THE MASQUERADE, INC.
ATLANTA
GA
THE MORRIS LIVING CENTER
MARIETTA
GA
THE MOTOR CONVOY, INC.
ATLANTA
GA
THE PLASTICS GROUP OF AMERICA
WOONSOCKET
RI
THE RAYMOND KING CO., INC.
CALHOUN
GA
THE RETREAT
NASHVILLE
GA
THE SPORT SHOE, INC.
NORCROSS
GA
THE TAPPAN COMPANY
DALTON
GA
THE TLC COMPANIES
CHESTERTON
IN
THE WILLIAM L BONNELL CO., INC
NEWNAN
GA
THOMAS AND BETTS
BAINBRIDGE
GA
THOMAS COUNTY PUBLIC SCHOOLS
THOMASVILLE
GA
THOMAS PACKING CO.
GRIFFIN
GA
THOMPSON HARDWOODS, INC.
HAZELHURST
GA
THOMPSON CONSTRUCTION CO.
CHAMBLEE
GA
THOMPSON'S FARM SUPPLY
VIDALIA
GA
THOMSON OAK FLOORING CO.
THOMSON
GA
TIDEWATER COMPANIES, INC.
BRUNSWICK
GA
TIFT COUNTY BOARD OF EDUCATION TIFTON
GA
TIMBER HARVESTING, INC.
DANVILLE
GA
TIMESAVER 84
SAVANNAH
GA
TINDALL CORP
MORROW
GA
TNS MILLS, INC.
LAVONIA
GA
TOBACCO EXPORTERS INT'L
TUCKER
GA
TOCCOA METAL TECHNOLOGIES
TOCCOA
GA
TOCCOA TIRE & RECAPPING
TOCCA
GA
TOG SHOP
AMERICUS
GA
TOM JAMES CO
BREMEN
GA
TOMMY GIBSON BUILDERS INC
MACON
GA
TONY'S FOOD MART
ROCKMART
GA
TOPCON AMERICA CORP.
PARAMUS
NJ
TORCO INC
MARIETTA
GA
TORRINGTON
CALHOUN
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 CO
MACON
GA
TRANE UNITARY PRODUCTS
VIDALIA
GA
Page 56
6,365.09 50,377.68
6,394.27 5,780.85
104.50 260,470.63
108.00 13,904.99 55,489.43
5,066.27 25,105.00 24,222.82 50,419.40
6,421.77 6,582.62 32,885.19 11,703.23 8,074.76 11,837.40 1,273.77 13,195.14 21,824.94 23,783.81 7,264.10 59,209.03 37,281.48 33,370.09 25,479.13 37,379.22 3,924.53 42,059.49 6,104.28 28,476.83 2,577.80 92,389.50 60,554.54 35,545.25 17,508.64 1,343.40 22,126.54 85,365.00 56,111.17 3,108.43 36,337.71 19,073.70 101,349.79
108.00
Subsequent Injury Trust Fund 2004 Annual Report
TRANS WORLD AIRLINES, INC. TRANSPOWER TRAVEL CENTERS OF AMERICA TRENT TUBE DIVISION TRILLIUM COOKIE CO TRINITY INDUSTRIES TRI-SOUTH CONTRACTORS,INC TROJAN BATTERY COMPANY TRU-CHECK INC TRUCKS, INC. TRU-GREEN LANDCARE TRUS JOIST MACMILLIAN TRW AERONAUTICAL SYSTEMS TUCKER CONCRETE TURNER BD OF ED TURNER BROADCASTING SYSTEM TURNER PLUMBING, HEATING & AIR TWIGGS COUNTY BOC TWIGGS COUNTY BOE TYCO U.S. CAN CO U.S. CAN CO U.S. FILTER UNDERGROUND UTILITIES, INC. UNION MISSION INC. UNITED DISTRIBUTORS, INC. UNITED DISTRIBUTORS, INC. UNITED INSURANCE CO OF AMER. UNITED PARCEL SERVICE UNITED WATER SERVICES ATL. UNIVERSAL BLANCHERS UPSON COUNTY US FOODSERVICE-ATLANTA US PERSONNEL US XPRESS, INC. UTILITIES CONST. CO OF SC UVALDA MANUFACTURING CO V.F. CORPORATION/LEE CO. V.T. INDUSTRIES, INC. VANCEVILLE TURF VANGUARD SERVICES VANTAGE PRODUCTS CORP. VARN TURPENTINE & CATTLE VAUGHAN CARTAGE CO., INC. VCG, Inc. VENTURE EXPRESS, INC. VIACON, INC
ATLANTA
GA
ALBANY
GA
WESTLAKE
OH
CARROLLTON
GA
ALBANY
GA
CHICAGO HEIGHTS IL
STONE MTN.
GA
LITHONIA
GA
SOMERSET
KY
JACKSON
GA
LILBURN
GA
COLBERT
GA
MACON
GA
TUCKER
GA
ASHBURN
GA
ATLANTA
GA
COLUMBUS
GA
JEFFERSONVILLE GA
JEFFERSONVILLE GA
AUGUSTA
GA
MORROW
GA
TALLAPOOSA
GA
THOMASVILLE
GA
SAINT MARY'S
GA
SAVANNAH
GA
SMYRNA
GA
ALBANY
GA
SAVANNAH
GA
JACKSONVILLE
FL
ATLANTA
GA
PEACHTREE CITY GA
THOMASTON
GA
FAIRBURN
GA
IRIVNG
TX
TUNNEL HILL
GA
CHARLESTON
SC
UVALDA
GA
JASPER
GA
ARMUCHEE
GA
TIFTON
GA
INDIANAPOLIS
IN
CONYERS
GA
JACKSONVILLE
FL
LAGRANGE
GA
ATLANTA
GA
LAVERGNE
TN
NORCROSS
GA
Page 57
8,559.21 4,926.44 21,735.62 13,001.16 1,755.31 54,231.78 3,721.25 2,142.25 1,576.56 29,623.09 54,428.98 13,867.27 1,917.40 36,775.90 25,829.21
156.75 1,079.06 68,002.84 5,731.58 20,780.44 9,468.54 22,616.24 4,680.07 79,832.67 53,879.95 20,959.32 4,328.09 2,365.96 5,600.00
771.00 64.91
139,007.55 33,297.38 3,848.22 29,371.87 49,027.44 21,653.31 6,711.50 187.66 5,112.29
574,666.77 24,890.58 16,832.57 254.79 12,179.06 17,988.72 43,530.59
Subsequent Injury Trust Fund 2004 Annual Report
VICTORY BAPTIST CHURCH VICTORY RETIREMENT, INC. VILLAGE PODIATRY, INC. VINCE HOSIERY MILL VINCENT KARM VISITING NURSES ASSOCIATION VISITING NURSES ASSOCIATION VISTA HOSPITAL CARE VOS ELECTRIC VOUGHT AIRCRAFT W & J, INC. W.A. BRAGG & CO. W.B. RODDENBERRY CO., INC. W.C. BRADLEY CO. WADE & SONS INC WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WALTON MONROE MILLS, INC. WASTE MGMT OF ATLANTA WASTE MGMT OF SAVANNAH WATER VISTA APARTMENTS WATER, GAS & LIGHT COMMISSION WATERS LOGGING WATTYL PAINT CORP. WAYCROSS COCA-COLA WAYFIELD FOODS, INC. WAYNE POULTRY WAYNE S. HADDOCK WEEKS TEXTILE WELLESLEY INN WENDY'S WESLEY TURTON D/B/A RAMADA WEST GEORGIA AUTO PARTS INC WEST LUMBER CO WEST PLUMBING SALES & SER WESTEK INC. WESTERN SIZZLIN' WESTSIDE HEATING & AIR WHITE CONSOLIDATED INDUSTRIES
STONE MTN.
GA
NASHVILLE
GA
SMYRNA
GA
VILLA RICA
GA
LAWRENCEVILLE GA
BAXLEY
GA
TIFTON
GA
MACON
GA
GREEN BAY
WI
MILLEDGEVILLE GA
SMYRNA
GA
AUGUSTA
GA
CAIRO
GA
COLUMBUS
GA
MACON
GA
MOULTRIE
GA
THOMASTON
GA
ALPHARETTA
GA
HINESVILLE
GA
SNELLVILLE
GA
STATESBORO
GA
JESUP
GA
TIFTON
GA
CEDARTOWN
GA
FORT OGLETHORPE GA
MONROE
GA
LAKE CITY
GA
GARDEN CITY
GA
LAWRENCEVILLE GA
ALBANY
GA
NICHOLS
GA
ATLANTA
GA
WAYCROSS
GA
ATLANTA
GA
PENDERGRASS GA
WAYCROSS
GA
QUITMAN
GA
ALPHARETTA
GA
VALDOSTA
GA
CORDELE
GA
CARROLLTON
GA
ATLANTA
GA
WARNER ROBBINS GA
THOMASTON
GA
VIDALIA
GA
EVANS
GA
NORCROSS
GA
Page 58
31,714.83 11,343.36 88,649.18 22,834.86 79,030.84 10,350.00 28,246.46 34,771.26 21,811.12 10,207.12 34,110.05 108,463.44
2,727.00 1,950.00 7,000.00 72,146.34 11,428.19 1,992.32 13,677.14
790.21 10,106.46
6,995.43 3,269.31 24,417.22 4,995.77 8,235.00 200,287.44 66,247.91 57,567.59 6,885.00 154,532.59 17,349.28 16,491.23 7,030.88 10,826.97 4,446.09 8,210.00 27,108.34 148,852.86
78.96 4,730.00 64,435.28 2,840.60 4,111.17 67,095.59 8,269.01
708.07
Subsequent Injury Trust Fund 2004 Annual Report
Page 59
WHITEHEAD DIE CASTING CO. WHITLOW ELECTRIC SERVICE,INC. WIGHT NURSERIES WIKA INSTRUMENT CORP WILKINS INDUSTRIES WILKINSON CO. BD OF EDUCATION WILLIAM CARTER CO WILLIAM CARTER CO WILLIAM J. LUMLEY & CO. WILLIAMS & ASSOCIATES INC WIREGRASS HOSPICE WOLVERINE METAL STAMPING, INC. WOOD HOLLOW CABINET, INC. WRIGHT & EVANS INC WS BADCOCK CORP. WWF, INC. YOKOGAWA CORP OF AMERICA YOUNG REFINING CORP. ZARTRAN, INC. ZUA AUTO PARTS, INC Total Companies: 1409
GAINESVILLE
GA
ELBERTON
GA
CAIRO
GA
LAWRENCEVILLE GA
ATHENS
GA
IRWINGTON
GA
MILNER
GA
BARNESVILLE
GA
ADRIAN
GA
MACON
GA
DOTHAN
AL
DECATUR
GA
DALTON
GA
ST. MARY'S
GA
THOMASON
GA
ATHENS
GA
NEWNAN
GA
DOUGLASVILLE GA
CEDARTOWN
GA
OAKWOOD
GA
Total:
24,621.25 73,993.13 30,275.02
1,787.14 101,387.45
4,089.79 42,059.81 158,637.37 27,225.00 31,121.10 42,352.36 109,713.67
7,351.58 20,142.23
5,373.55 20,018.97
9,806.03 164,583.11 219,290.71
46,585.63 $54,612,056.78
Subsequent Injury Trust Fund 2004 Annual Report
Page 60
ASSESSMENT 2004
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 2004 Annual Report
Page 61
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 Rate Adjustment for 2003
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2003 was $94,996,319.37. This was computed in the following manner:
Total Fund Disbursements/Calendar Year 2003
$90,543,370.39
(less) Net Assets (as of 12/31/2003) Fund Assessment
x
175%
- 63,454,578.81
$94,996,319.37
The assessment rate is based on data provided by insurers and self-insured employers' in the Annual Assessment Reports; the actual updated total of workers' compensation benefits (indemnity, medical, and rehabilitation) paid in Georgia during calendar year 2003 was $1,120,729,553.74. This revised amount is divided into the fund's assessment of $94,996,319.37 and yields an (adjusted) assessment rate of .08476293. This adjustment has caused an increase to be applied to the 2003 assessment.
Assessment Rate for 2004
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2004 is $125,909,963.38. This was computed in the following manner:
Total Fund Disbursements/Calendar Year 2004
$103,386,020.33
(less) Net Assets (as of 12/31/2004) Fund Assessment
x
175%
180,925,535.58
- 55,015,572.20
$125,909,963.38
Based on data reported by insurers and self-insured employers, the total of workers' compensation benefits paid in Georgia during calendar year 2004 was $1,232,524,424.65. This amount is divided into the fund assessment $125,909,963.38, which yields an assessment rate of .10215616.
In addition to the assessment, an additional $926,904.65 in penalties for late filing of Annual Assessment Report forms will be levied.
Subsequent Injury Trust Fund 2004 Annual Report
Page 62
Assessments Due for 2003 - 2004 Combined with the assessment adjustment for 2003 and the assessment amount for 2004, the total 2003 2004 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 2003-2004 assessment amount due from insurance companies.
Insurance Company Name
2003 $ Assessment
2003 Assessment $ Adjustment
2004 Claims Paid
2004 $ Assessment
2003 $ Balance
Due
2003 and 2004 Total
Assessment
ACCIDENT FUND INS CO OF AMER ACE AMERICAN INSURANCE CO ACE FIRE UNDERWRITERS INS. CO ACE INDEMNITY INSURANCE CO ACE PROPERTY & CASUALTY INS ACIG INSURANCE COMPANY ADVANTAGE WORKERS COMP. INS. AIG PREMIER INSURANCE CO 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 MUT 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
0.00 511,793.01 24,389.09
6,363.20 51,091.88 9,957.33 1,062.78
0.00 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
0.00 511,864.26 24,392.48
6,364.09 51,098.99 9,958.71 1,062.93
0.00 94,049.22
84.25 759.81 34,147.09 140,585.00 29,483.26 12,860.74 675,442.14 69,468.99 1,384,045.68 24,644.40 16,255.02 7,300.38 92,936.03 78,365.99 2,049.65 2,421,482.55 289,546.61 1,181,799.70 476,153.39 595,742.24 417,527.95 722,203.41
17,468.00 19,116,453.00 1,030,393.00
25,315.00 3,216,131.00
302,508.00 10,490.00
637.00 553,073.00 201,628.26 65,248.00 421,518.00 3,268,575.00 978,635.00
0.00 7,014,541.00
559,572.00 15,545,697.23
20,328.00 922,962.00 149,811.00 12,404.00 906,873.07 23,174.00 31,108,303.00 3,278,642.00 12,759,520.93 9,761,473.00 4,619,457.71 9,966,353.97
0.00
1,784.46 1,952,863.43
105,260.99 2,586.08
328,547.59 30,903.06 1,071.62
65.07 56,499.81 20,597.57 6,665.49 43,060.66 333,905.07 99,973.59
0.00 716,578.57 57,163.73 1,588,088.73
2,076.63 94,286.25 15,304.12 1,267.15 92,642.67 2,367.37 3,177,904.78 334,933.48 1,303,463.66 997,194.60 471,906.06 1,018,124.45
0.00
0.00 71.25 3.39 0.89 7.11 1.38 0.15 0.00 13.10 0.01 0.10 4.76 19.57 4.10 1.79 94.03 9.68 192.68 3.43 2.27 1.02 12.94 10.91 0.28 337.10 40.31 164.52 66.29 82.94 58.13 100.54
1,784.46 1,952,934.68
105,264.38 2,586.97
328,554.70 30,904.44 1,071.77
65.07 56,512.91 20,597.58 6,665.59 43,065.42 333,924.64 99,977.69
1.79 716,672.60 57,173.41 1,588,281.41
2,080.06 94,288.52 15,305.14 1,280.09 92,653.58 2,367.65 3,178,241.88 334,973.79 1,303,628.18 997,260.89 471,989.00 1,018,182.58
100.54
Subsequent Injury Trust Fund 2004 Annual Report
Page 63
AMERICAN RESOURCES INS CO 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 CENTRL 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 ATHENA ASSURANCE CO ATLANTIC MUTUAL INS. CO ATLANTIC SPECIALTY 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 EXCHG 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 CLARENDON NATIONAL INS CO
53,543.31 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
0.00 183,769.94
0.00 174,406.89
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 83,803.44 101,708.33 635,773.23
53,550.76 76,202.13 149,414.85
0.00 405,897.27 15,962.89 65,616.59 44,854.93 16,558.52 23,500.52 68,456.41 13,067.99 58,227.98 34,541.83 40,380.30 141,312.77 47,605.49
0.00 183,795.53
0.00 174,431.18
4,952.70 570.88
337,173.88 67,932.91 1,848.59 205,319.21 20,113.40 383,650.16 19,118.02 2,481,178.03 1,040,024.29 414,376.21 1,462.16 152,654.90 59,041.62 33,272.84 89,100.84 10,963.24 198,303.47
395.00 323.54 51,835.07 195,989.36 73,345.53 83,815.11 101,722.49 635,861.75
822,375.00 244,233.00 1,859,079.48 96,350.00 8,092,896.62 65,678.00 951,928.00 1,145,308.00 260,334.00 244,444.00 2,705,348.00 440,856.00 355,564.00 346,001.20 498,530.00 2,289,599.00 3,429,235.70
6,770.24 2,949,760.00
22,468.00 4,470,122.00
31,836.00 9,381.00 3,101,967.00 4,314,040.00
0.00 2,878,887.00
161,557.00 8,131,912.00
243,467.00 33,661,703.00 11,718,337.84 4,776,007.00
21,714.00 0.00
1,111,615.00 740,972.00 472,268.00 110,746.00
2,990,929.00 0.00
19,090.00 756,233.00 2,243,300.90 1,272,551.47 870,832.07 987,416.36 8,173,022.00
84,010.67 24,949.91 189,916.42 9,842.75 826,739.24 6,709.41 97,245.31 117,000.27 26,594.72 24,971.46 276,367.96 45,036.16 36,323.05 35,346.15 50,927.91 233,896.64 350,317.55
691.62 301,336.15
2,295.24 456,650.50
3,252.24 958.33
316,885.04 440,705.76
0.00 294,096.04 16,504.04 830,724.90 24,871.65 3,438,750.32 1,197,100.40 487,898.54
2,218.22 0.00
113,558.32 75,694.85 48,245.09 11,313.39 305,541.82
0.00 1,950.16 77,253.86 229,167.01 129,998.97 88,960.86 100,870.66 834,924.54
7.45 10.61 20.80 0.00 56.51 2.22 9.13 6.24 2.30 3.27 9.53 1.82 8.11 4.81 5.62 19.67 6.63 0.00 25.59 0.00 24.29 0.69 0.08 46.94 9.46 0.25 28.58 2.80 53.41 2.66 345.41 144.78 57.68 0.20 21.25 8.22 4.63 12.40 1.53 27.61 0.06 0.04 7.21 27.29 10.21 11.67 14.16 88.52
84,018.12 24,960.52 189,937.22 9,842.75 826,795.75 6,711.63 97,254.44 117,006.51 26,597.02 24,974.73 276,377.49 45,037.98 36,331.16 35,350.96 50,933.53 233,916.31 350,324.18
691.62 301,361.74
2,295.24 456,674.79
3,252.93 958.41
316,931.98 440,715.22
0.25 294,124.62 16,506.84 830,778.31 24,874.31 3,439,095.73 1,197,245.18 487,956.22
2,218.42 21.25
113,566.54 75,699.48 48,257.49 11,314.92 305,569.43
0.06 1,950.20 77,261.07 229,194.30 130,009.18 88,972.53 100,884.82 835,013.06
Subsequent Injury Trust Fund 2004 Annual Report
Page 64
COLONIAL AMERICAN CAS & SURETY COLUMBIA NATIONAL INS CO COMBINED SPECIALTY INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL INS OF NEWARK NJ COMMERCIAL MUTUAL INS CO COMPANION COMMERICAL 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 FAIRMONT SPECIALTY INS 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 FIDELITY & GUARANTY INS CO FIRE & CASUALTY INS CO OF CT FIREMAN'S FUND INS CO
0.00 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 11,554.97 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 16,112.05 940,511.26 149,317.17 214,686.73
0.00 98,542.75 131,067.14 701,568.96 1,845.83 659,869.38 59,995.20 478,708.82 249,238.61 1,850,305.15
0.00 6,982.26 786,591.01 15,947.30 15,335.39 91,934.30
140.66 1,252.12 46,020.68 1,448.42 81,404.79 83,325.86 20,926.02 12,773.35 6,050.89 903,185.81 53,927.45 556,183.75 159,980.62 1,018.68 25,634.01 94,458.92 407,075.50 11,556.58 6,273.98
107.56 205,022.90 316,587.68 360,634.65 28,697.08 30,729.53 173,579.05 112,056.14 14,337.40 16,114.30 940,642.21 149,337.96 214,716.62
228.86 1,448,593.15 1,235,118.00 16,088,416.00
0.00 7,008,505.28
242,379.00 10,083,995.00
0.00 15,537,799.67
425,199.83 1,148,224.00 8,025,080.17
253,511.00 195,449.00 1,314,802.00
1,526.00 0.00
204,228.00 13,280.95 712,179.00 779,974.00 142,448.00 91,237.00 19,325.00 10,982,491.00 835,929.00 6,371,440.00 1,327,674.00
0.00 671,221.00 1,351,708.48
0.00 80,797.00 222,961.00 4,751.00 4,314,050.00 4,157,329.00 4,227,926.00 327,382.00 208,886.00 2,310,384.00 765,664.59 224,274.19 126,491.13 11,947,058.52
0.00 2,185,897.00
23.38 147,982.71 126,174.91 1,643,530.80
0.00 715,961.99 24,760.51 1,030,142.21
0.00 1,587,281.95
43,436.78 117,298.15 819,811.37 25,897.71 19,966.32 134,315.12
155.89 0.00
20,863.15 1,356.73 72,753.47 79,679.15 14,551.94 9,320.42 1,974.17 1,121,929.11 85,395.30 650,881.84 135,630.08
0.00 68,569.36 138,085.35
0.00 8,253.91 22,776.84
485.34 440,706.78 424,696.77 431,908.68 33,444.09 21,338.99 236,019.96 78,217.35 22,910.99 12,921.85 1,220,465.62
0.00 223,302.84
0.00 13.71 18.25 97.67 0.26 91.86 8.35 66.64 34.69 257.58 0.00 0.97 109.50 2.22 2.13 12.80 0.02 0.18 6.41 0.20 11.33 11.60 2.92 1.78 0.85 125.74 7.51 77.43 22.27 0.14 3.57 13.15 56.67 1.61 0.87 0.01 28.54 44.07 50.20 3.99 4.28 24.16 15.60 2.00 2.25 130.95 20.79 29.89
23.38 147,996.42 126,193.16 1,643,628.47
0.26 716,053.85 24,768.86 1,030,208.85
34.69 1,587,539.53
43,436.78 117,299.12 819,920.87 25,899.93 19,968.45 134,327.92
155.91 0.18
20,869.56 1,356.93 72,764.80 79,690.75 14,554.86 9,322.20 1,975.02 1,122,054.85 85,402.81 650,959.27 135,652.35
0.14 68,572.93 138,098.50
56.67 8,255.52 22,777.71
485.35 440,735.32 424,740.84 431,958.88 33,448.08 21,343.27 236,044.12 78,232.95 22,912.99 12,924.10 1,220,596.57
20.79 223,332.73
Subsequent Injury Trust Fund 2004 Annual Report
Page 65
FIREMAN'S FUND INS CO OF GA FIREMAN'S FUND OF WISCONSIN FIREMAN'S INS CO OF NEWARK NJ FIRST LIBERTY INS CORP FIRST NATL INS CO OF AMER 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 C GA TIMBER HARVERSTERS' GENERAL CASUALTY CO OF WI GENERAL INS CO OF AMERIC GEORGIA CASUALTY & SURETY CO GEORGIA INSURANCE CO GERBER LIFE INS CO GLENS FALLS INS CO GLOBE INDEMNITY CO GRANGE MUTUAL CASUALTY COMPANY GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GRAY INSURANCE CO GREAT AMER ALLIANCE INS CO GREAT AMER INS CO OF NY GREAT AMERICAN ASSUR CO GREAT AMERICAN INS CO GREAT NORTHERN INS CO GREAT WEST CASUALTY CO GREATER NEW YORK MUTUAL INS GREENWICH INSURANCE CO GUARANTEE INSURANCE CO GUARANTY NATIONAL INS. CO. GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALITY INS HARCO NATIONAL INS CO 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 INS OF THE MIDWEST HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HOSPITALITY MUT CAPTIVE INS
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 0.00 101,486.77 80,756.98 132,027.89 100,880.46 275.86 22,583.38 91,511.89 33,490.93 1,155,861.51 142,367.41 137,897.29 601,817.44 624,495.65 197,485.53 47,491.82
71,891.00 57,588.19 1,169.73 19,343.83 96,571.17 23,949.29 26,719.72 185,128.85 10,263.35 11,031.73 67,456.03 153,699.52
737.69 52,508.14 415,817.44 165,088.77 26,300.84 10,053.61 16,862.65 9,223.90 168,668.06 35,139.34 1,792.71 119,590.27 68,603.63 35,757.04 70,548.50 17,814.37 58,966.69
790.33 52,878.93
0.00 0.00 101,500.90 80,768.22 132,046.27 100,894.50 275.90 22,586.53 91,524.63 33,495.60 1,156,022.44 142,387.23 137,916.49 601,901.23 624,582.60 197,513.03 47,498.43
673,515.00 135,384.00 15,276.80 281,739.00 847,971.17 280,894.87 447,833.61 997,121.00 209,346.00 169,093.00 692,983.00 3,406,140.00
9,406.00 248,776.00 5,630,026.00 2,076,360.00 412,169.96 108,568.62
0.00 467,992.00 3,815,173.00 635,118.64 14,133.70 619,247.62 1,188,404.26 1,107,742.22 900,460.40 291,157.00 1,417,725.00 76,080.00 374,559.00 44,760.00 41,806.00 832,800.00 923,817.00 1,446,859.26 957,776.00 60,103.00 282,706.00 1,253,660.00 2,107,777.00 10,807,462.00 2,058,902.00 1,425,742.00 10,718,939.00 10,441,089.00 2,392,535.00 1,159,193.00
68,803.71 13,830.31 1,560.62 28,781.37 86,625.48 28,695.14 45,748.96 101,862.05 21,385.98 17,273.89 70,792.48 347,958.18
960.88 25,414.00 575,141.84 212,112.96 42,105.70 11,090.95
0.00 47,808.27 389,743.42 64,881.28 1,443.84 63,259.96 121,402.82 113,162.69 91,987.58 29,743.48 144,829.34 7,772.04 38,263.51 4,572.51 4,270.74 85,075.65 94,373.60 147,805.59 97,842.72 6,139.89 28,880.16 128,069.09 215,322.40 1,104,048.82 210,329.52 145,648.33 1,095,005.65 1,066,621.56 244,412.19 118,418.71
10.01 8.02 0.16 2.69 13.44 3.33 3.72 25.77 1.43 1.54 9.39 21.40 0.10 7.31 57.89 22.98 3.66 1.40 2.34 1.28 23.48 4.90 0.25 16.65 9.55 4.98 9.82 2.48 8.21 0.11 7.36
0 0.00 14.13 11.24 18.38 14.04 0.04 3.15 12.74 4.67 160.93 19.82 19.20 83.79 86.95 27.50 6.61
68,813.72 13,838.33 1,560.78 28,784.06 86,638.92 28,698.47 45,752.68 101,887.82 21,387.41 17,275.43 70,801.87 347,979.58
960.98 25,421.31 575,199.73 212,135.94 42,109.36 11,092.35
2.34 47,809.55 389,766.90 64,886.18 1,444.09 63,276.61 121,412.37 113,167.67 91,997.40 29,745.96 144,837.55 7,772.15 38,270.87 4,572.51 4,270.74 85,089.78 94,384.84 147,823.97 97,856.76 6,139.93 28,883.31 128,081.83 215,327.07 1,104,209.75 210,349.34 145,667.53 1,095,089.44 1,066,708.51 244,439.69 118,425.32
Subsequent Injury Trust Fund 2004 Annual Report
Page 66
HOUSTON GENERAL INS CO INDEMNITY INS CO OF NA INDIANA LUMBERMENS MUTUAL INS INSURA PROP & CAS INS CO INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INSURANCE COMPANY OF THE WEST INSURANCE CORP. OF NEW YORK INTERNATIONAL BUS & MERCANTILE JEFFERSON PILOT FIN INS CO KANSAS CITY FIRE & MARINE INS KEY RISK INSURANCE CO LEGION INS CO-IN LIQUIDATION LIBERTY INSURANCE CORP LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INSURANCE CO LM INSURANCE CORP LUMBER MUTUAL INSURANCE CO LUMBERMENS 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 INSURANCE CO MEDMARC CASUALTY INS MID-CENTURY INSURANCE CO MIDDLESEX INSURANCE CO MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MITSUI SUMITOMO INS CO OF AMER MITSUI SUMITOMO INS USA, INC MONUMENTAL GENERAL CAS NATIONAL AMERICAN INSURANCE CO NATIONAL FARMERS UNION P & C NATIONAL FIRE INS CO HARTFORD NATIONAL INTERSTATE 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
15,343.09 0.00
9,453.48 1,820.37 54,852.88 1,049,534.18 1,597.64 43,227.99
0.00 51,578.18 1,158.52 211,513.23 1,073,277.29 635,549.23 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
68.99 30,147.67 3,446.40 145,717.87 17,063.71
0.00 453,170.74
15.93 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
15,345.23 0.00
9,454.80 1,820.62 54,860.52 1,049,680.31 1,597.87 43,234.01
0.00 51,585.36 1,158.68 211,542.67 1,073,426.73 635,637.72 1,438,695.62 824,519.79 443,482.62 5,405.50 1,390,492.37 461,260.28 17,595.43 32,830.97 92,972.22 87,657.50 255,430.94 38,348.63 72,945.20
0.00 61,602.65 17,185.01
69.00 30,151.87 3,446.88 145,738.16 17,066.08
0.00 453,233.83
15.94 44,269.30 486,778.21 353,925.92 18,569.44 49,250.65 24,406.04 23,347.36 21,682.95
929.68 87.73
0.00 6,791,659.00
0.00 605,170.00 438,491.00 17,706,547.00
0.00 185,373.00
3,167.00 513,212.00 12,167.84 5,355,304.00
0.00 4,966,538.00 20,408,684.00 11,071,533.00 8,533,314.00
120,412.00 9,898,580.57 5,456,392.84
158,659.00 185,190.00 1,573,399.00 1,060,215.00 3,324,415.71 478,241.57 640,832.14 53,897.00 574,108.00 328,853.00 97,790.00 751,377.00 262,887.00 451,725.60 46,874.00 257,841.00 4,300,165.64 29,203.00 894,734.00 6,702,346.40 2,580,592.00 321,594.00 586,310.00 437,570.00 209,224.00 193,116.00 17,888.05
512.00
0.00 693,809.80
0.00 61,821.84 44,794.56 1,808,832.85
0.00 18,936.99
323.53 52,427.77 1,243.02 547,077.29
0.00 507,362.45 2,084,872.79 1,131,025.30 871,730.59 12,300.83 1,011,200.98 557,404.14 16,207.99 18,918.30 160,732.40 108,307.49 339,609.54 48,855.32 65,464.95
5,505.91 58,648.67 33,594.36 9,989.85 76,757.79 26,855.53 46,146.55 4,788.47 26,340.05 439,288.41 2,983.27 91,402.59 684,685.97 263,623.37 32,852.81 59,895.18 44,700.47 21,373.52 19,727.99 1,827.37
52.30
2.14 0.00 1.32 0.25 7.64 146.13 0.23 6.02 0.00 7.18 0.16 29.44 149.44 88.49 200.28 114.78 61.74 0.75 193.57 64.21 2.45 4.57 12.94 12.20 35.56 5.34 10.16 0.00 8.58 2.40 0.01 4.20 0.48 20.29 2.37 0.00 63.09 0.01 6.16 67.76 49.27 2.59 6.85 3.39 3.25 3.02 0.13 0.01
2.14 693,809.80
1.32 61,822.09 44,802.20 1,808,978.98
0.23 18,943.01
323.53 52,434.95 1,243.18 547,106.73
149.44 507,450.94 2,085,073.07 1,131,140.08 871,792.33 12,301.58 1,011,394.55 557,468.35 16,210.44 18,922.87 160,745.34 108,319.69 339,645.10 48,860.66 65,475.11
5,505.91 58,657.25 33,596.76 9,989.86 76,761.99 26,856.01 46,166.84 4,790.84 26,340.05 439,351.50 2,983.28 91,408.75 684,753.73 263,672.64 32,855.40 59,902.03 44,703.86 21,376.77 19,731.01 1,827.50
52.31
Subsequent Injury Trust Fund 2004 Annual Report
Page 67
NORGUARD INSURANCE CO. NORTH AMERICAN SPECIALTY INS NORTH RIVER INSURANCE CO NORTHBROOK INDEMNITY CO NORTHBROOK PROP & CAS INS CO NORTHERN ASSUR CO OF AMER NORTHERN INS CO OF NY NORTHWESTERN NATIONAL INS CO OCCIDENTAL FIRE & CAS CO OF NC OHIO CASUALTY INSURANCE CO OHIO FARMERS INS CO OHIO SECURITY INSURANCE CO OLD DOMINION 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 CO PEERLESS INSURANCE COMPANY PENN LUMBERMENS MUTUAL PENN MFG ASSOC INS PENN MFG IND. CO PENN MILLERS MUTUAL PENN NATIONAL MUTUAL CAS PENNSYLVANIA GENERAL INS CO PETROLEUM CASUALTY CO PHOENIX INSURANCE CO PRINCETON INSURANCE CO PROTECTIVE INSURANCE CO PROTECTIVE LIFE INS/DIAMOND PROVIDENCE PROPERTY & CASUALTY PROVIDENCE WA INS CO OF N Y PROVIDENCE WASHINGTON INS CO QUANTA INDEMNITY CO REALM NATIONAL INSURANCE RECIPROCAL OF AMER-IN LIQUIDAT REDLAND INSURANCE CO REGENT INSURANCE CO REPUBLIC-FRANKLIN INSURANCE CO ROCHDALE INSURANCE COMPANY ROYAL INDEMNITY CO ROYAL INS CO OF AMERICA S.E. EMPLOYER MUT. CAP. INS CO SAFECO INS CO OF ILLINOIS
56,870.89 33,214.31 32,745.89
794.63 12,271.59 2,048.01 113,790.94 1,581.71 4,626.73 73,066.24 6,024.70 11,096.04 58,232.84 942,405.11 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 81,148.53 328,742.18 37,357.80 3,604.64 39,237.23 3,135.20 42,474.72 50,255.22 224,889.16 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
56,878.81 33,218.93 32,750.45
794.74 12,273.30 2,048.30 113,806.78 1,581.93 4,627.38 73,076.41 6,025.54 11,097.59 58,240.95 942,536.32 3,533.85 105,478.57 158,452.85 45,857.76 254,129.77 1,916,032.38 60,764.93 94,254.43 33,182.91 24,906.74 515,176.63 24,728.82 27,184.23 17,657.22 7,171.45 8,691.34 81,159.83 328,787.95 37,363.00 3,605.14 39,242.69 3,135.64 42,480.64 50,262.21 224,920.47 3,833.30 10,487.63 3,642.86 63,699.00 76,017.35 827,915.31 461,239.43 91,964.13 29,970.28
1,408,216.00 295,013.00 185,613.00 9,450.00 0.00 12,414.00 501,999.20 19,473.00 60,741.00 901,131.00 44,828.00 61,772.00
1,141,594.00 12,080,806.00
30,447.00 1,025,073.00
0.00 231,933.00 4,916,276.00 15,368,701.00 360,263.00 1,369,682.00 606,501.00 308,412.00 8,104,732.00 348,577.00 454,544.00 51,296.00 270,979.00 106,995.11 907,188.00 1,577,265.00 680,920.28 116,827.00 1,263,097.00
0.00 372,280.00
0.00 2,174,123.00
0.00 52,762.00
0.00 752,052.31 2,175,200.00 13,216,295.00
0.00 722,747.00 227,837.21
143,857.94 30,137.40 18,961.51
965.38 0.00
1,268.17 51,282.31 1,989.29 6,205.07 92,056.08 4,579.46 6,310.39 116,620.86 1,234,128.75 3,110.35 104,717.52
0.00 23,693.38 502,227.88 1,570,007.48 36,803.08 139,921.45 61,957.81 31,506.19 827,948.30 35,609.29 46,434.47 5,240.20 27,682.17 10,930.21 92,674.84 161,127.34 69,560.20 11,934.60 129,033.14
0.00 38,030.70
0.00 222,100.06
0.00 5,389.96
0.00 76,826.78 222,210.08 1,350,125.95
0.00 73,833.06 23,274.97
7.92 4.62 4.56 0.11 1.71 0.29 15.84 0.22 0.65 10.17 0.84 1.55 8.11 131.21 0.49 14.69 22.05 6.38 35.37 266.73 8.46 13.12 4.62 3.47 71.72 3.44 3.78 2.46 1.00 1.21 11.30 45.77 5.20 0.50 5.46 0.44 5.92 6.99 31.31 0.54 1.46 0.51 8.87 10.59 115.26 64.21 12.81 4.17
143,865.86 30,142.02 18,966.07
965.49 1.71
1,268.46 51,298.15 1,989.51 6,205.72 92,066.25 4,580.30 6,311.94 116,628.97 1,234,259.96 3,110.84 104,732.21
22.05 23,699.76 502,263.25 1,570,274.21 36,811.54 139,934.57 61,962.43 31,509.66 828,020.02 35,612.73 46,438.25 5,242.66 27,683.17 10,931.42 92,686.14 161,173.11 69,565.40 11,935.10 129,038.60
0.44 38,036.62
6.99 222,131.37
0.54 5,391.42
0.51 76,835.65 222,220.67 1,350,241.21
64.21 73,845.87 23,279.14
Subsequent Injury Trust Fund 2004 Annual Report
Page 68
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 CO 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 EXCHANGE SOUTHERN TRUST INSURANCE CO ST PAUL FIRE & CASUALTY INS CO ST PAUL FIRE & MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE CO STAR INSURANCE CO STATE AUTO PROP & CAS STATE AUTOMOBILE MUTUAL INS STATE FARM FIRE & CASUALTY CO STONEBRIDGE CASUALTY INS CO SUA INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE CAMDEN FIRE INS ASSOC TIG INSURANCE CO TIG PREMIER INSURANCE CO TOKIO MARINE & NICHIDO FIRE TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO TRANSPORTATION CASUALTY INS CO TRANSPORTATION INSURANCE CO TRAVELERS CAS & SUR CO TRAVELERS CAS & SUR CO OF AMER
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 11,276.39 476,183.48 763,925.62 132,427.47 20,140.55
0.00 63,142.05 193,516.83 38,885.85 4,738.18 298,511.02
0.00 10,700.68
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
37,974.01 132,400.80
1,848.93 6,283.31 114,242.21 5,528.92 4,724.18 57,542.59 92,532.05 38,059.23 89,995.94 466,745.86 22,814.88
173.68 138,297.59 19,336.03 475,313.98 24,771.80 40,049.13
53.82 867.63 7,396.41 35,416.16 11,277.96 476,249.78 764,031.98 132,445.90 20,143.36
0.00 63,150.84 193,543.78 38,891.27 4,738.84 298,552.59
0.00 10,702.17
9.32 10,402.53 81,284.85 257,239.90 125,821.08 13,357.62 585,228.33 8,940.94 1,658.64 714,028.19 257,728.47
782.96
239,530.00 0.00
132,578.00 134,213.00 4,926,573.00 34,808.00 49,455.00 1,391,083.00 1,721,045.00 1,114,785.00 1,472,747.00 6,693,352.72 363,793.00
2,412.00 929,492.00 170,039.00 12,094,415.00 49,852.00 472,302.00
889.00 34,632.00 137,896.00 101,213.00 163,048.00 4,097,496.19 15,043,961.57 2,123,348.64 173,026.62 121,098.17 442,641.00 2,010,859.00 250,821.00 105,200.00 3,187,293.00 116,578.62
0.00 1,513,891.00
270,979.00 4,523,589.00
0.00 2,735,923.00
0.00 5,436,840.71
76,593.00 116,362.00 7,644,298.65 2,946,337.00 76,087.00
24,469.47 0.00
13,543.66 13,710.68 503,279.78 3,555.85 5,052.13 142,107.70 175,815.35 113,882.15 150,450.18 683,767.21 37,163.70
246.40 94,953.33 17,370.53 1,235,518.99 5,092.69 48,248.56
90.82 3,537.87 14,086.93 10,339.53 16,656.36 418,584.48 1,536,833.35 216,913.14 17,675.74 12,370.92 45,218.50 205,421.63 25,622.91 10,746.83 325,601.61 11,909.22
0.00 154,653.29 27,682.17 462,112.48
0.00 279,491.39
0.00 555,406.77
7,824.45 11,887.10 780,912.20 300,986.47 7,772.76
5.29 18.43 0.25 0.88 15.91 0.77 0.66 8.01 12.89 5.29 12.53 64.97 3.18 0.02 19.26 2.69 66.17 3.45 5.58 0.00 0.12 1.03 4.93 1.57 66.30 106.36 18.43 2.81 0.00 8.79 26.95 5.42 0.66 41.57 0.00 1.49 0.00 1.45 11.31 35.81 17.52 1.86 81.47 1.25 0.23 99.40 35.88 0.11
24,474.76 18.43
13,543.91 13,711.56 503,295.69 3,556.62 5,052.79 142,115.71 175,828.24 113,887.44 150,462.71 683,832.18 37,166.88
246.42 94,972.59 17,373.22 1,235,585.16 5,096.14 48,254.14
90.82 3,537.99 14,087.96 10,344.46 16,657.93 418,650.78 1,536,939.71 216,931.57 17,678.55 12,370.92 45,227.29 205,448.58 25,628.33 10,747.49 325,643.18 11,909.22
1.49 154,653.29 27,683.62 462,123.79
35.81 279,508.91
1.86 555,488.24
7,825.70 11,887.33 781,011.60 301,022.35 7,772.87
Subsequent Injury Trust Fund 2004 Annual Report
Page 69
TRAVELERS CAS INS CO OF AMER TRAVELERS COMMERICAL CASUALTY TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMER TRAVELERS INSURANCE - ALT TRAVELERS INSURANCE CO TRAVELERS PROP CAS CO OF AMER 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. UNISUN INSURANCE COMPANY UNITED BUSINESS INS CO (A MUTU 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 VILLANOVA INS CO-IN LIQUIDATIO 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 YORK INSURANCE CO ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Total: 357 Grand Total:
494.95 0.00
126,570.64 184,825.77 283,853.99
4,420.28 3,992.96 3,013,219.56 40,249.24 43,108.32 3,381.91 8,448.25 694,578.99 183,867.18 295,641.94 3,251.99 18,711.18 213,089.17 265,865.40 74,171.00 14,624.13 130,168.67 360,162.37 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 15,277.83 312,856.51 2,961,707.77 6,925.69 $66,387,175.77
495.02 0.00
126,588.27 184,851.51 283,893.51
4,420.90 3,993.52 3,013,639.09 40,254.85 43,114.33 3,382.38 8,449.42 694,675.69 183,892.78 295,683.11 3,252.44 18,713.79 213,118.84 265,902.41 74,181.33 14,626.16 130,186.79 360,212.52 26,019.08 23,048.14 13,778.13 67,702.70 6,836.55 166,489.06 26,621.24 227,523.11 141,985.62 9,521.08 95,531.21 15,279.96 312,900.07 2,962,120.13 6,926.66 $66,396,418.99
2,696.00 750.00
857,816.00 1,848,730.00 7,339,457.00
222,976.00 827,841.00 36,910,866.00 577,899.38 414,486.00 96,763.00 326,486.00 9,732,375.00 1,777,763.21 1,115,968.00
0.00 701,127.00 1,964,666.00 3,552,433.00 1,467,195.80 173,343.86 654,880.06 4,599,868.26 460,767.00 312,873.00
0.00 979,091.00 16,432.00 2,553,793.00 310,969.00 7,111,232.00 3,528,846.00 92,686.00 843,513.00 108,721.00 4,296,363.00 38,441,874.92 67,482.90 $850,912,554.75
275.41 76.62 87,631.19 188,859.16 749,770.74 22,778.37 84,569.06 3,770,672.33 59,035.98 42,342.30 9,884.94 33,352.56 994,222.06 181,609.46 114,003.01 0.00 71,624.44 200,702.73 362,902.91 149,883.09 17,708.14 66,900.03 469,904.88 47,070.19 31,961.90 0.00 100,020.18 1,678.63 260,885.69 31,767.40 726,456.15 360,493.36 9,468.45 86,170.05 11,106.52 438,899.95 3,927,074.33 6,893.79 $86,925,959.08
0.07 0.00 17.63 25.74 39.52 0.62 0.56 419.53 5.61 6.01 0.47 1.17 96.70 25.60 41.17 0.45 2.61 29.67 37.01 10.33 2.03 18.12 50.15 3.62 3.21 1.92 9.43 0.95 23.18 3.71 31.67 19.76 1.32 13.30 2.13 43.56 412.36 0.97 $9,243.22
275.48 76.62 87,648.82 188,884.90 749,810.26 22,778.99 84,569.62 3,771,091.86 59,041.59 42,348.31 9,885.41 33,353.73 994,318.76 181,635.06 114,044.18 0.45 71,627.05 200,732.40 362,939.92 149,893.42 17,710.17 66,918.15 469,955.03 47,073.81 31,965.11 1.92 100,029.61 1,679.58 260,908.87 31,771.11 726,487.82 360,513.12 9,469.77 86,183.35 11,108.65 438,943.51 3,927,486.69 6,894.76 $86,935,202.30
Subsequent Injury Trust Fund 2004 Annual Report
Page 70
Group Self-Insured Employers The following is the 2003-2004 assessment amount due from group self-insured employers.
Group Self-Insured Employers Company Name
2003 $ Assessment
2003 Assessment $ Adjustment
2004 Claims Paid
2004 $ Assessment
2003 $ Balance
Due
2003 and 2004 Total
Assessment
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:
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
141,712.04 1,233,355.73 382,795.33 228,761.62 323,249.94 204,841.23 359,241.50 975,780.93 232,183.79 124,509.59 299,198.58 145,476.59
36,952.09 58,006.98 $4,746,065.94
2,528,955.11 15,662,777.74 4,434,960.00 2,446,698.78 5,353,751.00 4,114,538.00 4,449,195.54 13,954,658.06 2,473,012.28 1,242,528.73 3,637,341.27 3,497,392.44
880,102.62 1,194,888.00 $65,870,799.57
258,348.34 1,600,049.23 453,058.48 249,945.35 546,918.64 420,325.40 454,512.73 1,425,554.28 252,633.44 126,931.96 371,576.82 357,280.18
89,907.90 122,065.17 $6,729,107.92
19.73 171.69 53.29 31.85 45.00 28.51 50.01 135.84 32.32 17.33 41.65 20.26 5.15 8.08 $660.71
258,368.07 1,600,220.92 453,111.77 249,977.20 546,963.64 420,353.91 454,562.74 1,425,690.12 252,665.76 126,949.29 371,618.47 357,300.44
89,913.05 122,073.25 $6,729,768.63
Subsequent Injury Trust Fund 2004 Annual Report
Page 71
Self-Insured Employers The following is the 2003-2004 assessment amount due from self-insured employers.
Self-Insured Employers Company Name
2003 $ Assessment
2003 Assessment $ Adjustment
2004 Claims Paid
2004 $ Assessment
2003 $ Balance
Due
2003 and 2004 Total
Assessment
A T & T AAA COOPER TRANSPORTATION ABF FREIGHT SYSTEM, INC ACUITY BRANDS ADVENTIST HEALTH SYS SUNBELT AGL RESOURCES, INC. ALBANY INTERNATIONAL CORP ALBANY, CITY OF ALEXIS PLAYSAFE, INC. ALLIED SYSTEMS LTD ALPHARETTA, CITY OF 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. HLTH SYS INC ATHENS-CLARKE COUNTY ATLANTA BOARD OF EDUCATION ATLANTA CITY OF ATLANTA HOUSING AUTHORITY AUGUSTA-RICHMOND CO BD COMM AUTOZONE, INC AVERITT EXPRESS, INC AVONDALE MILLS INC BALDWIN COUNTY COMMISSIONERS BANKHEAD SERVICES, INC BARTOW COUNTY BD OF EDUCATION BEAULIEU GROUP LLC BELLSOUTH CORPORATION BELLSOUTH ENTERPRISES INC BENTON-GEORGIA INC BERRY COLLEGE BHA GROUP INC
88,977.80 54,442.24 43,739.13 5,401.10
0.00 35,050.85
0.00 28,615.60
477.61 33,406.92 23,541.70 8,236.11 59,008.86 11,539.26 6,449.14 20,953.62 16,866.59 89,269.59 3,279.57 13,841.96 131,932.05 156,041.27 692,539.84 5,912.80 15,080.11 4,878.07 21,809.55 12,640.69 82,875.06 34,733.13 13,142.94
0.00 276,557.64 12,098.05 11,618.20 15,176.06
7,975.19
88,990.18 54,449.82 43,745.22 65,154.47
0.00 35,055.73
740.35 27,834.62 1,672.63 92,327.51 5,981.90 8,237.26 59,017.07 18,598.78 28,262.89 20,956.54 7,621.94 218,920.29 3,280.03 13,843.89 41,407.96 156,063.00 692,636.27 5,913.63 99,775.41 128,495.71 19,186.99 12,642.45 9,954.54 34,737.97 13,144.77
0.00 276,596.15 14,091.09 11,619.82 15,178.17
7,976.30
822,568.99 444,162.92 512,361.90 1,230,529.00 16,203.43 502,377.30 24,312.37 228,856.67 63,445.96 889,462.00 124,613.41 71,449.86 918,452.98 122,312.05 678,470.55 193,895.65 40,227.97 864,708.47 46,699.22 332,162.91 722,205.07 2,445,216.29 11,115,523.00 88,670.17 1,336,263.19 1,943,608.59 315,101.34 128,674.89 212,477.45 573,392.07 315,222.25 1,615,721.75 3,441,898.25
0.00 132,729.84 130,660.69 92,097.26
84,030.49 45,373.98 52,340.92 125,706.12 1,655.28 51,320.94 2,483.66 23,379.12 6,481.40 90,864.02 12,730.03 7,299.04 93,825.63 12,494.93 69,309.95 19,807.64 4,109.53 88,335.30 4,770.61 33,932.49 73,777.70 249,793.91 1,135,519.15 9,058.20 136,507.52 198,551.59 32,189.54 13,144.93 21,705.88 58,575.53 32,201.89 165,055.93 351,611.11
0.00 13,559.17 13,347.79 9,408.30
12.38 7.58 6.09 9.07 0.00 4.88 0.10 (780.98) 0.23 12.85 0.84 1.15 8.21 2.59 3.94 2.92 1.06 30.48 0.46 1.93 5.76 21.73 96.43 0.83 (4,916.58) 17.89 2.67 1.76 1.39 4.84 1.83 0.00 38.51 1.96 1.62 2.11 1.11
84,042.87 45,381.56 52,347.01 125,715.19 1,655.28 51,325.82 2,483.76 22,598.14 6,481.63 90,876.87 12,730.87 7,300.19 93,833.84 12,497.52 69,313.89 19,810.56 4,110.59 88,365.78 4,771.07 33,934.42 73,783.46 249,815.64 1,135,615.58 9,059.03 131,590.94 198,569.48 32,192.21 13,146.69 21,707.27 58,580.37 32,203.72 165,055.93 351,649.62
1.96 13,560.79 13,349.90 9,409.41
Subsequent Injury Trust Fund 2004 Annual Report
Page 72
BIBB COUNTY BD-COMMISSION BIBB COUNTY BOARD OF EDUCATION BIG LOTS STORES, INC. BJ'S WHOLESALE CLUB INC BLACK & DECKER CORPORATION 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 EDUCATION CASCADE CORPORATION CATOOSA CO. BD. OF EDUCATION CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHATHAM AREA TRANSIT AUTHORITY CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHEVRON USA INC SOU DIV CHILDREN'S HEALTHCARE OF ATL CLAYTON COUNTY BD OF EDUCATION 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 COLONIAL GROUP
57,005.15 47,378.25 128,477.82 79,839.11 18,042.97 5,020.49 272,980.17 13,532.88 104,691.99 75,116.25 62,386.40 11,393.83 62,556.79 11,331.06 8,990.56 9,848.59 1,731.49 8,267.12 44,061.41 5,981.06 1,588.96 9,827.79 24,272.86 14,656.24 16,390.87 32,640.41 173,300.49 3,795.72 10,502.34 26,942.80 44,738.99 3,293.50 23,136.13 57,409.85 44,988.07 1,961.83 181,375.59 49,796.32 37,491.70 87,343.26 156,591.23 28,886.16 41,554.50 12,064.97 53,010.90
57,013.09 47,384.85 25,149.86 8,816.23 4,878.75 5,021.19 273,018.18 11,074.24 26,902.17 18,045.48 62,395.09 7,448.61 27,848.32 11,332.64 82,222.92 1,604.78
0.00 8,268.27 44,067.54 24,830.14 1,589.18 1,374.58 131,950.42 14,658.28 16,393.15 32,644.95 42,933.26 7,146.50 10,503.81 26,946.55 44,745.22 3,293.96 53,018.28 57,417.84 44,994.33 1,962.11 7,542.23 41,560.29 37,496.92 87,355.42 156,613.03 28,890.18 185,125.31 12,066.65 13,611.55
921,082.39 542,329.00 388,155.00 231,739.37 20,544.72 41,588.93 3,923,860.05 211,113.44 161,258.22 187,065.97 457,353.30 23,466.00 815,665.29 39,998.89 1,261,478.00 24,136.89
7,649.01 81,807.38 381,568.14
0.00 9,832.87 191,408.18 2,044,101.36 34,038.57 142,509.00 535,480.10 634,113.23 70,497.09 125,227.09 299,597.89 628,705.47 78,605.28 859,692.78 791,974.22 749,489.94 37,312.59 166,957.50 390,588.00 451,775.00 1,492,330.23 2,518,953.00 232,950.25 3,343,292.22 206,939.36 191,449.07
94,094.24 55,402.25 39,652.42 23,673.60 2,098.77 4,248.57 400,846.48 21,566.54 16,473.52 19,109.94 46,721.46 2,397.20 83,325.23 4,086.13 128,867.75 2,465.73
781.39 8,357.13 38,979.54
0.00 1,004.49 19,553.52 208,817.55 3,477.25 14,558.17 54,702.59 64,778.57 7,201.71 12,792.72 30,605.77 64,226.14 8,030.01 87,822.91 80,905.05 76,565.01 3,811.71 17,055.74 39,900.97 46,151.60 152,450.73 257,326.57 23,797.30 341,537.89 21,140.13 19,557.70
7.94 6.60 3.50 1.23 0.68 0.70 38.01 (2,458.64) 3.74 2.51 8.69 1.04 3.88 1.58 11.44 0.22 0.00 1.15 6.13 3.45 0.22 0.20 18.37 2.04 2.28 4.54 (130,367.23) 1.00 1.47 3.75 6.23 0.46 7.38 7.99 6.26 0.28 1.05 5.79 5.22 12.16 21.80 4.02 25.77 1.68 (181.88)
94,102.18 55,408.85 39,655.92 23,674.83 2,099.45 4,249.27 400,884.49 19,107.90 16,477.26 19,112.45 46,730.15 2,398.24 83,329.11 4,087.71 128,879.19 2,465.95
781.39 8,358.28 38,985.67
3.45 1,004.71 19,553.72 208,835.92 3,479.29 14,560.45 54,707.13 (65,588.66) 7,202.71 12,794.19 30,609.52 64,232.37 8,030.47 87,830.29 80,913.04 76,571.27 3,811.99 17,056.79 39,906.76 46,156.82 152,462.89 257,348.37 23,801.32 341,563.66 21,141.81 19,375.82
Subsequent Injury Trust Fund 2004 Annual Report
Page 73
COLONIAL PIPELINE COMPANY COLQUITT CO BD OF EDUCATION COLQUITT REGIONAL MEDICAL CENT COLUMBIA COUNTY BOE COLUMBIA GEORGIA CORP. 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 EDUCATION COWETA COUNTY BOC CRACKER BARREL OLD CNTRY STORE CRAWFORD & COMPANY CRIDER'S POULTRY INC CRISP COUNTY BD OF EDUCATION 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 HLTHCARE SYS DELHAIZE AMERICA INC. DELPHI AUTOMOTIVE SYS INC. DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOLLAR GENERAL CORP DOUGHERTY COUNTY BOC DOUGHERTY COUNTY SCHOOL SYSTEM DOUGLAS ASPHALT COMPANY DOUGLAS CO BD OF COMMISSIONERS DOUGLAS COUNTY SCHOOLS DOUGLAS, CITY OF
1,326.35 1,672.40 13,120.70 14,445.53
99.28 62,943.73 60,664.61 3,597.18 16,081.09 36,720.74 10,926.78 15,294.22 13,793.43 22,107.24 12,428.16 12,380.63 11,476.42 40,949.82
0.00 15,125.54 11,399.82 23,998.38 8,493.83 119,045.66 120,466.75 38,043.86 9,549.40 5,395.43 15,739.52 2,780.50 151,223.35 202,086.17 3,930.45 69,835.36 58,181.81 27,924.14 582,794.20 89,833.32 160,097.80 45,940.15 27,636.41 39,461.62 30,257.02 25,856.51 22,399.53
1,326.54 12,094.40 13,122.53 14,447.54
99.29 62,952.50 60,673.05 3,580.73 120,822.74 36,725.86 10,928.30 15,296.34 140,253.94 15,082.21 28,800.58 12,382.36 11,478.01 40,955.53
0.00 120,483.53 24,276.24 39,302.74
8,495.01 18,856.11 6,450.04 48,537.84 12,429.89 5,396.18 56,081.18 2,780.89 151,244.41 202,114.31 3,931.00 62,565.50 58,189.91 17,923.26 805,135.90 89,845.82 160,120.09 45,946.54 15,127.64 56,527.43 30,261.23 25,860.11 22,402.65
40,000.00 71,592.96 210,652.27 170,570.95 1,071.08 539,534.00 831,538.52 19,316.39 75,873.15 767,610.85 454,028.95 447,819.36 2,098,439.58 199,770.39 284,670.00 134,409.73 72,317.85 581,425.80 40,868.43 1,525,479.79 242,313.04 741,948.10 75,200.92 235,531.10 116,302.61 582,418.74 76,699.09 68,767.00 1,388,353.84 75,317.62 3,101,031.35 2,415,836.86 28,425.89 754,204.68 1,051,760.64 166,025.50 4,322,540.00 1,731,742.00 2,817,713.65 711,348.88 796,087.74 764,065.22 678,353.66 598,993.60 203,943.72
4,086.25 7,313.66 21,519.43 17,424.87
109.42 55,116.72 84,946.78 1,973.29 7,750.91 78,416.18 46,381.85 45,747.51 214,368.53 20,407.78 29,080.79 13,730.78 7,387.71 59,396.23 4,174.96 155,837.16 24,753.77 75,794.57 7,682.24 24,060.95 11,881.03 59,497.66 7,835.28 7,024.97 141,828.90 7,694.16 316,789.45 246,792.62 2,903.88 77,046.65 107,443.83 16,960.53 1,210,187.92 176,908.11 287,846.81 72,668.67 81,325.27 78,053.97 69,298.01 61,190.89 20,834.11
0.19 1.69 1.83 2.01 0.01 8.77 8.44 (16.45) 16.82 5.12 1.52 2.12 19.53 2.10 4.01 1.73 1.59 5.71 0.00 16.78 3.38 5.47 1.18 2.62 0.90 6.75 1.73 0.75 7.81 0.39 21.06 28.14 0.55 8.71 8.10 2.50 222,341.70 12.50 22.29 6.39 2.10 7.87 4.21 3.60 3.12
4,086.44 7,315.35 21,521.26 17,426.88
109.43 55,125.49 84,955.22 1,956.84 7,767.73 78,421.30 46,383.37 45,749.63 214,388.06 20,409.88 29,084.80 13,732.51 7,389.30 59,401.94 4,174.96 155,853.94 24,757.15 75,800.04 7,683.42 24,063.57 11,881.93 59,504.41 7,837.01 7,025.72 141,836.71 7,694.55 316,810.51 246,820.76 2,904.43 77,055.36 107,451.93 16,963.03 1,432,529.62 176,920.61 287,869.10 72,675.06 81,327.37 78,061.84 69,302.22 61,194.49 20,837.23
Subsequent Injury Trust Fund 2004 Annual Report
Page 74
DOUGLASVILLE-DOUGLAS COUNTY DSM CHEMICALS N. AMERICA DULUTH, CITY OF DURAND-WAYLAND, INC E I DUPONT DE NEMOURS & CO EAST POINT, CITY OF ELBERTA CRATE & BOX COMPANY ELBERTON GRANITE ASSOCIATION ELBERTON, CITY OF EMERSON ELECTRIC CO EMORY UNIVERSITY ENCOMPASS GROUP, LLC EQUITY GROUP GA DIVISION ESTES EXPRESS LINES EVANS GRADING CO., INC EVENFLO COMPANY INC EXEL HOLDINGS, USA, INC FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FEDERATED DEPARTMENT STORES FEDEX FREIGHT EAST FEDEX GROUND PKG SYS FEDEX SUPPLY CHAIN SERV INC FIELDALE FARMS CORPORATION FLEETWOOD HOMES OF GA INC FLEXSTEEL INDUSTRIES INC FLORIDA ROCK & TANK LINES INC FLORIDA ROCK INDUSTRIES INC FLOWERS FOODS INC. FLOYD CO. BD. OF COMMISSIONERS FLOYD COUNTY BD OF EDUCATION FLOYD HLTHCARE MGMT INC FLYING J, INC. FORD MOTOR COMPANY FOREST PARK, CITY OF FORSYTH CO. BD. OF EDUCATION FRANKLIN ALUMINUM CO INC FREUDENBERG-NOK FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHY GANNETT CO. INC & SUBSIDIARIES GENERAL MOTORS CORPORATION GEORGIA CRATE & BASKET CO
5,361.77 31,127.49 5,551.06 8,970.00 23,822.09 4,075.11 22,269.25 120,805.92 11,103.58 46,700.75 206,453.81 3,372.76 56,073.37 4,022.78 56,519.56 279,395.67
0.00 39,297.27 26,412.09 18,683.77 96,812.58 28,162.95 9,277.03 6,881.11 61,222.66 26,066.30 21,530.79 53,146.31 23,364.39 75,469.40 24,826.69 27,496.99 47,618.37 25,001.65 161,102.55 3,128.52 40,388.63
0.00 15,817.56 190,779.57 188,621.45 86,794.74 23,456.51 419,121.35 2,414.99
5,362.52 31,131.83 1,175.56 8,971.25 23,825.41 40,394.25 22,272.35 69,845.09 2,427.28 13,609.29 206,482.56 12,071.41 39,467.11 15,819.76 11,540.87 2,087.28
0.00 12,099.73 26,415.77 206,139.14 119,062.23 28,166.87 23,130.70 9,278.32 61,231.19 26,069.93 21,533.79 53,153.71 23,367.64 75,479.91 43,237.40 27,500.82 25,790.48 19,516.39 161,124.98 3,128.96 18,680.49
0.00 25,005.13 190,806.14 188,647.71 86,806.82 11,333.68 419,179.70 2,415.33
23,144.54 320,885.88 49,464.14 74,514.27 49,490.45 325,042.47 205,051.57 711,109.69 26,421.13 107,038.91 3,686,770.40 206,012.92 645,121.53 251,006.97 126,937.09
0.00 79,010.57 527,753.22 478,154.18 2,652,711.43 1,483,458.13 463,729.00 477,920.05
0.00 899,063.89 1,154,554.29 161,111.05 131,247.00 100,913.64 1,032,034.99 562,130.93 342,457.84 307,865.10 184,960.93 1,599,591.54 57,433.60 255,204.59 24,963.98 364,058.95 2,411,615.28 2,428,951.01 1,580,285.46 82,526.46 4,760,427.77 23,536.23
2,364.36 32,780.47 5,053.07 7,612.09 5,055.75 33,205.09 20,947.28 72,644.24 2,699.08 10,934.68 376,626.31 21,045.49 65,903.14 25,641.91 12,967.41
0.00 8,071.42 53,913.24 48,846.39 270,990.81 151,544.39 47,372.77 48,822.48
0.00 91,844.91 117,944.83 16,458.49 13,407.69 10,308.95 105,428.73 57,425.14 34,984.18 31,450.32 18,894.90 163,408.13 5,867.20 26,070.72 2,550.22 37,190.86 246,361.36 248,132.31 161,435.89 8,430.59 486,307.02 2,404.37
0.75 4.34 0.16 1.25 3.32 5.62 3.10 9.73 0.34 1.90 28.75 1.68 5.49 2.20 1.61 (84,570.97) 0.00 1.68 3.68 28.69 16.57 3.92 3.22 1.29 8.53 3.63 3.00 7.40 3.25 10.51 6.02 3.83 3.59 2.72 22.43 0.44 2.60 0.00 3.48 26.57 26.26 12.08 1.58 58.35 0.34
2,365.11 32,784.81 5,053.23 7,613.34 5,059.07 33,210.71 20,950.38 72,653.97 2,699.42 10,936.58 376,655.06 21,047.17 65,908.63 25,644.11 12,969.02 (84,570.97) 8,071.42 53,914.92 48,850.07 271,019.50 151,560.96 47,376.69 48,825.70
1.29 91,853.44 117,948.46 16,461.49 13,415.09 10,312.20 105,439.24 57,431.16 34,988.01 31,453.91 18,897.62 163,430.56 5,867.64 26,073.32 2,550.22 37,194.34 246,387.93 248,158.57 161,447.97 8,432.17 486,365.37 2,404.71
Subsequent Injury Trust Fund 2004 Annual Report
Page 75
GEORGIA DUCK & CORDAGE MILL GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GLYNN COUNTY BOARD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GOODY PRODUCTS, INC. GREAT ATLANTIC & PACIFIC TEA GREAT DANE LTD PARTNERSHIP GRIFFIN-SPALDING SCHOOLS GUARDIAN AUTOMOTIVE CORP GULFSTREAM AEROSPACE CORP GWINNETT CO BD OF EDUCATION GWINNETT HOSPITAL SYSTEM HALL COUNTY BOARD OF EDUCATION 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 COUNTY BD OF EDUCATION 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.
245,844.53 3,464,021.13
309,773.44 30,953.15 4,523.16 54,538.89 12,069.73
646.91 19,477.76 43,969.40 6,905.34 21,624.51 38,548.83 235,877.33 13,607.39 24,446.09 37,705.64 3,076.54 20,785.28 8,460.71 37,522.67 28,420.57 25,081.65 185,099.54 14,908.47 2,718.29 85,771.61 73,045.99 33,228.10 15,192.93 19,594.86 8,780.95 21,715.33 64,454.95 35,364.60
563.28 56,964.02 37,514.85 49,868.56 191,899.98 17,441.62 30,867.20 27,844.44 218,889.81 24,026.37
16,723.68 3,464,503.43
309,816.57 2,259.03 11,395.42 54,546.48 14,665.79 647.00 19,480.47 43,975.53 6,906.30 21,627.52 38,554.20
235,910.17 86,543.30 24,449.49 37,710.89 3,076.97 5,551.84 8,461.88 37,527.89 28,424.53 25,085.14 8,991.81 14,910.55 2,718.67 15,741.72 73,056.16 33,232.73 15,021.83 19,597.59 8,782.17 38,049.15 64,463.92 35,369.52
563.36 56,971.95 245,878.75 49,875.50 191,926.70 4,523.79 30,871.50 39,818.46 181,400.84 36,205.64
198,095.04 46,826,655.15 3,887,063.44
27,515.38 412,451.93 470,732.87 88,663.74
5,674.00 24,369.14 469,222.38 88,510.40 221,275.00 426,078.61 3,008,224.94 1,212,633.20 268,559.61 442,943.61 10,274.13
0.00 241,927.07 501,096.64 819,536.63 174,711.09 102,913.45 135,274.49 26,982.01 295,995.02 896,585.17 415,117.43 227,150.36 191,441.40 122,536.62 220,700.41 921,159.70 402,326.97 88,220.88 398,671.16 3,336,503.39 405,842.84 2,340,350.84 14,938.01 132,187.99 803,064.64 2,224,858.07 369,444.00
20,236.63 4,783,631.28
397,087.47 2,810.87 42,134.51 48,088.26 9,057.55 579.63 2,489.46 47,933.96 9,041.88 22,604.60 43,526.55
307,308.71 123,877.95 27,435.02 45,249.42
1,049.57 0.00
24,714.34 51,190.11 83,720.72 17,847.81 10,513.24 13,819.12 2,756.38 30,237.71 91,591.70 42,406.80 23,204.81 19,556.92 12,517.87 22,545.91 94,102.14 41,100.18 9,012.31 40,726.71 340,844.37 41,459.35 239,081.25 1,526.01 13,503.82 82,038.00 227,282.96 37,740.98
(66,151.38) 482.30 43.13 0.32 1.59 7.59 2.04 0.09 2.71 6.13 0.96 3.01 5.37 32.84 12.05 3.40 5.25 0.43 0.78 1.17 5.22 3.96 3.49 1.25 2.08 0.38 2.20 10.17 4.63
(171.10) 2.73 1.22 5.29 8.97 4.92 0.08 7.93 34.22 6.94 26.72 0.63 4.30 5.55 25.25 5.04
(45,914.75) 4,784,113.58
397,130.60 2,811.19 42,136.10 48,095.85 9,059.59 579.72 2,492.17 47,940.09 9,042.84 22,607.61 43,531.92
307,341.55 123,890.00 27,438.42 45,254.67
1,050.00 0.78
24,715.51 51,195.33 83,724.68 17,851.30 10,514.49 13,821.20 2,756.76 30,239.91 91,601.87 42,411.43 23,033.71 19,559.65 12,519.09 22,551.20 94,111.11 41,105.10 9,012.39 40,734.64 340,878.59 41,466.29 239,107.97 1,526.64 13,508.12 82,043.55 227,308.21 37,746.02
Subsequent Injury Trust Fund 2004 Annual Report
Page 76
JESUP CITY OF JOHN WIELAND HOMES, INC JOHNS MANVILLE INT'L., INC. JONES COMPANY (THE) K & F INDUSTRIES KAHN CONSTRUCTION COMPANY INC KEEBLER COMPANY KELLEY MANUFACTURING COMPANY KIMBERLY-CLARK CORP KING & PRINCE SEAFOOD CORP. KLEEN-TEX INDUSTRIES KLLM TRANSPORT K-MART CORP-IN BANKRUPTCY KNIGHT TRANSPORTATION 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 BRANDS, INC LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC MACON CITY OF MACON/BIBB CO WATER & SEWERAGE MARIETTA CITY SERVICES MAR-JAC POULTRY, INC. MARKETPLACE HOLDINGS, INC MARRIOTT INTERNATIONAL, INC. MARTA MAY DEPARTMENT STORES CO/DBA MCLANE COMPANY, INC. M-D BUILDING PRODUCTS MEADOWS REGIONAL MEDICAL CTR MEADWESTVACO MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC METALPLATE GALVANIZING L P METROMEDIA INTERNATIONAL GRP MICROMERITICS INSTRUMENTS CORP MILLEDGEVILLE, CITY OF MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC
3,736.02 14,295.50 9,263.30
903.08 740.25 2,662.43 75,410.34 4,302.38 8,655.65 4,386.95 12,671.95 2,080.12 326,813.32 262.78 43,633.88 4,364.25 24,298.92 70,105.16 3,438.86 167,899.36 4,616.70 19,513.67 14,089.13 19,184.32 228,289.23 104,623.09 24,511.45 39,812.91 7,541.18 3,782.36 1,175.40 349,803.25 13,526.98 31,342.36 12,092.71
0.00 51,218.74 59,383.28 13,400.78 15,155.15
92.79 1,523.55 118,179.92 12,108.43 531,671.95
3,736.54 89,282.02 9,264.59 56,716.87 4,364.85 2,662.80 75,420.84 4,302.98 8,656.85 4,387.56 12,673.72 19,295.59 326,858.83
262.81 279,434.57 43,639.95 17,444.05 37,520.07 11,105.13 167,922.74
4,617.34 13,691.80 27,640.26 3,439.34 228,321.01 104,637.66 17,149.53 46,707.25 24,029.71 3,782.88 85,783.56 349,851.96 3,373.23 31,346.73 11,401.41
0.00 51,225.87 21,715.43 13,402.65
477.67 14,477.65 1,523.77 23,917.77 12,110.11 531,745.97
52,223.30 847,988.44 84,563.00 613,526.11 107,749.76 18,929.57 992,781.69 110,257.86 148,354.73 29,976.68 121,540.64 517,534.18 3,135,568.40
5,553.78 5,412,587.78
333,607.54 334,085.53 447,711.94 182,183.51
0.00 127,311.25 143,178.10 566,758.00 50,919.94 2,970,699.58 1,182,521.89 221,020.76 752,852.95 308,571.00 28,504.00 1,144,661.03 3,876,969.61 48,722.51 456,038.09
0.00 8,384.77 451,235.48 206,012.02 524,390.64 1,552.42
0.00 33,443.92 283,707.25 160,200.91 7,864,668.01
5,334.93 86,627.24 8,638.63 62,675.47 11,007.30 1,933.77 101,418.77 11,263.52 15,155.35 3,062.30 12,416.13 52,869.30 320,317.63
567.35 552,929.18 34,080.07 34,128.89 45,736.53 18,611.17
0.00 13,005.63 14,626.52 57,897.82 5,201.79 303,475.26 120,801.90 22,578.63 76,908.57 31,522.43 2,911.86 116,934.18 396,056.33 4,977.30 46,587.10
0.00 856.56 46,096.48 21,045.40 53,569.73 158.59
0.00 3,416.50 28,982.44 16,365.51 803,424.28
0.52 12.43 1.29 7.90 0.60 0.37 10.50 0.60 1.20 0.61 1.77 2.69 45.51 0.03 38.90 6.07 2.43 5.22 1.55 23.38 0.64 1.91 3.85 0.48 31.78 14.57 (310.94) 6.50 3.34 0.52 11.95 48.71 0.47 4.37 1.59 0.00 7.13 3.03 1.87 0.06 2.02 0.22 3.33 1.68 74.02
5,335.45 86,639.67 8,639.92 62,683.37 11,007.90 1,934.14 101,429.27 11,264.12 15,156.55 3,062.91 12,417.90 52,871.99 320,363.14
567.38 552,968.08 34,086.14 34,131.32 45,741.75 18,612.72
23.38 13,006.27 14,628.43 57,901.67 5,202.27 303,507.04 120,816.47 22,267.69 76,915.07 31,525.77 2,912.38 116,946.13 396,105.04 4,977.77 46,591.47
1.59 856.56 46,103.61 21,048.43 53,571.60 158.65
2.02 3,416.72 28,985.77 16,367.19 803,498.30
Subsequent Injury Trust Fund 2004 Annual Report
Page 77
MONROE, CITY OF MOUNT VERNON MILLS MULLITE CO OF AMERICA MURRAY COUNTY BD OF EDUCATION MUSCOGEE COUNTY SCHOOL DIST NASH JOHNSON & SONS' FARMS INC NEWTON COUNTY NEWTON COUNTY BD OF EDUCATION 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 OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORPATION 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 QUIKTRIP CORPORATION RACETRAC PETROLEUM, INC RANDOLPH COUNTY HOSP AUTHORITY RECONSERVE RHODES NURSING HOME RICHMOND CTY BD OF EDUCATION RIVERDALE, CITY OF RMC USA, INC. ROCKDALE CO. BD OF EDUCATION ROCKWELL AUTOMATION, INC ROLLINS INC ROOKER ADMINISTRATIVE SERVICES ROPER CORPORATION ROSWELL CITY OF
10,348.14 72,157.03 6,131.15 4,113.75 45,363.47 86,658.25 4,847.73 13,036.20 18,853.49 1,604.56 54,444.92 64,414.74 132,259.42 84,854.44
99.92 24,626.47 92,314.66 101,107.42 56,708.97 34,023.53 2,426.94 22,398.90 53,111.10 82,774.68 6,230.99 18,596.19 8,815.00 17,690.02 23,127.48 18,677.89 21,712.40 3,930.29 10,016.96 3,358.81 26,898.43 1,401.88 65,340.83 11,332.10 39,666.92 15,094.47 7,447.57 13,126.27 17,981.05 206,110.45 36,291.71
10,349.58 72,167.07 4,091.62 4,114.32 45,369.78 3,930.83 4,848.40 13,038.02 16,868.93 9,849.96 54,452.50 24,514.87 132,277.83 84,866.25
99.94 24,629.90 47,625.00 101,121.50 1,731.73 34,028.27 3,075.81 22,402.02 53,118.49 82,786.21 6,231.86 9,829.16 5,401.85 17,692.49 6,882.07 10,769.40 30,957.46 70,114.92 10,018.36 3,359.28 1,282.46 1,402.07 65,349.92 4,208.75 39,672.44 15,096.57 48,291.16 13,128.10 17,983.56 59,391.55 36,296.76
117,831.08 893,797.65
0.00 0.00 829,637.88 210,151.80 77,550.20 176,343.73 225,306.29 134,377.00 710,799.31 543,833.73 1,616,174.83 689,721.44 0.00 484,305.00 785,035.86 1,260,512.00 122,252.24 234,229.71 12,294.43 178,713.06 397,961.17 792,360.04 26,767.00 113,650.80 184,689.70 141,315.03 62,076.54 491,613.00 328,108.53 701,492.30 290,699.29 54,489.88 43,923.38 81,087.96 768,550.67 35,322.25 107,605.18 187,582.05 152,916.16 457,151.92 323,645.00 536,187.61 831,838.31
12,037.17 91,306.94
0.00 0.00 84,752.62 21,468.30 7,922.23 18,014.60 23,016.43 13,727.44 72,612.53 55,555.97 165,102.21 70,459.29 0.00 49,474.74 80,196.25 128,769.07 12,488.82 23,928.01 1,255.95 18,256.64 40,654.18 80,944.46 2,734.41 11,610.13 18,867.19 14,436.20 6,341.50 50,221.30 33,518.31 71,661.76 29,696.72 5,566.48 4,487.04 8,283.63 78,512.19 3,608.39 10,992.53 19,162.66 15,621.33 46,700.88 33,062.33 54,774.87 84,977.41
1.44 10.04 (2,039.53) 0.57 6.31 0.54 0.67 1.82 2.34 1.37 7.58 3.42 18.41 11.81 0.02 3.43 6.63 14.08 0.24 4.74 0.43 3.12 7.39 11.53 0.87 1.37 0.75 2.47 0.96 1.50 4.31 9.76 1.40 0.47 0.18 0.19 9.09 0.58 5.52 2.10 6.73 1.83 2.51 8.27 5.05
12,038.61 91,316.98 (2,039.53)
0.57 84,758.93 21,468.84 7,922.90 18,016.42 23,018.77 13,728.81 72,620.11 55,559.39 165,120.62 70,471.10
0.02 49,478.17 80,202.88 128,783.15 12,489.06 23,932.75 1,256.38 18,259.76 40,661.57 80,955.99 2,735.28 11,611.50 18,867.94 14,438.67 6,342.46 50,222.80 33,522.62 71,671.52 29,698.12 5,566.95 4,487.22 8,283.82 78,521.28 3,608.97 10,998.05 19,164.76 15,628.06 46,702.71 33,064.84 54,783.14 84,982.46
Subsequent Injury Trust Fund 2004 Annual Report
Page 78
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 SCIENTIFIC-ATLANTA INC SHAW INDUSTRIES INC SHEPHERD CONSTRUCTION SHEPHERD MEDICAL CENTER SHERWIN-WILLIAMS COMPANY SHONEY'S LLC SI CORPORATION SIMMONS FOODS, INC SIX CONTINENTS HOTELS, INC SIZEMORE ,INC. SKF USA INC SNELL CONTRACTORS SONOCO PRODUCTS COMPANY SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GA HLTH SYSTEM 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 STANLEY WORKS & SUBSIDIARIES STONE CONTAINER CORPORATION 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 COMPANY
25,146.36 73,148.52
308.74 37,143.87 43,884.58 17,460.47 63,015.36 167,088.36 2,258.71 744,870.32 1,282.28 7,620.88
288.24 57,699.06 6,118.66
0.00 57,064.83 21,486.12 23,361.41 23,914.44 4,208.17 40,423.53 36,200.60 370,309.70 50,736.05 411,995.61 7,350.06 7,703.20 49,196.74 146,476.19 22,401.47 3,261.38 86,531.25 13,835.65 28,258.95 25,497.46 23,102.06 48,284.43 15,413.30 10,757.57 3,075.38 16,791.85 10,767.90 41,402.20 17,976.53
37,532.53 23,139.35
308.79 37,149.04 43,890.69 16,083.33 63,024.14 167,111.62 57,072.77 744,974.03 3,796.25 17,979.03
288.28 57,707.10 79,850.22
0.00 2,080.41 21,489.12 7,704.27 23,364.66 22,110.32 40,429.16 73,158.70 13,820.03 50,743.12 412,052.98 7,351.09 12,268.66 49,203.59 146,496.59 22,404.59 3,261.84 49,803.25 13,837.58 13,528.87 4,023.34 23,105.27 15,157.26 15,415.44 10,759.07 4,075.68
903.21 25,501.01 118,196.37 75,126.71
280,281.61 511,751.00
4,709.14 643,384.06 1,129,332.45 326,171.93 664,137.68 2,570,235.58 189,036.72 7,475,317.54 112,473.56 172,308.95 303,009.00 753,889.00 1,621,606.03 18,769.00
0.00 302,984.67 22,285.00 821,294.19
0.00 373,837.62 703,872.82 135,007.57 962,699.99 4,561,194.51 168,959.67 52,415.00 541,107.28 2,441,673.28 369,201.16
6,629.93 618,671.34 289,626.77 131,170.65 63,701.94 238,432.39 601,060.54 55,398.38
8,302.79 97,153.59 13,888.08 340,436.65 2,168,237.00 672,222.48
28,632.49 52,278.52
481.07 65,725.64 115,368.27 33,320.47 67,845.76 262,565.40 19,311.27 763,649.73 11,489.87 17,602.42 30,954.24 77,014.41 165,657.05 1,917.37
0.00 30,951.75 2,276.55 83,900.26
0.00 38,189.82 71,904.94 13,791.85 98,345.73 465,954.12 17,260.27 5,354.52 55,277.44 249,431.97 37,716.17
677.29 63,201.09 29,587.16 13,399.89 6,507.55 24,357.34 61,402.04 5,659.29
848.18 9,924.84 1,418.75 34,777.70 221,498.77 68,671.67
5.22 3.22 0.05 5.17 6.11 2.24 8.78 23.26 7.94 103.71 0.53 2.50 0.04 8.04 11.11 0.00 0.29 3.00 1.07 3.25 3.08 5.63 10.18 1.92 7.07 57.37 1.03 1.71 6.85 20.40 3.12 0.46 6.93 1.93 1.89 0.56 3.21 2.11 2.14 1.50 0.57 0.13 3.55 16.45 10.46
28,637.71 52,281.74
481.12 65,730.81 115,374.38 33,322.71 67,854.54 262,588.66 19,319.21 763,753.44 11,490.40 17,604.92 30,954.28 77,022.45 165,668.16 1,917.37
0.29 30,954.75 2,277.62 83,903.51
3.08 38,195.45 71,915.12 13,793.77 98,352.80 466,011.49 17,261.30 5,356.23 55,284.29 249,452.37 37,719.29
677.75 63,208.02 29,589.09 13,401.78 6,508.11 24,360.55 61,404.15 5,661.43
849.68 9,925.41 1,418.88 34,781.25 221,515.22 68,682.13
Subsequent Injury Trust Fund 2004 Annual Report
Page 79
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 EDUCATION TYSON FOODS INC UNILEVER UNITED STATES UNITED AIRLINES UNITED CATALYSTS, INC UNIVERSITY HOSPITAL USF HOLLAND, INC. VALDOSTA CITY OF VARIETY WHOLESALERS VISITING NURSE HEALTH SYSTEM VULCAN MATERIALS COMPANY WAFFLE HOUSE WAGGONERS TRUCKING CO., THE WALKER COUNTY BD OF EDUCATION WALTON CO BOARD OF ED WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WATKINS ASSOCIATED INDUSTRIES WAYCROSS MOLDED PRODUCTS INC WAYCROSS, CITY OF WELLINGTON LEISURE PRODUCTS WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYSTEM WEST POINT STEVENS, INC WEYERHAEUSER COMPANY WHITFIELD COUNTY BOE WILD ADVENTURES, INC. WINN-DIXIE STORES INC YELLOW FREIGHT SYSTEM INC YKK CORPORATION OF AMERICA Total: 391 Grand Total
13,689.89 12,266.95 14,663.75 19,292.90 6,240.12 28,796.57 82,211.48 43,231.38 14,475.63 274,054.43 11,483.61 26,813.50 25,786.89 42,478.67 17,920.76 39,926.58 65,145.40 18,114.54 47,120.88 155,687.71 13,818.11 37,527.31 7,145.50 66,877.50 48,531.09 66,165.75 14,325.24
0.00 25,404.86 1,374.38 20,447.36 140,234.41 21,482.22 63,820.60 9,953.15
0.00 383,885.60 59,753.21 24,682.29 $23,922,025.68
92.80 21,812.59 64,423.71 33,411.57 6,240.99 9,550.73 17,639.25 24,685.73 23,544.97 274,092.58 11,485.21 26,817.23 14,297.49 42,484.59 27,928.03 39,932.14 16,794.19 18,117.06 47,127.44 155,709.39 96,826.06 23,459.78 6,119.51 66,886.81 24,001.72 66,174.97 14,327.23
0.00 25,408.40 370,361.26 20,450.21 24,302.31 21,485.22 63,829.48 21,718.36
0.00 383,939.05 59,761.52 20,084.74 $23,853,824.83
9,195.15 405,096.44 643,267.46 338,805.08 60,596.48
7,131.04 150,678.92 326,400.76 228,363.42 3,442,295.52 53,472.00 315,668.43 178,409.21 643,187.54 188,008.00 379,480.60 421,894.25 124,654.04 409,008.19 1,361,077.16 1,061,892.57 394,582.18 59,148.91 982,062.47 261,015.18 1,732,916.41 200,006.30 59,658.12
0.00 4,658,978.53
290,523.85 246,771.91 138,988.03 619,347.40 249,665.46 36,844.00 5,173,602.36 743,953.88 427,190.80 $308,217,159.58
939.34 41,383.10 65,713.73 34,611.03 6,190.30
728.48 15,392.78 33,343.85 23,328.73 351,651.69 5,462.49 32,247.47 18,225.60 65,705.57 19,206.18 38,766.28 43,099.10 12,734.18 41,782.71 139,042.42 108,478.87 40,309.00 6,042.43 100,323.73 26,664.31 177,028.09 20,431.88 6,094.44
0.00 475,943.36 29,678.80 25,209.27 14,198.48 63,270.15 25,504.86
3,763.84 528,515.35 75,999.47 43,640.17 $32,254,895.40
0.01 3.04 8.97 4.65 0.87 1.33 (1,044.52) 3.44 3.27 38.15 1.60 3.73 1.99 5.92 3.89 5.56 2.34 2.52 6.56 21.68 13.48 3.27 0.85 9.31 3.34 9.22 1.99 0.00 3.54 51.56 2.85 3.39 3.00 8.88 3.03 0.00 53.45 8.31 (700.54) ($68,200.85)
939.35 41,386.14 65,722.70 34,615.68 6,191.17
729.81 14,348.26 33,347.29 23,332.00 351,689.84 5,464.09 32,251.20 18,227.59 65,711.49 19,210.07 38,771.84 43,101.44 12,736.70 41,789.27 139,064.10 108,492.35 40,312.27 6,043.28 100,333.04 26,667.65 177,037.31 20,433.87 6,094.44
3.54 475,994.92 29,681.65 25,212.66 14,201.48 63,279.03 25,507.89
3,763.84 528,568.80 76,007.78 42,939.63 $32,186,694.55