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