2005 annual report

STATE OF GEORGIA SUBSEQUENT INJURY TRUST
FUND
2005 ANNUAL REPORT
If you wish to obtain this report in an alternative format, please contact our office.

Subsequent Injury Trust Fund 2005 Annual Report

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STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND
SUITE 500 NORTH TOWER 1720 PEACHTREE STREET, NW
ATLANTA, GA 30309-2462
TELEPHONE: (404) 206-6360 FAX: (404) 206-6363
WEBSITE: http://sitf.georgia.gov

This publication can be accessed on the web. For additional copies, please call our office.

Subsequent Injury Trust Fund 2005 Annual Report
AGENCY OFFICIALS

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BOARD OF TRUSTEES John T. Fervier, II Chairman Donald R. Avery (resigned April 2005)
Jimmy C. Beck, Sr. James F. Braswell James C. Thompson
EX-OFFICIO MEMBERS Stan Carter, State Board of Workers Compensation John W. Oxendine, Insurance and Safety Fire Commissioner
ADMINISTRATOR Richard W. McGee
DEPUTY ADMINISTRATOR David L. Taylor

Subsequent Injury Trust Fund 2005 Annual Report

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MISSION STATEMENT
The Subsequent Injury Trust Fund provides reimbursement and information to employers, insurers, and their agents, in those Worker's
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 2005 Annual Report
TABLE OF CONTENTS

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Fund Administration ..............................................................................................................1 Introduction ........................................................................................................................1 How the Fund Works .........................................................................................................1 Reimbursement from the Fund...........................................................................................1 Claims Administration .......................................................................................................2 Claims Activity 2005 ......................................................................................................2 Financial Activity - 2005 ...................................................................................................3 New Legislation .................................................................................................................4
Claims Reported for 2005 ......................................................................................................5 Claims Reported by Insurance Companies ........................................................................5 Claims Reported by Group Self-Insurers...........................................................................9 Claims Reported by Self-Insured Companies ..................................................................10
Reimbursements Paid in 2005..............................................................................................16 Reimbursements Paid to Insurance Companies ...............................................................16 Reimbursements Paid to Group Self-Insurers..................................................................20 Reimbursements Paid to Self-Insured Companies...........................................................21 Individual Employers Benefiting from Reimbursements ................................................26
Assessment 2005..................................................................................................................54 Legal Requirements .........................................................................................................54 Assessment Calculation ...................................................................................................55 Assessment Rate for 2005................................................................................................56
Assessments Due for 2004 and 2005 ...................................................................................57 Insurance Companies .......................................................................................................57 Group Self-Insurers..........................................................................................................66 Self-Insured Companies ...................................................................................................67

Subsequent Injury Trust Fund 2005 Annual Report

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FUND ADMINISTRATION
Introduction
On July 1, 1977, the Georgia General Assembly enacted legislation establishing the Subsequent Injury Trust Fund. It is designed to reduce the impact of singularly large workers' compensation claims in the event a worker with a disability, injured on the job, aggravates a pre-existing permanent impairment.
The Subsequent Injury Trust Fund is a separate state agency, governed by a fivemember Board of Trustees appointed by the Governor for six-year terms. The administrator along 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 onthe-job injury of the employee must be directly caused by or combined with a prior impairment to create a greater liability for lost-time benefits and medical expenses. In addition, the employee must have a pre-existing impairment that the employer considered to be permanent and likely to be a hindrance to employment, and the employer must have knowledge of the prior impairment before the subsequent injury occurs.
O.C.G.A.34-9-361 contains a list of conditions that are presumed to be permanent and likely to be a hindrance to employment provided the employer could demonstrate prior knowledge.
Reimbursement from the Fund
All licensed workers' compensation insurance carriers and self-insured employers authorized by the State Board of Workers' Compensation in the state of Georgia may access the fund.
Employers/insurers must notify the fund of a possible claim by filing a Notice of Claim no later than 78 weeks following the date of injury.
In addition to the mandatory Notice of Claim, the employer must submit a notarized Employer's Knowledge Affidavit, certifying prior knowledge of the worker's pre-existing permanent impairment.
Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks; for 50% of all medical and rehabilitation expenses between $5,000 and $10,000; and for 100% of all medical and rehabilitation expenses in excess of $10,000.

Subsequent Injury Trust Fund 2005 Annual Report

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If the subsequent injury was not caused by or related to a prior impairment, the
reimbursement for medical expenses may be reduced or denied completely.
Claims Administration
The employer/insurer maintains management of the employee's claim for the life of that claim. Once the fund has been notified of the claim, the employer/insurer must keep the fund informed 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 2005
The following is a breakdown of claims activity for calendar year 2005. 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, 2005 Calendar Year 2005 Calendar Year 2005 Calendar Year 2005 December 31, 2005 Calendar Year 2005 Calendar Year 2005 Calendar Year 2005

22,279 16,777
882 18,375 21,563
1,481 89
2,963

Subsequent Injury Trust Fund 2005 Annual Report

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Financial Activity - 2005
The following table depicts the fund's revenues, expenditures, and fund balance for the calendar year ending December 31, 2005. 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, 2005
Revenues Assessments 2004, adjusted assessments 2003, and payments and refunds for prior years
Interest Earned
Miscellaneous Income Total Revenues
Prior Year Adjustments
Expenditures Personnel Services Operating Cost
Reimbursements (negotiated checks)
Total Expenditures

55,015,572
124,677,764 1,843,959 1,663 (87,425) 1,728,276 630,174
115,245,669

126,523,386 117,604,119

55,015,572

Fund Balance December 31, 2005

64,022,264

Subsequent Injury Trust Fund 2005 Annual Report

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New Legislation
Through House Bill 200, the Official Code of Georgia was amended by adding Chapter 34-9-368 establishing June 30, 2006 as the last date of injury eligible for reimbursement by the Fund.
34-9-368. (a) The Subsequent Injury Trust Fund shall not reimburse a self-insured employer or an insurer for a subsequent injury for which a claim is made for an injury occurring after June 30, 2006. The Subsequent Injury Trust Fund shall continue to reimburse selfinsured employers or insurers for claims for injuries occurring on and prior to June 30, 2006, which qualify for reimbursement.
(b) Self-insured employers and insurers shall continue to pay assessments pursuant to Code Section 34-9-358 to the extent necessary to fund claims for injuries occurring on and prior to June 30, 2006.
(c) Upon or in contemplation of the final payment of all claims filed for subsequent injuries for which claims are filed for injuries occurring on and prior to June 30, 2006, the board of trustees shall adopt and implement resolutions providing for the final dissolution of the Subsequent Injury Trust Fund. Such resolutions shall become effective when all claims made for injuries occurring on and prior to June 30, 2006, have been fully paid or otherwise resolved and shall include provisions for:
(1) The termination of assessments against insurers or self-insurers; (2) The pro rata refund of assessments previously collected and unexpended; (3) The termination of employment of the employees of the fund or the transfer of employment of any employees to any other state agency desiring to accept them; (4) A final accounting of the financial affairs of the fund; and (5) The transfer of the books, records, and property of the fund to the custody of the State Board of Worker's Compensation.
Upon the completion of all matters provided for in such resolutions, but not later than December 31, 2020, the Subsequent Injury Trust Fund and the members of its board of trustees shall be discharged from their duties except for such personnel necessary to administer any remaining claims.

Subsequent Injury Trust Fund 2005 Annual Report

CLAIMS REPORTED FOR 2005
Claims Reported by Insurance Companies
January 1, 2005 to December 31, 2005

Insurance Company

Claims Reported

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 NATIONAL INS. CO. AIU INSURANCE CO ALEA NORTH AMERICA ALL AMERICA INS. CO AMCOMP ASSURANCE AMCOMP PREFERRED AMERICAN ALTERNATIVE INS AMERICAN CAS CO OF READING PA AMERICAN ECONOMY INS CO AMERICAN GUAR & LIAB INS CO AMERICAN HOME ASSURANCE CO AMERICAN INSURANCE CO AMERICAN INTER INS CO OF GA AMERICAN INTERN. SOUTH INS CO AMERICAN MFG. MUTUAL INS AMERICAN MOTORISTS INS CO AMERICAN PROTECTION INS CO AMERICAN RESOURCES INS CO AMERICAN STATES INS CO AMERICAN STATES INS CO OF TX AMERICAN ZURICH INS CO AMGUARD INSURANCE CO. ARCH INSURANCE CO ARGONAUT INSURANCE CO ASSOCIATED INDEMNITY CORP ASSOCIATION INSURANCE CO ASSURANCE CO. OF AMERICA ATHENA ASSURANCE CO ATLANTIC MUTUAL INS. CO AUTO OWNERS INS. CO BANCINSURE, INC. BANKERS STANDARD INS CO BENCHMARK INS CO BITUMINOUS CASUALTY CORP BITUMINOUS FIRE & MARINE INS BRIDGEFIELD CASUALTY BUILDERS INSURANCE CANAL INSURANCE CO CAPITAL CITY INS CO CATERPILLAR INSURANCE CO CENTENNIAL INSURANCE CO

2 521
1 1 82 1 1 72 1 10 2 53 9 2 70 12 8 248 17 68 37 1 2 15 1 44 8 21 31 8 26 6 4 1 5 5 33 2 6 13 12 1 193 1259 23 12 1 1

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Subsequent Injury Trust Fund 2005 Annual Report
Insurance Company CHARTER OAK FIRE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY CO CINCINNATI INDEMNITY CO CINCINNATI INSURANCE CO CLARENDON NATIONAL INS CO COLUMBIA NATIONAL INS CO COMBINED SPECIALTY INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL MUTUAL INS CO COMPANION PROP & CAS 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 EMCASCO INSURANCE CO EMPLOYERS INS OF WAUSAU EMPLOYERS REINSURANCE CORP EVEREST NATIONAL INS EXCELSIOR 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 FIDELITY & DEPOSIT CO OF MD FIDELITY & GUARANTY INS CO FIREMAN'S FUND INS CO FIREMAN'S FUND INS OF GA FIRST LIBERTY INS CORP FIRST NATL INS CO OF AMER FLORISTS' MUTUAL INS CO FRANKENMUTH MUTUAL INS GA INSURERS INSOLVENCY POOL GA RESTAURANT MUTUAL CAP INS C GA TIMBER HARVERSTERS' GENERAL CASUALTY CO OF WI GEORGIA CASUALTY & SURETY CO GRANGE MUTUAL CASUALTY COMPANY GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GREAT AMER INS CO OF NY GREAT AMERICAN INS CO

Claims Reported
17 28 2 8 6 8 49 64 6 11 72 20 42 55 9 9 39 1 1 2 43 47 8 4 7 1 29 3 62 15 3 26 154 10 6 2 19 3 77 11 1 3 9 6 2 10 19 14 6 77 4 7 2 15 13

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Subsequent Injury Trust Fund 2005 Annual Report
Insurance Company GREAT NORTHERN INS CO GREAT WEST CASUALTY CO GREATER NEW YORK MUTUAL INS GROCERS INSURANCE CO GUARANTEE INSURANCE CO GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARLEYSVILLE MUTUAL INS CO HARLEYSVILLE-ATLANTIC INS CO 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 INDIANA LUMBERMENS MUTUAL INS INSURANCE CO OF STATE OF PA INSURANCE CORP. OF NEW YORK KEY RISK INSURANCE CO LEGION INS CO-IN LIQUIDATION 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 MIDWESTERN INDEMNITY CO MITSUI SUMITOMO INS CO OF AMER MONUMENTAL GENERAL CAS NATIONAL FIRE INS CO HARTFORD NATIONAL INTERSTATE INS NATIONAL LIABILITY & FIRE INS NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NETHERLANDS INSURANCE CO NEW HAMPSHIRE INSURANCE CO NORGUARD INSURANCE CO. NORTH RIVER INSURANCE CO OHIO CASUALTY INSURANCE CO OLD DOMINION INSURANCE CO OLD REPUBLIC INSURANCE CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO

Claims Reported
7 3 1 1 1 10 8 2 12 18 100 123 23 96 23 166 8 1 283 1 56 3 65 3 568 105 48 26 46 10 2 18 14 1 3 8 16 1 18 1 2 5 34 1 3 8 4 22 60 1 5 6 139 6 10

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Subsequent Injury Trust Fund 2005 Annual Report
Insurance Company PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN LUMBERMENS MUTUAL PENN MFG ASSOC INS PENN MILLERS MUTUAL PENN NATIONAL MUTUAL CAS PHOENIX INSURANCE CO PROTECTIVE INSURANCE CO PROVIDENCE PROP & CAS INS CO PROVIDENCE WASHINGTON INS CO RELIANCE INS CO IN LIQUIDATION RELIANCE NAT. IND. IN LIQ. ROCHDALE INSURANCE COMPANY ROYAL & SUNALLIANCE INS. CO ROYAL INDEMNITY CO ROYAL INS CO OF AMERICA S.E. EMPLOYER MUT. CAP. INS CO SAFECO INSURANCE CO AMERICA SAFETY FIRST INS 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 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 STAR INSURANCE CO STATE FARM FIRE & CASUALTY CO TECHNOLOGY INSURANCE CO TIG INSURANCE CO TOKIO MARINE & NICHIDO FIRE TRANSCONTINENTAL INS CO TRANSGUARD INS CO OF AMERICA TRANSPORTATION INSURANCE CO TRAVELERS CAS & SUR CO 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. UNISUN INSURANCE COMPANY

Claims Reported
85 7 1 37 2 229 6 1 24 6 13 2 1 1 19 55 15 2 120 2 1 14 1 20 79 17 24 52 14 211 10 1 8 113 20 2 1 14 21 96 2 24 12 1 11 11 11 22 694 1 228 36 22 1 1

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Subsequent Injury Trust Fund 2005 Annual Report

Insurance Company
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 WAUSAU BUSINESS INSURANCE WAUSAU UNDERWRITERS INS CO WEST AMERICAN INSURANCE CO WESTFIELD INSURANCE CO WESTPORT INSURANCE CORP YASUDA FIRE & MAR INS OF AMER ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL ZURICH/AMERICAN GUARANTEE
Total of Companies 232

Claims Reported

26

10

4

6

2

2

13

6

3

18

1

24

61

1

57

45

729

1

Total

9,757

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Claims Reported by Group Self-Insurers
January 1, 2005 to December 31, 2005

Group Self-Insurer
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 NURSING HOME SELECTIVE WC GA OILMEN'S ASSOCIATION GA OPERATORS SELF-INSURERS GA SCHOOL BD ASSOC W C FUND GA UNITED BUSINESSES GEMC WORKERS' COMP FUND GTMA/AYSA SELF INSURANCE ROOFING & SHEET METAL ASSOC Total of Companies 16

Claims Reported

Total

71 85 55 1 7 93 71 110 42 112 94 173 1 99 64 2
1,080

Subsequent Injury Trust Fund 2005 Annual Report

Claims Reported by Self-Insured Companies
January 1, 2005 to December 31, 2005

Self-Insurer

Claims Reported

A T & T

4

AAA COOPER TRANSPORTATION

22

ABF FREIGHT SYSTEM, INC

1

ACUITY BRANDS

31

AGL RESOURCES, INC.

7

ALBANY, CITY OF

3

ALEXIS PLAYSAFE, INC.

2

ALLIED SYSTEMS LTD

5

ALPHARETTA, CITY OF

3

ANHEUSER-BUSCH COMPANIES, INC.

2

ARCHBOLD MEDICAL CENTER

9

ARCHDIOCESES OF ATLANTA

2

ARCHER-DANIELS-MIDLAND CO

2

ASPLUNDH TREE EXPERT CO

4

ATHENS REG. HLTH SYS INC

23

ATHENS-CLARKE COUNTY

12

ATLANTA CITY OF

231

ATLANTA HOUSING AUTHORITY

2

ATLANTA PUBLIC SCHOOLS

19

AUGUSTA-RICHMOND CO BD COMM

69

AUTOZONE, INC

4

AVERITT EXPRESS, INC

14

BANKHEAD SERVICES, INC

4

BARTOW COUNTY BD OF EDUCATION

28

BEAULIEU GROUP LLC

17

BELLSOUTH CORPORATION

18

BENTON-GEORGIA INC

4

BERRY COLLEGE

2

BIBB COUNTY BD-COMMISSION

14

BIG LOTS STORES, INC.

4

BJ'S WHOLESALE CLUB INC

8

BLOSSMAN COMPANIES, INC

6

BLUE BIRD BODY COMPANY

40

BOBS CANDIES, INC.

4

BREMEN-BOWDEN INVESTMENT CO.

1

BROWN INDUSTRIES

3

BRUNSWICK, CITY OF

25

BURLEN CORPORATION

1

C T HARRIS INC

5

C. W. MATTHEWS CONTRACTING INC

2

CAGLE'S INC, & SUBSIDIARIES

5

CALFEE COMPANY OF DALTON, INC

2

CANDLER HEALTH SYSTEM

12

CARROLL CO. BOARD OF EDUCATION

1

CEMEX (SOUTHDOWN INC.)

3

CENTRAL GEORGIA HEALTH SYSTEMS

81

CERTAINTEED CORPORATION

3

CHATHAM AREA TRANSIT AUTHORITY

3

CHATHAM COUNTY BD OF EDUCATION

21

CHATHAM COUNTY GEORGIA

6

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Subsequent Injury Trust Fund 2005 Annual Report
Self-Insurer CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHILDREN'S HEALTHCARE OF ATL CITIGROUP INC. CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS CLAYTON COUNTY WATER AUTHORITY COATS & CLARK, INC. COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLLEGE PARK CITY OF COLONIAL GROUP COLQUITT CO BD OF EDUCATION COLQUITT REGIONAL MEDICAL CENT COLUMBIA COUNTY BOE 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 DALTON CITY OF DAN RIVER, INC. DART CONTAINER CORPORATION DEAN FOODS COMPANY DECATUR, CITY OF DEKALB COUNTY BOARD-ED DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HLTHCARE SYS DELHAIZE AMERICA INC. DELTA AIRLINES, INC. DILLARD DEPARTMENT STORES INC DOLLAR GENERAL CORP DOUGHERTY COUNTY BOC DOUGHERTY COUNTY SCHOOL SYSTEM DOUGLAS ASPHALT COMPANY DOUGLAS CO BD OF COMMISSIONERS DOUGLAS COUNTY SCHOOLS DOUGLAS, CITY OF DOUGLASVILLE-DOUGLAS COUNTY DULUTH, CITY OF DURAND-WAYLAND, INC EAST POINT, CITY OF

Claims Reported
1 1 41 9 12 1 47 194 4 1 36 11 13 47 2 4 7 3 3 7 2 5 6 1 11 2 30 16 1 9 24 7 4 3 1 1 4 4 19 66 48 11 355 1 5 9 6 14 21 59 2 4 1 1 14

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Subsequent Injury Trust Fund 2005 Annual Report
Self-Insurer ELBERTA CRATE & BOX COMPANY ELBERTON GRANITE ASSOCIATION ELBERTON, CITY OF EMORY UNIVERSITY ENCOMPASS GROUP, LLC ESTES EXPRESS LINES EVANS GRADING CO., INC EXEL HOLDINGS, USA, INC FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FEDERATED DEPARTMENT STORES FEDEX GROUND PKG SYS FIELDALE FARMS CORPORATION FIELDCREST CANNON INC FLEETWOOD HOMES OF GA INC FLEXSTEEL 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 GA S.I. GUARANTY TRUST FUND GENERAL MOTORS CORPORATION GEORGIA DUCK & CORDAGE MILL GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GERBER PRODUCTS COMPANY GFF HOLDING CO/GENERAL FIBERS GLYNN COUNTY BOARD OF COMMISSIONERS GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GOODY PRODUCTS, INC. GREAT DANE LTD PARTNERSHIP 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 HAVERTYS FURNITURE HENRY CO BOARD OF EDUCATION HERCULES INCORPORATED HILLCREST FOODS, INC HILTON HOTELS CORPORATION

Claims Reported
2 1 2 75 5 8 2 3 1 82 32 1 5 10 1 4 1 19 13 5 6 2 22 9 2 1 11 11 11 26 1 348 1 996 31 1 1 41 29 12 1 5 5 4 8 49 6 8 53 2 9 12 4 1 2

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Subsequent Injury Trust Fund 2005 Annual Report
Self-Insurer 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 J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JOHN WIELAND HOMES, INC JOHNS MANVILLE INT'L., INC. JONES COMPANY (THE) KELLEY MANUFACTURING COMPANY KELLOGG CO & SUBSIDIARIES KERR-MCGEE PIGMENTS (SAV) INC. KIMBERLY-CLARK CORP KING & PRINCE SEAFOOD CORP. 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 LIL' CHAMP FOOD STORES, INC LOWE'S HOME CENTERS, INC MACON CITY OF MACON/BIBB CO WATER & SEWERAGE MARIETTA CITY SERVICES MAR-JAC POULTRY, INC. MARRIOTT INTERNATIONAL, INC. MARTA MCDONALD'S OF GEORGIA INC MCLANE COMPANY, INC. MEADWESTVACO MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC MILLEDGEVILLE, CITY OF MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC MONROE, CITY OF MOUNT VERNON MILLS MUSCOGEE COUNTY SCHOOL DIST NATIONAL SERVICES INDUSTRIES NEWTON COUNTY NEWTON COUNTY BD OF EDUCATION

Claims Reported
2 1 9 2 55 9 3 2 3 5 1 24 2 53 1 13 2 7 2 52 28 6 1 1 2 5 1 3 89 2 9 5 12 1 30 8 2 18 2 96 340 2 3 5 13 1 1 1 94 8 1 6 16 8 33

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Subsequent Injury Trust Fund 2005 Annual Report
Self-Insurer NORDSTROM, INC. NORMAN W FRIES/CLAXTON POULTRY NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OVERNITE TRANSPORTATION CO OWENS-CORNING OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORPATION PCC AIRFOILS LLC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT LABORATORIES, INC PRESBYTERIAN HOMES OF GA RACETRAC PETROLEUM, INC RIVERDALE, CITY OF RMC USA, INC. ROCKDALE CO. BD OF EDUCATION ROCKWELL AUTOMATION, INC ROLLINS INC ROOKER ADMINISTRATIVE SERVICES ROPER CORPORATION ROSWELL CITY OF RTM, INC. RYAN'S FAMILY STEAK HOUSES SAINT JOSEPH'S OF SAVANNAH SATILLA HEALTH SERVICES INC SAVANNAH CITY OF SCIENTIFIC-ATLANTA INC SHAW INDUSTRIES INC SHEPHERD CONSTRUCTION SHERWIN-WILLIAMS COMPANY SHONEY'S LLC SI CORPORATION SIZEMORE ,INC. SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GA HLTH SYSTEM SOUTHEASTERN FREIGHT LINES SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN PAN SERVICES SOUTHERN REGIONAL HEALTH SYS. SOUTHWIRE COMPANY SPALDING CO BOARD OF COMM SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL STANLEY WORKS & SUBSIDIARIES STONE CONTAINER CORPORATION SUPERIOR RIGGING & ERECTING CO T. M. POLYFILM, INC TALON EQUITIES, INC TARGET CORPORATION TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS TIFTON ALUMINUM CO INC/ALCOA I

Claims Reported
1 9 2 25 8 13 3 1 1 7 3 3 7 4 4 1 2 1 1 1 5 3 6 8 4 7 4 2 11 1 9 2 59 21 6 10 78 21 2 1 5 1 11 10 6 4 2 2 1 5 1 1 5 1 2

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Subsequent Injury Trust Fund 2005 Annual Report
Self-Insurer 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 WAFFLE HOUSE 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 WELLSTAR HEALTH SYSTEM 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 of Companies 300

Claims Reported

4

11

1

81

1

4

1

31

7

24

11

5

56

1

19

8

5

7

2

3

41

2

1

5

8

1

38

17

26

Total

5,944

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Subsequent Injury Trust Fund 2005 Annual Report

Page 16

REIMBURSEMENTS PAID IN 2005
Reimbursements Paid to Insurance Companies
January 1, 2005 to December 31, 2005

Reimbursements Paid to Insurance Companies ACE AMERICAN INSURANCE CO ACE PROPERTY & CASUALTY INS AIG NATIONAL INS. 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 GUAR & LIAB 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 ZURICH INS CO AMERISURE INSURANCE CO ARGONAUT GREAT CENTRL INS CO ARGONAUT INSURANCE CO ASSOCIATED INDEMNITY CORP ASSOCIATION INSURANCE CO ATLANTIC MUTUAL INS. CO AUTO OWNERS INS. CO BANKERS STANDARD INS CO BITUMINOUS CASUALTY CORP BRIDGEFIELD CASUALTY BUILDERS INSURANCE CANAL INSURANCE CO CAPITAL CITY INS CO CASUALTY RECIPROCAL EXCHG 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

Amount $533,159.96
$51,345.73 $9,737.12
$88,551.67 $24,803.75 $26,330.61 $529,044.58 $403,292.67 $728,501.18 $12,390.73 $15,850.06 $1,327,821.49 $522,553.37 $885,544.89 $61,053.32 $15,972.42 $895,993.10 $152,267.88 $762,969.05 $131,834.50 $79,319.35
$2,975.00 $13,090.60 $50,695.48 $30,860.88 $41,310.66
$1,737.15 $27,284.60 $441,874.64 $138,405.08 $811,154.95 $296,296.73 $172,396.16 $3,124,633.64 $413,100.53 $262,024.93 $62,118.95 $82,270.92 $178,990.60 $107,962.49 $97,534.07 $105,693.80 $375,997.35 $108,574.33 $622,055.40 $63,930.41 $28,779.79 $66,310.43 $860,689.56

Subsequent Injury Trust Fund 2005 Annual Report

Reimbursements Paid to Insurance Companies COMPANION PROP & CAS CONNECTICUT INDEMNITY CO CONTINENTAL CASUALTY CO CONTINENTAL INSURANCE CO CORNERSTONE MUTUAL INS CO CRUM & FOSTER INDEMNITY CO CYPRESS INSURANCE CO DEERFIELD INSURANCE CO DISCOVER PROPERTY & CAS ELECTRIC INSURANCE CO ELECTRIC MUTUAL LIAB INS LTD EMC PROPERTY & CASUALTY EMPLOYERS INS OF WAUSAU EVEREST NATIONAL INS FAIRFIELD INSURANCE CO FCCI INSURANCE COMPANY FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FEDERATED RURAL ELECTRIC INS FIDELITY & CAS CO OF NY FIDELITY & GUARANTY INS CO FIREMAN'S FUND INS CO FIREMAN'S FUND INS CO OF GA FIREMAN'S FUND OF WISCONSIN 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' 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 GRANGE MUTUAL CASUALTY COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMER INS CO OF NY GREAT AMERICAN INS CO GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOUR SPECIALITY INS 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 HOSPITALITY MUT CAPTIVE INS

Amount $58,055.24 $221,495.62 $1,335,499.47 $42,266.76 $353,431.46 $23,763.93 $27,736.34 $15,969.73 $158,632.41 $16,374.48 $10,725.00
$2,619.66 $919,570.82 $240,514.09
$36,547.23 $146,810.47 $104,145.14 $541,706.69
$22,501.76 $59,614.59 $402,167.18 $703,600.82 $58,708.06 $54,015.50 $77,596.22 $44,286.54 $114,277.14 $3,182,759.69 $31,761.09 $154,844.47 $48,096.58 $401,713.59 $42,050.67 $659,002.83
$9,591.65 $22,584.67 $22,289.05 $293,881.48 $75,034.64 $84,329.52 $185,143.01 $177,967.48 $193,047.69 $196,306.73 $453,822.48 $141,181.95 $427,120.91 $1,176,832.18 $84,443.00 $103,993.42
$5,875.42 $508,083.61 $137,216.09
$88,529.84 $166,557.96

Page 17

Subsequent Injury Trust Fund 2005 Annual Report

Reimbursements Paid to Insurance Companies 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 MAG MUTUAL INS CO MANAGEDCARE MUT CAPTIVE INS MANUFACTURER'S ALLIANCE INS MARYLAND CASUALTY COMPANY MASSACHUSETTS BAY INSURANCE CO MITSUI SUMITOMO INS CO OF AMER MONUMENTAL GENERAL CAS 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. 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 PENN MFG IND. CO PHOENIX INSURANCE CO PRINCETON INSURANCE CO PROVIDENCE WA INS CO OF N Y PROVIDENCE WASHINGTON INS CO REALM NATIONAL INS-IN LIQUIDAT REGENT INSURANCE CO RELIANCE INS CO IN LIQUIDATION ROYAL & SUNALLIANCE INS. CO ROYAL INDEMNITY CO ROYAL INS CO OF AMERICA SAFECO INS CO OF ILLINOIS SAFECO INSURANCE CO AMERICA SAFETY NATIONAL CASUALTY SECURITY INS CO OF HARTFORD

Amount $297,302.91
$28,178.74 $325,654.02 $1,255,847.29
$98,694.74 $119,436.88
$42,951.30 $219,163.30 $1,307,955.63 $1,807,067.06
$33,061.25 $80,136.72 $1,834,894.85 $1,414,800.33 $140,014.12 $334,149.65 $262,296.72 $356,270.14 $15,816.51 $125,642.10
$1,415.20 $6,896.96 $270,674.89 $69,769.43 $191,529.82 $509,400.50 $198,390.97 $27,029.45 $8,865.00 $28,478.79 $48,648.94 $7,695.00 $92,329.55 $674,531.54 $273,924.90 $59,878.05 $2,315,376.84 $27,008.40 $4,451.48 $451,221.80 $47,119.90 $301,940.28 $336,856.82 $13,933.88 $25,374.83 $187,314.89
$189.39 $565,112.58 $1,475,222.76
$3,173.81 $192,695.61
$9,191.03 $400,925.46
$19,780.13 $79,525.95

Page 18

Subsequent Injury Trust Fund 2005 Annual Report

Reimbursements Paid to Insurance Companies SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SE SELECTIVE INSURANCE CO OF SC SENTRY INSURANCE A MUTUAL CO SOUTH CAROLINA INS CO-IN LIQ SOUTHEASTERN US CAP. INS, INC SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INSURANCE CO SOUTHERN PILOT 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 TOKIO MARINE & NICHIDO FIRE TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO 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 UNISUN INSURANCE COMPANY UNITED STATES FIRE INSURANCE UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO UTICA NATIONAL ASSURANCE 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:

Amount $181,731.89
$14,907.06 $126,778.82 $226,512.53
$44,414.52 $58,892.90 $15,870.93 $21,148.51
$2,054.95 $714,452.02
$9,872.24 $66,190.67 $120,816.56 $108,333.30 $27,154.71 $953,416.75 $362,193.37 $79,767.77 $646,144.43
$7,480.00 $578,994.25 $500,683.42 $108,041.88
$24,109.98 $1,554,737.19 $1,169,362.65
$265,419.59 $169,759.41
$2,355.15 $35,724.58 $119,797.45 $134,882.76 $97,191.80
$69.30 $424,047.75
$7,215.74 $21,504.16 $75,033.51 $103,194.54 $15,487.16 $55,569.92 $14,311.57 $104,197.78 $1,217,699.01 $1,529,539.13 $62,074,183.31

Page 19

Subsequent Injury Trust Fund 2005 Annual Report

Page 20

Reimbursements Paid to Group Self-Insurers
January 1, 2005 to December 31, 2005

Reimbursements Paid to Group Self-Insurers AGRITRUST OF GEORGIA ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GEORGIA 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 SCHOOL BD ASSOC W C FUND GA WHOLESALE & RETAIL WC FUND GEMC WORKERS' COMP FUND GTMA/AYSA SELF INSURANCE W. C. FUND FOR HEALTH CARE Grand Total:

Amount $263,319.88 $2,067,585.72 $154,523.14
$88,370.64 $159,694.30
$13,646.11 $577,083.62
$95,217.69 $364,703.70 $119,548.35 $1,319,943.61 $871,447.51 $322,622.09 $735,230.97
$31,032.51 $592,717.71 $113,474.72
$51,400.56 $7,941,562.83

Subsequent Injury Trust Fund 2005 Annual Report

Page 21

Reimbursements Paid to Self-Insured Companies
January 1, 2005 to December 31, 2005

Reimbursements Paid to Self-Insurers ABF FREIGHT SYSTEM, INC ACUITY BRANDS AGL RESOURCES, INC. ALBANY, CITY OF ALLIED SYSTEMS LTD AMERICAN PROTEINS, INC ANHEUSER-BUSCH COMPANIES, INC. ARCHBOLD MEDICAL CENTER ARCHDIOCESES OF ATLANTA ATHENS REG. HLTH SYS INC ATHENS-CLARKE COUNTY ATLANTA CITY OF ATLANTA PUBLIC SCHOOLS AUGUSTA, CITY COUNCIL OF AUGUSTA-RICHMOND CO BD COMM AVERITT EXPRESS, INC AVONDALE MILLS INC BARTOW COUNTY BD OF EDUCATION BAYLINER MARINE CORPORATION BEAULIEU OF AMERICA BELLSOUTH CORPORATION BELLSOUTH ENTERPRISES INC BENTON-GEORGIA INC BERRY COLLEGE BIBB COUNTY BD-COMMISSION BLACK & DECKER CORPORATION BLUE BIRD BODY COMPANY BLUE CIRCLE AMERICA BREMEN-BOWDEN INVESTMENT CO. BRUNO'S INC & SUBSIDIARIES BRUNSWICK, CITY OF BURLEN CORPORATION C T HARRIS INC C. W. MATTHEWS CONTRACTING INC CAGLE'S INC, & SUBSIDIARIES CANDLER HEALTH SYSTEM CARROLL CO. BOARD OF EDUCATION CEMEX (SOUTHDOWN INC.) CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHATHAM COUNTY BD OF EDUCATION CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHILDREN'S HEALTHCARE OF ATL CITIGROUP INC. CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS COACHMAN REC. VEHICLE CO OF GA

Amount $20,216.94 $92,069.96 $158,177.35 $197,199.98 $12,675.00 $87,481.48 $44,621.12 $55,961.80
$100.00 $15,765.72 $111,304.64 $1,259,715.58 $359,709.64
$2,658.12 $223,231.07
$48,497.11 $8,767.07
$26,583.67 $90,467.57 $890,960.61 $193,157.30 $19,150.56 $133,798.44
$9,052.80 $195,321.50
$40,931.82 $1,889,095.99
$106,675.39 $29,567.43 $68,827.75 $64,837.53 $82,962.05
$162,842.41 $20,019.70
$170,247.95 $123,559.16
$56,991.53 $6,958.90
$96,728.23 $27,260.77 $66,396.04 $53,586.06
$77.00 $133.00 $31,157.89 $295,582.45 $821.20 $24,453.50 $315,940.53 $121,392.70

Subsequent Injury Trust Fund 2005 Annual Report
Reimbursements Paid to Self-Insurers COATS & CLARK, INC. COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLUMBIA COUNTY BOE COLUMBUS CITY OF COLUMBUS FOUNDRIES INC CONAGRA FOODS, INC CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER COWETA CO BOARD OF EDUCATION COX ENTERPRISES INC CRACKER BARREL OLD CNTRY STORE CRIDER'S POULTRY INC DALTON CITY OF DAN RIVER, INC. DECATUR, CITY OF DEKALB COUNTY BOARD-ED DEKALB COUNTY GOVERNMENT DEKALB REGIONAL HLTHCARE SYS DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOLLAR GENERAL CORP DOUGHERTY COUNTY BOC DOUGLAS ASPHALT COMPANY DOUGLAS CO BD OF COMMISSIONERS DOUGLAS COUNTY SCHOOLS DRY BRANCH KAOLIN COMPANY ELBERTON GRANITE ASSOCIATION EMERSON ELECTRIC CO EMORY CLINIC, INC., EMORY UNIVERSITY ENGELHARD CORPORATION ESTES EXPRESS LINES FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FIELDALE FARMS CORPORATION FLEETWOOD HOMES OF GA INC FLORIDA ROCK INDUSTRIES INC FLOWERS FOODS INC. FLOYD COUNTY BD OF EDUCATION FORD MOTOR COMPANY 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

Amount $6,835.58 $219,325.62 $341,544.25 $20,444.46 $91,009.12 $28,474.37 $6,330.00 $31,559.56 $154,487.37 $66,324.17 $255,896.89 $140,557.18 $51,876.44 $3,168.70 $365,094.04 $5,252.26 $138,481.56 $239,645.79 $2,280.68 $123,564.86 $207,375.34 $50,100.11 $723,017.99 $68,200.00
$60.00 $142,238.27
$39,502.36 $21,544.11 $111,202.12 $54,210.74 $266,106.35 $221,904.49 $10,344.83 $953,574.79 $100,251.49 $33,307.74 $129,784.91 $59,199.68 $329,660.22
$7,556.24 $276,272.99
$9,910.00 $59,972.82 $295,053.66 $249,563.42 $26,416.61 $118,998.69 $140,458.85 $16,500.00 $136,722.75 $269,376.61 $312,832.40 $17,036.01 $291,709.19 $569,361.01

Page 22

Subsequent Injury Trust Fund 2005 Annual Report
Reimbursements Paid to Self-Insurers GENUINE PARTS COMPANY GEORGIA DUCK & CORDAGE MILL GEORGIA POWER CO GEORGIA STATE OF 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 DANE LTD PARTNERSHIP GWINNETT CO BD OF EDUCATION GWINNETT COUNTY BD OF COMMISS GWINNETT HOSPITAL SYSTEM HALL COUNTY BOARD OF EDUCATION HAMILTON HEALTH CARE SYSTEM HARDEE'S FOOD SYSTEMS INC HCA, INC. HENRY CO BOARD OF EDUCATION HERCULES INCORPORATED HORMEL FOODS CORP HORTON HOMES, INC HOUSTON COUNTY BD OF EDUCATION HOUSTON COUNTY COMMISSIONERS HOWARD SHEPPARD INC HUTCHESON MEDICAL CENTER HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION INGLES MARKETS INC INTERNATIONAL PAPER COMPANY J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JOHN WIELAND HOMES, INC JONES COMPANY KELLEY MANUFACTURING COMPANY KELLOGG CO & SUBSIDIARIES KENNESTONE REGIONAL HEALTH KLEEN-TEX INDUSTRIES K-MART CORP-IN BANKRUPTCY KROGER COMPANY, THE LA MAR & BOWDON MFG CO LANGDALE INDUSTRIES LEVI STRAUSS & CO LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC LOXCREEN COMPANY, INC. MACON CITY OF MACON/BIBB CO WATER & SEWERAGE MARIETTA CITY SERVICES MARRIOTT INTERNATIONAL, INC. MARTA MCKENZIE TANK LINES INC MCLANE COMPANY, INC.

Amount $10,187.75
$3,375.00 $163,747.02 $9,102,840.66 $715,440.46
$38,581.82 $78,703.88 $241,670.41 $222,966.86 $63,597.43 $91,393.92 $92,156.55 $267,460.35 $45,350.10 $133,609.72 $114,009.82 $14,193.26 $72,420.17 $40,502.34
$150.50 $149,276.82
$63,941.89 $63,143.87 $57,173.43 $21,171.65 $164,855.43 $14,395.62
$8,413.21 $566,365.59 $320,826.76
$50,028.16 $244,121.03
$49,825.25 $66,404.95 $63,669.40
$2,027.95 $250,944.53
$85,989.31 $3,890.54
$29,580.34 $249,021.88
$5,712.00 $83,455.00 $88,831.52 $42,539.63 $143,372.72 $463,781.59
$2,084.52 $137,982.21 $150,320.00 $440,630.37 $362,362.48 $359,425.69
$6,075.00 $1,830.12

Page 23

Subsequent Injury Trust Fund 2005 Annual Report
Reimbursements Paid to Self-Insurers MEAD CORPORATION MEMORIAL MEDICAL CENTER, INC. MERCK & CO INC MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC MULLITE CO OF AMERICA MURRAY COUNTY BD OF EDUCATION NABISCO, INC NATIONAL SERVICES INDUSTRIES NEWTON COUNTY BD OF EDUCATION NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OLD DOMINION FREIGHT LINES INC OLIVER RUBBER CO OVERNITE TRANSPORTATION CO OWENS-CORNING OWENS-ILLINOIS INC PARKER HANNIFIN CORPATION 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 RMC USA, 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 SEABOARD CORPORATION SEARS, ROEBUCK & CO SHAW INDUSTRIES INC SHONEY'S LLC SI CORPORATION SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GA HLTH SYSTEM SOUTHEASTERN FREIGHT LINES SOUTHEASTERN MILLS, INC SOUTHERN BELL TEL & TEL SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN NUCLEAR OPERATING CO SOUTHERN REGIONAL HEALTH SYS.

Amount $18,211.89 $415,565.53 $211,624.41 $11,247.96 $1,844,128.29 $18,375.00 $19,060.74 $22,084.86 $135,387.20 $14,804.89
$225.00 $267,312.38
$36,349.64 $79,941.79
$6,525.00 $72,584.97
$6,910.73 $37,451.74 $126,974.17
$6,917.16 $21,614.72 $128,676.74 $59,216.50 $16,830.70 $84,893.00 $90,859.80 $16,611.58
$6,962.48 $38,844.61 $307,996.10 $203,266.35 $190,701.74
$8,053.49 $26,202.59 $11,796.31 $14,418.48 $20,732.89 $39,314.99 $484,220.33 $418,959.42 $175,347.67 $127,049.66 $62,054.11 $1,013,496.75 $260,736.77 $215,680.33
$3,219.55 $63,746.86 $26,216.04 $10,090.68 $13,087.40 $801,494.95 $107,200.00
$2,836.75 $66,608.68

Page 24

Subsequent Injury Trust Fund 2005 Annual Report
Reimbursements Paid to Self-Insurers SOUTHWIRE COMPANY SPALDING & EVENFLO COMPANIES ST FRANCIS HOSPITAL STONE CONTAINER CORPORATION SUPERIOR RIGGING & ERECTING CO SYNTHETIC INDUSTRIES, INC TANNER HEALTH SERVICES TENNECO AUTOMOTIVE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS THREE SPRINGS INC. TIFTON ALUMINUM CO INC/ALCOA I TIP TOP POULTRY INC TROUP CO. BOARD OF EDUCATION TYSON FOODS INC UNILEVER UNITED STATES UNION CAMP CORPORATION UNITED CATALYSTS, INC UNITED HEALTH SERVICES INC UNIVERSITY HOSPITAL US GYPSUM/L & W SUPPLY & SUBS USF HOLLAND, INC. VALDOSTA CITY OF VISITING NURSE HEALTH SYSTEM VULCAN MATERIALS COMPANY WACHOVIA WAFFLE HOUSE WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WARREN SEWELL MFG. CO. WATKINS ASSOCIATED INDUSTRIES WATKINS ENGINEERS & CONST WELLSTAR HEALTH SYSTEM WESLEY HOMES, 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 ZARTIC INC Grand Total:

Amount $195,451.43
$14,867.03 $29,054.30
$4,250.00 $13,725.00 $58,810.82 $29,197.47 $59,825.86 $42,042.36 $155,838.63 $76,141.47
$177.18 $5,300.63 $20,925.00 $66,448.03 $256,575.10 $32,548.74 $33,222.29 $141,491.47
$140.30 $340,404.42
$901.04 $36,393.95
$2,362.20 $9,522.95 $213,340.49 $36,838.17 $282,302.33 $126,525.87 $3,112.79 $150,478.50 $405,364.93 $4,022.15 $324,613.50
$666.95 $16,510.11 $102,754.55 $13,325.20 $254,835.12
$1,616.42 $652,456.36
$12,600.00 $22,553.14 $45,791,256.80

Page 25

Subsequent Injury Trust Fund 2005 Annual Report

Page 26

Individual Employers Benefiting from Reimbursements
Reimbursements Paid to Insurance Companies January 1, 2005 to December 31, 2005

INDIVIDUAL EMPLOYER
1599 DDP ENTERPRISES INC 7 HILLS TRANSPORT A & B PAINTING SERVICE A & B SHEET METAL A S TECHNOLOGIES, INC. A.A. FRIEDMAN, INC. A.B. DICK CO. A.B. DICK CO. A.M. BRASWELL JR. FOOD A-1 CONTRACT STAFFING AAA FIRE PROTECTION, INC. AACTION AUTO PARTS AARON RENTS INC ABB DAIMLER-BENZ TRANS. ABC SCHOOL SUPPLY ACCORD HUMAN RESOURCES ACOUSTI OF COLUMBUS INC. ACOUSTI, INC. ACTION BLUE PRINT CO. ACTION ELECTRIC COMPANY, INC. ADC SYSTEMS INTEGRATION ADCOX SERVICE CO. INC ADDISON STEEL ADMINISTAFF ADP TOTAL SOURCE ADP TOTALSOURCE ADP TOTALSOURCE/LAKELAND ADVANCE AUTO ADVANCE AUTO ADVANCE AUTO ADVANCED DISPOSAL SERVICE ADVANCED ELEC. CONTRACTOR ADVANCED ENVIRONMENTAL TECH ADVANCED ENVIRONMENTAL TECH AERUS, LLC AFC/CHURCH'S AGNES SCOTT COLLEGE AGRI-CON TRACTOR AIR CANADA AIRGAS, INC AIR-RIDE, INC. AIRXCEL HOLDING CORPORATION AKZO NOBEL COATINGS, INC. AL ROGERS' HOMEWORK ALBANY BEVERAGE CO ALBRIGHTS FLOOR COVERING ALCON ASSOCIATES, INC. ALDEAN DUKES LOGGING INC ALEX FOODS INC

CITY
DAWSONVILLE CARTERSVILLE LAWRENCEVILLE FOREST PARK
ROSWELL AUGUSTA MARIETTA
NILES STATESBORO
TAMPA BRUNSWICK SAVANNAH
ATLANTA ATLANTA DULUTH MONROE COLUMBUS ATLANTA ATLANTA SMYRNA CHICKAMAUGA LAKE CITY ALBANY ATLANTA DOUGLASVILLE ATLANTA CARTERSVILLE CUMMING DOUGLAS THOMSON SUWANEE POWDER SPRINGS ALBANY DOTHAN TIFTON ATLANTA DECATUR ALBANY
TAMPA AUGUSTA SWANTON CORDELE BAXLEY ATHENS ALBANY LOGANVILLE ALBANY VALDOSTA ATLANTA

STATE
GA GA GA GA GA GA GA IL GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA FL GA OH GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$43,693.39 $924.12
$2,975.00 $12,254.32 $280,447.27
$5,795.62 $15,398.76 $13,090.60 $62,399.88 $90,843.78
$1,017.35 $12,353.13 $98,666.18
$1,690.65 $4,931.20 $28,061.78
$441.00 $10,717.46 $25,238.66
$6,786.94 $6,191.57 $20,643.78 $3,322.15 $27,683.53 $19,570.22 $15,590.56 $17,432.39 $77,010.54 $93,182.82 $21,215.70 $24,343.27 $2,052.73 $73,085.70 $5,145.36 $23,629.77 $33,080.09 $1,241.65 $60,493.05 $22,134.79 $10,139.32 $24,937.58 $39,543.64 $31,712.08 $13,672.53 $16,163.40 $17,931.75 $7,945.80 $4,303.58 $1,477.19

Subsequent Injury Trust Fund 2005 Annual Report

Page 27

INDIVIDUAL EMPLOYER
ALEXANDER & ALEXANDER SVC INC ALFRED MCCANNON WELL BORING ALL SOUTH SUPPLY ALLEN TERMITE & PEST CONTROL ALLERGY & ASTHMA CLINIC ALLGOOD OUTDOORS, INC. ALLIANCE IMAGING ALLISON SMITH CO. ALLSTATE INS CO ALLTELL GEORGIA COMM. ALPHA PRODUCTS, INC. ALUM-A-LIFT AMEDISYS HOME HEALTH, INC. AMERICAL CORP AMERICAL CORP AMERICAN AIRLINES AMERICAN CANCER SOCIETY AMERICAN EXCELSIOR CO. INC. AMERICAN LANDMARK FENCE AMERICAN MANAGEMENT TECH AMERICAN NATIONAL CAN AMERICAN RAILROAD IND AMERICAN RESTAURANT SERVICES AMERICAN SECURITY INS. CO AMERICAN SOUTHERN TIMBER AMERICAN VENDING CO., INC. AMERICAN WOODMARK CORP. AMERIPRIDE UNIFORM AMERISOURCE DIST. CORP. AMERISUITES AMERSON COMPANY AMI SPALDING REGIONAL HOSPITAL ANCHOR GLASS CONTAINER CORP. ANDERSSON METAL BUILDING ANDREW CORP. ANDREW ELECTRIC ANIMAL MEDICAL CARE CENTER APB, INC. APEX SUPPLY CO APPALACHIAN SURVEYORS APPALACHIAN WASTE SYSTEMS ARAMARK ARCHER DANIELS MIDLAND CO. ARROW CO. ARROW CO. ARROW TIRE CO. ARTISTIC JANITORIAL SERVICES ASHBURN HEALTH CARE ASHMORE CONCRETE CONTRCTRS ASSOCIATED BUILDERS ASSOCIATED STAFFING SERVICES I ATC HEALTHCARE SERVICES ATHENS COMMUNITY COUNCIL ON AG

CITY
ATLANTA COMER CARTERSVILLE BRUNSWICK MACON CUMMING ANAHEIM ATLANTA MACON CORNELIA ATLANTA WINSTON KENNESAW CARROLLTON HENDERSON DALLAS ATLANTA GRIFFIN MABLETON BOONES MILL FOREST PARK ATLANTA MARIETTA ATLANTA MOULTRIE EAST POINT JACKSON ATHENS ORLANDO DULUTH MACON GRIFFIN WARNER ROBBINS CONYERS NEWNAN LAWRENCEVILLE MARIETTA ELLENWOOD LAWRENCEVILLE CUMMING BLUE RIDGE ATLANTA MACON ATLANTA BUCHANAN GAINESVILLE MARIETTA ASHBURN EVANS CLEVELAND MONTICELLO MACON ATHENS

STATE
GA GA GA GA GA GA CA GA GA GA GA GA GA GA NC TX GA GA GA VA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$10,800.00 $7,439.76 $6,227.02
$88,313.54 $77,702.42 $12,836.22 $15,454.37 $22,758.96 $16,591.45 $26,080.66 $40,080.94 $32,653.05
$796.33 $8,390.45 $26,029.51 $23,698.82 $11,321.21 $12,950.54 $2,796.78 $70,070.10 $13,031.10 $10,747.49 $78,681.55 $8,964.93 $119,162.00 $2,115.50 $1,590.15 $6,417.84 $1,403.54 $2,018.70 $17,229.06 $23,259.17 $36,829.90 $34,043.34 $92,031.72 $28,969.98 $43,588.45 $13,563.32 $92,025.39 $39,048.85 $118,843.48 $58,613.71 $8,400.00 $28,301.50 $6,263.41 $62,905.74 $19,032.59 $3,802.57 $14,363.73 $162,144.60 $77,458.00 $92,249.56 $8,457.87

Subsequent Injury Trust Fund 2005 Annual Report

Page 28

INDIVIDUAL EMPLOYER
ATHENS DOWNTOWN DEVELOP ATHENS PAPER COMPANY ATKINSON COUNTY BOE ATLANTA CASUALTY GROUP ATLANTA FALCONS FOOTBALL CLUB ATLANTA FENCE COMPANY ATLANTA FREIGHTLINER TRUCK SAL ATLANTA HAULING-WASTE MGMNT ATLANTA HOCKEY CLUB, INC. ATLANTA JOURNAL CONSTITUTION ATLANTA MEDICAL CENTER ATLANTA PRICING SYSTEMS ATLANTA REGIONAL CLAIM HD ATLANTA STEEL ERECTORS, INC. ATLANTA UTILITY WORKS, INC. ATLANTIC COAST FIRE PROTECTION ATLANTIC SERVICES ATLANTIC SOUTHEAST AIRLINES ATLAS ROOFING COMPANY ATS, INC AUBREY SILVEY ENTERPRISES AUBURN DISTRIBUTION CENTER AUGUSTA REGIONAL MED. CTR. AUSTELL BOX BOARD AUTOMATED MACHINERY LTD, INC. AUTOZONE, INC. AVERY DENNISON AVIS RENT A CAR AVON PRODUCTS, INC. AWH CORPORATION B & A CONSTRUCTION CO. INC. B & B BEVERAGE CO.INC. B & H HOME-AUTO INC B & M WOOD PRODUCTS, INC B & S INDUSTRIAL CONTRACTO B.H. TRANSFER BABB'S AUTO SERVICE BABCOCK & WILCOX COMPANY BABCOCK & WILCOX COMPANY BACON COUNTY B. O. E. BAGCRAFT CORP. OF AMERICA BAKER CARPET MILLS, INC. BAKER'S PAINT BALLARD BROTHERS ELECTRIC BANK SOUTH BARDI HEATING & A/C BARKING HOUND VILLAGE BARLOW FABRICATION & MACHINE BARLOW LOGGING BARNSLEY INN & GOLF BARRETT & ASSOCIATES BARRETT PROPERTIES BARRINGTON HALL DEVELOPMENT BARRY MFG. CO.

CITY
ATHENS NASHVILLE PEARSON ALPHARETTA FLOWERY BRANCH LITHONIA JEFFERSON
SMYRNA ATLANTA ATLANTA ATLANTA ATLANTA ALPHARETTA SMYRNA EAST POINT DULUTH NORCROSS ATLANTA FOREST PARK THOMASVILLE CARROLLTON AUBURN AUGUSTA AUSTELL CUMMING
ROME FLOWERY BRANCH
ATLANTA SUWANEE
JASPER GAINESVILLE COLUMBUS
JASPER MANOR DUBLIN SANDERSVILLE DALTON ATLANTA BRUNSWICK
ALMA FOREST PARK
DALTON TUCKER MACON ATLANTA NORCROSS ATLANTA BRUNWICK WAYNESBORO ADAIRSVILLE ATLANTA BOGART WARNER ROBINS STONE MOUNTAIN

STATE
GA TN GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$9,132.73 $32,716.19 $58,194.98 $46,078.09 $100,882.50
$4,180.00 $84,240.76
$2,714.49 $32,553.22
$1,419.42 $64,352.34 $30,360.10
$1,473.35 $41,871.53
$2,893.89 $21,209.59 $19,700.40 $29,207.87 $148,666.35 $70,322.34 $36,500.01 $87,484.42 $18,812.98 $64,997.55 $105,706.94 $27,217.57 $148,583.42 $40,075.00 $198,696.05 $188,285.53
$4,794.51 $10,843.54
$23.38 $127.92 $1,415.20 $59,949.00 $13,441.04 $50,063.80 $15,376.48 $23,949.43 $13,317.67 $29,801.29 $79,965.82 $27,473.13 $19,723.86 $322,421.86 $1,481.11 $76,126.71 $28,925.00 $64,220.78 $8,050.00 $109,573.96 $177,453.65 $33,776.81

Subsequent Injury Trust Fund 2005 Annual Report

Page 29

INDIVIDUAL EMPLOYER
BARTENFELD ELECTRIC COMPANY BATES & ASSOCIATES BATES HARDWARD CO. BATSON-COOK COMPANY, INC. BATTLE LUMBER COMPANY BAXLEY WILDERNESS INSTITUTE BAYCOR BEASLEY RAILROAD CONSTR. BEKAERT CORP. BELCOURT APARTMENTS BELK INC. BELK INC. BELK INC. BELL MINOR HOME INC BELL TRUCKING BELLSOUTH ADV. & PUBLISH BEN MCELROY ASSOCIATES BENCO DENTAL BERKEL & COMPANY CONTRCTRS. BERLIN & HODGES BETTER BACKERS, INC. BETTER BRANDS OF ATLANTA BETZ LAB'S BEVIS ROPE MANUFACTURING INC BIG T TIRE & AUTO BILL HEARD CHEVROLET BILL THOMPSON TIRE BILLY GERRELL GRADING CO. BI-LO, INC. BLAIR HOUSE CONV. CTR. BLAKE CONSTRUCTION CO. BLOUNT CONSTRUCTION BLUE RIBBON RENTAL, INC. BLUE RIDGE HEALTH CARE INC BLUERIDGE RESIDENTIAL INC BOAEN MECHANICAL CONTRACTOR BOEING BOMBARDIER TRANSPORT BOOMERSHINE PONTIAC BORAL INDUSTRIES BOYD BROS. CONSTRUCTION CO. BRAND VAUGHAN LUMBER CO. BRENT WALKER FORD INC BRG OF SOUTH GEORGIA INC BRIDGES & SON BRIGHT HORIZONS FAMILY SOL. BRIGHTWAY JANITORAL, INC. BRITTS HOME FURNISHINGS BROCKWAY STANDARD INC BROOKS AUTO PARTS BROOKS INSTRUMENTS DIVISION BROOKS WELDING INC. BROWN & WILLIAMSON TOBACCO BROWN BROTHERS OF GA., INC.

CITY
ATLANTA BAINBRIDGE
ATLANTA WEST POINT
WADLEY BAXLEY CORNELIA JESUP ROME ROSWELL CARTERSVILE GAINESVILLE MACON GAINESVILLE SCREVEN ATLANTA ATHENS WILKES-BARRE BONNER SPRINGS MACON CHATSWORTH ATLANTA JACKSONVILLE ROSSVILLE COLUMBUS COLUMBUS ALBANY CUMMING CARTERSVILLE NORTH AUGUSTA ST. MARYS ATHENS CUYAHOGA FALLS BLUE RIDGE MARIETTA SAVANNAH DULUTH ATLANTA SMYRNA AUGUSTA LEESBURG TUCKER GLENNVILLE PELHAM HAMPTON ATLANTA LAFAYETTE SNELLVILLE HOMERVILLE DOUGLAS STATESBORO VALDOSTA MACON CONYERS

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA PA KS GA GA GA FL GA GA GA GA GA GA SC GA GA OH GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$8,516.66 $74,324.52 $21,728.05 $30,974.17 $30,674.94
$6,674.70 $1,085.84 $83,579.19 $401,053.10 $36,441.14 $33,044.69 $6,171.41 $55,672.71 $47,526.28 $122,249.29 $41,709.24 $23,519.34 $26,022.36 $14,211.48 $16,522.38 $9,945.00
$69.30 $202.40 $21,683.96 $481.00 $17,709.93 $27,805.37 $9,561.88 $2,316.48 $20,252.37 $10,266.00 $8,797.52 $2,425.54 $47,730.49 $101,266.29 $15,964.01 $20,158.52 $29,914.14 $17,438.31 $81,416.40 $26,978.91 $70,654.42 $9,680.00 $14,982.73 $28,198.51 $9,269.80 $98,978.58 $825.83 $48,365.72 $39,726.80 $13,184.29 $76,374.87 $200,762.80 $2,619.66

Subsequent Injury Trust Fund 2005 Annual Report

Page 30

INDIVIDUAL EMPLOYER
BROWN STEEL CONTRACTORS, INC. BRUNSWICK FLOORS, INC. BRUNSWICK/U.S. MARINE BUCKHEAD LIFE RESTAURANT BUILDERS FIRST SOURCE/S.E. GRP BUILDING TECHNOLOGY BULLINGTON LIFT TRUCKS BURGER KING BURGER KING BURKE COUNTY BOE BURLINGTON INDUSTRIES BURLINGTON NORTHERN BURNHAM SERVICE BUSINESS TEMPS/TEMP MASTER BWAY CORP C & D CHARTER POWER SYSTEMS C & H MECHANICAL & PLUMBING CADY BAG CO. CAMDEN COUNTY BOC CAMP OIL CO. CAMPBELL PRINTING CO CANOOCHEE EMC CAPRO INC CAR CRAFT CARA VITA CARDINAL SPECIALTY PRODUCTS CARE MORE MANAGEMENT, INC. CARE MORE MANAGEMENT, INC. CAREMORE INC. TREUTLEN CARLISLE COATINGS & WATERPROF CARMIKE CINEMAS CAROLINA HOLDINGS CARRIER CORP CARROLLTON MANOR, INC. CARSON, INC. CARTER & ASSOCIATES CARTER CONCRETE COMPANY CARWOOD MANUFACTURING CO. CASTLEBERRY INTERIORS CASWELL, INC. CATOOSA UTILITY DISTRICT CEBCOR/TABLES & CHAIRS, IN CECIL MALONE COMPANY CEDARTOWN PAPER BOARD CO CEDARWOOD APTS CELLOFOAM NORTH AMERICA CELLO-FOIL PRODUCTS, INC. CENTRAL GA EYE CENTER PC CENTRAL GA HOME HEALTH AGNCY CENTRAL HEALTH HOLDING CENTRAL LEASING MNGMT. INC. CENTURION INDUSTRIES CETCO (PC AMCOL INTL' GRP) CHAMBERS DEVELOPMENT CO.

CITY
NEWNAN BRUNSWICK VALDOSTA
ATLANTA BLAIRSVILLE TALLAPOOSA
MACON COMMERCE
MACON WAYNESBORO
SHANNON ALBANY
COLUMBUS AUGUSTA HOMERVILLE CONYERS DEMOREST PEARSON WOODBINE
ROME DALTON REIDSVILLE SWAINSBORO ATHENS MARIETTA CALHOUN MACON SUMMERVILLE SOPERTON ELBERTON COLUMBUS ACWORTH MARIETTA CARROLLTON SAVANNAH ATLANTA POWDER SPRINGS WINDER ROSWELL NEWNAN RINGGOLD ATLANTA ATLANTA CEDARTOWN AUGUSTA CONYERS ALBANY MACON MACON FORT OGLETHORPE OAK BROOK FREDONIA VILLA RICA ATLANTA

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA IL KS GA GA

TOTAL REIMBURSED
$9,045.00 $35,648.96
$5,864.75 $1,114.52 $13,984.93 $9,638.60 $3,055.20 $23,815.02
$46.48 $44,554.10
$8,705.62 $7,599.85
$39.82 $10,750.00 $97,534.07
$494.51 $6,756.88 $72,546.51 $326,737.46 $1,529.20 $22,054.55 $18,318.63 $21,069.45 $28,523.52 $28,053.54 $26,662.62 $9,320.96 $68,414.39 $81,051.52
$992.88 $25,792.62 $187,365.04
$9,360.72 $47,119.90 $16,179.90 $98,908.42 $26,953.51 $16,908.39 $67,529.63 $13,545.71
$535.44 $11,582.50 $40,627.71 $19,470.00 $14,505.60
$6,143.64 $55,885.07 $22,317.51 $46,499.72 $28,735.10 $24,014.30
$1,001.90 $35,925.00 $114,349.33

Subsequent Injury Trust Fund 2005 Annual Report

Page 31

INDIVIDUAL EMPLOYER
CHAMPION INTERNATIONAL CORP CHAPARRAL BOATS, INC. CHART INDUSTRIES CHARTER CENTRAL GA. CHARTER COMMUNICATIONS, INC. CHARTER MOBILE HOMES, INC. CHARTER TALBOT BHS CHATEAU ELAN RESORT CHATHAM STEEL CORPORATION CHEMICAL PRODUCTS CORP. CHEROKEE TOWN & COUNTRY CHERRY BLOSSOM FESTIVAL CHESTNUT RIDGE NURSING CHICK-FIL-A CHIPMAN-UNION, INC. CHOO-CHOO TRUCK WASH CHUMLEY'S PAVING & GRADING INC CHURCH OF JESUS CHRIST LDS CHURCHWELL'S DRYWALL CIBA VISION CORPORATION CIMCO CISCO'S TRAVEL PLAZA CITIZENS BANK OF WASHINGTON CO CITY CAFE & BAKERY CITY OF COVINGTON CITY OF EAST POINT POLICE DEPT CITY OF FORT VALLEY CITY OF HOGANSVILLE CITY OF LINWOOD CITY OF LOUISVILLE CITY OF NEWNAN HOUSING AUTH CITY OF ROME CITY OF THOMASTON CIVITAN REGIONAL BLOOD CTR. CJT INDUSTRIAL CONTRACTORS CKS PACKAGING CLARKLIFT OF ATLANTA CLARK'S SUPER MARKET CLASSIC COLLISION CLASSIC SURROUNDS CLAY M. NEWMAN LOGGING, INC. CLAYTON HOMES # 930 CLEVELAND GROUP, INC. CLOTHING FABRICS INC CMC, INC. COALE TRUCK TRANSPORT COASTAL DEPOT COASTAL GREAT SOUTHERN COASTAL PLAIN AREA EOA COASTAL RESTURANT MGMT, INC COBB COUNTY TRACTOR CO. COCA COLA BOTTLING COMPANY COCHRAN'S AUTO TRUCK STOP COHEN BROTHERS DRESS CORP

CITY
WAYCROSS NASHVILLE
CANTON ATLANTA DUBLIN HINESVILLE ATLANTA BRASELTON SAVANNAH CARTERSVILLE ATLANTA MACON CUMMING ATLANTA UNION POINT TUNNEL HILL ACWORTH ATLANTA COCHRAN DULUTH WAYNESBORO KINGSLAND SANDERSVILLE FAYETTEVILLE COVINGTON EAST POINT FORT VALLEY HOGANSVILLE LINWOOD LOUISVILLE NEWNAN
ROME THOMASTON GAINESVILLE
MACON ATLANTA ATLANTA GRIFFIN CHAMBLEE CORDELE HAZELHURST WAYCROSS ATLANTA WAYCROSS MCDONOUGH LAWRENCEVILLE GARDEN CITY SAVANNAH VALDOSTA SAVANNAH MARIETTA TIFTON RINGGOLD WAYCROSS

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$5,950.00 $75,578.52 $104,114.53 $114,637.51
$5,790.44 $4,874.10 $69,453.36 $26,101.68
$411.15 $43,721.43
$5,671.21 $397.90
$43,108.20 $157,288.21
$47,912.00 $4,556.67
$44,414.52 $87,253.67
$7,700.00 $60,042.83 $10,850.00 $10,904.24 $19,033.01
$9,191.03 $5,380.75 $5,940.00 $8,400.00 $19,714.81 $24,262.62 $53,715.17 $25,679.82 $63,765.35 $1,869.87 $5,401.05 $10,056.71 $1,154.92 $75,723.47 $14,887.28 $21,933.17 $11,911.16 $12,780.67 $14,249.37 $43,758.87 $4,415.05 $43,360.86 $124,827.72 $32,235.21 $46,062.18 $5,206.22 $59,791.34 $7,891.64 $77,445.00 $9,112.30 $41,820.69

Subsequent Injury Trust Fund 2005 Annual Report

Page 32

INDIVIDUAL EMPLOYER
COLCRAFT INC. COLEMAN AMERICAN MOVING COLISEUM PSYCHIATRIC HOSP COLLINS & AIKMAN FINISHING PLA COLLINS & AIKMAN FLOORCOVERG COLOR APPLICATIONS, INC. COLQUITT COUNTY COLUMBIA METROPOLITAN HO COLUMBUS ROOFING, INC. COMBINED INSURANCE COMBINED PROPERTIES COMBUSTION ENGINEERING COMBUSTION TECHNOLOGIES INC COMMERCIAL CONSTRC. SPECIA COMMUNITY NEWSPAPER, INC. COMPASS @ CO. D RAY JAMES ST P CONCRETE EXPRESS CONFEDERATE PACKAGING CONQUEST CARPET MILL CONSTANTINE DYEING CONTAINER GENERAL CORP. CONTINENTAL BAKING COMPANY CONTINENTAL CAN CO CONTINENTAL GRAIN CONTINENTAL GRAIN CONTINENTAL TELEPHONE CO. CONVENIENCE USA CONWAY SOUTHERN EXPRESS COOK SALES INC COOK'S MACHINE SHOP COOPER DDS, PC COOSA STEEL CORP COOSAWATTEE RIVER RESORT COSTAL SLEEVE LABEL COUNTRY PRIDE FOODS, INC. COURIER SYSTEMS, INC. COX MASONRY & STEEL, INC. CRAVEN POTTERY INC. CRESCENCIO MARTINEZ DBA CROSS PIPELINE COMPANY INC. CROTTS ENTERPRISES, INC. CRUM'S GARDEN CENTER CRYSTAL FARMS INC CRYSTAL SPRINGS PRINT WORKS CSI-SPEEDY DISPOSAL SRVCE CSRA PRIVATE DUTY CTF HOLDINGS LTD CUMMINS SOUTH INC CUSTOM BUILDING PRODUCTS CUSTOM SURFACES CYNDERELLA'S CYPRESS RESTAURANTS, INC. D & W HEATING & AIR D L LEE & SONS

CITY
STILLMORE MIDLAND CITY
MACON DALTON DALTON WOODSTOCK MOULTRIE ATLANTA COLUMBUS CHICAGO ATLANTA JULIETTE FLOWERY BRCH KENNESAW DAHLONEGA FOLKSTON SAVANAH DUBLIN ROSSVILLE CALHOUN FOREST PARK
ROME PERRY CORDELE SAVANNAH ATLANTA LAKELAND BYRON ANNA AUGUSTA WAYCROSS ROME ELLIJAY BRUNSWICK GAINESVILLE BAYONNE COLUMBUS COMMERCE SWEETWATER LOGANVILLE ROSWELL BAINBRIDGE, CHESTNUT MTN. CHICKAMAUGA ELLENWOOD WASHINGTON LAKE LANIER COLLEGE PARK LITHIA SPRINGS ATLANTA FITZGERALD ORLANDO LILBURN ALMA

STATE
GA AL GA GA GA GA GA GA GA IL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA IL GA GA GA GA GA GA NJ GA GA TX GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA

TOTAL REIMBURSED
$12,330.00 $5,764.50
$101,453.48 $37,357.85 $26,971.36 $60,215.33 $26,756.74 $7,800.00 $5,611.14 $952.64 $69,355.40 $9,591.65 $22,299.55 $9,498.97 $16,974.21 $17,413.84 $21,095.62 $35,471.67 $29,784.16 $23,150.44 $10,093.73 $7,005.13 $6,178.79 $12,228.00 $8,054.68 $14,414.90 $416.50 $30,135.30 $16,202.84 $14,673.69 $3,673.99
$119,673.57 $21,778.73
$150,019.10 $18,805.53 $10,858.14 $60,978.91 $16,096.99
$241,349.60 $2,114.01 $6,813.16
$11,787.36 $14,121.67
$969.09 $7,999.29 $26,077.73 $5,197.82 $14,317.70 $66,616.70 $17,530.48 $13,701.50
$347.07 $51,922.20
$9,575.66

Subsequent Injury Trust Fund 2005 Annual Report

Page 33

INDIVIDUAL EMPLOYER
DA VITA DABNEY'S INC-BOJANGLES DAIRY QUEEN DALE MILLER GRADING AND TRUCKI DALLAS WMS D/B/A BRICKMASTER DARBY PRINTING COMPANY DARRELL BLACK, INC. DARWOOD MANUFACTURING DATA TECH DAVEY TREE EXPERT COMPANY DAVIS WATER & WASTE IND INC DAWN FOOD PRODUCTS DAYS GLASS SERVICE DAYS INN-ROME DEERFIELD SPECIALTY PAPERS INC DEL MAR WINDOW COVERINGS DEL-COOK LUMBER COMPANY DELTA AIRLINES, INC. DENNIS TAYLOR AND COMPANY, INC DENON DIGITAL INDUSTRIES DESTINY INDUSTRIES DETAILS INC. DEVEREUX CENTER OF GA. DEVEREUX FOUNDATION DEVRO-TEEPAK, INC. DIAMOND HOLDING DIAMOND PLASTICS CORP. DIAMOND TRIUMPH AUTO GLASS DICKERSON TILE COMPANY DILLARD SMITH CONSTRUCTION CO. DIPLOMAT HOTELS, ETAL DIVERSCO, INC DIXIE INDUSTRIAL FINISHING CO. DIXIE ROADBUILDERS INC. DIXON MGMT INC DIXON TIMBER CO. DOCTORS HOSPITAL OF COLUMBUS DODGE COUNTY HOSP AUTHORITY DOGWOOD HOUSING DORNIER MEDICAL SYSTEMS DOUGLAS & LOMASON DOUGLAS GENERAL HOSPITAL DRUG TRANSPORT DRUG TRANSPORT DUBARD'S TIRE & ALIGNMENT DUBLINAIR NURSING HOME DUCHERN IND., INC. DURACELLE USA-GILLETE CO DURAND GRACE REALTY DURANGO GEORGIA PAPER DYNCORP E. COBB LAND DEVELOPMENT CO. E/Z BORE CONSTRUCTION & MANUFA

CITY
FOREST PARK CEDARTOWN
MCRAE COVINGTON
DULUTH ATLANTA MILLEDGEVILLE PELHAM ALPHARETTA CHAMBLEE THOMASVILLE DOUGLASVILLE DOUGLAS
ROME AUGUSTA ATHENS
ADEL ATLANTA DULUTH MADISON MOULTRIE MOORESVILLE KENNESAW KENNESAW ATLANTA MARIETTA MACON ALBANY BOWMAN SMYRNA ATLANTA SPARTANBURG TUCKER WAYCROSS BRINSWICK
JESUP COLUMBUS EASTMAN MILLEGEVILLE KENNESAW CARROLLTON DOUGLASVILLE
MACON TUCKER AUSTELL DUBLIN FAYETTEVILLE LAGRANGE LAGRANGE ST. MARYS ATLANTA MARIETTA TOCCOA

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA NC GA GA GA GA GA GA GA GA GA SC GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$2,332.52 $30,090.21
$5,284.00 $7,326.77 $107,500.00 $8,155.46 $8,297.43 $17,400.03 $70,109.83 $6,318.86 $12,425.00 $8,368.97 $12,732.87 $26,589.43 $12,770.68 $24,109.56 $161,611.00 $59,441.19 $54,798.30 $2,589.05 $14,051.55 $84,696.51 $24,674.35 $1,014.13 $3,329.83 $281,584.28 $30,188.78 $11,814.25 $202,531.75 $10,307.90 $21,878.89 $24,509.75 $11,212.74 $15,971.38
$22.00 $412.56 $13,623.66 $41,038.47 $9,280.76 $90,851.42 $50,695.48 $8,816.78 $29,109.31 $216,062.02 $10,659.49 $4,725.00 $78,764.09 $32,518.27 $93,190.00 $764,067.17 $13,543.34 $7,700.00 $31,929.41

Subsequent Injury Trust Fund 2005 Annual Report

Page 34

INDIVIDUAL EMPLOYER
EARL SMALL'S HARLEY DAVIDS EARTHGRAINS BAKING CO EAST - WEST EXPRESS EASTERN AIRLINES, INC. EASTSIDE MEDICAL CENTER ECC INTERNATIONAL ECI MANAGEMENT ECKERD ECKERD ECKERD ECKERD ECKERD YOUTH ALTERNATIVE EDDIE T. WILSON CONSTRUCTION EDDIE'S FOREIGN AUTO EDWARDS BAKING CO. EDWARDS PIPELINE EH, INC. ELECTROMAGNETIC SERVICES, INC ELEGANCE CLEANERS ELIXIR INDUSTRIES ELLIJAY TELEPHONE COMPANY ELLIOTT MACHINE SHOP ELLIOTT TRANSPORT ELLIS & GROSS INC EMPLOYER ADVANTAGE GROU EMPLOYMENT MATCH MAKERS ENCOMPASS/HOLDER CONSTRCTN ENGELHARD CORP. ENGINEERED FABRICS CORP. ENGLEHARD CORP. EPIX ETHICON, INC. F & W FARM SERVICE, INC F R GRANTHAM CONTRACTING FAB TECH FAIRBANKS SCALES INC. FAIRVIEW PARK HOSPITAL FAMILY DOLLAR, INC. FANNIN COUNTY BD. OF EDUCATION FARMER AUTOMATIC INC. FAYETTE CO BD OF EDUCATION FAYETTE MEDICAL CENTER FAYETTEVILLE BOWLING CENTER FEDERAL STATE INSPECTION FEPCO TRUCKING FIDELITY ASSOC. FINANCIAL SERVICE CORP FINNEY HVAC INC. FIREMAN'S FUND INS CO. FIRST BAPTIST CHURCH FISHER INDUSTRIES FISHER SCIENTIFIC FITZGERALD UNDERWEAR CORP FIVE SMITHS INC./ATLANTA FALCO

CITY
MARIETTA AUGUSTA VILLA RICA ATLANTA SNELLVILLE SANDERSVILLE MARIETTA CANTON COLUMBUS SHENANDOAH SMYRNA CLEARWATER LAFAYETTE
MACON ATLANTA ATHENS BRUNSWICK NORCROSS KENNESAW DOUGLAS ELLIJAY MACON GAINESVILLE KINGSLAND COLUMBUS MACON STONE MOUNTAIN GORDON ROCKMART ATTAPULGUS WOODBRIDGE CORNELIA THOMASVILLE DECATUR DOUGLAS DORAVILLE DUBLIN CHARLOTTE BLUE RIDGE STATESBORO FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE ALBANY CONLEY GASTONIA ATLANTA DORAVILLE ATLANTA LAFAYETTE ROSWELL SUWANEE TIFTON FLOWERY BRANCH

STATE
GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA OH GA GA GA GA GA NJ GA GA GA GA GA GA NC GA GA GA GA GA GA GA NC GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$1,927.99 $21,063.85 $24,284.34 $53,260.34
$1,791.60 $10,725.00 $28,891.51
$38.78 $12,250.00 $26,072.64
$8,555.37 $141,681.53
$4,853.04 $41,997.24
$4,805.00 $61,057.28 $46,346.13
$3,156.47 $117,454.31
$90,227.47 $6,759.58
$157,687.47 $58,235.25 $2,581.73 $41,432.24 $12,390.73 $881.27 $21,089.00 $27,813.54 $10,250.00 $7,944.72 $19,898.62 $214.45 $9,989.88 $14,921.36 $22,771.04
$273,392.76 $11,996.65 $2,355.15 $11,110.35 $8,865.00 $62,311.70 $34,693.65 $6,308.08 $18,075.13 $198.75 $865.00 $69,282.87 $26,286.00 $10,126.10 $4,981.28 $74,228.50 $5,518.74 $29,045.00

Subsequent Injury Trust Fund 2005 Annual Report

Page 35

INDIVIDUAL EMPLOYER
FIVE STAR QUALITY CARE COLLEGE FLASH FOODS FLEX-A-BED FLINT CONSTRUCTION CO. FLINT RIVER TEXTILES, INC FLINT RIVER TRUCKING, INC. FMC FMT ENTERPRISES LLC FOLGER POULTRY FARMS FORSTMANN & COMPANY, INC FOWLER-FLIMESTER CONCRETE INC FPIS FRANKLIN INDUSTRIES FREEMAN DECORATING CO. FREIGHTLINER OF CHATTANOOGA FREY-MOSS STRUCTURES FRUEHAUF CORPORATION FUTURECALL TELEMARKETNG WEST G & K G & K SERVICES INC G & L MARBLE, INC. G.I.R. SYSTEMS G.W. IVEY CONSTRUCTION, INC. GA ALLTEL TELECOM-HOMERVI GA ENVIRONMENTAL SPEC. GA PIPE & METAL FAB GA SUPERIOR TILE GABRIEL DESSERTS, INC. GAF MATERIALS CORP. GALAXY CARPET MILLS, INC. GALEY & LORD INDUSTRIES, INC. GAMBRO HEALTHCARE GARLAND CONSTRUCTION INC. GARNER BROTHERS CO GARNER ELECTRIC CO GARY WEST INC GAY CONSTRUCTION COMPANY GCO APPAREL CORP. GEICO GEM CITY STEEL INC. GENERAL BOX CO INC GENERAL ELECTRIC CO GENERAL NUTRITION CTRS GENERAL ROOFING SERVICE GENUINE PARTS GENUINE PARTS GEORGE HORMELL & COMPANY GEORGE MUSE CLOTHING CO GEORGIA BAPTIST CONVENTION GEORGIA BOOT INC GEORGIA CHAIR COMPANY GEORGIA DUPLICATING PRODUCTS GEORGIA ELECTRIC GEORGIA MARBLE COMPANY

CITY
COLLEGE PARK PERRY
LAFAYETTE LAWRENCEVILLE
ALBANY OGLETHORPE
ATLANTA ATLANTA DAHLONEGA TIFTON MILLEDGEVILLE OCOEE LAVONIA ATLANTA TUNNEL HILL CONYERS CONLEY AUGUSTA BUFORD ATLANTA WINSTON DALTON ST. MARYS HOMERVILLE MORROW VALDOSTA WATKINSVILLE MARIETTA SAVANNAH CHATSWORTH SHANNON SAVANNAH BOGART
ROME JONESBORO
COMER ATLANTA BOWDON MACON MARIETTA WAYCROSS
ROME PITTSBURGH
SMYRNA NORCROSS SYLVESTER
TUCKER ATLANTA ATLANTA BLAIRSVILLE GAINESVILLE MACON ALBANY ATLANTA

STATE
GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA PA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$123,119.04 $132,351.66 $109,644.10
$11,649.50 $16,861.65 $11,726.35
$339.00 $87,604.38
$7,695.00 $5,351.74 $27,000.96 $31,646.66 $13,559.54 $280,898.92 $77,043.73 $4,414.80 $6,318.80 $6,316.64 $36,390.53 $88,375.40 $20,509.73 $95,254.83 $1,043.37 $17,221.54 $139,379.04 $111,610.36
$262.50 $19,700.01 $15,750.00
$5,940.00 $42,905.64
$2,237.42 $18,679.44 $184,221.98
$2,560.00 $59,325.96 $11,853.63 $57,024.94 $69,473.05 $293,881.48 $146,369.47 $27,099.48 $83,923.19 $17,152.51
$478.72 $7,279.42 $17,928.82 $12,166.91 $6,859.00 $6,267.89 $16,516.79 $12,020.68 $11,527.60 $12,027.29

Subsequent Injury Trust Fund 2005 Annual Report

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INDIVIDUAL EMPLOYER
GEORGIA OPTIONS GEORGIA PLATING, INC. GEORGIA TECH ATHLETIC ASSOC. GIANT FOODS, INC. GILBERT & BENNETT GILMAN BUILDING PRODUCTS GILMAN PAPER CO. GILMAN PAPER CO. GILMER COUNTY OF B. O. E. GIRL SCOUTS COUNCIL OF NW GLIT INC GLOBE TICKET & LABEL CO GLOBE UNION INC GOBER PAINT & CONTRACTING GODDARD SCHOOL GOLD KIST INC GOLD KIST INC GOLD KIST INC GOLD KIST INC GOLDEN AGE PROPERTIES GOLDEN GALLON, INC. GOLDEN'S FOUNDRY & MACHINE CO GOOCH TRUCKING GOODWILL INDUSTRIES GOODWILL INDUSTRIES GOODY PRODUCTS, INC. GOODY PRODUCTS, INC. GOODYEAR TIRE & RUBBER GOODYEAR TIRE & RUBBER GOODYEAR TIRE & RUBBER GORDON COUNTY FARM COMPANY GOTTA GO PORTABLE TOILET GPS ENTERPRISES, INC. GRACEMORE NURSING & REHAB GRAND STAR-HARDEE'S GRASSO CONVEST DEVELOP. CORP. GREAT AMERICAN COOKIE CO. GREAT AMERICAN EATERY GREAT ATLANTIC NEWS GREAT OAKS NURSING HOME GREBA METAL PRODUCTS, INC. GREEN HEATING AND COOLING GREEN OAKS CENTER GREEN THUMB, INC. GREENMAN TECHNOLOGIES OF GA GREENWOOD CEMETARY GROGAN AND COMPANY, INC. H.H. TIMBER & LOGGING CO. HA SACK COMPANY, INC. HALCO INDUSTRIES INC HALLING RERFUSE/ALLIED WA HAMBERSHAM MEDICAL GROUP PC HAMBY'S GARAGE HANCOCK FABRICS

CITY
BOGART COVINGTON
ATLANTA WARNER ROBBINS
TOCCOA BLACKSHEAR BLACKSHEAR
ST. MARYS ELLIJAY ATLANTA WRENS ATLANTA ATLANTA
LOGANVILLE NORCROSS
ATHENS CARROLLTON
DOUGLAS ELLIJAY HAWKINSVILLE RINGGOLD COLUMBUS BLAIRSVILLE MACON SAVANNAH EASTMAN MANCHESTER CARTERSVILLE CEDARTOWN ROCKMART CALHOUN TIGER AUBURN BRUNSWICK
ADEL ATLANTA ATHENS ATLANTA ATLANTA ROSWELL WINSTON CANTON MOULTRIE
JESUP JACKSON ATLANTA CUMMING CUTHBERT STATESBORO NORCROSS ATLANTA CLARKESVILLE CUMMING SAVANNAH

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$46,985.09 $36,967.71 $26,108.88 $92,104.34
$9,981.72 $71,374.88
$8,299.04 $231,120.45
$5,041.76 $125,484.99
$7,645.18 $15,204.74 $29,350.98 $124,916.20 $19,839.16 $239,559.75 $11,985.29 $230,833.47 $51,913.58
$2,332.56 $40,789.46 $13,500.00
$6,837.00 $30,251.72 $34,697.80 $53,555.23 $12,680.81
$77.00 $4,489.37 $6,333.31 $14,241.49 $8,719.43 $80,329.35 $3,287.93 $47,449.24 $101,340.46
$667.12 $22,273.65
$456.48 $39,051.23 $12,079.63 $33,679.64
$5,777.28 $9,459.39 $18,341.43 $9,340.22 $54,006.86 $9,243.31 $10,130.65 $51,892.10 $13,162.38 $24,150.58 $13,511.38 $2,741.76

Subsequent Injury Trust Fund 2005 Annual Report

Page 37

INDIVIDUAL EMPLOYER
HANES HOSIERY, INC. HANSON AGGREGATES EAST INC. HARBISON WALKER REFRACTORIES HARMONY ENTERPRISES, INC. HARRIS CALORIFIC HARRIS INSULATION & SUPPLY INC HARRIS SERVICE CENTER HARRIS WASTE MANAGEMENT HARRISON'S BODY SHOP HART FENCE COMPANY HARTMAN & HARTMAN HARTWELL CO. WAREHOUSE HARTWELL INDUSTRIES, INC. HARVEY'S PERSONAL CARE HAYES MICRO COMPUTER PRO. HAYGOOD CONTRACTING, INC. HEALTHPRIME INC. HEAVYQUIP OF LITTLEROCK HENDERSON ELECTRIC CO HENDRIX HAULING CO. HENKELS & MCCOY HERITAGE RETIREMENT HERTZ PENSKE/GEICO TRUCK LSNG HI BRAND FOODS HICKS PAVING CO., INC. HIDDEN HILLS GRILL HIGGINS GENERAL HOSPITAL HIGHTOWER TV HILLCREST HOSPICE INC HILLHAVEN CONVALLESCENT CTR HILLIARD, INC. HINESVILLE RED & WHITE HOGAN TRANSPORT INC HOLCOMBE' S SUPER VALUE HOLDER'S LOGGING CO HOLLAND ELECTRIC/PLUMB. HOLLANDER HOME FASHNS CORP. HOLLOWAY CONSTRUCTION CO. HOLOX LTD. HOME DELIVERY FOOD SERVICES HOME DEPOT HOME DEPOT 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 SYS. HOTEL VENTURA OF AUGUSTA

CITY
LAGRANGE ATHENS CALHOUN
BOWDON JUNCTION GAINESVILLE ATLANTA DALTON CORDELE MACON
LITHIA SPRINGS DECATUR HARTWELL HARTWELL WAYCROSS NORCROSS
WOODSTOCK ALPHARETTA NORCROSS STONE MOUNTAIN
JESUP PERRY ST. SIMON'S ISLAND FOREST PARK PEACHTREE CITY ATHENS STONE MOUNTAIN BREMAN ROME RIVERDALE SAVANNAH EASTMAN HINESVILLE COLUMBUS TALLAPOOSA GOOD HOPE DOUGLASVILLE TIGNALL BALLGROUND NORCROSS JEFFERSON ATLANTA AUSTELL DULUTH FAYETTEVILLE MACON SAVANNAH ATLANTA MARIETTA CEDARTOWN HIRAM CUMMING TALLAPOOSA JACKSON AUGUSTA

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$8,875.33 $11,238.41
$201.02 $178,973.15
$98,593.99 $64,501.10 $16,448.04 $108,193.99 $107,983.20 $21,471.61
$608.90 $14,451.25
$4,081.28 $25,747.70 $19,324.26 $15,211.52
$6,124.46 $6,539.49 $20,135.74
$975.82 $211,110.55
$23,406.87 $57,501.82
$6,358.48 $15,874.44 $16,324.84
$7,695.00 $34,860.59 $95,858.25
$7,289.68 $28,247.78
$6,976.26 $8,811.83 $12,174.13 $8,952.75 $17,582.90 $5,460.81 $7,182.00 $8,994.67 $4,026.66 $318,128.13 $6,982.36 $32,965.70 $15,035.73 $8,633.79 $65,225.20 $11,622.74 $115,367.59 $60,842.59 $1,254.77 $45,459.47 $9,300.00 $21,109.40 $2,248.26

Subsequent Injury Trust Fund 2005 Annual Report

Page 38

INDIVIDUAL EMPLOYER
HOUSTON CO. ASSOCIATION HOUSTON STEEL, INC. HOWARD BAER INC HOWARD'S LANDSCAP & GRADING HP PELZER HUBERT MOORE LUMBER HUDDLE HOUSE HUDSON CABINET CO., INC. HUGHES CABINET SHOP HUGHES LOGGING COMPANY HUGHES SUPPLY, INC. HULSEY CONCRETE PRODUCTS HUMAN RESOURCES, INC. HUNT-MILLER INSURANCE HURST BOILER & WELDING CO, INC HV & TG THOMSON LUMBER CO IBM CORPORATION IFS LAGRANGE IKON SOLUTIONS ILLINOIS TOOL WORKS IMERYS KAOLIN INC. INDALEX AMERICA INC INDEPENDENT LIFE INSURANCE CO. INDIAN CREEK CHRISTIAN SCHOOL INDIAN RIVER TRANSPORT CO INDUSTRIAL MAINTENANCE SER INDUSTRIAL MANUFACTURING INDUSTRIAL TOOL & SUPPLY INGLETT & STRUBBS, INC. INGLETT & STUBBS, INC. INLAND CONTAINER CORP. INLAND CONTAINER CORP. INNOTRAC CORP INSURAMERICA INTERIM PERSONNEL INTERNATIONAL AUTO PROCESSING INTERNATIONAL RESCUE COMM INTERSTATE BRANDS CORP INTREPID ITHACA INDUSTRIES INC. ITHACA INDUSTRIES INC. ITT AUTOMOTIVE ITT THOMPSON ITT-RAYONIER, INC. ITT-RAYONIER, INC. J & M TRANSPORT J & S, INC. J C GLASS, INC. J&M TRANSPORTATION J. C. PENNEY COMPANY J. P. BEAMER CO., INC. J.A. JONES MANAGEMENT J.A. JONES MANAGEMENT J.B. HUNT TRANSPORT, INC.

CITY
WARNER ROBINS BYRON
NASHVILLE LILBURN THOMSON ALAPAHA
DAHLONEGA LILBURN
DANIELSVILLE ARLINGTON ORLANDO MONROE POULAND
WARNER ROBINS COOLIDGE AILEY ATLANTA LAGRANGE NORCROSS CHAMBLEE
DRY BRANCH GAINESVILLE
ROME STONE MOUNTAIN
WINTER HAVEN SUWANEE ALBANY SAVANNAH ATLANTA SMYRNA MACON ROME DULUTH LILBURN ATLANTA
BRUNSWICK NEW YORK COLUMBUS BRUNSWICK GLENNVILLE
MEIGS ROME ADEL JESUP MIDVILLE MARIETTA INDIANOLA NORCROSS LASCRUSES STONE MOUNTAIN CALHOUN CHARLOTTE KINGS BAY LOWELL

STATE
GA GA TN GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA NY GA GA GA GA GA GA GA GA GA PA GA NM GA GA NC GA AR

TOTAL REIMBURSED
$355.00 $21,290.70 $28,743.31
$5,357.88 $46,400.00 $31,037.60 $14,967.38
$4,214.76 $30,385.60
$1,929.45 $6,433.46 $3,653.69
$250.00 $24,623.55 $175,578.14 $33,740.00
$5,802.42 $5,875.42 $92,118.72 $163,538.50 $7,950.00
$448.00 $21,615.49 $72,140.49 $115,235.72 $15,707.96 $128,244.66
$6,579.34 $20,385.00 $35,528.85 $95,472.55
$9,557.61 $19,683.40
$755.53 $15,832.89
$9,611.43 $5,637.50 $22,268.32 $14,957.45 $5,652.95 $29,353.67 $1,513.68 $32,200.00 $223,938.57 $8,400.00
$901.80 $16,845.81 $58,256.55
$745.94 $18,600.25 $198,390.97 $10,372.40 $12,212.16
$363.21

Subsequent Injury Trust Fund 2005 Annual Report

Page 39

INDIVIDUAL EMPLOYER
J.G. DAVIDSON JR. ELECTRICAL J.M. HUBER ENGINEERING J.P. STEVENS & COMPANY, INC. J.P. THAYER CO JACKSON CO BD OF EDUCATION JAMES ELECTRIC COMPANY, INC. JAMES F. HOOVER JAMES HILL CONTRACTOR JAMESON HOSPITALITY, LLC JASPER LUMBER CO JB OPTICAL INC. JEAN THOMAS JEBCO, INC. JENKINS PLUMBING CO. JERRY & DEBBIE FIELDS JHM ENTERPRISES, INC. JIM WALTER HOMES, INC. JIM YOUNG CONSTRUCTION CO. JMPS HEALTH CARE JOEL ANDERSON JOHN DEMORE LOCK & KEY SVC. JOHN H. HARLAND CO JOHN PITTS COMPANY, INC. JOHNNY PHILLIP HEATING JOHNSON & JOHNSON JOHNSON & JOHNSON JOHNSON CO. BD. OF ED. JOHNSON CONTRACTING JONATHAN R. JOWERS JONES AUTOMATIC SPRINKLERS JRH OPTICS/PEARL VISION EXPRES JTM CORP. JUST FOR YOU JWI GROUP PRESS FABRIC K & F INDUSTRIES KATSHUSHIRO ROME CORP. KAWNEER COMPANY KEANE, INC. KELLEY BUICK KELLOGG COMPANY KEMIRA, INC. KEN SHEPPARD LOGGING KEN'S CONSTRUCTION, INC. KEN'S FOODS INC KEY HEALTH CENTER KEYSTONE MEMORIALS, INC. KFC/YUM! BRANDS, INC. KIDS KONDO INCORPORATED KING MUFFLER SHOP KINGSBRIDGE METAL, INC. KINNEY CONSTRUCTION CO KLIKLOK CORPORATION KLOCKNER NAMASCO CORP. KNIGHT'S INN

CITY
LAGRANGE SANDERSVILLE
LOUISVILLE LAGRANGE JEFFERSON GAINESVILLE
LAVONIA ACWORTH ATLANTA KENNESAW
ROME COMMERCE WARRENTON SPRINGFILED
DALLAS COLLEGE PARK FOREST PARK
CLEVELAND BUCHANAN MAYSVILLE
NEWNAN CONYERS FORSYTH CHAMBLEE CORNELIA ROYSTON WRIGHTSVILLE ACWORTH MARTINEZ AMERICUS DULUTH PHENIX CITY RIVERDALE JONESBORO ROCKMART
ROME JONESBORO
ATLANTA ROSWELL ELMHURST SAVANNAH
AILEY BUCKHEAD MCDONOUGH
MACON ELBERTON
ATHENS ATLANTA WAYCROSS CARROLLTON LEESBURG DECATUR SUWANEE BRUNSWICK

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA IL GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$23,377.93 $2,625.24 $7,749.00
$65,078.07 $30,206.83 $60,496.40 $43,959.96
$7,040.00 $3,282.29 $38,319.70 $66,317.00 $3,560.97 $16,633.93 $52,324.94 $29,625.95 $15,850.06
$596.61 $1,340.45 $5,901.04 $33,773.08 $88,551.67
$339.93 $100,401.68 $234,806.36 $118,808.25
$69,680.38 $46,918.63 $87,874.54 $25,087.88 $50,509.02 $24,189.10 $29,094.63
$415.85 $21,204.67 $17,405.79 $69,299.11
$8,744.38 $16,250.00 $64,346.81 $23,966.81
$124.20 $112.00 $2,531.93 $2,998.40 $23,933.70 $39,770.32 $65,762.06 $56,061.92 $23,994.97 $62,770.94 $9,117.44 $46,970.17 $17,820.78 $12,564.57

Subsequent Injury Trust Fund 2005 Annual Report

Page 40

INDIVIDUAL EMPLOYER
KOCH FOODS KOGER'S AUTO CARE INC. KRAFT FOOD INC KRAYONS ACADEMY KROGEL FREIGHT SYSTEMS OF GA KROGER CO KRYSTAL CO KRYSTAL/M.A.E. THOMASVILLE KYSOR WARREN L.E. SCHWARTZ & SON LA99, INC. LACEY MILLS, INC LAGRANGE MACHINE SHOP LAGRANGE MOLDED PRODUCTS LAGRANGE SCHOOL SYSTEM LAKE ARROWHEAD UTILITY CO LAKE LANIER ISLANDS LAKES CONSTRUCTION LAKEWAY TRUCKING, INC. LAKEWOOD BAPTIST CHURCH LAMAR COUNTY BOE LAMAR MANUFACTURING CO. LANCE, INC. LAND O'SUN DAIRIES LANE COMPANY LAPP INSULATOR CO LARSON & JUHL LARSON & JUHL LAUREL BAYE HEALTH LAKE LANIER LAW ENGINEERING CO LAWLER HOSIERY MILL INC LEAR CORPORATION LEARD HUGGINS, INC. LEASEWAY PERSONNEL CORP. LEGGETT & PLATT INC LEGGETT & PRATT LEGION INDUSTRIES, INC. LEMAY ELECTRIC LEVI STRAUSS & COMPANY LEVITON MANUFACTURING CO. LEWIS BROTHERS MANUFACTURING LIBERTY REGIONAL MEDICAL CENTE LIEBHARDT LIFE LIKE, INC. LILBURN DEVELOPERS, INC LOCKHEED MARTIN LOCKHEED MARTIN LOCKHEED MARTIN AERONAUTI LOCKHEED MARTIN CORPORATION LODINS SERVICES # 1, INC. LOGAN PAVING COMPANY LOOK PRODUCTS LOOMIS FARGO CO LORAL SPACE & COMMUNICATIONS

CITY
GAINESVILLE HINESVILLE NORCROSS ST. MARYS
MACON ATLANTA ALBANY THOMASVILLE COLUMBUS MACON ROSWELL CARTERSVILLE LAGRANGE LAGRANGE LAGRANGE WALESKA BUFORD
ROME MORRISTOWN GAINESVILLE BARNESVILLE
BOWDON CHARLOTTE
ATLANTA ATLANTA SANDERSVILLE ADAIRSVILLE NORCROSS BUFORD ATLANTA CARROLLTON ATLANTA SAVANNAH READING SOCIAL CIRCLE MONROE WAYNESBORO MARIETTA VALDOSTA ATLANTA BAXLEY HINESVILLE DALTON KENNESAW LILBURN BETHESADA KINGS BAY SMYRNA MARIETTA DECATUR ATHENS MILLEN MACON ROCKMART

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA TN GA GA GA NC GA GA GA GA GA GA GA GA GA GA PA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$22,167.14 $1,295.70
$23,664.83 $97,191.80
$5,028.96 $389,747.15
$22,663.11 $7,048.87 $2,153.53 $412.03
$27,974.70 $48,618.64
$7,728.71 $5,379.04 $30,947.80 $112,246.06 $15,380.26
$884.27 $206,037.88
$30,860.88 $1,164.18
$28,570.64 $30,878.89 $29,156.72 $26,082.75 $54,162.75 $17,059.57 $10,421.77 $76,674.32
$6,930.00 $52,519.53 $38,958.92 $198,499.35
$6,564.55 $10,570.53
$4,082.74 $15,082.95 $23,356.70
$9,437.76 $42,693.48 $84,456.57 $40,258.79 $38,755.36
$7,523.80 $11,502.49
$1,814.90 $64,717.38
$318.00 $1,947,282.35
$11,749.89 $9,000.00 $6,447.78
$38,946.56 $9,052.95

Subsequent Injury Trust Fund 2005 Annual Report

Page 41

INDIVIDUAL EMPLOYER
LORD & STEPHENS FUNERAL L'OREAL USA INC. LOWE'S CARPET CORP. LOWE'S COMPANIES LOWNDES ADVOCACY RELTC HEALTHCARE LYNN HAVEN NURSING HOME M B M CORP MACON BEVERAGE CO. MACON CIGAR & TOBACCO CO., INC MACON MALL/COLONIAL PROP. TR. MACON-BIBB CO WATER & SEWAGE MACY'S MAGNA LOMASON, INC. MAIL CONTRACTORS OF ARKANSAS MAIL-WELL, INC. MAIN AUTO PARTS MAKITA CORP OF AMERICA MAKITA CORP. OF AMERICA MANN MECHANICAL CO. INC. MANNINGTON CARPET, INC. MAPLEHURST, INC. MAREK INTERIOR SYSTEMS, INC. MARI STAFF, INC. MARINER POST ACUTE NETWO MARK'S & MORGAN JEWELERS, INC. MARK'S & MORGAN JEWELERS, INC. MARLEY COOLING TOWER MARMON HOLDINGS MARSHALLS MARSHALLS MARSHALLS MARTIN CONSTRUCTION COMPANY MARTIN MARIETTA MATERIALS MARTIN SPROCKET & GEAR MARTINS RESTAURANT SYSTEM MASTER PROMOTIONS MASTERCORP MATHEWS TRUCKING INC MATTHEWS INT'L. MAURICE'S INC MAXELL CORP OF AMERICA MAXWELL CHASE TECH. MC DESIGNS MC INC.-MC PRECAST INC. MCARTHUR CONCRETE MCC PANASONIC MCCLESKY MILLS MCCLURE LOGGING, INC. MCCOY ENVIRONMENTAL TECH MCCOY SUPPORT SERVICE MCDONALDS MCDONALDS CORP MCINVALE ENTERPRISES

CITY
ATHENS SAVANNAH CHATSWORTH
ALBANY VALDOSTA FORT VALLEY
MACON ALPHARETTA
MACON MACON MACON MACON ATLANTA CARROLLTON LITTLE ROCK ATLANTA AUSTELL BUFORD AVONDALE ESTS. AVONDALE ESTS. CALHOUN CARROLLTON HOUSTON ATLANTA LUMBER CITY AUGUSTA MACON OVERLAND PARK VALDOSTA DECATUR DOUGLASVILLE STONE MOUNTAIN SYLVESTER SUWANEE SCOTTSDALE MABLETON LITHIA SPRINGS CROSSVILLE BAXLEY MARIETTA DULUTH CONYERS SMYRNA CANTON PEACHTREE CITY ACWORTH PEACHTREE CITY SMITHVILLE JERSEY COLUMBUS WATKINSVILLE LILBURN CEDARTOWN REYNOLDS

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA AR GA GA GA GA GA GA GA TX GA GA GA GA KS GA GA GA GA GA GA GA GA GA TN GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$27,699.87 $13,687.89 $140,381.24
$6,998.38 $6,433.16 $44,272.32 $11,020.59 $45,501.18
$938.60 $49,182.00 $26,650.66
$8,428.97 $2,945.00 $1,423.86 $118,466.77 $8,287.50 $403,292.67 $129,217.91 $44,832.24 $32,471.30 $26,924.48 $13,539.84 $8,491.18 $21,555.75 $112,306.08 $26,582.74 $7,935.14 $6,891.23 $44,148.95 $1,802.68 $6,419.48 $20,993.61 $7,774.69 $72,085.00 $38,600.00 $52,346.82 $1,509.30 $159,142.79 $63,945.27 $14,366.19 $51,743.56 $11,198.76 $26,019.42 $14,500.15 $9,891.42 $27,705.72 $82,532.68 $18,493.75 $52,285.72 $21,345.69 $5,889.69
$290.75 $35,435.30 $30,175.14

Subsequent Injury Trust Fund 2005 Annual Report

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INDIVIDUAL EMPLOYER
MCMASTER-CARR SUPPLY CO MCPHERSON & ASSOCIATES MCRAE MANOR NURSING HOME MC'S PAINTING & DECORATING CO. MCWHORTER TECHNOLOGIES MD HODGES ENTERPRISES, INC. MDS PLUMBING MEAD CORPORATION MEADOWS REGIONAL MEDICAL CTR MECHANICAL MAINTENANCE MED CARE INC/ COOSA VALLEY MEDIA ONE MEDICAL CENTER LLP MEDIQ INCORPORATED MELVIN WILLIAMS MANUFACTURED MEMORIAL HOSPITAL & MANOR MENLO PARK, INC. MEN'S APPREL GROUP/SEQUA CORP MERCHANTS METALS, INC. MERICO, INC. MERIDIAN BEVERAGE CO INC MERRILL GARDENS OF CARRLTON MERRY ACRES MERRY LAND PROPERTIES, INC. METAL BUILDINGS, INC. METAL PRODUCTS COMPANY METRO BUILDERS SUPPLY INC. MGR HOMECARE, INC. MICKEY'S FOOD STORE MICRO CRAFT, INC. MICROFIBRERS, INC. MICRO-MED MID GEORGIA AMBULANCE MIDDLE GA. COMMUNITY MIDDLE GEORGIA HOSPITAL MIDDLE GEORGIA WILDERNESS INST MIKE L MOON ENTERPRISES MILLER BREWING CO MILLER BREWING CO MILLIKEN & COMPANY MISCELLANEOUS ERECTORS, INC. MJL GRADING CO./DEEP SOUTH MOBIL CHEMICAL CO. MODULAR CONTAINER SYSTEM MONDO BAKING CO MONROE AUTO EQUIPMENT MOORE TRUCK LINES INC MOORMANS, INC. MORI LUGGAGE & GIFTS MORROW ROOFING & SIDING MOTHERGOOSE NURSERY INC MOTOVARIO CORP. MOWREY ELEVATOR COMPANY MR. ZIP INC. OF TENN.

CITY
ATLANTA DULUTH MCRAE HIRAM COLUMBUS ATLANTA KENNESAW SPARTANBURG VIDALIA AUGUSTA
ROME LAWRENCEVILLE
DUBLIN PENNSAUKEN
AUGUSTA BAINBRIDGE PEACHTREE CITY
ATHENS FOREST PARK FOREST PARK
NORCROSS CARROLLTON
ALBANY AUGUSTA THOMASVILLE SUWANEE FAIRBURN GRIFFIN
HAHIRA QUITMAN JASPER BOCA RATON MACON WARNER ROBINS MACON COCHRAN BUENA VISTA ALBANY MOULTRIE LAGRANGE POWDER SPRINGS ROSWELL LAGRANGE LAVONIA
ROME HARTWELL ALAPAHA CORDELE ATLANTA FOREST PARK
ALBANY ALPHARETTA
MARIANNA CLEVELAND

STATE
GA GA GA GA GA GA GA SC GA GA GA GA GA NJ GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL TN

TOTAL REIMBURSED
$22,222.41 $2,706.17 $6,680.96 $9,055.00
$10,875.00 $706.08
$10,136.00 $10,150.00 $24,463.98
$3,852.00 $5,079.67 $22,326.12
$275.56 $146,915.65
$18,839.28 $2,781.34
$22,811.45 $310.10
$54,878.66 $13,645.00
$1,157.93 $3,691.38 $25,951.50 $78,390.06 $29,843.27 $107,234.64 $12,069.27 $7,340.76 $27,736.34 $4,472.83 $52,573.22 $28,468.74 $2,193.80 $4,416.54 $219,405.50 $42,925.27 $22,955.63 $710,408.71
$450.33 $5,411.15 $9,617.44 $203,945.27 $40,031.95 $41,822.98 $53,561.84 $8,383.33 $84,076.63 $26,666.34 $125,842.11 $6,436.18 $79,862.16
$155.23 $13,626.24 $26,378.96

Subsequent Injury Trust Fund 2005 Annual Report

Page 43

INDIVIDUAL EMPLOYER
MUELLIN GROUP INC. MURATA ELECTRONICS MURATA ELECTRONICS INC. MURRAY COUNTY BOARD OF ED. MUSCOGEE MANOR MUSCOGEE TEXTILES N & R HOTELS INC. NAT. MGM'T. RESOURCES CO. NATIONAL CEMENT CO., INC NATIONAL EMPLOYER SOLUTIONS NATIONAL ENVELOPE CORP. NATIONAL FREIGHT, INC. NATIONAL GYPSUM NATIONAL GYPSUM COMPANY NATIONAL HEALTH LABORATORIES NATIONAL MOTOR CLUB INC. NATIONAL PUBLIC RADIO, INC. NATIONAL WORKFORCE, INC. NATIONS RECOVERY CTR. NAU, INC. NCR CORP. NEC TECHNOLOGIES NESTLE TRANSPORTATION CO. NETCARE HEALTH SYSTEMS, INC. NEW RIVERSIDE OCHRE CO. NEWCOMB SPRING CORP NICHOLLS LOGGING, INC. NICHOLSON ENTERPRISES, INC NICHOLSON ENTERPRISES, INC. NOLAND COMPANY NORD KAOLIN CO NORITAKE CO., INC. NORMAL LIFE VALDOSTA NORTH AMERICA CONT. NORTH GEORGIA DISTRIBUTING NORTH GEORGIA INDUSTRY NORTH GEORGIA READY MIX NORTHERN TELECOM, INC. NORTHROP GRUMMAN CORP. NORTHWEST GEORGIA FOODS, INC. NSR, INC. NTR DBA BLUE WATER NUCO2, INC. OAK MANOR NURSING HOME INC OAKWOOD LANDSCAPING, INC. OCMULGEE FIELDS OCTAGON AIR SYSTEMS OELSCHIG'S NURSERY, INC. OFS BRIGHTWAVE OGLETHORPE COUNTY SCHOOL OLIN WOOTEN TRANSPORT CO. INC. OLYMPUS BUILDING SERVICE OMC OMNI HEALTH CARE, INC.

CITY
STATESBORO SMYRNA
ROCKMART CHATSWORTH
COLUMBUS COLUMBUS GAINESVILLE
MACON LAWRENCEVILLE
ALPHARETTA AUSTELL VINELAND
GARDEN CITY ATLANTA MARIETTA DALLAS
WASHINGTON LEESBURG ATLANTA AUGUSTA
PEACHTREE CITY MCDONOUGH MCDONOUGH ELLIJAY CARTERSVILLE DECATUR DOUGLAS YOUNG HARRIS
HOLLY SPRINGS MACON
JEFFERSONVILLE SAVANNAH VALDOSTA ADAIRSVILLE ROME GAINESVILLE DALTON
STONE MOUNTAIN ST. MARYS ROME CHAMBLEE
CARROLLTON STUART
COLUMBUS LILBURN MACON CONLEY
SAVANNAH NORCROSS LEXINGTON HAZLEHURST DOYLESTOWN CALHOUN COLUMBUS

STATE
GA GA GA GA GA GA GA GA GA GA GA NJ GA GA GA TX DC GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA PA GA GA

TOTAL REIMBURSED
$158,264.60 $48,834.04 $424.38 $26,799.20 $36,273.59 $2,426.71 $37,863.63 $27,951.24 $1,720.36 $30,174.45 $187.00 $50,000.00 $15,359.64 $2,139.00 $13,349.70
$157,845.69 $8,016.23
$19,066.35 $28,478.79
$88.00 $6,687.76 $16,727.50 $16,180.97 $17,575.45 $35,866.25
$909.56 $7,035.00 $15,801.74 $23,951.31 $12,375.00 $4,995.00 $17,524.36 $79,127.01 $48,358.56 $101,242.00 $76,520.07 $149,004.21 $9,518.47 $44,484.74 $90,121.62 $7,784.67 $73,257.44 $23,763.93 $31,909.72 $25,230.61 $8,315.12 $14,300.00 $15,151.65 $28,400.00 $24,209.88 $7,051.70 $15,612.62 $18,305.91 $12,067.90

Subsequent Injury Trust Fund 2005 Annual Report

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INDIVIDUAL EMPLOYER
ONEDA CORPORATION ONESOURCE BUSINESS SOLUTIONS OPEN DOOR COMMUNITY HOUSE ORIENTAL WEAVERS OSBORNE HEATING & AIR OTIS CONTRACTING, INC. OUR WAY, INC. OUTDOOR SYSTEMS, INC. OVERHEAD DOOR CO. OF ATL. OVERHEAD DOOR CORP. OWENS & PRIDGEN, INC. OXFORD OF DUBLIN OZBURN-HESSEY LOGISTICS P&M TRUCKING P.A.I. INDUSTRIES PACE AMERICA PACIFIC CORP/TENNECO PKG PACKAGING CORP. OF AMERICA PACTIV PACTIV PALM CREEK FARM PAPER PAK PRODUCTS PARADYME, INC. PARAMONT GRADING INC. PARKING COMPANY OF AMERICA PARKWOOD NURSING & REHAB PARSEC PARSONS BRINCKERHOFF/TUDOR PAYCHEX BUSINESS SOLUTIONS/ PAYLESS SHOE SOURCE INC PCI PROCOATERS INC PEACH REGIONAL MEDICAL CENTER PEACHFORD BEHAVIORAL PEACHTREE DOORS AND WINDOWS PEACHTREE HOMES PEACHTREE PARK, INC. PEEKS FIFTH AVE. PEPSI BOTTLING GROUP PEPSI-COLA COMPANY PERFUMANIA, INC. PETSMART PHOENIX CRANE RENTAL CO PHOENIX CRANE SERVICE PHOENIX RECLAMATION PHOTOCIRCUITS CORP PIERCE & COMPANY, INC. PIERCE COUNTY BOARD OF ED. PIGGLY WIGGLY SOUTHERN PIKE CREEK TURF INC. PIKE ELECTRIC INC. PILLSBURY CO PILOT CORP. PINE MTN. WILD ANIMAL PARK PINEHILL NURSING CENTER

CITY
COLUMBUS NORCROSS COLUMBUS
DALTON SNELLVILLE
ATLANTA TUCKER ATLANTA ATLANTA ATHENS BRUNSWICK DUBLIN MCDONOUGH DOUGLAS SUWANEE EASTMAN MACON VALDOSTA COVINGTON MACON DACULA WASHINGTON COLUMBIA CUMMING ATLANTA SNELLVILLE ATLANTA ATLANTA ROCHESTER ATHENS DECATUR FORT VALLEY ATLANTA GAINESVILLE JONESBORO ASHBURN
ROME WAYCROSS
ATLANTA MIAMI
MORROW MABLETON MABLETON
MACON PEACHTREE CITY
CONYERS BLACKSHEAR
VIDALIA ADEL
MOUNT AIRY LITHONIA KNOXVILLE
PINE MOUNTAIN BYROMVILLE

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA SC GA GA GA GA GA NY GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA NC GA TN GA GA

TOTAL REIMBURSED
$67,560.80 $14,191.58 $105,826.99 $22,966.46
$401.20 $42,824.02
$9,259.83 $138,864.27
$28,661.10 $10,632.80 $87,260.00 $11,613.44 $49,437.15
$2,184.71 $209,266.27
$43,196.22 $8,423.94
$84,880.01 $11,954.73
$6,935.22 $38,419.59 $34,763.14 $13,250.00 $12,112.62 $11,253.05 $67,554.59 $223,426.95
$242.91 $21,352.86
$8,844.00 $4,712.70
$841.96 $67,037.14 $132,287.08 $26,769.62 $25,890.69 $31,079.22 $40,971.14 $13,977.10 $54,200.00 $58,687.27 $35,724.58 $43,910.81 $16,392.15 $58,810.10 $49,123.63
$2,273.30 $4,400.00 $3,910.01 $224,136.65 $10,416.60 $60,418.33 $35,511.88 $82,333.43

Subsequent Injury Trust Fund 2005 Annual Report

Page 45

INDIVIDUAL EMPLOYER
PINKERTON-BURNS SECURITY PINSON TRUCKING COMPANY PIOLAX CORPORATION PIONEER LAND SURVEYING PITNEY BOWES PIZZA HUT, INC. PIZZA HUT, INC. PIZZA HUT, INC. PIZZA HUT, INC. PLAIN PRODUCTS, INC. PLANT CORPORATION PLANTERS INC PLAYTEX APPAREL PLOOF CARRIERS CORP POLITEX US, INC. PONCE DE LEON CHEVRON PONDER & ASSOCIATES POST PROPERTIES INC PRECISE MAINTENANCE, INC. PRECISION COMPONENTS PRECISION HEATING & AIR PRECISION MANUFACTURING TECH. PREMARK INTERNATIONAL INC. PRESIDENT BAKING CO. PRIME FLIGHT AVIATION SERVICES PRIME SOURCE PRIMERICA FINANCIAL SERVICE PRINTED FABRICS, INC PROCARE HOME PROCARE SOLUTIONS PROFORCE STAFFING PRYOR LIQUOR STORE PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PURAFIL, INC. PUTNAM COUNTY BOARD OF ED. QUAD GRAPHICS QUALITY MACHINE & FAB. QUALITY STORES, INC. QUEBECOR ATLANTA QUICK CHANGE

CITY
NORCROSS EATONTON
CANTON CARROLLTON
NORCROSS CUMMING DOUGLASVILLE WARNER ROBINS WOODSTOCK
PLAINS CALHOUN ATLANTA NEWNAN JACKSONVILLE
MACON ATLANTA BETHLEHEM ATLANTA DOUGLASVILLE COLUMBUS DALLAS VIDALIA CHAMBLEE AUGUSTA COLLEGE PARK SAVANNAH DULUTH CARROLLTON DOUGLAS MARIETTA MARIETTA ATLANTA ALPHARETTA ATHENS ATLANTA BRUNSWICK COLUMBUS CONYERS DACULA FLOWERY BRANCH KENNESAW LITHONIA MARTINEZ SAVANNAH SMYRNA VALDOSTA WOODSTOCK NORCROSS EATONTON THE ROCK LAFAYETTE STATESBORO ATLANTA DOUGLAS

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$53,338.37 $2,384.19
$19,060.09 $3,428.26
$17,004.13 $535,636.39
$50,874.26 $4,601.70
$10,380.00 $43,899.23 $14,759.16 $27,284.60
$6,174.32 $96,623.07 $23,528.25
$5,300.00 $10,058.03 $35,685.34
$3,850.25 $22,389.84 $35,870.83
$2,482.74 $603.68
$8,448.00 $47,995.36
$3,034.53 $41,973.38
$5,250.00 $172,229.31
$19,780.13 $6,948.07 $8,842.71
$60,283.84 $5,428.72
$59,121.40 $83,862.54 $19,612.90 $33,565.63 $24,448.47 $78,294.87 $65,470.79 $18,979.53 $40,862.36 $49,751.06 $35,928.16 $14,867.30 $23,581.93
$9,203.60 $30,000.00 $20,683.25
$8,379.70 $43,955.40
$6,360.00 $69,656.32

Subsequent Injury Trust Fund 2005 Annual Report

Page 46

INDIVIDUAL EMPLOYER
R & D MANUFACTURING CO., INC. R & W LOGISTICS R.E. SERVICES R.W. ALEXANDER CONTRACTORS R.W. ALLEN ASSOCIATES INC R/S EXPRESS, INC. RAILSERVE, INC. RA-LIN ASSOCIATES RALPH MAHAN RANDALL BROTHERS RAVEN TRANSPORT HOLDING CO. RAYLOC RAY-O-LITE RAYONIER, INC. RAYONIER, INC. RBX-HOOVERHANES RUBBER RCS-GRIFFON CORP RE MICHEL CO READY TRUCKING INC. REDMOND REGIONAL MEDICAL CTR. REEVES CONSTRUCTION CO. REEVES TRUCKING CO., INC. REGAL RUGS REID & REID CONTRACTORS, LLP RELIABLE FASTENERS INC RELIABLE SUPPLY COMPANY RELIANCE STEEL & ALUMINUM REMEDIATION SERVICES, INC. RENTOKIL CONTRACT SVC., INC. RESCAR, INC. RESIDENTIAL SOLID WASTE RESOURCING SERVICE OF ATLANTA REYNOLDS METAL CO. RHEEM MANUFACTURING CO RHODES CONSTRUCTION RHONE POULNEC, INC. RICH'S RICKY HAMMOND (GMTA) RIDGEWOOD MANOR RISK MANAGEMENT RISK MGMT DISASTER SERV RIVERDALE PLUMBING INC RIVERWOOD INT'L. CORP. RJB PROPERTIES RMC SERVICES ROADWAY EXPRESS ROADWAY EXPRESS ROADWAY EXPRESS ROBERT SHAW CONTROLS CO. ROBLAW INDUSTRIES ROEHL TRANSPORT ROGER'S CARTHER COMPANY ROME CITY SCHOOLS ROME TOOL & DYE COMPANY, INC.

CITY
GAINESVILLE AUGUSTA LAFAYETTE VALDOSTA AUGUSTA ATLANTA ATLANTA
CARROLLTON WOODSTOCK
ATLANTA JACKSONVILLE
ATLANTA ATLANTA EATONTON
JESUP TALLAPOOSA
CONYERS GLEN BURNIE ELLENWOOD
ROME THOMSON FITZGERALD
ELLIJAY CUMMING SMYRNA ATLANTA LOS ANGELES FITZGERALD DULUTH GORDON WINDER ATLANTA EASTMAN MILLEDGEVILLE AUGUSTA WOODBINE ATLANTA CONYERS DALTON DULUTH ALPHARETTA RIVERDALE
MACON HOMEWOOD
ATLANTA ATLANTA LAKE PARK SAVANNAH ELLIJAY FOLKSTON MARSHFIELD FORSTON
ROME ROME

STATE
GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA MD GA GA GA GA GA GA GA GA CA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA IL GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$267.81 $75,564.50
$3,913.34 $57.00
$48,808.45 $1,051.62 $2,725.90
$180,386.40 $213,054.59
$33,182.53 $103,824.29
$6,125.00 $33,365.07
$39.23 $202,790.07
$83,707.34 $70,053.85 $44,935.60 $40,256.45 $48,615.09 $76,834.92 $10,575.00 $10,950.41 $30,656.11 $14,311.57 $15,212.60
$2,354.05 $21,960.93 $224,790.27
$7,509.24 $97,540.25 $24,707.62
$158.69 $223,521.51
$16,233.50 $8,225.00
$13,032.60 $132,594.38
$10,626.65 $29,997.03 $12,231.00
$1,088.29 $16,126.04
$398.01 $169,506.29
$1,144.67 $9,297.40 $12,254.73 $356,513.08 $52,843.25
$339.15 $47,218.41
$5,742.40 $2,553.48

Subsequent Injury Trust Fund 2005 Annual Report

Page 47

INDIVIDUAL EMPLOYER
RONILE OF GEORGIA ROOMS TO GO FURNITURE ROPER INDUSTRIES ROSEDALE TRANSPORT, INC. ROSES DEPARTMENT STORE # 235 ROSIEK CONSTRUCTION CO. ROSS SIMON ROTADYNE ROTARY CORP. ROTATING ENGINEERED PRODUCTS RUSHDAH INC RUSSELL STANLEY S & D COFFEE, INC. S & S GRILL S.D. CLIFTON CONSTRUCTION SADDLE CREEK CORPORATION SADDLE CREEK CORPORATION SADDLE CREEK CORPORATION SADIE G. MAYS HEALTH & REHAB SAFELITE GLASS CORP. SAFFOLD ENTERPRISES SAKS INCORPORATED SAM LICHTENBERG CO, INC SANDERSON INDUSTRIES SAVANNAH COCA-COLA BOTTLING SAVANNAH FOODS INDUSTRY SAVANNAH NEWS PRESS SAVANNAH TIRE & RUBBER CO. SAVANNAH TIRE & RUBBER CO. SCAPE DRYER FABRICS SCHAFER, BETSY B. SCHNADIG CORP. SCHNEIDER NATIONAL CARRIERS SCHOLASTIC INC SCIBMATT-COPELANDS OF N'ORLNS SCIENTIFIC ATLANTA SCOTSMAN INDUSTRIES SCOTT BRIDGE CO. SCOVILL SE BUILDING MAINTENANCE SEA ISLAND COMPANY SEABOARD FARMS OF ATHENS SEALY INC SEARS LOGISTICS SERVICES SEARS POOL MGMT CONSULTA SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SEARS ROEBUCK & CO. SELECTIVE H.R. SOLUTIONS SELIG ENTERPRISES, INC.

CITY
LAFAYETTE SUWANEE COMMERCE
DALTON ALBANY BRUNSWICK CRANSTON COVINGTON GLENNVILLE GAINESVILLE NEWNAN LITHONIA CONCORD ELBERTON AUGUSTA ATLANTA LAKELAND VILLA RICA ATLANTA COLUMBUS BUCKHEAD COLUMBUS WAYNESBORO ATLANTA POOLER PORT WENTWORTH SAVANNAH GARDEN CITY RICHMOND HILL WAYCROSS THOMASVILLE CORNELIA GREEN BAY KENNESAW MARIETTA LAWRENCEVILLE CONYERS OPELIKA CLARKESVILLE LOGANVILLE SEA ISLAND ATHENS CONYERS STONE MOUNTAIN ATLANTA ALBANY ATLANTA BRUNSWICK CHICAGO DULUTH MACON TUCKER SARASOTA ATLANTA

STATE
GA GA GA GA GA GA RI GA GA GA GA GA NC GA GA GA GA GA GA OH GA GA GA GA GA GA GA GA GA GA GA GA WI GA GA GA GA AL GA GA GA GA GA GA GA GA GA GA IL GA GA GA FL GA

TOTAL REIMBURSED
$39,627.84 $21,820.83 $47,614.23 $165,205.14
$1,737.15 $8,580.00 $36,547.23
$335.19 $796.09 $5,013.40 $15,487.16 $2,285.48 $18,626.25 $12,677.62 $110,073.04 $37,712.87 $11,716.55 $27,972.07 $3,140.64 $97,685.54 $5,546.72 $20,000.00 $12,163.50 $6,623.52 $27,649.23 $14,521.01 $3,410.00 $874.86 $25,200.00 $14,413.41 $585.24 $8,478.64 $161,963.89 $9,993.40 $50,579.98 $9,995.94 $179,967.55 $33,310.14 $26,841.72 $136,052.93 $38,884.91 $8,386.58
$52.25 $4,242.38 $31,600.00 $1,601.71 $2,953.05 $16,123.00 $5,652.85 $95,031.81 $5,719.01 $2,353.47 $140,487.26 $27,789.43

Subsequent Injury Trust Fund 2005 Annual Report

Page 48

INDIVIDUAL EMPLOYER
SENIOR CONNECTIONS SERVICE MERCHANDISE SERVICEMASTER CONSUMER SERV. SERVPRO OF EAST COBB SEWELL MANUFACTURING CO SHARP RESIDENTIAL BUILDERS & SHEPHERD CONSTRUCTION CO SHERMAN INTERNATIONAL SHILOH INDUSTRIES SHO ENTERPRISES SHOE CITY, INC. SHRIVER MANAGEMENT SERVICES SI CORPORATION SIEMENS ENERGY & AUTOMATION SIEMENS ENERGY CORP SIG COX, INC. SIGNATURE FLIGHT SUPPORT SILVER EAGLE TRANSPORT, INC SIMKINS INDUSTRIES, INC. SINGLETON FURNITURE CO SKILSTAFF INC SLOAN'S RESTAURANT SMITH BROTHERS MECHANICAL SMITH-GRAY ELECTRIC CO. INC. SMITHS MARKET SNAP-ON INC.( J.H. WILLIAMS) SOFTSHEEN-CARSON SONY MUSIC SOUTHEAST BLDG. MAINTENANCE SOUTHEAST FOREST INDUSTRI SOUTHEAST FROZEN FOODS CO SOUTHEASTERN FREIGHT LINE SOUTHEASTERN STAGES, INC. SOUTHER STORES SOUTHERN AG CARIERS, INC. SOUTHERN AMBULANCE BUILDERS SOUTHERN BULK INDUSTRIES SOUTHERN CONCRETE CONSTR. SOUTHERN CONTAINER INC SOUTHERN CROSS CORP SOUTHERN CROSS TIMBER CO. SOUTHERN ELECTRONICS SOUTHERN ERECTORS INC SOUTHERN FOOD SERVICES SOUTHERN HOME CARE SVCS SOUTHERN MACHINERY MOVERS SOUTHERN PIZZA VENTURES SOUTHERN SAW SERVICE, INC. SOUTHERN WHOLESALE FLOORING SOUTHERNWOOD CABINETS, INC. SOUTHLAND ASSOCIATES, INC. SOUTHLAND LOGGING SOUTHLAND WASTE SYS. OF GA SOUTHTRUST BANK

CITY
CHAMBLEE BRENTWOOD LAWRENCEVILLE
MARIETTA BREMEN ALPHARETTA ATLANTA
ROME PENDERGRASS
SMYRNA MONTGOMERY
DUBLIN CHICKAMAUGA
TUCKER ALPHARETTA
AUGUSTA GARDEN CITY
ALBANY MARIETTA WAYCROSS ALEXANDER CITY WAYCROSS AUGUSTA COLUMBUS TALLAPOOSA COLUMBUS SAVANNAH CARROLLTON LOGANVILLE DAMASCUS CORDELE SUWANEE ATLANTA CORDOVA
ALBANY LAGRANGE GARDEN CITY
ALBANY DALTON NORCROSS NEWINGTON TUCKER PENSACOLA ATLANTA VALDOSTA LAGRANGE COMMERCE TWNSHP ATLANTA MARIETTA TEMPLE THOMASVILLE FITZGERALD MACON COLUMBUS

STATE
GA TN GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA GA GA GA GA GA TN GA GA GA GA GA GA GA GA FL GA GA GA MI GA GA GA GA GA GA GA

TOTAL REIMBURSED
$363.24 $50,835.86 $12,167.61 $17,861.64
$231.00 $124,809.57
$24,109.98 $61,189.36 $15,422.32 $125,105.02 $38,682.47
$6,917.01 $357,980.33
$3,702.79 $345.97
$62,314.68 $245,438.21
$517.00 $31,942.00
$8,262.00 $11,485.12 $12,360.83 $17,564.19 $27,843.16 $27,154.71 $26,361.21
$266.70 $84,640.81
$86.97 $118,026.84
$48,059.49 $7,383.25 $6,275.00
$21,310.46 $39,308.71
$8,023.97 $18,979.44 $57,756.65 $28,957.63
$3,375.00 $129,303.01
$9,142.96 $4,485.29 $19,669.98 $23,083.02 $27,073.41
$500.49 $91,269.10 $58,597.35 $167,372.48 $10,732.40 $85,788.50
$3,523.49 $3,899.39

Subsequent Injury Trust Fund 2005 Annual Report

Page 49

INDIVIDUAL EMPLOYER
SP NEWPRINT CO-DUBLIN SP RICHARDS SPARTAN MECHANICAL INC SPC COMPANY SPECTRUM CABLE SERVICES SPIRIT CONSTRUCTION SERVICES SPORTRAN, INC. STAFF LEASING STAFFING SOLUTIONS STAFFORD DEVELOPMENT, INC. STAIRCASE AND MILLWORK STAPLES INC STAR MANUFACTURING COMPANY STARBUCKS COFFEE CO STEPHENS COUNTY SCHOOL STEVE CRAWFORD FOREST PROD. STEWART CANDY CO STONE MOUNTAIN GROUP STORES AUTOMATED SYSTEMS STORK GAMCO, INC. STRINGER LUMBER CO. SUITT CONSTRUCTION COMPANY SULLIVAN'S ADMINISTRATIVE SERV SUNDANCE PLUMBING, INC. SUNSHINE BISQUITS, INC SUNSHINE CLEANING SERVICE SUPERIOR INSURANCE COMPANY SUPERIOR PLUMBING SERVICE SUPERIOR YARN TECHNOLOGY SUPREME CARPET, INC. SUPREME INDUSTRIES, INC. SUSSEX CORP. SUWANEE TIMBER INC SWEETHEART CUP CO SWEETHEART CUP CO SWIFT DENIM SWISHER INTERNATIONAL ,INC. SYDNEY PYLES PLUMBING SYNOVUS FINANCIAL CORP. T & M TILT-UP, INC. T. TECH, INC. T.C.B., & ASSOC., INC. T.D. REESE CONSTRUCTION T.T.C. ILLINOIS, INC. TAFCO-MABRY & HAYNES INC. TALLATOONA EOA, INC. TAMPA ARMATUR WORKS INC. TANNER SERVICE CENTER INC TARA MATERIALS, INC. TARTAN TEXTILE SERVICES TARTAN TEXTILE SERVICES TAYLOR ORCHARDS, INC. TAYLOR REPO, INC. TBN OF GA., INC./TBN OF TENN.

CITY
DUBLIN SMYRNA CHAMBLEE LAGRANGE JONESBORO SAVANNAH LAWRENCEVILLE BRADENTON GAINESVILLE TIFTON ALPHARETTA MARIETTA CEDARTOWN ATLANTA TOCCOA WAYNESBORO WAYCROSS SNELLVILLE BRISTOL GAINESVILLE MCDONOUGH ALBANY SAVANNAH MARIETTA COLUMBUS COLUMBUS ATLANTA MARIETTA DALTON CHATSWORTH GOSHEN CANTON FARGO AUGUSTA CONYERS COLUMBUS JACKSONVILLE MACON COLUMBUS BETHLEHEM ATLANTA MARIETTA SAVANNAH KANKAKEE AUSTELL CARTERSVILLE MACON EAST DUBLIN LAWRENCEVILLE HOUSTON
ROME REYNOLDS WEST BLACKSHEAR BRUNSWICK

STATE
GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA PA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA IL GA GA GA GA GA TX GA GA GA GA

TOTAL REIMBURSED
$52,158.18 $166,056.34
$36,298.14 $21,460.46 $98,619.11 $28,570.88 $20,272.79 $111,296.63
$1,046.69 $68,256.28 $19,720.70 $23,044.19 $76,485.26
$8,855.87 $966.79
$2,001.35 $34,816.72 $173,546.85 $13,973.16 $47,778.23
$4,451.48 $64,942.29 $46,971.91
$4,900.00 $17,884.70 $21,697.70 $16,202.71 $53,344.04 $17,680.28
$6,100.80 $12,076.53
$191.83 $54,995.64 $134,257.90
$2,228.01 $22,036.48 $46,119.80 $80,946.28 $12,800.60 $11,527.54
$7,951.08 $181,466.77
$28,049.45 $16,615.36 $50,860.91 $78,685.06 $77,596.22 $251,307.28
$7,412.19 $8,793.76 $21,565.75 $15,627.84 $15,778.52 $313,758.44

Subsequent Injury Trust Fund 2005 Annual Report

Page 50

INDIVIDUAL EMPLOYER
TDC CONCRETE TDK ELECTRONICS CORP. TEBARCO MECHANICAL CORP. TECH CON, INC. TEETS INTERNATIONAL TRUCKS INC TELIGENT TENNECO AUTOMOTIVE TENNECO AUTOMOTIVE TENNECO OIL CO. TERRY HICKS ELECTRIC CO TETON INDUSTRIAL TFE GROUP THE BOMBAY COMPANY THE BOOK WAREHOUSE THE CHEESECAKE FACTORY THE CONCRETE CO., INC. THE COOK'S WAREHOUSE INC. THE DARIEN NEWS, INC. THE GILBERT COMPANIES THE GREATER TRAVELERS REST THE KINGS CARPENTERS, INC. THE KRYSTAL COMPANY THE MARCUS JEWISH COMMUNITY THE MASQUERADE, INC. THE MI GROUP THE MOTOR CONVOY, INC. THE NETWORK, INC. THE RAYMOND KING CO., INC. THE RETREAT THE SUNSHINE HOUSE, INC. THE TAPPAN COMPANY THE TLC COMPANIES THE TLC COMPANIES THE WEATHER CHANNEL THE WILLIAM L BONNELL CO., INC THOMAS AND BETTS THOMAS COUNTY PUBLIC SCHOOLS THOMAS PACKING CO. THOMPSON CONSTRUCTION CO. THOMPSON HARDWOODS, INC. THOMPSON'S FARM SUPPLY THOMSON OAK FLOORING CO. THREE SPRINGS, INC. TIDEWATER COMPANIES, INC. TIFT COUNTY BOARD OF ED. TIFT HEALTH CARE TIFTON ALUMINUM CO., INC. TIMBER HARVESTING, INC. TIMESAVER 84 TIMESAVER, INC- 56 TINDALL CORPORATION TINDALL CORPORATION TIRES FIRST TNS MILLS, INC.

CITY
FOREST PARK PEACHTREE CITY
ALPHARETTA BLUE RIDGE
AUGUSTA VIENNA
HARTWELL ROYSTON MOULTRIE COVINGTON CEDAR SPRINGS KENNESAW DAWSONVILLE KNOXVILLE ATLANTA COLUMBUS ATLANTA
DARIEN MUNCIE DECATUR CANTON TUCKER CLEVELAND ATLANTA NORCROSS ATLANTA NORCROSS CALHOUN NASHVILLE KENNESAW DALTON CHESTERTON THOMASVILLE ATLANTA NEWNAN BAINBRIDGE THOMASVILLE GRIFFIN CHAMBLEE HAZELHURST VIDALIA THOMSON HUNTSVILLE BRUNSWICK TIFTON TIFTON TIFTON DANVILLE SAVANNAH TWIN CITY MORROW SPARTANBURG COLUMBUS LAVONIA

STATE
GA GA GA GA GA VA GA GA GA GA GA GA GA TN GA GA GA GA IN GA GA GA GA GA GA GA GA GA GA GA GA IN GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$16,148.95 $5,305.36
$10,383.94 $15,109.62
$2,860.00 $34,724.16 $184,179.49 $34,676.78 $13,348.94
$2,089.62 $12,135.66 $82,810.53 $32,495.96 $12,600.00
$6,247.00 $3,480.15 $25,471.89 $40,407.90 $109,046.06
$184.00 $27,772.22 $24,402.68
$3,182.91 $70,713.32 $18,972.72
$7,480.00 $131,959.92
$14,801.99 $82,620.31
$3,908.40 $8,995.15 $64,852.62 $41,556.77 $2,437.21 $10,718.00 $12,110.25 $1,639.58 $1,156.15 $14,239.35 $26,811.74 $6,915.04 $17,147.22 $183,298.54 $19,065.27 $59,832.20 $24,748.35 $8,488.00 $26,086.92 $2,881.33 $12,731.49
$43.38 $7,247.13 $41,568.00 $1,144.70

Subsequent Injury Trust Fund 2005 Annual Report

Page 51

INDIVIDUAL EMPLOYER
TOBACCO EXPORTERS INT'L TOCCOA METAL TECHNOLOGIES TOG SHOP TOM JAMES CO TOMMY GIBSON BUILDERS INC TONY'S FOOD MART TOPCON AMERICA CORP. TOPPAN INTERAMERICAN TOPPS CABLE CONTRACTING TORCO INC TOWN OF TRION POLICE DEPT. TRAILMOBILE, INC. TRAILWAY SOUTHEASTERN LINES TRANE UNITARY PRODUCTS TRANS WORLD AIRLINES, INC. TRANSPORTATION UNLIMITED INC TRANSPOWER TRAVEL CENTERS OF AMERICA TRENT TUBE DIVISION TRINTEX CORPORATION TRI-SOUTH CONTRACTORS,INC TRI-STATE EMC TRU-CHECK INC TRUCKS, INC. TRUCKSTOPS OF AMERICA TRU-GREEN LANDCARE TRUS JOIST MACMILLAN TRUS JOIST MACMILLIAN TRUSS TECH IND TRW AERONAUTICAL SYSTEMS TRW-BRUNSWICK JOB CORPS TRX-WORLD TRAVEL TUCKER CONCRETE TUGALO GAS CO INC TURNER BD OF ED TURNER BROADCASTING SYS. INC TUSCARORA TWIGGS CO. BD. OF ED. U TEC CONSTRUCTION CO U.S. CAN CO U.S. CAN CO U.S. SECURITY ASSOCIATES, INC. UNDERGROUND UTILITIES, INC. UNIPRO FOODSERVICES UNISIA OF GEORGIA CORP. UNITED DISTRIBUTORS, INC. UNITED DISTRIBUTORS, INC. UNITED FORMING, INC. UNITED INSURANCE CO OF AMER. UNITED PARCEL SERVICE UNITED PARCEL SERVICE UNITED WASTE SERVICE UNIVERSAL BLANCHERS UPSON COUNTY

CITY
TUCKER TOCCOA AMERICUS BREMEN MACON ROCKMART PARAMUS MCDONOUGH TOCCOA MARIETTA
TRION CONLEY ATLANTA VIDALIA ATLANTA CLEVELAND ALBANY BRUNSWICK CARROLLTON BOWDON STONE MOUNTAIN MCCAYSVILLE SOMERSET JACKSON BRUNSWICK LILBURN VALDOSTA COLBERT BUFORD MACON BRUNSWICK ATLANTA TUCKER TOCCOA ASHBURN ATLANTA HAYWARD JEFFERSONVILLE LAWRENCEVILLE MORROW TALLAPOOSA GAINESVILLE ST. MARYS ATLANTA MONROE ALBANY SMYRNA AUSTELL SAVANNAH DORAVILLE MACON WINDER PEACHTREE CITY THOMASTON

STATE
GA GA GA GA GA GA NJ GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA KY GA GA GA GA GA GA GA GA GA GA GA GA GA CA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$115,929.26 $16,758.09 $1,840.00 $69,778.95 $23,635.73 $24,145.15 $1,697.00 $10,185.62 $54,608.17 $36,735.09 $26,382.01
$151,687.88 $39,306.13 $1,334.44 $18,465.80 $59,796.13 $8,494.01 $15,931.87 $10,242.56 $53,188.23 $2,275.00 $4,183.13 $13,400.76 $7,469.33 $6,580.18 $18,601.85 $74,890.13 $26,339.03 $21,254.16 $5,118.75
$154,747.64 $7,257.66 $1,252.75
$36,840.82 $20,531.94
$2,801.36 $47,619.92 $151,319.77 $92,720.00 $20,642.67 $42,992.12 $15,645.99 $14,932.19 $94,144.23 $37,683.97
$330.00 $342.50 $3,364.84 $1,090.59 $23,371.95 $23,000.86 $21,487.76 $10,314.14 $30,177.08

Subsequent Injury Trust Fund 2005 Annual Report

Page 52

INDIVIDUAL EMPLOYER
URS LOGISTICS, INC. US FOODSERVICE-ATLANTA US XPRESS, INC. UTILITIES CONST. CO OF SC UVALDA MANUFACTURING CO V.F. CORPORATION/LEE CO. VANCEVILLE TURF VANGUARD SERVICES VANTAGE PRODUCTS CORP. VARN TURPENTINE & CATTLE VAUGHAN CARTAGE CO., INC. VENDOR'S SUPPLY OF GEORGIA VENTURE EXPRESS, INC. VIACON, INC VICTORY BAPTIST CHURCH VICTORY RETIREMENT, INC. VILLAGE PODIATRY, INC. VINCE HOSIERY MILL VISITING NURSES ASSOCIATION VISITING NURSES ASSOCIATION VISTA HOSPITAL CARE VOS ELECTRIC VOUGHT AIRCRAFT W AND W BUILDERS INC. W.A. BRAGG & CO. W.C. BRADLEY CO. W.M. ORR INC. WADE & CLAIRE, INC. WADE & SONS INC WADE INVESTMENTS WALKER COUNTY WALLACE COMPUTER SYSTEM WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WALTON GRAPHIC MEDIA WALTON MONROE MILLS, INC. WASTE MGMT OF ATLANTA SOU WASTE MGMT OF SAVANNAH WATER VISTA APARTMENTS WATER, GAS & LIGHT COMMISSION WATTYL PAINT CORP. WAYCROSS COCA-COLA WAYFIELD FOODS, INC. WAYNE COUNTY SCHOOLS

CITY
ATLANTA FAIRBURN TUNNEL HILL CHARLESTON
UVALDA JASPER TIFTON INDIANAPOLIS CONYERS JACKSONVILLE LAGRANGE LITHONIA LAVERGNE NORCROSS STONE MOUNTAIN NASHVILLE SMYRNA VILLA RICA BAXLEY TIFTON MACON GREEN BAY MILEDGEVILLE NORCROSS AUGUSTA COLUMBUS LILBURN BRUNSWICK MACON COLUMBUS LAFAYETTE ATLANTA CEDARTOWN DUBLIN FORT OGLETHORPE HINESVILLE HIRAM JESUP LAGRANGE MACON MARIETTA MOULTRIE NEWNAN TIFTON MONROE MONROE LAKE CITY GARDEN CITY LAWRENCEVILLE ALBANY ATLANTA WAYCROSS ATLANTA JESUP

STATE
GA GA GA SC GA GA GA IN GA FL GA GA TN GA GA GA GA GA GA GA GA WI GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

TOTAL REIMBURSED
$1,617.97 $91,726.66 $63,924.04
$4,168.36 $24,339.55
$3,565.00 $4,816.06 $496,255.23 $116,398.80 $10,998.18 $2,041.12 $15,187.50 $19,752.32 $51,449.42 $47,857.42 $58,978.66 $10,347.93 $41,050.51 $7,650.00 $20,813.92 $19,383.33 $13,629.76 $12,971.70 $65,716.62 $84,817.35 $14,165.75 $7,131.17 $6,492.27 $8,568.00 $26,883.92 $15,151.45 $1,663.70 $5,700.73 $24,893.48 $1,067.40 $156,023.77 $11,852.21 $36,466.34 $46,699.20 $1,714.69 $18,503.19 $8,328.57 $8,244.00 $44,113.59 $4,371.65 $6,561.00 $43,804.16 $68,247.91 $26,997.30 $2,860.00 $22,882.79 $15,309.76 $176,161.27 $84,861.07

Subsequent Injury Trust Fund 2005 Annual Report

Page 53

INDIVIDUAL EMPLOYER
WAYNE POULTRY WAYNE S. HADDOCK WEBER AIRCRAFT, INC. WEEKS TEXTILE WELLESLEY INN WELLINGTON BUILDERS INC WELLSTONE/TNS MILLS, INC WENDY'S WESLEY H. SMITH LANDSCAPE,INC. WESLEYAN COLLEGE WEST GEORGIA AUTO PARTS INC WEST LUMBER CO WEST PLUMBING SALES & SER WESTEK INC. WESTVALE MANUFACTURING CO WHEELER COUNTY HOSPITAL WHITEHEAD DIE CASTING CO. WHITLOW ELECTRIC SERVICE,INC. WIGHT NURSERIES WILDES VENDING COMPANY, INC WILKINS INDUSTRIES WILLIAM CARTER CO WILLIAM J. LUMLEY & CO. WILLIAMS ENTERPRISES WILLIAMS SERVICE GROUP WILSON BROTHERS, INC. WINGS, ETC. WINKLER HEATING & AIR CONDITIO WIREGRASS HOSPICE WISE BUSINESS FORMS WOOD HOLLOW CABINET, INC. WOODBURY BUSINESS FORMS WOODMAN INSULATION WRIGHT & EVANS INC WWF, INC. X-STREAM PLUMBING YAMAHA MUSIC MANUFACTURING YANCEY BROTHERS CO. YOKOGAWA CORP OF AMERICA YORK BEE CO YOUNG REFINING CORP. YUM! BRANDS, INC. ZARTRAN, INC.
TOTAL

CITY
PENDERGRASS WAYCROSS ATLANTA QUITMAN ALPHARETTA GRAYSON LAVONIA VALDOSTA CUMMING MACON
CARROLLTON ATLANTA
WARNER ROBBINS THOMASTON CANTON GLENWOOD GAINESVILLE ELBERTON CAIRO VALDOSTA ATHENS BARNESVILLE ADRIAN
CHATTANOOGA MILLEDGVILLE GLENNVILLE COLLEGE PARK GAINESVILLE
DOTHAN ALPHARETTA
DALTON WOODBURY
CUMMING ST. MARYS
ATHENS LOGANVILLE THOMASTON
AUSTELL NEWNAN
JESUP DOUGLASVILLE
LOUISVILLE CEDARTOWN

STATE
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA TN GA GA GA GA AL GA GA GA GA GA GA GA GA GA GA GA GA KY GA

TOTAL REIMBURSED
$6,272.75 $11,447.66
$1,816.26 $14,614.36
$46.85 $30,697.53 $11,039.72 $31,761.09 $106,999.79 $11,974.13
$4,290.00 $8,484.60 $2,778.75 $26,903.11 $22,007.94 $53,131.37 $20,923.31 $68,286.41 $99,125.49 $1,817.38 $13,896.78 $300,837.75 $81,024.27 $87,038.98 $35,632.32 $75,229.81
$872.19 $117,789.64 $127,981.88
$13,055.45 $168,283.91
$76,607.94 $178,915.64 $198,597.26
$48,778.04 $111,463.75
$59,656.18 $103,650.50
$14,194.57 $21,509.73
$55.00 $71,266.16 $216,640.17
$62,068,595.97

Subsequent Injury Trust Fund 2005 Annual Report

Page 54

ASSESSMENT 2005
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 selfinsurer bears to the total workers' compensation claims paid by all insurers and selfinsurers 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 2005 Annual Report

Page 55

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 selfinsured 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 self-insured employer during the calendar year.

Assessment Adjustment for 2004

The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2004 was $125,909,963.38. This was computed in the following manner:

Total Fund disbursements/calendar year 2004

$103,386,020.33

(minus) Net Assets (as of 12/31/2004) Fund Assessment

x

175%

- 55,015,572.20

$125,909,963.38

The assessment rate is based on data provided by insurers and self-insured employers' in the Annual Assessment Reports; the actual total of workers' compensation benefits (indemnity, medical, and rehabilitation) paid in Georgia during calendar year 2004 was $1,225,603,751.54. This amount is divided into the fund assessment of $125,909,963.38 and yields an (adjusted) assessment rate of .10273301. This adjustment has caused an increase to be applied to the 2004 assessment.

Subsequent Injury Trust Fund 2005 Annual Report

Page 56

Assessment Rate for 2005
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2005 is $141,784,943.62. This was computed in the following manner:

Total Fund disbursements/calendar year 2005

$117,604,118.75

(minus) Net Assets (as of 12/31/2005) Fund Assessment

x

175%

205,807,207.81

- 64,022,264.19

$141,784,943.62

Based on data received from insurers and self-insured employers, the reported total of workers' compensation benefits paid in Georgia during calendar year 2005 was $1,305,903,441.88. This amount is divided into the fund assessment $141,784,943.62, which yields an assessment rate of .10857230.

In addition to the assessment, an additional $489,472.72 in penalties for late filing of Claims Loss report forms will be levied.

Subsequent Injury Trust Fund 2005 Annual Report

Page 57

ASSESSMENTS DUE FOR 2004 AND 2005

Insurance Companies

Insurance Companies
ACCIDENT FUND INS CO OF AMER ACE AMERICAN INSURANCE CO ACE FIRE UNDERWRITERS INS. ACE INDEMNITY INSURANCE CO ACE PROPERTY & CASUALTY INS ACIG INSURANCE COMPANY ADVANTAGE WORKERS COMP. AEQUICAP INSURANCE CO AIG PREMIER INSURANCE CO AIU INSURANCE CO ALEA NORTH AMERICA ALFA INSURANCE CORP ALL AMERICA INS. CO AMCOMP ASSURANCE AMCOMP PREFERRED AMERICAN ALTERNATIVE INS AMERICAN AUTOMOBILE INS CO AMERICAN CAS CO OF READING 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 AMERICAN INSURANCE CO AMERICAN INTER INS CO OF GA AMERICAN INTERN. SOUTH INS AMERICAN MFG. MUTUAL INS AMERICAN MOTORISTS INS CO AMERICAN RESOURCES INS CO AMERICAN SAFETY CASUALTY AMERICAN STATES INS CO AMERICAN STATES INS CO OF TX AMERICAN ZURICH INS CO AMERISURE INSURANCE CO AMERISURE MUTUAL INS CO AMGUARD INSURANCE CO. ANSUR AMERICAN INS CO

2004 Assessment
Amount $1,784.46
$1,952,863.43 $105,260.99 $2,586.08 $328,547.59 $30,903.06 $1,071.62 $11,887.10 $65.07 $56,499.81 $20,597.57 $6,665.49 $43,060.66 $333,905.07 $99,973.59 $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
$84,010.67 $24,949.91 $189,916.42
$9,842.75 $826,739.24
$6,709.41 $97,245.31 $117,000.27
$0.00

2004 Assessment Adj. Amount
$1,794.54

2005 Claims Paid
$323,083.00

2005 Assessment
Due
$35,077.86

2004 Balance
Due
$10.08

$1,963,890.76 $31,444,612.00 $3,414,013.85 $11,027.33

$105,855.37

$959,064.00 $104,127.78

$594.38

$2,600.69

$22,613.00

$2,455.15

$14.61

$330,402.82 $2,269,490.00 $246,403.75 $1,855.23

$31,077.56

$169,622.00

$18,416.25

$174.50

$1,077.67

$62,989.00

$6,838.86

$6.05

$11,954.22

$145,122.00

$15,756.23

$67.12

$65.44

$0.00

$0.00

$0.37

$56,818.85

$443,213.00

$48,120.65

$319.04

$20,713.88

$376,273.26

$40,852.85

$116.31

$6,703.12

$13,307.00

$1,444.77

$37.63

$43,303.81

$926,533.44 $100,595.87

$243.15

$335,790.55 $6,068,137.00 $658,831.59 $1,885.48

$100,538.12 $1,098,853.00 $119,305.00

$564.53

$720,624.91 $3,264,788.00 $354,465.54 $4,046.34

$57,486.52

$0.00

$0.00

$322.79

$1,597,056.27 $13,507,373.11 $1,466,526.57 $8,967.54

$2,088.36

$0.00

$0.00

$11.73

$94,818.66

$717,843.00

$77,937.87

$532.41

$15,390.53

$9,771.00

$1,060.86

$86.41

$1,274.30

$9,124.00

$990.61

$7.15

$93,165.80

$0.00

$0.00

$523.13

$2,380.73

$24,054.00

$2,611.60

$13.36

$3,195,849.60 $36,093,359.00 $3,918,739.00 $17,944.82

$336,824.76 $2,403,180.00 $260,918.78 $1,891.28

$1,310,823.99 $16,863,957.53 $1,830,958.66 $7,360.33

$1,002,825.50 $11,013,317.00 $1,195,741.16 $5,630.90

$474,570.80 $2,159,235.84 $234,433.20 $2,664.74

$1,023,873.54 $6,048,643.50 $656,715.14 $5,749.09

$84,485.06

$888,934.00

$96,513.61

$474.39

$25,090.79

$374,687.00

$40,680.63

$140.88

$190,988.83 $1,538,673.34 $167,057.30 $1,072.41

$9,898.33

$141,498.00

$15,362.76

$55.58

$831,407.63 $8,051,388.37 $874,157.75 $4,668.39

$6,747.30

$297,036.00

$32,249.88

$37.89

$97,794.43 $1,853,778.00 $201,268.94

$549.12

$117,660.94 $1,829,026.00 $198,581.56

$660.67

$0.00

$442,944.00

$48,091.45

$0.00

2004 and 2005 Total
Assessment $35,087.94
$3,425,041.18 $104,722.16 $2,469.76 $248,258.98 $18,590.75 $6,844.91 $15,823.35 $0.37 $48,439.69 $40,969.16 $1,482.40 $100,839.02 $660,717.07 $119,869.53 $358,511.88 $322.79
$1,475,494.11 $11.73
$78,470.28 $1,147.27 $997.76 $523.13 $2,624.96
$3,936,683.82 $262,810.06
$1,838,318.99 $1,201,372.06
$237,097.94 $662,464.23
$96,988.00 $40,821.51 $168,129.71 $15,418.34 $878,826.14 $32,287.77 $201,818.06 $199,242.23 $48,091.45

Subsequent Injury Trust Fund 2005 Annual Report

Page 58

Insurance Companies
ARCH INSURANCE CO ARGONAUT GREAT CENTRL INS 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 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 CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO CENTRE INSURANCE CO CENTURY INDEMNITY CO CHARTER OAK FIRE INS 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 COLONIAL AMER. CAS & SURETY COLUMBIA NATIONAL INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL INS OF NEWARK NJ COMPANION COMMERICAL INS

2004 Assessment
Amount $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
$113,558.32 $75,694.85 $48,245.09 $11,313.39
$305,541.82 $1,950.16
$77,253.86 $229,167.01 $129,998.97
$88,960.86 $100,870.66 $834,924.54
$23.38 $147,982.71 $1,643,530.80
$0.00 $24,760.51

2004 Assessment Adj. Amount
$26,744.90

2005 Claims Paid
$1,118,480.00

2005 Assessment
Due
$121,435.95

2004 Balance
Due
$150.18

$25,112.47

$353,139.00

$38,341.11

$141.01

$277,928.54 $1,471,812.00 $159,798.01 $1,560.58

$45,290.46

$187,560.00

$20,363.82

$254.30

$36,528.16

$644,851.00

$70,012.96

$205.11

$35,545.74

$404,477.00

$43,915.00

$199.59

$51,215.49

$959,965.00 $104,225.61

$287.58

$235,217.40 $3,542,401.00 $384,606.62 $1,320.76

$352,295.71

$237,944.36

$25,834.17 $1,978.16

$695.53

$132,034.00

$14,335.24

$3.91

$303,037.72 $2,544,166.00 $276,225.95 $1,701.57

$2,308.21

$164,945.00

$17,908.46

$12.97

$459,229.09 $3,395,756.00 $368,685.04 $2,578.59

$3,270.61

$0.00

$0.00

$18.37

$963.74

$27,333.00

$2,967.61

$5.41

$318,674.41 $1,045,917.00 $113,557.61 $1,789.37

$443,194.31 $6,700,921.00 $727,534.41 $2,488.55

$0.00

$16,329.00

$1,772.88

$0.00

$295,756.73 $8,747,850.00 $949,774.19 $1,660.69

$16,597.24

$261,080.00

$28,346.06

$93.20

$835,415.80 $8,191,788.00 $889,401.26 $4,690.90

$25,012.10

$272,651.00

$29,602.35

$140.45

$3,458,168.07 $33,400,874.00 $3,626,409.71 $19,417.75

$1,203,860.12 $9,533,037.43 $1,035,023.80 $6,759.72

$490,653.57 $5,305,885.00 $576,072.14 $2,755.03

$2,230.74

$34,082.00

$3,700.36

$12.52

$114,199.55

$924,783.00 $100,405.82

$641.23

$76,122.28

$849,936.97

$92,279.61

$427.43

$48,517.51

$370,356.00

$40,210.40

$272.42

$11,377.27

$154,032.00

$16,723.61

$63.88

$307,267.14 $2,153,873.00 $233,850.95 $1,725.32

$1,961.17

$95,912.00

$10,413.39

$11.01

$77,690.09

$864,196.00

$93,827.75

$436.23

$230,461.05 $2,925,768.13 $317,657.38 $1,294.04

$130,733.04 $1,585,624.22 $172,154.87

$734.07

$89,463.20 $1,733,243.27 $188,182.21

$502.34

$101,440.25 $1,116,887.67 $121,263.06

$569.59

$839,639.15 $10,797,738.00 $1,172,335.25 $4,714.61

$23.51

$287.00

$31.16

$0.13

$148,818.33 $1,567,335.03 $170,169.17

$835.62

$1,652,811.40 $25,649,329.00 $2,784,806.64 $9,280.60

$0.00

$148.80

$16.16

$0.00

$24,900.32

$369,357.00

$40,101.94

$139.81

2004 and 2005 Total
Assessment $121,586.13 $38,482.12 $161,358.59 $20,618.12 $70,218.07 $44,114.59 $104,513.19 $385,927.38 $27,812.33 $14,339.15 $277,927.52 $17,921.43 $371,263.63 $18.37 $2,973.02 $115,346.98 $730,022.96 $1,772.88 $951,434.88 $28,439.26 $894,092.16 $29,742.80
$3,645,827.46 $1,041,783.52
$578,827.17 $3,712.88
$101,047.05 $92,707.04 $40,482.82 $16,787.49
$235,576.27 $10,424.40 $94,263.98
$318,951.42 $172,888.94 $188,684.55 $121,832.65 $1,177,049.86
$31.29 $171,004.79 $2,794,087.24
$16.16 $40,241.75

Subsequent Injury Trust Fund 2005 Annual Report

Page 59

Insurance Companies
COMPANION PROP & CAS 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 EMPLOYERS REINSURANCE EVEREST NATIONAL INS EVEREST SECURITY INS CO EXCELSIOR INSURANCE CO FAIRFIELD INSURANCE CO FAIRMONT SPECIALTY INS CO FARMINGTON CASUALTY CO FARMLAND MUTUAL FCCI INSURANCE COMPANY FEDERAL INSURANCE CO FEDERATED MUTUAL INS CO FEDERATED RURAL ELECTRIC FEDERATED SERVICE INS CO FFVA MUTUAL INS CO FIDELITY & CAS CO OF NY FIDELITY & DEPOSIT CO OF MD FIDELITY & GUAR UNDRWRITERS FIDELITY & GUARANTY INS CO FIREMAN'S FUND INS CO FIREMAN'S FUND INS CO OF GA FIREMAN'S FUND OF WISCONSIN FIREMAN'S INS CO OF NEWARK FIRST LIBERTY INS CORP FIRST NATL INS CO OF AMER

2004 Assessment
Amount $1,030,142.21 $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
$0.00 $650,881.84 $135,630.08
$68,569.36 $138,085.35
$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 $223,302.84 $68,803.71 $13,830.31
$1,560.62 $28,781.37 $86,625.48

2004 Assessment Adj. Amount
$1,035,959.16

2005 Claims Paid
$11,476,906.00

2005 Assessment
Due
$1,246,074.08

$1,596,244.93 $19,055,956.24 $2,068,949.00

$43,682.06

$623,207.86

$67,663.11

$117,960.51 $1,958,600.00 $212,649.71

$824,440.64 $3,591,256.77 $389,911.01

$26,043.95

$262,190.00

$28,466.57

$20,079.06

$131,226.00

$14,247.51

$135,073.57 $1,789,151.00 $194,252.24

$156.77

$6,214.00

$674.67

$0.00

$76,569.00

$8,313.27

$20,980.96

$338,599.00

$36,762.47

$1,364.39

$20,135.00

$2,186.10

$73,164.29

$690,844.00

$75,006.52

$80,129.08

$596,906.00

$64,807.46

$14,634.11

$62,708.00

$6,808.35

$9,373.05

$238,711.00

$25,917.40

$1,985.32

$58,172.00

$6,315.87

$1,128,264.36 $13,754,513.05 $1,493,359.12

$85,877.50

$709,638.00

$77,047.03

$0.00

$799,803.00

$86,836.45

$654,557.21 $5,035,467.00 $546,712.23

$136,395.95

$740,306.00

$80,376.73

$68,956.55

$588,380.74

$63,881.85

$138,865.08

$465,280.00

$50,516.52

$8,300.52

$106,146.00

$11,524.52

$22,905.45

$385,676.00

$41,873.73

$488.08

$83,570.00

$9,073.39

$443,195.34 $5,027,772.00 $545,876.77

$427,094.92 $8,271,489.00 $898,054.59

$434,347.56 $4,904,956.00 $532,542.35

$33,632.94

$340,866.00

$37,008.61

$21,459.49

$164,426.00

$17,852.11

$237,352.70 $2,802,383.00 $304,261.17

$78,659.03

$702,243.59

$76,244.20

$23,040.36

$211,633.43

$22,977.53

$12,994.81

$438,336.00

$47,591.15

$1,227,357.28 $13,806,372.00 $1,498,989.56

$224,563.78 $1,311,070.00 $142,345.89

$69,192.22

$921,302.00 $100,027.88

$13,908.41

$251,717.00

$27,329.49

$1,569.43

$15,028.20

$1,631.65

$28,943.90

$298,467.78

$32,405.33

$87,114.63

$739,346.40

$80,272.54

2004 Balance
Due $5,816.95 $8,962.98
$245.28 $662.36 $4,629.27 $146.24 $112.74 $758.45
$0.88 $0.00 $117.81 $7.66 $410.82 $449.93 $82.17 $52.63 $11.15 $6,335.25 $482.20 $0.00 $3,675.37 $765.87 $387.19 $779.73 $46.61 $128.61 $2.74 $2,488.56 $2,398.15 $2,438.88 $188.85 $120.50 $1,332.74 $441.68 $129.37 $72.96 $6,891.66 $1,260.94 $388.51 $78.10 $8.81 $162.53 $489.15

2004 and 2005 Total
Assessment $1,251,891.03 $2,077,911.98 $67,908.39 $213,312.07 $394,540.28 $28,612.81 $14,360.25 $195,010.69 $675.55 $8,313.27 $36,880.28 $2,193.76 $75,417.34 $65,257.39 $6,890.52 $25,970.03 $6,327.02 $1,499,694.37 $77,529.23 $86,836.45 $550,387.60 $81,142.60 $64,269.04 $51,296.25 $11,571.13 $42,002.34 $9,076.13 $548,365.33 $900,452.74 $534,981.23 $37,197.46 $17,972.61 $305,593.91 $76,685.88 $23,106.90 $47,664.11 $1,505,881.22 $143,606.83 $100,416.39 $27,407.59 $1,640.46 $32,567.86 $80,761.69

Subsequent Injury Trust Fund 2005 Annual Report

Page 60

Insurance Companies
FLORISTS INSURANCE CO FLORISTS' MUTUAL INS CO FRANKENMUTH MUTUAL INS FRONTIER INS CO-IN REHAB. GA FARM BUREAU MUTUAL INS GA RESTAURANT MUTL. CAP INS GA TIMBER HARVERSTERS' GENERAL CASUALTY CO OF WI GENERAL INS CO OF AMERIC GEORGIA CASUALTY & SURETY GEORGIA INSURANCE CO GERBER LIFE INS CO GLENS FALLS INS CO GRANGE MUTUAL CASUALTY CO 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 DIVIDE INS CO GREAT NORTHERN INS CO GREAT WEST CASUALTY CO GREATER NEW YORK MUTUAL GREENWICH INSURANCE CO GUARANTEE INSURANCE CO GUARANTY NATIONAL INS. CO. GUIDEONE MUTUAL INS CO GULF INSURANCE COMPANY HANOVER INSURANCE CO HARBOR SPECIALITY INS HARCO NATIONAL INS CO HARLEYSVILLE MUTUAL INS CO HARLEYSVILLE-ATLANTIC INS CO HARTFORD ACCIDT. & 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

2004 Assessment
Amount $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 $47,808.27 $389,743.42 $64,881.28
$1,443.84 $63,259.96 $121,402.82 $113,162.69 $91,987.58
$0.00 $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

2004 Assessment Adj. Amount
$28,857.18

2005 Claims Paid
$233,408.03

2005 Assessment
Due
$25,341.65

$46,007.29

$250,942.84

$27,245.44

$102,437.24

$478,223.00

$51,921.77

$21,506.74

$173,229.00

$18,807.87

$17,371.43

$32,770.00

$3,557.91

$71,192.23

$784,206.00

$85,143.05

$349,923.01 $2,244,700.00 $243,712.24

$966.31

$19,584.00

$2,126.28

$25,557.51

$193,756.20

$21,036.56

$578,389.52 $3,768,778.00 $409,184.90

$213,310.71 $4,479,633.00 $486,364.06

$42,343.46

$876,863.75

$95,203.11

$11,153.58

$116,196.36

$12,615.71

$48,078.23

$83,516.00

$9,067.52

$391,944.21 $5,717,316.00 $620,742.15

$65,247.65

$751,872.99

$81,632.58

$1,452.00

$45,509.20

$4,941.04

$63,617.17

$620,130.82

$67,329.03

$122,088.35 $1,570,929.22 $170,559.40

$113,801.69

$764,754.19

$83,031.12

$92,507.01

$312,500.38

$33,928.89

$0.00

$19,649.00

$2,133.34

$29,911.43

$240,352.00

$26,095.57

$145,647.16 $1,493,508.00 $162,153.60

$7,815.93

$126,659.00

$13,751.66

$38,479.57

$323,102.00

$35,079.93

$4,598.33

$647,020.00

$70,248.45

$4,294.86

$56,357.00

$6,118.81

$85,556.05 $1,114,014.00 $120,951.06

$94,906.50

$0.00

$0.00

$148,640.21 $1,229,623.67 $133,503.07

$98,395.21

$292,401.00

$31,746.65

$6,174.56

$32,506.00

$3,529.25

$29,043.24

$414,914.00

$45,048.17

$128,792.27 $1,262,762.00 $137,100.97

$216,538.28

$308,425.00

$33,486.41

$1,110,283.10 $7,976,407.00 $866,016.85

$211,517.20 $5,616,567.00 $609,803.60

$146,470.77 $1,671,932.00 $181,525.50

$1,101,188.87 $11,746,882.00 $1,275,386.00

$1,072,644.50 $11,751,023.00 $1,275,835.59

$245,792.32 $3,399,261.00 $369,065.59

$119,087.39 $1,309,128.31 $142,135.07

2004 Balance
Due $162.04 $258.33 $575.19 $120.76
$97.54 $399.75 $1,964.83
$5.43 $143.51 $3,247.68 $1,197.75 $237.76
$62.63 $269.96 $2,200.79 $366.37
$8.16 $357.21 $685.53 $639.00 $519.43
$0.00 $167.95 $817.82
$43.89 $216.06
$25.82 $24.12 $480.40 $532.90 $834.62 $552.49 $34.67 $163.08 $723.18 $1,215.88 $6,234.28 $1,187.68 $822.44 $6,183.22 $6,022.94 $1,380.13 $668.68

2004 and 2005 Total
Assessment $25,503.69 $27,503.77 $52,496.96 $18,928.63 $3,655.45 $85,542.80
$245,677.07 $2,131.71
$21,180.07 $412,432.58 $487,561.81
$95,440.87 $12,678.34
$9,337.48 $622,942.94
$81,998.95 $4,949.20
$67,686.24 $171,244.93
$83,670.12 $34,448.32
$2,133.34 $26,263.52 $162,971.42 $13,795.55 $35,295.99 $70,274.27
$6,142.93 $121,431.46
$532.90 $134,337.69
$32,299.14 $3,563.92
$45,211.25 $137,824.15
$34,702.29 $872,251.13 $610,991.28 $182,347.94 $1,281,569.22 $1,281,858.53 $370,445.72 $142,803.75

Subsequent Injury Trust Fund 2005 Annual Report

Page 61

Insurance Companies
HOUSTON GENERAL INS CO INDEMNITY INS CO OF NA INSURA PROP & CAS INS CO INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INSURANCE CORP. OF NEW YORK INTERN'TAL BUS & MERCANTILE JEFFERSON PILOT FIN INS CO KANSAS CITY FIRE & MARINE INS KEY RISK INSURANCE CO 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 INS CO MEDMARC CASUALTY INS MID-CENTURY INSURANCE CO MIDDLESEX INSURANCE CO MIDWEST EMPLOYERS CASLTY MIDWESTERN INDEMNITY CO MITSUI SUMITOMO INS OF AMER MITSUI SUMITOMO INS USA, INC MUTUAL ASSURANCE INC. NATIONAL AMERICAN INSURANCE NATIONAL FARMERS UNION P & C NATIONAL FIRE INS /HARTFORD NATIONAL INTERSTATE INS NATIONAL LIABILITY & FIRE INS NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT NATIONWIDE AGRIBUSINESS NATIONWIDE MUTUAL FIRE INS NATIONWIDE MUTUAL INS CO NETHERLANDS INSURANCE CO

2004 Assessment
Amount $0.00
$693,809.80 $61,821.84 $44,794.56
$1,808,832.85 $18,936.99 $323.53 $52,427.77 $1,243.02
$547,077.29 $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
$0.00 $4,788.47 $26,340.05 $439,288.41 $2,983.27
$0.00 $91,402.59 $684,685.97 $263,623.37 $32,852.81 $59,895.18 $44,700.47 $21,373.52

2004 Assessment Adj. Amount
$0.00

2005 Claims Paid
$516,423.00

2005 Assessment
Due
$56,069.23

2004 Balance
Due
$0.00

$697,727.57 $13,060,876.00 $1,418,049.35 $3,917.77

$62,170.94

$0.00

$0.00

$349.10

$45,047.50

$0.00

$0.00

$252.94

$1,819,046.87 $24,683,918.00 $2,679,989.75 $10,214.02

$19,043.93

$768,308.00

$83,416.97

$106.94

$325.36

$683.00

$74.15

$1.83

$52,723.81

$538,341.00

$58,448.92

$296.04

$1,250.04

$14,967.78

$1,625.09

$7.02

$550,166.50 $9,400,911.00 $1,020,678.53 $3,089.21

$510,227.40 $11,765,923.24 $1,277,453.35 $2,864.95

$2,096,645.54 $23,471,849.04 $2,548,392.64 $11,772.75

$1,137,411.91 $11,958,464.83 $1,298,358.03 $6,386.61

$876,653.03 $8,328,344.77 $904,227.55 $4,922.44

$12,370.29

$0.00

$0.00

$69.46

$1,016,910.98 $3,549,588.01 $385,386.93 $5,710.00

$560,551.66 $6,131,271.00 $665,686.19 $3,147.52

$16,299.52

$56,151.00

$6,096.44

$91.53

$19,025.13

$269,090.00

$29,215.72

$106.83

$161,640.02 $1,742,108.00 $189,144.67

$907.62

$108,919.08

$588,919.00

$63,940.29

$611.59

$341,527.23 $3,911,845.13 $424,718.02 $1,917.69

$49,131.20

$423,333.66

$45,962.31

$275.88

$65,834.61

$371,129.17

$40,294.35

$369.66

$5,537.00

$23,914.00

$2,596.40

$31.09

$58,979.84

$709,385.00

$77,019.56

$331.17

$33,784.06

$372,164.00

$40,406.70

$189.70

$10,046.26

$104,219.23

$11,315.32

$56.41

$77,191.22

$337,521.00

$36,645.43

$433.43

$27,007.17

$501,387.00

$54,436.74

$151.64

$0.00

$888.00

$96.41

$0.00

$4,815.51

$49,675.00

$5,393.33

$27.04

$26,488.78

$878,701.00

$95,402.59

$148.73

$441,768.96 $3,964,593.68 $430,445.05 $2,480.55

$3,000.11

$76,064.00

$8,258.44

$16.84

$0.00

$336,868.00

$36,574.53

$0.00

$91,918.72 $1,327,889.00 $144,171.96

$516.13

$688,552.22 $6,767,356.00 $734,747.41 $3,866.25

$265,111.98 $3,262,107.00 $354,174.46 $1,488.61

$33,038.32

$322,994.00

$35,068.20

$185.51

$60,233.39

$425,295.41

$46,175.30

$338.21

$44,952.88

$279,132.00

$30,306.00

$252.41

$21,494.21

$387,283.42

$42,048.25

$120.69

2004 and 2005 Total
Assessment $56,069.23
$1,421,967.12 $349.10 $252.94
$2,690,203.77 $83,523.91 $75.98 $58,744.96 $1,632.11
$1,023,767.74 $1,280,318.30 $2,560,165.39 $1,304,744.64
$909,149.99 $69.46
$391,096.93 $668,833.71
$6,187.97 $29,322.55 $190,052.29 $64,551.88 $426,635.71 $46,238.19 $40,664.01
$2,627.49 $77,350.73 $40,596.40 $11,371.73 $37,078.86 $54,588.38
$96.41 $5,420.37 $95,551.32 $432,925.60 $8,275.28 $36,574.53 $144,688.09 $738,613.66 $355,663.07 $35,253.71 $46,513.51 $30,558.41 $42,168.94

Subsequent Injury Trust Fund 2005 Annual Report

Page 62

Insurance Companies
NEW HAMPSHIRE INSURANCE CO NIAGARA FIRE INSURANCE CO NIPPOKAO INS CO, LTD US BRAN NORGUARD INSURANCE CO. NORTH AMERICAN SPECIALTY NORTH RIVER INSURANCE CO NORTHBROOK INDEMNITY CO NORTHERN ASSUR CO OF AMER NORTHERN INS CO OF NY NORTHWESTERN NATIONAL INS OCCIDENTAL FIRE & CAS CO / 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 PEERLESS INSURANCE CO 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 PROP & CAS INS CO PROVIDENCE WASHINGTON INS REALM NATIONAL INS-IN LIQ. REDLAND INSURANCE CO REGENT INSURANCE CO REPUBLIC WESTERN INS CO REPUBLIC-FRANKLIN INSURANCE

2004 Assessment
Amount $19,727.99
$1,827.37 $52.30
$143,857.94 $30,137.40 $18,961.51 $965.38 $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 $38,030.70 $222,100.06
$5,389.96 $0.00 $0.00
$76,826.78

2004 Assessment Adj. Amount
$19,839.39

2005 Claims Paid
$2,598,316.00

2005 Assessment
Due
$282,105.14

$1,837.69

$13,010.14

$1,412.54

$52.60

$796.00

$86.42

$144,670.27 $2,065,394.00 $224,244.58

$30,307.57

$174,075.00

$18,899.72

$19,068.58

$131,220.00

$14,246.86

$970.83

$8,925.00

$969.01

$1,275.33

$16,196.00

$1,758.44

$51,571.89

$136,742.11

$14,846.41

$2,000.52

$39,641.00

$4,303.91

$6,240.11

$59,340.00

$6,442.68

$92,575.90

$781,494.00

$84,848.60

$4,605.32

$37,350.00

$4,055.18

$6,346.02

$89,731.00

$9,742.30

$117,279.39

$957,324.00 $103,938.87

$1,241,097.56 $15,038,660.00 $1,632,781.91

$3,127.91

$51,873.00

$5,631.97

$105,308.83

$701,914.00

$76,208.42

$0.00

$564,278.00

$61,264.96

$23,827.18

$7,018.00

$761.96

$505,063.83 $5,574,637.00 $605,251.16

$1,578,872.91 $11,725,589.00 $1,273,074.17

$37,010.90

$734,982.00

$79,798.69

$140,711.55

$930,965.00 $101,077.01

$62,307.67 $1,040,105.02 $112,926.59

$31,684.09

$512,733.00

$55,668.60

$832,623.51 $6,820,871.00 $740,557.65

$35,810.36

$884,712.00

$96,055.22

$46,696.67

$364,884.00

$39,616.30

$5,269.79

$137,302.00

$14,907.19

$27,838.49

$38,045.00

$4,130.63

$10,991.93

$51,422.90

$5,583.10

$93,198.15

$483,729.00

$52,519.57

$162,037.18

$868,219.00

$94,264.53

$69,952.99 $1,369,907.40 $148,734.00

$12,001.99

$0.00

$0.00

$129,761.76 $1,591,411.72 $172,783.23

$38,245.44

$741,738.00

$80,532.20

$223,354.20

$0.00

$0.00

$5,420.40

$248,218.00

$26,949.60

$0.00

$2,250.00

$244.29

$0.00

$25,371.00

$2,754.59

$77,260.60

$248,011.54

$26,927.18

2004 Balance
Due $111.40
$10.32 $0.30
$812.33 $170.17 $107.07
$5.45 $7.16 $289.58 $11.23 $35.04 $519.82 $25.86 $35.63 $658.53 $6,968.81 $17.56 $591.31 $0.00 $133.80 $2,835.95 $8,865.43 $207.82 $790.10 $349.86 $177.90 $4,675.21 $201.07 $262.20 $29.59 $156.32 $61.72 $523.31 $909.84 $392.79 $67.39 $728.62 $214.74 $1,254.14 $30.44 $0.00 $0.00 $433.82

2004 and 2005 Total
Assessment $282,216.54 $1,422.86 $86.72 $225,056.91 $19,069.89 $14,353.93 $974.46 $1,765.60 $15,135.99 $4,315.14 $6,477.72 $85,368.42 $4,081.04 $9,777.93 $104,597.40
$1,639,750.72 $5,649.53
$76,799.73 $61,264.96
$895.76 $608,087.11 $1,281,939.60
$80,006.51 $101,867.11 $113,276.45
$55,846.50 $745,232.86
$96,256.29 $39,878.50 $14,936.78
$4,286.95 $5,644.82 $53,042.88 $95,174.37 $149,126.79
$67.39 $173,511.85
$80,746.94 $1,254.14
$26,980.04 $244.29
$2,754.59 $27,361.00

Subsequent Injury Trust Fund 2005 Annual Report

Page 63

Insurance Companies
ROCHDALE INSURANCE CO ROYAL INDEMNITY CO S.E. EMPLOYER MUT. CAP. INS SAFECO INS CO OF ILLINOIS SAFECO INSURANCE OF AMERCA 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 /SC SELECTIVE WAY INSURANCE CO SENTRY INSURANCE A MUTUAL SENTRY SELECT INSURANCE CO SHELBY INSURANCE CO SOMPO JAPAN INS, OF AMERICA SOUTH CAROLINA INS CO-IN LIQ SOUTHEASTERN US CAP. INS, INC SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INS / GA SOUTHERN INS CO OF VIRGINIA SOUTHERN MUTUAL CHURCH INS SOUTHERN PILOT INSURANCE CO SOUTHERN STATES INS EXCH SOUTHERN TRUST INSURANCE ST PAUL FIRE & CASUALTY INS 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 STONEBRIDGE CASUALTY INS CO SUA INSURANCE COMPANY T.H.E. INSURANCE CO TECHNOLOGY INSURANCE CO THE CAMDEN FIRE INS ASSOC TIG INSURANCE CO

2004 Assessment
Amount $222,210.08 $1,350,125.95
$73,833.06 $23,274.97 $24,469.47 $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 $0.00 $154,653.29 $27,682.17 $462,112.48

2004 Assessment Adj. Amount
$223,464.84

2005 Claims Paid
$1,641,113.00

2005 Assessment
Due
$178,179.41

$1,357,749.77 $6,952,822.00 $754,883.88

$74,249.97

$307,777.00

$33,416.06

$23,406.40

$130,238.72

$14,140.32

$24,607.64

$184,513.00

$20,033.00

$13,620.14

$96,783.00

$10,507.95

$13,788.11

$403,444.00

$43,802.84

$506,121.67 $3,015,642.00 $327,415.19

$3,575.93

$2,875.35

$312.18

$5,080.66

$0.00

$0.00

$142,910.14 $1,001,343.00 $108,718.11

$176,808.13 $2,133,836.00 $231,675.48

$114,525.22 $1,549,248.00 $168,205.42

$151,299.73 $1,719,278.00 $186,665.97

$687,628.27 $7,464,884.98 $810,479.73

$37,373.55

$777,450.00

$84,409.53

$247.79

$2,327.79

$252.73

$95,489.51

$853,974.00

$92,717.92

$17,468.62

$0.00

$0.00

$1,242,495.66 $16,397,310.00 $1,780,293.66

$5,121.45

$226,682.00

$24,611.39

$48,521.01

$771,469.00

$83,760.16

$91.33

$8,024.00

$871.18

$3,557.85

$58,777.00

$6,381.55

$14,166.47

$109,754.00

$11,916.24

$10,397.92

$226,067.00

$24,544.61

$16,750.41

$287,671.00

$31,233.10

$420,948.12 $1,999,347.00 $217,073.70

$1,545,511.45 $14,011,314.00 $1,521,240.59

$218,138.00

$913,836.00

$99,217.28

$17,775.55

$200,840.00

$21,805.66

$12,440.78

$156,072.00

$16,945.10

$45,473.84

$516,158.00

$56,040.46

$206,581.60 $2,719,774.00 $295,292.12

$25,767.60

$267,078.00

$28,997.27

$10,807.51

$39,029.00

$4,237.47

$327,440.20 $3,938,828.00 $427,647.62

$11,976.47

$277,673.00

$30,147.60

$0.00

$1,030.00

$111.83

$0.00

$2,236.00

$242.77

$155,526.58 $3,620,210.00 $393,054.53

$27,838.49

$78,648.00

$8,538.99

$464,721.91 $3,798,182.00 $412,377.36

2004 Balance
Due $1,254.76 $7,623.82
$416.91 $131.43 $138.17
$76.48 $77.43 $2,841.89 $20.08 $28.53 $802.44 $992.78 $643.07 $849.55 $3,861.06 $209.85
$1.39 $536.18
$98.09 $6,976.67
$28.76 $272.45
$0.51 $19.98 $79.54 $58.39 $94.05 $2,363.64 $8,678.10 $1,224.86 $99.81 $69.86 $255.34 $1,159.97 $144.69 $60.68 $1,838.59 $67.25
$0.00 $0.00 $873.29 $156.32 $2,609.43

2004 and 2005 Total
Assessment $179,434.17 $762,507.70 $33,832.97 $14,271.75 $20,171.17 $10,584.43 $43,880.27 $330,257.08 $332.26 $28.53 $109,520.55 $232,668.26 $168,848.49 $187,515.52 $814,340.79 $84,619.38 $254.12 $93,254.10 $98.09
$1,787,270.33 $24,640.15 $84,032.61 $871.69 $6,401.53 $11,995.78 $24,603.00 $31,327.15
$219,437.34 $1,529,918.69
$100,442.14 $21,905.47 $17,014.96 $56,295.80
$296,452.09 $29,141.96 $4,298.15
$429,486.21 $30,214.85 $111.83 $242.77
$393,927.82 $8,695.31
$414,986.79

Subsequent Injury Trust Fund 2005 Annual Report

Page 64

Insurance Companies
TOKIO MARINE & NICHIDO FIRE TRANS PACIFIC INS CO TRANSCONTINENTAL INS CO TRANSPORT INSURANCE CO TRANSPORTATION INSURANCE TRAVELERS CAS & SUR CO TRAVELERS CAS & SUR AMER TRAVELERS CAS INS CO AMER TRAVELERS CASUALTY CO / CT TRAVELERS COMMERICAL CAS TRAVELERS INDEMNITY CO / CT TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY / AMER TRAVELERS INSURANCE - ALT TRAVELERS INSURANCE CO TRAVELERS PROP CAS /AMER TRINITY UNIVERSAL INS CO TRINITY UNIVERSAL INS CO / KS TRUCK INSURANCE EXCHANGE TRUMBULL INSURANCE CO TRUSTGUARD INSURANCE CO TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS U.S. SPECIALTY INS. CO. UNITED BUS. INS CO (A MUTU UNITED STATES FIRE INS UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO UTICA NATIONAL ASSURANCE VALIANT INSURANCE CO VALLEY FORGE INSURANCE CO VANLINER INSURANCE CO VIGILANT INSURANCE CO VIRGINIA SURETY COMPANY, INC WAUSAU BUSINESS INSURANCE WAUSAU GENERAL INS CO WAUSAU UNDERWRITERS INS WEST AMERICAN INSURANCE CO WESTFIELD INSURANCE CO WESTFIELD NATIONAL INS CO WESTPORT INSURANCE CORP WILLIAMSBURG NATIONAL INS WORK FIRST CASUALTY CO

2004 Assessment
Amount $279,491.39
$0.00 $555,406.77
$7,824.45 $780,912.20 $300,986.47
$7,772.76 $275.41 $0.00 $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 $0.00
$33,352.56 $994,222.06 $181,609.46 $114,003.01
$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 $126,174.91 $100,020.18
$1,678.63 $260,885.69
$31,767.40 $726,456.15
$0.00 $360,493.36
$9,468.45 $46,146.55

2004 Assessment Adj. Amount
$281,069.60

2005 Claims Paid
$3,196,744.00

2005 Assessment
Due
$347,077.85

2004 Balance
Due
$1,578.21

$0.00

$22,097.00

$2,399.12

$0.00

$558,543.01 $2,849,634.27 $309,391.35 $3,136.24

$7,868.63

$102,849.00

$11,166.55

$44.18

$785,321.81 $9,074,619.24 $985,252.28 $4,409.61

$302,686.07 $2,651,444.00 $287,873.37 $1,699.60

$7,816.65

$199.00

$21.61

$43.89

$276.97

$14,010.00

$1,521.10

$1.56

$0.00

$452.00

$49.07

$0.00

$77.05

$0.00

$0.00

$0.43

$88,126.02

$833,682.00

$90,514.77

$494.83

$189,925.60 $2,339,316.00 $253,984.92 $1,066.44

$754,004.51 $21,999,788.00 $2,388,567.58 $4,233.77

$22,907.00

$305,091.00

$33,124.43

$128.63

$85,046.60

$895,845.00

$97,263.95

$477.54

$3,791,964.37 $27,811,439.00 $3,019,551.90 $21,292.04

$59,369.34

$637,688.00

$69,235.25

$333.36

$42,581.39

$350,936.32

$38,101.96

$239.09

$9,940.75

$53,519.00

$5,810.68

$55.81

$0.00

$488.00

$52.98

$0.00

$33,540.89

$75,601.00

$8,208.17

$188.33

$999,836.18 $12,050,130.00 $1,308,310.33 $5,614.12

$182,634.97 $1,134,520.00 $123,177.45 $1,025.51

$114,646.75

$670,641.00

$72,813.04

$643.74

$72,028.89 $1,024,278.00 $111,208.22

$404.45

$201,836.05 $1,654,966.00 $179,683.47 $1,133.32

$364,952.13 $1,859,354.00 $201,874.34 $2,049.22

$150,729.44 $1,228,376.23 $133,367.63

$846.35

$17,808.14

$118,253.20

$12,839.02

$100.00

$67,277.80

$398,877.00

$43,306.99

$377.77

$472,558.31 $3,648,225.82 $396,096.27 $2,653.43

$47,335.98

$929,109.00 $100,875.50

$265.79

$32,142.39

$299,289.00

$32,494.50

$180.49

$126,887.39 $1,748,796.00 $189,870.80

$712.48

$100,584.97 $3,630,865.95 $394,211.47

$564.79

$1,688.11

$3,820.26

$414.77

$9.48

$262,358.84 $3,406,956.83 $369,901.14 $1,473.15

$31,946.78

$146,290.00

$15,883.04

$179.38

$730,558.27 $4,790,599.00 $520,126.35 $4,102.12

$0.00

$2,263.00

$245.70

$0.00

$362,528.97 $6,596,788.00 $716,228.45 $2,035.61

$9,521.91

$432,407.00

$46,947.42

$53.46

$46,407.13

$0.00

$0.00

$260.58

2004 and 2005 Total
Assessment $348,656.06 $2,399.12 $312,527.59 $11,210.73 $989,661.89 $289,572.97 $65.50 $1,522.66 $49.07 $0.43 $91,009.60 $255,051.36
$2,392,801.35 $33,253.06 $97,741.49
$3,040,843.94 $69,568.61 $38,341.05 $5,866.49 $52.98 $8,396.50
$1,313,924.45 $124,202.96 $73,456.78 $111,612.67 $180,816.79 $203,923.56 $134,213.98 $12,939.02 $43,684.76 $398,749.70 $101,141.29 $32,674.99 $190,583.28 $394,776.26 $424.25 $371,374.29 $16,062.42 $524,228.47 $245.70 $718,264.06 $47,000.88 $260.58

Subsequent Injury Trust Fund 2005 Annual Report

Page 65

Insurance Companies
XL SPECIALTY INSURANCE CO YORK INSURANCE CO ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Grand Total:

2004 Assessment
Amount
$86,170.05

2004 Assessment Adj. Amount
$86,656.63

2005 Claims Paid
$624,772.00

2005 Assessment
Due
$67,832.93

2004 Balance
Due
$486.58

2004 and 2005 Total
Assessment
$68,319.51

$11,106.52

$11,169.24

$359,404.00

$39,021.32

$62.72

$39,084.04

$438,899.95

$441,378.30 $5,519,303.16 $599,243.44 $2,478.35

$601,721.79

$3,927,074.33 $3,949,249.52 $43,200,016.33 $4,690,325.13 $22,175.19

$4,712,500.32

$6,893.79

$6,932.72

$183,431.00

$19,915.53

$38.93

$19,954.46

$86,209,997.09 $86,696,803.13 $917,403,473.94 $99,604,605.21 $486,806.04 $100,091,411.25

Subsequent Injury Trust Fund 2005 Annual Report

Page 66

Group Self-Insurers

Group Self-Insurers
AGRITRUST OF GEORGIA ASSOCIATION CTY COM GA SI COMPTRUST AGC OF GA CONSTRCTN SUPPLIERS ASSC GA AUTO DEALERS ASSOC SI GA EDU. WC TRUST FUND GA HOSP. ASSOC WCSI FUND GA MUNICIPAL ASSN WCSIF GA NURSG HOME SELCTV WC GA OILMEN'S ASSOCIATION GA OPERATORS SELF-INS GA SCHOOL BD ASSOC WCFD GEMC WORKERS' COMP FUND GTMA/AYSA SELF INSURANCE ROOFING & SHEET METL ASSC Grand Total:

2004 Assessment
Amount $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 $49,231.97
$252,633.44 $126,931.96 $371,576.82 $357,280.18
$89,907.90 $122,065.17 $6,778,339.89

2004 Assessment Adj. Amount
$259,807.17

2005 Claims Paid
$2,940,114.12

$1,609,084.30 $16,767,604.40

$455,616.79 $5,777,007.00

$251,356.73 $2,963,369.20

$550,006.96 $4,129,734.41

$422,698.87 $4,235,338.00

$457,079.25 $4,935,102.68

$1,433,604.03 $12,941,196.35

$49,509.97

$985,169.17

$254,060.00 $2,471,290.33

$127,648.72 $1,244,696.22

$373,675.02 $4,418,175.27

$359,297.65 $2,753,464.04

$90,415.59 $1,504,119.40

$122,754.44 $1,369,000.33

$6,816,615.49 $69,435,380.92

2005 Assessment
Due $319,214.95 $1,820,497.38 $627,222.94 $321,739.81 $448,374.76 $459,840.39 $535,815.45 $1,405,055.45 $106,962.08 $268,313.68 $135,139.53 $479,691.45 $298,949.92 $163,305.70 $148,635.51 $7,538,759.00

2004 Balance
Due $1,458.83 $9,035.07 $2,558.31 $1,411.38 $3,088.32 $2,373.47 $2,566.52 $8,049.75
$278.00 $1,426.56
$716.76 $2,098.20 $2,017.47
$507.69 $689.27 $38,275.60

2004 and 2005 Total
Assessment $320,673.78
$1,829,532.45 $629,781.25 $323,151.19 $451,463.08 $462,213.86 $538,381.97
$1,413,105.20 $107,240.08 $269,740.24 $135,856.29 $481,789.65 $300,967.39 $163,813.39 $149,324.78
$7,577,034.60

Subsequent Injury Trust Fund 2005 Annual Report

Page 67

Self-Insured Companies

Self-Insurers A T & T

2004 Assessment
Amount
$84,030.49

2004 Assessment Adj. Amount
$84,504.99

AAA COOPER TRANSPORTATN

$45,373.98

$45,630.19

ABF FREIGHT SYSTEM, INC

$52,340.92

$52,636.48

ACUITY BRANDS

$125,706.12 $126,415.95

ADVENTIST HEALTH SYS SUNB

$1,655.28

$1,664.63

AGL RESOURCES, INC.

$51,320.94

$51,610.73

ALBANY INTERNATIONAL CORP

$2,483.66

$2,497.68

ALBANY, CITY OF

$23,379.12

$23,511.13

ALEXIS PLAYSAFE, INC.

$6,481.40

$6,517.99

ALLIED SYSTEMS LTD

$90,864.02

$91,377.11

ALPHARETTA, CITY OF

$12,730.03

$12,801.91

AMERICAN NAT'L RED CROSS

$7,299.04

$7,340.26

AMERICAN PROTEINS, INC

$88,248.40

$88,746.71

ANHEUSER-BUSCH CO INC.

$14,512.31

$14,594.25

ARCHBOLD MEDICAL CENTER

$69,309.95

$69,701.32

ARCHDIOCESES OF ATLANTA

$19,807.64

$19,919.48

ARCHER-DANIELS-MIDLAND

$4,109.53

$4,132.74

ASPLUNDH TREE EXPERT CO

$88,335.30

$88,834.10

ATCO RUBBER PRODUCTS

$4,770.61

$4,797.55

ATHENS REG. HLTH SYS INC

$33,932.49

$34,124.10

ATHENS-CLARKE COUNTY

$73,777.70

$74,194.30

ATLANTA CITY OF

$1,135,519.15 $1,141,931.14

ATLANTA HOUSING AUTH

$9,058.20

$9,109.35

ATLANTA PUBLIC SCHOOLS

$249,793.91 $251,204.43

AUGUSTA-RICHMOND BD COM

$136,507.52 $137,278.34

AUTOZONE, INC

$198,551.59 $199,672.76

AVERITT EXPRESS, INC

$32,189.54

$32,371.31

AVONDALE MILLS INC

$13,144.93

$13,219.16

BALDWIN COUNTY COMMISS.

$21,705.88

$21,828.45

BANKHEAD SERVICES, INC

$58,575.53

$58,906.29

BARTOW COUNTY BD OF ED.

$32,201.89

$32,383.73

BEAULIEU GROUP LLC

$165,055.93 $165,987.96

BELLSOUTH CORPORATION

$351,611.11 $353,596.57

BENTON-GEORGIA INC

$13,559.17

$13,635.74

BERRY COLLEGE

$13,347.79

$13,423.17

BHA GROUP INC

$9,408.30

$9,461.43

BIBB COUNTY BD-COMMISSION

$94,094.24

$94,625.57

BIBB COUNTY BOARD OF ED.

$55,402.25

$55,715.09

BIG LOTS STORES, INC.

$39,652.42

$39,876.33

BJ'S WHOLESALE CLUB INC

$23,673.60

$23,807.28

BLACK & DECKER CORP.

$2,098.77

$2,110.62

2005 Claims Paid
$833,180.00 $589,643.64 $836,633.06 $2,039,741.87 $136,760.46 $434,472.28
$73,703.54 $274,264.93
$30,054.79 $471,335.37 $177,864.75
$76,954.00 $1,018,929.15
$260,857.18 $648,764.36 $239,268.01
$58,127.92 $735,643.52
$38,197.48 $674,854.54 $578,642.85 $10,045,869.39 $220,740.00 $2,231,207.68 $1,227,681.46 $2,146,841.98 $651,167.00 $191,235.33 $125,270.80 $264,848.37 $272,914.26 $1,946,412.34 $4,469,501.99
$69,556.61 $219,070.62
$0.00 $402,702.15 $435,316.00 $613,259.00 $401,429.47
$0.00

2005 Assessment
Due $90,460.27 $64,018.97 $90,835.18 $221,459.47 $14,848.40 $47,171.65
$8,002.16 $29,777.57
$3,263.12 $51,173.97 $19,311.18
$8,355.07 $110,627.48
$28,321.86 $70,437.84 $25,977.88
$6,311.08 $79,870.51
$4,147.19 $73,270.51 $62,824.59 $1,090,703.15 $23,966.25 $242,247.35 $133,292.20 $233,087.57 $70,698.70 $20,762.86 $13,600.94 $28,755.20 $29,630.93 $211,326.46 $485,264.11
$7,551.92 $23,785.00
$0.00 $43,722.30 $47,263.26 $66,582.94 $43,584.12
$0.00

2004 Balance
Due

2004 and 2005 Total
Assessment

$474.50

$90,934.77

$256.21

$64,275.18

$295.56

$91,130.74

$709.83 $222,169.30

$9.35

$14,857.75

$289.79

$47,461.44

$14.02

$8,016.18

$132.01

$29,909.58

$36.59

$3,299.71

$513.09

$51,687.06

$71.88

$19,383.06

$41.22

$8,396.29

$498.31 $111,125.79

$81.94

$28,403.80

$391.37

$70,829.21

$111.84

$26,089.72

$23.21

$6,334.29

$498.80

$80,369.31

$26.94

$4,174.13

$191.61

$73,462.12

$416.60

$63,241.19

$6,411.99 $1,097,115.14

$51.15

$24,017.40

$1,410.52 $243,657.87

$770.82 $134,063.02

$1,121.17 $234,208.74

$181.77

$70,880.47

$74.23

$20,837.09

$122.57

$13,723.51

$330.76

$29,085.96

$181.84

$29,812.77

$932.03 $212,258.49

$1,985.46 $487,249.57

$76.57

$7,628.49

$75.38

$23,860.38

$53.13

$53.13

$531.33

$44,253.63

$312.84

$47,576.10

$223.91

$66,806.85

$133.68

$43,717.80

$11.85

$11.85

Subsequent Injury Trust Fund 2005 Annual Report

Page 68

Self-Insurers
BLOSSMAN COMPANIES, INC BLUE BIRD BODY COMPANY BOBS CANDIES, INC. BREMEN-BOWDEN INVESTMNT BROWN INDUSTRIES BRUNSWICK, CITY OF BURLEN CORPORATION C T HARRIS INC C. W. MATTHEWS CONTRACTG CAGLE'S INC, & SUBSIDIARIES CAHABA GOV'T BENFIT ADMIN. CALDWELL TANKS ALLIANCE CALFEE COMPANY OF DALTON CAMDEN COUNTY BOC CANDLER HEALTH SYSTEM CASCADE CORPORATION CATOOSA CO. BD. OF ED. CENTRAL GA HEALTH SYS CERTAINTEED CORPORATION CHATHAM TRANSIT AUTH CHATHAM COUNTY BD OF ED. CHATHAM COUNTY GEORGIA CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD COMMISSR CHEROKEE CO BD OF ED. CHEVRON USA INC SOU DIV CHILDREN'S HEALTHCARE ATL CLAYTON COUNTY BD OF ED. CLAYTON CO COMMISSIONERS CLAYTON CO WATER AUTH COACHMAN REC. VEHICLE / GA COASTAL TRANSPORT INC COATS & CLARK, INC. COBB CO BD/COMMISSIONERS COBB CO SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA ENTERPRISES INC COLLEGE PARK CITY OF COLONIAL GROUP COLONIAL PIPELINE COMPANY COLQUITT CO BD OF ED COLQUITT REGIONAL MED CTR

2004 Assessment
Amount
$4,248.57

2004 Assessment Adj. Amount
$4,272.56

$400,846.48 $403,109.95

$21,566.54

$21,688.32

$16,473.52

$16,566.54

$19,109.94

$19,217.85

$46,721.46

$46,985.28

$2,397.20

$2,410.73

$83,325.23

$83,795.75

$4,086.13

$4,109.21

$128,867.75 $129,595.43

$2,465.73

$2,479.66

$781.39

$785.81

$8,357.13

$8,404.32

$0.00

$0.00

$38,979.54

$39,199.64

$1,004.49

$1,010.16

$19,553.52

$19,663.94

$208,817.55 $209,996.69

$3,477.25

$3,496.88

$14,558.17

$14,640.38

$54,702.59

$55,011.48

$64,778.57

$65,144.36

$7,201.71

$7,242.38

$12,792.72

$12,864.96

$30,605.77

$30,778.59

$64,226.14

$64,588.81

$8,030.01

$8,075.36

$87,822.91

$88,318.83

$80,905.05

$81,361.90

$76,565.01

$76,997.36

$3,811.71

$3,833.23

$17,055.74

$17,152.05

$39,900.97

$40,126.28

$46,151.60

$46,412.21

$152,450.73 $153,311.58

$231,002.77 $232,307.18

$23,797.30

$23,931.68

$341,537.89 $343,466.47

$21,140.13

$21,259.50

$19,557.70

$19,668.14

$4,086.25

$4,109.32

$7,313.66

$7,354.96

$21,519.43

$21,640.94

2005 Claims Paid
$160,704.31 $2,742,235.29
$174,355.85 $333,733.07 $397,650.80 $385,495.85
$0.00 $338,109.34 $494,116.84 $1,191,830.05
$0.00 $2,231.35 $58,210.05 $121,317.16 $620,861.49 $15,603.10 $144,420.88 $2,626,387.55 $66,402.26 $158,660.00 $620,608.10 $895,217.52 $122,670.65 $129,147.97 $371,539.04 $864,094.00 $60,218.97 $892,378.90 $730,766.63 $1,025,853.85 $26,954.75 $27,490.91 $476,377.10 $511,610.92 $1,423,571.44 $2,000,657.33 $264,043.82 $2,839,428.06 $432,089.85 $155,169.63
$0.00 $149,751.55 $166,183.62

2005 Assessment
Due $17,448.04 $297,730.79 $18,930.22 $36,234.17 $43,173.86 $41,854.17
$0.00 $36,709.31 $53,647.40 $129,399.73
$0.00 $242.26 $6,320.00 $13,171.68 $67,408.36 $1,694.06 $15,680.11 $285,152.94 $7,209.45 $17,226.08 $67,380.85 $97,195.83 $13,318.63 $14,021.89 $40,338.85 $93,816.67 $6,538.11 $96,887.63 $79,341.01 $111,379.31 $2,926.54 $2,984.75 $51,721.36 $55,546.77 $154,560.43 $217,215.97 $28,667.84 $308,283.24 $46,912.99 $16,847.12
$0.00 $16,258.87 $18,042.94

2004 Balance
Due

2004 and 2005 Total
Assessment

$23.99

$17,472.03

$2,263.47 $299,994.26

$121.78

$19,052.00

$93.02

$36,327.19

$107.91

$43,281.77

$263.82

$42,117.99

$13.53

$13.53

$470.52

$37,179.83

$23.08

$53,670.48

$727.68 $130,127.41

$13.93

$13.93

$4.42

$246.68

$47.19

$6,367.19

$0.00

$13,171.68

$220.10

$67,628.46

$5.67

$1,699.73

$110.42

$15,790.53

$1,179.14 $286,332.08

$19.63

$7,229.08

$82.21

$17,308.29

$308.89

$67,689.74

$365.79

$97,561.62

$40.67

$13,359.30

$72.24

$14,094.13

$172.82

$40,511.67

$362.67

$94,179.34

$45.35

$6,583.46

$495.92

$97,383.55

$456.85

$79,797.86

$432.35 $111,811.66

$21.52

$2,948.06

$96.31

$3,081.06

$225.31

$51,946.67

$260.61

$55,807.38

$860.85 $155,421.28

$1,304.41 $218,520.38

$134.38

$28,802.22

$1,928.58 $310,211.82

$119.37

$47,032.36

$110.44

$16,957.56

$23.07

$23.07

$41.30

$16,300.17

$121.51

$18,164.45

Subsequent Injury Trust Fund 2005 Annual Report

Page 69

Self-Insurers
COLUMBIA CO BD OF ED COLUMBIA GEORGIA CORP. COLUMBUS FOUNDRIES INC COLUMBUS REG HEALTHCARE COLUMBUS WATER WORKS CONAGRA FOODS, INC CONTI GROUP CO, INC CONTINENTAL TIRE N. AMER. COOPER INDUSTRIES, INC COOPER TIRE AND RUBBER CORP OF MERCER UNIV COSTCO WHOLESALE CORP. COTTRELL INC COVINGTON, CITY OF COWETA CO BD OF ED COWETA COUNTY BOC CRACKER BARREL OLD CTRY CRAWFORD & COMPANY CRIDER'S POULTRY INC CRISP CO BD OF EDUCATION CWW GROUP, INC D L LEE & SONS INC DALTON CITY OF DAN RIVER, INC. DART CONTAINER CORP DEAN FOODS COMPANY DECATUR, CITY OF DEKALB CO BOARD-ED DEKALB CO GOVERNMENT DEKALB FARMERS MARKET DEKALB REG HLTHCARE SYS DELHAIZE AMERICA INC. DELPHI AUTOMOTIVE SYS INC. DELTA AIRLINES, INC. DIXIE GROUP & SUBSIDIARIES DOLLAR GENERAL CORP DOUGHERTY CO BOC DOUGHERTY CO SCHOOL SYS DOUGLAS ASPHALT COMPANY DOUGLAS CO BD OF COMMISSI DOUGLAS CO SCHOOLS DOUGLAS, CITY OF DOUGLASVILLE-DOUGLAS CO

2004 Assessment
Amount
$17,424.87

2004 Assessment Adj. Amount
$17,523.27

$109.42

$110.04

$55,116.72

$55,427.95

$84,946.78

$85,426.46

$1,973.29

$1,984.43

$7,750.91

$7,794.68

$78,416.18

$78,858.97

$46,381.85

$46,643.76

$45,747.51

$46,005.83

$214,368.53 $215,579.01

$20,407.78

$20,523.01

$29,080.79

$29,245.01

$13,730.78

$13,808.32

$7,387.71

$7,429.43

$59,396.23

$59,731.62

$4,174.96

$4,198.54

$155,837.16 $156,717.13

$24,753.77

$24,893.55

$75,794.57

$76,222.56

$7,682.24

$7,725.62

$24,060.95

$24,196.82

$11,881.03

$11,948.12

$59,497.66

$59,833.63

$7,835.28

$7,879.53

$7,024.97

$7,064.64

$141,828.90 $142,629.77

$7,694.16

$7,737.61

$316,789.45 $318,578.28

$246,792.62 $248,186.19

$2,903.88

$2,920.28

$77,046.65

$77,481.72

$107,443.83 $108,050.54

$16,960.53

$17,056.30

$1,210,187.92 $1,217,021.54

$176,908.11 $177,907.07

$287,846.81 $289,472.20

$72,668.67

$73,079.01

$81,325.27

$81,784.49

$78,053.97

$78,494.72

$69,298.01

$69,689.31

$61,190.89

$61,536.42

$20,834.11

$20,951.75

$2,364.36

$2,377.71

2005 Claims Paid
$395,296.00 $0.00
$401,326.44 $518,510.00
$32,205.97 $58,115.65 $506,727.07 $553,121.45 $561,356.88 $2,206,867.32 $195,146.71 $248,422.00 $139,813.23 $50,943.58 $307,313.35 $134,039.70 $823,446.24 $881,798.98 $703,249.16 $109,079.36
$0.00 $136,846.34 $605,253.98
$0.00 $101,163.00 $1,295,498.41
$46,456.32 $3,053,249.67 $2,622,430.30
$45,123.86 $833,317.99 $1,576,449.91 $165,034.00 $11,874,917.41 $752,194.78 $2,654,167.19 $389,623.69 $261,604.48 $1,655,867.32 $459,534.46 $803,393.10 $271,100.69
$44,249.45

2005 Assessment
Due $42,918.20
$0.00 $43,572.93 $56,295.82
$3,496.68 $6,309.75 $55,016.52 $60,053.67 $60,947.81 $239,604.66 $21,187.53 $26,971.75 $15,179.84 $5,531.06 $33,365.72 $14,553.00 $89,403.45 $95,738.94 $76,353.38 $11,843.00
$0.00 $14,857.72 $65,713.82
$0.00 $10,983.50 $140,655.24
$5,043.87 $331,498.34 $284,723.29
$4,899.20 $90,475.25 $171,158.79 $17,918.12 $1,289,287.10 $81,667.52 $288,169.04 $42,302.34 $28,403.00 $179,781.32 $49,892.71 $87,226.24 $29,434.03
$4,804.26

2004 Balance
Due

2004 and 2005 Total
Assessment

$98.40

$43,016.60

$0.62

$0.62

$311.23

$43,884.16

$479.68

$56,775.50

$11.14

$3,507.82

$43.77

$6,353.52

$442.79

$55,459.31

$261.91

$60,315.58

$258.32

$61,206.13

$1,210.48 $240,815.14

$115.23

$21,302.76

$164.22

$27,135.97

$77.54

$15,257.38

$41.72

$5,572.78

$335.39

$33,701.11

$23.58

$14,576.58

$879.97

$90,283.42

$139.78

$95,878.72

$427.99

$76,781.37

$43.38

$11,886.38

$135.87

$135.87

$67.09

$14,924.81

$335.97

$66,049.79

$44.25

$44.25

$39.67

$11,023.17

$800.87 $141,456.11

$43.45

$5,087.32

$1,788.83 $333,287.17

$1,393.57 $286,116.86

$16.40

$4,915.60

$435.07

$90,910.32

$606.71 $171,765.50

$95.77

$18,013.89

$6,833.62 $1,296,120.72

$998.96

$82,666.48

$1,625.39 $289,794.43

$410.34

$42,712.68

$459.22

$28,862.22

$440.75 $180,222.07

$391.30

$50,284.01

$345.53

$87,571.77

$117.64

$29,551.67

$13.35

$4,817.61

Subsequent Injury Trust Fund 2005 Annual Report

Page 70

Self-Insurers
DSM CHEMICALS N. AMERICA DULUTH, CITY OF DURAND-WAYLAND, INC E I DUPONT DE NEMOURS EAST POINT, CITY OF ELBERTA CRATE & BOX CO ELBERTON GRANITE ASSOC ELBERTON, CITY OF EMERSON ELECTRIC CO EMORY UNIVERSITY ENCOMPASS GROUP, LLC EQUITY GROUP GA DIVISION ESTES EXPRESS LINES EVANS GRADING CO., INC EXEL HOLDINGS, USA, INC FAYETTE COUNTY BD COMM FAYETTE COUNTY BD OF ED FEDERAL EXPRESS CORP FEDERATED DEPT STORES FEDEX FREIGHT EAST FEDEX GROUND PKG SYS FIELDALE FARMS CORP FLEETWOOD HOMES OF GA FLEXSTEEL INDUSTRIES INC FLORIDA ROCK & TANK LINES FLORIDA ROCK INDUSTRIES FLOWERS FOODS INC. FLOYD CO. BD COMMISS FLOYD COUNTY BD OF ED FLOYD HLTHCARE MGMT INC FLYING J, INC. FORD MOTOR COMPANY FOREST PARK, CITY OF FORSYTH CO. BD. OF ED FRANKLIN ALUMINUM CO INC FREUDENBERG-NOK FULTON COUNTY BD OF ED FULTON COUNTY, GEORGIA FULTON-DEKALB HOSP AUTH GANNETT CO. & SUBSIDIARIES GENERAL MOTORS CORP GEORGIA CRATE & BASKET CO GEORGIA DUCK CORDAGE MIL

2004 Assessment
Amount
$32,780.47

2004 Assessment Adj. Amount
$32,965.57

$5,053.07

$5,081.60

$7,612.09

$7,655.08

$5,055.75

$5,084.30

$33,205.09

$33,392.59

$20,947.28

$21,065.56

$72,644.24

$73,054.44

$2,699.08

$2,714.32

$10,934.68

$10,996.43

$376,626.31 $378,753.02

$21,045.49

$21,164.33

$65,903.14

$66,275.28

$25,641.91

$25,786.70

$12,967.41

$13,040.63

$8,071.42

$8,116.99

$53,913.24

$54,217.68

$48,846.39

$49,122.22

$270,990.81 $272,521.03

$151,544.39 $152,400.12

$47,372.77

$47,640.28

$48,822.48

$49,098.17

$91,844.91

$92,363.54

$117,944.83 $118,610.84

$16,458.49

$16,551.42

$13,407.69

$13,483.40

$10,308.95

$10,367.16

$105,428.73 $106,024.06

$57,425.14

$57,749.40

$34,984.18

$35,181.72

$31,450.32

$31,627.91

$18,894.90

$19,001.59

$163,408.13 $164,330.85

$5,867.20

$5,900.33

$26,070.72

$26,217.94

$2,550.22

$2,564.62

$37,190.86

$37,400.87

$246,361.36 $247,752.50

$248,132.31 $249,533.45

$161,435.89 $162,347.48

$8,430.59

$8,478.19

$486,307.02 $489,053.07

$2,404.37

$2,417.95

$20,236.63

$20,350.90

2005 Claims Paid
$142,515.89 $17,262.32
$106,065.35 $68,880.56
$494,928.60 $222,250.91 $889,035.99
$13,723.35 $526,618.51 $3,567,213.19 $269,478.00 $576,588.42 $178,925.29 $218,669.39 $240,969.31 $178,897.65 $482,973.47 $2,541,965.45 $1,789,597.37 $402,206.90 $591,400.26 $791,529.35 $1,141,638.24 $110,803.67
$0.00 $119,952.79 $1,083,216.37 $940,317.30 $229,501.00 $449,236.30 $105,612.93 $1,365,916.03
$84,310.89 $144,217.67
$80,935.00 $253,267.54 $2,348,643.22 $1,993,830.00 $1,993,112.00
$62,787.48 $5,132,635.69
$12,746.00 $515,057.43

2005 Assessment
Due $15,473.28
$1,874.21 $11,515.76
$7,478.52 $53,735.54 $24,130.29 $96,524.68
$1,489.98 $57,176.18 $387,300.54 $29,257.85 $62,601.53 $19,426.33 $23,741.44 $26,162.59 $19,423.33 $52,437.54 $275,987.04 $194,300.70 $43,668.53 $64,209.69 $85,938.16 $123,950.29 $12,030.21
$0.00 $13,023.55 $117,607.29 $102,092.41 $24,917.45 $48,774.62 $11,466.64 $148,300.64
$9,153.83 $15,658.04
$8,787.30 $27,497.84 $254,997.60 $216,474.71 $216,396.75
$6,816.98 $557,262.06
$1,383.86 $55,920.97

2004 Balance
Due

2004 and 2005 Total
Assessment

$185.10

$15,658.38

$28.53

$1,902.74

$42.99

$11,558.75

$28.55

$7,507.07

$187.50

$53,923.04

$118.28

$24,248.57

$410.20

$96,934.88

$15.24

$1,505.22

$61.75

$57,237.93

$2,126.71 $389,427.25

$118.84

$29,376.69

$372.14

$62,973.67

$144.79

$19,571.12

$73.22

$23,814.66

$45.57

$26,208.16

$304.44

$19,727.77

$275.83

$52,713.37

$1,530.22 $277,517.26

$855.73 $195,156.43

$267.51

$43,936.04

$275.69

$64,485.38

$518.63

$86,456.79

$666.01 $124,616.30

$92.93

$12,123.14

$75.71

$75.71

$58.21

$13,081.76

$595.33 $118,202.62

$324.26 $102,416.67

$197.54

$25,114.99

$177.59

$48,952.21

$106.69

$11,573.33

$922.72 $149,223.36

$33.13

$9,186.96

$147.22

$15,805.26

$14.40

$8,801.70

$210.01

$27,707.85

$1,391.14 $256,388.74

$1,401.14 $217,875.85

$911.59 $217,308.34

$47.60

$6,864.58

$2,746.05 $560,008.11

$13.58

$1,397.44

$114.27

$56,035.24

Subsequent Injury Trust Fund 2005 Annual Report

Page 71

Self-Insurers
GEORGIA, STATE OF GEORGIA-PACIFIC CORP GFF HOLDING CO/GEN FIBERS GLYNN CO BD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLDN PANTRY FOOD STORE GOODY PRODUCTS, INC. GREAT ATLTIC & PACIFC TEA GREAT DANE LTD PARTNSP GRIFFIN-SPALDING SCHOOLS GUARDIAN AUTOMOTIVE CORP GULFSTREAM AEROSPACE GWINNETT CO BD OF ED GWINNETT HOSPITAL SYSTEM HALL COUNTY BOARD OF ED HAMILTON HEALTH CARE SYS HAPEVILLE CITY OF HARRISON POULTRY, INC HAVERTYS FURNITURE HENRY CO BOARD OF ED HERCULES INCORPORATED HERSCHEND FAMILY ENTMT HILLCREST FOODS, INC HILTON HOTELS CORP HON INDUSTRIES, INC. HORMEL FOODS CORP HORTON HOMES, INC HOUSTON CO HOSPITAL AUTH HOUSTON CO BD OF ED HOUSTON CO COMMISS HOWARD SHEPPARD INC HUTCHESON MEDICAL CTR HYATT CORPORATION IDA CASON CALLAWAY FDTN IKON OFFICE SOLUTIONS INGLES MARKETS INC INTERFACE, INC INTERNATIONAL PAPER CO INTERSTATE PAPER LLC J & J INDUSTRIES INC J H HARVEY COMPANY J. C. PENNEY COMPANY, INC. JEFFERSON SMURFT CORP US

2004 Assessment
Amount
$4,783,631.28

2004 Assessment Adj. Amount
$4,810,643.23

$397,087.47 $399,329.73

$2,810.87

$2,826.74

$42,134.51

$42,372.43

$48,088.26

$48,359.80

$9,057.55

$9,108.69

$579.63

$582.91

$2,489.46

$2,503.52

$47,933.96

$48,204.63

$9,041.88

$9,092.94

$22,604.60

$22,732.25

$43,526.55

$43,772.34

$307,308.71 $309,044.00

$123,877.95 $124,577.46

$27,435.02

$27,589.94

$45,249.42

$45,504.93

$1,049.57

$1,055.49

$24,714.34

$24,853.90

$51,190.11

$51,479.17

$78,498.03

$78,941.29

$17,847.81

$17,948.60

$10,513.24

$10,572.61

$13,819.12

$13,897.16

$2,756.38

$2,771.94

$30,237.71

$30,408.46

$91,591.70

$92,108.89

$42,406.80

$42,646.26

$23,204.81

$23,335.84

$19,556.92

$19,667.35

$12,517.87

$12,588.56

$22,545.91

$22,673.22

$94,102.14

$94,633.51

$41,100.18

$41,332.26

$9,012.31

$9,063.20

$40,726.71

$40,956.69

$340,844.37 $342,769.04

$41,459.35

$41,693.46

$239,081.25 $240,431.29

$1,526.01

$1,534.63

$13,503.82

$13,580.07

$82,038.00

$82,501.25

$227,282.96 $228,566.37

$37,740.98

$37,954.09

2005 Claims Paid
$39,075,858.33 $6,081,883.82 $110,041.41 $405,947.12 $528,239.81 $228,973.74 $4,866.00 $214,234.25 $481,294.50 $180,202.00 $266,661.53 $768,255.66 $3,240,353.04 $1,441,723.11 $536,059.77 $549,597.57 $4,989.68 $185,576.54 $0.00 $682,981.60 $209,972.38 $52,369.04 $141,708.07 $11,710.68 $346,670.35 $860,148.31 $702,398.03 $136,422.48 $248,213.89 $88,756.47 $132,532.58 $565,249.14 $290,515.04 $58,051.30 $370,123.35 $4,380,073.59 $251,541.14 $6,567,729.98 $54,122.74 $391,468.35 $954,904.70 $0.00 $303,128.00

2005 Assessment
Due
$4,242,555.81

2004 Balance
Due

2004 and 2005 Total
Assessment

$27,011.95 $4,269,567.76

$660,324.11 $2,242.26 $662,566.37

$11,947.45

$15.87

$11,963.32

$44,074.61

$237.92

$44,312.53

$57,352.21

$271.54

$57,623.75

$24,860.21

$51.14

$24,911.35

$528.31

$3.28

$531.59

$23,259.91

$14.06

$23,273.97

$52,255.25

$270.67

$52,525.92

$19,564.95

$51.06

$19,616.01

$28,952.06

$127.65

$29,079.71

$83,411.28

$245.79

$83,657.07

$351,812.58 $1,735.29 $353,547.87

$156,531.19

$699.51 $157,230.70

$58,201.24

$154.92

$58,356.16

$59,671.07

$255.51

$59,926.58

$541.74

$5.92

$547.66

$20,148.47

$139.56

$20,288.03

$0.00

$289.06

$289.06

$74,152.88

$443.26

$74,596.14

$22,797.18

$100.79

$22,897.97

$5,685.83

$59.37

$5,745.20

$15,385.57

$78.04

$15,463.61

$1,271.46

$15.56

$1,287.02

$37,638.80

$170.75

$37,809.55

$93,388.28

$517.19

$93,905.47

$76,260.97

$239.46

$76,500.43

$14,811.70

$131.03

$14,942.73

$26,949.15

$110.43

$27,059.58

$9,636.49

$70.69

$9,707.18

$14,389.37

$127.31

$14,516.68

$61,370.40

$531.37

$61,901.77

$31,541.89

$232.08

$31,773.97

$6,302.76

$50.89

$6,353.65

$40,185.14

$229.98

$40,415.12

$475,554.66 $1,924.67 $477,479.33

$27,310.40

$234.11

$27,544.51

$713,073.55 $1,350.04 $714,423.59

$5,876.23

$8.62

$5,884.85

$42,502.62

$76.25

$42,578.87

$103,676.20

$463.25 $104,139.45

$0.00 $1,283.41

$1,283.41

$32,911.30

$213.11

$33,124.41

Subsequent Injury Trust Fund 2005 Annual Report

Page 72

Self-Insurers
JESUP CITY OF JOHN WIELAND HOMES, INC JOHNS MANVILLE INT'L., INC. JONES COMPANY (THE) K & F INDUSTRIES KAHN CONSTRUCTION CO INC KELLEY MANUFACTURING CO KELLOGG CO & SUBSIDIARIES KIMBERLY-CLARK CORP KING & PRINCE SEAFOD CORP KLEEN-TEX INDUSTRIES KLLM TRANSPORT K-MART CORP-IN BANKRPTCY KNIGHT TRANSPORTATION KROGER COMPANY, THE LABOR READY SE III LP LAGRANGE, CITY OF LANGDALE INDUSTRIES LAWRENCEVILLE, CITY OF LIBERTY NATIONAL LIFE INS LIMITED BRANDS, INC LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC MACON, CITY OF MACON/BIBB WATER SEWRG MARIETTA CITY SERVICES MAR-JAC POULTRY, INC. MARKETPLACE HOLDINGS, INC MARRIOTT INTERNATIONAL MARTA MAY DEPARTMENT STORES MCG HEALTH INC MCLANE COMPANY, INC. M-D BUILDING PRODUCTS MEADOWS REG MED CTR MEADWESTVACO MEMORIAL MEDICAL CENTER MERCK & CO INC METALPLATE GALVANIZING L P MICROMERITICS INSTRUMENT MILLEDGEVILLE, CITY OF MILTON J. WOOD COMPANY

2004 Assessment
Amount
$5,334.93

2004 Assessment Adj. Amount
$5,365.06

$86,627.24

$87,116.40

$8,638.63

$8,687.41

$62,675.47

$63,029.38

$11,007.30

$11,069.46

$1,933.77

$1,944.69

$11,263.52

$11,327.12

$101,418.77 $101,991.45

$15,155.35

$15,240.93

$3,062.30

$3,079.59

$12,416.13

$12,486.24

$52,869.30

$53,167.84

$320,317.63 $322,126.38

$567.35

$570.56

$552,929.18 $556,051.43

$34,080.07

$34,272.51

$34,128.89

$34,321.61

$45,736.53

$45,994.80

$18,611.17

$18,716.26

$13,005.63

$13,079.07

$14,626.52

$14,709.12

$57,897.82

$58,224.76

$5,201.79

$5,231.16

$303,475.26 $305,188.91

$120,801.90 $121,484.03

$22,578.63

$22,706.13

$76,908.57

$77,342.85

$31,522.43

$31,700.43

$2,911.86

$2,928.30

$116,934.18 $117,594.47

$396,056.33 $398,292.76

$4,977.30

$5,005.41

$0.00

$0.00

$46,587.10

$46,850.17

$0.00

$0.00

$856.56

$861.39

$46,096.48

$46,356.78

$21,045.40

$21,164.23

$53,569.73

$53,872.23

$158.59

$159.48

$3,416.50

$3,435.79

$28,982.44

$29,146.10

$16,365.51

$16,457.92

2005 Claims Paid
$45,339.05 $653,628.79 $241,453.04 $1,152,704.17 $123,403.36
$26,223.94 $235,005.71 $999,005.72
$85,292.73 $61,497.46 $112,896.52 $582,990.15 $3,582,850.01 $29,314.91 $6,922,099.19 $369,279.50 $253,536.96 $467,448.35 $200,810.88 $200,567.76 $390,837.40 $286,764.66
$0.00 $3,801,034.41
$950,893.50 $70,272.89
$576,565.41 $307,989.76
$9,513.00 $1,476,410.06 $4,016,179.21
$0.00 $92,783.61 $697,584.81 $148,246.04 $41,803.01 $548,333.25 $32,907.93 $10,523.75
$4,315.90 $38,064.20 $257,953.81 $112,767.00

2005 Assessment
Due $4,922.56
$70,965.98 $26,215.11 $125,151.74 $13,398.19
$2,847.19 $25,515.11 $108,464.35
$9,260.43 $6,676.92 $12,257.43 $63,296.58 $388,998.27 $3,182.79 $751,548.23 $40,093.52 $27,527.09 $50,751.94 $21,802.50 $21,776.10 $42,434.12 $31,134.70
$0.00 $412,687.05 $103,240.69
$7,629.69 $62,599.03 $33,439.16
$1,032.85 $160,297.24 $436,045.81
$0.00 $10,073.73 $75,738.39 $16,095.41
$4,538.65 $59,533.80
$3,572.89 $1,142.59
$468.59 $4,132.72 $28,006.64 $12,243.37

2004 Balance
Due

2004 and 2005 Total
Assessment

$30.13

$4,952.69

$489.16

$71,455.14

$48.78

$26,263.89

$353.91 $125,505.65

$62.16

$13,460.35

$10.92

$2,858.11

$63.60

$25,578.71

$572.68 $109,037.03

$85.58

$9,346.01

$17.29

$6,694.21

$70.11

$12,327.54

$298.54

$63,595.12

$1,808.75 $390,807.02

$3.21

$3,186.00

$3,122.25 $754,670.48

$192.44

$40,285.96

$192.72

$27,719.81

$258.27

$51,010.21

$105.09

$21,907.59

$73.44

$21,849.54

$82.60

$42,516.72

$326.94

$31,461.64

$29.37

$29.37

$1,713.65 $414,400.70

$682.13 $103,922.82

$127.50

$7,757.19

$434.28

$63,033.31

$178.00

$33,617.16

$16.44

$1,049.29

$660.29 $160,957.53

$2,236.43 $438,282.24

$28.11

$28.11

$0.00

$10,073.73

$263.07

$76,001.46

$0.00

$16,095.41

$4.83

$4,543.48

$260.30

$59,794.10

$118.83

$3,691.72

$302.50

$1,445.09

$0.89

$469.48

$19.29

$4,152.01

$163.66

$28,170.30

$92.41

$12,335.78

Subsequent Injury Trust Fund 2005 Annual Report

Page 73

Self-Insurers
MOHAWK INDUSTRIES, INC MONROE, CITY OF MOUNT VERNON MILLS MURRAY CO BD OF ED MUSCOGEE CO SCHOOL DIST NASH JOHNSON SONS FARMS NEWTON COUNTY NEWTON COUNTY BD OF ED NORDSON CORPORATION NORDSTROM, INC. NORMAN W FRIES/CLAXTON P NORTHEAST GA HEALTH SYS NORTHSIDE HOSPITAL OLD DOMINION FREIGHT LINES OLIN CORPORATION OVERNITE TRANSPORTATION OWENS-CORNING OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORP PATTERSON PUMP COMPANY PCC AIRFOILS LLC PHOEBE PUTNEY MEM HOSP PIEDMONT HOSPITAL PIEDMONT LABORATORIES PIGGLY WIGGLY CAROLINA CO PILOT TRAVEL CENTERS PPG INDUSTRIES INC. PRESBYTERIAN HOMES OF GA PRINTPACK, INC PROCTER & GAMBLE CO QUIKTRIP CORPORATION RACETRAC PETROLEUM, INC RANDOLPH CO HOSP AUTH RECONSERVE RHODES NURSING HOME RICHMOND CTY BD OF ED RIVERDALE, CITY OF RMC USA, INC. ROCKDALE CO. BD OF ED ROCKWELL AUTOMATION, INC ROLLINS INC ROOKER ADMIN SERVICES

2004 Assessment
Amount
$803,424.28

2004 Assessment Adj. Amount
$807,961.02

$12,037.17

$12,105.14

$91,306.94

$91,822.52

$0.00

$0.00

$84,752.62

$85,231.20

$21,468.30

$21,589.53

$7,922.23

$7,966.97

$18,014.60

$18,116.32

$23,016.43

$23,146.39

$13,727.44

$13,804.95

$72,612.53

$73,022.55

$55,555.97

$55,869.68

$165,102.21 $166,034.50

$70,459.29

$70,857.16

$0.00

$0.00

$49,474.74

$49,754.11

$80,196.25

$80,649.10

$128,769.07 $129,496.19

$12,488.82

$12,559.34

$23,928.01

$24,063.12

$1,255.95

$1,263.04

$18,256.64

$18,359.73

$40,654.18

$40,883.75

$80,944.46

$81,401.53

$2,734.41

$2,749.85

$11,610.13

$11,675.69

$18,867.19

$18,973.73

$14,436.20

$14,517.72

$6,341.50

$6,377.31

$50,221.30

$50,504.88

$33,518.31

$33,707.58

$71,661.76

$72,066.42

$29,696.72

$29,864.41

$5,566.48

$5,597.91

$4,487.04

$4,512.38

$8,283.63

$8,330.41

$78,512.19

$78,955.52

$3,608.39

$3,628.76

$10,992.53

$11,054.60

$19,162.66

$19,270.87

$15,621.33

$15,709.54

$46,700.88

$46,964.59

$33,062.33

$33,249.03

2005 Claims Paid
$8,242,836.80 $6,744.18
$1,193,287.16 $2,199.23
$817,845.85 $112,345.58 $130,063.85 $151,892.14 $418,400.67
$89,113.00 $566,069.42 $486,207.00 $2,616,699.24 $1,162,484.30
$2,133.88 $726,994.00 $375,612.91 $2,063,244.08 $146,219.67 $413,395.03
$9,705.50 $81,188.74 $634,820.79 $1,013,110.71 $98,092.93 $59,956.31 $254,753.26 $126,270.48 $34,851.81 $192,798.00 $359,786.27 $493,520.47 $315,498.35 $41,756.29
$594.49 $45,039.95 $646,642.37 $51,365.98 $305,507.01 $173,855.59 $127,530.88 $272,617.54 $125,962.29

2005 Assessment
Due $894,943.75
$732.23 $129,557.93
$238.78 $88,795.40 $12,197.62 $14,121.33 $16,491.28 $45,426.72
$9,675.20 $61,459.46 $52,788.61 $284,101.05 $126,213.59
$231.68 $78,931.41 $40,781.16 $224,011.16 $15,875.41 $44,883.25
$1,053.75 $8,814.85 $68,923.95 $109,995.76 $10,650.18 $6,509.59 $27,659.15 $13,709.48 $3,783.94 $20,932.52 $39,062.82 $53,582.65 $34,254.38 $4,533.58
$64.55 $4,890.09 $70,207.45 $5,576.92 $33,169.60 $18,875.90 $13,846.32 $29,598.71 $13,676.02

2004 Balance
Due

2004 and 2005 Total
Assessment

$4,536.74 $899,480.49

$67.97

$800.20

$515.58 $130,073.51

$0.00

$238.78

$478.58

$89,273.98

$121.23

$12,318.85

$44.74

$14,166.07

$101.72

$16,593.00

$129.96

$45,556.68

$77.51

$9,752.71

$410.02

$61,869.48

$313.71

$53,102.32

$932.29 $285,033.34

$397.87 $126,611.46

$0.00

$231.68

$279.37

$79,210.78

$452.85

$41,234.01

$727.12 $224,738.28

$70.52

$15,945.93

$135.11

$45,018.36

$7.09

$1,060.84

$103.09

$8,917.94

$229.57

$69,153.52

$457.07 $110,452.83

$15.44

$10,665.62

$65.56

$6,575.15

$106.54

$27,765.69

$81.52

$13,791.00

$35.81

$3,819.75

$283.58

$21,216.10

$189.27

$39,252.09

$404.66

$53,987.31

$167.69

$34,422.07

$31.43

$4,565.01

$25.34

$89.89

$46.78

$4,936.87

$443.33

$70,650.78

$20.37

$5,597.29

$62.07

$33,231.67

$108.21

$18,984.11

$88.21

$13,934.53

$263.71

$29,862.42

$186.70

$13,862.72

Subsequent Injury Trust Fund 2005 Annual Report

Page 74

Self-Insurers
ROPER CORPORATION ROSWELL CITY OF RTM, INC. RUBY TUESDAY INC RUSSELL CORPORATION RYAN'S FAMILY STEAK HOUSE RYDER SYSTEM INC SAINT JOSEPH'S OF SAVANH SATILLA HEALTH SERVICES 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 SIZEMORE INC. SKF USA INC SNELL CONTRACTORS SOUTH GEORGIA MED CTR SOUTHEAST GA HLTH SYSTEM SOUTHEAST-ATLANTIC BEV SOUTHEASTERN FRT LINES SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN PAN SERVICES SOUTHERN REG HEALTH SYS. SOUTHWIRE COMPANY SPALDING CO BD OF COMM SPARTA CITY OF SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL ST JOSEPH HOSP/AUGUSTA STANLEY WORKS & SUBS STONE CONTAINER CORP SUPERIOR RIGGNG & ERCTNG SUPERIOR UNIFORM GROUP SUTHERLANDS FOODSERVICE T. M. POLYFILM, INC TALON EQUITIES, INC TANNER HEALTH SERVICES

2004 Assessment
Amount
$54,774.87

2004 Assessment Adj. Amount
$55,084.17

$84,977.41

$85,457.25

$28,632.49

$28,794.17

$52,278.52

$52,573.72

$481.07

$483.78

$65,725.64

$66,096.78

$115,368.27 $116,019.72

$33,320.47

$33,508.62

$67,845.76

$68,228.86

$262,565.40 $264,048.04

$19,311.27

$19,420.31

$763,649.73 $767,961.87

$11,489.87

$11,554.75

$17,602.42

$17,701.82

$30,954.24

$31,129.03

$77,014.41

$77,449.29

$165,657.05 $166,592.47

$1,917.37

$1,928.20

$30,951.75

$31,126.53

$2,276.55

$2,289.41

$83,900.26

$84,374.02

$38,189.82

$38,405.46

$71,904.94

$72,310.97

$13,791.85

$13,869.73

$98,345.73

$98,901.07

$465,954.12 $468,585.24

$17,260.27

$17,357.74

$5,354.52

$5,384.75

$55,277.44

$55,589.58

$249,431.97 $250,840.45

$37,716.17

$37,929.15

$677.29

$681.11

$63,201.09

$63,557.97

$29,587.16

$29,754.23

$13,399.89

$13,475.56

$6,507.55

$6,544.29

$24,357.34

$24,494.88

$61,402.04

$61,748.76

$5,659.29

$5,691.24

$848.18

$852.97

$9,924.84

$9,980.88

$1,418.75

$1,426.76

$34,777.70

$34,974.08

2005 Claims Paid
$721,369.84 $404,259.20 $702,480.84 $346,976.00
$1,888.00 $437,692.27 $611,664.75 $409,056.94 $414,189.07 $2,080,277.86 $277,410.63 $6,711,699.95 $498,654.09 $218,325.00 $432,937.00 $197,497.07 $1,796,146.20
$67,417.00 $398,949.73
$41,693.00 $465,708.90 $282,945.76 $656,756.03 $130,498.23 $1,208,767.94 $6,028,439.10
$43,419.31 $90,748.00 $422,474.52 $2,220,894.66 $111,173.48
$3,435.92 $713,971.34 $353,096.57 $144,868.44
$97,375.26 $185,967.00 $1,799,859.40 $146,434.11
$34,118.11 $99,972.86 $126,915.00 $202,726.39

2005 Assessment
Due $78,320.78 $43,891.35 $76,269.96 $37,671.98
$204.98 $47,521.26 $66,409.85 $44,412.25 $44,969.46 $225,860.55 $30,119.11 $728,704.70 $54,140.02 $23,704.05 $47,004.97 $21,442.71 $195,011.72
$7,319.62 $43,314.89
$4,526.70 $50,563.09 $30,720.07 $71,305.51 $14,168.49 $131,238.72 $654,521.50
$4,714.13 $9,852.72 $45,869.03 $241,127.64 $12,070.36
$373.05 $77,517.51 $38,336.51 $15,728.70 $10,572.26 $20,190.86 $195,414.87 $15,898.69
$3,704.28 $10,854.28 $13,779.45 $22,010.47

2004 Balance
Due

2004 and 2005 Total
Assessment

$309.30

$78,630.08

$479.84

$44,371.19

$161.68

$76,431.64

$295.20

$37,967.18

$2.71

$207.69

$371.14

$47,892.40

$651.45

$67,061.30

$188.15

$44,600.40

$383.10

$45,352.56

$1,482.64 $227,343.19

$109.04

$30,228.15

$4,312.14 $733,016.84

$64.88

$54,204.90

$99.40

$23,803.45

$174.79

$47,179.76

$434.88

$21,877.59

$935.42 $195,947.14

$10.83

$7,330.45

$174.78

$43,489.67

$12.86

$4,539.56

$473.76

$51,036.85

$215.64

$30,935.71

$406.03

$71,711.54

$77.88

$14,246.37

$555.34 $131,794.06

$2,631.12 $657,152.62

$97.47

$4,811.60

$30.23

$9,882.95

$312.14

$46,181.17

$1,408.48 $242,536.12

$212.98

$12,283.34

$3.82

$376.87

$356.88

$77,874.39

$167.07

$38,503.58

$75.67

$15,804.37

$36.74

$10,609.00

$137.54

$20,328.40

$346.72 $195,761.59

$31.95

$15,930.64

$4.79

$3,709.07

$56.04

$10,910.32

$8.01

$13,787.46

$196.38

$22,206.85

Subsequent Injury Trust Fund 2005 Annual Report

Page 75

Self-Insurers
TARGET CORPORATION TECUMSEH PRODUCTS CO TERMINIX SERVICE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THERMAL CERAMICS THOMASVILLE CITY OF THREE SPRINGS INC. TIP TOP POULTRY INC TRC STAFFING SERVICES, INC TROUP CO BD OF ED TYSON FOODS INC UNILEVER UNITED STATES UNITED AIRLINES UNITED CATALYSTS, INC UNIVERSITY HOSPITAL USF HOLLAND, INC. VALDOSTA, CITY OF VARIETY WHOLESALERS VISITING NURSE HEALTH SYS VULCAN MATERIALS CO WAFFLE HOUSE WAGGONERS TRUCKING CO WALKER CO BD OF ED WALTON CO BOARD OF ED WAREHOUSE HOME FURNISH WARNER ROBINS, CITY OF WATKINS ASSOCIATED INDUS WAYCROSS MOLDED PRODS WAYCROSS, CITY OF WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYS WEST POINT STEVENS, INC WEYERHAEUSER COMPANY WHITFIELD COUNTY BOE WILD ADVENTURES, INC. WINN-DIXIE STORES INC YELLOW FREIGHT SYSTEM YKK CORP OF AMERICA Grand Total:

2004 Assessment
Amount
$221,498.77

2004 Assessment Adj. Amount
$222,749.51

2005 Claims Paid
$1,831,060.46

$68,671.67

$69,059.44

$282,885.00

$939.34

$944.65

$220.57

$41,383.10

$41,616.78

$286,136.00

$65,713.73

$66,084.80

$132,307.20

$34,611.03

$34,806.47

$340,495.38

$6,190.30

$6,225.26

$25,947.83

$728.48

$732.59

$35,356.95

$15,392.78

$15,479.70

$452,350.64

$33,343.85

$33,532.13

$341,562.13

$23,328.73

$23,460.46

$116,153.71

$351,651.69 $353,637.38

$2,955,422.00

$5,462.49

$5,493.34

$15,915.26

$32,247.47

$32,429.57

$369,187.80

$18,225.60

$18,328.52

$0.00

$65,705.57

$66,076.59

$331,487.54

$19,206.18

$19,314.63

$174,599.13

$38,766.28

$38,985.18

$277,881.45

$37,946.06

$38,160.33

$312,401.45

$12,734.18

$12,806.08

$174,899.28

$41,782.71

$42,018.64

$337,396.13

$139,042.42 $139,827.55

$776,680.66

$108,478.87 $109,091.42 $1,427,497.58

$40,309.00

$40,536.62

$610,307.45

$6,042.43

$6,076.55

$148,041.04

$100,323.73 $100,890.23

$401,690.93

$26,664.31

$26,814.88

$209,719.74

$177,028.09 $178,027.72

$505,090.31

$20,431.88

$20,547.25

$0.00

$6,094.44

$6,128.86

$252,818.16

$475,943.36 $478,630.89

$5,212,484.17

$29,678.80

$29,846.39

$118,141.59

$25,209.27

$25,351.62

$299,082.00

$14,198.48

$14,278.66

$0.00

$63,270.15

$63,627.42

$1,125,506.65

$25,504.86

$25,648.88

$484,405.80

$3,763.84

$3,785.10

$51,941.52

$528,515.35 $531,499.74

$5,980,361.52

$75,999.47

$76,428.62

$947,932.89

$43,640.17

$43,886.60

$531,656.91

$32,214,636.02 $32,396,543.88 $319,064,587.02

2005 Assessment
Due
$198,802.45

2004 Balance
Due

2004 and 2005 Total
Assessment

$1,250.74 $200,053.19

$30,713.48

$387.77

$31,101.25

$23.95

$5.31

$29.26

$31,066.44

$233.68

$31,300.12

$14,364.90

$371.07

$14,735.97

$36,968.37

$195.44

$37,163.81

$2,817.22

$34.96

$2,852.18

$3,838.79

$4.11

$3,842.90

$49,112.75

$86.92

$49,199.67

$37,084.19

$188.28

$37,272.47

$12,611.08

$131.73

$12,742.81

$320,876.96 $1,985.69 $322,862.65

$1,727.96

$30.85

$1,758.81

$40,083.57

$182.10

$40,265.67

$0.00

$102.92

$102.92

$35,990.36

$371.02

$36,361.38

$18,956.63

$108.45

$19,065.08

$30,170.23

$218.90

$30,389.13

$33,918.14

$214.27

$34,132.41

$18,989.22

$71.90

$19,061.12

$36,631.87

$235.93

$36,867.80

$84,326.01

$785.13

$85,111.14

$154,986.70

$612.55 $155,599.25

$66,262.48

$227.62

$66,490.10

$16,073.16

$34.12

$16,107.28

$43,612.51

$566.50

$44,179.01

$22,769.75

$150.57

$22,920.32

$54,838.82

$999.63

$55,838.45

$0.00

$115.37

$115.37

$27,449.05

$34.42

$27,483.47

$565,931.40 $2,687.53 $568,618.93

$12,826.90

$167.59

$12,994.49

$32,472.02

$142.35

$32,614.37

$0.00

$80.18

$80.18

$122,198.85

$357.27 $122,556.12

$52,593.05

$144.02

$52,737.07

$5,639.41

$21.26

$5,660.67

$649,301.61 $2,984.39 $652,286.00

$102,919.25

$429.15 $103,348.40

$57,723.21

$246.43

$57,969.64

$34,641,576.05 $181,907.86 $34,823,483.91