2010 annual report

STATE OF GEORGIA SUBSEQUENT INJURY TRUST
FUND
2010 ANNUAL REPORT

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State of Georgia Subsequent Injury Trust Fund
Marriott Marquis Tower Two Suite 1250
285 Peachtree Center Avenue Atlanta, GA 30303-1229
Telephone: (404) 656-7000 Fax: (404) 656-7100
Website: http://sitf.georgia.gov
Board of Trustees John T. Fervier, II Chairman
E. Pauline Hale John L. Quinn Barbara Tempel
Administrator Michael T. Coan
Deputy Administrator Allan Payne

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Table of Contents
Fund Administration ..................................................................................................4
Introduction _____________________________________________________________________ 4 How the Fund Works ______________________________________________________________ 4 Reimbursement from the Fund _______________________________________________________ 4 Legislation ______________________________________________________________________ 5 Claims Administration _____________________________________________________________ 8 Claims Activity 2010_____________________________________________________________ 8 Financial Activity 2010 ____________________________________________________________ 9
Claims Reported in 2010 .........................................................................................10 Reimbursements Paid in 2010 .................................................................................11
Reimbursements Paid to Insurance Companies _________________________________________ 11 Reimbursements Paid to Self-Insurers ________________________________________________ 16 Reimbursements Paid to Group Self-Insurers __________________________________________ 22
Individual Employers Benefiting from Reimbursements .........................................23 Assessment................................................................................................................55
Legal Requirements ______________________________________________________________ 55
Assessment Calculation 2010 ..................................................................................58
Assessment Adjustment for 2009 ____________________________________________________ 58 Assessment Rate for 2010 _________________________________________________________ 58
Assessments Due for 2010 .......................................................................................59
Assessments Due from Insurance Companies __________________________________________ 59 Assessments Due from Self-Insurers _________________________________________________ 70 Assessments Due from Group Self-Insurers ___________________________________________ 82

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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 governed by a five-member Board of Trustees appointed by the Governor for six-year terms. The Administrator and staff conduct the day-to-day 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.

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Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks; for 50% of all medical and rehabilitation expenses between $5,000 and $10,000; and for 100% of all medical and rehabilitation expenses in excess of $10,000.
If the subsequent injury was not caused by or related to a prior impairment, the reimbursement for medical expenses may be reduced or denied completely.
Legislation In 2005, House Bill 200 amended the Official Code of Georgia by adding Chapter 34-9368 establishing June 30, 2006 as the last date of injury eligible for reimbursement by the Fund.
34-9-368. Reimbursement of self-insured employers or insurers; actuarial study required; dissolution of Subsequent Injury Trust Fund
(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 Workers' 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

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trustees shall be discharged from their duties except for such personnel necessary to administer any remaining claims.
In 2006, an amendment to OCGA 34-9-362 was passed to establish time limits for employers or insurers to satisfactorily prove a claim once filed with the Subsequent Injury Trust Fund.
34-9-362. Notice by employer or insurer of claim against fund
(a) An employer or insurer shall notify the administrator of the fund of any possible claim against the fund as soon as practicable, but in no event later than 78 calendar weeks following the injury or the payment of an amount equivalent to 78 weeks of income or death benefits, whichever occurs last.
(b) The claim must be filed in accordance with the requirements of subsection (a) of this Code section prior to the final settlement of the claim.
(c) Failure to comply with the provisions of subsections (a) and (b) of this Code section will constitute a bar to recovery from the Subsequent Injury Trust Fund.
(d) For those notices of claim filed with the fund on or before July 1, 2006, the employer or insurer shall have until June 30, 2009, to obtain a reimbursement agreement issued by the fund or the claim for reimbursement shall be deemed automatically denied.
(e) For those notices of claim filed with the fund after July 1, 2006, the employer or insurer shall have three years from the date the notice was received by the fund to obtain a reimbursement agreement issued by the fund or the claim for reimbursement shall be deemed automatically denied.
(f) Notwithstanding subsections (d) and (e) of this Code section, if compensability of the underlying workers' compensation claim is at issue before the State Board of Workers' Compensation, then the employer or insurer shall have three years from the date of final adjudication of compensability by the State Board of Workers' Compensation or any appellate court to obtain a reimbursement agreement issued by the fund or the claim for reimbursement shall be deemed automatically denied.
(g) Upon actual or statutory automatic denial pursuant to subsection (d), (e), or (f) of this Code section, the employer or insurer shall have 20 days from the date of denial to request a hearing with the State Board of Workers' Compensation pursuant to Code Section 34-9-100; otherwise recovery shall be barred.
In 2009, an amendment was passed to OCGA 34-9-358 to establish a limit in the amount of funds collected from insurers and self-insurers in payment of assessments to the Subsequent Injury Trust Fund.

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34-9-358. Payment of assessments to fund by insurers and self-insurers; calculations
(a) Prior to January 1, 2010, each insurer and self-insurer under this chapter shall, under regulations prescribed by the board of trustees, make payments to the fund in an amount equal to that proportion of 175 percent of the total disbursement made from the fund during the preceding calendar year less the amount of the net assets in the fund as of December 31 of the preceding calendar year which the total workers' compensation claims paid by the insurer or self-insurer bears to the total workers' compensation claims paid by all insurers and self-insurers during the preceding calendar year.
(b) On or after January 1, 2010, each insurer and self-insurer under this chapter shall, under regulations prescribed by the board of trustees, make payments to the fund in an amount equal to that proportion of 175 percent of the total disbursement made from the fund during the preceding calendar year as of December 31 of the preceding calendar year which the total workers' compensation claims paid by the insurer or self-insurer bears to the total workers' compensation claims paid by all insurers and self-insurers during the preceding calendar year but not to exceed $100 million. The administrator is authorized to create and maintain a reserve of surplus moneys as may be deemed necessary by the board of trustees in order to ensure sufficient moneys will be available for the payment of all claims that are to be paid by the fund in accordance with Code Section 34-9-368.
(c) The administrator is authorized to reduce or suspend assessments for the fund when a completed actuarial survey shows further assessments are not needed for all bona fide claims that are to be paid by the fund.
(d) (1) When further assessments are not needed as all eligible workers' compensation claims for which the fund is liable in accordance with Code Section 34-9-368 have been paid and all related administrative costs have been accrued or paid and a balance remains in the fund, all insurers and self-insurers in this state who have maintained workers' compensation insurance in this state for any time during the preceding three years from the date that the last claim has been paid shall be entitled to a pro rata refund of assessments previously collected and unexpended in the remaining fund balance.
(2) The calculation for such pro rata refund to be paid by the fund to each individual insurer and self-insurer shall be determined by the following formula:
The balance remaining in the fund shall be the numerator and shall be divided by the total amount of assessments for workers' compensation coverage paid by all insurers and self-insurers during the three-year period, which shall be the denominator. The quotient of the numerator and denominator shall be multiplied by the total amount of assessments that are paid by the individual insurer or self-insurer during the three-year period. The product of those numbers shall represent the amount to be paid to such insurer or self-insurer as its pro rata refund from the balance remaining in the fund.

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(3) Nothing in this subsection shall preclude the board of trustees from authorizing a loss portfolio transfer of any unresolved claims.
(e) 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. Such employer who has ceased to be a self-insurer shall continue to be liable to the fund for assessments in subsequent calendar years so long as payments are made on any workers' compensation claims made while in self-insured status.
(f) 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.
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 2010 The following is a breakdown of claims activity for calendar year 2010. For information on prior years, please call (404) 656-7022 or visit our website at http://sitf.georgia.gov.

Open Claims Claims Received Closed Claims Reopened Claims Closed Open Claims Claims Accepted Claims Denied Notices in Pending

January 1, 2010 Calendar Year 2010 Calendar Year 2010 Calendar Year 2010 December 31, 2010 Calendar Year 2010 Calendar Year 2010 Calendar Year 2010

8,778 32 41
5,129 3,722
124 9
998

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Financial Activity 2010 The following depicts the fund's revenues, expenditures, and fund balance for the calendar year ending December 31, 2010. The fund's year-end balance is part of the formula for establishing the annual assessment. For information on prior years, please call (404) 656-7022 or visit our website at http://sitf.georgia.gov

BEGINNING BALANCE, January 1, 2010

$108,942,416.09

REVENUES

Assessment - 2009, Adj. 2008 payments and refunds from prior year

104,556,359.53 3,129.38

Interest Earned

174,419.45

Miscellaneous Income

181.87

TOTAL REVENUES

104,734,090.23

EXPENDITURES

Operating Cost

2,619,379.27

Reimbursements (Negotiated Checks) 127,410,684.80

TOTAL EXPENDITURES

130,030,064.07

Net Loss

(25,295,973.84)

ENDING BALANCE, December 31, 2010

$83,646,442.25

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CLAIMS REPORTED IN 2010

Subsequent Injury Trust Fund

Name

Claims Reported by Insurance Companies For 1/1/2010 To 12/31/2010 Claims Reported

BRIDGEFIELD CASUALTY

1

INSURANCE CO OF STATE OF PA

1

NEW HAMPSHIRE INSURANCE CO

1

OLD REPUBLIC INSURANCE CO

1

Total:

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Name

Subsequent Injury Trust Fund Claims Reported by Self-Insurers
For 1/1/2010 To 12/31/2010

CENTRAL GEORGIA HEALTH SYSTEMS COBB COUNTY SCHOOL SYSTEM COLUMBUS FOUNDRIES INC CONAGRA FOODS, INC SAVANNAH CITY OF SHAW INDUSTRIES INC SOUTHWIRE COMPANY Total:

Claims Reported 1 1 1 1 1 1 1 7

Name

Subsequent Injury Trust Fund Claims Reported by Group Self-Insured
For 1/1/2010 To 12/31/2010

ASSOCIATION CTY COM GA SI GA SCHOOL BD ASSOC W C FUND Total:

Claims Reported 20 1 21

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REIMBURSEMENTS PAID IN 2010
Reimbursements Paid to Insurance Companies

Total Dollars Paid By The Subsequent Injury Trust Fund

To Insurance Companies

From 1/1/2010 Through 12/31/2010

Name

Amount

21ST CENTURY N. AMERICA INS CO

$123,137.82

ACE AMERICAN INSURANCE CO

$2,676,754.77

ACE PROPERTY & CASUALTY INS

$245,791.73

AEQUICAP INSURANCE CO

$24,447.37

ALFA INSURANCE CORP

$101,460.34

ALLIED INSURANCE COMPANY

$15,833.23

ALLSTATE INSURANCE CO

$10,717.44

AMERICAN ALTERNATIVE INS

$44,559.96

AMERICAN CAS CO OF READING PA

$1,195,720.29

AMERICAN HOME ASSURANCE CO

$3,093,695.67

AMERICAN INSURANCE CO

$149,120.70

AMERICAN INTER INS CO OF GA

$586,443.36

AMERICAN MFG. MUTUAL INS

$34,087.17

AMERICAN MOTORISTS INS CO

$49,945.50

AMERICAN PROTECTION INS CO

$185,893.76

AMERICAN RESOURCES INS CO

$45,018.35

AMERICAN STATES INS CO

$2,185.58

AMERICAN ZURICH INS CO

$166,793.85

AMERISURE INSURANCE CO

$23,728.04

AMGUARD INSURANCE CO.

$22,904.01

ARGONAUT GREAT CENTRL INS CO

$80,452.36

ARGONAUT INSURANCE CO

$338,115.57

ARGONAUT LIMITED RISK INS CO

$19,116.97

ARROWOOD INDEMNITY CO

$47,072.17

ARROWPOINT CAPITAL

$807,663.77

ASSOCIATED INDEMNITY CORP

$118,204.89

ASSOCIATION INSURANCE CO

$274,266.96

ATLANTIC MUTUAL INS. CO

$535,496.45

AUTO OWNERS INS. CO

$732,925.99

AXIS INSURANCE CO

$89,609.74

BANKERS STANDARD INS CO

$42,560.33

BENCHMARK INS CO

$44,127.26

BRIDGEFIELD CASUALTY

$1,210,446.08

BUILDERS INSURANCE

$3,605,559.65

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Total Dollars Paid By The Subsequent Injury Trust Fund

To Insurance Companies

From 1/1/2010 Through 12/31/2010

CAPITAL CITY INS CO

$253,929.86

CENTENNIAL INSURANCE CO

$114,593.66

CENTRE INSURANCE CO

$20,245.77

CHARTER OAK FIRE INS CO

$25,480.54

CHARTIS CASUALTY COMPANY

$423,396.52

CHURCH MUTUAL INS CO

$78,355.22

CINCINNATI INDEMNITY CO

$195,568.12

CINCINNATI INSURANCE CO

$233,118.33

CLARENDON NATIONAL INS CO

$164,145.70

COLUMBIA NATIONAL INS CO

$193,359.48

COMMERCE & INDUSTRY INS CO

$150,814.68

COMMERCIAL MUTUAL INS CO

$1,016,778.10

COMPANION PROP & CAS

$525,472.56

CONNECTICUT INDEMNITY CO

$35,198.13

CONTINENTAL CASUALTY CO

$1,063,771.99

CONTINENTAL INSURANCE CO

$71,080.57

COREGIS INSURANCE CO

$63,784.77

CRUM & FOSTER INDEMNITY CO

$56,271.55

CYPRESS INSURANCE CO

$89,157.80

DISCOVER PROPERTY & CAS

$80,724.96

EASTGUARD INSURANCE CO

$2,776.48

ELECTRIC MUTUAL LIAB INS LTD

$3,157.58

EMPLOYERS ASSURANCE CO

$61.25

EMPLOYERS INS OF WAUSAU

$960,846.75

EMPLOYERS PREFERRED INS. CO.

$5,529.51

EMPLOYERS REINSURANCE CORP

$111,764.55

EVEREST NATIONAL INS

$258,357.47

FAIRFIELD INSURANCE CO

$33,677.95

FAIRMONT SPECIALTY INS CO

$59,238.10

FCCI INSURANCE COMPANY

$140,757.06

FEDERAL INSURANCE CO

$175,742.60

FEDERATED MUTUAL INS CO

$727,019.58

FEDERATED RURAL ELECTRIC INS

$5,985.58

FEDERATED SERVICE INS CO

$26,600.68

FFVA MUTUAL INS CO

$22,536.44

FIDELITY & CAS CO OF NY

$21,988.30

FIDELITY & GUARANTY INS CO

$1,109,563.51

FIREMAN'S FUND INS CO

$255,747.06

FIREMAN'S FUND INS CO OF GA

$42,634.82

FIRST LIBERTY INS CORP

$152,892.86

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Total Dollars Paid By The Subsequent Injury Trust Fund

To Insurance Companies

From 1/1/2010 Through 12/31/2010

FIRST NATL INS CO OF AMER

$26,016.84

FLORISTS' MUTUAL INS CO

$7,732.68

GA INSURERS INSOLVENCY POOL

$1,693,992.98

GA TIMBER HARVERSTERS' MUT CA

$338,702.23

GENERAL ACCIDENT INS OF AMER

$313,428.43

GEORGIA CASUALTY & SURETY CO

$143,027.32

GERBER LIFE INS CO

$218,932.43

GLENS FALLS INS CO

$50,207.45

GRANITE STATE INS CO

$69,600.00

GRAPHIC ARTS MUTUAL INS CO

$406,943.15

GRAY INSURANCE CO

$16,632.62

GREAT AMER INS CO OF NY

$721,585.37

GREAT AMERICAN INS CO

$338,412.86

GREAT WEST CASUALTY CO

$119,611.23

GUIDEONE MUTUAL INS CO

$59,075.02

GULF INSURANCE COMPANY

$57,059.83

HANOVER INSURANCE CO

$223,745.39

HARLEYSVILLE MUTUAL INS CO

$91,133.22

HARLEYSVILLE-ATLANTIC INS CO

$76,969.50

HARTFORD ACCIDENT & INDEMNITY

$136,436.44

HARTFORD CASUALTY INS CO

$1,115,580.26

HARTFORD FIRE INSURANCE CO

$550,018.94

HARTFORD INS CO OF S.E.

$27,148.34

HARTFORD INS OF THE MIDWEST

$500,381.84

HARTFORD UNDERWRITERS INS

$57,186.38

HEALTH CARE MUTUAL CAPTIVE

$245,864.25

HIGHLANDS INS CO-IN RECEIVERSH

$251,738.79

HOUSTON GENERAL INS CO

$95,549.49

HUMAN RESOURCES, INC.

$22,354.00

INDEMNITY INS CO OF NA

$1,045,485.44

INSURANCE CO OF N.A.

$22,281.07

INSURANCE CO OF STATE OF PA

$2,296,208.01

JEFFERSON PILOT FIN INS CO

$29,597.50

KEY RISK INSURANCE CO

$129,441.85

LIBERTY INSURANCE CORP

$733,723.88

LIBERTY MUTUAL FIRE INS

$588,715.32

LIBERTY MUTUAL INS. CO.

$1,869,670.66

LM INSURANCE CORP

$5,189.46

LUMBERMENS MUTUAL CAS CO

$379,189.05

LUMBERMEN'S UNDERWRITING

$35,437.87

14

Total Dollars Paid By The Subsequent Injury Trust Fund

To Insurance Companies

From 1/1/2010 Through 12/31/2010

MANUFACTURER'S ALLIANCE INS

$43,961.77

MARYLAND CASUALTY COMPANY

$209,564.25

MASSACHUSETTS BAY INSURANCE CO

$8,647.26

METLIFE INSURANCE CO OF CT.

$624,050.58

MITSUI SUMITOMO INS CO OF AMER

$13,906.17

NATIONAL FIRE INS CO HARTFORD

$762,039.66

NATIONAL SURETY CORP

$256,640.81

NATIONAL UNION FIRE OF PITT PA

$316,404.79

NEW HAMPSHIRE INSURANCE CO

$789,037.25

NORGUARD INSURANCE CO.

$872.87

NORTH RIVER INSURANCE CO

$289.13

NORTHBROOK PROP & CAS INS CO

$51,666.65

OCCIDENTAL FIRE & CAS CO OF NC

$6,480.00

OHIO CASUALTY INSURANCE CO

$103,460.08

OLD REPUBLIC INSURANCE CO

$1,078,760.06

OLD REPUBLIC UNION INS CO

$248,317.71

ONEBEACON AMERICA INS CO

$29,193.58

PACIFIC EMPLOYERS INSURANCE

$1,258,699.46

PACIFIC INDEMNITY CO

$18,316.29

PARK AVE PROP & CASUALTY INS

$292,997.81

PENN MFG ASSOC INS

$554,594.06

PENN MFG IND. CO

$20,718.12

PHOENIX INSURANCE CO

$7,744.35

PRINCETON INSURANCE CO

$132,418.46

RELIANCE INS CO IN LIQUIDATION

$188,529.55

RELIANCE NAT INS CO IN LIQ.

$27,650.61

ROCHDALE INSURANCE COMPANY

$161,007.05

ROYAL INS CO OF AMERICA

$49,230.99

SAFECO INSURANCE CO AMERICA

$276,663.52

SECURITY INS CO OF HARTFORD

$292,616.29

SELECTIVE INS CO OF AMERICA

$151,087.84

SELECTIVE INS CO OF SE

$50,601.31

SELECTIVE INSURANCE CO OF SC

$96,984.25

SELECTIVE WAY INSURANCE CO

$43,233.64

SENTRY INSURANCE A MUTUAL CO

$244,281.49

SOMPO JAPAN INS, OF AMERICA

$64,468.47

SOUTHEASTERN U.S. INS., INC

$1,224,790.29

SOUTHERN FIRE & CASUALTY CO

$16,834.71

SOUTHERN GUARANTY INSURANCE CO

$13,068.50

ST PAUL FIRE & CASUALTY INS CO

$195,131.84

15

Total Dollars Paid By The Subsequent Injury Trust Fund

To Insurance Companies

From 1/1/2010 Through 12/31/2010

ST PAUL FIRE & MARINE INS CO

$1,116,475.32

STANDARD FIRE INSURANCE CO

$9,210.22

STATE AUTOMOBILE MUTUAL INS

$4,490.22

STATE FARM FIRE & CASUALTY CO

$472,734.14

TECHNOLOGY INSURANCE CO

$218,130.91

TIG INSURANCE CO

$349,778.35

TOKIO MARINE & NICHIDO FIRE

$369,034.29

TRANSCONTINENTAL INS CO

$290,488.15

TRANSPORTATION INSURANCE CO

$581,692.61

TRAVELERS CAS & SUR CO

$492,162.00

TRAVELERS COMMERCIAL CASUALTY

$14,906.32

TRAVELERS INDEMNITY CO OF CT

$182,886.14

TRAVELERS INDEMNITY COMPANY

$18,392.60

TRAVELERS INDEMNITY OF AMER

$966,604.68

TRAVELERS PROP CAS CO OF AMER

$734,818.13

TWIN CITY FIRE INSURANCE CO

$80,651.34

U.S. FIDELITY & GUARANTY INS

$4,676.61

U.S. SPECIALTY INS. CO.

$168,027.04

UNISUN INSURANCE COMPANY

$10,025.54

UNITED BUSINESS INS CO (A MUTU

$14,047.70

UNITED STATES FIRE INSURANCE

$48,028.62

UNIVERSAL UNDERWRITERS INS

$1,245.35

UTICA MUTUAL INSURANCE CO

$38,241.79

UTICA NATIONAL ASSURANCE CO

$5,805.42

VALLEY FORGE INSURANCE CO

$139,766.88

VANLINER INSURANCE CO

$6,693.96

VIGILANT INSURANCE CO

$9,655.58

VIRGINIA SURETY COMPANY, INC

$52,599.39

WAUSAU GENERAL INS CO

$34,247.08

WAUSAU UNDERWRITERS INS CO

$178,508.80

WESTFIELD INSURANCE CO

$92,068.03

WESTPORT INSURANCE CORP

$862,241.83

WORK FIRST CASUALTY CO

$216,341.44

XL SPECIALTY INSURANCE CO

$15,860.91

YASUDA FIRE & MAR INS OF AMER

$122,847.00

YORK INSURANCE CO

$28,531.41

ZENITH INSURANCE CO

$162,194.11

ZURICH AMERICAN INS CO

$1,258,288.19

ZURICH AMERICAN INS CO OF IL Grand Total:

$1,313,309.63 $61,436,660.21

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Reimbursements Paid to Self-Insurers

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

AAA COOPER TRANSPORTATION

$36,078.64

ABF FREIGHT SYSTEM, INC

$33,727.17

ACUITY BRANDS

$532,671.17

AGL RESOURCES, INC.

$154,546.99

ALBANY, CITY OF

$32,664.12

ALLIED SYSTEMS LTD

$5,525.00

ALSCO, INC.

$59,776.28

ANHEUSER-BUSCH COMPANIES, INC.

$184,810.87

ARCHBOLD MEDICAL CENTER

$260,639.39

ASPLUNDH TREE EXPERT CO

$178,320.29

ATHENS REG. HLTH SYS INC

$120,845.05

ATHENS-CLARKE COUNTY

$92,153.99

ATLANTA CITY OF

$583,462.80

ATLANTA PUBLIC SCHOOLS

$405,373.49

AUGUSTA-RICHMOND CO BD COMM

$141,039.31

AVERITT EXPRESS, INC

$69,515.74

BARTOW COUNTY BD OF EDUCATION

$163,032.58

BEAULIEU GROUP LLC

$87,040.44

BEAULIEU OF AMERICA

$76,060.98

BELLSOUTH ENTERPRISES INC

$37,837.86

BELLSOUTH TELECOMMUNICATIONS,

$286,012.56

BERRY COLLEGE

$101,685.11

BIBB COUNTY BD-COMMISSION

$76,023.60

BLUE BIRD BODY COMPANY

$998,280.31

BLUE CIRCLE AMERICA

$56,033.73

BREMEN-BOWDEN INVESTMENT CO.

$201,250.42

BRUNO'S INC & SUBSIDIARIES

$3,602.05

BRUNSWICK, CITY OF

$137,975.64

C.W. MATTHEWS CONTRACTING INC

$13,596.34

CAGLE'S INC, & SUBSIDIARIES

$80,650.19

CALIBER SYSTEM, INC.

$97,093.72

CAMDEN COUNTY BOC

$10,165.63

CANDLER HEALTH SYSTEM

$191,829.66

CEMEX (SOUTHDOWN INC.)

$6,680.00

CENTRAL GEORGIA HEALTH SYSTEMS

$293,792.41

CERTAINTEED CORPORATION

$53,479.06

CHATHAM COUNTY BD OF EDUCATION

$196,186.05

17

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

CHATHAM COUNTY GEORGIA

$832,007.20

CHEMICAL PRODUCTS CORP

$18,880.00

CHEROKEE CO BD OF COMMISSIONER

$436.43

CHEROKEE CO BD OF EDUCATION

$258,150.19

CHEVRON USA INC SOU DIV

$91,048.77

CHILDREN'S HEALTHCARE OF ATL

$37,080.53

CITIGROUP INC.

$8,740.51

CLAYTON COUNTY BD OF EDUCATION

$144,479.08

CLAYTON COUNTY COMMISSIONERS

$190,829.76

COACHMAN REC. VEHICLE CO OF GA

$55,618.53

COASTAL TRANSPORT INC

$4,958.63

COATS & CLARK, INC.

$24,249.85

COBB COUNTY BD/COMMISSIONERS

$237,428.96

COBB COUNTY SCHOOL SYSTEM

$1,080,628.85

COCA-COLA COMPANY

$96,420.42

COCA-COLA ENTERPRISES INC

$145,232.07

COLONIAL GROUP

$48,535.81

COLUMBIA COUNTY BOE

$206,856.16

COLUMBUS CITY OF

$11,447.36

COLUMBUS REGIONAL HEALTHCARE

$221,549.34

CONAGRA POULTRY CO

$94,608.62

CONTINENTAL GRAIN COMPANY

$193,699.98

CONTINENTAL TIRE N. AMER., INC

$69,620.83

COTTRELL INC

$69,883.32

COX ENTERPRISES INC

$9,275.00

CRACKER BARREL OLD CNTRY STORE

$141,219.25

DALTON CITY OF

$129,699.12

DART CONTAINER CORP. OF GA

$9,357.07

DEAN FOODS COMPANY

$114,977.06

DEKALB COUNTY BOARD-ED

$271,217.28

DEKALB COUNTY GOVERNMENT

$295,708.63

DEKALB REGIONAL HLTHCARE SYS

$45,416.16

DELHAIZE AMERICA INC.

$118,857.22

DELPHI CORPORATION

$37,136.19

DELTA AIRLINES, INC.

$1,812,010.69

DOLLAR GENERAL CORP

$66,390.00

DOUGHERTY COUNTY BOC

$228,033.97

DOUGLAS CO BD OF COMMISSIONERS

$27,639.20

DOUGLAS COUNTY SCHOOLS

$102,582.09

18

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

ELBERTA CRATE & BOX COMPANY

$15,976.03

ELBERTON GRANITE ASSOCIATION

$159,017.84

EMORY UNIVERSITY

$274,412.42

EQUITY GROUP GA DIVISION

$51,659.07

ESTES EXPRESS LINES

$41,310.50

FAYETTE COUNTY BD OF COMM

$84,518.38

FAYETTE COUNTY BD OF EDUCATION

$23,957.09

FEDERAL EXPRESS CORP

$637,164.06

FIELDALE FARMS CORPORATION

$14,904.85

FLEETWOOD HOMES OF GA INC

$422,386.30

FLOWERS FOODS INC.

$18,046.27

FLOYD CO. BD. OF COMMISSIONERS

$190,382.55

FLOYD HLTHCARE MGMT INC

$24,812.25

FORD MOTOR COMPANY

$142,433.58

FORSYTH CO BD OF COMMISSIONERS

$20,707.44

FORT JAMES CORP.

$16,252.20

FRIGIDAIRE CO MICROWAVE PRODS.

$12,650.00

FULTON COUNTY BD OF EDUCATION

$12,320.00

FULTON COUNTY, GEORGIA

$577,007.41

FULTON-DEKALB HOSPITAL AUTHY

$248,220.89

GA BAPTIST HEALTH CARE SYSTEM

$678.45

GA S.I. GUARANTY TRUST FUND

$708,265.01

GENERAL MOTORS CORPORATION

$1,876,869.57

GEORGIA DUCK & CORDAGE MILL

$15,122.50

GEORGIA POWER CO

$63,245.34

GEORGIA STATE OF

$9,434,926.73

GEORGIA-PACIFIC CORPORATION

$253,654.11

GLYNN COUNTY BOARD OF COMMSNRS

$95,425.59

GLYNN COUNTY SCHOOLS

$249,023.09

GOLD KIST INC

$7,056.31

GREAT DANE LTD PARTNERSHIP

$94,482.43

GULFSTREAM AEROSPACE CORP

$103,267.75

GWINNETT CO BD OF EDUCATION

$191,310.68

GWINNETT COUNTY BD OF COMMISS

$126,203.86

GWINNETT HOSPITAL SYSTEM

$21,144.16

HALL COUNTY BOARD OF EDUCATION

$144,540.63

HAMILTON HEALTH CARE SYSTEM

$29,868.26

HANSON AGGREGATES

$13,500.00

HENRY CO BOARD OF EDUCATION

$74,156.31

19

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

HERCULES INCORPORATED

$63,143.62

HON INDUSTRIES, INC.

$2,761.87

HORMEL FOODS CORP

$30,694.29

HORTON HOMES, INC

$10,080.00

HOUSTON COUNTY BD OF EDUCATION

$125,727.37

HOUSTON COUNTY COMMISSIONERS

$29,831.48

HOWARD SHEPPARD INC

$13,088.80

HUTCHESON MEDICAL CENTER

$198,627.45

IDA CASON CALLAWAY FOUNDATION

$10,772.09

INGLES MARKETS INC

$389,525.94

INTERFACE, INC

$12,105.43

INTERNATIONAL PAPER COMPANY

$100,984.06

J & J INDUSTRIES INC

$16,141.60

J H HARVEY COMPANY

$95,312.33

JOHN WIELAND HOMES, INC

$240.11

JONES COMPANY

$26,423.45

JONES COMPANY (THE)

$41,206.85

KELLOGG CO & SUBSIDIARIES

$337,915.92

KING & PRINCE SEAFOOD CORP.

$29,611.09

KLEEN-TEX INDUSTRIES

$1,243.92

KLLM TRANSPORT SERVICES LLC

$344,106.37

K-MART CORP

$463,405.20

KROGER COMPANY, THE

$834,764.46

LANGDALE INDUSTRIES

$130,290.76

LAWRENCEVILLE, CITY OF

$542.99

LEVI STRAUSS & CO

$441,447.56

LOWE'S HOME CENTERS, INC

$604,820.38

LOXCREEN COMPANY, INC.

$3,106.50

MACON CITY OF

$141,635.60

MARIETTA CITY SERVICES

$3,151.61

MAR-JAC POULTRY, INC.

$29,052.57

MARRIOTT INTERNATIONAL, INC.

$47,822.85

MARTA

$264,631.99

MCG HEALTH INC

$8,388.84

MCLANE COMPANY, INC.

$121.77

MEAD CORPORATION

$52,009.91

MEADWESTVACO

$11,096.11

MEMORIAL MEDICAL CENTER

$134,625.64

MERCK SHARP & DOHME CORP

$103,102.16

20

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

METROMEDIA INTERNATIONAL GRP

$93,811.65

MILLEDGEVILLE, CITY OF

$5,889.48

MOHAWK INDUSTRIES, INC

$2,431,411.23

MOUNT VERNON MILLS

$154,946.87

MURRAY COUNTY BD OF EDUCATION

$1,021.60

MUSCOGEE COUNTY SCHOOL DIST

$70,643.21

NABISCO, INC

$298,090.37

NEWTON COUNTY

$94,128.60

NORDSON CORPORATION

$34.19

NORTHEAST GEORGIA HEALTH SYS

$11,700.00

OLIVER RUBBER CO

$246,594.43

OWENS-CORNING

$46,503.39

OWENS-ILLINOIS INC

$9,914.77

OXFORD CONSTRUCTION CO

$45,775.73

PARKER HANNIFIN CORP.

$42,800.84

PCC AIRFOILS LLC

$145,474.98

PEPSICO, INC

$4,220.00

PHOEBE PUTNEY MEMORIAL HOSP

$62,417.64

PIEDMONT HOSPITAL

$4,725.00

PIEDMONT LABORATORIES, INC

$6,140.84

PPG INDUSTRIES INC.

$34,713.55

PRESBYTERIAN HOMES OF GA

$18,593.51

PRINTPACK, INC

$14,739.53

QUEEN CARPET CORPORATION

$13,846.65

QUIKTRIP CORPORATION

$35,803.45

RALSTON PURINA COMPANY

$20,793.12

RICHMOND COUNTY BD OF COMMISS

$5,324.04

RMC USA, INC.

$19,403.44

ROCKWELL AUTOMATION, INC

$301.67

ROLLINS INC

$73,390.88

ROME, CITY OF

$221,740.88

ROOKER ADMINISTRATIVE SERVICES

$9.52

ROPER CORPORATION

$4,931.75

RUBY TUESDAY INC

$27,319.41

RYAN'S FAMILY STEAK HOUSES

$83.92

RYDER SYSTEM INC

$9,710.04

SAINT JOSEPH'S HEALTH SYSTEM

$65,809.28

SAINT JOSEPH'S OF SAVANNAH

$274,750.21

SAINT MARY'S HEALTH CARE

$3,234.50

21

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

SATILLA HEALTH SERVICES INC

$321,359.89

SAVANNAH CITY OF

$95,497.78

SCIENTIFIC-ATLANTA INC

$21,615.03

SEARS, ROEBUCK & CO

$7,665.24

SHAW INDUSTRIES INC

$1,411,930.45

SHERWIN-WILLIAMS COMPANY

$7,052.20

SHONEY'S LLC

$46,457.22

SMURFIT-STONE CONTAINER ENTERP

$142,292.61

SOUTH GEORGIA MEDICAL CENTER

$75.02

SOUTHEASTERN FREIGHT LINES

$3,188.44

SOUTHERN COMPANY

$1,049,862.22

SOUTHERN NUCLEAR OPERATING CO

$3,193.83

SOUTHERN REGIONAL HEALTH SYS.

$213,085.46

SOUTHWIRE COMPANY

$204,027.73

SPRINGS INDUSTRIES INC

$77.51

ST FRANCIS HOSPITAL

$278.61

STONE CONTAINER CORPORATION

$58,493.54

SUPERIOR RIGGING & ERECTING CO

$74,065.22

TARGET CORPORATION

$247,884.97

TENNECO AUTOMOTIVE, INC

$18,338.10

TEXTRON, INC

$13,456.44

THE DIXIE GROUP, INC.

$7,952.67

THERMAL CERAMICS

$94,940.48

THREE SPRINGS INC.

$22,774.53

TIFTON ALUMINUM CO INC/ALCOA I

$982.64

TIP TOP POULTRY INC

$11,565.00

TRANSUS, INC.

$20,602.21

TROUP CO. BOARD OF EDUCATION

$74,604.01

TYSON FOODS INC

$330,267.09

UNILEVER UNITED STATES

$81,307.00

UNION CAMP CORPORATION

$18,677.53

UNITED AIRLINES

$300.00

UNIVERSITY HOSPITAL

$411,893.80

UPS FREIGHT

$35,997.12

VULCAN MATERIALS COMPANY

$174,314.67

WACHOVIA

$17,038.73

WAFFLE HOUSE

$211,294.17

WAGGONERS TRUCKING CO., THE

$141,462.23

WAREHOUSE HOME FURNISHINGS

$253,911.17

22

Total Dollars Paid By The Subsequent Injury Trust Fund

To Self-Insured Employers

From 1/1/2010 Through 12/31/2010

Name

Amount

WARNER ROBINS CITY OF

$290,588.92

WATKINS ASSOCIATED INDUSTRIES

$149.71

WAYCROSS, CITY OF

$113,573.43

WAYNE FARMS LLC

$6,534.20

WELLSTAR HEALTH SYSTEM

$3,012,364.39

WESLEY HOMES, INC

$1,078.55

WEST GEORGIA HEALTH SYSTEM

$25,170.80

WEYERHAEUSER COMPANY

$330,044.37

WINN-DIXIE STORES INC

$267,887.60

YELLOW TRANSPORTATION

$68,116.70

YKK CORPORATION OF AMERICA

$13,483.76

Grand Total:

$49,855,328.78

Reimbursements Paid to Group Self-Insurers

Total Dollars Paid By The Subsequent Injury Trust Fund

To Group Self-Insured

From 1/1/2010 Through 12/31/2010

Name

Amount

AGRITRUST OF GEORGIA

$69,130.83

ASSOCIATION CTY COM GA SI

$8,335,441.71

COMPTRUST AGC OF GEORGIA

$749,652.29

CONSTRUCTION SUPPLIERS' ASSOC

$173,327.81

GA ASSOC OF CONVENIENCE STORES

$8,139.30

GA AUTO DEALERS ASSOCIATION SI

$548,561.01

GA CONCRETE & PRODUCTS ASSOC

$12,145.59

GA EDUCATION WC TRUST FUND

$606,650.11

GA HOSPITAL ASSOC WCSI FUND

$1,697,743.62

GA MUNICIPAL ASSN WCSIF

$1,379,322.29

GA NURSING HOME SELECTIVE WC

$34,425.18

GA OILMEN'S ASSOCIATION

$189,681.33

GA OPERATORS SELF-INSURERS

$398,526.82

GA RETAIL MERCHANTS'

$400.89

GA SCHOOL BD ASSOC W C FUND

$1,799,745.07

GA WHOLESALE & RETAIL WC FUND

$32,832.95

GEMC WORKERS' COMP FUND

$131,862.33

GTMA/AYSA SELF INSURANCE

$23,653.06

ROOFING & SHEET METAL ASSOC

$103,148.13

W. C. FUND FOR HEALTH CARE

$32,219.80

23

Total Dollars Paid By The Subsequent Injury Trust Fund

To Group Self-Insured

From 1/1/2010 Through 12/31/2010

Name

Amount

Grand Total:

$16,326,610.12

INDIVIDUAL EMPLOYERS BENEFITING FROM REIMBURSEMENTS

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

Employer

City

State

Total Reimbursed

7 HILLS TRANSPORT

CARTERSVILLE

GA $3,906.48

A & S RENTALS CENTER, INC.

MOULTRIE

GA $18,086.56

A.B. DICK CO.

MARIETTA

GA $4,784.84

A.J. CONCRETE PUMPING

ENGLEWOOD

CO $437.47

A.L. WILLIAMS, JR. LOGGING

QUITMAN

GA $87,056.06

A-1 BRANTLEY SEPTIC SERVICES

ALBANY

GA $62,839.14

A-1 CONTRACT STAFFING

TAMPA

FL $77,607.40

AACTION AUTO PARTS

SAVANNAH

GA $23,764.70

AARON RENTS, INC.

KENNESAW

GA $775.00

ABC GLASS

ATLANTA

GA $117,810.71

ACCORD HUMAN RESOURCES

MONROE

GA $99,340.12

ACCORD SERVICES

MARIETTA

GA $103.63

ACCUTECH HEATING & AC

AUSTELL

GA $339,209.63

ACE ELECTRIC, INC.

MACON

GA $43,374.01

ACS WASTE SERVICE

ALPHARETTA

GA $121,825.95

ACTION BLUE PRINT CO.

ATLANTA

GA $24,919.29

ACTION ELECTRIC COMPANY, INC.

SMYRNA

GA $9,746.65

ACUITY BRANDS, INC.

CONYERS

GA $35,076.80

ACUITY BRANDS, INC.

ATLANTA

GA $1,600.00

ADP TOTAL SOURCE, INC.

DOUGLASVILLE

GA $4,887.20

ADP TOTAL SOURCE, INC.

MACON

GA $48,036.25

ADP TOTAL SOURCE, INC.

LITHONIA

GA $6,589.39

ADVANCE AUTO

THOMSON

GA $24,711.45

ADVANCE AUTO

WAYCROSS

GA $180,218.12

AEROSPACE/DEF. COATING OF GA.

MACON

GA $82,606.83

AFC/CHURCH'S

ATLANTA

GA $79,625.21

AFFINITY HEALTH GROUP

TIFTON

GA $72,146.96

24

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

AFFORDABLE FIRE PROTECTION INC. NORCROSS

GA $77,360.15

AGBAYAI CONSTRUCTION CO.

WARNER ROBINS

GA $29,897.16

AIR QUALITY SYSTEMS, INC.

NORCROSS

GA $31,474.23

AIRGAS DRY ICE INC.

AUGUSTA

GA $23,865.63

AIRTRAN AIRWAYS

SAVANNAH

GA $19,463.72

AJM PACKAGING

FOLKSTON

GA $11,373.08

AKZO NOBEL RESINS, INC.

BAXLEY

GA $21,338.33

AL ROGERS' HOMEWORK

ATHENS

GA $49,744.14

ALAN COX AUTOMOTIVE

MARIETTA

GA $27,006.73

ALBANY BEVERAGE COMPANY

ALBANY

GA $129,787.94

ALCATEL USA CORP.

VALDOSTA

GA $39.00

ALDWORTH COMPANY, INC.

PEABODY

MA $9,750.88

ALEX FOODS INC

ATLANTA

GA $23,416.11

ALFRED MCCANNON WELL BORING

COMER

GA $12,192.94

ALIMENTA USA INC

CAMILLA

GA $1,063.03

ALL BUDGET MECHANIC SERVICES

ROSWELL

GA $175,521.07

ALL SEASON'S COMFORT

SAVANNAH

GA $22,983.43

ALL SOUTH SUPPLY

CARTERSVILLE

GA $20,509.86

ALLGOOD HEALTHCARE

AUGUSTA

GA $17,601.94

ALLIED AUTOMOTIVE GROUP

DACULA

GA $117,050.69

ALLISON SMITH CO.

ATLANTA

GA $24,954.00

ALLSTAFF MANAGEMENT, INC.

LAWRENCEVILLE

GA $5,493.84

ALLSTATE INSURANCE CO.

SOUTH BARRINGTON IL

$184.19

ALLTEL CORP.

DAHLONEGA

GA $80.56

ALLTEL CORP.

DALTON

GA $595.47

ALLTELL GEORGIA COMM.

CORNELIA

GA $11,248.56

ALPHA PRODUCTS, INC.

ATLANTA

GA $45,016.65

ALUMINUM FINISHING OF GA

ADEL

GA $5,419.92

AMC, INC.

ATLANTA

GA $21,403.85

AMERICAL CORP.

CARROLLTON

GA $37,991.21

AMERICAN MANAGEMENT TECH

BOONES MILL

VA $15,745.81

AMERICAN MEDICAL RESPONSE INC.

KENNESAW

GA $51,112.93

AMERICAN NATIONAL CAN

FOREST PARK

GA $11,960.39

AMERICAN SECURITY INSURANCE CO ATLANTA

GA $3,741.31

AMERICAN WOODMARK CORP.

JACKSON

GA $5,589.44

AMERSON COMPANY

MACON

GA $16,881.66

AMEX-TRAVEL

NORCROSS

GA $638.43

ANCHOR GLASS CONTAINER CORP.

WARNER ROBINS

GA $20,370.17

ANDERSON MFG

CAMILLA

GA $64,746.85

ANDREW ELECTRIC

LAWRENCEVILLE

GA $31,637.91

25

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

ANDRITZ (USA), INC.

ROSWELL

GA $442.77

ANGELICA CORP/ATS

ROCKMART

GA $142,387.00

ANIMAL MEDICAL CARE CENTER

MARIETTA

GA $7,543.85

ANNING-JOHNSON

ATLANTA

GA $87,115.03

ANSCO & ASSOCIATES/ DYCOM IND.

MARIETTA

GA $157,331.30

APACHE MILLS, INC.

CALHOUN

GA $98,177.99

APPLIANCE WAREHOUSE/COINMACH

DULUTH

GA $5,097.43

APPLIED INDUSTRIAL TECHNOLOGY

CLEVELAND

OH $87,875.37

APPLING HEALTHCARE

BAXLEY

GA $34,361.90

AQUA CHEM INC

THOMASVILLE

GA $5,713.96

AQUA KOOLERS, LLC

MACON

GA $21,629.45

ARMSTRONG WORLD INDUSTRIES

MACON

GA $21,285.25

ARROW CO.

AUSTELL

GA $22,074.49

ARROW CO.

BUCHANAN

GA $3,046.06

ARROW TIRE CO.

GAINESVILLE

GA $57,059.83

ASSISTED LIVING CARE, LLC

MARTINEZ

GA $6,286.88

ASSOCIATED HEALTHCARE SYSTEMS NASHVILLE

GA $9,380.53

ASSOCIATED RUBBER COMPANY

TALLAPOOSA

GA $46,918.97

ASSOCIATES IN OB/GYN

DALTON

GA $78,976.02

ASTRO DYE

CALHOUN

GA $12,705.85

ATC HEALTHCARE SERVICES

MACON

GA $101,584.96

ATHENS COUNTRY CLUB INC.

ATHENS

GA $88,236.25

ATLAMAHA HOMECARE

BAXLEY

GA $89,970.77

ATLANTA BREAD CO. INT'L INC.

SMYRNA

GA $90.15

ATLANTA CASUALTY GROUP

ALPHARETTA

GA $75,915.15

ATLANTA FREIGHTLINER TRUCK SAL

JEFFERSON

GA $46,968.63

ATLANTA HAULING-WASTE MGMNT

SMYRNA

GA $9,750.00

ATLANTA JOURNAL-CONSTITUTION

NORCROSS

GA $165.02

ATLANTA MEDICAL CENTER

ATLANTA

GA $40,088.82

ATLANTA METRO YMCA

ATLANTA

GA $58,640.06

ATLANTA PERMA-PAVE

ATLANTA

GA $216,341.44

ATLANTA STEEL ERECTORS, INC.

SMYRNA

GA $43,940.80

ATLANTECH INTERNATIONAL, INC.

MORROW

GA $1,300.00

ATLANTIC COAST FIRE PROTECTION

DULUTH

GA $92,835.78

ATLANTIC SOUTHEAST AIRLINES

ATLANTA

GA $103,893.49

ATLAS DRYWALL AND ACOUSTICS, INC AUSTELL

GA $17,618.59

ATLAS PAINTING & CONSTRUCTION

WARNER ROBINS

GA $10,099.33

ATLAS ROOFING CO

HAMPTON

GA $7,527.85

ATLAS SAND & GRAVEL OF GA INC.

SAVANNAH

GA $4,782.76

ATLAS TECHNOLOGIES INC

FENTON

MI $37,706.39

26

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

AUGUSTA CANAL AUTHORITY

AUGUSTA

GA $15,392.62

AUGUSTA INDUSTRIAL ELECTRIC

DEARING

GA $48.55

AURORA CARES DBA TARA CARES

DOUGLASVILLE

GA $60,630.19

AUSTELL BOX BOARD

AUSTELL

GA $99,483.29

AUTOMATED MACHINERY LTD, INC.

CUMMING

GA $4,490.22

AUTUMN BREEZE ASSISTED LIVING

GAINESVILLE

GA $41,025.28

AVERY DENNISON

FLOWERY BRANCH GA $61,447.11

AVIS RENT A CAR

ATLANTA

GA $2,521.00

B & A CONSTRUCTION CO. INC.

GAINESVILLE

GA $18,068.77

B & B VENDORS INC.

TIFTON

GA $252.66

B & M WOOD PRODUCTS

MANOR

GA $168,027.04

B P STUCCO AND SUPPLY

AIKEN

SC $38,237.83

B.C. MOORE & SONS

WADESBORO

NC $104,128.79

BABCOCK & WILCOX COMPANY

BRUNSWICK

GA $27,901.39

BACON COUNTY B. O. E.

ALMA

GA $5,401.02

BAGCRAFT CORP. OF AMERICA

FOREST PARK

GA $11,327.32

BALLARD BROTHERS ELECTRIC

MACON

GA $22,923.80

BANK SOUTH

FOREST PARK

GA $38,726.94

BAPTIST VILLAGE

WAYCROSS

GA $13,126.88

BARDI HEATING/AIR CONDITIONING

NORCROSS

GA $1,710.25

BARLOW LOGGING

WAYNESBORO

GA $50,943.75

BARRETT & ASSOCIATES

ATLANTA

GA $8,575.00

BARRETT PLUMBING & ELECTRIC

CAIRO

GA $1,576.48

BARRINGTON HALL DEVELOPMENT

WARNER ROBINS

GA $182,010.63

BARTOLOMUCCI & ASSOCIATES, INC

TUNNEL HILL

GA $63,468.23

BATES HARDWARE CO.

ATLANTA

GA $305,073.80

BATHCRAFT/JACUZZI BRANDS, INC.

VALDOSTA

GA $51,549.55

BEAUMONT PRODUCTS

KENNESAW

GA $1,987.67

BEKAERT CORP.

ROME

GA $68,522.51

BEL ARBOR NURSING HOME

MACON

GA $794.47

BELK OF SAVANNAH

SAVANNAH

GA $2,200.82

BELK STORES & AFFILIATES

CARTERSVILE

GA $22,680.91

BELL MINOR HOME INC

GAINESVILLE

GA $61,630.49

BELLSOUTH BUSINESS SYSTEMS

ATLANTA

GA $158,710.29

BELLSOUTH CORPORATION

ATLANTA

GA $79,711.60

BEN A. LONG CONST. CO., INC.

APPLING

GA $9,679.14

BENT TREE COMMUNITY

JASPER

GA $85,194.22

BERKEL & COMPANY CONTRACTORS

BONNER SPRINGS KS $35,643.99

BERLIN & HODGES

MACON

GA $36,755.50

BETTER BACKERS, INC.

CHATSWORTH

GA $14,234.00

27

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

BEVIS ROPE MANUFACTURING INC

ROSSVILLE

GA $15,772.94

BGD ENTER. DBA PAYLESS PLMBG.

BYRON

GA $54,825.41

BILL'S HEATING & COOLING INC

SUMMERVILLE

GA $48,902.08

BI-LO

COMMERCE

GA $67,972.91

BI-LO

ELBERTON

GA $67.93

BISHOP WELL PUMP SERVICE AND S

TIFTON

GA $1,719.73

BLADE SPORTSWEAR INC

MACON

GA $20,187.26

BLAINE ALDRIDGE CONCRETE

CUMMING

GA $39,451.84

BLAIR HOUSE CONVALESCENT CENTE NORTH AUGUSTA

SC $9,772.89

BLAKE CONSTRUCTION CO.

ST. MARYS

GA $7,285.00

BLOUNT CONSTRUCTION

ATHENS

GA $14,758.85

BLUE RIBBON RENTAL, INC.

CUYAHOGA FALLS OH $3,028.97

BOEING

DULUTH

GA $24,068.12

BON L. MANUFACTURING

NEWNAN

GA $13,416.37

BORAL MATERIALS

JULIETTE

GA $62,148.58

BOSTON MARKET

MARIETTA

GA $325.84

BRENTWOOD TERRACE NURSING HOME HAWKINSVILLE

GA $1,794.40

BRIDGFORD FOOD CORP

MABLETON

GA $8,975.87

BRIGGS MEDICAL

DES MOINES

IA

$35,690.55

BROCKWAY STANDARD INC

HOMERVILLE

GA $8,738.26

BROOKS INSTRUMENTS DIVISION

STATESBORO

GA $8,071.18

BROOKS WELDING INC.

VALDOSTA

GA $115,254.42

BROWN & WILLIAMSON TOBACCO

MACON

GA $423,531.64

BROWN CONSTRUCTION CO.

RINGGOLD

GA $2,010.29

BROWN STEEL CONTRACTORS, INC.

NEWNAN

GA $5,670.00

BRUNO'S FOODMAX STORES

DUBLIN

GA $27,387.67

BUCKEYE VACUUM CLEANER SUPPLY SMYRNA

GA $1,729.20

BUFORD CITY BOARD OF EDUCATION BUFORD

GA $626.37

BUILDERS RESOURCE MANAGEMENT SUWANEE

GA $61,400.00

BUILDING TECHNOLOGY

TALLAPOOSA

GA $17,206.07

BUNN LOGGING, INC.

FORSYTH

GA $39,559.24

BURLINGTON INDUSTRIES

SHANNON

GA $9,180.14

BURLINGTON NORTHERN

ALBANY

GA $10,871.23

BURT LUMBER CO., INC.

WASHINGTON

GA $4,387.20

BUTLER INDUSTRIES, INC.

MACON

GA $165,128.08

C & D CHARTER POWER SYSTEMS

CONYERS

GA $511.80

C & S WHOLESALE GROCERS

MACON

GA $62,329.90

CAL-MAINE FOODS, INC.

SHADYDALE

GA $19,685.29

CAMBRIDGE PLACEMENT, INC.

ATLANTA

GA $39,057.07

CANOOCHEE EMC

REIDSVILLE

GA $5,985.58

28

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

CAPRO INC.

SWAINSBORO

GA $17,907.27

CARA VITA

MARIETTA

GA $3,049.08

CARDINAL HEALTH 200, INC.

NORCROSS

GA $10,271.47

CARE MORE, INC.

MACON

GA $126,150.95

CAREMASTER MEDICAL SERVICES

GRIFFIN

GA $31,488.16

CAROLE FABRICS INC.

AUGUSTA

GA $25,925.30

CAROLINA HANDLING

CHARLOTTE

NC $19,253.83

CARRIAGE INDUSTRIES, INC.

CALHOUN

GA $9,415.00

CARROLLTON MANOR, INC.

CARROLLTON

GA $20,718.12

CARSON, INC.

SAVANNAH

GA $7,860.37

CARTER CONCRETE COMPANY

POWDER SPRINGS GA $143,173.56

CARTERSVILLE MEDICAL CENTER

CARTERSVILLE

GA $51,712.50

CARWOOD MANUFACTURING CO.

WINDER

GA $20,761.63

CASEY INDUSTRIAL INC

BROOMFIELD

CO $7,677.99

CATERPILLAR INC

GRIFFIN

GA $25,594.55

CBC CONSTRUCTION CO INC

GAINESVILLE

GA $87,627.97

C-E MINERALS

ANDERSONVILLE

GA $69,355.15

CECIL MALONE COMPANY

ATLANTA

GA $28,254.83

CEDARWOOD APTS

AUGUSTA

GA $30,000.00

CELLO-FOIL PRODUCTS, INC.

ALBANY

GA $35,198.13

CENTEK INDUSTRIES

THOMASVILLE

GA $528.92

CENTRAL GA EYE CENTER PC

MACON

GA $40,474.11

CENTRAL GA HOME HEALTH AGENCY MACON

GA $11,661.03

CENTRAL GEORGIA HOME CARE

MACON

GA $44,991.74

CENTRAL HEALTH HOLDING

FT. OGLETHORPE

GA $48,999.11

CENTRAL INDUSTRIES, INC

SAVANNAH

GA $71,060.00

CENTRAL PARK APARTMENTS

WAYCROSS

GA $1,431.72

CENTURION INDUSTRIES

FREDONIA

KS $2,337.72

CETCO ( PC AMCOL INTL' GRP)

VILLA RICA

GA $16,500.00

CHAMBERS DEVELOPMENT CO.

ATLANTA

GA $81,252.01

CHAMPION GARMENT CO.

ROME

GA $4,954.65

CHAMPION INTERNATIONAL CORP

WAYCROSS

GA $9,100.00

CHANDLER INTERIORS, INC

KENNESAW

GA $331.51

CHANMOR TITLE & ABSTACT, INC.

ATLANTA

GA $24,591.85

CHARLES BLACK CONSTRUCTION

CLEVELAND

GA $130,079.71

CHARLES SMITHGALL CENTRAL OFF.

GAINESVILLE

GA $13,632.00

CHARLES W MCKINNEY INC

CONYERS

GA $175.50

CHESTNUT RIDGE NURSING

CUMMING

GA $230,502.62

CHICK FIL-A

CARTERSVILLE

GA $83,780.13

CHICK-FIL-A

STOCKBRIDGE

GA $20,317.29

29

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

CHICK-FIL-A

FOREST PARK

GA $286.16

CHUMLEY'S PAVING & GRADING INC

ACWORTH

GA $5,289.05

CHURCH CHAIR INDUSTRIES INC.

ROME

GA $57,953.60

CHURCH OF JESUS CHRIST LDS

ATLANTA

GA $1,200.26

CIMCO

WAYNESBORO

GA $4,515.00

CITIZENS BANK OF WASHINGTON CO

SANDERSVILLE

GA $13,068.50

CITY OF COVINGTON

COVINGTON

GA $11,974.43

CITY OF EAST POINT POLICE DEPT

EAST POINT

GA $55,439.02

CITY OF ELBERTON

ELBERTON

GA $9,294.83

CITY OF FORSYTH

FORSYTH

GA $38,198.13

CITY OF FORT VALLEY

FT VALLEY

GA $991.64

CITY OF LOUISVILLE

LOUISVILLE

GA $72,973.87

CITY OF ROME

ROME

GA $17,521.30

CITY PLUMBING & ELECTRICAL

GAINESVILLE

GA $40.28

CIVES CORPORATION

THOMASVILLE

GA $673.23

CLARE BRIDGE OF DECATUR

DECATUR

GA $11,101.85

CLARK CONSTRUCTION

PATTERSON

GA $98,627.62

CLARKE COUNTY SCHOOL DISTRICT

ATHENS

GA $10,025.54

CLARKLIFT OF ATLANTA

ATLANTA

GA $51,904.64

CLAUDE RICKMAN CONST.

DILLARD

GA $189,930.00

CLAY M. NEWMAN LOGGING, INC

HAZLEZHURST

GA $54,197.81

CLUBHOUSE INVESTMENTS, INC.

MILLEN

GA $14,005.49

CMI INDUSTRIES, INC

CLARKESVILLE

GA $43,961.77

COASTAL DEPOT

GARDEN CITY

GA $12,411.45

COASTAL GREAT SOUTHERN

SAVANNAH

GA $5,404.04

COASTAL SAND, INC.

SAVANNAH

GA $8,430.95

COBB ERECTORS, INC.

POWDER SPRINGS GA $2,306.03

COCHRAN CEILING COMPANY, INC.

COCHRAN

GA $32,105.29

COCHRAN'S AUTO TRUCK STOP

RINGGOLD

GA $11,848.52

COFFEE CO. BD OF EDUCATION

DOUGLAS

GA $11,501.12

COLCRAFT INC

STILLMORE

GA $30.67

COLDIZ CONSTRUCTION, INC.

BLAIRSVILLE

GA $29,680.00

COLEMAN AMERICAN MOVING

MIDLAND CITY

AL $57,600.57

COLISEUM MEDICAL CENTER

MACON

GA $30,821.00

COLLINS & AIKMAN FLOORCOVERING DALTON

GA $139,345.13

COLORADO BOXED BEEF COMPANY

ATLANTA

GA $151,951.97

COLUMBIA POLK GENERAL HOSPITAL CEDARTOWN

GA $10,912.86

COMBINED INSURANCE

CHICAGO

IL

$7,858.41

COMBINED PROPERTIES

ATLANTA

GA $86,555.33

COMBINED SERVICES, INC.

DECATUR

GA $299.00

30

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

COMBUSTION ENGINEERING

JULIETTE

GA $11,913.21

COMBUSTION TECHNOLOGIES INC

FLOWERY BRCH

GA $9,951.84

COMMERCE RENTAL & SALES

COMMERCE

GA $138,023.62

COMMERCIAL CABINETRY, INC.

LOGANVILLE

GA $15,864.80

COMPLETE PERSONNEL INC.

DALTON

GA $105,183.24

CONCERTED SERVICES

WAYCROSS

GA $6,125.00

CONCORD MANAGEMENT, LTD

AUGUSTA

GA $39,326.90

CONE FINANCIAL GROUP

FITZGERALD

GA $102,355.56

CONQUEST CARPET MILL

ELLIJAY

GA $91,044.70

CONSTANTINE DYEING

CALHOUN

GA $32,437.45

CONTAINER GENERAL CORP.

FOREST PARK

GA $9,684.99

CONTINENTAL BAKING COMPANY

ROME

GA $8,719.98

CONTINENTAL CAN CO

PERRY

GA $6,973.50

CONTINENTAL GRAIN

SAVANNAH

GA $7,740.90

CONTINENTAL GRAIN

CORDELE

GA $8,150.92

CONTINENTAL PRODUCTS INC

DALTON

GA $162.64

CONTINENTAL TELEPHONE CO.

ATLANTA

GA $7,766.19

COOPER DDS, PC

WAYCROSS

GA $43,004.84

CORRECTIONS CORP OF AMERICA

MCRAE

GA $73,650.55

CORTEX, INC. MARION VENTULETT

ATLANTA

GA $4,081.89

COUNTRY CLUB OF COLUMBUS INC

COLUMBUS

GA $502.71

COUNTRY PRIDE FOODS, INC.

GAINESVILLE

GA $23,578.02

COVENTRY ELECTRICAL SUPPLIES

COVINGTON

GA $22,163.03

COWABUNGA INC. D/B/A

HAPEVILLE

GA $73,678.63

COWAN DISTRIBUTION

BALTIMORE

MD $155,480.74

COX-ATLANTA JOURNAL CONSTITUTION ATLANTA

GA $165,422.81

CRAVEN POTTERY INC.

COMMERCE

GA $878.74

CRETE CARRIER CORPORATION

LINCOLN

NE $117,384.28

CROSS-TOWN EXTERMINATING

FOREST PARK

GA $4,414.43

CRUM'S GARDEN CENTER

BAINBRIDGE,

GA $12,130.75

CRYSTAL FARMS INC

CHESTNUT MTN.

GA $24,357.23

CTF HOLDINGS LTD

LAKE LANIER

GA $872.68

CUMBERLAND GAS & ICE

KINGLAND

GA $59,238.10

CUMMINS SOUTH INC

COLLEGE PARK

GA $127,524.52

CVS PHARMACY

MARIETTA

GA $243,888.82

CYNDERELLA'S

FITZGERALD

GA $25,882.75

CYPRESS HEALTH CARE MGMT.

HOSCHTON

GA $76,676.47

CYPRESS RESTAURANTS, INC.

ORLANDO

FL $137.16

D & D SERVICE INC

POWDER SPRINGS GA $71,539.93

DACULA ANIMAL HOSPITAL

DACULA

GA $1,826.52

31

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

DAIMLER/CHRYSLER CORPORATION

MORROW

GA $11,299.90

DANNY CARDEN PLUMBING

TYRONE

GA $11,113.00

DARBY PRINTING COMPANY

ATLANTA

GA $7,166.75

DAVIS CENTRAL AIR CONDITIONING

VALDOSTA

GA $16,844.80

DAVIS POULTRY INC

LESLIE

GA $81,447.57

DAVIS TRANSFER

CARNESVILLE

GA $61.25

DECATUR HOUSING AUTHORITY

DECATUR

GA $126,408.76

DEERFIELD SPECIALTY PAPERS INC

AUGUSTA

GA $25,970.40

DEKALB PIPELINE COMPANY

CONYERS

GA $54,941.26

DELTA AIRLINES, INC.

ATLANTA

GA $102,021.79

DELTA LIFE INS CO

MACON

GA $4,748.93

DENSON CONTRACTING COMPANY

COLUMBUS

GA $3,948.69

DETAILS INC.

MOORESVILLE

NC $25,168.95

DEVEREUX FOUNDATION

KENNESAW

GA $14,905.51

DEVON CORP.

FT. OGLETHORPE

GA $531,558.32

DIAZ FOOD COMPANIES

ATLANTA

GA $46,980.66

DICKINSON FLEET SERVICES

DORAVILLE

GA $177,486.05

DIDIER LAND COMPANY

DALTON

GA $69,600.00

DIEBOLD INC.

ATLANTA

GA $15,980.95

DIGITRAX INC

NORCROSS

GA $6,596.99

DILLARD SMITH CONSTRUCTION CO.

SMYRNA

GA $14,915.34

DILLARDS

MACON

GA $212,831.44

DILLARDS INC

VALDOSTA

GA $44,119.45

DILLON TRANSPORT INC.

WILLOWBROOK

IL

$228,980.76

DIVERSCO, INC

SPARTANBURG

SC $2,179.93

DIXIEN, LLC

LAKE CITY

GA $16,041.04

DIXON TIMBER CO.

JESUP

GA $456.27

DODGE COUNTY HOSPITAL

EASTMAN

GA $95,549.49

DOGWOOD HOUSING

MILLEGEVILLE

GA $3,534.69

DON EVANS INC.

CALHOUN

GA $619.79

DONCASTERS, INC.

RINCON

GA $289.13

DOUGHERTY EQUIPMENT CO INC

GARDEN CITY

GA $155,898.81

DOUGLAS & LOMASON

CARROLLTON

GA $4,474.21

DOW- CONTINENTAL OPERATIONS

DALTON

GA $85.93

DOWN 2 EARTH TRAILERS

BAXTER

GA $1,485.09

DRUG TRANSPORT, INC.

TUCKER

GA $172,309.43

DRURY INNS, INC.083

MARIETTA

GA $22,277.94

DUBARD'S TIRE & ALIGNMENT

AUSTELL

GA $3,703.25

DURANGO GEORGIA PAPER CO

SAINT MARY'S

GA $26,016.84

DURDEN ELECTRIC CO

DUBLIN

GA $158.66

32

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

DYNCORP

ATLANTA

GA $11,050.00

E. COBB LAND DEVELOPMENT CO.

MARIETTA

GA $4,315.43

EARL SMALL'S HARLEY DAVIDS

MARIETTA

GA $36,748.97

EARTHGRAINS

COLUMBUS

GA $77,894.26

EASTERN AIRLINES, INC.

ATLANTA

GA $55,570.00

EASTSIDE CONCRETE CONSTRUCTION DECATUR

GA $39,088.85

EASTSIDE MED CTR

SNELLVILLE

GA $48.75

ECC INTERNATIONAL

SANDERSVILLE

GA $108,917.24

ECHOSTAR COMMUNICATIONS CORP GARDEN CITY

GA $9,900.00

ECI MANAGEMENT

MARIETTA

GA $93,121.14

ECKERD DRUG

SHENANDOAH

GA $32,501.20

ECKERD DRUGS

PEACHTREE CITY

GA $214,247.03

ECKERD YOUTH ALTERNATIVE

CLEARWATER

FL $11,158.14

ECONOMY MOBILE HOMES, INC.

MILEDGEVILLEI

GA $180,204.83

EFFINGHAM COUNTY BOARD OF EDUC SPRINGFIELD

GA $670.77

ELBERT FLOWERS TIMBER

HORTENSE

GA $67,959.53

ELBERT MEMORIAL HOSPITAL

ELBERTON

GA $48,020.00

ELECTROMAGNETIC SERVICES, INC

NORCROSS

GA $11,506.11

ELLIOTT TRANSPORT

GAINESVILLE

GA $216,994.00

EMANUEL HUTCHENS

ROCKMART

GA $151,834.52

EMORY EASTSIDE MEDICAL CENTER

SNELLVILLE

GA $31,282.59

ENGELHARD CORP.

MCINTYRE

GA $16,620.69

ENGELHARD CORP.

ATTAPULGUS

GA $17,649.53

ENGELHARD CORP.

GORDON

GA $5,775.00

ENGINEERED FABRICS CORP.

ROCKMART

GA $246,410.83

ERNST ENTERPRISES OF GEORGIA

LAWRENCEVILLE

GA $723.62

ESSEX GROUP

LITHONIA

GA $1,195.21

ESTEX MANUFACTURING COMPANY

FAIRBURN

GA $50,467.67

ETHICON, INC.

CORNELIA

GA $15,574.33

EXECUTIVE HOME CARE

ATLANTA

GA $1,324.68

EXEL, INC.

FAIRBURN

GA $70,779.61

EXIDE CORPORATION

COLUMBUS

GA $1,578.49

EXPRESS LANE, INC.

PANAMA CITY

FL $1,674.58

EXTREME POWER SPORTS

COLUMBUS

GA $93,653.69

F & P GEORGIA MFG., INC

ROME

GA $15,996.19

FAB TECH INDUSTRIES

ROCKMART

GA $85,965.34

FACTORY MUTUAL INSURANCE CO.

ALPHARETTA

GA $19,503.56

FAMILY DOLLAR

DAHLONEGA

GA $536.62

FAMILY DOLLAR, INC.

CHARLOTTE

NC $9,866.68

FANNIN COUNTY BD. OF EDUCATION

BLUE RIDGE

GA $2,960.76

33

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

FAYETTE CO BD OF EDUCATION

FAYETTEVILLE

GA $177,133.23

FAYETTEVILLE BOWLING CENTER

FAYETTEVILLE

GA $15,626.41

FEDERAL EXPRESS CORP

ATLANTA

GA $61,887.20

FEDERAL RENT A CAR SYSTEM

HAPEVILLE

GA $33,130.56

FEDERAL STATE INSPECTION

ALBANY

GA $6,396.20

FIESTA HOMES OF GEORGIA

DOUGLAS

GA $1,604.33

FIRST BAPTIST CHURCH

COCHRAN

GA $59,075.02

FIRST BAPTIST CHURCH

LAFAYETTE

GA $16,724.73

FIRST DATA POS, INC.

KENNESAW

GA $242,547.30

FIRST DATA RESOURCES, INC

MACON

GA $416.18

FIRST HOMEOWNERS CORPORATION ATLANTA

GA $3,512.71

FIRST NATIONAL BANK & TRUST CO

LOUISVILLE

GA $254,339.19

FITZGERALD & SONS PLUMBING

PEACHTREE CITY

GA $79,578.79

FITZGERALD UNDERWEAR CORP

TIFTON

GA $9,655.58

FIVE STAR FOOD SERVICE

DALTON

GA $8,692.45

FIVE STAR FOODS

AUGUSTA

GA $2,135.80

FLASH FOODS

WAYCROSS

GA $16,985.69

FLETCHER OIL CO. INC.

DOUGLAS

GA $26,600.68

FLINT CONSTRUCTION CO.

LAWRENCEVILLE

GA $5,775.00

FLINT LAND & CATTLE

WOODBURY

GA $154,630.83

FLINT RIVER TEXTILES, INC

ALBANY

GA $3,048.73

FLOWERS AND SONS LOGGING

HORTENSE

GA $135,461.82

FLOWERS, INC. BALLOONS

BOGART

GA $684.26

FLUOR CORP

ALISO VIEJO

CA $82,565.00

FOLGER POULTRY FARMS

DAHLONEGA

GA $4,239.00

FOODONICS INTERNATIONAL, INC.

BLACKSHEAR

GA $139,700.31

FORSYTH INNS D/B/A HAMPTON INN

FORSYTH

GA $53,940.57

FORSYTH NURSING HOME

FORSYTH

GA $99,069.70

FORUM HEALTHCARE

ROME

GA $36,361.28

FOX & HOUND RESTAURANT GROUP

WICHITA

KS $2,517.39

FRANK IRBY PLUMBING COMPANY

MACON

GA $101,703.35

FRANKLIN INDUSTRIES

LAVONIA

GA $6,668.20

FRED TAYLOR COMPANIES

ALBANY

GA $29,292.71

FRED'S, INC.

LAVONIA

GA $86,161.33

FREEMAN PLUMBING CO. INC.

COMMERCE

GA $56,014.95

FREEPORT KAOLIN CO

GORDON

GA $2,760.00

FRESENIUS MEDICAL CARE

COLLEGE PARK

GA $105,933.45

FRESH BEGININGS INC

VALDOSTA

GA $2,429.03

FRIEDMAN'S INC.

AUGUSTA

GA $78,013.73

FRUIT OF THE LOOM, INC.

RABUN

GA $3,269.59

34

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

FUJICOLOR PROCESSING INC

TIFTON

GA $67,301.01

FUJITSU AMERICA, INC

SUNNYVALE

CA $122,429.61

FUTURECALL TELEMARKITING WEST

AUGUSTA

GA $5,694.17

G & K SERVICES, INC.

MACON

GA $12,649.96

G & K SERVICES, INC.

ATLANTA

GA $12,571.56

G & P TRUCKING CO. INC.

GASTON

SC $3,240.00

G.P.S. ENTERPRISES, INC

AUBURN

GA $75,218.33

GA VALDOSTA/MARMON HOLDINGS INC VALDOSTA

GA $3,177.09

GAINEY TRANSPORTATION

GRAND RAPIDS

MI $557,414.01

GARLAND & ASSOCIATES CONTRACTOR BOGART

GA $20,287.54

GARNER BROS. CO.

ROME

GA $96,011.34

GARY'S PULPWOOD & LOGGING

COLLEGE PARK

GA $720.44

GATOR COCHRAN CONSTRUCTION CO AUGUSTA

GA $33,952.00

GATX CORPORATION

WAYCROSS

GA $84,820.68

GEICO CORP

MACON

GA $6,035.07

GEIGER INTERNATIONAL

ATLANTA

GA $3,736.78

GENERAL CABLE CORP.

WATKINSVILLE

GA $17,772.30

GENERAL CAR AND TRUCK LEASING

DAVENPORT

IA

$25,143.92

GENERAL ELECTRIC CO

ROME

GA $3,157.58

GENERAL HOUSING

WAYCROSS

GA $67,012.85

GENERAL MANUFACTURED HOUSING WAYCROSS

GA $25,383.96

GENERAL NUTRITION CTRS

PITTSBURGH

PA $125,860.55

GENERAL PARTS INC.

CARROLLTON

GA $10,067.33

GENERAL PRODUCE, INC.

FOREST PARK

GA $2,882.70

GENUINE PARTS

NORCROSS

GA $371.08

GEORGE HORMELL & COMPANY

TUCKER

GA $23,766.91

GEORGE MUSE CLOTHING CO

ATLANTA

GA $6,833.47

GEORGE WESTON LIMITED

CARROLLTON

GA $13,578.48

GEORGIA BAPTIST CHILDRENS HOME PALMETTO

GA $78,641.26

GEORGIA BOOT INC

BLAIRSVILLE

GA $6,824.22

GEORGIA DUPLICATING PRODUCTS

MACON

GA $16,834.71

GEORGIA FURNITURE MART AND PRI

MACON

GA $9,468.25

GEORGIA HOME HEALTH CARE

LYONS

GA $73,512.83

GEORGIA PALM BEACH ALUMINUM

BAINBRIDGE

GA $1,325.47

GEORGIA WAR VETERANS HOME

MILLEDGEVILLE

GA $20,198.64

GERAY INC

EVANS

GA $34,123.53

GILMAN BUILDING PRODUCTS

BLACKSHEAR

GA $22,318.45

GILMAN PAPER CO.

ST. MARY'S

GA $21,010.34

GILMER COUNTY OF B. O. E.

ELLIJAY

GA $9,190.53

GIRL SCOUTS COUNCIL OF NW

ATLANTA

GA $5,533.35

35

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

GIW INDUSTRIES

GROVETOWN

GA $3,014.67

GLENN ANDREWS PLUMBING

CANTON

GA $98.11

GLENN-LEE TRUCKING, INC.

GARDEN CITY

GA $1,575.12

GOBER PAINT & CONTRACTING

LOGANVILLE

GA $1,371.60

GOLD KIST, INC.

ATHENS

GA $80,050.33

GOLD KIST, INC.

CARROLLTON

GA $115,595.93

GOLD KIST, INC.

DOUGLAS

GA $4,151.16

GOLD KIST, INC.

TALKING ROCK

GA $38,900.02

GOLDEN AGE PROPERTIES

HAWKINSVILLE

GA $39,209.39

GOLDEN CORRAL RESTAURANTS

RALEIGH

NC $74,108.86

GOLDEN STATE FOODS CORP

CONYERS

GA $76,732.72

GOODWILL INDUSTRIES

SAVANNAH

GA $162,194.11

GOODY PRODUCTS, INC.

MANCHESTER

GA $8,099.56

GOODY PRODUCTS, INC.

EASTMAN

GA $3,593.90

GOODYEAR TIRE & RUBBER

CEDARTOWN

GA $5,244.61

GOODYEAR TIRE & RUBBER CO.

ROME

GA $36,942.48

GORDON COUNTY FARM COMPANY

CALHOUN

GA $9,116.37

GOZA AUTO PARTS & MACHINE SHOP ACWORTH

GA $37.00

GPSUM MGMT & SUPPLY, INC.

ATLANTA

GA $24,346.84

GRAPHIC PACKAGING CORPORATION MACON

GA $102,090.00

GREAT AMERICAN EATERY

ATLANTA

GA $62,829.61

GREAT OAKS NURSING HOME

ROSWELL

GA $38,884.27

GREBA METAL PRODUCTS, INC.

WINSTON

GA $8,250.68

GREEN ISLAND COUNTRY CLUB

COLUMBUS

GA $88,050.00

GREEN OAKS CENTER

MOULTRIE

GA $30,985.99

GREEN THUMB, INC.

JESUP

GA $22,039.82

GREENPOINT BANK

COLUMBUS

GA $11,270.41

GREENPOINT MORTGAGE

COLUMBUS

GA $146.00

GREENWOOD CEMETARY

ATLANTA

GA $1,400.15

GREYHOUND LINES, INC

ATLANTA

GA $59,976.31

GRIFFIN SERVICES

ATLANTA

GA $74,836.80

GS DEVELOPMENT, LLC

TIFTON

GA $14,735.82

GULF LIFE INSURANCE COMPANY

ALBANY

GA $2,800.00

H & L TIR & AUTO

BAXLEY

GA $70,361.89

H.H. TIMBER & LOGGING CO.

CUTHBERT

GA $77,394.38

HABITAT FOR HUMANITY INC.

ATLANTA

GA $17,662.05

HAIRSTON CONSTRUCTION CO

KENNESAW

GA $92,279.02

HAMMOCK-WICKS TIMBER

ROBERTA

GA $42,037.51

HAMPTON INN COLUMBUS AIRPORT

COLUMBUS

GA $15,447.85

HANCOCK FABRICS

SAVANNAH

GA $876.22

36

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

HANES HOSIERY, INC.

LAGRANGE

GA $8,080.66

HANS PAINT COMPANY

AUGUSTA

GA $103,662.64

HARBISON WALKER REFRACTORIES

CALHOUN

GA $3,092.10

HARMONY ENTERPRISES

BOWDON JUNCTION GA $74,806.45

HARMONY ENTERPRISES, INC.

BOWDON JUNCTION GA $23,832.49

HARRIS INSULATION & SUPPLY INC

ATLANTA

GA $20,018.00

HARTWELL CO. WAREHOUSE

HARTWELL

GA $8,546.59

HARVEY'S PERSONAL CARE

WAYCROSS

GA $85,966.38

HAULMARK INDUSTRIES - GEORGIA

FITZGERALD

GA $2,134.05

HAVERTY FURNITURE COMPANIES

MACON

GA $97,748.60

HAYES MICRO COMPUTER PRODUCTS NORCROSS

GA $6,225.38

HAYGOOD CONTRACTING, INC.

WOODSTOCK

GA $24,117.47

HEADRICK'S BODY SHOP, INC.

ROSSVILLE

GA $269,297.45

HEALTH MANGEMENT ASSOC.

STATESBORO

GA $83,467.12

HEALTH SCHOLARSHIPS,INC

MACON

GA $118,537.17

HEALTH SYSTEMS FACILITIES INC

THOMSON

GA $59,791.54

HEALTH SYSTEMS FACILITIES, INC

HAWKINSVILLE

GA $69,444.78

HEATCRAFT/LENNOX INDUSTRIES

TIFTON

GA $1,484.80

HENDERSON ELECTRIC CO

STONE MOUNTAIN GA $16,407.48

HENRY COUNTY TRAINING CENTER

MCDONOUGH

GA $11,802.18

HENRY SIGN SYSTEMS, INC.

DECATUR

GA $2,125.84

HERITAGE RETIREMENT

ST. SIMON ISLAND GA $5,680.20

HERTZ PENSKE/GEICO TRUCK LSNG

FOREST PARK

GA $81,227.48

HEWLETT PACKARD FIELD OFFICES

ATLANTA

GA $241,065.10

HI BRAND FOODS

PEACHTREE CITY

GA $7,079.43

HICKS PAVING CO., INC.

ATHENS

GA $70,591.78

HIGGINS GENERAL HOSPITAL

BREMAN

GA $6,480.00

HILLCREST HOSPICE INC

RIVERDALE

GA $80,152.55

HINESVILLE RED & WHITE

HINESVILLE

GA $10,501.96

HOLIDAY INN-MCDONOUGH

MCDONOUGH

GA $8,235.62

HOLLAND AMER C/O TBG SERVICES

ROSSVILLE

GA $508.77

HOLMAN CONTRACT WAREHOUSING IN GARDEN CITY

GA $102,379.65

HOME AMERICA MORTGAGE

LAWRENCEVILLE

GA $57,860.00

HOME DEPOT

ATLANTA

GA $206,187.01

HOME DEPOT

AUSTELL

GA $1,389.76

HOME DEPOT

BLAIRSVILLE

GA $94,051.50

HOME DEPOT

BRUNSWICK

GA $170,941.62

HOME DEPOT

CONYERS

GA $32,469.46

HOME DEPOT

CUMMING

GA $52,465.01

HOME DEPOT

DAWSONVILLE

GA $67,537.77

37

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

HOME DEPOT

DULUTH

GA $157,209.01

HOME DEPOT

LAGRANGE

GA $29,812.98

HOME DEPOT

MACON

GA $47,389.29

HOME DEPOT

MARIETTA

GA $82,290.10

HOME DEPOT

NORCROSS

GA $14,451.22

HOME DEPOT

SAVANNAH

GA $236,326.26

HOME DEPOT

SNELLVILLE

GA $12,127.38

HOME DEPOT

WARNER ROBINS

GA $6,003.58

HOME TRANSPORT, INC

WAYCROSS

GA $1,278.81

HON INDUSTRIES

CEDARTOWN

GA $36,938.34

HONEYWELL INTERNATIONAL, INC.

ELBERTON

GA $48,838.42

HOOVER PRECISION PRODUCTS

CUMMING

GA $7,955.11

HOOVER TREATED WOOD PRODUCTS THOMSON

GA $20,402.28

HORIZONS PEO D/B/A

ATLANTA

GA $154,777.99

HOSPITAL AUTHORITY OF LIBERTY

LUDOWICI

GA $28,321.61

HOUSE OF TYROL

CLEVELAND

GA $50,013.40

HOUSING AUTHORITY OF COLU

COLUMBUS

GA $2,065.62

HOWARD'S LANDSCAPING & GRADING LILBURN

GA $9,079.55

HUBBELL DIE CASTING

MOULTRIE

GA $1,014.88

HUDDLE HOUSE

MILLEN

GA $29.00

HUGHES SUPPLY, INC.

ORLANDO

FL $256.35

HUMAN RESOURCES INC. D/B/A

ALBANY

GA $176,108.04

I P S BALERS

BAXLEY

GA $21,744.47

IBM CORPORATION

ATLANTA

GA $15,899.21

IEF

CLEARWATER

FL $2,093.31

IHOP

RIVERDALE

GA $103,462.38

IMERYS CLAYS, INC.

DEEPSTEP

GA $1,634.54

IMERYS CLAYS, INC.

SANDERSVILLE

GA $56,198.87

IMERYS KAOLIN

DRY BRANCH

GA $18,400.00

IMERYS USA INC

DRY BRANCH

GA $47,345.55

INDEPENDENT LIFE INSURANCE CO.

ROME

GA $9,243.94

INDUSTRIAL CHEMICALS INC

JONESBORO

GA $3,655.00

INLAND CONTAINER CORP.

MACON

GA $251,738.79

INLAND CONTAINER CORP.

ROME

GA $15,349.77

INMAN INDUSTRIAL ELECTRIC, INC

JESUP

GA $58.19

INNER DIMENSIONS INC

BLUE RIDGE

GA $82,663.49

INTELLSTAF HEALTHCARE

ATLANTA

GA $700.68

INTERIM PERSONNEL

ATLANTA

GA $11,498.11

INTERNATIONAL AUTO PROCESSING

BRUNSWICK

GA $22,611.15

INTERNATIONAL RESCUE COMM

NEW YORK

NY $5,912.50

38

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

INTERSTATE BRANDS

COLUMBUS

GA $54,122.36

INTERSTATE BRANDS CORP.

COLUMBUS

GA $5,520.75

INTERSTATE DISTRIBUTORS, INC.

NORCROSS

GA $4,269.75

INTERSTATE MANAGEMENT &

JEKYLL ISLAND

GA $23,073.33

INVISTA S.A.R.L.

ATHENS

GA $80.56

IRWIN MANUFACTURING CORP.

OCILLA

GA $32.15

ITHACA INDUSTRIES INC.

MEIGS

GA $40,632.48

ITR INDUSTRIES

TOCCOA

GA $10,668.05

ITT AUTOMOTIVE

ROME

GA $6,931.30

ITT THOMPSON

ADEL

GA $1,575.00

ITT-RAYONIER, INC.

BAXLEY

GA $65,670.00

J PHILLIP HEATING & AIR

CHAMBLEE

GA $251,457.82

J&M TRANSPORTATION

LASCRUSES

NM $17,375.00

J. A. JONES

CHARLOTTE

NC $35,054.33

J. C. PENNEY COMPANY

STONE MOUNTAIN GA $11,959.95

J. O. CONLEY CORPORATION

MACON

GA $39,076.30

J. SAUNDERS CO., INC

WAYCROSS

GA $14,047.70

J.C. NASH TRUCK PARTS, INC.

ATHENS

GA $30,298.47

J.C. PENNEY COMPANY

ATLANTA

GA $87,260.16

J.M. HUBER

WRENS

GA $61,665.10

JACKSON CO BD OF EDUCATION

JEFFERSON

GA $41,439.56

JACUZZI BRANDS

MORRISTOWN

NJ $59,733.80

JAMES F. HOOVER

LAVONIA

GA $45,018.35

JAMES STEEL ERECTORS INC

SAVANNAH

GA $63,310.00

JEAN THOMAS

COMMERCE

GA $4,479.93

JEBCO, INC.

WARRENTON

GA $35,690.05

JERATH & SETHI, LLC

AUGUSTA

GA $7,644.00

JEVIC TRANSPORTATION INC.

CONLEY

GA $2,638.15

JOCKEY INTERNATIONAL, INC.

KENOSHA

WI $92,614.13

JOHN DEERE LANDSCAPES

MOLINE

IL

$103,269.40

JOHN DEMORE LOCK & KEY SVC.

NEWNAN

GA $101,460.34

JOHN HARLAND CO

CONYERS

GA $2,412.90

JOHN O. COOK INC

FITZGERALD

GA $49,427.48

JOHNSON & JOHNSON

ROYSTON

GA $2,632.21

JOHNSON INDUSTRIES, INC.

NORCROSS

GA $58,357.31

JOHNSON TRANSPORTATION, INC.

GARDEN CITY

GA $76,993.30

JOHNSTON ELECTRIC CO., INC.

WAYCROSS

GA $213,808.07

JONATHAN R. JOWERS

MARTINEZ

GA $225,254.67

JONES AUTOMATIC SPRINKLERS

AMERICUS

GA $34,199.33

JOY TRUCK LINE

DALTON

GA $14,839.95

39

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

JRH OPTICS/PEARL VISION EXPRES

DULUTH

GA $22,873.88

JUST BRAKES OF GA

DALLAS

TX $1,245.35

JUST KIDS LEARNING CENTER, INC

ROME

GA $18,243.91

JWI GROUP PRESS FABRIC

JONESBORO

GA $205,482.74

KEADLE HEATING & AIR CONDITION

WARNER ROBINS

GA $195,568.12

KEITH PORTER INSULATIN AND FIR

JEFFERSON

GA $9,994.08

KENCO LOGISTIC SERVICES

ELLENWOOD

GA $89,410.31

KENNEDY EQUIPMENT CO.

COLUMBUS

GA $132,418.46

KENNESAW TRANSPORTATION

RYDAL

GA $23,977.93

KEY HEALTH CENTER

MACON

GA $30,680.52

KICKBUSH CONSTRUCTION

BISHOP

GA $23,019.97

KIDS KONDO INCORPORATED

ATLANTA

GA $406,943.15

KING AMERICA FINISHING

DOVER

GA $4,948.50

KING MUFFLER SHOP

WAYCROSS

GA $32,665.04

KINGS SAVANNAH, LLC

SAVANNAH

GA $18,073.86

KINNEY CONSTRUCTION CO

LEESBURG

GA $35,713.81

KLIKLOK WOODMAN CORPORATION

DECATUR

GA $29,172.95

KNIGHT'S ACE HARDWARE

CEDARTOWN

GA $3,939.20

KRAFT FOODS, INC.

ATLANTA

GA $137,990.34

KRAFT FOODS, INC.

NORCROSS

GA $16,097.11

KROGEL FREIGHT SYSTEMS OF GA

MACON

GA $7,600.00

KROGER CO.

ATLANTA

GA $307,126.48

KROGER CO.

MABLETON

GA $157,581.14

KRYSTAL/M.A.E. THOMASVILLE

THOMASVILLE

GA $13,995.24

KUBOTA MFG CO OF AMERICA

GAINESVILLE

GA $23,986.61

L&L PAVEMENT MAINTENANCE

MOULTRIE

GA $3,214.41

LAFARGE NORTH AMERICA

NEWNAN

GA $114,976.01

LAFARGE NORTH AMERICA, INC.

DULUTH

GA $17,508.78

LAKEWOOD BAPTIST CHURCH

GAINESVILLE

GA $19,113.00

LAMAR COUNTY BOE

BARNESVILLE

GA $55,688.47

LANCE GRADING & CONSTRUCTION

BLUE RIDGE

GA $3,423.84

LANCE TRUCKING CO., INC

BLUE RIDGE

GA $98,613.76

LANCE, INC.

CHARLOTTE

NC $5,359.68

LANDRUM PLUMBING CO. INC.

POWDER SPRINGS GA $22,701.37

LANE REALTY CONST.

ATLANTA

GA $2,549.25

LANIER PARKING SYSTEMS INC

ATLANTA

GA $46,730.70

LAPP INSULATOR CO

SANDERSVILLE

GA $105,252.94

LARSON & JUHL

ADAIRSVILLE

GA $15,524.76

LAUREL BAYE HEALTH LAKE LANIER

BUFORD

GA $140,315.03

LAW ENGINEERING CO

ATLANTA

GA $9,944.75

40

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

LAWLER HOSIERY MILL INC

CARROLLTON

GA $8,652.93

LEGGETT & PLATT, INC.

SOCIAL CIRCLE

GA $4,335.38

LEGGETT & PRATT

MONROE

GA $4,822.32

LEON FARMER & CO

ATHENS

GA $17,101.03

LESCO RESTORATIONS INC

SPARTANBURG

SC $182,121.00

LEVI STRAUSS & COMPANY

VALDOSTA

GA $7,232.27

LEXUS OF SOUTH ATLANTA

UNION CITY

GA $7,907.73

LIBERTY MUTUAL INSURANCE

GAINESVILLE

GA $122,266.28

LIFE CARE CENTERS OF AMERICA

THOMASVILLE

GA $31,608.80

LINPAC, INC.

ATLANTA

GA $2,496.77

LITHONIA LIGHTING

COCHRAN

GA $73,609.27

LOCKHEED MARTIN

BETHESADA

GA $273.93

LOCKHEED MARTIN

KINGS BAY

GA $28,479.55

LOCKHEED MARTIN

MARIETTA

GA $465,229.82

LOGAN PAVING COMPANY

ATHENS

GA $900.00

LONG'S PLASTERING & REMODELING

SOPERTON

GA $18,546.97

LOOK PRODUCTS

MILLEN

GA $6,928.17

LOPEZ DRYWALL

WOODSTOCK

GA $109,546.54

LORAL SPACE & COMMUNICATIONS

ROCKMART

GA $19,281.62

LOWE'S COMPANIES

ALBANY

GA $6,253.31

LTC HEALTHCARE

FT. VALLEY

GA $4,497.28

LUND INTERNATIONAL, INC.

LAWRENCEVILLE

GA $57,146.43

LUPTON-SMITH HOLDINGS

ATLANTA

GA $19,958.91

LYNN HAVEN NURSING HOME, LLC

GRAY

GA $79,841.38

MACHINE CRAFT INC

DALTON

GA $14,050.00

MACON KRAFT

MACON

GA $64,224.00

MACON MALL/COLONIAL PROP. TR.

MACON

GA $22,622.83

MACON NORTHSIDE HOSPITAL

MACON

GA $37,261.28

MACON-BIBB CO WATER & SEWAGE

MACON

GA $10,575.33

MACY'S

ATLANTA

GA $31,930.00

MADISON CO. BD. OF ED.

DANIELSVILLE

GA $12,034.75

MAGNOLIA MANOR

AMERICUS

GA $67,400.60

MAIL CONTRACTORS OF AMERICA

ATLANTA

GA $2,055.73

MAIL CONTRACTORS OF ARKANSAS

LITTLE ROCK

AR $66,943.93

MANATRON

PORTAGE

MI $9,069.37

MANN MECHANICAL CO. INC.

AVONDALE ESTS.

GA $11,248.48

MANNINGTON CARPET INC

CALHOUN

GA $50,102.87

MANPOWER TEMP. SERVICES

DUBLIN

GA $12,000.60

MAREK INTERIOR SYSTEMS, INC.

HOUSTON

TX $99,884.27

MARELL POULTRY COMPANY INC

MURRAYVILLE

GA $2,317.62

41

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

MARINE TRAILERS, INC.

BUFORD

GA $1,359.60

MARINER HEALTH CARE, INC

ATLANTA

GA $80,318.56

MARINER HEALTH CARE, INC.

HOGANSVILLE

GA $33,827.54

MARK TWAIN REDI MIX, INC.

HANNIBAL

MO $43,456.49

MARK'S & MORGAN JEWELERS, INC.

MACON

GA $131,370.32

MARK'S & MORGAN JEWELERS, INC.

AUGUSTA

GA $6,944.77

MARLEY COOLING TOWER

OVERLAND PARK

KS $15,833.23

MARSHALLS

DULUTH

GA $39,445.04

MARTEN TRANSPORT, LTD.

MONDOVI

WI $2,226.95

MARTIN ASSOCIATES HOMEBUILDERS CUMMING

GA $17,529.02

MARTIN CONSTRUCTION COMPANY

SYLVESTER

GA $4,731.34

MASTER PROMOTIONS

LITHIA SPRINGS

GA $3,753.74

MASTERCUTS

ROME

GA $66,130.01

MATSUSHITA ELECTRIC CORP

COLUMBUS

GA $54,944.46

MAXEY BROTHERS INC

BISHOP

GA $142,869.67

MAXWELL CHASE TECH.

SMYRNA

GA $33,170.08

MCARTHUR CONCRETE PRODUCTS

ACWORTH

GA $37,715.00

MCC PANASONIC

PEACHTREE CITY

GA $45,952.06

MCCLESKY MILLS

SMITHVILLE

GA $11,682.95

MCDONALDS CORP.

CHATSWORTH

GA $1,943.45

MCDUFFIE COUNTY SCHOOLS

THOMSON

GA $110,925.61

MCG HEALTH, INC.

AUGUSTA

GA $73,960.87

MCKINNEY COMMUNITY HEALTH

WAYCROSS

GA $65,495.07

MCLANAHAN CRUSHED STONE INC

ELBERTON

GA $30,343.93

MCMASTER-CARR SUPPLY CO

ATLANTA

GA $51,658.93

MC'S PAINTING & DECORATING CO.

HIRAM

GA $10,818.22

MCWHORTER TECHNOLOGIES

COLUMBUS

GA $44,892.60

MD HODGES ENTERPRISES, INC.

ATLANTA

GA $4,939.11

MEADOWS REGIONAL MEDICAL CTR.

VIDILIA

GA $81,291.79

MECHANICAL MAINTENANCE

AUGUSTA

GA $32,115.49

MEDICAL CENTER LLP

DUBLIN

GA $15,256.05

MEDTRONIC INC

REDMOND

WA $66,515.00

MELLON FINANCIAL CORP

PITTSBURG

PA $2,219.15

MEMORIAL HOSPITAL & MANOR

BAINBRIDGE

GA $3,028.05

MENDERS INC

ATLANTA

GA $1,913.97

MERCHANTS METALS, INC.

FOREST PARK

GA $26,497.31

MERICO, INC.

FOREST PARK

GA $11,462.50

MERIDIAN BEVERAGE CO INC

NORCROSS

GA $897.73

METAL BUILDINGS, INC.

THOMASVILLE

GA $37,517.00

METAL STRIPPING SYSTEM, INC.

NASHVILLE

TN $13,322.50

42

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

METRO IRON WORKS INC

COVINGTON

GA $86,537.62

MGR HOMECARE, INC.

GRIFFIN

GA $4,609.75

MI METALS, INC.

MILLEN

GA $95,979.16

MIC, INC.

ELLABELL

GA $312,805.03

MICRO MANAGEMENT CONSULTING

LOGANVILLE

GA $7,213.08

MID GEORGIA AMBULANCE SERV INC

MACON

GA $16,236.66

MID SOUTH SUBCONTRACTORS INC.

FOREST PARK

GA $88,798.93

MIDDLE GA. COMMUNITY

WARNER ROBINS

GA $423.00

MIDDLE GEORGIA HOSPITAL

MACON

GA $8,684.01

MID-GEORGIA AMBULANCE

MACON

GA $37,009.67

MIKE KERNE DBA SKYLINE LAWN

ROSSVILLE

GA $945.63

MILLENNIUM MAT CORPORATION

SUWANEE

GA $226,921.47

MILLER BREWING CO

ALBANY

GA $411,630.82

MILLER BREWING CO

MOULTRIE

GA $2,606.26

MILLIKEN & COMPANY

LAGRANGE

GA $48,216.17

MILLIKEN & COMPANY

TOCCOA

GA $3,753.00

MISCELLANEOUS ERECTORS, INC.

POWDER SPRINGS GA $3,246.75

MISSION FOODS

PENDERGRASS

GA $43,415.59

MITCHELL A. NEIDLINGER

SPRINGFIELD

GA $45,340.50

MODERN BUILDERS SUPPLY, INC.

WAYCROSS

GA $92,012.65

MODULAR CONTAINER SYSTEM

LAVONIA

GA $270,227.01

MONROE AUTO EQUIPMENT

HARTWELL

GA $5,137.05

MOORE INGRAM JOHNSON AND STEEL MARIETTA

GA $18,823.33

MOORE'S ASPHALT PAVING CO.

SNELLVILLE

GA $16,938.77

MOORMANS, INC.

CORDELE

GA $1,495.32

MORGAN CORPORATION

RYDAL

GA $35,417.21

MORI LUGGAGE & GIFTS

ATLANTA

GA $27,596.85

MSC INDUSTRIAL DIRECT

MELVILLE

NY $537.25

MULLINAX WATERPROOFING

BUCHANAN

GA $13,518.50

MURATA ELECTRONICS

SMYRNA

GA $2,685.17

MURRAY COUNTY BOARD OF EDUCATI CHATSWORTH

GA $428.80

MUSCOGEE GLASS COMPANY, INC.

COLUMBUS

GA $57,117.63

MUSCOGEE MANOR NURSING HOME

COLUMBUS

GA $117.00

MUTEC

COLUMBUS

GA $72,914.38

MYERS FLOOR COVERING INC

LOGANVILLE

GA $12,100.19

NATIONAL CEMENT CO., INC

LAWRENCEVILLE

GA $944.00

NATIONAL EMPLOYER SOLUTIONS

ROME

GA $22,774.75

NATIONAL EMPLOYER SOLUTIONS

DALTON

GA $24,944.51

NATIONAL EMPLOYER SOLUTIONS

ALPHARETTA

GA $408,806.39

NATIONAL HEALTH LABORATORIES

MARIETTA

GA $11,547.33

43

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

NATIONAL HOT ROD ASSOCIATION

GLENDORA

CA $315.97

NATIONAL PUBLIC RADIO, INC.

WASHINGTON

DC $3,821.92

NATIONAL SERVICE INDUSTRIES

ATLANTA

GA $123,137.82

NATIONAL VISION, INC.

LAWRENCEVILLE

GA $22,285.63

NATIONS RECOVERY CTR.

ATLANTA

GA $687.00

NAT'L MGMT RESOURCES, INC

MACON

GA $141,259.61

NCR CORP.

PEACHTREE CITY

GA $8,338.34

NEATON ROME, INC.

ROME

GA $64,468.47

NEFF RENTAL

MACON

GA $21,330.00

NEFF RENTAL

BRUNSWICK

GA $23,888.19

NESTLE TRANSPORTATION CO.

MCDONOUGH

GA $59,255.31

NETCARE HEALTH SYSTEMS, INC.

ELLIJAY

GA $30,437.55

NETWORK COMMUNICATIONS

LAWRENCEVILLE

GA $9,562.60

NEW CENTENNIAL INC.

COLUMBUS

GA $4,100.06

NEW YORK LIFE INSURANCE CO.

ALPHARETTA

GA $40,442.66

NEWCASTLE CONSTRUCTION INC

BRUNSWICK

GA $44.68

NEWEL RECYCLING OF ATLANTA

EAST POINT

GA $144,047.84

NEWS/SHOPPER, INC.

WOODSTOCK

GA $28,510.33

NICHOLSON ENTERPRISES, INC.

HOLLY SPRINGS

GA $2,931.55

NICOLON/BAYCOR

CORNELIA

GA $32,187.15

NOLAND COMPANY

MACON

GA $2,268.10

NORCROSS AUTOMOTIVE INC

DORAVILLE

GA $180,870.83

NORDIC COLD STORAGE

ATLANTA

GA $532,595.22

NORTH AMERICAN CONTAINER CORP. NEWNAN

GA $8,613.76

NORTH FULTON REG./TENET

ROSWELL

GA $20,438.74

NORTH GEORGIA DISTRIBUTING

ROME

GA $43,524.80

NORTH GEORGIA READY MIX

DALTON

GA $111,438.52

NORTHERN TELECOM, INC.

STONE MOUNTAIN GA $17,932.09

NORTHSIDE WOMENS SPECIALIST PC ATLANTA

GA $98,621.73

NORTHWEST AIRLINES, INC.

ATLANTA

GA $1,418.43

NPC INTERNATIONAL

HAZELHURST

GA $12,349.94

NSR, INC.

CHAMBLEE

GA $19,271.29

NU CRAFT DENTAL ARTS INC

BOGART

GA $35,533.13

O. ANDERSON CURRIE JR., DDS

ATLANTA

GA $92,862.94

OAK GROVE LANDFILL

WINDER

GA $95,367.18

OAK MTN VILLAGE ASSIST LIVING

CARROLLTON

GA $14,906.32

OCMULGEE FIELDS

MACON

GA $25,389.13

OELSCHIG'S NURSERY, INC.

SAVANNAH

GA $7,732.68

OFFICE DEPOT

BUFORD

GA $96,693.15

OFFICE DEPOT

DOUGLASVILLE

GA $2,541.38

44

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

OFFICE SERVICES, LLC

SAVANNAH

GA $19,198.68

OFS BRIGHTWAVE, LLC

NORCROSS

GA $10,206.79

OGLETHORPE COUNTY SCHOOL

LEXINGTON

GA $13,856.75

OLD FASHION FOODS, INC.

AUSTELL

GA $58,587.65

OLDE HARBOR INN

SAVANNAH

GA $7,393.39

OLIN WOOTEN TRANSPORT CO. INC.

HAZLEHURST

GA $8,595.61

OMC

CALHOUN

GA $64,170.78

OMNOVA SOLUTIONS

CALHOUN

GA $3,823.52

ONEDA CORPORATION

COLUMBUS

GA $9,696.72

O'REILLY'S AUTO PARTS

THOMASVILLE

GA $75,610.20

ORIENTAL WEAVERS RUG MFG CO IN DALTON

GA $225,732.69

ORIGINAL APPALACHIAN ARTWORKS

CLEVELAND

GA $125,739.71

OVERHEAD DOOR CORP.

ATHENS

GA $33,356.00

OWENS & PRIDGEN, INC.

BRUNSWICK

GA $33,175.32

OWENS SIDING AND REMODELING

ROSSVILLE

GA $163,546.32

OXFORD INDUSTRIES

TOCCOA

GA $6,235.73

OXFORD OF DUBLIN

DUBLIN

GA $3,825.38

PACTIV

COVINGTON

GA $34,855.46

PALM HARBOR HOMES, INC./NATION

ARABI

GA $20,031.30

PANAPRINT, INC.

MACON

GA $22,536.44

PAPER PAK PRODUCTS

WASHINGTON

GA $104,207.56

PARKWAY GARDEN CHAPEL

FOREST PARK

GA $186,997.20

PARTITIONS INC

CLARKSTON

GA $844.96

PATTEN SEED CO.

LAKELAND

GA $935.01

PAYCHEX BUS. SOL/ARBOR NOM

NORCROSS

GA $685.56

PAYCHEX INC

KENNESAW

GA $16,696.01

PEACH STATE FAIR INC

GAINESVILLE

GA $1,214.43

PEAKE HEALTHCARE CENTER

MACON

GA $53,399.57

PEASE CONSTRUCTION COMPANY INC ST. SIMONS

GA $54,828.91

PEDIATRIC SERVICES OF AMERICA

NORCROSS

GA $4,895.62

PENDLETON CREEK FARMS

VIDALIA

GA $4,390.94

PEOPLEASE CORP.

WASHINGTON

GA $94,835.37

PEOPLEASE CORP.

MT. PLEASANT

SC $43,384.45

PEP BOYS INC.

LILBURN

GA $79,250.00

PEPSI-COLA COMPANY

ATLANTA

GA $5,820.37

PETE ALEWINE POOL CO. INC.

MARTINEZ

GA $104,701.52

PETERSON AMERICAN CORP.

ATHENS

GA $304,380.30

PETSMART INC

SMYRNA

GA $520.46

PETSMART INC

DOUGLASVILLE

GA $64,761.82

PHILIP SERVICES CORP.

LAKE CITY

GA $7,166.65

45

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

PHOENIX CRANE RENTAL CO.

MABLETON

GA $68,056.77

PIERCE & COMPANY, INC.

CONYERS

GA $92,224.70

PIERCE CO BOARD OF EDUCATION

BLACKSHEAR

GA $10,515.96

PIGGLY WIGGLY

BLUE RIDGE

GA $11,803.03

PIGGLY WIGGLY SOUTHERN

VIDALIA

GA $4,510.00

PIKE ELECTRIC INC.

MOUNT AIRY

NC $38,230.02

PILGRIM'S PRIDE CORPORATION

ATHENS

GA $73,101.56

PINE RIDGE MEMORIAL PARK

KENNESAW

GA $34,697.76

PIOLAX CORPORATION

CANTON

GA $26,658.73

PIPE CONSTRUCTION

ST. SIMONS ISLAND GA $119,867.47

PITNEY BOWES

NORCROSS

GA $15,720.06

PIZZA HUT, INC.

WOODSTOCK

GA $8,099.68

PLANTERS TIRE & AUTO SERVICE

FITZGERALD

GA $2,185.58

PLATEAU EXCAVATION

AUSTELL

GA $194,180.18

PLAYNATION PLAY SYSTEMS, INC.

KENNESAW

GA $2,776.48

PLYMART, INC.

MARIETTA

GA $35.08

POETIC LICENSE, INC.

ATLANTA

GA $161,832.30

POLK COUNTY SCHOOLS

CEDARTOWN

GA $55,267.06

POLLUTION EQUIPMENT MGMT. CO.

ATLANTA

GA $19,894.45

PORTEC INC

WINDER

GA $3,520.00

POST PROPERTIES, INC.

ATLANTA

GA $8,950.97

POWERHOUSE, INC.

ATLANTA

GA $1,802.69

PRD ENTERPRISES

WAYCROSS

GA $573.44

PREMARK INTERNATIONAL INC.

CHAMBLEE

GA $1,985.12

PREMIER TRANSPORTATION

FOREST PARK

GA $74,520.25

PRESTIGE FUND RAISERS/PFR LLC

TYRONE

GA $42,997.77

PRIME CARE NURSING SERVICE INC

ROME

GA $263.04

PRIME SOURCE

SAVANNAH

GA $4,303.25

PRIORITY ONE SERVICES

ALEXANDRIA

VA $81,065.00

PROCORE SOLUTIONS

MARIETTA

GA $230,663.24

PROFESSIONAL TRANSPORTATION

EVANSVILLE

IN

$18,304.51

PROPERTY RESOURCES, INC.

DECATUR

GA $286.38

PRS CONSTRUCTION LLC

ROSWELL

GA $6,557.74

PTREE/CARDON DOORS & WINDOWS

GAINSVILLE

GA $10,827.52

PUBLIX

ACWORTH

GA $5,351.25

PUBLIX

ALPHARETTA

GA $110,405.32

PUBLIX

ATLANTA

GA $33,717.20

PUBLIX

BRASELTON

GA $27,464.96

PUBLIX

CANTON

GA $51,634.27

PUBLIX

COLUMBUS

GA $6,252.10

46

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

PUBLIX

CONYERS

GA $389.83

PUBLIX

DACULA

GA $137,306.83

PUBLIX

KENNESAW

GA $130,392.39

PUBLIX

LAKELAND

FL $3,288.04

PUBLIX

LITHONIA

GA $16,079.93

PUBLIX

LOGANVILLE

GA $3,172.11

PUBLIX

NEWNAN

GA $290.27

PUBLIX

NORCROSS

GA $17,014.00

PUBLIX

POWDER SPRINGS GA $3,020.83

PUBLIX

ROSWELL

$16,687.93

PUBLIX

SMYRNA

GA $32,169.14

PUBLIX

SNELLVILLE

GA $1,086.44

PUBLIX

VALDOSTA

GA $75,092.56

PUBLIX

WARNER ROBINS

GA $26,534.64

PUBLIX

WOODSTOCK

GA $3,741.22

PYLES PLUMBING & UTITLITY

MACON

GA $42,325.93

QUAD GRAPHICS

THE ROCK

GA $26,798.06

QUALITY DIST.-QUALA SYSTEMS

AUGUSTA

GA $63,345.80

QUALITY ENTERPRISES USA, INC.

ATLANTA

GA $38,322.07

QUALITY MACHINE & FAB.

LAFAYETTE

GA $10,457.60

QUEBECOR - AUGUSTA

EVANS

GA $153,440.30

QUICK CHANGE #33

DOUGLAS

GA $12,459.68

R & D MANUFACTURING CO., INC.

GAINESVILLE

GA $126.62

R & M GRADING & HAULING

KENNESAW

GA $7,248.17

R & W LOGISTICS

AUGUSTA

GA $136,192.28

R J REYNOLDS TOBACCO

WINSTON-SALEM

NC $38,538.96

R. J. REYNOLDS TOBACCO CO.

MACON

GA $55,800.00

R.L. HAWKINS CONSTRUCTION CO

ATHENS

GA $2,120.28

R.W. ALEXANDER CONTRACTORS

VALDOSTA

GA $50.00

RAGGHIANTI FOUDATIONS

ALPHARETTA

GA $682.52

RANDSTAD NORTH AMERICA

ATLANTA

GA $1,211.81

RANEW'S PAINT & BODY SHOP

MILNER

GA $12,488.65

RARE HOSPITALITY INTERNATIONAL

DOUGLASVILLE

GA $36,091.35

RAYLOC

ATLANTA

GA $7,525.00

RAYONIER INC

JESUP

GA $545,478.52

RAYONIER, INC.

MIDVILLE

GA $9,310.00

RAZZI CORP.

ALPHARETTA

GA $28,444.46

RCS INC

NORCROSS

GA $1,840.00

RCS-GRIFFON CORP

CONYERS

GA $62,342.73

REDMOND REGIONAL MEDICAL CTR

ROME

GA $66,636.34

47

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

REEVES & WAGNER CONSTRUCTION

WOODSTOCK

GA $246,311.01

REEVES TRUCKING CO., INC.

FITZGERALD

GA $10,617.56

REGAL MARINE INDUSTRIES

VALDOSTA

GA $13,663.70

RELIABLE FASTENERS INC

SMYRNA

GA $28,531.41

RELIANCE HEATING & AIR COND.

CONYERS

GA $13,900.27

REMEDIATION SERVICES, INC.

FITZGERALD

GA $20,687.56

RENT-A-CENTER

ROME

GA $4,676.61

RENTOKIL CONTRACT SVC., INC.

DULUTH

GA $467.23

RENTOKIL, INC.

ATLANTA

GA $22,913.88

RENTZ COMMUNICATIONS INC.

BAXLEY

GA $43,193.36

REPUBLIC SERVICES, INC.

WINDER

GA $16,375.49

RESCAR, INC.

GORDON

GA $22,238.96

RESCARE GEORGIA

TUCKER

GA $12,985.47

RESPIRONICS, INC.

KENNESAW

GA $23,667.66

REYNOLDS METALS

MOULTRIE

GA $62,584.98

RHEEM MANUFACTURING CO.

MILLEGEVILLE

GA $835,211.76

RHEEM MANUFACTURING CO.

NEW YORK

NY $25,311.18

RHEEM MANUFACTURING CO.

TAMPA

FL $19,202.19

RICHARDSON HOUSING GROUP INC

LAWRENCEVILLE

GA $28,253.66

RICH'S

ATLANTA

GA $3,475.36

RICOH ELECTRONICS

LAWRENCEVILLE

GA $7,516.29

RIDDLE ACOUSTICS, INC.

HAHIRA

GA $4,582.18

RIDGEWOOD MANOR

DALTON

GA $80,334.68

RIVERWOOD TOWNHOUSE, INC

ATLANTA

GA $115,815.44

RJ REYNOLDS TOBACCO CO

MACON

GA $13,228.13

RJK ENTERPRISES INC

COLUMBUS

GA $30,038.21

ROBERT M. ANDERSON, INC.

COVINGTON

GA $3,847.61

ROBERT SHAW CONTROLS CO.

ELLIJAY

GA $6,344.78

ROCKDALE PIPELINE

CONYERS

GA $132,428.00

ROGERS CARTAGE CO.

FORSTON

GA $78,985.26

ROGERS CASH & CARRY

THOMASTON

GA $7,175.00

ROME CITY SCHOOLS

ROME

GA $13,955.34

ROME ELECTRIC MOTOR WORKS

ROME

GA $64,475.40

ROME TOOL & DYE COMPANY, INC.

ROME

GA $195,231.26

RONILE OF GEORGIA, INC.

LAFAYETTE

GA $1,446.83

ROSS SIMON

CRANSTON

RI

$21,874.92

ROSS STORES, INC.

CANTON

GA $29,347.94

ROSS VENTURES

MAYSVILLE

GA $208,774.29

ROYAL AMERICAN

PANAMA CITY

FL $22,523.84

ROYS BOYS PIZZA

LOGANVILLE

GA $100,770.90

48

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

RUAN TRANSPORT CORPORATION

ATLANTA

GA $127.66

RUAN TRANSPORT CORPORATION

CEDARTOWN

GA $132,890.75

RUAN TRANSPORT CORPORATION

DES MOINES

IA

$46,358.84

RUSHDAH INC

NEWNAN

GA $805.61

RYERSON TULL INC

NORCROSS

GA $147.03

S & S ELECTRIC

WINDER

GA $43,201.89

S & S GRILL

ELBERTON

GA $27,596.30

S. LICHTENBERG & CO. INC.

WAYNESBORO

GA $7,702.39

SADDLE CREEK CORPORATION

VILLA RICA

GA $8,052.81

SAFETY KLEEN CORP

NORCROSS

GA $132,814.64

SAFT AMERICA, INC

VALDOSTA

GA $1,409.87

SAIA MOTOR FREIGHT

ATLANTA

GA $500.00

SAINT GOBAIN CORP

VALLEY FORGE

PA $13,748.84

SAMSONITE CORP

COMMERCE

GA $34,247.08

SAMUEL CHEATWOOD

HEPHZIBAH

GA $866.10

SARA LEE BAKERY GROUP

FOREST PARK

GA $143,174.78

SARA LEE CORPORATION

AUSTELL

GA $18,879.99

SARA LEE CORPORATION

FOREST PARK

GA $138,126.74

SARA LEE CORPORATION

ROME

GA $867.47

SARPJ, INC

LAKE WORTH

FL $17,433.99

SAVANNAH CHRISTIAN PREP. SCH

SAVANNAH

GA $20,820.13

SCALE SYSTEMS

NORCROSS

GA $28,825.84

SCAPE DRYER FABRICS

WAYCROSS

GA $22,734.03

SCHOLASTIC INC

KENNESAW

GA $34,740.44

SCHUFF INTERNATIONAL

ALBANY

GA $84,005.00

SCI @ SANDY CREEK

WAYCROSS

GA $100,453.47

SCI/STOCKBRIDGE SENIOR LIVING

TAMPA

FL $76,879.81

SCOTT'S LAWN SERVICE

NORCROSS

GA $21,231.95

SCOVILL

CLARKESVILLE

GA $47,476.93

SEA ISLAND COMPANY

SEA ISLAND

GA $31,123.15

SEARS ROEBUCK & CO.

KENNESAW

GA $167,612.00

SEARS ROEBUCK & CO.

ALBANY

GA $1,032.45

SECURITY FINANCE

VIDALIA

GA $26,961.09

SECURITY GROUP INC

SPARTANBURG

SC $14,729.43

SERVICE MERCHANDISE

BRENTWOOD

TN $19,525.00

SERVPRO OF EAST COBB

MARIETTA

GA $9,080.36

SHAW INVESTMENTS INC

ROCKY FACE

GA $3,010.00

SHEPARD EXPOSITION SERVICES

ATLANTA

GA $634.26

SHO ENTERPRISES

SMYRNA

GA $4,861.21

SHOE CITY, INC.

MONTGOMERY

AL $66,496.35

49

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

SHOWHOMES OF ATLANTA

ALPHARETTA

GA $4,457.97

SIEMENS ENERGY & AUTOMATION

STONE MOUNTAIN GA $1,539.86

SIEMENS ENERGY & AUTOMATION

TUCKER

GA $40,950.83

SIEMENS ENERGY CORP

ALPHARETTA

GA $5,206.03

SIEMENS WATER TECHNOLOGIES

THOMASVILLE

GA $32,609.37

SIGNAL MACHINE COMPANY

FT. OGLETHORPE

GA $1,336.40

SIGVARIS INC

PEACHTREE CITY

GA $99,978.34

SIMKINS INDUSTRIES, INC.

MARIETTA

GA $11,854.06

SIMPLEX GRINNELL / TYCO INTERN

CONYERS

GA $30,960.00

SINGLE SOURCE TRANSPORT

GARDEN CITY

GA $836.97

SITE MASTER, INC.

EVANS

GA $83,896.66

SITEL CORP

WAYCROSS

GA $50,683.43

SIX FLAGS OVER GEORGIA

ATLANTA

GA $185,275.09

SKILSTAFF INC

ALEXANDER CITY

AL $6,116.98

SKYWEST AIRLINES

ATLANTA

GA $15,567.04

SMCS AMERICAN RESIDENTIAL SERV

MARIETTA

GA $107,527.99

SMCS-TERMINIX

ATHENS

GA $17,919.04

SMCS-TERMINIX

LAGRANGE

GA $765.04

SMITH & SONS FOODS, INC

ATLANTA

GA $1,534.46

SMITH & SONS FOODS, INC

MACON

GA $65,396.00

SMITH-GRAY ELECTRIC CO. INC.

COLUMBUS

GA $102,740.13

SNELLING PERSONNEL

STATESBORO

GA $115,438.09

SOLO CUP

AUGUSTA

GA $16,442.94

SOLVAY PHARMACEUTICALS

MARIETTA

GA $3,206.67

SONY MUSIC

CARROLLTON

GA $223,700.65

SOUTHEAST EXPRESS LUBES

ATLANTA

GA $169,117.82

SOUTHEAST PIPE SURVEY

PATTERSON

GA $2,223.01

SOUTHEASTERN EQUIPMENT CO INC

AUGUSTA

GA $24,447.37

SOUTHEASTERN FREIGHT LINE

SUWANEE

GA $4,839.50

SOUTHEASTERN HOSE

BREMEN

GA $40,644.57

SOUTHEASTERN PORTABLE BLDG INC EATONTON

GA $93,966.84

SOUTHER STORES

CORDOVA

TN $47,650.89

SOUTHERN CONCRETE CONSTRUCTION ALBANY

GA $12,144.88

SOUTHERN CRAFT MASTERS

LOGANVILLE

GA $681,918.02

SOUTHERN FOODSERVICE MGMT

BRUNSWICK

GA $3,827.60

SOUTHERN FOREST INDUSTRIES

SMARR

GA $136,607.14

SOUTHERN HOME CARE SVCS.

VALDOSTA

GA $6,769.81

SOUTHERN SAW SERVICE LP

ATLANTA

GA $48,358.51

SOUTHERN STAIRCASE

ALPAHRETTA

GA $73,282.15

SOUTHERN WAREHOUSE SERVICES

MACON

GA $18,053.47

50

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

SOUTHERNWOOD CABINETS, INC.

TEMPLE

GA $14,823.77

SOUTHLAND WASTE SYSTEMS OF GA BRUNSWICK

GA $59,939.13

SOUTHSIDE MECHANICAL, INC

FAYETTEVILLE

GA $181,790.56

SPARTA HEALTH CARE

SPARTA

GA $453.76

SPARTAN MECHANICAL INC

CHAMBLEE

GA $35,026.78

SPC COMPANY

LAGRANGE

GA $20,689.05

SPECTRA GEM, INC.

NORCROSS

GA $119,361.14

SPECTRUM CABLE SERVICES

JONESBORO

GA $44,559.96

SPECTRUM STORES

WEST POINT

GA $11,125.93

SPIRIT CONSTRUCTION SERVICES

SAVANNAH

GA $6,791.03

SPORTRAN, INC.

LAWRENCEVILLE

GA $10,287.31

SPRINGHILL SERVICES INC

MCINTYRE

GA $145,424.33

STAFFING CONCEPTS, INC.

GAINESVILLE

GA $109,506.60

STAFFING SOLUTIONS

GAINESVILLE

GA $11,715.01

STAFFORDS SPORTING GOODS

THOMASVILLE

GA $96,445.89

STANDRIDGE COLOR CORP.

SOCIAL CIRCLE

GA $11,820.84

STAPLES, INC

ATLANTA

GA $232,461.49

STAR MANUFACTURING COMPANY

CEDARTOWN

GA $35,209.03

STATEWIDE HEALTH CARE INC

SAVANNAH

GA $8,264.23

STEAK N SHAKE

TIFTON

GA $10,510.63

STEPHENS COUNTY SCHOOLS

TOCCOA

GA $8,563.55

STEPHENS PIT STOP

YOUNG HARIS

GA $214,350.25

STEVE CRAWFORD FOREST PROD.

WAYNESBORO

GA $32,885.79

STOCK BUILDING SUPPLY

TUCKER

GA $8,048.74

STOFFEL SEALS CORP

TALLAPOSSA

GA $1,869.67

STOKES CONTRACTING CO

BLOOMINGDALE

GA $13,200.00

STRUCTURAL SPECIALTIES

VALDOSTA

GA $83,994.55

SULLIVANS ADMINISTRATIVE MGR.

SAVANNAH

GA $69,755.47

SUMTER REGIONAL HOSPITAL

AMERICUS

GA $13,673.59

SUN INTERNATIONAL TRAVEL

NORCROSS

GA $14,412.00

SUNDANCE PLUMBING, INC.

MARIETTA

GA $7,000.00

SUNLINK HEALTH SYSTEMS

ELLIJAY

GA $102,799.16

SUNSHINE BISQUITS, INC

COLUMBUS

GA $14,738.77

SUNTRUST BANK

ATLANTA

GA $11,487.81

SUPER 8 MOTEL

COLUMBUS

GA $10,034.49

SUPERIOR ELECTRIC

JULIETTE

GA $6,750.00

SUPERIOR PANTS COMPANY

ATHENS

GA $6,705.13

SUPREME CARPET, INC.

CHATSWORTH

GA $8,911.23

SUWANEE TIMBER INC

FARGO

GA $17,947.64

SWAN CONSTRUCTION CO.

AUGUSTA

GA $49,921.25

51

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

SWIFTY SERVE CORP

CORAOOPLOIS

PA $5,013.79

SYDELL, INC. D/B/A SPA SYDELL

ATLANTA

GA $2,502.00

SYNOVUS FINANCIAL CORP.

COLUMBUS

GA $5,425.00

SYSTEM SERVICES AND INDUSTRIAL

SAVANNAH

GA $6,594.49

T.T.C. ILLINOIS, INC.

KANKAKEE

IL

$26,037.22

TAP PHARMACEUTICAL

LAKE FOREST

IL

$54,706.09

TAPPI TECHNICAL ASSOC THE PULP

NORCROSS

GA $11,360.00

TARTAN TEXTILE SERVICES

ROME

GA $18,801.63

TAYLOR ORCHARDS, INC.

REYNOLDS

GA $53,229.11

T-BONZ MANAGEMENT, INC.

CHARLESTON

SC $5,093.17

TEETS INTERNATIONAL TRUCKS INC

AUGUSTA

GA $4,400.00

TEL TEC, INC.

CORBIN

KY $11,804.96

TEMPLE-INLAND, INC. F/K/A

ROME

GA $242,188.00

TENNECO AUTOMOTIVE INC

HARTWELL

GA $168,365.68

TENNECO OIL CO.

MOULTRIE

GA $14,037.41

TEXAS ROADHOUSE

GAINESVILLE

GA $61,339.36

THACKSTON & SONS CONSTRUCTION MARIETTA

GA $5,960.13

THE AUGUSTA CHRONICLE

AUGUSTA

GA $86,043.16

THE BOEING COMPANY

MACON

GA $7,743.68

THE BOOK WAREHOUSE

KNOXVILLE

TN $6,750.00

THE DARIEN NEWS, INC.

DARIEN

GA $25,480.54

THE GARDENS AT TOWNE LAKE

WOODSTOCK

GA $190.44

THE KINGS CARPENTERS, INC.

CANTON

GA $27,539.15

THE LIGHTHOUSE RESTAURANT

MILNER

GA $31,942.87

THE MASQUERADE, INC.

ATLANTA

GA $53,013.94

THE MOTOR CONVOY, INC.

ATLANTA

GA $4,030.00

THE RAYMOND KING CO., INC.

CALHOUN

GA $21,042.26

THE SEA PALMS CORP

ST SIMONS ISLAND GA $77,351.26

THE SPORTS AUTHORITY

AUGUSTA

GA $3,750.56

THE TAPPAN COMPANY

DALTON

GA $8,468.08

THE TIMKEN CO.

DAHLONGA

GA $14,105.20

THE WILLIAM L BONNELL CO., INC

NEWNAN

GA $6,977.34

THOMAS AND BETTS

BAINBRIDGE

GA $10,514.84

THOMAS CONCRETE OF GEORGIA INC ATLANTA

GA $37,233.17

THOMAS COUNTY BD OF EDUCATION

THOMASVILLE

GA $4,905.88

THOMPSON CONSTRUCTION CO.

CHAMBLEE

GA $14,539.95

THOMPSON HARDWOODS, INC.

HAZELHURST

GA $22,116.84

THOMSON OAK FLOORING CO.

THOMSON

GA $9,750.00

THREE DOLLAR CAFE V INC

KENNESAW

GA $3,251.85

TIFTON ALUMINUM CO., INC.

TIFTON

GA $13,490.10

52

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

TIMBER HARVESTING, INC.

DANVILLE

GA $13,580.71

TIMESAVER, INC- 56

TWIN CITY

GA $19,393.28

TIMKEN U.S. CORPORATION

DAHLONEGA

GA $19,516.31

TIRE KINGDOM

RIVIERA BEACH

FL $29,295.09

TIRE PRO INC.

LAGRANGE

GA $18,700.00

TJ MAXX COMPANIES, INC.

WARNER ROBBIN

GA $1,633.94

TOLBERT PLASTERING CO. INC.

ATHENS

GA $108,951.95

TOM JAMES CO

BREMEN

GA $25,935.79

TOMMY L GRIFFIN PLUMBING AND

MACON

GA $1,056.75

TOM'S FOODS, INC.

COLUMBUS

GA $15,725.00

TOOMSBORO NURSING CTR

COLUMBUS

GA $878.25

TOPCOR SVC

BATON ROUGE

LA $16,632.62

TOWN OF TRION POLICE DEPT.

TRION

GA $56,510.14

TOWNS COUNTY B. O. E.

HIAWASSEE

GA $1,336.25

TPS STAFFING INC.

DALTON

GA $118,202.52

TRAMMEL CROW RESIDENTIAL

ATLANTA

GA $16,343.08

TRANE UNITARY PRODUCTS

VIDALIA

GA $204.93

TRANSCO RAILWAY PRODUCTS, INC

MACON

GA $5,716.62

TRANSPORTATION SERVICES UNLMTD ETON

GA $18,226.38

TRANSPOWER

ALBANY

GA $5,497.35

TREDEGAR CORPORATION

NEWNAN

GA $8,457.61

TRENT TUBE DIVISION

CARROLLTON

GA $7,928.88

TRI COUNTY AMBULANCE

ELLIJAY

GA $102,991.06

TRIANGLE PACIFIC CORPORATION

ATLANTA

GA $37,507.97

TRINTEX CORP.

BOWDON

GA $21,007.60

TRIPLE CROWN MEDIA, INC.

ALBANY

GA $75.04

TRIVEST INC

MIAMI

FL $12,152.00

TRIWOOD CORP. OF GEORGIA

AMERICUS

GA $500.00

TRIZECHAHN CORPORATION

ATLANTA

GA $5,940.24

TRUCK & I INC

ATLANTA

GA $6,693.96

TRUCKSTOPS OF AMERICA

BRUNSWICK

GA $76,685.16

TRUETT MCCONNELL COLLEGE

CLEVELAND

GA $1,329.46

TRUI-CHECK INC

SOMERSET

KY $5,525.68

TRW-BRUNSWICK JOB CORPS

BRUNSWICK

GA $63,319.06

TUCKER CONCRETE CO.

TUCKER

GA $47,618.17

TUFTCO CO.

DALTON

GA $7,744.35

TURBINE ENGINE COMPONENTS

THOMASVILLE

GA $22,382.85

TURNER BROADCASTING SYS., INC

ATLANTA

GA $285.46

TUXEDO GLASS & MIRROR CO. INC.

ATLANTA

GA $15,915.70

TYBRISS BEACH RESORT CONDOMINI TYBEE ISLAND

GA $12,137.69

53

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

TYTAM SERVICES INC

STOCKBRIDGE

GA $288,750.55

U.S. CAN CO

MORROW

GA $100,629.20

U.S. CAN CO

TALLAPOOSA

GA $22,212.31

U.S. ELEVATOR CORP.

ATLANTA

GA $47,943.44

U.S. INDUSTRIES, INC.

VALDOSTA

GA $28,114.28

UNITED DISTRIBUTORS, INC.

SMYRNA

GA $106,931.21

UNITED DISTRIBUTORS, INC.

SAVANNAH

GA $4,368.64

UNITED DISTRIBUTORS, INC.

ALBANY

GA $7,631.02

UNITED NORTH TRANSFER STATION

WINDER

GA $86,616.18

UNITED PARCEL SERVICE

ATLANTA

GA $81,279.95

UNITED PARCEL SERVICE

BLACKSHEAR

GA $1,430.92

UNITED PARCEL SERVICE

DORAVILLE

GA $16,083.37

UNITED PARCEL SERVICE

FOREST PARK

GA $1,894.22

UNITED PARCEL SERVICE

JACKSONVILLE

FL $7,228.42

UNITED PARCEL SERVICE

UNADILLA

GA $12,128.03

UNITED SERVICES CONTRACTING

ALPHARETTA

GA $45,399.88

UNITED STATIONERS SUPPLY CO.

SUWANEE

GA $4,736.24

UNIVERSAL TRAILER

FITZGERALD

GA $69,679.38

US BATTERY MANUFACTURING CO

AUGUSTA

GA $56,159.70

US FOODSERVICE

FAIRBURN

GA $14,101.73

US XPRESS ENTERPRISES INC.

CHATTANOOGA

TN $34,115.75

USABILITY SYSTEMS

ALPHARETTA

GA $86,787.30

UTILITIES CONST. CO OF SC

CHARLESTON

SC $22,309.98

V.T. GRIFFIN SERVICES

KINGS BAY

GA $27,103.78

VAL-U-MAX SUPERMARKETS

ALAMO

GA $75,622.29

VARN TURPENTINE & CATTLE

FOLKSTON

GA $12,553.38

VARN TURPENTINE & CATTLE

JACKSONVILLE

FL $5,070.99

VINCE HOSIERY MILL

VILLA RICA

GA $13,697.58

VISION WEB PRESS, INC.

LILBURN

GA $53,892.63

VISITING NURSES ASSOCIATION

BAXLEY

GA $114,815.00

VLR CONSTRUCTION NC.

KENNESAW

GA $3,403.67

VOS ELECTRIC

GREEN BAY

WI $4,950.00

VT INDUSTRIES, INC.

ROME

GA $28,593.92

W & J, INC.

SMYRNA

GA $12,238.40

W. M. WRIGLEY, JR., CO.

GAINESVILLE

GA $4,500.00

W.A. BRAGG & CO.

AUGUSTA

GA $31,313.74

W.A.R. TRUCKING COMPANY, INC.

LITHONIA

GA $7,487.95

W.C. BRADLEY CO., INC.

COLUMBUS

GA $108,400.00

WACHOVIA CORP

COLUMBUS

GA $12,491.13

WADE & SONS INC

MACON

GA $6,650.00

54

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

WAGA TV/FOX 5

ATLANTA

GA $13,509.63

WALKER BROTHERS, INC.

FAIRBURN

GA $42,184.32

WALKER CO RURAL WATER & SEWAGE ROCK SPRING

GA $22,090.02

WALKER NURSERY FARMS

JONESBORO

GA $185.87

WAL-MART

AUGUSTA

GA $736.79

WAL-MART

AUSTELL

GA $12,510.68

WAL-MART

CALHOUN

GA $54,191.28

WAL-MART

CANTON

GA $114,414.79

WAL-MART

DAHLONEGA

GA $47,837.47

WAL-MART

DALTON

GA $50,629.67

WAL-MART

DOUGLAS

GA $348,392.63

WAL-MART

FITZGERALD

GA $23,670.90

WAL-MART

HIRAM

GA $208,944.85

WAL-MART

LAGRANGE

GA $14,463.38

WAL-MART

MARIETTA

GA $500.00

WAL-MART

MCDONOUGH

GA $80,921.43

WAL-MART

NEWNAN

GA $8,148.37

WAL-MART

ROME

GA $59,063.74

WAL-MART

SANDERSVILLE

GA $163,002.80

WAL-MART

SAVANNAH

GA $127,977.36

WAL-MART

THOMSON

GA $88,590.92

WAL-MART

TIFTON

GA $95,716.92

WAL-MART

TOCCOA

GA $17,411.06

WAL-MART

VALDOSTA

GA $146,137.57

WAL-MART

WINDER

GA $246,133.01

WALTERS MANAGEMENT COMPANY

GAINESVILLE

GA $27,237.77

WARD CONSTRUCTION INC.

CORNELIA

GA $31,707.18

WASTE MANAGEMENT OF ATLANTA

LAKE CITY

GA $41,136.67

WATER, GAS & LIGHT COMMISSION

ALBANY

GA $4,730.00

WATKINS & SHEPARD TRUCKING

MISSOULA

MT $241.05

WATSON-HUNT FUNERAL HOME

PERRY

GA $71,354.79

WAYCON PIZZA ENTERPRISES

ATHENS

GA $55,772.90

WAYCROSS COCA-COLA

WAYCROSS

GA $14,878.62

WAYNE POULTRY

PENDERGRASS

GA $7,231.55

WAYNE SHEET METAL WORKS

JESUP

GA $22,675.15

WELCH TARKINGTON INC.

ATLANTA

GA $30,349.22

WELLSTONE INVESTORS, LLC

LAVONIA

GA $88,286.70

WERNER ENTERPRISES

ATLANTA

GA $123,711.47

WESLEY WILKES

ELLABELL

GA $102,709.95

WESLEYAN COLLEGE

MACON

GA $3,730.22

55

Individual Employers Benefiting From Reimbursements

Paid to Insurance Companies by The Subsequent Injury Trust Fund

01/01/2010 Through 12/31/2010

WEST GA EYE CARE CTR

COLUMBUS

GA $38,859.56

WEST GEORGIA AUTO PARTS INC

CARROLLTON

GA $4,840.00

WEST MARINE INC

BRUNSWICK

GA $7,276.00

WESTEK INC.

THOMASTON

GA $112,787.46

WESTSIDE HEATING & AIR

EVANS

GA $3,865.75

WHISNANT CONTRACTING CO.

STOCKBRIDGE

GA $18,103.49

WHITEHALL JEWELLERS

MORROW

GA $62,397.61

WHITLOW ELECTRIC SERVICE INC.

ELBERTON

GA $21,663.23

WIKA INSTRUMENT CORP

LAWRENCEVILLE

GA $8,065.04

WILKINSON CO. BD OF EDUCATION

IRWINGTON

GA $1,132.89

WILLIAM CARTER CO

BARNESVILLE

GA $86,206.73

WILLIAM CARTER CO

HOGANSVILLE

GA $19,358.42

WILLIAMS SERVICE GROUP

MILLEDGVILLE

GA $30,843.31

WILLIAMSON RENTALS

MONROE

GA $156.00

WILLINGHAM MECHANICAL INC.

BOLINGBROKE

GA $66,283.56

WILSON BROTHERS, INC.

GLENNVILLE

GA $21,512.08

WIRLWIND STEEL BUILDINGS, INC.

LITHIA SPRINGS

GA $228,587.68

WOODCREST, INC.

ATLANTA

GA $306.86

WOODRUFF CO

COLUMBUS

GA $5,805.42

WORLD CHAMPIONSHIP WRESTLING

SMYRNA

GA $132,421.63

WOW EXPRESS INC.

MONROE

GA $32,246.57

WRIGLEY MFG CO.

FLOWERY BRANCH GA $238.61

WSM TRUCKING CO., INC.

ROME

GA $86,139.17

YAMAHA MUSIC MFG.

THOMASTON

GA $11,221.00

YATES BLEACHERY CO.

FLINTSTONE

GA $8,583.60

YONAH MOUNTAIN MFG. CORP.

CLEVELAND

GA $26,413.88

YORK INTERNATIONAL

DULUTH

GA $3,182.80

ZARTIC, INC.

CEDARTOWN

GA $40,085.59

ZARTRAN, INC.

CEDARTOWN

GA $113,075.00

Total

$61,436,660.21

ASSESSMENT
Legal Requirements 34-9-358. Payment of assessments to fund by insurers and self-insurers
(a) Prior to January 1, 2010, each insurer and self-insurer under this chapter shall, under regulations prescribed by the board of trustees, make payments to the fund in an amount equal to that proportion of 175 percent of the total disbursement made from the

56
fund during the preceding calendar year less the amount of the net assets in the fund as of December 31 of the preceding calendar year which the total workers' compensation claims paid by the insurer or self-insurer bears to the total workers' compensation claims paid by all insurers and self-insurers during the preceding calendar year.
(b) On or after January 1, 2010, each insurer and self-insurer under this chapter shall, under regulations prescribed by the board of trustees, make payments to the fund in an amount equal to that proportion of 175 percent of the total disbursement made from the fund during the preceding calendar year as of December 31 of the preceding calendar year which the total workers' compensation claims paid by the insurer or self-insurer bears to the total workers' compensation claims paid by all insurers and self-insurers during the preceding calendar year but not to exceed $100 million. The administrator is authorized to create and maintain a reserve of surplus moneys as may be deemed necessary by the board of trustees in order to ensure sufficient moneys will be available for the payment of all claims that are to be paid by the fund in accordance with Code Section 34-9-368.
(c) The administrator is authorized to reduce or suspend assessments for the fund when a completed actuarial survey shows further assessments are not needed for all bona fide claims that are to be paid by the fund.
34-9-359. Reports by employers of compensation and benefits paid; failure to pay assessments
(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

57
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.

58

ASSESSMENT CALCULATION 2010

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 2009
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2009 was $100,000,000.00. This was computed in the following manner:

Total Fund disbursements/calendar year 2009 $156,766,700.23

Fund Assessment not to exceed $100 million Fund Assessment

x

175%

$274,341,725.40

$100,000,00.00

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 2009 was $1,422,201,091.66. This amount is divided into the fund assessment of $100,000,000.00 and yields an (adjusted) assessment rate of .07031354. This adjustment has caused an increase to be applied to the 2009 assessment.

Assessment Rate for 2010
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2010 is $100,000,000.00. This was computed in the following manner:

Total Fund disbursements/calendar year 2010 $130,030,064.07

x

175%

Fund Assessment not to exceed $100 million $227,552,612.12

Fund Assessment

$100,000,000.00

Based on data received from insurers and self-insured employers, the reported total of workers' compensation benefits paid in Georgia during calendar year 2010 was $1,436,130,515.24. This amount is divided into the fund assessment of $100,000,000.00, which yields an assessment rate of .06963155.

In addition to the assessment, an additional $106,457.46 in penalties for late filing of Claims Loss report forms will be levied.

59

ASSESSMENTS DUE FOR 2010
Assessments Due from Insurance Companies

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMER ACCIDENT FUND NATIONAL INS CO ACCIDENT INSURANCE CO. ACE AMERICAN INSURANCE CO ACE FIRE UNDERWRITERS INS. CO ACE PROPERTY & CASUALTY INS ACIG INSURANCE COMPANY ADVANTAGE WORKERS COMP. INS. AEQUICAP INS CO - IN LIQUIDATI AIU INSURANCE CO ALEA NORTH AMERICA ALFA INSURANCE CORP ALL AMERICA INS. CO ALLMERICA FIN BENEFIT INS CO AMERICAN ALTERNATIVE INS AMERICAN AUTOMOBILE INS CO AMERICAN CAS CO OF READING PA AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY INSURANCE CO AMERICAN FIRE & CASUALTY CO AMERICAN GUAR & LIAB INS CO AMERICAN HARDWARE MUT INS AMERICAN HOME ASSURANCE CO AMERICAN INSURANCE CO AMERICAN INTER INS CO OF GA AMERICAN MFG. MUTUAL INS AMERICAN MOTORISTS INS CO AMERICAN RESOURCES INS CO

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

$22,677.70 $271,727.21 $16,448.44 $134,155.97 $2,035,153.45 $71,772.62 $209,066.83 $25,325.26 $5,319.09 $36,123.67 $32,955.50 $7,246.87 $2,230.11 $60,187.91 $0.00 $77,585.06 $5,371.59 $583,031.58 $0.00 $77,841.36 $0.00 $5,824.60 $71,240.55 $4,251.79 $2,493,275.90 $122,634.40 $730,151.96 $24,996.78 $97,064.22 $39,421.02

$22,689.34 $271,866.67 $16,456.88 $134,224.82 $2,036,197.99 $71,809.46 $209,174.13 $25,338.26 $5,321.82 $36,142.21 $32,972.41 $7,250.59 $2,231.26 $60,218.80 $0.00 $77,624.88 $5,374.35 $583,330.82 $0.00 $77,881.32 $0.00 $5,827.59 $71,277.12 $4,253.97 $2,494,555.58 $122,697.34 $730,526.71 $25,009.61 $97,114.04 $39,441.26

$210,917.00 $4,331,854.00 $294,804.00 $4,926,883.00 $29,529,887.00 $885,859.00 $3,188,182.00 $124,000.00 $286,275.00 $0.00 $692,267.00 $22,541.00 $83,640.00 $988,833.51 $30,093.00 $923,272.00 $227,323.00 $8,923,144.87 $13,914.00 $1,099,366.00 $427.00 $90,098.00 $1,339,333.31 $16,980.00 $22,161,916.00 $3,637,186.00 $10,350,793.50 $1,117,744.03 $3,388,036.77 $249,508.00

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$14,686.48 $301,633.71 $20,527.66 $343,066.50 $2,056,211.80 $61,683.74 $221,998.05 $8,634.31 $19,933.77 $0.00 $48,203.62 $1,569.56 $5,823.98 $68,854.01 $2,095.42 $64,288.86 $15,828.85 $621,332.41 $968.85 $76,550.56 $29.73 $6,273.66 $93,259.85 $1,182.34 $1,543,168.56 $253,262.90 $720,741.80 $77,830.25 $235,914.25 $17,373.63

$11.64 $139.46 $8.44 $68.85 $1,044.54 $36.84 $107.30 $13.00 $2.73 $18.54 $16.91 $3.72 $1.15 $30.89 $0.00 $39.82 $2.76 $299.24 $0.00 $39.96 $0.00 $2.99 $36.57 $2.18 $1,279.68 $62.94 $374.75 $12.83 $49.82 $20.24

$14,698.12 $301,773.17 $20,536.10 $343,135.35 $2,057,256.34 $61,720.58 $222,105.35 $8,647.31 $19,936.50 $18.54 $48,220.53 $1,573.28 $5,825.13 $68,884.90 $2,095.42 $64,328.68 $15,831.61 $621,631.65 $968.85 $76,590.52 $29.73 $6,276.65 $93,296.42 $1,184.52 $1,544,448.24 $253,325.84 $721,116.55 $77,843.08 $235,964.07 $17,393.87

60

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
AMERICAN SAFETY CASUALTY INS AMERICAN STATES INS CO AMERICAN STATES INS CO OF TX AMERICAN ZURICH INS CO AMERISURE INSURANCE CO AMERISURE MUTUAL INS CO AMGUARD INSURANCE CO. AMTRUST INS CO OF KS ANSUR AMERICAN INS CO ARCH INSURANCE CO ARGONAUT GREAT CENTRL INS CO ARGONAUT INSURANCE CO ARGONAUT LIMITED RISK INS CO ARGONAUT-MIDWEST INS CO ARROWOOD INDEMNITY 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 ATLANTIC STATES INS. CO. AUTO OWNERS INS. CO AXIS INSURANCE CO AXIS REINSURANCE CO BANCINSURE, INC. BANKERS STANDARD INS CO BENCHMARK INS CO BITUMINOUS CASUALTY CORP BITUMINOUS FIRE & MARINE INS BRIDGEFIELD CASUALTY BRIDGEFIELD EMPLOYERS INS. CO

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

$1,183.05 $43,493.25 $7,227.69 $1,489,946.46 $110,201.05 $120,468.80 $209,345.29 $35,194.18 $113,950.21 $381,426.47 $39,343.15 $68,119.88 $43,757.42 $43,440.40 $189,254.91 $26,733.48 $35,578.11 $108,323.23 $325,149.82 $67,395.39 $34.08 $19,561.31 $42,328.33 $29,664.96 $901,183.67 $17,134.77 $136.20 $5,948.71 $16,638.19 $103,928.50 $146,567.95 $8,075.28 $1,336,350.76 $0.00

$1,183.66 $43,515.57 $7,231.40 $1,490,711.17 $110,257.61 $120,530.63 $209,452.74 $35,212.25 $114,008.69 $381,622.24 $39,363.35 $68,154.84 $43,779.88 $43,462.70 $189,352.04 $26,747.20 $35,596.37 $108,378.83 $325,316.70 $67,429.98 $34.10 $19,571.35 $42,350.06 $29,680.19 $901,646.20 $17,143.57 $136.27 $5,951.76 $16,646.73 $103,981.84 $146,643.18 $8,079.43 $1,337,036.64 $0.00

$0.00 $1,001,578.00 $65,986.00 $29,787,620.27 $2,396,956.00 $2,115,702.00 $3,215,571.00 $366,945.00 $1,444,760.00 $5,314,414.00 $1,103,266.00 $662,793.00 $108,961.00 $411,279.00 $3,942,324.00 $159,855.00 $80,600.00 $1,652,549.00 $4,685,017.00 $991,445.20 $0.00 $324,903.00 $203,038.00 $285,920.00 $13,237,725.00 $7,871.00 $0.00 $121,817.00 $78,066.00 $1,056,943.00 $2,809,120.06 $155,636.31 $19,079,448.00 $897.00

2010
Assessment Amt

2009
Balance Due

$0.00 $69,741.43 $4,594.71 $2,074,158.17 $166,903.76 $147,319.61 $223,905.19 $25,550.95 $100,600.88 $370,050.88 $76,822.12 $46,151.30 $7,587.12 $28,637.99 $274,510.13 $11,130.95 $5,612.30 $115,069.55 $326,225.00 $69,035.87 $0.00 $22,623.50 $14,137.85 $19,909.05 $921,763.31 $548.07 $0.00 $8,482.31 $5,435.86 $73,596.58 $195,603.38 $10,837.20 $1,328,531.54 $62.46

$0.61 $22.32 $3.71 $764.71 $56.56 $61.83 $107.45 $18.07 $58.48 $195.77 $20.20 $34.96 $22.46 $22.30 $97.13 $13.72 $18.26 $55.60 $166.88 $34.59 $0.02 $10.04 $21.73 $15.23 $462.53 $8.80 $0.07 $3.05 $8.54 $53.34 $75.23 $4.15 $685.88

2009 And 2010 Total Assessment
$0.61 $69,763.75 $4,598.42 $2,074,922.88 $166,960.32 $147,381.44 $224,012.64 $25,569.02 $100,659.36 $370,246.65 $76,842.32 $46,186.26 $7,609.58 $28,660.29 $274,607.26 $11,144.67 $5,630.56 $115,125.15 $326,391.88 $69,070.46 $0.02 $22,633.54 $14,159.58 $19,924.28 $922,225.84 $556.87 $0.07 $8,485.36 $5,444.40 $73,649.92 $195,678.61 $10,841.35 $1,329,217.42 $62.46

61

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
BROTHERHOOD MUTUAL INS CO BUILDERS INSURANCE (A MUTUAL C BUILDERS MUTUAL INSURANCE CO CALIFORNIA INSURANCE CO CANAL INSURANCE CO CAPITAL CITY INS CO CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTENNIAL INSURANCE CO CENTRAL MUTUAL INS CO CENTRE INSURANCE CO CENTURY INDEMNITY CO CHARTER OAK FIRE INS CO CHARTIS CASUALTY COMPANY CHARTIS PROPERTY CASUALTY CO CHEROKEE INSURANCE CO CHUBB INDEMNITY INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY CO CINCINNATI INDEMNITY CO CINCINNATI INSURANCE CO CITIZENS INS CO OF AMERICA CLARENDON NATIONAL INS CO COLONIAL AMERICAN CAS & SURETY COLUMBIA NATIONAL INS CO COMMERCE & INDUSTRY INS CO COMMERCIAL MUTUAL INS CO COMPANION COMMERCIAL INS CO COMPANION PROP & CAS COMPTRUST ACG MUTUAL CAP. INS CONTINENTAL CASUALTY CO CONTINENTAL INSURANCE CO COTTON STATES MUTUAL INS CO CRUM & FOSTER INDEMNITY CO

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

$39,796.66 $2,420,332.66 $0.00 $35,906.59 $504,598.42 $267,662.78 $77,165.65 $228,666.30 $15,745.25 $89,582.17 $20,553.00 $4,904.66 $254,172.74 $1,220,992.82 $64,173.66 $13,191.99 $37,240.87 $122,231.64 $361,822.70 $127,620.75 $168,936.18 $40,775.69 $61,599.61 $1,846.40 $106,067.82 $2,930,635.08 $164,594.07 $146,284.31 $1,392,190.36 $281,514.47 $586,078.72 $45,534.78 $1,237.80 $6,971.38

$39,817.08 $2,421,574.90 $0.00 $35,925.02 $504,857.40 $267,800.16 $77,205.25 $228,783.67 $15,753.33 $89,628.15 $20,563.55 $4,907.18 $254,303.19 $1,221,619.50 $64,206.60 $13,198.77 $37,259.99 $122,294.37 $362,008.41 $127,686.25 $169,022.89 $40,796.62 $61,631.22 $1,847.35 $106,122.26 $2,932,139.24 $164,678.55 $146,359.39 $1,392,904.90 $281,658.96 $586,379.52 $45,558.15 $1,238.43 $6,974.96

$488,712.00 $27,081,140.00 $17,026.00 $737,970.00 $5,427,823.00 $2,544,721.00 $37,598.00 $4,158,144.00 $130,630.00 $802,160.99 $249,327.00 $331,906.00 $3,505,467.00 $16,402,632.00 $798,462.00 $349,102.00 $1,406,545.00 $2,302,568.00 $4,016,489.52 $1,053,692.10 $1,498,975.61 $468,872.00 $4,824,318.00 $91,209.00 $919,619.00 $29,332,059.00 $0.00 $3,331,089.00 $13,142,421.00 $3,544,585.00 $5,552,523.51 $462,828.27 $21,268.00 $168,585.00

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$34,029.77 $1,885,701.75 $1,185.55 $51,385.99 $377,947.73 $177,192.87 $2,618.01 $289,538.01 $9,095.97 $55,855.71 $17,361.03 $23,111.13 $244,091.10 $1,142,140.69 $55,598.15 $24,308.51 $97,939.91 $160,331.38 $279,674.39 $73,370.21 $104,376.00 $32,648.28 $335,924.74 $6,351.02 $64,034.50 $2,042,436.73 $0.00 $231,948.89 $915,127.14 $246,814.95 $386,630.82 $32,227.45 $1,480.92 $11,738.83

$20.42 $1,242.24 $0.00 $18.43 $258.98 $137.38 $39.60 $117.37 $8.08 $45.98 $10.55 $2.52 $130.45 $626.68 $32.94 $6.78 $19.12 $62.73 $185.71 $65.50 $86.71 $20.93 $31.61 $0.95 $54.44 $1,504.16 $84.48 $75.08 $714.54 $144.49 $300.80 $23.37 $0.63 $3.58

$34,050.19 $1,886,943.99 $1,185.55 $51,404.42 $378,206.71 $177,330.25 $2,657.61 $289,655.38 $9,104.05 $55,901.69 $17,371.58 $23,113.65 $244,221.55 $1,142,767.37 $55,631.09 $24,315.29 $97,959.03 $160,394.11 $279,860.10 $73,435.71 $104,462.71 $32,669.21 $335,956.35 $6,351.97 $64,088.94 $2,043,940.89 $84.48 $232,023.97 $915,841.68 $246,959.44 $386,931.62 $32,250.82 $1,481.55 $11,742.41

62

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
CUMIS INS SOCIETY INC CYPRESS INSURANCE CO DALLAS NATIONAL INSURANCE CO DELTA FIRE & CASUALTY INS DEPOSITORS INSURANCE CO DISCOVER PROPERTY & CAS DONEGAL MUTUAL INSURANCE CO EASTERN ADVANTAGE ASSURANCE CO EASTERN ALLIANCE INS. CO EASTGUARD INSURANCE CO ELECTRIC INSURANCE CO EMC PROPERTY & CASUALTY EMCASCO INSURANCE CO EMPLOYERS ASSURANCE CO EMPLOYERS FIRE INS CO EMPLOYERS INS OF WAUSAU EMPLOYERS MUTUAL CAS INS CO EMPLOYERS PREFERRED INS. CO. 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 INS FEDERATED SERVICE INS CO FFVA MUTUAL INS CO FHM INSURANCE COMPANY FIDELITY & DEPOSIT CO OF MD FIDELITY & GUAR UNDERWRITERS

2009 Assessment Amt
$23,349.76 $534,616.32 $18,087.31 $794.42 $0.00 $1,832.98 $69,924.26 $0.00 $526.45 $49,316.91 $85,201.87 $6,067.55 $23.33 $401,009.99 $25,174.87 $509,777.03 $29,814.23 $0.00 $25,880.94 $761.81 $73,194.83 $0.00 $9,912.85 $59,895.66 $13,007.80 $337,047.16 $458,816.85 $187,371.47 $39,857.94 $22,335.23 $579,926.31 $48,192.63 $14,066.32 $2,415.58

2009 Assessment Adjustment Amt
$23,361.74 $534,890.71 $18,096.60 $794.82 $0.00 $1,833.92 $69,960.14 $0.00 $526.72 $49,342.22 $85,245.60 $6,070.66 $23.34 $401,215.81 $25,187.79 $510,038.67 $29,829.53 $0.00 $25,894.23 $762.20 $73,232.40 $0.00 $9,917.94 $59,926.40 $13,014.47 $337,220.15 $459,052.34 $187,467.64 $39,878.39 $22,346.70 $580,223.96 $48,217.37 $14,073.54 $2,416.82

2010
Claims Paid
$33,384.00 $4,443,411.00 $415,497.00 $0.00 $3,213.00 $391.00 $113,733.00 $5,406.00 $42,794.00 $1,361,767.00 $768,774.00 $0.00 $113,463.00 $7,843,157.00 $195,688.00 $4,983,812.00 $400,972.00 $298,674.00 $878,505.00 $0.00 $943,952.00 $162,783.00 $217,651.00 $909,471.00 $61,508.00 $4,454,760.00 $7,975,439.93 $2,315,603.00 $515,377.00 $182,281.00 $10,268,617.00 $1,377,345.00 $134,837.00 $85,828.00

2010 Assessment Amt
$2,324.58 $309,401.60 $28,931.70 $0.00 $223.73 $27.23 $7,919.41 $376.43 $2,979.81 $94,821.95 $53,530.93 $0.00 $7,900.60 $546,131.18 $13,626.06 $347,030.55 $27,920.30 $20,797.13 $61,171.66 $0.00 $65,728.84 $11,334.83 $15,155.38 $63,327.88 $4,282.90 $310,191.84 $555,342.24 $161,239.03 $35,886.50 $12,692.51 $715,019.72 $95,906.67 $9,388.91 $5,976.34

2009 Balance Due
$11.98 $274.39 $9.29 $0.40 $0.00 $0.94 $35.88 $0.00 $0.27 $25.31 $43.73 $3.11 $0.01 $205.82 $12.92 $261.64 $15.30 $0.00 $13.29 $0.39 $37.57 $0.00 $5.09 $30.74 $6.67 $172.99 $235.49 $96.17 $20.45 $11.47 $297.65 $24.74 $7.22 $1.24

2009 And 2010 Total Assessment
$2,336.56 $309,675.99 $28,940.99 $0.40 $223.73 $28.17 $7,955.29 $376.43 $2,980.08 $94,847.26 $53,574.66 $3.11 $7,900.61 $546,337.00 $13,638.98 $347,292.19 $27,935.60 $20,797.13 $61,184.95 $0.39 $65,766.41 $11,334.83 $15,160.47 $63,358.62 $4,289.57 $310,364.83 $555,577.73 $161,335.20 $35,906.95 $12,703.98 $715,317.37 $95,931.41 $9,396.13 $5,977.58

63

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
FIDELITY & GUARANTY INS CO FIREMAN'S FUND INS CO FIRST LIBERTY INS CORP FIRST NATL INS CO OF AMER FLORISTS INSURANCE CO FLORISTS' MUTUAL INS CO FRANK WINSTON CRUM INS INC. FRANKENMUTH MUTUAL INS GA RESTAURANT MUTUAL CAP INS C GA TIMBER HARVERSTERS' MUT CA GENERAL CASUALTY CO OF WI GENERAL INS CO OF AMERIC GEORGIA CASUALTY & SURETY CO GERBER LIFE 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 INS GREENWICH INSURANCE CO GUARANTEE INSURANCE CO GUIDEONE MUTUAL INS CO HANOVER INSURANCE CO HARBOR SPECIALITY INS HARCO NATIONAL INS CO HARLEYSVILLE INSURANCE CO HARLEYSVILLE MUTUAL INS CO

2009 Assessment Amt
$740,274.69 $81,255.86 $74,309.57 $2,115.42 $1,895.03 $15,284.44 $2,242.84 $21,303.00 $68,551.03 $17,230.14 $1,908.31 $23,851.12 $208,671.24 $1,325.43 $9,983.97 $377,687.01 $127,919.57 $5,329.03 $93,107.67 $497,620.15 $31,307.77 $9,950.02 $23,714.57 $8,237.29 $261,009.54 $1,101.18 $9,747.63 $295,846.92 $46,340.40 $72,573.36 $18,552.90 $2,749.40 $0.00 $100,265.15

2009 Assessment Adjustment Amt
$740,654.63 $81,297.57 $74,347.71 $2,116.51 $1,896.00 $15,292.28 $2,243.99 $21,313.93 $68,586.22 $17,238.98 $1,909.29 $23,863.36 $208,778.34 $1,326.11 $9,989.09 $377,880.85 $127,985.23 $5,331.76 $93,155.46 $497,875.55 $31,323.84 $9,955.13 $23,726.74 $8,241.52 $261,143.50 $1,101.74 $9,752.63 $295,998.77 $46,364.19 $72,610.61 $18,562.42 $2,750.81 $0.00 $100,316.61

2010
Claims Paid
$5,906,778.00 $1,572,648.00 $2,387,114.00 $11,462.00 $36,123.00 $222,412.00 $30.00 $364,703.00 $0.00 $0.00 $419,846.00 $46,205.00 $1,989,474.00 $17,913.00 $310,747.00 $3,488,006.00 $1,009,111.00 $38,755.49 $4,598,928.00 $3,859,811.00 $215,722.00 $38,814.00 $844,486.00 $218,755.00 $2,437,042.00 $15,977.00 $102,335.74 $5,648,595.00 $774,255.00 $1,889,739.00 $196,470.00 $50,217.00 $14,054.00 $872,963.00

2010 Assessment Amt
$411,298.11 $109,505.92 $166,218.45 $798.12 $2,515.30 $15,486.89 $2.09 $25,394.84 $0.00 $0.00 $29,234.53 $3,217.33 $138,530.16 $1,247.31 $21,637.80 $242,875.26 $70,265.96 $2,698.60 $320,230.48 $268,764.62 $15,021.06 $2,702.68 $58,802.87 $15,232.25 $169,695.01 $1,112.50 $7,125.80 $393,320.43 $53,912.58 $131,585.46 $13,680.51 $3,496.69 $978.60 $60,785.77

2009 Balance Due
$379.94 $41.71 $38.14 $1.09 $0.97 $7.84 $1.15 $10.93 $35.19 $8.84 $0.98 $12.24 $107.10 $0.68 $5.12 $193.84 $65.66 $2.73 $47.79 $255.40 $16.07 $5.11 $12.17 $4.23 $133.96 $0.56 $5.00 $151.85 $23.79 $37.25 $9.52 $1.41 $0.00 $51.46

2009 And 2010 Total Assessment
$411,678.05 $109,547.63 $166,256.59 $799.21 $2,516.27 $15,494.73 $3.24 $25,405.77 $35.19 $8.84 $29,235.51 $3,229.57 $138,637.26 $1,247.99 $21,642.92 $243,069.10 $70,331.62 $2,701.33 $320,278.27 $269,020.02 $15,037.13 $2,707.79 $58,815.04 $15,236.48 $169,828.97 $1,113.06 $7,130.80 $393,472.28 $53,936.37 $131,622.71 $13,690.03 $3,498.10 $978.60 $60,837.23

64

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
HARLEYSVILLE PREFERRED INS CO HARLEYSVILLE WORCESTER INS CO HARLEYSVILLE-ATLANTIC INS CO HARTFORD ACCIDENT & INDEMNITY HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF S.E. HARTFORD INS OF THE MIDWEST HARTFORD UNDERWRITERS INS HEALTH CARE MUTUAL CAPTIVE HIGHLANDS INS CO-IN RECEIVERSH HOSPITALITY MUT CAPTIVE INS HOUSTON GENERAL INS CO IMPERIAL CAS & IND. CO-IN LIQU INDEMNITY INS CO OF NA INSURANCE CO OF N.A. INSURANCE CO OF STATE OF PA INSURANCE COMPANY OF THE WEST JEFFERSON PILOT FIN INS CO KEY RISK INSURANCE CO KODIAK INSURANCE CO. LIBERTY INSURANCE CORP LIBERTY MUTUAL FIRE INS LIBERTY MUTUAL INS. CO. LM INSURANCE CORP LUMBER MUTUAL INSURANCE CO LUMBERMENS MUTUAL CAS CO LUMBERMEN'S UNDERWRITING LYNDON PROPERTY INS MAG MUTUAL INS CO MANUFACTURER'S ALLIANCE INS MARYLAND CASUALTY COMPANY MASSACHUSETTS BAY INSURANCE CO MEMIC INDEMNITY CO

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

$543.03 $7.03 $134,405.38 $48,478.66 $568,144.15 $1,453,106.59 $168,913.80 $350,003.80 $593,166.23 $157,126.51 $9,083.57 $13,226.95 $24,151.13 $34,278.19 $2,994,790.12 $0.00 $1,760,268.82 $8,029.27 $18,247.72 $688,792.44 $1,633.60 $1,558,981.84 $1,334,874.65 $527,883.80 $904,875.27 $131.38 $174,362.34 $267,655.61 $434.39 $60,547.84 $80,315.62 $94,024.72 $21,098.00 $3,188.98

$543.31 $7.03 $134,474.36 $48,503.55 $568,435.75 $1,453,852.39 $169,000.49 $350,183.44 $593,470.68 $157,207.15 $9,088.24 $13,233.74 $24,163.53 $34,295.78 $2,996,327.20 $0.00 $1,761,172.28 $8,033.39 $18,257.09 $689,145.96 $1,634.44 $1,559,781.99 $1,335,559.78 $528,154.74 $905,339.70 $131.45 $174,451.83 $267,792.98 $434.61 $60,578.91 $80,356.84 $94,072.98 $21,108.83 $3,190.62

$245,907.00 $102,781.00 $1,233,658.00 $1,041,952.00 $5,164,194.00 $22,835,713.00 $3,015,310.00 $4,658,082.00 $7,750,512.00 $2,770,828.00 $0.00 $39,180.07 $275,533.00 $0.00 $45,345,047.00 $169,104.00 $26,791,390.00 $2,507.00 $154,597.34 $10,712,829.00 $101,485.00 $46,200,425.00 $18,719,534.00 $4,174,102.00 $11,364,119.00 $1,798.48 $478,306.24 $4,043,199.00 $524.00 $1,262,096.00 $1,296,291.00 $691,922.27 $318,496.00 $40,216.00

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$17,122.89 $7,156.80 $85,901.52 $72,552.73 $359,590.83 $1,590,086.09 $209,960.71 $324,349.47 $539,680.16 $192,937.05 $0.00 $2,728.17 $19,185.79 $0.00 $3,157,445.91 $11,774.97 $1,865,526.01 $174.57 $10,764.85 $745,950.89 $7,066.56 $3,217,007.20 $1,303,470.17 $290,649.19 $791,301.22 $125.23 $33,305.20 $281,534.21 $36.49 $87,881.70 $90,262.75 $48,179.62 $22,177.37 $2,800.30

$0.28 $0.00 $68.98 $24.89 $291.60 $745.80 $86.69 $179.64 $304.45 $80.64 $4.67 $6.79 $12.40 $17.59 $1,537.08 $0.00 $903.46 $4.12 $9.37 $353.52 $0.84 $800.15 $685.13 $270.94 $464.43 $0.07 $89.49 $137.37 $0.22 $31.07 $41.22 $48.26 $10.83 $1.64

$17,123.17 $7,156.80 $85,970.50 $72,577.62 $359,882.43 $1,590,831.89 $210,047.40 $324,529.11 $539,984.61 $193,017.69 $4.67 $2,734.96 $19,198.19 $17.59 $3,158,982.99 $11,774.97 $1,866,429.47 $178.69 $10,774.22 $746,304.41 $7,067.40 $3,217,807.35 $1,304,155.30 $290,920.13 $791,765.65 $125.30 $33,394.69 $281,671.58 $36.71 $87,912.77 $90,303.97 $48,227.88 $22,188.20 $2,801.94

65

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
MERIDIAN SECURITY INS CO MID-CENTURY INSURANCE CO MIDDLESEX INSURANCE CO MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MITSUI SUMITOMO INS CO OF AMER MITSUI SUMITOMO INS USA, INC MONROE GUARANTY INS. CO. NATIONAL AMERICAN INSURANCE CO NATIONAL FIRE INS CO HARTFORD NATIONAL INTERSTATE INS NATIONAL LIABILITY & FIRE INS NATIONAL SURETY CORP NATIONAL TRUST INSURANCE CO NATIONAL UNION FIRE OF PITT PA NATIONWIDE AGRIBUSINESS NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NETHERLANDS INSURANCE CO NEW HAMPSHIRE INSURANCE CO NIPPONKAO INS CO LTD US BRANCH NORGUARD INSURANCE CO. NORTH AMERICAN SPECIALTY INS NORTH RIVER INSURANCE CO NORTHBROOK INDEMNITY CO NORTHERN ASSUR CO OF AMER NORTHERN INS CO OF NY NORTHWESTERN NATIONAL INS CO NOVA CASUALTY COMPANY OCCIDENTAL FIRE & CAS CO OF NC OHIO CASUALTY INSURANCE CO OHIO FARMERS INS CO OHIO SECURITY INSURANCE CO OLD DOMINION INSURANCE CO

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

$228.33 $257.43 $34,456.60 $89,833.37 $40,263.37 $84,980.36 $40,096.11 $23,309.84 $11,446.79 $633,712.45 $3,787.96 $307,311.08 $88,804.37 $1,008,304.45 $365,029.19 $34,271.58 $24,431.12 $17,279.12 $166,933.73 $2,722,808.72 $21.01 $218,047.82 $183,521.88 $67,317.95 $569.25 $2,030.25 $48,605.51 $1,277.01 $250.47 $161.29 $29,472.90 $1,076.72 $4,174.41 $70,859.37

$228.45 $257.56 $34,474.28 $89,879.48 $40,284.03 $85,023.98 $40,116.69 $23,321.81 $11,452.67 $634,037.70 $3,789.90 $307,468.81 $88,849.95 $1,008,821.97 $365,216.54 $34,289.17 $24,443.66 $17,287.99 $167,019.41 $2,724,206.21 $21.02 $218,159.73 $183,616.08 $67,352.50 $569.54 $2,031.29 $48,630.46 $1,277.67 $250.60 $161.37 $29,488.02 $1,077.27 $4,176.55 $70,895.74

$609.00 $1,389.00 $275,777.50 $2,280,709.00 $459,093.00 $837,164.00 $505,464.00 $742,287.00 $213,117.00 $5,925,412.90 $25,025.00 $5,676,503.00 $741,556.00 $13,491,852.00 $11,434,027.00 $846,429.00 $224,252.00 $104,337.00 $2,599,952.00 $41,874,867.00 $24,773.00 $3,046,413.00 $2,325,172.00 $988,583.00 $9,232.00 $59,551.00 $477,205.07 $3,733.81 $32,537.00 $810.00 $438,017.00 $337,084.00 $32,043.00 $952,375.00

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$42.41 $96.72 $19,202.81 $158,809.30 $31,967.36 $58,293.03 $35,196.24 $51,686.59 $14,839.67 $412,595.68 $1,742.53 $395,263.70 $51,635.69 $939,458.57 $796,169.02 $58,938.16 $15,615.01 $7,265.15 $181,038.69 $2,915,811.90 $1,724.98 $212,126.46 $161,905.33 $68,836.57 $642.84 $4,146.63 $33,228.53 $259.99 $2,265.60 $56.40 $30,499.80 $23,471.68 $2,231.20 $66,315.35

$0.12 $0.13 $17.68 $46.11 $20.66 $43.62 $20.58 $11.97 $5.88 $325.25 $1.94 $157.73 $45.58 $517.52 $187.35 $17.59 $12.54 $8.87 $85.68 $1,397.49 $0.01 $111.91 $94.20 $34.55 $0.29 $1.04 $24.95 $0.66 $0.13 $0.08 $15.12 $0.55 $2.14 $36.37

$42.53 $96.85 $19,220.49 $158,855.41 $31,988.02 $58,336.65 $35,216.82 $51,698.56 $14,845.55 $412,920.93 $1,744.47 $395,421.43 $51,681.27 $939,976.09 $796,356.37 $58,955.75 $15,627.55 $7,274.02 $181,124.37 $2,917,209.39 $1,724.99 $212,238.37 $161,999.53 $68,871.12 $643.13 $4,147.67 $33,253.48 $260.65 $2,265.73 $56.48 $30,514.92 $23,472.23 $2,233.34 $66,351.72

66

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
OLD REPUBLIC GENERAL INS CORP OLD REPUBLIC INSURANCE CO OLD REPUBLIC UNION INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO ONEBEACON MIDWEST INS CO OWNERS INSURANCE CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PATRIOT GENERAL INSURANCE CO PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PEGASUS INSURANCE COMPANY PENN MFG ASSOC INS PENN MFG IND. CO PENN MILLERS MUTUAL PENN NATIONAL MUTUAL CAS PENNSYLVANIA GENERAL INS CO PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INSURANCE CO PRAETORIAN INSURANCE CO PREFERRED PROFESSIONAL INS CO PREMIER GROUP INS. CO. PRINCETON INSURANCE CO PROASSURANCE INDEMNITY CO. INC PROTECTIVE INSURANCE CO PROVIDENCE WASHINGTON INS CO PUBLIC SERVICE MUTUAL INS CO REDLAND INSURANCE CO REGENT INSURANCE CO REPUBLIC-FRANKLIN INSURANCE CO ROCHDALE INSURANCE COMPANY SAFECO INS CO OF ILLINOIS

2009 Assessment Amt
$12,472.63 $961,664.74 $269.58 $49,522.71 $30,126.48 $6,411.20 $925,693.36 $97,387.57 $46,498.66 $108,602.09 $5,315.79 $72,782.44 $649.29 $371,358.87 $151,592.30 $24,257.74 $12,586.27 $3,837.29 $4,915.01 $24,617.78 $201,634.42 $1,100.33 $57.21 $10,336.41 $10,177.51 $500.59 $84,707.89 $175.76 $6,620.07 $2,167.64 $9,903.29 $52,571.70 $152,923.99 $14,073.91

2009 Assessment Adjustment Amt
$12,479.04 $962,158.32 $269.72 $49,548.12 $30,141.94 $6,414.49 $926,168.47 $97,437.55 $46,522.52 $108,657.83 $5,318.52 $72,819.80 $649.63 $371,549.47 $151,670.10 $24,270.19 $12,592.73 $3,839.26 $4,917.54 $24,630.41 $201,737.91 $1,100.90 $57.24 $10,341.72 $10,182.74 $500.84 $84,751.37 $175.85 $6,623.47 $2,168.75 $9,908.37 $52,598.68 $153,002.47 $14,081.13

2010
Claims Paid
$124,918.00 $19,593,199.00 $3,972.00 $232,744.00 $1,346,521.00 $19,047.00 $14,421,237.00 $4,306,726.00 $1,437,593.70 $1,561,545.09 $8,642.00 $778,765.00 $0.00 $6,875,050.00 $3,352,118.00 $610,362.00 $91,929.00 $37,879.00 $81,428.32 $132,292.00 $2,841,710.00 $785,846.00 $8,654.00 $30,711.00 $0.00 $4,910.39 $1,170,396.00 $5,186.00 $56,265.00 $0.00 $89,977.00 $874,853.00 $3,236,721.00 $70,406.00

2010
Assessment Amt

2009
Balance Due

$8,698.23 $1,364,304.82 $276.58 $16,206.33 $93,760.34 $1,326.27 $1,004,173.09 $299,884.01 $100,101.88 $108,732.81 $601.76 $54,226.61 $0.00 $478,720.39 $233,413.17 $42,500.45 $6,401.16 $2,637.57 $5,669.98 $9,211.70 $197,872.67 $54,719.68 $602.59 $2,138.45 $0.00 $341.92 $81,496.49 $361.11 $3,917.82 $0.00 $6,265.24 $60,917.37 $225,377.90 $4,902.48

$6.41 $493.58 $0.14 $25.41 $15.46 $3.29 $475.11 $49.98 $23.86 $55.74 $2.73 $37.36 $0.34 $190.60 $77.80 $12.45 $6.46 $1.97 $2.53 $12.63 $103.49 $0.57 $0.03 $5.31 $5.23 $0.25 $43.48 $0.09 $3.40 $1.11 $5.08 $26.98 $78.48 $7.22

2009 And 2010 Total Assessment
$8,704.64 $1,364,798.40 $276.72 $16,231.74 $93,775.80 $1,329.56 $1,004,648.20 $299,933.99 $100,125.74 $108,788.55 $604.49 $54,263.97 $0.34 $478,910.99 $233,490.97 $42,512.90 $6,407.62 $2,639.54 $5,672.51 $9,224.33 $197,976.16 $54,720.25 $602.62 $2,143.76 $5.23 $342.17 $81,539.97 $361.20 $3,921.22 $1.11 $6,270.32 $60,944.35 $225,456.38 $4,909.70

67

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
SAFECO INSURANCE CO AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY SEABRIGHT INSURANCE CO SECURITY NATIONAL INS CO SELECT INSURANCE CO SELECTIVE INS CO OF AMERICA SELECTIVE INS CO OF SE SELECTIVE INSURANCE CO OF SC SELECTIVE WAY INSURANCE CO SENTINEL INSURANCE CO LTD SENTRY CASUALTY COMPANY SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE CO SOMPO JAPAN FIRE & MARINE INS SOMPO JAPAN INS, OF AMERICA SOUTHERN FIRE & CASUALTY CO SOUTHERN GUARANTY INSURANCE CO SOUTHERN INS CO OF VIRGINIA SOUTHERN MUTUAL CHURCH INS SOUTHERN PILOT INSURANCE CO SOUTHERN STATES INS EXCHANGE SOUTHERN TRUST INSURANCE CO SPARTA INSURANCE COMPANY ST PAUL FIRE & CASUALTY INS CO ST PAUL FIRE & MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE CO STAR INSURANCE CO STARNET INSURANCE CO STATE AUTO PROP & CAS STATE AUTOMOBILE MUTUAL INS

2009 Assessment Amt
$2,120.76 $456.52 $31,613.90 $24,252.92 $1,009.68 $5,117.39 $237,169.17 $131,632.30 $94,135.27 $291,930.92 $29,266.07 $7,813.74 $716,912.28 $76,982.65 $0.00 $47,221.68 $2,458.31 $31,635.97 $19,611.21 $17,385.38 $3,124.68 $17,280.67 $14,655.59 $6,747.41 $7,585.54 $186,785.85 $36,107.16 $2,077.12 $6,954.10 $87,257.07 $140,987.08 $46,853.08 $3,142.81 $39,854.42

2009 Assessment Adjustment Amt
$2,121.85 $456.76 $31,630.12 $24,265.37 $1,010.19 $5,120.02 $237,290.90 $131,699.86 $94,183.58 $292,080.76 $29,281.09 $7,817.76 $717,280.23 $77,022.16 $0.00 $47,245.92 $2,459.57 $31,652.20 $19,621.27 $17,394.30 $3,126.28 $17,289.54 $14,663.12 $6,750.87 $7,589.43 $186,881.72 $36,125.69 $2,078.19 $6,957.67 $87,301.85 $141,059.44 $46,877.13 $3,144.42 $39,874.88

2010
Claims Paid
$69,362.00 $100.00 $721,022.00 $543,850.50 $9,971.00 $81,411.00 $2,835,498.00 $2,217,019.00 $1,135,159.00 $5,602,170.00 $1,873,925.00 $865,078.52 $8,932,858.19 $683,328.68 $26,534.00 $1,017,060.00 $69,315.00 $443,992.00 $153,964.00 $257,182.00 $403,112.00 $330,368.00 $415,163.00 $634,897.00 $783,535.00 $5,465,674.00 $300,316.00 $11,122.00 $70,274.00 $1,206,871.00 $2,844,220.00 $817,715.73 $53,915.00 $187,035.00

2010 Assessment Amt
$4,829.78 $6.96 $50,205.88 $37,869.15 $694.30 $5,668.77 $197,440.12 $154,374.47 $79,042.88 $390,087.78 $130,484.30 $60,236.76 $622,008.76 $47,581.24 $1,847.60 $70,819.46 $4,826.51 $30,915.85 $10,720.75 $17,907.98 $28,069.31 $23,004.04 $28,908.44 $44,208.86 $54,558.76 $380,583.35 $20,911.47 $774.44 $4,893.29 $84,036.30 $198,047.45 $56,938.81 $3,754.19 $13,023.54

2009 Balance Due
$1.09 $0.24 $16.22 $12.45 $0.51 $2.63 $121.73 $67.56 $48.31 $149.84 $15.02 $4.02 $367.95 $39.51 $0.00 $24.24 $1.26 $16.23 $10.06 $8.92 $1.60 $8.87 $7.53 $3.46 $3.89 $95.87 $18.53 $1.07 $3.57 $44.78 $72.36 $24.05 $1.61 $20.46

2009 And 2010 Total Assessment
$4,830.87 $7.20 $50,222.10 $37,881.60 $694.81 $5,671.40 $197,561.85 $154,442.03 $79,091.19 $390,237.62 $130,499.32 $60,240.78 $622,376.71 $47,620.75 $1,847.60 $70,843.70 $4,827.77 $30,932.08 $10,730.81 $17,916.90 $28,070.91 $23,012.91 $28,915.97 $44,212.32 $54,562.65 $380,679.22 $20,930.00 $775.51 $4,896.86 $84,081.08 $198,119.81 $56,962.86 $3,755.80 $13,044.00

68

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
STATE FARM FIRE & CASUALTY CO STONEBRIDGE CASUALTY INS CO SUNZ INSURANCE COMPANY T.H.E. INSURANCE CO TECHNOLOGY INSURANCE CO TIG INSURANCE CO TNUS INSURANCE COMPANY TOKIO MARINE & NICHIDO FIRE TOWER INSURANCE CO OF NY TOWER NATIONAL INS. CO. TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA TRANSPORT INSURANCE CO TRANSPORTATION INSURANCE CO TRAVELERS CAS & SUR CO TRAVELERS CAS & SUR CO OF AMER TRAVELERS CAS INS CO OF AMER TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMER TRAVELERS INSURANCE - ALT TRAVELERS PROP CAS CO OF AMER TRINITY UNIVERSAL INS CO TRI-STATE INS. CO OF MN TRUCK INSURANCE EXCHANGE TRUMBULL INSURANCE COMPANY TRUSTGUARD INSURANCE CO TWIN CITY FIRE INSURANCE CO U.S. FIDELITY & GUARANTY INS U.S. SPECIALTY INS. CO. ULLICO CASUALTY CO UNION INSURANCE COMPANY UNITED BUSINESS INS CO (A MUTU UNITED STATES FIRE INSURANCE

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

$377,981.75 $15,322.53 $0.00 $2,337.57 $770,822.34 $205,438.12 $0.00 $223,618.76 $39,464.66 $0.00 $9,698.85 $7,574.65 $167.33 $237,837.84 $236,725.23 $0.00 $40,922.99 $237,348.80 $674,891.06 $2,839,972.16 $30.64 $1,579,009.94 $3,087.20 $42.80 $2,226.53 $0.00 $25,516.55 $1,011,078.80 $101,391.34 $6,305.65 $780.50 $2,577.50 $45,605.23 $262,922.21

$378,175.75 $15,330.39 $0.00 $2,338.77 $771,217.96 $205,543.56 $0.00 $223,733.54 $39,484.92 $0.00 $9,703.83 $7,578.53 $167.42 $237,959.91 $236,846.73 $0.00 $40,944.00 $237,470.62 $675,237.45 $2,841,429.78 $30.66 $1,579,820.37 $3,088.79 $42.82 $2,227.67 $0.00 $25,529.65 $1,011,597.74 $101,443.38 $6,308.88 $780.90 $2,578.82 $45,628.64 $263,057.16

$3,249,232.00 $0.00 $81,489.00 $52,795.00 $9,294,695.00 $579,061.00 $44,566.00 $1,757,176.36 $449,646.00 $172,308.00 $230,679.48 $60,364.00 $3,392.00 $3,910,458.70 $3,572,987.00 $164.00 $907,145.00 $2,942,610.00 $10,204,709.00 $44,535,764.00 $4,017.00 $13,599,643.00 $56,933.85 $0.00 $89,075.00 $100.00 $408,397.00 $13,850,575.00 $1,073,731.00 $0.00 $550,442.00 $69,272.00 $955,409.00 $2,325,761.00

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$226,249.06 $0.00 $5,674.21 $3,676.20 $647,204.02 $40,320.91 $3,103.20 $122,354.91 $31,309.55 $11,998.07 $16,062.57 $4,203.24 $236.19 $272,291.30 $248,792.62 $11.42 $63,165.91 $204,898.50 $710,569.70 $3,101,094.28 $279.71 $946,964.22 $3,964.39 $0.00 $6,202.43 $6.96 $28,437.32 $964,437.01 $74,765.55 $0.00 $38,328.13 $4,823.52 $66,526.61 $161,946.34

$194.00 $7.86 $0.00 $1.20 $395.62 $105.44 $0.00 $114.78 $20.26 $0.00 $4.98 $3.88 $0.09 $122.07 $121.50 $0.00 $21.01 $121.82 $346.39 $1,457.62 $0.02 $810.43 $1.59 $0.02 $1.14 $0.00 $13.10 $518.94 $52.04 $3.23 $0.40 $1.32 $23.41 $134.95

$226,443.06 $7.86 $5,674.21 $3,677.40 $647,599.64 $40,426.35 $3,103.20 $122,469.69 $31,329.81 $11,998.07 $16,067.55 $4,207.12 $236.28 $272,413.37 $248,914.12 $11.42 $63,186.92 $205,020.32 $710,916.09 $3,102,551.90 $279.73 $947,774.65 $3,965.98 $0.02 $6,203.57 $6.96 $28,450.42 $964,955.95 $74,817.59 $3.23 $38,328.53 $4,824.84 $66,550.02 $162,081.29

69

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Insurance Companies

Company Name
UNITED WISCONSIN INS CO UNITRIN AUTO & HOME INS. CO. UNIVERSAL UNDERWRITERS INS UTICA MUTUAL INSURANCE CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INSURANCE CO VANLINER INSURANCE CO VIGILANT INSURANCE CO VININGS INSURANCE CO VIRGINIA SURETY COMPANY, INC WAUSAU BUSINESS INSURANCE WAUSAU GENERAL INS CO WAUSAU UNDERWRITERS INS CO WESCO INSURANCE COMPANY WEST AMERICAN INSURANCE CO WESTFIELD INSURANCE CO WESTFIELD NATIONAL INS CO WESTPORT INSURANCE CORP WILLIAMSBURG NATIONAL INS CO WORK FIRST CASUALTY CO XL SPECIALTY INSURANCE CO YORK INSURANCE CO ZENITH INSURANCE CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Grand Total:

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$715.42 $3,981.92 $34,305.81 $46,493.29 $32,083.82 $359,968.20 $66,822.00 $14,886.24 $13,865.04 $40,888.06 $248,519.41 $75,972.05 $475,846.08 $3,369.10 $11,632.54 $521,354.11 $5,945.40 $908,976.81 $30,162.74 $46,118.50 $244,159.60 $44.56 $304,984.05 $2,798,682.18 $7,939.46 $73,536,027.06

$715.79 $3,983.97 $34,323.41 $46,517.15 $32,100.29 $360,152.95 $66,856.29 $14,893.88 $13,872.16 $40,909.05 $248,646.96 $76,011.05 $476,090.31 $3,370.83 $11,638.51 $521,621.70 $5,948.46 $909,443.34 $30,178.22 $46,142.17 $244,284.92 $44.58 $305,140.58 $2,800,118.60 $7,943.53 $73,573,769.53

$136,112.00 $48,270.00 $981,099.06 $544,939.00 $533,597.00 $6,923,379.37 $1,379,494.00 $212,803.00 $411,508.00 $154,480.00 $5,146,720.00 $1,138,995.00 $10,375,166.00 $49,155.00 $295,631.00 $7,235,977.00 $182,802.00 $6,541,431.00 $454,673.00 $578,243.00 $3,861,527.40 $12,108.00 $4,383,123.00 $32,275,083.39 $45,600.00 $1,044,490,261.40

$9,477.69 $3,361.11 $68,315.45 $37,944.95 $37,155.19 $482,085.64 $96,056.31 $14,817.80 $28,653.94 $10,756.68 $358,374.09 $79,309.99 $722,438.89 $3,422.74 $20,585.24 $503,852.29 $12,728.79 $455,489.98 $31,659.59 $40,263.96 $268,884.14 $843.10 $305,203.65 $2,247,364.08 $3,175.20 $72,729,475.85

$0.37 $2.05 $17.60 $23.86 $16.47 $184.75 $34.29 $7.64 $7.12 $20.99 $127.55 $39.00 $244.23 $1.73 $5.97 $267.59 $3.06 $466.53 $15.48 $23.67 $125.32 $0.02 $156.53 $1,436.42 $4.07 $37,742.47

$9,478.06 $3,363.16 $68,333.05 $37,968.81 $37,171.66 $482,270.39 $96,090.60 $14,825.44 $28,661.06 $10,777.67 $358,501.64 $79,348.99 $722,683.12 $3,424.47 $20,591.21 $504,119.88 $12,731.85 $455,956.51 $31,675.07 $40,287.63 $269,009.46 $843.12 $305,360.18 $2,248,800.50 $3,179.27 $72,764,931.83

70

Assessments Due from Self-Insurers

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
A T & T AAA COOPER TRANSPORTATION ABF FREIGHT SYSTEM, INC ADVENTIST HEALTH SYS SUNBELT AGL RESOURCES, INC. ALBANY INTERNATIONAL CORP ALBANY WATER GAS & LIGHT COMM ALBANY, CITY OF ALLENS INC ALLIED SYSTEMS LTD ALPHARETTA, CITY OF ALSCO, INC. AMERICAN NATIONAL RED CROSS AMERICAN PROTEINS, INC ANHEUSER-BUSCH COMPANIES, INC. ARCHBOLD MEDICAL CENTER ARCHER-DANIELS-MIDLAND CO ASPLUNDH TREE EXPERT CO ATCO RUBBER PRODUCTS, INC. ATHENS REG. HLTH SYS INC ATHENS-CLARKE COUNTY ATLANTA CITY OF ATLANTA HOUSING AUTHORITY ATLANTA PUBLIC SCHOOLS AUGUSTA-RICHMOND CO BD COMM AUTOZONE, INC AVERITT EXPRESS, INC AVONDALE MILLS INC BALDWIN COUNTY COMMISSIONERS BANKHEAD SERVICES, INC BARTOW COUNTY BD OF EDUCATION

2009 Assessment Amt
$6,171.98 $43,885.83 $79,229.71 $10,216.32 $78,594.48 $686.98 $580.52 $33,242.75 $6,892.56 $57,217.60 $15,260.78 $1,512.19 $55,500.58 $0.00 $21,917.70 $83,861.37 $9,512.58 $12,003.18 $4,511.44 $13,102.22 $16,228.66 $448,180.29 $2,025.40 $181,029.91 $109,142.05 $25,404.90 $74,264.77 $1,276.09 $4,838.63 $606.41 $24,210.94

2009 Assessment Adjustment Amt
$6,175.15 $43,908.36 $79,270.37 $10,221.57 $78,634.82 $687.33 $580.82 $33,259.81 $6,896.10 $57,246.96 $15,268.61 $1,512.97 $55,529.06 $0.00 $21,928.94 $83,904.41 $9,517.46 $12,009.34 $4,513.75 $13,108.94 $16,236.99 $448,410.32 $2,026.44 $181,122.83 $109,198.07 $25,417.94 $74,302.89 $1,276.74 $4,841.12 $606.72 $24,223.37

2010
Claims Paid
$136,870.58 $855,490.58 $1,296,049.83 $272,729.66 $400,172.63 $26,135.60 $47,264.73 $372,699.37 $32,748.41 $0.00 $288,845.80 $0.00 $99,909.00 $531,842.21 $0.00 $1,042,619.35 $49,067.07 $0.00 $49,943.40 $573,518.53 $349,477.19 $6,752,233.60 $2,553.00 $2,891,947.83 $1,746,202.90 $346,650.55 $1,666,501.39 $152,203.96 $56,451.78 $0.00 $107,984.03

2010 Assessment Amt
$9,530.51 $59,569.14 $90,245.96 $18,990.59 $27,864.64 $1,819.86 $3,291.12 $25,951.63 $2,280.32 $0.00 $20,112.78 $0.00 $6,956.82 $37,033.00 $0.00 $72,599.20 $3,416.62 $0.00 $3,477.64 $39,934.98 $24,334.64 $470,168.49 $177.77 $201,370.81 $121,590.81 $24,137.82 $116,041.07 $10,598.20 $3,930.82 $0.00 $7,519.10

2009 Balance Due
$3.17 $22.53 $40.66 $5.25 $40.34 $0.35 $0.30 $17.06 $3.54 $29.36 $7.83 $0.78 $28.48 $0.00 $11.24 $43.04 $4.88 $6.16 $2.31 $6.72 $8.33 $230.03 $1.04 $92.92 $56.02 $13.04 $38.12 $0.65 $2.49 $0.31 $12.43

2009 And 2010 Total Assessment
$9,533.68 $59,591.67 $90,286.62 $18,995.84 $27,904.98 $1,820.21 $3,291.42 $25,968.69 $2,283.86 $29.36 $20,120.61 $0.78 $6,985.30 $37,033.00 $11.24 $72,642.24 $3,421.50 $6.16 $3,479.95 $39,941.70 $24,342.97 $470,398.52 $178.81 $201,463.73 $121,646.83 $24,150.86 $116,079.19 $10,598.85 $3,933.31 $0.31 $7,531.53

71

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
BASF CORPORATION BEAULIEU GROUP LLC BELLSOUTH ENTERPRISES INC BELLSOUTH TELECOMMUNICATIONS, BENTON-GEORGIA INC BERRY COLLEGE BIBB COUNTY BD-COMMISSION BIBB COUNTY BOARD OF EDUCATION BIG LOTS STORES, INC. BJ'S WHOLESALE CLUB INC BLOSSMAN COMPANIES, INC BLUE BIRD BODY COMPANY BLUE CIRCLE AMERICA BREMEN-BOWDEN INVESTMENT CO. BROWN INDUSTRIES BRUNSWICK FAMILY BOAT CO. BRUNSWICK, CITY OF BURLEN CORPORATION C.W. MATTHEWS CONTRACTING INC CAGLE'S INC, & SUBSIDIARIES CAHABA GOV'T BENEFIT ADMIN. CALDWELL TANKS ALLIANCE, INC. CALFEE COMPANY OF DALTON, INC CAMDEN COUNTY BOC CANDLER HEALTH SYSTEM CARROLL CO. BOARD OF EDUCATION CASCADE CORPORATION CATHOLIC ARCHDIOCESES OF ATL CATOOSA CO. BD. OF EDUCATION CEMEX (SOUTHDOWN INC.) CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA

2009 Assessment Amt
$0.00 $121,478.20 $4,331.45 $187,037.28 $33,766.98 $8,590.16 $25,369.94 $24,617.01 $32,187.36 $28,663.11 $10,030.01 $102,183.75 $0.00 $29,466.92 $0.00 $0.00 $25,993.96 $256.58 $47,650.95 $56,692.69 $656.09 $312.22 $10,696.07 $1,568.92 $56,598.10 $2,781.59 $96.96 $12,988.45 $15,136.10 $531.51 $112,438.34 $16,316.48 $50,703.42 $53,523.57

2009 Assessment Adjustment Amt
$0.00 $121,540.55 $4,333.67 $187,133.28 $33,784.31 $8,594.57 $25,382.96 $24,629.65 $32,203.88 $28,677.82 $10,035.15 $102,236.20 $0.00 $29,482.04 $0.00 $0.00 $26,007.30 $256.71 $47,675.41 $56,721.79 $656.43 $312.38 $10,701.56 $1,569.73 $56,627.15 $2,783.02 $97.01 $12,995.12 $15,143.87 $531.78 $112,496.05 $16,324.86 $50,729.44 $53,551.04

2010
Claims Paid
$50,791.20 $1,071,128.30 $91,728.36 $3,054,900.52 $641,490.57 $184,368.76 $145,484.46 $393,744.45 $380,745.00 $339,458.95 $87,394.32 $1,741,403.31 $129,454.97 $325,444.64 $170,694.44 $8,218.10 $232,049.34 $7,303.79 $563,353.45 $645,300.68 $49,317.97 $0.00 $25,395.86 $55,661.25 $729,165.53 $5,523.43 $1,918.79 $220,799.15 $159,208.09 $101,872.35 $1,658,539.54 $230,052.48 $989,724.16 $318,994.06

2010 Assessment Amt
$3,536.67 $74,584.32 $6,387.19 $212,717.46 $44,667.98 $12,837.88 $10,130.31 $27,417.04 $26,511.86 $23,637.05 $6,085.40 $121,256.61 $9,014.15 $22,661.21 $11,885.72 $572.24 $16,157.96 $508.57 $39,227.17 $44,933.29 $3,434.09 $0.00 $1,768.35 $3,875.78 $50,772.93 $384.60 $133.61 $15,374.59 $11,085.91 $7,093.53 $115,486.68 $16,018.91 $68,916.03 $22,212.05

2009 Balance Due
$0.00 $62.35 $2.22 $96.00 $17.33 $4.41 $13.02 $12.64 $16.52 $14.71 $5.14 $52.45 $0.00 $15.12 $0.00 $0.00 $13.34 $0.13 $24.46 $29.10 $0.34 $0.16 $5.49 $0.81 $29.05 $1.43 $0.05 $6.67 $7.77 $0.27 $57.71 $8.38 $26.02 $27.47

2009 And 2010 Total Assessment
$3,536.67 $74,646.67 $6,389.41 $212,813.46 $44,685.31 $12,842.29 $10,143.33 $27,429.68 $26,528.38 $23,651.76 $6,090.54 $121,309.06 $9,014.15 $22,676.33 $11,885.72 $572.24 $16,171.30 $508.70 $39,251.63 $44,962.39 $3,434.43 $0.16 $1,773.84 $3,876.59 $50,801.98 $386.03 $133.66 $15,381.26 $11,093.68 $7,093.80 $115,544.39 $16,027.29 $68,942.05 $22,239.52

72

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHILDREN'S HEALTHCARE OF ATL CITY OF CARTERSVILLE CLAYTON COUNTY BD OF EDUCATION CLAYTON COUNTY COMMISSIONERS CLAYTON COUNTY WATER AUTHORITY COACHMAN REC. VEHICLE CO OF GA COASTAL TRANSPORT INC COATS & CLARK, INC. COBB COUNTY BD/COMMISSIONERS COBB COUNTY SCHOOL SYSTEM COCA-COLA COMPANY COCA-COLA REFRESHMENTS USA INC COLLEGE PARK CITY OF COLONIAL GROUP COLONIAL PIPELINE COMPANY COLQUITT CO BD OF EDUCATION COLQUITT REGIONAL MEDICAL CENT COLUMBIA COUNTY BOE COLUMBUS REGIONAL HEALTHCARE COLUMBUS WATER WORKS CONAGRA FOODS, INC CONAGRA POULTRY CO CONTINENTAL GRAIN COMPANY CONTINENTAL TIRE N. AMER., INC COOPER INDUSTRIES, LLC COOPER TIRE AND RUBBER CORPORATION OF MERCER UNIV COSTCO WHOLESALE CORP. COTTRELL INC COVINGTON, CITY OF

2009 Assessment Amt
$0.00 $23,646.79 $47,970.02 $50,330.22 $108,568.25 $4,740.33 $89,833.73 $47,700.58 $10,562.00 $4,648.79 $0.00 $21,185.71 $126,867.22 $204,046.29 $30,095.20 $157,118.83 $14,365.13 $35,185.80 $180.28 $16,120.74 $35,254.03 $33,822.05 $25,003.34 $8,857.45 $2,831.57 $118,166.30 $2,846.38 $10,546.49 $10,111.54 $190,170.54 $9,129.61 $50,675.54 $8,958.15 $1,835.32

2009 Assessment Adjustment Amt
$0.00 $23,658.92 $47,994.64 $50,356.05 $108,623.97 $4,742.76 $89,879.83 $47,725.07 $10,567.42 $4,651.17 $0.00 $21,196.58 $126,932.34 $204,151.01 $30,110.65 $157,199.47 $14,372.50 $35,203.86 $180.37 $16,129.01 $35,272.12 $33,839.41 $25,016.17 $8,862.00 $2,833.03 $118,226.95 $2,847.84 $10,551.90 $10,116.72 $190,268.14 $9,134.29 $50,701.55 $8,962.75 $1,836.26

2010
Claims Paid
$84,147.91 $399,758.81 $1,214,581.29 $887,291.14 $1,301,201.00 $9,528.95 $1,349,916.27 $648,093.96 $355,926.00 $0.00 $339,750.59 $441,703.00 $1,693,493.57 $2,380,238.79 $478,621.56 $2,698,569.17 $213,170.61 $258,780.12 $0.00 $143,274.34 $333,603.22 $137,267.61 $535,882.66 $96,485.69 $74,836.27 $36,133.53 $0.00 $380,720.39 $31,743.89 $1,238,949.05 $32,414.97 $801,981.00 $22,887.19 $40,530.63

2010 Assessment Amt
$5,859.35 $27,835.83 $84,573.18 $61,783.46 $90,604.64 $663.52 $93,996.76 $45,127.79 $24,783.68 $0.00 $23,657.36 $30,756.46 $117,920.58 $165,739.72 $33,327.16 $187,905.55 $14,843.40 $18,019.26 $0.00 $9,976.41 $23,229.31 $9,558.16 $37,314.34 $6,718.45 $5,210.97 $2,516.03 $0.00 $26,510.15 $2,210.38 $86,269.94 $2,257.10 $55,843.18 $1,593.67 $2,822.21

2009 Balance Due
$0.00 $12.13 $24.62 $25.83 $55.72 $2.43 $46.10 $24.49 $5.42 $2.38 $0.00 $10.87 $65.12 $104.72 $15.45 $80.64 $7.37 $18.06 $0.09 $8.27 $18.09 $17.36 $12.83 $4.55 $1.46 $60.65 $1.46 $5.41 $5.18 $97.60 $4.68 $26.01 $4.60 $0.94

2009 And 2010 Total Assessment
$5,859.35 $27,847.96 $84,597.80 $61,809.29 $90,660.36 $665.95 $94,042.86 $45,152.28 $24,789.10 $2.38 $23,657.36 $30,767.33 $117,985.70 $165,844.44 $33,342.61 $187,986.19 $14,850.77 $18,037.32 $0.09 $9,984.68 $23,247.40 $9,575.52 $37,327.17 $6,723.00 $5,212.43 $2,576.68 $1.46 $26,515.56 $2,215.56 $86,367.54 $2,261.78 $55,869.19 $1,598.27 $2,823.15

73

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
COWETA CO BOARD OF EDUCATION COWETA COUNTY BOC CRACKER BARREL OLD CNTRY STORE CRAWFORD & COMPANY CRIDER'S POULTRY INC CRISP COUNTY BD OF EDUCATION D L LEE & SONS INC DALTON CITY OF DART CONTAINER CORP. OF GA DEAN FOODS COMPANY DECATUR, CITY OF DEKALB COUNTY BOARD-ED DEKALB COUNTY GOVERNMENT DEKALB FARMERS MARKET DEKALB REGIONAL HLTHCARE SYS DELHAIZE AMERICA LLC. DELTA AIRLINES, INC. DOLLAR GENERAL CORP DOUGHERTY COUNTY BOC DOUGHERTY COUNTY SCHOOL SYSTEM DOUGLAS CO BD OF COMMISSIONERS DOUGLAS COUNTY SCHOOLS DOUGLAS, CITY OF DSM CHEMICALS N. AMERICA DULUTH, CITY OF DURAND-WAYLAND, INC E I DUPONT DE NEMOURS & CO EAST POINT, CITY OF EATON CORPORATION ELBERTA CRATE & BOX COMPANY ELBERTON GRANITE ASSOCIATION ELBERTON, CITY OF EMERSON ELECTRIC CO EMORY UNIVERSITY

2009 Assessment Amt
$38,441.10 $11,786.19 $77,555.74 $32,272.81 $56,188.93 $30.04 $2,520.98 $21,435.90 $6,836.73 $52,025.86 $10,952.81 $221,254.68 $330,383.86 $1,650.70 $57,299.20 $111,328.85 $499,639.26 $286,215.64 $23,982.82 $60,652.90 $54,686.05 $99,919.49 $19,408.13 $5,057.96 $3,612.52 $9,598.16 $3,135.75 $22,158.69 $0.00 $5,301.87 $76,540.58 $648.49 $5,005.02 $181,430.67

2009 Assessment Adjustment Amt
$38,460.83 $11,792.24 $77,595.55 $32,289.38 $56,217.77 $30.05 $2,522.28 $21,446.90 $6,840.23 $52,052.56 $10,958.44 $221,368.24 $330,553.43 $1,651.55 $57,328.60 $111,385.99 $499,895.70 $286,362.54 $23,995.13 $60,684.03 $54,714.12 $99,970.77 $19,418.09 $5,060.56 $3,614.37 $9,603.09 $3,137.36 $22,170.06 $0.00 $5,304.59 $76,579.87 $648.82 $5,007.59 $181,523.79

2010 Claims Paid

2010
Assessment Amt

$614,448.15 $0.00 $732,042.08 $316,430.89 $1,156,146.24 $32,921.94 $132,527.29 $489,871.12 $159,086.93 $380,593.46 $437,032.00 $3,721,492.63 $4,155,234.64 $34,918.72 $948,900.74 $2,230,321.76 $13,043,610.08 $3,875,840.69 $248,860.38 $673,092.24 $485,988.80 $966,680.48 $316,690.76 $97,382.13 $35,218.53 $0.00 $103,306.69 $444,440.86 $101,007.29 $83,307.10 $1,234,099.11 $40,679.39 $63,356.00 $2,471,446.02

$42,784.98 $0.00 $50,973.22 $22,033.57 $80,504.25 $2,292.41 $9,228.08 $34,110.49 $11,077.47 $26,501.31 $30,431.22 $259,133.30 $289,335.43 $2,431.44 $66,073.43 $155,300.76 $908,246.79 $269,880.79 $17,328.53 $46,868.46 $33,840.15 $67,311.46 $22,051.67 $6,780.87 $2,452.32 $0.00 $7,193.40 $30,947.11 $7,033.29 $5,800.80 $85,932.23 $2,832.57 $4,411.58 $172,090.62

2009 Balance Due
$19.73 $6.05 $39.81 $16.57 $28.84 $0.01 $1.30 $11.00 $3.50 $26.70 $5.63 $113.56 $169.57 $0.85 $29.40 $57.14 $256.44 $146.90 $12.31 $31.13 $28.07 $51.28 $9.96 $2.60 $1.85 $4.93 $1.61 $11.37 $0.00 $2.72 $39.29 $0.33 $2.57 $93.12

2009 And 2010 Total Assessment
$42,804.71 $6.05 $51,013.03 $22,050.14 $80,533.09 $2,292.42 $9,229.38 $34,121.49 $11,080.97 $26,528.01 $30,436.85 $259,246.86 $289,505.00 $2,432.29 $66,102.83 $155,357.90 $908,503.23 $270,027.69 $17,340.84 $46,899.59 $33,868.22 $67,362.74 $22,061.63 $6,783.47 $2,454.17 $4.93 $7,195.01 $30,958.48 $7,033.29 $5,803.52 $85,971.52 $2,832.90 $4,414.15 $172,183.74

74

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
ENGINEERED FABRICS CORP. EQUITY GROUP GA DIVISION ESTES EXPRESS LINES EVANS GRADING CO., INC EXEL HOLDINGS, USA, INC FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FEDEX FREIGHT, INC FEDEX GROUND PKG SYS FIELDALE FARMS CORPORATION FLEETWOOD LIQUIDATING TRUST FLEXSTEEL INDUSTRIES INC FLORIDA ROCK & TANK LINES INC FLORIDA ROCK INDUSTRIES INC FLOWERS FOODS INC. FLOYD CO. BD. OF COMMISSIONERS FLOYD COUNTY BD OF EDUCATION FLOYD HLTHCARE MGMT INC FLYING J, INC. FORD MOTOR COMPANY FOREST PARK, CITY OF FORSYTH CO. BD. OF EDUCATION FRANKLIN ALUMINUM CO INC FREUDENBERG-NOK FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHY GANNETT CO. INC & SUBSIDIARIES GEORGIA CRATE & BASKET CO GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION GFF HOLDING CO/GENERAL FIBERS GIW INDUSTRIES INC

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$41,065.87 $12,677.76 $36,766.30 $4,985.79 $10,059.22 $18,355.34 $43,787.07 $169,903.95 $71,460.05 $42,242.57 $110,730.35 $12,366.88 $2,872.87 $4,771.00 $8,709.26 $64,400.60 $47,933.03 $10,764.57 $56,188.28 $11,025.92 $96,642.73 $12,505.31 $43,035.41 $1,935.89 $14,766.54 $268,981.96 $248,281.87 $111,979.03 $2,445.94 $177.59 $3,390,203.64 $54,578.12 $3,237.33 $2,196.74

$41,086.95 $12,684.27 $36,785.17 $4,988.35 $10,064.38 $18,364.76 $43,809.54 $169,991.15 $71,496.73 $42,264.25 $110,787.18 $12,373.23 $2,874.35 $4,773.45 $8,713.73 $64,433.65 $47,957.63 $10,770.10 $56,217.12 $11,031.58 $96,692.34 $12,511.73 $43,057.50 $1,936.89 $14,774.12 $269,120.01 $248,409.30 $112,036.51 $2,447.19 $177.68 $3,391,943.67 $54,606.13 $3,238.99 $2,197.87

$345,054.19 $60,147.01 $1,738,428.28 $25,657.37 $47,556.18 $270,456.73 $367,571.64 $2,395,078.45 $664,698.54 $459,352.91 $1,515,436.09 $0.00 $80,589.76 $78,805.00 $292,556.93 $1,085,922.17 $242,167.55 $331,313.35 $540,892.90 $459,384.14 $735,203.90 $37,460.85 $537,774.22 $14,205.16 $132,887.64 $3,761,874.95 $2,302,030.88 $1,556,961.83 $21,511.00 $47,130.68 $68,263,682.18 $1,652,455.10 $25,290.65 $169,251.22

$24,026.66 $4,188.13 $121,049.46 $1,786.56 $3,311.41 $18,832.32 $25,594.58 $166,773.02 $46,283.99 $31,985.46 $105,522.16 $0.00 $5,611.59 $5,487.31 $20,371.19 $75,614.44 $16,862.50 $23,069.86 $37,663.21 $31,987.63 $51,193.39 $2,608.46 $37,446.05 $989.13 $9,253.17 $261,945.18 $160,293.98 $108,413.67 $1,497.84 $3,281.78 $4,753,306.00 $115,063.01 $1,761.03 $11,785.22

$21.08 $6.51 $18.87 $2.56 $5.16 $9.42 $22.47 $87.20 $36.68 $21.68 $56.83 $6.35 $1.48 $2.45 $4.47 $33.05 $24.60 $5.53 $28.84 $5.66 $49.61 $6.42 $22.09 $1.00 $7.58 $138.05 $127.43 $57.48 $1.25 $0.09 $1,740.03 $28.01 $1.66 $1.13

$24,047.74 $4,194.64 $121,068.33 $1,789.12 $3,316.57 $18,841.74 $25,617.05 $166,860.22 $46,320.67 $32,007.14 $105,578.99 $6.35 $5,613.07 $5,489.76 $20,375.66 $75,647.49 $16,887.10 $23,075.39 $37,692.05 $31,993.29 $51,243.00 $2,614.88 $37,468.14 $990.13 $9,260.75 $262,083.23 $160,421.41 $108,471.15 $1,499.09 $3,281.87 $4,755,046.03 $115,091.02 $1,762.69 $11,786.35

75

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
GLYNN COUNTY BOARD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GOODY PRODUCTS, INC. GRAYBAR ELECTRIC CO., INC. GREAT ATLANTIC & PACIFIC TEA 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 HANSON AGGREGATES HAPEVILLE CITY OF HARRISON POULTRY, INC HEARTLAND EXPRESS HENRY CO BOARD OF EDUCATION HERCULES INCORPORATED HERSCHEND FAMILY ENTERTAINMENT HILLCREST FOODS, INC HILTON WORLDWIDE, INC HON INDUSTRIES, INC. HORMEL FOODS CORP HORTON HOMES, INC HOUSTON COUNTY BD OF EDUCATION HOUSTON COUNTY COMMISSIONERS HOUSTON HEALTHCARE HOWARD SHEPPARD INC HUTCHESON MEDICAL CENTER HYATT CORPORATION IDA CASON CALLAWAY FOUNDATION

2009 Assessment Amt
$37,163.33 $55,530.82 $9,294.41 $5,277.95 $147.09 $16,331.99 $30,679.66 $16,381.91 $9,819.04 $98,932.05 $364,507.13 $140,122.20 $95,425.24 $27,609.96 $51,929.46 $5,006.89 $0.00 $15,464.17 $36,795.81 $93,746.54 $0.00 $22,819.23 $8,846.44 $3,318.90 $58,446.58 $17,578.18 $26,183.45 $68,153.48 $23,743.67 $23,078.06 $9,913.95 $20,230.15 $15,088.96 $12,218.09

2009 Assessment Adjustment Amt
$37,182.41 $55,559.32 $9,299.18 $5,280.66 $147.17 $16,340.37 $30,695.40 $16,390.32 $9,824.08 $98,982.83 $364,694.21 $140,194.11 $95,474.21 $27,624.13 $51,956.12 $5,009.46 $0.00 $15,472.11 $36,814.69 $93,794.65 $0.00 $22,830.95 $8,850.98 $3,320.61 $58,476.57 $17,587.20 $26,196.89 $68,188.46 $23,755.86 $23,089.91 $9,919.04 $20,240.53 $15,096.71 $12,224.36

2010
Claims Paid
$747,307.59 $592,094.40 $74,409.07 $67,667.00 $0.00 $238,622.31 $438,817.72 $355,109.85 $135,188.00 $589,930.31 $537,926.84 $2,110,342.48 $1,591,871.00 $477,469.88 $1,635,596.74 $0.00 $13,880.38 $432,479.05 $454,890.26 $1,288,594.90 $129,830.63 $170,513.98 $93,183.68 $42,629.15 $537,324.36 $657,595.51 $387,114.44 $816,058.08 $321,699.38 $479,409.71 $192,961.34 $266,305.30 $314,055.56 $63,326.06

2010 Assessment Amt
$52,036.19 $41,228.45 $5,181.22 $4,711.76 $0.00 $16,615.64 $30,555.56 $24,726.85 $9,413.35 $41,077.76 $37,456.68 $146,946.42 $110,844.45 $33,246.97 $113,889.14 $0.00 $966.51 $30,114.19 $31,674.71 $89,726.86 $9,040.31 $11,873.15 $6,488.52 $2,968.33 $37,414.73 $45,789.39 $26,955.38 $56,823.39 $22,400.43 $33,382.04 $13,436.20 $18,543.25 $21,868.18 $4,409.49

2009 Balance Due
$19.08 $28.50 $4.77 $2.71 $0.08 $8.38 $15.74 $8.41 $5.04 $50.78 $187.08 $71.91 $48.97 $14.17 $26.66 $2.57 $0.00 $7.94 $18.88 $48.11 $0.00 $11.72 $4.54 $1.71 $29.99 $9.02 $13.44 $34.98 $12.19 $11.85 $5.09 $10.38 $7.75 $6.27

2009 And 2010 Total Assessment
$52,055.27 $41,256.95 $5,185.99 $4,714.47 $0.08 $16,624.02 $30,571.30 $24,735.26 $9,418.39 $41,128.54 $37,643.76 $147,018.33 $110,893.42 $33,261.14 $113,915.80 $2.57 $966.51 $30,122.13 $31,693.59 $89,774.97 $9,040.31 $11,884.87 $6,493.06 $2,970.04 $37,444.72 $45,798.41 $26,968.82 $56,858.37 $22,412.62 $33,393.89 $13,441.29 $18,553.63 $21,875.93 $4,415.76

76

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
IKON OFFICE SOLUTIONS INGLES MARKETS INC INTERFACE, INC INTERNATIONAL PAPER COMPANY INTERSTATE PAPER LLC J & J INDUSTRIES INC J. C. PENNEY COMPANY, INC. JESUP CITY OF JOHN WIELAND HOMES, INC JOHNS MANVILLE INT'L., INC. JONES COMPANY (THE) KELLEY MANUFACTURING COMPANY KELLOGG CO & SUBSIDIARIES KIMBERLY-CLARK CORP KING & PRINCE SEAFOOD CORP. KLEEN-TEX INDUSTRIES KLLM TRANSPORT SERVICES LLC K-MART CORP KNIGHT TRANSPORTATION KROGER COMPANY, THE LAGRANGE, CITY OF LANGDALE INDUSTRIES LAWRENCEVILLE, CITY OF LEVI STRAUSS & CO LIBERTY NATIONAL LIFE INS CO LIMITED BRANDS, INC LOUISIANA-PACIFIC CORP LOW TEMP INDUSTRIES LOWE'S HOME CENTERS, INC MACON CITY OF MACON/BIBB CO WATER & SEWERAGE MACY'S MAPLEHURST DELI-BAKE STH MARIETTA CITY SERVICES

2009 Assessment Amt
$59,638.53 $218,522.73 $749.90 $82,244.52 $13,132.96 $15,290.30 $41,204.24 $5,008.60 $33,144.03 $7,024.78 $87,039.94 $7,965.60 $60,240.56 $6,367.20 $742.83 $2,008.94 $18,689.17 $193,836.82 $35,787.78 $428,776.14 $10,454.90 $147,998.73 $21,840.58 $33,138.32 $2,105.75 $1,207.44 $8,039.48 $0.00 $350,226.95 $113,519.06 $61,043.49 $72,432.90 $14,118.39 $24,314.30

2009 Assessment Adjustment Amt
$59,669.14 $218,634.89 $750.29 $82,286.74 $13,139.70 $15,298.15 $41,225.39 $5,011.17 $33,161.04 $7,028.38 $87,084.61 $7,969.69 $60,271.48 $6,370.47 $743.21 $2,009.97 $18,698.76 $193,936.31 $35,806.15 $428,996.21 $10,460.27 $148,074.69 $21,851.79 $33,155.33 $2,106.83 $1,208.06 $8,043.61 $0.00 $350,406.70 $113,577.32 $61,074.82 $72,470.08 $14,125.64 $24,326.78

2010
Claims Paid
$1,131,455.67 $3,235,154.00 $482,202.25 $1,374,641.86 $563,175.26 $190,190.23 $305,658.00 $153,733.38 $404,055.26 $168,240.89 $1,145,376.80 $81,253.47 $1,054,502.46 $63,991.06 $2,007.93 $19,288.70 $0.00 $1,411,041.63 $95,577.97 $5,782,771.67 $202,536.70 $1,326,653.25 $389,816.11 $0.00 $143,149.65 $23,192.05 $114,525.11 $120,552.94 $4,822,618.62 $1,245,447.43 $291,976.40 $1,359,953.00 $25,832.45 $478,672.52

2010 Assessment Amt
$78,785.01 $225,268.79 $33,576.49 $95,718.44 $39,214.77 $13,243.24 $21,283.44 $10,704.69 $28,134.99 $11,714.87 $79,754.36 $5,657.81 $73,426.64 $4,455.80 $139.82 $1,343.10 $0.00 $98,253.02 $6,655.24 $402,663.35 $14,102.94 $92,376.92 $27,143.50 $0.00 $9,967.73 $1,614.90 $7,974.56 $8,394.29 $335,806.41 $86,722.43 $20,330.77 $94,695.64 $1,798.75 $33,330.71

2009 Balance Due
$30.61 $112.16 $0.39 $42.22 $6.74 $7.85 $21.15 $2.57 $17.01 $3.60 $44.67 $4.09 $30.92 $3.27 $0.38 $1.03 $9.59 $99.49 $18.37 $220.07 $5.37 $75.96 $11.21 $17.01 $1.08 $0.62 $4.13 $0.00 $179.75 $58.26 $31.33 $37.18 $7.25 $12.48

2009 And 2010 Total Assessment
$78,815.62 $225,380.95 $33,576.88 $95,760.66 $39,221.51 $13,251.09 $21,304.59 $10,707.26 $28,152.00 $11,718.47 $79,799.03 $5,661.90 $73,457.56 $4,459.07 $140.20 $1,344.13 $9.59 $98,352.51 $6,673.61 $402,883.42 $14,108.31 $92,452.88 $27,154.71 $17.01 $9,968.81 $1,615.52 $7,978.69 $8,394.29 $335,986.16 $86,780.69 $20,362.10 $94,732.82 $1,806.00 $33,343.19

77

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
MAR-JAC POULTRY, INC. MARKETPLACE HOLDINGS, INC MARRIOTT INTERNATIONAL, INC. MARTA MCG HEALTH INC MCLANE COMPANY, INC. M-D BUILDING PRODUCTS MEADOWS REGIONAL MEDICAL CTR MEADWESTVACO MEMORIAL MEDICAL CENTER MERCK SHARP & DOHME CORP METALPLATE GALVANIZING L P METROMEDIA INTERNATIONAL GRP MICROMERITICS INSTRUMENTS CORP MILLEDGEVILLE, CITY OF MILTON J. WOOD COMPANY MOHAWK INDUSTRIES, INC MONROE, CITY OF MOUNT VERNON MILLS MURRAY COUNTY BD OF EDUCATION MUSCOGEE COUNTY SCHOOL DIST NASH JOHNSON & SONS' FARMS INC NEWTON COUNTY NEWTON COUNTY BD OF EDUCATION NORDSON CORPORATION NORDSTROM, INC. NORMAN W FRIES/CLAXTON POULTRY NORTHEAST GEORGIA HEALTH SYS NORTHSIDE HOSPITAL OLD DOMINION FREIGHT LINES INC OWENS-CORNING OWENS-ILLINOIS INC OXFORD CONSTRUCTION CO PARKER HANNIFIN CORP.

2009 Assessment Amt
$56,518.06 $105.25 $93,217.51 $365,508.17 $18,621.70 $21,763.85 $18.68 $4,188.09 $20,441.33 $26,335.20 $3,581.89 $0.00 $5,496.89 $2,630.10 $0.00 $2,307.45 $159,475.03 $3,247.12 $34,427.28 $920.17 $44,598.37 $1,040.23 $13,989.21 $67,161.74 $13,829.97 $16,748.53 $13,078.70 $27,875.58 $180,063.28 $33,621.77 $14,363.15 $40,733.50 $42,148.52 $5,782.34

2009 Assessment Adjustment Amt
$56,547.07 $105.30 $93,265.35 $365,695.77 $18,631.26 $21,775.02 $18.69 $4,190.24 $20,451.82 $26,348.72 $3,583.73 $0.00 $5,499.71 $2,631.45 $0.00 $2,308.63 $159,556.88 $3,248.78 $34,444.95 $920.64 $44,621.26 $1,040.76 $13,996.39 $67,196.21 $13,837.07 $16,757.12 $13,085.42 $27,889.88 $180,155.69 $33,639.03 $14,370.52 $40,754.40 $42,170.16 $5,785.31

2010
Claims Paid
$971,330.32 $38,605.26 $1,612,937.94 $7,457,930.95 $376,308.22 $406,190.35 $19,114.84 $92,616.53 $323,170.41 $599,745.05 $57,374.21 $4,323.00 $0.00 $5,660.54 $179,650.45 $2,599.82 $585,794.86 $107,406.41 $342,195.47 $14,721.12 $404,653.31 $71,324.00 $0.00 $647,669.77 $74,959.00 $313,890.00 $774,451.50 $368,985.00 $3,032,961.00 $852,685.78 $444,093.26 $563,451.26 $301,443.29 $175,255.78

2010 Assessment Amt
$67,635.24 $2,688.14 $112,311.37 $519,307.29 $26,202.92 $28,283.66 $1,331.00 $6,449.03 $22,502.86 $41,761.18 $3,995.06 $301.02 $0.00 $394.15 $12,509.34 $181.03 $40,789.80 $7,478.87 $23,827.60 $1,025.05 $28,176.64 $4,966.40 $0.00 $45,098.25 $5,219.51 $21,856.65 $53,926.26 $25,693.00 $211,189.78 $59,373.83 $30,922.90 $39,233.98 $20,989.96 $12,203.33

2009 Balance Due
$29.01 $0.05 $47.84 $187.60 $9.56 $11.17 $0.01 $2.15 $10.49 $13.52 $1.84 $0.00 $2.82 $1.35 $0.00 $1.18 $81.85 $1.66 $17.67 $0.47 $22.89 $0.53 $7.18 $34.47 $7.10 $8.59 $6.72 $14.30 $92.41 $17.26 $7.37 $20.90 $21.64 $2.97

2009 And 2010 Total Assessment
$67,664.25 $2,688.19 $112,359.21 $519,494.89 $26,212.48 $28,294.83 $1,331.01 $6,451.18 $22,513.35 $41,774.70 $3,996.90 $301.02 $2.82 $395.50 $12,509.34 $182.21 $40,871.65 $7,480.53 $23,845.27 $1,025.52 $28,199.53 $4,966.93 $7.18 $45,132.72 $5,226.61 $21,865.24 $53,932.98 $25,707.30 $211,282.19 $59,391.09 $30,930.27 $39,254.88 $21,011.60 $12,206.30

78

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
PATTERSON PUMP COMPANY PCC AIRFOILS LLC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL PIEDMONT LABORATORIES, INC. PIGGLY WIGGLY CAROLINA CO INC PIKE ELECTRIC, INC. PILOT TRAVEL CENTERS PPG INDUSTRIES INC. PRINTPACK, INC PROCTER & GAMBLE COMPANY QUIKTRIP CORPORATION RACETRAC PETROLEUM, INC RANDOLPH COUNTY HOSP AUTHORITY RAYONIER INC RECONSERVE OF GEORGIA INC REGIONS FINANCIAL CORP RHODES NURSING HOME RICHMOND CTY BD OF EDUCATION RIVERDALE, CITY OF RMC USA, INC. ROCKDALE CO. BD OF EDUCATION ROCKWELL AUTOMATION, INC ROLLINS INC ROME, CITY OF ROOKER ADMINISTRATIVE SERVICES ROPER CORPORATION ROSEBURG FOREST PRODUCTS ROSWELL CITY OF RTM, INC. RUBY TUESDAY INC RUSSELL BRANDS, LLC RYAN'S FAMILY STEAK HOUSES RYDER SYSTEM INC

2009 Assessment Amt
$3,188.66 $24,417.96 $40,345.08 $89,479.03 $0.00 $5,780.78 $0.00 $9,975.45 $1,764.46 $15,150.69 $36,783.02 $31,197.66 $22,570.02 $76.43 $25,112.83 $3,335.37 $9,460.75 $17,491.50 $66,078.82 $1,715.81 $22,554.48 $25,415.13 $0.00 $63,606.37 $0.00 $1,558.84 $39,334.94 $4,633.26 $37,981.51 $14,617.46 $25,057.29 $1,588.94 $6,737.50 $64,185.38

2009 Assessment Adjustment Amt
$3,190.29 $24,430.49 $40,365.79 $89,524.96 $0.00 $5,783.75 $0.00 $9,980.57 $1,765.36 $15,158.47 $36,801.90 $31,213.67 $22,581.61 $76.47 $25,125.71 $3,337.08 $9,465.61 $17,500.48 $66,112.73 $1,716.69 $22,566.06 $25,428.17 $0.00 $63,639.02 $0.00 $1,559.64 $39,355.13 $4,635.64 $38,001.00 $14,624.96 $25,070.15 $1,589.76 $6,740.96 $64,218.33

2010
Claims Paid
$56,019.61 $177,038.53 $908,286.54 $1,146,499.12 $12,993.86 $253,062.16 $182,589.20 $94,404.34 $234,289.76 $189,586.01 $810,871.00 $370,775.37 $499,203.26 $1,170.91 $194,882.93 $105,024.06 $157,646.80 $249,916.00 $1,401,477.00 $92,871.14 $346,395.66 $306,252.84 $260,389.00 $683,318.21 $209,610.86 $0.00 $405,232.87 $83,969.70 $221,895.45 $182,747.52 $116,462.00 $10,984.91 $8,735.08 $938,774.33

2010 Assessment Amt
$3,900.73 $12,327.47 $63,245.40 $79,832.51 $904.78 $17,621.11 $12,713.97 $6,573.52 $16,313.96 $13,201.17 $56,462.20 $25,817.66 $34,760.30 $81.53 $13,570.00 $7,312.99 $10,977.19 $17,402.04 $97,587.02 $6,466.76 $24,120.07 $21,324.86 $18,131.29 $47,580.51 $14,595.53 $0.00 $28,216.99 $5,846.94 $15,450.92 $12,724.99 $8,109.43 $764.90 $608.24 $65,368.31

2009 Balance Due
$1.63 $12.53 $20.71 $45.93 $0.00 $2.97 $0.00 $5.12 $0.90 $7.78 $18.88 $16.01 $11.59 $0.04 $12.88 $1.71 $4.86 $8.98 $33.91 $0.88 $11.58 $13.04 $0.00 $32.65 $0.00 $0.80 $20.19 $2.38 $19.49 $7.50 $12.86 $0.82 $3.46 $32.95

2009 And 2010 Total Assessment
$3,902.36 $12,340.00 $63,266.11 $79,878.44 $904.78 $17,624.08 $12,713.97 $6,578.64 $16,314.86 $13,208.95 $56,481.08 $25,833.67 $34,771.89 $81.57 $13,582.88 $7,314.70 $10,982.05 $17,411.02 $97,620.93 $6,467.64 $24,131.65 $21,337.90 $18,131.29 $47,613.16 $14,595.53 $0.80 $28,237.18 $5,849.32 $15,470.41 $12,732.49 $8,122.29 $765.72 $611.70 $65,401.26

79

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
SAINT JOSEPH'S OF SAVANNAH SATILLA HEALTH SERVICES INC SAVANNAH CITY OF SCIENTIFIC-ATLANTA INC SEVEN-UP SNAPPLE SOUTHEAST SHAW INDUSTRIES INC SHEPHERD CONSTRUCTION SHEPHERD MEDICAL CENTER SHERWIN-WILLIAMS COMPANY SHONEY'S LLC SIMMONS FOODS, INC SIMPSON LUMBER CO LLC SIZEMORE ,INC. SKF USA INC SMURFIT-STONE CONTAINER ENTERP SNELL CONTRACTORS SONOCO PRODUCTS COMPANY 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 SPARTA CITY OF SPRINGS INDUSTRIES INC ST FRANCIS HOSPITAL ST JOSEPH HOSPITAL/AUGUSTA STANLEY BLACK & DECKER, INC. STANLEY WORKS & SUBSIDIARIES SUPERIOR RIGGING & ERECTING CO SUTHERLAND'S FOODSERVICE, INC.

2009 Assessment Amt
$55,290.19 $61,718.49 $163,080.11 $0.00 $3,135.00 $500,478.80 $16,736.59 $5,062.58 $32,783.61 $51,805.67 $965.80 $267.83 $24,045.79 $366.92 $1,913.80 $24,951.36 $902.38 $26,511.57 $79,220.43 $37,561.79 $309,182.95 $26,678.07 $5,606.55 $39,313.74 $96,840.14 $10,124.59 $1,349.35 $6,049.51 $8,207.31 $3,130.48 $22,139.36 $1,899.93 $18,003.99 $1,953.67

2009 Assessment Adjustment Amt
$55,318.57 $61,750.17 $163,163.81 $0.00 $3,136.61 $500,735.67 $16,745.18 $5,065.18 $32,800.44 $51,832.26 $966.29 $267.97 $24,058.13 $367.11 $1,914.78 $24,964.16 $902.84 $26,525.18 $79,261.09 $37,581.07 $309,341.64 $26,691.77 $5,609.43 $39,333.92 $96,889.84 $10,129.78 $1,350.04 $6,052.62 $8,211.52 $3,132.09 $22,150.73 $1,900.90 $18,013.23 $1,954.67

2010
Claims Paid
$675,191.76 $668,161.51 $3,961,232.80 $103,584.66 $94,793.92 $4,921,708.09 $173,175.51 $260,772.85 $733,410.80 $3,121.12 $13,122.72 $53,179.85 $65,291.54 $3,922.00 $0.00 $324,479.87 $6,581.92 $0.00 $1,438,693.01 $511,506.39 $5,607,932.82 $180,784.81 $26,552.01 $226,230.02 $1,338,525.65 $106,516.08 $29,939.37 $219,087.00 $0.00 $27,891.00 $2,431.27 $5,399.03 $485,459.05 $54,802.90

2010 Assessment Amt
$47,014.65 $46,525.12 $275,826.78 $7,212.76 $6,600.65 $342,706.16 $12,058.48 $18,158.02 $51,068.53 $217.33 $913.76 $3,703.00 $4,546.35 $273.09 $0.00 $22,594.04 $458.31 $0.00 $100,178.42 $35,616.98 $390,489.05 $12,588.33 $1,848.86 $15,752.75 $93,203.62 $7,416.88 $2,084.72 $15,255.37 $0.00 $1,942.09 $169.29 $375.94 $33,803.27 $3,816.01

2009 Balance Due
$28.38 $31.68 $83.70 $0.00 $1.61 $256.87 $8.59 $2.60 $16.83 $26.59 $0.49 $0.14 $12.34 $0.19 $0.98 $12.80 $0.46 $13.61 $40.66 $19.28 $158.69 $13.70 $2.88 $20.18 $49.70 $5.19 $0.69 $3.11 $4.21 $1.61 $11.37 $0.97 $9.24 $1.00

2009 And 2010 Total Assessment
$47,043.03 $46,556.80 $275,910.48 $7,212.76 $6,602.26 $342,963.03 $12,067.07 $18,160.62 $51,085.36 $243.92 $914.25 $3,703.14 $4,558.69 $273.28 $0.98 $22,606.84 $458.77 $13.61 $100,219.08 $35,636.26 $390,647.74 $12,602.03 $1,851.74 $15,772.93 $93,253.32 $7,422.07 $2,085.41 $15,258.48 $4.21 $1,943.70 $180.66 $376.91 $33,812.51 $3,817.01

80

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
T. M. POLYFILM, INC TALON EQUITIES, INC TANNER HEALTH SERVICES TARGET CORPORATION TECUMSEH PRODUCTS COMPANY TENNECO AUTOMOTIVE, INC TERMINIX SERVICE, INC TEXTILE RUBBER & CHEMICAL TEXTRON, INC THE DIXIE GROUP, INC. THERMAL CERAMICS THOMASVILLE CITY OF THREE SPRINGS INC. TIP TOP POULTRY INC TRC STAFFING SERVICES, INC TRONOX PIGMENTS (SAV) INC. TROUP CO. BOARD OF EDUCATION TRUEBLUE, INC. TYSON FOODS INC UNILEVER UNITED STATES UNITED AIRLINES UNIVERSITY HOSPITAL UPS FREIGHT USF HOLLAND, INC. VALDOSTA CITY OF VARIETY WHOLESALERS VISITING NURSE HEALTH SYSTEM VULCAN MATERIALS COMPANY WAFFLE HOUSE WAGGONERS TRUCKING CO., THE WALKER COUNTY BD OF EDUCATION WALTON CO BOARD OF ED WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF

2009 Assessment Amt
$10,187.28 $4,807.19 $11,267.56 $268,692.70 $1,258.69 $446.94 $11.60 $19,095.20 $21,419.70 $0.00 $11,083.27 $43,472.52 $0.00 $48,332.69 $28,981.42 $2,551.45 $765.77 $25,322.30 $116,979.30 $4,630.14 $19,489.06 $45,694.07 $19,147.47 $1,488.71 $24,966.41 $42,541.37 $21,742.80 $22,872.67 $41,508.59 $41,548.04 $24,749.56 $16,980.17 $107,573.46 $26,356.80

2009 Assessment Adjustment Amt
$10,192.51 $4,809.66 $11,273.35 $268,830.61 $1,259.34 $447.17 $11.61 $19,105.00 $21,430.70 $0.00 $11,088.96 $43,494.84 $0.00 $48,357.49 $28,996.29 $2,552.76 $766.16 $25,335.29 $117,039.34 $4,632.51 $19,499.07 $45,717.52 $19,157.30 $1,489.47 $24,979.22 $42,563.21 $21,753.96 $22,884.41 $41,529.90 $41,569.37 $24,762.26 $16,988.88 $107,628.67 $26,370.33

2010
Claims Paid
$80,143.96 $74,170.49 $163,122.83 $4,010,197.22 $65,107.96 $0.00 $3,010.41 $158,682.55 $324,494.89 $424,947.15 $401,484.65 $512,324.58 $68,932.05 $504,481.85 $619,500.93 $139,513.85 $271,087.76 $401,796.47 $2,312,461.35 $0.00 $385,495.65 $244,409.19 $592,216.40 $394,539.91 $364,044.58 $333,301.76 $200,306.44 $570,972.71 $1,044,170.73 $118,540.59 $210,682.44 $296,355.27 $1,164,621.88 $394,896.54

2010 Assessment Amt
$5,580.55 $5,164.61 $11,358.50 $279,236.25 $4,533.57 $0.00 $209.62 $11,049.31 $22,595.08 $29,589.73 $27,956.00 $35,673.95 $4,799.85 $35,127.85 $43,136.81 $9,714.57 $18,876.26 $27,977.71 $161,020.27 $0.00 $26,842.66 $17,018.59 $41,236.95 $27,472.43 $25,348.99 $23,208.32 $13,947.65 $39,757.71 $72,707.23 $8,254.17 $14,670.14 $20,635.68 $81,094.43 $27,497.26

2009 Balance Due
$5.23 $2.47 $5.79 $137.91 $0.65 $0.23 $0.01 $9.80 $11.00 $0.00 $5.69 $22.32 $0.00 $24.80 $14.87 $1.31 $0.39 $12.99 $60.04 $2.37 $10.01 $23.45 $9.83 $0.76 $12.81 $21.84 $11.16 $11.74 $21.31 $21.33 $12.70 $8.71 $55.21 $13.53

2009 And 2010 Total Assessment
$5,585.78 $5,167.08 $11,364.29 $279,374.16 $4,534.22 $0.23 $209.63 $11,059.11 $22,606.08 $29,589.73 $27,961.69 $35,696.27 $4,799.85 $35,152.65 $43,151.68 $9,715.88 $18,876.65 $27,990.70 $161,080.31 $2.37 $26,852.67 $17,042.04 $41,246.78 $27,473.19 $25,361.80 $23,230.16 $13,958.81 $39,769.45 $72,728.54 $8,275.50 $14,682.84 $20,644.39 $81,149.64 $27,510.79

81

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Self-Insured Companies

Company Name
WATKINS ASSOCIATED INDUSTRIES WAYCROSS MOLDED PRODUCTS INC WAYCROSS, CITY OF WAYNE FARMS LLC WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYSTEM WEYERHAEUSER COMPANY WHITFIELD COUNTY BOE WINN-DIXIE STORES INC YELLOW TRANSPORTATION YKK CORPORATION OF AMERICA Grand Total:

2009
Assessment Amt

2009 Assessment
Adjustment Amt

2010 Claims Paid

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$10,522.39 $3,989.96 $793.09 $19,050.84 $423,754.91 $9,901.20 $7,158.18 $0.00 $17,697.56 $97,855.03 $92,711.64 $7,277.25 $20,462,770.40

$10,527.79 $3,992.01 $793.49 $19,060.61 $423,972.41 $9,906.28 $7,161.85 $0.00 $17,706.64 $97,905.25 $92,759.22 $7,280.98 $20,473,272.93

$165,431.36 $39,460.60 $76,912.63 $287,418.10 $537,843.33 $305,748.19 $254,084.87 $275,971.38 $241,036.84 $1,813,457.89 $1,876,065.04 $562,682.92 $305,915,924.95

$11,519.24 $2,747.70 $5,355.55 $20,013.37 $37,450.86 $21,289.72 $17,692.32 $19,216.31 $16,783.77 $126,273.88 $130,633.32 $39,180.48 $21,301,400.01

$5.40 $2.05 $0.40 $9.77 $217.50 $5.08 $3.67 $0.00 $9.08 $50.22 $47.58 $3.73 $10,502.53

$11,524.64 $2,749.75 $5,355.95 $20,023.14 $37,668.36 $21,294.80 $17,695.99 $19,216.31 $16,792.85 $126,324.10 $130,680.90 $39,184.21 $21,299,188.57

82

Assessments Due from Group Self-Insurers

Georgia Subsequent Injury Trust Fund Assessment Adjustment - Debit/Credit 2010 Assessment
2009 Assessment Adjustment Group Self-Insured Companies

Company Name
AGRITRUST OF GEORGIA ASSOCIATION CTY COM GA SI 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 RETAIL MERCHANTS' WCT GA SCHOOL BD ASSOC W C FUND GEMC WORKERS' COMP FUND GTMA/AYSA SELF INSURANCE ROOFING & SHEET METAL ASSOC Grand Total:

2009 Assessment Amt
$236,349.21 $1,704,819.87 $164,325.25 $616,395.65 $405,251.94 $317,548.10 $1,291,565.51 $89,307.69 $214,250.79 $157,035.81 $0.00 $311,245.78 $231,568.44 $74,204.85 $136,024.29 $5,949,893.18

2009 Assessment
Adjustment Amt

2010 Claims Paid

2010
Assessment Amt

2009
Balance Due

2009 And 2010
Total Assessment

$236,470.52 $1,705,694.87 $164,409.59 $616,712.02 $405,459.93 $317,711.08 $1,292,228.41 $89,353.53 $214,360.75 $157,116.41 $0.00 $311,405.53 $231,687.29 $74,242.94 $136,094.11 $5,952,946.98

$3,685,855.36 $26,267,096.98 $1,709,329.71 $8,658,476.47 $6,432,977.54 $3,462,386.44 $19,554,237.33 $1,168,754.15 $2,504,923.70 $1,579,179.18 $26,760.81 $4,204,814.85 $3,953,922.58 $131,603.33 $2,384,010.46 $85,724,328.89

$256,651.82 $1,829,018.68 $119,023.28 $602,903.14 $447,938.20 $241,091.33 $1,361,591.85 $81,382.16 $174,421.72 $109,960.69 $1,863.40 $292,787.78 $275,317.76 $9,163.74 $166,002.34 $5,969,117.89

$121.31 $875.00 $84.34 $316.37 $207.99 $162.98 $662.90 $45.84 $109.96 $80.60 $0.00 $159.75 $118.85 $38.09 $69.82 $3,053.80

$256,773.13 $1,829,893.68 $119,107.62 $603,219.51 $448,146.19 $241,254.31 $1,362,254.75 $81,428.00 $174,531.68 $110,041.29 $1,863.40 $292,947.53 $275,436.61 $9,201.83 $166,072.16 $5,972,171.69