STATE OF GEORGIA SUBSEQUENT INJURY TRUST FUND 2010 ANNUAL REPORT 2 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 3 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 4 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. 5 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 6 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. 7 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. 8 (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 9 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 10 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: 4 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 11 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 12 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 13 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 16 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