2012 annual report

STATE OF GEORGIA SUBSEQUENT INJURY TRUST
FUND
July 2013

SITF 2012 Annual Report Page 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 Steve Heinen
Administrator Michael T. Coan
Deputy Administrator Allan Payne

SITF 2012 Annual Report Page 3
Fund Administration ..................................................................................................4
Introduction _____________________________________________________________________ 4 How the Fund Works ______________________________________________________________ 4 Reimbursement from the Fund _______________________________________________________ 4 Legislation ______________________________________________________________________ 4 Claims Administration _____________________________________________________________ 7 Claims Activity 2012_____________________________________________________________ 7 Settlement Reimbursement Limits ____________________________________________________ 8 Financial Activity _________________________________________________________________ 9
Reimbursements Paid in 2012 .................................................................................10
Reimbursements to Insurance Companies _____________________________________________ 10 Reimbursements to Self-Insurers ____________________________________________________ 15 Reimbursements to Group Self-Insurers ______________________________________________ 21
Individual Employers Benefitting from SITF Reimbursements ...............................22 Assessment by the Fund ...........................................................................................46
Legal Requirements ______________________________________________________________ 46 Assessment Calculation ___________________________________________________________ 47 Assessment Adjustment for 2011 ____________________________________________________ 47 Assessment Rate for 2012 _________________________________________________________ 47
Assessments Due for 2012 .......................................................................................48
Assessments Due from Insurance Companies __________________________________________ 48 Assessments Due from Self-Insurers _________________________________________________ 55 Assessments Due from Group Self-Insurers ___________________________________________ 63

SITF 2012 Annual Report Page 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 sixyear 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 on-the-job injury of the employee must be directly caused by or combined with a prior impairment to create a greater liability for lost-time benefits and medical expenses. In addition, the employee must have a preexisting impairment that the employer considered to be permanent and likely to be a hindrance to employment, and the employer must have knowledge of the prior impairment before the subsequent injury occurs.
O.C.G.A.34-9-361 contains a list of conditions that are presumed to be permanent and likely to be a hindrance to

employment provided the employer could demonstrate prior knowledge.
Reimbursement from the Fund
All licensed workers' compensation insurance carriers and self-insured employers authorized by the State Board of Workers' Compensation in the state of Georgia may access the fund.
Employers/insurers must notify the fund of a possible claim by filing a Notice of Claim no later than 78 weeks following the date of injury.
In addition to the mandatory Notice of Claim, the employer must submit a notarized Employer's Knowledge Affidavit, certifying prior knowledge of the worker's pre-existing permanent impairment.
Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks; for 50% of all medical and rehabilitation expenses between $5,000 and $10,000; and for 100% of all medical and rehabilitation expenses in excess of $10,000.
If the subsequent injury was not caused by or related to a prior impairment, the reimbursement for medical expenses may be reduced or denied completely.
Legislation
In 2005, House Bill 200 amended the Official Code of Georgia by adding Chapter 34-9-368 setting the date to dissolve the agency and 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,

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2006. The Subsequent Injury Trust Fund shall continue to reimburse self-insured 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 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 34-9100; otherwise recovery shall be barred.

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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.
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.
(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 selfinsurer 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 selfinsurer.

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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.
The fund makes reimbursement payments to insurers and self-insurers in accordance with the Board approved reimbursement agreement.

Claims Activity 2012
The following is a breakdown of claims activity for calendar year 2012. 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

1/1/2012 CY 2012 CY 2012 CY 2012 12/31/2013 CY 2012 CY 2012 CY 2012

3,347 0
54 1,965 1,436
17 3
524

SITF 2012 Annual Report Page 8

Settlement Reimbursement Limits
The Fund has two types of reimbursements to issue to insurers and self-insurers. The Fund has an ongoing obligation to issue reimbursement funds for accepted claims that are open and will remain open for a period of time, and for requests for settlements that must be processed so that the settlement payments are made timely.
Reimbursement is made based on availability of monies for the regular reimbursement of indemnity and medical expenses as well as the reimbursement for total settlements of claims.
Legislation requires a mandatory $100 million annual assessment (approximately 7%) beginning in 2010 and continuing until an actuarial study determines assessments are no longer needed.
In an effort to recognize the effects of the $100 million cap, the Fund has implemented a structured reimbursement for settled claims. Settlement cases are placed on an installment repayment plan so that cases can move forward in a timely fashion.
The purpose of the new installment program is to allow the Fund to authorize settlement of a claim with reimbursement of settlement proceeds over a period of one to three years. In this way, the insurer and self insurer can minimize ongoing reimbursement cost because the claim is settled and avoid the cost of staff monitoring reimbursement requests, and obtaining appropriate reimbursement from the Fund.
The purpose of the settlement structure reimbursement process is to ensure that the Fund has adequate monies on hand to accommodate the ongoing responsibility of reimbursement of medical and indemnity in cases that have not settled. Additionally, in that the Fund has a sunset date of 2020, the Fund will also be maximizing the amount of cases, which can be "settled" while still continuing to build a surplus of funds

available to cover the remaining liabilities in 2020.
Unless these structured installments are made by the fund, there will only be approximately $30 million available for settlements per year. This does not accomplish the purpose of the Fund; results in additional administrative and backlog costs, and creates a backlog for the insurer and self-insurer and may result in higher settlement costs to all parties. This program will allow settlement of more cases over a three year period. The Fund has instituted the structured reimbursement process as follows:
(1) Any settlement up to $75,000.00 will be reimbursed in full as the current backlog allows.
(2) Any settlement of a case from $75,000.00 to $150,000.00 will be paid under an installment process of $75,000.00 paid in the first year. The remaining installment will be reimbursed on the payment anniversary date twelve (12) months later. The Fund will automatically issue a settlement reimbursement payment on the anniversary date of the initial installment payment.
(3) Any settlements of $150,000.00 to $225,000.00 will be paid at $75,000.00 per twelve (12) month period with the second and third payments being automatically issued on the anniversary date of the initial payment.
(4) Any settlements above $250,000.00 will be reimbursed in three (3) equal installments per twelve (12) month period with the second and third payments being automatically issued on the anniversary date of the initial payment.

SITF 2012 Annual Report Page 9
Financial Activity The following depicts the Fund's revenues, expenditures, and fund balance for the calendar year ending December 31, 2012. The fund's year-end balance is part of the formula for establishing the annual assessment. For information on prior years, please call (404) 656-7000 or visit our website at http://sitf.georgia.gov.

BEGINNING BALANCE, January 1, 2012

58,602,269.44

REVENUES
Assessment - 2011, Adj. 2010 payments and refunds from prior year
Interest Earned

99,958,255.36 3,246.51
64,983.28

Miscellaneous Income TOTAL REVENUES

285.68

100,026,770.83

EXPENDITURES

Operating Cost

2,299,210.37

Reimbursements (Negotiated Checks) 101,025,779.67

TOTAL EXPENDITURES Net Loss ENDING BALANCE, December 31, 2012

103,324,990.04 (3,298,219.21) 55,304,050.23

SITF 2012 Annual Report Page 10

Reimbursements Paid in 2012

Reimbursements to Insurance Companies

Total Dollars Paid by the Fund to Insurance Companies

From 1/1/2012 Through 12/31/2012

Name

Amount

21ST CENTURY NATIONAL INS CO

$38,612.58

ACE AMERICAN INSURANCE CO

$1,509,316.61

ACE PROPERTY & CASUALTY INS

$228,304.62

ADVANTAGE WORKERS COMP. INS.

$18,922.93

ALEA NORTH AMERICA

$1.44

ALFA INSURANCE CORP

$272,042.62

ALL AMERICA INS. CO

$93,774.30

ALLIED INSURANCE COMPANY

$9,453.58

ALLSTATE INSURANCE CO

$22,869.25

AMERICAN ALTERNATIVE INS

$50,557.23

AMERICAN CAS CO OF READING PA

$439,719.38

AMERICAN ECONOMY INS CO

$76.00

AMERICAN HOME ASSURANCE CO

$1,234,183.71

AMERICAN INSURANCE CO

$146,444.82

AMERICAN INTER INS CO OF GA

$343,450.47

AMERICAN MFG. MUTUAL INS

$31,278.07

AMERICAN MOTORISTS INS CO

$37,019.75

AMERICAN PROTECTION INS CO

$122,915.23

AMERICAN RESOURCES INS CO

$47,334.82

AMERICAN ZURICH INS CO

$50,005.75

AMERISURE INSURANCE CO

$82,394.44

AMGUARD INSURANCE CO.

$217.81

ARGONAUT INSURANCE CO

$63,404.33

ARGONAUT LIMITED RISK INS CO

$20,561.09

ARROWOOD INDEMNITY CO

$164,860.25

ARROWPOINT CAPITAL

$505,979.24

ASSOCIATED INDEMNITY CORP

$1,898.04

ASSOCIATION INSURANCE CO

$43,319.74

ATLANTIC MUTUAL INS. CO

$46,194.36

ATLANTIC SPECIALTY INS CO

$12.98

AUTO OWNERS INS. CO

$531,957.98

AXIS INSURANCE CO

$70,777.00

BANKERS STANDARD INS CO

$166,836.73

BENCHMARK INS CO

$77,325.34

BITUMINOUS CASUALTY CORP

$96,757.12

BRIDGEFIELD CASUALTY

$343,526.43

BUILDERS INSURANCE (A MUTUAL C

$1,044,786.17

CANAL INSURANCE CO

$825,330.74

SITF 2012 Annual Report Page 11

Total Dollars Paid by the Fund to Insurance Companies

From 1/1/2012 Through 12/31/2012

Name

Amount

CAPITAL CITY INS CO

$236,846.48

CENTENNIAL INSURANCE CO

$1,888.01

CENTRE INSURANCE CO

$150,000.00

CHARTER OAK FIRE INS CO

$41,129.14

CHARTIS CASUALTY COMPANY

$493,223.27

CHURCH MUTUAL INS CO

$183,447.19

CINCINNATI CASUALTY CO

$42,733.26

CINCINNATI INSURANCE CO

$320,980.71

CLARENDON NATIONAL INS CO

$93,517.55

COLUMBIA NATIONAL INS CO

$222,396.94

COMMERCE & INDUSTRY INS CO

$225,362.21

COMPANION PROP & CAS

$34,325.50

CONNECTICUT INDEMNITY CO

$42,890.93

CONTINENTAL CASUALTY CO

$984,961.32

CONTINENTAL INSURANCE CO

$87,710.87

COREGIS INSURANCE CO

$268.28

CRUM & FOSTER INDEMNITY CO

$25,694.49

CYPRESS INSURANCE CO

$262,544.67

DISCOVER PROPERTY & CAS

$57,218.93

ELECTRIC INSURANCE CO

$52,601.55

ELECTRIC MUTUAL LIAB INS LTD

$54,356.18

EMPLOYERS ASSURANCE CO

$18,292.00

EMPLOYERS INS OF WAUSAU

$358,636.66

EMPLOYERS REINSURANCE CORP

$84,467.93

EVEREST NATIONAL INS

$138,993.01

FAIRFIELD INSURANCE CO

$50,907.96

FAIRMONT SPECIALTY INS CO

$210,078.62

FEDERAL INSURANCE CO

$265,148.12

FEDERATED MUTUAL INS CO

$458,772.91

FEDERATED RURAL ELECTRIC INS

$227,560.65

FEDERATED SERVICE INS CO

$27,351.82

FFVA MUTUAL INS CO

$245,010.08

FIDELITY & CAS CO OF NY

$68,149.32

FIDELITY & GUARANTY INS CO

$170,344.89

FIREMAN'S FUND INS CO

$222,366.07

FIREMAN's FUND INS CO OF GA

$57,417.40

FIRST LIBERTY INS CORP

$107,988.59

FLORISTS' MUTUAL INS CO

$14,663.97

GA INSURERS INSOLVENCY POOL

$2,920,618.31

GENERAL ACCIDENT INS OF AMER

$215,848.19

GENERAL INS CO OF AMERIC

$2.96

SITF 2012 Annual Report Page 12

Total Dollars Paid by the Fund to Insurance Companies

From 1/1/2012 Through 12/31/2012

Name

Amount

GEORGIA CASUALTY & SURETY CO

$63,215.24

GLENS FALLS INS CO

$34,332.96

GRAY INSURANCE CO

$2,421.48

GREAT AMER INS CO OF NY

$655,563.92

GREAT AMERICAN INS CO

$105,724.83

GUIDEONE MUTUAL INS CO

$4,004.98

GULF INSURANCE COMPANY

$104,786.90

HANOVER INSURANCE CO

$291,712.97

HARLEYSVILLE MUTUAL INS CO

$65,029.90

HARLEYSVILLE-ATLANTIC INS CO

$44,216.80

HARTFORD ACCIDENT & INDEMNITY

$115,675.08

HARTFORD CASUALTY INS CO

$983,164.03

HARTFORD FIRE INSURANCE CO

$370,825.48

HARTFORD INS CO OF S.E.

$75,579.07

HARTFORD INS OF THE MIDWEST

$291,200.44

HARTFORD UNDERWRITERS INS

$119,494.33

HEALTH CARE MUTUAL CAPTIVE

$89,450.53

HIGHLANDS INS CO-IN RECEIVERSH

$41,545.67

HOME INS. CO-IN LIQUIDATION

$531.26

HOUSTON GENERAL INS CO

$451,881.38

INDEMNITY INS CO OF NA

$618,781.72

INSURANCE CO OF N.A.

$491.49

INSURANCE CO OF STATE OF PA

$1,342,637.83

JEFFERSON PILOT FIN INS CO

$89,732.52

KEY RISK INSURANCE CO

$86,208.00

LIBERTY INSURANCE CORP

$1,105,807.90

LIBERTY MUTUAL FIRE INS

$402,826.11

LIBERTY MUTUAL INS. CO.

$1,927,170.40

LM INSURANCE CORP

$22,500.00

LUMBERMENS MUTUAL CAS CO

$561,475.60

LUMBERMEN'S UNDERWRITING

$351,359.34

MAG MUTUAL INS CO

$20,102.71

MANUFACTURER'S ALLIANCE INS

$49,571.53

MARYLAND CASUALTY COMPANY

$309,151.08

MASSACHUSETTS BAY INSURANCE CO

$85,675.00

METLIFE INSURANCE CO OF CT.

$1,024,170.67

MITSUI SUMITOMO INS CO OF AMER

$77,168.19

NATIONAL FIRE INS CO HARTFORD

$528,732.42

NATIONAL LIABILITY & FIRE INS

$50,401.17

NATIONAL SURETY CORP

$127,009.48

NATIONAL UNION FIRE OF PITT PA

$235,985.33

SITF 2012 Annual Report Page 13

Total Dollars Paid by the Fund to Insurance Companies

From 1/1/2012 Through 12/31/2012

Name

Amount

NETHERLANDS INSURANCE CO

$80,965.87

NEW HAMPSHIRE INSURANCE CO

$490,690.43

NIPPONKAO INS CO LTD US BRANCH

$1.58

NORTHBROOK PROP & CAS INS CO

$21,892.47

OHIO CASUALTY INSURANCE CO

$205,525.04

OHIO FARMERS INS CO

$21.55

OLD REPUBLIC INSURANCE CO

$1,005,652.18

ONEBEACON AMERICA INS CO

$32,233.89

ONEBEACON MIDWEST INS CO

$1.22

PACIFIC EMPLOYERS INSURANCE

$1,524,041.84

PACIFIC INDEMNITY CO

$51,104.95

PARK AVE PROP & CASUALTY INS

$75,203.61

PEERLESS INSURANCE COMPANY

$103,442.90

PENN MFG ASSOC INS

$298,311.88

PENN MFG IND. CO

$152,060.13

PHOENIX INSURANCE CO

$3,627.21

PRINCETON INSURANCE CO

$20,115.63

PROVIDENCE WASHINGTON INS CO

$2,419.71

RELIANCE INS CO IN LIQUIDATION

$76,504.89

REPUBLIC WESTERN INS CO

$12,597.71

ROCHDALE INSURANCE COMPANY

$35,373.77

ROYAL INS CO OF AMERICA

$219,527.20

SAFECO INSURANCE CO AMERICA

$310,857.88

SECURITY INS CO OF HARTFORD

$70,169.30

SELECTIVE INS CO OF AMERICA

$131,829.17

SELECTIVE INS CO OF SE

$275,401.66

SELECTIVE INSURANCE CO OF SC

$128,185.27

SENTRY INSURANCE A MUTUAL CO

$250,344.92

SENTRY SELECT INSURANCE CO

$1,431.52

SOMPO JAPAN INS, OF AMERICA

$114,777.71

SOUTHEASTERN U.S. INS., INC

$116,525.81

SOUTHERN FIRE & CASUALTY CO

$30,290.80

SOUTHERN GUARANTY INSURANCE CO

$13,442.56

SOUTHERN TRUST INSURANCE CO

$36,750.20

ST PAUL FIRE & CASUALTY INS CO

$181,047.66

ST PAUL FIRE & MARINE INS CO

$609,929.92

STANDARD FIRE INSURANCE CO

$31,267.53

STAR INSURANCE CO

$84,787.01

STATE AUTOMOBILE MUTUAL INS

$5,789.28

STATE FARM FIRE & CASUALTY CO

$376,511.30

STATE FARM GENERAL INS CO

$70,280.25

SITF 2012 Annual Report Page 14

Total Dollars Paid by the Fund to Insurance Companies

From 1/1/2012 Through 12/31/2012

Name

Amount

TECHNOLOGY INSURANCE CO

$38,692.85

TIG INSURANCE CO

$404,109.97

TOKIO MARINE & NICHIDO FIRE

$84,365.11

TRANSCONTINENTAL INS CO

$185,847.23

TRANSPORTATION INSURANCE CO

$673,309.44

TRAVELERS CAS & SUR CO

$706,956.70

TRAVELERS COMMERCIAL CASUALTY

$13,958.34

TRAVELERS INDEMNITY CO OF CT

$24,542.31

TRAVELERS INDEMNITY COMPANY

$14,740.82

TRAVELERS INDEMNITY OF AMER

$1,222,123.22

TRAVELERS PROP CAS CO OF AMER

$1,490,444.37

TWIN CITY FIRE INSURANCE CO

$290,450.10

U.S. FIDELITY & GUARANTY INS

$94,374.96

UNISUN INSURANCE COMPANY

$22,101.13

UNITED STATES FIRE INSURANCE

$119,081.06

UNITRIN AUTO & HOME INS. CO.

$3.08

UNIVERSAL UNDERWRITERS INS

$62.72

UTICA MUTUAL INSURANCE CO

$24,814.85

UTICA NATIONAL ASSURANCE CO

$3,337.18

VALLEY FORGE INSURANCE CO

$132,257.06

VIGILANT INSURANCE CO

$6,938.06

VIRGINIA SURETY COMPANY, INC

$75,009.87

WAUSAU GENERAL INS CO

$29,593.33

WAUSAU UNDERWRITERS INS CO

$381,921.07

WESTFIELD INSURANCE CO

$121,585.35

WESTPORT INSURANCE CORP

$541,628.84

XL SPECIALTY INSURANCE CO

$105,315.58

YORK INSURANCE CO

$48,843.35

ZENITH INSURANCE CO

$485,441.67

ZURICH AMERICAN INS CO

$1,480,295.57

ZURICH AMERICAN INS CO OF IL

$1,091,175.84

Grand Total:

$48,350,712.07

SITF 2012 Annual Report Page 15

Reimbursements to Self-Insurers

Total Dollars Paid by the Fund to Self-Insured Employers

From 1/1/2012 Through 12/31/2012

Name

Amount

A T & T

$268,251.30

AAA COOPER TRANSPORTATION

$89,366.62

ABF FREIGHT SYSTEM, INC

$78,269.38

ACUITY BRANDS

$51,112.46

AGL RESOURCES, INC.

$244,504.78

ALBANY, CITY OF

$23,327.72

ALLIED SYSTEMS LTD

$16,900.00

ALPHARETTA, CITY OF

$2,020.29

ALSCO, INC.

$2,000.00

AMERICAN NATIONAL RED CROSS

$118,085.50

ARCHBOLD MEDICAL CENTER

$601,008.01

ATHENS REG. HLTH SYS INC

$57,275.79

ATHENS-CLARKE COUNTY

$28,423.86

ATLANTA CITY OF

$181,595.05

ATLANTA PUBLIC SCHOOLS

$136,182.60

AUGUSTA-RICHMOND CO BD COMM

$206,012.18

BANK OF AMERICA

$6,300.00

BARTOW COUNTY BD OF EDUCATION

$58,346.57

BEAULIEU GROUP LLC

$14,624.45

BEAULIEU OF AMERICA

$97,800.76

BELLSOUTH ENTERPRISES INC

$165,839.69

BELLSOUTH TELECOMMUNICATIONS

$328,933.57

BERRY COLLEGE

$117,505.52

BIBB COUNTY BD-COMMISSION

$47,631.72

BIG LOTS STORES, INC.

$72,023.34

BLUE BIRD BODY COMPANY

$607,895.16

BLUE CIRCLE AMERICA/LAFARGE

$53,893.27

BREMEN-BOWDEN INVESTMENT CO.

$44,039.62

BRUNSWICK, CITY OF

$88,976.44

C.W. MATTHEWS CONTRACTING INC

$49,889.62

CAGLE'S INC, & SUBSIDIARIES

$126,265.94

CANDLER HEALTH SYSTEM

$176,762.37

CARROLL CO. BOARD OF EDUCATION

$37,461.64

CEMEX (SOUTHDOWN INC.)

$22,867.18

CENTRAL GEORGIA HEALTH SYSTEMS

$41,805.38

CERTAINTEED CORPORATION

$110,263.09

CHATHAM COUNTY BD OF EDUCATION $134,350.55

CHATHAM COUNTY GEORGIA

$215,739.86

CHEMICAL PRODUCTS CORP

$18,400.00

SITF 2012 Annual Report Page 16

Total Dollars Paid by the Fund to Self-Insured Employers

From 1/1/2012 Through 12/31/2012

Name

Amount

CHEROKEE CO BD OF COMMISSIONER

$6,048.09

CHEROKEE CO BD OF EDUCATION

$6,798.88

CHILDREN'S HEALTHCARE OF ATL

$26,835.57

CITIGROUP INC.

$21,240.54

CITY OF FORSYTH

$102,504.34

CLAYTON COUNTY BD OF EDUCATION

$44,626.59

CLAYTON COUNTY COMMISSIONERS

$24,163.92

COACHMAN REC. VEHICLE CO OF GA

$24,576.20

COATS & CLARK, INC.

$28,887.32

COBB COUNTY BD/COMMISSIONERS

$128,196.65

COBB COUNTY SCHOOL SYSTEM

$448,552.04

COCA-COLA COMPANY

$179,078.51

COCA-COLA REFRESHMENTS USA INC

$78,120.48

COLONIAL GROUP

$105,777.07

COLUMBUS CITY OF

$21,495.21

CONAGRA FOODS, INC

$4.79

CONAGRA POULTRY CO

$69,487.21

CONTINENTAL GRAIN COMPANY

$31,389.00

CONTINENTAL TIRE N. AMER., INC

$64,372.93

COOPER INDUSTRIES, LLC

$76,489.13

COOPER TIRE AND RUBBER

$70,007.23

COSTCO WHOLESALE CORP.

$8,000.00

COTTRELL INC

$45,288.41

COWETA CO BOARD OF EDUCATION

$918.83

CRACKER BARREL OLD CNTRY STORE $201,405.47

DALTON CITY OF

$155,917.60

DEKALB COUNTY BOARD-ED

$157,224.40

DEKALB COUNTY GOVERNMENT

$218,449.14

DEKALB REGIONAL HLTHCARE SYS

$130,745.48

DELHAIZE AMERICA LLC.

$78,202.79

DELTA AIRLINES, INC.

$1,429,840.99

DOLLAR GENERAL CORP

$159,525.27

DOUGHERTY COUNTY BOC

$185,406.27

DOUGLAS CO BD OF COMMISSIONERS

$22,038.40

DOUGLAS COUNTY SCHOOLS

$8,500.00

DOUGLAS, CITY OF

$52,656.57

DRY BRANCH KAOLIN COMPANY

$29,747.22

E I DUPONT DE NEMOURS & CO

$9,450.00

ELBERTON GRANITE ASSOCIATION

$136,551.97

EMORY UNIVERSITY

$381,524.80

ESTES EXPRESS LINES

$75,000.00

SITF 2012 Annual Report Page 17

Total Dollars Paid by the Fund to Self-Insured Employers

From 1/1/2012 Through 12/31/2012

Name

Amount

FAYETTE COUNTY BD OF COMM

$30,167.10

FAYETTE COUNTY BD OF EDUCATION

$23,511.15

FEDERAL EXPRESS CORP

$8,262.41

FLOWERS FOODS INC.

$81,363.68

FLOYD CO. BD. OF COMMISSIONERS

$89,503.43

FLOYD HLTHCARE MGMT INC

$35,000.00

FORD MOTOR COMPANY

$166,512.22

FORSYTH CO BD OF COMMISSIONERS

$74,100.57

FORT JAMES CORP.

$48,002.67

FRIGIDAIRE CO MICROWAVE PRODS.

$12,650.00

FULTON COUNTY, GEORGIA

$952,644.22

FULTON-DEKALB HOSPITAL AUTHY

$46,505.83

GA S.I. GUARANTY TRUST FUND

$3,355,544.29

GENERAL MOTORS CORPORATION

$288,332.20

GEORGIA KRAFT CO

$28,055.00

GEORGIA POWER CO

$62,888.77

GEORGIA STATE OF

$8,441,566.81

GEORGIA-PACIFIC CORPORATION

$447,563.94

GLYNN COUNTY BOARD OF COMMSNRS $141,067.73

GLYNN COUNTY SCHOOLS

$416,421.02

GREAT DANE LTD PARTNERSHIP

$36,987.51

GULFSTREAM AEROSPACE CORP

$58,870.60

GWINNETT CO BD OF EDUCATION

$15,110.34

GWINNETT COUNTY BD OF COMMISS

$110,455.61

GWINNETT HOSPITAL SYSTEM

$82,030.69

HALL COUNTY BOARD OF EDUCATION

$213,147.92

HAMILTON HEALTH CARE SYSTEM

$235,714.94

HANSON AGGREGATES

$12,362.88

HCA, INC.

$406.83

HENRY CO BOARD OF EDUCATION

$30,608.78

HERCULES INCORPORATED

$118,187.10

HON INDUSTRIES, INC.

$23,759.31

HORMEL FOODS CORP

$57,895.09

HOUSTON COUNTY BD OF EDUCATION $143,669.62

HOUSTON COUNTY COMMISSIONERS

$35,993.98

HOWARD SHEPPARD INC

$5,149.65

HUTCHESON MEDICAL CENTER

$147,705.13

IDA CASON CALLAWAY FOUNDATION

$3,786.40

IKON OFFICE SOLUTIONS

$8,000.00

INGLES MARKETS INC

$213,817.89

INTERNATIONAL PAPER COMPANY

$115,214.74

SITF 2012 Annual Report Page 18

Total Dollars Paid by the Fund to Self-Insured Employers

From 1/1/2012 Through 12/31/2012

Name

Amount

J & J INDUSTRIES INC

$36,319.04

J H HARVEY COMPANY

$17,350.07

JONES COMPANY

$21,202.05

JONES COMPANY (THE)

$378,288.71

KELLOGG CO & SUBSIDIARIES

$410,303.64

KLEEN-TEX INDUSTRIES

$5,238.68

KLLM TRANSPORT SERVICES LLC

$12,187.74

K-MART CORP

$580,932.23

KROGER COMPANY, THE

$580,893.70

LANGDALE INDUSTRIES

$151,662.48

LAWRENCEVILLE, CITY OF

$2,539.62

LEGACY VULCAN

$197,557.33

LEVI STRAUSS & CO

$6,671.09

LOWE'S HOME CENTERS, INC

$243,977.15

LOXCREEN COMPANY, INC.

$3,803.13

MADISON CO BOARD OF EDUCATION

$4,227.86

MARIETTA CITY SERVICES

$29,788.70

MAR-JAC POULTRY, INC.

$3,024.65

MARRIOTT INTERNATIONAL, INC.

$1,599.36

MARTA

$611,495.65

MAYO CLINIC HLTH SYS IN WAYCRO

$246,860.39

MCG HEALTH INC

$11,192.50

MCLANE COMPANY, INC.

$169,199.56

MEAD CORPORATION

$83,017.88

MEMORIAL MEDICAL CENTER

$245,423.40

MERCK SHARP & DOHME CORP

$14,426.17

MID GEORGIA AMBULANCE, inc

$50,000.00

MILLEDGEVILLE, CITY OF

$33,281.55

MOHAWK INDUSTRIES, INC

$1,686,172.19

MOUNT VERNON MILLS

$81,663.84

MUSCOGEE COUNTY SCHOOL DIST

$8,496.48

NABISCO, INC

$9,631.24

NORTHEAST GEORGIA HEALTH SYS

$11,025.00

NORTHSIDE HOSPITAL

$2,526,498.01

OLIVER RUBBER CO

$99,509.00

OWENS-CORNING

$20,938.68

OWENS-ILLINOIS INC

$37,928.33

OXFORD CONSTRUCTION CO

$103,051.31

PARKER HANNIFIN CORP.

$57,924.70

PCC AIRFOILS LLC

$95,264.28

PEPSICO, INC

$15,842.88

SITF 2012 Annual Report Page 19

Total Dollars Paid by the Fund to Self-Insured Employers

From 1/1/2012 Through 12/31/2012

Name

Amount

PHOEBE PUTNEY MEMORIAL HOSP

$600.44

PIEDMONT HOSPITAL

$5,850.00

PIEDMONT LABORATORIES, INC.

$9,333.85

PRINTPACK, INC

$47,753.36

QUEEN CARPET CORPORATION

$27,168.44

RALSTON PURINA COMPANY

$18,543.66

RHODES NURSING HOME

$93,542.33

RMC USA, INC.

$88,034.91

ROLLINS INC

$129,021.97

ROME, CITY OF

$203,358.75

ROPER CORPORATION

$9,599.53

RUBY TUESDAY INC

$86,136.02

RYDER SYSTEM INC

$27,441.08

SAINT JOSEPH'S HEALTH SYSTEM

$35,159.59

SAINT JOSEPH'S OF SAVANNAH

$232,074.31

SAINT MARY'S HEALTH CARE

$32,669.48

SAVANNAH CITY OF

$426,044.16

SCIENTIFIC-ATLANTA INC

$266.16

SEARS, ROEBUCK & CO

$18,919.90

SHAW INDUSTRIES INC

$982,349.60

SHERWIN-WILLIAMS COMPANY

$79,912.23

SMURFIT-STONE CONTAINER ENTERP

$37,000.00

SOUTHEASTERN FREIGHT LINES

$309.67

SOUTHERN COMPANY

$687,437.56

SOUTHERN MILLS INC

$208,374.98

SOUTHERN NUCLEAR OPERATING CO

$242.25

SOUTHERN REGIONAL HEALTH SYS.

$28,687.84

SOUTHWIRE COMPANY

$423,883.24

SUPERIOR RIGGING & ERECTING CO

$23,068.77

TARGET CORPORATION

$217,293.54

TENNECO AUTOMOTIVE, INC

$16,046.51

TEXTILE RUBBER & CHEMICAL

$14,101.15

TEXTRON, INC

$81,744.81

THE DIXIE GROUP, INC.

$181,078.11

THERMAL CERAMICS

$455,911.40

THREE SPRINGS INC.

$11,931.30

TIP TOP POULTRY INC

$11,790.00

TRANSUS, INC.

$86,220.00

TRC STAFFING SERVICES, INC

$4,806.48

TYSON FOODS INC

$235,767.38

UNION CAMP CORPORATION

$80,919.91

SITF 2012 Annual Report Page 20

Total Dollars Paid by the Fund to Self-Insured Employers

From 1/1/2012 Through 12/31/2012

Name

Amount

UNIVERSITY HOSPITAL

$539,245.63

UPS FREIGHT

$138,027.48

USF HOLLAND, INC.

$70,000.00

VARIETY WHOLESALERS

$147,092.67

VISITING NURSE HEALTH SYSTEM

$18,514.02

WAFFLE HOUSE

$200,153.75

WAGGONERS TRUCKING CO., THE

$28,585.17

WAREHOUSE HOME FURNISHINGS

$183,324.24

WARNER ROBINS CITY OF

$104,453.27

WAYCROSS, CITY OF

$118,710.42

WELLSTAR HEALTH SYSTEM

$726,667.06

WESLEY WOODS

$510.59

WEST GEORGIA HEALTH SYSTEM

$182,296.49

WEYERHAEUSER COMPANY

$107,045.74

WINN-DIXIE STORES INC

$52,447.92

YELLOW TRANSPORTATION

$124,775.20

Grand Total:

$43,214,189.23

SITF 2012 Annual Report Page 21

Reimbursements to Group Self-Insurers

Total Dollars Paid by the Fund to Group Self-Insurers

From 1/1/2012 Through 12/31/2012

Name

Amount

AGRITRUST OF GEORGIA

$96,704.57

ASSOCIATION CTY COM GA SI

$2,756,693.16

COMPTRUST AGC OF GEORGIA

$572,849.12

CONSTRUCTION SUPPLIERS' ASSOC

$274,448.80

GA AUTO DEALERS ASSOCIATION SI

$553,296.48

GA CONCRETE & PRODUCTS ASSOC

$44,443.75

GA EDUCATION WC TRUST FUND

$861,367.54

GA HOSPITAL ASSOC WCSI FUND

$711,532.68

GA MOVERS ASSOCIATION

$179,727.21

GA MUNICIPAL ASSN WCSIF

$1,596,504.31

GA NURSING HOME SELECTIVE WC

$103,037.00

GA OILMEN'S ASSOCIATION

$16,653.74

GA OPERATORS SELF-INSURERS

$98,040.76

GA RETAIL MERCHANTS' WCT

$2,119.64

GA SCHOOL BD ASSOC W C FUND

$1,445,714.35

GA WHOLESALE & RETAIL WC FUND

$24,459.38

GEMC WORKERS' COMP FUND

$181,007.06

GTMA/AYSA SELF INSURANCE

$261,206.38

ROOFING & SHEET METAL ASSOC

$66,876.27

W. C. FUND FOR HEALTH CARE

$90,325.43

Grand Total:

$9,937,007.63

SITF 2012 Annual Report Page 22

Individual Employers Benefitting from SITF Reimbursements

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer A & S RENTALS CENTER, INC A & T FENCE CO. A-1 BRANTLEY SEPTIC SERVICES A-1 CONTRACT STAFFING AACTION AUTO PARTS ABC GLASS ACCORD HUMAN RESOURCES ACE ELECTRIC, INC ACS WASTE SERVICE ACTION BLUE PRINT CO. ACTION ELECTRIC COMPANY, INC. ACUITY BRANDS, INC. FO1 ADCOX SERVICE CO. INC ADMINISTAFF ADP TOTAL SOURCE ADP TOTALSOURCE AFC/CHURCH'S AIRGAS DRY ICE, INC. AIRTRAN AIRWAYS AKZO NOBEL RESINS, INC. ALAN COX AUTOMOTIVE ALBANY BEVERAGE CO ALEX FOODS INC ALFRED MCCANNON WELL BORING ALIMENTA USA INC ALL BUDGET MECHANIC SERVICES ALL SEASON'S COMFORT ALL SOUTH SUPPLY ALLGOOD HEALTHCARE ALLISON SMITH CO. ALLTEL CORPORATION ALLTEL CORPORATION ALLTELL GEORGIA COMM. ALPHA PRODUCTS, INC. ALSTOM, INC. AMC, INC AMERICAN MANAGEMENT TECH AMERICAN NATIONAL CAN

City MOULTRIE LAVONIA ALBANY TAMPA SAVANNAH ATLANTA MONROE MACON ALPHARETTA ATLANTA SMYRNA ATLANTA LAKE CITY ATLANTA DOUGLASVILLE MACON ATLANTA AUGUSTA SAVANNAH BAXLEY MARIETTA ALBANY ATLANTA COMER CAMILLA ROSWELL SAVANNAH CARTERSVILLE AUGUSTA ATLANTA DALTON DAHLONEGA CORNELIA ATLANTA WINDSOR ATLANTA BOONES MILL FOREST PARK

State GA GA GA FL GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA CT GA VA GA

Total Reimbursed $992.54
$2,419.71 $268.28
$72,719.56 $7,809.34
$14,061.00 $63,356.11 $67,499.06 $86,666.67 $24,814.85 $13,759.02 $25,076.83 $17,000.00
$2,637.02 $40,055.10 $47,429.76 $50,000.00 $33,705.74 $76,009.20 $23,717.40 $39,309.68
$8,676.18 $29,124.40 $19,633.34
$3,939.46 $952.91
$35,373.77 $23,491.53 $32,476.10
$6,524.39 $164.84 $91.42
$25,452.74 $14,367.47 $61,980.05 $93,522.99 $19,111.01 $10,698.75

SITF 2012 Annual Report Page 23

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer AMERICAN SECURITY INSURANCE CO AMERICAN WOODMARK CORP. AMERSON COMPANY AMPORTS, INC ANCHOR GLASS CORP. ANDREW ELECTRIC ANIMAL MEDICAL CARE CENTER ANSCO & ASSOCIATES/ DYCOM IND. APACHE MILLS, INC APL LOGISTICS APPLIED INDUSTRIAL TECHNOLOGY APPLING HEALTHCARE AQUA KOOLERS, LLC ARCADIAN ARCTIC ENGINEERS & CONSTRCTOR ARMOR PACKAGING CORP ARMSTRONG WORLD INDUSTRIES ARROW CO. ARROW CO. ARROW TIRE CO. ARTISTIC JANITORIAL SERVICES ASSISTED LIVING CARE, LLC. ASSOCIATED HEALTHCARE SYSTEMS ATC HEALTHCARE SERVICES ATHENS COUNTRY CLUB INC. ATLANTA BUILDING MAINTENANCE ATLANTA CASUALTY GROUP ATLANTA FREIGHTLINER TRUCK SAL ATLANTA JOURNAL CONSTITUTION ATLANTA MEDICAL CENTER ATLANTA SAND & GRAVEL OF GA,. ATLANTA STEEL ERECTORS, INC. ATLANTA STRUCTURAL CONCRETE ATLANTA UTILITY WORKS, INC. ATLAS LOGISTICS GRP RETAIL SER ATLAS ROOFING CO ATLAS TECHNOLOGIES INC ATLAS VAN LINES AUGUSTA CANAL AUTHORITY AUSTELL BOX BOARD

City ATLANTA JACKSON MACON BRUNSWICK WARNER ROBINS LAWRENCEVILLE MARIETTA MARIETTA CALHOUN LITHIA SPRING CLEVELAND BAXLEY MACON AUGUSTA ATLANTA LAWRENCEVILLE MACON BUCHANAN AUSTELL GAINESVILLE MARIETTA MARTINEZ NASHVILLE MACON ATHENS ALPHARETTA ALPHARETTA JEFFERSON NORCROSS ATLANTA SAVANNAH SMYRNA BUCHANAN EAST POINT ATLANTA HAMPTON FENTON EVANSVILLE AUGUSTA AUSTELL

State GA GA GA GA GA GA GA GA GA GA OH GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA MI TN GA GA

Total Reimbursed $10,996.76 $95,315.58 $25,860.50
$144,088.23 $51,904.75 $41,199.98 $1,888.01 $20,000.00 $8,209.00 $87,357.03
$368,134.25 $56,494.12 $21,439.13 $42,080.20 $18,292.00 $93,774.30 $96,209.96 $3,880.40 $23,424.90
$104,786.90 $57,188.86 $65.97 $75,000.00
$168,336.95 $22,950.00 $1,948.87 $52,916.54
$111,035.54 $132,007.44
$454.88 $14.57
$37,614.52 $67,500.00 $127,468.56 $75,000.00 $97,605.61 $59,248.38 $230,679.61 $15,349.50 $59,270.67

SITF 2012 Annual Report Page 24

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer AUTOMATED MACHINERY LTD, INC. AUTUMN BREEZE ASSISTED LIVING AVERY DENNISON AVIS RENT A CAR B & A CONSTRUCTION CO. INC. B. B. TRUCK WASH OF JACKSON BABCOCK & WILCOX COMPANY BAGCRAFT CORP. OF AMERICA BALLARD BROTHERS ELECTRIC BARRETT & ASSOCIATES BARTENFELD ELECTRIC COMPANY BATTLE LUMBER COMPANY, INC. BEAUMONT PRODUCTS BEKAERT CORPORATION BELK INC BELK STORES & AFFILIATES BELKS, INC. BELL MINOR HOME INC BELLSOUTH BUSINESS SYSTEMS BELLSOUTH ENTERTAINMENT BEN A. LONG CONST. CO., INC. BERKEL & COMPANY CONTRACTORS BERLIN & HODGES BEST WESTERN - SAVANNAH BETTER BACKERS, INC. BETZ LAB'S BEVIS ROPE MANUFACTURING INC BGD ENTER. DBA PAYLESS PLUMBI BILL HEARD CHEVROLET BLAINE ALDRIDGE CONCRETE BLAIR HOUSE CONVALESCENT CENTE BLAKE CONSTRUCTION CO. BLOUNT CONSTRUCTION BLUE RIBBON RENTAL, INC. BORAL MATERIALS BOUCHILLON BODY SERVICE BOWDEN MUFFLER SHOP BRANDON HALL SCHOOL BRIGGS MEDICAL BROCKWAY STANDARD INC

City CUMMING GAINESVILLE FLOWERY BRANCH ATLANTA GAINESVILLE JACKSON BRUNSWICK FOREST PARK MACON ATLANTA ATLANTA WADLEY KENNESAW ROME NEWNAN CARTERSVILE TIFTON GAINESVILLE ATLANTA ATLANTA APPLING BONNER SPRINGS MACON SAVANNAH CHATSWORTH JACKSONVILLE ROSSVILLE BYRON COLUMBUS CUMMING NORTH AUGUSTA ST. MARYS ATHENS CUYAHOGA FALLS JULIETTE SAVANNAH BOWDEN ATLANTA DES MOINES HOMERVILLE

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA KS GA GA GA FL GA GA GA GA SC GA GA OH GA GA GA GA IA GA

Total Reimbursed $5,789.28
$176,796.67 $32,015.45 $8,750.00 $83,805.10 $2,743.66 $29,186.96 $160.15 $42,661.26 $8,400.00 $8,558.30 $6,300.00 $79,086.95
$149,849.41 $101,409.95
$34,827.49 $14,019.15 $180,414.10 $117,474.82 $34,544.98
$4,243.31 $138,253.70
$78,110.55 $206,524.69
$13,580.94 $34,146.78 $18,398.52 $100,900.42 $27,613.56 $50,674.33
$7,795.72 $5,580.00 $21,082.69 $20,412.11 $98,647.83 $26,054.60 $75,000.00 $25,674.61 $7,677.08 $9,152.88

SITF 2012 Annual Report Page 25

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer BROOKS INSTRUMENTS DIVISION BROOKS WELDING INC. BROWN & WILLIAMSON TOBACCO BROWN STEEL CONTRACTORS, INC. BROWNLOW AND SONS COMPANY INC BUFORD CITY BOARD OF EDUCATION BUILDING TECHNOLOGY BURLINGTON INDUSTRIES BURLINGTON NORTHERN BURNT MOUNTAIN CENTER INC C & S WHOLESALE GROCERS CAMBRIDGE PLACEMENT, INC. CANOOCHEE EMC CAPRO INC CAR CRAFT CARDINAL INDUSTRIES CARE MORE, INC CAREMASTER MEDICAL SERVICES CAROLINA HANDLING CARRIAGE INDUSTRIES, INC. CARROLLTON MANOR, INC. CARTER CONCRETE COMPANY CARWOOD MANUFACTURING COMPANY CASWELL, INC. CATERPILLAR INC C-E MINERALS CECIL MALONE COMPANY CELLO-FOIL PRODUCTS, INC. CENTRAL GA EMPLOYMENT CENTRAL GA EMPLOYMENT & PAYROL CENTRAL GA EYE CENTER PC CENTRAL GA HOME HEALTH AGENCY CENTRAL GEORGIA HOME CARE CENTRAL HEALTH HOLDING CENTRAL HEATING AND AIR CENTRAL INDUSTRIES, INC CENTURION INDUSTRIES CETCO ( PC AMCOL INTL' GRP) CHAMBERS DEVELOPMENT CO. CHAMPION GARMENT CO.

City STATESBORO VALDOSTA MACON NEWNAN MARIETTA BUFORD TALLAPOOSA SHANNON ALBANY JASPER MACON ATLANTA REIDSVILLE SWAINSBORO ATHENS COLLEGE PARK MACON GRIFFIN CHARLOTTE CALHOUN CARROLLTON POWDER SPRINGS WINDER NEWNAN GRIFFIN ANDERSONVILLE ATLANTA ALBANY ATLANTA WARNER ROBINS MACON MACON MACON FT. OGLETHORPE ATLANTA SAVANNAH FREDONIA VILLA RICA ATLANTA ROME

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA NC GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA KS GA GA GA

Total Reimbursed $83,299.75
$123,000.66 $201,595.21
$9,720.00 $476.00
$24,632.10 $19,820.25
$7,258.38 $12,006.69 $94,139.24 $40,000.00 $36,216.64
$7,443.95 $75,000.00 $26,677.17 $49,875.00 $75,000.00 $11,789.61 $75,000.00
$9,065.00 $152,060.13 $157,862.66
$22,245.14 $38,612.58 $28,941.34 $17,527.00
$2,613.99 $42,890.93 $46,318.81 $70,207.00 $40,945.06
$7,756.05 $43,290.84 $11,275.00
$9,240.51 $44,200.00
$4,881.48 $15,000.00 $13,339.45
$596.01

SITF 2012 Annual Report Page 26

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer CHAMPION INTERNATIONAL CORP CHARLES BLACK CONSTRUCTION CO. CHART INDUSTRIES INC. CHARTER COMMUNICATIONS, INC. CHATHAM STEEL CORPORATION CHEMICAL PRODUCTS CORP. CHICK-FIL-A CHICK-FIL-A CHILDCARE NETWORK # 24 CHUMLEY'S PAVING & GRADING INC CHURCH HOME FOR THE AGED CHURCH OF JESUS CHRIST LDS CIMCO CINTAS CORPORATION CITIZENS BANK OF WASHINGTON CO CITY OF EAST POINT POLICE DEPT CITY OF ELBERTON CITY OF ROME CLARKE COUNTY SCHOOL DISTRICT CLARKLIFT OF ATLANTA CLAUDE RICKMAN CONST. CLAYTON HOMES - CMH MFG. CLOTHING FABRICS INC CMI INDUSTRIES, INC COASTAL DEPOT COASTAL GREAT SOUTHERN COASTAL SAND, INC. COBB COUNTY TRACTOR CO. COCHRAN CEILING COMPANY, INC. COCHRAN'S AUTO TRUCK STOP COFER & JACKSON PIPELINE, LLC COHUTTA WATER, INC COLEMAN AMERICAN MOVING COLISEUM MEDICAL CENTER COLLINS & AIKMAN FLOORCOVERING COLQUITT COUNTY COLUMBIA POLK GENERAL HOSPITAL COMBINED INSURANCE COMBINED SERVICES, INC. COMBUSTION ENGINEERING

City WAYCROSS CLEVELAND BALLGROUND GROVETOWN SAVANNAH CARTERSVILLE STOCKBRIDGE COLUMBUS AUGUSTA ACWORTH PERRY ATLANTA WAYNESBORO CINCINNATI SANDERSVILLE EAST POINT ELBERTON ROME ATHENS ATLANTA DILLARD WAYCROSS WAYCROSS CLARKESVILLE GARDEN CITY SAVANNAH SAVANNAH MARIETTA COCHRAN RINGGOLD LAWRENCEVILLE ACWORTH MIDLAND CITY MACON DALTON MOULTRIE CEDARTOWN CHICAGO DECATUR JULIETTE

State GA GA GA GA GA GA GA GA GA GA GA GA GA OH GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA IL GA GA

Total Reimbursed $7,000.00
$36,866.74 $4,396.08
$182,341.35 $199.08
$1,008.46 $1,971.69 $1,121.21 $40,290.05 $28,029.93
$400.90 $75,000.00
$9,135.00 $10,000.00 $13,442.56
$3,713.06 $288.05
$27,184.82 $22,101.13 $40,226.75
$2,510.12 $47,696.34 $20,893.25 $49,571.53
$116.00 $4,677.16 $13,319.90 $18,651.23 $125,609.68 $13,261.05 $430,683.88 $103,442.90 $30,000.00 $4,415.97 $88,718.33 $101,404.68 $5,088.28 $4,999.00
$29.90 $16,909.13

SITF 2012 Annual Report Page 27

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer COMBUSTION TECHNOLOGIES INC COMCAST CORP. CONTAINER GENERAL CORP. CONTINENTAL CAN CO CONTINENTAL GRAIN CONTINENTAL GRAIN CONTINENTAL TELEPHONE CO. COOPER DDS, PC CORRECTIONS CORP OF AMERICA CORTEX, INC. COUNTRY CLUB OF COLUMBUS INC COVENTRY ELECTRICAL SUPPLIES COWABUNGA, INC.DBA DOMINO'S PI COX ENTERPRISES CROWN GLASS AND MIRROR CROWN LIFT TRUCKS CRYSTAL FARMS INC CSR INC. D/B/A CTF HOLDINGS LTD CUMBERLAND GAS & ICE CUMMINS SOUTH INC CVS PHARMACY CYNDERELLA'S DAIMLER/CHRYSLER CORPORATION DALE LONG PLASTERING DARBY PRINTING COMPANY DAVIS CENTRAL AIR CONDITIONING DECK'S WHOLESALE & PINE GROVE DEERFIELD SPECIALTY PAPERS INC DELTA AIRLINES, INC. DELTA LIFE INS CO DETAILS INC. DEVEREUX FOUNDATION DEVON CORPORATION DILLARD SMITH CONSTRUCTION CO. DILLARD SMITH CONSTRUCTION CO. DILLARDS DILLON TRANSPORT, INC. DIVERSCO, INC DIXON TIMBER CO.

City FLOWERY BRANCH ROME FOREST PARK PERRY SAVANNAH CORDELE ATLANTA WAYCROSS MCRAE ATLANTA COLUMBUS COVINGTON HAPEVILLE ATLANTA ATLANTA NORCROSS CHESTNUT MTN. AUSTELL LAKE LANIER KINGLAND COLLEGE PARK MARIETTA FITZGERALD MORROW SOPERTON ATLANTA VALDOSTA RINGGOLD AUGUSTA ATLANTA MACON MOORESVILLE KENNESAW FT. OGLETHORPE COLLEGE PARK SMYRNA MACON WILLOWBROOK SPARTANBURG JESUP

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA NC GA GA GA GA GA IL SC GA

Total Reimbursed $9,857.94 $4,245.25
$22,869.25 $13,328.00
$7,810.95 $8,324.72 $6,254.85 $39,380.14 $27,794.04 $32,277.46 $9,818.75 $9,709.86
$519.64 $169,533.17
$75,000.00 $96,282.62 $42,151.23
$6,427.71 $697.16
$210,078.62 $14,364.00 $55,162.84 $922.00 $4,246.71 $67,065.27 $75,000.00 $37,447.72 $19,052.85 $81,993.00 $79,013.33 $5,167.40 $80,509.22 $81,841.67 $83,421.00 $75,000.00 $20,685.24 $67,485.71
$120,215.91 $3,202.55 $323.59

SITF 2012 Annual Report Page 28

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer DOGWOOD HOUSING DOUGHERTTY EQUIPMENT COMPANY DOUGLAS & LOMASON DRUG TRANSPORT, INC. DUBARD'S TIRE & ALIGNMENT DUBLINAIR NURSING HOME DYNCORP EARL SMALL'S HARLEY DAVIDS EARTHGRAINS EASTERN AIRLINES, INC. EASTSIDE CONCRETE CONSTRUCTION EATON CORP ECC INTERNATIONAL ECHOSTAR COMMUNICATIONS CORPOR ECKERD DRUG ECKERD DRUGS ECKERD YOUTH ALTERNATIVE ECONOMY MOBILE HOMES, INC. EDDIE'S FOREIGN AUTO EFFINGHAM COUNTY BOARD OF EDUC ELIXIR INDUSTRIES ELLIOTT TRANSPORT EMORY EASTSIDE MEDICAL CENTER ENGELHARD CORP. ENGELHARD CORP. ENGELHARD CORP. ENGINEERED FABRICS CORP. ENGINEERED REFRIGERATION EPPS HAULING, INC. EQUITY RESIDENTIAL PROPERTIES ESSEX GROUP ETHICON, INC. EXEL, INC. EXIDE CORPORATION FACTORY MUTUAL INSURANCE CO. FAMILY DOLLAR, INC. FANNIN COUNTY BD. OF EDUCATION FANNIN REGIONAL HOSPITAL FAYETTE CO BD OF EDUCATION FAYETTEVILLE BOWLING CENTER

City MILLEGEVILLE GARDEN CITY CARROLLTON TUCKER AUSTELL DUBLIN ATLANTA MARIETTA COLUMBUS ATLANTA DECATUR CLEVELAND SANDERSVILLE GARDEN CITY SHENANDOAH PEACHTREE CITY CLEARWATER MILEDGEVILLEI MACON SPRINGFIELD DOUGLAS GAINESVILLE SNELLVILLE ATTAPULGUS GORDON MCINTYRE ROCKMART MOBILE MACON DUBLIN LITHONIA CORNELIA FAIRBURN COLUMBUS ALPHARETTA CHARLOTTE BLUE RIDGE BLUE RIDGE FAYETTEVILLE FAYETTEVILLE

State GA GA GA GA GA GA GA GA GA GA GA OH GA GA GA GA FL GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA NC GA GA GA GA

Total Reimbursed $59,324.25
$243,298.48 $7,394.44
$86,656.10 $13,653.00 $26,425.00 $15,447.73 $44,525.34
$4,948.82 $82,265.94 $13,680.00 $66,099.01 $130,964.17 $92,472.59 $37,448.19 $23,586.87 $11,580.25
$3,987.69 $50,036.25 $77,325.34
$934.88 $70,169.30 $29,104.79 $13,466.98
$7,981.24 $49,558.62 $43,351.26
$583.88 $184,806.21 $240,492.94
$2,243.38 $19,807.11 $50,005.75
$674.03 $565.01 $13,081.05 $4,643.01 $8,405.10 $36,711.35 $20,100.99

SITF 2012 Annual Report Page 29

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer FEDERAL RENT A CAR SYSTEM FEDERAL STATE INSPECTION FEDERAL-MOGUL CORP FIRST BAPTIST CHURCH FIRST BAPTIST CHURCH FIRST DATA POS. INC. FIRST NATIONAL BANK & TRUST CO FITZGERALD UNDERWEAR CORP FLASH FOODS FLETCHER OIL CO., INC. FLINT CONSTRUCTION CO. FLINT LAND & CATTLE FLINT RIVER TEXTILES, INC FLOWERS AND SONS LOGGING FLOWERS, INC. BALLOONS FOLGER POULTRY FARMS FOREST RIVER INC FORSYTH NURSING HOME
FORT OGLETHORPE NURSING FOX & HOUND RESTAURANT GROUP FOXWORTH PAINTING CONTRACTORS FRANKLIN INDUSTRIES FRED TAYLOR COMPANIES FRED'S INC. FRIENDLY GUS FUJICOLOR PROCESSING, INC. FUJITSU AMERICA, INC FUTURE MANAGEMENT G & D CONSTRUCTION G & K SERVICES, INC. G & P TRUCKING CO., INC. GAF MATERIALS CORP. GAINESVILLE CITY BD OF EDUC GALAXY CARPET MILLS, INC. GARNER BROTHERS COMPANY GATOR COCHRAN CONSTRUCTION CO GATX CORPORATION GE HEALTHCARE GEICO CORP

City HAPEVILLE ALBANY LAGRANGE COCHRAN LAFAYETTE KENNESAW LOUISVILLE TIFTON WAYCROSS DOUGLAS LAWRENCEVILLE WOODBURY ALBANY HORTENSE BOGART DAHLONEGA OCILLA FORSYTH FORT OGLETHORPE WICHITA COLUMBUS LAVONIA ALBANY LAVONIA DUBLIN TIFTON SUNNYVALE FOREST PARK FRANKLIN MACON GASTON SAVANNAH GAINESVILLE CHATSWORTH ROME AUGUSTA WAYCROSS FLORENCE MACON

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA
GA KS GA GA GA GA GA GA CA GA GA GA SC GA GA GA GA GA GA SC GA

Total Reimbursed $13,127.23 $11,747.00
$103,786.66 $4,004.98 $3,033.09
$20,967.00 $139,637.88
$6,938.06 $149.80
$27,351.82 $7,210.41 $1,329.71
$89,823.08 $27,179.14
$117.08 $7,020.00 $1,021.75 $75,000.00
$75,000.00 $4,172.21
$40,776.44 $10,166.49 $10,000.00 $31,371.00 $89,815.08 $19,958.63 $24,562.22 $48,487.32 $75,909.03 $15,190.66
$7,128.00 $33,304.78 $63,629.00
$7,965.00 $92,481.23 $27,073.12 $86,395.96 $16,232.64
$3,972.77

SITF 2012 Annual Report Page 30

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer GEIGER INTERNATIONAL GENERAL CABLE CORP. GENERAL CAR & TRUCK LEASING GENERAL ELECTRIC CO GENERAL ELECTRIC CO GENERAL NUTRITION CTRS GENERAL PARTS, INC. GENERAL PRODUCE, INC. GENTRY MACHINE WORKS, INC. GENUINE PARTS GEORGE HORMELL & COMPANY GEORGE MUSE CLOTHING CO GEORGIA BOOT INC GEORGIA DUPLICATING PRODUCTS GEORGIA ENVIRONMENTAL GEORGIA FURNITURE MART AND PRI GEORGIA HOME HEALTH CARE GEORGIA MARBLE COMPANY GEORGIA PIPING & FIREPROTECTIO GEORGIA WAR VETERANS HOME GERAY INC GILMAN BUILDING PRODUCTS GILMAN PAPER CO. GILMER COUNTY SCHOOLS GIRL SCOUTS COUNCIL OF NW GLOBAL STONE FILLER PRODUCTS GMTA MANAGEMENT GOLD KIST INC.(PILGRIMS PRIDE) GOLD KIST, INC DBA PILGRIM'S P GOLD KIST, INC. GOLDEN AGE PROPERTIES GOLDEN STATE FOODS CORP GOODWILL INDUSTRIES GOODWILL INDUSTRIES OF ATLANTA GOODY PRODUCTS, INC. GOODY PRODUCTS, INC. GOODYEAR TIRE & RUBBER GOODYEAR TIRE & RUBBER GORDON COUNTY FARM COMPANY GRADY EMC

City ATLANTA WATKINSVILLE DAVENPORT ROME CHAMBLEE PITTSBURGH CARROLLTON FOREST PARK COLUMBUS NORCROSS TUCKER ATLANTA BLAIRSVILLE MACON MORROW MACON LYONS ATLANTA WHITE MILLEDGEVILLE EVANS BLACKSHEAR ST. MARY'S ELLIJAY ATLANTA ELLIJAY FORT VALLEY CARROLLTON ATLANTA ATHENS HAWKINSVILLE CONYERS SAVANNAH ATLANTA EASTMAN MANCHESTER CEDARTOWN ROME CALHOUN CAIRO

State GA GA IA GA GA PA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $18,040.28 $27,550.14 $14,958.27 $86,943.99 $3,781.10
$190,989.24 $41,410.06 $45,104.24 $1,459.94 $857.54 $39,179.66 $8,100.16 $11,198.72 $30,290.80
$120,678.67 $15,115.47 $24,350.47 $6,580.97 $2,010.24 $75,000.00 $84,812.51 $59,303.07 $13,843.68 $10,364.46
$100,646.62 $214,917.64
$34,552.87 $17,184.00
$2,657.24 $231,145.96
$25,232.29 $20,187.16 $217,922.08 $140,766.10
$6,935.05 $1,471.56 $7,628.41 $79,605.67 $9,288.89 $220,083.75

SITF 2012 Annual Report Page 31

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer GREAT OAKS NURSING HOME GREBA METAL PRODUCTS, INC. GREEN ISLAND COUNTRY CLUB GREEN OAKS CENTER GREEN THUMB, INC. GREENPOINT BANK GREENWOOD CEMETARY GRIFFIN SERVICES GUARDIAN FOUNDATION INC. GULF LIFE INSURANCE COMPANY H.A. SACK CO., INC. D/B/A HABITAT FOR HUMANITY, INC. HAIRSTON CONSTRUCTION CO HANCOCK FABRICS HANES HOSIERY, INC. HARBISON WALKER REFRACTORIES
HARMONY ENTERPRISES, INC. HARRIS INSULATION & SUPPLY INC HARTWELL CO. WAREHOUSE HARVEY'S PERSONAL CARE HAVERTY FURNITURE COMPANIES HAYES MICRO COMPUTER PRODUCTS HAYGOOD CONTRACTING, INC. HEALTH MANGEMENT ASSOC. HEALTH SYSTEMS FACILITIES, INC HELEN'S ENTERPRISES, INC. HENDERSON ELECTRIC CO HENRY COUNTY TRAINING CENTER HERTZ PENSKE/GEICO TRUCK LSNG HEWLETT PACKARD FIELD OFFICES HI BRAND FOODS HICKS PAVING CO., INC. HIGHTOWER TV HILLCREST HOSPICE INC HINESVILLE PLATE GLASS & MIRRO HINESVILLE RED & WHITE HOLIDAY INN-MCDONOUGH HOME DEPOT HOME DEPOT

City ROSWELL WINSTON COLUMBUS MOULTRIE JESUP COLUMBUS ATLANTA ATLANTA ATLANTA ALBANY STATESBORO ATLANTA KENNESAW SAVANNAH LAGRANGE CALHOUN BOWDON JUNCTION ATLANTA HARTWELL WAYCROSS MACON NORCROSS WOODSTOCK STATESBORO THOMSON ATHENS STONE MOUNTAIN MCDONOUGH FOREST PARK ATLANTA PEACHTREE CITY ATHENS ROME RIVERDALE HINESVILLE HINESVILLE MCDONOUGH SAVANNAH BRUNSWICK

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA
GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $166,625.36 $102.68 $70,774.08 $240.00 $22,973.47 $24,755.22 $367.30 $273,674.55 $37,772.51 $11,640.25 $1,234.65 $101,099.34 $46,293.00 $3,880.45 $7,641.98 $2,050.29
$55,888.76 $135,813.74
$18,468.27 $83,753.43 $80,711.38 $15,209.64 $30,258.71 $22,085.00 $18,505.46 $105,925.00 $13,097.35
$9,461.10 $203,890.93
$45,000.00 $13,490.08 $44,137.93
$4,909.71 $237,165.04 $245,010.08
$5,255.10 $16,996.72 $34,427.90 $145,680.34

SITF 2012 Annual Report Page 32

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer HOME DEPOT HOME DEPOT HOME DEPOT HOME DEPOT HOME DEPOT HOME DEPOT HON INDUSTRIES HONEYWELL INTERNATIONAL, INC HOOVER PRECISION PRODUCTS HOPEWELL MISSION BAPTIST CHURCH HOSPITAL AUTHORITY OF LIBERTY HOUSE OF TYROL HOUSING AUTHORITY OF COLUMBUS HOUSTON CO. ASSOCIATION HOWARD'S LANDSCAPING & GRADING HUGHES LOGGING COMPANY HUSSEY, GAY, BELL & DEYOUNG I P S BALERS IEF IMERYS CLAYS, INC. IMERYS CLAYS, INC. IMERYS KAOLIN INC. INDEPENDENT LIFE INSURANCE CO. INLAND CONTAINER CORP. INLAND CONTAINER CORP. INNER DIMENSIONS INC INTERIM PERSONNEL INTERNATIONAL AUTO PROCESSING INTERNATIONAL RESCUE COMM INTERSTATE DISTRIBUTORS, INC. ITHACA INDUSTRIES INC. ITR INDUSTRIES J & M TANK LINES, INC. J & S, INC. J PHILLIP HEATING & AIR J. A. JONES J. B. HUNT TRANSPORT, INC. J. C. NASH TRUCK PARTS, INC. J. C. PENNEY COMPANY J. C. PENNEY COMPANY

City MARIETTA DULUTH ATLANTA CONYERS CUMMING AUSTELL CEDARTOWN ELBERTON CUMMING NORCROSS LUDOWICI CLEVELAND COLUMBUS WARNER ROBINS LILBURN ARLINGTON GAINESVILLE BAXLEY CLEARWATER SANDERSVILLE DEEPSTEP DRY BRANCH ROME ROME MACON BLUE RIDGE ATLANTA BRUNSWICK NEW YORK NORCROSS MEIGS TOCCOA AMERICUS INDIANOLA CHAMBLEE CHARLOTTE FOREST PARK ATHENS ATLANTA STONE MOUNTAIN

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA GA GA NY GA GA GA GA PA GA NC GA GA GA GA

Total Reimbursed $105,602.33 $18,065.66 $445,460.36 $27,109.88 $132,727.30 $8,502.76 $272,172.04 $76,123.11 $75,000.00 $75,000.00 $75,000.00 $36,293.58 $61,181.36 $1,447.00 $10,381.93 $4,196.69 $96,996.76 $16,876.80 $39,258.46 $14,768.54 $13,961.21 $8,749.55 $7,075.61 $491.49 $41,545.67 $23,985.00 $12,138.43 $27,040.60 $11,000.00 $8,325.00 $63,690.59 $47,996.00 $80,824.79 $36,980.92 $78,370.53 $41,441.99 $75,000.00 $38,251.58 $8,953.72 $11,557.90

SITF 2012 Annual Report Page 33

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer J. G. DAVIDSON JR. ELECTRICAL J. O. CONLEY CORPORATION JACKSON CO BD OF EDUCATION JAMES F. HOOVER JAMES W. HURT & ASSOC. JEAN THOMAS JEBCO, INC. JM BURGESS, INC. JOCKEY INTERNATIONAL, INC. JOHANNSEN TROPHIES & SPORTING JOHN DEMORE LOCK & KEY SVC. JOHNSON & JOHNSON JOHNSON INDUSTRIES, INC. JOHNSTON ELECTRIC CO., INC. JONES AUTOMATIC SPRINKLERS JRH OPTICS/PEARL VISION EXPRES KENCO LOGISTIC SERVICES KENNEDY EQUIPMENT CO. KEY HEALTH CENTER KING MUFFLER SHOP KINGS SAVANNAH, LLC KINNEY CONSTRUCTION CO KINRO, INC. KLIKLOK WOODMAN CORP. KRAFT FOODS, INC. KRAFT FOODS, INC. KROGEL FREIGHT SYSTEMS OF GA KROGER CO. KRYSTAL/M.A.E. THOMASVILLE KUBOTA MFG. CO. OF AMERICA LAFARGE NORTH AMERICA, INC.. LANCE TRUCKING CO., INC. LANCE, INC. LANDRUM PLUMBING CO. INC. LANIER PARKING SYSTEMS INC. LAPP INSULATOR CO. LARSON & JUHL LAUREL BAYE HEALTH LAKE LANIER LAW ENGINEERING CO LAWLER HOSIERY MILL INC

City LAGRANGE MACON JEFFERSON LAVONIA CORDELE COMMERCE WARRENTON LINCOLNTON KENOSHA AUGUSTA NEWNAN ROYSTON NORCROSS WAYCROSS AMERICUS DULUTH ELLENWOOD COLUMBUS MACON WAYCROSS SAVANNAH LEESBURG CAIRO DECATUR ATLANTA NORCROSS MACON ATLANTA THOMASVILLE GAINESVILLE DULUTH BLUE RIDGE CHARLOTTE POWDER SPRINGS ATLANTA SANDERSVILLE ADAIRSVILLE BUFORD ATLANTA CARROLLTON

State GA GA GA GA GA GA GA GA WI GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA NC GA GA GA GA GA GA GA

Total Reimbursed $12,500.69 $38,561.87 $54,377.50 $47,334.82 $36,750.20 $6,202.98 $39,533.13 $77,957.33 $4,485.77 $76.00
$272,042.62 $17,366.80 $43,970.85 $93,333.32 $40,590.39 $78,343.54 $38,102.00 $20,115.63 $54,845.40 $37,663.24 $83,087.30 $35,022.30 $509.01 $49,781.42 $333.66 $32,334.70 $13,504.69
$526,527.17 $54,507.96 $75,000.00 $29,669.95
$127,479.21 $40,672.00 $86,151.37 $75,593.75 $88,256.40 $35,290.02 $60,679.08 $11,475.88 $16,075.67

SITF 2012 Annual Report Page 34

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer LEGGETT & PLATT INC LEON FARMER & CO LEVI STRAUSS & COMPANY LEXINGTON PRECISION CORP LIBERTY COUNTY SCHOOLS LIBERTY MUTUAL INSURANCE CO. LINPAC, INC. LOCKHEED MARTIN LOCKHEED MARTIN LOOK PRODUCTS LORAL SPACE & COMMUNICATIONS/ LOWE'S COMPANIES LUPTON-SMITH HOLDINGS LYNN HAVEN NURSING HOME, LLC MACON CIGAR & TOBACCO CO., INC MACON MALL/COLONIAL PROP. TR. MACON NORTHSIDE HOSPITAL MACON-BIBB CO WATER & SEWAGE MACY'S MAIL CONTRACTORS OF ARKANSAS MANATRON MANN MECHANICAL CO. INC. MANNINGTON CARPETS, INC. MANPOWER TEMP. SERVICES MANSOUR'S MAREK INTERIOR SYSTEMS, INC. MARELL POULTRY COMPANY INC MARINER HEALTH CARE, INC. MARINER POST ACUTE NETWORK MARK'S & MORGAN JEWELERS, INC. MARK'S & MORGAN JEWELERS, INC. MARLEY COOLING TOWER MARSHALLS MARTIN ASSOCIATES HOMEBUILDERS MARTIN CONSTRUCTION COMPANY MARTIN MARIETTA MATERIAL D/B/A MASTER PROMOTIONS MASTERCUTS MAXEY BROTHERS INC MAXWELL CHASE TECH.

City COVINGTON ATHENS VALDOSTA JASPER HINESVILLE GAINESVILLE ATLANTA MARIETTA KINGS BAY MILLEN ROCKMART ALBANY ATLANTA GRAY MACON MACON MACON MACON ATLANTA LITTLE ROCK PORTAGE AVONDALE ESTS. CALHOUN DUBLIN LAGRANGE HOUSTON MURRAYVILLE HOGANSVILLE LUMBER CITY MACON AUGUSTA OVERLAND PARK DULUTH CUMMING SYLVESTER AUGUSTA LITHIA SPRINGS ROME BISHOP SMYRNA

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA AR MI GA GA GA GA TX GA GA GA GA GA KS GA GA GA GA GA GA GA GA

Total Reimbursed $69,096.00 $2,863.30 $8,671.93
$345,387.09 $168.00
$36,448.60 $480.67
$645,941.54 $448.13
$21,105.98 $3,186.83 $8,676.63 $217.81
$40,000.00 $2,164.91
$39,739.40 $6,500.00 $9,980.84 $9,300.00
$85,300.10 $27,736.29 $25,948.76 $190,162.40 $17,724.32 $15,493.10 $124,894.50
$4,455.09 $53,105.83
$8,639.04 $31,346.77 $17,884.27
$9,453.58 $27,705.49 $20,688.83 $21,959.61 $52,320.00 $21,963.51 $15,531.39 $38,831.61 $78,605.36

SITF 2012 Annual Report Page 35

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer MCARTHUR CONCRETE PRODUCTS MCC INDUSTRIAL, INC. MCC PANASONIC MCDONALD'S CORP MCG HEALTH, INC. MCKINNEY COMMUNITY HEALTH MCLANAHAN CRUSHED STONE, INC. MCMASTER-CARR SUPPLY CO MC'S PAINTING & DECORATING CO. MCWHORTER TECHNOLOGIES MD HODGES ENTERPRISES, INC. MEDICAL CENTER LLP MEMORIAL HOSPITAL & MANOR MENLO PARK, INC. MENLO WORLDWIDE LOGISTICS MERCHANTS METALS, INC. MERICO, INC. MERRITT CONTRACTING CO. METAL BUILDINGS, INC. METAL PRODUCTS COMPANY METRO BUILDERS SUPPLY INC. METRO IRON WORKS, INC. METRO WATERPROOFING, INC. MGR HOMECARE, INC. MIC, INC. MICRO MANAGEMENT CONSULTING MID GEORGIA AMBULANCE MID SOUTH SUBCONTRACTORS, INC. MIDDLE GEORGIA HOSPITAL MID-SOUTH TRENCHLESS, INC. MILLER BREWING CO MILLER BREWING CO MILLIKEN & COMPANY MILLIKEN & COMPANY MISCELLANEOUS ERECTORS, INC. MODERN FIBERS INC MONROE AUTO EQUIPMENT MOORE INGRAM JOHNSON AND STEEL MOORE'S ASPHALT PAVING CO. MOORMANS, INC.

City ACWORTH MACON PEACHTREE CITY CHATSWORTH AUGUSTA WAYCROSS ELBERTON ATLANTA HIRAM COLUMBUS ATLANTA DUBLIN BAINBRIDGE PEACHTREE CITY SUWANEE FOREST PARK FOREST PARK GAINESVILLE THOMASVILLE SUWANEE FAIRBURN COVINGTON SCOTTSDALE GRIFFIN ELLABELL LOGANVILLE MACON FOREST PARK MACON CHATTANOOGA ALBANY MOULTRIE LAGRANGE TOCCOA POWDER SPRINGS FITZGERALD HARTWELL MARIETTA SNELLVILLE CORDELE

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $27,594.42 $84,787.01 $30,137.64 $12,380.99 $59,697.02
$258,172.64 $48,374.17 $26,403.08 $7,875.00
$148,024.66 $4,874.83 $9,590.98
$13,727.16 $255,796.05
$15,443.12 $178,323.37
$9,660.00 $39,198.56 $78,975.00 $109,354.96
$1,379.00 $138,480.42
$26,075.35 $4,695.29
$12,441.41 $141.17
$2,464.83 $76,666.68 $14,180.08
$1,579.72 $120,274.68
$1,129.31 $128,680.77
$10,557.00 $2,025.00 $1,997.40 $5,170.00
$30,565.79 $27,165.42
$2,098.60

SITF 2012 Annual Report Page 36

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer MORGAN CORPORATION MORI LUGGAGE & GIFTS MRS. FIELD'S ORIGINAL COOKIES MSI INVENTORY SERVICE MULLINAX WATERPROOFING MURATA ELECTRONICS MURRAY COUNTY BOARD OF EDUCATI MUSCOGEE GLASS COMPANY, INC. MYERS FLOOR COVERING INC NATIONAL EMPLOYER SOLUTIONS NATIONAL EMPLOYER SOLUTIONS NATIONAL EMPLOYER SOLUTIONS NATIONAL PUBLIC RADIO, INC. NATIONAL VISION, INC. NATIONWIDE INSURANCE CO NATURALIZER SHOES/BROWN SHOES NCR CORPORATION NCR CORPORATION NEATON ROME, INC. NEFF RENTALS, INC. NESTLE CORPORATION NESTLE TRANSPORTATION CO. NETWORK COMMUNICATIONS NEW CENTENNIAL, INC. NEW MORN FOODS NEW YORK LIFE INSURANCE CO. NEWS / SHOPPER, INC. NEWS PUBLISHING COMPANY, INC. NICOLON / BAYCOR NOLAND COMPANY NORCROSS AUTOMOTIVE INC NORDIC COLD STORAGE NORTH FULTON REGIONAL NORTH GEORGIA READY MIX NORTHERN TELECOM, INC. NORTHLAKE MEDICAL CENTER NORTHROP GRUMMAN CORP. NORTHSIDE WOMENS SPECIALIS PC NORTHWEST AIRLINES, INC. NPC INTERNATIONAL

City RYDAL ATLANTA EAST POINT FLOWWOD BUCHANAN SMYRNA CHATSWORTH COLUMBUS LOGANVILLE ROME DALTON ALPHARETTA WASHINGTON LAWRENCEVILLE LEXINGTON ATLANTA NORCROSS PEACHTREE CITY ROME AUGUSTA MCDONOUGH MCDONOUGH LAWRENCEVILLE COLUMBUS GAINESVILLE ALPHARETTA WOODSTOCK ROME CORNELIA MACON DORAVILLE ATLANTA ROSWELL DALTON STONE MOUNTAIN ATLANTA PERRY ATLANTA ATLANTA CORDELE

State GA GA GA MS GA GA GA GA GA GA GA GA DC GA KY GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $57,920.43 $30,353.73 $18,922.93 $11,846.98 $3,000.00 $1,698.35 $4,500.00 $1,107.10 $10,000.00 $22,510.85 $31,782.32 $62,683.71 $985.25 $22,981.85 $12,250.18 $86,220.00 $92,445.90 $15,518.92
$114,777.71 $1,431.52
$90,913.62 $64,328.54 $40,212.56
$5,406.32 $264,053.48 $118,656.34
$27,494.73 $210,516.08
$49,907.30 $4,871.44
$97,360.69 $602,647.38
$94,785.00 $192,930.90
$19,611.82 $64,217.79
$4,448.25 $289,438.45
$6,200.88 $153,510.19

SITF 2012 Annual Report Page 37

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer NPC INTERNATIONAL NSR, INC. NUCRAFT DENTAL ARTS, INC. O. ANDERSON CURRIE JR., DDS OAK GROVE LANDFILL OAK MOUNTAIN VILLAGE ASSISTED OCMULGEE FIELDS OELSCHIG'S NURSERY, INC. OFFICE SERVICES, LLC OFS BRIGHTWAVE, LLC OGLETHORPE COUNTY SCHOOLS OLIN WOOTEN TRANSPORT CO. INC. OMNOVA SOLUTIONS ONEDA CORPORATION ORIGINAL APPALACHIAN ARTWORKS OTIS SPUNKMEYER, INC. OUTBOARD MARINE CORP. OVERHEAD DOOR CORP. OWENS & PRIDGEN, INC. OXFORD OF DUBLIN PACTIV PAPER PAK PRODUCTS PAYCHEX INC PDS MECHANICAL PEDIATRIC SERVICES OF AMERICA PEPSI-COLA COMPANY PETE ALEWINE POOL CO. INC. PETSMART INC PHOENIX CRANE RENTAL CO. PIERCE & COMPANY, INC. PIERCE CO BOARD OF EDUCATION PIGGLY WIGGLY PIKE ELECTRIC, INC. PILGRIM'S PRIDE, INC. PINE RIDGE MEMORIAL PARK PIOLAX CORPORATION PITNEY BOWES PIZZA HUT, INC. PIZZA HUT, INC. PLATEAU EXCAVATION

City HAZELHURST CHAMBLEE BOGART ATLANTA WINDER CARROLLTON MACON SAVANNAH SAVANNAH NORCROSS LEXINGTON HAZLEHURST CALHOUN COLUMBUS CLEVELAND NORCROSS CALHOUN ATHENS BRUNSWICK DUBLIN COVINGTON WASHINGTON KENNESAW JESUP NORCROSS ATLANTA MARTINEZ DOUGLASVILLE MABLETON CONYERS BLACKSHEAR VIDALIA MOUNT AIRY ATHENS KENNESAW CANTON NORCROSS ROSWELL WOODSTOCK AUSTELL

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA NC GA GA GA GA GA GA GA

Total Reimbursed $24,104.81 $18,773.90 $40,536.10 $40,153.36 $7,395.00 $13,958.34 $18,176.21 $11,084.68 $19,898.49 $2,566.35 $24,373.94 $6,300.00 $16,933.44 $4,774.01 $24,542.31 $12,688.26 $16,511.44 $11,190.40
$120,844.91 $7,474.86
$93,051.35 $19,320.16 $53,624.29 $139,414.08
$9,971.27 $9,163.92 $94,299.82 $5,706.24 $198,189.37 $53,061.23 $75,364.01 $7,150.00 $168,464.94 $110,428.16 $22,118.99 $6,427.52 $22,602.10 $2,061.27 $4,699.16 $105,335.87

SITF 2012 Annual Report Page 38

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer POETIC LICENSE, INC. POLLUTION EQUIPMENT MGMT. CO. PORTEC INC POST PROPERTIES, INC. PRECISION MILLWORKS, INC PREMARK INTERNATIONAL INC. PREMIER TRANSPORTATION PRESTIGE FUND RAISERS, LLC PRIME SOURCE PRIORITY ONE SERVICES PROCORE SOLUTIONS PROFESSIONAL MEDICAL SERVICES PROFESSIONAL TRANSPORTATION PTREE/CARDON DOORS & WINDOWS PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX PUBLIX SUPERMARKETS, INC. QUAD GRAPHICS QUALA SYSTEMS, INC QUALITY ENTERPRISES QUALITY MACHINE & FAB. QUEBECOR - AUGUSTA QUICK CHANGE #33 R. J. REYNOLDS TOBACCO CO R. J. REYNOLDS TOBACCO CO RABUN APPAREL RAMON FRANCO. MD RAYLOC RAYONIER, INC. RAYONIER, INC.

City ATLANTA ATLANTA WINDER ATLANTA CUMMING CHAMBLEE FOREST PARK TYRONE SAVANNAH ALEXANDRIA MARIETTA ORLANDO EVANSVILLE GAINSVILLE VALDOSTA CARROLLTON SMYRNA ATLANTA LITHONIA KENNESAW DACULA ALPHARETTA DACULA SMYRNA CONYERS ROSWELL VILLA RICA THE ROCK AUGUSTA ATLANTA LAFAYETTE EVANS DOUGLAS MACON WINSTON-SALEM RABUN GAP ATLANTA ATLANTA JESUP MIDVILLE

State GA GA GA GA GA GA GA GA GA VA GA FL IN GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA NC GA GA GA GA GA

Total Reimbursed $5,218.50
$17,648.93 $8,910.00
$28,717.58 $80,352.33
$832.97 $170,899.15
$274.24 $7,636.50 $17,946.40 $179,203.28
$531.26 $2,937.47 $116,030.00 $75,000.00
$482.80 $24,211.58 $90,491.45 $21,077.61 $140,649.74 $178,540.44 $159,859.55
$2,776.68 $12,815.25 $53,200.60 $131,495.74 $11,433.42 $121,210.65 $250,260.12 $75,160.16 $15,686.40 $190,541.41 $18,274.05 $146,123.23
$5,200.00 $75,000.00 $20,102.71
$9,275.00 $744,597.18
$7,000.00

SITF 2012 Annual Report Page 39

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer RAZZI CORP. RCS-GRIFFON CORP READY MIX USA, LLC REDMOND REGIONAL MEDICAL CTR REEVES & WAGNER CONSTRUCTION REEVES TRUCKING CO., INC. REGAL MARINE INDUSTRIES RELIABLE FASTENERS INC RELIABLE SUPPLY COMPANY RELIANCE HEATING & AIR CONDITI REMEDIATION SERVICES, INC. RENTOKIL, INC. REPUBLIC SERVICES, INC. RESCARE, INC. RESPIRONICS REYNOLDS AMERICAN INC RHEEM MANUFACTURING RHEEM MANUFACTURING RHEEM MANUFACTURING RICHPORT PROPERTIES INC. RICH'S RICOH ELECTRONICS RJK ENTERPRISES INC ROADWAY EXPRESS ROBERT SHAW CONTROLS CO. ROGER WOOD FOODS ROGERS CASH & CARRY ROME CITY SCHOOLS ROSES DEPARTMENT STORE # 235 ROSS SIMON ROSS STORES, INC. ROYS BOYS PIZZA RUMMEL STAMPINGS, INC S & S ELECTRIC S & S GRILL SADDLE CREEK CORPORATION SAFT AMERICA, INC. SAIA MOTOR FREIGHT SAMSONITE CORP SARA LEE CORPORATION

City ALPHARETTA CONYERS DALTON ROME WOODSTOCK FITZGERALD VALDOSTA SMYRNA ATLANTA CONYERS FITZGERALD ATLANTA WINDER GORDON KENNESAW MACON TAMPA NEW YORK MILLEDGEVILLE TUCKER ATLANTA LAWRENCEVILLE COLUMBUS ATLANTA ELLIJAY SAVANNAG THOMASTON ROME ALBANY CRANSTON CANTON LOGANVILLE ROME WINDER ELBERTON VILLA RICA VALDOSTA ATLANTA COMMERCE FOREST PARK

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL NY GA GA GA GA GA GA GA GA GA GA GA RI GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $75,113.32 $74,964.69 $26,055.15 $89,076.75
$143,918.96 $16,563.58 $91,906.31 $48,843.35 $36,630.10 $75,000.00 $22,262.60 $75,000.00 $8,368.41 $31,029.82 $39,943.39 $24,442.11 $701.57 $75,083.00
$324,826.48 $4,971.26 $8,317.90 $8,260.87
$38,193.47 $12,458.48
$8,545.21 $43,645.52
$5,049.07 $3,927.10
$646.17 $41,657.05 $82,716.66
$1,251.87 $225,086.22
$23,131.47 $7,292.36
$12,107.93 $1,297.39
$12,557.08 $29,593.33 $108,443.65

SITF 2012 Annual Report Page 40

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer SARA LEE CORPORATION SAVANNAH AREA FAMILY EMERGENCY SAVANNAH CHRISTIAN SCHOOL SAVANNAH COCA-COLA BOTTLING CO SAVANNAH FOODS INDUSTRY SAWYER & WIEDEMEYER, INC. SCALE SYSTEMS SCAPE DRYER FABRICS SCHOLASTIC INC SCI/STOCKBRIDGE SENIOR LIVING SCOVILL SEA ISLAND COMPANY SECURITY FINANCE SECURITY GROUP INC SELECTIVE HR/DIXIE PAINTING SERVPRO OF EAST COBB SHAPIRO PACKING CO. SHEPARD ELECTRIC INC SHEPARD L SHEPARD EXPOSITION SERVICES SHO ENTERPRISES SHOWHOMES OF ATLANTA SIEMENS ENERGY & AUTOMATION SIEMENS ENERGY CORP SIGVARIS INC SIMCO INTERIORS INC SIMKINS INDUSTRIES, INC. SKILSTAFF INC SMCS-TERMINIX SMITH & SONS FOOD, INC. SMITHS MARKET SOLO CUP SOUTHEAST EXPRESS LUBES SOUTHEASTERN ELECTRIC COMPANY SOUTHEASTERN FREIGHT LINE SOUTHEASTERN HOSE SOUTHEASTERN PORTABLE BLDG INC SOUTHERN CONCRETE CONSTRUCTION SOUTHERN CRAFT MASTERS SOUTHERN MACHINE & FABRICATION SOUTHERN MANAGEMENT

City STONE MOUNTAIN SAVANNAH SAVANNAH POOLER PORT WENTWORTH BRUNSWICK NORCROSS WAYCROSS KENNESAW TAMPA CLARKESVILLE SEA ISLAND VIDALIA SPARTANBURG ATHENS MARIETTA AUGUSTA FAYETTEVILLE ATLANTA SMYRNA ALPHARETTA TUCKER ALPHARETTA PEACHTREE CITY CLEVELAND MARIETTA ALEXANDER CITY ATHENS ATLANTA TALLAPOOSA AUGUSTA ATLANTA LAVONIA SUWANEE BREMEN EATONTON ALBANY LOGANVILLE CARTERSVILLE ABBEVILLE

State GA GA GA GA GA GA GA GA GA FL GA GA GA SC GA GA GA GA GA GA GA GA GA GA GA GA AL GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $9,400.00
$56,655.74 $15,866.88 $12,825.00 $19,761.76 $119,149.67 $62,505.30 $25,435.92
$266.75 $6,695.81 $51,823.82 $5,231.52 $84,950.69 $75,000.00 $149,398.00 $6,374.68 $119,843.62 $113,252.44
$498.26 $17,029.60 $36,676.08 $132,947.00
$2,174.92 $32,909.42
$8,595.84 $16,207.88
$1,906.15 $75,259.80 $22,500.00 $70,280.25
$893.90 $3,061.56 $42,733.26 $23,190.76 $85,748.00 $93,025.16 $9,788.34 $773,699.92 $2,563.94 $83,167.72

SITF 2012 Annual Report Page 41

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer SOUTHERN SAW SERVICE LP SOUTHERN SENIOR LIVING SOUTHERN STAIRCASE SOUTHERN WAREHOUSE SERVICES SOUTHSIDE MECHANICAL, INC SPARTAN MECHANICAL INC SPC COMPANY SPECTRA GEM, INC. SPECTRUM CABLE SERVICES SPECTRUM STORES SPRINGHILL SERVICES INC STAFFING CONCEPTS INC/ M & S STAFFING CONCEPTS, INC. STAFFING SOLUTIONS STANDRIDGE COLOR CORP. STAR CHOICES INC STAR MANUFACTURING COMPANY STAR PACKAGING CORPORATION STATEWIDE HEALTH CARE INC STEAK N SHAKE STEPHENS COUNTY SCHOOLS STEVE CRAWFORD FOREST PROD. STOCK BUILDING SUPPLY STORK GAMCO, INC. SUMTER REGIONAL HOSPITAL SUNLINK HEALTH SYSTEMS SUNSHINE BISQUITS, INC SUPER 8 MOTEL SUPERIOR ELECTRIC SUPERIOR PLUMBING SERVICE SUPREME CARPET, INC. SWAN CONSTRUCTION CO. SWEETHEART CUP CO., INC. SWIFT INDEPENDENT PACKING CO SWIFTY SERVE CORP SYNOVUS FINANCIAL CORP. SYSTEM SERVICES AND INDUSTRIAL T.T.C. ILLINOIS, INC. TAPPI TECHNICAL ASSOC THE PULP TARTAN TEXTILE SERVICES

City ATLANTA DOUGLAS ALPHARETTA MACON FAYETTEVILLE CHAMBLEE LAGRANGE NORCROSS JONESBORO WEST POINT MCINTYRE BAXLEY GAINESVILLE GAINESVILLE SOCIAL CIRCLE MACON CEDARTOWN COLLEGE PARK SAVANNAH TIFTON TOCCOA WAYNESBORO TUCKER GAINESVILLE AMERICUS ELLIJAY COLUMBUS COLUMBUS JULIETTE MARIETTA CHATSWORTH AUGUSTA CONYERS MOULTRIE CORAOOPLOIS COLUMBUS SAVANNAH KANKAKEE NORCROSS HOUSTON

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA PA GA GA IL GA TX

Total Reimbursed $166,958.80 $50,401.17 $86,040.00 $23,209.75 $410,875.75 $39,112.50 $25,155.44 $255,024.33 $48,392.32 $43,976.00 $174,254.79 $75,203.61 $27,896.64 $37,957.84 $28,724.12 $13.44 $36,448.25 $300,000.00 $16,112.70 $63,812.00 $4,137.24 $18,825.41 $30,565.20 $56,333.95 $4,513.97 $38,949.65 $27,161.99 $1,494.58 $3,645.00 $810.50 $10,690.39 $501.25 $16,720.66 $6,204.00 $7,796.73 $22,383.41 $12,625.57 $121,995.80 $10,848.80 $33,328.26

SITF 2012 Annual Report Page 42

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer TARTAN TEXTILE SERVICES TAYLOR ORCHARDS, INC. TEETS INTERNATIONAL TRUCKS INC TENNECO AUTOMOTIVE INC TENNECO OIL CO. TERRY NIX EQUIPMENT THACKSTON & SONS CONSTRUCTION THE BOOK WAREHOUSE THE CAPITAL CITY MACHINE SHOP THE DARIEN NEWS, INC. THE HERTZ CORPORATION THE KINGS CARPENTERS, INC. THE MASQUERADE, INC. THE MOTOR CONVOY, INC. THE R & R MFG CO INC THE RAYMOND KING CO., INC. THE SEA PALMS CORP THE TAPPAN COMPANY THE TIMKEN CO. THOMAS CONCRETE OF GEORGIA INC THOMAS COUNTY BD OF EDUCATION THOMPSON HARDWOODS, INC. THOMPSON CONSTRUCTION CO. THOMPSON'S FARM SUPPLY THOMS TRANSPORT THOMSON OAK FLOORING CO. TIFTON ALUMINUM CO., INC. TIMBER HARVESTING, INC. TIMESAVER, INC- 56 TIRE KINGDOM TIRE PRO, INC. TOLBERT PLASTERING CO. INC. TOM JAMES COMPANY TOM'S FOODS, INC. TOOMSBORO NURSING CTR TOWN OF TRION POLICE DEPT. TOWNS COUNTY SCHOOLS TRANCO LOGISTICS, LLC TRANSPORTATION SERVICES UNLMTD TRANSPOWER

City ROME REYNOLDS AUGUSTA HARTWELL MOULTRIE UNION CITY MARIETTA KNOXVILLE ATLANTA DARIEN HAPEVILLE CANTON ATLANTA ATLANTA AUBURN CALHOUN ST SIMONS ISLAND DALTON DAHLONGA ATLANTA THOMASVILLE HAZELHURST CHAMBLEE VIDALIA BLACKSHEAR THOMSON TIFTON DANVILLE TWIN CITY RIVIERA BEACH LAGRANGE ATHENS BREMEN COLUMBUS COLUMBUS TRION HIAWASSEE CHATTANOOGA ETON ALBANY

State GA GA GA GA GA GA GA TN GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA GA GA GA GA GA TN GA GA

Total Reimbursed $45,041.57 $14,663.79 $6,380.00
$285,833.77 $25,424.49 $670.34 $531.24 $12,340.95 $658.16 $41,129.14 $75,000.00 $19,427.39 $41,898.81 $12,090.00 $2,769.80 $47,474.17 $130.98 $10,912.46 $16,585.60 $10,155.00 $10,902.64 $25,618.17 $27,455.80 $8,999.33 $90,160.08 $16,900.00 $3,752.30 $17,894.37
$126,414.62 $42,114.87 $22,610.00 $30,930.00 $68,175.38 $10,000.00 $46,941.00 $87,240.21 $3,441.47 $75,000.00
$146,790.08 $26,243.62

SITF 2012 Annual Report Page 43

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer TREDEGAR CORPORATION TRENT TUBE DIVISION TRIANGLE PACIFIC CORPORATION TRINTEX CORP. TRIVEST INC TRIZECHAHN CORPORATION TRU-CHECK INC TRUCKSTOPS OF AMERICA TRUS JOIST MACMILLAN TRW-BRUNSWICK JOB CORPS TUCKER CONCRETE CO. TUFTCO CO. TUGALO GAS CO INC TURBINE ENGINE COMPONENTS TYTAM SERVICES INC U.S. CAN CO U.S. CAN CO U.S. SECURITY ASSOCIATES, INC. U-HAUL CO. UNITED DISTRIBUTORS, INC. UNITED DISTRIBUTORS, INC. UNITED NORTH TRANSFER STATION UNITED PARCEL SERVICE UNITED PARCEL SERVICE UNITED PARCEL SERVICE UNITED PARCEL SERVICE UNIVERSAL TRAILER US FOODSERVICE US XPRESS ENTERPRISES INC. UTILITIES CONST. CO OF SC UVALDA MANUFACTURING CO V.T. GRIFFIN SERVICES VALUE STORAGE, LTD. VARN TURPENTINE & CATTLE VIACON, INC VINCE HOSIERY MILL VISION WEB PRESS, INC. VOITH FABRICS, INC. VOS ELECTRIC VT INDUSTRIES, INC.

City NEWNAN CARROLLTON ATLANTA BOWDON MIAMI ATLANTA SOMERSET BRUNSWICK VALDOSTA BRUNSWICK TUCKER DALTON TOCCOA THOMASVILLE STOCKBRIDGE MORROW TALLAPOOSA GAINESVILLE COLUMBUS SAVANNAH ALBANY WINDER ATLANTA UNADILLA BLACKSHEAR JACKSONVILLE FITZGERALD FAIRBURN CHATTANOOGA CHARLESTON UVALDA KINGS BAY ARLINGTON FOLKSTON NORCROSS VILLA RICA LILBURN WAYCROSS GREEN BAY ROME

State GA GA GA GA FL GA KY GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA FL GA GA TN SC GA GA TX GA GA GA GA GA WI GA

Total Reimbursed $5,119.82 $3,204.20
$26,922.94 $70,007.00 $74,624.80
$592.55 $9,319.28 $27,273.23
$603.00 $41,425.17
$1,523.19 $3,627.21 $230,075.81 $78,769.61 $70,979.74 $69,398.00 $203,236.33 $16,724.50 $12,597.71 $10,822.59 $75,000.00 $12,553.24 $55,950.00 $6,153.50 $1,346.73 $14,831.10 $24,933.81 $50,000.00 $95,758.84 $19,125.00 $17,220.07 $27,715.57 $27,081.66 $6,810.82 $27,334.42 $75,000.00 $52,220.10 $46,570.91 $12,375.00 $46,030.36

SITF 2012 Annual Report Page 44

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer W & J, INC. W. CLAIRE HICKS, M.D. W.A. BRAGG & CO. WADE & SONS INC WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WAL-MART WALTERS MANAGEMENT COMPANY WARD CONSTRUCTION INC. WASTE MANAGEMENT OF ATLANTA WATER, GAS & LIGHT COMMISSION WATSON-HUNT FUNERAL HOME WAYCON PIZZA ENTERPRISES WAYCROSS COCA-COLA WAYNE POULTRY WAYNE SHEET METAL WORKS WEEKS TEXTILE WELCH TARKINGTON, INC. WELLS CARGO, INC. WESLEYAN COLLEGE WEST GEORGIA AUTO PARTS INC WEST GEORGIA EYE CARE CENTER WESTEC, INC. WESTERN PLASTICS INC WHISNANT CONTRACTING CO. WHITLOW ELECTRIC SERVICE, INC. WHOLE FOODS MARKET WIKA INSTRUMENT CORP WILLIAM CARTER CO WILLIAM CARTER CO WILLIAMS & ASSOCIATES

City SMYRNA JESUP AUGUSTA MACON HIRAM CANTON NEWNAN TIFTON WINDER CORNELIA CARROLLTON FITZGERALD DOUGLASVILLE DALTON TOCCOA BRUNSWICK GAINESVILLE CORNELIA LAKE CITY ALBANY PERRY ATHENS WAYCROSS PENDERGRASS JESUP QUITMAN ATLANTA WAYCROSS MACON CARROLLTON COLUMBUS THOMASTON CALHOUN STOCKBRIDGE ELBERTON ATLANTA LAWRENCEVILLE BARNESVILLE HOGANSVILLE ATLANTA

State GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

Total Reimbursed $23,003.51
$141,637.15 $192,122.21
$7,525.00 $66,121.05 $25,000.00 $76,354.47 $12,475.42 $92,494.76 $47,711.41 $31,107.21 $45,239.44
$1,389.32 $16,472.56 $46,200.19 $47,483.95 $25,262.99 $76,217.47 $76,504.89
$5,720.00 $79,245.02 $101,772.02
$4,331.47 $8,160.53 $75,000.00 $6,581.64 $91,666.67 $77,999.42 $8,608.20 $5,830.00 $53,667.40 $24,287.29 $79,017.00 $15,390.54 $121,893.03 $29,881.38 $103,296.36 $130,260.73 $1,855.78 $1,655.70

SITF 2012 Annual Report Page 45

Individual Employers Benefiting from SITF Reimbursements 01/01/2012 Through 12/31/2012

Employer WILLIAMS SERVICE GROUP WINGFOOT COMMERCIAL TIRE SYSTEM WOODRUFF CO WORLD AIRWAYS, INC WORLD CHAMPIONSHIP WRESTLING WOW EXPRESS, INC. XEROX CORPORATION YAMAHA MUSIC MFG. YATES BLEACHERY CO. YUM! BRANDS, INC. TOTAL:

City MILLEDGVILLE MACON COLUMBUS PEACHTREE CITY SMYRNA MONROE ATLANTA THOMASTON FLINTSTONE LOUISVILLE

State GA GA GA GA GA GA GA GA GA KY

Total Reimbursed $37,819.80 $34,845.10 $3,337.18 $13,797.21 $93,840.55 $65,000.00 $17,343.19 $75,469.84 $77,835.47 $35,792.82
$48,043,559.11

SITF 2012 Annual Report Page 46

Assessment by the Fund
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 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 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.

SITF 2012 Annual Report Page 47

Assessment Calculation
The assessment and assessment rate are derived from the fund's financial activity for the calendar year and the claims loss data provided by insurance companies and selfinsured employers. This claims loss data is obtained on an annual basis in the form of an Annual Assessment Report. As required in O.C.G.A.34-9-359, this is a report of the total amount of compensation, medical benefits, and rehabilitation benefits paid by each insurer and self-insured employer during the calendar year.

Assessment Adjustment for 2011
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2011 was $100,000,000.00. This was computed in the following manner:

Total

Fund $125,230,471.93

disbursements/calendar

year 2011

Fund Assessment not to exceed $100 million Fund Assessment

x

175%

$219,153,325.88

$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 2011 was $1,405,383,670.63. .

This amount is divided into the fund assessment of $100,000,000.00 and yields an (adjusted) assessment rate of .07115495. This adjustment has caused an increase to be applied to the 2011 assessment.

Assessment Rate for 2012
The Georgia Subsequent Injury Trust Fund Assessment for calendar year 2012 is $100,000,000.00. This was computed in the following manner:

Total

Fund $103,324,990.04

disbursements/calendar

year 2012

x

175%

Fund Assessment not to $180,818,732.57

exceed $100 million

Fund Assessment $100,000,00.00

Based on data received from insurers and self-insured employers, the reported total of workers' compensation benefits paid in Georgia during calendar year 2012 was $1,464,074,070.22. This amount is divided into the fund assessment of $100,000,000.00, which yields an assessment rate of .06830256.

In addition to the assessment, an additional $328,134.12 in penalties for late filing of Claims Loss report forms will be levied.

SITF 2012 Annual Report Page 48 Assessments Due for 2012

Assessments Due from 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. AIU INSURANCE CO ALFA INSURANCE CORP ALL AMERICA INS. CO ALLIED EASTERN INDEMNITY CO ALLIED PROPERTY & CASUALTY INS ALLMERICA FIN BENEFIT INS CO AMCO INSURANCE CO AMER BUS & MERCANTILE INS MUT. AMER MOTORISTS INS CO IN REHAB 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 HOME ASSURANCE CO AMERICAN INSURANCE CO AMERICAN INTER INS CO OF GA AMERICAN MFG. MUT INS- IN REHA AMERICAN RESOURCES INS CO AMERICAN SAFETY CASUALTY INS AMERICAN SELECT INSURANCE CO 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

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

2012

2011 2011 And 2012

Assessment Amt

Adjustment Amt

Claims Paid

Assessment Balance

Total

Amt

Due Assessment

$44,013.50 $44,015.83

$992,724.00 $67,805.59 $2.33 $67,807.92

$440,135.63 $440,158.95 $6,752,786.00 $461,232.57 $23.32 $461,255.89

$30,156.72 $30,158.31 $1,293,061.00 $88,319.38 $1.59 $88,320.97

$428,711.55 $428,734.26 $5,413,193.00 $369,734.94 $22.71 $369,757.65

$2,017,666.10 $2,017,773.01 $25,396,959.00 $1,734,677.32 $106.91 $1,734,784.23

$75,425.73 $75,429.73

$775,347.00 $52,958.18 $4.00 $52,962.18

$77,039.87 $77,043.95 $1,443,979.00 $98,627.46 $4.08 $98,631.54

$26,887.46 $26,888.89

$424,345.00 $28,983.85 $1.43 $28,985.28

$35,543.93 $35,545.81

$300,996.00 $20,558.80 $1.88 $20,560.68

$10,870.19 $10,870.77

$308,489.00 $21,070.59 $0.58 $21,071.17

$4,413.79

$4,414.03

$0.00

$0.00 $0.24

$0.24

$3,837.89

$3,838.10

$619,854.00 $42,337.62 $0.21 $42,337.83

$26.82

$26.83

$165,247.00 $11,286.79 $0.01 $11,286.80

$0.00

$0.00

$6,646.00

$453.94 $0.00

$453.94

$29,678.51 $29,680.08

$523,643.00 $35,766.16 $1.57 $35,767.73

$0.00

$0.00

$1.00

$0.07 $0.00

$0.07

$4,843.47

$4,843.73

$119,969.00

$8,194.19 $0.26

$8,194.45

$97,975.26 $97,980.46

$609,138.57 $41,605.72 $5.20 $41,610.92

$83,041.40 $83,045.80

$484,071.00 $33,063.29 $4.40 $33,067.69

$12,621.58 $12,622.25

$135,793.00

$9,275.01 $0.67

$9,275.68

$653,489.66 $653,524.28 $8,117,788.49 $554,465.74 $34.62 $554,500.36

$112.99

$112.99

$7,827.00

$534.60 $0.00

$534.60

$81,514.85 $81,519.17 $1,063,731.00 $72,655.55 $4.32 $72,659.87

$0.00

$0.00

$9,617.00

$656.87 $0.00

$656.87

$11,890.43 $11,891.06

$576,431.00 $39,371.71 $0.63 $39,372.34

$126,213.16 $126,219.84 $1,583,502.00 $108,157.24 $6.68 $108,163.92

$629,909.65 $629,943.03 $9,655,838.00 $659,518.45 $33.38 $659,551.83

$82,800.26 $82,804.65 $1,100,224.00 $75,148.12 $4.39 $75,152.51

$745,498.64 $745,538.14 $13,784,205.41 $941,496.52 $39.50 $941,536.02

$8,614.25

$8,614.70

$147,344.59 $10,064.01 $0.45 $10,064.46

$4,324.92

$4,325.15

$189,020.00 $12,910.55 $0.23 $12,910.78

$7,620.86

$7,621.26

$4,852.00

$331.40 $0.40

$331.80

$0.00

$0.00

$40,258.00

$2,749.72 $0.00

$2,749.72

$65,357.20 $65,360.66

$612,179.00 $41,813.39 $3.46 $41,816.85

$6,855.13

$6,855.49

$134,698.00

$9,200.22 $0.36

$9,200.58

$2,428,765.74 $2,428,894.43 $45,308,653.00 $3,094,696.99 $128.69 $3,094,825.68

$196,400.74 $196,411.14 $3,923,717.00 $267,999.92 $10.40 $268,010.32

$143,442.13 $143,449.73 $1,605,402.00 $109,653.07 $7.60 $109,660.67

$313,287.33 $313,303.93 $4,171,379.00 $284,915.86 $16.60 $284,932.46

$11,957.10 $11,957.73

$577,456.00 $39,441.72 $0.63 $39,442.35

$151,781.97 $151,790.02 $1,311,026.32 $89,546.45 $8.05 $89,554.50

$558,961.61 $558,991.22 $7,367,963.00 $503,250.73 $29.61 $503,280.34

$65,433.40 $65,436.87

$380,863.00 $26,013.92 $3.47 $26,017.39

$66,654.28 $66,657.81

$788,049.00 $53,825.76 $3.53 $53,829.29

$0.00

$0.00

$208,858.00 $14,265.54 $0.00 $14,265.54

$39,615.98 $39,618.08

$274,884.00 $18,775.28 $2.10 $18,777.38

$218,540.28 $218,551.86

$0.00

$0.00 $11.58

$11.58

$32,042.22 $32,043.92

$461,433.00 $31,517.06 $1.70 $31,518.76

SITF 2012 Annual Report Page 49

Company Name
ASSOCIATED INDUSTRIES INS CO ASSOCIATION CASUALTY INS CO ASSOCIATION INSURANCE CO ASSURANCE CO. OF AMERICA ATLANTIC SPECIALTY INS CO ATLANTIC STATES INS. CO. AUTO OWNERS INS. CO BANCINSURE, INC. BANKERS STANDARD INS CO BENCHMARK INS CO BERKLEY NATIONAL INS. CO. BERKSHIRE HATHAWAY HOMESTATE I BITUMINOUS CASUALTY CORP BITUMINOUS FIRE & MARINE INS BRIDGEFIELD CASUALTY BRIDGEFIELD EMPLOYERS INS. CO BROTHERHOOD MUTUAL INS CO BUILDERS INSURANCE (A MUTUAL C BUILDERS MUTUAL INSURANCE CO CALIFORNIA INSURANCE CO CANAL INSURANCE CO CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS 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 COMPANION COMMERCIAL INS CO COMPANION PROP & CAS COMPTRUST ACG MUTUAL CAP. INS CONTINENTAL CASUALTY CO CONTINENTAL INSURANCE CO CONTINENTAL WESTERN INS CO COUNTRY MUTUAL INS. CO. CRUM & FORSTER INDEMNITY CO CUMIS INS SOCIETY INC CYPRESS INSURANCE CO DALLAS NATIONAL INSURANCE CO DELTA FIRE & CASUALTY INS DISCOVER PROPERTY & CAS DONEGAL MUTUAL INSURANCE CO

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

2012

2011 2011 And 2012

Assessment Amt

Adjustment Amt

Claims Paid

Assessment Balance

Total

Amt

Due Assessment

$4,836.43

$4,836.69

$25,961.00

$1,773.20 $0.26

$1,773.46

$139,631.84 $139,639.24 $2,986,326.00 $203,973.71 $7.40 $203,981.11

$349,603.46 $349,621.98 $5,576,256.00 $380,872.56 $18.52 $380,891.08

$87,212.14 $87,216.76

$811,733.00 $55,443.44 $4.62 $55,448.06

$0.00

$0.00

$162.00

$11.07 $0.00

$11.07

$30,790.25 $30,791.88

$319,154.00 $21,799.04 $1.63 $21,800.67

$882,920.76 $882,967.54 $13,478,135.00 $920,591.12 $46.78 $920,637.90

$2,028.59

$2,028.70

$0.00

$0.00 $0.11

$0.11

$58,164.24 $58,167.32 $1,639,109.00 $111,955.34 $3.08 $111,958.42

$39,707.13 $39,709.23

$879,606.00 $60,079.34 $2.10 $60,081.44

$0.00

$0.00

$2,102.00

$143.57 $0.00

$143.57

$2,354.18

$2,354.30 $1,193,007.00 $81,485.43 $0.12 $81,485.55

$169,230.05 $169,239.02 $3,112,483.16 $212,590.57 $8.97 $212,599.54

$54,724.53 $54,727.43

$864,336.83 $59,036.42 $2.90 $59,039.32

$1,475,175.57 $1,475,253.73 $18,773,881.00 $1,282,304.13 $78.16 $1,282,382.29

$10,662.29 $10,662.85

$91,550.00

$6,253.10 $0.56

$6,253.66

$16,035.13 $16,035.98

$417,120.00 $28,490.36 $0.85 $28,491.21

$2,030,605.73 $2,030,713.32 $26,272,450.00 $1,794,475.59 $107.59 $1,794,583.18

$10,471.46 $10,472.02

$317,959.00 $21,717.41 $0.56 $21,717.97

$59,471.71 $59,474.86

$513,605.00 $35,080.54 $3.15 $35,083.69

$319,655.55 $319,672.49 $2,822,623.00 $192,792.38 $16.94 $192,809.32

$83,430.45 $83,434.87 $1,476,249.00 $100,831.59 $4.42 $100,836.01

$322,485.89 $322,502.98 $3,610,359.00 $246,596.76 $17.09 $246,613.85

$53,407.71 $53,410.54

$50,861.05

$3,473.94 $2.83

$3,476.77

$2,382.57

$2,382.69

$0.00

$0.00 $0.12

$0.12

$5,283.69

$5,283.97

$59,373.00

$4,055.33 $0.28

$4,055.61

$352,092.25 $352,110.91 $5,097,076.00 $348,143.34 $18.66 $348,162.00

$931,270.19 $931,319.53 $16,242,966.00 $1,109,436.16 $49.34 $1,109,485.50

$20,150.94 $20,152.01

$495,702.00 $33,857.72 $1.07 $33,858.79

$43,541.18 $43,543.49

$557,640.00 $38,088.24 $2.31 $38,090.55

$111,860.51 $111,866.44 $1,477,286.79 $100,902.47 $5.93 $100,908.40

$112,698.42 $112,704.39 $1,545,756.00 $105,579.09 $5.97 $105,585.06

$229,663.57 $229,675.74 $2,907,744.89 $198,606.42 $12.17 $198,618.59

$101,159.35 $101,164.71 $1,350,485.73 $92,241.63 $5.36 $92,246.99

$114,593.63 $114,599.70 $1,281,179.94 $87,507.87 $6.07 $87,513.94

$30,132.10 $30,133.69

$907,504.00 $61,984.85 $1.59 $61,986.44

$87,260.95 $87,265.57 $1,524,136.00 $104,102.39 $4.62 $104,107.01

$1,464.86

$1,464.94

$28,583.00

$1,952.29 $0.08

$1,952.37

$44,343.05 $44,345.40

$946,704.00 $64,662.31 $2.35 $64,664.66

$1,549,356.50 $1,549,438.60 $20,595,571.00 $1,406,730.22 $82.10 $1,406,812.32

$270,184.37 $270,198.68 $4,915,052.00 $335,710.63 $14.31 $335,724.94

$977,452.85 $977,504.65 $12,245,615.00 $836,406.85 $51.80 $836,458.65

$255,681.62 $255,695.17 $2,772,955.00 $189,399.93 $13.55 $189,413.48

$363,025.62 $363,044.85 $3,579,294.49 $244,474.98 $19.23 $244,494.21

$48,949.95 $48,952.54

$722,551.93 $49,352.15 $2.59 $49,354.74

$810.70

$810.74

$25,696.00

$1,755.10 $0.04

$1,755.14

$1,382.33

$1,382.40

$42,797.00

$2,923.14 $0.07

$2,923.21

$9,200.63

$9,201.12

$130,342.00

$8,902.69 $0.49

$8,903.18

$6,498.81

$6,499.15

$1,638.00

$111.88 $0.34

$112.22

$208,231.75 $208,242.79 $2,483,571.00 $169,634.26 $11.04 $169,645.30

$108,284.55 $108,290.29 $3,025,048.00 $206,618.52 $5.74 $206,624.26

$0.00

$0.00

$21,496.00

$1,468.23 $0.00

$1,468.23

$4,416.14

$4,416.37

$0.00

$0.00 $0.23

$0.23

$16,595.66 $16,596.54

$377,226.00 $25,765.50 $0.88 $25,766.38

SITF 2012 Annual Report Page 50

Company Name
EASTERN ADVANTAGE ASSURANCE CO EASTERN ALLIANCE INS. CO EASTGUARD INSURANCE CO ELECTRIC INSURANCE CO 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 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 FIDELITY & GUARANTY INS CO FIREMAN'S FUND INS CO FIRST DAKOTA INDEMNITY CO FIRST LIBERTY INS CORP FIRST NATL INS CO OF AMER FIRST NONPROFIT INS. CO. FLORISTS INSURANCE CO FLORISTS' MUTUAL INS CO FRANK WINSTON CRUM INS CO FRANKENMUTH MUTUAL INS GA FARM BUREAU MUTUAL INS CO GATEWAY INSURANCE CO GENERAL CASUALTY CO OF WI GENERAL INS CO OF AMERIC GENESIS INSURANCE CO GEORGIA CASUALTY & SURETY CO GERBER LIFE INS CO GRANGE MUTUAL CASUALTY COMPANY GRANITE STATE INS CO GRAPHIC ARTS MUTUAL INS CO GRAY INSURANCE CO GREAT AMER ALLIANCE INS CO GREAT AMER INS CO OF NY GREAT AMERICAN ASSUR CO GREAT AMERICAN INS CO GREAT DIVIDE INS CO GREAT NORTHERN INS CO GREAT WEST CASUALTY CO GREATER NEW YORK MUTUAL INS

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$1,386.88

$1,386.95

$19,625.00

$10,583.31 $10,583.87

$281,319.00

$126,321.16 $126,327.86 $1,655,261.00

$49,054.40 $49,057.00

$739,198.00

$13.59

$13.59

$121,608.00

$391,147.92 $391,168.65 $4,944,300.00

$13,802.83 $13,803.56

$208,751.00

$323,167.59 $323,184.72 $4,555,931.00

$21,444.82 $21,445.96

$826,385.00

$129,511.23 $129,518.09 $4,210,577.00

$95,827.90 $95,832.98 $1,230,477.00

$4,440.33

$4,440.57

$6,611.00

$95,560.94 $95,566.01

$910,637.00

$68,911.63 $68,915.28

$739,973.00

$128,580.29 $128,587.10 $2,010,979.00

$4,224.74

$4,224.97

$342,707.00

$369,038.62 $369,058.17 $3,861,453.00

$487,282.17 $487,307.98 $5,723,486.53

$207,784.36 $207,795.37 $3,385,268.00

$0.00

$0.00

$386,041.00

$13,611.15 $13,611.87

$878,178.00

$734,324.22 $734,363.13 $12,147,656.00

$184,093.43 $184,103.19 $4,326,514.00

$13,729.12 $13,729.85

$55,975.00

$11,461.32 $11,461.92

$436,542.00

$637,469.18 $637,502.96 $5,719,158.00

$51,492.11 $51,494.84 $1,021,111.00

$0.00

$0.00

$547.00

$138,268.16 $138,275.49 $1,903,006.00

$12,781.17 $12,781.85

$19,272.00

$13,228.78 $13,229.48

$421,883.00

$3,223.08

$3,223.25

$56,588.00

$19,500.90 $19,501.94

$418,639.00

$131,051.08 $131,058.03 $1,957,394.00

$40,145.99 $40,148.11

$578,644.14

$0.00

$0.00

$1,759.00

$0.00

$0.00

$10,000.00

$17,980.69 $17,981.64

$332,428.00

$0.00

$0.00

$38,495.00

$0.00

$0.00

$29,083.00

$82,914.68 $82,919.07 $1,439,071.00

$663.20

$663.24

$0.00

$26,885.75 $26,887.18

$373,502.01

$165,213.32 $165,222.08 $1,274,721.00

$80,071.19 $80,075.43

$895,532.00

$6,103.47

$6,103.79

$26,555.45

$539,091.50 $539,120.07 $10,061,731.00

$196,606.22 $196,616.64 $1,653,095.00

$14,539.03 $14,539.80

$61,988.00

$423.92

$423.94

$1,030.00

$22,843.66 $22,844.87

$545,723.00

$39,750.88 $39,752.99

$392,430.00

$198,329.43 $198,339.94 $1,801,608.00

$3,126.81

$3,126.98

$39,974.00

2012

2011 2011 And 2012

Assessment Balance

Amt

Due

$1,340.44 $0.07

$19,214.81 $0.56

$113,058.56 $6.70

$50,489.12 $2.60

$8,306.14 $0.00

$337,708.35 $20.73

$14,258.23 $0.73

$311,181.75 $17.13

$56,444.21 $1.14

$287,593.19 $6.86

$84,044.73 $5.08

$451.55 $0.24

$62,198.84 $5.07

$50,542.05 $3.65

$137,355.01 $6.81

$23,407.77 $0.23

$263,747.13 $19.55

$390,928.78 $25.81

$231,222.47 $11.01

$26,367.59 $0.00

$59,981.81 $0.72

$829,716.00 $38.91

$295,511.98 $9.76

$3,823.24 $0.73

$29,816.94 $0.60

$390,633.13 $33.78

$69,744.50 $2.73

$37.36 $0.00

$129,980.18 $7.33

$1,316.33 $0.68

$28,815.69 $0.70

$3,865.11 $0.17

$28,594.12 $1.04

$133,695.02 $6.95

$39,522.88 $2.12

$120.14 $0.00

$683.03 $0.00

$22,705.68 $0.95

$2,629.31 $0.00

$1,986.44 $0.00

$98,292.23 $4.39

$0.00 $0.04

$25,511.14 $1.43

$87,066.71 $8.76

$61,167.13 $4.24

$1,813.81 $0.32

$687,241.99 $28.57

$112,910.62 $10.42

$4,233.94 $0.77

$70.35 $0.02

$37,274.28 $1.21

$26,803.97 $2.11

$123,054.44 $10.51

$2,730.33 $0.17

Total Assessment
$1,340.51 $19,215.37 $113,065.26 $50,491.72
$8,306.14 $337,729.08
$14,258.96 $311,198.88
$56,445.35 $287,600.05
$84,049.81 $451.79
$62,203.91 $50,545.70 $137,361.82 $23,408.00 $263,766.68 $390,954.59 $231,233.48 $26,367.59 $59,982.53 $829,754.91 $295,521.74
$3,823.97 $29,817.54 $390,666.91 $69,747.23
$37.36 $129,987.51
$1,317.01 $28,816.39
$3,865.28 $28,595.16 $133,701.97 $39,525.00
$120.14 $683.03 $22,706.63 $2,629.31 $1,986.44 $98,296.62
$0.04 $25,512.57 $87,075.47 $61,171.37
$1,814.13 $687,270.56 $112,921.04
$4,234.71 $70.37
$37,275.49 $26,806.08 $123,064.95
$2,730.50

SITF 2012 Annual Report Page 51

Company Name
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 HARLEYSVILLE PREFERRED INS CO HARLEYSVILLE WORCESTER 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 HDI-GERLING AMERICA INS CO HEALTH CARE MUTUAL CAPTIVE HIGHLANDS INS CO-IN RECEIVERSH HOUSTON GENERAL INS CO 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 MUT CAS CO- IN REHA LUMBERMEN'S UNDERWRITING MADISON INSURANCE CO MAG MUTUAL INS CO MANUFACTURER'S ALLIANCE INS MARYLAND CASUALTY COMPANY MASSACHUSETTS BAY INSURANCE CO MEMIC INDEMNITY CO MERIDIAN SECURITY INS CO MICHIGAN COMMERCIAL INS MUTUAL MIDDLESEX INSURANCE CO MIDWEST BUILDER'S CAS. MUT. CO MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MITSUI SUMITOMO INS CO OF AMER MITSUI SUMITOMO INS USA, INC MONROE GUARANTY INS. CO. MOTORISTS COMMERCIAL MUT INS C NATIONAL AMERICAN INSURANCE CO NATIONAL CASUALTY COMPANY NATIONAL FIRE INS CO HARTFORD NATIONAL INTERSTATE INS

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

2012

2011 2011 And 2012

Assessment Amt

Adjustment Amt

Claims Paid

Assessment Balance

Total

Amt

Due Assessment

$17,416.81 $17,417.74

$175,484.00 $11,986.01 $0.93 $11,986.94

$652,189.57 $652,224.13 $13,996,016.00 $955,963.72 $34.56 $955,998.28

$52,571.54 $52,574.33

$945,106.00 $64,553.16 $2.79 $64,555.95

$0.00

$0.00

$30,396.00

$2,076.12 $0.00

$2,076.12

$8,967.04

$8,967.52

$148,578.00 $10,148.26 $0.48 $10,148.74

$5,391.20

$5,391.48

$25,064.00

$1,711.94 $0.28

$1,712.22

$595.68

$595.71

$75,046.00

$5,125.83 $0.03

$5,125.86

$42,125.13 $42,127.36

$0.00

$0.00 $2.23

$2.23

$35,236.77 $35,238.64

$500,947.00 $34,215.96 $1.87 $34,217.83

$110,539.69 $110,545.55 $1,035,133.00 $70,702.23 $5.86 $70,708.09

$195,030.79 $195,041.13 $3,893,508.00 $265,936.56 $10.34 $265,946.90

$378,084.99 $378,105.02 $8,350,023.00 $570,327.95 $20.03 $570,347.98

$2,011,127.81 $2,011,234.37 $31,285,991.00 $2,136,913.28 $106.56 $2,137,019.84

$162,557.68 $162,566.29 $2,971,224.00 $202,942.21 $8.61 $202,950.82

$323,805.25 $323,822.41 $8,107,665.00 $553,774.28 $17.16 $553,791.44

$650,873.56 $650,908.05 $8,506,274.00 $581,000.29 $34.49 $581,034.78

$0.00

$0.00

$5,038.00

$344.11 $0.00

$344.11

$228,823.62 $228,835.74 $3,466,363.00 $236,761.47 $12.12 $236,773.59

$4,862.72

$4,862.98

$0.00

$0.00 $0.26

$0.26

$0.00

$0.00

$123,281.00

$8,420.41 $0.00

$8,420.41

$3,518,908.68 $3,519,095.13 $53,155,995.00 $3,630,690.54 $186.45 $3,630,876.99

$19,572.55 $19,573.59

$223,736.00 $15,281.74 $1.04 $15,282.78

$1,743,357.74 $1,743,450.11 $20,328,348.00 $1,388,478.21 $92.37 $1,388,570.58

$251.95

$251.96

$819.61

$55.98 $0.01

$55.99

$6,581.61

$6,581.96

$32,623.91

$2,228.30 $0.35

$2,228.65

$890,009.90 $890,057.06 $12,469,556.00 $851,702.60 $47.16 $851,749.76

$22,774.78 $22,775.99

$116,489.00

$7,956.50 $1.21

$7,957.71

$3,185,208.94 $3,185,377.71 $45,506,729.00 $3,108,226.09 $168.77 $3,108,394.86

$1,091,259.66 $1,091,317.49 $11,662,437.00 $796,574.30 $57.83 $796,632.13

$339,445.92 $339,463.90 $5,352,898.00 $365,616.64 $17.98 $365,634.62

$1,024,412.99 $1,024,467.27 $15,641,020.00 $1,068,321.71 $54.28 $1,068,375.99

$191.58

$191.59

$1,516.69

$103.59 $0.01

$103.60

$46,049.90 $46,052.34

$332,464.55 $22,708.18 $2.44 $22,710.62

$288,115.32 $288,130.59 $3,711,246.00 $253,487.60 $15.27 $253,502.87

$950.51

$950.56

$267,680.00 $18,283.23 $0.05 $18,283.28

$126,143.64 $126,150.33 $1,794,881.00 $122,594.97 $6.69 $122,601.66

$62,635.88 $62,639.20 $2,047,187.00 $139,828.11 $3.32 $139,831.43

$34,230.12 $34,231.93

$462,780.00 $31,609.06 $1.81 $31,610.87

$32,860.39 $32,862.13

$582,996.00 $39,820.12 $1.74 $39,821.86

$9,817.87

$9,818.39

$37,964.00

$2,593.04 $0.52

$2,593.56

$514.14

$514.17

$87,720.00

$5,991.50 $0.03

$5,991.53

$11,498.32 $11,498.92

$194,465.00 $13,282.46 $0.60 $13,283.06

$15,616.76 $15,617.59

$60,360.00

$4,122.74 $0.83

$4,123.57

$0.00

$0.00

$62.46

$4.27 $0.00

$4.27

$199,280.22 $199,290.78 $3,961,203.00 $270,560.31 $10.56 $270,570.87

$29,657.88 $29,659.45

$161,679.00 $11,043.09 $1.57 $11,044.66

$23,310.05 $23,311.29

$478,975.00 $32,715.22 $1.24 $32,716.46

$48,444.99 $48,447.56

$612,571.00 $41,840.17 $2.57 $41,842.74

$79,353.77 $79,357.98 $1,500,389.00 $102,480.41 $4.21 $102,484.62

$1,254.83

$1,254.90

$19,195.00

$1,311.07 $0.07

$1,311.14

$5,099.55

$5,099.82

$180,152.00 $12,304.84 $0.27 $12,305.11

$0.00

$0.00

$21,306.00

$1,455.25 $0.00

$1,455.25

$246,067.31 $246,080.35 $3,857,522.94 $263,478.69 $13.04 $263,491.73

$3,133.21

$3,133.38

$51,483.00

$3,516.42 $0.17

$3,516.59

SITF 2012 Annual Report Page 52

Company Name
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 NEW YORK MARINE & GENERAL INS NORGUARD INSURANCE CO. NORTH AMERICAN SPECIALTY INS NORTH POINTE INSURANCE CO 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 SECURITY INSURANCE CO OLD DOMINION INSURANCE CO OLD REPUBLIC GENERAL INS CORP OLD REPUBLIC INSURANCE CO OLD REPUBLIC UNION INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE CO OWNERS INSURANCE CO PACIFIC EMPLOYERS INSURANCE PACIFIC INDEMNITY CO PATRIOT GENERAL INSURANCE CO PEERLESS INDEMNITY INS CO PEERLESS 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 PROP & CAS INS CO OF HARTFORD PROTECTIVE INSURANCE CO PUBLIC SERVICE INS CO QBE INSURANCE CORPORATION REGENT INSURANCE CO REPUBLIC IND. CO. OF AMERICA REPUBLIC-FRANKLIN INSURANCE CO ROCHDALE INSURANCE COMPANY

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

2012

2011 2011 And 2012

Assessment Amt

Adjustment Amt

Claims Paid

Assessment Balance

Total

Amt

Due Assessment

$406,231.76 $406,253.28 $3,436,266.00 $234,705.76 $21.52 $234,727.28

$61,739.16 $61,742.43

$446,771.00 $30,515.60 $3.27 $30,518.87

$1,031,930.25 $1,031,984.93 $11,460,833.00 $782,804.23 $54.68 $782,858.91

$632,530.29 $632,563.81 $10,846,844.00 $740,867.21 $33.52 $740,900.73

$43,735.42 $43,737.74

$433,725.00 $29,624.53 $2.32 $29,626.85

$4,513.12

$4,513.36

$89,358.00

$6,103.38 $0.24

$6,103.62

$9,970.91

$9,971.44 $1,228,245.00 $83,892.28 $0.53 $83,892.81

$262,099.60 $262,113.49 $4,493,625.00 $306,926.09 $13.89 $306,939.98

$2,891,328.66 $2,891,481.86 $43,570,602.00 $2,975,983.66 $153.20 $2,976,136.86

$0.00

$0.00

$20,579.00

$1,405.60 $0.00

$1,405.60

$163,699.01 $163,707.69 $2,603,552.00 $177,829.27 $8.68 $177,837.95

$98,616.89 $98,622.11 $1,025,116.00 $70,018.05 $5.22 $70,023.27

$182,625.37 $182,635.05 $1,092,910.00 $74,648.55 $9.68 $74,658.23

$119,547.07 $119,553.41

$911,688.00 $62,270.62 $6.34 $62,276.96

$505.32

$505.34

$0.00

$0.00 $0.02

$0.02

$2,942.60

$2,942.76

$37,935.00

$2,591.06 $0.16

$2,591.22

$118,147.67 $118,153.93

$982,480.00 $67,105.90 $6.26 $67,112.16

$193.06

$193.07

$2,704.10

$184.70 $0.01

$184.71

$2,125.07

$2,125.18

$56,644.00

$3,868.93 $0.11

$3,869.04

$413.03

$413.05

$5,481.00

$374.37 $0.02

$374.39

$46,776.64 $46,779.11

$144,598.00

$9,876.41 $2.47

$9,878.88

$14,253.50 $14,254.26

$92,807.00

$6,338.96 $0.76

$6,339.72

$75,674.47 $75,678.48 $1,365,393.00 $93,259.84 $4.01 $93,263.85

$35,661.26 $35,663.15 $1,219,534.00 $83,297.29 $1.89 $83,299.18

$1,052,203.07 $1,052,258.83 $4,180,422.00 $285,533.52 $55.76 $285,589.28

$792.20

$792.24

$17,183.00

$1,173.64 $0.04

$1,173.68

$32,690.98 $32,692.71

$218,109.00 $14,897.40 $1.73 $14,899.13

$18,447.79 $18,448.77

$0.00

$0.00 $0.98

$0.98

$890,823.52 $890,870.72 $11,802,610.00 $806,148.48 $47.20 $806,195.68

$253,220.08 $253,233.49 $8,965,006.00 $612,332.86 $13.41 $612,346.27

$56,912.76 $56,915.77

$930,403.31 $63,548.93 $3.01 $63,551.94

$102,592.67 $102,598.10 $1,100,468.25 $75,164.80 $5.43 $75,170.23

$4,707.93

$4,708.18

$175,470.00 $11,985.05 $0.25 $11,985.30

$83,958.39 $83,962.84

$547,532.00 $37,397.84 $4.45 $37,402.29

$428,236.54 $428,259.23 $6,438,837.00 $439,789.05 $22.69 $439,811.74

$226,125.78 $226,137.76 $2,310,087.00 $157,784.86 $11.98 $157,796.84

$42,949.27 $42,951.55

$708,133.00 $48,367.30 $2.28 $48,369.58

$4,603.98

$4,604.22

$76,178.00

$5,203.15 $0.24

$5,203.39

$3,548.88

$3,549.07

$485,519.00 $33,162.19 $0.19 $33,162.38

$7,088.29

$7,088.67

$101,038.00

$6,901.15 $0.38

$6,901.53

$13,962.71 $13,963.45

$601,235.00 $41,065.89 $0.74 $41,066.63

$223,207.73 $223,219.55 $3,519,069.00 $240,361.42 $11.82 $240,373.24

$120,853.55 $120,859.96 $2,907,148.00 $198,565.65 $6.41 $198,572.06

$0.00

$0.00

$16,150.00

$1,103.09 $0.00

$1,103.09

$4,419.13

$4,419.36

$201,732.00 $13,778.81 $0.23 $13,779.04

$17,403.37 $17,404.29

$53,124.00

$3,628.51 $0.92

$3,629.43

$1,043.08

$1,043.13

$262,633.00 $17,938.51 $0.05 $17,938.56

$132,169.79 $132,176.79 $1,870,346.00 $127,749.42 $7.00 $127,756.42

$2,733.98

$2,734.13

$1,189.00

$81.21 $0.15

$81.36

$0.00

$0.00

$10,437.00

$712.87 $0.00

$712.87

$30,203.25 $30,204.85

$297,505.00 $20,320.35 $1.60 $20,321.95

$0.00

$0.00

$21,173.00

$1,446.17 $0.00

$1,446.17

$86,852.11 $86,856.71 $1,186,220.00 $81,021.86 $4.60 $81,026.46

$351,778.62 $351,797.26 $6,209,443.00 $424,120.85 $18.64 $424,139.49

SITF 2012 Annual Report Page 53

Company Name
SAFECO INS CO OF ILLINOIS 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 INSURANCE COMPANY SOUTHERN MUTUAL CHURCH INS SOUTHERN MUTUAL INS CO 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 STATE FARM FIRE & CASUALTY CO STONEBRIDGE CASUALTY INS CO SUNZ INSURANCE COMPANY SYNERGY 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

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$4,247.73

$4,247.95

$0.00

$2,896.78

$2,896.93

$8,876.00

$1,743.77

$1,743.87

$74,493.00

$62,927.81 $62,931.15 $2,216,290.00

$44,848.72 $44,851.10

$674,108.00

$3,529.03

$3,529.21

$27,700.00

$7,714.14

$7,714.55

$87,639.00

$145,381.93 $145,389.63 $1,348,683.00

$48,823.87 $48,826.46

$806,942.00

$41,663.71 $41,665.92 $1,867,902.00

$192,779.92 $192,790.14 $2,416,638.00

$116,538.45 $116,544.62 $1,145,499.00

$99,276.28 $99,281.54 $1,332,052.37

$484,316.78 $484,342.44 $6,470,923.88

$27,481.47 $27,482.93

$476,308.56

$12,619.37 $12,620.04

$311,333.00

$31,276.07 $31,277.72

$557,590.00

$4,875.21

$4,875.47

$239,701.00

$13,162.75 $13,163.45

$66,727.00

$21,025.74 $21,026.86

$357,842.00

$11,493.12 $11,493.73

$136,047.00

$13,237.61 $13,238.31

$225,724.00

$0.00

$0.00

$1,339.00

$36,956.71 $36,958.66

$406,014.00

$35,291.91 $35,293.78 $1,334,371.00

$58,078.22 $58,081.30

$207,259.00

$45,594.03 $45,596.45 $1,534,075.00

$29,178.17 $29,179.72

$771,561.00

$135,380.56 $135,387.73

$674,955.00

$16,177.50 $16,178.36

$90,615.00

$724.75

$724.78

$9,938.00

$4,022.96

$4,023.17

$110,319.00

$73,600.56 $73,604.46 $1,072,629.00

$173,876.48 $173,885.69 $2,050,493.00

$91,393.54 $91,398.39 $2,974,178.00

$6,280.87

$6,281.20

$144,185.00

$5,463.06

$5,463.35

$46,506.00

$232,939.29 $232,951.63 $3,502,631.00

$0.00

$0.00

$9,319.00

$79,735.36 $79,739.58 $2,857,713.00

$32.71

$32.71

$35,381.00

$441.14

$441.16

$24,813.00

$669,776.79 $669,812.28 $12,884,922.00

$3,914.38

$3,914.59

$0.00

$8,022.22

$8,022.65

$170,684.00

$140,373.45 $140,380.89 $1,622,216.30

$78,811.60 $78,815.78 $1,630,367.00

$29,694.45 $29,696.02 $1,104,833.00

$14,669.92 $14,670.69

$181,102.88

$3,587.09

$3,587.28

$8,385.00

$155.25

$155.26

$1,293.00

$236,707.52 $236,720.06 $2,534,929.68

$207,970.13 $207,981.15 $2,525,298.00

$7.40

$7.40

$305.00

2012

2011 2011 And 2012

Assessment Balance

Amt

Due

$0.00 $0.22

$606.25 $0.15

$5,088.06 $0.10

$151,378.28 $3.34

$46,043.30 $2.38

$1,891.98 $0.18

$5,985.97 $0.41

$92,118.50 $7.70

$55,116.20 $2.59

$127,582.49 $2.21

$165,062.56 $10.22

$78,240.51 $6.17

$90,982.59 $5.26

$441,980.67 $25.66

$32,533.09 $1.46

$21,264.84 $0.67

$38,084.82 $1.65

$16,372.19 $0.26

$4,557.62 $0.70

$24,441.52 $1.12

$9,292.36 $0.61

$15,417.53 $0.70

$91.46 $0.00

$27,731.80 $1.95

$91,140.96 $1.87

$14,156.32 $3.08

$104,781.25 $2.42

$52,699.59 $1.55

$46,101.15 $7.17

$6,189.24 $0.86

$678.79 $0.03

$7,535.07 $0.21

$73,263.31 $3.90

$140,053.92 $9.21

$203,143.97 $4.85

$9,848.20 $0.33

$3,176.48 $0.29

$239,238.66 $12.34

$636.51 $0.00

$195,189.11 $4.22

$2,416.61 $0.00

$1,694.79 $0.02

$880,073.16 $35.49

$0.00 $0.21

$11,658.15 $0.43

$110,801.53 $7.44

$111,358.24 $4.18

$75,462.92 $1.57

$12,369.79 $0.77

$572.72 $0.19

$88.32 $0.01

$173,142.19 $12.54

$172,484.32 $11.02

$20.83 $0.00

Total Assessment
$0.22 $606.40 $5,088.16 $151,381.62 $46,045.68 $1,892.16 $5,986.38 $92,126.20 $55,118.79 $127,584.70 $165,072.78 $78,246.68 $90,987.85 $442,006.33 $32,534.55 $21,265.51 $38,086.47 $16,372.45 $4,558.32 $24,442.64 $9,292.97 $15,418.23
$91.46 $27,733.75 $91,142.83 $14,159.40 $104,783.67 $52,701.14 $46,108.32
$6,190.10 $678.82
$7,535.28 $73,267.21 $140,063.13 $203,148.82
$9,848.53 $3,176.77 $239,251.00
$636.51 $195,193.33
$2,416.61 $1,694.81 $880,108.65
$0.21 $11,658.58 $110,808.97 $111,362.42 $75,464.49 $12,370.56
$572.91 $88.33
$173,154.73 $172,495.34
$20.83

SITF 2012 Annual Report Page 54

Company Name
TRAVELERS CAS INS CO OF AMER TRAVELERS INDEMNITY CO OF CT TRAVELERS INDEMNITY COMPANY TRAVELERS INDEMNITY OF AMER TRAVELERS PROP CAS CO OF AMER TRINITY UNIVERSAL INS CO 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 UNITED WISCONSIN 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 INSURANCE AMERICA INC XL SPECIALTY INSURANCE CO YORK INSURANCE CO ZENITH INSURANCE CO ZNAT INSURANCE COMPANY ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL Grand Total:

2012 Assessment due from Insurance Companies

2011

2011 Assessment

2012

2012

2011 2011 And 2012

Assessment Amt

Adjustment Amt

Claims Paid

Assessment Balance

Total

Amt

Due Assessment

$77,128.09 $77,132.18 $2,736,741.00 $186,926.42 $4.09 $186,930.51

$340,973.60 $340,991.67 $5,532,471.00 $377,881.93 $18.07 $377,900.00

$629,588.33 $629,621.69 $10,849,006.00 $741,014.88 $33.36 $741,048.24

$3,207,282.10 $3,207,452.04 $49,207,297.00 $3,360,984.36 $169.94 $3,361,154.30

$720,208.04 $720,246.20 $10,364,439.00 $707,917.72 $38.16 $707,955.88

$3,611.52

$3,611.71

$43,230.00

$2,952.72 $0.19

$2,952.91

$5,798.11

$5,798.42

$116,313.00

$7,944.48 $0.31

$7,944.79

$5,123.81

$5,124.08

$380,072.00 $25,959.89 $0.27 $25,960.16

$14,078.11 $14,078.86

$171,661.10 $11,724.89 $0.75 $11,725.64

$902,919.08 $902,966.92 $15,810,195.00 $1,079,876.79 $47.84 $1,079,924.63

$133,219.27 $133,226.33 $2,303,092.00 $157,307.08 $7.06 $157,314.14

$1,438.04

$1,438.11

$24,530.00

$1,675.46 $0.07

$1,675.53

$44,835.42 $44,837.79 $1,015,768.00 $69,379.55 $2.37 $69,381.92

$10,363.53 $10,364.07

$249,306.00 $17,028.24 $0.54 $17,028.78

$71,020.26 $71,024.02 $1,290,862.00 $88,169.18 $3.76 $88,172.94

$320,728.96 $320,745.95 $3,281,665.00 $224,146.12 $16.99 $224,163.11

$30,670.36 $30,671.98 $1,081,190.00 $73,848.04 $1.62 $73,849.66

$0.00

$0.00

$167,205.00 $11,420.53 $0.00 $11,420.53

$48,312.58 $48,315.14

$978,823.00 $66,856.12 $2.56 $66,858.68

$64,674.86 $64,678.28 $1,510,035.00 $103,139.26 $3.42 $103,142.68

$451,511.65 $451,535.57 $4,945,909.60 $337,818.29 $23.92 $337,842.21

$101,351.30 $101,356.67 $1,279,949.00 $87,423.79 $5.37 $87,429.16

$13,401.97 $13,402.68

$231,767.00 $15,830.28 $0.71 $15,830.99

$30,133.45 $30,135.05 $1,314,272.00 $89,768.14 $1.60 $89,769.74

$0.00

$0.00

$25,298.00

$1,727.92 $0.00

$1,727.92

$347,051.98 $347,070.36 $3,611,067.00 $246,645.12 $18.38 $246,663.50

$71,386.98 $71,390.76

$381,462.00 $26,054.83 $3.78 $26,058.61

$670,147.99 $670,183.50 $9,444,803.00 $645,104.22 $35.51 $645,139.73

$27,162.67 $27,164.11 $1,330,394.00 $90,869.32 $1.44 $90,870.76

$15,476.73 $15,477.55

$105,716.00

$7,220.67 $0.82

$7,221.49

$475,068.32 $475,093.50 $7,242,806.00 $494,702.19 $25.18 $494,727.37

$21,913.14 $21,914.30

$97,040.00

$6,628.08 $1.16

$6,629.24

$225,393.56 $225,405.50 $4,382,662.00 $299,347.03 $11.94 $299,358.97

$38,718.69 $38,720.74

$815,071.00 $55,671.44 $2.05 $55,673.49

$46,088.67 $46,091.12

$990,693.00 $67,666.87 $2.45 $67,669.32

$16,455.28 $16,456.15

$312,563.00 $21,348.85 $0.87 $21,349.72

$199,101.35 $199,111.90 $2,740,557.00 $187,187.06 $10.55 $187,197.61

$123.02

$123.03

$994.00

$67.89 $0.01

$67.90

$305,108.00 $305,124.17 $5,405,898.00 $369,236.67 $16.17 $369,252.84

$0.00

$0.00

$299,695.00 $20,469.94 $0.00 $20,469.94

$1,953,101.10 $1,953,204.59 $24,822,027.00 $1,695,407.99 $103.49 $1,695,511.48

$7,940.76

$7,941.18

$84,099.00

$5,744.18 $0.42

$5,744.60

$72,055,885.51 $72,059,703.49 $1,052,539,848.51 $71,891,166.19 $3,817.98 $71,894,984.17

SITF 2012 Annual Report Page 55

Assessments Due from Self-Insurers

Company Name
A T & T AAA COOPER TRANSPORTATION ABF FREIGHT SYSTEM, INC ADVENTIST HEALTH SYS SUNBELT AGL RESOURCES, INC. ALBANY INTERNATIONAL ALBANY WATER GAS & LIGHT COMM ALBANY, CITY OF ALLENS INC ALLIED SYSTEMS LTD ALPHARETTA, CITY OF 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 BALDWIN COUNTY COMMISSIONERS BARTOW COUNTY BD OF EDUCATION BASF CORPORATION BEASLEY FOREST PRODUCTS INC 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/LAFARGE BREMEN-BOWDEN INVESTMENT CO. BRIGGS & STRATTON CORP BROWN INDUSTRIES BRUNSWICK FAMILY BOAT CO. BRUNSWICK, CITY OF BURLEN CORPORATION C.W. MATTHEWS CONTRACTING INC CAMDEN COUNTY BOC CANDLER HEALTH SYSTEM CARROLL CO. BOARD OF EDUCATION

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$4,848.86

$4,849.11

$0.00

$50,952.68

$50,955.38 $642,053.13

$63,116.14

$63,119.48 $1,179,580.62

$34,239.87

$34,241.68 $442,328.47

$3,825.61

$3,825.81 $855,595.25

$2,731.28

$2,731.43

$0.00

$1,868.72

$1,868.82

$36,348.00

$16,032.68

$16,033.53 $403,827.15

$6,739.60

$6,739.96

$0.00

$26,125.50

$26,126.89 $375,641.00

$4,835.74

$4,836.00 $322,351.87

$21,610.95

$21,612.09 $123,267.18

$6,664.06

$6,664.42

$38,026.48

$27,931.05

$27,932.53 $358,504.50

$8,952.38

$8,952.86 $108,840.53

$22,445.46

$22,446.65 $715,571.59

$1,474.05

$1,474.12

$36,147.63

$31,426.68

$31,428.34 $570,561.19

$32,248.12

$32,249.82 $472,598.94

$691,099.95

$691,136.57 $7,295,722.28

$396.91

$396.93

$41,274.96

$185,750.15

$185,760.00 $2,156,423.68

$112,227.09

$112,233.04 $1,662,913.71

$3,668.29

$3,668.48 $879,366.74

$74,061.59

$74,065.52 $2,049,290.20

$5,895.65

$5,895.97 $119,931.84

$20,737.08

$20,738.18 $569,222.43

$713.48

$713.52

$42,347.93

$0.00

$0.00

$66,948.90

$93,325.94

$93,330.89 $1,547,464.78

$4,080.42

$4,080.64

$0.00

$166,770.04

$166,778.88 $1,598,208.19

$32,787.30

$32,789.04 $225,345.19

$6,014.27

$6,014.59 $289,169.37

$13,374.78

$13,375.49 $357,566.30

$34,041.15

$34,042.95 $678,523.15

$15,676.10

$15,676.93 $286,490.23

$10,211.91

$10,212.46 $336,941.36

$23,989.93

$23,991.20

$0.00

$142,645.57

$142,653.13 $1,834,261.89

$32,734.36

$32,736.09

$29,401.25

$25,570.65

$25,572.00 $393,978.49

$14,598.90

$14,599.68 $307,106.05

$10,152.07

$10,152.61

$82,453.14

$598.08

$598.11

$9,403.71

$31,835.91

$31,837.60 $451,314.85

$1,420.58

$1,420.66

$21,216.32

$43,210.48

$43,212.76 $1,455,609.16

$6,526.81

$6,527.15 $134,761.55

$41,758.43

$41,760.64 $1,056,497.63

$443.74

$443.77

$0.00

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$0.00

$0.25

$43,853.87

$2.70

$80,568.38

$3.34

$30,212.17

$1.81

$58,439.35

$0.20

$0.00

$0.15

$2,482.66

$0.10

$27,582.43

$0.85

$0.00

$0.36

$25,657.24

$1.39

$22,017.46

$0.26

$8,419.46

$1.14

$2,597.31

$0.36

$24,486.78

$1.48

$7,434.09

$0.48

$48,875.37

$1.19

$2,468.98

$0.07

$38,970.79

$1.66

$32,279.72

$1.70

$498,316.51

$36.62

$2,819.19

$0.02

$147,289.26

$9.85

$113,581.26

$5.95

$60,063.00

$0.19

$139,971.77

$3.93

$8,191.65

$0.32

$38,879.35

$1.10

$2,892.47

$0.04

$4,572.78

$0.00

$105,695.81

$4.95

$0.00

$0.22

$109,161.71

$8.84

$15,391.65

$1.74

$19,751.01

$0.32

$24,422.69

$0.71

$46,344.87

$1.80

$19,568.02

$0.83

$23,013.96

$0.55

$0.00

$1.27

$125,284.78

$7.56

$2,008.18

$1.73

$26,909.74

$1.35

$20,976.13

$0.78

$5,631.76

$0.54

$642.30

$0.03

$30,825.96

$1.69

$1,449.13

$0.08

$99,421.83

$2.28

$9,204.56

$0.34

$72,161.49

$2.21

$0.00

$0.03

Total Assessment
$0.25 $43,856.57 $80,571.72 $30,213.98 $58,439.55
$0.15 $2,482.76 $27,583.28
$0.36 $25,658.63 $22,017.72
$8,420.60 $2,597.67 $24,488.26 $7,434.57 $48,876.56 $2,469.05 $38,972.45 $32,281.42 $498,353.13 $2,819.21 $147,299.11 $113,587.21 $60,063.19 $139,975.70 $8,191.97 $38,880.45 $2,892.51 $4,572.78 $105,700.76
$0.22 $109,170.55
$15,393.39 $19,751.33 $24,423.40 $46,346.67 $19,568.85 $23,014.51
$1.27 $125,292.34
$2,009.91 $26,911.09 $20,976.91
$5,632.30 $642.33
$30,827.65 $1,449.21
$99,424.11 $9,204.90
$72,163.70 $0.03

SITF 2012 Annual Report Page 56

Company Name
CASCADE CORPORATION CATHOLIC ARCHDIOCESES OF ATL CATOOSA CO. BD. OF EDUCATION CENTRAL GEORGIA HEALTH SYSTEMS CERTAINTEED CORPORATION CGLA LIQUIDATION, INC. CHATHAM COUNTY BD OF EDUCATION CHATHAM COUNTY GEORGIA CHEMICAL PRODUCTS CORP CHEROKEE BRICK & TILE CHEROKEE CO BD OF COMMISSIONER CHEROKEE CO BD OF EDUCATION CHEVRON USA INC SOU DIV CHILDREN'S HEALTHCARE OF ATL 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 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 COSTCO WHOLESALE CORP. COTTRELL INC COVINGTON, CITY OF COWETA CO BOARD OF EDUCATION COWETA COUNTY BOC CRACKER BARREL OLD CNTRY STORE CRAWFORD & COMPANY CRIDER'S POULTRY INC CRISP COUNTY BD OF EDUCATION D L LEE & SONS INC DALTON CITY OF DART CONTAINER CORP OF CA DART CONTAINER CORP. OF GA DEAN FOODS COMPANY DECATUR, CITY OF DEKALB COUNTY BOARD-ED

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$90.49

$90.50

$585.61

$11,824.41

$11,825.03 $292,779.48

$12,939.44

$12,940.12 $350,834.95

$131,870.33

$131,877.32 $2,120,424.01

$32,164.27

$32,165.98 $269,923.25

$29,158.23

$29,159.78 $301,536.62

$45,728.66

$45,731.09 $719,022.00

$49,930.26

$49,932.90 $778,999.84

$4,845.36

$4,845.61

$59,780.91

$37,514.00

$37,515.99

$80,329.93

$106,842.71

$106,848.38

$996,994.39

$48,981.05

$48,983.64 $1,079,276.73

$0.00

$0.00

$20,507.42

$79,516.25

$79,520.47 $1,687,851.43

$2,267.88

$2,268.00

$47,515.51

$83,810.90

$83,815.34 $1,197,504.08

$57,542.39

$57,545.44 $622,693.64

$23,796.44

$23,797.70

$54,984.00

$1,919.17

$1,919.27

$0.00

$11,924.60

$11,925.23

$68,743.18

$8,575.82

$8,576.28 $189,329.94

$124,454.64

$114,380.56 $2,488,343.54

$200,632.43

$200,643.06 $2,633,261.94

$94,448.15

$94,453.15 $1,825,120.74

$103,356.28

$103,361.76 $1,053,366.07

$18,494.51

$18,495.49 $378,277.88

$27,674.61

$27,676.07

$77,833.77

$21,377.24

$21,378.37 $253,824.95

$15,711.26

$15,712.10 $307,379.33

$37,278.87

$37,280.85 $522,226.42

$53,444.57

$53,447.40 $453,522.00

$10,449.58

$10,450.14 $106,624.42

$0.00

$0.00

$59,815.60

$4,513.52

$4,513.76 $550,687.80

$843.43

$843.47

$0.00

$20,937.30

$20,938.41 $459,767.91

$1,483.56

$1,483.64

$0.00

$16,810.65

$16,811.54 $448,608.39

$59,599.11

$59,602.27 $767,395.47

$8,651.19

$8,651.65

$89,621.11

$4,458.23

$4,458.46 $100,546.17

$51,838.12

$51,840.87 $535,276.17

$0.00

$0.00 $110,027.79

$34,885.61

$34,887.46 $863,102.23

$19,785.45

$19,786.50 $181,630.00

$70,795.37

$70,799.13 $530,125.05

$920.08

$920.13

$0.00

$8,527.96

$8,528.41 $117,129.10

$49,515.87

$49,518.49 $306,891.69

$299.14

$299.15

$44,763.00

$7,482.70

$7,483.09 $115,094.00

$7,711.60

$7,712.01 $320,773.91

$5,925.33

$5,925.64 $264,406.00

$292,232.24

$292,247.72 $4,294,358.24

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$40.00

$0.01

$19,997.59

$0.62

$23,962.93

$0.68

$144,830.39

$6.99

$18,436.45

$1.71

$20,595.72

$1.55

$49,111.04

$2.43

$53,207.68

$2.64

$4,083.19

$0.25

$5,486.74

$1.99

$68,097.27

$5.67

$73,717.36

$2.59

$1,400.71

$0.00

$115,284.57

$4.22

$3,245.43

$0.12

$81,792.59

$4.44

$42,531.57

$3.05

$3,755.55

$1.26

$0.00

$0.10

$4,695.34

$0.63

$12,931.72

$0.46

$169,960.23 ($10,074.08)

$179,858.53

$10.63

$124,660.42

$5.00

$71,947.60

$5.48

$25,837.35

$0.98

$5,316.25

$1.46

$17,336.89

$1.13

$20,994.80

$0.84

$35,669.40

$1.98

$30,976.71

$2.83

$7,282.72

$0.56

$4,085.56

$0.00

$37,613.39

$0.24

$0.00

$0.04

$31,403.33

$1.11

$0.00

$0.08

$30,641.10

$0.89

$52,415.08

$3.16

$6,121.35

$0.46

$6,867.56

$0.23

$36,560.73

$2.75

$7,515.18

$0.00

$58,952.09

$1.85

$12,405.79

$1.05

$36,208.90

$3.76

$0.00

$0.05

$8,000.22

$0.45

$20,961.49

$2.62

$3,057.43

$0.01

$7,861.21

$0.39

$21,909.68

$0.41

$18,059.61

$0.31

$293,315.66

$15.48

Total Assessment
$40.01 $19,998.21 $23,963.61 $144,837.38 $18,438.16 $20,597.27 $49,113.47 $53,210.32
$4,083.44 $5,488.73 $68,102.94 $73,719.95 $1,400.71 $115,288.79 $3,245.55 $81,797.03 $42,534.62 $3,756.81
$0.10 $4,695.97 $12,932.18 $159,886.15 $179,869.16 $124,665.42 $71,953.08 $25,838.33 $5,317.71 $17,338.02 $20,995.64 $35,671.38 $30,979.54 $7,283.28 $4,085.56 $37,613.63
$0.04 $31,404.44
$0.08 $30,641.99 $52,418.24
$6,121.81 $6,867.79 $36,563.48 $7,515.18 $58,953.94 $12,406.84 $36,212.66
$0.05 $8,000.67 $20,964.11 $3,057.44 $7,861.60 $21,910.09 $18,059.92 $293,331.14

SITF 2012 Annual Report Page 57

Company Name
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 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 ENGINEERED FABRICS CORP. EQUITY GROUP GA DIVISION ESTES EXPRESS LINES EVANS GRADING CO., INC EXEL HOLDINGS, USA, INC FAMILY DOLLAR STORES OF GA FAYETTE COUNTY BD OF COMM FAYETTE COUNTY BD OF EDUCATION FEDERAL EXPRESS CORP FEDEX FREIGHT, INC FEDEX GROUND PKG SYS FIELDALE FARMS CORPORATION 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 NORTH AMERICA L.P. FULTON COUNTY BD OF EDUCATION FULTON COUNTY, GEORGIA FULTON-DEKALB HOSPITAL AUTHY GANNETT CO. INC & SUBSIDIARIES GEORGIA CRATE & BASKET CO GEORGIA DUCK & CORDAGE MILL GEORGIA STATE OF GEORGIA-PACIFIC CORPORATION

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$341,772.83

$341,790.94 $3,943,242.40

$3,214.72

$3,214.89

$70,747.68

$84,742.99

$84,747.48 $820,495.56

$135,318.38

$135,325.55 $2,242,724.74

$783,779.04

$783,820.57 $11,524,584.87

$243,283.88

$243,296.77 $4,392,470.36

$2,415.36

$2,415.49

$96,142.34

$51,482.26

$51,484.99 $802,947.02

$44,532.53

$44,534.89 $840,305.60

$69,021.22

$69,024.87 $1,177,412.30

$46,371.69

$46,374.14 $504,422.04

$10,329.48

$10,330.02 $113,578.53

$7,377.43

$7,377.82 $135,703.55

$7,549.62

$7,550.02

$43,957.00

$25,389.59

$25,390.93 $315,032.96

$3,768.81

$3,769.01

$40,154.87

$6,312.45

$6,312.78 $100,513.08

$119,374.24

$119,380.56 $1,169,705.42

$1,152.77

$1,152.83

$25,122.40

$4,453.49

$4,453.73

$59,038.00

$139,052.79

$139,060.16 $1,090,740.52

$22,886.32

$22,887.53 $253,179.82

$20,228.90

$20,229.97 $440,351.01

$84,413.57

$84,418.05 $969,308.24

$2,192.41

$2,192.53 $119,481.58

$2,942.86

$2,943.02

$45,396.99

$0.00

$0.00 $884,225.75

$18,303.99

$18,304.96 $429,926.48

$20,844.12

$20,845.23 $478,191.89

$213,573.93

$213,585.25 $4,202,881.91

$78,667.99

$78,672.16 $1,177,809.70

$37,809.71

$37,811.71 $878,943.97

$162,038.50

$162,047.09 $1,956,468.65

$2,591.47

$2,591.61

$76,118.59

$6,805.89

$6,806.26

$49,446.00

$427.88

$427.91

$2,952.59

$95,873.33

$95,878.41 $1,767,288.15

$20,557.46

$20,558.55 $510,850.64

$28,956.93

$28,958.46 $168,537.33

$40,854.16

$40,856.32 $831,718.04

$18,288.32

$18,289.29 $156,607.95

$50,132.83

$50,135.49 $427,798.03

$7,841.39

$7,841.81 $136,514.57

$49,304.09

$49,306.70 $625,772.76

$9,276.98

$9,277.47

$11,021.39

$6,826.23

$6,826.59 $279,041.00

$260,292.10

$260,305.90 $4,470,252.89

$83,912.96

$83,917.41 $2,766,438.60

$117,289.72

$117,295.93 $1,612,650.09

$1,457.89

$1,457.96

$88,259.00

$1,975.18

$1,975.28

$7,430.28

$0.00

$0.00

$26,051.25

$4,714,503.62 $4,714,753.43 $73,298,798.03

$120,248.58

$120,254.95 $1,148,425.39

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$269,333.55

$18.11

$4,832.25

$0.17

$56,041.95

$4.49

$153,183.84

$7.17

$787,158.65

$41.53

$300,016.97

$12.89

$6,566.77

$0.13

$54,843.34

$2.73

$57,395.02

$2.36

$80,420.27

$3.65

$34,453.32

$2.45

$7,757.70

$0.54

$9,268.90

$0.39

$3,002.38

$0.40

$21,517.56

$1.34

$2,742.68

$0.20

$6,865.30

$0.33

$79,893.87

$6.32

$1,715.92

$0.06

$4,032.45

$0.24

$74,500.37

$7.37

$17,292.83

$1.21

$30,077.10

$1.07

$66,206.23

$4.48

$8,160.90

$0.12

$3,100.73

$0.16

$60,394.88

$0.00

$29,365.08

$0.97

$32,661.73

$1.11

$287,067.59

$11.32

$80,447.42

$4.17

$60,034.12

$2.00

$133,631.82

$8.59

$5,199.09

$0.14

$3,377.29

$0.37

$201.67

$0.03

$120,710.30

$5.08

$34,892.41

$1.09

$11,511.53

$1.53

$56,808.47

$2.16

$10,696.72

$0.97

$29,219.70

$2.66

$9,324.29

$0.42

$42,741.88

$2.61

$752.79

$0.49

$19,059.21

$0.36

$305,329.72

$13.80

$188,954.84

$4.45

$110,148.13

$6.21

$6,028.32

$0.07

$507.51

$0.10

$1,779.37

$0.00

$5,006,495.55

$249.81

$78,440.39

$6.37

Total Assessment
$269,351.66 $4,832.42
$56,046.44 $153,191.01 $787,200.18 $300,029.86
$6,566.90 $54,846.07 $57,397.38 $80,423.92 $34,455.77
$7,758.24 $9,269.29 $3,002.78 $21,518.90 $2,742.88 $6,865.63 $79,900.19 $1,715.98 $4,032.69 $74,507.74 $17,294.04 $30,078.17 $66,210.71 $8,161.02 $3,100.89 $60,394.88 $29,366.05 $32,662.84 $287,078.91 $80,451.59 $60,036.12 $133,640.41 $5,199.23 $3,377.66
$201.70 $120,715.38
$34,893.50 $11,513.06 $56,810.63 $10,697.69 $29,222.36
$9,324.71 $42,744.49
$753.28 $19,059.57 $305,343.52 $188,959.29 $110,154.34
$6,028.39 $507.61
$1,779.37 $5,006,745.36
$78,446.76

SITF 2012 Annual Report Page 58

Company Name
GFF HOLDING CO/GENERAL FIBERS GIW INDUSTRIES INC GLYNN COUNTY BOARD OF COMMSNRS GLYNN COUNTY SCHOOLS GOLDEN PANTRY FOOD STORES INC GOODY PRODUCTS, INC. GREAT ATLANTIC & PACIFIC TEA GREAT DANE LTD PARTNERSHIP GRIFFIN-SPALDING SCHOOLS GUARDIAN AUTOMOTIVE CORP GULFSTREAM AEROSPACE CORP GWINNETT CO BD OF EDUCATION GWINNETT 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 HERSCHEND FAMILY ENTERTAINMENT HILLCREST FOODS, INC HILTON WORLDWIDE, INC HOME DEPOT INC (THE) 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 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

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$919.97

$920.02

$0.00

$26,235.67

$26,237.06 $212,895.74

$98,172.35

$98,177.56 $970,365.46

$55,635.26

$55,638.21 $550,082.02

$2,743.81

$2,743.95

$95,509.47

$7,608.76

$7,609.17

$12,326.00

$13,634.28

$13,635.00

$0.00

$22,454.64

$22,455.83 $328,038.74

$13,550.89

$13,551.61 $211,317.46

$2,587.55

$2,587.69 $219,626.00

$60,262.11

$60,265.30 $996,537.52

$355,765.03

$355,783.88 $5,168,440.03

$150,973.47

$150,981.47 $2,515,411.03

$142,798.64

$142,806.21 $2,228,764.70

$44,901.38

$44,903.76 $376,870.83

$34,077.69

$34,079.49 $709,736.06

$0.00

$0.00

$49,739.12

$3,707.11

$3,707.31

$17,700.51

$24,082.98

$24,084.26 $541,931.48

$29,015.40

$29,016.94 $526,233.60

$90,801.48

$90,806.29 $1,456,114.23

$12,002.09

$12,002.72 $139,640.53

$3,552.95

$3,553.14

$99,397.99

$1,701.39

$1,701.48

$620.00

$4,597.82

$4,598.06 $1,018,122.48

$25,261.74

$25,263.07 $468,309.73

$35,037.22

$35,039.08 $1,396,030.06

$14,994.39

$14,995.19 $186,401.00

$75,935.04

$75,939.07 $729,712.62

$28,734.62

$28,736.14 $155,152.91

$57,448.36

$57,451.41 $713,058.80

$18,594.23

$18,595.22 $537,924.68

$30,891.78

$30,893.41 $511,050.80

$23,481.22

$23,482.46 $265,375.49

$8,021.44

$8,021.86

$91,719.38

$253,297.74

$253,311.16 $3,510,271.00

$21,209.81

$21,210.94 $478,469.99

$29,449.89

$29,451.45 $985,058.00

$4,254.80

$4,255.02 $115,423.90

$20,336.53

$20,337.61 $627,899.54

$13,704.07

$13,704.80 $373,228.00

$13,964.44

$13,965.18 $153,632.90

$39,287.25

$39,289.33 $534,094.75

$10,239.73

$10,240.27 $105,985.79

$124,808.49

$124,815.10

$780,711.82

$3,370.01

$3,370.19

$95,014.91

$33,167.62

$33,169.37 $1,093,287.37

$2,167.97

$2,168.09

$46,876.98

$1,466.27

$1,466.35

$28,621.72

$285.46

$285.48

$12,680.54

$15,244.96

$15,245.77 $345,404.70

$28,759.88

$28,761.41 $426,701.54

$8,025.66

$8,026.08 $158,081.48

$503,947.76

$503,974.46 $6,974,805.67

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$0.00

$0.05

$14,541.32

$1.39

$66,278.45

$5.21

$37,572.01

$2.95

$6,523.54

$0.14

$841.90

$0.41

$0.00

$0.72

$22,405.89

$1.19

$14,433.52

$0.72

$15,001.02

$0.14

$68,066.06

$3.19

$353,017.69

$18.85

$171,809.01

$8.00

$152,230.33

$7.57

$25,741.24

$2.38

$48,476.79

$1.80

$3,397.31

$0.00

$1,208.99

$0.20

$37,015.31

$1.28

$35,943.10

$1.54

$99,456.33

$4.81

$9,537.81

$0.63

$6,789.14

$0.19

$42.35

$0.09

$69,540.37

$0.24

$31,986.75

$1.33

$95,352.43

$1.86

$12,731.67

$0.80

$49,841.24

$4.03

$10,597.34

$1.52

$48,703.74

$3.05

$36,741.63

$0.99

$34,906.08

$1.63

$18,125.83

$1.24

$6,264.67

$0.42

$239,760.50

$13.42

$32,680.73

$1.13

$67,281.98

$1.56

$7,883.75

$0.22

$42,887.15

$1.08

$25,492.43

$0.73

$10,493.52

$0.74

$36,480.04

$2.08

$7,239.10

$0.54

$53,324.62

$6.61

$6,489.76

$0.18

$74,674.33

$1.75

$3,201.82

$0.12

$1,954.94

$0.08

$866.11

$0.02

$23,592.03

$0.81

$29,144.81

$1.53

$10,797.37

$0.42

$476,397.08

$26.70

Total Assessment
$0.05 $14,542.71 $66,283.66 $37,574.96
$6,523.68 $842.31 $0.72
$22,407.08 $14,434.24 $15,001.16 $68,069.25 $353,036.54 $171,817.01 $152,237.90 $25,743.62 $48,478.59
$3,397.31 $1,209.19 $37,016.59 $35,944.64 $99,461.14 $9,538.44 $6,789.33
$42.44 $69,540.61 $31,988.08 $95,354.29 $12,732.47 $49,845.27 $10,598.86 $48,706.79 $36,742.62 $34,907.71 $18,127.07
$6,265.09 $239,773.92
$32,681.86 $67,283.54
$7,883.97 $42,888.23 $25,493.16 $10,494.26 $36,482.12
$7,239.64 $53,331.23
$6,489.94 $74,676.08
$3,201.94 $1,955.02
$866.13 $23,592.84 $29,146.34 $10,797.79 $476,423.78

SITF 2012 Annual Report Page 59

Company Name
LAGRANGE, CITY OF LANGDALE INDUSTRIES LAWRENCEVILLE, CITY OF LEGACY VULCAN 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 MAR-JAC POULTRY, INC. MARKETPLACE HOLDINGS, INC MARRIOTT INTERNATIONAL, INC. MARTA MASTEC NORTH AMERICA INC MAYO CLINIC HLTH SYS IN WAYCRO MCG HEALTH INC MCLANE COMPANY, INC. M-D BUILDING PRODUCTS MEADOWS REGIONAL MEDICAL CTR MEADWESTVACO MEMORIAL MEDICAL CENTER MERCER UNIV. (THE CORP OF) MERCK SHARP & DOHME CORP METALPLATE GALVANIZING L P 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 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. PATTERSON PUMP COMPANY PCC AIRFOILS LLC PHOEBE PUTNEY MEMORIAL HOSP PIEDMONT HOSPITAL

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$5,039.13

$5,039.39

$90,408.78

$37,933.96

$37,935.97 $680,543.78

$5,789.24

$5,789.55 $114,629.21

$9,189.93

$9,190.42 $761,188.14

$9,266.00

$9,266.49

$87,622.50

$725.43

$725.47

$9,579.28

$86.16

$86.17

$711.31

$6,705.31

$6,705.66

$80,739.57

$11,934.34

$11,934.98 $202,336.02

$448,062.67

$448,086.41 $5,633,291.85

$86,407.37

$86,411.95 $2,160,792.48

$10,287.05

$10,287.60 $204,655.85

$75,631.00

$75,635.01 $2,392,791.00

$4,588.43

$4,588.67

$0.00

$38,577.93

$38,579.97 $473,848.71

$97,650.04

$97,655.21 $1,180,345.90

$2,486.53

$2,486.66

$20,908.12

$135,079.35

$135,086.51 $1,938,651.80

$476,499.63

$476,524.88 $8,567,683.05

$14,076.76

$14,077.50 $428,161.04

$54,896.40

$54,899.31 $1,226,202.40

$12,279.98

$12,280.63

$68,768.99

$4,379.04

$4,379.27

$98,025.84

$1,232.69

$1,232.76

$0.00

$7,780.69

$7,781.11 $111,322.52

$6,938.97

$6,939.33

$24,782.17

$32,599.07

$32,600.80 $179,265.08

$6,289.92

$6,290.25 $122,289.39

$836.11

$836.15

$66,075.98

$157.10

$157.11

$6,741.00

$1,062.39

$1,062.45

$18,407.94

$37,983.08

$37,985.09 $436,366.67

$810.28

$810.33

$710.20

$139,838.32

$139,845.73

$0.00

$11,900.03

$11,900.67

$68,461.11

$52,236.87

$52,239.63 $838,522.44

$5,772.16

$5,772.47

$533.27

$41,981.23

$41,983.45 $625,014.57

$0.00

$0.00

$59,202.00

$44,056.39

$44,058.72 $733,336.48

$12,676.22

$12,676.89 $511,233.00

$22,086.18

$22,087.35 $265,568.00

$48,467.51

$48,470.08 $844,389.70

$52,990.92

$52,993.73 $394,995.71

$183,929.65

$183,939.39

$0.00

$67,511.74

$67,515.32 $354,945.44

$24,731.36

$24,732.67 $180,944.73

$21,976.52

$21,977.68 $299,589.05

$13,404.35

$13,405.06 $371,178.62

$12,808.45

$12,809.13 $312,686.20

$4,881.45

$4,881.71 $115,777.73

$7,554.23

$7,554.63

$43,126.70

$6,785.05

$6,785.41 $641,019.08

$78,705.50

$78,709.67 $1,123,478.33

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$6,175.15

$0.26

$46,482.88

$2.01

$7,829.47

$0.31

$51,991.10

$0.49

$5,984.84

$0.49

$654.29

$0.04

$48.58

$0.01

$5,514.72

$0.35

$13,820.07

$0.64

$384,768.25

$23.74

$147,587.66

$4.58

$13,978.52

$0.55

$163,433.75

$4.01

$0.00

$0.24

$32,365.08

$2.04

$80,620.65

$5.17

$1,428.08

$0.13

$132,414.88

$7.16

$585,194.69

$25.25

$29,244.50

$0.74

$83,752.76

$2.91

$4,697.10

$0.65

$6,695.42

$0.23

$0.00

$0.07

$7,603.61

$0.42

$1,692.69

$0.36

$12,244.26

$1.73

$8,352.68

$0.33

$4,513.16

$0.04

$460.43

$0.01

$1,257.31

$0.06

$29,804.96

$2.01

$48.51

$0.05

$0.00

$7.41

$4,676.07

$0.64

$57,273.23

$2.76

$36.42

$0.31

$42,690.10

$2.22

$4,043.65

$0.00

$50,088.76

$2.33

$34,918.52

$0.67

$18,138.97

$1.17

$57,673.98

$2.57

$26,979.22

$2.81

$0.00

$9.74

$24,243.68

$3.58

$12,358.99

$1.31

$20,462.70

$1.16

$25,352.45

$0.71

$21,357.27

$0.68

$7,907.92

$0.26

$2,945.66

$0.40

$43,783.24

$0.36

$76,736.45

$4.17

Total Assessment
$6,175.41 $46,484.89
$7,829.78 $51,991.59
$5,985.33 $654.33 $48.59
$5,515.07 $13,820.71 $384,791.99 $147,592.24 $13,979.07 $163,437.76
$0.24 $32,367.12 $80,625.82
$1,428.21 $132,422.04 $585,219.94
$29,245.24 $83,755.67
$4,697.75 $6,695.65
$0.07 $7,604.03 $1,693.05 $12,245.99 $8,353.01 $4,513.20
$460.44 $1,257.37 $29,806.97
$48.56 $7.41
$4,676.71 $57,275.99
$36.73 $42,692.32
$4,043.65 $50,091.09 $34,919.19 $18,140.14 $57,676.55 $26,982.03
$9.74 $24,247.26 $12,360.30 $20,463.86 $25,353.16 $21,357.95
$7,908.18 $2,946.06 $43,783.60 $76,740.62

SITF 2012 Annual Report Page 60

Company Name
PIEDMONT LABORATORIES, INC. PIGGLY WIGGLY CAROLINA CO INC PIKE ELECTRIC, LLC. PILOT TRAVEL CENTERS PPG INDUSTRIES INC. PRESBYTERIAN HOMES OF GA 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 ROCKDALE CO. BD OF EDUCATION ROCKTENN CP, LLC ROCKWELL AUTOMATION, INC ROCOH USA, INC. ROLLINS INC ROME, CITY OF ROOKER ADMINISTRATIVE SERVICES ROPER CORPORATION ROSEBURG FOREST PRODUCTS ROSWELL CITY OF RTM, LLC RUBY TUESDAY INC RUSSELL BRANDS, LLC RYAN'S FAMILY STEAK HOUSES RYDER SYSTEM INC SAIA MOTOR FREIGHT LINE LLC SAINT JOSEPH'S OF SAVANNAH SAINT MARY'S HEALTH CARE 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 SNELL CONTRACTORS SOUTH GEORGIA MEDICAL CENTER SOUTHEAST GA HLTH SYSTEM SOUTHEASTERN FREIGHT LINES SOUTHERN COMPANY SOUTHERN MILLS INC SOUTHERN PAN SERVICES

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$895.90

$895.95

$14,917.45

$8,389.99

$8,390.44 $336,623.00

$84.96

$84.96

$1,881.43

$14,520.75

$14,521.52 $192,382.04

$14,194.09

$14,194.84 $222,610.00

$998.25

$998.30

$85,211.40

$6,936.93

$6,937.30 $129,049.32

$48,910.89

$48,913.48 $698,705.58

$30,183.91

$30,185.50 $689,030.42

$28,549.27

$28,550.78 $403,641.00

$3,235.67

$3,235.85 $107,825.89

$32,281.13

$32,282.84 $466,800.56

$3,912.40

$3,912.61

$5,162.24

$8,870.56

$8,871.03 $174,249.05

$9,306.01

$9,306.50

$13,530.47

$109,656.21

$109,662.02 $1,352,592.00

$8,740.99

$8,741.46

$43,096.00

$43,007.89

$43,010.17 $457,946.55

$9,316.99

$9,317.48

$8,213.58

$6,446.14

$6,446.48

$154.00

$54,670.37

$54,673.26 $714,428.84

$14,696.76

$14,697.54 $408,213.80

$1,624.82

$1,624.91 $308,621.57

$7,779.13

$7,779.54

$818.24

$17,599.73

$17,600.66 $218,848.70

$8,613.79

$8,614.25 $146,959.32

$8,774.86

$8,775.33 $404,300.00

$9,340.99

$9,341.49 $223,181.50

$4,752.28

$4,752.53 $111,486.00

$3,709.61

$3,709.81

$6,083.05

$106.22

$106.22

$42,062.00

$28,499.18

$28,500.69 $572,630.04

$11,730.28

$11,730.90 $338,474.10

$37,466.16

$37,468.15 $556,502.56

$0.00

$0.00

$11,567.92

$257,190.56

$257,204.19 $4,117,355.88

$850.16

$850.21

$5,860.92

$158.75

$158.76

$173.34

$386,370.51

$386,390.98 $3,985,147.98

$17,585.73

$17,586.67 $568,585.87

$13,864.31

$13,865.04 $462,731.24

$54,885.73

$54,888.63 $942,072.77

$0.00

$0.00

$38,754.00

$1,047.42

$1,047.48

$8,201.70

$4,625.83

$4,626.07

$43,423.66

$4,344.92

$4,345.15 $193,076.03

$532.07

$532.10

$3,448.33

$10,665.82

$10,666.39 $433,055.36

$0.00

$0.00 $755,833.17

$99,842.99

$99,848.28 $954,179.72

$44,107.56

$44,109.90 $889,758.07

$428,441.71

$428,464.41 $5,033,179.05

$11,887.92

$11,888.55 $301,027.09

$9,347.63

$9,348.12

$0.00

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$1,018.90

$0.05

$22,992.21

$0.45

$128.51

$0.00

$13,140.19

$0.77

$15,204.83

$0.75

$5,820.16

$0.05

$8,814.40

$0.37

$47,723.38

$2.59

$47,062.54

$1.59

$27,569.71

$1.51

$7,364.78

$0.18

$31,883.67

$1.71

$352.59

$0.21

$11,901.66

$0.47

$924.17

$0.49

$92,385.50

$5.81

$2,943.57

$0.47

$31,278.92

$2.28

$561.01

$0.49

$10.52

$0.34

$48,797.32

$2.89

$27,882.05

$0.78

$21,079.64

$0.09

$55.89

$0.41

$14,947.93

$0.93

$10,037.70

$0.46

$27,614.73

$0.47

$15,243.87

$0.50

$7,614.78

$0.25

$415.49

$0.20

$2,872.94

$0.00

$39,112.10

$1.51

$23,118.65

$0.62

$38,010.55

$1.99

$790.12

$0.00

$281,225.95

$13.63

$400.32

$0.05

$11.84

$0.01

$272,195.81

$20.47

$38,835.87

$0.94

$31,605.73

$0.73

$64,345.98

$2.90

$2,647.00

$0.00

$560.20

$0.06

$2,965.95

$0.24

$13,187.59

$0.23

$235.53

$0.03

$29,578.79

$0.57

$51,625.34

$0.00

$65,172.92

$5.29

$60,772.75

$2.34

$343,779.01

$22.70

$20,560.92

$0.63

$0.00

$0.49

Total Assessment
$1,018.95 $22,992.66
$128.51 $13,140.96 $15,205.58
$5,820.21 $8,814.77 $47,725.97 $47,064.13 $27,571.22 $7,364.96 $31,885.38
$352.80 $11,902.13
$924.66 $92,391.31
$2,944.04 $31,281.20
$561.50 $10.86
$48,800.21 $27,882.83 $21,079.73
$56.30 $14,948.86 $10,038.16 $27,615.20 $15,244.37
$7,615.03 $415.69
$2,872.94 $39,113.61 $23,119.27 $38,012.54
$790.12 $281,239.58
$400.37 $11.85
$272,216.28 $38,836.81 $31,606.46 $64,348.88 $2,647.00 $560.26 $2,966.19 $13,187.82 $235.56 $29,579.36 $51,625.34 $65,178.21 $60,775.09
$343,801.71 $20,561.55 $0.49

SITF 2012 Annual Report Page 61

Company Name
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. SWIFT TRANSPORTATION COMPANY 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 USF HOLLAND, INC. VALDOSTA CITY OF VARIETY WHOLESALERS VISITING NURSE HEALTH SYSTEM WACHOVIA (nka WELLS FARGO WAFFLE HOUSE WAGGONERS TRUCKING CO., THE WAL MART ASSOCIATES INC WALKER COUNTY BD OF EDUCATION WALTON CO BOARD OF ED WAREHOUSE HOME FURNISHINGS WARNER ROBINS CITY OF WATKINS ASSOCIATED INDUSTRIES WAYCROSS MOLDED PRODUCTS INC WAYCROSS, CITY OF WAYNE FARMS LLC WELLSTAR HEALTH SYSTEM WENDY'S INTERNATIONAL INC WEST GEORGIA HEALTH SYSTEM WEYERHAEUSER COMPANY

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

Assessment Amt

Adjustment Amt

Claims Paid

$26,356.63

$26,358.03 $284,233.62

$83,818.88

$83,823.32 $1,255,628.98

$29,775.93

$29,777.51

$42,155.00

$915.71

$915.76

$21,911.72

$2,087.15

$2,087.26

$28,427.00

$14,538.90

$14,539.67 $350,542.00

$335.76

$335.78

$0.00

$517.41

$517.44

$3,884.02

$0.00

$0.00

$947.30

$718.17

$718.21 $141,115.77

$1,681.84

$1,681.93

$23,400.00

$0.00

$0.00

$21,640.05

$7,549.90

$7,550.30

$68,113.62

$6,006.65

$6,006.96

$42,163.29

$17,471.12

$17,472.05 $252,599.44

$265,067.24

$265,081.28 $2,887,870.79

$3,290.35

$3,290.52 $112,978.35

$134.86

$134.87

$9,399.39

$3,495.36

$3,495.55

$30,751.23

$12,487.78

$12,488.45

$0.00

$13,744.58

$13,745.31 $192,143.19

$57,584.88

$57,587.93 $128,046.26

$47,721.82

$47,724.35 $234,642.81

$16,919.02

$16,919.92 $468,215.33

$338.25

$338.27

$6,782.98

$53,352.37

$53,355.20 $888,205.61

$6,989.83

$6,990.20 $753,252.11

$2,331.54

$2,331.66

$20,682.51

$19,981.39

$19,982.45 $283,594.32

$65,973.82

$65,977.32 $530,871.78

$154,996.98

$155,005.19 $2,150,387.21

$952.36

$952.41

$30,658.62

$8,928.54

$8,929.01 $999,165.79

$47,195.74

$47,198.24 $266,986.36

$31,470.42

$31,472.09 $435,104.04

$28,827.73

$28,829.25 $395,939.98

$21,414.21

$21,415.34 $533,214.72

$29,244.39

$29,245.94 $271,189.64

$556.52

$556.54

$23,354.43

$115,021.27

$115,027.37 $1,169,114.79

$28,424.30

$28,425.80 $255,706.48

$374,604.19

$374,624.03 $10,136,051.57

$11,098.15

$11,098.73 $330,980.65

$14,162.43

$14,163.18 $127,219.44

$50,533.41

$50,536.09 $768,050.17

$0.00

$0.00 $599,015.11

$4,511.06

$4,511.30

$16,225.70

$3,580.69

$3,580.88

$350.00

$19,019.35

$19,020.36

$0.00

$21,334.06

$21,335.19 $174,235.12

$142,199.67

$142,207.20

$929,336.77

$6,495.33

$6,495.67

$94,207.36

$12,045.56

$12,046.19 $195,352.16

$20,922.37

$20,923.48 $557,299.52

2012

2011

2011 And 2012

Assessment Amt

Balance Due

$19,413.88

$1.40

$85,762.67

$4.44

$2,879.29

$1.58

$1,496.63

$0.05

$1,941.64

$0.11

$23,942.92

$0.77

$0.00

$0.02

$265.29

$0.03

$64.70

$0.00

$9,638.57

$0.04

$1,598.28

$0.09

$1,478.07

$0.00

$4,652.33

$0.40

$2,879.86

$0.31

$17,253.19

$0.93

$197,248.97

$14.04

$7,716.71

$0.17

$642.00

$0.01

$2,100.39

$0.19

$0.00

$0.67

$13,123.87

$0.73

$8,745.89

$3.05

$16,026.70

$2.53

$31,980.31

$0.90

$463.29

$0.02

$60,666.72

$2.83

$51,449.05

$0.37

$1,412.67

$0.12

$19,370.22

$1.06

$36,259.90

$3.50

$146,876.95

$8.21

$2,094.06

$0.05

$68,245.58

$0.47

$18,235.85

$2.50

$29,718.72

$1.67

$27,043.71

$1.52

$36,419.93

$1.13

$18,522.95

$1.55

$1,595.17

$0.02

$79,853.53

$6.10

$17,465.41

$1.50

$692,318.27

$19.84

$22,606.83

$0.58

$8,689.41

$0.75

$52,459.79

$2.68

$40,914.27

$0.00

$1,108.26

$0.24

$23.91

$0.19

$0.00

$1.01

$11,900.70

$1.13

$63,476.08

$7.53

$6,434.60

$0.34

$13,343.05

$0.63

$38,064.98

$1.11

Total Assessment
$19,415.28 $85,767.11
$2,880.87 $1,496.68 $1,941.75 $23,943.69
$0.02 $265.32
$64.70 $9,638.61 $1,598.37 $1,478.07 $4,652.73 $2,880.17 $17,254.12 $197,263.01 $7,716.88
$642.01 $2,100.58
$0.67 $13,124.60
$8,748.94 $16,029.23 $31,981.21
$463.31 $60,669.55 $51,449.42
$1,412.79 $19,371.28 $36,263.40 $146,885.16
$2,094.11 $68,246.05 $18,238.35 $29,720.39 $27,045.23 $36,421.06 $18,524.50
$1,595.19 $79,859.63 $17,466.91 $692,338.11 $22,607.41
$8,690.16 $52,462.47 $40,914.27
$1,108.50 $24.10 $1.01
$11,901.83 $63,483.61
$6,434.94 $13,343.68 $38,066.09

Company Name
WHITFIELD COUNTY BOE WINN-DIXIE STORES INC YELLOW TRANSPORTATION YKK CORPORATION OF AMERICA Grand Total:

SITF 2012 Annual Report Page 62

2012 Assessment Due from Self-Insured Companies

2011

2011 Assessment

2012

2012

2011

2011 And 2012

Assessment Amt

Adjustment Amt

Claims Paid

Assessment Amt

Balance Due

Total Assessment

$33,162.36

$33,164.12 $413,382.27

$28,235.07

$1.76

$28,236.83

$143,625.35

$143,632.96 $2,054,731.48 $140,343.42

$7.61

$140,351.03

$51,762.70

$51,765.44

$0.00

$0.00

$2.74

$2.74

$10,587.19

$10,587.75 $246,710.71

$16,850.97

$0.56

$16,851.53

$22,038,326.59 $22,029,413.69 $329,647,084.38 $22,515,739.87 ($8,912.90) $22,506,826.97

SITF 2012 Annual Report Page 63 Assessments Due from Group Self-Insurers

2012 Assessment Due from Group Self-Insured Companies

2011

2011 Assessment

2012

2012

2011

2011 And 2012

Company Name

Assessment Amt Adjustment Amt Claims Paid Assessment Amt Balance Due Total Assessment

AGRITRUST OF GEORGIA

$293,223.74

$293,239.28 $5,420,110.69 $370,207.44

$15.54

$370,222.98

ASSOCIATION CTY COM GA SI

$1,792,475.05 $1,792,570.03 $25,231,426.95 $1,723,371.05

$94.98 $1,723,466.03

CONSTRUCTION SUPPLIERS' ASSOC

$58,346.47

$58,349.56 $708,016.05

$48,359.31

$3.09

$48,362.40

GA AUTO DEALERS ASSOCIATION SI $574,152.31

$574,182.73 $9,870,804.19 $674,201.20

$30.42

$674,231.62

GA EDUCATION WC TRUST FUND

$551,899.84

$551,929.08 $6,661,364.00 $454,988.21

$29.24

$455,017.45

GA HOSPITAL ASSOC WCSI FUND

$298,839.30

$298,855.13 $3,451,454.00 $235,743.14

$15.83

$235,758.97

GA MUNICIPAL ASSN WCSIF

$1,128,034.03 $1,128,093.80 $14,809,727.23 $1,011,542.28

$59.77 $1,011,602.05

GA NURSING HOME SELECTIVE WC

$89,007.35

$89,012.07 $1,502,586.80 $102,630.53

$4.72

$102,635.25

GA OILMEN'S ASSOCIATION

$190,025.28

$190,035.35 $2,028,414.20 $138,545.88

$10.07

$138,555.95

GA OPERATORS SELF-INSURERS

$175,840.08

$175,849.40 $2,177,931.85 $148,758.32

$9.32

$148,767.64

GA RETAIL MERCHANTS' WCT

$4,678.35

$4,678.59

$0.00

$0.24

$0.24

GA SCHOOL BD ASSOC W C FUND

$462,112.86

$462,137.35 $5,984,299.05 $408,742.94

$24.49

$408,767.43

GEMC WORKERS' COMP FUND

$291,781.81

$291,797.27 $4,041,002.32 $276,010.80

$15.46

$276,026.26

Grand Total:

$5,910,416.47 $5,910,729.64 $81,887,137.33 $5,593,101.10

$313.17 $5,593,414.27