07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 1 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
$0 $100.00 $0 $100.00 21st CENTURY NATIONAL INS. CO. $0 $100.00 21st CENTURY NORTH AMERICA $0 $100.00 A.I.U. INSURANCE CO. $570,841 $4, 16.54 ACADIA INSURANCE COMPANY $803,882 $6,360.38 ACCIDENT FUND GENERAL INS. CO. $12,455,920 $98,552.29 ACCIDENT FUND INSURANCE $13,749,926 $108,790.58 ACCIDENT FUND NATIONAL $4,954,244 $39,198 4(1 ACCIDENT INSURANCE COMPANY $4,033,108 $31,910. 9 ACE AMERICAN INSURANCE CO. $15,901,731 $ 25,815.84 ACE FIRE UNDERWRITERS INS. CO. $188,710 $ ,493.09 ACE PROPERTY AND CASUALTY $220,782 $1,746.8 ACIG INSURANCE COMPANY $81,636 $64 .91 ACUITY, A MUTUAL INSURANCE CO. $0 $100.00 ADVANTAGE WORKERS' COMPENSATION $3,116, 02 $24,654.22 AI ASSURANCE COMPANY $144,666 $1,144.61 AIG PROPERTY CASUALTY COMPANY $1,851,354 $ 4,648.07 AIOI NISSAY DOWA INSURANCE $0 $100.00 ALEA NORTH AMERICA INSURANCE CO $0 $100.00 ALL AMERICA INS. CO. $446,498 $3,532.73 ALLIED EASTERN INDEMNITY CO. $2,677,271 $21, 18 . 79
ALLIED PROPERTY & CASUALTY $30 f 15 $238.59 ALLMERICA FINANCIAL ALLIANCE $277,101 $2,192.45 ALLMERICA FINANCIAL BENEFIT $2,470,335 $19,545.50 ALLSTATE INDEMNITY CO. $0 $100.00 ALLSTATE INS. CO. $0 $100.00 ALLSTATE NORTHBROOK INDEMNITY CO $0 $ 00.00 ALLSTATE VEHICLE & PROPERTY $0 $ 00.00 AMCO INSURANCE COMPANY $121,405 $ 960. 7 AMERICAN ALTERNATIVE INS. CO. $174,976 $ ,384.42 AMERICAN AUTOMOBILE INSURANCE CO $27,974 $221.33 AMERICAN BUILDERS INSURANCE $10,234,866 $80,979.13 AMERICAN BUSINESS & MERCANTILE $45,500 $360.00 AMERICAN CASUALTY CO. OF $7,415,724 $58,673.84 AMERICAN COMPENSATION INS. CO. $3,589,924 $28,403.78 AMERICAN ECONOMY INS. CO. $291,532 $2,306.63 AMERICAN FAMILY HOME $0 $100.00 AMERICAN FAMILY INSURANCE CO. $491,964 $3,892.46 AMERICAN FAMILY MUTUAL $804,262 $6,363.39 AMERICAN FIRE & CASUALTY CO. $2,246,136 $17,771.62 AMERICAN GUARANTEE & LIABILITY $1,752,403 $13,865.16 AMERICAN HOME ASSURANCE CO. $1,179,406 $9,331.56 AMERICAN INSURANCE COMPANY $716,994 $5,672.92 AMERICAN INTERSTATE INS. CO. $39,541,864 $312,858.57 AMERICAN MINING INSURANCE CO. $4,263,857 $33,736.00 AMERICAN MODERN HOME $15,593 $123.37 AMERICAN PROPERTY INSURANCE CO. $0 $100.00 AMERICAN RESOURCES INS. CO. INC. $1,055,832 $8,353.83 AMERICAN SELECT INSURANCE CO. $1,233,301 $9,757.98 AMERICAN STATES INS. CO. $185,238 $1,465.62 AMERICAN STATES INS. CO. $40,509 $320.51 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 2 of 16 F. Y. 2019 ANNUAL ASSESS:t-::IENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
AMERICAN ZURICH INS. CO. $40,731,486 $322,270.96 AMERISURE INSURANCE CO. $19,094,395 $151,076.47 AMERISURE MUTUAL INSURANCE CO. $17,376,251 $137,482.37 AMERISURE PARTNERS INSURANCE CO. $615,479 $4,869.7 AMFED CASUALTY INSURANCE CO. $0 $100.00 AMFED NATIONAL INSURANCE CO. $0 $100.00 AMGUARD INSURANCE COMPANY $19,145,360 $15 ,479.71 AMTRUST INSURANCE CO. OF $8,039,783 $63,61 .44 ANSUR AMERICA INSURANCE CO. $),7]],854 $13,597 BJ ARCH INSURANCE COMPANY $13,472,221 $106, 93. 3 ARGONAUT GREAT CENTRAL INS. CO. $1,945 $100.00 ARGONAUT INSURANCE CO. $3,669,959 $29,037.03 ARGONAUT LIMITED RISK INS. CO. $0 $100.00 ARGONAUT-MIDWEST INS. CO. $595,764 $4,7 3.74 ARROWOOD INDEMNITY CO. $0 $100.00 ASHMERE INSURNCE COMPANY $803,353 $6,356.20 ASSOCIATED INDEMNITY CO. $43,260 $342. 8 ASSOCIATION CASUALTY INS. CO. $698,121 $5, 23. 9 ATLANT C SPECIALTY INSURANCE CO. $ ,062,979 $ 6,3 2.46 ATLANTIC STATES NSURANCE CO. $2,319,452 $18,3 1.70 AUTOMOBILE INS. CO. OF $0 $ 00.00 AUTO-OWNERS INS. CO. $20,664,743 $163,50 .19 BANKERS STANDARD INS. CO. $65, 8 $515.7 BENCHMARK INSURANCE COMPANY $2,461,547 $19,475.97 BERKLEY INSURANCE COMPANY $0 $100.00 BERKLEY NATIONAL INSURANCE CO. $987,486 $7,813.07 BERKLEY REGIONAL INSURANCE CO. $170,535 $ ,349.29 BERKSHIRE HATHAWAY DIRECT INS CO $0 $100.00 BERKSHIRE HATHAWAY HOMESTATE $11,002,614 $87,053.61 BITCO GENERAL INSURANCE $13,750,823 $108,797.67 BITCO NATIONAL INSURANCE $1,341,860 $10,616.91 BLOOMINGTON COMPENSATION $4,684,423 $37,063.55 BRICKSTREET MUTUAL INSURANCE CO. $651,263 $5,152.85 BRIDGEFIELD CASUALTY INS. CO. $48,648,802 $384,913.44 BRIDGEFIELD EMPLOYERS INSURANCE $415,619 $3,288.41 BRIERFIELD INSURANCE CO., INC. $0 $100.00 BROTHERHOOD MUTUAL INS. COMPANY $2,920,203 $23,104.89 BUILDERS INSURANCE $59,582,038 $471,418.13 BUSINESSFIRST INSURANCE COMPANY $2,466,610 $19,516.03 CALIFORNIA INSURANCE COMPANY $5,892,358 $46,620.83 CAROLINA CASUALTY INSURANCE CO. $14,089,037 $111,473.65 CAROLINA MUTUAL INSURANCE, INC $2,572,894 $20,356.95 CENTRAL MUTUAL INS. CO. $694,893 $5,498.05 CENTRE INSURANCE COMPANY $0 $100.00 CENTURY INDEMNITY CO. $0 $100.00 CHARTER OAK FIRE INSURANCE CO. $9,209,257 $72,864.42 CHEROKEE INSURANCE COMPANY $453,742 $3,590.05 CHUBB INDEMNITY INSURANCE CO. $3,640,325 $28,802.56 CHUBB NATIONAL INSURANCE CO. $477,381 $3,777.08 CHURCH MUTUAL INS. CO. $4,119,139 $32,590.98 CINCINNATI CASUALTY COMPANY $7,412,201 $58,645.96 CINCINNATI INDEMNITY CO. $5,012,597 $39,660.09 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 3 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
CINCINNATI INS. CO. $4,121,876 $32,612.63 CIT ZENS INSURANCE CO. OF $1,841,709 $14,571.76 CLARENDON NATIONAL INSURANCE CO. $7,917 $100.00 COLONIAL AMERICAN CASUALTY & $0 $100.00 COLORADO CASUALTY INSURANCE CO. $0 $100.00 COLUMBIA MUTUAL INS. CO. $0 $100.00 COLUMBIA NATIONAL INSURANCE CO. $831,817 $6,581.41 COMMERCE & INDUSTRY INS. CO. $5,384,615 $42,603.53 COMPTRUST AGC MUTUAL CAPTIVE CONTINENTAL CASUALTY CO. $3,733,747 $29,541.72 CONTINENTAL INS. CO. $2,491,319 $19,7 1.53 CONTINENTAL WESTERN INS. CO. $2,110,280 $16,696.71 CRUM & FORSTER INDEMNITY CO. $248,934 $ ,969.59 CYPRESS INSURANCE COMPANY $0 $ 00.00 DAKOTA TRUCK UNDERWRITERS $106 $100.00 DELTA FIRE & CASUALTY INS. CO. $0 $100.00 DEPOSITORS INSURANCE COMPANY $86,344 $683.16 DIAMOND STATE INSURANCE CO. $0 $100.00 DISCOVER PROPERTY & CAS.INS. CO. $0 $100.00 DONEGAL MUTUAL INSURANCE CO. $3,388,216 $26,807.85 EASTERN ADVANTAGE ASSURANCE CO. $303,661 $2,402.59 EASTERN ALLIANCE INSURANCE CO. $2,973,723 $23, 28. 35 EASTGUARD INSURANCE COMPANY $381,980 $3,022.26 ELECTRIC INSURANCE COMPANY $2,616,125 $20,699.00 EMC PROPERTY & CASUALTY INS. CO. $966,799 $7,649.40 EMCASCO INSURANCE COMPANY $571,093 $4,518.54 EMPLOYERS ASSURANCE COMPANY $9,065,485 $71,726.88 EMPLOYERS COMPENSATION INSURANCE $434,515 $3,437.92 EMPLOYERS INS. OF WAUSAU A $2,524,013 $19,970.20 EMPLOYERS MUTUAL CASUALTY INS.CO $598,007 $4,731.48 EMPLOYERS PREFERRED INS. CO. $16,922,353 $133,891.09 EVEREST NATIONAL INSURANCE CO. $4,539,938 $35,920.37 EVEREST SECURITY INSURANCE CO. $0 $ 00.00 EXCELSIOR INS. CO. $454,929 $3,599.44 FALLS LAKE NATIONAL INSURANCE $555,950 $4,398.72 FARMERS INSURANCE EXCHANGE $0 $100.00 FARMINGTON CASUALTY CO. $11,076,818 $87,640.72 FARMLAND MUTUAL INSURANCE CO. $1,980,631 $15,670.92 FCCI INSURANCE COMPANY $10,921,907 $86,415.05 FEDERAL INSURANCE CO. $10,733,127 $84,921.41 FEDERATED MUTUAL INS. CO. $9,331,021 $73,827.83 FEDERATED RESERVE INSURANCE CO. $0 $100.00 FEDERATED RURAL ELECTRIC $5,267,922 $41,680.24 FEDERATED SERVICE INS. CO. $402,948 $3,188.16 FFVA MUTUAL INSURANCE CO. $20,346,685 $160,984.69 FHM INSURANCE COMPANY $3,104,309 $24,561.56 FIDELITY & DEPOSIT CO. OF $0 $100.00 FIDELITY & GUARANTY INS. CO. $0 $100.00 FIDELITY & GUARANTY INSURANCE $0 $100.00 FIREMAN'S FUND INSURANCE CO. $557,667 $4,412.31 FIREMENS INSURANCE COMPANY $1,089,293 $8,618.58 FIRST DAKOTA INDEMNITY COMPANY $53 $100.00 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 4 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
FIRST LIBERTY INSURANCE CORP. $2,740,581 $21,683.71 FIRST NATIONAL INS. CO. OF $0 $100.00 FIRST NON PROFIT INSURANCE CO. $568,902 $4,501.20 FIRSTLINE NATIONAL INSURANCE CO. $0 $100.00 FLORISTS' INSURANCE CO. $0 $ 00.00 FLORIST'S MOTOAL INS. CO. $432,340 $3,420.71 FOREMOST INSURANCE COMPANY $1,930,151 $15,271.52 FOREMOS PROPERTY & CASUALTY $1,047,322 $8,286. 0 FOREMOST SIGNATTJRF INSPBANCE CO $1, 369, 574 $10,836.19 FORESTRY MOTOAL INSURANCE CO. $3,304,190 $26,143.03 FRANK WINSTON CROM INSURANCE CO. $984,340 $7,788.18 FRANKENMUTH MOTOAL INSURANCE CO. $5,419,862 $42,882.41 GENERAL CASUALTY CO. OF $811,955 $6,424.6 GENERAL INSURANCE COMPANY $0 $100.00 GEORGIA CASUALTY & SURETY CO. $389,829 $3,084.36 GRANGE MOTOAL CASUALTY COMPANY $1,371,991 $10,855.3 GRAN TE STATE INSURANCE CO. $4,711,685 $37,279.2 GRAPHIC ARTS MOTOAL INSURANCE CO $1,899,394 $15,0 8.17 GRAY INSURANCE COMPANY $620,547 $4,909.82 GREAT AMERICAN ALLIANCE INS. CO. $19,327,683 $152,92 .26 GREAT AMERICAN ASSURANCE CO. $737,217 $ ,832. GREAT AMERICAN INS. OF NEW YORK $ ,288,414 $10,194.04 GREAT AMERICAN INSURANCE CO. $0 $100.00 GREAT DIVIDE INSURANCE COMPANY $3,819,282 $30,218.48 GREAT MIDWEST INSURANCE COMPANY $459,409 $3,634.88 GREAT NORTHERN INS. CO. $934,518 $7,393.99 GREAT WEST CASUALTY CO. $4,184,345 $33,106.89 GREATER NEW YORK MUTUAL INS. $0 $100.00 GREENWICH INSURANCE COMPANY $238,367 $1,885.98 GREYHAWK INSURANCE COMPANY $0 $100.00 GOIDEONE ELITE INSURANCE CO. $58 $ 00.00 GUIDEONE MOTOAL INSURANCE CO. $1,421,235 $11,244.93 HANOVER AMERICAN INSURANCE CO. $1,791,882 $14,177.52 HANOVER INSURANCE COMPANY $1,921,977 $15,206.84 HARCO NATIONAL INS. CO. $0 $100.00 HARFORD MUTUAL INSURANCE CO. $0 $100.00 HARLEYSVILLE INSURANCE COMPANY $383,333 $3,032.96 HARLEYSVILLE PREFERRED INS. CO. $164,998 $1,305.48 HARLEYSVILLE WORCHESTER INS. CO. $744,638 $5,891.64 HARTFORD ACCIDENT & INDEMNITY $16,733,625 $132,397.86 HARTFORD CASUALTY INS. CO. $7,057,060 $55,836.06 HARTFORD FIRE INS. CO. $7,364,095 $58,265.34 HARTFORD INS. CO. OF MIDWEST $7,600,769 $60,137.93 HARTFORD INSURANCE COMPANY $4,381,514 $34,666.91 HARTFORD UNDERWRITERS INS. CO. $13,109,399 $103,722.67 HDI-GLOBAL INSURANCE COMPANY $446,625 $3,533.73 HEALTH CARE MUTUAL CAPTIVE $5,291,850 $41,869.56 IMPERIUM INSURANCE COMPANY $3,200,725 $25,324.41 INDEMNITY INS.CO.OF NO. AMERICA $20,765,882 $164,301.42 INDIANA LUMBERMENS MUTUAL INS CO $0 $100.00 INSURANCE CO OF THE STATE OF PA. $7,455,336 $58,987.25 INSURANCE CO. OF NORTH AMERICA $4 $100.00 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 5 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
INSURANCE COMPANY OF THE WEST $11,851,522 $93,770.24 INTREPID INSURANCE COMPANY $59,598 $471. 4 KEY RISK INSURANCE COMPANY $7,113,222 $56,280.41 LANCER INSURANCE CO. $0 $100.00 LIBERTY INS. CORP. $18,708,360 $148,022.13 LIBERTY MUTUAL FIRE INS. $10,226,780 $80,915. 5 BERTY MUTUAL INS. CO. $4 0,101 $3,561.24 ION INSURANCE COMPANY $2,053,729 $16,249.28 LM TNSURANCE CORPORATION $28,835,829 $228.751 52 MAG MUTUAL INSURANCE CO. $4,209,686 $33,307.39 MAIN STREET AMERICA $1,295,654 $10,251.32 MANUFACTURERS ALLIANCE INS. CO. $1,580,614 $12,505.9 MARKEL INSURANCE COMPANY $5,543,513 $43,860.74 MASSACHUSETTS BAY INS. CO. $2,158,101 $17,075.08 MEMIC INDEMNITY COMPANY $2,195,874 $17,373.94 MERIDIAN SECURITY INSURANCE CO. $1,271,182 $10,057.70 MICHIGAN COMMERCIAL INS. MUTUAL $6,902,393 $54,612.32 MID CENTURY INSURANCE COMPANY $0 $100.00 MIDDLESEX INSURANCE CO. $876,995 $6,938.86 MIDSOUTH MUTUAL INSURANCE CO. $0 $100.00 MIDWEST BUILDERS CASUALTY $13,137 $103.94 MIDWEST EMPLOYERS CASUALTY CO. $1,780,784 $14,089.71 MIDWESTERN INDEMNITY CO. (THE) $111,810 $884.65 MILFORD CASUALTY INSURANCE CO. $0 $100.00 MITUSI SUMITOMO INS. USA, INC. $5,663,706 $44,811.72 MITUSI SUMITOMO INSURANCE $2,530,294 $20,019.90 MONROE GUARANTY INSURANCE CO. $5,897,733 $46,663.36 MOTORISTS COMMERCIAL MUTUAL $0 $100.00 NATIONAL AMERICAN INS. CO. $34,428 $272.40 NATIONAL BUILDERS INSURANCE co $911,065 $7,208.42 NATIONAL CASUALTY COMPANY $636,187 $5,033.57 NATIONAL FIRE INS.CO.OF HARTFORD $2,059,727 $16,296.73 NATIONAL INDEMNITY COMPANY $0 $100.00 NATIONAL INTERSTATE INSURANCE co $1,603,880 $12,690.03 NATIONAL LIABILITY & FIRE $5,553,765 $43,941.86 NATIONAL SURETY CORP. $498,506 $3,944.22 NATIONAL TROST INSURANCE CO. $7,217,086 $57,102.19 NATIONAL UNION FIRE INS. $2,967,313 $23,477.63 NATIONWIDE AGRIBUSINESS INS. CO. $2,068,618 $16,367.08 NATIONWIDE MUTUAL FIRE INS. CO. $179,343 $1,418.98 NATIONWIDE MUTUAL INSURANCE CO. $110,777 $876.48 NATIONWIDE PROPERTY & CASUALTY $120,727 $955.20 NETHERLANDS INSURANCE CO. $937,733 $7,419.42 NEW HAMPSHIRE INS. CO. $24,724,808 $195,624.77 NEW YORK MARINE & GENERAL $5,305,394 $41,976.73 NGM INSURANCE COMPANY $385,454 $3,049.74 NLC MUTUAL INSURANCE CO. $0 $100.00 NORGUARD INSURANCE COMPANY $14,206,266 $112,401.18 NORMANDY INSURANCE CO., INC. $0 $100. 00 NORTH AMERICAN SPECIALTY INS. CO $0 $100.00 NORTH POINTE INSURANCE COMPANY $392,204 $3,103.15 NORTH RIVER INS. CO. $1,435,494 $11,357.75 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 6 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
NORTHSTONE INSURANCE COMPANY $5,808 $100.00 NOVA CASUALTY COMPANY $753,169 $5,959.14 OAK RIVER INSURANCE COMPANY $358,947 $2,840.02 OBI AMERICA INSURANCE COMPANY $153 $100.00 OBI NATIONAL INSURANCE CO. $458,732 $3,629.53 OHIO CASUALTY INS. CO. $780,087 $6,172.11 OHIO FARMERS INS. CO. $0 $100.00 OHIO SECURITY INSURANCE COMPANY $7,702,893 $60,945.94 OLD DOMINION INSURANCE COMPANY $1,383.494 $1 Q, 946 32 OLD REPUBLIC GENERAL $982,949 $7,777.18 OLD REPUBLIC INSURANCE CO. $28,994,275 $229,40 .16 OLD REPUBLIC UNION INSURANCE CO. $0 $100.00 OWNERS INSURANCE COMPANY $22,340,451 $176,759.54 PACIFIC EMPLOYERS INS. CO. $402,346 $3,183.40 PACIFIC INDEMNITY CO. $2,959,531 $23,416.06 PATRIOT GENERAL INSURANCE CO. $318,495 $2, 19. 96 PEERLESS INDEMNITY INSURANCE CO. $6,492 $100.00 PEERLESS INS. CO. $522,081 $4,130.75 PENN MILLERS INSURANCE CO. $930,774 $7,364.36 PENN STAR INSURANCE $0 $100.00 PENN-NATIONAL MUTUAL CASUALTY $48,855 $386.54 PENNSYLVANIA MANUFACTURERS $5,990,326 $47,395.97 PENNSYLVANIA MANUFACTURERS $81 ,197 $6,426. PETROLEUM CASUALTY CO. $631 $ 00.00 PHARMACISTS MUTUAL INSURANCE CO. $56 , 901 $4,477.46 PHOENIX INSURANCE CO. $12,553,076 $99,32 .00 PINNACLEPOINT INSURANCE COMPANY $104,574 $827.40 PLAZA INSURANCE COMPANY $0 $100.00 PRAETORIAN INSURANCE COMPANY $5,757,748 $45,555.79 PREFERRED PROFESSIONAL INS. CO. $35,459 $280. 5 PREMIER GROUP INSURANCE CO. $362,274 $2,866.34 PRINCETON INSURANCE COMPANY $0 $100.00 PROASSURANCE INDEMNITY CO., INC. $0 $100.00 PROPERTY & CASUALTY INSURANCE $6,403,659 $50,666.29 PROTECTIVE PROPERTY & $0 $100.00 PROVIDENCE WASHINGTON INSURANCE $0 $100.00 QBE INSURANCE COMPANY $2,686,465 $21,255.54 REDWOOD FIRE & CASUALTY $3,738,913 $29,582.60 REGENT INSURANCE COMPANY $917,017 $7,255.52 RENAISSANCE REINSURANCE US, INC $0 $100.00 REPUBLIC FRANKLIN INS. CO. $1,886,266 $14,924.30 REPUBLIC INDEMNITY COMPANY $947,496 $7,496.67 RIVERPORT INSURANCE COMPANY $1,015,335 $8,033.42 RLI INSURANCE COMPANY $412,750 $3,265.71 ROCHDALE INSURANCE COMPANY $895,829 $7,087.87 ROCKWOOD CASUALTY INSURANCE $81,438 $644.34 RURAL TRUST INSURANCE COMPANY $398,061 $3,149.49 SAFECO INS. CO. OF AMERICA $0 $100.00 SAFECO INSURANCE COMPANY $0 $100.00 SAFETY FIRST INSURANCE CO. $80,820 $639.45 SAFETY NATIONAL CASUALTY CORP. $4,544,970 $35,960.19 SAGAMORE INSURANCE COMPANY $0 $100.00 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 7 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019 SAMSUNG FIRE & MARINE $130,981 $1,036.33 SEABRIGHT INSURANCE COMPANY $0 $100.00 SECURITY NATIONAL INSURANCE CO. $16,224,408 $ 28,368.89 SELECT INSURANCE COMPANY $0 $100.00 SELECTIVE INSURANCE COMPANY $1,620,114 $1 ,818.48 SELECTIVE INSURANCE COMPANY $1,876,212 $14,844.7 SELECTIVE INSURANCE COMPANY OF $1,628,31 $12,883.33 SELECT WAY INSURANCE CO. $2,465,580 $19,507.88 SENECA INSURANCE CO. INC. $7,744 s100 00 SENT NEL INSURANCE CO., LTD $2,668,363 $21,112.3 SENTRY CASUALTY COMPANY $2,650,231 $20,968.85 SENTRY INSURANCE A MUTUAL CO. $4,025,269 $31,848.27 SENTRY SELECT INSURANCE CO. $303,194 $2,398.90 SILVER OAK CASUALTY, INC. $93,074 $736.41 SOMPO AMERICA FIRE & MARINE $255,799 $2,023.90 SOMPO AMERICA INSURANCE COMPANY $4,042,834 $31,987.24 SOUTHERN FIRE & CASUALTY CO. $0 $100.00 SOUTHERN GUARANTY INS. CO. $0 $100.00 SOUTHERN INSURANCE CO. $ , 32 , 908 $18,371.13 SOUTHERN INSURANCE COMPANY $5 ,473 $438.9 SOUTHERN MUTUAL CHURCH $704,175 $5,571.49 SOUTHERN MUTUAL INSURANCE CO. $391,027 $3,093.84 SOUTHERN PILOT INSURANCE CO. $ 66 $100.00 SOUTHERN STATES INS. EXCHANGE $554,446 $4,386.82 SOUTHERN TRUST INS. CO. $645,867 $5,110.15 SPARTA INSURANCE COMPANY $0 $100.00 ST. PAUL FIRE & MARINE INS. CO. $0 $100.00 ST. PAUL GUARDIAN INS. CO. $0 $ 00.00 ST. PAUL MERCURY INS. CO. $0 $100.00 ST.PAUL PROTECTIVE INSURANCE CO. $0 $100.00 STANDARD FIRE INSURANCE CO. $2,994,562 $23,693.23 STAR INSURANCE COMPANY $1,228,635 $9,721.06 STARNET INSURANCE COMPANY $22,719,337 $179,757.32 STARR INDEMNITY LIABILITY CO. $5,694,296 $45,053.75 STARSTONE NATIONAL INSURANCE CO. $138,715 $1,097.52 STATE AUTO PROPERTY AND CASUALTY $549,046 $4,344. 0 STATE AUTOMOBILE MUTUAL INS. CO. $358,743 $2,838.40 STATE FARM FIRE & CASUALTY $9,441,642 $74,703.07 STATE NATIONAL INSURANCE CO. $3,659,952 $28,957.85 STONEWOOD INSURANCE COMPANY $0 $100.00 STONINGTON INSURANCE COMPANY $220,323 $1,743.21 SUMMITPOINT INSURANCE COMPANY $26,953 $213.25 SUNZ INSURANCE COMPANY $8,161,164 $64,571.82 SYNERGY INSURANCE COMPANY $3,076,005 $24,337.61 T.H.E. INSURANCE COMPANY $141,746 $1,121.51 TECHNOLOGY INSURANCE COMPANY $79,328,907 $627,657.02 TNUS INSURANCE COMPANY $195,850 $1,549.58 TOKIO MARINE AMERICA INS. CO. $1,592,399 $12,599.20 TRANS PACIFIC INS. CO. $1,377,808 $10,901.33 TRANSAMERICA CASUALTY INS. CO. $0 $100.00 TRANSGUARD INSURANCE COMPANY $383,336 $3,032.99 TRANSPORTATION INSURANCE CO. $1,721,511 $13,620.74 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 8 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( INSURER) FOR 2017 FOR F. Y. 2019
TRAVELERS CASUALTY SURETY $0 $100.00 TRAVELERS CASUALTY & SURETY CO. $1,745,446 $13,810. 2 TRAVELERS CASUALTY COMPANY $0 $100.00 TRAVELERS CASUALTY COMPANY $0 $100.00 TRAVELERS CASUALTY INSURANCE $7,186,596 $56,860.96 TRAVELERS COMMERCIAL CASUALTY CO $0 $ 00.00 TRAVELERS COMMERCIAL INS. CO. $0 $100.00 TRAVELERS CONSTITUTION STATE $0 $ 00.00 TRAVELERS INDEMNITY $9. 956,031 $78.772 96 TRAVELERS INDEMNITY COMPANY $14,908,440 $117,956.84 TRAVELERS INDEMNITY COMPANY $34,387,429 $272,076.2 TRAVELERS PROPERTY CASUALTY CO. $27,621,908 $218,546.87 TRI STATE INSURANCE COMPANY $274,240 $2,169.8 TRIANGLE INSURANCE COMPANY $0 $100.00 TRINITY UNIVERSAL INS. CO. $0 $ 00.00 TRIUMPHE CASUALTY COMPANY $1,469,515 $1 ,626.93 TRUCK INS. EXCHANGE $54, 682 $432.65 TRUMBULL INSURANCE COMPANY $3,745,530 $29,634.95 TRUSTGARD INSURANCE COMPANY $157,783 $1,248.39 TWIN CITY FIRE INS. CO. $16,651,454 $131,747.71 U.S. SPECIALTY INSURANCE CO. $0 $100.00 UNION INSURANCE COMPANY $3,116,358 $24,656.89 UNITED BUSINESS INSURANCE CO. $7,23 ,782 $57,218.4 UNITED STATES FIDEL TY $0 $100.00 UNITED STATES FIRE INS. CO. $2,047,611 $16,200.8 UNITED WISCONSIN INSURANCE CO. $3,006,589 $23,788.39 UNIVERSAL UNDERWRITERS INS. CO. $0 $100.00 UTICA MUTUAL INS. CO. $1,402,467 $11,096.44 UTICA NATIONAL ASSURANCE CO. $4,600,503 $36,399.7 UTICA NATIONAL INSURANCE $251,608 $1,990.74 VALLEY FORGE INS. CO. $4,225,988 $33,436.37 VANLINER INS. CO. $3,526,890 $27,905.0 VIGILANT INS. CO. $595,247 $4,709.64 WAUSAU BUSINESS INSURANCE CO. $70,339 $556.53 WAUSAU GENERAL INSURANCE CO. $21,813 $172.59 WAUSAU UNDERWRITERS INS. CO. $124,312 $983.57 WESCO INSURANCE COMPANY $31,352,481 $248,063.48 WEST AMERICAN INS. CO. $845,334 $6,688.35 WESTCHESTER FIRE INSURANCE CO. $0 $100.00 WESTFIELD INSURANCE COMPANY $3,234,993 $25,595.54 WESTFIELD NATIONAL INSURANCE CO. $914,991 $7,239.49 WESTPORT INSURANCE CORPORATION $0 $100.00 WILLIAMSBURG NATIONAL INSURANCE $343,495 $2,717.76 WORK FIRST CASUALTY CO. $2,656,485 $21,018.33 XL INSURANCE COMPANY $4,527,221 $35,819.76 XL SPECIALTY INSURANCE COMPANY $8,136,829 $64,379.28 ZENITH INSURANCE COMPANY $3,773,866 $29,859.15 ZNAT INSURANCE COMPANY $12,303,462 $97,346.03 ZURICH AMERICAN INS. CO. $2,181,092 $17,256.98 ZURICH AMERICAN INSURANCE CO. $45,606,639 $360,843.59 ZURICH INSURANCE CO. & AMERICAN $0 $100.00 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 9 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT FOR 2017 FOR F. Y. 2019
TOTAL FOR ALL 413 INSURERS ;1,555,327 ,093 $12,316,133.61 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 10 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT FOR 2017 FOR F. Y. 2019
$0 $100.00 $0 $100.00 A. G. RHODES HOME, INC. $466,579 $3,69 .61 AAA COOPER TRANSPORTATION $2,635,933 $20, 85 . 72 ABF FREIGHT SYSTEM DELAWARE, INC $2,071,745 $16,391.82 ACM GEORGIA LLC $0 $100.00 ADVENTIST HEALTH SYSTEM $746,613 $5,907.2 AGRITRUST OF GEORGIA $12,844,689
ALPHARETTA, CITY OF $654,267 $5,176.62 AMERICAN NATIONAL RED CROSS $372, 661 $2,948.53 AMERICAN PROTEINS, INC. $1,061,786 $8,400.94 APEX GRANITE CO. $23,184 $183.43 ARCHBOLD MEDICAL CENTER $1,358,510 $10,748.65 ASPLUNDH TREE EXPERT, LLC $1,736,313 $13,737.86 ASSOCIATION COUNTY COMMISSIONERS $28,467,201 $225,234.90 ATCO RUBBER PRODUCTS, INC. $166,836 $1,320.02 ATHENS-CLARKE COUNTY UNIFIED $1,097,013 $8,679.66 ATLANTA PUBLIC SCHOOLS $1,186,249 $9,385.70 ATLANTA, CITY OF $10,666,992 $84,398.14 AU MEDICAL CENTER, INC. $2,343,248 $18,539.98 AUGUSTA-RICHMOND COUNTY $2,44 ,367 $19,316.30 AVERITT EXPRESS, INC. $3,271,034 $25,880.70 BALDWIN COUNTY COMMISSIONERS $334,153 $2,643.8 BARTOW COUNTY BOARD OF EDUCATION $575,867 $4,556.31 BASTON MONUMENTS, INC. $39,408 $311. 80 BEASLEY FOREST PRODUCTS, INC. $1,060,507 $8,390.82 BERRY COLLEGE, INC. $361,351 $2,859.04 BIBB CO. BD OF EDUCATION $1,267,905 $10,031.77 BIG LOT STORES, INC. $300,037 $2,373.92 BJ'S WHOLESALE CLUB, INC. $245,417 $1,941.76 BLUE BIRD BODY COMPANY $4,697,931 $37,170.43 BLUE RIBBON QUARRIES, INC. $20,856 $165.01 BLUE RIDGE QUARRIES, INC. $12,648 $100.07 BLUE SKY QUARRIES, INC. $41,945 $331.87 BREMEN BOWDON INVESTMENT CO. $286,414 $2,266.13 BRIGGS AND STRATTON CORP. $510,278 $4,037.36 BROWNSTONE MEMORIALS, INC. $43,261 $342.28 BRUNSWICK, CITY OF $210,635 $1,666.56 BORTON MONUMENT COMPANY, INC. $37,538 $297.00 C.W. MATTHEWS CONTRACTING CO. $2,697,002 $21,338.91 CALLAWAY IDA CASON FOUNDATION $246,801 $1,952.71 CAMDEN COUNTY BOARD $345,264 $2,731.76 CARTERSVILLE, CITY OF $475,912 $3,765.46 CATHOLIC ARCHDIOCESE OF ATLANTA $5,955,070 $47,117.02 CATOOSA COUNTY BOARD OF $465,546 $3,683.44 CENTRAL GRANITE COMPANY, INC. $89,011 $704.26 CENTURY GRANITE CO., INC. $78,817 $623.61 CERTAIN-TEED CORPORATION $435,267 $3,443.87 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 11 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( 1S'Etln~SURER) FOR 2017 FOR F. Y. 2019
CHATHAM CO. BO. OF EDUCATION $1,955,980 $15,475.88 CHATHAM COUNTY $1,217,487 $9,632.86 CHEMICAL PRODUCTS CORPORATION $111,584 $882.86 CHEROKEE CO. BOARD OF $1,607,534 $12,718.95 CHEROKEE COUNTY SCHOOL DISTRICT $1,907,464 $15,092.02 CHEVRON CORPORATION $47,72 $377. 7 CHILDREN'S HEALTHCARE OF ATLANTA $7,274,410 $57,555.75 CHILDS & CHILDS GRANITE CO.,INC. $37,938 $300. 7 CLAYTON COUNTY BOARD OF $2,511,145 $19,868.39 CLAYTON COUNTY PUBLIC SCHOOLS $2,768,703 $21,906.2 CLAYTON COUNTY WATER AUTHORITY $426,662 $3,375.79 COATS & CLARK, INC. $611,581 $4,838.88 COBB CO. SCHOOL SYSTEM $4,026,733 $31,859.8 COBB COUNTY GOVERNMENT $6,529,193 $51,659.53 COCA-COLA COMPANY, THE $3,730,768 $29,518.1 COLLEGE PARK, CITY OF $327,912 $2, 94.47 COLONIAL GROUP, INC. $1,013,840 $8,021. 9 COLQUITT REGIONAL MEDICAL CENTER $705,170 $5,579.36 COLUMBIA COUNTY BO OF EDUCATION $918,048 $7,263.67 COLUMBUS CONSOLIDATED GOVERNMENT $2,944,419 $23,296.49 COLUMBUS REGIONAL HEALTHCARE $2, 37,58 $20,077. 6 COLUMBUS WATER WORKS $280,899 $2,222.50 COMET MACHINE & HYDRAULICS, LLC $995 $100.00 CONSTRUCTION SUPPLIERS' $3,126,620 $24,738.08 CONTINENTAL GENERAL TIRE, INC. $ 92,379 $ I 22.12 CORPORATION OF MERCER UNIVERSITY $562,074 $4,447.18 COSTCO WHOLESALE CORPORATION $2,252,768 $17,824.09 COVINGTON, CITY OF $329,938 $2,610.50 COWETA COUNTY BOARD OF $1,139,992 $9,019.71 COWETA COUNTY BOARD OF EDUCATION $1,150,694 $9,104.39 CRACKER BARREL OLD COUNTRY $1,048,811 $8,298.28 CRAWFORD & COMPANY, INC. $216,687 $1,714.45 CRIDER FOODS $815,347 $6,451.09 DALTON, CITY OF $644,874 $5,102.30 DART CONTAINER CORP. OF GEORGIA $615,447 $4,869.47 DART CONTAINER CORPORATION $125,904 $996.16 DECATUR, CITY OF $497,377 $3,935.29 DEKALB COUNTY GOVERNMENT $7,083,318 $56,043.81 DEKALB COUNTY SCHOOL DISTRICT $5,849,381 $46,280.80 DEKALB MEDICAL $3,515,183 $27,812.43 DELHAIZE AMERICA, LLC $453,751 $3,590.12 DELTA AIR LINES, INC. $51,867,359 $410,378.93 DESIGN MART,LLC $245 $100.00 DIAMOND CUT & POLISH CO., INC. $2,022 $100.00 DIXIE GRANITE COMPANY, INC. $78,833 $623. 73 DIXIE GROUP & SUBS, INC. $469,787 $3,716.99 DOLLAR GENERAL CORPORATION $1,356,531 $10,732.99 DON JONES ENTERPRISES, INC. $11,627 $100.00 DOUGHERTY COUNTY BOARD OF $773,698 $6,121.56 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 12 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT FOR 2017 FOR F. Y. 2019
DOUGHERTY COUNTY COMMISSION $675,274 $5,342.83 DOUGLAS COUNTY BOARD OF $1,047,397 $8,287.09 DOUGLAS, CITY OF $247,783 $1,960.48 DULUTH, CITY OF $240,240 $1,900.80 E.I. DUPONT DE NEMOURS & CO. $141,964 $ ,123.23 E.R. SNELL CONTRACTOR, INC. $2,071,351 $16,388.70 EAGLE GRANITE CO., INC. $294,217 $2,327.87 EAGLES DANBURG QUARRY, INC. $7,649 $100.00 , 58.02 ELBERTON GRANITE ASSOCIATION,INC $68 9 $100.00 EMORY UNIVERSI $36,510,253 $288,872.21 EQUITY GROUP-GA DIVISION $ ,644,813 $20,925.98 ESTES EXPRESS LINES $3,236,273 $25, 60 . 67 FAYETTE CO. BD. OF COMMISSIONERS $891,929 $7,057.02 FEDERAL EXPRESS CORPORATION $7,258,00 $57,425.95 FEDEX FREIGHT EAST, INC. $4,993,141 $39,506. 5 FEDEX GROUND PACKAGE SYSTEM, INC $7,115,984 $56,302. 7 FIELDALE CORPORATION $2,770,278 $2 ,918.67 FLATWOODS GRANITE, LLC $31,065 $245.79 FLEXSTEEL INDUSTRIES INC. $213,254 $1,687.28 FLORIDA ROCK INDUSTRIES INC. $31,430 $248.68 FLOWERS FOODS, INC. $2,577,798 $20,39 .76 FLOYD COUNTY ED.OF COMMISSIONERS $64 , 24 $5,121.0 FLOYD HEALTHCARE MANAGEMENT, INC $1,721,195 $13,618.24 FORD MOTOR COMPANY $197,220 $1,560.42 FOREST PARK, CITY OF $343,626 $2,7 8.80 FORSYTH COUNTY BO. OF EDUCATION $1,257,518 $9,949.59 FORSYTH COUNTY BOARD $1,460,713 $11,5 7.28 FRANKLIN ALUMINUM COMPANY $479,787 $3,796. FREUDENBERG-NOK $857,830 $6,787.22 FULTON CO. BD. OF EDUCATION $4,239,928 $33,546.67 FULTON COUNTY BD. OF COMM. $7,036,361 $55,672.28 G.B. MOON GRANITE MEMORIALS, INC $7,633 $100.00 GA. MUNICIPAL ASSN.SELF INS.FUND $21,859,156 $172,951.49 GAINESVILLE, CITY OF $833,960 $6,598.36 GENEVA GRANITE COMPANY, INC. $27,591 $218.30 GEORGIA AUTOMOBILE DEALERS $16,259,334 $128,645.23 GEORGIA CRATE & BASKET CO. $209,567 $1,658.11 GEORGIA EDUCATION WORKERS' $9,854,489 $77,969.55 GEORGIA HOSPITAL ASSOC. $6,159,620 $48,735.43 GEORGIA OILMEN'S WORKERS' $5,096,687 $40,325.42 GEORGIA OPERATORS-SELF-INSURERS $4,673,404 $36,976.37 GEORGIA SCHOOL BOARDS ASSN. $13,107,635 $103,708. 72 GEORGIA STONE INDUSTRIES, INC. $150 $100.00 GEORGIA, STATE OF 114,583,592 $906,595.07 GIW INDUSTRIES, INC. $565,151 $4,471.52 GLASS ART IMAGING, LLC $4,407 $100.00 GLYNN COUNTY SCHOOL SYSTEM $1,016,857 $8,045.46 GOLD EAGLE QUARRIES, INC. $12,464 $100.00 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 13 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY(1SEtlnlQ[SURER) FOR 2017 FOR F. Y. 2019
GRADY MEMORIAL HOSPITAL CORP. $5,933,774 $46,948. GRANITE SALES & SUPPLY CORP. $5,346 $100.00 GREEN COUNTY QUARRIES, INC. $14,433 $114.20 GRIFFIN SPALDING COUNTY $695,880 $5,505.86 GUARDIAN AUTOMOTIVE CORPORATION $426,510 $3,374. 8 GULFSTREAM AEROSPACE CORP. $5,261,660 $41,630.70 GWINNETT COUNTY BOARD $6,689,278 $52,926. 3 GWINNETT COUNTY PUBLIC SCHOOLS $8,866,497 $70,152.47 GWINNETT HOSPITAL SYSIEM $3,829,317 $30,297.88 HALL COUNTY BO. OF COMMISSIONERS $1,632,081 $12,91 .16 HALL COUNTY BOARD OF EDUCATION $975,912 $7,721.50 HAMILTON HEALTH CARE SYSTEM, INC $1,660,814 $ 3,140. 0 HAPEVILLE, CITY OF $169,675 $1,342.48 HARMONY BLUE GRANITE CO. $7,796 $100.00 HARPER'S QUARRY, INC. $15,780 $124.85 HARRISON POULTRY, INC. $909,689 $7,197.54 HEARTLAND EXPRESS, INC. $13,419 $106.17 HENRY COUNTY BOARD OF EDUCATION $1,676,221 $13,262.40 HERSHEND FAMILY ENTERTAINMENT $330,407 $2,6 4.21 LLCREST FOODS INC. $124,180 $982.52 HILLCREST GRANITE CO. $153,287 $1,212.82 HNI CORPORATION $1,002,939 $7,935.34 HOME DEPOT, INC. $13,041,872 $103,188.39 HORMEL FOODS CORPORATION $757,180 $5,990.87 HOSPITAL AUTHORITY OF $119,3 3 $944.01 HOUSING AUTHORITY OF THE CITY $543,034 $4,296.53 HOUSTON COUNTY BD OF EDUCATION $1,482,156 $11,726.94 HOUSTON COUNTY BOARD OF $656,880 $5,197.29 HOUSTON HEALTHCARE $1,274,629 $10,084.97 HOWARD SHEPPARD, INC. $1,144,05 $9,051.83 HULME'S TOOL SHOP $4,907 $100.00 HUNTER GRANITE SALES, INC. $38,764 $306.70 HYATT HOTELS, INC. $950,841 $7,523.13 IMEX INTERNATIONAL, INC. $3,251 $100.00 INGLES MARKETS, INC. $2,630,553 $20,813.16 INTERFACE, INC. $1,377,222 $10,896.70 J & B GRANITE COMPANY $17,138 $135.60 J & L ENTERPRISES $10,035 $100.00 J & R FINISHING COMPANY $38,642 $305.74 JESUP, CITY OF $141,119 $1,116.55 JOHNS MANVILLE $493,889 $3,907.69 JOHNSON MACHINE SHOP, INC. $10,996 $100.00 KELLEY MANUFACTURING CO. $195,478 $1,546.64 KEYSTONE GRANITE COMPANY, INC. $44,900 $355.25 KEYSTONE MEMORIALS, INC. $272,266 $2,154.19 KIMBERLY-CLARK GLOBAL SALES, LLC $502,897 $3,978.96 KING'S MONUMENT COMPANY, INC. $76,048 $601.70 KLLM TRANSPORT CO. $91,063 $720. 50 KNIGHT-SWIFT TRANSPORTATION $3,070,033 $24,290.36 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 14 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY ( :(:SEtlnll¥SURER) FOR 2017 FOR F. Y. 2019
KROGER COMPANY, (THE) $ 0,077,512 $79,734.13 L&M GRANITE, LLC $40,847 $323.18 LAGRANGE, CITY OF $736,904 $5,830.45 LANGDALE COMPANY (THE) $1,619,920 $12,8 6.94 LAWRENCEVILLE, CITY OF $319,074 $2,524.54 LOW TEMP INDUSTRIES, INC. $159,827 $1,264.56 LOWE'S HOME CENTERS, LLC $9,928,073 $78,551.75 M.B. KAHN CONSTRUCTION CO., INC. $39,079 $309.20 llACON vi'ATER AUTHORITY $192,651 $1,524.27 MACON-BIBB COUNTY $1,535,556 $12,149.4 MACYS, INC. $2,409,236 $ 9,062.08 MAJESTIC GRANITE CO. $26,274 $207.88 MARIETTA, CITY OF $1,126,375 $8,911.97 MAR-JAC POULTRY, INC. $1,345,306 $10,644. 7 MARRIOTT INTERNATIONAL, INC. $5,130,104 $40,589.82 MARTA $6,523,162 $51,611.81 MASTEC, INC. $1,224,577 $9,688.96 MEADOWS REGIONAL MEDICAL CENTER $631,450 $4,996.09 METALPLATE GALVANIZING, L.P. $152,923 $1,209.94 MICROMERITICS INSTRUMENT CORP. $78,859 $623.94 MIDDLETON GRANITE CO. $91,617 $724.88 MIDDLETON SAWING & POLISHING LLC $14,126 $111.77 MILES SUPPLY OF ELBERTON, INC. $11,243 $100.00 MILLEDGEVILLE, CITY OF $230,139 $ ,820.88 MIZE GRANITE SALES, INC. $28,624 $226.48 MJW CONSOLIDATED, INC. $134,545 $1,064.53 MONROE, CITY OF $278,470 $2,203. 8 MOUNT VERNON MILLS, INC. $911,802 $7,214.25 NASH JOHNSON & SONS' FARMS, INC. $585,357 $4,631.39 NAVICENT HEALTH, INC. $3,358,251 $26,570.77 NEWTON COUNTY SCHOOL SYSTEM $929, 72 $7,356.43 NORDSON CORPORATION $215,960 $1,708.69 NORDSTROM, INC. $471,473 $3,730.33 NORMAN W. FRIES, INC. $1,898,362 $15,020.00 NORTHEAST GA. HEALTH SYSTEM,INC. $5,071,280 $40,124.40 NORTHSIDE HEALTH SERVICES $6,670,391 $52,776.70 OLD DOMINION FREIGHT LINES $6,058,569 $47,935.91 OWENS-CORNING SALES, INC. $823,633 $6,516.65 OWENS-ILLINOIS, INC. $566,849 $4,484.96 OXFORD CONSTRUCTION COMPANY $650,365 $5,145.74 PARKER HANNIFIN CORPORATION $177,816 $1,406.90 PATTERSON PUMP CO. $419,641 $3,320.24 PCC AIRFOILS, INC. $710,271 $5,619.72 PEOPLE READY, INC. $0 $100.00 PHOEBE PUTNEY MEMORIAL HOSPITAL $2,556,632 $20,228.29 PIEDMONT HEALTHCARE INC. $9,040,831 $71,531.82 PILOT TRAVEL CENTERS, LLC $821,071 $6,496.38 PRESBYTERIAN HOMES OF GA, INC. $421,392 $3,334.09 PRINTPACK, INC. $850,284 $6,727.52 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 15 of 16 F. Y. 2019 ANNUAL ASSESSMENT
ANNUAL PREMIUMS ASSESSMENT COMPANY (ilill£1)bl.¥SURER) FOR 201 7 FOR F. Y. 2019
PROCTER & GAMBLE COMPANY $872,046 $6,899.70 PYRAMID MATERIALS, INC. $19,415 $153.61 QUARRIES II, LLC $32 9 $100.00 QUARRIES INC. $50,763 $401.64 QUIKTRIP CORPO~~TION $2,500,154 $19,781.43 RACETRAC PETROLEUM, INC. $990,498 $7,836.90 REG ONS FINANCIAL CORPORATION $257,699 $2,038.94 RELIANCE GRANITE COMPANY, INC $20,110 $159. 1 REYNOLDS MARBLE & GRANITE CO. $15,049 $119.01 RICHMOND CO. BO. OF EDUCATION $2,656,498 $2 ,018.44 RIVER EDGE GRANITE CO., INC. $4 , 948 $339.81 RIVERDALE, CITY OF $113,226 $895.85 ROCKDALE COUNTY BO. OF EDUCATION $729,090 $5,768.62 ROEHL TRANSPORT, INC. $952,686 $7,537.73 ROLLINS, INC. $702,143 $ ,555.41 ROPER CORPORATION $1,31 ,5 3 $10,376.80 ROSWELL, CITY OF $1,109,622 $8,779.4 RTM, LLC $ 30,073 $4,193.98 ROBY TUESDAY INC. $346,039 $2,737.89 RYDER SYSTEM, INC. $1,978,015 $ ,650.22 SAIA, NC. $2,134,901 $16,89 .52 SAVANNAH, CITY OF $2,666,068 $21,094. 6 SCIC, LLC $784,757 $6,209.06 SHAW INDUSTRIES, INC. $13,218,268 $104,584.05 SHEPHERD CENTER, INC. $1,010,319 $7,993. 3 SHERWIN WILLIAMS CO. $1,784,741 $14,121.02 SIZEMORE, INC. $753,463 $5,961.46 SKF USA, INC. $251,262 $1,988.01 SOLID ROCK GRANITE INTERIORS,INC $13,819 $109.34 SOUTH CAROLINA ELECTRIC & GAS $10,153 $100.00 SOUTHEAST GEORGIA HEALTH SYSTEMS $1,455,602 $11,516.85 SOUTHEASTERN FREIGHT LINES $5,586,955 $44,204.46 SOUTHERN COMPANY $7,733,685 $61,189.57 SOUTHERN COMPANY GAS $1,803,444 $14,269.00 SOUTHERN GRANITE CO. $25,440 $201.28 SOUTHERN LEGACY WAFFLES, LLC $105,126 $831.77 SOUTHERN MILLS, INC. $384,832 $3,044.82 SOOTHWIRE COMPANY $3,567,758 $28,228.40 SPARTAN TOOL CO.,INC. $14,413 $114.04 SPECIALTY GRANITE & SUPPLY CO. $11,606 $100.00 ST. JOSEPH CANDLER HEALTH SYSTEM $1,643,360 $13,002.40 STAR GRANITE CO., INC. $408,280 $3,230.35 SUPERIOR GRANITE CO., INC. $7,738 $100.00 TANNER HEALTH SERVICES $2,113,024 $16,718.42 TECHNOWIRE COMPANY, INC. $9,547 $100.00 TERMINIX SERVICE, INC. $44,062 $348.62 TEXTRON INC. $1,424,899 $11,273.92 THERMAL CERAMICS INC. $655,693 $5,187.90 THOMASVILLE, CITY OF $572,310 $4,528.17 07/26/2018 GEORGIA STATE BOARD OF WORKERS' COMPENSATION Page 16 of 16 F. Y. 2019 ANNUAL ASSESS:MENT
ANNUAL PREMIUMS ASSESSMENT COMPANY(1SEtlnl.}ISURER) FOR 2017 FOR F. Y. 2019 IP TOP INC. $1,336,630 $10,575.53 TRI-STAR USA, INC. $13,187 $104.34 TROUP COUNTY BOARD OF EDUCATION $1,752,313 $13,864.45 TURNER GRANITE INTERIORS, LLC $4,547 $100.00 TYSON FOODS, INC. $6,048,782 $47,858.47 UNIVERS TY HEALTH, INC. $2,899,518 $22,94 3 USF HOLLAND, INC. $1,332,729 $10,544.66 VALDOSTA, CITY OF $706,855 $5,592.70 VARIETY WHOLESALERS, INC. $370,271 $2,929.62 VIS TING NURSE HEALTH SYSTEM $765,551 $6,057.0 VULCAN MATERIALS CO. $1, 80,200 $12,502.68 WAFFLE HOUSE $2, 90 , 032 $23,000.68 WAGGONERS TRUCKING (THE) $11,132 $100.00 WALKER COUNTY BOARD OF EDUCATION $435,432 $3,445.17 WALKER GRANITE COMPANY, INC. $59,482 $470.63 WALLACE GRANITE SALES $15,780 $124.85 WAL-MART ASSOCIATES INC. $34,263,281 $271,093.98 WALTON COUNTY SCHOOLS $606,012 $4,794.82 WAREHOUSE HOME FURNISHINGS $943, 58 $7,467.09 WARNER ROBINS, CITY OF $7 0,157 $ ,618.82 WAYCROSS, CITY OF $204,462 $1,6 7.72 WAYNE FARMS, LLC $970,190 $7,676. 3 WELCH'S GRANITE CO., INC. $25,369 $200.72 WELLSTAR HEALTH SYSTEM $5,374,225 $42,521.32 WENDY'S INTERNATIONAL, INC. $9,884 $100.00 WEYERHAEUSER CO. $205, 710 $ ,627.59 WILLIS DIMENSION STONE, INC. $49,099 $388.48 WILSON INDUSTRIAL ELE., INC. $25,692 $203.28 WOODSTOCK, CITY OF $247,802 $1,960.63 YKK CORPORATION OF AMERICA $1,128,482 $8,928.65 YOUR DEKALB FARMERS MARKET, INC. $249,005 $1,970.15
TOTAL FOR ALL 323 SELF-INSURERS $796,682,178 $6,304,800.22 TOTAL FOR ALL 736 COMPANIES $2,352,009,271 $18,621,133.83