STATE OF NEW YORK WORKERS' COMPENSATION BOARD Report of Group Self-Insurers As of Month 7/1/

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1 Report of s (A) Associated Builders & Contractors Compensation Trust Effective Date: 5/1/97 Approximate Number of Active Members (A) Automobile Dealers Workers' Compensation Self-Insurance Trust Effective Date: 12/29/95 Industry Served: Retailers/Wholesalers - Automobiles Approximate Number of Active Members (A) Automotive Service and Repair Self-Insurance Trust Effective Date: 1/1/05 Industry Served: Auto Service and Repair Approximate Number of Active Members (A) Baumann Self-Insurance Trust Fund Effective Date: 11/1/92 Industry Served: Passenger Transportation - Bus Operators Approximate Number of Active Members - 4 (A) Beer Wholesalers Compensation Trust of New York Effective Date: 2/1/00 Industry Served: Retailers/Wholesalers - Malt & Carbonated Approximate Number of Active Members - 30 (A) Community Residence Insurance Saving Plan SI Trust Effective Date: 12/15/95 Approximate Number of Active Members ACTIVE GROUP SELF-INSURERS Reller Risk Management, LLC Charles Reller 6315 Fly Road East Syracuse, NY charles.reller@rellerrisk.com Bryan Bingel bbingel@fcsadministrators.com New York Compensation Managers, Inc. Anthony D'Amato P. O. Box South Bay Road Syracuse, NY tdamato@workerscomp.com Edward Keaney 3355 Veterans Memorial Highway Ronkonkoma, NY ekeaney@abatransportation.com RMSCO, Inc. Theodore Strobeck 115 Continuum Drive Liverpool, NY tfstrobeck@rmscoinc.com Program Risk Management, Inc. Edward Sorenson P. O. Box Watervliet-Shaker Road Albany, NY esorenson@prm.com 04/30/08 12/31/08 12/31/08 08/31/08 12/31/08 11/30/08 Membership limited; enhanced financial monitoring. Enhanced financial monitoring. Closed to new members; enhanced financial monitoring; mandatory scheduled deposits. Membership limited; enhanced financial monitoring. Page No. 1 of 10

2 Report of s (A) Contractors Self-Insurance Trust Fund Effective Date: 8/15/97 Approximate Number of Active Members (A) Electrical Employers Self-Insurance Safety Plan Effective Date: 1/1/67 Industry Served: Electrical Workers - IBEW Local #3 Approximate Number of Active Members (A) ESTRA Self-Insurance Trust Effective Date: 5/15/95 Industry Served: Auto/Towing/Recovery/Related Operations Approximate Number of Active Members (A) Healthcare of New York Workers' Compensation Trust Effective Date: 9/1/01 Approximate Number of Active Members (A) Healthcare writers Mutual Risk Management Group Effective Date: 4/1/96 Approximate Number of Active Members - 4 (A) Hudson Health Care Workers' Compensation Group Trust Effective Date: 1/1/02 Approximate Number of Active Members - 4 (A) Human Services Self-Insurance Trust Fund Effective Date: 12/29/95 Approximate Number of Active Members - 60 NCA Comp Inc. Steven Gidwitz 14 Lafayette Square sgidwitz@ncacomp.com Steven Farago Harry Van Arsdale Jr. Avenue Flushing, NY sfarago@jibei.com Program Risk Management, Inc. John Conroy P. O. Box Watervliet-Shaker Road Albany, NY jconroy@prm.com SAFE, LLC Gina Emerson 620 Erie Boulevard West Syracuse, NY gemerson@honytrust.com Self Funding, Inc. John Berger 5687 Main Street Williamsville, NY jberger@selffundinginc.com Webster Insurance Joe Gugliotti 530 Preston Avenue Meriden, CT jgugliotti@websterinsurance.com Bryan Bingel bbingel@fcsadministrators.com 09/30/08 12/31/07 03/31/08 08/31/07 Fiscal Year changed to 12/31. Next reporting as of 12/31/08. 12/31/07 12/31/07 12/31/07 Page No. 2 of 10

3 Report of s (A) Long Term Care Risk Management Group Effective Date: 10/1/92 Approximate Number of Active Members - 30 (A) McGuire Group Trust Effective Date: 1/1/94 Approximate Number of Active Members - 8 (A) New York Bus Operators Compensation Trust Effective Date: 1/1/93 Industry Served: Passenger Transportation - Bus Operators Approximate Number of Active Members - 50 (A) New York Choice Self-Insurance Trust Effective Date: 9/1/97 Industry Served: Gas/Petroleum/Fuel Oils - Sale of Approximate Number of Active Members - 90 (A) New York College & University Risk Management Group Effective Date: 6/30/94 Industry Served: Schools (Elementary, Colleges, Universities) Approximate Number of Active Members - 40 (A) New York Lumbermen's Insurance Trust Fund Effective Date: 4/1/81 Industry Served: New York Lumbermen Approximate Number of Active Members (A) New York Operators Self-Insurance Trust Effective Date: 12/31/95 Industry Served: Eating and Drinking Establishments Approximate Number of Active Members First Niagara Risk Management, Inc. Robert Fortenbaugh 726 Exchange Street - Suite 900 Buffalo, NY robert.fortenbaugh@fnrm.com Daniel Cronmiller 560 Delaware Avenue Buffalo, NY dcronmiller@mcguiregroup.com Arthur J. Gallagher & Co. Lynn Cagnetta 2 Gannett Drive White Plains, NY lynn_cagnetta@ajg.com Pauline Salay psalay@fcsadministrators.com Marsh USA, Inc. Annette Borodzik 665 Main Street annette.m.borodzik@marsh.com W. J. Cox Associates, Inc. Roxanne Dungan 9600 Main Street Clarence, NY rdungan@wjcox.com Arthur J. Gallagher & Co. Lynn Cagnetta 2 Gannett Drive White Plains, NY lynn_cagnetta@ajg.com 12/31/08 12/31/08 12/31/07 09/30/08 12/31/07 12/31/07 12/31/07 Membership limited; enhanced financial monitoring. Closed to new members; enhanced financial monitoring; mandatory scheduled deposits. Enhanced financial monitoring. Page No. 3 of 10

4 Report of s (A) New York State Health Providers Workers' Compensation Trust Effective Date: 4/1/92 Approximate Number of Active Members - 10 (A) New York State Motor Truck Association Compensation Trust Effective Date: 7/1/94 Industry Served: Transportation Approximate Number of Active Members - 80 (A) Niagara Business Trust Effective Date: 2/1/98 Approximate Number of Active Members - 60 (A) Northeast Health Workers' Compensation Plan Effective Date: 1/1/95 Approximate Number of Active Members - 15 (A) NYAHSA Services, Inc. Self-Insurance Trust Effective Date: 10/2/95 Approximate Number of Active Members (A) NYSARC Workers' Compensation Trust Effective Date: 5/1/99 Approximate Number of Active Members - 20 (A) OHI Workers' Compensation Trust Effective Date: 1/1/98 Industry Served: Gas/Petroleum/Fuel Oils - Sale of Approximate Number of Active Members - 80 Nanci Hurlburt 201 North Union Street Olean, NY nyshpa@aol.com First Niagara Risk Management, Inc. Robert Fortenbaugh 726 Exchange Street - Suite 900 Buffalo, NY robert.fortenbaugh@fnrm.com Pauline Salay psalay@fcsadministrators.com Robert Allen 600 Northern Boulevard Albany, NY allenb@nehealth.com Cool Insurance Agency John Snow 784 Troy-Schenectady Road jfsnow@coolins.com Cody Management Services, Inc. David Harvey 357 Bay Road Queensbury, NY codym@albany.twcbc.com 12/31/07 06/30/08 12/31/07 12/31/07 12/31/07 12/31/07 12/31/07 Enhanced financial monitoring. Page No. 4 of 10

5 Report of s (A) Preferred Manufacturers Insurance Trust Fund Effective Date: 1/1/93 Approximate Number of Active Members - 90 (A) Printing Industries Association Workers' Compensation SI Trust Effective Date: 4/1/96 Industry Served: Printing Operations - Commercial Approximate Number of Active Members - 30 (A) Special Trades, Contracting and Construction Trust Effective Date: 10/1/95 Approximate Number of Active Members (A) Team Transportation Workers' Comp Trust Effective Date: 10/15/95 Industry Served: Transportation Approximate Number of Active Members (A) ViaHealth Workers' Compensation Trust Effective Date: 10/1/96 Approximate Number of Active Members - 9 (A) Western New York Hospital Risk Management Group Effective Date: 7/1/94 Approximate Number of Active Members - 25 NCA Comp, Inc. Steven Gidwitz 14 Lafayette Square sgidwitz@ncacomp.com NCA Comp Inc. Steven Gidwitz 14 Lafayette Square sgidwitz@ncacomp.com New York Compensation Managers, Inc. David Francey P. O. Box South Bay Road Syracuse, NY ddavis@workerscomp.com Program Risk Management, Inc. John Conroy P. O. Box Watervliet-Shaker Road Albany, NY jconroy@prm.com Mary Tribuzzi 1425 Portland Avenue Rochester, NY mary.tribuzzi@viahealth.org Marsh USA, Inc. Annette Borodzik 665 Main Street annette.m.borodzik@marsh.com 12/31/08 Membership voted to close on 9/1/09. 03/31/08 09/30/08 12/31/07 12/31/08 12/31/07 Enhanced financial monitoring. Membership limited to 966 per legislation Closed to new members; enhanced financial monitoring; mandatory scheduled deposits. Page No. 5 of 10

6 Report of s (I) Builders Self-Insurance Trust Fund Total Members from 10/1/98-9/30/ INACTIVE GROUP SELF-INSURERS Marsh USA, Inc. Robert Bossert 665 Main Street robert.c.bossert.jr@marsh.com Trust terminated effective 9/30/07. Estimated member deficit bills to be issued on 7/1/09. (I) Business Council WC Manufacturers Group Self-Insurance Trust Total Members from 1/1/96-1/1/09-1,264 (I) Contractors Compensation Trust Total Members from 11/1/99-1/1/09-2,865 (I) Cooperative Association of Food Enterprises WC Trust Industry Served: Eating and Drinking Establishments Total Members from 6/13/95-1/1/09-3,986 (I) Elderwood Senior Care Self-Insurance Trust Total Members from 11/1/05-1/1/09-14 (I) ELEC-CON Trust Industry Served: Electrical Contractors and Supplies Total Members from 7/1/01-1/1/ (I) Elite Contractors Trust of New York Total Members from 8/27/99-7/16/08-2,676 (I) Empire State Agricultural Compensation Trust Industry Served: Agriculture and Related Services Total Members from 12/31/97-1/1/09-1,801 As of 5/1/09 Trust transferred to State contracted Richard Courtney 7 Limestone Drive Williamsville, NY rcourtney@elderwood.com Bryan Bingel bbingel@fcsadministrators.com Agri-Services Agency, LLC Janice Klodowski P. O. Box 4910 Syracuse, NY jan.klodowski@agri-servicesagency.com Trust voluntarily terminated Trust voluntarily terminated Trust voluntarily terminated Trust voluntarily terminated Trust voluntarily terminated Trust terminated effective 7/16/08. Trust transitioned to FCS Administrators on 9/8/08. Trust voluntarily terminated Trustees monitoring run off. Trustees monitoring run off. Trustees monitoring run off. Trustees monitoring run off. Trustees monitoring run off. Trustees monitoring run off. Trustees monitoring run off. Page No. 6 of 10

7 1 (I) Empire State Education Trust Industry Served: Schools (Elementary, Colleges, Universities) Total Members from 6/30/00-1/1/ (I) Empire State Hospitality WC Trust Industry Served: Lodging/Amusement/Recreation Services Total Members from 3/1/96-1/1/ (I) Empire State Transportation WC Trust Industry Served: Passenger Transportation - Bus Operators Total Members from 1/1/95-1/1/ (I) First Automotive Services Trust Industry Served: Auto Service and Repair Total Members from 1/1/05-1/1/09-1,007 (I) Health Care Providers Self-Insurance Trust Approximate Number of Active Members (I) Healthcare Industry Trust of New York Total Members from 9/12/99-12/31/ (I) Independent Grocers Workers' Compensation Self-Insurance Trust Industry Served: Retailers/Wholesalers - Food Approximate Number of Active Members - 30 (I) Manufacturing Industry WC Self-Insurance Trust Total Members from 1/1/98-3/31/ STATE OF NEW YORK Report of s Program Risk Management, Inc. John Conroy P. O. Box Watervliet-Shaker Road Albany, NY jconroy@prm.com As of 2/11/08 Trust transferred to State contracted Pauline Salay psalay@fcsadministrators.com Consolidated Risk Services, Inc. 985 Old Eagle School Road Wayne, PA As of 3/31/06 Trust transferred to State contracted Regulatory Funding Position Operating Restrictions Imposed Trust voluntarily terminated Trustees monitoring run off. Trust voluntarily terminated Trustees monitoring run off. Trust voluntarily terminated Trustees monitoring run off. Trust voluntarily terminated Trustees monitoring run off. Trust terminated effective 7/1/2009. ( ) ( ) ( ) Trust terminated effective 12/31/07. Trustees monitoring run off. Trust voluntarily terminated Trustees monitoring run off. effective 7/1/09. ( ) ( ) ( ) Trust terminated effective Forensic audit completed & 3/31/06. member deficit bills issued on 4/15/08. Page No. 7 of 10

8 Report of s (I) Manufacturing Self-Insurance Trust New York Compensation Managers, Inc. P. O. Box South Bay Road Syracuse, NY Total Members from 12/1/97-8/31/ As of 6/1/07 Trust transferred to State contracted (I) Mercantile Self-Insurance Trust New York Compensation Managers, Inc. Lew Rumsmoke Industry Served: Retailers/Wholesalers - Various Types P. O. Box South Bay Road Total Members from 10/1/94-2/29/ Syracuse, NY lrumsmoke@workerscomp.com (I) New York Healthcare Facilities Workers' Compensation Trust Hamilton Wharton Group, Inc. 110 Wall Street New York, NY Total Members from 1/1/98-7/31/ As of 7/31/06 Trust transferred to State contracted (I) New York McDonald's Operators WC Trust Industry Served: Eating and Drinking Establishments Total Members from 1/1/99-1/1/ (I) New York Petroleum Associations Compensation Trust Industry Served: Gas/Petroleum/Fuel Oils - Sale of Total Members from 7/1/01-1/1/ (I) New York State Cemeteries Trust Industry Served: Cemeteries Total Members from 2/1/02-3/31/ ( ) ( ) ( ) Trust terminated effective 8/31/06. Attorney General issued summons and complaint for collections under joint and several. Trust terminated effective 2/29/08. Trust terminated effective 7/31/06. Member deficit assessment coordinated by Forensic audit completed & member deficit bills issued on 4/15/08. Trust voluntarily terminated Trust voluntarily terminated Trustees monitoring run off. Trustees monitoring run off. Trust terminated effective 3/31/08. (I) NY Transportation Workers' Compensation Trust Industry Served: Transportation Total Members from 12/1/00-1/1/09-1,375 As of 7/7/08 Trust transferred to State contracted Trust voluntarily terminated Trustees monitoring run off. Page No. 8 of 10

9 Report of s (I) Provider Agency Trust for Human Services Consolidated Risk Services, Inc. 985 Old Eagle School Road Wayne, PA Total Members from 1/1/97-3/1/06-46 As of 3/1/06 Trust transferred to State contracted (I) Public Entity Trust of New York Industry Served: Public Entity Total Members from 1/1/02-8/2/ As of 7/7/08 Trust transferred to State contracted (I) Real Estate Management Trust of New York Industry Served: Real Estate and Property Management Total Members from 1/1/01-1/31/ As of 7/7/08 Trust transferred to State contracted (I) Retail and Wholesale Industry WC Self-Insurance Trust NCA Comp, Inc. Steven Gidwitz Industry Served: Retailers/Wholesalers - Various Types 14 Lafayette Square Total Members from 7/16/98-7/31/ As of 10/15/08 Trust transferred to State contracted (I) Retailers of New York Worker's Compensation Trust Industry Served: Retailers/Wholesalers - Various Types Total Members from 9/1/97-1/1/09-1,421 (I) Selective Safety Trust Industry Served: Transportation Total Members from 10/1/95-1/1/ (I) Trade Industry Workers' Compensation Trust for Manufacturers Total Members from 12/27/01-1/31/ ( ) ( ) ( ) Trust terminated effective 3/1/06. Forensic audit completed & member deficit bills issued on 4/15/08. ( ) ( ) ( ) Trust terminated effective 8/2/07. Estimated member deficit bills issued on 9/15/08. ( ) ( ) ( ) Trust terminated effective 1/31/08. Estimated member deficit bills issued on 1/15/09. ( ) ( ) ( ) Trust terminated effective 7/31/06. Trust voluntarily terminated Trustees monitoring run off. Trust voluntarily terminated Trust terminated effective 1/31/08. Trustees monitoring run off. Estimated member deficit bills issued on 9/15/08. As of 5/16/08 Trust transferred to State contracted Page No. 9 of 10

10 Report of s (I) Transportation Industry Workers' Compensation Trust Industry Served: Transportation Total Members from 12/27/00-1/31/ Trust terminated effective 1/31/08. Estimated member deficit bills issued on 10/15/08. (I) Wholesale and Retail Workers' Compensation Trust of New York Industry Served: Retailers/Wholesalers - Various Types Total Members from 9/27/99-4/29/ As of 9/8/08 Trust transferred to State contracted Trust terminated effective 4/29/08. Estimated member deficit bills issued on 10/1/08. As of 8/11/08 Trust transferred to State contracted Page No. 10 of 10

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