27
Proposed Groups Group W Nbr Insurer Name E W000004 UNINSURED EMPLOYERS FUND B W010003 TRAVELERS CASUALTY & SURETY CO F W010250 ACADIA INSURANCE CO B W010508 TRAVELERS CASUALTY & SURETY CO OF IL B W010698 TRAVELERS CASUALTY CO OF CONNECTICUT E W011001 ACE FIRE UNDERWRITERS INS CO E W012009 ACE PROPERTY & CASUALTY INS CO A W014005 GREAT AMERICAN ASSURANCE CO E W015002 COUNTRYWIDE INSURANCE COMPANY F W015754 AIU INSURANCE CO F W016380 ALEA NORTH AMERICA INSURANCE CO E W019004 ACE AMERICAN INS COMPANY B W019509 ST PAUL PROTECTIVE INSURANCE CO B W020002 ALLSTATE INSURANCE COMPANY A W020507 GREAT AMERICAN ALLIANCE INS CO B W020754 AMERICAN ALTERNATIVE INS CO F W021000 AMERICAN AUTOMOBILE INSURANCE CO E W022008 AMERICAN CASUALTY COMPANY OF READING PA B W024004 AMERICAN EMPLOYERS INS CO A W026009 AMERICAN AND FOREIGN INSURANCE CO B W027007 AMERICAN GUARANTEE & LIABILITY INS CO F W029003 AMERICAN HOME ASSURANCE CO F W030001 AMERICAN INSURANCE CO A W031009 AMERICAN MANUFACTURERS MUTUAL INS CO A W032007 AMERICAN MOTORIST INSURANCE CO A W033005 AMERICAN MUTUAL INSURANCE CO OF BOSTON A W034003 AMERICAN MUTUAL LIABILITY INS CO A W035000 GREAT AMERICAN INSURANCE CO OF NY A W036008 VILLANOVA INSURANCE COMPANY A W036578 AMERICAN STATES INSURANCE CO B W036636 AMERICAN ZURICH INSURANCE CO F W036669 AMGUARD INSURANCE CO B W037006 ARGONAUT INSURANCE COMPANY B W037253 ARGONAUT-MIDWEST INSURANCE CO F W037501 AMERISURE INS CO F W038004 ASSOCIATED INDEMNITY CORP B W039002 ASSURANCE CO OF AMERICA A W040000 ATLANTIC MUTUAL INSURANCE COMPANY B W040257 ATLANTIC SPECIALTY INS CO B W041503 AUTOMOBILE INS CO OF HARTFORD CONN \\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups Printed: 5/2/2016 5:15 PM Page 1 of 27

Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

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Page 1: Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

Proposed Groups

Group W Nbr Insurer Name

E W000004 UNINSURED EMPLOYERS FUND

B W010003 TRAVELERS CASUALTY & SURETY CO

F W010250 ACADIA INSURANCE CO

B W010508 TRAVELERS CASUALTY & SURETY CO OF IL

B W010698 TRAVELERS CASUALTY CO OF CONNECTICUT

E W011001 ACE FIRE UNDERWRITERS INS CO

E W012009 ACE PROPERTY & CASUALTY INS CO

A W014005 GREAT AMERICAN ASSURANCE CO

E W015002 COUNTRYWIDE INSURANCE COMPANY

F W015754 AIU INSURANCE CO

F W016380 ALEA NORTH AMERICA INSURANCE CO

E W019004 ACE AMERICAN INS COMPANY

B W019509 ST PAUL PROTECTIVE INSURANCE CO

B W020002 ALLSTATE INSURANCE COMPANY

A W020507 GREAT AMERICAN ALLIANCE INS CO

B W020754 AMERICAN ALTERNATIVE INS CO

F W021000 AMERICAN AUTOMOBILE INSURANCE CO

E W022008 AMERICAN CASUALTY COMPANY OF READING PA

B W024004 AMERICAN EMPLOYERS INS CO

A W026009 AMERICAN AND FOREIGN INSURANCE CO

B W027007 AMERICAN GUARANTEE & LIABILITY INS CO

F W029003 AMERICAN HOME ASSURANCE CO

F W030001 AMERICAN INSURANCE CO

A W031009 AMERICAN MANUFACTURERS MUTUAL INS CO

A W032007 AMERICAN MOTORIST INSURANCE CO

A W033005 AMERICAN MUTUAL INSURANCE CO OF BOSTON

A W034003 AMERICAN MUTUAL LIABILITY INS CO

A W035000 GREAT AMERICAN INSURANCE CO OF NY

A W036008 VILLANOVA INSURANCE COMPANY

A W036578 AMERICAN STATES INSURANCE CO

B W036636 AMERICAN ZURICH INSURANCE CO

F W036669 AMGUARD INSURANCE CO

B W037006 ARGONAUT INSURANCE COMPANY

B W037253 ARGONAUT-MIDWEST INSURANCE CO

F W037501 AMERISURE INS CO

F W038004 ASSOCIATED INDEMNITY CORP

B W039002 ASSURANCE CO OF AMERICA

A W040000 ATLANTIC MUTUAL INSURANCE COMPANY

B W040257 ATLANTIC SPECIALTY INS CO

B W041503 AUTOMOBILE INS CO OF HARTFORD CONN

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Page 2: Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

Proposed Groups

Group W Nbr Insurer Name

E W043251 BANKERS STANDARD INSURANCE COMPANY

F W045009 AIG PROPERTY CASUALTY CO

A W047500 CATLIN INDEMNITY COMPANY

E W049506 C I M INSURANCE CORPORATION

A W051007 CENTENNIAL INSURANCE COMPANY

A W052500 FIRST CENTRAL INSURANCE CO

B W054001 CHARTER OAK FIRE INS CO

E W054605 CHUBB INDEMNITY INS CO

E W054639 CHURCH MUTUAL INSURANCE COMPANY

E W054696 WESTCHESTER FIRE INS CO

B W054753 CINCINNATI INSURANCE COMPANY

E W056253 CITIZENS INSURANCE CO OF AMERICA

F W056386 CLARENDON NATIONAL INSURANCE CO

F W058002 COMMERCE AND INDUSTRY INS CO

A W058507 COMMERCIAL COMPENSATION INS CO

E W060008 LAMORAK INSURANCE COMPANY

E W060750 CONNECTICUT GENERAL FIRE & CASLTY INS CO

A W061006 CONNECTICUT INDEMNITY COMPANY

E W063002 CONTINENTAL CASUALTY COMPANY

E W064000 CONTINENTAL INSURANCE CO

A W066005 COVENANT INSURANCE CO

A W067250 CREDIT GENERAL INSURANCE CO

F W067508 CRUM & FORSTER INDEMNITY CO

A W068001 CUMIS INSURANCE SOCIETY INC

A W069009 SENTRY SELECT INSURANCE COMPANY

F W071005 SENECA INSURANCE COMPANY INC

E W071757 ELECTRIC INSURANCE CO

B W073001 EMPIRE INSURANCE COMPANY

E W074009 EMPLOYERS FIRE INSURANCE COMPANY

A W075006 EMPLOYERS MUTUAL CASUALTY CO

A W076004 EMPLOYERS INS OF WAUSAU A MUTUAL CO

F W076889 ERIE INSURANCE COMPANY

F W076947 ERIE INSURANCE CO OF NEW YORK

A W077002 EXCELSIOR INSURANCE CO

A W078000 SELECTIVE INSURANCE CO OF NEW YORK

F W078257 FAIRFIELD INSURANCE COMPANY

F W078505 FAIRMONT INSURANCE COMPANY

F W079008 FARM FAMILY CASUALTY INS CO

B W079503 FARMINGTON CASUALTY COMPANY

E W080006 FEDERAL INSURANCE COMPANY

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Page 3: Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

Proposed Groups

Group W Nbr Insurer Name

E W083000 FIDELITY AND CASUALTY CO OF NEW YORK

B W084008 FIDELITY & DEPOSIT COMPANY OF MD

B W084503 FIDELITY AND GUARANTY INSURANCE COMPANY

F W085500 FIRE DISTRICTS OF NY MUTUAL INS CO

A W085757 FIRE & CASUALTY INS CO OF CONNECTICUT

F W086003 FIREMANS FUND INSURANCE CO

F W087258 FIREMENS INSURANCE CO OF WASHINGTON DC

A W087381 ARCH INSURANCE COMPANY

A W087449 FIRST LIBERTY INSURANCE CO

A W089007 FLORISTS MUTUAL INSURANCE CO

B W090757 HOMELAND INS COMPANY OF NY

E W091003 BEDIVERE INSURANCE COMPANY

B W091508 AUTOONE INSURANCE COMPANY

F W091755 GENERAL CASUALTY CO OF WISCONSIN

F W092001 ALLIANZ GLOBAL RISKS US INS CO

F W093884 GENESIS INSURANCE CO

A W096002 GLOBE INDEMNITY COMPANY

F W098008 GRANITE STATE INSURANCE CO

A W099006 GRAPHIC ARTS MUTUAL INS CO

A W100002 GREAT AMERICAN INS CO

F W100135 GREAT DIVIDE INSURANCE CO

E W100507 GREAT NORTHERN INSURANCE CO

A W100754 GREAT WEST CASUALTY COMPANY

E W101000 GREATER NEW YORK MUTUAL INS CO

B W102008 GULF INSURANCE CO

E W103006 HANOVER INSURANCE CO

B W104509 HARCO NATIONAL INSURANCE CO

F W105001 HARTFORD ACCIDENT & INDEMNITY CO

F W106009 HARTFORD CASUALTY INS CO

F W106504 HARTFORD FIRE INSURANCE CO

F W106751 HARTFORD INSURANCE CO OF THE MIDWEST

A W106884 HEREFORD INS CO

A W107007 HIGHLANDS INSURANCE CO

B W108005 HOLYOKE MUTUAL INS CO IN SALEM

A W109003 HOME INDEMNITY COMPANY

A W110001 HOME INSURANCE COMPANY

F W111504 HOUSTON GENERAL INS CO

F W112254 ILLINOIS NATIONAL INSURANCE CO

E W112502 INDEMNITY INSURANCE CO OF NORTH AMERICA

E W114003 FREMONT INDUSTRIAL INDEMNITY CO

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

B W114508 MARKEL INS CO

E W115000 INSURANCE COMPANY OF GREATER NY

E W116008 INSURANCE COMPANY OF NORTH AMERICA

F W117006 INS CO OF THE STATE OF PA

E W118004 INTERBORO MUTUAL INDEMNITY INS CO

A W118251 XL SPECIALTY INSURANCE COMPANY

A W118756 OLD REPUBLIC GENERAL INS CORP

B W119507 SPECIALTY SURPLUS INSURANCE CO

A W122824 LM INSURANCE CORPORATION

A W123251 LIBERTY INSURANCE CORP

A W123509 LIBERTY MUTUAL FIRE INS CO

A W124002 LIBERTY MUTUAL INSURANCE CO

A W130009 LUMBERMENS MUTUAL CASUALTY CO

A W130256 LUMBERMENS UNDERWRITING ALLIANCE

F W132500 MAIN STREET AMERICA ASSURANCE CO

A W133508 MANUFACTURERS ALLIANCE INS CO

B W134001 MARYLAND CASUALTY CO

E W134506 MASSACHUSETTS BAY INSURANCE CO

F W135008 MERCHANTS MUTUAL INSURANCE CO

A W136006 MICHIGAN MILLERS MUTUAL INS CO

F W137004 AMERISURE MUTUAL INSURANCE COMPANY

F W139638 MIDWEST EMPLOYERS CASUALTY CO

E W147003 NATIONAL FIRE INSURANCE CO OF HARTFORD

F W148001 NGM INSURANCE COMPANY

A W148506 LEGION INSURANCE COMPANY

A W148639 NATIONAL INTERSTATE INSURANCE CO

F W148753 NATIONAL LIABILITY AND FIRE INS CO

F W149009 NATIONAL SURETY CORPORATION

F W150007 NATL UNION FIRE INS CO OF PITT PA

F W152003 NATIONWIDE MUTUAL INSURANCE CO

A W153001 NETHERLANDS INSURANCE COMPANY

F W154009 NEW HAMPSHIRE INSURANCE CO

F W155006 AMERICAN EUROPEAN INSURANCE COMPANY

A W156004 NEW JERSEY MANFACTURERS INS CO

F W156509 HARLEYSVILLE INS CO OF NY

A W156756 LMI INSURANCE COMPANY

F W158000 HARTFORD UNDERWRITERS INS CO

A W159008 NEWARK INSURANCE COMPANY

F W160659 NORGUARD INSURANCE CO

A W160675 NORTH AMERICAN SPECIALTY INS CO

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Page 5: Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

Proposed Groups

Group W Nbr Insurer Name

B W160816 DISCOVER PROPERTY & CASUALTY INS CO

F W161004 NORTH RIVER INS CO

B W162002 NORTHERN ASSURANCE CO OF AMERICA

B W163000 NORTHERN INSURANCE CO OF NY

A W164008 NORTHWESTERN NATIONAL INS CO

E W164255 NOVA CASUALTY COMPANY

A W165005 OHIO CASUALTY INSURANCE CO

A W166003 OLD REPUBLIC INSURANCE COMPANY

F W166250 ORISKA INSURANCE CO

B W166508 AUTOONE SELECT INSURANCE COMPANY

E W167001 PACIFIC EMPLOYERS INSURANCE CO

E W168009 PACIFIC INDEMNITY COMPANY

E W168256 PARAMOUNT INSURANCE COMPANY

A W168504 PATRIOT GENERAL INSURANCE CO

A W170005 PEERLESS INSURANCE COMPANY

B W172001 PENNSYLVANIA INSURANCE COMPANY

A W173009 PENNSYLVANIA MANUFACTURERS ASSN INS CO

A W173504 PENNSYLVANIA MFG INDEMNITY CO

B W175004 PENN NATIONAL MUTUAL CASUALTY INS CO

A W176507 PHICO INSURANCE COMPANY

B W177000 PHOENIX INSURANCE CO

A W178008 RELIANCE NATIONAL INDEMNITY COMPANY

B W179006 POTOMAC INSURANCE CO

B W179063 POTOMAC INSURANCE CO OF ILLINOIS

A W179196 PREFERRED PROFESSIONAL INS CO

F W179501 TIG INS CO OF NY

F W179758 PRINCETON INSURANCE COMPANY

B W181002 PROTECTIVE INSURANCE CO

F W182000 PROVIDENCE WASHINGTON INS COMPANY

A W183693 EVEREST NATIONAL INS COMPANY

E W184006 PUBLIC SERVICE INSURANCE CO

A W186258 REALM NATIONAL INSURANCE CO

A W187009 RELIANCE INSURANCE COMPANY

A W187504 RELIANCE INS COMPANY OF NEW YORK

A W187637 RELIANCE NATIONAL INSURANCE COMPANY

A W187751 REPUBLIC FRANKLIN INSURANCE CO

A W187884 REPWEST INSURANCE COMPANY

E W188502 ROCHDALE INS CO

A W190003 ROYAL INSURANCE COMPANY OF AMERICA

A W191001 ARROWOOD INDEMNITY COMPANY

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Page 6: Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

Proposed Groups

Group W Nbr Insurer Name

A W193007 SAFEGUARD INSURANCE COMPANY

B W193502 SAFETY NATIONAL CASUALTY CORP

B W194005 ST PAUL FIRE & MARINE INS CO

B W195002 ST PAUL MERCURY INSURANCE CO

E W196000 SEABOARD FIRE & MARINE INS CO

A W197008 SECURITY INSURANCE CO OF HARTFORD

A W198253 SELECTIVE INS CO OF AMERICA

A W198329 SELECTIVE INSURANCE COMPANY OF SC

A W198386 SELECTIVE WAY INSURANCE CO

A W200000 SENTRY INSURANCE A MUTUAL CO

B W202006 STANDARD FIRE INS CO

A W202501 STAR INSURANCE COMPANY

F W203004 STATE FARM FIRE AND CASUALTY CO

C W204002 STATE INSURANCE FUND

D W204002 STATE INSURANCE FUND

B W204135 STATE NATIONAL INSURANCE COMPANY INC

E W204259 STRATHMORE INSURANCE CO

B W204507 MITSUI SUMITOMO INS CO OF AMERICA

B W206254 TOKIO MARINE AMERICA INS CO

E W206759 TECHNOLOGY INSURANCE CO INC

B W207500 TOKIO MARINE & NICHIDO FIRE INS CO LTD

F W207757 TOWER INSURANCE CO OF NY

F W208003 TIG INSURANCE COMPANY

E W209001 TRANSCONTINENTAL INSURANCE CO

E W211007 TRANSPORTATION INSURANCE COMPANY

B W212005 TRAVELERS INDEMNITY COMPANY

B W212252 TRAVELERS INDEMNITY CO OF AMERICA

B W212500 TRAVELERS INDEMNITY CO OF CONNECTICUT

B W212757 TRAVELERS PROPERTY CASUALTY CO OF AMER

B W213003 METLIFE INSURANCE COMPANY OF CT

A W214001 TRUCK INSURANCE EXCHANGE

F W215008 TWIN CITY FIRE INSURANCE CO

A W215503 ULLICO CASUALTY COMPANY

F W216501 UNIGARD INSURANCE CO

F W217004 UNIGARD JAMESTOWN MUTUAL INS CO

F W218002 SEATON INSURANCE CO

A W218507 UNITED COMMUNITY INSURANCE CO

A W219000 UNITED PACIFIC INSURANCE CO

A W219505 UNITED PACIFIC INS CO OF NY

B W220008 UNITED STATES FIDELITY & GUARANTY CO

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W221006 UNITED STATES FIRE INS CO 994

F W221253 UNITED STATES LIABILITY INS CO

B W221501 UNIVERSAL UNDERWRITERS INS CO

A W221758 UTICA NATIONAL ASSURANCE CO

A W222004 UTICA MUTUAL INSURANCE CO

A W222509 UTICA NATIONAL INS CO OF TEXAS

E W224000 VALLEY FORGE INSURANCE COMPANY

A W224505 VAN LINER INSURANCE COMPANY

E W225007 VIGILANT INSURANCE COMPANY

A W225254 VIRGINIA SURETY COMPANY INC

A W225445 WAUSAU BUSINESS INSURANCE COMPANY

A W225486 WAUSAU GENERAL INSURANCE CO

A W225502 WAUSAU UNDERWRITERS INSURANCE CO

A W227060 WESTPORT INSURANCE CORP

F W227102 MOUNTAIN VALLEY INDEMNITY COMPANY

F W227193 HARLEYSVILLE WORCESTER INS CO

A W227508 SOMPO JAPAN INS CO OF AMERICA

B W228001 ZURICH AMERICAN INSURANCE CO

A W303002 ADT COMPANY INC

A W303507 APA TRANSPORT CORPORATION

A W303754 ABEX CORPORATION

A W303879 ADIRONDACK STEEL CASTING CO INC

A W304133 AIRBORNE EXPRESS INC

A W305007 AMOCO OIL COMPANY

A W307250 ALBANY INTERNATIONAL CORPORATION

A W307508 AL-TECH SPECIALTY STEEL CORPORATION

A W311757 AIL SYSTEMS INC

A W314009 ALCOA INC

A W315501 AURUBIS BUFFALO INC

A W317507 AMERICAN CYANAMID COMPANY

A W319008 AMERICAN EXPRESS BANK LTD

A W321509 ROLL INTERNATIONAL CORPORATION

A W322507 AMERICAN SALES COMPANY

A W323000 TRANE INC

A W325005 AT&T CORP

A W328504 AMPCO-PITTSBURGH CORP

A W329882 ABF FREIGHT SYSTEMS INC (DEL)

A W331755 ARMOR KONE ELEVATOR INC

A W332001 ARMSTRONG WORLD INDUSTRIES INC

A W332506 ARNOT OGDEN MEDICAL CENTER

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Page 8: Proposed Groups - wcb.ny.gov€¦ · e w204259 strathmore insurance co b w204507 mitsui sumitomo ins co of america b w206254 tokio marine america ins co e w206759 technology insurance

Proposed Groups

Group W Nbr Insurer Name

A W333132 ASCENSION HEALTH

A W333199 ASPIRE OF WESTERN NEW YORK

A W333256 ASSOCIATED BUILDERS & CONTRACTOR TRUST

A W334007 ASSOCIATED TRANSPORT INC

A W334759 AUTOZONE INC

A W335251 AUTOMOBILE DEALERS WC SELF-INS TRUST

A W335756 BJ'S WHOLESALE CLUB INC

A W336382 BALL CORPORATION

A W338503 ABA TRANSPORTATION HOLDING COMPANY INC

A W342752 BEER WHOLESALERS COMP TRUST OF NY

A W343008 BETHLEHEM STEEL CORPORATION

A W343503 BETHLEHEM STEEL CORP 1988

A W344253 BIG V SUPERMARKETS INC

A W347504 OFFICEMAX INCORPORATED

A W347751 BOMBARDIER INC

A W348007 BORDEN INC

A W351506 BRADLEES INC

A W354252 BROOKDALE HOSPITAL MED CTR

A W356943 BROWNING FERRIS INDUSTRIES OF NY INC

A W361638 BUSH INDUSTRIES INC

A W361687 BUSINESS COUNCIL WC MFG GP SI TRUST

A W361828 CALDOR CORP

A W364251 CAREER HORIZONS INC

A W364509 CAROLINA FREIGHT CARRIERS CORP

A W364517 CARGILL INC

A W364608 PLAINVIEW HOSPITAL

A W365134 CHAMPION INTERNATIONAL CORP

A W365258 CHAMPLAIN VALLEY PHYS HOSP MED CTR

A W365324 CHARMER INDUSTRIES INC

A W367007 CHICAGO PNEUMATIC TOOL COMPANY

A W367130 CHICAGO PNEUMATIC TOOL CO (1990)

A W367254 CHILDREN AND WOMEN'S HEALTH INC

A W368385 AT-A-GLANCE INC

A W368757 CARTHAGE SPECIALTY PAPERBOARD INC

A W370753 TRUSTEES OF COLUMBIA UNIVERSITY

A W371504 COMMUNITY RES INS SAVING PLAN SI TRUST

A W372007 COMSTOCK GREENWOOD INC

A W372254 CONAGRA FOODS INC

A W372387 CON AGRA MAPLE LEAF MILLING INC

A W372502 CONDEC CORPORATION

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

B W373005 CONSOLIDATED EDISON COMPANY OF NY INC

A W374003 CONSOL FREIGHTWAYS CORP OF DELAWARE

A W375265 CONTRACTORS SELF-INS TRUST FUND

A W375331 CONTRACTORS WORKERS COMP TRUST

A W375398 COOPER INDUSTRIES INC

A W375937 COOPER US INC (2005)

A W375943 COOP ASSOC OF FOOD ENT WC TRUST

A W376008 CORNELL UNIVERSITY

A W378004 CORNING INCORPORATED

A W378251 CORNING HOSPITAL

A W378442 COSTCO WHOLESALE CORP

A W378632 CRAWFORD FURNITURE MFG CORP

A W379002 CROUSE HINDS COMPANY

A W379259 CROUSE HEALTH HOSPITAL INC

A W379440 JAMES RIVER CORP OF NEVADA

A W379507 COLT INDUSTRIES OPERATING CORP

A W379697 CRUCIBLE MATERIALS CORP 1989

A W379887 CUMMINS INC

A W380257 BIRDS EYE FOODS INC

A W380323 CURTIS NIAGARA LLC

A W380380 CURTIS SCREW COMPANY INC

A W381255 DPWN HOLDINGS (USA) INC

A W382253 TARGET CORPORATION

A W384630 DELPHI CORPORATION

A W384754 DENNYS INC

A W384820 DEPAUL GROUP INC

A W388003 R E DIETZ COMPANY

A W389506 WHITE ROSE INC

A W389753 DOLGENCORP OF NY INC

A W390504 DRESSER INDUSTRIES INC

A W391007 E I DUPONT DENEMOURS AND CO

B W395008 EASTMAN KODAK COMPANY

A W397756 ELEC-CON TRUST

A W398002 ELECTRICAL EMPLOYERS SELF INS SFTY PLAN

B W398259 WASHINGTON MILLS ELECTRO MINERAL CORP

B W398325 ELDERWOOD SENIOR CARE SI TRUST

B W398531 EMERSON POWER TRANSMISSION CORP

B W398770 EMPIRE STATE AGRICULTURAL COMP TRUST

B W398788 EMPIRE STATE HOSPITALITY WC TRUST

B W399505 EMPIRE STATE TRANSPORTATION WC TRUST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

B W400006 ENDICOTT JOHNSON CORP

B W400501 TEAM TRANSPORTATION WORKERS COMP TRUST

B W410880 ESTRA SELF INSURANCE TRUST

B W412001 EXXON CORPORATION NJ

B W413075 FCA US LLC

B W413132 FHE SERVICES INC

B W413785 FEDERAL EXPRESS CORPORATION

B W413843 MACYS INC

B W413868 SHOP VAC CORPORATION

B W413876 FEUER LEATHER CORP

B W415509 MILLARD FILLMORE HOSPITALS (1991)

B W417323 FINGER LAKES REGIONAL HEALTH SYSTEM INC

B W417380 LIFETIME HEALTHCARE INC

B W417752 FIRST NATIONAL SUPERMARKETS (1989)

B W417885 FLEET BOSTON FINANCIAL CORPORATION

B W419006 FOOD FAIR INC

B W420509 MCKESSON CORPORATION

B W421002 FORD MOTOR COMPANY

B W421754 BON SECOURS HEALTH SYSTEM, INC

B W422380 FULTON BOILER WORKS INC

B W424006 GAF CORPORATION

B W424634 GANNETT CO INC

B W424758 GARLOCK SEALING TECHNOLOGIES INC

B W430003 GENERAL MILLS INC

B W431001 GENERAL MOTORS CORPORATION

B W433759 GENEVA REGIONAL HEALTH SYS INC

B W434005 GEORGIA PACIFIC CORPORATION

B W437008 GLEASON WORKS

B W437750 GOLUB CORPORATION

B W438501 GOULD PUMPS INC

B W439756 CPP - SYRACUSE INC

B W440507 GREAT ATLANTIC & PACIFIC TEA CO INC

B W440754 ROCHESTER GENERAL HEALTH SYSTEM

B W446256 CBS CORPORATION

B W446389 HNI CORPORATION

B W446447 H J WILSONS CO INC

B W448252 DELHAIZE AMERICA LLC

B W448633 HARDEN FURNITURE

B W449003 HARRIS STRUCTUAL STEEL CO

B W450134 HEALTH QUEST SYSTEMS INC

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

B W450753 HEALTHCARE UNDERWRITERS MUTUAL INS TRUST

B W450886 HEALTHCARE OF NY WC TRUST (HONY)

B W450944 HEALTHSTAR NETWORK INC

B W452007 HERCULES INCORPORATED

B W452502 HICKEY-FREEMAN CO INC

B W453252 HIGHLAND HOSPITAL OF ROCHESTER

B W453757 HOLLINGSWORTH AND VOSE CO

B W454888 HILLSIDE FAMILY OF AGENCIES

B W455000 HILTON WORLDWIDE INC

B W458509 SIX CONTINENTS HOTELS INC

B W461008 HONEYWELL INC

B W462576 HOSPITAL FOR JOINT DISEASE ORTH INST

B W466759 SAMARITAN MEDICAL CENTER

B W468508 HUDSON HEALTH CARE WORKERS COMP GROUP

B W470504 J B HUNT TRANSPORT INC

B W472880 INDEPENDENT GROCERS WC SELF INS TRUST

B W473003 INGERSOLL RAND COMPANY

B W473508 INTERNATIONAL BUSINESS MACHINE CORP

B W475503 INTERNATIONAL IMAGING MATERIALS

B W476006 INTERNATIONAL PAPER COMPANY

B W480503 DYNO NOBEL INC

B W487508 ST JOSEPHS HOSPITAL HEALTH CNTR

B W488639 KENNECOTT CORP

B W488829 KEY CORP

B W488860 KEYSPAN CORPORATION

B W489009 KIMBERLY CLARK CORPORATION

B W489256 KING KULLEN GROCERY CO INC

B W491500 KRASDALE FOODS INC

B W492003 K MART CORPORATION

B W492508 L & JG STICKLEY

B W492755 LANDIS PLASTIC INC

B W498257 LENOX HILL HOSPITAL

B W499040 LIBBEY GLASS INC

B W499073 L BRANDS SERVICE COMPANY LLC

B W499750 LIPE ROLLWAY CORP

B W509004 LOBLAW INC

B W511505 LONG ISLAND LIGHTING CO (1995)

B W512503 LONG TERM CARE RISK MGMT GROUP

B W515506 LOWE'S HOME CENTERS LLC

B W516132 LUCENT TECHNOLOGIES INC

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

B W517387 MAGNA POWERTRAIN USA, INC

B W517569 KEYSPAN CORPORATION

B W517601 MARMON INDUSTRIAL CORPORATION

B W517627 MARRIOTT INTERNATIONAL INC

B W519383 JOHN T MATHER MEM HOSPITAL OF PORT JEFF

B W519508 MATLACK INC

B W519698 MAY DEPARTMENT STORES CO

B W519722 T MARZETTI COMPANY

B W520506 MCGRATH SERVICES CORP

B W520571 MCGUIRE GROUP TRUST

B W520696 MCWANE INC

B W520720 PREFERRED MANUFACTURERS INS TRUST FD

B W520746 MEMORIAL SLOAN KETTERING CANCER CTR

B W520829 METROPOLITAN MUSEUM OF ART

B W520852 MERRILL LYNCH & CO INC & SUB

B W521256 METRO NY COLLEGE AND UNIV WC GROUP

B W521504 SPECIAL TRADES CONTR & CONST TRUST

B W522759 MOBIL CORPORATION

B W524003 MOBIL OIL CORPORATION

B W537005 N L INDUSTRIES INC

B W537500 NYSARC INC CHAUTAUQUA CHAPTER (1994)

B W537633 NYSARC INC CHAUTAUQUA CHAPTER (2008)

B W537757 NYAHSA SERVICES INC SI TRUST

B W537823 NY TRANSPORTATION WORKERS COMP TRUST

B W537880 NYU HOSPITALS CENTER

B W538003 NABISCO INC

B W539001 NASSAU METALS CORPORATION

B W541254 NATIONAL FUEL GAS COMPANY

B W548002 NEPTUNE WORLD WIDE MOVING

B W548507 NEW YORK MCDONALDS OPER WC TRUST

B W549257 NEW ERA CAP CO INC

B W549638 NEW PROCESS GEAR INC (2004)

B W549943 NEW YORK BUS OPERATORS COMP TRUST

B W550503 NEW YORK OPERATORS SELF INS TRUST

B W551006 NEW YORK LUMBERMENS INS TRUST FUND

B W552509 NEW YORK NEWS INC

B W552632 NEW YORK STATE MOTOR ASSOC COMP TRUST

B W552756 NEW YORK STATE HEALTH PROVIDERS WC TRUST

B W552889 BUILDING EXTERIOR SERVICES TRUST OF NY

B W553002 VERIZON NEW YORK INC

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W554000 NEW YORK UNIVERSITY

F W554299 NEW YORK CHOICE SELF-INS TRUST

F W554828 NEW YORK PETROLEUM ASSOC COMP TRUST

F W555064 NIAGARA BUSINESS TRUST

F W555122 NIAGARA FALLS MEMORIAL MEDICAL CENTER

F W555502 TOPS MARKETS INC

F W556500 NATIONAL GRID USA

F W557417 NORDSTROM INC

F W557789 PHILIPS ELECTRONICS NORTH AMERICA CORP

F W557862 SAINT-GOBAIN ABRASIVES INC

F W558092 PROCTER & GAMBLE PHARMACEUTICALS

F W558381 NYSARC WORKERS COMPENSATION TRUST

F W558555 OHI WORKERS COMPENSATION TRUST

F W558605 O-AT-KA MILK COOPERATIVE INC

F W558696 OCCIDENTAL CHEMICAL CORP

F W558720 OLDCASTLE INC

F W559009 OLIN CORPORATION

F W559256 OUR LADY OF VICTORY HOMES OF CHARITY INC

F W559504 ONEIDA LTD

F W560502 ORANGE & ROCKLAND UTILITIES INC

F W560759 OSWEGO HOSPITAL

F W561500 OUR LADY OF LOURDES MEMORIAL HOSPITAL

F W561633 OUR LADY OF VICTORY HOSP OF LACKAWANNA

F W561757 OWENS ILLINOIS INC 1987

F W562250 OWENS CORNING

F W562508 OWENS ILLINOIS INC

F W565253 VISITING NURSE SERVICE OF NEW YORK

F W565386 UNITY HEALTH SYSTEM

F W565501 PARKER HANNIFIN CORPORATION

F W565691 PATHMARK STORES INC

F W566004 PENN DIXIE INDUSTRIES INC

F W568078 PEOPLE INC

F W569255 PFALTZGRAFF CO

F W570253 PITTWAY CORPORATION

F W572622 PRESBYTERIAN HOSPITAL IN THE CITY OF NY

F W572887 PRESTON TRUCKING CO INC 1990

F W572945 PRICE COMPANY

F W573000 PROCTER AND GAMBLE MANUFACTURING CO

F W574255 QUALEX INC

F W576003 RAILWAY EXPRESS AGENCY INC

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W576250 RALSTON PURINA COMPANY

F W576755 RAYMOND CORP

F W577506 USF RED STAR INC

F W579007 LTV STEEL COMPANY INC

F W580005 REST INN SAFETY PLAN INC

F W580500 RETAILER OF NEW YORK WC TRUST

F W581003 REVERE COPPER & BRASS INC

F W586002 ROADWAY EXPRESS INC

F W586259 FEDEX GROUND PACKAGE SYSTEM INC

F W587505 ROCHESTER INSTITUTE OF TECHNOLOGY

F W588008 FRONTIER CORPORATION

F W589501 UNIVERSITY OF ROCHESTER (1979)

F W591002 ROCKEFELLER UNIVERSITY

F W591127 ROMAN CATHOLIC DIOCESE OF ALBANY

F W591192 ROMAN CATHOLIC DIOCESE OF BUFFALO

F W591259 ROMAN CATHOLIC ARCHDIOCESE OF NEW YORK

F W591374 ROMAN CATHOLIC ARCHDIOCESE OF OGDENSBURG

F W591382 ROMAN CATHOLIC DIOCESE OF BROOKLYN

F W591408 ROMAN CATHOLIC DIOCESE OF ROCHESTER

F W591432 ROMAN CATHOLIC DIOCESE OF ROCKVILLE CTR

F W591507 ROMAN CATHOLIC DIOCESE OF SYRACUSE

F W592133 ROSINA FOOD PRODUCTS INC

F W592257 ROSWELL PARK CANCER INSTITUTE CORP

F W595755 RYDER SYSTEMS INC

F W596258 P I E NATIONWIDE INC

F W596845 ST BARNABAS COMMUNITY ENTERPRISES INC

F W596878 SKF USA INC

F W596944 ST JOSEPHS HOSPITAL

F W597009 SJM HOLDING CORPORATION

F W597256 ST LUKES MEMORIAL HOSPITAL CTR

F W597538 ST LUKES-ROOSEVELT HOSP CTR

F W597561 ST MARYS HOSPITAL AT AMSTERDAM

F W597629 ROCHESTER ST MARYS HOSP OF SIST CHARITY

F W597751 ST MARYS HOSPITAL OF TROY

F W600258 SAMARITAN-KEEP NURSING HOME INC

F W600381 NORTHEAST HEALTH WORKERS COMP PLAN

F W600720 SAXON INDUSTRIES INC

F W600944 SCOTT PAPER COMPANY

F W601009 SEALRIGHT CO INC

F W604003 SEARS ROEBUCK & COMPANY

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W607501 LEHMAN BROTHERS INC

F W608004 SHELL OIL COMPANY

F W610505 SHOPWELL INC

F W615009 SINGER COMPANY

F W616502 SISTERS OF CHARITY HOSPITAL OF BUFFALO

F W616635 SISTERS OF ST FRANCIS HEALTHCARE GROUP

F W616882 SNYDER TANK CORP

F W617500 SOCIETY OF THE NEW YORK HOSPITAL

F W617757 SONOCO PRODUCTS CO

F W626758 STANDARD PRODUCTS CO

F W627756 STARBUCKS CORPORATION

F W628002 STAR SUPERMARKETS INC

F W629133 STATEN ISLAND UNIVERSITY HOSPITAL

F W629257 CARBORUNDUM COMPANY (1989)

F W629505 STOP AND SHOP COMPANIES INC

F W630503 STEWARTS SHOPS CORP

F W630750 STEWARTS MARKETING CORP

F W633507 STROEHMANN BAKERIES INC

F W633754 SUGAR CREEK CORP

F W634000 SUPERMARKETS GENERAL HOLDINGS CORP

F W638225 SWIFT TRANSPORTATION CO LLC

F W639504 SYRACUSE UNIVERSITY

F W640387 USF HOLLAND INC

F W645501 TIMES MIRROR COMPANY

F W646509 CAYUGA MEDICAL CENTER AT ITHACA

F W648000 TRANSAMERICAN FREIGHT LINES INC

F W650006 TRICO PRODUCTS CORPORATION

F W651046 US MANAGEMENT WC INC

F W651160 UNIFRAX CORP (1997)

F W653000 UNITED AIRLINES

F W655500 NEW YORK UNITED HOSPITAL MEDICAL CENTER

F W659007 UNITED STATES STEEL CORP

F W662035 HUMAN SERVICES SELF INSURANCE TRUST FUND

F W662068 UPSTATE NIAGARA COOPERATIVE INC

F W662092 NY COLLEGE AND UNIVERSITY RISK MGMT GRP

F W662126 VERMONT AMERICAN CORPORATION

F W662191 WNY HOSPITAL RISK MGMT GROUP

F W665509 WEGMANS FOOD MARKET INC

F W667257 WEIS MARKETS INC

F W669006 AT AND T TECHNOLOGIES INC

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W676001 WESTINGHOUSE ELECTRIC CORP

F W677009 MEADWESTVACO CORPORATION

F W677504 WEYERHAEUSER COMPANY

F W678254 WHITE CASTLE SYSTEMS INC

F W678759 M WILE & COMPANY INC

F W687503 XEROX CORPORATION

F W688006 YELLOW TRANSPORTATION INC

F W800502 ADIRONDACK CENTRAL SCHOOL

F W800759 ALBANY CITY SCHOOL DISTRICT

F W801005 CITY OF ALBANY NEW YORK

F W801500 COUNTY OF ALBANY

F W801633 ALBION CENTRAL SCHOOL DIST

F W801690 ALDEN CENTRAL SCHOOL DIST

F W802003 ALLEGANY COUNTY MUTUAL SELF INS PLAN

F W802045 AMHERST CENTRAL SCHOOL DIST

F W802102 ANDOVER CENTRAL SCHOOL DISTRICT

F W802169 TOWN OF AMHERST

F W802193 AMITYVILLE UNION FREE SCHOOL DIST

F W802250 ARDSLEY UNION FREE SCHOOL DIST

F W802326 ARKPORT CENTRAL SCHOOL DISTRICT

F W802342 ARLINGTON CENTRAL SCHOOL DIST

F W802359 AUSABLE VALLEY CENTRAL SCHOOL

F W802375 AUBURN ENLARGED CITY SCHOOL DIST

F W802383 AVERILL PARK CENTRAL SCHOOL DIST

F W802441 AVOCA CENTRAL SCHOOL DIST

F W802508 TOWN OF BABYLON

F W802631 BALDWINSVILLE SCHOOL DIST

F W802698 BABYLON UNION FREE SCHOOL DIST

F W802755 BALDWIN UNION FREE SCHOOL DIST

F W802797 BATH CENTRAL SCHOOL

F W802813 BAYPORT-BLUE POINT UNION FREE SCHL DIST

F W802839 BAY SHORE UNION FREE SCHOOL DIST

F W803076 BEACON CITY SCHOOL DISTRICT

F W803134 BEEKMANTOWN CENTRAL SCHOOL DIST

F W803258 BEDFORD CENTRAL SCHOOL DISTRICT

F W803506 BELLMORE MERRICK CENTRAL HIGH SCH DIST

F W803886 BETHLEHEM CENTRAL SCHOOL DIST

F W803944 BETHPAGE UNION FREE SCHOOL DIST

F W804256 CITY OF BINGHAMTON (1995)

F W804504 COMMUNITY COLLEGES OF CUNY

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W805253 BOCES - SUFFOLK COUNTY 3RD SUPV DISTRICT

F W805261 BOCES CAPITAL REGION

F W805295 BOLIVAR-RICHBURG CENTRAL SCHOOL DISTRICT

F W805311 BAINBRIDGE GUILFORD CENTRAL SCHOOL DIST

F W805329 BRASHER FALLS CENTRAL SCHOOL DISTRICT

F W805378 BRENTWOOD UNION FREE SCHOOL DIST

F W805386 BREWSTER CENTRAL SCHOOL DISTRICT

F W805501 TOWN OF BROOKHAVEN

F W805758 BROOKHAVEN COMSEWOGUE UFSD

F W805881 BROOME DELAWARE-TIOGA BOCES

F W806004 BROOME COUNTY SELF INSURANCE PLAN

F W806509 BRUNSWICK CENTRAL SCHOOL DIST

F W806756 BRUSHTON-MOIRA CENTRAL SCHOOL DIST

F W807002 CITY OF BUFFALO

F W807507 BUFFALO SEWER AUTHORITY

F W807663 CNY CENTRO INC

F W808000 CITY OF BUFFALO BD OF EDUCATION

F W808075 BURNT HILLS-BALLSTON LAKE CSD

F W808240 CANTON CENTRAL SCHOOL DIST

F W808257 CARTHAGE CENTRAL SCHOOL DISTRICT

F W808380 CAPITAL DISTRICT TRANS AUTHORITY

F W808505 CARMEL CENTRAL SCHOOL DISTRICT

F W808638 CATTARAUGUS-LITTLE VALLEY CSD

F W808752 CATTARAUGUS COUNTY SELF INS PLAN

F W808885 CATTARAUGUS/ALLEGANY/ERIE/WYOMING BOCES

F W809388 CAZENOVIA CENTRAL SCHOOL DIST

F W809792 CENTRAL ISLIP UNION FREE SCHOOL DIST

F W809842 CENTRAL SQUARE CENTRAL SCHOOLS

F W809883 CHAPPAQUE CENTRAL SCHOOL DIST

F W809941 CHARLOTTE VALLEY CENTRAL SCHOOL

F W810006 CHAUTAUQUA COUNTY SELF INSURANCE PLAN

F W810501 CHURCHVILLE-CHILI CENTRAL SCHOOL DIST

F W811004 COUNTY OF CHEMUNG

F W811251 CHEEKTOWAGA-SLOAN UFSD

F W811509 TOWN OF CHEEKTOWAGA

F W812002 CHENANGO COUNTY SELF INSURANCE PLAN

F W812168 TOWN OF CHILI

F W812192 CHITTENANGO CENTRAL SCHOOL DISTRICT

F W812325 TOWN OF CLARKSTOWN

F W812507 CLARKSTOWN CENTRAL SCHOOL DIST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W812630 CLIFTON FINE CENTRAL SCHOOL DIST

F W812820 COUNTY OF CLINTON

F W814008 CITY OF COHOES

F W814255 COHOES CITY SCHOOL DIST

F W814388 TOWN OF COLONIE

F W815005 COLUMBIA COUNTY MUTUAL SELF INS

F W815252 COMMACK UNION FREE SCHOOL DIST

F W815500 CONNETQUOT CENTRAL SCHOOL DIST OF ISLIP

F W815799 COPIAGUE UNION FREE SCHOOL DIST

F W815856 CORNING-PAINTED POST AREA SCHOOL DIST

F W816003 CORTLAND COUNTY SELF INSURANCE PLAN

F W816045 CORTLAND CITY SCHOOL DIST

F W816078 TOWN OF CORTLANDT

F W816136 COXSACKIE ATHENS CENTRAL SCHOOL DIST

F W816383 CUBA-RUSHFORD CENTRAL SCHOOL DIST

F W816474 DANSVILLE CENTRAL SCHOOL DIST

F W816508 DEER PARK UNION FREE SCHOOL DIST

F W817001 DELAWARE COUNTY SELF INSURANCE FUND

F W817035 SULLIVAN WEST CENTRAL SCHOOL DISTRICT

F W817043 DELHI CENTRAL SCHOOL

F W817050 DEPEW UNION FREE SCHOOL DIST

F W817076 DE RUYTER CENTRAL SCHOOL

F W817118 DOBBS FERRY UNION FREE SCHOOL DISTRICT

F W817134 DUTCHESS COUNTY SELF INSURANCE PLAN

F W817324 DUTCHESS COUNTY BOCES

F W817357 EAST GREENBUSH CENTRAL SCHOOLS

F W817399 TOWN OF EAST HAMPTON

F W817506 EAST ISLIP SCHOOL DISTRICT

F W817571 EAST ROCKAWAY UNION FREE SCHOOL DISTRICT

F W817639 EAST MEADOW UNION FREE SCHOOL DIST

F W817662 EAST SYRACUSE MINOA SCHOOL DIST

F W817688 EAST WILLISTON UNION FREE SCHOOL DIST

F W817696 EAST ROCHESTER UNION FREE SCHOOL DIST

F W817704 EASTCHESTER UNION FREE SCHOOL DIST

F W817712 TOWN OF EASTCHESTER

F W817720 EASTPORT UNION FREE SCHOOL DIST

F W817738 EDWARDS-KNOX CENTRAL SCHOOL DIST

F W817753 ELMIRA CITY SCHOOL DISTRICT

F W817761 EASTPORT/SOUTH MANOR CSD

F W817779 ELDRED CENTRAL SCHOOL DIST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W817944 ELWOOD UNION FREE SCHOOL DIST

F W817977 ERIE #2 AREA SCHOOLS SF WC CONSORTIUM

F W818009 COUNTY OF ERIE

F W818256 ERIE COUNTY MEDICAL CENTER CORP

F W818504 BOCES-FIRST SUP DIST OF ERIE COUNTY

F W819007 ESSEX COUNTY SELF INSURANCE PLAN

F W819130 FABIUS-POMPEY CENTRAL SCHOOL DISTRICT

F W819254 FAIRPORT CENTRAL SCHOOL DISTRICT

F W819502 FARMINGDALE UNION FREE SCHOOL DISTRICT

F W819635 FAYETTEVILLE-MANLIUS CENTRAL SCHOOL DIST

F W819858 FLORAL PARK-BELLEROSE SCHOOL DIS

F W819882 FORT ANN CENTRAL SCHOOL DIST

F W819965 FRANKLIN-ESSEX-HAMILTON BOCES

F W820005 FRANKLIN COUNTY SELF INSURANCE PLAN

F W820252 FRANKLINVILLE CENTRAL SCHOOL DISTRICT

F W820443 FREEPORT UNION FREE SCHOOL DIST

F W820500 VILLAGE OF FREEPORT

F W820633 FRIENDSHIP CENTRAL SCHOOL DIST

F W820690 FRONTIER CENTRAL SCHOOL DISTRICT

F W820716 INCORPORATED VILLAGE OF GARDEN CITY

F W820724 FULMONT WORKERS COMPENSATION PLAN

F W820757 GARDEN CITY UNION FREE SCHOOL DISTRICT

F W821003 COUNTY OF FULTON SELF INS PLAN

F W821631 TOWN OF GATES

F W821755 GATES CHILI CENTRAL SCHOOL DIST

F W822506 GENERAL BROWN CENTRAL SCHOOL DISTRICT

F W823009 GENESEE COUNTY SELF INSURANCE PLAN

F W823090 CITY OF GLEN COVE

F W823108 GLEN COVE CITY SCHOOL DIST

F W823124 GLENS FALLS CITY SCHOOL DIST

F W823132 GREAT NECK UNION FREE SCHOOL DIST

F W823199 TOWN OF GREECE

F W823256 GREECE CENTRAL SCHOOL DISTRICT

F W823322 GREENBURGH CENTRAL SCHOOL DIST #7

F W823389 COUNTY OF GREENE

F W823504 TOWN OF GREENBURGH

F W823579 GOUVERNEUR CENTRAL SCHOOL DIST

F W823611 GREENWOOD LAKE UNION FREE SCHOOL DIST

F W823637 HALDANE CENTRAL SCHOOL DISTRICT

F W823751 HALF HOLLOW HILLS CENTRAL SCHOOL DIST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W823769 TOWN OF HAMBURG

F W823777 HAMMONDSPORT CENTRAL SCHOOL DIST

F W823785 HAMPTON BAYS UNION FREE SCHOOL DIST

F W823793 HAUPPAUGE UNION FREE SCHOOL DIST

F W823835 HARBORFIELDS CENTRAL SCHOOL DIST

F W824007 TOWN OF HEMPSTEAD

F W824049 TOWN/VILLAGE OF HARRISON

F W824072 HARRISON CENTRAL SCHOOL DIST

F W824130 HARRISVILLE CENTRAL SCHOOL DIST

F W824254 HENDRICK HUDSON SCHOOL DISTRICT

F W824387 HEMPSTEAD UNION FREE SCHOOL DIST

F W824502 INCORPORATED VILLAGE OF HEMPSTEAD

F W824635 HERKIMER COUNTY

F W825004 HERKIMER COUNTY SELF INSURANCE PLAN

F W826093 HERRICK UNION FREE SCHOOL DIST

F W826101 HEWLETT WOODMERE UFSD

F W826127 HIGHLAND FALLS-FORT MONTGOMERY CSD

F W826135 HICKSVILLE UNION FREE SCHOOL DISTRICT

F W826168 HOOSIC VALLEY CENTRAL SCHOOL

F W826176 HILTON CENTRAL SCHOOL DISTRICT

F W826192 TOWN OF HUNTINGTON

F W826218 HORNELL CITY SCHOOL DIST

F W826234 HUDSON FALLS CENTRAL SCHOOL DIST

F W826259 HUNTINGTON UNION FREE SCHOOL DISTRICT

F W826267 HORSEHEADS CENTRAL SCHOOL DISTRICT

F W826291 HYDE PARK CENTRAL SCHOOL DIST

F W826325 INDIAN RIVER CENTRAL SCHOOL DIST

F W826382 TOWN OF IRONDEQUOIT

F W826507 TOWN OF ISLIP

F W826754 ISLIP UNION FREE SCHOOL DIST

F W826887 ITHACA SCHOOL DIST

F W829139 JAMESVILLE-DEWITT CENTRAL SCHOOL DIST

F W829501 JAMESTOWN CITY SCHOOL DISTRICT

F W830004 JEFFERSON COUNTY

F W830079 JEFFERSON LEWIS BOCES

F W830111 JORDAN-ELBRIDGE CENTRAL SCHOOL DIST

F W830137 KATONAH LEWISBORO SCHOOLS

F W830178 KESHEQUA CENTRAL SCHOOL DIST

F W830194 KINDERHOOK CENTRAL SCHOOL DIST

F W830228 KINGS PARK CENTRAL SCHOOL DIST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W830319 CITY OF LACKAWANA

F W830368 LAKE PLACID CENTRAL SCHOOL DIST

F W830376 LAKE GEORGE SCHOOL DIST

F W830384 LAKELAND CSD OF SHRUB OAK

F W830442 LAWRENCE UNION FREE SCHOOL DIST

F W830475 LETCHWORTH CENTRAL SCHOOL DIST

F W830509 LEVITTOWN UNION FREE SCHOOL DISTRICT

F W831002 LEWIS COUNTY SELF INSURANCE FUND

F W831259 LINDENHURST UNION FREE SCHOOL DISTRICT

F W831473 LIVERPOOL CENTRAL SCHOOL DISTRICT (1994)

F W832000 LIVINGSTON COUNTY SELF INS PLAN

F W832257 LIVINGSTON-STEUBEN-WYOMING BOCES

F W832380 LIVONIA CENTRAL SCHOOL DISTRICT

F W832448 LOCKPORT CITY SCHOOL DISTRICT

F W832471 CITY OF LOCKPORT

F W833008 CITY OF LONG BEACH

F W833073 LONG BEACH CITY SCHOOL DIST

F W833131 LYME CENTRAL SCHOOL DIST

F W833503 LYNBROOK UNION FREE SCHOOL DISTRICT

F W833883 MADISON-ONEIDA-HERKIMER WC CONSORTIUM

F W834501 MAHOPAC CENTRAL SCHOOL DISTRICT

F W834576 MAINE-ENDWELL CENTRAL SCHOOL DISTRICT

F W834634 MALVERNE UNION FREE SCHOOL DISTRICT

F W834758 MAMARONECK UNION FREE SCHOOL DISTRICT

F W834881 MANHASSET UNION FREE SCHOOL DISTRICT

F W835003 MANHATTAN & BRONX SURF TRANS OPER AUTH

F W835078 MARATHON CENTRAL SCHOOL DIST

F W835136 MASSAPEQUA UNION FREE SCHOOL DIST

F W835342 MECHANICVILLE PUBLIC SCHOOL DIST

F W835359 MEDINA CENTRAL SCHOOL DIST

F W835383 METROPOLITAN SUBURBAN BUS AUTHORITY

F W835441 MEXICO CENTRAL SCHOOL DISTRICT

F W835508 MIDDLE COUNTRY CENTRAL SCHOOL DISTRICT

F W835755 LONGWOOD CENTRAL SCHOOL DIST

F W835888 ENLARGED CITY SCHOOL DIST OF MIDDLETOWN

F W836001 CITY OF MIDDLETOWN

F W836829 MILLER PLACE UNION FREE SCHOOL DISTRICT

F W836886 MINERVA CENTRAL SCHOOL DIST

F W836910 MINISINK VALLEY CENTRAL SCHOOL DISTRICT

F W837009 COUNTY OF MONROE

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

F W837256 MONROE COUNTY WATER AUTHORITY

F W837504 BOCES - MONROE COUNTY - FIRST SUP DIST

F W837751 MONROE - ORLEANS BOCES

F W837942 MONROE-WOODBURY CENTRAL SCHOOL DISTRICT

F W837975 MONTICELLO CENTRAL SCHOOL DIST

F W838007 MONTOGOMERY COUNTY MUTUAL SELF INS PLAN

F W839005 CITY OF MOUNT VERNON

F W839252 MOUNT VERNON CSD

F W840003 COUNTY OF NASSAU

F W840078 NASSAU HEALTH CARE CORP

F W840326 NEW HARTFORD CENTRAL SCHOOL DIST

F W840383 NEWARK VALLEY CENTRAL SCHOOL DIST

F W840508 CITY OF NEWBURGH

F W841001 CITY OF NEW ROCHELLE

F W841258 NEWBURGH ENLARGED CITY SCHOOL DIST

F W841381 NEWCOMB CENTRAL SCHOOL

F W841506 NEW ROCHELLE CITY SCHOOL DISTRICT

E W842009 BOARD OF EDUCATION CNY

E W843007 BOARD OF HIGHER EDUCATION CNY

E W843254 NEW YORK CITY HOUSING AUTHORITY

E W843502 HEALTH & HOSPITALS CORPORATION CNY

E W844005 NYC TRANSIT BOARD OF TRANSPORTATION

E W846000 DEPARTMENT OF HEALTH CNY

E W846505 POLICE FIRE SANITATION & CORRECTIONS CNY

E W847008 CNY OTHER THAN ED HED WATER HHC & HEALTH

F W847750 POWER AUTHORITY OF THE STATE OF NEW YORK

E W848006 NEW YORK CITY TRANSIT AUTHORITY

F W848139 NEW YORK MUNICIPAL WORKERS COMP ALLIANCE

F W848758 TOWN OF NIAGARA

F W849004 CITY OF NIAGARA FALLS

F W850002 NIAGARA FALLS BOARD OF EDUCATION

E W851000 NIAGARA COUNTY MUTUAL SELF INS PLAN

E W851075 NIAGARA FRONTIER TRANS AUTHORITY

E W851083 NIAGARA WHEATFIELD CENTRAL SCHOOL DIST

E W851091 TOWN OF NISKAYUNA

E W851109 NISKAYUNA CENTRAL SCHOOL DIST

E W851133 NORTH BABYLON UNION FREE SCHOOL DIST

E W851190 NORTH COLONIE CENTRAL SCHOOL DISTRICT

E W851224 TOWN OF NORTH HEMPSTEAD

E W851257 NORTHPORT-EAST NORTHPORT UFSD

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

E W851380 NORTH SALEM CENTRAL SCHOOL DIST

E W851505 NORTH SHORE CENTRAL SCHOOL DIST

E W851752 CITY OF NORTH TONAWANDA

E W851885 NORTH SYRACUSE CENTRAL SCHOOL DISTRICT

E W852008 NORTH TONAWANDA BOARD OF EDUCATION

E W852503 NYACK UNION FREE SCHOOL DISTRICT

E W852578 OCEANSIDE UNION FREE SCHOOL DIST

E W852636 ODESSA-MONTOUR CENTRAL SCHOOL

E W852883 OLEAN CITY SCHOOL DIST

E W852941 ONEIDA COUNTY BOCES

E W854004 ONEIDA COUNTY SELF INSURANCE FD

E W855001 COUNTY OF ONONDAGA

E W855506 ONONDAGA CORTLAND MADISON BOCES

E W856009 ONTARIO COUNTY MUTUAL SELF INS PLAN

E W857007 COUNTY OF ORANGE

E W857387 TOWN OF ORANGETOWN

E W857502 SOUTH ORANGETOWN CENTRAL SCHOOL DIST

E W857635 TOWN OF ORCHARD PARK

E W857882 ORLEANS-NIAGARA BOCES

E W858005 ORLEANS COUNTY SELF INS PLAN

E W858500 OSSINING UNION FREE SCHOOL DIST

E W858757 VILLAGE OF OSSINING

E W858880 OSWEGO COUNTY BOCES

E W859003 OSWEGO COUNTY SELF INSURANCE PLAN

E W860001 OTSEGO COUNTY SELF INSURANCE PLAN

E W860258 OTESGO-NORTHERN CATSKILLS BOCES

E W860506 TOWN OF OYSTER BAY

E W860548 PARISHVILLE-HOPKINTON CENTRAL SCHL DIST

E W860571 CITY SCHOOL DISTRICT OF PEEKSKILL

E W860597 PAWLING CENTRAL SCHOOL DIST

E W860605 PATCHOGUE MEDFORD SCHOOL DISTRICT

E W860613 CITY OF PEEKSKILL

E W860662 PELHAM UNION FREE SCHOOL DIST

E W860688 PHOENIX CENTRAL SCHOOL DISTRICT

E W860696 PENFIELD CENTRAL SCHOOL DIST

E W860712 PERU CENTRAL SCHOOL DIST

E W860720 PITTSFORD CENTRAL SCHOOL DIST

E W860738 PINE PLAINS CENTRAL SCHOOL DIST

E W860746 PLAINEDGE UNION FREE SCHOOL DIST

E W860795 PINE BUSH CENTRAL SCHOOL DIST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

E W860829 PLAINVIEW-OLD BETHPAGE CSD (1987)

E W860845 PLATTSBURGH CITY SCHOOL DIST

E W860852 BOCES CLINTON ESSEX WARREN & WASHINGTON

E W861009 PORT AUTHORITY OF NEW YORK & NEW JERSEY

E W861041 PORT BYRON CENTRAL SCHOOL DIST

E W861074 CITY OF PORT JERVIS CITY SCHOOL DIST

E W861132 PORT WASHINGTON UNION FREE SCHOOL DIST

E W861140 VILLAGE OF PORT CHESTER

E W861165 POTSDAM CENTRAL SCHOOL DIST

E W861199 CITY OF POUGHKEEPSIE

E W861207 POUGHKEEPSIE CITY SCHOOL DIST

E W861215 PRATTSBURG CENTRAL SCHOOL DIST

E W861223 PUBLIC EMPLOYERS RISK MANAGEMENT ASSN

E W861256 COUNTY OF PUTNAM

E W861447 BOCES PUTNAM WESTCHESTER COUNTIES

E W861454 QUEENSBURY SCHOOL DIST

E W861470 RAMAPO CENTRAL SCHOOL DISTRICT

E W861488 TOWN OF RAMAPO

E W861496 EAST RAMAPO CENTRAL SCHOOL DIST

E W861504 RENSSELAER COUNTY SELF INSURANCE PLAN

E W861629 REMSENBURG SPEONK UNION FREE SCHL DIST

E W861694 BOCES RENSSELAER-COLUMBIA-GREENE

E W861702 RHINEBECK CENTRAL SCHOOL DIST

E W861728 RIVERHEAD CENTRAL SCHOOL DIST

E W861744 TOWN OF RIVERHEAD

E W861751 CITY OF ROCHESTER

E W862007 ROCHESTER CITY SCHOOL DISTRICT

E W862130 ROCHESTER-GENESEE REGIONAL TRANS AUTH

E W862254 NORTH ROCKLAND CENTRAL SCHOOL DIST

E W862759 ROCKLAND COUNTY SELF INSURANCE PLAN

E W862767 CITY OF ROME

E W862775 ROCKY POINT UNION FREE SCHOOL DIST

E W862783 ROOSEVELT UNION FREE SCHOOL DIST

E W862825 ROCKLAND COUNTY BOCES

E W862858 ROCKVILLE CENTRE UNION FREE SCHOOL DIST

E W862866 ROME CITY SCHOOL DIST

E W862874 INC VILLAGE OF ROCKVILLE CENTRE

E W862882 SACHEM CENTRAL SCHOOL DISTRICT

E W862916 RYE CITY SCHOOL DIST

E W863005 ST LAWRENCE COUNTY SELF INS PLAN

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Proposed Groups

Group W Nbr Insurer Name

E W863757 SALAMANCA CITY SCHOOL DISTRICT

E W863856 SALMON RIVER CENTRAL SCHOOL DIST

E W863880 SARANAC CENTRAL SCHOOL DIST

E W864003 SARATOGA COUNTY SELF INS PLAN

E W864250 SARATOGA SPRINGS CITY SCHOOLS

E W864326 SAUQUOIT VALLEY CENTRAL SCHOOL

E W864441 SAYVILLE UNION FREE SCHOOL DIST

E W864508 SHENENDEHOWA CENTRAL SCHOOL DIST

E W864631 SCARSDALE UNION FREE SCHOOL DIST

E W864755 SCHENECTADY CITY SCHOOL DISTRICT

E W865000 CITY OF SCHENECTADY

E W865505 SCHENECTADY COUNTY

E W865638 SCHENEVUS CENTRAL SCHOOL

E W865919 SCHUYLER-CHEMUNG-TIOGA BOCES

E W865927 BOCES SCHU-STEU-CHEM-TIOG-ALLE

E W865943 SCIO CENTRAL SCHOOL DIST

E W866008 SENECA COUNTY SELF INSURANCE PLAN

E W866503 SEWANHAKA CENTRAL HIGH SCHOOL DISTRICT

E W866693 SHOREHAM WADING RIVER CSD

E W866750 SMITHTOWN CENTRAL SCHOOL DIST

E W866883 TOWN OF SMITHTOWN

E W866917 SOUTHOLD UNION FREE SCHOOL DIST

E W866933 SOLVAY UNION FREE SCHOOL DIST

E W866966 SOUTH COUNTY CENTRAL SCHOOL DIST

E W866974 SOUTH HUNTINGTON UNION FREE SCHOOL DIST

E W866982 SPENCERPORT CENTRAL SCHOOL DIST

E W866990 STATEN ISLAND RAPID TRANSIT OPER AUTH

E W867006 STEUBEN COUNTY SELF INSURANCE PLAN

E W867022 SOUTH GLENS FALLS CENTRAL SCHOOL DIST

E W867048 STILLWATER CENTRAL SCHOOL DIST

E W867063 SOUTH COLONIE SCHOOL DIST

E W867139 BOCES SOUTHERN WESTCHESTER

E W867162 SPACKENKILL UNION FREE SCHOOL DIST

E W867329 STEUBEN-ALLEGANY BOCES

E W867378 VILLAGE OF SUFFERN

E W867386 BOCES FIRST SUPERVISORY DIST SUFFOLK CTY

E W867501 COUNTY OF SUFFOLK

E W868004 SULLIVAN COUNTY SELF INSURANCE PLAN

E W868137 SULLIVAN COUNTY BOCES

E W868251 SWEET HOME SCHOOL DISTRICT

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

E W868509 SYOSSET CENTRAL SCHOOL DISTRICT

E W869002 CITY OF SYRACUSE

E W869135 SYRACUSE CITY SCHOOL DISTRICT

E W869192 TACONIC HILLS CENTRAL SCHOOL DISTRICT

E W869259 TARRYTOWN UNION FREE SCHOOL DIST

E W870000 TIOGA COUNTY MUTUAL SELF INS PLAN

E W870505 THREE VILLAGE CENTRAL SCHOOL DIST

E W870752 TOMPKINS COUNTY

E W871636 CITY OF TONAWANDA

E W871750 TOWN OF TONAWANDA

E W872006 KENMORE-TOWN OF TONAWANDA UFSD

E W872253 TRI-VALLEY CENTRAL SCHOOL DIST

E W872501 TRIBOROUGH BRIDGE & TUNNEL AUTH (1990)

E W873004 CITY OF TROY

E W873251 CITY SCHOOL DISTRICT OF TROY

E W873442 TULLY CENTRAL SCHOOL DIST

E W873509 ULSTER COUNTY SELF INSURANCE PLAN

E W873632 ULSTER COUNTY BOCES

E W873889 UNATEGO CENTRAL SCHOOL DIST

E W874002 TOWN OF UNION

E W874077 UNIONDALE UNION FREE SCHOOL DIST

E W874135 UTICA CITY SCHOOL DISTRICT

E W874192 VALLEY CENTRAL SCHOOL DIST

E W874226 INCORPORATED VILLAGE OF VALLEY STREAM

E W874259 VALLEY STREAM CENTRAL HIGH SCHOOL DIST

E W874507 WANTAGH UNION FREE SCHOOL DIST

E W874630 WAPPINGERS CENTRAL SCHOOL DIST

E W874754 WARREN COUNTY SELF INSURANCE PLAN

E W874911 WARWICK VALLEY CENTRAL SCHOOL DIST

E W874945 WASHINGTONVILLE CENTRAL SCHOOL DIST

E W875009 WASHINGTON COUNTY SELF INS PLAN

E W875504 BOCES WASH-WARREN-HAMILTON-ESX CTYS

E W876007 CITY OF WATERTOWN

E W876502 WATERTOWN CITY SCHOOL DIST

E W877005 CITY OF WATERVLIET

E W877252 WATERVILLE CENTRAL SCHOOL DIST

E W877351 WATKINS GLEN CENTRAL SCHOOL DIST

E W878003 WAYNE COUNTY SELF INSURANCE PLAN

E W878078 WAYNE FINGER LAKES BOCES

E W878110 WEBSTER CENTRAL SCHOOL DIST

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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Proposed Groups

Group W Nbr Insurer Name

E W878128 WEBUTUCK CENTRAL SCHOOL DIST

E W878136 WEST BABYLON UNION FREE SCHOOL DIST

E W878185 WEST GENESEE CENTRAL SCHOOL DIST

E W878193 WEST IRONDEQUOIT CENTRAL SCHOOL DIST

E W878250 WEST ISLIP UNION FREE SCHOOL DISTRICT

E W878383 TOWN OF WEST SENECA

E W878508 WEST SENECA CENTRAL SCHOOL DIST

E W878631 WESTBURY UNION FREE SCHOOL DIST

E W878755 COUNTY OF WESTCHESTER

E W878797 WESTCHESTER COUNTY HEALTH CARE CORP

E W878854 WESTHILL CENTRAL SCHOOL DISTRICT

E W878912 WHEATLAND CHILI CENTRAL SCHOOL DIST

E W878920 WILLIAMSVILLE CENTRAL SCHOOL DIST

E W878938 WHITESBORO CENTRAL SCHOOL

E W878946 CITY OF WHITE PLAINS

E W878961 WINDSOR CENTRAL SCHOOL DIST

E W878979 WHITE PLAINS CITY SCHOOL DIST

E W879001 WYOMING COUNTY WORKERS COMP

E W879076 WHITEHALL CENTRAL SCHOOL DIST

E W879258 WYANDANCH UNION FREE SCHOOL DIST

E W879753 WHITNEY POINT CENTRAL SCH DIST

E W880009 YATES COUNTY MUTUAL SELF INS PLAN

E W881007 CITY OF YONKERS

E W883250 TOWN OF YORKTOWN

E W887756 YORK CENTRAL SCHOOL DIST

E W890008 YORKTOWN CENTRAL SCHOOL DISTRICT

E W990004 UNINSURED EMPLOYERS FUND (TPA)

D W995005 THE AGGREGATE TRUST FUND

E W997001 FUND FOR REOPENED CASES

\\SDF Reimbursement Form wFormulas.xlsx\Proposed Groups

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