Run date: 06-FEB-13 NCAComp Page: 1CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101414 0.00 0.00 0.00 0.00

TRIP/SLIP & FALL 11,769.06 4,934.47 926.88 0.00 0.00 17,630.41ANKLES 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 12/15/95 I CL 11,769.06 4,934.47 926.88 17,630.41

W000101415 0.00 0.00 0.00 0.00STRUCK BY OBJECT 102.40 299.20 0.00 0.00 0.00 401.60EYES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 01/30/96 I CL 102.40 299.20 0.00 401.60

W000101416 0.00 0.00 0.00 0.00OTHER 0.00 1,753.57 263.10 0.00 0.00 2,016.67BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/01/96 M CL 0.00 1,753.57 263.10 2,016.67

W000101417 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 37.17 0.00 0.00 0.00 37.17MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/06/96 M CL 0.00 37.17 0.00 37.17

W000101418 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 1,252.46 313.50 0.00 0.00 1,565.96BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/21/96 M CL 0.00 1,252.46 313.50 1,565.96

W000101419 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 95.00 0.00 0.00 95.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/22/96 M CL 0.00 0.00 95.00 95.00

W000101420 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 6,229.31 11,110.81 11,143.30 0.00 0.00 28,483.42BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/23/96 I CL 6,229.31 11,110.81 11,143.30 28,483.42

Run date: 06-FEB-13 NCAComp Page: 2CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000047224 109,993.93 187,570.83 4,512.36 302,077.12

TRIP/SLIP & FALL 61,701.04 66,728.02 19,729.75 26,893.74 5,367.51 148,158.81NECK,SHOULDERS 59606622 557.66 0.00 0.00 0.00 155.36 557.66MULTIPLE INJURIES 03/06/96 6 OP 171,694.97 254,298.85 24,242.11 450,235.93

W000101422 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 308.82 0.00 0.00 0.00 308.82BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/09/96 M CL 0.00 308.82 0.00 308.82

W000101423 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 169.05 1,584.40 394.44 0.00 0.00 2,147.89BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/11/96 I CL 169.05 1,584.40 394.44 2,147.89

W000101424 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 64.18 3.90 0.00 0.00 68.08BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/18/96 M CL 0.00 64.18 3.90 68.08

W000101425 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 632.48 14.30 0.00 0.00 646.78BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/19/96 M CL 0.00 632.48 14.30 646.78

W000101426 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 474.18 35.68 0.00 0.00 509.86ARMS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 04/21/96 M CL 0.00 474.18 35.68 509.86

W000101427 0.00 0.00 0.00 0.00STRUCK BY OBJECT 1,183.58 769.49 34.98 0.00 0.00 1,988.05BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 04/26/96 I CL 1,183.58 769.49 34.98 1,988.05

Run date: 06-FEB-13 NCAComp Page: 3CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101428 0.00 0.00 0.00 0.00

TRIP/SLIP & FALL 281.63 542.58 0.00 0.00 0.00 824.21BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/04/96 I CL 281.63 542.58 0.00 824.21

W000101429 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 802.11 9.89 0.00 0.00 812.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/08/96 M CL 0.00 802.11 9.89 812.00

W000101430 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 715.92 4,792.51 1,619.90 0.00 0.00 7,128.33MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 05/11/96 I CL 715.92 4,792.51 1,619.90 7,128.33

W000101431 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 481.22 106.07 0.00 0.00 587.29BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/11/96 M CL 0.00 481.22 106.07 587.29

W000101432 0.00 0.00 0.00 0.00FALL FROM HEIGHT 8,338.45 6,605.05 1,143.17 0.00 0.00 16,086.67KNEES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 05/13/96 I CL 8,338.45 6,605.05 1,143.17 16,086.67

W000101433 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/16/96 M CL 0.00 0.00 0.00 0.00

W000101434 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00KNEES 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 05/17/96 M CL 0.00 0.00 0.00 0.00

Run date: 06-FEB-13 NCAComp Page: 4CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101435 0.00 0.00 0.00 0.00

STRUCK BY OBJECT 0.00 144.39 5.20 0.00 0.00 149.59OTHER 0.00 0.00 0.00 0.00 0.00 0.00OTHER 05/18/96 M CL 0.00 144.39 5.20 149.59

W000101436 0.00 0.00 0.00 0.00OTHER 0.00 275.05 7.80 0.00 0.00 282.85NOSE 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 05/18/96 M CL 0.00 275.05 7.80 282.85

W000101437 0.00 0.00 0.00 0.00STRUCK BY OBJECT 83.50 227.57 84.61 0.00 0.00 395.68OTHER 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 05/18/96 I CL 83.50 227.57 84.61 395.68

W000101438 0.00 0.00 0.00 0.00OTHER 0.00 527.25 641.63 0.00 0.00 1,168.88MOUTH 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 05/26/96 M CL 0.00 527.25 641.63 1,168.88

W000101439 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 0.00 0.00 0.00 0.00 0.00ARMS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 06/03/96 M CL 0.00 0.00 0.00 0.00

W000101440 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 269.43 42.92 0.00 0.00 312.35HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/04/96 M CL 0.00 269.43 42.92 312.35

W000101441 0.00 0.00 0.00 0.00FALL FROM HEIGHT 160.00 420.10 12.14 0.00 0.00 592.24KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/05/96 I CL 160.00 420.10 12.14 592.24

Run date: 06-FEB-13 NCAComp Page: 5CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101442 0.00 0.00 0.00 0.00

OTHER 0.00 0.00 0.00 0.00 0.00 0.00ANKLES 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/05/96 M CL 0.00 0.00 0.00 0.00

W000101443 0.00 0.00 0.00 0.00STRUCK BY OBJECT 65.68 398.25 28.22 0.00 0.00 492.15BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/05/96 I CL 65.68 398.25 28.22 492.15

W000101444 0.00 0.00 0.00 0.00OTHER 0.00 0.00 266.31 0.00 0.00 266.31MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/06/96 M CL 0.00 0.00 266.31 266.31

W000101445 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/07/96 M CL 0.00 0.00 0.00 0.00

W000101446 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 1,112.70 4.63 0.00 0.00 1,117.33FACIAL 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 06/08/96 M CL 0.00 1,112.70 4.63 1,117.33

W000101447 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 15,679.90 16,781.51 5,504.40 0.00 0.00 37,965.81NECK 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 06/10/96 I CL 15,679.90 16,781.51 5,504.40 37,965.81

W000101448 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 220.78 21.06 0.00 0.00 241.84KNEES 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/11/96 M CL 0.00 220.78 21.06 241.84

Run date: 06-FEB-13 NCAComp Page: 6CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101449 0.00 0.00 0.00 0.00

OTHER 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/12/96 M CL 0.00 0.00 0.00 0.00

W000101450 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 45,942.76 24,615.54 4,346.37 0.00 0.00 74,904.67MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/12/96 I CL 45,942.76 24,615.54 4,346.37 74,904.67

W000101451 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 4,640.00 1,169.20 72.09 0.00 0.00 5,881.29MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 06/12/96 I CL 4,640.00 1,169.20 72.09 5,881.29

W000101452 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 2,279.60 8,636.24 1,573.73 0.00 0.00 12,489.57MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/12/96 I CL 2,279.60 8,636.24 1,573.73 12,489.57

W000101453 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/12/96 M CL 0.00 0.00 0.00 0.00

W000101454 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 94.92 25.99 0.00 0.00 120.91MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/12/96 M CL 0.00 94.92 25.99 120.91

W000101455 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/12/96 M CL 0.00 0.00 0.00 0.00

Run date: 06-FEB-13 NCAComp Page: 7CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101456 0.00 0.00 0.00 0.00

AUTOMOBILE ACCIDENTS 16,827.61 23,871.00 7,386.95 0.00 0.00 48,085.56MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/12/96 I CL 16,827.61 23,871.00 7,386.95 48,085.56

W000101457 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00FINGERS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/16/96 M CL 0.00 0.00 0.00 0.00

W000101458 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 87.36 0.00 0.00 0.00 87.36CHEST 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/17/96 M CL 0.00 87.36 0.00 87.36

W000101459 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 688.90 1,783.33 849.92 0.00 0.00 3,322.15BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/22/96 I CL 688.90 1,783.33 849.92 3,322.15

W000101460 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/24/96 M CL 0.00 0.00 0.00 0.00

W000101461 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 81.33 0.00 0.00 0.00 81.33ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/25/96 M CL 0.00 81.33 0.00 81.33

W000101462 0.00 0.00 0.00 0.00OTHER 0.00 136.31 11.70 0.00 0.00 148.01MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/25/96 M CL 0.00 136.31 11.70 148.01

Run date: 06-FEB-13 NCAComp Page: 8CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101463 0.00 0.00 0.00 0.00

BENDING/STRETCHING/REACHING 0.00 24.29 7.80 0.00 0.00 32.09MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/28/96 M CL 0.00 24.29 7.80 32.09

W000101464 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 900.02 0.00 530.00 0.00 0.00 1,430.02ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/30/96 I CL 900.02 0.00 530.00 1,430.02

W000101465 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 142,988.60 17,480.05 6,120.71 0.00 0.00 166,589.36KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/03/96 I CL 142,988.60 17,480.05 6,120.71 166,589.36

W000101466 0.00 0.00 0.00 0.00CAUGHT IN UNDER BETWEEN 0.00 0.00 0.00 0.00 0.00 0.00FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 07/04/96 M CL 0.00 0.00 0.00 0.00

W000101467 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 85.36 0.00 0.00 0.00 85.36BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/08/96 M CL 0.00 85.36 0.00 85.36

W000101468 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 1,839.90 2,648.36 43.02 0.00 0.00 4,531.28BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/08/96 I CL 1,839.90 2,648.36 43.02 4,531.28

W000101469 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 141.02 12.14 0.00 0.00 153.16ELBOW 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 07/11/96 M CL 0.00 141.02 12.14 153.16

Run date: 06-FEB-13 NCAComp Page: 9CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101470 0.00 0.00 0.00 0.00

OTHER 0.00 314.78 13.00 0.00 0.00 327.78SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 07/11/96 M CL 0.00 314.78 13.00 327.78

W000101471 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 0.00 0.00 0.00 0.00 0.00EYES 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 07/12/96 M CL 0.00 0.00 0.00 0.00

W000101472 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 142.50 2.22 0.00 0.00 144.72HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 07/13/96 M CL 0.00 142.50 2.22 144.72

W000101473 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 8,791.87 573.65 0.00 0.00 9,365.52BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/16/96 M CL 0.00 8,791.87 573.65 9,365.52

W000101474 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 8,775.65 959.84 774.76 0.00 0.00 10,510.25HANDS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 07/18/96 I CL 8,775.65 959.84 774.76 10,510.25

W000101475 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00OTHER 07/19/96 M CL 0.00 0.00 0.00 0.00

W000101476 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 646.01 26.00 0.00 0.00 672.01THUMBS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 07/25/96 M CL 0.00 646.01 26.00 672.01

Run date: 06-FEB-13 NCAComp Page: 10CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101477 0.00 0.00 0.00 0.00

BENDING/STRETCHING/REACHING 0.00 2,164.58 645.85 0.00 0.00 2,810.43KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/25/96 M CL 0.00 2,164.58 645.85 2,810.43

W000101478 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 10,729.07 1,902.85 0.00 0.00 12,631.92BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/25/96 M CL 0.00 10,729.07 1,902.85 12,631.92

W000101479 0.00 0.00 0.00 0.00OTHER 0.00 280.40 13.81 0.00 0.00 294.21FACIAL 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 07/26/96 M CL 0.00 280.40 13.81 294.21

W000101480 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 33,341.65 3,732.77 4,114.63 0.00 0.00 41,189.05BACK 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 07/29/96 I CL 33,341.65 3,732.77 4,114.63 41,189.05

W000101481 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 1,326.83 41.71 0.00 0.00 1,368.54BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/30/96 M CL 0.00 1,326.83 41.71 1,368.54

W000101482 0.00 0.00 0.00 0.00OTHER 0.00 761.00 3.90 0.00 0.00 764.90MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 07/31/96 M CL 0.00 761.00 3.90 764.90

W000101483 0.00 0.00 0.00 0.00FALL FROM HEIGHT 9,189.44 11,930.24 2,687.97 0.00 0.00 23,807.65ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/31/96 I CL 9,189.44 11,930.24 2,687.97 23,807.65

Run date: 06-FEB-13 NCAComp Page: 11CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101484 0.00 0.00 0.00 0.00

CAUGHT IN UNDER BETWEEN 15,599.97 5,045.85 384.55 0.00 0.00 21,030.37HANDS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 08/01/96 I CL 15,599.97 5,045.85 384.55 21,030.37

W000101485 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 330.49 20.52 0.00 0.00 351.01HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 08/04/96 M CL 0.00 330.49 20.52 351.01

W000101486 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 59.07 0.00 0.00 0.00 59.07BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/05/96 M CL 0.00 59.07 0.00 59.07

W000101487 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 1,280.00 761.99 45.76 0.00 0.00 2,087.75NECK 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 08/09/96 I CL 1,280.00 761.99 45.76 2,087.75

W000101488 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 791.70 5,968.49 628.10 0.00 0.00 7,388.29BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/12/96 I CL 791.70 5,968.49 628.10 7,388.29

W000101489 0.00 0.00 0.00 0.00OTHER 135.61 448.10 13.00 0.00 0.00 596.71BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/13/96 I CL 135.61 448.10 13.00 596.71

W000101490 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 109.70 376.72 9.61 0.00 0.00 496.03BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/13/96 I CL 109.70 376.72 9.61 496.03

Run date: 06-FEB-13 NCAComp Page: 12CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101491 0.00 0.00 0.00 0.00

STRUCK BY OBJECT 63.87 208.77 7.80 0.00 0.00 280.44ARMS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 08/14/96 I CL 63.87 208.77 7.80 280.44

W000101492 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 242.38 0.00 0.00 0.00 242.38EYES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 08/16/96 M CL 0.00 242.38 0.00 242.38

W000101493 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/19/96 M CL 0.00 0.00 0.00 0.00

W000101494 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 954.91 994.07 0.00 0.00 1,948.98MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 08/21/96 M CL 0.00 954.91 994.07 1,948.98

W000101495 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 70.70 10.61 0.00 0.00 81.31HEAD 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 08/22/96 M CL 0.00 70.70 10.61 81.31

W000101496 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 293.32 840.61 9.64 0.00 0.00 1,143.57BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/25/96 I CL 293.32 840.61 9.64 1,143.57

W000101497 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 219.29 0.00 0.00 0.00 219.29BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/26/96 M CL 0.00 219.29 0.00 219.29

Run date: 06-FEB-13 NCAComp Page: 13CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101498 0.00 0.00 0.00 0.00

STRUCK AGAINST 0.00 114.40 12.78 0.00 0.00 127.18ARMS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 08/29/96 M CL 0.00 114.40 12.78 127.18

W000101499 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 729.39 918.01 22.12 0.00 0.00 1,669.52KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/30/96 I CL 729.39 918.01 22.12 1,669.52

W000101500 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 13,221.88 7,597.41 1,460.33 0.00 0.00 22,279.62MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CARPAL TUNNEL 09/01/96 I CL 13,221.88 7,597.41 1,460.33 22,279.62

W000101501 0.00 0.00 0.00 0.00TEMPERATURE EXTREMES 0.00 373.14 16.90 0.00 0.00 390.04HANDS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 09/01/96 M CL 0.00 373.14 16.90 390.04

W000101502 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 1,242.58 3,170.76 131.66 0.00 0.00 4,545.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/03/96 I CL 1,242.58 3,170.76 131.66 4,545.00

W000101503 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/03/96 M CL 0.00 0.00 0.00 0.00

W000101504 0.00 0.00 0.00 0.00CAUGHT IN UNDER BETWEEN 0.00 291.74 37.65 0.00 0.00 329.39FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/03/96 M CL 0.00 291.74 37.65 329.39

Run date: 06-FEB-13 NCAComp Page: 14CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101505 0.00 0.00 0.00 0.00

BENDING/STRETCHING/REACHING 63,966.28 31,487.58 7,671.06 0.00 0.00 103,124.92BACK 0.00 0.00 0.00 0.00 0.00 0.00HERNIA/RUPTURE 09/04/96 I CL 63,966.28 31,487.58 7,671.06 103,124.92

W000101506 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 57.26 29.93 0.00 0.00 87.19FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 09/10/96 I CL 0.00 57.26 29.93 87.19

W000101507 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 118.65 3.90 0.00 0.00 122.55MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 09/11/96 M CL 0.00 118.65 3.90 122.55

W000101508 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 103.27 145.00 0.00 0.00 248.27OTHER 0.00 0.00 0.00 0.00 0.00 0.00OTHER 09/11/96 M CL 0.00 103.27 145.00 248.27

W000101509 0.00 0.00 0.00 0.00FALL FROM HEIGHT 7,611.89 8,804.44 2,063.22 0.00 0.00 18,479.55MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 09/11/96 I CL 7,611.89 8,804.44 2,063.22 18,479.55

W000101510 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 98.52 0.00 0.00 0.00 98.52MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/15/96 M CL 0.00 98.52 0.00 98.52

W000101511 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 268.19 2.96 0.00 0.00 271.15MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/15/96 M CL 0.00 268.19 2.96 271.15

Run date: 06-FEB-13 NCAComp Page: 15CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101512 0.00 0.00 0.00 0.00

STRUCK BY OBJECT 0.00 91.19 0.00 0.00 0.00 91.19FEET 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/15/96 M CL 0.00 91.19 0.00 91.19

W000101513 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 93.00 0.00 0.00 93.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/16/96 M CL 0.00 0.00 93.00 93.00

W000101514 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 1,132.00 412.44 0.00 0.00 1,544.44MOUTH 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/17/96 M CL 0.00 1,132.00 412.44 1,544.44

W000101515 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 175.85 70.50 0.00 0.00 246.35BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/18/96 M CL 0.00 175.85 70.50 246.35

W000101516 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/20/96 M CL 0.00 0.00 0.00 0.00

W000101517 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 31.79 3.90 0.00 0.00 35.69FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 09/21/96 M CL 0.00 31.79 3.90 35.69

W000101518 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 17,679.79 15,487.81 2,823.17 0.00 0.00 35,990.77MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/25/96 I CL 17,679.79 15,487.81 2,823.17 35,990.77

Run date: 06-FEB-13 NCAComp Page: 16CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101519 0.00 0.00 0.00 0.00

STRUCK AGAINST 0.00 189.36 0.00 0.00 0.00 189.36FEET 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/27/96 M CL 0.00 189.36 0.00 189.36

W000101520 0.00 0.00 0.00 0.00FALL FROM HEIGHT 1,109.71 1,495.32 182.70 0.00 0.00 2,787.73MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/02/96 I CL 1,109.71 1,495.32 182.70 2,787.73

W000101521 0.00 0.00 0.00 0.00STRUCK AGAINST 64.00 319.53 35.43 0.00 0.00 418.96FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 10/02/96 I CL 64.00 319.53 35.43 418.96

W000101522 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 81.40 0.00 0.00 81.40ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/02/96 M CL 0.00 0.00 81.40 81.40

W000101523 0.00 0.00 0.00 0.00OTHER 21.33 385.95 7.29 0.00 0.00 414.57NOSE 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 10/03/96 I CL 21.33 385.95 7.29 414.57

W000101524 0.00 0.00 0.00 0.00OTHER 1,660.67 857.03 147.05 0.00 0.00 2,664.75NOSE 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 10/04/96 I CL 1,660.67 857.03 147.05 2,664.75

W000101525 0.00 0.00 0.00 0.00OTHER 0.00 344.05 13.00 0.00 0.00 357.05OTHER 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/04/96 M CL 0.00 344.05 13.00 357.05

Run date: 06-FEB-13 NCAComp Page: 17CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101526 0.00 0.00 0.00 0.00

BENDING/STRETCHING/REACHING 0.00 62.36 5.23 0.00 0.00 67.59BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/07/96 M CL 0.00 62.36 5.23 67.59

W000101527 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 450.45 7.55 0.00 0.00 458.00SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/08/96 M CL 0.00 450.45 7.55 458.00

W000101528 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 521.44 44.20 0.00 0.00 565.64MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/10/96 M CL 0.00 521.44 44.20 565.64

W000101529 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/16/96 M CL 0.00 0.00 0.00 0.00

W000101530 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 52.16 218.98 0.00 0.00 0.00 271.14KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/16/96 I CL 52.16 218.98 0.00 271.14

W000101531 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 0.00 6.69 0.00 0.00 6.69MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/17/96 M CL 0.00 0.00 6.69 6.69

W000101532 0.00 0.00 0.00 0.00OTHER 0.00 645.12 31.20 0.00 0.00 676.32THUMBS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/19/96 M CL 0.00 645.12 31.20 676.32

Run date: 06-FEB-13 NCAComp Page: 18CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101533 0.00 0.00 0.00 0.00

OTHER 0.00 107.63 6.50 0.00 0.00 114.13MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/19/96 M CL 0.00 107.63 6.50 114.13

W000101534 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 285.40 9.86 0.00 0.00 295.26BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/21/96 M CL 0.00 285.40 9.86 295.26

W000101535 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/21/96 M CL 0.00 0.00 0.00 0.00

W000101536 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 321.87 452.43 80.63 0.00 0.00 854.93BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/25/96 I CL 321.87 452.43 80.63 854.93

W000101537 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 203.67 0.00 0.00 0.00 203.67ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/26/96 M CL 0.00 203.67 0.00 203.67

W000101538 0.00 0.00 0.00 0.00FALL FROM HEIGHT 631.48 104.04 0.00 0.00 0.00 735.52BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/28/96 I CL 631.48 104.04 0.00 735.52

W000101539 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 18,641.78 19,529.02 6,143.83 0.00 0.00 44,314.63FEET 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 10/31/96 I CL 18,641.78 19,529.02 6,143.83 44,314.63

Run date: 06-FEB-13 NCAComp Page: 19CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101540 0.00 0.00 0.00 0.00

STRUCK BY OBJECT 0.00 40.00 0.00 0.00 0.00 40.00ELBOW 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/01/96 M CL 0.00 40.00 0.00 40.00

W000101541 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 798.30 160.60 0.00 0.00 958.90FINGERS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 11/05/96 M CL 0.00 798.30 160.60 958.90

W000101542 0.00 0.00 0.00 0.00OTHER 36,534.00 9,307.31 4,755.53 0.00 0.00 50,596.84MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/07/96 I CL 36,534.00 9,307.31 4,755.53 50,596.84

W000101543 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00KNEES 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 11/07/96 M CL 0.00 0.00 0.00 0.00

W000101544 0.00 0.00 0.00 0.00REPETITIVE MOTION 5,380.56 8,576.03 271.67 0.00 0.00 14,228.26KNEES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/11/96 I CL 5,380.56 8,576.03 271.67 14,228.26

W000101545 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/13/96 M CL 0.00 0.00 0.00 0.00

W000101546 0.00 0.00 0.00 0.00FALL FROM HEIGHT 4,477.72 4,239.08 379.90 0.00 0.00 9,096.70BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/14/96 I CL 4,477.72 4,239.08 379.90 9,096.70

Run date: 06-FEB-13 NCAComp Page: 20CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101547 0.00 0.00 0.00 0.00

STRUCK BY OBJECT 0.00 138.24 6.33 0.00 0.00 144.57EYES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/15/96 M CL 0.00 138.24 6.33 144.57

W000101548 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 766.64 88.65 0.00 0.00 855.29HANDS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/15/96 M CL 0.00 766.64 88.65 855.29

W000101549 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 2,338.83 174.70 0.00 0.00 2,513.53HANDS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 11/19/96 M CL 0.00 2,338.83 174.70 2,513.53

W000101550 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 80.00 0.00 0.00 0.00 80.00ARMS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/21/96 M CL 0.00 80.00 0.00 80.00

W000101551 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 184.20 7.80 0.00 0.00 192.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/21/96 M CL 0.00 184.20 7.80 192.00

W000101552 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 17.74 67.48 5.20 0.00 0.00 90.42SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/27/96 I CL 17.74 67.48 5.20 90.42

W000101553 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 212.18 455.33 97.45 0.00 0.00 764.96SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/04/96 I CL 212.18 455.33 97.45 764.96

Run date: 06-FEB-13 NCAComp Page: 21CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101554 0.00 0.00 0.00 0.00

TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00ABDOMEN 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 12/05/96 M CL 0.00 0.00 0.00 0.00

W000101555 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 2,400.00 6,016.27 559.60 0.00 0.00 8,975.87MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 12/06/96 I CL 2,400.00 6,016.27 559.60 8,975.87

W000101556 0.00 0.00 0.00 0.00STRUCK AGAINST 937.30 465.64 109.55 0.00 0.00 1,512.49FINGERS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 12/09/96 I CL 937.30 465.64 109.55 1,512.49

W000101557 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 154.41 5.20 0.00 0.00 159.61FINGERS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/10/96 M CL 0.00 154.41 5.20 159.61

W000101558 0.00 0.00 0.00 0.00OTHER 0.00 2,489.19 77.40 0.00 0.00 2,566.59NOSE 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/10/96 M CL 0.00 2,489.19 77.40 2,566.59

W000101559 0.00 0.00 0.00 0.00STRUCK AGAINST 608.87 172.40 290.20 0.00 0.00 1,071.47ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/11/96 I CL 608.87 172.40 290.20 1,071.47

W000101560 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 12/11/96 M CL 0.00 0.00 0.00 0.00

Run date: 06-FEB-13 NCAComp Page: 22CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 10/01/2012 - 10/31/2012 ***

CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000

Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL

============ ============ ============ ============ ============ ============W000101561 0.00 0.00 0.00 0.00

FALL FROM HEIGHT 3,891.25 1,159.19 432.80 0.00 0.00 5,483.24ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/12/96 I CL 3,891.25 1,159.19 432.80 5,483.24

W000101562 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 185.90 10.83 0.00 0.00 196.73FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 12/13/96 M CL 0.00 185.90 10.83 196.73

W000101563 0.00 0.00 0.00 0.00TEMPERATURE EXTREMES 0.00 274.30 15.60 0.00 0.0