Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE POOL COMMITTEE CONSISTS OF THE SERVICING CARRIERS FOR THE WISCONSIN WORKER'S COMPENSATION INSURANCE POOL, AND ONE OR MORE ADDITIONAL CARRIERS ADDED TO MEET THE REQUIREMENT THAT THE COMMITTEE BE COMPRISED OF AN EQUAL NUMBER OF STOCK AND MUTUAL CARRIERS. THE POOL COMMITTEE PRIMARILY EXISTS TO BRING ABOUT A MAXIMUM DEGREE OF UNIFORMITY IN THE POOL BY ALLOWING A REGULAR MEETING FORMAT TO DISCUSS OPERATIONAL PROBLEMS AND SOLUTIONS. RECOMMENDATIONS FROM THE POOL COMMITTEE ARE REGULARLY FORWARDED TO THE GOVERNING BOARD FOR ACTION AND ADOPTION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF FORM 990 IS PROVIDED TO THE ORGANIZATIONS MANAGEMENT FOR REVIEW PRIOR TO FILING AND IS MADE AVAILABLE TO GOVERNING BOARD MEMBERS UPON FINALIZATION. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PUBLIC INSPECTION OF DOCUMENTS AVAILABLE ONLINE AT WWW.WCRB.ORG | |
| FORM 990, PART VI, SECTION C, LINE 19 | PUBLIC INSPECTION OF DOCUMENTS AVAILABLE ONLINE AT WWW.WCRB.ORG | |
| CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC | FORM 990, PART VII | EMPLOYERS MUTUAL CASUALTY CO - P.O. BOX 327, BROOKFIELD, WI 53005. LIBERTY MUTUAL GROUP - P.O. BOX 8090, WAUSAU, WI XXX-XX-XXXX. TRI-STATE INSURANCE CO. OF MN - 222 SOUTH NINTH STREET, MINNEAPOLIS, MN XXX-XX-XXXX. GENERAL CASUALTY COMPANY - ONE GENERAL DRIVE, SUN PRAIRIE, WI 53596. WEST BEND MUTUAL INSURANCE COMPANY - 1900 SOUTH 18TH AVE., WEST BEND, WI 53095. SOCIETY INSURANCE - P.O. BOX 1029, FOND DU LAC, WI XXX-XX-XXXX. MIDDLESEX INSURANCE CO - 1800 N. POINT DRIVE, STEVENS POINT, WI 54481. TRAVELERS INSURANCE CO - 385 WASHINGTON ST. MC 505K, ST PAUL, MN XXX-XX-XXXX. |
| COMMITTEE MEMBERS | FORM 990, PART VII | ALL MEMBERS OF THE REJECTED RISK COMMITTEE SERVE WITHOUT COMPENSATION AND WITHOUT REIMBURSEMENT OF EXPENSES INCURRED IN THEIR DUTIES. TIME DEVOTED TO THE ORGANIZATION CANNOT BE REASONABLY ESTIMATED AND ACTUAL TIME IS UNKOWN. |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | ASSESSMENTS DECLARED AND NOT COLLECTED TO NET ASSETS 1,767,227. TOTAL TO FORM 990, PART XI, LINE 5: 1,767,227. |
| HAS GOVERNING BODY CHANGED ITS OVERSIGHT RESPONSIBILITIES? | PART XI LINE 2C | NO CHANGE FROM PRIOR YEAR. |
| OTHER CHANGES IN NET ASSETS OR FUND BALANCES | FORM 990, PART XI, LINE 5 | POOL RULES REQUIRE THAT AN ASSESSMENT BE DECLARED BUT NOT COLLECTED IN AN AMOUNT SUFFICIENT TO ACHIEVE THE TARGET FUND VALUE BASED ON ACTUARIAL ESTIMATES OF OUTSTANDING LOSSES THUS, 2010 ASSESSMENTS OF $1,767,227 WERE DECLARED & NOT COLLECTED FROM ALL POOL MEMBERS IN 2010 BASED ON PRIOR PREMIUM WRITINGS IN ACCORDANCE WITH POOL RULES. THE ASSESSMENTS IS ACCOUNTED FOR AS AN ACCOUNT RECEIVABLE AND ADJUSTMENT TO NET ASSETS. |
| SHARING OF FACILITIES, EQUIPMENT, MAILING LISTS, OR OTHER ASSETS | SCHEDULE R (FORM 990), PART V, LINE 1M | ADMINISTRATIVE SERVICES ARE PROVIDED TO THE WISCONSIN WORKER'S COMPENSATION INSURANCE POOL (WWCIP) BY THE WISCONSIN COMPENSATION RATING BUREAU (BUREAU). SINCE THE ADMINISTRATION OF THE POOL BY THE BUREAU IS PROVIDED FOR BY THE STATUTES OF THE STATE OF WISCONSIN, THE POOL DOES NOT REIMBURSE THE BUREAU. |
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