Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
WORKERS COMPENSATION RESEARCH INSTITUTE
Employer identification number
36-3264285
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
5,512,238
5,159,519
5,698,396
5,406,323
6,010,928
27,787,404
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
101,585
134,568
161,471
238,462
279,301
915,387
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
5,613,823
5,294,087
5,859,867
5,644,785
6,290,229
28,702,791
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
3,251,393
3,182,469
3,386,183
3,169,843
3,296,578
16,286,466
c
Add lines 7a and 7b..
3,251,393
3,182,469
3,386,183
3,169,843
3,296,578
16,286,466
8
Public support (Subtract line 7c from line 6.)
12,416,325
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
5,613,823
5,294,087
5,859,867
5,644,785
6,290,229
28,702,791
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
202,292
207,008
260,966
225,209
220,875
1,116,350
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
202,292
207,008
260,966
225,209
220,875
1,116,350
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
40,771
40,771
13
Total support. (Add lines 9, 10c, 11, and 12.)..
5,816,115
5,501,095
6,120,833
5,869,994
6,551,875
29,859,912
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
41.580 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
40.830 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
3.740 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
4.050 %
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
WORKERS COMPENSATION RESEARCH INSTITUTE
Employer identification number
36-3264285
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION IS A RESEARCH ORGANIZATION WHOSE MEMBERS CONSISTS OF EMPLOYERS, INSURERS, STATE FUNDS, STATE GOVERNMENTS AND LABOR ORGANIZATIONS.
FORM 990, PART VI, SECTION A, LINE 7A
THE RESPONSIBLITY FOR POLICYMAKING RESTS WITH THE ORGANIZATION'S BOARD OF DIRECTORS, A REPRESENTATIVE GROUP THAT IS ELECTED BY THE MEMBERSHIP FOR STAGGERED THREE-YEAR TERMS.
FORM 990, PART VI, SECTION B, LINE 11
AFTER THE PREPARATION OF THE 990 BY THE ACCOUNTING DEPARTMENT AND AN OUTSIDE ACCOUNTING FIRM, IT IS REVIEWED BY THE EXECUTIVE DIRECTOR AND DEPUTY DIRECTOR PRIOR TO FILING. A COPY IS ALSO PROVIDED TO THE TREASURER OF THE BOARD OF DIRECTORS AND THE EXECUTIVE COMMITTEE FOR REVIEW PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED ANNUALLY TO THE BOARD OF DIRECTORS AND THE DEPUTY DIRECTOR TRACKS THE DISCLOSURES, IF ANY, BY ANY BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 15
ANNUALLY, THE BOARD OF DIRECTORS DETERMINES THE COMPENSATION FOR BOTH EXECUTIVE DIRECTOR AND THE DEPUTY DIRECTOR WHICH ARE TWO KEY MANAGEMENT POSITIONS FOR THE ORGANIZATION. THE COMPENSATION DETERMINATION IS BASED ON APPROPRIATE COMPARABLE DATA AND IS APROVED BY AND DOCUMENTED BY A COMPENSATION COMMITTEE. A COMPENSATION SURVEY OF SIMILIAR POSITIONS IS CONDUCTED BY AN OUTSIDE CONSULTANT EVERY THREE YEARS.
FORM 990, PART VI, SECTION C, LINE 19
DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII
CRISTINA DOBLEMAN - STANFORD UNIV., 651 SERRA STREET RM 250, STANFORD, CA 94305-6207. DAVID PATTERSON - ESIS, INC. PO BOX 1000 436 WALNUT ST.-WA03F, PHILADELPHIA, PA 19106. JON E STEWART - KY EMPLOYERS' MUTUAL INS.,250 WEST MAIN STREET, SUITE 900, LEXINGTON, KY 40507. TRACY A RYAN - LIBERTY MUTUAL; 175 BERKELEY STREET, BOSTON, MA 02117. STEVE PERROOTS - MARRIOTT INTL. INC.; 10400 FERNWOOD RD., BETHESEDA, MD 20817. BARBARA N SANDELANDS - CHUBB & SON, A DIV OF FED INSURANCE CO., 202 HALL'S M WHITEHOUSE STATION, NJ 08889. JOSEPH WELLS - THE HARTFORD, ONE HARTFORD PLAZA, HARTFORD, CT 06115. MICHAEL FENLON - UPS, 55 GLENLAKE PARKWAY, NE, ATLANTA, GA 30328. JANINE MARTIN KRAL - NORDSROM, INC., 1700 SEVENTH AVENUE, SUITE 1000, SEATTLE, WA 98101. PETE MCPARTLAND - SENTRY INSURANCE, 1800 NORTH POINT DRIVE, STEVENS POINT, WI 54481. VINCENT DONNELLY - THE PMA INSURANCE GROUP, 380 SENTRY PARKWAY, BLUE BELL, PA 19422-2328. VINCENT ARMENTANO - THE TRAVELERS CO., INC. ONE TOWER SQ., 7MS, HARTFORD, CT 06183-1120. DARRELL BROWN - SEDGWICK CLAIMS MGMT. SERV., INC. 3760 KILROY AIRPORT WAY, LONG BEACH, CA 90806. SRIVATSAN SRIDHARAN - GALLAGHER BASSETT SVC, INC. THE GALLAGHER CENTRE. TWO ITASCA, IL 60143-3141. SHELLEY BOYCE - MEDRISK, INC;2701 RENAISSANCE BOULEVARD, SUITE 200, KING OF PRUSSIA, PA 19406. DAVID STILLS - WAL-MART STORES, INC. 922 WEST WALNUT, ROGERS, AR 72756-3540. KEITH BATEMAN - PROPERTY CASUALTY INSURERS ASSOC OF AMERICA. 8700 WEST BRYN CHICAGO, IL 60631-3512. THOMAS NOWAK - AIG; 175 WATER ST. 3RD FL, NEW YORK, NY 10038. PETER MCCARRON - ZURICH; 1400 AMERICAN LANE T2F6, SCHAUMBURG, IL 60196.
FORM 990, PART IX, LINE 11G
CONTRACTS & CONSULTING: PROGRAM SERVICE EXPENSES 323,080. MANAGEMENT AND GENERAL EXPENSES 54,455. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 377,535. DATA ACQUISITION: PROGRAM SERVICE EXPENSES 330,842. MANAGEMENT AND GENERAL EXPENSES 55,764. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 386,606.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.