Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | EVERY INSURER WRITING WORKERS' COMPENSATION INSURANCE OR THE LIABILITY FOR SIMILAR BENEFITS OF EMPLOYERS EXEMPT FROM WORKERS' COMPENSATION INSURANCE IN THE STATE OF WISCONSIN IS AUTOMATICALLY A MEMBER OF THE BUREAU. MEMBERS OF THE BUREAU ELECT THE MEMBERS OF THE GOVERNING BODY FROM AMONG THE MEMBERSHIP. |
| FORM 990, PART VI, SECTION A, LINE 7B | WHILE NOT A STATE AGENCY, WCRB IS REGULATED BY THE STATE OF WISCONSIN OFFICE OF THE COMMISSIONER OF INSURANCE (OCI) AND WORKS VERY CLOSELY WITH THE WORKER'S COMPENSATION DIVISION OF THE WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT (DWD). |
| 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 19 | DOCUMENTS ARE AVAILABLE VIA WEBSITE: WWW.WCRB.ORG |
| FORM 990, PART VII | AMERICAN HOME ASSURANCE COMPANY - 175 WATER STREET, NEW YORK, NY 10038. SECURA INSURANCE, A MUTUAL COMPANY - 2401 SOUTH MEMORIAL DR, APPLETON, WI 54912. SENTRY INSURANCE, A MUTUAL COMPANY - 1800 NORTH POINT DR, STEVENS POINT, WI 54481. EMPLOYERS INSURANCE COMPANY OF WAUSAU - P.O. BOX 8017, WAUSAU, WI 54402. UNITED WISCONSIN INSURANCE COMPANY - P.O. BOX 3026, MILWAUKEE, WI 53201. TRAVLERS INDEMNITY COMPANY - 1 TOWER SQUARE, HARTFORD, CT 06183. GENERAL CASUALTY INSURANCE COMPANY - 500 PARK BLVD. #1205, ITASCA, IL 60143. SOCIETY INSURANCE A MUTUAL COMPANY - 150 CAMELOT DRIVE, FOND DU LAC, WI 54936. CHRIS READER - 501 E. WASHINGTON AVENUE, MADISON, WI 53703. DAN BURAZIN - 3829 SWOBODA ROAD, VERONA, WI 53593. |
| FORM 990, PART XI, LINE 9: | SURPLUS -536,521. UNREALIZED GAIN ON POSTRETIREMENT BENEFITS 2,534,546. PRIOR SERVICE COST ON POSTRETIREMENT 96,528. PENSION TRUST ADJUSTMENT -19,745. CHANGE IN POSTRETIREMENT BENEFIT -155,951. |
| PART XII LINE 2C | THE BUREAU HAS A GOVERNING COMMITTEE THAT OVERSEES THE AUDIT. |
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