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
AFFILIATES RISK MANAGEMENT SERVICES INC
Employer identification number
13-4167849
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.") .
1,000,000
1,000,000
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......
4,725,000
5,666,919
6,936,347
8,962,250
11,786,195
38,076,711
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.
4,725,000
5,666,919
6,936,347
8,962,250
12,786,195
39,076,711
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.
1,820,150
2,215,061
2,691,712
3,355,064
4,878,910
14,960,897
c
Add lines 7a and 7b..
1,820,150
2,215,061
2,691,712
3,355,064
4,878,910
14,960,897
8
Public support (Subtract line 7c from line 6.)
24,115,814
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...
4,725,000
5,666,919
6,936,347
8,962,250
12,786,195
39,076,711
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
153,749
181,961
191,772
217,291
181,324
926,097
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
153,749
181,961
191,772
217,291
181,324
926,097
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.)
..
13,265
17,510
97,109
79,811
55,228
262,923
13
Total support. (Add lines 9, 10c, 11, and 12.)..
4,892,014
5,866,390
7,225,228
9,259,352
13,022,747
40,265,731
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
59.890 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
59.050 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.300 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
3.370 %
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
AFFILIATES RISK MANAGEMENT SERVICES INC
Employer identification number
13-4167849
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
POLICYHOLDERS' TRUST IS THE SOLE MEMBER OF AFFILIATES RISK MANAGEMENT SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF DIRECTORS IS ELECTED AT THE ANNUAL MEETING OF THE MEMBER OF ARMS.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBER MUST APPROVE ANY AMENDMENTS TO THE CERTIFICATE OF INCORPORATION OF ARMS IF THE AMENDMENT RELATES TO THE COMPOSITION AND TENURE OF THE BOARD OF ARMS.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS PROVIDED TO EACH OF THE DIRECTORS FOR THEIR REVIEW, AND THE 990 IS FILED ONLY AFTER THE BOARD EITHER FORMALLY APPROVES THE 990 AT A MEETING OR NONE OF THE DIRECTORS PROTEST THE DRAFT 990 AS PROVIDED, OR OTHERWISE RAISES ANY QUESTIONS OR ISSUES REGARDING THE DRAFT FORM, WITHIN A PRESCRIBED TIME PERIOD.
FORM 990, PART VI, SECTION B, LINE 12C
ARMS MAINTAINS A WRITTEN CONFLICT OF INTEREST POLICY, WHICH IS ANNUALLY REVIEWED BY MANAGEMENT. THE BOARD OF DIRECTORS AND OFFICERS OF THE ORGANIZATION ARE REQUIRED TO CERTIFY ANNUALLY THAT THEY HAVE READ AND UNDERSTAND THE CONFLICT OF INTEREST POLICY AND SUBMIT A WRITTEN QUESTIONNAIRE EACH YEAR DISCLOSING ANY KNOWN CONFLICTS. THE RESPONSES TO THE QUESTIONNAIRES ARE REVIEWED BY MANAGEMENT. MANAGEMENT EXPLAINS THE FORM ANNUALLY AT A BOARD OF DIRECTOR'S MEETING. MANAGEMENT ALSO MONITORS ALL TRANSACTIONS DURING THE NORMAL COURSE OF BUSINESS TO IDENTIFY OTHER POTENTIAL CONFLICTS. INDIVIDUALS WHO BELIEVE THEY ARE IN A POTENTIAL CONFLICT ARE REQUIRED TO RECUSE THEMSELVES FROM THE DELIBERATION AND DECISION-MAKING PROCESS.
FORM 990, PART VI, SECTION B, LINE 15A
FOR THE CEO'S COMPENSATION, PRIOR TO ANY INCREASE IN COMPENSATION OR BENEFITS, OR CHANGES TO THE TERMS OF THE CEO'S EMPLOYMENT CONTRACT, THE BOARD (I) EVALUATES THE CEO'S ACCOMPLISHMENTS AND WORK PERFORMANCE AND (II) COMMISSIONS AN INDEPENDENT SALARY REVIEW BY AN OUTSIDE CONSULTANT AND/OR REVIEWS COMPARABILITY DATA OF OTHER SIMILARLY-SITUATED NON-PROFIT AND FOR-PROFIT ORGANIZATIONS TO DETERMINE THE REASONABLENESS OF THE PROPOSED COMPENSATION AND/OR CONTRACT TERMS IN LIGHT OF THE COMPARABILITY DATA. THE CEO RECUSES HERSELF FROM THE MEETINGS DURING SUCH DELIBERATIONS. THE BOARD THEN VOTES REGARDING ANY CHANGES TO THE COMPENSATION FOLLOWING SUCH DELIBERATION, WITH THE CEO ABSTAINING FROM SUCH VOTE AND NOT IN ATTENDANCE. MINUTES OF THE MEETINGS AT WHICH SUCH VOTE IS TAKEN ARE DRAFTED AND SIGNED BY THE CHAIRMAN OR SECRETARY PRIOR TO THE NEXT BOARD MEETING.
FORM 990, PART VI, SECTION C, LINE 19
ARMS PROVIDES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS AND 990 TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G
OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,657,707. MANAGEMENT AND GENERAL EXPENSES 169,583. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,827,290.
FORM 990, PART XII, LINE 2C.
THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. THE PROCESS IS REVIEWED BY THE AUDIT COMMITTEE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.