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 6 | THE COMPANY IS A MUTUAL INSURANCE COMPANY, POLICYHOLDERS ARE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE POLICYHOLDERS HAVE THE RIGHT TO ELECT THE OFFICERS AND DIRECTORS AT THE ANNUAL MEETING. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE POLICYHOLDERS HAVE THE RIGHT TO VOTE ON ACTIONS OF THE BOARD AT THE ANNUAL MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE COMPANY ENGAGES AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM TO PREPARE THE 990. UPON COMPLETION A COPY IS PROVIDED TO THE COMPANY FOR THEM TO REVIEW, SIGN, AND FILE WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPANY AT IT'S ANNUAL MEETING REVIEWS AND REAFFIRMS ALL POLICIES AND PROCEDURES THAT GOVERN OPERATION OF THE COMPANY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE DIRECTORS MEET QUARTERLY AND AT THE ANNUAL MEETING TO DETERMINE STAFFING AND COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE COMPANY RETAINS A COPY OF THE FINANCIAL STATEMENTS AND TAX RETURNS TO PROVIDE UPON REQUEST BY A MEMBER. |
| FORM 990, PART VIII, LINE 2A | PREMIUMS PREMIUMS WRITTEN 375,537 UNEARNED PREMIUMS - CURRENT YEAR (145,922) UNEARNED PREMIUMS - PRIOR YEAR 147,706 REINSURANCE CEDED (134,617) POLICY FEES 36,582 NET PREMIUMS EARNED 239,171 |
| FORM 990, PART IX, LINE 4 | NET LOSSES LOSSES PAID 484,204 REINSURANCE RECOVERED (159,027) NET LOSSES PAID 325,177 UNPAID LOSSES CY 211,089 UNPAID LOSSES PY 0 REINS RECOV ON UNPAID CY (208,495) REINS RECOV ON UNPAID PY 0 NET LOSS ADJUSTMENT EXPENSE 7,767 NET LOSSES INCURRED 335,538 |
| FORM 990, PART XI, LINE 9: | MERGER OF NET ASSETS PER MERGER AGREEMENT -233,906. |
| FORM 990, PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED SINCE PRIOR YEAR. |
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