Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE TWO EMPLOYER REPRESENTATIVE BOARD MEMBERS DO NOT HAVE VOTING RIGHTS TO VOTE ON BUDGET AND OPERATING EXPENSES OF THE POOL. THEY CAN VOTE ON ALL OTHER MATTERS. |
| 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 A, LINE 7B | WHILE NOT A STATE AGENCY, WWCIP 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 11B | 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 B, LINE 12C | BOARD MEMBERS AND KEY PERSONNEL ARE REQUIRED TO SIGN A "CODE OF ETHICS AND STANDARDS OF PROFESSIONAL CONDUCT" YEARLY. |
| 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 |
| FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC | AMERICAN HOME ASSURANCE - 175 WATER STREET, NEW YORK, NY 10038. GENERAL CASUALTY COMPANY - 30 WEST MONROE, SUITE 510, CHICAGO, IL 60603. WEST BEND MUTUAL INSURANCE - 1900 SOUTH 18TH AVE., WEST BEND, WI 53095. SOCIETY INSURANCE CO - 150 CAMELOT DR, FOND DU LAC, WI 54936. SFM MUTUAL INSURANCE COMPANY - 3500 AMERICAN BLVD W #700, BLOOMINGTON, MN 55431. TRAVELERS INDEMNITY CO - 1 TOWER SQUARE, HARTFORD, CT 06183. SECURA INSURANCE CO - 2401 SOUTH MEMORIAL DR, APPLETON, WI 54912. SENTRY INSURANCE A MUTUAL CO - 1800 NORTH POINT DR, STEVENS POINT, WI 54481. UNITED WISCONSIN INSURANCE CO - P.O. BOX 3026, MILWAUKEE, WI 53201. EMPLOYERS INSURANCE COMPANY OF WAUSAU - P.O. BOX 327, BROOKFIELD, WI 53005. CHRIS READER - P.O. BOX 8090, WAUSAU, WI 54402. DAN BURAZIN - 1800 NORTH POINT DR, STEVENS POINT, WI 54481. |
| 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 UNKNOWN. |
| FORM 990, PART XI, LINE 9: | DISBURSEMENTS DECLARED, NOT DISTRIB -9,755,137. AMORTIZATION PREMIUM ON INVESTMENTS -200,615. |
| FORM 990, PART XII, LINE 2C: | NO CHANGE FROM PRIOR YEAR |
| FORM 990, PART XI, LINE 9 | POOL RULES REQUIRE THAT A DISTRIBUTION BE DECLARED BUT NOT DISTRIBUTED IN AN AMOUNT SUFFICIENT TO ACHIEVE THE TARGET FUND VALUE BASED ON ACTUARIAL ESTIMATES OF OUTSTANDING LOSSES THUS, 2018 DISBURSEMENTS OF $9,755,137 WERE DECLARED BUT NOT DISTRIBUTED FROM ALL POOL MEMBERS IN 2018 BASED ON PRIOR PREMIUM WRITINGS IN ACCORDANCE WITH POOL RULES. THE DISTRIBUTION IS ACCOUNTED FOR AS A LIABILITY AND ADJUSTMENT TO NET 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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