2024-05-15T15:39:57-05:00 2023-12-31 593186310 THOMAS HOWELL FERGUSON PA 2615 CENTENNIAL BLVD SUITE 200 TALLAHASSEE FL 32308 990 2023-01-01 592225004 FLORIDA SELF-INSURERS GUARANTY ASSOCIATION INC FLOR 8502221882 1427 E PIEDMONT DRIVE 2ND FLOOR TALLAHASSEE FL 323087943 BRIAN GEE EXECUTIVE DIRECTOR 8502221882 2024-05-03 1 BRIAN GEE XXX-XX-XXXX 0 STACEY T KOLKA P01371120 8506688100 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z BRIAN GEE 1427 E PIEDMONT DRIVE 2ND FLOOR TALLAHASSEE FL 323087943 2862758 0 X WWW.FSIGA.ORG X 1982 FL TO PROVIDE FUNDS FOR THE SETTLEMENT OF COVERED WORKERS' COMPENSATION CLAIMS OF INDIVIDUAL INSOLVENT SELF-INSURERS OTHER THAN PUBLIC UTILITIES OR GOVERNMENTAL ENTITIES. 7 7 6 9 0 0 161944 213455 1492707 600123 726059 1868687 0 0 2380710 2682265 0 0 0 0 909629 947401 0 0 0 276769 262623 1186398 1210024 1194312 1472241 81215921 78521934 18603277 12941714 62612644 65580220 TO GUARANTEE PAYMENT OF FLORIDA WORKERS' COMPENSATION BENEFITS TO THE EMPLOYEES OF ITS INSOLVENT MEMBERS WHILE MINIMIZING THE TOTAL COST TO ITS MEMBERSHIP. 0 0 PROVIDED ADMINISTRATIVE AND PROFESSIONAL SERVICES TO SUPPORT THE REGULATION OF 102 CURRENT SELF-INSURERS AND 134 FORMER SELF-INSURERS, AS WELL AS, ADMINISTRATION AND PAYMENT OF WORKERS' COMPENSATION CLAIMS OF 14 ACTIVE INSOLVENCIES WITH 30 CLAIMANTS. 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 6 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X BRIAN GEE 8502221882 1427 E PIEDMONT DRIVE 2ND FLOOR TALL FL 323087943 CLAUDE D REVELS CHAIRMAN 1.00 X X 0 0 0 CHARLES A BOWDEN VICE-CHAIRMAN 1.00 X X 0 0 0 MICHELE ADAMS SECRETARY AND DIRECTOR THRU 8/27 1.00 X X 0 0 0 TRAVIS CAMP TREASURER 1.00 X X 0 0 0 ALAN BENDER DIRECTOR 1.00 X 0 0 0 CHARLES E BAILES IV DIRECTOR 1.00 X 0 0 0 CHRISTINE WINTERLING SECRETARY (ELECTED 12/1) 1.00 X X 0 0 0 EDWARD M SHAW DIRECTOR THRU 6/1 1.00 X 0 0 0 MARK RESLER DIRECTOR 1.00 X 0 0 0 BRIAN GEE EXECUTIVE DIRECTOR 40.00 X 255922 0 90885 RENN R VICKERS ASST EXEC DIRECTOR/OPERATI 40.00 X 146790 0 28038 402712 0 118923 2 0 1 0 0 213455 213455 CLAIM RECOVERIES (NET) 900099 401113 401113 FEES/CONTR. FROM GVMTS. 524298 199010 199010 600123 1549180 1549180 500000 180493 319507 319507 319507 2682265 600123 0 1868687 346808 428336 85667 39202 47388 9696 39366 14949 7318 20531 29776 3467 1818 6211 38936 DUES & SUBSCRIPTIONS 65731 MEMBER AUDITS 21999 STAFF EXPENSE 2059 MISCELLANEOUS 399 367 1210024 150005 108879 50430878 49962121 13565014 7963684 59949 63198 153971 143661 16521 10310 16823691 20296237 169863 117505 81215921 78521934 447601 494232 3391 83 18152285 12447399 18603277 12941714 X 62612644 65580220 62612644 65580220 81215921 78521934 1472241 1495335 0 X 0 1 X 1 0 0 1 0 113996 103812 10184 39975 39849 126 10310 CLAIMS PAYABLE - INSOLVENT 9467121 SECURITY DEPOSITS - INSOLVENT 2852312 SECURITY DEPOSITS - SOLVENT 127966 12447399 X 4448947 1495335 1495335 2953612 -271347 -271347 2682265 1481371 0 1481371 -271347 -271347 1210024 PART X, LINE 2: WITH FEW EXCEPTIONS, THE ASSOCIATION IS NO LONGER SUBJECT TO EXAMINATION BY MAJOR TAX JURISDICTIONS FOR YEARS ENDED DECEMBER 31, 2019 AND PRIOR. PART XI, LINE 4B - OTHER ADJUSTMENTS: CLAIMS EXPENSE -271,347. PART XII, LINE 4B - OTHER ADJUSTMENTS: CLAIMS EXPENSE -271,347. SCHEDULE D PAGE 4, PARTS XI AND XII, LINES 4B FOR AUDIT PRESENTATION PURPOSES, CLAIMS EXPENSE IS REPORTED AS AN EXPENSE ON THE AUDITED FINANCIAL STATEMENTS. FOR TAX RETURN PRESENTATION PURPOSES, THE CLAIMS EXPENSE IS ADDED TO CLAIMS RECOVERIES REVENUE (REPORTED ON FORM 990 PART VIII, LINE 2A). X 0 1 0 BRIAN GEE EXECUTIVE DIRECTOR 255922 0 0 0 0 0 52307 0 38578 0 346807 0 0 0 RENN R VICKERS ASST EXEC DIRECTOR/OPERATI 146790 0 0 0 0 0 28038 0 0 0 174828 0 0 0 PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN (457 PLAN) BRIAN GEE $22,500 FORM 990, PART VI, SECTION A, LINE 7A APPOINTMENTS TO THE BOARD OF DIRECTORS ARE MADE BY THE FLORIDA DEPARTMENT OF FINANCIAL SERVICES UPON RECOMMENDATION OF MEMBER SELF-INSURERS PURSUANT TO FLORIDA LAW. FORM 990, PART VI, SECTION A, LINE 7B ACTIVITIES ARE SUBJECT TO REVIEW AND OVERSIGHT BY THE FLORIDA DEPARTMENT OF FINANCIAL SERVICES PURSUANT TO FLORIDA LAW. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND ACCOMPANYING SCHEDULES ARE PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE ORGANIZATION'S ASSISTANT EXECUTIVE DIRECTOR AND EXECUTIVE DIRECTOR FOR ACCURACY. ALL ISSUES OR QUESTIONS ARE RESOLVED WITH THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORMS. THE FORM 990 AND ACCOMPANYING SCHEDULES ARE THEN DISTRIBUTED TO THE MEMBERS OF THE BOARD OF DIRECTORS FOR REVIEW AND COMMENT. DISTRIBUTION TO THE BOARD OF DIRECTORS MAY BE IN THE FORM OF ELECTRONIC MAIL, NOTIFICATION OF A LINK TO A WEBSITE OR ACTUAL MAILING OF THE DOCUMENT. IF NECESSARY, CORRECTIONS ARE MADE RESULTING FROM THE DIRECTORS' REVIEWS BEFORE THE RETURN IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12B OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO CERTIFY COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS ARE REQUIRED TO SIGN A STATEMENT AND DISCLOSE ANY CONFLICTS OF INTEREST. IF A QUESTION OF CONFLICT OF INTEREST ARISES AT A BOARD MEETING, THE CHAIRMAN OF THE BOARD WILL REFER TO THE GENERAL COUNSEL FOR RESOLUTION. FORM 990, PART VI, SECTION B, LINE 15A THE CHAIRMAN OF THE BOARD OF DIRECTORS ANNUALLY EVALUATES THE PERFORMANCE OF THE EXECUTIVE DIRECTOR, REVIEWS COMPARABLE COMPENSATION INFORMATION OF NOT FOR PROFIT ENTITIES OF SIMILAR SIZE AND FUNCTION, AND RECOMMENDS COMPENSATION OF THE EXECUTIVE DIRECTOR TO THE BOARD OF DIRECTORS FOR ITS CONSIDERATION AND APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 FLORIDA SELF-INSURERS GUARANTY ASSOCIATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND FORM 990S AVAILABLE TO THE PUBLIC UPON REQUEST. REGULATION SECTION 1.263(A)-1(F) - DE MINIMIS SAFE HARBOR ELECTION TAXPAYER NAME: FLORIDA SELF-INSURERS GUARANTY ASSOCIATION, INC. TAXPAYER ADDRESS: 1427 E. PIEDMONT DR., 2ND FL, TALLAHASSEE, FL 32308-7943 TAXPAYER ID NUMBER: 59-2225004 YEAR-END: 12/31/2023 UNDER IRC REGULATION SECTION 1.263(A)-1(F), THE TAXPAYER HEREBY ELECTS TO APPLY THE DE MINIMIS SAFE HARBOR ELECTION.