2024-09-04T10:36:02-05:00 2023-12-31 561750124 BATCHELOR TILLERY & ROBERTS LLP 3605 GLENWOOD AVENUE SUITE 350 RALEIGH NC 27612 990 2023-01-01 561566179 NORTH CAROLINA SELF INSURANCE SECURITY ASSOCIATION NORT 7046368933 POST OFFICE BOX 12442 RALEIGH NC 276052442 THOMAS R YARBORO CHAIRMAN 7046368933 2024-09-04 1 0 DAVID C CORN JR P02450220 9197878212 2023 2024-08-08 14:25:15Z THOMAS R YARBORO PO BOX 12442 RALEIGH NC 276052442 22164292 0 X WWW.NCSISA.ORG X 1986 NC THE ASSOCIATION PROVIDES A MECHANISM FOR PAYMENT OF COVERED WORKERS'COMPENSATION CLAIMS. 11 11 0 0 0 0 0 0 1620340 4504795 299059 1350633 0 0 1919399 5855428 0 0 0 0 0 0 0 0 0 1536342 9526619 1536342 9526619 383057 -3671191 42811926 49828194 7255971 14369028 35555955 35459166 X SEE SCHEDULE O 0 0 PURSUANT TO THE 2006 AND 2011 STATUTORY AMENDMENTS, THE ASSOCIATION EXPANDED ITS PROGRAM SERVICES TO INCLUDE THE PURCHASE OF FINANCIAL GUARANTEES, INSURANCE, REINSURANCE OR OTHER INSTRUMENTS TO COLLECTIVELY SECURE ALL OUTSTANDING INDIVIDUAL MEMBER SELF-INSURER WORKERS' COMPENSATION LIABILITIES ACCORDING TO ACTUARIAL REPORTS PROVIDED BY EACH MEMBER SELF-INSURER. THE ASSOCIATION, IN ACCORDANCE WITH ITS STATUTORY MANDATE, MAY IMPLEMENT THE ASSOCIATION AGGREGATE SECURITY SYSTEM (AASS) ON AN ANNUAL BASIS. THE AASS PROVIDES FOR A PORTFOLIO BASED SECURITY SYSTEM WHICH REPLACED INDIVIDUAL STATUTORY DEPOSITS COVERING MEMBER SELF-INSURER WORKERS' COMPENSATION LIABILITIES, REQUIRED AS A CONDITION OF BEING A LICENSED SELF-INSURER. THE AASS MAY USE A COMBINATION OF THE SECURITY FUND, FINANCIAL GUARANTEES, INSURANCE POLICIES OR OTHER INSTRUMENTS WHICH WERE PURCHASED BY THE ASSOCIATION. AS OF DECEMBER 31, 2023, THE ASSOCIATION HAD COVERAGE THROUGH A THREE-YEAR INSURANCE POLICY WHICH COVERED ALL PARTICIPATING MEMBER SELF-INSURERS IN THE AASS AS OF DECEMBER 1, 2022 AND WILL REMAIN IN EFFECT THROUGH NOVEMBER 30, 2025. THE ANNUAL COSTS OF THE AASS INCLUDE THE INSURANCE POLICY AS WELL AS DESIGN AND IMPLEMENTATION WHICH ARE PAID FROM THE AASS ASSESSMENTS OF PARTICIPATING SELF-INSURERS AS DETERMINED BY THE ASSOCIATION BOARD OF DIRECTORS. AASS ASSESSMENTS ARE BASED ON THE CREDIT WORTHINESS OF PARTICIPATING SELF-INSURERS AND THEIR PRO-RATA SHARE OF THE AGGREGATE OUTSTANDING WORKERS' COMPENSATION CLAIMS LIABILITIES. THE ASSOCIATION IS AUTHORIZED TO MONITOR AND HAS EVALUATED THE FINANCIAL CONDITION OF ALL PARTICIPATING SELF-INSURERS IN THE 2023-2024 AASS. ALTHOUGH GROUP SELF-INSURERS DO NOT PARTICIPATE IN THE AASS, THE ASSOCIATION IS REQUIRED TO PAY COVERED CLAIMS AGAINST INSOLVENT GROUP SELF-INSURERS IN ACCORDANCE WITH ITS STATUTORY MANDATE. ACCORDINGLY, THE ASSOCIATION HAS DISCRETION TO CONDUCT A SEPARATE ASSESSMENT OF GROUP SELF-INSURERS. UPON THE INSOLVENCY OF A MEMBER SELF-INSURER, THE ASSOCIATION WORKS IN CONCERT WITH THE NORTH CAROLINA DEPARTMENT OF INSURANCE, INVESTIGATES AND PARTICIPATES IN BANKRUPTCY PROCEEDINGS, AND WORKS WITH CORPORATE REPRESENTATIVES FROM THE INSOLVENT SELF-INSURER TO DETERMINE THE ACTION PLAN FOR THE PAYMENT OF OUTSTANDING MEMBER WORKERS' COMPENSATION CLAIMS. THE ASSOCIATION INVESTIGATES ALL RELEVANT INSURANCE CARRIERS TO DETERMINE WHAT IF ANY RECOVERIES MAY BE AVAILABLE FOR THE PAYMENT OF WORKERS' COMPENSATION CLAIMS. IN ACCORDANCE WITH ITS STATUTORY MANDATE, UPON DEFAULT, THE ASSOCIATION PURSUES RECOVERIES IN THE BANKRUPTCY COURT AND RECOVERIES FROM ALL RELEVANT INSURANCE CARRIERS OR FINANCIAL INSTITUTIONS AND PAYS COVERED CLAIMS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X DAVID C CORN JR 9197878212 3605 GLENWOOD AVENUE SUITE 350 RALEIGH NC 27612 X THOMAS R YARBORO CHAIRMAN, BOARD OF DIRECTORS 3.00 X X 0 0 0 SCOTT MYERS DIRECTOR 1.00 X 0 0 0 TIA SCHWEIKERT DIRECTOR 1.00 X 0 0 0 PATRICK EGLINTON VICE CHAIRMAN, BOARD OF DIRECTORS 2.00 X X 0 0 0 JULIE GROVES DIRECTOR 1.00 X 0 0 0 MELISSA CULBRETH SECRETARY-TREASURER, BOARD OF DIRECTORS 2.00 X X 0 0 0 NEAL COPE DIRECTOR 1.00 X 0 0 0 LEIGH HICKMAN DIRECTOR 1.00 X 0 0 0 CHARLES C KYLES DIRECTOR 1.00 X 0 0 0 STEPHANIE ROGERS DIRECTOR 1.00 X 0 0 0 GILL FRAZIER DIRECTOR 1.00 X 0 0 0 0 0 0 0 0 0 0 STUART LAW FIRM PLLC 1033 WADE AVENUE SUITE 202 RALEIGH NC 27605 LEGAL SERVICES 479283 MARSH USA INC 1166 6TH AVE NEW YORK NY 10036 CONSULTING/FEE & INSURANCE 366140 2 PROCEEDS FROM INSOLVENT MEMBERS 525920 3248018 3248018 ASSESSMENTS 524298 1256777 1256777 4504795 1139036 1139036 16520461 16308864 211597 211597 211597 5855428 4504795 0 1350633 116840 241967 33378 19265 102359 15000 26939 CHANGE IN EST. LIAB. CL 7281809 CLAIMS AND RELATED EXPE 1236968 AGGREGATE SECURITY SYST 400913 OTHER GENERAL/ADMINISTR 51181 9526619 1128977 3132986 2118249 1765989 449238 494999 38793692 43919933 321770 514287 42811926 49828194 440827 436875 1114402 949602 5700742 12982551 7255971 14369028 X 35555955 35459166 35555955 35459166 42811926 49828194 -3671191 3574402 0 X X 0 0 0 0 ESTIMATED FUTURE LIAB.-CLAIMS 12179425 RESIDUAL EQUITY LIABILITIES 803126 12982551 9327471 3574402 -102359 3472043 5855428 0 5855428 9424260 0 9424260 102359 102359 9526619 SCHEDULE D, PART XI, LINE 2D: INVESTMENT FEES NETTED AGAINST INVESTMENT RETURN IN AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XII, LINE 4B: INVESTMENT FEES NETTED AGAINST INVESTMENT RETURN IN AUDITED FINANCIAL STATEMENTS PRESLAR RISK SERVICES INC OWNED BY FORMER DIRECTOR 119600 MANAGEMENT SERVICES 0 FORM 990, PART VI, SECTION A, LINE 3 THIRD PARTY SERVICES PROVIDED BY DEWEY PRESLAR AND PRESLAR RISK SERVICES. AS DISCLOSED IN SCHEDULE L, PART IV, THE ASSOCIATION HAS ENTERED INTO A MANAGEMENT AGREEMENT WITH A FORMER DIRECTOR TO PERFORM EXECUTIVE DIRECTOR MANAGEMENT SERVICES FORM 990, PART VI, SECTION A, LINE 6 THE BOARD OF DIRECTORS GOVERNS THE ASSOCIATION IN ACCORDANCE WITH N.C. GEN. STAT. 97-132 AND THE ASSOCIATION PLAN OF OPERATION, WHICH PROVIDES THE BOARD SHALL CONSIST OF ELEVEN (11) PERSONS WHO ARE REPRESENTATIVES, OWNERS, EMPLOYEES, OR OFFICERS OF ASSOCIATION MEMBER SELF-INSURERS AND ARE ELECTED BY THE MEMBER SELF-INSURERS FOR STAGGERED TERMS OF THREE (3) YEARS SO THAT THE TERMS OF ALL DIRECTORS SHALL NOT EXPIRE IN THE SAME YEAR. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD ANNUALLY APPOINTS A NOMINATING COMMITTEE TO EVALUATE AND NOMINATE CANDIDATES FOR ELECTION TO THE BOARD OF DIRECTORS AT THE ASSOCIATION ANNUAL MEETING IN JULY OF EACH YEAR. THE BOARD MAY FILL VACANCIES BETWEEN ANNUAL MEETINGS BY A MAJOITY VOTE OF THE REMAINING DIRECTORS. MEMBER SELF-INSURERS MAY SUBMIT CANDIDATES TO THE NOMINATING COMMITTEE WHO PROVIDES ITS REPORT TO MEMBER SELF-INSURERS IN THE NOTICE OF THE ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FINANCIAL STATEMENTS AND FORM 990: THE BOARD OF DIRECTORS RECEIVES THE AUDITED FINANCIAL STATEMENTS AND FORM 990. THE AUDIT AND INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE AUDITED FINANCIAL STATEMENTS BEFORE THEY ARE FILED WITH THE NORTH CAROLINA DEPARTMENT OF INSURANCE. THE AUDIT AND INVESTMENT COMMITTEE REVIEWS, REVISES AND RECOMMENDS APPROVAL TO THE BOARD OF DIRECTORS OF THE FORM 990 BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY: THE BOARD OF DIRECTORS HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED ANNUALLY, AND EACH DIRECTOR EXECUTES AN ANNUAL FORM PROVIDINGTHEY HAVE REVIEWED THE POLICY AND ACKNOWLEDGE THAT THEY HAVE NO CONFLICT OF INTEREST BEYOND THE INHERENT CONFLICT OF INTEREST THAT THEY ARE EMPLOYED BY A MEMBER SELF-INSURER OF THE ASSOCIATION. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION DETERMINATION FOR EXECUTIVE DIRECTOR SERVICES: THE BOARD OF DIRECTORS REVIEWED FORM 990'S OF SIMILAR ORGANIZATIONS FOR LEVELS OF COMPENSATION PAID TO OTHER EXECUTIVE DIRECTORS TO DETERMINE A REASONABLE AMOUNT TO BE PAID FOR EXECUTIVE DIRECTOR MANAGEMENT SERVICES. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC INSPECTION: THE ASSOCIATION'S PLAN OF OPERATION AND SUMMARY FINANCIAL STATEMENTS ARE POSTED ON THE ASSOCIATION'S WEBSITE (NCSISA.ORG). THE ASSOCIATION'S CONFLICT OF INTEREST POLICY IS AVAILABLE FOR INSPECTION UPON REQUEST. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: THE ASSOCIATION WAS ESTABLISHED IN 1986 BY THE NORTH CAROLINA GENERAL ASSEMBLY AND IS AUTHORIZED UNDER ARTICLE 4, CHAPTER 97 OF THE NORTH CAROLINA GENERAL STATUTES AND IS A TAX EXEMPT UNINCORPORATED LEGAL ENTITY THAT PROVIDES THE MECHANISM FOR THE PAYMENT OF COVERED WORKERS' COMPENSATION CLAIMS AGAINST INSOLVENT MEMBER SELF-INSURERS. THE ASSOCIATION IS TAX-EXEMPT UNDER SECTION 501(C)(6) OF THE INTERNAL REVENUE CODE AND SERVES A UNIQUE ROLE AS THE STATUTORY SAFETY NET FOR INJURED WORKERS OF INSOLVENT CURRENT OR FORMER SELF-INSURERS. MEMBER SELF-INSURERS ARE DEFINED BY NORTH CAROLINA LAW AS INDIVIDUAL EMPLOYERS OR GROUPS OF TWO OR MORE EMPLOYERS THAT HAVE POOLED THEIR LIABILITIES UNDER APPLICABLE INSURANCE LAW AND HAVE BEEN LICENSED BY THE NORTH CAROLINA DEPARTMENT OF INSURANCE. ALL LICENSED INDIVIDUAL AND GROUP SELF-INSURERS MUST DEMONSTRATE THE REQUISITE FINANCIAL STRENGTH TO SECURE THEIR RESPECTIVE WORKERS' COMPENSATION OBLIGATIONS AND ARE REQUIRED BY STATUTE TO BE MEMBERS OF THE ASSOCIATION. INDIVIDUAL SELF-INSURERS MUST PARTICIPATE IN THE ANNUAL ASSOCIATION AGGREGATE SECURITY SYSTEM (AASS). IF AN INDIVIDUAL LICENSED SELF-INSURER IS EXCLUDED FROM THE AASS, IT MUST POST A STATUTORY DEPOSIT WITH THE NORTH CAROLINA DEPARTMENT OF INSURANCE. THE ASSOCIATION IS AUTHORIZED TO MONITOR AND ASSESS THE FINANCIAL CONDITION OF ALL INDIVIDUAL MEMBER SELF-INSURERS THAT PARTICIPATE IN THE AASS. THE ASSOCIATION SERVES AS A RESOURCE FOR ALL MEMBER SELF-INSURERS, THE NORTH CAROLINA DEPARTMENT OF INSURANCE AND THE NORTH CAROLINA INDUSTRIAL COMMISSION. THE ASSOCIATION PAYS COVERED WORKERS' COMPENSATION CLAIMS OF INJURED WORKERS FROM ITS SECURITY FUND WHICH HAS BEEN CREATED BY MEMBER SELF-INSURER ASSESSMENTS AND STATUTORY OR TERMINATING DEPOSITS PREVIOUSLY POSTED BY MEMBER SELF-INSURERS. AGGREGATE SECURITY INCLUDING INSTRUMENTS SUHC AS FINANCIAL GUARANTEES, INSURANCE OR REINSURANCE IS ALSO PURCHASED BY THE ASSOCIATION TO PROTECT THE SECURITY FUND. THE PROCEEDS OF THE SECURITY FUND ARE INVESTED AND ADMINISTERED BY INVESTMENT ADVISORS IN ACCORDANCE WITH AN INVESTMENT POLICY, WHICH IS APPROVED ANNUALLY BY THE NORTH CAROLINA STATE TREASURER. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: INDEPENDENT CONTRACTORS - ADDITIONAL DESCRIPTION OF SERVICES: STUART LAW FIRM, PLLC ADVISES THE EXECUTIVE DIRECTOR AND PREPARES REPORTS FOR QUARTERLY BOARD MEETINGS, ANALYZES INSURANCE REGULATORY REQUESTS FROM THE DEPARTMENT AND MEMBER SELF-INSURERS, ENGAGES IN LEGISLATIVE ANALYSIS AND ONGOING INTERPRETATION OF THE ASSOCIATION STATUTORY MANDATE INCLUDING THE IMPLEMENTATION OF THE ASSOCIATION AGGREGATE SECURITY SYSTEM, AND THE DETERMINATION OF COVERED CLAIMS. IT IS INVOLVED IN INSURANCE REGULATORY AND BANKRUPTCY LITIGATION, COVERAGE ANALYSIS, WORKER'S COMPENSATION DEFENSE AS WELL AS ANALYSIS AND NEGOTIATION OF ALL BUSINESS, CORPORATE, SURETY, SECURITIES AND BANKRUPTCY TRANSACTIONS INVOLVING THE ASSOCIATION. MARSH USA PROVIDES CONSULTING AND PLACEMENT SERVICES FOR THE ASSOCIATION AGGREGATE SECURITY SYSTEM.