2025-11-06T07:49:14-06:00 2024-12-31 382157642 MANER COSTERISAN PC 2425 E GRAND RIVER SUITE 1 LANSING MI 489123291 990 2024-01-01 382435776 MICHIGAN WORKERS COMPENSATION PLACEMENT FACILITY MICH 7344629600 19500 VICTORY PARKWAY DRIVE 475 LIVONIA MI 48152 DAVE BRUECKMAN PRESIDENT & CEO 7344629600 2025-10-03 1 1 AMBER RATHBUN CPA P01786612 5173237500 2025-10-04 2024 2025-03-06 01:10:19Z DAVE BRUECKMAN 19500 VICTORY PARKWAY DRIVE 475 LIVONIA MI 48152 3066700 0 X WWW.CAOM.COM X 1983 MI RESPONSIBLE FOR ADDRESSING ALL PLAN AND POOL ADMINISTRATION DUTIES ASSOCIATED WITH SUPPORTING THE MICHIGAN WORKERS' COMPENSATION RESIDUAL MARKET, I.E. MARKET OF LAST RESORT 9 9 0 11 0 0 0 0 3148522 3000916 34926 65784 0 0 3183448 3066700 0 0 0 0 1841038 2067238 0 0 0 403270 326609 2244308 2393847 939140 672853 3058469 2698248 2251911 2157977 806558 540271 X THE MICHIGAN WORKERS' COMPENSATION PLACEMENT FACILITY (A.K.A. THE FACILITY) ADDRESSES ALL PLAN AND POOL ADMINISTRATION RESPONSIBILITIES REQUIRED TO OFFER AN ALTERNATIVE COVERAGE SOURCE FOR BUSINESSES UNABLE TO PROCURE WC INSURANCE COVERAGE IN THE VOLUNTARY MARKET. PLAN ADMINISTRATION DUTIES INCLUDE PROCESSING APPLICATIONS AGAINST ESTABLISHED ELIGIBILITY GUIDELINES, APPOINTING SERVICING CARRIERS TO ISSUE POLICIES AND PROCESS ANY SUBSEQUENT CLAIM ACTIVITY AND ESTABLISHING A VIABLE OUTSIDE VENDOR AND/OR SUITABLE INTERNAL RESOURCES TO ADDRESS THE VARIOUS POOL ADMINISTRATION RESPONSIBILITIES 0 0 THE MWCPF (THE FACILITY) IS PRIMARILY FOCUSED ON REVIEWING POTENTIAL INSURANCE APPLICANTS AND ASSIGNING THEM TO ONE OF THEIR CONTRACTED SERVICING CARRIERS CONSISTENT WITH THEIR ESTABLISHED QUOTA SHARE. THE FACILITY UTILIZES EXTERNAL RESOURCES TO ASSIST WITH THE SERVICING CARRIER SELECTION PROCESS, ANNUALLY EVALUATE EACH SERVICING CARRIER'S PERFORMANCE AGAINST ESTABLISHED PERFORMANCE STANDARDS AND MAINTAIN POOL RESERVES SUFFICIENT TO COVER THE FACILITY'S ULTIMATE LIABILITY. INTERNAL STAFF PROMULGATE EXPERIENCE MODS AND PREPARE THE ANNUAL FACILITY RATE FILING. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X EILEEN LABELL 7344629600 19500 VICTORY PARKWAY DRIVE 475 LIVONIA MI 48152 JAMES RALPH BOARD MEMBER 1.00 X 1000 0 0 DAWN ELZINGA BOARD MEMBER 1.00 X 0 0 0 AMANDA WARNER BOARD MEMBER 1.00 X 2000 0 0 JASON SWEET BOARD MEMBER 1.00 X 0 0 0 EDDIE HERRERA BOARD MEMBER 1.00 1.00 X 0 0 0 KYLEE MITCHELL WELLS BOARD MEMBER 1.00 X 1500 0 0 TRACEY MCLENON BOARD MEMBER 1.00 X 1500 0 0 RYAN VAUGHN BOARD MEMBER 1.00 X 0 0 0 BRIAN HOFFMAN BOARD MEMBER 1.00 1.00 X 0 0 0 BRIAN MELAS BOARD MEMBER (ENDED 10/24) 1.00 1.00 X 0 0 0 ED HANLON BOARD MEMBER (ENDED 12/24) 1.00 X 0 0 0 DAVE BRUECKMAN PRESIDENT 20.50 17.00 X 175358 143474 37094 ALAN BURNS SVP, CHIEF ACTUARY 20.50 17.00 X 141813 116029 35214 PAUL LIPSCOMB VP, OPERATIONS 20.50 17.00 X 80582 65930 26305 ALEX BEDOWAY DIRECTOR, ACTUARIAL & DATA REPORTING 20.50 17.00 X 95539 78169 27885 JAYARAJ SUBRAMANIAN CIO 20.50 17.00 X 103261 84487 25211 MICHAEL C TITHOF ACTUARY III 20.50 17.00 X 69989 57263 25111 JAYAN THOMAS SENIOR DEVELOPER II 20.50 17.00 X 61794 50559 8751 734336 595911 185571 3 0 1 0 0 MEMBER ASSESSMENTS 524298 3000916 3000916 3000916 65784 65784 3066700 3000916 0 65784 451989 1120366 167946 217657 109280 10555 24063 55823 18187 5779 97573 7811 2820 16524 COOPERATIVE INDUSTRY VE 73975 MISCELLANEOUS EXPENSES 13454 SALES & USE TAX 45 2393847 2177657 2356239 845878 341090 34934 919 3058469 2698248 2251911 2067440 90537 2251911 2157977 X 806558 540271 806558 540271 3058469 2698248 X 672853 -30306 -908834 X 0 1 X 1 0 0 X 3066700 0 3066700 0 3066700 2393847 0 2393847 0 2393847 PART X, LINE 2: IN THE PREPARATION OF TAX RETURNS, TAX POSITIONS ARE TAKEN BASED ON INTERPRETATION OF FEDERAL, STATE AND LOCAL INCOME TAX LAWS. MANAGEMENT PERIODICALLY REVIEWS AND EVALUATES THE STATUS OF UNCERTAIN TAX POSITIONS AND MAKES ESTIMATES OF AMOUNTS, INCLUDING INTEREST AND PENALTIES, ULTIMATELY DUE OR OWED. NO AMOUNTS HAVE BEEN IDENTIFIED, OR RECORDED, AS UNCERTAIN TAX POSITIONS. FEDERAL, STATE, AND LOCAL TAX RETURNS GENERALLY REMAIN OPEN FOR EXAMINATION BY THE VARIOUS TAXING AUTHORITIES FOR A PERIOD OF THREE TO FOUR YEARS. X X 0 0 0 DAVE BRUECKMAN PRESIDENT 175358 143474 0 0 0 0 10729 8778 9673 7914 195760 160166 0 0 ALAN BURNS SVP, CHIEF ACTUARY 141813 116029 0 0 0 0 8792 7193 10576 8653 161181 131875 0 0 JAYARAJ SUBRAMANIAN CIO 103261 84487 0 0 0 0 6326 5176 7540 6169 117127 95832 0 0 ALEX BEDOWAY DIRECTOR, ACTUARIAL & DATA REPORTING 95539 78169 0 0 0 0 5894 4822 9443 7726 110876 90717 0 0 PAUL LIPSCOMB VP, OPERATIONS 80582 65930 0 0 0 0 5033 4118 9435 7719 95050 77767 0 0 MICHAEL C TITHOF ACTUARY III 69989 57263 0 0 0 0 4427 3622 9384 7678 83800 68563 0 0 FORM 990, PART VI, SECTION A, LINE 6 ALL WORKERS COMPENSATION INSURERS IN MICHIGAN MUST BE A MEMBER OF THE FACILITY AS A CONDITION OF ITS AUTHORITY TO TRANSACT INSURANCE IN MICHIGAN. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBER CARRIERS MAY PARTICIPATE IN THE ELECTION OF THE GOVERNING BOARD, WHICH CONSISTS OF 8 MEMBER CARRIERS FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED AND VERIFIED BY THE PRESIDENT AND THE OFFICE MANAGER PRIOR TO NOTIFYING THE GOVERNING BOARD MEMBERS OF ITS AVAILABILITY. THE GOVERNING BOARD MEMBERS MAY REQUEST A COPY FOR THEIR REVIEW AND/OR RAISE ANY QUESTIONS AT THE SEPTEMBER GOVERNING BOARD MEETING PRIOR TO FILING THE RETURN FORM 990, PART VI, SECTION B, LINE 12C GOVERNING BOARD MEMBERS ARE ANNUALLY REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ACKNOWLEDGING THAT THEY DO NOT HAVE ANY CONFLICTS OF INTEREST SERVING ON THE BOARD. FURTHER, SINCE THE BOARD IS COMPRISED OF MEMBER CARRIERS, BOARD REPRESENTATIVES ARE ASKED TO ABSTAIN FROM VOTING IF THE ISSUE BEING DISCUSSED COULD IMPACT THEIR COMPANY FORM 990, PART VI, SECTION B, LINE 15 ALL POSITIONS IN THE ORGANIZATION, INCLUDING OFFICERS AND PRESIDENT ARE PERIODICALLY BENCHMARKED BY AN OUTSIDE COMPANY. COMPENSATION FOR EACH POSITION IS GIVEN A RANGE, AND COMPENSATION REMAINS WITHIN THAT RANGE. ANY CHANGES TO COMPENSATION ARE PART OF A COMPREHENSIVE MERIT PROGRAM AND IS BASED ON PERFORMANCE. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART XI, LINE 9: PRIOR YEAR REAPPORTIONMENT -908,834. FORM 990, PART XI, LINE 8 THE PRIOR YEAR FORM 990 NET ASSETS DID NOT TIE TO THE AUDIT, RESULTING IN A PRIOR PERIOD ADJUSTMENT ON THE CURRENT YEAR RETURN. COMPENSATION ADVISORY ORGANIZATION OF MICHIGAN 17197 N LAUREL PARK DRIVE LIVONIA MI 48152 382435780 PROVIDES MEMBERS WITH WORKERS' COMP PREMIUM, LOSS & INFORMATION MI 501(C)(6) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 COMPENSATION ADVISORY ORGANIZATION OF MICHIGAN N 55472 ACTUAL EXPENSES COMPENSATION ADVISORY ORGANIZATION OF MICHIGAN O 2067238 ACTUAL EXPENSES COMPENSATION ADVISORY ORGANIZATION OF MICHIGAN P 271137 ACTUAL EXPENSES