2026-05-22T14:44:19-05:00 2025-12-31 994625061 CRI ADVISORS LLC 3011 ARMORY DRIVE SUITE 300 NASHVILLE TN 37204 990 2025-01-01 995014821 TENNESSEE SELF-INSURERS' GUARANTY ASSOCIATION TENN 6159698938 1320 ADAMS STREET 1600 NASHVILLE TN 37208 BRADLEY JACKSON EXECUTIVE DIRECTOR 6159698938 2026-05-14 1 JOHN V RAYBURN P00429464 6156651811 2026-05-14 2025 2025-03-06 01:10:19Z BRADLEY JACKSON 1320 ADAMS STREET STE 1600 NASHVILLE TN 37208 1026938 0 X N/A X 2024 TN SEE SCHEDULE O. 5 5 0 0 0 0 0 0 0 1022384 0 0 0 4554 0 1026938 0 0 0 0 0 0 0 0 0 0 301617 0 301617 0 725321 0 875321 0 150000 0 725321 X SEE SCHEDULE O. 0 0 THE ASSOCIATION IS LIABLE FOR THE WORKER COMPENSATION LIABILITIES OF ANY MEMBER SELF-INSURED WHO BECOMES INSOLVENT AND FAILS TO MEET WORKER COMPENSATION OBLIGATIONS FOR THE PAYMENT OF MEDICAL BILLS OR BENEFITS TO THEIR TENNESSEE-BASED EMPLOYEES OR FORMER EMPLOYEES PURSUANT TO TENNESSEE LAW. THE ASSOCIATION ENGAGES IN ACTIVITY FOR THE PURPOSE OF PREPARING TO MEET OR MEETING THE LIABILTIES OF INSOLVENT MEMBER SELF-INSUREDS. ALL FUNDING AND EXPENDITURES ARE FURTHER ALLOCATED TOWARDS THIS PURPOSE. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 3 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X BEN WHITEHOUSE 6156516737 1320 ADAMS STREET SUITE 1400 NASHVILLE TN 37208 X X ROB BEHNKE CHAIRMAN/DIRECTOR 0.50 X X 0 0 0 BAILEY PIPKIN DIRECTOR 0.50 X 0 0 0 STEVEN LORADY TREASURER/DIRECTOR 0.50 X X 0 0 0 CONNIE DOWNUM SECRETARY/DIRECTOR 0.50 X X 0 0 0 BRADLEY JACKSON EXECUTIVE DIRECTOR 1.00 X X 0 0 0 0 0 0 0 0 0 0 MARSH USA LLC 1166 AVENUE OF THE AMERICAS NEW YORK NY 10036 CONSULTING/FEE & INSURANCE 123188 1 ASSESSMENTS 524298 1022384 1022384 1022384 UNAPPLIED CASH PMNT IN 524298 4554 4554 4554 1026938 1026938 0 0 205188 77616 10000 448 6380 BANK CHARGES 1365 DUES AND SUBSCRIPTIONS 620 301617 875321 0 875321 150000 0 150000 X 0 0 0 0 0 725321 0 725321 0 875321 725321 0 X 0 0 0 BRADLEY JACKSON CONSULTING LLC OWNED BY EXEC DIRECTOR, BRADLEY JACKSON 84000 MANAGEMENT SERVICES 0 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION THE ASSOCATION WAS CREATED TO CARRY OUT ITS MANDATE ESTABLISHED BY THE TENNESSEE GENERAL ASSEMBLY IN 2024 TENN. PUB. ACTS. CH. 666 (THE ACT) BY SERVING AS THE STATE'S GUARANTY FUND FOR SELF-INSURED BUSINESSES. THE ASSOCIATION IS LIABLE FOR THE WORKER COMPENSATION LIABILITIES OF ANY MEMBER SELF-INSURED WHO BECOMES INSOLVENT AND FAILS TO MEET WORKER COMPENSATION OBLIGATIONS FOR PAYMENT OF MEDICAL BILLS OR BENEFITS TO THEIR TENNESSEE-BASED EMPLOYEES OR FORMER EMPLOYEES PURSUANT TO TENNESSEE LAW. ALL COMPANIES LICENSED TO BE SELF-INSURED EMPLOYERS BY THE TENNESSEE COMMISSIONER OF INSURANCE AT THE TIME OF THE ACT'S PASSAGE OR SUBSEQUENTLY LICENSED, ARE REQUIRED TO BE MEMBERS OF THE ASSOCIATION. THE ASSOCIATION'S EXPENSES AND BENEFITS ARE FUNDED THROUGH MANDATORY ASSESSMENTS OF THE MEMBERSHIP. FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION ALL COMPANIES LICENSED TO BE SELF-INSURED EMPLOYERS BY THE TENNESSEE COMMISSIONER OF INSURANCE AT THE TIME OF THE ACT'S PASSAGE OR SUBSEQUENTLY LICENSED, ARE REQUIRED TO BE MEMBERS OF THE ASSOCIATION. THE ASSOCIATION'S EXPENSES AND BENEFITS ARE FUNDED THROUGH MANDATORY ASSESSMENTS OF THE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE LAW FIRM OF BUTLER SNOW, LLP, IS ENGAGED TO PROVIDE LEGAL AND ADMINISTRATIVE SERVICES. IN ADDITION TO TRADITIONAL LEGAL REPRESENTATION, THE FIRM PROVIDES ADMINISTRATIVE SUPPORT INCLUDING COORDINATING THE ACTIVITIES OF THE ASSOCIATION AND OTHER ADMINISTRATIVE AND CLERICAL FUNCTIONS AS NECESSARY. CARR RIGGS & INGRAM ADVISORS LLC ESTABLISHES AND MAINTAINS THE ASSOCIATION'S ACCOUNTS, MAINTAINS THE ASSOCIATION'S BOOKS AND RECORDS, AND OVERSEES THE COLLECTION OF FUNDS REMITTED AND THE PAYMENT OF CLAIMS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS FIVE (5) MEMBERS WHO SERVE AS THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS COMPOSED OF A CHAIRMAN, TREASURER, SECRETARY, EXECUTIVE DIRECTOR, AND ONE (1) DIRECTOR. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT OF FORM 990 WAS PROVIDED TO THE MEMBERS OF THE GOVERNING BODY FOR REVIEW AND APPROVAL PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS OF THE ASSOCIATION HAS ADOPTED A POLICY THAT PROHIBITS BOARD MEMBERS, THE ADMINISTRATOR AND RETAINED CONSULTANTS FROM HAVING A CONFLICT OF INTEREST OR AN INTEREST IN A MATTER THAT MAY BE PERCEIVED AS A CONFLICT OF INTEREST. BOARD MEMBERS, THE ADMINISTRATOR AND RETAINED CONSULTANTS ARE REQUIRED TO REPORT TO THE BOARD OF DIRECTORS ANY CONFLICT OF INTEREST THAT THEY ENCOUNTER THEMSELVES OR THAT MAY COME TO THEIR ATTENTION WITH RESPECT TO ANOTHER PERSON. BOARD MEMBERS, THE ADMINISTRATOR AND CONSULTANTS ARE REQUIRED TO EXECUTE AT LEAST ANNUALLY A STATEMENT CONFIRMING THEIR UNDERSTANDING OF THE POLICY AND DISCLOSING ANY CONFLICT SITUATIONS OF WHICH THEY MAY BE AWARE. FORM 990, PART VI, SECTION B, LINE 15 NO COMPENSATION PAID IN 2025. FORM 990, PART VI, SECTION C, LINE 19 RECORDS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, LINE 1A, COMPENSATION OF EXECUTIVE DIRECTOR: PAYMENTS FOR MANAGEMENT SERVICES IN THE AMOUNT OF $84,000 WERE MADE TO BRADLEY JACKSON CONSULTING, LLC. THE LLC IS OWNED BY THE EXECUTIVE DIRECTOR, BRADLEY JACKSON. SEE SCHEDULE L.