2018-11-13T18:08:51-06:00 2017-12-31 942290202 SHEA LABAGH DOBBERSTEIN PC 44 MONTGOMERY STREET SUITE 3200 SAN FRANCISCO CA 94104 990 2017-01-01 940358760 WORKERS' COMPENSATION INSUR RATING BUREAU OF CALIFORNIA WORK 4157770777 1221 BROADWAY SUITE 900 OAKLAND CA 94612 SANDRA MOLNAR DIRECTOR OF FINANCE 4157787022 2018-11-12 1 RONALD K SIMONIAN P00232207 4153974444 2018-11-12 64.88.174.3 2018-11-12 13:55:32 PS P 99A6CFE8424118605CAA572DC8C1740E946294C9 5079B407BCACA61734BCEC7B1CD4F731C7FDF80A 2017 2019-02-21 02:37:17Z WILLIAM JAMES MUDGE 1221 BROADWAY SUITE 900 OAKLAND CA 94612 39346432 0 X WWW.WCIRB.COM X 1915 CA COOPERATE WITH DETERMINING ADVISORY PURE PREMIUM RATES FOR WORKERS' COMP INSURANCE. 8 8 247 0 1369540 -329404 0 0 38302403 38992417 -14001 -29089 297582 295974 38585984 39259302 0 0 0 0 28479425 27100603 0 0 0 12086171 11264492 40565596 38365095 -1979612 894207 33192680 33667588 35771683 35657427 -2579003 -1989839 TO PROMOTE THE PUBLIC WELFARE AND COOPERATE WITH THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA IN DETERMINING ADVISORY PURE PREMIUM RATES FOR WORKERS' COMPENSATION INSURANCE. 0 0 38365095 37629191 THE PURPOSE OF THE BUREAU IS TO PROMOTE THE PUBLIC WELFARE AND COOPERATE WITH THE INSURANCE COMMISSIONER OF THE STATE OF CALIFORNIA IN DETERMINING ADVISORY PURE PREMIUM RATES FOR WORKERS' COMPENSATION INSURANCE. 38365095 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 19 0 1 247 1 1 1 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 1 0 0 1 1 0 0 1 1 1 1 0 CA X SANDRA MOLNAR 4157787022 1221 BROADWAY SUITE 900 OAKLAND CA 94612 DESIGNEE OF PACIFIC COMP INS CO GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF HARTFORD ACC & INDEM CO GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF OAK RIVER INSURANCE CO GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF ACE PROP & CASUALTY INS GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF ZENITH INSURANCE CO GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF STATE COMPENSATION INS FD GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF ZURICH AMERICAN INS CO GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 DESIGNEE OF NATL UNION FIRE INS PA GOVERNING COMMITTEE MEMBER 0.00 X 0 0 0 WILLIAM JAMES MUDGE PRESIDENT/CEO 40.00 X 677341 0 231923 BRENDA J KEYS SENIOR VICE PRESIDENT 40.00 X 353827 0 17886 DAVID M BELLUSCI EXECUTIVE VICE PRESIDENT 40.00 X 450576 0 31923 ERIC S RILEY SENIOR VICE PRESIDENT 40.00 X 294878 0 31856 JOHN GEORGEVITS SENIOR VICE PRESIDENT 40.00 X 316117 0 23269 MICHELLE G SHENG VICE PRESIDENT/DQ ASSURANC 40.00 X 256727 0 43788 WARD M BROOKS VICE PRESIDENT, ACTUARIAL 40.00 X 271515 0 17568 TONY MILANO VICE PRESIDENT, ACTUARIAL 40.00 X 236312 0 23808 SANDRA MOLNAR DIRECTOR OF FINANCE 40.00 X 192509 0 14975 KASERIN KONG-SANTOS SR. DIRECTOR IT ENGINEERING 40.00 X 206571 0 20811 PAUL KIM DIRECTOR, CTA 40.00 X 155056 0 19781 CHRISTOPHER WONG SENIOR DIRECTOR IT OPERATI 40.00 X 208162 0 30584 ROLF R SERAO MANAGING DIRECTOR, ENTERPRISE PROJECT OFFICE 40.00 X 196590 0 9042 SHARON FAGGIANO-CALLAWAY MANAGING DIRECTOR, CUSTOMER EXPERIENCE 40.00 X 221077 0 30547 KIRAN KRISHNA SR. DIRECTOR, ENTERPRISE D 40.00 X 209990 0 1045 KRISTEN MARSH MANAGING ATTORNEY 40.00 X 210820 0 21691 ARTHURO SANCHEZ DIRECTOR/PROJECT MANAGER 40.00 X 172037 0 12230 HENDERIK VALK SR. DATABASE ENGINEER 40.00 X 166936 0 21537 LINDA RADLER DIRECTOR/MEDICAL ANALYTICS 40.00 X 208578 0 11614 WENDY WAGGENER DIRECTOR/DATA STEWARD 40.00 X 183812 0 12434 PAUL BRINKLEY-ROGERS LEAD IT ARCHITECT 40.00 X 170545 0 30089 5359976 0 658401 83 0 1 0 TCS AMERICA-STAR 379 THORNALL ST 4TH FLOOR EDISON NJ 08837 CONSULTING FOR MAINFRAME AND STAR 1789376 PRUDENTIAL RETIREMENT 280 TRUMBULL ST FLOOR 20 HARTFORD CT 06103 RETIREMENT PLAN ASSET MANAGEMENT 579545 JOURNEY TEAM DBA SALINAS VALLEY COMPUTER 859 W SOUTH JORDAN PKWY SOUTH JORDAN UT 84095 IT CONSULTING & SERVICES 393623 SOFTCHOICE CORPORATION 16609 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 IT CONSULTING & SERVICES 273073 ACCOUNTING PRINCIPALS INC DEPT CH 14031 PALATINE IL 60055 ACCOUNTING & FINANCE STAFFING AGENCY 112723 11 ASSESSMENTS & MEMBERSHIP DUES 524298 36844221 36844221 FINES 524298 726713 726713 COVERAGE RECORDS 524298 704706 704706 PREMIUM WEB SERVICES 524298 317335 317335 NON WCPOLS POLICY PROCESSING 524298 214750 214750 184692 58257 126435 38992417 430 430 289660 289660 57611 87130 -29519 -29519 -29519 PARTNERSHIP INCOME 524298 6314 6314 6314 39259302 37629191 1369540 260571 5028570 15194093 3013713 2456247 1407980 232653 259449 1795091 152569 851156 1726509 273600 115626 8234 4551822 305813 DUES AND SUBSCRIPTIONS 296875 MAINTENANCE AND REPAIRS 246521 TELECOMMUNICATIONS 242764 PRINTING /PUBLICATIONS/ 128913 76897 38365095 4579972 6303219 281969 289194 860316 990992 10484528 3925670 7427994 6558858 19382947 18524206 659482 1001119 33192680 33667588 3792257 3256071 247801 140086 31731625 32261270 35771683 35657427 X 0 0 0 0 -2579003 -1989839 -2579003 -1989839 33192680 33667588 X 894207 -305043 X X 0 1 X 1 0 0 1 0 5444809 991187 4453622 3093585 2027267 1066318 1946134 907216 1038918 6558858 457(B) CAFETERIA PLAN DEFERRAL 1002114 DEFERRED RENT 3314245 ACCRUED PENSION BENEFIT OBLIGATION 18812534 ACCRUED POST RETIREMENT MEDICAL OBLIGATION 9132377 32261270 X 39252379 0 39252379 6923 6923 39259302 38364916 0 38364916 179 179 38365095 PART X, LINE 2: THE WCIRB IS A QUALIFIED ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER THE PROVISIONS OF THE INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(6) AND SECTION 23701E OF THE CALIFORNIA REVENUE AND TAXATION CODE. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE WCIRB'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES IN THE UNITED STATES OF AMERICA PROVIDES ACCOUNTING AND DISCLOSURE GUIDANCE ABOUT POSITIONS TAKEN BY AN ORGANIZATION IN ITS TAX RETURNS THAT MIGHT BE UNCERTAIN. MANAGEMENT HAS CONSIDERED ITS TAX POSITION AND BELIEVES THAT ALL OF THE POSITIONS TAKEN BY THE WCIRB IN ITS FEDERAL AND STATE TAX RETURNS ARE MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION. PART XI, LINE 4B - OTHER ADJUSTMENTS: SHIPPING AND HANDLING 179. INTEREST INCOME 430. PARTNERSHIP INCOME 6,314. PART XII, LINE 4B - OTHER ADJUSTMENTS: SHIPPING AND HANDLING 179. X X X X 0 1 0 WILLIAM JAMES MUDGE PRESIDENT/CEO 524000 0 153341 0 0 0 208100 0 23823 0 909264 0 0 0 BRENDA J KEYS SENIOR VICE PRESIDENT 297902 0 46133 0 9792 0 8100 0 9786 0 371713 0 0 0 DAVID M BELLUSCI EXECUTIVE VICE PRESIDENT 356673 0 80750 0 13153 0 8100 0 23823 0 482499 0 0 0 ERIC S RILEY SENIOR VICE PRESIDENT 247989 0 37989 0 8900 0 8100 0 23756 0 326734 0 0 0 JOHN GEORGEVITS SENIOR VICE PRESIDENT 275000 0 41117 0 0 0 8100 0 15169 0 339386 0 0 0 MICHELLE G SHENG VICE PRESIDENT/DQ ASSURANC 230316 0 26411 0 0 0 7702 0 36086 0 300515 0 0 0 WARD M BROOKS VICE PRESIDENT, ACTUARIAL 243724 0 27791 0 0 0 8100 0 9468 0 289083 0 0 0 TONY MILANO VICE PRESIDENT, ACTUARIAL 211769 0 24543 0 0 0 7089 0 16719 0 260120 0 0 0 SANDRA MOLNAR DIRECTOR OF FINANCE 172666 0 19843 0 0 0 5775 0 9200 0 207484 0 0 0 KASERIN KONG-SANTOS SR. DIRECTOR IT ENGINEERING 185323 0 21248 0 0 0 6197 0 14614 0 227382 0 0 0 PAUL KIM DIRECTOR, CTA 143967 0 11089 0 0 0 4652 0 15129 0 174837 0 0 0 CHRISTOPHER WONG SENIOR DIRECTOR IT OPERATI 190703 0 17459 0 0 0 6245 0 24339 0 238746 0 0 0 ROLF R SERAO MANAGING DIRECTOR, ENTERPRISE PROJEC 180212 0 16378 0 0 0 5898 0 3144 0 205632 0 0 0 SHARON FAGGIANO-CALLAWAY MANAGING DIRECTOR, CUSTOMER EXPERIEN 201767 0 19310 0 0 0 6632 0 23915 0 251624 0 0 0 KIRAN KRISHNA SR. DIRECTOR, ENTERPRISE D 192355 0 17635 0 0 0 0 0 1045 0 211035 0 0 0 KRISTEN MARSH MANAGING ATTORNEY 189110 0 21710 0 0 0 6325 0 15366 0 232511 0 0 0 ARTHURO SANCHEZ DIRECTOR/PROJECT MANAGER 162046 0 9991 0 0 0 5161 0 7069 0 184267 0 0 0 HENDERIK VALK SR. DATABASE ENGINEER 166436 0 500 0 0 0 5001 0 16536 0 188473 0 0 0 LINDA RADLER DIRECTOR/MEDICAL ANALYTICS 208578 0 0 0 0 0 0 0 11614 0 220192 0 0 0 WENDY WAGGENER DIRECTOR/DATA STEWARD 168241 0 15571 0 0 0 5514 0 6920 0 196246 0 0 0 PAUL BRINKLEY-ROGERS LEAD IT ARCHITECT 160386 0 10159 0 0 0 5116 0 24973 0 200634 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS MEMBERS FORM 990, PART VI, SECTION A, LINE 7A THERE IS AN ANNUAL MEMBERSHIP MEETING WHERE OFFICERS ARE ELECTED BY POPULAR VOTE FORM 990, PART VI, SECTION B, LINE 11B WCIRB'S GOVERNING BOARD HAS DESIGNATED A SUB-COMMITTEE (THE AUDIT COMMITTEE) TO REVIEW THE PROPRIETY OF THE 2017 TAX RETURN FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 THE BUDGET AND COMPENSATION SUBCOMMITTEE REVIEW THE SALARY SCHEDULE FOR ALL EXECUTIVE OFFICER POSITIONS ANNUALLY. AS NEEDED, STAFF WILL PROVIDE COMMERCIALLY AVAILABLE SALARY INFORMATION TO THE SUBCOMMITTEE AND MAY OBTAIN ADDITIONAL SALARY INFORMATION FROM OTHER RATING BUREAUS. PERIODICALLY, THE GOVERNING COMMITTEE AND OR BUDGET AND COMPENSATION SUBCOMMITTEE WILL COMMISSION A CUSTOM STUDY OF EXECUTIVE SALARIES. THE LAST SUCH STUDY WAS CONDUCTED BY AN INDEPENDENT CONSULTING FIRM IN 2005. THE GOVERNING COMMITTEE ADOPTED THE SALARY MATRIX AND EXECUTIVE OFFICER SALARY SCHEDULE RECOMMENDED BY INDEPENDENT CONSULTING FIRM ON DECEMBER 8, 2005. SINCE THEN, THE EXECUTIVE OFFICER SALARY SCHEDULE HAS BEEN ADJUSTED ON AN ANNUAL BASIS BY THE SAME PERCENTAGE AMOUNT AS THE SALARY SCHEDULE THAT APPLIES TO ALL OTHER POSITIONS. THE SUBCOMMITTEE REVIEWS THE MERIT MATRIX ANNUALLY.THE SUBCOMMITTEE ALSO REVIEWS THE INDIVIDUAL SALARIES AND PERFORMANCE OF THE PRESIDENT AND SENIOR VICE PRESIDENTS ANNUALLY AND MAKES ITS RECOMMENDATIONS TO THE GOVERNING COMMITTEE. SENIOR MANAGER PERFORMANCE EVALUATIONS ARE SUBJECT TO PROCEDURES ADOPTED BY THE GOVERNING COMMITTEE ON MARCH 26, 2008. THESE PROCEDURES ARE DOCUMENTED IN THE BUDGET AND COMPENSATION SUBCOMMITTEE MEETING MATERIALS AND MINUTES. MERIT INCREASES ARE SUBJECT TO THE ADOPTED MERIT MATRIX. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: MINIMUM PENSION AND POSTRETIREMENT MEDICAL LIABILITY ADJUSTMENT -298,299. INCOME FROM COMP DATA EXCHANGE -6,744. FORM 990, PART XII, LINE 1 THE ORGANIZATIONS FINANCIAL STATEMENTS ARE PREPARED ON THE GAAP BASIS FORM 990, PART XII, LINE 2C THE SELECTION OF THE INDEPENDENT ACCOUNTANT IS RECOMMENDED BY THE DIRECTOR OF FINANCE AND THE SENIOR VICE PRESIDENT, AND APPROVED BY THE AUDIT COMMITTEE. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED AND APPROVED BY THE AUDIT COMMITTEE AND RECOMMENDED TO THE GOVERNING COMMITTEE AT ITS REGULAR MEETING.