OR, if not included in a risk pool or group rating for WC, use the paragraph below: Workers’ Compensation coverage is provided by the State of Ohio. The Cemetery pays the State Workers’ Compensation System a premium based on a rate per $100 of salaries. This rate is calculated based on accident history and administrative costs (if material). Can be deleted if immaterial. Commercial Insurance The Cemetery has obtained commercial insurance for the following Comprehensive property and general liability; Vehicles; and Errors and omissions. The Cemetery is uninsured for the following risks: Comprehensive property and general liability; Vehicles; and Errors and omissions. During 20CY, the Cemetery paid [Insert the following sentence if uninsured losses were material.] $XXX for losses that exceeded insurance coverage. [Also disclose any significant changes in coverage from the prior year. Risk Pool Membership The Cemetery is a member of the XYZ Self Insurance Pool (the Pool). The Pool assumes the risk of loss up to the limits of the [name of subdivision’s] policy. The Pool may make supplemental assessments if the experience of the overall pool is unfavorable. [Modify the preceding sentence as needed.] The Pool covers the following risks: General liability and casualty; Public official’s liability; and Vehicle. The Pool reported the following summary of assets and actuarially-measured liabilities available to pay those liabilities as of December 31: Self-Insurance The Cemetery is also self-insured for [describe type of coverage, such as employee health or liability insurance]. The Self-Insurance Fund pays covered claims to service providers, and recovers these costs from charges to other funds based on an actuarially determined cost per employee. [OR] Interfund rates are charged based on claims approved by the claims administrator. [OR] [describe other method of cost recovery]. A comparison of Self Insurance Fund cash and investments to the actuarially-measured liability as of December 31 follows:
OR, if not included in a risk pool or group rating for WC, use the paragraph below: Workers’ Compensation coverage is provided by the State of Ohio. The Cemetery pays the State Workers’ Compensation System a premium based on a rate per $100 of salaries. This rate is calculated based on accident history and administrative costs (if material). Can be deleted if immaterial. Commercial Insurance The Cemetery has obtained commercial insurance for the following Comprehensive property and general liability; Vehicles; and Errors and omissions. The Cemetery is uninsured for the following risks: Comprehensive property and general liability; Vehicles; and Errors and omissions. [Insert the following sentence if uninsured losses were material.] During 20CY, the Cemetery paid $XXX for losses that exceeded insurance coverage. [Also disclose any significant changes in coverage from the prior year. Risk Pool Membership The Cemetery is a member of the XYZ Self Insurance Pool (the Pool). The Pool assumes the risk of loss up to the limits of the [name of subdivision’s] policy. The Pool may make supplemental assessments if the experience of the overall pool is unfavorable. [Modify the preceding sentence as needed.] The Pool covers the following risks: General liability and casualty; Public official’s liability; and Vehicle. The Pool reported the following summary of assets and actuarially-measured liabilities available to pay those liabilities as of December 31: Self-Insurance The Cemetery is also self-insured for [describe type of coverage, such as employee health or liability insurance]. The Self-Insurance Fund pays covered claims to service providers, and recovers these costs from charges to other funds based on an actuarially determined cost per employee. [OR] Interfund rates are charged based on claims approved by the claims administrator. [OR] [describe other method of cost recovery]. A comparison of Self Insurance Fund cash and investments to the actuarially-measured liability as of December 31 follows:
AOS_Regulatory_Basis_Cemetery_Footnote_Shell_Dec2016.docx