s-1_instructions_2021_edits

Public reporting burden for this collection of information is estimated to average 35 minutes, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control
number. Reporting of this information is mandatory and is required by the Labor-Management Reporting and Disclosure Act of 1959,
as amended, for the purpose of public disclosure. As this is public information, there are no assurances of confidentiality. If you have
any comments regarding this estimate or any other aspect of this information collection, including suggestions for reducing this burden,
please send them to the U.S. Department of Labor, Office of Labor-Management Standards, Room N-5609, 200 Constitution Avenue,
NW, Washington, DC 20210.

DO NOT SEND YOUR COMPLETED FORM S-1 TO THE ABOVE ADDRESS

INSTRUCTIONS FOR FORM S-1
SURETY COMPANY ANNUAL REPORT
GENERAL INSTRUCTIONS
I. WHY FILE
The Labor-Management Reporting and Disclosure Act of
1959, as amended (LMRDA), requires public disclosure
of financial information from any surety company which
issues a bond required by the LMRDA or the Employee
Retirement Income Security Act of 1974 (ERISA). The
Secretary, under the authority of the LMRDA, has
prescribed the filing of the Surety Company Report,
Form S-1, for surety companies to satisfy this reporting
requirement.
II. WHO MUST FILE
Form S-1 must be filed by any surety company having a
bond in force which insures the following: (1) a welfare
or pension plan covered by the ERISA; or (2) any labor
organization or trust in which a labor organization is
interested covered by the LMRDA. A single report for a
group of surety companies will not be accepted.
III. WHAT MUST BE REPORTED
Any surety company required to file Form S-1 must
report financial information regarding its bond
experience under the LMRDA and the ERISA, including
premiums received, total claims paid, amounts
recovered by way of subrogation, administrative and
legal expenses, and related data and information.
IV. WHO MUST SIGN THE REPORT
Both the president and the treasurer or corresponding
principal officers of the surety company must sign the
completed Form S-1. You do not need to have the
report notarized.
V. WHEN TO FILE
Each surety company required to file a report under the
LMRDA must file Form S-1 within 150 days after the end
of its fiscal year.
VI. HOW TO FILE
The Form S-1 must be completed and submitted
electronically via the Office of Labor-Management

Standards (OLMS) Electronic Forms System (EFS),
available on the OLMS website at www.dol.gov/olms. If
you must file an amended report, follow the prompts
within EFS.
NOTE: Upon registering with OLMS, the signatories
and preparers must enter the email addresses they
use to conduct business, in order to file the form via
the OLMS Electronic Forms System. While the email
addresses will not appear on the report, OLMS may
use the email address of the signatories and any
preparers to contact the surety company concerning
LMRDA compliance.
If you have difficulty navigating the software, or have
questions about its functions and features, call the
OLMS Help Desk at: (866) 401-1109. For questions
concerning the reporting requirements, please send an
email to [email protected] or call (202)
693-0123.
TEMPORARY HARDSHIP EXEMPTION: If a surety
company experiences unanticipated technical
difficulties that prevent the timely preparation and
submission of an electronic filing, the organization may
assert a temporary hardship exemption to prepare and
submit Form S-1 in paper format by the required due
date. An electronic format copy of the filed paper
format document shall be submitted to the Department
within ten business days after the required due date.
Unanticipated technical difficulties that may result in
additional delays should be brought to the attention of
OLMS which can be reached by email at [email protected] or by phone at (202) 693-0123.
NOTE: If either the paper filing or the electronic filing is
not received in the timeframe specified above, the
report will be considered delinquent.
VII. PUBLIC DISCLOSURE
Pursuant to the LMRDA, the U.S. Department of Labor
is required to make all submitted reports available for
public inspection. Reports may be viewed and
downloaded from the OLMS website at
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front of your old four-digit file number to meet the new
format requirement. For example, if your old file
number was 1234, enter 01234 in Item 1 of this year’s
report. If you have never previously filed the Form S-1,
leave this space blank.

www.unionreports.gov. For assistance, please email
[email protected] or call (202)693-0123.
VIII. OFFICER RESPONSIBILITIES AND PENALTIES
The president and treasurer or corresponding principal
officers of the surety company required to sign Form S-1
are personally responsible for its filing and accuracy.
Under the LMRDA, these individuals are subject to
criminal penalties for willful failure to file a required report
and/or false reporting. False reporting includes
making any false statement or misrepresentation of a
material fact while knowing it to be false, or for knowingly
failing to disclose a material fact in a required report or in
the information required to be contained in it or in any
information required to be submitted with it.

2.
YEAR ENDING — Enter the month, day, and
year of the ending date of the fiscal year covered by
this report.
3.
NAME OF SURETY COMPANY— Enter the
full legal name of the surety company filing this report.
4.
ADDRESS OF PRINCIPAL OFFICE—Enter the
complete address of the surety company where
mailshould be sent and received, including any building
and room number.

The reporting surety company and the officers required to
sign Form S-1 are also subject to civil prosecution for
violations of the filing requirements. Section 210 of the
LMRDA provides that “whenever it shall appear that any
person has violated or is about to violate any of the
provisions of this title, the Secretary may bring a civil
action for such relief (including injunctions) as may be
appropriate.”

• You must report the information on the basis of
the following code classifications as described in
the Fidelity Uniform Statistical Plan of the Surety
Association of America:

IX. RECORDKEEPING

Labor Unions - National or International Unions
Only…………………………………………….691

Special Instructions for Completing PARTS II and III

LMRDA

The individuals required to file Form S-1 are responsible
for maintaining records which must provide in sufficient
detail the information and data necessary to verify the
accuracy and completeness of the report. You must
retain the records for at least 5 years after the date the
report is filed. You must retain any record necessary to
verify, explain, or clarify the report including, but not
limited to, vouchers, worksheets, receipts, and applicable
resolutions.

Labor Unions - Local Unions Only……………...692
Labor Unions - National or International Unions including
Local Unions Under a Single
Policy………..……………………………………695
ERISA
Labor Unions - Health, Welfare and Pension Plans and
Trusts of…........................................…….697
Pension Retirement and Welfare Plans (non-profit) Other Than Labor Unions…….....……..872

Individuals are subject to penalties for willfully making any
false entry in or concealing, withholding, or destroying
any books, records, or statements required to be kept.

• The figures you report should not reflect any
reinsurance assumed or ceded.

X. COMPLETING FORM S-1

PART II — PREMIUM DATA

Read these instructions carefully before completing Form
S-1.

5. DIRECT PREMIUMS WRITTEN—Enter the Gross
Premiums (including Co-Surety) written or renewed
during the year, less Returns. See Special Instructions
above.

The Form S-1 must be completed and submitted
electronically. You may click on the “Validate” button at any
time to check for errors. This action will generate an “Errors
Page” listing any errors that will need to be corrected before
you will be able to sign the form. Clicking on the signature
lines will also perform the validation function.

6. DIRECT PREMIUMS EARNED—Enter the sum of
the “Direct Premiums Written” and the Unearned
Premium at the end of the preceding year less the
Unearned Premium at the end of the current year.

NOTE: Separate space will be available for reporting
experience figures for “Honesty” and “Faithful Discharge”
contracts.

7. EXPENSES INCURRED-OTHER THAN LOSS
ADJUSTMENT—Enter the sum of the following items
allocable to the premiums reported herein as reflected in
Part II of the Insurance Expense Exhibit filed under State
law:

PART I — IDENTIFICATION
1. FILE NUMBER — Enter the five-digit file number
assigned by OLMS for the reporting surety company.
Surety companies that filed a Form S-1 prior to October
2003 were assigned four-digit file numbers. OLMS has
now expanded file numbers to five digits. Place a zero in

Line 6 - Commission and Brokerage incurred
Line 7 - Other Acquisition, Field Supervision and
Collection Expenses Incurred.
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a. Date notice of loss received — Enter the date
(month, day, year) that you received notice of the
loss. Enter either (1) the date Notice of Loss was
received or (2) the date reserve was posted. The
basis selected must be used for all such entries.

Line 13 - General Expenses Incurred.
Line 14 - Taxes, Licenses, and Fees Incurred.
NOTE: Those amounts allocable to lines 7 and 13 may be
in the proportion to total expenses of lines 7 and 13 that the
premiums reported herein bear to total fidelity premiums.

b. Name and Address of Insured Sustaining
Loss Organization Name — Enter the full name
and complete mailing address of the insured
organization sustaining the loss, including Building
and room number, if any.

8. PERCENT OF DIRECT PREMIUMS EARNED—
Calculate the percent of the direct premiums earned
allocated to net losses by dividing the amount in Item 7
(Expenses Incurred – Other than Loss Adjustment) by the
amount in Item 6 (Direct Premiums Earned). Enter the total
in Item 8.

c. Bond Class Code — Enter the Surety
Association classification code to which loss is
charged.
d. Amount of Bond Coverage Available — Enter
the amount of the available bond coverage.
e. Gross Loss to Insured (if known) — Enter the
gross loss of the insured, if known.
f. Amount Paid to Insured in Report Year —
Enter the amount you paid to the insured during the
reporting year.
g. Amount of Salvage Recovered in Report Year
— Enter the amount of salvage recovered during
the reportable year.

PART III — LOSS DATA
9.
DIRECT LOSSES PAID—Enter the losses paid on
direct business only. The losses should not reflect
adjustments for salvage.
10. DIRECT LOSSES INCURRED—Enter the sum of
“Direct Losses Paid” and “Direct Losses Unpaid of the
current year less Direct Losses Unpaid from the previous
year. Include losses Incurred But Not Reported estimated
on a basis of relationship to the total Fidelity line.
11. DIRECT LOSS ADJUSTMENT EXPENSES
INCURRED—Enter the portion of Part II, Line 5, Column
20 of Insurance Expense Exhibit filed Under State law
which is allocable to “Direct Losses Incurred.”

ADDITIONAL INFORMATION AND SIGNATURES
16. ADDITIONAL INFORMATION—Enter any
additional information necessary for completing an item.
You must indicate the item to which the additional
information applies.

12. DIRECT SALVAGE RECOVERED—Enter only the
salvage recovered during the current year on “Direct
Losses Paid” in the current or prior years (net as to any
recovery expenses).

17-18. SIGNATURES—The completed Form S-1 which is
filed with OLMS must be signed by the president and
treasurer, or corresponding principal officers, of the surety
company. This report must bear two (2) signatures. If the
report is signed by an officer other than the president and/
or treasurer, so indicate by entering the correct title in the
title field next to the signature. Then you must Save and
revalidate the form. Once the form has passed validation,
then you must click to sign the report.

13. NET LOSSES—Calculate the net losses by adding
the amount in Item 10 (Direct Losses Incurred) to the
amount in Item 11 (Direct Loss Adjustment Expenses
Incurred), then subtracting the amount in Item 12
(Direct Salvage Recovered). Enter the total in Item 13.
14. PERCENT OF DIRECT PREMIUMS EARNED
ALLOCATED TO NET LOSSES—Calculate the percent
of direct premiums earned allocated to net losses by
dividing the amount in Item 13 (Net Losses) by the amount
in Item 6 (Direct Premiums Earned). Enter the total in
Item 14.

Enter the date the report was signed and the telephone
number(s) used by signatories to conduct official business.
You do not have to report a private, unlisted telephone
number.
NOTE: Upon registering with OLMS, the signatories and
preparers must enter the email addresses they use to
conduct business, in order to file the form via the OLMS
Electronic Forms System. While the email addresses will
not appear on the report, OLMS may use the email
address of the signatories and any preparers to contact
the surety company concerning LMRDA compliance.

PART IV—ITEMIZATION OF LOSSES REPORTED
DURING YEAR
15. REPORT INFORMATION FOR EACH LOSS FOR
WHICH A NOTICE WAS RECEIVED DURING THE
REPORT YEAR—Complete Item 15 with reference to
each Notice of Loss received during the report year
involving a welfare or pension plan covered by the ERISA
or involving any labor organization or trust in which a labor
organization is interested, either of which is covered by the
LMRDA. You must complete this Item whether or not
such welfare or pension plan, labor organization, or trust is
insured under a contract as reported in Parts Il and III
above.

Contact the nearest OLMS field office listed below if you
have questions about filing a surety company annual
report.

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If You Need Assistance
The Office of Labor-Management Standards has
district offices located in the following cities to assist
you if you have any questions concerning LMRDA
and CSRA reporting requirements.
Atlanta-Nashville
Boston-Buffalo
Chicago
Cincinnati-Cleveland
Dallas-New Orleans
Denver-St. Louis
Detroit-Milwaukee
Los Angeles
Philadelphia-Pittsburgh
New York
San Francisco-Seattle
Washington
Copies of labor organization annual financial reports,
employer reports, and labor relations consultant
reports filed for the year 2000 and after can be
viewed and printed at www.unionreports.gov. Copies
of reports for the year 1999 and earlier can be
ordered through the website.
Information about OLMS, including key personnel
and telephone numbers, compliance assistance
materials, the text of the LMRDA, and related Federal
Register and Code of Federal Regulations (CFR)
documents, is also available on the Internet at:
http://www.dol.gov/olms.
Additionally, you can call the OLMS national office at
(202) 693-0123 or email [email protected].
Revised XX/2021

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