1

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, Division of Interpretations and 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. WHERE TO FILE

The completed Form S-1 and any required attachments 

and additional pages must be mailed to the following 

address:

U.S. Department of Labor

Office of Labor-Management Standards

200 Constitution Avenue, NW

Room N-5603 

Washington, DC 20210

VII. PUBLIC DISCLOSURE

Pursuant to the LMRDA, the U.S. Department of Labor is

required to make all submitted reports available for

public inspection. You may examine Form S-1 reports

at, and purchase copies from, the Office of LaborManagement Standards (OLMS) Public Disclosure Room

at the address listed in Section VI, or at the OLMS 

field office in whose jurisdiction the reporting organization

is located. At the end of these instructions 

is a list of OLMS field offices.

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.

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
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provisions of this title, the Secretary may bring a civil

action for such relief (including injunctions) as may be

appropriate.”

IX. RECORDKEEPING

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.

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.

X. COMPLETING FORM S-1

Read these instructions carefully before completing Form

S-1.

Information Entry. Entries on the report should be

typed or clearly printed in black ink. Do not use a pencil

or any other color ink.

Entering Dollars. In all Items dealing with monetary

values, report amounts in dollars only; do not enter

cents. Round cents to the nearest dollar. Enter a single

“0” in the boxes for reporting dollars if the surety

company has nothing to report.

Entering Dollars:

$1,573,844 — do not enter cents

Entering Zero:

$_,_ _ _, _ _ 0

Additional Pages. If you need additional space to

complete an item, enter the additional information on a 

separate letter-size (8.5 x 11) page(s), indicating the

number of the item to which the information applies.

Print clearly at the top of each attached page the

following information: (1) full name of the surety

company, (2) its file number as reported in Item 1 of

Form S-1, and (3) the ending date of the reporting period

as reported in Item 2. All attachments must be labeled

sequentially 1 of_, 2of_,etc.

NOTE: Separate space is provided for reporting

experience figures for “Honesty” and “Faithful Discharge”

contracts.

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 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.

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 mail

should be sent and received, including any building and

room number.

Special Instructions for Completing PARTS II and III

• 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:

LMRDA

Labor Unions - National or International Unions

Only....................................................691

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

• The figures you report should not reflect 

any reinsurance assumed or ceded.

PART II — PREMIUM DATA

5. DIRECT PREMIUMS WRITTEN—Enter the Gross

Premiums (including Co-Surety) written or renewed

during the year, less Returns. See Special Instructions

above.

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.

7. EXPENSES INCURRED-OTHER THAN LOSS

ADJUSTMENT—Enter the sum of the following items

allocable to the premiums reported herein as reflected in
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Part II of the Insurance Expense Exhibit filed under State

law:

Line 6 - Commission and Brokerage incurred

Line 7 - Other Acquisition, Field Supervision and

Collection Expenses Incurred.

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.

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.

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.”

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).

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.

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.

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.

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.

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.

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.

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 in Items

17 and/or 18 by (1) crossing out the pre-printed officer

title(s) and (2) inserting the appropriate officer title(s).

You must have original signatures on the Form S-1 filed
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with OLMS; stamped or mechanical signatures are not 

acceptable.

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.

Contact the nearest OLMS field office listed below if 

you have questions about filing a surety company 

annual report.

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.olms.dol.gov. 

Additionally, you can call the OLMS national office at 

(202) 693-0123 or email OLMS-Public@dol.gov.

(Technical Revisions 3/2015; 11/2016; 4/2020)