Common use of PREMIUM PAYMENT PLAN Clause in Contracts

PREMIUM PAYMENT PLAN. The Premium Payment Plan for a full Fund Year shall be as follows: • $0 to $2,000 - 50% due January 1st, 50% due April 1st. • Over $2,000 - 25% due January 1st, remainder due in 6 monthly installments February - July. Upon failure to make a required payment of premium by the due date, the required premium payment shall accumulate interest at a floating rate equal to the prime rate (as published by the Wall Street Journal), plus six percent (6%) per annum or, if such rate is illegal, at the maximum rate allowed by law from the date the payment was due until the date of payment of the required premium payment plus accumulated interest. This Schedule 1 shall in no way impair the right of the Group to declare a default and pursue any and all remedies for non- payment of premium by a Member pursuant to the terms of this Agreement and the bylaws of the Group (including recov- ery of costs of collection and attorneys’ fees). SCHEDULE 2 ASSESSMENT PLAN In the event that the Group incurs a Deficit in any Fund Year, such Deficit shall be made up immediately. If such deficit exists the Members shall pay an additional premium assessed pursuant to the provisions of Section 7 (d) of the Indemnity Agreement and assessed pro-rata based on the Net Premium of the Members shall be subject to automatic assessment without further action by the Group. In the event an individual Mem- ber fails to pay any premium, assessment or other contribu- tion to the Group when due, the Members of the Group shall be subject to automatic assessment without further action by the Group. These obligations with respect to the Fund Year in question shall survive termination of this Agreement and any termination of the Member’s membership in the Group. SCHEDULE 3 REFUND OR CREDIT PLAN For the Fund Year 20 and, Unless modified, for subsequent years. With advice from the Administrator and approval from the Commissioner of Insurance, the Board of Directors of the Massachusetts Retail Merchants’ Workers’ Compensation Group, Inc. (the “Group”) will, after the end of each Fund Year, determine the total Surplus available either for distribution to the Members of the Group as a return, or to be taken into account in establishing the Contribution for subsequent years. The Surplus for any Fund Year shall be determined by an independent actuary for the Group and shall be equal to the market value of assets less the percent value of liabilities, less reserves for incurred but not reported claims, and less the contingency reserves for the Fund Year, if any. In order to participate in the distribution of the Surplus as a return, a Member must have continued to be a Member to the end of the Fund Year. In order for a Surplus to be taken into account in establishing a Member’s Contribution for subsequent Fund Years, the Member must have contributed to the Surplus in the Fund Year to which the Surplus arose. Members can expect to receive a distribution from the Surplus as a return of premium, if any, no earlier than twenty-four (24) months after the end of the Fund Year and annually thereafter. Any such distribution shall be made in accordance with the terms of the Code of Massachusetts Regulations, as may be amended from time to time, including Section 67.08 (4) of said Regulations. ON THE BASIS of the foregoing, the undersigned Member applied for membership in the Group and agrees to be bound hereby if accepted as a Member in the Group. 90 DAY TERMINATION NOTICE REQUIRED. See § 13. Company: Contact: Signature/Title: This Membership is accepted and the foregoing is agreed to as of this day of . Massachusetts Retail Merchants Workers’ Compensation Group, Inc. BY: Commonwealth of Massachusetts Division of Insurance APPLICATION FOR MEMBERSHIP IN A WORKERS’ COMPENSATION SELF-INSURANCE GROUP Name of Group: Massachusetts Retail Merchants Workers’ Compensation Group, Inc. __ __ __ _ __ __ _ __ _ Name of Applicant Address Telephone Number Fax Number Email address Number of Employees Federal Employer I.D. Number Nature of Business Type of Business Corporate ( ) Partnership ( ) Individual ( ) Other (Specify) If the applicant is an affiliate of another company, provide the name and address of the parent: The following documents must be included with this application: