This document provides a summary of workers' compensation metrics for Sample Company over 5 policy years. Key information includes: - Total claims were 131 with $1.47M in total incurred costs across all years - Frequency (claims per $1M payroll) ranged from 0.88 to 2.09 and severity (losses per $100 payroll) ranged from $0.69 to $3.90 across years - Top claim causes by count and cost were slips/trips/falls and strains from lifting/carrying

1. BKS SAMPLE ANALYTICS

2. Policy Year Carrier
Work Comp
Claims
Lost Time
(Ind)
Med Only
Report
Only
Total Paid
Total
Reserves
Total
Incurred
Ultimate
Incurred
Losses
Payroll
Non-Zero
Claims per
$1M
Losses per
$100 of
Payroll
Standard
Premium
Δ SIR /
Ded. and
Standard
SIR /
Deductible
SIR/Deducti
ble
Aggregate
Piercings
Premium + TPA
Costs
Standard
Loss Ratio
Loss Ratio MOD Rate
Year 1 Carrier 44 22 20 2 $783,522 $0 $783,522 $783,522 $20,101,677 2.09 $3.90 $469,391 - - - 167% - 0.95
Year 2 Carrier 19 5 13 1 $228,375 $0 $228,375 $228,375 $20,390,031 0.88 $1.12 $544,101 - - - 42% - 1.07
Year 3 Carrier 27 5 18 4 $138,631 $31,757 $170,388 $215,200 $24,669,583 0.93 $0.69 $709,492 $446,137 $500,000 $0 $92,968 24% 0% 1.11
Year 4 Carrier 32 7 21 4 $157,723 $62,578 $220,301 $331,113 $25,400,710 1.10 $0.87 $700,274 $384,607 $500,000 $0 $95,365 31% 0% 1.07
Year 5 Carrier 9 2 7 0 $13,467 $58,033 $71,501 N/A $6,722,489 1.34 $1.06 $187,037 $89,118 $500,000 $0 $26,419 38% 0% 0.97
131 41 79 11 $1,321,719 $152,368 $1,474,087 $1,629,711 $97,284,490 1.23 $1.52 $2,610,295 $830,744 - $0 $92,968 56% 0% -
* Most recent payroll and premium estimated policy year-to-valuation date
Policy Year Claims per $1M Year 4
Year 1 2.09 Class Code Payroll Claims per $1M
Year 2 0.88 ########## 8824 $21,202,866 2.41
Year 3 0.93 ########## 8810 $5,200,000 0.19
Year 4 1.10 Total $26,402,866 1.97
Year 5 1.34
Total 1.23
Year 5
Class Code Payroll Claims per $1M
8824 $20,500,000 2.24
8810 $6,353,000 0.63
Total $26,853,000 1.86
Class Code
8824
8810
Policy Year Losses per $100 Year 4
Year 1 $3.90 Class Code Losses per $100 ELR
Year 2 $1.12 July 1, 1905 8044 $4.37 $1.39
Year 3 $0.69 July 2, 1905 8810 $0.02 $0.09
Year 4 $0.87 July 3, 1905 Total $3.51 $1.13
Year 5 $1.06 July 4, 1905
Total $1.52 July 5, 1905
July 6, 1905
Year 5
Class Code Losses per $100 ELR
8044 $0.94 $1.39
8810 $0.50 $0.09
Total $0.84 $1.13
* ELR=Expected Loss Ratio, industry average
losses by class code
*Overall
ELR is a
weighted
average
Total
*ELR
represents
Description
Health Care Employees
Clerical/Office
Policy Year
SAMPLE COMPANY, LLC. WC DASHBOARD AND KPI'S
Class Code
0.00
0.50
1.00
1.50
2.00
2.50
Year 1 Year 2 Year 3 Year 4 Year 5
Non-Zero Claims per $1,000,000 of Payroll by Policy Year
$0.00
$0.50
$1.00
$1.50
$2.00
$2.50
$3.00
$3.50
$4.00
Year 1 Year 2 Year 3 Year 4 Year 5
Losses per $100 of Payroll by Policy Year

3. Executive Director Beds
Total
Injuries
Injuries Per
Bed
Injuries Per Bed
Current vs Prior
Total Claim
Severity
Claims per
Bed
Claims per $100
Current vs Prior
Sample Executive Director 1 38 10 0.26 -4.65% $14,494 381.42 -9.91%
Sample Executive Director 2 63 3 0.05 -4.76% $24,003 381.00 -15.18%
Sample Executive Director 3 76 4 0.05 -4.31% $33,408 439.58 -17.29%
Sample Executive Director 4 25 1 0.04 -4.76% $8,963 358.50 -12.51%
Sample Executive Director 5 117 6 0.05 -5.03% $49,166 420.22 -4.67%
Sample Executive Director 6 42 2 0.05 -4.76% $18,777 447.08 -4.67%
Sample Executive Director 7 41 2 0.05 -4.35% $16,914 412.54 -11.58%
Sample Executive Director 8 63 3 0.05 -4.76% $25,655 407.22 -8.76%
Sample Executive Director 9 114 6 0.05 -4.31% $49,007 429.89 -16.11%
Sample Executive Director 10 85 5 0.06 -5.12% $33,327 392.08 -14.97%
Sample Executive Director 11 7 3 0.43 -4.76% $2,483 354.70 -12.20%
Executive Director Rank & Rate - Prior 13 Fiscal Periods

4. Policy
Year
Claim
Number
Date of Loss Claimant
Claim
Status
Accident Description Location Lag Days Total Paid
Total
Reserves
Total
Incurred
Δ Last
Quarter
Year 1 3208084
March 9,
Year 1
Sample
Claimant 1
OPEN
EE was on bus with residents and bus was
pulled over and pulling resident in chair and
caused unknown injury
The Oaks of Kissimmee Health and
Rehabilitation Center
2 $69,950 $129,642 $199,593 $0
Year 2 3841783
August 25,
Year 2
Sample
Claimant 2
OPEN
The employees foot became tangled in the
edge of a comforter, causing the employee to
trip and strike her right shoulder against a wall
as she fell
Southern Lifestyle Senior Living Center 0 $156,845 $23,575 $180,420 $0
Year 1 4659689
October 19,
Year 1
Sample
Claimant 3
OPEN
EE was outside at the dumpster site assisting
with trash when the door slammed closed
severing the right
DeBary Health and Rehabilitation Center 0 $74,587 $14,742 $89,329 $0
Year 2 6175460
March 26,
Year 2
Sample
Claimant 4
OPEN
EMPLOYEE WAS HELPING A RESIDENT IN THE
SHOWER WHEN THE RESIDENT FELL ON HER
CAUSING PAIN TO HER RIGHT SHOULDER AND
LOWER BACK
Longwood Health and Rehabilitation Center 0 $1,545 $58,309 $59,854 $59,854
Year 3 6856246
February
25, Year 3
Sample
Claimant 5
CLOSED
EE was working and while assisting a resident
that was going to fall ee sprained wrist
The Rehabilitation Center of Winter Park 1 $54,633 $0 $54,633 $0
Year 5 3708368
December
10, Year 5
Sample
Claimant 6
OPEN
EMPLOYEE WAS STRUCK IN THE HEAD, RIGHT
SHOULDER AND BACK BY A CLOSET DOOR
WHEN IT FELL OFF THE TRACK
Margate Health and Rehabilitation Center 1 $10,823 $24,510 $35,333 $0
Year 4 1700315
February
11, Year 4
Sample
Claimant 7
CLOSED Resident fell on the employees lower back Southern Lifestyle Senior Living Center 0 $28,435 $0 $28,435 $94
Year 1 5042017
December
8, Year 1
Sample
Claimant 8
CLOSED
Employee was walking down the hallway and
approached coworker asking for a door stop. As
The Oaks of Kissimmee Health and
Rehabilitation Center
7 $27,018 $0 $27,018 $0
Year 1 2239092
May 20,
Year 1
Sample
Claimant 9
CLOSED Per EE bi fold door off track fell on forehead Southern Lifestyle Senior Living Center 0 $22,045 $0 $22,045 $0
Year 2 1339021
April 22,
Year 2
Sample
Claimant 8
OPEN
EMPLOYEE SLIPPED AND FELL, INJURING HER
LEFT KNEE AND LOWER BACK
Flagler Health and Rehabilitation Center 1 $2,079 $18,871 $20,950
New
Claim
$447,960 $269,650 $717,611 $59,948
SAMPLE COMPANY, LLC. WC LARGE LOSS SUMMARY (>$20K)
Total

5. No. of Claims
Policy Year No. of Claims
Year 1 42
Year 2 18
Year 3 23 ########
Year 4 28 ########
Year 5 9
Total 120
Tot. Incurred
Policy Year Tot. Incurred
Year 1 $783,522
Year 2 $228,375
Year 3 $170,388
Year 4 $220,301
Year 5 $286,002
Total $1,688,589
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
* Annualized value calculated using
the average of most recent 12
month performance
** Annualized value calculated
using the average of most recent
12 month performance
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
0
5
10
15
20
25
30
35
40
45
Year 1 Year 2 Year 3 Year 4 Year 5
Frequency by Policy Year (20XX Annualized)
2017 Annualized
No. of Claims
Payroll (Projected)
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
Year 1 Year 2 Year 3 Year 4 Year 5
Severity by Policy Year (20XX Annualized)
2017 Annualized
Tot. Incurred
Payroll (Projected)

6. No. of Claims
Policy Year Lost Time Med Only Record Only Total
Year 1 22 20 2 44
Year 2 5 13 1 19
Year 3 5 18 4 27
Year 4 7 21 4 32
Year 5 2 7 9
Total 41 79 11 131
* Payroll estimated policy year-to-valuation date
Tot. Incurred
Policy Year Lost Time Med Only Record Only Total
Year 1 $705,856 $77,666 $0 $783,522
Year 2 $213,026 $15,350 $0 $228,375
Year 3 $165,803 $4,584 $0 $170,388
Year 4 $197,565 $22,736 $0 $220,301
Year 5 $39,818 $31,683 $71,501
Total $1,322,068 $152,019 $0 $1,474,087
* Payroll estimated policy year-to-valuation date
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
0
5
10
15
20
25
30
35
40
45
50
Year 1 Year 2 Year 3 Year 4 Year 5
Frequency by Claim Type by Policy Year
Record Only
Med Only
Lost Time
Payroll
$0
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
Year 1 Year 2 Year 3 Year 4 Year 5
Severity by Claim Type by Policy Year
Record Only
Med Only
Lost Time
Payroll

7. Policy Year
Month No. of Claims
January 11
February 8
March 13 April 18, 3631
April 10 September 28, 3630
May 12
June 8
July 14
August 11
September 11
October 13
November 9
December 11
Total 131
Policy Year
Month Tot. Incurred
January $65,907
February $74,775
March $100,632
April $87,161
May $58,355
June $58,953
July $276,487
August $113,609
September $392,945
October $134,354
November $72,935
December $37,974
Total $1,474,087
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
0
2
4
6
8
10
12
14
January February March April May June July August September October November December
Frequency by Month (Year 1 through Year 5 - All Policy Years)
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
January February March April May June July August September October November December
Severity by Month (Year 1 through Year 5 - All Policy Years)

8. Policy Year
Claim Cause No. of Claims Δ
Sprain/Strain-Lifting/Carrying 13 0
Slip/Trip/Fall 13 +2
Strain/Sprain-Non-Lifting 9 +1 ########
Struck By 8 0 ########
Strike Against/Step On 7 +1
Laceration/Puncture 6 0
MVA 4 0
Caught Between 2 0
Animal/Insect 2 0
Foreign Body in Eye 1 0
Absorption/Inhalation 1 0
Misc 1 0
Personal Illness 1 0
Total 68 +4
Policy Year
Claim Cause Tot. Incurred Δ
Slip/Trip/Fall $196,339 $14,499
Struck By $85,657 $7,756
MVA $72,383 $8,785
Strain/Sprain-Non-Lifting $37,167 $4,042
Animal/Insect $31,219 $5,655
Sprain/Strain-Lifting/Carrying $29,863 $6,257
Laceration/Puncture $3,063 -$198
Caught Between $2,923 $482
Strike Against/Step On $2,758 $1,182
Absorption/Inhalation $591 $62
Foreign Body in Eye $155 $16
Misc $57 $6
Personal Illness $14 $2
Total $462,189 $48,546
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Frequency by Claim Cause (Prior 3 Policy Years)
Severity by Claim Cause (Prior 3 Policy Years)
Slip/Trip/Fall
Struck By
MVA
Strain/Sprain-Non-Lifting
Animal/Insect
Sprain/Strain-Lifting/Carrying
Laceration/Puncture
Caught Between
Strike Against/Step On
Absorption/Inhalation
Foreign Body in Eye
Misc
Personal Illness

9. Policy Year
Occupation No. of Claims Δ
Delivery Driver 15 0
Delivery Helper 12 0
Warehouse 8 +1 ########
Shop Technician 4 0 ########
Sales 4 +1
Service Tech 4 0
ROS Operator 2 0
Housekeeper 2 0
Customer Service 2 0
QA 2 +1
Parts 1 0
FABBER 1 0
Maintenance 1 0
Wrapper 1 0
Receiving 1 0
Loader 1 0
Store Warehouse 1 0
OPS. MANAGER 1 +1
GENERAL MANAGER 1 0
Display Manager 1 0
- 1 0
Shipping 1 0
Warehouse Manager 1 0
Total 68 +4
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Delivery Driver
Delivery Helper
Warehouse
Shop Technician
Sales
Service Tech
ROS Operator
Housekeeper
Customer Service
QA
Parts
FABBER
Maintenance
Wrapper
Receiving
Loader
Store Warehouse
OPS. MANAGER
GENERAL MANAGER
Display Manager
-
Shipping
Warehouse Manager
Frequency by Occupation (Prior 3 Policy Yrs)

10. Policy Year
Occupation Tot. Incurred Δ
Delivery Driver $273,163 $39,338
Sales $40,530 $637
Service Tech $32,894 $4,261 April 18, 3631
Delivery Helper $32,433 $0 September 28, 3630
Warehouse Manager $19,806 $0
ROS Operator $17,158 $0
Receiving $11,532 $0
Housekeeper $10,404 $167
Parts $6,307 $3,494
Shop Technician $5,479 $0
Warehouse $4,625 $649
Customer Service $3,215 $0
Maintenance $1,389 $0
GENERAL MANAGER $1,277 $0
FABBER $667 $0
OPS. MANAGER $581 $581
WRAPPER $226 -$581
QA $178 $0
Display Manager $113 $0
Store Warehouse $97 $0
Loader $79 $0
- $26 $0
Shipping $10 $0
Total $462,189 $48,546
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Severity by Occupation (Prior 3 Policy Years)
Delivery Driver
Sales
Service Tech
Delivery Helper
Warehouse Manager
ROS Operator
Receiving
Housekeeper
Parts
Shop Technician
Warehouse
Customer Service
Maintenance
GENERAL MANAGER
FABBER
OPS. MANAGER
WRAPPER
QA
Display Manager

11. Policy Year
Job Description DELIVERY DRIVER
Claim Cause No. of Claims Δ
Sprain/Strain-Lifting/Carrying 9 +6
Slip/Trip/Fall 2 -2 ########
Struck By 1 -1 ########
Strain/Sprain-Non-Lifting 1 -1
MVA 1 0
Caught Between 1 0
Total 15 +2
Policy Year
Job Description DELIVERY DRIVER
Claim Cause Tot. Incurred Δ
Slip/Trip/Fall $218,638 $91,214
Struck By $24,137 -$24,138
MVA $23,751 -$22,427
Sprain/Strain-Lifting/Carrying $3,443 -$1,693
Strain/Sprain-Non-Lifting $2,037 -$2,971
Caught Between $1,157 -$576
Total $273,163 $39,409
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Delivery Driver Frequency by Cause (Prior 3 Policy Years)
Delivery Driver Sev. by Cause (3 Prior Policy Years)
Slip/Trip/Fall
Struck By
MVA
Sprain/Strain-Lifting/Carrying
Strain/Sprain-Non-Lifting
Caught Between

12. Policy Year
Job Description DELIVERY HELPER
Claim Cause No. of Claims Δ
Sprain/Strain-Lifting/Carrying 5 0
Slip/Trip/Fall 4 0 ########
Strain/Sprain-Non-Lifting 2 0 ########
Struck By 1 0
Laceration/Puncture 1 0
MVA 1 0
Total 12 0
Policy Year
Job Description DELIVERY HELPER
Claim Cause Tot. Incurred Δ
MVA $24,104 $0
Slip/Trip/Fall $4,417 $0
Sprain/Strain-Lifting/Carrying $2,409 $0
Struck By $1,095 $0
Strain/Sprain-Non-Lifting $291 $0
Laceration/Puncture $117 $0
Total $32,433 $0
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Delivery Helper Freq. by Cause (Prior 3 Policy Years)
Delivery Helper Sev. by Cause (Prior 3 Policy Years)
MVA
Slip/Trip/Fall
Sprain/Strain-Lifting/Carrying
Struck By
Strain/Sprain-Non-Lifting
Laceration/Puncture

13. Policy Year
Job Description SALES
Claim Cause No. of Claims Δ
Slip/Trip/Fall 3 0
Struck By 1 0 ########
Total 4 0
Policy Year
Job Description SALES
Claim Cause Tot. Incurred Δ
Slip/Trip/Fall $32,710 $0
Total $7,820 $0
January 0, 1900 $40,530 $0
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Slip/Trip/Fall Struck By
Sales Frequency by Claim Cause (Prior 3 Policy Years)
Sales Severity by Claim Cause (Prior 3 Policy Years)
Slip/Trip/Fall
Struck By

14. No. of Claims
Age Cat Year 3 Year 4 Year 5 Total % Δ
18-25 4 8 1 21 31% 0
26-33 8 6 1 28 41% +1 632345
34-41 3 4 2 15 22% +1 632142
42-49 4 6 3 24 35% +3
50-57 4 4 1 16 24% +1
58-65 4 3 1 14 21% +1
66+ 3 1 6 9% +1
Total 27 32 9 68 100% +8
Tot. Incurred
Age Cat Year 3 Year 4 Year 5 Total % Δ
18-25 $12,841 $5,486 $142 $75,602 16% $3,437
26-33 $97,875 $10,690 $7,178 $548,007 119% $20,727
34-41 $7,561 $4,682 $11,421 $52,468 11% $2,190
42-49 $45,289 $23,798 $14,483 $279,156 60% $12,564
50-57 $4,238 $32,256 $4,074 $58,265 13% $2,645
58-65 $2,174 $139,836 $31,576 $172,319 37% $6,737
66+ $3,554 $2,626 $7,345 2% $246
Total $170,388 $220,301 $71,501 $462,189 100% $48,546
Avg. Claim Cost
Age Cat Year 3 Year 4 Year 5 Total % Δ
18-25 $3,210 $686 $142 $3,600 - $0
26-33 $12,234 $1,782 $7,178 $19,572 - $2,686
34-41 $2,520 $1,171 $5,711 $3,498 - $56
42-49 $11,322 $3,966 $4,828 $11,632 - -$1,528
50-57 $1,060 $8,064 $4,074 $3,642 - -$237
58-65 $544 $46,612 $31,576 $12,309 - $909
66+ $1,185 $2,626 $1,224 - $140
Total $6,311 $6,884 $7,945 $6,797 - $417
SAMPLE COMPANY, LLC. WC CLAIMANT TENURE METRICS
18-25 26-33 34-41 42-49 50-57 58-65 66+
Average Claim Cost by Lag Category (Prior 3 Policy Years)
18-25 26-33 34-41 42-49 50-57 58-65 66+
Frequency by Age Category by Policy Year (Prior 3 Policy Years)
20XX
20XH
20XG
18-25 26-33 34-41 42-49 50-57 58-65 66+
Severity by Lag Category by Policy Year (Prior 3 Policy Years)
20XX
20XH
20XG

15. No. of Claims
Tenure Cat Year 3 Year 4 Year 5 Total % Δ
<6 Months 7 12 2 20 30% +1
<1 5 2 7 10% 0 632345
1-2 4 7 4 15 22% +2 632142
3-5 0 6 2 7 10% +1
6-9 1 3 1 4 6% 0
10+ 2 1 1 5 7% +1
Not Listed 7 2 1 10 15% 0
Total 27 32 9 68 100% +5
Tot. Incurred
Tenure Cat Year 3 Year 4 Year 5 Total % Δ
<6 Months $14,749 $8,727 $10,528 $36,887 8% $714
<1 $5,285 $8,539 $14,518 3% $167
1-2 $62,585 $42,668 $27,342 $154,913 34% $7,918
3-5 $5,013 $102,517 $5,412 $52,224 11% $4,390
6-9 $16 $3,734 $7,178 $3,096 1% -$900
10+ $68,158 $1,269 $5,251 $145,445 31% $35,250
Not Listed $14,581 $52,848 $15,788 $55,106 12% $1,007
Total $170,388 $220,301 $71,501 $462,189 100% $48,546
Avg. Claim Cost
Tenure Cat Year 3 Year 4 Year 5 Total % Δ
<6 Months $2,039 $732 $6,629 $1,818 - -$20
<1 $1,096 $4,536 $2,036 - $33
1-2 $14,423 $6,182 $7,378 $10,463 - -$1,687
3-5 $10,398 $18,154 $3,408 $7,326 - $80
6-9 $17 $1,488 $13,559 $807 - -$332
10+ $28,273 $1,011 $4,959 $29,469 - $1,080
Not Listed $2,160 $28,075 $29,822 $5,583 - $144
Total $6,311 $6,884 $7,945 $6,797 - $417
SAMPLE COMPANY, LLC. WC CLAIMANT TENURE METRICS
<6 Months <1 1-2 3-5 6-9 10+ Not Listed
Average Claim Cost by Tenure Category (Prior 3 Policy Years)
<6 Months <1 1-2 3-5 6-9 10+ Not Listed
Frequency by Tenure Category by Policy Year (Prior 3 Policy Years)
20XX
20XH
20XG
<6 Months <1 1-2 3-5 6-9 10+ Not Listed
Severity by Tenure Category by Policy Year (Prior 3 Policy Years)
20XX
20XH
20XG

16. Policy Year (Multiple Items)
<1 Year Category No. of Claims Δ
<1 Month 3 0
1 Month 5 +1
2 Months 3 0
3 Months 5 0
4 Months 2 0 April 18, 3631
5 Months 1 0 September 28, 3630
6 Months 1 0
7 Months 2 0
8 Months 1 0
9 Months 2 0
11 Months 2 0
Total 27 +1
Policy Year (Multiple Items)
<1 Year Category Tot. Incurred Δ
<1 Month $906 $0
1 Month $1,163 $1,500
2 Months $6,999 -$1,500
3 Months $2,793 $1,844
4 Months $24,904 $0
5 Months $627 $0
6 Months $26 $0
7 Months $4,248 $0
8 Months $2,999 $0
9 Months $6,008 $432
11 Months $731 $0
Total $51,405 $2,275
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Severity of Claims for Claimants <1 Year Tenure (Prior 3 Policy Years)
<1 Month
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
11 Months
0
1
2
3
4
5
6
7
8
9
<1 Month 1 Month 2 Months 3 Months 4 Months 5 Months 6 Months 7 Months 8 Months 9 Months 11 Months
Frequency of Claims for Claimants <1 Year Tenure (Prior 3 Policy Years)

17. Policy Year
Location No. of Claims Δ
DeBary Health and Rehabilitation Center 24 0
Lake Placid Health and Rehabilitation Center 12 +5
Longwood Health and Rehabilitation Center 7 0
Parkside Health and Rehabilitation Center 4 +2
Southern Lifestyle Senior Living Center 3 0
The Oaks of Kissimmee Health and Rehabilitation Center 3 0
The Rehabilitation Center of Winter Park 2 0
Boynton Health Care Center 2 0
Coastal Health and Rehabilitation Center 2 +1
Flagler Health and Rehabilitation Center 2 0
Margate Health and Rehabilitation Center 1 0
Royal Palm Beach Health and Rehabilitation Center 1 0
Salerno Bay Health and Rehabilitation Center 1 0
Seaside Health and Rehabilitation Center 1 0
Viera del Mar Health and Rehabilitation Center 1 0
Wave Crest Health and Rehabilitation Center 1 0
Arcadia Health and Rehabilitation Center 1 0
Total 68 +8
Policy Year
Location Tot. Incurred Δ
DeBary Health and Rehabilitation Center $259,016 $36,621
The Oaks of Kissimmee Health and Rehabilitation Center $50,652 $542
Southern Lifestyle Senior Living Center $38,481 $3,456
Lake Placid Health and Rehabilitation Center $27,687 $4,507
Parkside Health and Rehabilitation Center $22,586 $1,193
Boynton Health Care Center $21,554 $1,007
Margate Health and Rehabilitation Center $11,832 $0
Coastal Health and Rehabilitation Center $11,628 $883
The Rehabilitation Center of Winter Park $7,049 $300
Longwood Health and Rehabilitation Center $5,129 $0
Seaside Health and Rehabilitation Center $2,548 $0
Flagler Health and Rehabilitation Center $2,014 $0
Salerno Bay Health and Rehabilitation Center $1,370 $0
Wave Crest Health and Rehabilitation Center $321 $36
Royal Palm Beach Health and Rehabilitation Center $271 $0
Viera del Mar Health and Rehabilitation Center $38 $0
Arcadia Health and Rehabilitation Center $13 $0
Total $462,189 $48,546
SAMPLE COMPANY, LLC. WC FREQUENCY AND SEVERITY METRICS
Location 1
Location 2
Location 3
Location 4
Location 5
Location 6
Location 7
Location 8
Location 9
Location 10
Location 11
Location 12
Location 13
Location 14
Location 15
Location 16
Location 17
Frequency by Location (20XG-20XX Policy Years)
Severity by Location (20XG-20XX Policy Years)
Location 1
Location 6
Location 5
Location 2
Location 4
Location 8
Location 11
Location 9
Location 7
Location 3
Location 14
Location 10
Location 13
Location 16
Location 12
Location 15
Location 17

18. 632345
632142
SAMPLE COMPANY, LLC. WC TIMELINE
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
Prior Policy 1 Prior Policy 2 Prior Policy 3 Policy Year 1 Policy Year 2 Policy Year 3 Policy Year 4 Policy Year 5 Policy Year
6
#ofClaims
Claim Frequency Timeline (Prior 8 Policy Years)
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
2015 2016 2017 2018
#ofClaims
Claim Frequency Timeline (Prior 3 Policy Years)

19. No. of Claims
Lag Category Policy Year 3 Policy Year 4 Policy Year 5 Total % Δ
0-1 days 7 7 2 16 24% +1
2-3 days 13 9 2 24 35% +2 632345
4-7 days 7 8 2 17 25% +1 632142
8-14 days 2 1 3 4% +1
15-29 days 3 1 1 5 7%
30+ days 1 1 1 3 4% +1
Total 31 28 9 68 100% +6
Tot. Incurred
Lag Category Policy Year 3 Policy Year 4 Policy Year 5 Total % Δ
0-1 days $79,282 $54,557 $3,075 $136,914 30% $8,636
2-3 days $117,120 $9,453 $4,983 $131,556 28% $3,547
4-7 days $16,562 $9,706 $1,940 $28,208 6% $778
8-14 days $12,273 $581 $12,854 3% $581
15-29 days $146,374 $618 $1,168 $148,160 32%
30+ days $39 $303 $4,074 $4,416 1% $714
Total $359,378 $86,910 $15,821 $462,109 100% $48,537
Avg. Claim Cost
Lag Category Policy Year 3 Policy Year 4 Policy Year 5 Total % Δ
0-1 days $11,326 $7,794 $1,538 $8,557 - $358
2-3 days $9,009 $1,050 $2,492 $5,482 - -$268
4-7 days $2,366 $1,213 $970 $1,659 - -$102
8-14 days $6,137 $581 $4,285 - -$1,284
15-29 days $48,791 $618 $1,168 $29,632 - $11,064
30+ days $39 $303 $4,074 $1,472 - -$109
Total $11,593 $3,104 $1,758 $6,796 - $417
SAMPLE COMPANY, LLC. WC LAG REPORTING METRICS
0-1 days 2-3 days 4-7 days 8-14 days 15-29 days 30+ days
Average Claim Cost by Lag Category (Prior 3 Policy Years)
0-1 days 2-3 days 4-7 days 8-14 days 15-29 days 30+ days
Frequency by Lag Category by Policy Year (Prior 3 Policy Years)
2017
2016
2015
0-1 days 2-3 days 4-7 days 8-14 days 15-29 days 30+ days
Severity by Lag Category by Policy Year (Prior 3 Policy Years)
2017
2016
2015

20. Policy Year Carrier
No. of
Claims
No. of
Open
Claims
Non-Zero
Value
Claims
Zero
Value
Claims
Total Paid
Total
Reserves
Total
Incurred
No. of Beds
Annual
Premium
Earned
Premium
Non-Zero
Claims
per Bed
Losses
per Bed
Loss Ratio
Year 1 Sample Carrier 1 3 0 3 0 $555,409 $0 $555,409 - - $203,573 - - 273%
Year 2 Sample Carrier 1 5 0 1 4 $1,984 $0 $471,003 - - $275,000 - - 171%
Year 3 Sample Carrier 1 5 0 2 3 $10,983 $0 $145,263 - - $315,119 - - 46%
Year 4 Sample Carrier 2 8 4 5 3 $30,629 $440,374 $133,267 671 $252,688 $310,698 0.01 $701.94 43%
Year 5 Sample Carrier 3 6 5 1 5 $83,000 $0 $83,000 671 $235,796 $295,679 0.00 $123.70 28%
14 9 6 8 $113,629 $440,374 $216,267 1342 $488,483 $606,377 0.00 $161.15 36%
*Current Year earned premium estimated year-to-valuation date
Policy Year Claims per Bed
Year 4 0.01
Year 5 0.00
Total 0.01
Policy Year Losses per Bed
Year 4 $680.67
Year 5 $123.70
Total $804.36
SAMPLE COMPANY, LLC. GL-PL DASHBOARD & KPI'S
2 Year Total
0.00
0.00
0.00
0.01
0.01
Year 4 Year 5
Non-Zero Claims per Bed by Policy Year
0
100
200
300
400
500
600
700
2016 2017
Losses per Bed by Policy Year
19

21. Policy
Year
Claim
Number
Date of
Loss
Claimant
Claim
Status
Accident Description Location Lag Days Total Paid
Total
Reserves
Total
Incurred
Δ Last
Quarter
Year 3 5452652
March 9,
Year 3
Claimant 1 OPEN
EE was on bus with residents and bus was
pulled over and pulling resident in chair and
caused unknown injury
The Oaks of
Kissimmee Health
and Rehabilitation
2 $69,950 $129,642 $199,593 $0
Year 4 8670121
August 25,
Year 4
Claimant 2 OPEN
The employees foot became tangled in the
edge of a comforter, causing the employee to
trip and strike her right shoulder against a
wall as she fell
Southern Lifestyle
Senior Living
Center
0 $156,845 $23,575 $180,420 $0
Year 3 3824948
October 19,
Year 3
Claimant 3 OPEN
EE was outside at the dumpster site assisting
with trash when the door slammed closed
severing the right
DeBary Health and
Rehabilitation
Center
0 $74,587 $14,742 $89,329 $0
Year 5 5268510
March 26,
Year 5
Claimant 4 OPEN
EMPLOYEE WAS HELPING A RESIDENT IN THE
SHOWER WHEN THE RESIDENT FELL ON HER
CAUSING PAIN TO HER RIGHT SHOULDER AND
LOWER BACK
Longwood Health
and Rehabilitation
Center
0 $1,545 $58,309 $59,854 $59,854
Year 3 4749638
February
25, Year 3
Claimant 5 CLOSED
EE was working and while assisting a resident
that was going to fall ee sprained wrist
The Rehabilitation
Center of Winter
Park
1 $54,633 $0 $54,633 $0
Year 5 7158100
December
10, Year 5
Claimant 6 OPEN
EMPLOYEE WAS STRUCK IN THE HEAD, RIGHT
SHOULDER AND BACK BY A CLOSET DOOR
WHEN IT FELL OFF THE TRACK
Margate Health
and Rehabilitation
Center
1 $10,823 $24,510 $35,333 $0
Year 4 1940288
February
11, Year 4
Claimant 7 CLOSED Resident fell on the employees lower back
Southern Lifestyle
Senior Living
Center
0 $28,435 $0 $28,435 $94
Year 3 1776979
December
8, Year 3
Claimant 8 CLOSED
Employee was walking down the hallway and
approached coworker asking for a door stop.
As
The Oaks of
Kissimmee Health
and Rehabilitation
Center
7 $27,018 $0 $27,018 $0
Year 1 5603834
May 20,
Year 1
Claimant 6 CLOSED Per EE bi fold door off track fell on forehead
Southern Lifestyle
Senior Living
Center
0 $22,045 $0 $22,045 $0
Year 5 5701827
April 22,
Year 5
Claimant 3 OPEN
EMPLOYEE SLIPPED AND FELL, INJURING HER
LEFT KNEE AND LOWER BACK
Flagler Health and
Rehabilitation
Center
1 $2,079 $18,871 $20,950
New
Claim
$447,960 $269,650 $717,611 $59,948
SAMPLE COMPANY, LLC. WC LARGE LOSS SUMMARY (>$20K)
Total
20

22. Policy Year No. of Claims
Year 1 3
Year 2 5
Year 3 5
Year 4 8
Year 5 6
Total 14
Policy Year Tot. Incurred
Year 1 $555,409
Year 2 $471,003
Year 3 $145,263
Year 4 $133,267
Year 5 $116,317
Total $1,421,259
SAMPLE COMPANY, LLC. GL FREQUENCY AND SEVERITY METRICS
* Annualized value does not include
development
0
100
200
300
400
500
600
700
800
0
1
2
3
4
5
6
7
8
9
Year 1 Year 2 Year 3 Year 4 Year 5
Non-Report Only Frequency by Policy Year (Year 5 Annualized)
2018 Annualized
No. of Claims
Beds
0
100
200
300
400
500
600
700
800
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
Year 1 Year 2 Year 3 Year 4 Year 5
Severity by Policy Year (20XY Annualized)
2018 Annualized
Tot. Incurred
Beds

23. Policy Year
Month No. of Claims
January 2
February 3
March 4
April 1
May 1
June 2
July 1
August 2
September 2
October 3
November 3
December 3
Total 27
Policy Year
Month Tot. Incurred
January $18,159
February $308,981
March $473,519
April $13,546
May $50,815
June $62,253
July $22,949
August $10,092
September $22,271
October $88,889
November $19,781
December $296,687
Total $1,387,942
SAMPLE COMPANY, LLC. GL FREQUENCY AND SEVERITY METRICS
January February March April May June July August September October November December
Frequency by Month (Prior 5 Policy Years)
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
January February March April May June July August September October November December
Severity by Month (Prior 5 Policy Years)

24. Policy Year
Claim Cause No. of Claims Δ
Slip/Trip/Fall 11 +2
Delivery Damage 3 0
Product Liability 2 0
Property Damage - Motor Vehicle 1 0
Strike Against/Step On 1 0
Laceration 1 0
Struck by 1 0
Unknown 0 0
Total 19 +2
Policy Year
Claim Cause Tot. Incurred Δ
Slip/Trip/Fall $243,409 $468
Laceration $63,946 $123
Delivery Damage $29,714 $57
Product Liability $22,046 $42
Strike Against/Step On $1,925 $4
Property Damage - Motor Vehicle $465 $1
Struck by $25 $0
Unknown $0 $0
Total $361,530 $695
BKS SAMPLE GL FREQUENCY AND SEVERITY METRICS
0
5
10
15
20
25
30
35
Frequency by Claim Cause (Prior 3 Policy Years)
Severity by Claim Cause (Prior 3 Policy Years)
Slip/Trip/Fall
Laceration
Delivery Damage
Product Liability
Strike Against/Step On
Property Damage - Motor Vehicle
Struck by
Unknown

25. Policy Year
Claim Cause No. of Claims Δ
DeBary Health and Rehabilitation Center 3 0
Lake Placid Health and Rehabilitation Center 2 0
Longwood Health and Rehabilitation Center 2 +1
Parkside Health and Rehabilitation Center 2 0
Southern Lifestyle Senior Living Center 1 +1
The Oaks of Kissimmee Health and Rehabilitation Center 1 0
The Rehabilitation Center of Winter Park 1 0
Boynton Health Care Center 1 0
Coastal Health and Rehabilitation Center 1 0
Flagler Health and Rehabilitation Center 1 0
Margate Health and Rehabilitation Center 1 0
Royal Palm Beach Health and Rehabilitation Center 1 0
Salerno Bay Health and Rehabilitation Center 1 0
Seaside Health and Rehabilitation Center 1 0
Viera del Mar Health and Rehabilitation Center 0 0
Wave Crest Health and Rehabilitation Center 0 0
Arcadia Health and Rehabilitation Center 0 0
Total 19 +2
Policy Year
Claim Cause Tot. Incurred Δ
The Oaks of Kissimmee Health and Rehabilitation Center $192,935 $1,470
Parkside Health and Rehabilitation Center $82,506 -$7,597
DeBary Health and Rehabilitation Center $25,898 $612
Coastal Health and Rehabilitation Center $22,475 $0
Longwood Health and Rehabilitation Center $20,173 $10,001
The Rehabilitation Center of Winter Park $6,019 $6,450
Viera del Mar Health and Rehabilitation Center $4,194 -$238
Margate Health and Rehabilitation Center $3,852 $0
Boynton Health Care Center $1,925 $0
Wave Crest Health and Rehabilitation Center $1,137 $0
Lake Placid Health and Rehabilitation Center $416 $0
Royal Palm Beach Health and Rehabilitation Center $0 $0
Flagler Health and Rehabilitation Center $0 -$10,003
Arcadia Health and Rehabilitation Center $0 $0
Seaside Health and Rehabilitation Center $0 $0
Salerno Bay Health and Rehabilitation Center $0 $0
Southern Lifestyle Senior Living Center $0 $0
Total $361,530 $695
SAMPLE COMPANY, LLC. GL FREQUENCY AND SEVERITY METRICS
Location
1
Location
2
Location
3
Location
4
Location
5
Location
6
Location
7
Location
8
Location
9
Location
10
Location
11
Location
12
Location
13
Location
14
Location
15
Location
16
Location
17
Frequency by Location (Prior 3 Policy Years)
Severity by Location (Prior 3 Policy Years)
Location 6
Location 4
Location 1
Location 9
Location 3
Location 7
Location 15
Location 11
Location 8
Location 16
Location 2
Location 12
Location 10
Location 17
Location 14

26. 632345
632142
SAMPLE COMPANY, LLC. GL FREQUENCY AND SEVERITY METRICS
0
1
2
3
4
5
6
7
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
Prior Policy 1 Prior Policy 2 Policy Year 1 Policy Year 2 Policy Year 3 Policy Year 4 Policy Year 5 Policy Year 6
GL Claim Timeline
No. of Claims Linear (No. of Claims)
0
1
1
2
2
3
3
4
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
March
May
July
September
November
January
Prior Policy 1 Prior Policy 2 Policy Year 1 Policy Year 2 Policy Year 3 Policy Year 4 Policy Year 5 Policy Year 6
Non-Report Only GL Claim Timeline
No. of Non-Report Only Claims Linear (No. of Non-Report Only Claims)

27. ##
##
SAMPLE COMPANY, LLC. GL FREQUENCY AND SEVERITY METRICS
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
Policy Year 4 Policy Year 5 Policy Year 6
Non-Report Only GL Claim Timeline
No. of Non-Report Only Claims Linear (No. of Non-Report Only Claims)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
Policy Year 4 Policy Year 5 Policy Year 6
GL Claim Timeline
No. of Claims Linear (No. of Claims)