I-1 Have you experienced volatility in coverage availability in the commercial market?

Yes No Somewhat Just beginning

I-2 Do you expect to realize instant and significant savings by having a captive?

Yes No No Answer

I-3 The success of a captive is very much based on the ability to manage and minimize claims costs. How much time and effort is your organization willing to commit to loss control and claims administration activities?

Maximum Time Maximum/Average Time Average Time Average/Minimum Time

Minimum Time No Answer

I-4 Do operating divisions, subsidiary corporations and/or joint ventures require low risk retention levels?

Ultimate Importance Important Not Important No Answer

I-5 Is it important that you separate risk financing from other operational funding?

Ultimate Importance Important Not Important No Answer

I-6 Have you considered other methods of financing retained losses instead of a captive?

Yes No No Answer

I-7 Does your organization`s insurance rates seem abnormally high compared to your loss history?

Yes No No Answer

I-8 Is your organization’s loss pattern fairly predictable?

Yes No No Answer

I-9 Does your organization need specific coverages that the commercial market can not, or will not, underwrite?

Yes No No Answer

I-10 Does your organization want to include catastrophic loss coverage in the captive?

Yes No No Answer

I-11 Do your insurance rates seem abnormally high compared to the loss history of for that line of business in the industry ?

High Mid-range Low No Answer

I-12 Are your organization`s liability lines more frequency or severity oriented?

LS/LF LS/HF HS/LF HS/HF No Answer

I-13 Does your organization wish to consolidate all or most of its insurance needs into a single multi-line program ?

Ultimate Importance Important Not Important No Answer

C-1 Is the organization to be covered in the captive tax-exempt?

Yes No No Answer

C-2 Is this company privately held or publicly traded?

Yes No No Answer

C-3 What is your organization’s risk appetite?

Large Medium Small No Answer

C-4 Are you considering a captive to remedy a short-term situation?

Yes No No Answer

C-5 Is your company rapidly growing or diversifying?

Yes No No Answer

C-6 Does your organization concerned with equitable cost allocation between subsidiaries?

Yes No No Answer

C-7: Is it important to isolate risk management funding from general operational funding?

Ultimate Importance Important Not Important No Answer

T-1: Does your organization currently pay federal income taxes?

Yes No No Answer

T-2: How important are income tax considerations?

Ultimate Importance Important Not Important No Answer

T-3: Is your organization willing to take aggressive tax positions?

Take Questionable Deductions Not Sure Avoid IRS Audits No Answer

T-4: Does your organization pay considerable foreign income taxes?

Yes No No Answer

CF-1: Is your organization willing to provide capital for a long-term commitment?

Yes No No Answer

CF-2: Does the risk manager/CFO and/or senior management want to make the risk management department a profit center?

Yes No No Answer

CF-3: Can your organization post letters of credit without disrupting the financing of other business activities?

Yes No No Answer

CF-4: What is the cost of letters of credit for your organization?

Greater than 1% Less or equal than 1% Less or equal than 1/2% No Answer

CF-5: Would posting letters of credit, in an amount of approximately half of the captive's premium, result in a reduced ability to finance
other business activities?

Yes No No Answer

CF-6: What is the total premium for all lines of coverage to be covered by the captive?

Greater than $1,250,001 Less than $1,250,001 Less than $750,001 No Answer

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