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The ERM-14 form, officially known as the Request for Ownership Information, plays a crucial role in the administration of workers' compensation insurance policies. This confidential document is essential for reporting ownership changes and other significant transactions that may affect premium calculations. Timeliness is key; policyholders must submit ownership changes to their insurance carrier in writing within 90 days of any alteration. The form requires specific details, such as the contact information of the person completing it, the type of transaction taking place, and a description of the transaction itself. Various transaction types are covered, including name changes, sales or transfers of ownership interests, mergers, and the formation of new entities. If necessary, the ownership information can also be provided in a narrative format on the employer's letterhead, signed by an authorized individual. Incomplete submissions may lead to processing delays, making accuracy and completeness vital when filling out the form.

Sample - Erm 14 Form

REQUEST FOR OWNERSHIP INFORMATION—ERM-14 FORM

The purpose of this confidential form is to obtain ownership information to assist in calculating premium for your workers compensation insurance policy. Your policy requires that you report ownership changes, and other changes as detailed below, to your insurance carrier in writing within 90 days of the change. If you have questions, contact your agent, insurance company, or the appropriate rating organization. Incomplete information or a missing signature may result in a delay in processing.

The ownership information required on this ERM-14 Form can also be submitted in narrative form on the letterhead of the employer, signed by an owner, partner, member, or executive officer.

Section A—Contact Information

Name of person completing this form ____________________________ Your Employer __________________________

Phone # _____________________________ Email Address ________________________________________________

Relationship to business entity reporting ownership information _______________________________________________

Section B—Transaction Information

Type of Transaction (check all that apply)

Transaction

Effective Date

Name and/or legal entity change

The name and/or legal status of the entity has changed. DBA name changes do not need to be reported.

Sale, transfer, or conveyance of all or a portion of an entity’s ownership interest

Complete or partial sale of the business entity’s ownership interest.

Sale, transfer, or conveyance of an entity’s physical assets to another entity that takes over its operations

An entity’s assets have been sold or transferred. The acquiring entity has taken over the operations, and the selling entity retained its legal business name.

Merger or consolidation

Two or more entities have merged or combined to form a single entity.

Formation of a new entity that acts as, or in effect is, a successor to another entity that:

(Select one)

Has dissolved

Is nonoperative

May continue to operate in a limited capacity

Formation of a new entity

A new entity has formed that is not a successor to another entity. Report this change only to determine combinability with another entity.

An irrevocable trust or receiver, established either voluntarily or by court mandate

A change has occurred to the business, either voluntarily or by court mandate, requiring the entity to be put in a trust or receivership.

Determination of combinability of separate entities

Two or more entities may need to be combined or separated based on their ownership interest.

Section C—Description of Transaction(s)

Include a brief description of the transaction(s) selected above. Attach additional information on the employer’s letterhead, if needed.

–If this is a partial sale, transfer, or conveyance of an existing business (e.g., sale of one or more plants or locations), explain what portion or location of the entire operation was sold, transferred, or conveyed.

–If any of the entities that underwent a change in ownership were related through common ownership to any other entity before the transaction described above, list the entities and their current owners’ names and percentages of ownership below.

ERM-14 (Rev. 2/20)

© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.

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Section D—Business Entity Information

Copies of this page may be submitted for transactions with more than three entities.

 

 

Entity 1

Entity 2

Entity 3

 

 

Entity before the change or

Entity after the change or

Entity after a merger or

 

Entity Information

to determine combinability

to determine combinability

consolidation or to determine

 

 

with another entity

with another entity

combinability with another entity

1.

Name of Business

 

 

 

 

Provide the legal name of the

 

 

 

 

business entity.

 

 

 

 

 

 

 

 

2.

Primary Address

 

 

 

 

(Street, City, State, Zip)

 

 

 

 

 

 

 

 

3.

Legal Status

 

 

 

 

(See examples in item 4 below)

 

 

 

 

 

 

 

 

4.

Ownership

 

 

 

 

List names of individual owners,

 

 

 

 

partners, etc. and percentages of

 

 

 

 

ownership (if applicable).

 

 

 

 

Ownership should total 100%.

 

 

 

– Sole Proprietorship: Owner

 

 

 

– Corporation: Owner(s) and

 

 

 

 

percentages of ownership

 

 

 

– General Partnership:

 

 

 

 

Partners and percentages of

 

 

 

 

ownership

 

 

 

– Limited Partnership:

 

 

 

 

General partners and

 

 

 

 

percentages of ownership

 

 

 

– Limited Liability Company:

 

 

 

 

Members and percentages of

 

 

 

 

ownership

 

 

 

– Revocable Trust: Grantor(s)

 

 

 

– Irrevocable Trust: Trustee(s)

 

 

 

– Other: If no voting stock, list

 

 

 

 

members of board of directors or

 

 

 

 

comparable governing body

 

 

 

 

 

 

 

 

5.

FEIN

 

 

 

 

 

 

 

 

6.

Risk ID Number

 

 

 

 

 

 

 

 

7.

Policy Number

 

 

 

 

 

 

 

 

8.

Policy Effective Date

 

 

 

 

 

 

 

 

9.

Contact Name

 

 

 

 

 

 

 

10. Contact Phone/Email

 

 

 

 

 

 

 

 

Section E—Certification

This is to certify that the information contained on this form is complete and correct.

_________________________________________________

_________________________

________________________________

Signature of Owner, Partner, Member, or Executive Officer Title

Business Name

_________________________________________________

_________________________

 

Print name of above signature

Date

 

ERM-14 (Rev. 2/20)

© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved.

Page 2 of 2
↓ Erm 14 PDF

File Specs

Fact Name Details
Purpose of the ERM-14 Form The ERM-14 form is designed to collect ownership information necessary for calculating premiums on workers' compensation insurance policies.
Reporting Requirements Changes in ownership must be reported to the insurance carrier in writing within 90 days to ensure proper premium calculation.
Submission Options Ownership information can be submitted using the ERM-14 form or in a narrative format on the employer's letterhead, provided it is signed by an authorized individual.
Legal Framework The ERM-14 form is governed by state-specific workers' compensation laws, which may vary by state. Always check local regulations for compliance.

Erm 14 - Usage Guidelines

Filling out the ERM-14 form is a crucial step in ensuring that your workers' compensation insurance policy remains accurate and up to date. This form helps your insurance carrier understand any ownership changes within your business. It's essential to complete it thoroughly to avoid delays in processing your information.

  1. Contact Information: Fill in your name, the name of your employer, your phone number, email address, and your relationship to the business entity.
  2. Transaction Information: Check all applicable types of transactions that have occurred. Be sure to note the effective date of each transaction.
  3. Description of Transactions: Provide a brief description of the selected transactions. If necessary, attach additional information on your employer’s letterhead.
  4. Business Entity Information: For each entity involved, provide the legal name, primary address, legal status, ownership details, FEIN, risk ID number, policy number, policy effective date, and contact name and phone/email.
  5. Certification: Sign the form to certify that all information is complete and correct. Include your title, the business name, and the date of signing.

Your Questions, Answered

What is the purpose of the ERM-14 form?

The ERM-14 form is used to request ownership information necessary for calculating premiums for workers' compensation insurance policies. It helps ensure that your insurance carrier has accurate and up-to-date ownership details, which is important for your coverage and compliance.

Who needs to fill out the ERM-14 form?

The form should be completed by someone with a significant role in the business, such as an owner, partner, member, or executive officer. This person is responsible for reporting any ownership changes to the insurance carrier within 90 days of the change.

What types of ownership changes must be reported?

Ownership changes that need to be reported include changes in the legal name or status of the entity, sales or transfers of ownership interest, mergers, and the formation of new entities. If a business is put into an irrevocable trust or receivership, that must also be reported.

Can I submit the ownership information in a different format?

Yes, you can provide the required ownership information in a narrative format on your company's letterhead. This document must be signed by an owner, partner, member, or executive officer to be valid.

What happens if I don’t complete the form correctly?

If the ERM-14 form is incomplete or lacks a signature, it may delay processing. It’s crucial to provide accurate and complete information to avoid any issues with your workers' compensation insurance policy.

How long do I have to report ownership changes?

You must report any ownership changes in writing to your insurance carrier within 90 days of the change. Timely reporting helps ensure that your coverage remains valid and that your premiums are calculated correctly.

What should I include in the description of the transaction?

In the transaction description, briefly explain the nature of the ownership change. If it’s a partial sale, specify which part of the business was sold. If related entities were involved, list their names and current ownership percentages.

Do I need to provide additional documentation?

If necessary, you can attach additional information on your employer's letterhead. This is especially useful if the transaction is complex or involves multiple entities.

Is there a specific format for the contact information section?

Yes, the contact information section requires you to provide your name, employer, phone number, email address, and your relationship to the business entity. Make sure all details are accurate to facilitate communication with your insurance carrier.

What is the significance of the certification section?

The certification section is crucial as it confirms that the information provided is complete and correct. The form must be signed by an authorized individual, which holds them accountable for the accuracy of the information submitted.

Common mistakes

  1. Failing to provide complete contact information. Ensure that all fields, including name, phone number, and email address, are filled out accurately.

  2. Not reporting ownership changes within the required 90 days. Timely reporting is essential to avoid penalties.

  3. Omitting necessary transaction details. Clearly describe the nature of the transaction in Section C to avoid confusion.

  4. Not checking all applicable transaction types in Section B. Review the list carefully to ensure all relevant changes are marked.

  5. Providing inaccurate ownership percentages. Ensure that the total ownership equals 100% to prevent processing delays.

  6. Neglecting to include additional documentation when necessary. Attach any relevant information on the employer's letterhead if required.

  7. Forgetting to sign the form. The signature of an owner, partner, member, or executive officer is mandatory for validation.

  8. Using outdated version of the form. Always check that you are using the most current version of the ERM-14 form.

  9. Failing to include contact information for follow-up. Providing a contact name and phone/email is crucial for any questions.

  10. Not reviewing the form for errors before submission. Double-check all entries to ensure accuracy and completeness.

Documents used along the form

The ERM-14 form is essential for providing ownership information related to workers' compensation insurance. Alongside this form, several other documents may be necessary to ensure complete and accurate reporting. Below is a list of these documents, each serving a specific purpose in the ownership reporting process.

  • Ownership Change Notification: This document formally notifies the insurance carrier of any changes in ownership. It should detail the nature of the change, including names of new owners and their ownership percentages.
  • Business License: A copy of the current business license may be required to verify the legal status of the entity. This document ensures that the business is operating within the law and is properly registered.
  • Partnership Agreement: If applicable, this document outlines the terms of the partnership, including ownership stakes and responsibilities. It is crucial for clarifying the roles of each partner in the business.
  • Asset Transfer Agreement: This document is necessary when physical assets are sold or transferred. It provides a detailed account of the assets involved and the terms of the transfer.
  • Merger Agreement: In the case of a merger, this agreement outlines the terms and conditions of the merger, including the new entity's structure and ownership distribution.
  • Trust Documents: If the business is placed in a trust, these documents provide details about the trust's formation and the responsibilities of the trustee. They clarify how the trust affects ownership and management of the business.

Understanding these additional documents can help ensure that all necessary information is reported accurately and promptly. Proper documentation is vital for compliance and can prevent delays in processing your workers' compensation insurance policy.

Similar forms

The ERM-14 form is similar to the IRS Form 1065, which is used by partnerships to report income, deductions, gains, and losses from the operation of a partnership. Both forms require detailed information about ownership and transactions. While the ERM-14 focuses on changes in ownership for workers' compensation insurance, Form 1065 emphasizes the financial aspects of partnership operations. Both documents must be completed accurately to avoid processing delays, ensuring that stakeholders have the necessary information for compliance and decision-making.

Another document akin to the ERM-14 is the IRS Form 1120, which corporations use to report their income and calculate their tax liability. Like the ERM-14, Form 1120 requires comprehensive details about ownership and changes in the corporate structure. Both forms serve as crucial tools for maintaining transparency with regulatory bodies. Timely and accurate submission of either form is vital to prevent penalties and ensure proper insurance coverage or tax compliance.

The ERM-14 also resembles the Change of Ownership Form used in real estate transactions. This form captures ownership changes in property and requires information about the new owners and the nature of the transaction. Similar to the ERM-14, it must be filed within a specific timeframe to ensure that records are updated promptly. Both documents aim to keep relevant parties informed and maintain accurate records for legal and financial purposes.

Additionally, the Business Entity Registration Form shares similarities with the ERM-14. This form is used to register a new business entity or update existing registration details. Both forms require information about ownership, structure, and contact details. The timely submission of each form is crucial for legal compliance and to avoid disruptions in business operations or insurance coverage.

The Membership Change Form for Limited Liability Companies (LLCs) is another document comparable to the ERM-14. This form is used to report changes in membership or ownership within an LLC. Both documents require detailed information about ownership percentages and the nature of the change. Ensuring that these forms are accurately completed and submitted helps maintain proper records and compliance with state regulations.

The Stock Transfer Form is also similar to the ERM-14, as it documents the transfer of shares from one party to another in a corporation. Both forms require detailed information about the parties involved and the nature of the transaction. Accurate completion of these forms is essential to reflect ownership changes correctly in the corporate records, ensuring compliance with both corporate governance and insurance requirements.

Another related document is the Partnership Agreement, which outlines the terms of ownership and management among partners in a business. While the ERM-14 focuses on reporting changes to an insurance provider, the Partnership Agreement serves as a foundational document that governs the relationship between partners. Both documents are critical for ensuring clarity and compliance in ownership matters.

The Certificate of Amendment is akin to the ERM-14 in that it is used to officially document changes to a business entity's structure, such as a name change or change in ownership. Both forms require specific information about the entity and the nature of the change. Proper filing of these documents is essential to maintain legal standing and ensure that all stakeholders are informed of the current status of the entity.

Finally, the Articles of Incorporation can be compared to the ERM-14. This foundational document establishes a corporation's existence and outlines its structure, including ownership details. While the ERM-14 focuses on ongoing changes in ownership, the Articles of Incorporation serve as the initial declaration of ownership and governance. Both documents are vital for maintaining accurate records and ensuring compliance with regulatory requirements.

Dos and Don'ts

When filling out the ERM-14 form, there are important steps to take and common mistakes to avoid. Below is a list of things you should and shouldn't do.

  • Do provide accurate contact information for the person completing the form.
  • Do check all applicable transaction types to ensure you report all necessary changes.
  • Do include a brief description of the transaction in Section C.
  • Do ensure that ownership percentages total 100% in Section D.
  • Do sign the form to certify that the information is correct.
  • Don't leave any sections blank; incomplete information may delay processing.
  • Don't report DBA name changes, as they are not required.
  • Don't forget to attach additional information on letterhead if necessary.
  • Don't submit the form without reviewing it for errors.

Misconceptions

Understanding the ERM-14 form is crucial for businesses, especially when it comes to workers' compensation insurance. Here are ten common misconceptions about this form:

  • The ERM-14 form is optional. Some believe that submitting this form is not necessary. In reality, it is required to report ownership changes to your insurance carrier.
  • Only major changes need to be reported. Many think that only significant changes, like a sale, must be documented. However, even minor changes in ownership or legal status should be reported.
  • DBA name changes must be reported. There is a misconception that doing business as (DBA) name changes need to be included. This is incorrect; only legal name changes are necessary to report.
  • Submission of the form guarantees immediate processing. Some individuals expect that submitting the ERM-14 will lead to instant updates. Processing may still take time, especially if the form is incomplete.
  • Any employee can fill out the form. It is often assumed that any staff member can complete the ERM-14. However, it must be filled out by an owner, partner, member, or executive officer.
  • Providing incomplete information is acceptable. There is a belief that minor omissions will not matter. Incomplete information can lead to delays in processing the form.
  • The form can be submitted verbally. Some think they can provide ownership changes over the phone. All changes must be submitted in writing using the ERM-14 form.
  • Only one form is needed for multiple transactions. Many believe that one ERM-14 form can cover several ownership changes. Each transaction may require its own submission for clarity.
  • Changes do not need to be reported immediately. It is often thought that there is no rush to report changes. In fact, you must report ownership changes within 90 days.
  • All ownership changes are the same. Some assume that all changes are treated equally. Different types of transactions, like mergers or asset sales, may have specific reporting requirements.

Awareness of these misconceptions can help ensure that businesses remain compliant and avoid potential issues with their workers' compensation insurance policies.

Key takeaways

The following are key takeaways regarding the completion and use of the ERM-14 form, which is essential for reporting ownership information for workers' compensation insurance policies.

  • Purpose: The ERM-14 form is used to report ownership changes that affect the calculation of premiums for workers' compensation insurance.
  • Reporting Requirement: Any changes in ownership must be reported to the insurance carrier in writing within 90 days of the change.
  • Contact Information: Section A requires the name, employer, phone number, email address, and relationship to the business of the person completing the form.
  • Transaction Types: Section B outlines various types of transactions, including mergers, sales, and changes in legal status that must be indicated on the form.
  • Descriptive Details: Section C allows for a brief description of the transactions selected, providing clarity on the nature of the ownership change.
  • Multiple Entities: If multiple entities are involved, additional pages may be submitted to provide information for each entity affected by the transaction.
  • Ownership Breakdown: Section D requires detailed ownership information, including names and percentages, ensuring that total ownership equals 100%.
  • Certification: The form must be signed by an owner, partner, member, or executive officer, certifying that the information provided is accurate and complete.
  • Consequences of Incomplete Information: Missing signatures or incomplete information may lead to delays in processing the form.
  • Submission Format: Ownership information can also be submitted in narrative form on the employer's letterhead, signed by an authorized individual.