2024-05-15T09:12:34-05:00 2023-06-30 PwC US Tax LLP 655 NEW YORK AVE NW SUITE 1100 WASHINGTON DC 20001 990EZ 2022-07-01 851454519 USC CAPTIVE INSURANCE COMPANY % UNIV OF SOUTHERN CALIFORNIA USCC 2138211900 UNIVERSITY GARDENS UGB205 LOS ANGELES CA 900898003 ERIK BRINK TREASURER/DIRECTOR 2138211900 2024-05-14 true ERIK BRINK 999009999 TRAVIS L PATTON P00369623 2024141000 2024-05-14 3 2022 2023-04-26 12:10:37Z X X X X 16535 X 0 0 0 0 0 0 16535 16535 0 16535 16535 250000 250000 X 246314 93529 0 0 12436 156471 258750 250000 8750 0 250000 250000 X SEE SCHEDULE O See Schedule O, PART III, LINE 28 DISCLOSURE 16535 16535 JASON BENNETT DIRECTOR/PRESIDENT 5.0 0 0 0 ERIK BRINK TREASURER/DIRECTOR 2.0 0 0 0 CAROLYN DOMEN-BROSHEARS SECRETARY 2.0 0 0 0 DIANE HANSON DIRECTOR 2.0 0 0 0 BEONG-SOO KIM DIRECTOR 2.0 0 0 0 STEVEN SHAPIRO DIRECTOR 2.0 0 0 0 JAMES M STATEN DIRECTOR (THRU 02/28/23) 2.0 0 0 0 DAVID PENG DIRECTOR 2.0 0 0 0 false false false false false false false false UNIV OF SOUTHERN CALIFORNIA UNIVERSITY GARDENS UGB205 LOS ANGELES CA 900898003 2138211900 false false false false false true false false false false false true X X 1 UNIVERSITY OF SOUTHERN CALIFORNIA 951642394 2 true 0 0 1 0 0 true false false false false false false false false false false false false false false true false FORM 990-EZ, PART III, ORGANIZATION'S PRIMARY ACTIVITY USC CAPTIVE INSURANCE COMPANY ("USCCIC") IS A PUBLIC BENEFIT CORPORATION AND SPONSORED CAPTIVE INSURANCE COMPANY ORGANIZED IN ACCORDANCE WITH THE VERMONT NONPROFIT CORPORATION ACT AND CHAPTER 141 OF TITLE 8 OF THE VERMONT STATUTES ANNOTATED. USCCIC IS ORGANIZED AND OPERATED AS A SUPPORTING ORGANIZATION DESCRIBED IN INTERNAL REVENUE CODE SECTION 509(A)(3) TO PROVIDE SERVICES AND RESOURCES FOR THE BENEFIT OF, TO PERFORM FUNCTIONS OF, AND TO CARRY OUT THE PURPOSES OF, THE UNIVERSITY OF SOUTHERN CALIFORNIA (USC) AND USC'S TAX EXEMPT AFFILIATES, SO LONG AS USC AND SUCH AFFILIATES ARE DESCRIBED IN PARAGRAPHS (1) OR (2) OF SECTION 509(A). SPECIFICALLY, USCCIC'S SOLE PLANNED ACTIVITY IS TO FACILITATE SELF-INSURANCE WITH RESPECT TO CERTAIN CASUALTY EXPOSURES OF USC AND USC'S TAX-EXEMPT AFFILIATES. FORM 990EZ PART I LINE 8 Description:PROGRAM FEE REVENUE Amount:16535 FORM 990EZ PART I LINE 16 Description:CAPTIVE MANAGEMENT FEES Amount:15000 FORM 990EZ PART I LINE 16 Description:MISCELLANEOUS EXPENSES Amount:1035 FORM 990EZ PART I LINE 16 Description:LICENSE FEES Amount:500 FORM 990EZ PART II LINE 24 Description:PROGRAM FEES RECEIVABLE BOY Amount:12436 EOY Amount:156471