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IMPORTANT ANNOUNCEMENT (TIME SENSITIVE - RESPONSE NEEDED) Insurance Brokerage Antitrust Litigation - Class Action Settlement


TO: All Eligible ELCA Congregations and Synods having held liability and/or property insurance coverage through Charity First for the period August 26, 1994, through September 1, 2005, or any portion thereof


FROM: ELCA – Office of the Treasurer and Office of the Secretary


The ELCA was awarded a net amount of $57,648.97 in settlement of a class-action suit involving Charity First, former administra- tor of the ELCA-endorsed synodical and congregational insurance program during the period August 26, 1994, through September 1, 2005.


On behalf of participating ELCA congregations and synods, the ELCA Churchwide Organization received the settlement amount. In accordance with action of the ELCA Church Council, the ELCA Office of the Treasurer and Office of the Secretary are to dis- tribute settlement proceeds to eligible congregations and synods. Eligible congregations and synods are defined as those holding liability and/or property insurance coverage through Charity First during the period August 26, 1994, through September 1, 2005, or any portion thereof.


Each eligible congregation and synod must complete the attached Claim Form in order to receive a portion of the proceeds. Please submit the completed, signed Claim Form to the ELCA – Office of the Treasurer via U.S. mail or e-mail on or before February 20, 2012. Claim Forms postmarked or sent electronically after February 20, 2012, will be ineligible for the distribution. If you have any questions you may contact the ELCA Office of the Treasurer at 773-380-2892 or via e-mail at otinfo@elca.org.


This announcement and a downloadable Claim Form are available at http://www.elca.org/~/media/Files/Who%20We%20Are/ Office%20of%20the%20Secretary/CLAIMFORM_4f1r_pdf.pdf


Thank you for your cooperation. CLAIM FORM


Insurance Brokerage Antitrust Litigation-Class Action Settlement In order to expedite allocated payments from the above class action settlement, it is essential that you provide the following information:


1) Was your congregation/synod insured through Charity First for liability and/or property insurance coverages from 8/26/94 through 9/1/05 or any portion thereof? NO______


YES_____


2) If “YES”, please list each policy period and the respective premium paid for each policy year. Then, provide a total premium paid amount for all policy periods. Attach additional sheet as necessary. For example:


Policy period: 1/1/95 - 1/1/96 Policy period: 1/1/96 - 1/1/97


Policy Period Premium Paid: $500


Premium Paid: $500 Total Premium Paid: $1,000


Premium Paid


__________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ TOTAL: _________________________


As the authorized representative of this congregation/synod, I verify to the best of my knowledge, that the above total premium claimed is correct. Name of Authorized Individual Representative: (Print)_____________________________________________ Name of Authorized Individual Representative: (Signature) _________________________________________ Congregation/Synod Name and ID Number: ______________________________________________________ Congregation/Synod address:


Street___________________________________________________ City________________________________ State________Zipcode___________ E-mail Address_________________________________________________


IMPORTANT NOTE: All claims are subject to verification. This Claim Form must be received on or before 2/20/2012. Claim Forms postmarked or sent electronically after 2/20/2012 will be ineligible for the distribution. Please send this completed, signed Claim Form to the following using U.S. mail or e-mail: otinfo@elca.org Evangelical Lutheran Church in America – Office of the Treasurer, 8765 W. Higgins Rd. – 8th Floor (Claims), Chicago, IL 60631


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