WC-85 Instructions

Form WC-85: Annual Financial Statement must be completed using audited income statement and balance sheet information for the most recent fiscal year. For example, if the fiscal year ended September 30, the financial statements should be as of September 30. If you attach your company's most recent audited income statement and balance sheet including the auditor’s statement or published annual report you may fill in summary totals (i.e., Total Assets, Total Liabilities, and Total Net Worth) on the WC-85 form in lieu of completing the detailed financial section of the WC-85. The balance of the WC-85 form must be completed in its entirety, including all signatures and notary.

*Please note that the highlighted areas on the forms are areas that MUST be completed.


  • Employer name must be in the name of the self insured entity; if using the guarantor's financial, the name must be read: (name of Guarantor) guarantor of (name of Self-Insured Entirety)
  • Fiscal year ending must be for the most recent Fiscal Year ending
  • Figures must be from audited financials
  • Total current assets must be in if including income statement and balance sheet
  • Total liabilities, total net worth and total liabilities/net worth must be filled in if including income statement and balance sheet
WC-85 Instructions Page 1
WC-85 Instructions Page 2

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