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Failure to provide information will result in a delinquency notice with penalties being issued. SECTION II. Do not include hospital surgical or rehabilitation payments. Do not subtract subrogation recovery or refunds when calculating compensation payments. ILLINOIS WORKERS COMPENSATION COMMISSION RATE ADJUSTMENT FUND AND SECOND INJURY FUND ASSESSMENT TRANSMITTAL FORM FOR 07/01/2016 12/31/2016 2016-2nd Half ASSESSMENT IS DUE BY MARCH 15 2017 Company Name Contact Person Address 1 City State...

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