Active physician management is present throughout ISMIE. ISMIE is guided by its Board of Directors, comprised of 20 physician policyholders. Under the direction of the ISMIE Board, the company's day-to-day activities are overseen by the Illinois State Medical Insurance Services, Inc. (ISMIS), which is a wholly-owned subsidiary of ISMIE Mutual Insurance Company. The ISMIS Board is comprised of six physician policyholders. Through a management agreement, ISMIS manages the underwriting and issuance of insurance policies, the collection and investment of premiums, and the service and administration of the policyholders and their claims.