2023-08-14T13:30:36-05:00 2022-09-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-10-01 936087366 ASANTE FOUNDATION ASAN 5417895590 229 BARTLETT STREET MEDFORD OR 97504 HEATHER ROWENHORST CFO 5417895098 2023-08-04 1 HEATHER ROWENHORST XXX-XX-XXXX KURT BENNION CPA P01469618 4252506100 2023-08-04 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ROY VINYARD 229 BARTLETT STREET MEDFORD OR 97504 28616876 0 X WWW.ASANTE.ORG/GIVING/ X 1973 OR SUPPORT ASANTE HEALTHCARE SYSTEM AND ITS HEALTHCARE SERVICES IN OREGON AND CALIFORNIA. 24 20 0 221 6332 4322 11289495 26522170 0 0 2952975 2088374 -262837 6332 13979633 28616876 3311033 9387865 0 0 1770204 1935667 101044 0 0 1285110 2087389 6467391 13410921 7512242 15205955 43111994 49566738 252241 172491 42859753 49394247 X THE ASANTE FOUNDATION'S PRIMARY EXEMPT PURPOSE IS TO RAISE MONIES AND IN-KIND DONATIONS TO FURTHER THE EXEMPT PURPOSE OF ASANTE, A 501(C)(3) HOSPITAL AND HEALTHCARE SYSTEM WHICH SERVICES THE HEALTHCARE NEEDS OF THE CITIZENS OF SOUTHERN OREGON AND NORTHERN CALIFORNIA. 0 0 6651330 6467465 0 DURING THE TAX YEAR, THE ASANTE FOUNDATION'S LARGEST PROGRAM SERVICE ACCOMPLISHMENT IS RAISING OVER $24 MILLION IN DONATIONS TO BENEFIT VARIOUS DEPARTMENTS AND CAPITAL PROJECTS THROUGHOUT ASANTE HEALTHCARE SYSTEM.OF THE CAPITAL PROJECTS OVER $12 MILLION WAS DONATED FOR THE EXPANSION OF THE PAVILION, AND OVER $5.5 MILLION WAS DONATED TO SUPPORT THE CONSTRUCTION OF A NEW CANCER CENTER.THE ASANTE FOUNDATION ALSO HELPS SUPPORT NUMEROUS CLINICAL DEPARTMENTS AT ROGUE REGIONAL MEDICAL CENTER (ARRMC), A 378 LICENSED BED HOSPITAL LOCATED IN MEDFORD, OREGON. THIS INCLUDES DONATIONS OF $273,000 TO THE BEHAVIORAL HEALTH PROGRAMS. ROUGHLY $53,000 WAS DONATED TO SUPPORT THE FRANCIS CHENEY FAMILY PLACE WHICH OFFERS PATIENTS THAT HAVE TO TRAVEL LONG DISTANCES LOW OR NO COST HOUSING WHILE RECEIVING TREATMENT(S). OTHER DONATIONS HELP SUPPORT THE IMAGING CENTER, THE EMERGENCY DEPARTMENT, NURSE EDUCATION, THE CANCER CENTERS AND MANY MORE. 1362747 1304483 0 THE ASANTE FOUNDATION'S SECOND LARGEST PROGRAM SERVICE ACCOMPLISHMENT IS RAISING DONATIONS TO HELP SUPPORT VARIOUS DEPARTMENTS AND CAPITAL PROJECTS AT ASANTE THREE RIVERS MEDICAL CENTER (ATRMC), A 125 LICENSED BED HOSPITAL LOCATED IN GRANTS PASS, OREGON.OF THE CAPITAL PROJECTS, $129,233 WAS DONATED FOR THE EXPANSION OF THE EMERGENCY DEPARTMENT.IN ADDITION TO CAPITAL PROJECTS, GENEROUS DONATIONS OF NEARLY $43,000 WERE MADE FOR FREE MAMMOGRAMS AND BREAST CANCER EDUCATION FOR UNINSURED WOMEN IN THE AREA. OTHER DEPARTMENTS THAT BENEFITED FROM FOUNDATION DONATIONS INCLUDE THE IMAGING DEPARTMENT, FAMILYBIRTH AND MANY MORE. 1688090 1615916 0 THE ASANTE FOUNDATION'S THIRD LARGEST PROGRAM SERVICE ACCOMPLISHMENT IS RAISING DONATIONS TO HELP SUPPORT VARIOUS DEPARTMENTS AND CAPITAL PROJECTS AT ASANTE ASHLAND COMMUNITY HOSPITAL, ASANTE PHYSICIAN PARTNERS AND THE NURSING EXCELLENCE INITIATIVE.DURING THE TAX YEAR THE FOUNDATION CONTRIBUTED OVER $233,000 FOR RENOVATION PROJECTS AT THE HOSPITAL. THEY ALSO CONTRIBUTED $581,471 TO AGE-FRIENDLY CARE AT ASANTE ASHLAND COMMUNITY HOSPITAL. THE ASANTE FOUNDATION'S ON-GOING MISSION IS TO CONTINUALLY ASSESS THE NEEDS OF THE HOSPITALS IT SUPPORTS, AS WELL AS THE COMMUNITY WE SERVE.OVER THE YEARS, THE FOUNDATION HAS CONTRIBUTED MILLIONS OF DOLLARS TO HELP ENHANCE IMPORTANT CLINICAL DEPARTMENTS OF THE HOSPITALS AND HELP PURCHASE NEEDED MEDICAL EQUIPMENT. IT HAS ALSO MADE SIGNIFICANT CONTRIBUTIONS TO MAJOR BUILDING PROJECTS AT ASANTE ROGUE REGIONAL MEDICAL CENTER AND ASANTE THREE RIVERS MEDICAL CENTER. 9702167 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 24 20 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 OR X HEATHER ROWENHORST 5417895098 2650 SISKIYOU BLVD MEDFORD OR 97504 SCOTT KELLY TRUSTEE & ASANTE CEO 1.00 41.00 X X 0 1665840 33733 GREG WOJTAL ASANTE CAFO 1.00 41.00 X 0 753363 40467 DR CHRIS DAVID TRUSTEE & ASANTE PROVIDER 2.00 40.00 X 0 376204 48684 FLOYD HARMON EXECUTIVE DIRECTOR 40.00 0.00 X X 0 294043 47952 ANDREA REEDER VP & EXECUTIVE DIR ASANTE 2.00 0.00 X 0 199529 31909 TRAVIS HAMLYN CHAIR 2.00 2.00 X X 0 0 0 SUSAN BINETTE VICE CHAIR & CHAIR OF NOM. COMM. 2.00 0.00 X X 0 0 0 JUDY GAMBEE TRUSTEE & SECRETARY 2.00 0.00 X X 0 0 0 ROYAL STANDLEY TREASURER 2.00 0.00 X X 0 0 0 GEORGE ALAMEDA TRUSTEE 2.00 0.00 X 0 0 0 CAROLINE BROOKS TRUSTEE 2.00 0.00 X 0 0 0 JEFF CROCKETT TRUSTEE (THROUGH DECEMBER 2021) 2.00 0.00 X 0 0 0 VICKIE CROCKETT TRUSTEE (THROUGH DECEMBER 2021) 2.00 0.00 X 0 0 0 BRIAN GROSS MD TRUSTEE 2.00 2.00 X 0 0 0 DR BRIAN HALL TRUSTEE 2.00 0.00 X 0 0 0 DIONNE IRVINE TRUSTEE 2.00 0.00 X 0 0 0 DR HELEN KOENIGSMAN TRUSTEE 2.00 0.00 X 0 0 0 SCOTT LEWIS TRUSTEE 2.00 0.00 X 0 0 0 TARA MILLAN TRUSTEE (THROUGH FEBRUARY 7, 2022) 2.00 0.00 X 0 0 0 AMANDA MUSTARD TRUSTEE 2.00 0.00 X 0 0 0 PATRICIA ORSINI TRUSTEE 2.00 0.00 X 0 0 0 STEVE ROE TRUSTEE 2.00 2.00 X 0 0 0 JOHN SCHIAVONE TRUSTEE 2.00 0.00 X 0 0 0 CAL SCHMIDT TRUSTEE 2.00 0.00 X 0 0 0 DOUG SCHMOR ASANTE GOV. BOARD CHAIR 2.00 2.00 X X 0 0 0 DAVID THOMASON TRUSTEE 2.00 0.00 X 0 0 0 TOM WALKER TRUSTEE 2.00 0.00 X 0 0 0 PATRICIA WINTERMUTE TRUSTEE (THROUGH DECEMBER 2021) 2.00 2.00 X 0 0 0 JIM WRIGHT TRUSTEE 2.00 0.00 X 0 0 0 0 3288979 202745 0 0 1 0 0 427941 26094229 367154 26522170 1116036 1116036 972338 0 972338 972338 972338 LEASE SALE COMMISSIONS 900099 6332 6332 6332 28616876 0 6332 2088374 9302114 9302114 85751 85751 1379128 74749 1304379 82641 82641 359820 359820 114078 114078 77840 77840 1106180 6924 1099256 146441 121726 24715 99605 749 98856 95229 212 95017 41153 41153 58524 129 58395 166581 166581 MISCELLANEOUS 230526 59321 171205 DUES & FEES 57620 50118 7502 SUPPLIES 6782 374 6408 UBI TAXES 908 908 13410921 9702167 3708754 0 498 2370345 6114673 382424 155381 0 0 63232 45430 7420 24456 2914501 477342 2293741 2437159 38692877 32081193 1671802 6338101 43111994 49566738 41863 11940 210378 160551 252241 172491 X 14382740 3527054 28477013 45867193 42859753 49394247 43111994 49566738 15205955 -8671461 0 X X 0 1 X 1 0 X X X 2 ASANTE 930223960 3 1 9287686 0 ASANTE PHYSICIAN PARTNERS 383849354 3 1 14428 0 2 9302114 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7562672 25000 370297 322872 7635097 7035242 286934 402584 162088 7562672 6379534 882339 243395 470026 7035242 6085738 102373 472807 210613 6379534 5971920 69017 320130 275328 6085739 0.08020 0.87760 0.04220 0 0 390500 390500 782798 110613 672185 1741203 366729 1374474 2437159 INTERCOMPANY RECEIVABLE 6338101 6338101 PAYROLL BENEFITS PAYABLE 78362 ANNUITIES DUE 82189 160551 X PART V, LINE 4: THE ENDOWMENTS ARE SET UP ACCORDING TO DONOR INTENT. UP TO 5% OF ENDOWMENT EARNINGS CAN BE USED TO SUPPORT A VARIETY OF DEPARTMENTS AND SERVICES THROUGHOUT ASANTE HEALTHCARE SYSTEM. PART X, LINE 2: ASANTE HAS RECEIVED A DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) STATING THAT IT IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC), EXCEPT FOR UNRELATED BUSINESS INCOME. MANAGEMENT BELIEVES ASANTE IS OPERATED IN A MANNER THAT QUALIFIES FOR TAX-EXEMPT STATUS. INCOME TAXES ARE PROVIDED FOR THE TAX EFFECTS OF TRANSACTIONS RELATED TO ASANTE'S TAX-EXEMPT PURPOSE REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS; HOWEVER, SUCH ACTIVITIES ARE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY ASANTE AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF ASANTE HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY ASANTE AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2022, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN, OR EXPECTED TO BE TAKEN, THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR AN ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. ASANTE IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, NO SUCH AUDITS ARE CURRENTLY IN PROCESS. 1 ASANTE 2650 SISKIYOU BLVD MEDFORD OR 97504 930223960 501(C)(3) 9287686 0 N/A N/A SUPPORT HOSPITAL DEPARTMENTS ASANTE PHYSICIAN PARTNERS 2650 SISKIYOU BLVD MEDFORD OR 97504 383849354 501(C)(3) 14428 0 N/A N/A SUPPORT PALLIATIVE CARE DEPARTMENT 2 0 EMPLOYEE COVID RELIEF 25 20543 N/A N/A EMPLOYEE FIRE RELIEF 85 65208 N/A N/A PART I, LINE 2: APPROPRIATE USE OF ALL TRANSFERRED FUNDS IS ENSURED THROUGH COMMON EXECUTIVE AND ADMINISTRATIVE MANAGEMENT. EMPLOYEES APPLIED FOR ASSISTANCE WITH COVID-RELATED PERSONAL EXPENSES AND/OR FOR PERSONAL ASSISTANCE RELATED TO A MAJOR FIRE IN THE MEDFORD AREA IN 2021. THE APPLICATION PROCESS ENSURED THE INDIVIDUAL WAS IMPACTED BY THE DISASTER, BUT DID NOT OTHERWISE RESTRICT HOW THE ASSISTANCE FUNDS WERE TO BE SPENT. WHENEVER POSSIBLE, PAYMENTS ARE MADE DIRECTLY TO CREDITORS, LANDLORDS, UTILITIES, ETC., RATHER THAN PROVIDING THE MONEY TO THE INDIVIDUAL. 0 1 0 0 0 0 0 0 0 SCOTT KELLY TRUSTEE & ASANTE CEO 0 862750 0 341103 0 461987 0 17400 0 16333 0 1699573 0 460289 GREG WOJTAL ASANTE CAFO 0 515158 0 160812 0 77393 0 17400 0 23067 0 793830 0 72937 DR CHRIS DAVID TRUSTEE & ASANTE PROVIDER 0 369951 0 6253 0 0 0 17400 0 31284 0 424888 0 0 FLOYD HARMON EXECUTIVE DIRECTOR 0 209671 0 54971 0 29401 0 16502 0 31450 0 341995 0 26181 ANDREA REEDER VP & EXECUTIVE DIR ASANTE 0 163250 0 35629 0 650 0 12238 0 19671 0 231438 0 0 PART I, LINE 4B ASANTE, THE PARENT CORPORATION OF THE FOUNDATION, HAS AN EXECUTIVE RESTORATION PLAN WHICH INCLUDES ASANTE CEO SCOTT KELLY. THIS PLAN STATES FIXED PAYMENTS WILL BE RECEIVED AT PRE-DETERMINED INTERVALS FROM ASANTE IF STILL EMPLOYED BY ASANTE IN THEIR CURRENT ROLL AT THE TIME OF VESTING. IF EMPLOYMENT TERMINATES BY ASANTE FOR ANY REASON PRIOR TO VESTING, THEY WILL NOT HAVE CLAIM TO THE FUNDS. SELECT EXECUTIVES OF ASANTE, THE PARENT CORPORATION, AGREED TO PARTICIPATE IN CAP-EX IN PLACE OF A TRADITIONAL SERP. SEE SCHEDULE L, PART V, FOR A BROADER DESCRIPTION. ROY VINYARD FORMER ASANTE CEO SEE PART V X 3000000 5944468 0 1 1 5944468 SCHEDULE L, PART II, COLUMN C: A RELATED ORGANIZATION, ASANTE, PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS THROUGH AN ALTERNATIVE FUNDING ARRANGEMENT THE IRS CALLS "COLLATERAL ASSIGNMENT SPLIT DOLLAR" (CASD). ALTHOUGH THE IRS REQUIRES REPORTING IN THE LOAN SECTION OF SCHEDULE L, CASD IS NOT AN ACTUAL LOAN--NO FUNDS ARE TRANSFERRED TO THE EXECUTIVE. RATHER, THE "LOAN" TREATMENT APPLIES BECAUSE AFTER THE EXECUTIVE HAS RECEIVED RETIREMENT BENEFITS, ASANTE RECOVERS ALL OF ITS OUTLAYS PLUS INTEREST. THE RECOVERY RIGHT IS A KEY ADVANTAGE OF CASD FOR ASANTE. RATHER THAN PAYING RETIREMENT BENEFITS TO THE EXECUTIVE THAT WOULD NEVER BE RECOVERED, UNDER CASD ASANTE RECOVERS NOT ONLY ITS OUTLAYS, BUT ALSO CONSIDERATION FOR THE TIME VALUE OF MONEY.CASD WORKS AS FOLLOWS. ASANTE DEPOSITS FUNDS INTO A CASH VALUE LIFE INSURANCE POLICY ON THE EXECUTIVE'S LIFE. DURING LIFE, TO THE EXTENT THE EXECUTIVE FULFILLS SERVICE AND VESTING REQUIREMENTS, THE EXECUTIVE CAN BORROW AGAINST VALUES IN THE POLICY TO SUPPLEMENT RETIREMENT INCOME. POLICY PERFORMANCE IS CLOSELY MONITORED. IF POLICY PERFORMANCE LAGS, THE EXECUTIVE'S BORROWING RIGHTS ARE REDUCED TO PROTECT THE EO'S RECOVERY RIGHTS.AT THE EXECUTIVE'S DEATH, THE POLICY DEATH PROCEEDS ARE FIRST USED TO REPAY THE EO ITS DEPOSITS PLUS COMPOUNDED INTEREST (AT THE IRS LONG-TERM APPLICABLE FEDERAL RATE). THE EXECUTIVE'S BENEFICIARY THEN RECEIVES ANY PROJECTED RETIREMENT BORROWING THE EXECUTIVE DID NOT ACCESS DURING LIFE. ANY REMAINING DEATH PROCEEDS ARE AVAILABLE TO BE PAID TO THE EXECUTIVE'S BENEFICIARY. X 1 14500 FMV X 1 20000 FMV X 4 106754 FMV X MISCELLANEOUS 15 225900 FMV 0 0 1 1 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS WAS USED IN PART I. PART I, LINE 32B: ALL SECURITIES DONATIONS ARE RECEIVED AND SOLD BY OUR INVESTMENT MANAGER. FORM 990, PART VI, SECTION A, LINE 2 JEFF CROCKETT AND VICKIE CROCKETT HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 ALL EXECUTIVE SERVICES ARE PROVIDED BY ASANTE, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 ASANTE IS THE SOLE MEMBER OF ASANTE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A ASANTE, AS THE SOLE MEMBER OF ASANTE FOUNDATION, RETAINS THE RIGHT TO APPOINT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B ASANTE, AS THE SOLE MEMBER OF ASANTE FOUNDATION, RETAINS THE RIGHT TO APPROVE GOVERNANCE DECISIONS MADE BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FEDERAL FORM 990 IS A FEDERALLY MANDATED LEGAL DOCUMENT THAT IS HIGHLY REGULATED. BEFORE FINAL SUBMISSION OF THE DOCUMENTS, THEY WERE REVIEWED BY THE MANAGER OF FINANCE, DIRECTOR OF FINANCE AND CFO. AFTER SUBMISSION THE FINAL RETURNS WILL BE PRESENTED TO THE FOUNDATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR, THE FOUNDATION MAILS TO ALL BOARD MEMBERS A CONFLICT OF INTEREST QUESTIONNAIRE TO COMPLY WITH THE FOUNDATION'S CONFLICT OF INTEREST POLICY. THE PURPOSE OF THE POLICY IS TO PROTECT THE INTERESTS OF BOTH THE ASANTE FOUNDATION AND ASANTE (ITS SUPPORTED ORGANIZATION) WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTERESTS OF A BOARD MEMBER. ASANTE'S CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR ADMINISTERING, MONITORING, AND INVESTIGATING ANY POSSIBLE CONFLICTS AND MAKES AN ANNUAL REPORT TO THE ASANTE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF ASANTE'S BOARD OF DIRECTORS ANNUALLY REVIEWS THE COMPENSATION OF THE CEO AND OTHER KEY EMPLOYEES. THE REVIEW COMPARES THE COMPENSATION OF THE CEO AND OTHER KEY EMPLOYEES WITH COMPENSATION DATA FOR JOB INCUMBENTS IN COMPARABLE POSITIONS AT OTHER HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND SCOPE. AT LEAST EVERY THREE YEARS, THE REVIEW IS CONDUCTED AND PRESENTED TO THE COMPENSATION COMMITTEE BY AN OUTSIDE CONSULTANT, CHOSEN BY THE COMPENSATION COMMITTEE. ON ALTERNATE YEARS, THE GENERAL MARKET MOVEMENT IS CONSIDERED AND THE REVIEW IS COMPLETED AND PRESENTED BY THE HUMAN RESOURCES EXECUTIVE. THE COMPENSATION COMMITTEE SETS THE ACTUAL ANNUAL CASH COMPENSATION FOR THE CEO AND SALARY RANGES FOR THE OTHER KEY EMPLOYEES. THE COMMITTEE ALSO SETS TOTAL COMPENSATION OPPORTUNITY FOR THE CEO AND EACH OF THE KEY EMPLOYEES, CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. MINUTES OF THE COMMITTEE DELIBERATIONS AND DECISIONS ARE RECORDED AND MAINTAINED. THE MOST RECENT EXECUTIVE COMPENSATION REVIEW BY AN OUTSIDE CONSULTANT WAS COMPLETED IN 2021. THE HUMAN RESOURCES EXECUTIVE PROVIDED THE UPDATED RECOMMENDATIONS IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH EMMA AND AS A COMPONENT OF FILED FORMS 990. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. ASANTE 2650 SISKIYOU BLVD MEDFORD OR 97504 930223960 HEALTHCARE & MANAGEMENT ACTIVITIES OR 501(C)(3) LINE 3 N/A 0 ASANTE PHYSICIAN PARTNERS 2650 SISKIYOU BLVD MEDFORD OR 97504 383849354 PHYSICIAN GROUP OR 501(C)(3) LINE 3 ASANTE 0 SOUTHERN OREGON INSURANCE COMPANY 745 FORT STREET SUITE 800 HONOLULU HI 96813 201578637 CAPTIVE INSURANCE HI 501(C)(3) LINE 12B, II ASANTE 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0