HAMDEN ASSURANCE RISK RETENTION GROUP INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HAMDEN ASSURANCE RISK RETENTION GROUP INC (EIN 20-8530788)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-14
- IRS object ID
- 201133189349307053
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-14T16:34:31-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 2600 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 46204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208530788 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hamden Assurance Risk Retention Group Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HAMD | NameControl |
| Phone | 6036505668 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 Main Street Suite 330 | AddressLine1 |
| City | Burlington | City |
| State | VT | State |
| ZIP Code | 05401 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Daniel P Jantzen | Name |
| Title | Treasurer | Title |
| Date Signed | 2011-11-14 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3176817000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DANIEL P JANTZEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Medical Center Drive | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 03756 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4383034 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2007 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | See Attachment 1 | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 405325 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 405846 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 130343 | InvestmentIncomePriorYear |
| Investment Income Current Year | 66005 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 535668 | TotalRevenuePriorYear |
| Total Revenue Current Year | 471851 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 389098 | OtherExpensePriorYear |
| Other Expenses Current Year | 364974 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 389098 | TotalExpensesPriorYear |
| Total Expenses Current Year | 364974 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 146570 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 106877 | RevenuesLessExpensesCY |
| Total Assets BOY | 73050514 | TotalAssetsBOY |
| Total Assets EOY | 78067960 | TotalAssetsEOY |
| Total Liabilities BOY | 71870642 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 76740806 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1179872 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1327154 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO BENEFIT, TO PERFORM THE FUNCTIONS OF, AND TO CARRY OUT THE PURPOSES OF THE CHARITABLE CLASS OF BENEFICIARIES, THROUGH THE PROVISION OF SELF-INSURANCE COVERAGE AND OTHER SERVICES THAT RISK RETENTION GROUPS ARE PERMITTED TO PROVIDE UNDER THE APPLICABLE FEDERAL AND STATE LAW; TO ACQUIRE, ESTABLISH, RETAIN AND MAINTAIN A FUND OR FUNDS TO BE HELD, INVESTED AND USED EXCLUSIVELY FOR THE FOREGOING PURPOSES. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 295184 | Expense |
| Revenue | 405846 | Revenue |
| Description | Hamden Assurance Risk Retention Group, Inc. (Hamden) was incorporated on February 28, 2007, under the laws of the State of Vermont by its Class A members: Dartmouth-Hitchcock Medical Center, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital and the Trustees of Dartmouth College. Commencing operations on October 1, 2007, Hamden writes medical professional and general liability coverage for its members (insureds) which are also the owners. Insurance coverage is provided though a primary and an excess policy. | Description |
| Total Program Service Expense | 295184 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | true | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 1 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DANIEL P JANTZEN | NamePerson |
| Telephone Number | 6036505668 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE MEDICAL CENTER | AddressLine1 |
| City | Lebanon | City |
| State | NH | State |
| ZIP Code | 03756 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| JOHN C COLLINS | ||||||
| CHAIRMAN | 1.0 | X | X | 0 | 376380 | 55295 |
| RICHARD H SHOWALTER JR | ||||||
| SECRETARY/TREAS.UNTIL(4/30/10) | 1.0 | X | X | 0 | 246600 | 15077 |
| ADAM M KELLER | ||||||
| DIRECTOR | 1.0 | X | 0 | 443092 | 44022 | |
| Anne Page | ||||||
| Director | 1.0 | X | 0 | 219544 | 41930 | |
| Randall Wachsmann | ||||||
| Assistant Secretary | 1.0 | X | X | 0 | 0 | 0 |
| Daniel P Jantzen | ||||||
| Secrerary/Treas.(Eff 4/30/10) | 1.0 | X | X | 0 | 528264 | 32570 |
| Peter A Johnson | ||||||
| President (Eff 4/30/10) | 1.0 | X | X | 0 | 421481 | 30493 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2235361 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 219387 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CEDING COMMISSIONS | Description |
| Business Code | 524298 | BusinessCode |
| Total Revenue Column | 405846 | TotalRevenueColumn |
| Related Or Exempt Function Income | 405846 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 405846 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 39929 | TotalRevenueColumn |
| Exclusion | $39,929 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3937259 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3911183 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 26076 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26076 | TotalRevenueColumn |
| Exclusion | $26,076 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 471851 | TotalRevenueColumn |
| Related Or Exempt Function Income | 405846 | RelatedOrExemptFunctionIncome |
| Exclusion | $66,005 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68425 | Total |
| Program Services | 47898 | ProgramServices |
| Management And General | 20527 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8518 | Total |
| Management And General | 8518 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36000 | Total |
| Management And General | 36000 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4280 | Total |
| Management And General | 4280 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 465 | Total |
| Management And General | 465 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| ACTUARIAL FEES | 5000 | 5000 |
| PREMIUM TAX EXPENSE | 203451 | 203451 |
| STATE FEES AND REGISTRATIONS | 1130 | 1130 |
| DUES AND ASSESSMENTS | 12299 | 12299 |
| LINE OF CREDIT FEES | 25406 | 25406 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 364974 | Total |
| Program Services | 295184 | ProgramServices |
| Management And General | 69790 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 656570 | BOY |
| EOY | 459286 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1677612 | BOY |
| EOY | 3144553 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 362923 | BOY |
| EOY | 309154 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1847451 | BOY |
| EOY | 2294757 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68505958 | BOY |
| EOY | 71860210 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73050514 | BOY |
| EOY | 78067960 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 227643 | BOY |
| EOY | 423198 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 306000 | BOY |
| EOY | 299537 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71336999 | BOY |
| EOY | 76018071 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71870642 | BOY |
| EOY | 76740806 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1050000 | BOY |
| EOY | 1050000 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129872 | BOY |
| EOY | 277154 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1179872 | BOY |
| EOY | 1327154 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73050514 | BOY |
| EOY | 78067960 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 106877 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 40405 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (4 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| DARTMOUTH-HITCHCOCK CLINIC | |||
| 222519596 | 0 | true | $256,212 |
| MARY HITCHCOCK MEMORIAL HOSPITAL | |||
| 020222140 | 0 | true | $94,163 |
| TRUSTEES OF DARTMOUTH COLLEGE | |||
| 020222111 | 0 | true | $5,475 |
| DARTMOUTH-HITCHCOCK MEDICAL CENTER | |||
| 222715483 | 0 | true | $9,124 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 4 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 364974 | SumOfAmounts |
| General Explanation | The Organization provides Medical, Professional, and General Liability Coverage to its member (supported) organizations. In addition, the Organization pays expenses on the behalf of its supporting organizations as part of its ordinary business activties. | GeneralExplanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment | |
| Other Land Buildings | OtherLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEPOSIT ASSET | 70854292 |
| LETTER OF CREDIT | 1000000 |
| ACCRUED INTEREST | 5918 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 71860210 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEPOSIT LIABILITY | $72,702,332 |
| PREMIUM TAXES PAYABLE | $171,186 |
| DUE TO MEMBERS AND AFFILIATES | $3,144,553 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 76018071 | TotalOfAmounts |
| Total Revenue | 471851 | TotalRevenue |
| Total Expenses | 364974 | TotalExpenses |
| Excess Or Deficit For Year | 106877 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 40405 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 40405 | TotalAdjustments |
| Excess Or Deficit Per FS | 147282 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 507511 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 40405 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 40405 | RevenueNotRptdF990 |
| Revenue Subtotal | 467106 | RevenueSubtotal |
| Other Revenues Not Included | 4745 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 4745 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 471851 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 360229 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 360229 | ExpensesSubtotal |
| Other Expenses Not Included | 4745 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4745 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 364974 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Schedule D, Part XII | Investment expenses reclassed as netted with revenue in the audited financial statements - $4,745 |
| Schedule D, Part XIII | Investment expenses reclassed as netted with revenue in the audited financial statements - $4,745. |
| ASC 740 (FIN 48) Footnote Schedule D Part X | No ASC 740 (FIN 48) footnote was included in the audited financial statements as there were no material uncertain tax positions at or since adoption. |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | Region |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConducted |
| Specific Services Provided | Insurance | SpecificServicesProvided |
| Total Expenditures | 9133355 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Amount Spent | 9133355 | SubtotalAmountSpent |
| Total Amount Spent | 9133355 | TotalAmountSpent |
| Transfer To Foreign Corp | false | TransferToForeignCorp |
| Interest In Foreign Trust | false | InterestInForeignTrust |
| Own Foreign Corp | false | OwnForeignCorp |
| Passive Foreign Invest Co | false | PassiveForeignInvestCo |
| Foreign Partnership | false | ForeignPartnership |
| Boycott Countries | false | BoycottCountries |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN C COLLINS | ||||||||||||
| 0 | 104956 | 0 | 116408 | 155016 | 0 | 31410 | 0 | 23885 | 0 | 431675 | 0 | 0 |
| RICHARD H SHOWALTER JR | ||||||||||||
| 0 | 179529 | 0 | 0 | 67071 | 0 | 0 | 0 | 15077 | 0 | 261677 | 0 | 0 |
| ADAM M KELLER | ||||||||||||
| 0 | 396393 | 0 | 0 | 46699 | 0 | 24500 | 0 | 19522 | 0 | 487114 | 0 | 37450 |
| Anne Page | ||||||||||||
| 0 | 217708 | 0 | 0 | 1836 | 34661 | 7269 | 0 | 261474 | 0 | |||
| Daniel P Jantzen | ||||||||||||
| 0 | 469627 | 0 | 58637 | 12250 | 20320 | 0 | 560834 | 0 | 0 | |||
| Peter A Johnson | ||||||||||||
| 0 | 388659 | 0 | 0 | 32822 | 0 | 8820 | 0 | 21673 | 0 | 451974 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Dartmouth-Hitchcock Defined Contribution Supplemental Retirement Plan | Identifier |
| Return Reference | Schedule J, Part I, Line 4b | ReturnReference |
| Explanation | Peter Johnson received $32,822 from a supplemental non-qualified retirement plan. John Collins received $26,745 from a supplemental non-qualified retirement plan. Daniel Jantzen received $58,223 from a supplemental non-qualified retirement plan. Anne Page received $14 from a supplemental non-qualified retirement plan. Richard Showalter received $23,700 from a supplemental non-qualified retirement plan. Terms and Conditions: An eligible employee is a participant in the Dartmouth-Hitchcock Retirement Plan and/or any prior pension arrangements sponsored by Dartmouth-Hitchcock (including two qualified defined benefit plans) who would be entitled to additional contributions or benefit accruals under the terms of the plans for the plan year, but are limited by IRC Section 401(A) and/or 415. For eligible employees, the employer will pay the eligible employee an amount determined by the employer each year to offset the amount of the reduction in the benefit accrual or contributions as a result of limitations imposed by IRC sections 401(A)(17) and/or 415. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Organization's Delegation of Management Control | Form 990, Part VI, Line 3 | The Organization has a management agreement with Chartis Insurance Management Services to provide day-to-day accounting, and administrative services (such as legal and insurance registrations). In addition, the Organization has a claims service agreement with Atlantic Risk Management (ARM) to provide third-party claims administration services. ARM is a division of the Dartmouth-Hitchcock Clinic. However, the board retains all voting rights and decision making over the Organization. Description of Classes of Members or Stockholders Form 990, Part VI, Line 6 There are two classes of members: Class A Members and Class B Members. The initial Class A Members shall be Dartmouth-Hitchcock, Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. Class B Members shall be entities affiliated with or related to the Class A Members. affiliated with or related to the Class A Members. |
| Description of Classes of Persons and the Nature of Their Rights | Form 990, Part VI, Line 7a | Each class A Member shall have full voting rights. The number of votes Each Class A Member Shall be entitled to cast on each matter submitted to a vote of the members shall be based on a ratio that one class A member's risk bears to risks all Class A members of the corporation as set forth in the Coporation's Bylaws, Predicated on either the class A member's first year premiums or deposits. Class B members shall, voting as a separate class, have the right to elect one Class B Director of the Corporation. Class B Members shall NOT have the right to vote on any other matters submitted to a vote of the Members, except as otherwise provided under Vermont law. Each class B Member shall have one vote for each matter on which the class B members are entitled to vote. |
| Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights | Form 990, Part VI, Line 7b | The affairs of the Organization shall be managed by a Board of Directors consisting of at least three and no more than seven members of Dartmouth-Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and the Trustees of Dartmouth College. The Class B Members shall, voting as a separate class, have the right to elect one Class B Director of the Organization. All additional members of the Board of Directors, if any shall be appointed by the Hospital, and the Trustees of Dartmouth College. |
| Governance Over Approval and Filling of 990 | Form 990, Part VI, Line 11b | An ad hoc committee including at least, but not limited to, the president and vice president review the form before its filing and report to the board at their annual meeting. |
| Conflict of Interest Policy Enforcement | Form 990, Part VI, Line 12c | The entity has a conflict of interest policy which requires Directors and Officers to disclose potential conflicts of interest of themselves and family members. A conflict of interest statement is required to be completed of each Director or Officer on an annual basis. The solicitation and collection of interest statements is organized by legal counsel who submit to the Board of Directors any statements that disclose a potential conflict of interest. Any conflicts disclosed or otherwise perceived are required to be addressed by the Board of Directors; whereupon any action including, but not limited to, restriction would be determined. If the board or committee has reasonable cause to believe that an interested person has failed to disclose actual or possible conflicts of interest, it shall inform such person on the basis for such belief and afford him/her an opportunity to explain the alleged failure to disclose. If, after hearing the response of the interested person and making such further investigation as may be warranted in the circumstances, the board or committee determines that such person has in fact failed to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. Policies Form 990, Part VI, Line 13 and 14 The organization is currently in the process of reviewing and approving a formal Whistleblower and Record Retention Policy at the board level. |
| Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public | Form 990, Part VI, Line 19 | The Organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. |
| Other Changes in Net Assets or Fund Balances | Form 990, Part XI, Line 5 | Other Changes in net assets or fund balances: $40,405 unrealized gain/losses |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOHN C COLLINS TITLE:CHAIRMAN HOURS:40 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:RICHARD H SHOWALTER JR TITLE:SECRETARY/TREAS.UNTIL(4/30/10) HOURS:60 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ADAM M KELLER TITLE:DIRECTOR HOURS:40 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Anne Page TITLE:Director HOURS:40 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Daniel P. Jantzen TITLE:Secrerary/Treas.(Eff 4/30/10) HOURS:60 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Peter A. Johnson TITLE:President (Eff 4/30/10) HOURS:60 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| Dartmouth-Hitchcock Clinic | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 222519596 | Healthcare | NH | 501(C)(3) | 9 | D-H Health |
| Mary Hitchcock Memorial Hospital | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 020222140 | Hospital | NH | 501(C)(3) | 3 | D-H Health |
| Dartmouth College | |||||||||
| 37 Dewey Field Road | Hanover | NH | 03755 | 222527266 | Higher Educ. | NH | 501(C)(3) | 2 | NA |
| Dartmouth-Hitchcock Medical Center | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 222715483 | Support Org. | NH | 501(C)(3) | 11 Type I | NA |
| Dartmouth-Hitchcock Health | |||||||||
| One Medical Center Drive | Lebanon | NH | 03756 | 264812335 | Healthcare | NH | 501(C)(3) | 7 | NA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
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