2022-10-11T15:30:40-05:00 2021-12-31 990 2021-01-01 208530788 Hamden Assurance Risk Retention Group Inc HAMD 6036504339 30 Main Street Suite 330 Burlington VT 05401 Daniel P Jantzen Treasurer 2022-10-11 Daniel Jantzen 999009999 2021 2022-09-23 18:48:47Z Daniel Jantzen One Medical Center Drive Lebanon NH 03756 3426219 false X n/a X 2007 VT 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. 6 2 0 2 0 0 0 0 687670 937925 46852 13145 0 0 734522 951070 0 0 0 0 0 0 0 0 0 675753 775053 675753 775053 58769 176017 76237478 76466314 76187478 76416314 50000 50000 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. false false 708433 0 937925 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 THROUGH A PRIMARY AND AN EXCESS POLICY. 708433 true false false false false false false false false false false false true true false true false false false true false false false false false false false false true false false false false false false false false false false false false false true false false false true 5 0 true 0 false false false false false false false false X 6 2 false false false false true true true true true false false true true true true true false false VT X Daniel Jantzen 6036504339 One Medical Center Lebanon NH 03756 Carol Barsky MD Board Vice President (eff. 11/19/21) 1.0 40.0 X X 0 396101 19486 DANIEL P JANTZEN BOARD TREASURER 1.0 42.0 X X 0 1021339 63190 EDWARD MERRENS BOARD PRESIDENT 1.0 40.0 X X 0 796359 48247 GEORGE T BLIKE MD BOARD VICE PRESIDENT (through 11/19/21) 1.0 20.5 X X 0 245035 20819 JOHN KACAVAS BOARD SECRETARY 1.0 42.0 X X 0 769932 68891 LAWRENCE DACEY MD BOARD CHAIRMAN 1.0 40.5 X X 0 74617 18383 RANDALL WACHSMANN BOARD ASSISTANT SECRETARY 1.0 0 X X 0 0 0 ROBERT GAGLIARDI BOARD DIRECTOR 1.0 0 X 0 0 0 0 3303383 239016 0 false true false 0 0 CEDING COMMISSIONS 524298 937925 937925 0 0 0 0 937925 10898 10898 0 0 2477396 2475149 2247 0 2247 2247 0 0 0 0 0 951070 937925 0 13145 78974 56025 22949 5518 5518 30087 30087 5682 5682 0 0 0 0 1052 1052 71457 71457 ACTUARIAL FEES 170000 170000 PREMIUM TAX EXPENSE 400682 400682 LETTER OF CREDIT FEES 7804 7804 STATE FEES AND REG 1490 1490 2307 975 1332 0 775053 708433 66620 0 0 0 967695 1042014 0 0 16381509 7943737 0 0 0 0 0 0 0 0 138005 334498 0 0 0 0 1890081 394844 0 0 0 0 56860188 66751221 76237478 76466314 306859 31989 0 0 362223 418416 0 0 0 0 0 0 0 0 0 0 75518396 75965909 76187478 76416314 50000 50000 50000 50000 76237478 76466314 X 176017 -15804 -160213 X false true X true false X X X 4 DARTMOUTH-HITCHCOCK CLINIC 222519596 9 true 0 0 MARY HITCHCOCK MEMORIAL HOSPITAL 020222140 3 true 0 0 TRUSTEES OF DARTMOUTH COLLEGE 020222111 2 true 0 0 DARTMOUTH-HITCHCOCK MEDICAL CENTER 222715483 9 true 0 0 4 0 0 true true false false false false false false false false false false false false false true false Schedule A, Part IV, Section A, Line 2 Supported Org. Without IRS Status 509(a)1 or (2) THE LIST OF SPECIFIED SUPPORTED ORGANIZATIONS OF HAMDEN ASSURANCE RISK RETENTION GROUP, INC. ("HAMDEN") INCLUDES DARTMOUTH-HITCHCOCK MEDICAL CENTER, WHICH ITSELF IS A SUPPORTING ORGANIZATION DESCRIBED IN SECTION 509(A)(3) OF THE INTERNAL REVENUE CODE. AS DESCRIBED TO THE IRS IN HAMDEN'S FORM 1023 EXEMPTION APPLICATION, DHMC WAS INCLUDED AS A CLASS A MEMBER OF HAMDEN (AND, THUS, A SPECIFIED SUPPORTED ORGANIZATION) PRIMARILY BASED ON ITS POTENTIAL DESIGNATION AS A DEFENDANT IN ANY LITIGATION AGAINST HAMDEN'S OTHER SPECIFIED SUPPORTED ORGANIZATIONS. FROM THE TIME OF FILING ITS FORM 1023, UP TO AND INCLUDING THE FILING OF THIS FORM 990, THE NEED FOR HAMDEN TO OPERATE FOR THE BENEFIT OF DHMC OR ANY OTHER SECTION 509(A)(3) ORGANIZATION WAS AND IS A REMOTE CONTINGENCY WITHIN THE MEANING OF TREASURY REGULATION SECTION 1.509(A)-4(D)(4)(I)(B). ACCORDINGLY, HAMDEN MEETS THE REQUIREMENTS OF TREASURY REGULATION SECTION 1.509(A)-4(D)(2)(II). DEPOSIT ASSET 65245415 ACCRUED INTEREST 189 PAID LOSS RECOVERABLE 1505617 66751221 DEPOSIT LIABILITY 66578864 PREMIUM TAXES PAYABLE 318327 DUE TO MEMBERS AND AFFILIATES 9068718 75965909 929584 -15804 0 0 0 -15804 945388 5682 0 5682 951070 769371 0 0 0 0 0 769371 5682 0 5682 775053 Central America and the Caribbean 0 0 Program Services INSURANCE 32127338 0 0 0 0 0 0 32127338 0 32127338 false false false false false false Schedule F, Part I, Line 3 Method used to account for expenditures on org's financial statements CENTRAL AMERICA AND THE CARIBBEAN-Accrual false false false false false false false false false GEORGE T BLIKE MD BOARD VICE PRESIDENT (through 11/19/21) 0 222135 0 0 0 22900 0 20819 0 0 0 265854 0 0 DANIEL P JANTZEN BOARD TREASURER 0 799582 0 85000 0 136757 0 27660 0 35530 0 1084529 0 0 JOHN KACAVAS BOARD SECRETARY 0 589512 0 62100 0 118320 0 27660 0 41231 0 838823 0 0 EDWARD MERRENS BOARD PRESIDENT 0 659793 0 67000 0 69566 0 27660 0 20587 0 844606 0 0 Carol Barsky MD Board Vice President (eff. 11/19/21) 0 380769 0 10000 0 5332 0 17400 0 2086 0 415587 0 0 Form 990, Part VI, Line 6 Classes of members or stockholders THERE ARE TWO CLASSES OF MEMBERS: CLASS A MEMBERS AND CLASS B MEMBERS. THE INITIAL CLASS A MEMBERS SHALL BE DARTMOUTH-HITCHCOCK MEDICAL CENTER, 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. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body 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 OF ALL CLASS A MEMBERS OF THE CORPORATION AS SET FORTH IN THE CORPORATION'S BYLAWS, PREDICATED ON EITHER THE CLASS A MEMBER'S FIRST YEAR PREMIUMS OR DEPOSITS. CLASS B MEMBERS, VOTING AS A SEPARATE CLASS, SHALL 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. IN ADDITION TO APPROVING BOARD MEMBERS, HAMDEN'S MEMBERS MUST APPROVE AMENDMENTS TO THE BYLAWS, ARTICLES, AND DISSOLUTION OF THE CORPORATION. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders 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 CLINIC, HOSPITAL, AND THE TRUSTEES OF DARTMOUTH COLLEGE. Form 990, Part VI, Line 11b Review of form 990 by governing body AN AD HOC COMMITTEE INCLUDING AT LEAST (BUT NOT LIMITED TO) THE PRESIDENT REVIEWS THE FORM BEFORE ITS FILING AND REPORTS TO THE BOARD AT THE BOARD'S ANNUAL MEETING. A COPY OF THE FULL FORM 990 IS GIVEN TO THE BOARD FOR REVIEW PRIOR TO THE FILING. Form 990, Part VI, Line 12c Conflict of interest policy THE HAMDEN RISK RETENTION GROUP'S BOARD OF TRUSTEES APPROVED A POLICY CONCERNING A VOLUNTARY SELF-DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST. THE DARTMOUTH-HITCHCOCK COMPLIANCE AND AUDIT SERVICES DEPARTMENT CONDUCTS AN ANNUAL SURVEY OF ALL OFFICERS AND TRUSTEES AND PERFORMS OTHER PROCEDURES AS CONSIDERED NECESSARY TO REPORT ON COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. THE DEPARTMENT THEN REPORTS TO EACH BOARD ANY POTENTIAL CONFLICTS FOR THEIR REVIEW. PER THE POLICY, CONFLICTS OR OTHERWISE PERCEIVED CONFLICTS ARE REQUIRED TO BE ADDRESSED BY THE BOARD OF TRUSTEES ON AN ONGOING BASIS. IN THE EVENT A CONFLICT ARISES, THE INDIVIDUAL MAY BE REMOVED FROM PARTICIPATING IN ANY DECISION-MAKING REGARDING THE IDENTIFIED CONFLICT AND/OR ITS CORRESPONDING TRANSACTIONS. 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 UNDER 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. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, Line 9 OTHER CHANGES TO NET ASSETS THE ENTRY ON LINE 9 REFLECTS THE ADJUSTMENT FOR RETROSPECTIVE PREMIUMS, WHICH IS A DUE FROM REINSURER/TO MEMBERS AND AFFILIATES ACCOUNT. AMOUNTS DUE FROM REINSURER CONSIST OF REINSURANCE DEPOSITS FOR RETROSPECTIVE SETTLEMENTS FOR PREMIUMS RELATED TO ALL APPLICABLE INCOME AND COSTS UNDER THE REINSURANCE CONTRACTS; WHICH INCLUDES DEVELOPMENT, GENERAL AND ADMINISTRATIVE EXPENSES, AND INVESTMENT INCOME. AMOUNTS DUE TO MEMBERS AND AFFILIATES CONSIST OF RETURN PREMIUMS FROM RETROSPECTIVE SETTLEMENTS RELATED TO ALL APPLICABLE INCOME AND COSTS UNDER THE CONTRACTS; WHICH INCLUDES LOSS DEVELOPMENT, GENERAL AND ADMINISTRATIVE EXPENSES, AND INVESTMENT INCOME, FOR THE DIRECT POLICIES, DUE TO THE HAMDEN'S MEMBERS. Form 990, Part XI, Line 9 Other changes in net assets or fund balances ADJUSTMENT FOR RETROSPECTIVE PREMIUMS - -160213; Schedule F, Part I, Line 3(f) Column F THE AMOUNT REPORTED UNDER COLUMN (F) TO CENTRAL AMERICA/CARIBBEAN REPRESENTS THE AMOUNT ACCOUNTED FOR WITHIN THE BALANCE SHEET OF THE AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION. DARTMOUTH-HITCHCOCK CLINIC ONE MEDICAL CENTER DRIVE LEBANON NH 03756 222519596 PHYSICIAN SERVICES NH 501(c)(3) 10 Dartmouth-Hitchcock Health false Dartmouth-Hitchcock Health One Medical Center Drive Lebanon NH 03756 Supporting Org NH 501(c)(3) 7 NA false The Hitchcock Foundation One Medical Center Drive Lebanon NH 03756 020222139 Health Care Research NH 501(c)(3) 7 Dartmouth Hitchcock Clinic false Pompanoosuc Investment Corporation One Medical Center Drive Lebanon NH 03756 020352330 Real Estate Holding NH Dartmouth Hitchcock Clinic C Corporation 0 0 0 false false false false false false false false false false false false false false false false false true false false