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HAMDEN ASSURANCE RISK RETENTION GROUP INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
HAMDEN ASSURANCE RISK RETENTION GROUP INC (EIN 20-8530788)
Tax period
2018-01-01 to 2018-12-31
Filed
2019-11-13
IRS object ID
201913179349305376
Schema version
2018v3.1
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

FieldValueIRS element (for citing)
Return2019-11-13T13:31:09-06:00ReturnTs
Tax Period End2018-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2018-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN208530788EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Hamden Assurance Risk Retention Group IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHAMDBusinessNameControlTxt
Phone6036531155PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line130 Main Street Suite 330AddressLine1Txt
CityBurlingtonCityNm
State AbbreviationVTStateAbbreviationCd
ZIP05401ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDaniel JantzenPersonNm
Person TitleCFOPersonTitleTxt
Signature2019-11-13SignatureDt
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-04-17 16:48:07ZBuildTS

Form 990 IRS990

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Daniel JantzenBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical Center DriveAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,739,231GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addressn/aWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2007FormationYr
Legal Domicile StateVTLegalDomicileStateCd
Activity Or MissionTO 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.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers2TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$526,439PYProgramServiceRevenueAmt
CY Program Service Revenue$547,926CYProgramServiceRevenueAmt
PY Investment Income$15,288PYInvestmentIncomeAmt
CY Investment Income$18,487CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$541,727PYTotalRevenueAmt
CY Total Revenue$566,413CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$470,256PYOtherExpensesAmt
CY Other Expenses$526,343CYOtherExpensesAmt
PY Total Expenses$470,256PYTotalExpensesAmt
CY Total Expenses$526,343CYTotalExpensesAmt
PY Revenues Less Expenses$71,471PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$40,070CYRevenuesLessExpensesAmt
Total Assets BOY$71,535,519TotalAssetsBOYAmt
Total Assets EOY$64,239,179TotalAssetsEOYAmt
Total Liabilities BOY$71,485,519TotalLiabilitiesBOYAmt
Total Liabilities EOY$64,189,179TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$50,000NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$50,000NetAssetsOrFundBalancesEOYAmt
MissionTO 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$460,044ExpenseAmt
Revenue$547,926RevenueAmt
DescHAMDEN 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.Desc
Total Program Service Expenses$460,044TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document4IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OfYes (true)Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldVTStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Daniel JantzenBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6036505634PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1One Medical CenterAddressLine1Txt
CityLebanonCityNm
State AbbreviationNHStateAbbreviationCd
ZIP03756ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
GEORGE T BLIKE MD
BD VICE PRESIDENT1.040.0Yes (X)Yes (X)$0$488,455$76,016
LAWRENCE DACEY MD
BOARD CHAIRMAN1.00.5Yes (X)Yes (X)$0$75,081$13,254
DANIEL P JANTZEN
BOARD TREASURER1.060.0Yes (X)Yes (X)$0$802,407$43,841
JOHN KACAVAS
BOARD SECRETARY1.040.0Yes (X)Yes (X)$0$628,988$40,940
EDWARD MERRENS
BOARD PRESIDENT1.060.0Yes (X)Yes (X)$0$710,556$41,527
RANDALL WACHSMANN
BD ASSISTANT SECRETARY1.00Yes (X)Yes (X)$0$0$0
ROBERT GAGLIARDI
BOARD DIRECTOR1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,705,487TotReportableCompRltdOrgAmt
Total Other Compensation$215,578TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Federated Campaigns$0FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$0FundraisingAmt
Related Organizations$0RelatedOrganizationsAmt
Government Grants$0GovernmentGrantsAmt
All Other Contributions$0AllOtherContributionsAmt
Noncash Contributions$0NoncashContributionsAmt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
CEDING COMMISSIONS524298$547,926$547,926$0$0
$0$0$0$0
$0$0$0$0
$0$0$0$0
$0$0$0$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$547,926TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$32,340TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$32,340ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,158,965SecuritiesAmt
Other$0OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,172,818SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$13,853SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$13,853TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$13,853ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$0ContriRptFundraisingEventAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

Total Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
$0$0$0$0
$0$0$0$0
$0$0$0$0

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$566,413TotalRevenueColumnAmt
Related Or Exempt Func Income$547,926RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$18,487ExclusionAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$113,705TotalAmt
Program Services$92,775ProgramServicesAmt
Management And General$20,930ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$12,571TotalAmt
Management And General$12,571ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$26,069TotalAmt
Management And General$26,069ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$5,092TotalAmt
Management And General$5,092ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$643TotalAmt
Management And General$643ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$53,072TotalAmt
Program Services$53,072ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,479TotalAmt
Program Services$5,479ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
ACTUARIAL FEES$176,000$176,000
PREMIUM TAX EXPENSE$122,730$122,730
LETTER OF CREDIT FEES$7,783$7,783
STATE FEES AND REG$1,255$1,255

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,944TotalAmt
Program Services$950ProgramServicesAmt
Management And General$994ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$526,343TotalAmt
Program Services$460,044ProgramServicesAmt
Management And General$66,299ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$663,080BOYAmt
EOY$737,328EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$24,530,938BOYAmt
EOY$16,020,260EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$128,286BOYAmt
EOY$150,442EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$0LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$0LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,995,708BOYAmt
EOY$1,885,242EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$44,217,507BOYAmt
EOY$45,445,907EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$71,535,519BOYAmt
EOY$64,239,179EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$333,638BOYAmt
EOY$227,498EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$269,709BOYAmt
EOY$278,218EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$70,882,172BOYAmt
EOY$63,683,463EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$71,485,519BOYAmt
EOY$64,189,179EOYAmt

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$50,000BOYAmt
EOY$50,000EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$50,000BOYAmt
EOY$50,000EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$71,535,519BOYAmt
EOY$64,239,179EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$40,070ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$17,291NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$57,361OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations4SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (4 entries)

EINEINOrganization TypeOrganizationTypeCdGoverning Document ListedGoverningDocumentListedIndSupportSupportAmtOther SupportOtherSupportAmt
DARTMOUTH-HITCHCOCK CLINIC
2225195969Yes (true)$0$0
MARY HITCHCOCK MEMORIAL HOSPITAL
0202221403Yes (true)$0$0
TRUSTEES OF DARTMOUTH COLLEGE
0202221112Yes (true)$0$0
DARTMOUTH-HITCHCOCK MEDICAL CENTER
2227154839Yes (true)$0$0
FieldValueIRS element (for citing)
Supported Organizations Total4SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationYes (true)SuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part IV, Section A, Line 2 Supported Org. Without IRS Status 509(a)1 or (2)FormAndLineReferenceDesc
ExplanationTHE LIST OF SPECIFIED SUPPORTED ORGANIZATIONS OF HAMDEN ASSURANCE RISK RETENTION GROUP, INC. 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 HRRG'S FORM 1023 EXEMPTION APPLICATION, DHMC WAS INCLUDED AS A CLASS A MEMBER OF HRRG (AND, THUS, A SPECIFIED SUPPORTED ORGANIZATION) PRIMARILY BASED ON ITS POTENTIAL DESIGNATION AS A DEFENDANT IN ANY LITIGATION AGAINST HRRG'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 HRRG 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, HRRG MEETS THE REQUIREMENTS OF TREASURY REGULATION SECTION 1.509(A)-4(D)(2)(II).ExplanationTxt

Schedule D IRS990ScheduleD

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
DEPOSIT ASSET$45,440,305
ACCRUED INTEREST$5,602
FieldValueIRS element (for citing)
Total Book Value Other Assets$45,445,907TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DEPOSIT LIABILITY$46,707,103
PREMIUM TAXES PAYABLE$66,492
DUE TO MEMBERS AND AFFILIATES$16,909,868
FieldValueIRS element (for citing)
Total Liability$63,683,463TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$578,611TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$17,290NetUnrealizedGainsInvstAmt
Other Revenue$0OtherRevenueAmt
Revenue Not Reported$17,290RevenueNotReportedAmt
Revenue Subtotal$561,321RevenueSubtotalAmt
Investment Expenses Not Incld$5,092InvestmentExpensesNotIncldAmt
Other Revenues Not Included$0OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$5,092RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$566,413TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$521,251TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$0OtherExpensesIncludedAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$521,251ExpensesSubtotalAmt
Investment Expenses Not Incld2$5,092InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$0OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$5,092ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$526,343TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 ASC 740 FOOTNOTEFormAndLineReferenceDesc
ExplanationTHE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE RELATED TO ASC 740.ExplanationTxt

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

FieldValueIRS element (for citing)
RegionCentral America and the CaribbeanRegionTxt
Offices0OfficesCnt
Employee0EmployeeCnt
Type Of Activities ConductedProgram ServicesTypeOfActivitiesConductedTxt
Specific Services ProvidedINSURANCESpecificServicesProvidedTxt
Region Total Expenditures$8,154,777RegionTotalExpendituresAmt
FieldValueIRS element (for citing)
Subtotal Offices0SubtotalOfficesCnt
Subtotal Employees0SubtotalEmployeesCnt
Continuation Total Office0ContinuationTotalOfficeCnt
Continuation Total Employee0ContinuationTotalEmployeeCnt
Total Office0TotalOfficeCnt
Total Employee0TotalEmployeeCnt
Subtotal Spent$8,154,777SubtotalSpentAmt
Continuation Spent$0ContinuationSpentAmt
Total Spent$8,154,777TotalSpentAmt
Transfer To Foreign CorpfalseTransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipfalseForeignCorpOwnershipInd
Passive Foreign Investmest CofalsePassiveForeignInvestmestCoInd
Foreign PartnershipfalseForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule F, Part I, Line 3(f) SCH F, PART I, COLUMN FFormAndLineReferenceDesc
ExplanationTHE $8,154,777 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GEORGE T BLIKE MD
BD VICE PRESIDENT$0$439,154$0$5,250$0$44,051$0$52,781$0$23,235$0$564,471$0$0
DANIEL P JANTZEN
BOARD TREASURER$0$640,347$0$10,250$0$151,810$0$26,580$0$17,261$0$846,248$0$0
JOHN KACAVAS
BOARD SECRETARY$0$546,595$0$10,250$0$72,143$0$21,080$0$19,860$0$669,928$0$0
EDWARD MERRENS
BOARD PRESIDENT$0$647,898$0$10,250$0$52,408$0$28,864$0$12,663$0$752,083$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule J, Part I, Line 4b Supplemental nonqualified retirement planFormAndLineReferenceDesc
ExplanationTHE FOLLOWING INDIVIDUALS RECEIVED FUNDS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DANIEL JANTZEN $106,613 EDWARD MERRENS $ 51,994 GEORGE BLIKE $ 43,277 JOHN KACAVAS $ 26,369 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 A QUALIFIED DEFINED BENEFIT PLAN) 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. MARY HITCHCOCK MEMORIAL HOSPITAL AND DARTMOUTH-HITCHCOCK CLINIC, BOTH RELATED ORGANIZATIONS, SPONSOR A SPLIT DOLLAR LIFE PLAN FOR CERTAIN LONG-TERM EMPLOYEES. THE ORIGINAL OBJECTIVES FOR OFFERING THESE PLANS WERE TO BETTER ENABLE MHMH TO ATTRACT AND RETAIN QUALIFY EXECUTIVE PERSONNEL, IMPROVE THE PHYSICIAN'S POST-RETIREMENT LIFE INSURANCE BENEFITS, AND TO REPLACE AN INCREASINGLY COSTLY RETIREE LIFE INSURANCE PROGRAM. THE PLAN WAS FROZEN IN 1998 AND THEREFORE NO FURTHER COSTS OF THE INDIVIDUAL EMPLOYEE INSURANCE PREMIUMS HAVE BEEN FUNDED BY THE ORGANIZATION. THE NUMBER OF PARTICIPANTS AND DOLLAR VALUE CONTINUES TO DWINDLE AS INDIVIDUALS RETIRE/LEAVE THE ORGANIZATION.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 3 DESCRIPTION OF ORGANIZATION'S DELEGATION OF MANAGEMENT CONTROLTHE ORGANIZATION HAS A MANAGEMENT AGREEMENT WITH AIG MANAGEMENT SERVICES TO PROVIDE DAY-TO-DAY ACCOUNTING AND ADMINISTRATIVE SERVICES (SUCH AS LEGAL AND INSURANCE REGISTRATIONS). THE BOARD RETAINS ALL VOTING RIGHTS AND DECISION MAKING OVER THE ORGANIZATION.
Form 990, Part VI, Line 15b OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR UNDERTAKENSOME OF THE ORGANIZATIONS' OFFICERS ARE COMPENSATED BY DARTMOUTH-HITCHCOCK CLINIC AND MARY HITCHCOCK MEMORIAL HOSPITAL, BOTH RELATED AND SUPPORTED ORGANIZATIONS OF HRRG. ALTHOUGH PAID BY A RELATED ORGANIZATION, THE COMPENSATION FOR THE REPORTED OFFICERS IS EVALUATED BY INTERNAL HR STAFF USING NATIONAL BENCHMARKING DATA, ALONG WITH ONGOING EVALUATIONS BY AN INDEPENDENT THIRD PARTY FIRM FOR REASONABLENESS, WITH THE LAST FORMAL PROCESS IN 2017. EXTERNAL BENCHMARKING FROM AN INDEPENDENT THIRD PARTY HAS BEEN USED FOR ANY OFFICER WHO WAS HIRED OR RECEIVED A COMPENSATION ADJUSTMENT SINCE THE LAST FORMAL PROCESS. COMPENSATION RATES ARE DETERMINED BY FOLLOWING THE GUIDELINES OF THE COMPENSATION COMMITTEE CHARTER AND PHILOSOPHY DOCUMENTS AND A FORMAL REVIEW BY COMPENSATION COMMITTEE MEMBERS OF DHC AND MHMH.
Form 990, Part VI, Line 2 Family/business relationships amongst interested personsHAMDEN ASSURANCE RISK RETENTION GROUP IS PART OF THE DARTMOUTH-HITCHCOCK HEALTH SYSTEM, WHICH OWNS FOR-PROFIT SUBSIDIARIES THAT PROVIDE SERVICES AND SUPPORTS THE MISSION OF THE ORGANIZATIONS. AS A RESULT, SOME OFFICERS OF HARRG MAY ALSO BE OFFICERS OF RELATED FOR-PROFITS ENTITIES. - Business relationship
Form 990, Part VI, Line 6 Classes of members or stockholdersTHERE 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 bodyEACH 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 CORPORATION'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. IN ADDITION TO APPROVING BOARD MEMBERS, HRRG 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 stockholdersTHE 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 bodyAN AD HOC COMMITTEE INCLUDING AT LEAST, BUT NOT LIMITED TO, THE PRESIDENT, REVIEW THE FORM BEFORE ITS FILING AND REPORT TO THE BOARD AT THEIR 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 policyTHE 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, AND 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 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.
Form 990, Part VI, Line 19 Required documents available to the publicTHE 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 ASSETSTHE 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 RRG'S MEMBERS.
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesADJUSTMENT FOR RETROSPECTIVE PREMIUMS - -57361;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (15 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
DARTMOUTH-HITCHCOCK CLINIC
ONE MEDICAL CENTER DRIVELEBANONNH03756222519596PHYSICIAN SVCNH501(c)(3)10D-HHYes (true)
MARY HITCHCOCK MEMORIAL HOSPITAL
ONE MEDICAL CENTER DRIVELEBANONNH03756020222140HOSPITALNH501(c)(3)3D-HHYes (true)
TRUSTEES OF DARTMOUTH COLLEGE
37 DEWEY FIELD ROADHANOVERNH03755222527266HIGHER EDUCNH501(c)(3)2NAfalse
DARTMOUTH-HITCHCOCK HEALTH
ONE MEDICAL CENTER DRIVELEBANONNH03756264812335PARENT ORGNH501(c)(3)7NAfalse
THE HITCHCOCK FOUNDATION
ONE MEDICAL CENTER DRIVELEBANONNH03756020222139HLTHCRE RSRCHNH501(c)(3)7DHCYes (true)
THE NEW LONDON HOSPITAL ASSOCIATION INC
273 COUNTY RDNEW LONDONNH03257020222171HOSPITALNH501(c)(3)3D-HHYes (true)
WINDSOR HOSPITAL ASSOCIATION
289 COUNTY RDWINDSORVT05089030183721HOSPITALVT501(c)(3)3D-HHYes (true)
MT ASCUTNEY HOSP CMMTY HLTH FOUND
289 COUNTY RDWINDSORVT05089030300481FOUNDATIONVT501(c)(3)3WHAYes (true)
HISTORIC HOMES OF RUNNEMEDE
289 COUNTY RDWINDSORVT05089237396147HEALTHCAREVT501(c)(3)10WHAYes (true)
CHESHIRE MEDICAL CENTER
580 COURT STREETKEENENH03431020354549HOSPITALNH501(c)(3)3D-HHYes (true)
CHESHIRE HEALTH FOUNDATION
580 COURT STREETKEENENH03431020202220SUPPORTING ORGNH501(c)(3)Type ICMCYes (true)
DARTMOUTH-HITCHCOCK MEDICAL CENTER
ONE MEDICAL CENTER DRIVELEBANONNH03756222715483SUPPORTING ORGNH501(c)(3)Type INAYes (true)
CHESHIRE HEALTH SERVICES
580 COURT STREETKEENENH03431473379283HEALTHCARENH501(c)(3)3CMCYes (true)
VNA & HOSPICE OF VT AND NH
205 BILLINGS FARM RD 5WILDERVT05088036006494HOSPICEVT501(c)(3)10D-HHYes (true)
ALICE PECK DAY MEMORIAL HOSPITAL
10 ALICE PECK DAY DRIVELEBANONNH03766020222791HOSPITALNH501(c)(3)3D-HHYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
D-MASTER INV PROG
1 MED CTR DRLEBANONNH03756020505863POOLED INVNHMHMH
ONE CARE VT ACO LLC
111 COLCHESTER AVEBURLINGTONVT05401455399218SHARED SAVINGVTNA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
POMPANOOSUC INVESTMENT CORPORATION
ONE MEDICAL CENTER DRIVELEBANONNH03756020352330RL ESTATE HLDNHDHCC CorporationYes (true)
HAMDEN ASSURANCE COMPANY LTD
202588083LIAB. INSDHCC CorporationYes (true)BD
HITCHCOCK HEALTH CONNECT
ONE MEDICAL CENTER DRIVELEBANONNH03756800908979TELEHEALTHNHD-HHC CorporationYes (true)
KEARSARGE COMMUNITY SERVICES INC
273 COUNTY ROADNEW LONDONNH03257020460136RL ESTATE HLDNHNLHC CorporationYes (true)
NEW LONDON MEDICAL CENTER EAST INC
273 COUNTY ROADNEW LONDONNH03257020480857RL ESTATE HLDNHNLHC CorporationYes (true)
NEW LONDON PHYSICIAN GROUP INC
273 COUNTY ROADNEW LONDONNH03257020494420PHYSICIAN GRPNHNLHC CorporationYes (true)
KEENE HEALTH SERVICES
580 COURT STREETKEENENH03431020374997REAL EST HLDGNHCHFC CorporationYes (true)
KEENE HEALTH REALTY
580 COURT STREETKEENENH03431020374998REAL EST HLDGNHCHFC CorporationYes (true)
KEENE HEALTH ENTERPRISES
580 COURT STREETKEENENH03431020374999REAL EST HLDGNHCHFC CorporationYes (true)
IMAGINECARE
ONE MEDICAL CENTER DRIVELEBANONNH03756813105071SFTWRE TECHNOLGOYNHD-HHC CorporationYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (4 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
DARTMOUTH HITCHCOCK CLINIC
Q$2,509,120FMV
MARY HITCHCOCK MEMORIAL HOSPITAL
Q$5,854,612FMV
HAMDEN ASSURANCE COMPANY LTD
R$8,154,777FMV
ALICE PECK DAY MEMORIAL HOSPITAL
Q$347,480FMV