2024-10-14T20:36:03-05:00 2023-11-30 390859910 BAKER TILLY ADVISORY GROUP LP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2022-12-01 980343815 ASSOCIATED HEALTH ASSURANCE LTD ASSO 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 KENT KLEPPE VICE PRESIDENT 7635205200 2024-09-06 1 1 LAWRENCE H MOHR CPA P00447603 6128764500 2024-09-06 2022 2024-10-15 13:58:12Z KENT KLEPPE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 4432154 0 X WWW.NORTHMEMORIAL.COM X 1976 BD ASSOCIATED HEALTH ASSURANCE, LTD IS A CAPTIVE INSURANCE COMPANY WHICH PROVIDES PROFESSIONAL LIABILITY INSURANCE AND WORKER'S COMPENSATION REIMBURSEMENT COVERAGE SOLELY FOR NORTH MEMORIAL HEALTH CARE, THE TAX EXEMPT PARENT COMPANY. 4 1 0 0 0 0 0 0 4065083 4069000 366011 363154 0 0 4431094 4432154 0 0 0 0 5000 5000 0 0 0 4304969 4995619 4309969 5000619 121125 -568465 12447723 13512565 8194582 9478043 4253141 4034522 NONE 0 0 305000 655000 PROVIDED HOSPITAL PROFESSIONAL LIABILITY (NON-PHYSICIAN) INSURANCE POLICY, ON A FIRST DOLLAR BASIS, EXCLUSIVELY TO NORTH MEMORIAL HEALTH CARE. SPECIFIC COVERAGE PROVIDED: $2MM EACH CLAIM, $4MM IN THE AGGREGATE ON A CLAIMS-MADE BASIS, WITH A RETROACTIVE DATE OF 3-1-1976. 8 NEW PROFESSIONAL LIABILITY CLAIMS WERE MADE DURING THE YEAR. $53,938 WAS PAID ON NEW CLAIMS DURING THE YEAR, WHILE $431,683 WAS PAID ON CLAIMS FROM PRIOR POLICY YEARS. 4532440 3414000 PROVIDED WORKERS COMPENSATION AND EMPLOYERS LIABILITY DEDUCTIBLE INSURANCE POLICY THAT COVERED NORTH MEMORIAL HEALTH CARE'S $750,000 PER CLAIM DEDUCTIBLE WITH RESPECT TO ITS WORKER'S COMPENSATION INSURANCE POLICY THAT IS CARRIED BY A DIFFERENT THIRD-PARTY INSURANCE COMPANY ($15.875MM IN ANNUAL AGGREGATE). NORTH MEMORIAL HEALTH CARE MAKES MONTHLY WORKERS' COMPENSATION PAYMENTS TO ITS INSURANCE PROVIDER THEN SUBMITS A CLAIM FOR REIMBURSEMENT FROM ASSOCIATED HEALTH ASSURANCE FOR ITS INSURED DEDUCTIBLE. 397 NEW WORKERS' COMPENSATION INDEMNITY CLAIMS AND/OR MEDICAL CLAIMS WERE MADE DURING THE YEAR. $965,551 WAS PAID ON NEW CLAIMS DURING THE YEAR, WHILE $2,062,044 WAS PAID ON CLAIMS FROM PRIOR POLICY YEARS. 4837440 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 BD 0 0 0 0 0 0 0 0 0 0 X 4 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 KENT KLEPPE PRESIDENT 2.00 40.00 X X 0 158392 26518 STEPH GALE VICE PRESIDENT 2.00 40.00 X X 0 71846 8435 CHIARA NANNINI SECRETARY 2.00 X X 5000 0 0 DANIEL FROMM PRESIDENT 2.00 40.00 X X 0 720094 47133 SARAH LUSHER ALT. BOARD MEMBER 2.00 X 0 0 0 CAROL BEEHLER DIRECTOR 2.00 40.00 X 0 144458 26637 5000 1094790 108723 0 0 1 0 0 INSURANCE PREMIUMS 900099 4069000 4069000 4069000 363154 363154 4432154 4069000 0 363154 5000 5000 71000 71000 37042 37042 1301 1301 32320 32320 6525 6525 LOSS & LOSS ADJUSTMENTS 4610348 4610348 CLAIMS HANDLING FEES 227092 227092 SECRETARIAL FEES 9941 9941 BANK FEES 50 50 5000619 4837440 163179 0 953711 1372721 1690 7639 10202449 10839548 1289873 1292657 12447723 13512565 85931 84297 284500 284500 7824151 9109246 8194582 9478043 X 120000 120000 380000 380000 3753141 3534522 4253141 4034522 12447723 13512565 -568465 349846 0 X X 0 1 X 1 0 X X 1 NORTH MEMORIAL HEALTH CARE 410729979 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 MUTUAL FUNDS - PIMCO 2022139 F MUTUAL FUNDS - VANGUARD 8817409 F 10839548 ACCRUED INTEREST RECEIVABLE 4657 FUNDS WITHHELD BY CEDING COMPANY 1288000 1292657 INSURANCE BALANCE PAYABLE 454152 OUSTANDING LOSS RESERVE 1940713 INCURRED BUT NOT REPORTED RESERVE 6714381 9109246 4782000 349846 349846 4432154 0 4432154 5000619 0 5000619 0 5000619 BERMUDA 1 1 PROGRAM SERVICES GENERAL AND ADMINISTRATIVE EXPENSES 163179 1 1 0 0 1 1 163179 0 163179 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 0 0 0 0 0 0 0 0 0 DANIEL FROMM PRESIDENT 0 574616 0 128625 0 16853 0 18000 0 29133 0 767227 0 0 KENT KLEPPE PRESIDENT 0 151019 0 4769 0 2604 0 9399 0 17119 0 184910 0 0 CAROL BEEHLER DIRECTOR 0 137387 0 5263 0 1808 0 8975 0 17662 0 171095 0 0 FORM 990, PART VI, SECTION A, LINE 3 ASSOCIATED HEALTH ASSURANCE UTILIZES AON INSURANCE MANAGERS, INC. TO OPERATE THE DAY-TO-DAY ACTIVITIES OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 ASSOCIATED HEALTH ASSURANCE, LTD (AHAL) IS A WHOLLY OWNED SUBSIDIARY OF NORTH MEMORIAL HEALTH CARE. NORTH MEMORIAL HEALTH CARE IS THE ONLY STOCKHOLDER OF AHAL. FORM 990, PART VI, SECTION A, LINE 7A NORTH MEMORIAL HEALTH CARE OWNS 100% OF THE STOCK OF ASSOCIATED HEALTH ASSURANCE, LTD (AHAL) AND ELECTS ALL BOARD MEMBERS TO THE AHAL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B ALL BOARD DECISIONS ARE APPROVED BY NORTH MEMORIAL HEALTH CARE (NORTH MEMORIAL) AS NORTH MEMORIAL ELECTS NORTH MEMORIAL MANAGEMENT EMPLOYEES TO SIT ON THE ASSOCIATED HEALTH ASSURANCE, LTD BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTANT FOR MANAGEMENT REVIEW. ONCE FINALIZED, THE RETURN IS REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR KEY POSITIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 INFORMATION IS AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: NO CHANGES HAVE BEEN MADE TO THE OVERSIGHT PROCESS OF THE AUDIT OR THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT. NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 410729979 ACUTE CARE MN 501(C)(3) 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0