Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Members or stockholder classes and rights Part VI line 6 | Any person with a current policy is a voting member of the organizaton |
| Member election for additional members Part VI line 7a | The policyholder/owners elect 5 to 9 members to serve as directors for a 3 year term at the annual policyholder meeting. |
| Form 990 governing body review Part VI line 11 | Form 990 is reviewed, signed and filed by the manager of the organization or a designated officer. The board of directors does not review it prior to filing. |
| Conflict of interest policy compliance Part VI line 12c | The organizations conflict of interest policy is monitored and enforced through the policy application underwriting and issuance process, claim settlement process, and annual discussion and review by management and the board of directors. |
| CEO executive director top management comp Part VI line 15a | Director compensation is determined by the number of meetings attended by the board member.The board determines management and staff compensation based upon experience and qualifications. |
| Other officer or key employee compensation Part VI line 15b | The board of directors determines management and staff compensation based upon experience and qualifications. |
| Governing documents etc available to public Part VI line 19 | Financial and governing documents are available to the public upon request. |
| Explanation of other changes in net assets or fund balances Part XI line 9 | Line 9: Other Changes in Net Assets or Fund BalancesThe following assets (net of accumulated depreciation) are excluded from Part X as required by statutory accounting rules and Minnesota Statute 67A due to non-admitted classification:Furniture and fixtures 356Prepaid expenses 2,857Patronage equities 3,503Total non-admitted assets at the end of the year 6,716Total non admitted assets at the beginning of the year 4,352Change in Non-admitted assets (2,364) |
| List of other expenses Part IX line 24e | Premium refunds $9,226 |
| Part XII Response or note to any line in Part XIII | Line 1 As a regulated entity, the organization is required to report using statutory accounting rules as codified in Minnesota Statute 67A and as promulgated by the Department of Commerce of the State of Minnesota. The most significant item of this statutory basis of accounting is the exclusion of non-admitted assets (as described in Part XI) from the reported assets. |
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