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Nonprofiteer
← SOUTHERN OREGON INSURANCE INC

Form 990 for tax year 2023

Filed by SOUTHERN OREGON INSURANCE INC.

Totals

Total revenue
$5,350,727
Total expenses
$4,169,948
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$3,259,353
Investment income
$2,091,374
Other revenue
$0
Total assets, end of year
$43,322,136
Total liabilities, end of year
$10,822,017
Net assets or fund balances, end of year
$32,500,119
Program services expenses (Part IX)
$3,676,939
Management and general expenses
$493,009
Fundraising expenses
$0
Program service expenses (Part III)
$3,676,939

Program services were 88.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: PREMIUMS

    total $3,259,353 · related or exempt $3,259,353

  • 3 · Investment income

    total $964,167 · excluded $964,167

  • 7a · Gross sales of assets other than inventory

    securities $26,478,497

  • 7b · Less cost or other basis and sales expenses

    securities $25,351,290

  • 7c · Gain or loss

    securities $1,127,207

  • 7d · Net gain or loss

    total $1,127,207 · excluded $1,127,207

Functional expenses

Part IX, the statement of functional expenses.

  • 11a · Fees: management

    total $76,618 · management and general $76,618

  • 11b · Fees: legal

    total $10,471 · management and general $10,471

  • 11c · Fees: accounting

    total $45,864 · management and general $45,864

  • 11f · Fees: investment management

    total $95,160 · management and general $95,160

  • 11g · Fees: other

    total $250,000 · management and general $250,000

  • 24a · Other expenses: LOSSES & LOSS ADJUSTMEN

    total $3,537,291 · program services $3,537,291

  • 24b · Other expenses: CLAIMS MANAGEMENT FEES

    total $112,500 · program services $112,500

  • 24c · Other expenses: ACTUARIAL FEES

    total $19,000 · program services $19,000

  • 24d · Other expenses: MISCELLANEOUS EXPENSE

    total $14,272 · management and general $14,272

  • 24e · All other expenses

    total $8,772 · program services $8,148 · management and general $624

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    beginning of year $10,248,134 · end of year $9,778,733

  • 11 · Investments: publicly traded securities

    beginning of year $26,408,319 · end of year $32,703,530

  • 15 · Other assets

    beginning of year $830,356 · end of year $839,873

  • 17 · Accounts payable and accrued expenses

    beginning of year $69,210 · end of year $174,535

  • 19 · Deferred revenue

    beginning of year $1,083,605 · end of year $1,087,887

  • 25 · Other liabilities

    beginning of year $9,682,848 · end of year $9,559,595

  • 29 · Capital stock, trust principal or current funds

    beginning of year $3,000,000 · end of year $3,000,000

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $23,651,146 · end of year $29,500,119

Mission and programs · 2023

Mission

SCHEDULE OTHE PRIMARY PUPOSE FOR WHICH THIS CORPORATION IS FORMED IS TO BE A NONPROFIT CAPTIVE INSURANCE COMPANY PURSUANT TO ARTICLE 19 OF CHAPTER 431 OF THE HAWAII REVISED STATUTES, AS AMENDED.THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES, BY SUPPORTING, BENEFITING OR CARRYING OUT SOME OR ALL OF THE PURPOSES OF ASANTE, DBA ASANTE HEALTH SYSTEM (AHS) AND OTHER ORGANIZATIONS ("AFFILIATES") THAT ARE CONTROLLED DIRECTLY OR INDIRECTLY BY AHS AND THAT ARE NON-PRIVATE FOUNDATIONS UNDER SECTION 509(A)(1) OR (2) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED ("CODE"), OR CORRESPONDING SECTIONS OF ANY FUTURE FEDERAL TAX CODE.

Activities or mission (Part I)

TO BE A NONPROFIT CAPTIVE INS. CO PURSUANT TO ART. 19 OF CH. 431 OF THE HI REV. STATUTES, AS AMD.

  • SOUTHERN OREGON INSURANCE INC. RECEIVED ITS CERTIFICATE OF AUTHORITY AS A PURE CAPTIVE INSURANCE COMPANY FROM THE INSURANCE COMMISSIONER OF THE STATE OF HAWAII. THE COMPANY PROVIDES ITS PARENT WITH ALTERNATIVE RISK FINANCING OPTIONS, AND IS AUTHORIZED TO PROVIDE HEALTHCARE PROFESSIONAL AND GENERAL LIABILITY COVERAGE ON A CLAIMS-MADE BASIS.

    Expenses $3,676,939 · Revenue $3,259,353

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Tom Gessel

    CHAIR/PRESIDENT

    Total calculated
    $1,050,000
    From this org
    $0
    From related orgs
    $1,050,000
    Other
    $0
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,050,000 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $1,050,000 related

  • Heather Rowenhorst

    TREASURER

    Total calculated
    $495,653
    From this org
    $0
    From related orgs
    $495,653
    Other
    $0
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $495,653 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $495,653 related

  • James Grebosky MD

    DIRECTOR

    Total calculated
    $190,539
    From this org
    $0
    From related orgs
    $149,423
    Other
    $41,116
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $149,423 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $17,400 related
    Nontaxable benefits
    $0 + $23,716 related
    Filer's total
    $0 + $190,539 related

  • Peter Angstadt

    VP/SECRETARY

    Total calculated
    $0
    Hours/week
    2 + 2 related

  • Jen Ligons

    ASSISTANT SECRETARY

    Total calculated
    $120,030
    From this org
    $0
    From related orgs
    $90,478
    Other
    $29,552
    Hours/week
    0 + 40 related

  • Scott Kelly

    FORMER CHAIR/PRES THRU 2/13/23

    Total calculated
    $304,563
    From this org
    $0
    From related orgs
    $270,830
    Other
    $33,733
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $270,830 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $17,400 related
    Nontaxable benefits
    $0 + $16,333 related
    Filer's total
    $0 + $304,563 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
CEO COMPENSATION SOUTHERN OREGON INSURANCE DOES NOT PAY ANY OF ITS OFFICERS OR DIRECTORS DIRECTLY. ASANTE, THE PARENT ORGANIZATION OF SOUTHERN OREGON INSURANCE, PAYS ITS FORMER CEO, SCOTT KELLY. HOWEVER, ASANTE HAS A COMPENSATION COMMITTEE THAT UTILIZES AN INDEPENDENT COMPENSATION CONSULTING FIRM THAT CONDUCTS COMPENSATION SURVEYS. ASANTE'S COMPENSATION COMMITTEE RECOMMENDS THE TERMS OF THE CEO COMPENSATION PACKAGE, AND ASANTE'S BOARD APPROVES ITS TERMS.
PART I, LINE 4B
ASANTE HAS AN EXECUTIVE RESTORATION PLAN WHICH INCLUDES JAMES GREBOSKY, AND SCOTT KELLY. THIS PLAN STATES FIXED PAYMENTS WILL BE RECEIVED AT PRE-DETERMINED INTERVALS FROM ASANTE IF STILL EMPLOYED BY ASANTE IN THEIR CURRENT ROLE AT THE TIME OF VESTING. IF EMPLOYMENT IS TERMINATED BY ASANTE FOR ANY REASON PRIOR TO VESTING, THEY WILL NOT HAVE CLAIM TO THE FUNDS.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2023
Filed
12 August 2025
IRS schema version
2023v6.0
Source object
202502279349300410

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