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Nonprofiteer
← PROMEDICA INDEMNITY INSURANCE CORPORATION

Form 990 for tax year 2023

Filed by PROMEDICA INDEMNITY INSURANCE CORPORATION.

Totals

Total revenue
$45,835,586
Total expenses
$40,122,249
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$37,971,791
Investment income
$7,863,795
Other revenue
$0
Total assets, end of year
$156,104,094
Total liabilities, end of year
$126,697,904
Net assets or fund balances, end of year
$29,406,190
Program services expenses (Part IX)
$38,622,013
Management and general expenses
$1,500,236
Fundraising expenses
$0
Program service expenses (Part III)
$38,622,013

Program services were 96.3% 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: BASIC PREMIUM REVENUE

    total $37,971,791 · related or exempt $37,971,791

  • 3 · Investment income

    total $2,577,990 · excluded $2,577,990

  • 7a · Gross sales of assets other than inventory

    securities $26,835,316

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

    securities $21,549,511

  • 7c · Gain or loss

    securities $5,285,805

  • 7d · Net gain or loss

    total $5,285,805 · excluded $5,285,805

Functional expenses

Part IX, the statement of functional expenses.

  • 11a · Fees: management

    total $70,000 · management and general $70,000

  • 11b · Fees: legal

    total $9,597 · management and general $9,597

  • 11c · Fees: accounting

    total $20,000 · management and general $20,000

  • 11f · Fees: investment management

    total $269,456 · management and general $269,456

  • 11g · Fees: other

    total $959,927 · management and general $959,927

  • 13 · Office expenses

    total $20,721 · management and general $20,721

  • 17 · Travel

    total $8,207 · management and general $8,207

  • 24a · Other expenses: UNDERWRITING LOSS

    total $38,525,202 · program services $38,525,202

  • 24b · Other expenses: STATE PREMIUM TAX

    total $142,328 · management and general $142,328

  • 24c · Other expenses: INDEMNITY GRANTS PROGRA

    total $96,811 · program services $96,811

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $782,900 · end of year $11,015,316

  • 4 · Accounts receivable

    end of year $13,727,016

  • 9 · Prepaid expenses and deferred charges

    beginning of year $5,404,432 · end of year $131,250

  • 11 · Investments: publicly traded securities

    beginning of year $81,502,573 · end of year $90,873,922

  • 15 · Other assets

    beginning of year $19,410,968 · end of year $40,356,590

  • 17 · Accounts payable and accrued expenses

    beginning of year $194,124 · end of year $1,514,318

  • 25 · Other liabilities

    beginning of year $73,213,896 · end of year $125,183,586

  • 27 · Net assets without donor restrictions

    beginning of year $33,692,853 · end of year $29,406,190

Mission and programs · 2023

Mission

PROMEDICA INDEMNITY CORPORATION WILL PROVIDE MEDICAL PROFESSIONAL AND GENERAL LIABILITY INSURANCE COVERAGE EXCLUSIVELY FOR PROMEDICA HEALTH SYSTEM, INC. AND ITS SUBSIDIARIES.

Activities or mission (Part I)

PROMEDICA INDEMNITY CORPORATION PROVIDES MEDICAL PROFESSIONAL AND GENERAL LIABILITY INSURANCE COVERAGE EXCLUSIVELY FOR PROMEDICA HEALTH SYSTEM, INC. AND ITS SUBSIDIARIES.

  • PROVIDE MEDICAL PROFESSIONAL AND GENERAL LIABILITY INSURANCE COVERAGE EXCLUSIVELY FOR PROMEDICA HEALTH SYSTEM, INC. AND ITS SUBSIDIARIES.

    Expenses $38,622,013 · Revenue $37,971,791

As filed on the 2023 return.

Listed in Part VII

  • Steve Sadowski

    TRUSTEE/CHIEF LEGAL OFFICER

    Total calculated
    $1,413,208
    From this org
    $0
    From related orgs
    $1,407,180
    Other
    $6,028
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $625,095 related
    Bonus
    $0 + $774,925 related
    Other
    $0 + $7,160 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $6,028 related
    Filer's total
    $0 + $1,413,208 related

  • Larry Peterson

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    1

  • Scott Fought

    TREASURER

    Total calculated
    $569,006
    From this org
    $0
    From related orgs
    $561,900
    Other
    $7,106
    Hours/week
    1

    Schedule J breakdown matched by us

    Base
    $0 + $341,443 related
    Bonus
    $0 + $220,350 related
    Other
    $0 + $107 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $7,106 related
    Filer's total
    $0 + $569,006 related

  • Benjamin Gould

    ASSISTANT SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Stephanie Mapes

    ASSISTANT SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Elaine Canning

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Dan Farrell

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Bob Gagliardi

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Thomas Winston

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Robert Laclair

    TRUSTEE

    Total calculated
    $30,000
    From this org
    $0
    From related orgs
    $30,000
    Other
    $0
    Hours/week
    1 + 23 related

  • Terrence Metzger

    TRUSTEE/TREASURER

    Total calculated
    $1,059,169
    From this org
    $0
    From related orgs
    $1,055,090
    Other
    $4,079
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $480,090 related
    Bonus
    $0 + $575,000 related
    Other
    $0
    Deferred
    $0
    Nontaxable benefits
    $0 + $4,079 related
    Filer's total
    $0 + $1,059,169 related

  • Louis Robichaux

    TREASURER - PART YEAR

    Total calculated
    $0
    Hours/week
    1 + 54 related

  • Arturo Polizzi

    PRESIDENT AND CEO

    Total calculated
    $2,127,450
    From this org
    $0
    From related orgs
    $2,121,593
    Other
    $5,857
    Hours/week
    1 + 54 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,315,647 related
    Bonus
    $0 + $789,979 related
    Other
    $0 + $15,967 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $5,857 related
    Filer's total
    $0 + $2,127,450 related

  • Steven M Cavanaugh

    TREASURER, CFO - FORMER

    Total calculated
    $1,340,837
    From this org
    $0
    From related orgs
    $1,335,180
    Other
    $5,657
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $1,335,180 related
    Deferred
    $0
    Nontaxable benefits
    $0 + $5,657 related
    Filer's total
    $0 + $1,340,837 related

  • Jeffrey C Kuhn

    SECRETARY, CHIEF LEGAL OFFICER - FORMER

    Total calculated
    $779,348
    From this org
    $0
    From related orgs
    $748,426
    Other
    $30,922
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $26,526 related
    Bonus
    $0
    Other
    $0 + $721,900 related
    Deferred
    $0 + $26,526 related
    Nontaxable benefits
    $0 + $4,396 related
    Filer's total
    $0 + $779,348 related

  • Gary Akenberger

    SR VP FINANCE - FORMER

    Total calculated
    $572,179
    From this org
    $0
    From related orgs
    $528,647
    Other
    $43,532
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0 + $246,095 related
    Bonus
    $0 + $83,570 related
    Other
    $0 + $198,982 related
    Deferred
    $0 + $36,639 related
    Nontaxable benefits
    $0 + $6,893 related
    Filer's total
    $0 + $572,179 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 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
A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, INC., USES AN INDEPENDENT CONSULTANT, COMPENSATION COMMITTEE, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVES.
PART I, LINES 4A-B
ELIGIBLE EMPLOYEES PARTICIPATE IN VARIOUS NONQUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EMPLOYEE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO SUPPLEMENTAL NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. STEVEN CAVANAUGH RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $1,335,180 DURING 2023. JEFFERY KUHN RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $721,900 DURING 2023. MATTHEW KANG RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, PROMEDICA HEALTH SYSTEM, IN THE AMOUNT OF $583,664 DURING 2023. GARY AKENBERGER RECEIVED SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION, THE TOLEDO HOSPITAL, IN THE AMOUNT OF $195,150 DURING 2023.

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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • NORMAN SPECIALTY HOSPITAL LLC

    HEALTH CARE · DE · general or managing partner

  • MERCYMANOR PARTNERSHIP

    SKILLED NURSING · PA · general or managing partner

  • THE SURGICAL INSTITUTE OF MONROE AMBULATORY SURGERY CENTER LLC

    AMBULATORY SURGICAL CENTER · MI

  • PROMEDICA SENIOR CARE OF GEORGIA LLC

    SKILLED NURSING · OH · general or managing partner

  • PROMEDICA VENTURES INNOVATION FUND III LLC

    HOLDING COMPANY · OH

  • ROCKET VENTURE FUND II LLC

    INVESTMENT FUND · OH

  • SENIOR & REHAB CARE AT METROHEALTH LLC

    SKILLED NURSING · OH · general or managing partner

  • AIR DIVERTER SOLUTIONS LLC

    DEVELOPMENT · OH

  • PROMEDICA DOWNTOWN CAMPUS LANDLORD LLC

    REAL ESTATE · OH · general or managing partner

  • NORTHWEST OHIO DEDICATED BREAST MRI LLC

    MEDICAL DIAGNOSTICS · OH · general or managing partner

  • PROMEDICA INTUITIVE MANAGEMENT OF OHIO LLC

    HEALTH CARE · MI

  • REYNOLDS ROAD SURGICAL CENTER LTD

    FREESTANDING AMBULATORY SURGICAL CENTER · OH

  • WEST CENTRAL SURGICAL CENTER LLC

    AMBULATORY SURGICAL CENTER · OH · general or managing partner

  • PROMEDICA MASTER TENANT LLC

    REAL ESTATE · OH · general or managing partner

  • ARROWHEAD BEHAVIORAL HEALTH LLC

    HEALTH CARE · PA · general or managing partner

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • HERRICK MEMORIAL DEVELOPMENT CORP

    C · FACILITY LEASING · MI · controlled entity

  • LENAWEE CLINICAL PARTNERS

    C · PHYSICIAN SUPPORT · OH · controlled entity

  • PROMEDICA SENIOR CARE OF PISCATAWAY NJ LLC

    C · SKILLED NURSING · NJ · controlled entity

  • HERRICK MEMORIAL OFFICE PLAZA CONDOMINIUM ASSOCIATION

    C · FACILITY MANAGEMENT · MI · controlled entity

  • MONROE HEALTH VENTURES INC

    C · PHARMACY · MI · controlled entity

  • PROMEDICA MANAGER MEMBER LLC

    C · REAL ESTATE · OH · controlled entity

  • PROMEDICA INSURANCE CORP INC AND SUBSIDIARIES

    C · HEALTH CARE INSURANCE · OH · controlled entity

  • PROMEDICA INNOVATIONS LLC

    C · INVESTMENT COMPANY · OH · controlled entity

  • PROMEDICA HEALTH NETWORK INC

    C · PHYSICIAN MANAGEMENT SERVICES · OH · controlled entity

  • PHS TOLEDO INNOVATION CENTER HOLDINGS LLC

    C · HOLDING COMPANY · OH · controlled entity

  • FORT INDUSTRY JV PARTNER LLC

    C · REAL ESTATE · OH · controlled entity

  • PROMEDICA NORTH PHYSICIAN CORPORATION

    C · PHYSICIAN HEALTH CARE SERVICES · OH · controlled entity

  • PROMEDICA AT HOME INC

    C · PHYSICIAN SUPPORT · MI · controlled entity

  • PROMEDICA CENTRAL CORPORATION OF MICHIGAN

    C · PHYSICIAN HEALTH CARE SERVICES · OH · controlled entity

Provenance

Return type
form_990
Tax year
2023
Filed
7 November 2024
IRS schema version
2023v5.1
Source object
202433179349303238

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