2024-03-14T11:38:37-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 810460228 Montana Self-Insurers Guaranty Fund MONT 4062341420 519 Pleasant St Miles City MT 593013030 Janet Bastian Executive Director 4062341420 2024-03-13 1 Janet Bastian 999009999 1 Deb Nelson CPA P01264758 6122536500 2024-03-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Janet Bastian 519 Pleasant St Miles City MT 593013030 160932 0 X N/A X MCA SEC 39 1989 MT To provide coverage of workers compensation claims for bankrupt member self-insurers in Montana. 5 5 0 5 0 0 0 0 94278 113065 38422 47867 0 0 132700 160932 0 0 0 0 0 0 0 0 0 62010 81087 62010 81087 70690 79845 3199960 3268992 353667 353667 2846293 2915325 Workers Compensation Self-Insurers Guaranty Fund is required by the State of Montana statutes (Montana Code Annotated Title 39, Chapter 71, Part 26). 0 0 The Montana Self-Insurers Guaranty Fund provides for coverage of workers compensation claims of bankrupt self-insurers in the State of Montana when needed. All self-insurers for workers compensation in the State of Montana must belong to the Montana Self-Insurers Guaranty Fund. Currently there are 26 active members. 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Greg Johnson 4062341420 519 Pleasant St Miles City MT 593013030 X Donna Haeder President/Chairperson 1.00 X X 0 0 0 Greg Johnson Secretary/Treasurer 1.00 X X 0 0 0 Lea Potozcny Board Member 1.00 X 0 0 0 Jamie Haun Board Member 1.00 X 0 0 0 Chris Hopkins Board Member 1.00 X 0 0 0 Janet Bastian Executive Director 4.00 X 0 0 0 0 0 0 0 0 0 0 0 Member Assessments 813910 113065 113065 113065 47867 47867 160932 113065 0 47867 59415 21400 75 109 Medical Claim Review 88 81087 62879 16 3131011 3263762 245 136 5825 5078 3199960 3268992 353667 353667 353667 353667 X 2846293 2915325 2846293 2915325 3199960 3268992 79845 -10813 0 X 0 0 0 0 1 0 0 Estimated Liability for Unpaid Claims and Claims Adjustment Expenses 353667 353667 Form 990, Part VI, Section A, line 3 Management of the Organization is delegated to the Montana Health Network, Inc. The organization's Executive Director, Janet Bastian, is compensated by the Montana Health Network, Inc. During the fiscal year ending June 30, 2023, Montana Health Network was paid a total of $59,415 pursuant to the management contract. Form 990, Part VI, Section A, line 6 The organization has one class of members: private, self-insured workers compensation organizations. Form 990, Part VI, Section A, line 7a The self-insured employer members elect the governing body. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The organization provides a copy of the Form 990 to each board member for approval prior to filing the return with the IRS. Form 990, Part VI, Section B, line 12c All board members are covered by the Conflict of Interest Policy. The board determines whether a conflict exists by careful review of the circumstances involved in any given situation. The Conflict of Interest Policy is distributed to each board member annually. Board members acknowledge receipt of and compliance with the policy annually by signing, dating, and returning the acknowledgement form to the Executive Director. If a conflict arises as determined by the board, the board member involved is restricted from voting on relevant issues. Form 990, Part VI, Section B, line 15 The Executive Director is employed by the Montana Health Network, Inc. (MHN) and is covered under their compensation and evaluation process as set by MHN policy. Compensation is authorized by the board as per their management contract with MHN. Form 990, Part VI, Section C, line 19 Under written or verbal request, the governing documents, the Conflict of Interest Policy, and the financial statements will be made available to the public by email.