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      <OtherExpensesIncludedAmt>1</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>1</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>10503017</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>10503017</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d-Other revenue included on Sch D but not on 990</FormAndLineReferenceDesc>
        <ExplanationTxt>Other revenue included on line 1 are differences in rounding</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XII, Line 2d-Other expenses included on Sch D but not on 990</FormAndLineReferenceDesc>
        <ExplanationTxt>Other expenses included on line 1 are differences in rounding</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Members or stockholder classes and rights Part VI line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>Member insurer means an insurer licensed or which holds a certificate of authority to transact in this state any kind of insurance for which coverage is provided under North Dakota Century Code Section 26.1-38.1-01.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Member election for additional members Part VI line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Members elect the Board of Directors at the annual meeting.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>Form 990 was provided to the Board of Directors for review prior to being filed with the IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Officer director etc mailing address Part VI line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Blue Cross Blue Shield of North Dakota, Attn Cyndee Thormodson, 4510 13th Avenue S, Fargo ND 58121 Northwestern Mutual Life Insurance Company, Attn Justin Ugent, 720 E Wisconsin Avenue, Milwaukee WI 53202 Pacific Life Insurance Company, Attn Devin Smith, 9417 Briar Circle, Minneapolis MN 55437 Metropolitan Life Insurance Company, Attn: Bernadette Flynn, 200 Park Avenue, New York NY 10166 Principal Life Insurance Company, Attn James Harrison, 711 High Street, Des Moines IA 50392 Sanford Health Plan, Attn Brian Maude, 4800 West 57th Street, Sioux Falls SD 57108 Standard Insurance Company, Attn James Huang, 900 SW Fifth Avenue, Portland OR 97204 The Guardian Life Insurance Company of America, Attn Laura Haines, 115 Stewart Avenue, Alexandria VA 22301</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>A Conflict of Interest disclosure notice is requested annually from each Director.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The Association provides a copy of the documents upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VI response or note to any other line in Part VI</FormAndLineReferenceDesc>
        <ExplanationTxt>1a. The Board of Directors may appoint from among its members an Executive Committee of three members, one of whom shall be the Chair of the Board. The Board of Directors reserves to itself the sole power to determine assessments. Subject to the foregoing limitation, the Executive Committee shall possess and exercise all other powers of the Board of Directors during the intervals between meetings.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>