SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
DMG Insurance Company Inc
 
Employer identification number

26-1262665
Return Reference Explanation
Form 990, Part VI, Section A, line 6 The supported organization, District Medical Group, is the sole member of DMG Insurance Company.
Form 990, Part VI, Section A, line 7a The District Medical Group Board of Directors has final approval authority of the elected directors of DMG Insurance Company.
Form 990, Part VI, Section A, line 8b DMG Insurance does not have any committees that act on behalf of the governing body.
Form 990, Part VI, Section B, line 11b A copy of the draft is sent to each of the Board Members. Input from the Board Members is incorporated into the draft, which is then reviewed by the CFO and the Controller. The draft is also reviewed by the outside captive management company. An outside accounting firm is consulted every few years as well. The updated draft is sent to the Board Members and then signed and forwarded to the IRS.
Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy and Procedure is reviewed with the Board annually, and the Conflict of Interest Disclosure Statement is completed annually, and retained by the President. Any potential conflicts of interest identified from the Disclosure Statements are reviewed by the President, Board Chairman, and the organization's legal counsel, if needed, and unresolved potential conflicts are noted so that actual conflicts of interest are avoided.
Form 990, Part VI, Section C, line 19 DMG makes its governing documents, conflict of interest policy and financial statements available to the public through written requests received at the corporate office. The request is to be reviewed by the appropriate corporate officer, who will oversee the fulfilling of the request.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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