2019-11-13T12:11:45-06:00 2018-12-31 ERNST & YOUNG US LLP 5 TIMES SQUARE NEW YORK NY 10036 990 2018-01-01 824019223 MONTEFIORE MEDICINE ACADEMIC HEALTH SYSTEM SELF INSURANCE TRUST % EVAN RESNICK MONT 9143498455 111 EAST 210TH STREET BRONX NY 104672401 COLLEEN M BLYE Exec V.P. & C.F.O. 9143498455 2019-11-11 true NICOLE M SOKOLOWSKI P01683199 2127733000 164.57.159.253 26308520193175000011 2019-11-13 P 24558E047A149CE0743DDA4F89040DC2FD5B7974 047C777BBD395ADD529156C75D94AFF56594489C 2018 2020-03-31 21:24:44Z X COLLEEN M BLYE 111 EAST 210TH STREET BRONX NY 104672401 68486248 false X www.montefiorehealtsystem.org X 2018 NY To provide for the discharge of liabilities of the settlements of claims against, and the reimbursement of losses suffered by the Grantor's controlled entities. 1 0 0 0 0 0 0 0 0 68486248 0 0 0 0 0 68486248 0 0 0 0 0 0 0 0 0 0 66996706 0 66996706 0 1489542 0 71983582 0 70588216 0 1395366 To provide for the discharge of liabilities of the settlement of claims against, and the reimbursement of losses suffered by, the Grantor and its controlled entities in connection with it charitable operations. false false 66996706 0 68486248 Montefiore Medicine Academic Health System Self Insurance Trust is a Section 501(c)(3) supporting organization, organized and operated for the benefit of Montefiore Medicine Academic Health System (MMAHS) and its controlled entities, the supported organizations. Montefiore Medicine Academic Health System Self Insurance Trust was formed by MMAHS, a section 501(c)(3) parent of an integrated healthcare delivery system, comprised primarily of section 501(c)(3) hospital organizations. The trust was formed to satisfy the malpractice claims of MMAHS and its controlled entities and to protect MMAHS, it controlled entities and covered persons against loss and expense arising from medical malpractice liability. The sole purpose of the trust is to provide for the discharge of liabilities of the settlement of claims against, and the reimbursement of losses suffered by MMAHS and its controlled entities. 66996706 true false false false false false false false false false false false false true true false false false false false true false false false false false false false false false false false false false false false false false false false false false false true true false false false true 0 0 0 false false false false false false false false false false false false X 1 0 false false false false false true true false false false false false false false false false false false NY X EVAN RESNICK 9143498455 555 SOUTH BROADWAY BLDG A Tarrytown NY 105916301 Comerica Bank Trust Sole corporate trustee 0.5 0.0 X 4500 0 0 4500 0 0 0 false false false 0 0 INSURANCE PREMIUMS 524150 68486248 68486248 0 0 68486248 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 68486248 68486248 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 0 0 INSURANCE CLAIMS EXPENSE 66994000 66994000 MISCELLANEOUS EXPENSES 2706 2706 66996706 66996706 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7622753 0 0 0 0 0 0 0 64360829 0 71983582 0 1771 0 0 0 1934393 0 0 0 0 0 0 0 0 0 0 0 68652052 0 70588216 X 0 1395366 0 0 0 0 0 1395366 0 71983582 1489542 -94176 X false false false X X X 8 MONTEFIORE MEDICAL CENTER 131740114 3 true 0 0 MONTEFIORE NEW ROCHELLE HOSPITAL 462931956 3 true 0 0 MONTEFIORE MOUNT VERNON HOSPITAL 462916938 3 true 0 0 SCHAFFER EXTENDED CARE CENTER 462929888 3 true 0 0 MONTEFIORE NYACK HOSPITAL 131740119 3 true 0 0 WHITE PLAINS HOSPITAL MEDICAL CENTER 131740130 3 true 0 0 THE WINIFRED MASTERSON BURKE REHABILITATION HOSPITAL 131739937 3 true 0 0 MONTEFIORE ST LUKE'S HOSPITAL 141340054 3 true 0 0 8 0 0 false false false false false true true false false false false false false false false false false false Part IV, Section A., line 1 The organization's supported organizations are designated in the trust agreement as the Grantor's (Montefiore Medicine Academic Health System) supported organizations. These supported entities are all 501(C)(3) hospital organization that are affiliated with the Montefiore Health System. Part IV, Section A., Line 5A During, the tax year, the organization removed Montefiore North Ambulatory Care Center, Inc., EIN 01-0796859, as a supported organization. The entity was dissolved in 2017 and its activities merged into Montefiore Medical Center, another supported organization of the trust. Part IV, Section C., Line 1 The trustee, Comerica Bank & Trust, the institutional trustee, is supervised and controlled in connection with the Grantor, Montefiore Medicine Academic Health System, an intermediary supporting organization, whose supported organizations are those supported organization of the trust. Currently, each of the Trustees and Officers of Montefiore Medicine Academic Health System, Inc. (MMAHS) serve as Directors, Trustees and / or Officers of one or more of the Trust supported organizations. Given the overlap among the individuals responsible for the governance of both MMAHS and the supported organizations, and the regular coordination and interaction among the boards and officers, the Trust will inherently have the information necessary to ensure that it is aware of and responsive to the needs of the supported organizations. PREMIUMS RECEIVABLE 64360829 64360829 0 INSURANCE LOSSES & LAE LIABILITIES 61494000 LONG TERM MALPRACTICE LIABILITIES 5500000 UNEARNED PREMIUMS 1658052 68652052 Central America and the Caribbean Investments malpractice insurance 7378461 7378461 7378461 false false false false true false Part VI, Section A., Line 7a The grantor, Montefiore Medicine Academic Health System, Inc., has the right to replace the Trustee at any time upon (90) days prior notice, or upon shorter notice if acceptable to the Trustee. Upon the resignation or removal of the Trustee, the grantor has the authority to name a successor Trustee who shall become a signatory to and be bound by the terms and provision of the Trust agreement as it may be amended contemporaneously with the appointment of a successor Trustee. Part VI, Section A., Line 7b Montefiore Medicine Academic Health System, Inc. controls the Trust by virtue of its powers and status as the Trust's grantor. Part VI, Section A., Lines 8a & 8b The sole corporate trustee of the organization is Comerica Bank and Trust, a national banking association that acts at the direction of the Hospital System, Montefiore Medicine Academic Health System, Inc. for the purpose of holding funds and using them to satisfy malpractice claims against the hospital. Since the sole trustee is a national banking association, there are no regular scheduled Board meetings or documentation concerning the bank's regular business activities. Part VI, Section B., Line 11b The Form 990 was prepared by Montefiore's Finance Department with the assistance of various departments. The Form 990 was reviewed and approved by the Vice-President-Finance and Montefiore's senior leadership team including the Chief Financial Officer. In addition, an independent accounting firm was engaged to review the Form 990 prior to filing of the return. Part VI, Section B, Line 12a The trust adheres to a conflict of interest policy that has been adopted and implemented by Montefiore Medical Center. Montefiore Medical Center regularly and consistently monitors and enforces compliance with the policy, ensuring that no persons who has a conflict of interest will have influence over the Trust. Form 990, Part VI, Section C., Line 19 The financial statements and governing documents are made available upon request. MONTEFIORE MEDICINE ACADEMIC HEALTH SYST 555 SOUTH BROADWAY TARRYTOWN NY 10591 471582973 SYS PARENT NY 501(C)(3) 12b TYPE II NA true MONTEFIORE HEALTH SYSTEM INC 555 SOUTH BROADWAY TARRYTOWN NY 10591 201615393 SUPPORT SERV NY 501(C)(3) 12B TYPE II MMAHS true MONTEFIORE MEDICAL CENTER 111 EAST 210TH STREET BRONX NY 10467 131740114 ACD MED CTR NY 501(C)(3) 3 MHS true MMC CORPORATION 111 EAST 210TH STREET BRONX NY 10467 133430322 REAL ESTATE NY 501(C)(3) 12A TYPE I MMC true MMC RESIDENTIAL CORP I INC 3411 WAYNE AVENUE BRONX NY 10467 911943271 STAFF HOUSING NY 501(C)(2) MMC true MONTEFIORE HOSP HOUSING SECTION II INC 3450 WAYNE AVENUE BRONX NY 10467 237160641 STAFF HOUSING NY 501(C)(2) MMC true MOSHOLU PRESERVATION CORPORATION 3400 RESERVOIR OVAL EAST BRONX NY 10467 133109387 COMMUNITY SER NY 501(C)(3) 12A TYPE I MMC true GUNHILL MRI PC 200 EAST GUNHILL ROAD BRONX NY 10467 133734486 DIAG SERVICES NY 501(C)(3) 12A TYPE I MMC true MONTEFIORE NEW ROCHELLE HOSPITAL 16 GUION PLACE NEW ROCHELLE 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