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CHILDREN'S HOSPITAL SELF-INSURANCE TRUST: Form 990EZ, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
CHILDREN'S HOSPITAL SELF-INSURANCE TRUST (EIN 52-1640399)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-05-14
IRS object ID
201921349349202902
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-05-14T11:26:42-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Grant Thornton LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11000 WILSON BLVD SUITE 1400AddressLine1Txt
CityARLINGTONCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22209ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2017-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521640399EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL SELF-INSURANCE TRUSTBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% CORPORATE OFFICERSInCareOfNm
Business Name ControlCHILBusinessNameControlTxt
Phone2024765000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 MICHIGAN AVENUE NWAddressLine1Txt
CityWASHINGTONCityNm
State AbbreviationDCStateAbbreviationCd
ZIP20010ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonALEC KINGPersonNm
Person TitleCFOPersonTitleTxt
Phone2024765000PhoneNum
Signature2019-05-03SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMary TorrettaPreparerPersonNm
PTINP00847851PTIN
Phone7038477500PhoneNum
Preparation2019-04-26PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address209.220.136.124IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id54681420191345000001FederalOriginalSubmissionId
Federal Original Submission Id2019-05-14FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdAA918D8483008E32154F6CC583B06457B9AF9E42AtSubmissionCreationDeviceId
At Submission Filing Device IdF3025B962F5CDC81089D134DBE2E83273904A17CAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Website AddressN/AWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Gross Receipts$0GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Cost Or Other Basis Expense Sale$0CostOrOtherBasisExpenseSaleAmt
Gain Or Loss From Sale Of Assets$0GainOrLossFromSaleOfAssetsAmt
Special Events Direct Expenses$0SpecialEventsDirectExpensesAmt
Special Events Net Income Loss$0SpecialEventsNetIncomeLossAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt
Gross Profit Loss Sls Of Invntry$0GrossProfitLossSlsOfInvntryAmt
Total Revenue$0TotalRevenueAmt
Salaries Other Comp Empl Bnft$41,453SalariesOtherCompEmplBnftAmt
Fees And Other Pymt To Ind Cntrct$2,507,129FeesAndOtherPymtToIndCntrctAmt
Other Expenses Total$10,206,369OtherExpensesTotalAmt
Total Expenses$12,754,951TotalExpensesAmt
Excess Or Deficit For Year-$12,754,951ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$0NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets$12,754,951OtherChangesInNetAssetsAmt
Info In Schedule O Part IIYes (X)InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$118,519BOYAmt
EOY$397,424EOYAmt

Land And Buildings LandAndBuildingsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$118,519BOYAmt
EOY$397,424EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$118,519BOYAmt
EOY$397,424EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
Primary Exempt PurposeMALPRACTICE/GENERAL LIABILITY INSURANCEPrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp

FieldValueIRS element (for citing)
Description Program Srvc AccomCHILDREN'S HOSPITAL SELF-INSURANCE TRUST WAS CREATED TO PROVIDE A MECHANISM FOR PAYING MALPRACTICE AND COMPREHENSIVE GENERAL LIABILITY CLAIMS ARISING AGAINST CHILDREN'S HOSPITAL AND OTHER AFFILIATED ENTITIES AS WELL AS INDIVIDUALS PERFORMING SERVICES FOR OR ON BEHALF OF THE AFFILIATED ORGANIZATIONS.DescriptionProgramSrvcAccomTxt
Grants And Allocations$0GrantsAndAllocationsAmt
Program Service Expenses$10,206,369ProgramServiceExpensesAmt
FieldValueIRS element (for citing)
Total Program Service Expenses$10,206,369TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp

FieldValueIRS element (for citing)
PersonSEDGWICK CLAIMS MANAGEMENT SERVICESPersonNm
TitleINSTITUTIONAL TRUSTEETitleTxt
Average Hrs Per Wk Devoted To Pos1.0AverageHrsPerWkDevotedToPosRt
Compensation$41,453CompensationAmt
Employee Benefit Program$0EmployeeBenefitProgramAmt
Expense Account Other Allwnc$0ExpenseAccountOtherAllwncAmt
FieldValueIRS element (for citing)
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not RptfalseChgMadeToOrgnzngDocNotRptInd
Organization Had UBIfalseOrganizationHadUBIInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Form1120 Pol FiledfalseForm1120PolFiledInd
Made Loans To From OfficersfalseMadeLoansToFromOfficersInd
Tax Imposed Under IRC4911$0TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912$0TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955$0TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr$0TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization$0TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
States Where Copy Of Return Is FldDCStatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCORPORATE OFFICERSPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 MICHIGAN AVENUE NWAddressLine1Txt
CityWASHINGTONCityNm
State AbbreviationDCStateAbbreviationCd
ZIP20010ZIPCd
FieldValueIRS element (for citing)
Phone3015726283PhoneNum
FieldValueIRS element (for citing)
Foreign Financial AccountfalseForeignFinancialAccountInd
Foreign OfficefalseForeignOfficeInd
Donor Advised FndsfalseDonorAdvisedFndsInd
Operate HospitalfalseOperateHospitalInd
Tanning Services ProvidedfalseTanningServicesProvidedInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
School OperatingfalseSchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt
Other Employee Paid Over100k0OtherEmployeePaidOver100kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdService TypeServiceTypeTxtCompensationCompensationAmt
ARMSTRONG DONOHUE CEPPOS
204 MONROE STREET SUITE 101ROCKVILLEMD20850LEGAL SERVICES$432,295
JACKSON AND CAMPBELL PC
1120 20TH STREET NW Suite 300WASHINGTONDC20036LEGAL SERVICES$425,652
MILES AND STOCKBRIDGE
1500 K STREET NWWASHINGTONDC200051209LEGAL SERVICES$419,071
WILSON ELSER MOSKOWITZ EDELMAN DICK
700 11TH STREET NW SUITE 400WASHINGTONDC20001LEGAL SERVICES$149,255
SEYFARTH SHAW LLP
815 CONNECTICUT AVENUE NWWASHINGTONDC20006LEGAL SERVICES$134,813
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Filed Schedule AYes (true)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type3 Func IntYes (X)SupportingOrgType3FuncIntInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN530196580EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (true)GoverningDocumentListedInd
Support$12,754,951SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$12,754,951SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp

FieldValueIRS element (for citing)
Timely Provided DocumentsYes (true)TimelyProvidedDocumentsInd
Officers Close RelationshipfalseOfficersCloseRelationshipInd
Supported Org Voice InvestmentYes (true)SupportedOrgVoiceInvestmentInd

Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp

FieldValueIRS element (for citing)
Activities TestYes (X)ActivitiesTestInd
Activities Further Exempt PrpsYes (true)ActivitiesFurtherExemptPrpsInd
Activities Engaged Org InvlmntYes (true)ActivitiesEngagedOrgInvlmntInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990-EZ, SCHEDULE A, PART IV, SECTION D, LINES 2 AND 3THE SUPPORTED ORGANIZATION, CHILDREN'S HOSPITAL (THE HOSPITAL), RETAINS OWNERSHIP OF ALL INCOME AND ASSETS OF CHILDREN'S HOSPITAL SELF-INSURANCE TRUST FUND (SELF-INSURANCE TRUST). THE HOSPITAL'S BOARD OF DIRECTORS AND/OR ADMINISTRATIVE OFFICERS PROVIDE OVERSIGHT AND FINAL CONSENT AUTHORITY OVER THE SELF-INSURANCE TRUST. ADDITIONALLY, ALL CLAIMS AND CLAIM SETTLEMENTS ARE SUPERVISED AND AUTHORIZED BY THE HOSPITAL'S PROVIDERS' REPRESENTATIVES IN ADDITION TO BOARD ADMINISTRATORS AND PROFESSIONAL CONSULTANT PERSONNEL.
FORM 990-EZ, SCHEDULE A, PART IV, SECTION E, LINE 2AIN OCTOBER 1976, THE HOSPITAL ESTABLISHED THE FILING ORGANIZATION, A SELF-INSURANCE TRUST, TO PROVIDE A SELF-INSURANCE MECHANISM TO PAY PROFESSIONAL AND COMPREHENSIVE GENERAL LIABILITY CLAIMS OR SUITS AGAINST THE HOSPITAL AND ITS EMPLOYEES. OVER THE YEARS, THE CORPUS OF THE SELF-INSURANCE TRUST HAS INCREASED AS WELL AS THE NUMBER AND CATEGORIES OVER COVERED PERSONS. THE CATEGORIES AND SCOPE OF COVERAGE UNDER THE TRUST HAVE ALSO INCREASED IN ORDER TO ALLOW THE HOSPITAL TO FURTHER ITS EXEMPT ACTIVITIES.
FORM 990-EZ, SCHEDULE A, PART IV, SECTION E, LINE 2BTHE SELF-INSURANCE TRUST WAS CREATED TO PROVIDE A MECHANISM TO PAY MALPRACTICE AND COMPREHENSIVE GENERAL LIABILITY CLAIMS ARISING AGAINST CHILDREN'S HOSPITAL (EIN:53-0196580) IN FURTHERANCE OF ITS CHARITABLE PURPOSE OF PROVIDING MEDICAL CARE TO CHILDREN AND OTHER AFFILIATED ENTITIES AS WELL AS INDIVIDUALS PERFORMING SERVICES FOR OR ON BEHALF OF THE AFFILIATED ORGINIZATIONS. THE HOSPITAL OR OTHER AFFILIATED ENTITIES WOULD BE REQUIRED TO PERFORM THESE DUTIES IF NOT FOR THE ESTABLISHMENT OF THE SELF-INSURANCE TRUST.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990EZ PART I LINE 16Description:CLAIM SETTLEMENTS Amount:10206369
FORM 990EZ PART I LINE 20Description:TRANSFERS FROM AFFILIATE Amount:12754951

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