2015-05-15T09:16:03-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2013-07-01 367046706 Ascension Health Alliance Professional & General Liability Self-Insurance Trust ASCE 3147338000 4600 Edmundson Road St Louis MO 631343806 Elizabeth Foshage Sr VP Finance 3147338672 2015-05-14 1 Alicia Janisch P00741382 5137847100 2015-05-13 2013 2016-02-25 16:41:14Z Elizabeth Foshage 101 South Hanley Rd Suite 450 Clayton MO 63105 74080773 0 X www.ascensionhealth.org X 1983 MO Receive, hold and invest contributions and disburse claims and expenses payable. 0 0 0 0 11704 9447 0 0 65629127 67061515 18169277 12827046 70084 -8669729 83868488 71218832 0 0 0 0 0 0 0 0 0 69509674 77862493 69509674 77862493 14358814 -6643661 489501411 540499258 382022006 398619558 107479405 141879700 To receive, hold and invest contributions for professional and general liabilities and to disburse claims and expenses payable under the program. 0 0 77724097 58391786 Ascension Health Alliance Professional and General Liability Self Insurance Trust (hereinafter "Trust"), was formed to maintain the self-insurance funding for the payment of claims arising against liability coverage for the tax-exempt member organizations of the sponsors of Ascension Health Alliance. The trust receives participant contributions from covered entities and pays the claims and administrative expenses of the program. Ascension Health Alliance, a tax-exempt entity, is the sponsor of the self-insurance program; all beneficiaries of the trust are tax-exempt organizations related to the sponsors of Ascension Health Alliance. 77724097 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 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 1 1 1 0 0 1 432 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 1 1 0 0 0 X Jeanine Wescott 3147338877 11775 Borman Dr St Louis MO 631464134 X X State St Bank Trust Co Trustee 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 Quantros Inc Dept CH 16932 Palatine IL 600556932 Development Fees for New Event Reporting 2408750 Towers Watson Pennsylvania Inc 1500 Market Street Philadelphia PA 191024790 Actuarial Services 268495 Integro USA Inc 14569 Collection Center Dr Chicago IL 606960000 Insurance Broker 136283 CS Stars LLC PO Box 201739 Dallas TX 753201739 Claims System Support 135988 TrialNet Inc dba Acuity Mgt Solutions 5 East 2nd Street Richmond VA 232240000 Electronic Billing 129315 5 Participant Cont. 525100 67061515 67061515 67061515 12642933 11704 12631229 3046054 2861941 184113 184113 184113 Miscellaneous Income 900099 -8669729 -8669729 -8669729 71218832 58391786 11704 12815342 7239 7239 138396 138396 290450 290450 684128 684128 251381 251381 145316 145316 81724 81724 14538 14538 74538 74538 Claim Payments 73275864 73275864 Patient Comp Fund Exp 5804277 5804277 Service Fees 4373916 4373916 Reserve for Losses -9226975 -9226975 1947701 1947701 77862493 77724097 138396 0 27068694 0 31238062 34804766 139153 3986603 431055502 501707889 489501411 540499258 1937930 2570520 380084076 396049038 382022006 398619558 X 107479405 141879700 107479405 141879700 489501411 540499258 X -6643661 31994442 9049514 X 0 1 X 1 0 X X X X 0 0 0 See Part IV 453358926 See Part IV 1 0 1 0 Part I, Line 11 h (i) - Name of Supported Organizations: Ascension Health Alliance Professional and General Liability Self-Insurance Trust is organized and at all times shall be operated exclusively for the benefit of, to perform the functions of, and to carry out the purposes of the Daughters of Charity of St. Vincent de Paul in the United States, St. Louise Province, the Congregation of St. Joseph, the Congregation of the Sisters of St. Joseph of Carondelet, and the Congregation of Alexian Brothers of the Immaculate Conception Province - American Province, and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province by and through Ascension Health Ministries. Ascension Health Ministries is the Canonical sponsor which was formed by the founding sponsors and which has been conferred public juridic personality by decree of The Congregation for Institutes of Consecrated Life and Societies of Apostolic Life of the Roman Catholic Church. Part I, Line 11 h (vii) - Amount of Monetary Support: Ascension Health Alliance Professional & General Liabilities Self-Insurance Trust provides support through the payment of claims arising against liability coverage for the tax-exempt member organizations of the sponsors of Ascension Health Alliance. 0 Ascension Alpha Fund, LLC 484421027 C Claim Payment Funds 14745341 C Investment - M&T Bank 2541521 C 501707889 Reserve for Losses 396049038 396049038 X Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Ascension Health Alliance Professional & General Liability Self-Insurance Trust: The System accounts for uncertainty in income tax provisions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2014. Form 990, Part VI, Section A, line 7a Ascension Health Alliance is the plan sponsor of Ascension Health Alliance Professional & General Liability Self-Insurance Trust, and as plan sponsor reserved the right to amend the Trust. The reserved right to amend the Trust includes the ability to appoint a new trustee. Form 990, Part VI, Section A, line 7b Ascension Health Alliance is the plan sponsor of the Ascension Health Alliance Professional & General Liability Self-Insurance Trust. As plan sponsor, Ascension Health Alliance holds certain rights as provided in the trust agreement. Form 990, Part VI, Section A, line 8a Ascension Health Alliance Professional & General Liability Self-Insurance Trust did not hold meetings of the governing body during the year. All decisions of the organization were made by the plan sponsor, Ascension Health Alliance. Form 990, Part VI, Section A, line 8b There are no committees with authority to act on behalf of the governing body. This question is more appropriately answered as not applicable. Form 990, Part VI, Section B, line 11 Ascension Health Alliance Management works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, the Plan Sponsor is provided the Form 990 to review. Form 990, Part VI, Section B, line 12 Ascension Health Alliance Professional & General Liability Self-Insurance Trust does not have officers, directors, trustees or key employees; therefore, these questions are more appropriately answered not applicable. Form 990, Part VI, Section B, line 15 Ascension Health Alliance Professional & General Liability Self-Insurance Trust does not have a CEO, Executive Director, top management official, or any other officers or key employees; therefore, these questions are more appropriately answered not applicable. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part VII, Line 9: State Street Bank and Trust Company - #1 Lincoln Center, Boston, MA 02111 Form 990, Part XI, line 9: Net Asset Transfer Related to Marian Acquisition 9,049,514. Ascension Health Alliance PO Box 45998 St Louis MO 63145 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 1 Catholic Healthcare Investment Management Company PO Box 45998 St Louis MO 63145 273174701 Supporting Organization MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 1 Ascension Health Global Mission 101 South Hanley Suite 450 St Louis MO 63105 651205990 Supporting Organization MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 1 Ascension Health-IS Inc PO Box 45998 St Louis MO 63145 651257719 Supporting Organization MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 1 Ascension Health Welfare Benefits Trust PO Box 46944 St Louis MO 63146 431601369 Trust MO Section 501(c)(9) N/A Ascension Health 1 The TriMedx Foundation 5451 Lakeview Parkway S Drive Indianapolis IN 46268 201643383 Supporting Organization IN Section 501(c)(3) Schedule A, Line 7 MedXcel LLC 1 CHV II LLC 101 South Hanley Rd Ste 200 Clayton MO 63105 360534243 Investing MO N/A CHV III LLC 101 South Hanley Rd Ste 200 Clayton MO 63105 Investing MO N/A Ascension Alpha Fund LLC 101 South Hanley Rd Ste 200 St Louis MO 63141 900786464 Investing DE Ascension Health Alliance Excluded 12028736 520805592 0 11704 0 Clinical Holdings Corp 101 South Hanley Rd Ste 200 Clayton MO 63105 453802297 Holding Company MO N/A C 0 Ascension Health Master Pension Trust 11775 Borman Drive Ste 200 St Louis MO 63146 366891022 Trust MO N/A T 0 Ascension Health Worker's Compensation Self-Insurance Trust 11775 Borman Drive Ste 200 St Louis MO 63146 Trust MO N/A T 0 Ascension Health Insurance Limited PO Box 1159 Grand Cayman BWI CJ Insurance CJ N/A C 0 Ascension Health Risk Purchasing Group 101 South Hanley Rd Ste 450 St Louis MO 63105 274176480 Supporting Organization MO N/A C 0 Travel Services Corporation PO Box 45998 St Louis MO 631455998 263764978 Travel Services MO N/A C 0 AH Incubations Accelerator Inc 101 South Hanley Rd Ste 450 St Louis MO 63105 455078523 Medical Service MO N/A C 0 TriMedx Inc 5451 Lakeview Parkway South Dr Indianapolis IN 46268 460563336 Medical Equipment IN N/A C 0 TriMedx India Pvt Ltd 5451 Lakeview Parkway South Dr Indianapolis IN 46268 Trust IN N/A T 0 Smart Health Inc 101 South Hanley Rd Ste 200 Clayton MO 63105 454413419 Medical Service MO N/A C 0 Health City Cayman Islands Ltd 1283 Sea View Rd PO Box 10590 Grand Cayman BWI CJ Hospitals CJ N/A C 0 Sunflower Assurance Ltd 878 West Bay Road PO Box 1159 Grand Cayman KY1 CJ Insurance CJ N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 Ascension Health Alliance P 4373916 Services Fees