2014-05-15T13:56:21-05:00 2013-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2012-07-01 367046706 Ascension Health Alliance Professional & General Liability Self-Insurance Trust ASCE 3147338000 4600 Edmundson Road St Louis MO 631343806 Elizabeth Foshage 3147338672 2014-05-15 1 Alicia Janisch P00741382 5137847100 2012 2015-11-30 17:44:51Z Elizabeth Foshage 4600 Edmundson Road St Louis MO 631343806 87617894 0 X www.ascensionhealth.org X 1983 MO Receive, hold and invest contributions and dispurse claims and expenses payable. 0 0 0 0 -1257 0 0 0 60714976 65629127 29163941 18169277 0 70084 89878917 83868488 0 0 0 0 0 0 0 0 0 57851503 69509674 57851503 69509674 32027414 14358814 388471309 489501411 297179681 382022006 91291628 107479405 To receive, hold and invest contributions for professional and general liabilities and to disburse claims and expenses payable under the program. 0 0 69430773 0 65699211 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. 69430773 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 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 1 656 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 - Suite 200 St Louis MO 631464134 X X State St Bank Trust Co 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 Towers Watson Pennsylvania Inc 1500 Market Street Philadelphia PA 191024790 Actuarial Services 278000 1 Participant Cont. 525100 65629127 65629127 65629127 17647314 -1257 17648571 4271369 3749406 521963 521963 521963 Miscellaneous Income 900099 70084 70084 70084 83868488 65699211 -1257 18170534 14800 14800 78901 78901 631444 631444 223518 223518 83253 83253 59961 59961 271078 271078 50415 50415 Claim Payments 61642729 61642729 0 0 Patient Comp Fund Exp 4774084 4774084 0 0 Service Fees 4012360 4012360 0 0 Reserve for Losses -3608430 -3608430 0 0 1275561 1275561 69509674 69430773 78901 0 6792533 27068694 46308230 31238062 161721 139153 335208825 431055502 388471309 489501411 6599656 1937930 290580025 380084076 297179681 382022006 X 91291628 107479405 0 0 91291628 107479405 388471309 489501411 X 14358814 2467019 -638056 X 0 1 X 1 0 X X X X 0 0 0 See Part IV 453358926 See Part IV 1 0 1 0 Schedule A, Part IV, Supplemental Information: 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. Schedule A, Part IV, Supplemental Information: 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 414104446 F Claim Payment Funds 14356446 F Investment - M&T Bank 2594610 F 431055502 Reserve for Losses 380084076 380084076 Form 990, Part VI, Section A, line 7a Ascension Health Alliance is the plan sponsor of Ascension Health Alliance Professional and 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 and 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 and 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 and General Liability Self Insurance Trust does not have officers, directors, trustees or key employees; therefore, these questions are more appropriately answered not applicable. Ascension Health Alliance Professional and 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. Alternate Mailing Address: Form 990, Part VII, Line 9: State Street Bank and Trust Company - #1 Lincoln Center, Boston, MA 02111 Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer to Ascension Health Alliance -638,056. 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 19852875 488736816 0 -1257 0 0.03570 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 Ascension Health Alliance P 4012360 Services Fees Ascension Health Alliance R 638056 Net Asset Transfer