2012-05-14T09:55:19-05:00 2011-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2010-07-01 367046706 Ascension Health Professional and General Liability Self Insurance Trust ASCE 3147338677 4600 Edmundson Road St Louis MO 63134 Elizabeth C Foshage 3147338672 2012-05-11 1 Alicia Janisch 5137847100 2010 2016-02-24 21:20:13Z Elizabeth C Foshage 4600 Edmundson Road St Louis MO 63134 116525993 0 X www.ascensionhealth.org X 1983 MO Receive, hold, and invest contributions and dispurse claims and expenses payable. 0 0 0 0 0 0 0 0 107874943 76350300 21895334 37420032 0 429528 129770277 114199860 0 0 0 0 0 0 0 0 0 87671633 66897872 87671633 66897872 42098644 47301988 417103957 416334790 309785097 314615630 107318860 101719160 To receive, hold and invest contributions for professional and general liabilities and to disburse claims and expenses payable under the program. 0 0 66832618 76350300 Ascension Health 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. The trust receives participant contributions from covered entities and pays the claims and administrative expenses of the program. Ascension Health, 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. 66832618 1 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 0 0 0 0 1 1003 0 1 0 0 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 MO X Pam Stout 3147338677 11775 Borman Dr - Suite 200 St Louis MO 631464134 X State St Bank Trust Co 1.00 X 0 0 0 0 0 0 0 0 0 0 Marsh USA Inc 600 Renaissance Center - Suite 2100 Detroit MI 482431809 Insurance Broker 215900 Towers Watson Pennsylvania Inc 1500 Market St Philadelphia PA 191024790 Actuarial Services 214600 Mackinaw Admin-Healthcare Risk Practice PO Box 489 Brighton MI 48116 Claims Management & Investigation 131729 CS Stars LLC PO Box 201739 Dallas TX 753201739 Claims System Support 126733 4 Participant Cont. 525100 76350300 76350300 76350300 37307757 37307757 2438408 2326133 112275 112275 112275 Settlement from Broker 900099 429528 429528 429528 114199860 76350300 0 37849560 34907 34907 65254 65254 965996 965996 206596 206596 78982 78982 77565 77565 160754 160754 51434 51434 Claim Payments 49739397 49739397 0 0 Patient Comp Fund Exp 5907435 5907435 0 0 Reserve for Losses 4515534 4515534 0 0 Ascension Services Fees 3979152 3979152 0 0 Project Expense 969249 969249 0 0 145617 145617 66897872 66832618 65254 0 17507991 33526497 29429784 51444540 211406 173382 369954776 331190371 417103957 416334790 830395 1145394 308954702 313470236 309785097 314615630 X 107318860 101719160 107318860 101719160 417103957 416334790 X 47301988 -52901688 X 0 1 1 X 0 X X X X 0 0 0 See Part IV 311662309 See Part IV 1 66897872 1 66897872 Schedule A, Part IV, Supplemental Information: Part I, Line 11 h (i) - Supported Organization: Northeast, Southeast, East Central and West Central Provinces of the Daughters of Charity of St. Vincent de Paul, the Congregation of St. Joseph and the Congregation of the Sisters of St. Joseph of Carondelet (CSJ) and their affiliated organizations provided that such organizations are described under Section 501(c)(3) of the Code and are classified as public charities under Sections 509(a)(1) and 509(a)(2) of the Code. 0 Investment State Street 318131220 F Claim Payment Funds 10318819 F Investment - M&T Bank 2740332 F 331190371 Reserve for Losses 313470236 313470236 Form 990, Part VI, Section A, line 7a Ascension Health is the plan sponsor of Ascension Health 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 is the plan sponsor of Ascension Health Professional and General Liability Self Insurance Trust. As plan sponsor, Ascension Health holds certain rights as provided in the trust agreement. Form 990, Part VI, Section A, line 8a Ascension Health 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. 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 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 Professional and General Liability Self Insurance Trust does not have officers, directors, trustees or key employees; therefore, these questions are answered as not applicable. Form 990, Part VI, Lines 15a & 15b: Ascension Health 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 as 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(es): Form 990, Part VI, 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 5: Net unrealized gains on investments: 18,591,312. Net Asset Transfer -71,493,000. Total to Form 990, Part XI, Line 5: -52,901,688. Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 Ascension Health O 3979152 Actual Costs Ascension Health Q 71493000 Market Value