2011-05-16T14:41:49-05:00 2010-06-30 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2009-07-01 367046706 Ascension Health Professional and General Liability Self Insurance Trust ASCE 3147338677 4600 Edmundson Road St Louis MO 631343806 Elizabeth Foshage 3147338672 2011-05-16 1 5137847100 2009 2016-02-24 21:20:13Z Elizabeth Foshage 4600 Edmundson Road St Louis MO 631343806 133742652 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 110875735 107874943 -15680683 21895334 45588 0 95240640 129770277 0 0 0 0 0 105651914 87671633 105651914 87671633 -10411274 42098644 342099733 417103957 298966570 309785097 43133163 107318860 To receive, hold and invest contributions for professional and general liabilities and to disburse claims and expenses payable under the program. 0 0 87601798 107874943 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 "premiums" 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. 87601798 1 0 0 0 0 0 0 0 0 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 0 0 1 1133 0 1 0 0 0 0 0 0 0 0 0 0 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 C 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 253900 Integro USA Inc 14569 Collection Center Dr Chicago IL 606960000 Insurance Broker 234342 Towers Watson Pennsylvania Inc 1500 Market St Philadelphia PA 191024790 Actuarial Services 204600 Mackinaw Admin-Healthcare Risk Practice PO Box 489 Brighton MI 481160000 Claims Management & Investigation 171354 CS Stars LLC PO Box 201739 Dallas TX 753201739 Claims System Support 154730 5 Participant Cont. 525100 107874943 107874943 107874943 21899030 21899030 3968679 3972375 -3696 -3696 -3696 129770277 107874943 0 21895334 37850 37850 69835 69835 1071970 1071970 258595 258595 86139 86139 1369 1369 29046 29046 115322 115322 Claim Payments 63254127 63254127 0 0 Reserve for Losses 12460960 12460960 0 0 Patient Comp Fund Exp 5089304 5089304 0 0 Ascension Services Fees 3998520 3998520 0 0 Project Expense 1044202 1044202 0 0 154394 154394 87671633 87601798 69835 0 17353880 17507991 27756767 29429784 4931473 211406 292057613 369954776 342099733 417103957 2472828 830395 296493742 308954702 298966570 309785097 X 43133163 107318860 43133163 107318860 342099733 417103957 X 0 1 1 X 0 X X X X 0 0 0 See Part IV 311662309 See Part IV 1 87671633 1 87671633 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 358118732 F Claim Payment Funds 9002986 F Investment - M&T Bank 2833058 F 369954776 Reserve for Losses 308954702 308954702 129770277 87671633 42098644 22087053 22087053 64185697 Part X: Description of Uncertain Tax Positions Under FIN 48: Per the financial statements of Ascension Health (which include the activity of Ascension Health Professional and General Liability Self Insurance Trust), there is no current year ASC 740 (fka FIN 48) footnote. Form 990, Part VI, Section A, line 7a Ascension Health is the plan sponsor of the 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 the 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. The 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, 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. Form 990, Part VI, Line 9: Alternate mailing address(es): State Street Bank and Trust Company #1 Lincoln Center, Boston, MA 02111 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health Parent 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 1 0 0 0 Ascension Health O 3998520