CHILDREN'S HOSPITAL SELF-INSURANCE TRUST: Form 990EZ, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CHILDREN'S HOSPITAL SELF-INSURANCE TRUST (EIN 52-1640399)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-13
- IRS object ID
- 202221339349204327
- Schema version
- 2020v4.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-13T15:25:54-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 366055558 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRANT THORNTON LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1000 WILSON BLVD SUITE 1400 | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | VA | StateAbbreviationCd |
| ZIP | 22209 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 521640399 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL SELF-INSURANCE TRUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIL | BusinessNameControlTxt |
| Phone | 2024765000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MICHIGAN AVENUE NW | AddressLine1Txt |
| City | WASHINGTON | CityNm |
| State Abbreviation | DC | StateAbbreviationCd |
| ZIP | 20010 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ALDWIN LINDSAY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2024765000 | PhoneNum |
| Signature | 2022-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ALDWIN | PersonFirstNm |
| Person Last | LINDSAY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARY TORRETTA | PreparerPersonNm |
| PTIN | P00847851 | PTIN |
| Phone | 7038477500 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Website Address | N/A | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Trust | Yes (X) | TypeOfOrganizationTrustInd |
| Gross Receipts | $0 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Total Revenue | $0 | TotalRevenueAmt |
| Salaries Other Comp Empl Bnft | $8,575 | SalariesOtherCompEmplBnftAmt |
| Fees And Other Pymt To Ind Cntrct | $3,369,986 | FeesAndOtherPymtToIndCntrctAmt |
| Other Expenses Total | $9,285,421 | OtherExpensesTotalAmt |
| Total Expenses | $12,663,982 | TotalExpensesAmt |
| Excess Or Deficit For Year | -$12,663,982 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | $0 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $12,663,982 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,735 | BOYAmt |
| EOY | $0 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,735 | BOYAmt |
| EOY | $0 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $453,735 | BOYAmt |
| EOY | $0 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | TO SUPPORT CHILDREN'S NATIONAL MEDICAL CENTER DBA CHILDREN'S NATIONAL AND SUBSIDIARIES BY PAYING ALL PROFESSIONAL AND COMPREHENSIVE GENERAL LIABILITY CLAIMS AND LOSSES AGAINST CHILDREN'S HOSPITAL DBA CHILDREN'S NATIONAL HOSPITAL AND ITS EMPLOYEES. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | CHILDREN'S HOSPITAL SELF-INSURANCE TRUST WAS CREATED TO PROVIDE A MECHANISM FOR PAYING MALPRACTICE AND COMPREHENSIVE GENERAL LIABILITY CLAIMS ARISING AGAINST CHILDREN'S NATIONAL HOSPITAL AND OTHER AFFILIATED ENTITIES AS WELL AS INDIVIDUALS PERFORMING SERVICES FOR OR ON BEHALF OF THE AFFILIATED ORGANIZATIONS. | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $0 | GrantsAndAllocationsAmt |
| Program Service Expenses | $9,282,605 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $9,282,605 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEDGWICK CLAIMS MANAGEMENT SERVICES | PersonNm |
| Title | INSTITUTIONAL TRUSTEE | TitleTxt |
| Average Hrs Per Wk Devoted To Pos | 1.00 | AverageHrsPerWkDevotedToPosRt |
| Compensation | $8,575 | CompensationAmt |
| Employee Benefit Program | $0 | EmployeeBenefitProgramAmt |
| Expense Account Other Allwnc | $0 | ExpenseAccountOtherAllwncAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | Yes (1) | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | DC | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CORPORATE OFFICERS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MICHIGAN AVENUE NW | AddressLine1Txt |
| City | WASHINGTON | CityNm |
| State Abbreviation | DC | StateAbbreviationCd |
| ZIP | 20010 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3015726283 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| JACKSON AND CAMPBELL PC | |||||
| 1120 20TH ST NW 300 | WASHINGTON | DC | 20036 | LEGAL SERVICES | $1,082,327 |
| MILES AND STOCKBRIDGE | |||||
| 1500 K ST NW | WASHINGTON | DC | 200051209 | LEGAL SERVICES | $595,361 |
| BLANKINGSHIP & KEITH | |||||
| 4020 UNIVERSITY DR | FAIRFAX | VA | 22030 | LEGAL SERVICES | $424,721 |
| SEYFARTH SHAW LLP | |||||
| 815 CONNECTICUT AVE NW | WASHINGTON | DC | 20006 | LEGAL SERVICES | $221,634 |
| ARMSTRONG DONOHUE CEPPOS | |||||
| 204 MONROE ST 101 | ROCKVILLE | MD | 20850 | LEGAL SERVICES | $149,025 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 530196580 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $12,663,982 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $12,663,982 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | 0 | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (1) | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Test | Yes (X) | ActivitiesTestInd |
| Activities Further Exempt Prps | Yes (1) | ActivitiesFurtherExemptPrpsInd |
| Activities Engaged Org Invlmnt | Yes (1) | ActivitiesEngagedOrgInvlmntInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE A, PART IV, SECTION D, LINES 2 AND 3 | THE SUPPORTED ORGANIZATION, CHILDREN'S NATIONAL HOSPITAL (THE HOSPITAL), RETAINS OWNERSHIP OF ALL INCOME AND ASSETS OF CHILDREN'S HOSPITAL SELF-INSURANCE TRUST FUND. 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. |
| SCHEDULE A, PART IV, SECTION E, LINE 2A | IN 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. |
| SCHEDULE A, PART IV, SECTION E, LINE 2B | THE SELF-INSURANCE TRUST WAS CREATED TO PROVIDE A MECHANISM TO PAY MALPRACTICE AND COMPREHENSIVE GENERAL LIABILITY CLAIMS ARISING AGAINST CHILDREN'S NATIONAL 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 ORGANIZATIONS. THE HOSPITAL OR OTHER AFFILIATED ENTITIES WOULD BE REQUIRED TO PERFORM THESE DUTIES IF NOT FOR THE ESTABLISHMENT OF THE SELF-INSURANCE TRUST. |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | CASH | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2021-06-30 | DistributionDt |
| Fair Market Value Of Asset | $453,735 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | BOOK VALUE | MethodOfFMVDeterminationTxt |
| EIN | 530196580 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MICHIGAN AVE NW | AddressLine1Txt |
| City | WASHINGTON | CityNm |
| State Abbreviation | DC | StateAbbreviationCd |
| ZIP | 20010 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 0 | DirectorOfSuccessorInd |
| Employee Of Successor | 0 | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: CLAIM SETTLEMENTS. AMOUNT: 9,282,605. DESCRIPTION: TRAVEL. AMOUNT: 2,816. TOTAL TO FORM 990-EZ, LINE 16: 9,285,421. |
| FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS | DESCRIPTION: TRANSFER FROM AFFILIATES (CHILDREN'S HOSPITAL). AMOUNT: 12,663,982. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 453,735. END OF YEAR AMOUNT: 0. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. | DeclarationDesc |