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CHILDREN'S HOSPITAL SELF-INSURANCE TRUST: Form 990EZ, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
CHILDREN'S HOSPITAL SELF-INSURANCE TRUST (EIN 52-1640399)
Tax period
2019-07-01 to 2020-06-30
Filed
2021-05-13
IRS object ID
202111339349203401
Schema version
2019v5.2
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

FieldValueIRS element (for citing)
Return2021-05-13T20:04:01-05:00ReturnTs
Tax Period End2020-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN366055558PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GRANT THORNTON LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11000 WILSON BLVD SUITE 1400AddressLine1Txt
CityARLINGTONCityNm
State AbbreviationVAStateAbbreviationCd
ZIP22209ZIPCd
FieldValueIRS element (for citing)
Return Type990EZReturnTypeCd
Tax Period Begin2019-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN521640399EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL SELF-INSURANCE TRUSTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCHILBusinessNameControlTxt
Phone2024765000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 MICHIGAN AVENUE NWAddressLine1Txt
CityWASHINGTONCityNm
State AbbreviationDCStateAbbreviationCd
ZIP20010ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonALDWIN LINDSAYPersonNm
Person TitleCFOPersonTitleTxt
Phone2024765000PhoneNum
Signature2021-05-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARY TORRETTAPreparerPersonNm
PTINP00847851PTIN
Phone7038477500PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Website AddressN/AWebsiteAddressTxt
Organization501c3Yes (X)Organization501c3Ind
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Gross Receipts$0GrossReceiptsAmt
Info In Schedule O Part IYes (X)InfoInScheduleOPartIInd
Total Revenue$0TotalRevenueAmt
Salaries Other Comp Empl Bnft$16,480SalariesOtherCompEmplBnftAmt
Fees And Other Pymt To Ind Cntrct$3,667,024FeesAndOtherPymtToIndCntrctAmt
Other Expenses Total$6,141,444OtherExpensesTotalAmt
Total Expenses$9,824,948TotalExpensesAmt
Excess Or Deficit For Year-$9,824,948ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY$0NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets$9,824,948OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY$0NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIYes (X)InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

FieldValueIRS element (for citing)
BOY$705,042BOYAmt
EOY$453,735EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

FieldValueIRS element (for citing)
BOY$0BOYAmt

Form990 Total Assets Form990TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$705,042BOYAmt
EOY$453,735EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$705,042BOYAmt
EOY$453,735EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
Primary Exempt PurposeTO 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

FieldValueIRS element (for citing)
Description Program Srvc AccomCHILDREN'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$0GrantsAndAllocationsAmt
Program Service Expenses$6,095,799ProgramServiceExpensesAmt
FieldValueIRS element (for citing)
Total Program Service Expenses$6,095,799TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp

FieldValueIRS element (for citing)
PersonSEDGWICK CLAIMS MANAGEMENT SERVICESPersonNm
TitleINSTITUTIONAL TRUSTEETitleTxt
Average Hrs Per Wk Devoted To Pos1.00AverageHrsPerWkDevotedToPosRt
Compensation$16,480CompensationAmt
Employee Benefit Program$0EmployeeBenefitProgramAmt
Expense Account Other Allwnc$0ExpenseAccountOtherAllwncAmt
FieldValueIRS element (for citing)
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt0ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI0OrganizationHadUBIInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Direct Indirect Pltcl Expend$0DirectIndirectPltclExpendAmt
Made Loans To From Officers0MadeLoansToFromOfficersInd
Tax Imposed Under IRC4911$0TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912$0TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955$0TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr$0TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization$0TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
States Where Copy Of Return Is FldDCStatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CORPORATE OFFICERSBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 MICHIGAN AVENUE NWAddressLine1Txt
CityWASHINGTONCityNm
State AbbreviationDCStateAbbreviationCd
ZIP20010ZIPCd
FieldValueIRS element (for citing)
Phone3015726283PhoneNum
FieldValueIRS element (for citing)
Foreign Financial Account0ForeignFinancialAccountInd
Foreign Office0ForeignOfficeInd
Donor Advised Fnds0DonorAdvisedFndsInd
Operate Hospital0OperateHospitalInd
Tanning Services Provided0TanningServicesProvidedInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
School Operating0SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Part VI Of Comp Of Hghst Pd EmplNONEPartVIOfCompOfHghstPdEmplTxt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdService TypeServiceTypeTxtCompensationCompensationAmt
BLANKINGSHIP & KEITH
4020 UNIVERSITY DRFAIRFAXVA22030LEGAL SERVICES$720,524
JACKSON AND CAMPBELL PC
1120 20TH ST NW 300WASHINGTONDC20036LEGAL SERVICES$700,421
MILES AND STOCKBRIDGE
1500 K ST NWWASHINGTONDC200051209LEGAL SERVICES$491,988
ARMSTRONG DONOHUE CEPPOS
204 MONROE ST 101ROCKVILLEMD20850LEGAL SERVICES$322,922
SEYFARTH SHAW LLP
815 CONNECTICUT AVE NWWASHINGTONDC20006LEGAL SERVICES$245,582
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Filed Schedule AYes (1)FiledScheduleAInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type3 Func IntYes (X)SupportingOrgType3FuncIntInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN530196580EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$9,824,948SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$9,824,948SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp

FieldValueIRS element (for citing)
Timely Provided DocumentsYes (1)TimelyProvidedDocumentsInd
Officers Close Relationship0OfficersCloseRelationshipInd
Supported Org Voice InvestmentYes (1)SupportedOrgVoiceInvestmentInd

Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp

FieldValueIRS element (for citing)
Activities TestYes (X)ActivitiesTestInd
Activities Further Exempt PrpsYes (1)ActivitiesFurtherExemptPrpsInd
Activities Engaged Org InvlmntYes (1)ActivitiesEngagedOrgInvlmntInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE A, PART IV, SECTION D, LINES 2 AND 3THE 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 2AIN 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 2BTHE 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 O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSESDESCRIPTION: CLAIM SETTLEMENTS. AMOUNT: 6,095,799. DESCRIPTION: TRAVEL. AMOUNT: 45,645. TOTAL TO FORM 990-EZ, LINE 16: 6,141,444.
FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETSDESCRIPTION: TRANSFER FROM AFFILIATES (CHILDREN'S HOSPITAL). AMOUNT: 9,824,948.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIESDESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 705,042. END OF YEAR AMOUNT: 453,735.

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

FieldValueIRS element (for citing)
DeclarationTHE 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