2021-05-13T20:04:01-05:00 2020-06-30 366055558 GRANT THORNTON LLP 1000 WILSON BLVD SUITE 1400 ARLINGTON VA 22209 990EZ 2019-07-01 521640399 CHILDREN'S HOSPITAL SELF-INSURANCE TRUST CHIL 2024765000 111 MICHIGAN AVENUE NW WASHINGTON DC 20010 ALDWIN LINDSAY CFO 2024765000 2021-05-13 1 MARY TORRETTA P00847851 7038477500 2019 2022-09-23 18:48:47Z X X N/A X X 0 X 0 16480 3667024 6141444 9824948 -9824948 0 9824948 0 X 705042 453735 0 705042 453735 705042 453735 0 0 X 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. 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. 0 6095799 6095799 SEDGWICK CLAIMS MANAGEMENT SERVICES INSTITUTIONAL TRUSTEE 1.00 16480 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DC CORPORATE OFFICERS 111 MICHIGAN AVENUE NW WASHINGTON DC 20010 3015726283 0 0 0 0 0 0 0 0 0 0 0 NONE BLANKINGSHIP & KEITH 4020 UNIVERSITY DR FAIRFAX VA 22030 LEGAL SERVICES 720524 JACKSON AND CAMPBELL PC 1120 20TH ST NW 300 WASHINGTON DC 20036 LEGAL SERVICES 700421 MILES AND STOCKBRIDGE 1500 K ST NW WASHINGTON DC 200051209 LEGAL SERVICES 491988 ARMSTRONG DONOHUE CEPPOS 204 MONROE ST 101 ROCKVILLE MD 20850 LEGAL SERVICES 322922 SEYFARTH SHAW LLP 815 CONNECTICUT AVE NW WASHINGTON DC 20006 LEGAL SERVICES 245582 0 1 X X 1 CHILDREN'S HOSPITAL 530196580 3 1 9824948 0 1 9824948 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 X 1 1 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. FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: 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 ASSETS DESCRIPTION: TRANSFER FROM AFFILIATES (CHILDREN'S HOSPITAL). AMOUNT: 9,824,948. FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 705,042. END OF YEAR AMOUNT: 453,735. 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.