Civic Intelligence

Provena Health - Self Insurance Trust

EIN 36-2987310 • 501(c)3 • Chicago, IL

Profile

To self insure hospital professional liability.

200 South Wacker DriveChicago, IL 60606

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2014

Liabilities / Revenue

7th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)3 • $10M-$25M nonprofits • Source year 2014

Net Margin

6th percentile

-42%

Higher net margin than 6% of similar nonprofits.

501(c)3 • $10M-$25M nonprofits • Source year 2014

Top Officer Pay

15th percentile

$0

Higher top officer pay than 15% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

501(c)3 • $10M-$25M nonprofits • Source year 2014

Asset Growth

1st percentile

-100%

Faster asset growth than 1% of similar nonprofits.

501(c)3 • $10M-$25M nonprofits • Annualized from 2013 to 2014

Revenue Growth

96th percentile

223%

Faster revenue growth than 96% of similar nonprofits.

501(c)3 • $10M-$25M nonprofits • Annualized from 2013 to 2014

Balance Sheet
Liabilities / AssetsScore unavailable

Assets

Down

$0

Down $4,978,706 (-100%) from 2013

Liabilities

Flat

$0

Flat from 2013

Net Assets

Down

$0

Down $4,978,706 (-100%) from 2013

Operations
Liabilities / Revenue7th percentileNet Margin6th percentile

Revenue

Up

$8,661,549

Up $5,978,050 (+223%) from 2013

Expenses

Down

$12,322,570

Down $7,593,922 (-38%) from 2013

Net Income

Up

-$3,661,021

Up $13,571,972 (+79%) from 2013

Trend Graphs

Balance Sheet Trend

Asset Growth1st percentile

Grouped bars show assets, liabilities, and net assets across loaded filings.

$60M$40M$20M$0Assets 2010: $54,697,333Liabilities 2010: $0Net Assets 2010: $54,697,3332010Assets 2011: $53,213,706Liabilities 2011: $0Net Assets 2011: $53,213,7062011Assets 2012: $22,211,699Liabilities 2012: $0Net Assets 2012: $22,211,6992012Assets 2013: $4,978,706Liabilities 2013: $0Net Assets 2013: $4,978,7062013Assets 2014: $0Liabilities 2014: $0Net Assets 2014: $02014

Highlighted filing

2014

Assets$0
Liabilities$0
Net Assets$0
Open 2014 Filing

Operations Trend

Revenue Growth96th percentile

Revenue, expenses, and net income by year, with the latest filing highlighted.

$40M$20M$0-$20MExpenses 2010: $17,888,9802010Expenses 2011: $27,190,7082011Expenses 2012: $12,364,3042012Revenue 2013: $2,683,499Expenses 2013: $19,916,492Net Income 2013: -$17,232,9932013Revenue 2014: $8,661,549Expenses 2014: $12,322,570Net Income 2014: -$3,661,0212014

Highlighted filing

2014

Revenue$8,661,549
Expenses$12,322,570
Net Income-$3,661,021
Open 2014 Filing

Filings

Most recent year

2014 • Form 990Detailed filing. Detailed filing data is available for this year.

Open filing
Assets
$0
Liabilities
$0
Net assets
$0
Revenue
$8,661,549
Expenses
$12,322,570
Net income
-$3,661,021
Balance SheetOperations
YearAssetsLiabilitiesNet AssetsRevenueExpensesNet Income
2014Detailed filing. Detailed filing data is available for this year.$0.00$0.00$0.00$8.66$12.3$3.66
2013Detailed filing. Detailed filing data is available for this year.$4.98$0.00$4.98$2.68$19.9$17.2
2012Facts available. Structured filing facts are available, but richer extracted sections are limited.$22.2$0.00$22.2$12.4
2011Facts available. Structured filing facts are available, but richer extracted sections are limited.$53.2$0.00$53.2$27.2
2010Facts available. Structured filing facts are available, but richer extracted sections are limited.$54.7$0.00$54.7$17.9
Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2014 to Dec 31, 2014
Signed
Nov 9, 2015
Return Version
2014v5.0
Gross Receipts
$21,721,312
Mission and Program Overview

Mission

To self insure hospital professional liability.

To self insure hospital professional liability

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments in Publicly Traded Securities$4,165,005$0▼ $4,165,005
Cash and Non-Interest-Bearing Accounts$125,886$0▼ $125,886
Savings and Temporary Cash Investments$91,259$0▼ $91,259
Accounts Receivable-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Land, Buildings, and Equipment, Net-$0-
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$4,978,706$0▼ $4,978,706
Other Assets Total$596,556$0▼ $596,556
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Unrestricted Net Assets$4,978,706$0▼ $4,978,706
Total Net Assets Fund Balance$4,978,706$0▼ $4,978,706
Total Liabilities and Net Assets / Fund Balance$4,978,706$0▼ $4,978,706
Compensation and Service Providers
Top Officer Pay15th percentile

Board Members and Trustees

NameTitle
-Trustee

Highest Paid Contractors

ContractorServicesLocationCompensation
Hinshaw & Culbertson LLPLegal Fees8142 SOLUTIONS CENTER DR, Chicago, IL 60677$1,152,207
Johnson & Bell LtdLegal Fees33 WEST MONROE SUITE 2700, Chicago, IL 60603$934,608
Hall Prangle & SchoonveldLegal Fees200 S WACKER DR STE 3300, Chicago, IL 60606$773,161
Anderson Rasor & Partners LLPLegal Fees100 S WACKER DRIVE STE 1000, Chicago, IL 60606$515,408
Barker & Castrp LLCLegal Fees115 S LASALLE ST STE 2900, Chicago, IL 60603$118,507
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$8,036,618
Investment Income
$624,931
Other Revenue
$0
Change in Net Assets
$-3,661,021
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$12,322,570
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Legal$3,307,893--$3,307,893
Other Expenses$103,071--$103,071
All Other Expenses$95,916$268-$96,184
Fees for Service Investment Mgmnt Fees$30,363--$30,363
Fees for Services Accounting-$6,850-$6,850
Total Functional Expenses$12,315,452$7,118$0$12,322,570
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
No
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, Line 8A

“There are no individuals named as officers, directors, or trustees of the trust, therefore, no meetings are held.”

Form 990, Part VI, Section A, Line 8B

“The trust has no sub committees.”

Form 990, Part VI, Section B, Line 11

“The tax return is reviewed by the authorized signer. There is no governing body.”

Form 990, Part VI, Section C, Line 19

“UPON REQUEST”

Filing and Contact Details

Filer

Filer Name
Provena Health - Self Insurance Trust
EIN
36-2987310
Phone
6309142334
Address
200 SOUTH WACKER DRIVE, CHICAGO, IL 60606

Signing Officer

Name
Brian Knutson
Title
Trust Officer
Phone
5135344641
Signed
2015-11-09
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Brian Knutson
Formed
1982
Legal Domicile
Il
Voting Board Members
0
Independent Board Members
0
Employees
0
Volunteers
0

Preparer

Firm
Wermer Rogers Doran & Ruzon LLC
Address
755 ESSINGTON ROAD, JOLIET, IL 60435-2845
Preparer
Mary E Lancaster
Phone
8157306250
Supplemental Narrative

Additional Explanations

FORM 990, PART XI, LINE 9:

“Transfer of funds back to parent organization -1,317,685.”

Raw XML AppendixShowing 400 of 442 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt0THE TRUST DOES NOT HAVE OFFICERS OR DIRECTORS AND THE ONLY TRUSTEE IS FROM FIFTH THIRD BANK WHO IS THE CUSTODIAN OF THE INVESTMENTS. THE TRUST WAS CREATED TO HOLD AND INVEST FUNDS TO PAY EXPENSES RELATED TO THE SELF INSURANCE PORTION OF MALPRACTICE LAW SUITS AGAINST THE SUPPORTED ENTITIES.
IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt1THE TRUST PROVIDES FUNDING FOR SELF-INSURING AGAINST A PORTION OF THE MALPRACTICE CLAIMS THE RELATED HEALTH CARE ORGANIZATION INCUR AS PART OF THEIR NORMAL ACTIVITY OF PROVIDING HEALTH CARE TO THE RESPECTIVE COMMUNITIES.
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IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc1PART IV, SECTION E, LINE 2
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IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt0PRESENCE HEALTH
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt1PRESENCE SENIOR SERVICES
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt2PRESENCE HOSPITALS
IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt3ASSOCIATION-FRANCISCAN SISTERS OF THE SACRED HEART
IRS990ScheduleA/SupportingOrganization509a3Ind0X
IRS990ScheduleA/SupportingOrgType3FuncIntInd0X
IRS990ScheduleA/SupportSumAmt00
IRS990/ScheduleBRequiredInd00
IRS990/ScheduleJRequiredInd00
IRS990ScheduleN/AssetsDistributedInd00
IRS990ScheduleN/AttorneyGeneralNotifiedInd00
IRS990ScheduleN/BondsOutstandingInd00
IRS990ScheduleN/DirectorOfSuccessorInd00
IRS990ScheduleN/EmployeeOfSuccessorInd00
IRS990ScheduleN/LiabilitiesPaidInd00
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0REMAINING CASH BALANCE.
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/BusinessName/BusinessNameLine1Txt0PRESENCE HEALTH
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/DistributionDt02014-12-31
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/EIN0363366652
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/FairMarketValueOfAssetAmt01317685
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/IRCSectionTxt0501(C)3
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/MethodOfFMVDeterminationTxt0N/A - ONLY DISTRIBUTION WAS CASH
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine1Txt0200 SOUTH WACKER DRIVE
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm0CHICAGO
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd0IL
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCd060606
IRS990ScheduleN/OwnerOfSuccessorInd00
IRS990ScheduleN/ReceiveCompensationInd00
IRS990ScheduleN/RequiredToNotifyAGInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THERE ARE NO INDIVIDUALS NAMED AS OFFICERS, DIRECTORS, OR TRUSTEES OF THE TRUST, THEREFORE, NO MEETINGS ARE HELD.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1THE TRUST HAS NO SUB COMMITTEES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2THE TAX RETURN IS REVIEWED BY THE AUTHORIZED SIGNER. THERE IS NO GOVERNING BODY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3UPON REQUEST
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4TRANSFER OF FUNDS BACK TO PARENT ORGANIZATION -1,317,685.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 8A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 8B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 11
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART XI, LINE 9:
IRS990ScheduleR/AssetExchangeInd00
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd00
IRS990ScheduleR/AssetSaleToOtherOrgInd00
IRS990ScheduleR/DivRelatedOrganizationInd00
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd00
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd00
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd10
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd20
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt0PRESENCE LIFE CONNECTIONS
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt1PRESENCE HOSPITALS
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt2PRESENCE PRV HEALTH
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN0371127787
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN1364195126
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN2363366652
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt0501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt1501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt2501(C)(3)
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd0IL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd1IL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd2IL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0SENIOR SERVICES
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt1MEDICAL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt2HEALTH
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt0LINE 3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt1LINE 3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt2LINE 3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt019065 HICKORY CREEK DR 300
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt1333 N MADISON
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt219065 HICKORY CREEK DR 300
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0MOKENA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm1JOLIET
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm2MOKENA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd0IL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd1IL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/StateAbbreviationCd2IL
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd060448
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd160435
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd260448
IRS990ScheduleR/LoansOrGuaranteesFromOthOrgInd00
IRS990ScheduleR/LoansOrGuaranteesToOtherOrgInd00
IRS990ScheduleR/PaidEmployeesSharingInd00
IRS990ScheduleR/PerformOfServicesByOtherOrgInd00
IRS990ScheduleR/PerformOfServicesForOthOrgInd00
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd00
IRS990ScheduleR/ReimbursementPaidByOtherOrgInd00
IRS990ScheduleR/ReimbursementPaidToOtherOrgInd00
IRS990ScheduleR/RentalOfFacilitiesToOthOrgInd00
IRS990ScheduleR/RentalOfFcltsFromOthOrgInd00
IRS990ScheduleR/SharingOfFacilitiesInd00
IRS990ScheduleR/TransferFromOtherOrgInd00
IRS990ScheduleR/TransferToOtherOrgInd00
IRS990/SchoolOperatingInd00
IRS990/SignificantChangeInd00
IRS990/SignificantNewProgramSrvcInd00
IRS990/SubjectToProxyTaxInd00
IRS990/TaxablePartyNotificationInd00
IRS990/TaxExemptBondsInd00
IRS990/TempOrPermanentEndowmentsInd00
IRS990/TerminateOperationsInd01
IRS990/TotalAssetsBOYAmt04978706
IRS990/TotalAssetsEOYAmt00
IRS990/TotalAssetsGrp/BOYAmt04978706
IRS990/TotalAssetsGrp/EOYAmt00
IRS990/TotalCompGreaterThan150KInd00
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt07118
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt012315452
IRS990/TotalFunctionalExpensesGrp/TotalAmt012322570
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesBOYAmt00
IRS990/TotalLiabilitiesEOYAmt00
IRS990/TotalLiabilitiesGrp/BOYAmt00
IRS990/TotalLiabilitiesGrp/EOYAmt00
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt04978706
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt00
IRS990/TotalOtherCompensationAmt00
IRS990/TotalProgramServiceExpensesAmt012315452
IRS990/TotalProgramServiceRevenueAmt08036618
IRS990/TotalReportableCompFromOrgAmt00
IRS990/TotalRevenueGrp/ExclusionAmt00
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt08661549
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt08661549
IRS990/TotalRevenueGrp/UnrelatedBusinessRevenueAmt00
IRS990/TotalVolunteersCnt00
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt04978706
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt00
IRS990/TotReportableCompRltdOrgAmt00
IRS990/TrnsfrExmptNonChrtblRltdOrgInd00

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