Dignity Health Workers Compensation Self Insurance Trust

“Form 990, part v, line 2a the organization does not have employees. The organization operates as the administration company of the workers' compensation self-insurance program for the supported organization, dignity health, and its related entities. Form 990, part vi, section a, line 2 r. Grossman and d. Morissette - business relationship form 990, part vi, section a, line 7a dignity health, the trustor of the organization, has the power to appoint and remove the institutional trustee by delivery to the institutional trustee of written notice to that effect. The institutional trustee, and any successor trustee, may resign as trustee upon written notice to that effect delivered to the trustor. Such removal or resignation shall become effective 60 days from the date of the delivery of such written notice, unless an earlier or later date is agreed upon by trustor and the trustee. Form 990, part vi, section b, line 11b the supported organization's svp finance & corporate controller reviewed the form 990. In addition, the supported organization's vp of financial services and reporting worked closely with an independent, outside accounting firm engaged to review the form 990. The final version of the form 990 was not provided to the institutional trustee before the return was filed. Form 990, part vi, section b, line 12c the organization has adopted dignity health's conflicts of interest policies (the "coi policies"). Under such policies, the evp/general counsel is designated as the organization's filing officer and is responsible for collecting, reviewing and validating annual disclosures of all covered persons including the members of dignity health's governing bodies including its board of directors and board committees, as well as dignity health's officers and executive leaders, key employees, management personnel at the vice president level and above, and any other personnel designated by the filing officer ("covered persons"). All covered persons are required to disclose actual or potential conflicts arising from the business, ownership, financial and personal interests held by such covered persons or their family members. Covered persons are required to disclose to their supervisors and to relevant decision makers any interest that may present a conflict of interest, or the appearance of a conflict of interest. Such disclosure is required on a transactional basis at the time such conflicts arise, when an individual becomes a covered person (e.g. Upon hiring or upon promotion), and annually thereafter. As part of the annual disclosure survey conducted pursuant to the coi policies, each covered person is required to certify that he/she: (1) has received a copy of the coi policy or coi policies applicable to his/her position; (2) has read the coi policy and understands said policy; and (3) agrees to comply with all requirements of the coi policies, including completing the conflicts of interest disclosure survey as required by the coi policies. Using the information from the annual disclosure survey, the filing officer prepares annual reports of reported conflicts of interest and distributes those reports to the governing body chairs, including the chair of the board of directors and the chair of dignity health board committees, as well as to key leaders of the organization to enable the responsible individuals to monitor and manage disclosed conflicts of interest and assure decisions are made in the organization's best interests. The procedures for addressing a conflict of interest related to a proposed transaction in the case of governing bodies include, but are not limited to: (1) the actual or potential conflict of interest is fully disclosed to the applicable governing body and any other relevant decision-makers; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the interested person may be excl”

“Description:prof fees for claim process total fees:7071038”

“Description:administrative services total fees:846783”

“Description:actuary services total fees:115313”

“Description:other prof fees - consulting total fees:8532”