2024-02-15T13:52:35-06:00 2023-03-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2022-04-01 911283260 NORTHWEST LABORERS - EMPLOYERS HEALTH AND SECURITY TRUST FUND NORT 2062824100 11724 NE 195TH STREET 300 BOTHELL WA 980118242 STACY MARTIN SECRETARY 2062824100 2024-02-15 1 STACY MARTIN 999009999 1 PAUL ANASTASI CPA P00395796 5093230272 2024-02-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ANDREW LEDBETTER 11724 NE 195TH STREET 300 BOTHELL WA 980118242 190034521 0 X HTTPS://WWW.NWLABORERS.ORG/YOUR-HEALTH-PLAN X 1969 WA TO PROVIDE HEALTH AND WELFARE BENEFITS. 12 0 16 0 0 0 0 0 115838280 126712680 7877286 1949485 8134962 9995017 131850528 138657182 0 0 107714448 121895188 0 0 0 0 0 8608888 9016612 116323336 130911800 15527192 7745382 143002816 150445644 49964042 58384426 93038774 92061218 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 TO PROVIDE HEALTH AND SECURITY BENEFITS TO QUALIFIED PARTICIPANTS IN THE PLAN. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 16 1 0 0 0 0 0 0 0 0 X 12 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 X ZENITH AMERICAN SOLUTIONS INC 2062824100 11724 NE 195TH STREET SUITE 300 BOTHELL WA 980118242 X ANDREW LEDBETTER CHAIRMAN 1.00 40.00 X X 0 152421 24931 STACY MARTIN SECRETARY 1.00 40.00 X X 0 216360 49500 DALE CANNON UNION TRUSTEE 1.00 40.00 X 0 227084 65600 SHANNON STULL UNION TRUSTEE 1.00 40.00 X 0 124583 40400 KAYNE SEGURA UNION TRUSTEE (OUTGOING) 1.00 40.00 X 0 57437 43800 MARK HORTON EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 DAN KUNEY EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 ANISSA LINDGREN EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 CARL STEWART EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 KARI SHIFLETT EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 JOHN ADAMS UNION TRUSTEE 1.00 40.00 X 0 90148 48800 ADAM LAMBE UNION TRUSTEE 1.00 40.00 X 0 146617 39900 SCOTT HOLSTROM UNION TRUSTEE 1.00 40.00 X 0 105577 50700 0 1120227 363631 0 0 1 0 ZENITH AMERICAN SOLUTIONS 11724 NE 195TH ST STE 300 BOTHELL WA 98011 ADMINISTRATION 3602060 PREMERA BLUE CROSS 7110 220TH ST SW MOUNTLAKE TERRACE WA 98043 CLAIMS PROCESSING 2956625 DELTA DENTAL 9706 FOURTH AVE NE SEATTLE WA 98115 CLAIMS PROCESSING 377287 STOLL LAW GROUP 9725 SE 36TH ST STE 201 MERCER ISLAND WA 98040 LEGAL & PROFESSIONAL 170826 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON AVE STE 600 SPOKANE WA 99201 ACCOUNTING SERVICES 166980 7 EMPLOYER CONTRIBUTIONS 525100 119614726 119614726 EMPLOYEE AND RETIREE SELF-PAYMENT 525100 7097954 7097954 126712680 3224705 3224705 50102119 51377339 -1275220 -1275220 -1275220 DRUG REBATES AND SUBSIDY 525100 9825655 9825655 LIQUIDATED DAMAGES 525100 169362 169362 9995017 138657182 136707697 0 1949485 121895188 5195423 238617 131688 256514 2771775 367908 5056 38269 STORAGE 9872 INTERNATIONAL FOUNDATIO 1490 130911800 8210275 4001458 3799612 3868833 9078192 16762558 121914737 125812795 143002816 150445644 342366 221355 49621676 58163071 49964042 58384426 X 0 0 0 0 93038774 92061218 93038774 92061218 143002816 150445644 X 7745382 -4542108 -4180830 X 0 1 X 0 0 0 BANK OVERDRAFTS 843626 AMOUNTS DUE INSURANCE COMPANIES 119684 BENEFITS PAYABLE 7462518 CLAIMS IBNR 15640000 ACCUMULATED ELIGIBIILITY CREDITS 34097243 58163071 X 133858560 -4542108 -4542108 138400668 256514 256514 138657182 126429797 0 126429797 256514 4225489 4482003 130911800 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO THE APPROPRIATE SECTION OF THE INTERNAL REVENUE CODE (IRC), AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN HAS OBTAINED A FAVORABLE DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS), BUT HAS SINCE BEEN AMENDED. HOWEVER, THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. THEREFORE, THEY BELIEVE THAT THE PLAN IS QUALIFIED, AND THE RELATED TRUST IS TAX-EXEMPT AS OF THE FINANCIAL STATEMENT DATES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE PLAN'S FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT AS OF MARCH 31, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF THE LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS AND THE PLAN COULD BE SUBJECT TO INCOME TAX IF CERTAIN ISSUES WERE FOUND BY THE IRS THAT COULD RESULT IN THE DISQUALIFICATION OF THE PLAN'S TAX-EXEMPT STATUS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PAYABLE 4,225,489. 0 0 0 DALE CANNON UNION TRUSTEE 0 227084 0 0 0 0 0 42900 0 22700 0 292684 0 0 STACY MARTIN SECRETARY 0 216360 0 0 0 0 0 38500 0 11000 0 265860 0 0 ADAM LAMBE UNION TRUSTEE 0 146617 0 0 0 0 0 22500 0 17400 0 186517 0 0 ANDREW LEDBETTER CHAIRMAN 0 152421 0 0 0 0 0 0 0 24931 0 177352 0 0 SHANNON STULL UNION TRUSTEE 0 124583 0 0 0 0 0 29100 0 11300 0 164983 0 0 SCOTT HOLSTROM UNION TRUSTEE 0 105577 0 0 0 0 0 24200 0 26500 0 156277 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY MANAGEMENT AND OPERATIONS OF THE PLAN ARE HANDLED BY A THIRD PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE SIGNING TRUSTEE AS WELL AS THE PLAN ADMINISTRATOR PRIOR TO ITS FILING. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN PROVIDES FOR PARTICIPANT INSPECTION OF DOCUMENTS AND FINANCIAL STATEMENTS UPON REQUEST THROUGH THE PLAN ADMINISTRATORS. FORM 990, PART VII, LINE 1A: REASONABLE EFFORT WAS MADE IN DETERMINING THE RELATED ORGANIZATION COMPENSATION OF TRUSTEES EMPLOYED BY RELATED TAX EXEMPT ENTITIES BY REVIEWING RECENT FORM 990 AND LM-2 FILINGS OF THOSE ENTITIES. CONSISTENT WITH THE VOLUNTEER EXCEPTION IN THE INSTRUCTIONS TO FORM 990, COMPENSATION OF TRUSTEES EMPLOYED BY RELATED FOR-PROFIT EMPLOYERS IS NOT REPORTED. FORM 990, PART XI, LINE 9: CHANGE IN ACCUMULATED ELIGIBILITY CREDITS -4,180,830. 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