2024-03-18T13:31:31-05:00 2023-05-31 MILLER KAPLAN ARASE LLP 2101 4TH AVE STE 1830 SEATTLE WA 981212345 990 2022-06-01 930478837 THE BLEDSOE HEALTH TRUST % GARTH FISHER BLED 2063294900 2323 EASTLAKE AVE E SEATTLE WA 98102 RODGER GLOS TRUSTEE 2063294900 2024-03-11 true RODGER GLOS 999009999 Catalina Kirby P02018896 2065963930 2 2022 2023-04-26 12:10:37Z RODGER M GLOS 2323 Eastlake Ave E Seattle WA 98102 65887411 false X N/A X 1959 OR SEE SCHEDULE O 8 0 0 0 0 0 0 0 54682740 47260897 4117530 3951117 52450 0 58852720 51212014 0 0 51167065 39893231 0 0 0 0 0 1130580 1064774 52297645 40958005 6555075 10254009 147123274 151777312 12857431 10712047 134265843 141065265 ORGANIZATIONS'S MISSION IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE ACTIVE PARTICIPANTS AND THEIR COVERED DEPENDENTS. THE PLAN ALSO PROVIDES HEALTH BENEFITS TO SELF-PAY PARTICIPANTS AND RETIREES FOR WHICH A CONTRIBUTION IS RECEIVED. false false ORGANIZATION'S MISSION IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE ACTIVE PARTICIPANTS AND THEIR COVERED DEPENDENTS. THE PLAN ALSO PROVIDES HEALTH BENEFITS TO SELF-PAY PARTICIPANTS AND RETIREES FOR WHICH A CONTRIBUTION IS RECEIVED. false false false false false false false false false true false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 0 0 true 0 false false false false false false false false X 8 0 false false false false false false false true false false false false true true true true true false X GARTH FISHER 2063294900 2323 EASTLAKE AVE E SEATTLE WA 98102 X RODGER M GLOS TRUSTEE 1.0 0.0 X 0 0 0 DANIEL SILVERMAN TRUSTEE 1.0 0.0 X 0 0 0 KELLYE T WISE TRUSTEE 1.0 0.0 X 0 0 0 TONY HADLEY TRUSTEE 1.0 0.0 X 0 0 0 PAUL MARKS ALTERNATE TRUSTEE 1.0 0.0 X 0 0 0 JERRY KING TRUSTEE 1.0 0.0 X 0 0 0 TODD GORHAM TRUSTEE 1.0 0.0 X 0 0 0 DAYNA ERNER TRUSTEE 1.0 0.0 X 0 0 0 JAMES GLEASON TRUSTEE 1.0 0.0 X 0 0 0 Derek Glos Alternate Trustee 1.0 0.0 X 0 0 0 Brian Oelberg Alternate Trustee 1.0 0.0 X 0 0 0 Paul Schmitt Alternate Trustee 1.0 0.0 X 0 0 0 0 0 0 0 false false false REGENCE BLUECROSS BLUESHIELD OF ORE PO Box 1271 PORTLAND OR 97207 CLAIMS ADMIN 2132888 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVE E SEATTLE WA 98102 THIRD-PARTY ADMIN 523940 EXPRESS SCRIPTS INC 225 SUMMIT AVE MONTVALE NJ 07645 CLAIMS ADMIN 421267 3 0 EMPLOYER CONTRIBUTIONS 900099 43688598 43688598 SELF-PAY CONTRIBUTIONS 900099 3572299 3572299 47260897 4990100 4990100 0 0 0 0 0 13636414 14675397 -1038983 -1038983 -1038983 0 0 0 0 0 0 0 0 0 0 51212014 47260897 3951117 0 0 0 39893231 0 0 0 0 0 0 510105 71750 63005 0 0 39413 180983 0 126523 13835 0 0 2398 0 0 0 0 0 37972 ACA PCORI FEE 17764 WAPAL ASSESSMENT 1026 40958005 -7846 49690 1306380 1374950 0 0 4106862 3995766 0 0 0 0 0 0 0 0 1023842 1035044 0 0 114286862 120011883 26407174 25309979 0 0 0 0 0 0 147123274 151777312 107931 358547 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12749500 10353500 12857431 10712047 X 0 0 0 0 134265843 141065265 134265843 141065265 147123274 151777312 10254009 -3454587 X false true X true 0 0 BENEFIT OBLIGATIONS 10353500 10353500 X 47757427 -3454587 -3454587 51212014 51212014 43354005 43354005 -2396000 -2396000 40958005 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN A TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY A TAX AUTHORITY. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B: CHANGE IN BENEFIT OBLIGATIONS. PART I, LINE 1: TO PROVIDE HEALTH BENEFITS TO ELIGIBLE ACTIVE PARTICIPANTS AND THEIR COVERED DEPENDENTS. THE PLAN ALSO PROVIDES HEALTH BENEFITS TO SELF-PAY PARTICIPANTS AND RETIREES FOR WHICH A CONTRIBUTION IS RECEIVED. PART VI, LINE 11B: FORM 990 IS REVIEWED BY THE ADMINISTRATIVE OFFICE PRIOR TO BEING FILED. THE ADMINISTRATIVE OFFICE NOTIFIES THE BOARD OF TRUSTEES OF UNUSUAL OR SIGNIFICANT ITEMS, IF NOTED. PART VI, LINE 12C: TRUSTEES ARE REQUIRED TO NOTIFY THE TRUST OF ANY CHANGES IN INTERESTS THAT COULD GIVE RISE TO CONFLICTS. PART VI, LINE 19: THE PLAN'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED AT THE ADMINISTRATIVE OFFICE AND ARE AVAILABLE UPON REQUEST. PART VII, SECTION A: MEMBERS OF THE BOARD OF TRUSTEES SERVE FOR NO COMPENSATION. COMPENSATION PAID TO TRUSTEES BY THEIR EMPLOYERS IS REPORTED ON THE EMPLOYERS' ANNUAL TAX FILINGS. THIS INFORMATION IS UNKOWN TO THE PLAN ADMINISTRATOR. CIC-TOC PENSION PLAN 2323 EASTLAKE AVE E SEATTLE WA 98102 456909074 PENSION BEN. WA 1.401-1(B)3 NA false LUMBER INDUSTRY PENSION PLAN 2323 EASTLAKE AVE E SEATTLE WA 98102 456909074 PENSION BEN. WA 1.401-1(B)3 NA false CIC DEFINED CONTRIBUTION RETIREMENT PLAN 2323 EASTLAKE AVE E SEATTLE WA 98102 456909074 PENSION BEN. WA 1.401-1(B)3 NA false CARPENTERS INDUSTRIAL COUNCIL 12788 SE STARK ST PORTLAND OR 97233 421693707 LABOR ORG. OR 501(C)(5) NA false see supplemental information na see supplemental information na false false false false false false false false false false false false false false false false false true true PARTS II, III AND IV - IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: A CONTRIBUTING EMPLOYER IS A RELATED ORGANIZATION SOLELY TO THE EXTENT THAT THE EMPLOYER IS SIGNATORY TO A COLLECTIVE BARGAINING AGREEMENT OR PARTICIPATION AGREEMENT REQUIRING CONTRIBUTIONS TO THE TRUST. THE PLAN ADMINISTRATOR DOES NOT MAINTAIN INFORMATION CONCERNING THE ENTITY TYPE OF EACH OF THE TRUST'S CONTRIBUTING EMPLOYERS. THE PLAN CONTRACTS WITH VIGILANT SERVICES, INC. FOR ONE OF ITS MEMBERS TO SERVE AS AN EMPLOYER TRUSTEE AND CHAIRMAN OF THE BOARD OF TRUSTEES OF THE PLAN, REPRESENTING CONTRIBUTING EMPLOYERS THAT ARE NOT REPRESENTED BY ANOTHER TRUSTEE. A MONTHLY FEE IS PAID BY THE PLAN TO VIGILANT SERVICES, INC. UNDER THE TERMS OF THE AGREEMENT. FOR THE PLAN YEAR ENDED MAY 31, 2023, THE MONTHLY FEE WAS $4,750 EFFECTIVE JANUARY 1, 2018.