2023-05-13T03:17:04-05:00 2022-06-30 910614823 SCHOEDEL & SCHOEDEL CPAS PLLC 422 W RIVERSIDE AVE STE 1420 SPOKANE WA 992010395 990 2021-07-01 201842198 SEIU Healthcare NW Health Benefits Trust SEIU 2062547120 215 Columbia St 300 Seattle WA 98104 Merissa Clyde Executive Director 2062953717 2023-05-13 1 Merissa Clyde 999009999 SCOTT OPPERUD CPA P00542597 5097472158 2023-05-10 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Merissa Clyde 215 Columbia St 300 Seattle WA 98104 313981321 0 X www.myseiubenefits.org X 2004 WA The Trust was established as a result of collective bargaining between the Service Employees International Union, Local 775 (SEIU 775) and various employers or employer representatives signatory thereto to provide health, vision and dental benefits covering qualified employees reported under the collective bargaining agreements. 10 9 0 0 0 0 1008678 0 281785177 305449897 8008972 8531424 0 0 290802827 313981321 0 0 222941468 239484735 0 0 0 0 0 33165173 34099611 256106641 273584346 34696186 40396975 374711079 366303429 26647330 30385410 348063749 335918019 The Trust provides health and welfare benefits pursuant to collective bargaining agreements between various employers and the Trust. 0 0 The Trust was established as a result of collective bargaining between SEIU 775 and various employers or employer representatives signatory thereto to provide health, vision and dental benefits covering qualified employees reported under the collective bargaining agreements. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 15 0 1 0 0 0 0 0 0 0 0 0 X 10 9 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Clark Nuber PS 4254544919 10900 NE 4th St 1700 Bellevue WA 98004 X Sterling Harders Labor Trustee 1.00 X X 0 0 0 Brittany Williams Labor Trustee 1.00 X 0 0 0 Eric Erickson Employer Trustee 1.00 X 0 0 0 Adam Glickman Labor Trustee 1.00 X 0 0 0 Mark Robinson Employer Trustee 1.00 X 0 0 0 Shaine Truscott Labor Trustee 1.00 X 0 0 0 Tangie Webb Labor Trustee 1.00 X 0 0 0 Steven Hill Employer Trustee 1.00 X 0 0 0 Lou McDermott Employer Trustee 1.00 X 0 0 0 Abby Solomon Executive Director 5.00 35.00 X X 0 198010 40327 0 198010 40327 0 0 1 0 Kaiser of Washington 601 Union St Suite 3100 Seattle WA 98101 Claims Adjudication 19730232 SEIU Benefits Group 215 Columbia Street Seattle WA 98104 Plan administration 6876244 MagnaCare 11600 Stewart Ave Suite 200 Westbury NY 11590 Contract administrator 5998347 Kaiser of Washington Options Inc 601 Union St Suite 3100 Seattle WA 98101 Claims Adjudication 5368595 Clark Nuber PS 10900 NE 4th Street Suite 1400 Bellevue WA 98004 Plan administration 444956 8 Employer contributions 525100 289265549 289265549 Participant contributions 525100 16184348 16184348 305449897 8531424 8531424 313981321 305449897 0 8531424 239484735 13084467 80434 561014 36500 17055930 298084 69298 528728 7334 4571 1805491 Dues 495377 ACA taxes and fees 72383 273584346 830885 958190 51316501 49597196 27730307 28680395 198254 176273 36570 5681 35461 30889 292604372 284914988 1995299 1945498 374711079 366303429 2272906 1897218 24374424 28488192 26647330 30385410 X 0 0 0 0 348063749 335918019 348063749 335918019 374711079 366303429 40396975 -52542705 0 X 0 1 X 0 0 36570 5681 30889 30889 Claims payable 6488192 Claims incurred but not reported 22000000 28488192 261438616 -52542705 -52542705 313981321 0 313981321 269470578 24374424 24374424 245096154 28488192 28488192 273584346 Part XII, Line 2d - Other Adjustments: Prior year benefit claims payable 6,374,424. Prior year claims incurred but not reported 18,000,000. Part XII, Line 4b - Other Adjustments: Current year benefit claims payable 6,488,192. Current year claims incurred but not reported 22,000,000. 1 X 0 0 0 Abby Solomon Executive Director 0 198010 0 0 0 0 0 23999 0 16328 0 238337 0 0 Part I, Line 3 The compensation of the executive director is determined by the Board of Trustees in consultation with an outside compensation consultant if needed. SEIU Healthcare 775NW Common management and governance 209876 SEIU Healthcare 775NW provides a member resource center benefiting the SEIU Healthcare NW Health Benefits Trust. Payments for these services totaled $209,876 for the year. 0 SEIU 775 Benefits Group Trustees in common 6876244 The SEIU 775 Benefits Group provides certain administrative services to the SEIU Healthcare NW Health Benefits Trust. Payments for these services totaled $6,876,244 for the year. 0 Form 990, Part VI, Section A, line 2 SEIU Healthcare 775NW, the SEIU Healthcare NW Training Partnership and the SEIU 775 Benefits Group are service providers to this trust as well as participating employers. Sterling Harders is a trustee of this trust and serves as the Trust's Chair. Sterling Harders is also the President of SEIU Healthcare 775NW, a trustee of the SEIU Healthcare NW Training Partnership, a trustee of the SEIU 775 Secure Retirement Trust, and a trustee of the SEIU 775 Benefits Group. Adam Glickman is a trustee of this trust, the Secretary-Treasurer of SEIU Healthcare 775NW, a trustee of the SEIU Healthcare NW Training Partnership, a trustee of the SEIU 775 Benefits Group and a trustee of the SEIU 775 Secure Retirement Trust. Shaine Truscott is a trustee of this trust, a trustee of the SEIU Healthcare NW Training Partnership, and an employee of SEIU Healthcare 775NW. Bill Moss is a trustee of this trust, a trustee of SEIU Healthcare NW Training Partnership and a trustee of the SEIU 775 Health Benefits Group. Abby Solomon is the Executive Director of this trust, the SEIU Healthcare NW Training Partnership and the SEIU 775 Health Benefits Group. Brittany Williams is a trustee of this trust and an executive board member of SEIU Healthcare 775NW. Form 990, Part VI, Section A, line 3 The Trust has contracted with various organizations (Zenith American Solutions, MagnaCare, Aetna, AmeriFlex, Kaiser of Washington, Delta Dental of Washington, Willamette Dental Group, SEIU Healthcare NW Training Partnership, SEIU Healthcare 775NW, and Clark Nuber, P.S.) to provide administrative, bookkeeping, claims processing, member communications, and record and book-keeping services. Form 990, Part VI, Section A, line 7a Any vacancies of Employer Trustees are filled by appointment of the remaining Employer Trustees. The appointment of an Employer Trustee may be terminated, at any time, by the remaining Employer Trustees by such method as is satisfactory to them. Any vacancies of the Labor Trustees are filled by appointment of the president of SEIU Healthcare 775NW according to SEIU Healthcare 775NW's internal rules, procedures, policies or bylaws. The appointment of a Labor Trustee may be terminated, at any time, by the president of SEIU Healthcare 775NW according to SEIU Healthcare 775NW's internal rules, procedures, policies or bylaws. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC, from information provided by the third-party administrator and other consultants and advisors. Draft copies of the Trust's financial statements and Form 990 were first provided to the Trust's consultants and advisors, who reviewed the Form 990 for accuracy and completeness. Any questions, concerns or issues raised by the consultants and advisors were addressed and any necessary revisions were made to the Form 990. The revised Form 990 was then provided to the Board of Trustees for its review and approval. Any additional questions, concerns or issues raised by the Board of Trustees were addressed and any necessary revisions were made to the Form 990. The final version of the Form 990 was reviewed and approved for filing by the Board of Trustees. Form 990, Part VI, Section B, line 12c A copy of the Trust's Conflict of Interest Policy has been distributed to each Trustee and other fiduciaries. At least annually, a fiduciary is obligated to disclose or update to the Board of Trustees a list of relatives as defined in the policy involved in any transaction, as well as the fiduciary's business or other interests in any transaction impacting Trust assets (except for the receipt of benefits under the terms of the trust and plan). Further, any fiduciary who has knowledge of any transaction that may arguably be restricted pursuant to the policy, and that has not been specifically permitted by ERISA Section 408 or Department of Labor administrative exemptions, is obligated to disclose such information to the Board of Trustees. The Board of Trustees investigates any actual or potential conflicts of interest. If the Board of Trustees determines that a conflict exists with respect to a fiduciary, it will prohibit the fiduciary from discussions, votes, or attempts to influence the issue or decision that is impacted. Form 990, Part VI, Section B, line 15 There are no compensated management officials, officers or key employees of the organization. If the organization had such compensated individuals, policies and procedures would be developed to determine compensation. Form 990, Part VI, Section C, line 19 The Trust's governing documents, conflict of interest policy, financial statements, and Form 990 are available to the general public upon written request sent to the organization at: 215 Columbia St Ste 300, Seattle, WA 98104. Form 990, Part VII, Section A, Line 1A: None of the Trustees are compensated by the organization. The Executive Director is compensated by a related organization. The Board of Trustees is comprised of ten individuals, four of whom are representatives of the employers, five of whom are representatives of the union, and the Executive Director. One or more trustee maybe required or encouraged to serve on this board of trustees. As such their regular compensation may take into consideration services performed by them in regard to the Trust. The Trust does not readily have access to information related to compensation paid by other entities to the Trustees, other than the Executive Director. In their roles as Trustees, all are fiduciaries and understand their obligations under the Trust Agreement and the Trust's policies and procedures, which include a conflict-of-interest policy. Coastal CAP 101 E Market St Aberdeen WA 98520 Home care services WA 501(c)(3) Line 7 N/A 0 Concerned Citizens PO Box 1787 Forks WA 98331 911156809 Home care services WA 501(c)(3) Line 7 N/A 0 Korean Women's Association 123 E 96th Street Tacoma WA 98445 911066806 Home care services WA 501(c)(3) Line 11 N/A 0 SEIU Healthcare 775NW 215 Columbia Street Seattle WA 98104 810588837 Local union representing home care and nursing home workers. WA 501(c)(5) N/A 0 SEIU 925 Multiemployer Health Benefits Trust PO Box 6 Mukilteo WA 98275 To provide health benefits for participants WA 501(c)(9) N/A 0 State of Washington - Department of Social and Health Services PO Box 45842 Olympia WA 98504 To improve safety and health of individuals, families, and communities. WA 501(c)(3) Line 6 N/A 0 CDM Caregiving Services 2300 NE Anderson Vancouver WA 98661 911057994 Home care services WA 501(c)(3) Line 7 N/A 0 Working Washington 116 Warren Ave N Suite A Seattle WA 98109 451657758 To build a powerful workers movement WA 501(c)(4) N/A 0 Olympic Community Action Programs 823 Commerce Loop Port Townsend WA 82904 910814319 To improve safety and health of individuals, families, and communities. WA 501(c)(3) Line 7 N/A 0 Senior Life Resources Northwest 1824 Fowler St Richland WA 99352 910909913 To support in-home care and senior nutrition services WA 501(c)(3) Line 7 N/A 0 Behavioral Health Resources 3857 Martin Way E Olympia WA 65268 910666889 To promote mental health and substance use disorder recovery WA 501(c)(3) Line 7 N/A 0 Catholic Community Services 1323 Yakima Ave Tacoma WA 98405 911585652 To provide quality integrated services and housing WA 501(c)(3) Line 7 N/A 0 SEIU 775 Benefits Group 215 Columbia Street Suite 300 Seattle WA 98104 852581812 To provide comprehensive training, support, and career development benefits. WA 501(c)(3) Line 2 N/A 0 Addus Health Care 6801 Gaylord parkway Suite 110 Frisco TX 75034 Home care services TX N/A C 0 Amicable Healthcare Inc 15220-B 32nd Avenue South SeaTac WA 99188 Home care services WA N/A S 0 Catholic Community Services 100 23rd Ave S Seattle WA 98144 Home care services WA N/A S 0 Chesterfield Services Inc 703 Columbia Street Suite 200 Seattle WA 98104 911718148 Home care services WA N/A C 0 ResCare of WA 805 N Whttington Parkway Louisville KY 40222 Home care services WA N/A C 0 HomeCare Montana 82 8th St Belgrade MT 59714 471844286 Home care services MT N/A C 0 First Choice In-Home Care Inc 15015 Main St Suite 209 Bellevue WA 98007 912152603 Home care services WA N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 1 SEIU Healthcare 775NW M 209876 Cost SEIU 775 Benefits Group M 6876244 Cost