2023-05-15T18:49:48-05:00 2022-06-30 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2021-07-01 916068079 NORTHWEST IRONWORKERS HEALTH AND SECURITY PLAN NORT 2064417574 7525 SE 24TH STREET SUITE 200 MERCER ISLAND WA 98040 JEFF ILENSTINE CHAIRMAN 2064417574 2023-05-15 1 JEFF ILENSTINE 999009999 PAUL ANASTASI CPA P00395796 5093230272 2023-05-15 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z 7525 SE 24TH STREET SUITE 200 MERCER ISLAND WA 98040 134661894 0 X N/A X 1966 WA HEALTH BENEFITS FOR PARTICIPANTS. 15 8 39 0 0 0 0 0 55286237 53549319 1313249 894357 82723 3863966 56682209 58307642 0 0 57243170 47860284 0 0 0 0 0 3628846 3693757 60872016 51554041 -4189807 6753601 63843277 65147164 54888006 47181643 8955271 17965521 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE PLAN. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1668 0 1 39 1 0 0 0 0 0 0 0 0 X 15 8 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X WELFARE & PENSION ADMINISTRATION SERVICE INC 2064417574 7525 SOUTHEAST 24TH STREET SUITE MERCER ISLAND WA 98040 X JEFF ILENSTINE CHAIRMAN 1.00 X X 0 0 0 STEVE PENDERGRASS SECRETARY 1.00 X X 0 0 0 KEN CARR TRUSTEE 1.00 X 0 0 0 ROBERT DECKER TRUSTEE 1.00 X 0 0 0 DICK DEVRIES TRUSTEE 1.00 X 0 0 0 ALLAN HARDING TRUSTEE 1.00 X 0 0 0 DAVE HARRISON TRUSTEE (OUTGOING) 1.00 X 0 0 0 KEVIN PATTERSON TRUSTEE 1.00 X 0 0 0 JASON FUSSELL TRUSTEE 1.00 X 0 0 0 GREG GALES TRUSTEE 1.00 X 0 0 0 ROBERT KORTH TRUSTEE 1.00 X 0 0 0 ANTHONY LADD TRUSTEE 1.00 X 0 0 0 CHRIS MCCLAIN TRUSTEE 1.00 X 0 0 0 JOHN MORSE TRUSTEE (OUTGOING) 1.00 X 0 0 0 RODNEY G SPRINKLE TRUSTEE 1.00 X 0 0 0 DAN CURTISS TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 WELFARE & PENSION ADMINISTRATION SERVICE 7525 SOUTHEAST 24TH STREET SUITE 2 MERCER ISLAND WA 98040 THIRD PARTY ADMIN 1409167 PREMERA BLUECROSS 7001 220ST SOUTHWEST BUILDING 1 MOUNTLAKE TERRACE WA 98043 CLAIMS PROCESSING 987447 INNOVATIVE CARE MANAGEMENT INC 15 82ND DRIVE SUITE 180 GLADSTONE OR 97027 MEDICAL MANAGEMENT 176093 RAEL & LETSON 999 3RD AVENUE SUITE 1530 SEATTLE WA 98104 ACTUARY 172130 LEGACY LABRATORY SERVICE 1130 NW 22ND AVE SUITE 360 PORTLAND OR 97210 TESTING SERVICES 114794 5 EMPLOYER CONTRIBUTIONS 525100 48516957 48516957 PARTICIPANT CONTRIBUTIONS 525100 4909350 4909350 DRUG TEST REIMBURSEMENTS 525100 123012 123012 53549319 883474 883474 76365135 76354252 10883 10883 10883 REFUNDS 900099 3628573 3628573 COBRA SUBSIDY 900099 222717 222717 LIQUIDATED DAMAGES 900099 12676 12676 3863966 58307642 57424168 0 883474 47860284 1058599 59555 29806 111455 1964139 157429 2635 447 19191 DRUG TEST PROGRAM 189787 EMPLOYEE ASSISTANCE PRO 63180 PCORI TAX 19487 EMPLOYER WITHDRAWAL LIA 12032 6015 51554041 4564823 3965182 2859600 7578866 5577054 6971102 20948 291225 50820852 46340789 63843277 65147164 2329242 2336311 52558764 44845332 54888006 47181643 X 0 0 0 0 8955271 17965521 8955271 17965521 63843277 65147164 X 6753601 -5325351 7582000 X 0 1 X 0 0 0 AMOUNTS DUE INSURANCE COMPANIES 656545 HEALTH REIMBURSEMENT ACCOUNTS (HRA) LIABILITY 7860027 CLAIMS INCURRED BUT NOT REPORTE4D 9175000 LAG MONTHS ELIGIBILITY COVERAGE 8256000 ACCUMULATED ELIGIBIILITY CREDITS 18721000 EMPLOYER WITHDRAWAL LIABILITY 176760 44845332 X 52870836 -5325351 -5325351 58196187 111455 111455 58307642 51574158 0 51574158 111455 -131572 -20117 51554041 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC), AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN HAS OBTAINED A DETERMINATION LETTER IN WHICH THE INTERNAL REVENUE SERVICE (IRS) STATED THAT THE PLAN, AS DESIGNED, WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS DESIGNED AND IS CURRENTLY BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. 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 JUNE 30, 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. DISCUSSION 4/ PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN AMOUNTS DUE INSURANCE COMPANIES 17,261. CHANGE IN CLAIMS INCURRED BUT NOT REPORTED -2,964,000. CHANGE IN HRA LIABILITY 2,815,167. FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE TRUST ARE CONTRACTED OUT TO A PROFESSIONAL ADMINISTRATION COMPANY, BUT THE BOARD OF TRUSTEES RETAIN ULTIMATE RESPONSIBILITY FOR THE OPERATIONS OF THE TRUST. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO THE CHAIRMAN AND THIRD PARTY ADMINISTRATOR BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE PLAN'S THIRD PARTY ADMINISTRATOR SENDS AN ANNUAL QUESTIONNAIRE TO EACH TRUSTEE REGARDING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 18 PARTICIPANTS OF THE PLAN MAY REQUEST INFORMATION FROM THE PLAN'S THIRD PARTY ADMINISTRATOR, HOWEVER, NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 PARTICIPANTS OF THE PLAN MAY REQUEST INFORMATION FROM THE PLAN'S THIRD PARTY ADMINISTRATOR, HOWEVER, NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN LAG MONTHS ELIGIBILITY COVERAGE 1,829,000. CHANGE IN ACCUMULATED ELIGIBILITY CREDITS 5,753,000. 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