2022-02-07T18:50:09-06:00 2021-03-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2020-04-01 911283260 NORTHWEST LABORERS - EMPLOYERS HEALTH AND SECURITY TRUST FUND NORT 2062824100 11724 NE 195TH STREET NO 300 BOTHELL WA 980118242 STACY MARTIN SECRETARY 2062824100 2022-02-07 1 STACY MARTIN 999009999 PAUL ANASTASI CPA P00395796 5093230272 2022-02-07 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z ANDREW LEDBETTER 11724 NE 195TH STREET NO 300 BOTHELL WA 980118242 188780815 0 X HTTPS://WWW.NWLABORERS.ORG/YOUR-HEALTH-PLAN X 1969 WA TO PROVIDE HEALTH AND WELFARE BENEFITS. 12 0 25 0 0 0 0 0 109335504 105207396 4454199 3479581 4694785 8524880 118484488 117211857 0 0 102435965 106903560 0 0 0 0 0 8111937 7878123 110547902 114781683 7936586 2430174 128743749 133006616 50720910 46127801 78022839 86878815 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 114781683 TO PROVIDE HEALTH AND SECURITY BENEFITS TO QUALIFIED PARTICIPANTS IN THE PLAN. 114781683 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 25 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 BOTHELL WA 980118242 X ANDREW LEDBETTER CHAIRMAN 1.00 40.00 X X 0 137221 23055 JERMAINE SMILEY SECRETARY 1.00 40.00 X X 0 190549 53000 STACY MARTIN UNION TRUSTEE 1.00 40.00 X X 0 126889 0 DALE CANNON UNION TRUSTEE 1.00 40.00 X 0 192177 72681 BRIAN BELARDE UNION TRUSTEE (OUTGOING) 1.00 40.00 X 0 153013 55000 SHANNON STULL UNION TRUSTEE 1.00 40.00 X 0 110470 52795 KAYNE SEGURA UNION TRUSTEE 1.00 40.00 X 0 127318 49000 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 0 1037637 305531 0 0 1 0 ZENITH AMERICAN SOLUTIONS 201 QUEEN ANNE AVENUE NORTH 100 SEATTLE WA 98109 ADMINISTRATION 3511911 PREMERA BLUE CROSS 7110 220TH ST SW MOUNTLAKE TERRACE WA 98043 CLAIMS PROCESSING 2664384 DELTA DENTAL 9706 FOURTH AVE NE SEATTLE WA 98115 CLAIMS PROCESSING 344431 MANNING & NAPIER ADVISORS LLC 290 WOODCLIFF DRIVE FAIRPORT NY 14450 INVESTMENT ADVISOR 153239 STOLL LAW GROUP 9101 N HARLAN ST 140 WESTMINSTER CO 80031 LEGAL & PROFESSIONAL 149857 8 EMPLOYER CONTRIBUTIONS 525100 97894942 97894942 EMPLOYEE AND RETIREE SELF-PAYMENT 525100 7312454 7312454 105207396 3069515 3069515 71979024 71568958 410066 410066 410066 DRUG REBATES AND SUBSIDY 525100 8488304 8488304 LIQUIDATED DAMAGES 525100 36576 36576 8524880 117211857 113732276 0 3479581 106903560 4351511 205230 102279 243106 2537222 401156 1181 20721 STORAGE 14626 INTERNATIONAL FOUNDATIO 1091 114781683 11932338 5527487 798878 766621 8368621 9790893 107643912 116921615 128743749 133006616 360598 400356 50360312 45727445 50720910 46127801 X 0 0 0 0 78022839 86878815 78022839 86878815 128743749 133006616 X 2430174 4796809 1628993 X 0 1 X 0 0 0 BANK OVERDRAFTS 667328 AMOUNTS DUE INSURANCE COMPANIES 269725 BENEFITS PAYABLE 6213948 CLAIMS IBNR 12254000 ACCUMULATED ELIGIBIILITY CREDITS 26322444 45727445 X 121765560 4796809 4796809 116968751 243106 243106 117211857 115165768 0 115165768 243106 -627191 -384085 114781683 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, 2021, 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 -627,191. 0 0 0 DALE CANNON UNION TRUSTEE 0 180404 0 0 0 11773 0 58702 0 13979 0 264858 0 0 JERMAINE SMILEY SECRETARY 0 190549 0 0 0 0 0 40000 0 13000 0 243549 0 0 BRIAN BELARDE UNION TRUSTEE (OUTGOING) 0 153013 0 0 0 0 0 41000 0 14000 0 208013 0 0 KAYNE SEGURA UNION TRUSTEE 0 127318 0 0 0 0 0 35000 0 14000 0 176318 0 0 SHANNON STULL UNION TRUSTEE 0 110470 0 0 0 0 0 38707 0 14088 0 163265 0 0 ANDREW LEDBETTER CHAIRMAN 0 137221 0 0 0 0 0 0 0 23055 0 160276 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 1,628,993. 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CONTRIBUTING EMPLOYER N/A 0 RIVIERA COMMUNITY CLUB INC CONTRIBUTING EMPLOYER N/A 0 ROCKFORD CORPORATION CONTRIBUTING EMPLOYER N/A 0 RODAN & SON CONCRETE INC CONTRIBUTING EMPLOYER N/A 0 ROGNLINS INC CONTRIBUTING EMPLOYER N/A 0 ROLLING PLAINS CONSTRUCTION CONTRIBUTING EMPLOYER N/A 0 RV & ASSOCIATES CONTRIBUTING EMPLOYER N/A 0 SABEY CONSTRUCTION INC CONTRIBUTING EMPLOYER N/A 0 SAK BUILDERS INC CONTRIBUTING EMPLOYER N/A 0 SALINAS CONSTRUCTION INC CONTRIBUTING EMPLOYER N/A 0 SALINAS SAWING & SEALING CONTRIBUTING EMPLOYER N/A 0 SCAPES & CO INC CONTRIBUTING EMPLOYER N/A 0 SCARSELLA BROTHERS INC CONTRIBUTING EMPLOYER N/A 0 SCC (SHAWN CANEPA CONTRACTING) CONTRIBUTING EMPLOYER N/A 0 SCHERER TRUCKING & EXCAVATION CONTRIBUTING EMPLOYER N/A 0 SCHMITT ELECTRIC CONTRIBUTING EMPLOYER N/A 0 SCHOCK & COMPANY INC CONTRIBUTING EMPLOYER N/A 0 SCHWIESOW CONST INC CONTRIBUTING EMPLOYER N/A 0 SDB INC CONTRIBUTING EMPLOYER N/A 0 SECURE A SITE INC CONTRIBUTING EMPLOYER N/A 0 SELLEN CONSTRUCTION CO INC CONTRIBUTING EMPLOYER N/A 0 SHAMROCK PAVING INC CONTRIBUTING EMPLOYER N/A 0 SHAMROCK TRAFFIC INC CONTRIBUTING EMPLOYER N/A 0 SHIMMICK CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER N/A 0 SHORELINE CONSTRUCTION CO CONTRIBUTING EMPLOYER N/A 0 SITE DEVELOPMENT INC CONTRIBUTING EMPLOYER N/A 0 SKAAR CONSTRUCTION CONTRIBUTING EMPLOYER N/A 0 SKANSKA USA BUILDING INC CONTRIBUTING EMPLOYER N/A 0 SKANSKA USA CIVIL CA DISTRICT CONTRIBUTING EMPLOYER N/A 0 SNELSON COMPANIES INC CONTRIBUTING EMPLOYER N/A 0 SOUND EARTH WORKS INC CONTRIBUTING EMPLOYER N/A 0 SOUND EXCAVATION INC CONTRIBUTING EMPLOYER N/A 0 SPECIALIZED LANDSCAPING INC CONTRIBUTING EMPLOYER N/A 0 SPILKER MASONRY CO CONTRIBUTING EMPLOYER N/A 0 SPOKANE CONCRETE CUT INC CONTRIBUTING EMPLOYER N/A 0 SPOKANE TRAFFIC CONTROL CONTRIBUTING EMPLOYER N/A 0 SS LANDSCAPING SERVICES INC CONTRIBUTING EMPLOYER N/A 0 STACY AND WITBECK INC CONTRIBUTING EMPLOYER N/A 0 STEBBINS ENGRG CORP CONTRIBUTING EMPLOYER N/A 0 STELLAR J CORP CONTRIBUTING EMPLOYER N/A 0 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