2022-05-16T17:11:06-05:00 2021-06-30 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2020-07-01 916068079 NORTHWEST IRONWORKERS HEALTH AND SECURITY PLAN NORT 2064417574 7525 SE 24TH STREET SUITE 200 MERCER ISLAND WA 98040 JEFF ILENSTINE CHAIRMAN 2064417574 2022-05-16 1 JEFF ILENSTINE 999009999 PAUL ANASTASI CPA P00395796 5093230272 2022-05-16 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z 7525 SE 24TH STREET SUITE 200 MERCER ISLAND WA 98040 152104183 0 X N/A X 1966 WA HEALTH BENEFITS FOR PARTICIPANTS. 16 8 50 0 0 0 0 0 50762973 55286237 1088343 1313249 193709 82723 52045025 56682209 0 0 42918298 57243170 0 0 0 0 0 3411145 3628846 46329443 60872016 5715582 -4189807 55581290 63843277 31155834 54888006 24425456 8955271 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE PLAN. 0 0 60872016 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE PLAN. 60872016 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 1 0 1 1507 0 1 50 1 0 0 0 0 0 0 0 0 X 16 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 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 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 1.00 X 0 0 0 RODNEY G SPRINKLE TRUSTEE 1.00 X 0 0 0 KEVIN KOESTER TRUSTEE JOINED 3/2020 1.00 X 0 0 0 JOE BOWERS TRUSTEE DEPARTED 3/2020 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 1215639 PREMERA BLUECROSS 7001 220ST SOUTHWEST BUILDING 1 MOUNTLAKE TERRACE WA 98043 CLAIMS PROCESSING 950528 INNOVATIVE CARE MANAGEMENT INC 15 82ND DRIVE SUITE 180 GLADSTONE OR 97027 MEDICAL MANAGEMENT 272046 ENVISION PHARMACEUTICAL SERVICES 2181 EAST AURORA ROAD TWINSBURG OH 44087 CLAIMS PROCESSING 154800 RAEL & LETSON 999 3RD AVENUE SUITE 1530 SEATTLE WA 98104 ACTUARY 149070 5 EMPLOYER CONTRIBUTIONS 525100 50108002 50108002 PARTICIPANT CONTRIBUTIONS 525100 5056716 5056716 DRUG TEST REIMBURSEMENTS 525100 121519 121519 55286237 893466 893466 95841757 95421974 419783 419783 419783 REFUNDS 900099 46061 46061 LIQUIDATED DAMAGES 900099 29595 29595 INCOME FROM DORMANT ACCOUNTS 900099 7067 7067 82723 56682209 56262426 0 419783 57243170 985967 44345 33459 87827 2023164 145158 18249 DRUG TEST PROGRAM 214551 EMPLOYEE ASSISTANCE PRO 47193 PCORI TAX 18720 EMPLOYER WITHDRAWAL LIA 10213 60872016 4213864 4564823 3350158 2859600 6043953 5577054 23969 20948 41949346 50820852 55581290 63843277 1506238 2329242 29649596 52558764 31155834 54888006 X 0 0 0 0 24425456 8955271 24425456 8955271 55581290 63843277 X -4189807 2756622 -14037000 X 0 1 X 0 0 0 AMOUNTS DUE INSURANCE COMPANIES 639284 HEALTH REIMBURSEMENT ACCOUNTS (HRA) LIABILITY 5044860 CLAIMS INCURRED BUT NOT REPORTE4D 12139000 LAG MONTHS ELIGIBILITY COVERAGE 10085000 ACCUMULATED ELIGIBIILITY CREDITS 24474000 EMPLOYER WITHDRAWAL LIABILITY 176620 52558764 X 59351004 2756622 2756622 56594382 87827 87827 56682209 51912068 0 51912068 87827 8872121 8959948 60872016 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, 2021, 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 73,229. CHANGE IN CLAIMS INCURRED BUT NOT REPORTED 6,290,000. CHANGE IN HRA LIABILITY 2,508,892. 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 VII, SECTION A, LINE 1: TRUSTEES ARE NOT COMPENSATED BY THE HEALTH TRUST. COMPENSATION PAID TO CERTAIN TRUSTEES BY THE RELATED TRAINING TRUST IS REPORTED ON THAT TRUST'S FORM 990 FILED WITH THE IRS, AND COMPENSATION PAID TO CERTAIN TRUSTEES BY RELATED UNIONS IS REPORTED ON THOSE UNIONS' FORMS 990 FILED WITH THE IRS AND FORMS LM-2 FILED WITH OLMS. FORMS 990 ARE AVAILABLE PUBLICLY AT WWW.GUIDESTAR.ORG, AND FORMS LM2 ARE AVAILABLE PUBLICLY AT HTTPS://WWW.DOL.GOV/AGENCIES/OLMS/PUBLIC-DISCLOSURE-ROOM. FORM 990, PART XI, LINE 9: CHANGE IN LAG MONTHS ELIGIBILITY COVERAGE -2,543,000. CHANGE IN ACCUMULATED ELIGIBILITY CREDITS -11,494,000. 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