2022-02-15T17:41:10-06:00 2021-03-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2020-04-01 811094866 LABORERS AGC TRUST OF MONTANA HEALTH AND WELFARE LABO 5093280300 111 WEST CATALDO AVENUE NO 220 SPOKANE WA 99201 RICHARD J MORRISON CHAIRMAN 5093280300 2022-02-15 1 RICHARD MORRISON 999009999 PAUL ANASTASI CPA P00395796 5093230272 2022-02-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z RICHARD J MORRISON 111 WEST CATALDO AVENUE NO 220 SPOKANE WA 99201 33241757 0 X N/A X 1961 MT PREMIUM AND BENEFIT PAYMENTS AND OTHER RELATED EXPENSES FOR MEDICAL, DENTAL, VISION, ACCIDENTAL DEATH AND DISMEMBERMENT, LIFE INSRUANCE, AND TIME LOSS BENEFITS. 6 0 12 0 0 0 0 0 12073716 10634463 522547 836293 37374 25159 12633637 11495915 0 0 9085457 9273217 0 0 0 0 0 843924 749957 9929381 10023174 2704256 1472741 16386741 19634520 1313468 1452616 15073273 18181904 PREMIUM AND BENEFIT PAYMENTS AND OTHER RELATED EXPENSES FOR MEDICAL, DENTAL, VISION, ACCIDENTAL DEATH AND DISMEMBERMENT, LIFE INSRUANCE, AND TIME LOSS BENEFITS. 0 0 10023174 TO PROVIDE QUALIFIED HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS AND THEIR DEPENDENTS. 10023174 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 0 0 1 3 0 1 12 0 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS INC 5093280300 111 WEST CATALDO AVENUE SUITE 220 SPOKANE WA 99201 KIM RICKARD UNION TRUSTEE 1.00 40.00 X 0 59669 35000 MICKEY MULHOLLAND UNION TRUSTEE 1.00 40.00 X 0 54149 35000 WARREN SMELTZER SECRETARY 1.00 40.00 X X 0 48450 22000 RICHARD J MORRISON CHAIRMAN 1.00 40.00 X X 0 0 0 NICK NEUMAN EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 JO PERKINS EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 0 162268 92000 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 111 EAST CATALDO AVENUE SUITE 220 SPOKANE WA 99201 THIRD PARTY ADMINISTRATOR 261990 PREMERA BLUE CROSS 7001 220TH STREET SOUTHWEST MOUNTLAKE TERRACE WA 98043 NETWORK ACCESS 238726 2 EMPLOYER CONTRIBUTIONS 900099 10310078 10310078 RETIREES CONTRIBUTIONS 900099 182091 182091 PARTICIPANTS CONTRIBUTION 900099 142294 142294 10634463 533297 533297 22048838 21745842 302996 302996 302996 PENALTIES AND INTEREST 900099 25159 25159 25159 11495915 10634463 0 861452 9273217 554456 17845 37477 66492 29470 32862 2492 8863 10023174 1497195 614161 459883 324582 961981 2168984 4127 4127 13407613 16476443 55942 46223 16386741 19634520 1188 469 1312280 1452147 1313468 1452616 X 0 0 0 0 15073273 18181904 15073273 18181904 16386741 19634520 X 1472741 1704709 -68819 X 0 1 X 0 0 0 CLAIMS PAYABLE 466945 CLAIMS INCURRED BUT NOT REPORTED 985202 1452147 X 13065313 1704709 -68819 1635890 11429423 66492 66492 11495915 9816815 0 9816815 66492 139867 206359 10023174 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 XI, LINE 2D - OTHER ADJUSTMENTS: MEDICARE GAP REIMBURSEMENT -68,819. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN CLAIMS PAYABLE -260,625. CHANGE IN CLAIMS IBNR 400,492. FORM 990, PART VI, SECTION A, LINE 3 DAY TO DAY TASKS WERE DELEGATED TO A THIRD PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CHAIRMAN OF THE BOARD OF TRUSTEES AND THE THIRD-PARTY ADMINISTRATOR PRIOR TO FILING. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS THAT ARE AVAILABLE TO PUBLIC WILL BE SENT UPON REQUEST. FORM 990, PART XI, LINE 9: MEDICARE GAP REIMBURSEMENT -68,819. 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