2022-11-14T18:48:07-06:00 2021-12-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2021-01-01 916065367 RETIREE'S WELFARE TRUST RETI 2063294900 2323 EASTLAKE AVE E SEATTLE WA 98102 JOE TESSIER CHAIRMAN 2063294900 2022-11-14 1 JOE TESSIER 999009999 PAUL ANASTASI CPA P00395796 5093230272 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JOE TESSIER 2323 EASTLAKE AVE E SEATTLE WA 98102 169146599 0 X N/A X 1964 WA TO PROVIDE HEALTH BENEFITS FOR RETIRED EMPLOYEES WHO MEET THE ELIGIBILITY RULES IN EFFECT WHEN THEY RETIRE AND/OR QUALIFIED MEMBERS OF THEIR FAMILY. 6 2 0 2 0 0 0 0 42056802 45186603 1280696 920296 0 0 43337498 46106899 0 0 25589274 28913083 0 0 0 0 0 3611222 3789127 29200496 32702210 14137002 13404689 97777796 113632369 4889171 5559484 92888625 108072885 TO PROVIDE HEALTH BENEFITS FOR RETIRED EMPLOYEES WHO MEET THE ELIGIBILITY RULES IN EFFECT WHEN THEY RETIRE AND/OR QUALIFIED MEMBERS OF THEIR FAMILY. 0 0 32702210 THE TRUST PROVIDES HEALTH BENEFITS FOR RETIRED PARTICIPANTS AND THEIR SPOUSES AND DEPENDENTS. 32702210 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 1297 0 1 0 0 0 0 0 0 0 0 0 X 6 2 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X NORTHWEST ADMINISTRATORS 2067263253 2323 EASTLAKE AVE E SEATTLE WA 981023305 JOE TESSIER CHAIRMAN 1.00 X X 0 0 0 BRIAN PERSON SECRETARY 1.00 40.00 X X 0 0 0 ANTHONY DECOSMO TRUSTEE 1.00 40.00 X 0 0 0 RANDY ZEILER TRUSTEE 1.00 X 0 0 0 LEONARD CROUCH TRUSTEE 1.00 40.00 X 0 118850 61000 TED BUNSTINE TRUSTEE 1.00 40.00 X 0 128044 51000 STEVEN C CHANDLER TRUSTEE (OUTGOING) 1.00 40.00 X 0 82007 49000 0 328901 161000 3 0 1 0 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVENUE E SEATTLE WA 981023393 ADMINISTRATIVE SERVICES 3056486 PREMERA BLUE CROSS 7001 220TH STREET SW MS 103 MOUNTLAKE TERRACE WA 98043 PPO NETWORK 376304 2 EMPLOYER CONTRIBUTIONS 900099 27428168 27428168 RETIREE SELF-PAYMENTS 900099 17758435 17758435 45186603 913123 913123 123046873 123039700 7173 7173 7173 46106899 45186603 0 920296 28913083 2908400 23209 45355 180227 565666 50011 15159 OTHER ADMINISTRATIVE EX 1100 32702210 8744350 12408284 2308120 3326382 12388 13415 86712938 97884288 97777796 113632369 649171 829484 1460000 1490000 2780000 3240000 4889171 5559484 X 0 0 0 0 92888625 108072885 92888625 108072885 97777796 113632369 13404689 1779571 0 X 0 1 X 0 0 0 CLAIMS INCURRED BUT NOT REPORTED 3240000 3240000 X 47706243 1779571 1779571 45926672 180227 180227 46106899 31994725 0 31994725 180227 527258 707485 32702210 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 DATE. 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 DECEMBER 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 CLAIMS PAYABLE 67,258. CHANGE IN CLAIMS IBNR 460,000. 0 0 0 LEONARD CROUCH TRUSTEE 0 118850 0 0 0 0 0 24000 0 37000 0 179850 0 0 TED BUNSTINE TRUSTEE 0 128044 0 0 0 0 0 27000 0 24000 0 179044 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS SELECTED A PROFESSIONAL THIRD PARTY ADMINISTRATOR TO RUN THE DAY TO DAY OPERATIONS OF THE TRUST. THE BOARD OF TRUSTEES RETAINS ULTIMATE RESPONSIBILITY FOR THE ACTIONS OF THE THIRD PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED AND APPROVED BY THE SIGNING TRUSTEE AND THIRD-PARTY ADMINISTRATOR BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C MANAGEMENT MONITORS POLICY FOR CONFLICTS OF INTEREST BY REVIEWING ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC MAY EXAMINE WITHOUT CHARGE AT THE PLAN ADMINISTRATOR'S OFFICE AND AT UNION HALLS ALL PLAN DOCUMENTS INCLUDING INSURANCE CONTRACTS, COLLECTIVE BARGAINING AGREEMENTS, AND COPIES OF ALL DOCUMENTS FILED WITH THE U.S. DEPARTMENT OF LABOR, SUCH AS ANNUAL REPORTS AND PLAN DESCRIPTION. PUBLIC MAY OBTAIN COPIES OF ALL PLAN DOCUMENTS AND OTHER PLAN INFORMATION UPON A WRITTEN REQUEST TO THE PLAN ADMINISTRATOR. THE ADMINISTRATOR MAY MAKE A REASONABLE CHARGE FOR THE COPIES. PUBLIC MAY RECEIVE A SUMMARY OF THE PLAN'S ANNUAL FINANCIAL REPORT. THE PLAN ADMINISTRATOR IS REQUIRED BY LAW TO FURNISH EACH PARTICIPANT WITH A COPY OF THIS SUMMARY FINANCIAL REPORT. 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