2021-03-15T17:27:42-05:00 2020-04-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2019-05-01 237122650 SERVICE EMPLOYEES HEALTH AND WELFARE TRUST SERV 2063294900 2323 EASTLAKE AVENUE EAST SEATTLE WA 98102 SERGIO SALINAS CHAIRMAN 2064487348 2021-03-01 1 MICHAEL T MEAD CPA P01893207 4252506100 2021-03-01 2019 2022-09-23 18:48:47Z SERGIO SALINAS 3720 AIRPORT WAY S SEATTLE WA 98124 62667761 0 X N/A X 1970 WA TO PROVIDE HEALTH & WELFARE BENEFITS 8 1 0 8 0 0 0 0 36669937 42200190 440159 762784 0 24787 37110096 42987761 0 0 31159109 35873893 0 0 0 0 0 2407786 2642706 33566895 38516599 3543201 4471162 37163803 41811603 11172324 10988244 25991479 30823359 TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS ASSPECIFIED IN THE PLAN. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS AS SPECIFIED IN THE PLAN. 0 0 0 0 0 0 0 0 0 0 1 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 4 0 0 0 0 0 0 0 0 0 0 X 8 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 0 0 0 WA X NORTHWEST ADMINISTRATORS INC 2063294900 2323 EASTLAKE AVE E SEATTLE WA 98102 X X CHARLIE JONES CO-CHAIR/TRUSTEE 1.00 X X 0 0 0 SERGIO SALINAS CO-CHAIR/TRUSTEE 1.00 X X 0 0 0 JIM RAGSDALE TRUSTEE 1.00 X 0 0 0 FRED PROCKIW TRUSTEE 1.00 X 0 0 0 ELIZABETH CRANSTON TRUSTEE 1.00 X 0 0 0 GREG RAMIREZ TRUSTEE 1.00 X 0 0 0 ZENIA JAVALERA TRUSTEE 1.00 X 0 0 0 MICHAEL MENDONCA TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 PREMERA 7001 220TH ST SW SEATTLE WA 98108 CLAIMS PROCESSING 2130834 NORTHWEST ADMINISTRATORS 2323 EASTLAKE AVE E SEATTLE WA 98102 THIRD PARTY ADMINISTRATION 210550 DELTA DENTAL 400 FAIRVIEW AVE N SUITE 800 SEATTLE WA 98109 CLAIMS PROCESSING 123963 3 EMPLOYER CONTR. 900099 42158990 42158990 EMPLOYEE CONTR. 900099 41200 41200 42200190 762784 762784 19680000 19680000 0 LIQUIDATED DAMAGES 900099 24787 24787 24787 42987761 42224977 0 762784 35873893 2428767 21100 47650 42257 79200 1603 1615 9955 ACA PCORI FEES 10559 38516599 3617364 1770535 4247780 4686577 9630 17631 24922844 28955072 4366185 6381788 37163803 41811603 38720 33003 11133604 10955241 11172324 10988244 X 0 0 0 0 25991479 30823359 25991479 30823359 37163803 41811603 4471162 360718 0 X X 0 1 X 1 0 0 SHORT TERM FUNDS 6381788 F 6381788 PREMIUMS PAYABLE 503241 LAG MONTH ELIGIBILITY COVERAGE 6275000 CLAIMS INCURRED BUT NOT REPORTED 4177000 10955241 X 43306222 360718 360718 42945504 42257 42257 42987761 38652705 0 38652705 42257 -178363 -136106 38516599 PART X, LINE 2: 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 INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN PREMIUMS PAYABLE 51,637. CHANGE IN IBNR -550,000. CHANGE IN LAG MONTHS ELIGIBILITY COVERAGE 320,000. FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE PLAN ARE MANAGED BY NORTHWEST ADMINISTRATORS, INC.. THE BOARD OF TRUSTEES RETAINS ULTIMATE RESPONSIBILITY FOR THE ACTIONS OF THE PROFESSIONAL ADMINISTRATORS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES THAT ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEWED BY THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES ARE REQUIRED TO ANNUALLY PROVIDE A WRITTEN STATEMENT THAT THEY ARE NOT AWARE OF ANY CONFLICTS OF INTEREST. TRUSTEES WITH CONFLICTS OF INTEREST SHALL RECUSE THEMSELVES FROM DISCUSSIONS, VOTES, OR ATTEMPTS TO INFLUENCE THE ISSUE OR DECISION THAT IS IMPACTED. FOR A COPY OF THE CONFLICT OF INTEREST POLICY, PLEASE CONTACT PLAN MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE ON REQUEST FORM 990, PART VII, SECTION A, LINE 6: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED TAX EXEMPT ORGANIZATIONS IS REPORTED ON FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ANY ADDITIONAL INFORMATION, PLEASE CONTACT THE PLAN ADMINISTRATOR. FORM 990, PART XII, LINE 2C: THE PROCESS AND METHODS USED TO SELECT THE INDEPENDENT AUDITOR HAVE NOT CHANGED FROM PRIOR YEARS. 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