2021-04-23T19:48:59-05:00 2020-06-30 MILLER KAPLAN ARASE LLP 600 STEWART ST STE 618 SEATTLE WA 981011261 990 2019-07-01 916037488 Internatioanl Brotherhood EW Local 191 % TONYA OSBORNE INTE 2065963930 11724 NE 195TH ST STE 300 BOTHELL WA 98011 CINDY AUSTIN TRUSTEE 2065963930 2021-04-01 true Catalina Kirby P02018896 2065963930 2019 2022-09-23 18:48:47Z X DAVE GINESTRA 11724 NE 195TH ST STE 300 BOTHELL WA 98011 81562667 false X N/A X See Schedule O 6 6 0 0 0 0 0 0 33323328 34065101 1520978 2243252 0 0 34844306 36308353 0 0 31200238 29086202 0 0 0 0 0 853194 736116 32053432 29822318 2790874 6486035 64463855 70726129 22030945 21445718 42432910 49280411 SEE SCHEDULE O false false See Schedule O false false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 3 0 true 0 false false false false false false false false X 6 6 false false false false false false false true false false false true true true true true true false X TONYA OSBORNE 2065963930 11724 NE 195TH ST STE 300 BOTHELL WA 98011 TIM SILSBEE TRUSTEE 1.0 0.0 X X 0 0 0 Cindy Austin TRUSTEE 1.0 0.0 X 0 0 0 JOE LORENZO TRUSTEE 1.0 0.0 X 0 0 0 Dave Ginestra TRUSTEE 1.0 0.0 X X 0 0 0 DAMIEN FISHER TRUSTEE 1.0 0.0 X 0 0 0 DAVE MILNE TRUSTEE 1.0 0.0 X 0 0 0 0 0 0 0 false false false REGENCE BLUESHIELD PO BOX 1271 M/5 ELLA PORTLAND OR 97027 PPO PROVIDER 1361092 BENESYS INC 18300 CASCADE AVE S STE 141 TUKWILA WA 98188 CONTRACT ADMIN 246684 2 0 EMPLOYER CONTRIBUTIONS 900099 33697309 33697309 0 0 PARTICIPANT CONTRIBUTIONS 900099 367792 367792 0 0 34065101 1859253 0 0 1859253 0 0 0 0 0 45638313 45254314 383999 383999 0 0 383999 0 0 0 0 0 0 0 0 0 0 36308353 34065101 0 2243252 0 0 0 29086202 0 0 0 0 0 0 246684 69120 98003 0 0 121077 42400 0 103462 26504 0 0 0 0 10267 0 0 0 10637 ACA FEES 7962 29822318 7254515 6325386 0 0 0 0 3552047 2582903 0 0 0 0 0 0 0 0 0 0 0 0 53657293 61817840 0 0 0 0 0 0 0 0 64463855 70726129 889198 465760 0 0 51747 56958 0 0 0 0 0 0 0 0 0 0 21090000 20923000 22030945 21445718 X 0 0 0 0 42432910 49280411 42432910 49280411 64463855 70726129 6486035 361466 X false true X true 0 BENEFIT CLAIMS PAYABLE 20923000 20923000 X 36669819 361466 361466 36308353 36308353 29989318 29989318 -167000 -167000 29822318 Part XII Line 4b Change in Benefit obligations - -$167,000 Part 1, Line 1 and Part III, Line 1 and 4a To provide qualified health and welfare benefits to employees and their dependents pursuant to collective bargaining agreements between various employers and the Union Local 191 of the International Brotherhood of Electrical Workers. Part VI, Line 11b The Form 990 was reviewed by Plan Administration prior to filing. Any unusual items or items needed to be addressed were brought to the Trustees' attention. Part VI, Line 12c Trustees are required to complete an annual conflict of interest questionnaire, which are reviewed at Trustee meetings. Any conflicts or potential conflicts are addressed by the Board as deemed necessary. Part VI, Line 19 The Plan Document, Conflict of Interest Policy, and Financial Statements are maintained in the Plan's Administration Office and are available upon request. Part VII, Section A Trustee compensation and benefits from related tax-exempt organizations are properly reported and available on those organizations' tax filings. See Part VII See Part VII See Part VII false false false false false false false false false false false false false false false false false false false Schedule R - Identification of Related-Party Transactions This information is not maintained by the Administrative Office. If specific information is needed, please contact the Administrative Office.