2021-11-09T18:18:27-06:00 2020-12-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2020-01-01 916065367 RETIREE'S WELFARE TRUST RETI 2063294900 2323 EASTLAKE AVE E SEATTLE WA 98102 JOE TESSIER CHAIRMAN 2063294900 2021-11-02 1 JOE TESSIER 999009999 PAUL ANASTASI CPA P00395796 5093230272 2021-11-02 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JOE TESSIER 2323 EASTLAKE AVE E SEATTLE WA 98102 172232369 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 41110946 42056802 1359326 1280696 0 0 42470272 43337498 0 0 26994923 25589274 0 0 0 0 0 3514288 3611222 30509211 29200496 11961061 14137002 80896989 97777796 4772131 4889171 76124858 92888625 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 29200496 THE TRUST PROVIDES HEALTH BENEFITS FOR RETIRED PARTICIPANTS AND THEIR SPOUSES AND DEPENDENTS. 29200496 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 1212 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 X 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 STEVEN C CHANDLER TRUSTEE 1.00 40.00 X 0 105974 47000 TED BUNSTINE TRUSTEE 1.00 40.00 X 0 118020 49000 0 223994 96000 0 0 1 0 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVENUE E SEATTLE WA 981023393 ADMINISTRATIVE SERVICES 2982015 PREMERA BLUE CROSS 7001 220TH STREET SW MS 103 MOUNTLAKE TERRACE WA 98043 PPO NETWORK 352538 2 EMPLOYER CONTRIBUTIONS 900099 24322310 24322310 RETIREE SELF-PAYMENTS 900099 17734492 17734492 42056802 1273441 1273441 128902126 128894871 7255 7255 7255 43337498 42056802 0 1280696 25589274 25589274 2843121 2843121 13085 13085 55056 55056 160653 160653 498668 498668 23919 23919 1063 1063 14592 14592 OTHER ADMINISTRATIVE EX 1065 1065 29200496 29200496 0 0 8152765 8744350 2266991 2308120 12307 12388 70464926 86712938 80896989 97777796 572131 649171 1550000 1460000 2650000 2780000 4772131 4889171 X 0 0 0 0 76124858 92888625 76124858 92888625 80896989 97777796 14137002 2626765 0 X 0 1 X 0 0 0 CLAIMS INCURRED BUT NOT REPORTED 2780000 2780000 X 45803610 2626765 2626765 43176845 160653 160653 43337498 28808087 0 28808087 160653 231756 392409 29200496 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, 2020, 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 101,756. CHANGE IN AMOUNTS DUE TO INSURANCE COMPANY CHANGE IN CLAIMS IBNR 130,000. 0 0 0 TED BUNSTINE TRUSTEE 0 118020 0 0 0 0 0 26000 0 23000 0 167020 0 0 STEVEN C CHANDLER TRUSTEE 0 105974 0 0 0 0 0 24000 0 23000 0 152974 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. FORM 990, PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. CERTAIN TRUSTEES ARE EMPLOYED BY FOR-PROFIT CONTRIBUTING EMPLOYERS, WHICH ARE DEFINED AS RELATED PARTIES IN THE INSTRUCTIONS TO SCHEDULE R. PER THE VOLUNTEER EXCEPTION IN THE INSTRUCTIONS TO FORM 990, THIS COMPENSATION IS NOT REPORTABLE IN PART VII OF FORM 990 AS RELATED-ORGANIZATION COMPENSATION. 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