2020-01-24T16:15:22-06:00 2019-03-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2018-04-01 916058475 SOUND HEALTH & WELLNESS TRUST SOUN 2062824100 11724 NE 195TH ST NO 300 BOTHELL WA 980113145 SCOTT KLITZKE POWERS CHAIRMAN 4258289202 2020-01-24 1 TODD M STOKES P01451940 9252779100 66.7.226.66 2020-01-24 14:15:08 PS P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2018 2020-09-23 17:36:50Z SCOTT KLITZKE POWERS 11724 NE 195TH ST NO 300 BOTHELL WA 980113145 337684812 0 X WWW.SOUNDHEALTHWELLNESS.COM X 1957 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 10 0 0 0 0 0 0 0 294208350 298090760 2790933 8207327 0 0 296999283 306298087 0 0 247586469 249046537 0 0 0 0 0 24555616 24681269 272142085 273727806 24857198 32570281 257806616 290642174 87597936 76371868 170208680 214270306 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 0 0 1 0 0 0 0 0 0 0 0 0 X 10 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X ZENITH AMERICAN SOLUTIONS INC 2062824100 11724 NE 195TH ST SUITE 300 BOTHELL WA 980113145 X SCOTT KLITZKE POWERS TRUSTEE/CHAIRMAN 1.20 X 0 0 0 BRENT R BOHN TRUSTEE 1.20 X 0 0 0 JAMES CROWE TRUSTEE 1.20 X 0 109365 18575 FRANK JORGENSEN TRUSTEE 1.20 X 0 0 0 TODD CROSBY TRUSTEE - PAST 1.20 X 0 156182 16739 EMILIA CONTRERAS TRUSTEE 1.20 X 0 111744 16739 JOE MIZRAHI TRUSTEE 1.20 X 0 111509 16739 FAYE GUENTHER TRUSTEE/SECRETARY 1.20 X 0 143613 16739 YVONNE PETERS TRUSTEE 1.20 X 0 0 0 SEAN HAMMOND TRUSTEE 1.20 X 0 0 0 SARAH CHERIN TRUSTEE 1.20 X 0 111537 16739 0 743950 102270 0 0 1 0 KAISER FOUNDATION HEALTH PLAN OF WA 320 WESTLAKE AVENUE NORTH STE 100 SEATTLE WA 98109 HMO ADMINISTRATION 11715087 ZENITH AMERICAN SOLUTIONS INC 11724 NE 195TH ST SUITE 300 BOTHELL WA 980113145 ADMINISTRATION 6744366 AETNA 601 UNION STREET STE 810 SEATTLE WA 98101 ADMINISTRATION 4227464 WASHINGTON DENTAL SERVICE 9706 FOURTH AVENUE NE SEATTLE WA 98115 DENTAL ADMINISTRATION 1886244 STAYWELL HEALTH MANAGMENT 3000 AMES CROSSING ROAD STE 100 SAINT PAUL MN 55121 PHARMACY BENEFIT ADMINISTRATION 520882 15 EMPLOYER CONTRIBUTIONS 900099 277277235 277277235 PARTICIPANT CONTRIBUTIONS 900099 16581227 16581227 PRESCRIPTION REBATES 900099 4232298 4232298 298090760 4294239 4294239 35299813 31386725 3913088 3913088 3913088 306298087 298090760 0 8207327 249046537 5626375 520664 129060 63614 17257218 860484 28564 69316 PCORI TAX 96077 NEWSLETTER EXPENSE 29897 273727806 75628778 106428842 27391358 25741606 666960 126569 137122016 148698976 16997504 9646181 257806616 290642174 393190 527210 87204746 75844658 87597936 76371868 X 0 0 0 0 170208680 214270306 170208680 214270306 257806616 290642174 32570281 -2380545 13871890 0 X X 0 1 X 1 0 0 IBNR AND ESTIMATED CLAIMS PAYABLE 31837658 ACCUMULATED ELIGIBILITY CREDITS 44007000 75844658 X 303853928 -2380545 -2380545 306234473 63614 63614 306298087 271152390 -13871890 -13871890 285024280 63614 -11360088 -11296474 273727806 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 TO RECOGNIZE A TAX ASSET OR LIABILITY 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. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2016. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 0 0 0 TODD CROSBY TRUSTEE - PAST 0 0 0 0 0 156182 0 0 0 16739 0 172921 0 0 FAYE GUENTHER TRUSTEE/SECRETARY 0 0 0 0 0 143613 0 0 0 16739 0 160352 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH ZENITH AMERICAN SOLUTIONS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B IN ADDITION TO PROVIDING A COMPLETE COPY OF THIS FORM 990 TO ALL OF THE TRUSTEES OF THE TRUST, THE FORM 990 IS REVIEWED BY THE EXECUTIVE COMMITTEE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT-OF-INTEREST POLICY PERTAINS TO ALL TRUSTEES AND SERVICE PROVIDERS WHO CAN INFLUENCE THE ACTIONS OF THE TRUST. A CONFLICT OF INTEREST INCLUDES AN INTEREST, DIRECT OR INDIRECT, OF A TRUSTEE OR SERVICE PROVIDER TO A TRUST, WHICH MAY RESULT IN THE TRUSTEE OR SERVICE PROVIDER BENEFITING FINANCIALLY FROM A DECISION MADE IN RELATION TO HIS OR HER CAPACITY AS A TRUSTEE OR SERVICE PROVIDER TO THE TRUST. DISCLOSURES OF POSSIBLE CONFLICTS OF INTEREST ARE MADE TO EITHER THE SECRETARY OR THE CHAIRMAN OF THE TRUST. THE TRUSTEES DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE DECISION OF THE TRUSTEES, IN RELATION TO A CONFLICT OF INTEREST, IS BINDING AND FINAL. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION REPORTED ON PART VII, SECTION A REPRESENTS COMPENSATION PAID TO THOSE TRUSTEES EMPLOYED BY A LABOR UNION, A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE RELATED TAX-EXEMPT ORGANIZATIONS' FORM 990, FILED WITH THE INTERNAL REVENUE SERVICE. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE TRUST'S THIRD-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES HAVE RESPONSIBILTY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FORM 990, PART V, LINE 1A THE TRUST DOES NOT ISSUE FORMS 1099 DIRECTLY TO REPORTABLE SERVICE PROVIDERS. RATHER, THE CONTRACT ADMINISTRATOR USES THEIR EMPLOYER IDENTIFICATION NUMBER FOR THE FORMS 1099 ISSUED ON BEHALF OF THE TRUST. SOUND RETIREMENT TRUST 11724 NE 195TH STREET SUITE 300 BOTHELL WA 98011 916069306 TO PROVIDE PENSION BENEFITS WA 501(A) N/A N/A 0 SOUND HEALTH & WELLNESS RETIREE TRUST 11724 NE 195TH STREET SUITE 300 BOTHELL WA 98011 911950259 TO PROVIDE RETIREE HEALTH AND WELFARE BENEFITS WA 501(C) 9 N/A N/A 0 UFCW LOCAL UNION 367 6403 LAKEWOOD DRIVE WEST TACOMA WA 98467 910383680 LOCAL UNION WA 501(C) 5 N/A N/A 0 UFCW LOCAL UNION 1439 1719 NORTH ATLANTIC STREET SPOKANE WA 99205 910487097 LOCAL UNION WA 501(C) 5 N/A N/A 0 UFCW LOCAL UNION 21 5030 FIRST AVENUE SOUTH STE 200 SEATTLE WA 98134 203286319 LOCAL UNION WA 501(C) 5 N/A N/A 0 GENERAL TEAMSTERS LOCAL UNION 38 2601 EVERETT AVENUE EVERETT WA 98201 910267959 LOCAL UNION WA 501(C) 5 N/A N/A 0 ALLIED EMPLOYERS INC 4030 LAKE WASHINGTON BLVD NE STE 20 KIRKLAND WA 98033 910698183 SPONSORING ASSOCIATION WA 501(C) 6 N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF MARCH 31, 2019 THERE ARE APPROXIMATELY 98 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES, AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. ABERDEEN OFFICE EQUIPMENT AFFORDABLE DENTAL CARE BURIEN CLINIC AFFORDABLE ALBERTSON'S COMPANIES ALLIED EMPLOYERS, INC. AHMR, INC ASHLEY HOUSE AVENUE DENTAL CARE BALLARD PLAZA PHARMACY BARTELL DRUG CO BAVARIAN MEAT PRODUCTS BERTS RED APPLE MARKET BLUHER'S DBA FARMHOUSE MKT BORNSTEIN SEAFOOD INC THE MARKETS LLC CAMANO PLAZA MARKET CAP FOODS DBA WEST SEA THFTWY CITY CENTER DRUG CLAUS MEAT MARKET CROWN DRUG COMPANY CORNELL'S VALLEY RX & HOMECARE DON & JOES MEATS DEL TEET FURNITURE BYRNIE UTZ MEN'S HAT STORE EB MANAGEMENT COMPANY EKMAN & THULIN P.S. ELMA & RAYMOND THRIFTWAYS FORKS OUTFITTERS FRANCO THE TAILOR, INC KROGER DBA FRED MEYER GORDONS SELECT GROCERY HARBOR DRUG INC HARBORS HOME HEALTH/HOSPICE HARRISON MEDICAL CENTER HUDSON GROUP ILWU LOCAL #23 JEFFERSON COUNTY JEFFERSON HEALTHCARE JEFFERSON FAMILY PHARMACY KEN'S CORNER RED APPLE KATTERMAN'S SAND POINT PHARM KC FOODS PUGET SOUND LABOR AGENCY KENT VALLEY OPTICAL KROGER DBA FRED MEYER KROGER DBA QFC LABORER'S INTERNATIONAL #252 SANDPOINT CLINIC PHARMACY ABERDEEN HEALTH MART METROPOLITAN MARKETS MID-VALLEY HOSPITAL N MASON SCHOOL DIST #403 NW ADMINISTRATORS OMAK PHARMACY BIMBO BAKERIES USA OSTROM'S DRUG & GIFT ALPINE DENTAL CARE PAYLESS FOODS BALLINGER THRIFTWAY PICK-RITE INC PIERCE CTY CENTRAL LABOR COUNC POULSBO RED APPLE PRAIRIE CENTER RED APPLE MKT KROGER DBA QFC RALPH'S RED APPLE REWARDS DENTAL ROSE & ASSOCIATES, LLC SAAR'S INC RAYMOND PHARMACY SEQUIM SCHOOL DIST #323 SAFEWAY STORES INC SOUTH BEND PHARMACY SOINES DBA RED WING SHOE STORE SOUTHGATE DRUG COMPANY SPANAWAY WATER CO. INC STADIUM THRIFTWAY STERLING DENTAL CARE ST JOSEPH'S MEDICAL CENTER STORMAN'S SUNRISE DENTAL SWAIN'S GENERAL STORE SWANSON'S FOOD PIONEER SELECT MARKET TACOMA LONGSHOREMEN CR UNION HAGGEN INC TOWN & COUNTRY UFCW LOCAL #21 UFCW LOCAL 367 SUPERVALU MEAT WAREHOUSE UNITED WAY OF SKAGIT CO FRANZ FAMILY BAKERIES UWAJIMAYA INC THE VALU DRUG CO ISLAND MKT CO DBA VASHON THRWY VASHON MARKET FRESH IGA WEISFIELD/STERLING INC WOODSIDE/BRASETH GALLERY ZENITH AMERICAN SOLUTIONS