2020-07-08T18:00:10-05:00 2019-05-31 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2018-06-01 816009559 MONTANA OPERATING ENG CONST & MINING INDUSTRY HEALTH & SECURITY TRUST MONT 5095345625 111 W CATALDO NO 220 SPOKANE WA 99201 HARLEY HUESTIS TRUSTEE 4097275300 2020-07-07 1 PAUL ANASTASI P00395796 5093230272 2020-07-02 209.210.95.36 2020-07-07 16:00:35 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 2018 2020-09-23 17:36:50Z HARLEY HUESTIS 1001 RIVER DR N GREAT FALLS MT 59401 19519773 0 X N/A X 1959 MT TO PROVIDE ACCIDENT, HOSPITAL, MEDICAL, SURGICAL, DISABILITY, DENTAL, VISION, LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBEREMENT BENEFITS 7 7 0 7 0 0 0 0 12046385 14210143 237667 327687 0 0 12284052 14537830 0 0 11713462 13284746 0 0 0 0 0 760957 433924 12474419 13718670 -190367 819160 12989590 13743071 7164443 6899032 5825147 6844039 TO PROVIDE ACCIDENT, HOSPITAL, MEDICAL, SURGICAL, DISABILITY, DENTAL, VISION, LIFE INSURANCE AND ACCIDENTAL DEATH AND DISMEMBEREMENT BENEFITS 0 0 PROVIDED PARTICIPANTS WITH ACCIDENT, HOSPITAL, MEDICAL, SURGICAL, DISABILITY, DENTAL, VISION, LIFE INSURANCE AND ACCIDENTAL DEATH & DISMEMBEREMENT BENEFITS 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 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 5095345625 111 W CATALDO SUITE 220 SPOKANE WA 99201 X HARLEY HUESTIS TRUSTEE 1.00 X 0 0 0 STEVE GROSS TRUSTEE 1.00 X 0 0 0 MIKE JOHNSON TRUSTEE 1.00 X 0 0 0 JIM KEANE TRUSTEE 1.00 X 0 0 0 KEVIN MURPHY TRUSTEE 1.00 X 0 0 0 KYLE SCHELLINGER TRUSTEE 1.00 X 0 0 0 DOUG GOODHEART TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC PO BOX 5434 SPOKANE WA 98205 THIRD PARTY ADMIN. 155923 BLUE CROSS BLUE SHIELD OF MONTANA 3645 ALICE STREET HELENA MT 59604 CLAIMS ADMINISTRATOR 112028 2 EMPLOYER CONTRIBUTIONS 525100 13905928 13905928 EMPLOYEE CONTRIBUTION 525100 240660 240660 LATE CHARGES & PENALTY 525100 63555 63555 14210143 291244 291244 5018386 4981943 36443 36443 36443 14537830 14246586 0 291244 13284746 145516 23725 34982 176528 21264 9678 POSTAGE AND SHIPPING 18055 PCORI FEES 4176 13718670 803713 1106319 2730019 2330934 1131253 1353902 8324605 8951916 12989590 13743071 2144443 1837032 5020000 5062000 7164443 6899032 X 0 0 0 0 5825147 6844039 5825147 6844039 12989590 13743071 X 819160 173802 -47070 73000 X 0 1 X 1 0 0 ESTIMATED CLAIMS IBNR 620000 ESTIMATED LIABILITY FOR FUTURE BENEFITS 4442000 5062000 X 14664562 173802 173802 14490760 47070 47070 14537830 13519514 0 13519514 199156 199156 13718670 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLANS ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC), AND ACCORDINGLY, THE PLANS NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) IN FEBRUARY 1962. THE ADMINISTRATOR AND COUNSEL BELIEVE THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. THEREFORE, THEY BELIEVE THAT THE PLAN IS QUALIFIED AND THE RELATED TRUST IS TAX-EXEMPT AS OF THE FINANCIAL STATEMENT DATES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE PLANS 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 MAY 31, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 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 2D - OTHER ADJUSTMENTS: A PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN CLAIMS PAYABLE 84,156. CHANGE IN ESTIMATED CLAIMS IBNR 115,000. FORM 990, PART VI, SECTION A, LINE 3 LINE 3 EXPLANATION - THE DAY TO DAY OPERATIONS OF THE PLAN ARE MANAGED BY ZENITH AMERICAN SOLUTIONS, INC. A THIRD PARTY ADMINISTRATOR FORM 990, PART VI, SECTION B, LINE 11B LINE 11B EXPLANATION - A COPY IS SENT TO THE CHAIRMAN PRIOR TO FILING. THE RETURN IS REVIEWED, THEN PRESENTED AT THE NEXT BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY REQUIRES THE TRUST OFFICE TO DISTRIBUTE A QUESTIONNAIRE TO FIDUCIARIES OF THE PLAN IN CONJUNCTION WITH THE ANNUAL AUDIT. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST VIA MAIL OR TELEPHONE AT (509)-534-5625. FORM 990, PART XI, LINE 9: CHANGE IN ACCUMULATED ELIGIBILITY CREDITS 73,000. 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