2019-01-21T11:51:51-06:00 2018-03-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY SUITE 400 SAN RAMON CA 945834210 990 2017-04-01 911950259 SOUND HEALTH & WELLNESS RETIREE TRUST SOUN 2062824100 11724 NE 195TH STREET NO 300 BOTHELL WA 98011 SCOTT KLITZKE POWERS CHAIRMAN 4258289202 2019-01-21 1 TODD M STOKES P01451940 9252779100 66.7.226.66 2019-01-21 09:51:41 PS P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2017 2019-02-21 02:37:17Z X SCOTT KLITZKE POWERS 11724 NE 195TH STREET NO 300 BOTHELL WA 98011 4063235 0 X WWW.SOUNDHEALTHWELLNESS.COM X 1998 WA TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS 10 0 0 0 0 0 0 0 3651343 3972219 759714 72705 11554 18311 4422611 4063235 0 0 5236516 4897473 0 0 0 0 0 543774 594253 5780290 5491726 -1357679 -1428491 7431244 5863006 1644624 1526638 5786620 4336368 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE RETIREES 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 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 STREET SUITE 300 BOTHWELL WA 98011 X SCOTT KLITZKE POWERS CHAIRMAN 1.00 X 0 0 0 BRENT R BOHN TRUSTEE 1.00 X 0 0 0 JAMES CROWE TRUSTEE 1.00 X 0 104390 0 FRANK JORGENSEN TRUSTEE 1.00 X 0 0 0 TODD CROSBY TRUSTEE 1.00 X 0 154600 14810 EMILIA CONTRERAS TRUSTEE 1.00 X 0 104410 14810 SEAN HAMMOND TRUSTEE 1.00 X 0 0 0 FAYE GUENTHER SECRETARY 1.00 X 0 128480 14810 YVONNE PETERS TRUSTEE 1.00 X 0 0 0 JOE MIZRAHI TRUSTEE 1.00 X 0 104330 0 JAMES TO TRUSTEE - PAST 1.00 X 0 86904 0 0 683114 44430 0 0 1 0 AETNA 600 UNIVERSITY STREET SUITE 920 SEATTLE WA 98101 ADMINISTRATION 167623 ZENITH AMERICAN SOLUTIONS INC 11724 NE 195TH STREET SUITE 300 BOTHELL WA 980113145 ADMINISTRATION 139588 2 RETIREE SELF PAY CONTR 900099 2547240 2547240 EMPLOYER CONTRIBUTIONS 900099 1424979 1424979 3972219 72705 72705 PRESCRIPTION REBATE IN 900099 18311 18311 18311 4063235 3990530 0 72705 4897473 123651 70690 10900 25553 332872 7491 3984 17636 PCORI TAX 1476 5491726 2926611 1468321 198546 110233 19134 19260 4286953 4265192 7431244 5863006 26578 75508 218600 207315 1399446 1243815 1644624 1526638 X 0 0 0 0 5786620 4336368 5786620 4336368 7431244 5863006 -1428491 -21761 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE & IBNR 1243579 PREMIUMS PAYABLE 236 1243815 X 4015921 -21761 -21761 4037682 25553 25553 4063235 5621804 0 5621804 25553 -155631 -130078 5491726 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 2015. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 0 0 0 TODD CROSBY TRUSTEE 0 0 0 0 0 154600 0 0 0 14810 0 169410 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH ZENITH AMERICAN SOLUTIONS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR 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 DECISIONS MADE IN RELATION TO HIS OR HER CAPACITY AS A TRUSTEE OR SERVICE PROVIDER TO THE TRUST. DISCLOSURE OF POSSIBLE CONFLICTS OF INTEREST ARE MADE TO EITHER THE SECRETARY OR THE CHAIR 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 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 HAS RESPONSIBILITY 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 HEALTH & WELLNESS TRUST 11724 NE 195TH STREET SUITE 300 BOTHELL WA 980113145 916058475 ACTIVE EMPLOYEES WELFARE BENEFITS WA 501(C) 9 N/A N/A 0 SOUND RETIREMENT TRUST 11724 NE 195TH STREET SUITE 300 BOTHELL WA 980113145 916069306 RETIREMENT BENEFITS WA 501(A) N/A N/A 0 UFCW LOCAL UNION 367 6403 LAKEWOOD DRIVE TACOMA WA 984673331 910383680 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 UFCW LOCAL UNION 1439 1719 NORTH ATLANTIC STREET SPOKANE WA 992050298 910487097 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 UFCW LOCAL UNION 21 5030 FIRST AVENUE SOUTHSTE 200 SEATTLE WA 98134 203286319 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 GENERAL TEAMSTERS LOCAL UNION 38 2601 EVERETT AVENUE EVERETT WA 98201 910267959 SPONSORING LOCAL 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, INDENTIFICATION OF RELATED ORGANIZATIONS THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH & WELFARE BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS. AS OF MARCH 31, 2018 THERE ARE APPROXIMATELY 80 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 AVENUE DENTAL CARE 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 BRIDLE TRAILS RED APPLE MKT THE DENNIS CO DON & JOES MEATS BYRNIE UTZ MEN'S HAT STORE ELMA & RAYMOND THRIFTWAYS FORKS OUTFITTERS FRANCO THE TAILOR, INC GORDONS SELECT GROCERY HARBOR DRUG INC HARRISON MEDICAL CENTER ILWU LOCAL #23 JEFFERSON COUNTY JEFFERSON HEALTHCARE J SPRINGER DBA KEN'S CORNER KC FOODS PUGET SOUND LABOR AGENCY KROGER DBA FRED MEYER KROGER DBA QFC LABORER'S INTERNATIONAL #252 ABERDEEN HEALTH MART METROPOLITAN MARKETS N MASON SCHOOL DIST #403 OMAK PHARMACY BIMBO BAKERIES USA ALPINE DENTAL CARE PAYLESS FOODS BALLINGER THRIFTWAY PICK-RITE INC PIERCE CTY CENTRAL LABOR COUNC POULSBO RED APPLE PRAIRIE CENTER RED APPLE MKT RALPH'S RED APPLE REWARDS DENTAL ROSE & ASSOCIATES, LLC SAAR'S INC RAYMOND PHARMACY SEQUIM SCHOOL DIST #323 SAFEWAY STORES INC SHOP-N-KART SOUTH BEND PHARMACY SOINES DBA RED WING SHOE STORE DBA MARTIN'S SOUTHGATE DRUG SPANAWAY WATER CO. INC STADIUM THRIFTWAY STERLING DENTAL CARE STORMAN'S SUNRISE DENTAL SWAIN'S INC SWANSON'S FOOD PIONEER SELECT MARKET TACOMA LONGSHOREMEN CR UNION HAGGEN INC TOWN & COUNTRY UFCW LOCAL #21 UFCW LOCAL 367 UNIFIED GROCERS INC UNITED WAY OF SKAGIT CO FRANZ FAMILY BAKERIES UWAJIMAYA INC THE VALU DRUG CO ISLAND MKT CO DBA VASHON THRWY VASHON MARKET FRESH IGA ZENITH AMERICAN SOLUTIONS