2019-05-14T19:18:23-05:00 2018-06-30 910614823 SCHOEDEL & SCHOEDEL CPAS PLLC 422 W RIVERSIDE AVE STE 1420 SPOKANE WA 992010395 990 2017-07-01 201842198 SEIU Healthcare NW Health Benefits Trust SEIU 8663713200 215 Columbia Street No 300 Seattle WA 98104 Richard Leigh 775NW General Counsel 2062577157 2019-05-14 1 SCOTT OPPERUD CPA P00542597 5097472158 2019-05-07 207.114.231.3 2019-05-14 17:18:11 PD P 27B4D77D99AA8CF831BCDC28DA5A4554726DA7CC BB2AC30269F7780B330423FB8C0571A23705F2F4 2017 2019-02-21 02:37:17Z Abby Solomon 215 Columbia Street No 300 Seattle WA 98104 239391455 0 X www.myseiubenefits.org X 2004 WA The Trust was established as a result of collective bargaining between the Service Employees International Union, Local 775 (SEIU 775) and various employers or employer representatives signatory thereto to provide health, vision and dental benefits covering qualified employees reported under the collective bargaining agreements. 12 12 0 0 0 0 0 0 203206981 235214049 295758 3769996 30780 407410 203533519 239391455 0 0 143743328 167558616 0 0 0 0 0 18587123 23480649 162330451 191039265 41203068 48352190 158175833 206933030 16434260 20065607 141741573 186867423 The Trust provides health and welfare benefits pursuant to collective bargaining agreements between various employers and the Trust. 0 0 The Trust was established as a result of collective bargaining between SEIU 775 and various employers or employer representatives signatory thereto to provide health, vision and dental benefits covering qualified employees reported under the collective bargaining agreements. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 18 0 1 0 0 0 0 0 0 0 X 12 12 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Clark Nuber PS 4254544919 10900 NE 4th St 1700 Bellevue WA 98004 X Sterling Harders Labor Trustee 1.00 X X 0 0 0 Bill Moss Employer Trustee 1.00 X X 0 0 0 Mark Robinson Employer Trustee 1.00 X X 0 0 0 David Rolf Labor Trustee 1.00 X 0 0 0 Memo Rivera Labor Trustee 1.00 X 0 0 0 Eric Erickson Employer Trustee 1.00 X 0 0 0 Adam Glickman Labor Trustee 1.00 X 0 0 0 Diane Lutz Employer Trustee 1.00 X 0 0 0 Shaine Truscott Labor Trustee 1.00 X 0 0 0 Monique Taylor Swan Labor Trustee 1.00 X 0 0 0 Preston Cody Employer Trustee 1.00 X 0 0 0 Steven Hill Employer Trustee 1.00 X 0 0 0 Abby Solomon Executive Director 10.00 30.00 X 0 79533 33682 Charissa Raynor Executive Director 10.00 30.00 X 0 175827 47132 0 255360 80814 0 0 1 0 SEIU Training Partnership 215 Columbia Street Seattle WA 98104 Plan administration 6318960 Kaiser of Washington 601 Union St Suite 3100 Seattle WA 98101 Claims Adjudication 6026768 Kaiser of Washington Options Inc 601 Union St Suite 3100 Seattle WA 98101 Claims Adjudication 5175938 Zenith American Solutions 11724 NE 195th Street Suite 300 Bothell WA 98011 Contract administrator 1133218 Delta Dental of Washington 9706 Fourth Avenue NE Seattle WA 981152157 Dental claims administrator 454685 5 Employer contributions 525100 229555331 229555331 Participant contributions 525100 5658718 5658718 235214049 3769996 3769996 Other Income 525100 407410 407410 407410 239391455 235621459 0 3769996 167558616 7368649 54128 410041 30000 13521434 464103 93375 187361 92303 16947 1242308 191039265 991100 1051044 112594181 31491340 22086364 23093438 0 28329 22497750 150883318 6438 385561 158175833 206933030 1845354 1772955 14588906 18292652 16434260 20065607 X 0 0 0 0 141741573 186867423 141741573 186867423 158175833 206933030 48352190 -3226340 0 X 0 1 X 1 0 0 Claims payable 2292652 Claims incurred but not reported 16000000 18292652 236165115 -3226340 -3226340 239391455 0 239391455 187335519 14588906 14588906 172746613 18292652 18292652 191039265 Part XII, Line 2d - Other Adjustments: Prior year benefit claims payable 1,863,906. Prior year claims incurred but not reported 12,725,000. Part XII, Line 4b - Other Adjustments: Current year benefit claims payable 2,292,652. Current year claims incurred but not reported 16,000,000. 1 0 0 0 Charissa Raynor Executive Director 0 175827 0 0 0 0 0 35165 0 11967 0 222959 0 0 SEIU Healthcare NW Training Partnership Trustees in common 6318960 The SEIU Healthcare NW Training Partnership provides certain administrative services to the SEIU Healthcare NW Health Benefits Trust. Payments for these services totaled $6,318,960 for the year. 0 SEIU Healthcare 775NW Common management and governance 289510 SEIU Healthcare 775NW provides a member resource center benefiting the SEIU Healthcare NW Health Benefits Trust. Payments for these services totaled $289,510 for the year. 0 Form 990, Part VI, Section A, line 2 SEIU Healthcare 775NW and the SEIU Healthcare NW Training Partnership are service providers to this trust as well as participating employers. David Rolf is a trustee of this trust, is the President of SEIU Healthcare 775NW, and is a trustee of the SEIU Healthcare NW Training Partnership. Sterling Harders is a trustee of this trust and serves as the Trust's Chair. Sterling Harders is also the Vice President of SEIU Healthcare 775NW, and a trustee of the SEIU Healthcare NW Training Partnership. Adam Glickman is a trustee of this trust, the Secretary-Treasurer of SEIU Healthcare 775NW, and a trustee of the SEIU Healthcare NW Training Partnership. Shaine Truscott is a trustee of this trust, a trustee of the SEIU Healthcare NW Training Partnershipand, and an employee of SEIU Healthcare 775NW. Bill Moss is a trustee of this trust and a trustee of SEIU Healthcare NW Training Partnership. Memo Rivera is a trustee of this trust and an executive board member of SEIU Healthcare 775NW. Monique Taylor Swan is a trustee of this trust and an executive board member of SEIU Healthcare 775NW. Abby Solomon is the Executive Director of this trust and SEIU Healthcare NW Training Partnership. Charissa Raynor was the Executive Director of this trust and SEIU Healthcare NW Training Partnership. Form 990, Part VI, Section A, line 3 The Trust has contracted with various organizations (Zenith American Solutions, Kaiser of Washington, Delta Dental of Washington, SEIU Healthcare NW Training Partnership, SEIU Healthcare 775NW and Clark Nuber, P.S.) to provide administrative, bookkeping, claims processing, member communications, and record and book-keeping services. Form 990, Part VI, Section A, line 7a Any vacancies of Employer Trustees are filled by appointment of the remaining Employer Trustees. The appointment of an Employer Trustee may be terminated, at any time, by the remaining Employer Trustees by such method as is satisfactory to them. Any vacancies of the Labor Trustees are filled by appointment of the president of SEIU Healthcare 775NW according to SEIU Healthcare 775NW's internal rules, procedures, policies or bylaws. The appointment of a Labor Trustee may be terminated, at any time, by the president of SEIU Healthcare 775NW according to SEIU Healthcare 775NW's internal rules, procedures, policies or bylaws. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC from information provided by the third-party administrator and other consultants and advisors. Draft copies of the Trust's financial statements and Form 990 were first provided to the Finance Director of the SEIU Healthcare NW Training Partnershipthe and the Trust's consultants and advisors, who reviewed the Form 990 for accuracy and completeness. Any questions, concerns or issues raised by the Finance Director, consultants and advisors were addressed and any necessary revisions were made to the Form 990. The revised Form 990 was then provided to the Board of Trustees for its review and approval. Any additional questions, concerns or issues raised by the Board of Trustees were addressed and any necessary revisions were made to the Form 990. The final version of the Form 990 was reviewed and approved for filing by the Board of Trustees. Form 990, Part VI, Section B, line 12c A copy of the Trust's Conflict of Interest Policy has been distributed to each Trustee and other fiduciaries. At least annually, a fiduciary is obligated to disclose or update to the Board of Trustees a list of relatives as defined in the policy involved in any transaction, as well as the fiduciary's business or other interests in any transaction impacting Trust assets (except for the receipt of benefits under the terms of the trust and plan). Further, any fiduciary who has knowledge of any transaction that may arguably be restricted pursuant to the policy, and that has not been specifically permitted by ERISA Section 408 or Department of Labor administrative exemptions, is obligated to disclose such information to the Board of Trustees. The Board of Trustees investigates any actual or potential conflicts of interest. If the Board of Trustees determines that a conflict exists with respect to a fiduciary, it will prohibit the fiduciary from discussions, votes, or attempts to influence the issue or decision that is impacted. Form 990, Part VI, Section B, line 15 There are no compensated management officials, officers or key employees of the organization. If the organization had such compensated individuals, policies and procedures would be developed to determine compensation. Form 990, Part VI, Section C, line 19 The Trust's governing documents, conflict of interest policy, financial statements, and Form 990 are available to the general public upon written request sent to the organization at: 215 Columbia St Ste 300, Seattle, WA 98104. Form 990, Part VII, Section A, Line 1A: None of the Trustees are compensated by the organization. The Board of Trustees is comprised of twelve individuals, six of whom are representatives of the employers and six of whom are respresentatives of the union. One or more trustee maybe required or encouraged to serve on this board of trustees. As such their regular compensation may take into consideration services performed by them in regard to the Trust. The Trust does not readily have access to information related to compensation paid by other entities to the Trustees. In their roles as Trustees, all are fiduciaries and understand their obligations under the Trust Agreement and the Trust's policies and procedures, which include a conflict of interest policy. Coastal CAP 117 East Third Aberdeen WA 98520 Home care services WA 501(c)(3) Line 7 N/A 0 Concerned Citizens PO Box 1787 Forks WA 98331 911156809 Home care services WA 501(c)(3) Line 7 N/A 0 Korean Women's Association 123 E 96th Street Tacoma WA 98445 911066806 Home care services WA 501(c)(3) Line 11 N/A 0 SEIU Healthcare NW Training Partnership 215 Columbia Street Suite 300 Seattle WA 98104 510673005 To provide comprehensive training, support, and career development benefits. WA 501(c)(3) Line 2 N/A 0 SEIU Healthcare 775NW 215 Columbia Street Seattle WA 98104 810588837 Local union representing home care and nursing home workers. WA 501(c)(5) N/A 0 SEIU 925 Multiemployer Health Benefits Trust PO Box 6 Mukilteo WA 98275 To provide health benefits for participants WA 501(c)(9) N/A 0 State of Washington - Department of Social and Health Services PO Box 45842 Olympia WA 98504 To improve safety and health of individuals, families, and communities. WA N/A 0 CDM Caregiving Services 2300 NE Anderson Vancouver WA 98661 911057994 Home care services WA 501(c)(3) Line 7 N/A 0 Working Washington 116 Warren Ave N Suite A Seattle WA 98109 451657758 To build a powerful workers movement WA N/A 0 Community Psychiatric Clinic 11000 Lake City Way NE Seattle WA 98125 910621380 To provide accredited outpatient mental health treatment and counseling WA 501(c)(3) N/A 0 Olympic Community Action Programs 823 Commerce Loop Port Townsend WA 82904 910814319 To improve safety and health of individuals, families, and communities. WA 501(c)(3) Line 7 N/A 0 Senior Life Resources Northwest 1824 Fowler St Richland WA 99352 910909913 To support in-home care and senior nutrition services WA 501(c)(3) Line 7 N/A 0 Behavioral Health Resources 3857 Martin Way E Olympia WA 65268 910666889 To promote mental health and substance use disorder recovery WA 501(c)(3) Line 7 N/A 0 Catholic Community Services 1323 Yakima Ave Tacoma WA 98405 911585652 To provide quality integrated services and housing WA 501(c)(3) Line 7 N/A 0 Addus Health Care 6801 Gaylord parkway Suite 110 Frisco TX 75034 Home care services WA N/A C 0 Amicable Healthcare Inc 15220-B 32nd Avenue South SeaTac WA 99188 Home care services WA N/A S 0 Capital Opportunities PO Box 877 Bozeman MT 59771 Home care services MT N/A C 0 Chesterfield Services Inc 703 Columbia Street Suite 200 Seattle WA 98104 911718148 Home care services WA N/A C 0 ResCare of WA 747 St Helens Avenue Suite 200 Tacoma WA 98402 Home care services WA N/A C 0 Fidelis Senior Care 85 Enterprise 2nd Floor Aliso Vieio CA 92656 452957814 Home care services CA N/A C 0 Home Care Services LLC 82 8th St Belgrade MT 59714 471844286 Home care services MT N/A S 0 First Choice In-Home Care Inc 15015 Main St Suite 209 Bellevue WA 98007 912152603 Home care services WA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1