2018-03-20T11:25:01-04:00 2017-05-31 MILLER KAPLAN ARASE LLP 600 STEWART ST STE 618 SEATTLE WA 981011261 990 2016-06-01 930478837 THE BLEDSOE HEALTH TRUST % GARTH FISHER BLED 2063294900 2323 EASTLAKE AVE EAST SEATTLE WA 98102 ROGER M GLOS CHAIRMAN 2018-03-14 true Crane Curran P01499738 2065963930 204.1.171.253 95416620180795000000 2018-03-20 P 039912D053BF53F1AE4529A2B713A8DB94554935 8C6E67AC980B7473522F3092D30D7F22078FCE35 2016 2021-01-29 14:40:06Z Roger M Glos 2323 Eastlake Ave E Seattle WA 98102 97008236 false X N/A X 1959 OR SEE SCHEDULE O 10 0 0 0 0 0 0 47428327 48068249 3487789 3373038 1196 1514808 50917312 52956095 0 0 51447942 55864744 0 0 0 0 0 2284341 1172894 53732283 57037638 -2814971 -4081543 111734878 111831975 13591665 13667697 98143213 98164278 THE ORGANIZATIONS'S MISSION IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE ACTIVE PARTICIPANTS AND THEIR COVERED DEPENDENTS. THE PLAN ALSO PROVIDES HEALTH BENEFITS TO SELF PAY PARTICIPANTS AND RETIREES FOR WHICH A CONTRIBUTION IS RECEIVED. false false THE ORGANIZATION'S MISSION IS TO PROVIDE HEALTH BENEFITS TO ELIGIBLE ACTIVE PARTICIPANTS AND THEIR COVERED DEPENDENTS. THE PLAN ALSO PROVIDES HEALTH BENEFITS TO SELF-PAY PARTICIPANTS AND RETIREES FOR WHICH A CONTRIBUTION IS RECEIVED. false false false false false false false false false true false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 2 0 true 0 false false false false false false X 10 0 false false false false false false false true false false false false true true true true true false X GARTH FISHER 2063294900 2323 EASTLAKE AVE EAST SEATTLE WA 98102 X RODGER M GLOS TRUSTEE 1.0 0.0 X 0 0 0 KEVIN PETERSON TRUSTEE 1.0 0.0 X 0 0 0 JOHN SAHLBERG TRUSTEE 1.0 0.0 X 0 0 0 KELLYE T WISE TRUSTEE 1.0 0.0 X 0 0 0 TONY HADLEY TRUSTEE 1.0 0.0 X 0 0 0 PAUL MARKS ALTERNATE TRUSTEE 1.0 0.0 X 0 0 0 CAL WELBORN SR TRUSTEE 1.0 0.0 X 0 0 0 JERRY KING TRUSTEE 1.0 0.0 X 0 0 0 TODD GORHAM TRUSTEE 1.0 0.0 X 0 0 0 RAY CALICA TRUSTEE 1.0 0.0 X 0 0 0 0 0 0 0 false false false REGENCE BLUECROSS BLUESHIELD OF ORE PO Box 1271 PORTLAND OR 97207 ADMIN SERVICE ORG 6094965 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVE EAST SEATTLE WA 98102 Administrative Fees 535810 2 0 EMPLOYER CONTRIBUTIONS 900099 41835027 41835027 SELF-PAY CONTRIBUTIONS 900099 6233222 6233222 48068249 2894311 2894311 0 0 0 0 0 44530868 44052141 478727 478727 478727 0 0 0 0 0 0 0 0 0 REBATES 900099 1512537 1512537 MISCELLANEOUS INCOME 900099 2271 2271 1514808 52956095 49583057 3373038 0 0 0 55864744 0 0 0 0 0 0 530774 62365 68582 0 0 50517 5425 0 92739 0 0 0 0 0 14562 0 0 0 41369 ACA REINSURANCE FEE 146685 ACA PCORI FEE 14880 CONSULTING 99996 TRUSTEE SERVICES 45000 57037638 0 796 883529 2511916 0 0 7132702 3794873 0 0 0 0 0 0 0 0 1024781 1025296 0 0 90409248 92978978 12284618 11520116 0 0 0 0 0 0 111734878 111831975 182228 81541 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13409437 13586156 13591665 13667697 X 0 0 0 0 98143213 98164278 98143213 98164278 111734878 111831975 -4081543 4102608 X false true X true GROSVENOR INSTITUTIONAL PARTNE 11520116 F 11520116 0 BENEFIT OBLIGATIONS 13586156 13586156 X 55495649 4102608 -1512537 2590071 52905578 50517 50517 52956095 55297865 -1512537 -1512537 56810402 50517 176719 227236 57037638 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN A TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY A TAX AUTHORITY. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D AND PART XII, LINE 2D: MEDICAL EXPENSE REFUNDS AND REBATES RECEIVED. PART XII, LINE 4B: CHANGE IN BENEFIT OBLIGATIONS. PART I, LINE 1 AND PART III, LINES 1 AND 4A - ORGANIZATION'S MISSION: TO PROVIDE HEALTH BENEFITS TO ELIGIBLE ACTIVE PARTICIPANTS AND THEIR COVERED DEPENDENTS. THE PLAN ALSO PROVIDES HEALTH BENEFITS TO SELF-PAY PARTICIPANTS AND RETIREES FOR WHICH A CONTRIBUTION IS RECEIVED. PART VI, LINE 11B: FORM 990 IS REVIEWED BY THE ADMINISTRATIVE OFFICE PRIOR TO BEING FILED. THE ADMINISTRATIVE OFFICE NOTIFIES THE BOARD OF TRUSTEES OF UNUSUAL OR SIGNIFICANT ITEMS, IF NOTED. PART VI, LINE 12C: TRUSTEES ARE REQUIRED TO NOTIFY THE PLAN OF ANY CHANGES IN INTERESTS THAT COULD GIVE RISE TO CONFLICTS. PART VI, LINE 19: THE PLAN'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED AT THE ADMINISTRATIVE OFFICE AND ARE AVAILABLE UPON REQUEST. PART VII - SECTION A: MEMBERS OF THE BOARD OF TRUSTEES SERVE FOR NO COMPENSATION. COMPENSATION PAID TO TRUSTEES BY THEIR EMPLOYERS IS REPORTED ON THE EMPLOYERS' ANNUAL TAX FILINGS. THIS INFORMATION IS UNKNOWN TO THE PLAN ADMINISTRATOR. CIC-TOC PENSION PLAN 2323 EASTLAKE AVE E SEATTLE WA 98102 456909074 PENSION BEN. WA 1.401-1(B)3 NA false LUMBER INDUSTRY PENSION PLAN 2323 EASTLAKE AVE E SEATTLE WA 98102 456909074 PENSION BEN. WA 1.401-1(B)3 NA false CIC DEFINED CONTRIBUTION RETIREMENT PLAN 2323 EASTLAKE AVE E SEATTLE WA 98102 456909074 PENSION BEN. WA 1.401-1(B)3 NA false CARPENTERS INDUSTRIAL COUNCIL 12788 SE STARK ST PORTLAND OR 97233 421693707 LABOR ORG. OR 501(C)5 NA false see supplemental information na see supplemental information na false false false false false false false false false false false false false false false false false false true PARTS II, III AND IV - IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS: A CONTRIBUTING EMPLOYER IS A RELATED ORGANIZATION SOLELY TO THE EXTENT THAT THE EMPLOYER IS SIGNATORY TO A COLLECTIVE BARGAINING AGREEMENT OR PARTICIPATION AGREEMENT REQUIRING CONTRIBUTIONS TO THE PLAN. THE PLAN ADMINISTRATOR DOES NOT MAINTAIN INFORMATION CONCERNING THE ENTITY TYPE OF EACH OF THE PLAN'S CONTRIBUTING EMPLOYERS. THE PLAN CONTRACTS WITH VIGILANT SERVICES, INC. FOR ONE OF ITS MEMBERS TO SERVE AS AN EMPLOYER TRUSTEE AND CHAIRMAN OF THE BOARD OF TRUSTEES OF THE PLAN, REPRESENTING CONTRIBUTING EMPLOYERS THAT ARE NOT REPRESENTED BY ANOTHER TRUSTEE. A MONTHLY FEE IS PAID BY THE PLAN TO VIGILANT SERVICES, INC. UNDER TERMS OF THE AGREEMENT. THE MONTHLY FEE WAS $3,750 AND $3,000 FOR THE PLAN YEARS ENDED MAY 31, 2017 AND 2016, RESPECTIVELY.