2017-01-12T13:44:21-06:00 2016-03-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2015-04-01 916058475 SOUND HEALTH & WELLNESS TRUST SOUN 2062824100 201 QUEEN ANNE AVE NORTH NO 100 SEATTLE WA 981094896 SCOTT KLITZKE POWERS CHAIRMAN 4258289202 2017-01-12 1 KATHLEEN D HAAB P01068129 9252779100 2015 2021-01-29 14:40:06Z SCOTT KLITZKE POWERS 201 QUEEN ANNE AVE NORTH NO 100 SEATTLE WA 981094896 299452117 0 X WWW.SOUNDHEALTHWELLNESS.COM X 1957 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 11 1 0 0 0 0 0 0 283166347 296014123 2661859 3437994 0 0 285828206 299452117 0 0 235034954 221448522 0 0 0 0 0 26693107 26733442 261728061 248181964 24100145 51270153 143550578 186622847 77365234 72397634 66185344 114225213 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED 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 0 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 11 1 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 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 98109 X SCOTT KLITZKE POWERS TRUSTEE/CHAIRMAN 1.00 X 0 0 0 BRENT R BOHN TRUSTEE 1.00 X 0 0 0 CINDY THORNTON TRUSTEE 1.00 X 0 0 0 FRANK JORGENSEN TRUSTEE 1.00 X 0 0 0 TODD CROSBY TRUSTEE/SECRETARY 1.00 X 0 130087 16085 EMILIA CONTRERAS TRUSTEE 1.00 X 0 97303 0 JAMES CROWE TRUSTEE 1.00 X 0 100236 0 FAYE GUENTHER TRUSTEE 1.00 X 0 115920 15877 DAVID SCHMITZ TRUSTEE 1.00 X 0 97541 18798 RANDY ZEILER TRUSTEE 1.00 X 0 0 0 RUTH DICK TRUSTEE 1.00 X 0 94753 0 0 635840 50760 0 0 0 0 GROUP HEALTH OPTIONS INC 320 WESTLAKE AVENUE NORTH STE 100 SEATTLE WA 98109 HMO ADMINISTRATION 8281065 ZENITH AMERICAN SOLUTIONS INC 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 981094896 ADMINISTRATION 6717555 AETNA 601 UNION STREET STE 810 SEATTLE WA 98101 ADMINISTRATION 3476733 WASHINGTON DENTAL SERVICE 9706 FOURTH AVENUE NE SEATTLE WA 98115 DENTAL ADMINISTRATION 1108476 CATAMARAN 4805 E THISTLE LANDING STE 100D PHOENIX AZ 85044 PHARMACY BENEFIT MGMT 525919 20 EMPLOYER CONTRIBUTIONS 900099 277725641 277725641 PARTICIPANT CONTRIBUTIONS 900099 17512635 17512635 PRESCRIPTION REBATES 900099 775847 775847 296014123 3437994 3437994 299452117 296014123 0 3437994 221448522 6170858 427604 126872 25000 16829830 798198 22942 53330 TRANSITIONAL REINSURANC 2090176 NEWSLETTER EXPENSE 98940 PCORI TAX 89692 248181964 34387390 79198105 23820047 25306444 602907 608350 75951819 72743337 8788415 8766611 143550578 186622847 859405 925981 76505829 71471653 77365234 72397634 X 0 0 0 0 66185344 114225213 66185344 114225213 143550578 186622847 51270153 -3230284 0 X X 0 1 X 1 0 0 IBNR AND ESTIMATED CLAIMS PAYABLE 30221653 ACCUMULATED ELIGIBILITY CREDITS 41250000 71471653 X 296196833 -3230284 -3230284 299427117 25000 25000 299452117 252061888 0 252061888 25000 -3904924 -3879924 248181964 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 2013. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 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 11 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 COMPNSATION 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 ORGANIZATION'S FORM 990, FILED WITH THE INTERNAL REVENUE SERVICE. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE TRUST'S THRID-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES HAVE 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 RETIREMENT TRUST 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 98109 916069306 TO PROVIDE PENSION BENEFITS WA 501(A) N/A N/A 0 SOUND HEALTH & WELLNESS RETIREE TRUST 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 98109 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, 2016, THERE ARE APPROXIMATELY 108 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. A&H STORES, INC ABERDEEN HEALTH MART ABERDEEN OFFICE EQUIPMENT AHMR, INC ALLIED EMPLOYERS, INC. ALPINE DENTAL CARE ASHLEY HOUSE BARTELL DRUG CO BAVARIAN MEAT PRODUCTS BERTS RED APPLE MARKET BLUHER'S DBA FARMHOUSE MKT BORNSTEIN SEAFOOD INC BRIDLE TRAILS RED APPLE MKT BYRNIE UTZ MEN'S HAT STORE CAP FOODS DBA WEST SEA THFTWY CITY CENTER DRUG CLAUS MEAT MARKET DBA MARTIN'S SOUTHGATE DRUG DES MOINES DRUG DON & JOES MEATS EB MANAGEMENT COMPANY EKMAN THULIN, P.S. EVERYBODY'S FORKS OUTFITTERS FRANCO THE TAILOR, INC FRANZ & GAIS BAKERIES GOLDEN STEER CHOICE MEATS GORDONS GROCERY HAGGEN & TOP FOOD & DRUG HARBORS HOME HEALTH/HOSPICE ILWU LOCAL #23 ISLAND MKT CO DBA VASHON THRW JEFFERSON COUNTY JEFFERSON HEALTHCARE JEFFERSON MENTAL HEALTH JIM'S PHARMACY KATTERMAN'S SAND POINT PHARM KAUFMAN SCROGGS FURNITURE KC FOODS KENT VALLEY OPTICAL METROPOLITAN MARKETS MID-VALLEY HOSPITAL NW ADMINISTRATORS OMAK PHARMACY OSTROM'S DRUG & GIFT PAYLESS FOODS PICK-RITE INC PIERCE CTY CENTRAL LABOR COUN PIONEER SELECT MARKET POULSBO RED APPLE PRAIRIE CENTER RED APPLE MKT PUGET SOUND LABOR AGENCY RALPH'S RED APPLE ROGER'S MARKETPLACE SAAR'S INC SAFEWAY STORES INC SAGEN'S PHARMACY SEQUIM SCHOOL DIST #323 SHOP-N-KART SPANAWAY WATER CO. INC ST JOSEPH'S MEDICAL CENTER STERLING DENTAL CARE STORMAN'S SUNRISE DENTAL SWAIN'S INC SWANSONS FOOD INC TACOMA LONGSHOREMEN CR UNION THE DENNIS CO THE MARKETS LLC THE VALU DRUG CO TOWN & COUNTRY UFCW LOCAL #21 UFCW LOCAL 367 UNITED WAY OF SKAGIT CO UWAJIMAYA INC WA STATE PHARMACY ASSOC WHITE CENTER PHARMACY WIITAMAKI JEWELERS WOODSIDE/BRASETH GALLERY BALLARD PLAZA PHARMACY N MASON SCHOOL DIST #403 NORTHWEST EMPLOYEE RELATIONS ROSE & ASSOCIATES, LLC SOINES DBA RED WING SHOE STOR CROWN DRUG COMPANY DEL TEET FURNITURE HARBOR DRUG INC J SPRINGER DBA KEN'S KORNER LAFFERTY'S PHARMACY INC MEDICAL CENTER HARRISON MEDICAL CENTER BALLINGER THRIFTWAY LABORER'S INTERNATIONAL #252 UNIFIED GROCERS INC VASHON MARKET FRESH IGA AVENUE DENTAL CARE SOUTH BEND PHARMACY STADIUM THRIFTWAY AFFORDABLE DENTAL GROUP ALBERTSONS INC BIMBO BAKERIES USA CAMANO PLAZA MARKET CORNELL'S VALLEY RX & HOMECAR HUDSON GROUP KROGER DBA FRED MEYER KROGER DBA QFC WEISFIELD/STERLING INC ZENITH AMERICAN SOLUTIONS