2017-01-12T13:44:52-06:00 2016-03-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY SUITE 400 SAN RAMON CA 945834210 990 2015-04-01 911950259 SOUND HEALTH & WELLNESS RETIREE TRUST SOUN 2062824100 201 QUEEN ANNE AVENUE NORTH NO 100 SEATTLE WA 98109 SCOTT KLITZKE POWERS CHAIRMAN 4258289202 2017-01-12 1 KATHLEEN D HABB P01068129 9252779100 2015 2021-01-29 14:40:06Z SCOTT KLITZKE POWERS 201 QUEEN ANNE AVENUE NORTH NO 100 SEATTLE WA 98109 8812539 0 X WWW.SOUNDHEALTHWELLNESS.COM X 1998 WA TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS 11 1 0 0 0 0 0 0 2478419 2482744 421557 1014285 646573 0 3546549 3497029 0 0 5163144 5305455 0 0 0 0 0 541621 527976 5704765 5833431 -2158216 -2336402 12643136 8680116 1591541 1034901 11051595 7645215 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 1 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 AVE NORTH SEATTLE WA 981094896 X SCOTT KLITZKE POWERS CHAIRMAN 1.20 X 0 0 0 BRENT R BOHN TRUSTEE 1.20 X 0 0 0 CINDY THORNTON TRUSTEE 1.20 X 0 0 0 FRANK JORGENSEN TRUSTEE 1.20 X 0 0 0 TODD CROSBY SECRETARY 1.20 X 0 130087 16085 EMILIA CONTRERAS TRUSTEE 1.20 X 0 97303 0 JAMES CROWE TRUSTEE 1.20 X 0 100236 0 FAYE GUENTHER TRUSTEE 1.20 X 0 115920 15877 DAVID SCHMITZ TRUSTEE 1.20 X 0 97541 18798 RANDY ZEILER TRUSTEE 1.20 X 0 0 0 RUTH DICK TRUSTEE 1.20 X 0 94753 0 0 635840 50760 0 0 0 0 AETNA 600 UNIVERSITY STREET SUITE 920 SEATTLE WA 98101 ADMINISTRATION 128976 ZENITH AMERICAN SOLUTIONS INC 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 981094896 ADMINISTRATION 118457 2 RETIREE SELF PAY CONTRIBUTIONS 900099 1982732 1982732 EMPLOYER CONTRIBUTIONS 900099 500012 500012 2482744 329795 329795 6000000 5315510 684490 684490 684490 3497029 2482744 0 1014285 5305455 118851 32656 8400 25316 289642 7432 4664 18105 TRANSITIONAL REINSURANC 22910 5833431 24258 2415535 59142 90387 18980 18927 9585743 4864656 2955013 1290611 12643136 8680116 26166 30361 160290 184500 1405085 820040 1591541 1034901 X 0 0 0 0 11051595 7645215 11051595 7645215 12643136 8680116 -2336402 -1069978 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 1290611 F 1290611 CLAIMS PAYABLE & IBNR 820040 820040 X 2401735 -1069978 -1069978 3471713 25316 25316 3497029 6361664 0 6361664 25316 -553549 -528233 5833431 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 PLAN HAS CONTRACTED WITH ZENITH AMERICAN SOLUTIONS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR 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 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-INTERST 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. COMPNESATION 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, ZENTIH 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 201 QUEEN ANNE AVE N STE 100 SEATTLE WA 981094824 916058475 ACTIVE EMPLOYEES WELFARE BENEFITS WA 501(C) 9 N/A N/A 0 SOUND RETIREMENT TRUST 201 QUEEN ANNE AVE N STE 100 SEATTLE WA 981094824 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, IDENTIFICATION 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, 2016 THERE ARE APPROXIMATELY 83 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 HEALTH MART ABERDEEN OFFICE EQUIPMENT AFFORDABLE DENTAL GROUP AHMR, INC ALBERTSONS INC ALLIED EMPLOYERS, INC. ALPINE DENTAL CARE AVENUE DENTAL CARE BALLINGER THRIFTWAY BAVARIAN MEAT PRODUCTS BERTS RED APPLE MARKET BIMBO BAKERIES USA BLUHER'S DBA FARMHOUSE MKT BORNSTEIN SEAFOOD INC BRIDLE TRAILS RED APPLE MKT BYRNIE UTZ MEN'S HAT STORE CAMANO PLAZA MARKET CAP FOODS DBA WEST SEA THFTWY CITY CENTER DRUG CLAUS MEAT MARKET CROWN DRUG COMPANY DBA MARTIN'S SOUTHGATE DRUG DON & JOES MEATS ELMA & RAYMOND THRIFTWAYS FORKS OUTFITTERS FRANCO THE TAILOR, INC FRANZ & GAIS BAKERIES GORDONS GROCERY HAGGEN INC HAGGEN OPERATIONS HOLDING HARBOR DRUG INC HARRISON MEDICAL CENTER ILWU LOCAL #23 ISLAND MKT CO DBA VASHON THRWY J SPRINGER DBA KEN'S KORNER JEFFERSON COUNTY JEFFERSON HEALTHCARE KAUFMAN SCROGGS FURNITURE KC FOODS KROGER DBA FRED MEYER KROGER DBA QFC LABORER'S INTERNATIONAL #252 METROPOLITAN MARKETS N MASON SCHOOL DIST #403 OMAK PHARMACY PAYLESS FOODS PICK-RITE INC PIERCE CTY CENTRAL LABOR COUNC PIONEER SELECT MARKET POULSBO RED APPLE PRAIRIE CENTER RED APPLE MKT PUGET SOUND LABOR AGENCY RALPH'S RED APPLE RAYMOND PHARMACY RETIREE WELFARE ROGER'S MARKETPLACE ROSE & ASSOCIATES, LLC SAAR'S INC SAFEWAY STORES INC SEQUIM SCHOOL DIST #323 SHOP-N-KART SOINES DBA RED WING SHOE STORE SOUTH BEND PHARMACY SPANAWAY WATER CO. INC STADIUM THRIFTWAY 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 UNIFIED GROCERS INC UNITED WAY OF SKAGIT CO UWAJIMAYA INC VASHON MARKET FRESH IGA WIITAMAKI JEWELERS ZENITH AMERICAN SOLUTIONS