2014-02-15T15:48:51-06:00 2013-03-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2012-04-01 916058475 RETAIL CLERKS WELFARE TRUST RETA 2062824100 201 QUEEN ANNE AVE NORTH NO 100 SEATTLE WA 981094896 RANDY ZEILER 2062824100 2014-02-18 1 KATHLEEN HAAB P01068129 9252779100 2012 2015-11-30 17:44:51Z RANDY ZEILER 201 QUEEN ANNE AVE NORTH NO 100 SEATTLE WA 981094896 254836250 0 X WWW.SOUNDHEALTHWELLNESS.COM X 1957 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 12 1 0 0 10383 9383 0 0 247991993 240703630 3941078 4755061 0 0 251933071 245458691 0 0 227630943 241522277 0 0 0 0 0 20885759 22907578 248516702 264429855 3416369 -18971164 117753574 102982804 73082718 75802224 44670856 27180580 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 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 1 1 0 0 0 0 0 X 12 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 DERRICK ANDERSON 1.00 X 0 0 0 BRENT R BOHN 1.00 X 0 0 0 FRANK JORGENSEN 1.00 X 0 0 0 SCOTT K POWERS 1.00 X 0 0 0 CARL WOJCIECHOWSKI 1.00 X 0 0 0 RANDY ZEILER 1.00 X 0 0 0 DAVID BLITZSTEIN 1.00 X 0 0 0 TODD CROSBY 1.00 X 0 102754 13388 DAVID SCHMITZ 1.00 X 0 138885 13370 MIKE WILLIAMS 1.00 X 0 62740 13388 BRENDA WILLIS 1.00 X 0 92142 13388 DIANE ZAHN 1.00 X 0 138897 13388 RUTH DICK 1.00 X 0 89435 13388 FAYE GUENTHER 1.00 X 0 94696 13388 0 719549 93698 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 981094896 ADMINISTRATION 7274242 GROUP HEALTH OPTIONS INC 320 WESTLAKE AVENUE NORTH STE 100 SEATTLE WA 98109 HMO ADMINISTRATION 6869364 WASHINGTON DENTAL SERVICE 9706 FOURTH AVENUE NE SEATTLE WA 98115 DENTAL ADMINISTRATION 2321112 CAREWISE HEALTH INC 9200 SHELBYVILLE ROAD STE 700 LOIUSVILLE KY 40222 PERSONAL HEALTH ASSESSMENT ADMINISTRATIO 1207470 FIRST CHOICE HEALTH 600 UNIVERSITY STREET STE 1400 SEATTLE WA 98101 HEALTH CARE PROVIDER 1028166 21 EMPLOYER CONTRIBUTIONS 900099 221354257 221354257 PARTICIPANT CONTRIBUTIONS 900099 18374412 18374412 PRESCRIPTION REBATES 900099 686681 686681 HRA CLAIM REFUNDS 900099 288280 288280 240703630 3882620 10383 3872237 10250000 9377559 872441 872441 872441 245458691 240703630 10383 4744678 241522277 6558695 265111 109639 22917 14989103 829771 17594 28602 NEWSLETTER EXPENSE 86146 264429855 12389700 3776028 20980593 18857497 487388 475746 74437935 71199065 9457958 8674468 117753574 102982804 437459 558393 72645259 75243831 73082718 75802224 X 0 0 0 0 44670856 27180580 44670856 27180580 117753574 102982804 -18971164 1480888 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 8674468 F 8674468 IBNR AND ESTIMATED CLAIMS PAYABLE 27000000 CASH OVERDRAFTS 5303831 ACCUMULATED ELIGIBILITY CREDITS 42940000 75243831 X 246916662 1480888 1480888 245435774 22917 22917 245458691 262936938 0 262936938 22917 1470000 1492917 264429855 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2010. 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 OF OR SERVICE PROVIDER TO THE TRUST. DISCLOSURE 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-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 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 THIRD-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART XII 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. RETAIL CLERKS PENSION TRUST 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 98109 916069306 TO PROVIDE PENSION BENEFITS WA 501(A) N/A N/A 0 RETAIL CLERKS RETIREE WELFARE 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, 2013, THERE ARE APPROXIMATELY 130 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 I THROUGH IV BY FEDERAL TAX CLASSIFICATION. A & J MEATS A&H STORES, INC ABERDEEN HEALTH MART ABERDEEN OFFICE EQUIPMENT ACE ELECTRIC ADMINISTRATIVE OFFICE #141 AFFORDABLE DENTAL GROUP AHMR, INC ALBERTSONS INC ALL SMILEZ DENTISTRY ALLEN CREEK IGA ALLIED EMPLOYERS, INC. ASHLEY HOUSE AVENUE DENTAL CARE BALLARD PLAZA PHARMACY BARTELL DRUG CO 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 CENTRAL CO-OP/MADISON MARKET CITY CENTER DRUG CLAUS MEAT MARKET CORNELL'S VALLEY PHARMACY CROWN DRUG COMPANY DBA MARTIN'S SOUTHGATE DRUG DEL TEET FURNITURE DES MOINES DRUG DMG DENTAL DESIGN DON & JOES MEATS EB MANAGEMENT COMPANY EKMAN, BOHRER & THULIN EVERYBODY'S FORKS OUTFITTERS FRANCO THE TAILOR, INC FRANZ & GAIS BAKERIES GARGUILES RED APPLE GOLDEN STEER CHOICE MEATS GORDONS GROCERY HAGGEN INC HARBOR DRUG INC HARBORS HOME HEALTH/HOSPICE HARRISON MEDICAL CENTER HERBIG JEWELERS HOSTESS BRANDS HUDSON GROUP ILWU LOCAL #23 ISLAND MKT CO DBA VASHON THRWY J SPRINGER LLC JEFFERSON COUNTY JEFFERSON HEALTHCARE JEFFERSON MENTAL HEALTH JIM'S PHARMACY KATTERMAN'S SAND POINT PHARM KAUFMAN SCROGGS FURNITURE KC FOODS KENT VALLEY OPTICAL KIRBY CO/SHELTON RED APPLE KROGER DBA FRED MEYER KROGER DBA QFC LABORER'S INTERNATIONAL #252 LAFFERTY'S PHARMACY INC MARDIX PHARMACY MATTHEWS AT LAKEMONT LLC MEDICAL CENTER METROPOLITAN MARKETS MID-VALLEY HOSPITAL MOUNT VERNON RED APPLE MARKET N MASON SCHOOL DIST #403 NORTHWEST EMPLOYEE RELATIONS NW ADMINISTRATORS OSTROMS DRUGS PATEL DENTAL CARE PAYLESS FOODS PENHOLLOW MARKETS, INC PENHOLLOW MKTS LLC 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 RANDYS LOAN & COIN RAYMOND DRUG RITE AID CORP ROGER'S MARKETPLACE ROSE & ASSOCIATES, LLC RXTRA CARE U&I PHARMACY SAAR'S INC SAFEWAY STORES INC SAGEN'S PHARMACY SEQUIM SCHOOL DIST #323 SHOP-N-KART SOINES DBA RED WING SHOE STORE SOUTH BEND PHARMACY SPANAWAY WATER CO. INC ST JOSEPH'S MEDICAL CENTER STADIUM THRIFTWAY STERLING DENTAL CARE STOLZ VASHON MARKET STORMAN'S SUMMIT TRADING COMPANY SUNRISE DENTAL SWAIN'S INC SWANSONS FOOD INC TACOMA LONGSHOREMEN CR UNION THE DENNIS CO THE MARKETS LLC THE VALU DRUG CO TM MEATS LLC TOWN & COUNTRY TUKWILA TRADING CO UFCW LOCAL #21 UFCW LOCAL 367 UNIFIED GROCERS INC UNITED WAY OF SKAGIT CO UWAJIMAYA INC VASHON MARKET FRESH IGA WA STATE PHARMACY ASSOC WEISFIELD/STERLING INC WHITE CENTER PHARMACY WIITAMAKI JEWELERS WOODSIDE/BRASETH GALLERY ZENITH AMERICAN SOLUTIONS