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SCHOOL DISTRICT 1 HEALTH & WELFARE TRUST FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SCHOOL DISTRICT 1 HEALTH & WELFARE TRUST FUND (EIN 93-6090239)
Tax period
2010-11-01 to 2011-10-31
Filed
2012-04-03
IRS object ID
201230949349300218
Schema version
2010v3.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-03T11:30:49-05:00Timestamp
Tax Period End Date2011-10-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BJORKLUND & MONTPLAISIR CPA'SBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line19020 SW WASHINGTON SQ RD SUITE 46AddressLine1
CityPORTLANDCity
StateORState
ZIP Code97223ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-11-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN936090239EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SCHOOL DISTRICT NO 1 HEALTH ANDBusinessNameLine1
Business Name Line2WELFARE TRUST FUNDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSCHONameControl
Phone8006544411Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line17600 SW MOHAWK STREETAddressLine1
CityTUALATINCity
StateORState
ZIP Code970628121ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLEONARD ANDERSONName
TitleTRUSTEE/CHAIRMANTitle
Phone8006544411Phone
Date Signed2012-03-31DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD A LAYNEName
Phone5036436400Phone
Date Prepared2012-03-22DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPATI PIRO-BOSLEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line17600 SW MOHAWK STREETAddressLine1
CityTUALATINCity
StateORState
ZIP Code970628121ZIPCode
FieldValueIRS element (for citing)
Gross Receipts68372496GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteSDTRUST.COMWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1972YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionPROVIDES MEDICAL, VISION, DENTAL, PRESCRIPTION, SUPPLEMENTAL INCOME, DEATH AND VOLUNTARY ACCIDENT BENEFITS TO PARTICIPANTS ON WHOSE BEHALF THE SCHOOL DISTRICT CONTRIBUTES TO THE PLAN IN ACCORDANCE WITH THE COLLECTIVE BARGAINING AGREEMENTSActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year65405351ProgramServiceRevenuePriorYear
Program Service Revenue CY67224514ProgramServiceRevenueCY
Investment Income Prior Year237512InvestmentIncomePriorYear
Investment Income Current Year199340InvestmentIncomeCurrentYear
Other Revenue Prior Year747106OtherRevenuePriorYear
Other Revenue Current Year948642OtherRevenueCurrentYear
Total Revenue Prior Year66389969TotalRevenuePriorYear
Total Revenue Current Year68372496TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year65789599BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY67980165BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1782351OtherExpensePriorYear
Other Expenses Current Year1765433OtherExpensesCurrentYear
Total Expenses Prior Year67571950TotalExpensesPriorYear
Total Expenses Current Year69745598TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1181981RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1373102RevenuesLessExpensesCY
Total Assets BOY16097462TotalAssetsBOY
Total Assets EOY15043937TotalAssetsEOY
Total Liabilities BOY7856197TotalLiabilitiesBOY
Total Liabilities EOY8069378TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8241265NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6974559NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPROVIDES MEDICAL, VISION, DENTAL, PRESCRIPTION, SUPPLEMENTAL INCOME, DEATH AND VOLUNTARY ACCIDENT BENEFITS TO PARTICIPANTS ON WHOSE BEHALF THE SCHOOL DISTRICT CONTRIBUTES TO THE PLAN IN ACCORDANCE WITH THE COLLECTIVE BARGAINING AGREEMENTSMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionPROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS.Description
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquipfalseReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10961819NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ASSOCIATED THIRD PARTY ADMINISTRATOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8006544411TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line17600 SW MOHAWK STAddressLine1
CityTUALATINCity
StateORState
ZIP Code970628121ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
LEONARD ANDERSON
TRUSTEE2.00XX000
HANK HARRIS
ALTERNATE TR2.00X000
DAVID WYNDE
TRUSTEE2.00X000
PAM BYBEE
ALTERNATE TR2.00X000
MICHELLE RIDDELL
TRUSTEE2.00X000
LISA NEWLYN
TRUSTEE2.00X000
BELINDA REAGAN
TRUSTEE2.00X000
TERRI BURTON
TRUSTEE2.00X000
SCOTT LUCY
TRUSTEE2.00X000
BROCK LOGAN
TRUSTEE2.00X000
DAVID WINKLER
ALTERNATE TR2.00X000
BECKY WRIGHT
TRUSTEE2.00X000
DEE SIMMONS
ALTERNATE TR2.00X000
MICHELLE BATTEN
ALTERNATE TR2.00X000
JACK ROY
TRUSTEE2.00X000
RUSS PETERSON
TRUSTEE2.00X000
GWEN SULLIVAN
TRUSTEE2.00X000
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ASSOCIATED THIRD PARTY ADMINISTRATOR
7600 SW MOHAWK STREETTUALATINOR970628121CONTRACT ADMIN855355
MERCER HUMAN RESOURCE CONSULTING
111 SW COLUMBIA STREETPORTLANDOR97201CONSULTANT325283
INNOVATIVE CARE MANAGEMENT
15 82ND DRIVE SUITE 180GLADSTONEOR970272560CLAIMS REVIEW101532
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS6356860863568608
PARTICIPANT CONTRIBUTIONS36559063655906
FieldValueIRS element (for citing)
Total Program Service Revenue67224514TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column199340TotalRevenueColumn
Related Or Exempt Function Income199340RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ERRP REFUND478949478949
EXPERIENCE REFUND456959456959
SETTLEMENTS1273412734
FieldValueIRS element (for citing)
Total Other Revenue948642TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column68372496TotalRevenueColumn
Related Or Exempt Function Income68372496RelatedOrExemptFunctionIncome

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total67980165Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total855355Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total44400Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total32210Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total325283Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total108641Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total104897Total

Insurance Insurance

FieldValueIRS element (for citing)
Total26888Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
CLAIMS ADMINISTRATION126446
CLAIMS COST CONTROL101532
BANK CHARGES37021
WEBSITE MAINTENANCE2760

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total69745598Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3325605BOY
EOY1382454EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5101428BOY
EOY5691028EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY13913BOY
EOY12976EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY7656516BOY
EOY7957479EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY16097462BOY
EOY15043937EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY54024BOY
EOY92822EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY257691BOY
EOY52050EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7544482BOY
EOY7924506EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7856197BOY
EOY8069378EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY8241265BOY
EOY6974559EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8241265BOY
EOY6974559EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16097462BOY
EOY15043937EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1373102ReconcilationRevenueExpenses
Reconcilation Other Changes106396ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
INSURANCE PREMIUMS PAYABLE$3,292,422
CLAIMS INCURRED BUT NOT REPORTED$2,772,740
CLAIMS PAYABLE$1,859,344
FieldValueIRS element (for citing)
Total Of Amounts7924506TotalOfAmounts
Total Revenue68372496TotalRevenue
Total Expenses69745598TotalExpenses
Excess Or Deficit For Year-1373102ExcessOrDeficitForYear
Net Unrealized GL On Investments106396NetUnrealizedGLOnInvestments
Other$380,024OtherAmount
Total Adjustments486420TotalAdjustments
Excess Or Deficit Per FS-886682ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt68478892TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments106396NetUnrealizedGainsInvestments
Revenue Not Rptd F990106396RevenueNotRptdF990
Revenue Subtotal68372496RevenueSubtotal
Total Revenue Per Form99068372496TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt69365574TotExpensesEtcAuditedFinclStmt
Expenses Subtotal69365574ExpensesSubtotal
Other Expenses Not Included380024OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt380024ExpensesNotRptdOnFinStmt
Total Expenses Per Form99069745598TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8INCREASE IN BENEFIT OBLIGATIONS 380,024
EXPENSE AMOUNTS INCLUDED ON RETURN - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 4BINCREASE IN BENEFIT OBLIGATIONS 380,024

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S MISSIONFORM 990 - ORGANIZATION'S MISSIONPROVIDES MEDICAL, VISION, DENTAL, PRESCRIPTION, SUPPLEMENTAL INCOME, DEATH AND VOLUNTARY ACCIDENT BENEFITS TO PARTICIPANTS ON WHOSE BEHALF THE SCHOOL DISTRICT CONTRIBUTES TO THE PLAN IN ACCORDANCE WITH THE COLLECTIVE BARGAINING AGREEMENTS
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTRUSTEES REVIEW FORM 990 AND ASK QUESTIONS OF THE PREPARER PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTRUSTEES ARE REQUIRED TO NOTIFY THE TRUST OF ANY CHANGES IN THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ANO COMPENSATION IS PAID
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BNO COMPENSATION IS PAID.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE TRUST DOCUMENT, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED IN THE TRUSTS' OFFICE AND ARE AVAILABLE UPON REQUEST.