2022-11-15T10:23:30-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 980041446 990 2021-01-01 936041903 THE NELSON TRUST NELS 5032240048 5331 S MACADAM AVE 220 PORTLAND OR 97239 KELLYE WISE CO-CHAIRMAN 5032240048 2022-11-14 1 KELLYE WISE 999009999 MICHAEL T MEAD CPA P01893207 4252506100 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z KELLYE WISE 5331 S MACADAM AVE 220 PORTLAND OR 97239 36368516 0 X WWW.OURBENEFITOFFICE.COM/NELSON/BENEFITS/ X 1967 WA PROVIDE HEALTH & WELFARE BENEFITS. 7 0 25 7 0 0 0 0 10436214 11021296 1658936 2232854 4497 0 12099647 13254150 0 0 11388567 13189131 0 0 0 0 0 1304444 1414937 12693011 14604068 -593364 -1349918 40191203 37665901 4500827 3625433 35690376 34040468 TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AS SPECIFIED IN THE PLAN. 0 0 TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AS SPECIFIED IN THE PLAN. 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 2 0 1 25 0 0 0 0 0 0 0 0 0 X 7 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 0 0 0 X BENESYS INC 5032240048 5331 S MACADAM AVE SUITE 220 PORTLAND OR 97239 X X KELLYE WISE MANAGEMENT TRUSTEE CO-CHAIR 0.50 X X 0 0 0 WAYNE THOMPSON UNION TRUSTEE CO-CHAIR 0.50 X X 0 0 0 CARYN KAUFMANN UNION TRUSTEE 0.50 X 0 0 0 MARY SINGER MANAGEMENT TRUSTEE 0.50 X 0 0 0 BRANDON BRYANT UNION TRUSTEE 0.50 X 0 0 0 KIM ECKROTH MANAGEMENT TRUSTEE 0.50 X 0 0 0 MIKE HICKS UNION TRUSTEE 0.50 X 0 0 0 0 0 0 0 0 0 0 PREMERA BLUE CROSS 7001 220TH ST SW BLDG 1 MOUNTLAKE TERRACE WA 98043 CLAIMS PAYER 486727 BENESYS INC 5331 S MACADAM AVE 200 PORTLAND OR 97239 THIRD PARTY ADMINISTRATOR 242123 MERCER HEALTH & BENEFITS 1301 FIFTH AVE SUITE 1900 SEATTLE WA 98101 CONSULTING 181000 JOSEPH L REINHART PC 7355 SW HERMOSO WAY PORTLAND OR 97223 LEGAL 114101 4 EMPLOYER CONTRIBUTIONS 900099 10248826 10248826 EMPLOYEE CONTRIBUTIONS 900099 742454 742454 LIQUIDATED DAMAGES & INTEREST 900099 30016 30016 11021296 781857 781857 24565363 23114366 1450997 1450997 1450997 13254150 11021296 0 2232854 13189131 242123 114101 55184 79118 279000 22538 77390 CLAIMS ADMINISTRATION 545483 14604068 1235214 912923 1114154 1217470 41120 47558 32289076 29890714 5511639 5597236 40191203 37665901 139227 113602 63236 59393 4298364 3452438 4500827 3625433 X 0 0 0 0 35690376 34040468 35690376 34040468 40191203 37665901 -1349918 -299990 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 5597236 F 5597236 AMOUNTS DUE TO INSURANCE COMPANIES 104594 LAG MONTHS ELIGIBILITY COVERAGE 2210744 CLAIMS INCURRED BUT NOT REPORTED 1137100 3452438 X 12875042 -299990 -299990 13175032 79118 79118 13254150 15370876 0 15370876 79118 -845926 -766808 14604068 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 RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS -845,926. FORM 990, PART VI, SECTION A, LINE 3 THE PLAN IS ADMINISTERED BY BENESYS. FORM 990, PART VI, SECTION A, LINE 8B THE TRUST DOES NOT HAVE ANY COMMITTEES THAT ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY THE PLAN'S BOARD OF TRUSTEES BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ANNUAL CERTIFICATION FROM BOARD MEMBERS AND REVIEWS THEIR RESPONSES. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MADE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, LINE 6 TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER TAX-EXEMPT ORGANIZATIONS IS REPORTED ON FORM 990 FILED WITH THE IRS BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE PLAN ADMINISTRATOR. FORM 990, PART X, LINE 2C: THE PROCESS AND METHODS USED BY THE BOARD OF DIRECTORS TO SELECT THE INDEPENDENT AUDIT FIRM HAS NOT CHANGED FROM THE PRIOR YEAR. CITY OF ELKTON CITY OF REEDSPORT CITY OF WINSTON DIST LODGE W24 IAMAW WOODWORKERS LOC LODG W-12 BUTTE SCHOOL DIST #1 MASON COUNTY CORRECTIONS CITY OF INTERNATIONAL FALLS BELL LUMBER & POLE CO CASTLE & COLEMAN LOGGING CLEARWATER PAPER CORP COLLINS PRODUCTS LLC GREEN DIAMOND RESOURCE KOONTZ MACHINE & WELDING KOPPERS COMPANY WEBFOOT TRUCK & EQUIPMENT WEYERHAEUSER PAE AVIATION & TECH NW CONTEXT CONGRGATIONS ROSEBURG FOREST PROD AMENTUM 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0