2021-01-15T12:13:59-06:00 2020-03-31 410746749 CLIFTONLARSONALLEN LLP 601 W RIVERSIDE AVE SUITE 700 SPOKANE WA 99201 990 2019-04-01 910589283 NORTHWEST SHEET METAL WORKERS WELFARE FUND NORT 5095340600 1322 NORTH POST SPOKANE WA 99201 BARON DERR CHAIRMAN 5095340600 2021-01-14 1 TINA HENTON P00630282 5093636300 2021-01-14 2019 2022-09-23 18:48:47Z BARON DERR 1322 NORTH POST SPOKANE WA 99201 135591518 0 X N/A X 1952 WA HEALTH AND WELFARE BENEFITS 10 10 204 0 0 0 0 0 97165222 103784111 2635612 3552888 0 0 99800834 107336999 0 0 80283555 93601764 0 0 0 0 0 2246881 2045492 82530436 95647256 17270398 11689743 117363272 130501065 46474152 50355309 70889120 80145756 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AS SPECIFIED IN THE PLAN. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AS SPECIFIED IN THE PLAN. 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 1 513 0 1 204 1 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 WA X DAVID KIMMET 5095340600 1322 N POST ST SPOKANE WA 99201 X BARON W DERR CHAIRMAN 1.00 X X 0 0 0 TIM CARTER SECRETARY 1.00 X X 0 0 0 GREG HAYTER TRUSTEE 1.00 X 0 0 0 JOHN CARTER TRUSTEE 1.00 X 0 0 0 JULIE MULLER TRUSTEE 1.00 X 0 0 0 JEFF LINK TRUSTEE 1.00 X 0 0 0 JIM REYNOLDS TRUSTEE 1.00 X 0 0 0 LANCE DEYETTE TRUSTEE 1.00 X 0 0 0 KOLBY HANSON TRUSTEE 1.00 X 0 0 0 RANDY GOLDING TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 AETNA 151 FARMINGTON AVENUE HARTFORD CT 06156 PPO FEES 1796404 AW REHN AND ASSOCIATES 1322 N POST ST SPOKANE WA 99201 ADMINISTRATION 1067619 VALENZ CLAIM (DBA UNITED CLAIMS SOLUTION 23048 N 15TH AVE PHOENIX AZ 85027 MEDICAL CLAIMS ADMINISTRATOR 521928 DELTA DENTAL OF WA PO BOX 75983 SEATTLE WA 98175 DENTAL CLAIMS ADMINISTRATOR 310248 ENVISION PHARMACEUTICAL SERVICES 2181 E AURUORA RD STE 201 TWINSBURG OH 44087 RX CLAIMS ADMINISTRATOR 126335 8 EMPLOYER CONTRIBUTIONS 900099 89140785 89140785 SUPP. BENEFIT CONTRIBS 900099 8534535 8534535 PARTICIPANT CONTRIBUTI 900099 5889276 5889276 LIQUIDATED DAMAGES 900099 219515 219515 103784111 3070149 3070149 28737258 28254519 482739 482739 482739 107336999 103784111 0 3552888 93601764 1193954 103404 77600 83490 212666 184703 52283 67028 48154 AFFORDABLE CARE ACT FEE 22189 MISCELLANEOUS 21 95647256 9993191 10431360 613428 572836 9236575 8886512 97520078 110610357 117363272 130501065 242280 138482 46231872 50216827 46474152 50355309 X 0 0 0 0 70889120 80145756 70889120 80145756 117363272 130501065 11689743 -2433107 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 21195143 ESTIMATED LIABILITY FOR INCURRED BUT UNREPORTED CLAIMS 11862000 ESTIMATED LIABILITY FOR EXTENDED MEDICAL COVERAGE 16301974 ESTIMATED LIABILITY FOR SEVERANCE BENEFITS 857710 50216827 X 104820402 -2433107 -2433107 107253509 83490 83490 107336999 88917754 0 88917754 83490 6646012 6729502 95647256 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN OBTAINED A FAVORABLE DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) ON JUNE 21, 1988 AND THE PLAN SPONSOR BELIEVES THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND OPERATE AS DESIGNED. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN ACCUMULATED ELIGIBILITY CREDITS 1,999,805. DECREASE IN ESTIMATED LIABILITY FOR CLAIMS IBNR 1,904,000. INCREASE IN ESTIMATED LIABILITY FOR EXTENDED MEDICAL COVERAGE 2,884,570. DECREASE IN ESTIMATED LIABILITY FOR SEVERANCE BENEFITS -115,497. DECREASE IN ESTIMATED LIABILITY FOR RETIREE SUBSIDY -26,866. FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE PLAN ARE MANAGED BY AW REHN & ASSOCIATES FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PRESENTED TO THE BOARD OF TRUSTEES AND LEGAL COUNSEL BEFORE SIGNATURE AND FILING FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE ASKED ANNUALLY IN WRITING IF ANY CONFLICTS EXIST. ANY CONFLICTS ARE BROUGHT TO THE BOARD OF TRUSTEES FOR RESOLUTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. A SUMMARY ANNUAL REPORT REQUIRED BY ERISA IS SENT TO THE PARTICIPANTS ANNUALLY. ACCORDING TO THE REGULATIONS OF THE EBSA, PARTICIPANTS CAN REQUEST THE FULL ANNUAL REPORT AND FORM 5500 FROM THE PLAN ADMINISTRATOR. FORM XII, LINE 2C THE OVERSIGHT PROCESS AND METHOD FOR CHOOSING THE INDEPENDENT AUDITOR HAS NOT CHANGED FROM PRIOR YEARS. 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