2021-05-17T12:55:29-05:00 2020-07-31 931015766 BJORKLUND & MONTPLAISIR CPA'S 9020 SW WASHINGTON SQ RD SUITE 46 PORTLAND OR 97223 990 2019-08-01 910597991 EMPLOYEE PAINTERS' TRUST HEALTH AND WELFARE TRUST PAIN 2065189730 18300 CASCADE AVE S STE 141 TUKWILA WA 98188 STACEY GRUND CO-CHAIRMAN 2065189730 2021-05-11 true RICHARD A LAYNE P00359754 5036436400 2021-05-15 2019 2022-09-23 18:48:47Z STACEY GRUND 18300 CSCADE AVE S STE 141 TUKWILLA WA 98188 137300473 false X N/A X 1952 WA THE PLAN IS MULTIEMPLOYER HEALTH AND WELFARE PLAN DESIGNED TO PROVIDE BENEFITS FOR ELIGIBLE PARTICIPANTS AND BENEFICIARIES AS SPECIFIED IN THE PLAN DOCUMENT. 10 0 1 0 0 75739367 79649559 1903199 1692475 0 77642566 81342034 0 82816554 71618571 0 0 0 2875305 5713556 85691859 77332127 -8049293 4009907 102667937 110934817 40856728 43703562 61811209 67231255 THE PLAN IS MULTIEMPLOYER HEALTH AND WELFARE PLAN DESIGNED TO PROVIDE BENEFITS FOR ELIGIBLE PARTICIPANTS AND BENEFICIARIES AS SPECIFIED IN THE PLAN DOCUMENT. false false THE PLAN IS MULTIEMPLOYER HEALTH AND WELFARE PLAN DESIGNED TO PROVIDE BENEFITS FOR ELIGIBLE PARTICIPANTS AND BENEFICIARIES AS SPECIFIED IN THE PLAN DOCUMENT. false false false false false false false false false false false false false true false true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 8 0 1 true false false false false false false false false X 10 0 false false false false false false false true true false false true true true true false true true true false X BENESYS INC 8443442721 18300 CASCADE AVE S STE 141 TUKWILA WA 98188 STACEY GRUND CO-CHAIRMAN 1.00 X 0 0 0 STEVE MALCOM EMPLOYER TRU 1.00 X 0 0 0 JEREMY GIBSON EMPLOYER TRU 1.00 X 0 0 0 TODD HERBST EMPLOYER TRU 1.00 X 0 0 0 HAROLD DALY EMPLOYER TRU 1.00 X 0 0 0 RUSS JAMES UNION TRUSTE 1.00 X 0 0 0 JASON LAMBERTH UNION TRUSTE 1.00 X 0 0 0 TODD SPRINGER UNION TRUSTE 1.00 X 0 0 0 LISA DEROSIA UNION TRUSTE 1.00 X 0 0 0 DAVE WINKLER CO-CHAIRMAN 1.00 X 0 0 0 MELISSA KOLLMAN EXECUTIVE DI 40.00 X 74981 0 26249 74981 26249 false false false AETNA 600 UNIVERSITY ST STE 920 SEATTLE WA 98101 CLAIMS ADMINIST 1765038 BENESYS 18300 CASCADE AVENUE S SUITE 141 TUKWILLA WA 98188 ADMINISTRATOR 1522911 INNOVATIVE CARE MANAGEMENT PO BOX 22386 PORTLAND OR 97269 UTILIZATION REV 478851 CHRISTENSEN JAMES & MARTIN 7440 W SAHARA AVE LAS VEGAS NV 89117 ATTORNEY 252247 THE URBAN LAW FIRM 4270 S DECATUR BLVD STE A-9 LAS VEGAS NV 89103 ATTORNEY 225581 5 EMPLOYER CONTRIBUTIONS 77158526 77158526 SELF PAY CONTRIBUTIONS 2491033 2491033 79649559 2377741 2377741 55273173 55958439 -685266 -685266 -685266 81342034 81342034 71618571 1498751 482075 243127 181845 2907396 252432 46073 17699 BANK FEES 31338 PCORI FEES 27037 OTHER EXPENSES 25783 77332127 0 0 0 538034 20069130 16524351 651804 7217458 7841748 1826 1616 78386268 82370519 102667937 110934817 389144 331101 40467584 43372461 40856728 43703562 X 61811209 67231255 61811209 67231255 102667937 110934817 4009907 1410139 X false true true false BENEFIT OBLIGATIONS 35804000 DUE TO RELATED TRUST AND ORGANIZATNS 7217348 PENDING TRANSACTIONS 351113 43372461 82570328 1410139 1410139 81160189 181845 181845 81342034 73177282 -3973000 -3973000 77150282 181845 181845 77332127 SCHEDULE D, PAGE 4, PART XII, LINE 2D CHANGE IN BENFIT OBLIGATIONS -3,973,000 FORM 990, PAGE 6, PART VI, LINE 11B THE PLAN'S CPA PREPARED THE FORM 990 WHICH IS REVIEWED BY THE PLAN ADMINISTRATOR AND PRESENTED TO A DESIGNED TRUSTEE TO REVIEW AND APPROVE PRIOR TO FILING. THE FULL BOARD CAN REQUEST COPIES OF THE COMPLETED 990. FORM 990, PAGE 6, PART VI, LINE 12C TRUESTEES ARE REQUIRED TO NOTIFY THE PLAN OF ANY CHANGES IN THEIR INTERESTS THAT GIVE RISE TO CONFLICTS. FORM 990, PAGE 6, PART VI, LINE 15A THE EXECUTIVE DIRTECTORS'S COMPENSATION AND BENEFITS ARE REVIEWED AT LEAST ANNUALLY BY THE BOARD OF TRUSTEES. COMPENSATION AND BENEFITS ARE COMENSURATE WITH THE LEVEL OF SERVICE PERFORMED. FORM 990, PAGE 6, PART VI, LINE 15B THE BOARD OF TRUSTEES SERVE WITHOUT COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 19 THE PLAN'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MAINTAINED AT THE PLAN OFFICE AND ARE AVAILABLE UP ON REQUEST. 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