2017-11-09T13:58:36-06:00 2016-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2016-01-01 463907102 OREGON HOMECARE WORKERS BENEFIT TRUST OREG 2068592642 12121 HARBOUR REACH DRIVE NO 105 MUKILTEO WA 98275 BRIAN RUDIGER TRUSTEE 2068592642 2017-11-09 1 KATHLEEN D HAAB P01068129 9252779100 66.7.226.66 2017-11-09 11:58:12 PS P 72DCDAB48BBD05C01ADC32EAF6F951C821B03640 6DD8E3D40C39F05221E97E07BD1CB8F36D910CAE 2016 2018-03-14 21:41:22Z BRIAN RUDIGER 12121 HARBOUR REACH DRIVE NO 105 MUKILTEO WA 98275 21055475 0 X WWW.ORHOMECARETRUST.ORG X 2013 OR PROVIDE HEALTH AND RELATED BENEFITS TO PARTICIPANTS. 10 8 0 0 0 0 0 0 14361925 21055056 0 419 0 0 14361925 21055475 0 0 11581882 18484518 0 0 0 0 0 698518 1032003 12280400 19516521 2081525 1538954 4790239 10973533 4692000 9336340 98239 1637193 TO PROVIDE DENTAL, VISION, EMPLOYEE ASSISTANCE PROGRAM AND PAID TIME OFF BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDED DENTAL, VISION, EMPLOYEE ASSISTANCE PROGRAM AND PAID TIME OFF BENEFITS TO ELIGIBLE PARTICIPANTS. 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 2215 0 1 0 0 0 0 0 0 0 X 10 8 0 1 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X BENEFIT SOLUTIONS INC 2068592642 12121 HARBOUR REACH DRIVE NO 105 MUKILTEO WA 98275 BRIAN RUDIGER TRUSTEE 1.00 X 0 103830 50389 PAUL MCKENNA TRUSTEE 1.00 X 0 97717 40428 ADAM RIGGS TRUSTEE 1.00 X 0 0 0 GARY FLETCHER TRUSTEE 1.00 X 0 0 0 JOY'E WILLMAN TRUSTEE 1.00 X 0 0 0 REBECCA SANDOVAL TRUSTEE 1.00 X 0 0 0 BOBBIE SOTIN TRUSTEE 1.00 X 0 0 0 ANNIE SMITH TRUSTEE 1.00 X 0 0 0 MALETA CHRISTIAN TRUSTEE 1.00 X 0 0 0 PATRICIA LAWRENCE TRUSTEE 1.00 X 0 0 0 HEATHER CONROY TRUSTEE - PAST 1.00 X 0 110869 41733 CAROL CONLON TRUSTEE - PAST 1.00 X 0 0 0 0 312416 132550 0 0 1 0 BENEFIT SOLUTIONSINC 12121 HARBOUR REACH DR STE 105 MUKILTEO WA 98275 ADMINISTRATOR 707029 1 STATE OF OR CONTRIBUTIONS 900099 21039268 21039268 PARTICIPANT CONTRIBUTIONS 900099 15788 15788 21055056 419 419 21055475 21055056 0 419 18484518 707029 50164 19825 228154 26831 19516521 4790239 10973533 4790239 10973533 118340 4692000 9218000 4692000 9336340 X 0 0 0 0 98239 1637193 98239 1637193 4790239 10973533 1538954 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 9218000 9218000 X 21055475 0 21055475 0 21055475 14990521 0 14990521 4526000 4526000 19516521 PART X, LINE 2: THE TRUST HAS ANALYZED THE TAX POSITIONS TAKEN BY THE TRUST AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2016, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE TRUST IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 4,526,000. 1 0 0 BRIAN RUDIGER TRUSTEE 0 103830 0 0 0 0 0 15105 0 35284 0 154219 0 0 HEATHER CONROY TRUSTEE - PAST 0 64797 0 0 0 46072 0 16208 0 25525 0 152602 0 0 PART 1, LINE 4A: HEATHER CONROY RECEIVED OTHER REPORTABLE COMPENSATION FROM A RELATED ORGANIZATION FOR UNUSED SICK PAY AND UNUSED VACATION TIME AS PART OF HER SEVERANCE FROM THE RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH BENEFITS SOLUTIONS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES WAS PROVIDED A COPY OF FORM 990. THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR'S MANAGEMENT AND BY THE TRUST DIRECTOR PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST BUT NOT TO THE GENERAL PUBLIC. FORM 990, PART XII, LINE 1: THE ORGANIZATION USES THE MODIFIED CASH BASIS OF ACCOUNTING. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE ANNUAL AUDIT AND HIRING THE AUDITOR. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. FORM 990, PART VI, SECTION B, LINES 12A AND 13: IN MARCH 2017, THE TRUST ADOPTED A CONFLICT-OF-INTEREST AND WHISTLEBLOWER POLICY. OREGON HOMECARE WORKERS SUPPLEMENTAL TRUST 12121 HARBOUR REACH DRIVE ST 105 MUKILTEO WA 98275 463915049 PROVIDE ASSISTANCE REGARDING HEALTH RELATED BENEFITS TO PARTICIPANTS. OR 501(C)(5) N/A N/A 0 SERVICE EMPLOYEES INTERNATIONAL UNION 503 1730 COMMERCIAL STREET SE SALEM OR 97302 930323147 LABOR ORGANIZATION OR 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0